Objectives: Pancreas transplantation provides long-term near-normal glycemic control for recipients with type 1 diabetes, but it is unknown how this control compares with an automated insulin delivery (AID) system. Methods: In this prospective study, we compared parameters from 31 consecutive pancreas-kidney transplantation recipients versus from 377 people using an AID-either MiniMedTM 780G (n = 200) or Tandem t:slim X2TM Control-IQTM (n = 177). Results: Compared with the MiniMed and Tandem AID groups, transplant recipients at 1 month (mean ± standard deviation [SD]: 36 ± 12 days) after pancreas transplantation exhibited significantly lower glycated hemoglobin (38 mmol/mol [36, 40] vs. 55 [53, 56.5] and 56 [54.7, 57.2], respectively), lower mean glycemia (6.4 mmol/L [6, 6.8] vs. 8.5 [8.3, 8.7] and 8.2 [8.0, 8.4], respectively), and spent more time in range (90% [86, 93] vs. 72% [70, 74] and 75% [73, 77], respectively). Time in hypoglycemia did not differ significantly between the groups. Conclusions: Overall, compared with AID treatment, pancreas transplantation led to significantly better diabetes control parameters, with the exception of time below range. Clinical trials registration number is Eudra CT No. 2019-002240-24.

• Keywords
• automated insulin delivery system, continuous glucose monitoring, hypoglycemia, pancreas transplantation, type 1 diabetes,
• MeSH
• Diabetes Mellitus, Type 1 * blood   surgery   drug therapy   MeSH
• Adult MeSH
• Glycated Hemoglobin analysis   MeSH
• Hypoglycemic Agents * administration & dosage   therapeutic use   MeSH
• Insulin * administration & dosage   therapeutic use   MeSH
• Insulin Infusion Systems * MeSH
• Blood Glucose * analysis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Prospective Studies MeSH
• Glycemic Control * methods   MeSH
• Kidney Transplantation MeSH
• Pancreas Transplantation * MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Clinical Trial MeSH
• Comparative Study MeSH
• Names of Substances
• Glycated Hemoglobin MeSH
• hemoglobin A1c protein, human MeSH Browser
• Hypoglycemic Agents * MeSH
• Insulin * MeSH
• Blood Glucose * MeSH

IMPORTANCE: Advanced diabetes technologies such as continuous glucose monitoring (CGM), continuous subcutaneous insulin infusion (insulin pumps [CSII]), and glucometers alongside insulin access represent the criterion standard for managing type 1 diabetes (T1D) in children. Global disparities in their access and reimbursement may be associated with glycemic outcomes. OBJECTIVE: To describe how accessibility and reimbursement of advanced diabetes technologies and insulin are associated with glycated hemoglobin (HbA1c) levels in centers participating in the SWEET initiative, an international pediatric diabetes registry. DESIGN, SETTING, AND PARTICIPANTS: This global multicenter cross-sectional study collected data from 81 centers in 56 countries. Web-based questionnaires were distributed to representatives of all 121 pediatric diabetes centers participating in the SWEET initiative from March 1 to May 31, 2024, and used to map accessibility of and reimbursement for CGM, CSII, glucometers, and insulin. Reimbursement data were compared with HbA1c levels using the SWEET Study dataset. Participants included 42 349 children with T1D. EXPOSURES: Responses were categorized into 4 groups based on the extent of reimbursement for diabetes technologies and insulin. MAIN OUTCOMES AND MEASURES: Mean HbA1c levels across centers calculated from measurements current as of December 31, 2023, analyzed by categories of accessibility of and reimbursement for diabetes technologies and insulin. RESULTS: Data collected from 81 of 121 SWEET centers (67%) across 56 countries included HbA1c levels from 42 349 children with T1D (22 021 male [52%]; mean [SD] age, 14.3 [4.4] years; mean [SD] diabetes duration, 6.0 [4.2] years). Universal access with complete reimbursement for all technologies and insulin was reported by 32 centers from 19 countries, while 8 countries reported no reimbursement for any technologies or insulin. Centers with full reimbursement for CSII, CGM, glucometers, and insulin showed mean HbA1c levels of 7.62% (95% CI, 7.59%-7.64%) to 7.75% (95% CI, 7.73%-7.77%) compared with 9.65% (95% CI, 9.55%-9.71%) to 10.49% (95% CI, 10.40%-10.58%) in centers with no reimbursement and/or no availability (P < .001 for all items). CONCLUSIONS AND RELEVANCE: This cross-sectional study found that HbA1c levels were associated with the accessibility of modern diabetes technologies and insulin. Efforts to ensure universal accessibility are required to reduce global inequities and glycemic outcomes for children with T1D.

• MeSH
• Global Health MeSH
• Diabetes Mellitus, Type 1 * drug therapy   blood   MeSH
• Healthcare Disparities * statistics & numerical data   MeSH
• Child MeSH
• Health Services Accessibility * statistics & numerical data   MeSH
• Glycated Hemoglobin analysis   MeSH
• Hypoglycemic Agents * therapeutic use   MeSH
• Insulin * therapeutic use   economics   administration & dosage   MeSH
• Insulin Infusion Systems * economics   statistics & numerical data   MeSH
• Blood Glucose analysis   MeSH
• Humans MeSH
• Adolescent MeSH
• Cross-Sectional Studies MeSH
• Glycemic Control MeSH
• Blood Glucose Self-Monitoring economics   statistics & numerical data   MeSH
• Check Tag
• Child MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Multicenter Study MeSH
• Names of Substances
• Glycated Hemoglobin MeSH
• Hypoglycemic Agents * MeSH
• Insulin * MeSH
• Blood Glucose MeSH

Until recently, people with type 2 diabetes mellitus (PwT2DM) with poor glycaemic control on oral antidiabetic medication were initiated on insulin therapy. While insulin-based therapies have been efficient in reducing hyperglycaemia, they have also been linked with an increased risk of hypoglycaemia, increased treatment burden, and weight gain. The advent of novel classes of antidiabetic agents, such as glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i) presents a significant shift in the T2DM treatment algorithms. These medications are not only efficient in the reduction of glycaemia but are also able to reduce weight and have cardiovascular and renal benefits. PwT2DM on complex insulin regimens can now benefit from therapy simplification, taking advantage of once-daily fixed-ratio combinations (FRC) of basal insulin and glucagon-like peptide-1 receptor agonist. Current evidence suggests that this approach is equally efficient in terms of glycaemic control with the additional benefit of the reduction of body weight, total daily dose of insulin, and the number of insulin injections administered per day with no increase or reduction of hypoglycaemia. The primary aim of this review is to present the current evidence supporting the simplification of complex insulin regimens in PwT2DM with the two currently available FRCs on the market (insulin glargine 100 U/mL and GLP-1 RA lixisenatide [iGlarLixi] or insulin degludec and GLP-1 RA liraglutide [IDegLira]) and to provide a simple clinical practice-oriented algorithm for clinicians based on the currently available evidence.

• Keywords
• GLP‐1 analogue, IDegLira, basal insulin, fixed‐ratio combination, glucose lowering medication, hypoglycaemia, iGlarLixi,
• MeSH
• Glucagon-Like Peptide-1 Receptor Agonists * MeSH
• Diabetes Mellitus, Type 2 * drug therapy   blood   MeSH
• Insulin, Long-Acting administration & dosage   therapeutic use   MeSH
• Drug Combinations MeSH
• Sodium-Glucose Transporter 2 Inhibitors MeSH
• Hypoglycemia chemically induced   prevention & control   MeSH
• Hypoglycemic Agents * administration & dosage   therapeutic use   adverse effects   MeSH
• Insulin Glargine administration & dosage   therapeutic use   MeSH
• Insulin * administration & dosage   therapeutic use   MeSH
• Drug Therapy, Combination MeSH
• Blood Glucose drug effects   metabolism   MeSH
• Humans MeSH
• Liraglutide administration & dosage   MeSH
• Glycemic Control MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Glucagon-Like Peptide-1 Receptor Agonists * MeSH
• Insulin, Long-Acting MeSH
• Drug Combinations MeSH
• Sodium-Glucose Transporter 2 Inhibitors MeSH
• Hypoglycemic Agents * MeSH
• Insulin Glargine MeSH
• Insulin * MeSH
• Blood Glucose MeSH
• Liraglutide MeSH

BACKGROUND: Diabetes mellitus (DM) is a chronic disease with prevalence increasing worldwide. The aim of this study was to investigate satisfaction with the current method of insulin delivery (INS) amongst patient with type 1 diabetes mellitus (T1DM) using multiple daily injection (MDI) or continuous subcutaneous insulin infusion (CSII). Furthermore, a sub-aim was to test the effect of selected variables on patient satisfaction with MDI or CSII using regression analysis. METHODS: A cross-sectional study carried out in the territory of Moravia in the Czech Republic. A quantitative approach using the Insulin Delivery System Rating Questionnaire (IDSRQ) among 197 respondents with T1DM with INS delivery with MDI or CSII for at least 1 year. Statistical methods used were descriptive statistics, Student's t-tests and regression analysis. RESULTS: Highly significant differences were found between CSII and MDI patients in satisfaction with the current method of INS delivery (p < 0.001), in how the current method of delivery helps patients maintain stable blood glucose values, prevent high blood glucose (p < 0.001), and in overall satisfaction with the current method of INS delivery (p < 0.001). The average overall satisfaction score was 56.19 points for MDI and 62.08 points for CSII. Regression analysis revealed predictors of overall satisfaction on the mean score on how the current method of INS delivery helps MDI patients (p < 0.01). The effect of other selected variables was not confirmed. CONCLUSION: The results of the study showed higher overall satisfaction with the method of INS delivery in CSII patients. The current method of INS delivery does not interfere with daily life and activities in most patients.

• Keywords
• Continuous subcutaneous insulin infusion, Insulin delivery system rating questionnaire, Multiple daily injection, Regression analysis, Type 1 diabetes mellitus,
• MeSH
• Diabetes Mellitus, Type 1 * drug therapy   blood   psychology   MeSH
• Adult MeSH
• Hypoglycemic Agents * administration & dosage   therapeutic use   MeSH
• Injections, Subcutaneous MeSH
• Insulin * administration & dosage   therapeutic use   MeSH
• Insulin Infusion Systems * MeSH
• Blood Glucose MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Cross-Sectional Studies MeSH
• Surveys and Questionnaires MeSH
• Patient Satisfaction * MeSH
• Infusions, Subcutaneous MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• Czech Republic MeSH
• Names of Substances
• Hypoglycemic Agents * MeSH
• Insulin * MeSH
• Blood Glucose MeSH

Diabetes requires precise insulin management to maintain glycemic control and prevent severe complications. Glucose-responsive delivery systems envision an autonomous approach to improve insulin therapy. Here, a glucose-sensitive insulin delivery system comprising hyaluronic acid conjugated with a diboronate glucose binder as a carrier for diol-modified insulin is shown. This approach seeks improved precision in insulin delivery, leveraging bidentate glucose binding to achieve enhanced glucose affinity and specificity. Modification of insulin with a diol motif preserves its native conformation and function. These insulin formulations correct blood glucose in diabetic mice, including glucose-responsive function when subjected to a glucose challenge. However, the absence of secondary interactions, such as electrostatic complexation, ultimately limits the duration of function relative to that of previous platforms. Integrating complementary interactions alongside dynamic-covalent glucose binders therefore enhances the functional duration and therapeutic efficacy in the design of glucose-responsive polymeric carriers, offering design insights into the development of new carriers for glucose-responsive insulin delivery.

• MeSH
• Diabetes Mellitus, Experimental * drug therapy   MeSH
• Glucose * metabolism   MeSH
• Hypoglycemic Agents * administration & dosage   chemistry   MeSH
• Insulin * administration & dosage   chemistry   pharmacology   MeSH
• Blood Glucose drug effects   MeSH
• Hyaluronic Acid * chemistry   MeSH
• Boronic Acids * chemistry   MeSH
• Drug Delivery Systems * MeSH
• Mice MeSH
• Drug Carriers * chemistry   MeSH
• Animals MeSH
• Check Tag
• Male MeSH
• Mice MeSH
• Animals MeSH
• Publication type
• Journal Article MeSH
• Names of Substances
• Glucose * MeSH
• Hypoglycemic Agents * MeSH
• Insulin * MeSH
• Blood Glucose MeSH
• Hyaluronic Acid * MeSH
• Boronic Acids * MeSH
• Drug Carriers * MeSH

OBJECTIVE: This study examined the association between diabetic ketoacidosis (DKA) at type 1 diabetes diagnosis and long-term glycemic outcomes, insulin requirements, BMI SD score (SDS), and diabetes technology uptake in youth. RESEARCH DESIGN AND METHODS: Data were from nine countries (Austria, Czechia, Germany, Italy, Luxembourg, New Zealand, Slovenia, Switzerland, and U.S. [Colorado]), including youth (0.5-15.9 years) diagnosed with type 1 diabetes in 2019-2020 and followed for 2 years thereafter. Participants were divided into three groups: no DKA, nonsevere, and severe DKA at diagnosis. HbA1c, insulin requirements, BMI SDS, and use of technology, including automated insulin delivery (AID), were assessed. RESULTS: The analysis included 9,269 individuals (54.8% males, mean age 9.0 years). DKA at diagnosis was observed in 34.2% of participants and severe DKA in 12.8%. After 1 year, adjusted mean HbA1c was higher in the severe DKA group (7.41%) compared with nonsevere DKA (7.23%, P = 0.001) and no DKA groups (7.14, P < 0.001), and this difference persisted after 2 years (7.58% vs. 7.38% [P < 0.001] and vs. 7.32% [P < 0.001]). Higher BMI SDS was observed in both DKA groups compared with no DKA. The use of AID was associated with lower HbA1c levels compared with other treatment modalities and moderated differences between DKA groups after 2 years of follow-up (P = 0.072). CONCLUSIONS: Severe and nonsevere DKA at type 1 diabetes diagnosis were both associated with persistently higher HbA1c and higher BMI SDS. AID use diminishes the association of DKA at diagnosis and higher HbA1c over time.

• MeSH
• Diabetes Mellitus, Type 1 * complications   drug therapy   epidemiology   blood   MeSH
• Diabetic Ketoacidosis * epidemiology   etiology   MeSH
• Child MeSH
• Glycated Hemoglobin metabolism   MeSH
• Insulin therapeutic use   administration & dosage   MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Follow-Up Studies MeSH
• Child, Preschool MeSH
• Registries MeSH
• Check Tag
• Child MeSH
• Infant MeSH
• Humans MeSH
• Adolescent MeSH
• Male MeSH
• Child, Preschool MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Geographicals
• New Zealand epidemiology   MeSH
• Names of Substances
• Glycated Hemoglobin MeSH
• Insulin MeSH

AIM: To determine whether people with type 1 diabetes (T1D) initiating glucose sensor monitoring experience greater improvements in HbA1c when provided with education on carbohydrate counting and flexible insulin dosing than those who do not receive nutrition education. MATERIALS AND METHODS: Our retrospective observational study included 329 people with T1D initiating glucose sensor monitoring between 2015 and 2021. The participants were divided into two groups: one group attended at least one structured educational session with a registered dietitian (n = 126), while the other group did not receive structured education (n = 203). After 12 months of glucose sensor initiation, we compared glycaemic outcomes and CGM metrics between the two groups. RESULTS: At glucose sensor initiation, both groups with and without education had similar HbA1c levels (7.64% [60.0 mmol/mol] vs. 7.66% [60.2 mmol/mol]). After twelve months, the education group demonstrated greater improvement in glycemic outcomes (HbA1c 7.17% [54.9mmol/mol] vs. 7.37% [57.1 mmol/mol], p < 0.05) and spent significantly more time in the target range than did the group without structured education (68.8% vs. 64.1%, p < 0.05). We observed an inverse correlation between the number of completed educational sessions and HbA1c after 12 months, as well as between the number of educational sessions and the change in HbA1c. CONCLUSIONS: People with T1D who initiated glucose sensor monitoring alongside nutrition education showed greater improvements in HbA1c and increased time spent in the target glucose range compared to individuals who did not receive structured education. TRAIL REGISTRATION: ClinicalTrials.gov identifier: NCT06264271.

• Keywords
• glucose sensors, glycemic outcomes, nutrition education, type 1 diabetes,
• MeSH
• Diabetes Mellitus, Type 1 * blood   drug therapy   diet therapy   MeSH
• Adult MeSH
• Glycated Hemoglobin analysis   MeSH
• Hypoglycemic Agents administration & dosage   therapeutic use   MeSH
• Insulin administration & dosage   MeSH
• Blood Glucose * analysis   MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Glycemic Control * methods   MeSH
• Retrospective Studies MeSH
• Blood Glucose Self-Monitoring * methods   MeSH
• Patient Education as Topic * methods   MeSH
• Check Tag
• Adult MeSH
• Middle Aged MeSH
• Humans MeSH
• Young Adult MeSH
• Male MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Observational Study MeSH
• Names of Substances
• Glycated Hemoglobin MeSH
• hemoglobin A1c protein, human MeSH Browser
• Hypoglycemic Agents MeSH
• Insulin MeSH
• Blood Glucose * MeSH

BACKGROUND: Hyperkalaemia is a life-threatening electrolyte disturbance and also a potential cause of cardiac arrest. The objective was to assess the effects of acute pharmacological interventions for the treatment of hyperkalaemia in patients with and without cardiac arrest. METHODS: The review was reported according to PRISMA guidelines and registered on PROSPERO (CRD42023440553). We searched OVID Medline, EMBASE, and CENTRAL on September 9, 2024 for randomized trials, non-randomized trials, observational studies, and experimental animal studies. Two investigators performed abstract screening, full-text review, data extraction, and bias assessment. Outcomes included potassium levels, ECG findings, and clinical outcomes. Certainty of evidence was evaluated using GRADE. RESULTS: A total of 101 studies were included, with two studies including patients with cardiac arrest. In meta-analyses including adult patients without cardiac arrest, treated with insulin in combination with glucose, inhaled salbutamol, intravenous salbutamol dissolved in glucose, or a combination, the average reduction in potassium was between 0.7 and 1.2 mmol/l (very low to low certainty of evidence). The use of bicarbonate had no effect on potassium levels (very low certainty of evidence). In neonatal and paediatric populations, inhaled salbutamol and intravenous salbutamol reduced the average potassium between 0.9 and 1.0 mmol/l (very low to low certainty of evidence). There was no evidence to support a clinical beneficial effect of calcium for treatment of hyperkalemia. CONCLUSIONS: Evidence supports treatment with insulin in combination with glucose, inhaled or intravenous sal-butamol, or the combination. No evidence supporting a clinical effect of calcium or bicarbonate for hyperkalaemia was identified.

• Keywords
• Beta2-agonists, Bicarbonate, Calcium, Hyperkalaemia, Insulin, Pharmacological interventions, Systematic review,
• MeSH
• Albuterol administration & dosage   therapeutic use   MeSH
• Potassium blood   MeSH
• Hyperkalemia * drug therapy   complications   MeSH
• Insulin administration & dosage   therapeutic use   MeSH
• Humans MeSH
• Heart Arrest * etiology   MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Meta-Analysis MeSH
• Systematic Review MeSH
• Names of Substances
• Albuterol MeSH
• Potassium MeSH
• Insulin MeSH

This report presents a fatal case of a young female Type I diabetic patient who developed convulsions and loss of consciousness after taking methamphetamine and spending some time in a dance club. During the convulsions, she was given sugar and when no response occurred, her boyfriend who was not experienced in the use of insulin administered a dose of insulin to her. The woman lost consciousness and died despite the efforts of the emergency service. A biochemical analysis revealed a high level of insulin (196.67 mU/L) and low levels of glucose (2.96 mmol/L) and C-peptide (26 pmol/L). Toxicological analysis revealed a methamphetamine concentration of 389 ng/mL and an amphetamine concentration of 19 ng/mL. The forensic perspective of the difficult determination of the contribution of each of the factors to the death, i.e., the pre-existing medical condition (Type I diabetes), the use of methamphetamine, the physical exertion at the dance club, and, finally, the non-indicated administration of insulin, is discussed. The ruling of the court is also reported.

• Keywords
• Hypoglycemia, Insulin overdose, Legal consequences, Methamphetamine, Type I diabetes,
• MeSH
• Unconsciousness etiology   chemically induced   MeSH
• C-Peptide blood   MeSH
• Diabetes Mellitus, Type 1 * complications   blood   drug therapy   MeSH
• Fatal Outcome MeSH
• Hypoglycemic Agents * blood   adverse effects   MeSH
• Insulin * blood   administration & dosage   MeSH
• Blood Glucose analysis   MeSH
• Humans MeSH
• Methamphetamine * blood   adverse effects   poisoning   MeSH
• Amphetamine-Related Disorders * complications   MeSH
• Central Nervous System Stimulants * blood   adverse effects   MeSH
• Dancing MeSH
• Physical Exertion MeSH
• Seizures chemically induced   etiology   MeSH
• Check Tag
• Humans MeSH
• Female MeSH
• Publication type
• Journal Article MeSH
• Case Reports MeSH
• Names of Substances
• C-Peptide MeSH
• Hypoglycemic Agents * MeSH
• Insulin * MeSH
• Blood Glucose MeSH
• Methamphetamine * MeSH
• Central Nervous System Stimulants * MeSH

Automated insulin delivery systems (AID) represent a major advance in the treatment of type 1 diabetes. These systems automate insulin delivery by integrating continuous glucose monitoring, control algorithms and insulin pump actions. Despite their advances, there is a need to adjust the settings in specific situations, either by using special features or even by manually adjusting the dose. The article provides an overview of the possibilities of adjustments in the insulin dosing for intercurrent disease, alcohol consumption and increased physical activity for four certified automatic insulin delivery systems available in the Czech Republic.

• Keywords
• type 1 diabetes, hypoglycaemia, continuous glucose monitoring, automated insulin delivery systems, intercurrent disease, alcohol consumption, physical activity,
• MeSH
• Diabetes Mellitus, Type 1 * drug therapy   MeSH
• Hypoglycemic Agents administration & dosage   MeSH
• Insulin * administration & dosage   MeSH
• Insulin Infusion Systems * MeSH
• Humans MeSH
• Check Tag
• Humans MeSH
• Publication type
• Journal Article MeSH
• Review MeSH
• Names of Substances
• Hypoglycemic Agents MeSH
• Insulin * MeSH