OBJECTIVE: To inform the update of the European Association for the Study of Diabetes clinical practice guidelines for nutrition therapy. DESIGN: Systematic review and meta-analysis of randomised controlled trials. DATA SOURCES: Medline, Embase, and the Cochrane Library searched up to 13 May 2021. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials of three or more weeks investigating the effect of diets with low glycaemic index (GI)/glycaemic load (GL) in diabetes. OUTCOME AND MEASURES: The primary outcome was glycated haemoglobin (HbA1c). Secondary outcomes included other markers of glycaemic control (fasting glucose, fasting insulin); blood lipids (low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, apo B, triglycerides); adiposity (body weight, BMI (body mass index), waist circumference), blood pressure (systolic blood pressure (SBP) and diastolic blood pressure (DBP)), and inflammation (C reactive protein (CRP)). DATA EXTRACTION AND SYNTHESIS: Two independent reviewers extracted data and assessed risk of bias. Data were pooled by random effects models. GRADE (grading of recommendations assessment, development, and evaluation) was used to assess the certainty of evidence. RESULTS: 29 trial comparisons were identified in 1617 participants with type 1 and 2 diabetes who were predominantly middle aged, overweight, or obese with moderately controlled type 2 diabetes treated by hyperglycaemia drugs or insulin. Low GI/GL dietary patterns reduced HbA1c in comparison with higher GI/GL control diets (mean difference −0.31% (95% confidence interval −0.42 to −0.19%), P<0.001; substantial heterogeneity, I2=75%, P<0.001). Reductions occurred also in fasting glucose, LDL-C, non-HDL-C, apo B, triglycerides, body weight, BMI, systolic blood pressure (dose-response), and CRP (P<0.05), but not blood insulin, HDL-C, waist circumference, or diastolic blood pressure. A positive dose-response gradient was seen for the difference in GL and HbA1c and for absolute dietary GI and SBP (P<0.05). The certainty of evidence was high for the reduction in HbA1c and moderate for most secondary outcomes, with downgrades due mainly to imprecision. CONCLUSIONS: This synthesis suggests that low GI/GL dietary patterns result in small important improvements in established targets of glycaemic control, blood lipids, adiposity, blood pressure, and inflammation beyond concurrent treatment with hyperglycaemia drugs or insulin, predominantly in adults with moderately controlled type 1 and type 2 diabetes. The available evidence provides a good indication of the likely benefit in this population. STUDY REGISTRATION: ClinicalTrials.gov NCT04045938.

• MeSH
• diabetes mellitus 1. typu prevence a kontrola   MeSH
• diabetes mellitus 2. typu prevence a kontrola   MeSH
• diabetická dieta MeSH
• glykemická nálož * MeSH
• glykemický index * MeSH
• kardiometabolické riziko MeSH
• lidé MeSH
• regulace glykemie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• metaanalýza MeSH
• práce podpořená grantem MeSH
• systematický přehled MeSH

BACKGROUND: FTO, a gene recently discovered in genomewide associated studies for type 2 diabetes mellitus (T2D), play an important role in the management of energy homeostasis, nucleic acid demethylation and regulation of body fat mass by lipolysis. The aim of this study was to analyze the association of FTO rs8050136 A>C genetic variant with clinical and biochemical parameters of T2D in the population of West Balkan region (Bosnians and Herzegovinians and Kosovars). METHODS: The study included 638 patients with T2D and prediabetes and 360 healthy controls of both genders, aged from 40 to 65 years. Patients were recruited at the Clinical Centre University of Sarajevo, University Hospital of Clinical Centre in Banja Luka, General Hospital in Tešanj and Health Centre in Prizren. Genotyping of analyzed FTO polymorphism rs8050136 A>C was performed by qPCR allelic discrimination. RESULTS: Genotype frequencies of the analyzed polymorphism were comparable between patients with T2D, prediabetic patients, and healthy population. Logistic regression analyses didn't show significant association of FTO rs8050136 A allele with increased risk of T2D. However, risk A allele was significantly associated with higher levels of HbA1c, insulin, HOMA-IR index, diastolic blood pressure, and inflammatory markers (fibrinogen and leukocytes) as well as showed tendency of association with increased values of obesity markers (BMI, waist and hip circumference). CONCLUSIONS: Results of our study showed a significant association of FTO genetic variant rs8050136 A>C with the major markers of insulin resistance, obesity and inflammation, opening new avenues for solving many unclear questions in the pathogenesis of T2D.

UVOD: FTO, gen koji je u cjelogenomskim studijama povezanosti, nedavno otkriven kao kandidatni gen za tip 2 dijabetes (T2D), ima značajnu ulogu u upravljanju energetske homeostaze, demetilaciji nukleinskih kiselina i regulaciji indeksa tjelesne mase (ITM) tako što reguliše proces lipolize. Cilj studije je bio da analiziramo povezanost FTO rs8050136 A>C genetske varijante sa kliničkim i biohemijskim parametrima T2D u populacijama regiona Zapadnog Balkana (Bosancima i Hercegovcima i Kosovarima). METODE: U studiju je uključeno 638 pacijenata oboljelih od T2D, predijabetesa, i 360 zdravih kontrola, oba spola, starosti od 40 do 65 godina. Pacijenti se regrutovani u Kliničkom centru Univerziteta u Sarajevu, Univerzitetskoj bolnici Kliničkog centra u Banja Luci, Opštoj bolnici u Tešnju i Domu zdravlja u Prizrenu. Genotipizacija FTO genetskog polimorfizma rs8050136 A>C je analizirana korištenjem metode qPCR alelne diskriminacije. REZULTATI: Frekvencije genotipova analiziranog polimorfizma uspoređivane su između pacijenata sa T2D, predijabetesom i zdravih ispitanika. Također, rezultati logistike analize nisu pokazali značajnu povezanost A alela FTO rs8050136 polimorfizma sa povećanim rizikom razvoja T2D. Međutim, rizični A alel je pokazao značajnu asociranost sa višim vrijednostima HbA1c, inzulina, HOMA IR indeksa, diastolnog krvnog pritiska, i inflamatornih markera (fibrinogena i leukocita), kao i tendenciju povezanosti sa povišenim vrijednostima parametara gojaznosti (ITM, opseg struka i opseg kukova). ZAKLJUČAK: Rezultati naše studije pokazali su značajnu povezanost FTO genetske varijante rs8050136 A>C sa najbitnijim markerima inzulinske rezistencije, gojaznosti i inflamacije, otvarajući na taj način nove puteve i mogućnosti riješavanja mnogih nejasnih pitanja vezanih za patogenezu T2D.

• Klíčová slova
• FTO gene, Type 2 diabetes, gene variant, inflammation, obesity,
• Publikační typ
• časopisecké články MeSH

AIMS: Chronic kidney disease (CKD) challenges diabetes management and is associated with increased cardiovascular morbidity and mortality. We examined whether clinical outcomes with insulin glargine 300 U/mL (Gla-300) and insulin degludec 100 U/mL (IDeg-100) are affected by renal function in a prespecified subgroup analysis from the BRIGHT trial. MATERIALS AND METHODS: BRIGHT (NCT02738151) was a multicentre, open-label, randomized, active-controlled, two-arm, parallel-group, 24-week study in insulin-naïve uncontrolled type 2 diabetes (T2D). Participants were randomized 1:1 to evening Gla-300 (n = 466) or IDeg-100 (n = 463) and stratified based on baseline estimated glomerular filtration rate (eGFR) for this analysis. RESULTS: Heterogeneity of treatment effect across renal function subgroups was observed (P = .02), reflecting a greater mean glycated haemoglobin (HbA1c) reduction from baseline to week 24 with Gla-300 versus IDeg-100 in the eGFR <60 mL/min/1.73 m2 subgroup (least squares mean difference: -0.43% [95% confidence interval: -0.74% to -0.12%]), while there were no differences in hypoglycaemia incidence or rates over 24 weeks in that subgroup. HbA1c reductions were similar between treatments in the other eGFR subgroups. However, heterogeneity was observed for annualized rates of anytime (24 hours) or nocturnal (00:00-05:59 hours) confirmed hypoglycaemia (≤70 mg/dL [≤3.9 mmol/L]) over 24 weeks showing less hypoglycaemia with Gla-300 versus IDeg-100 in the ≥90 mL/min/1.73 m2 . CONCLUSIONS: Kidney function seems to affect the glucose-lowering effects of Gla-300 versus IDeg-100 in insulin-naïve T2D. Greater HbA1c reductions with Gla-300 without increase in hypoglycaemia risk, were observed in patients with eGFR <60 mL/min/1.73 m2 .

• Klíčová slova
• basal insulin, diabetes complications, insulin analogues, randomized trial, type 2 diabetes,
• MeSH
• diabetes mellitus 2. typu * komplikace   farmakoterapie   MeSH
• dlouhodobě působící inzulin MeSH
• hypoglykemika škodlivé účinky   MeSH
• inzulin glargin škodlivé účinky   MeSH
• ledviny MeSH
• lidé MeSH
• regulace glykemie MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• multicentrická studie MeSH
• práce podpořená grantem MeSH
• randomizované kontrolované studie MeSH
• Názvy látek
• dlouhodobě působící inzulin MeSH
• hypoglykemika MeSH
• insulin degludec MeSH Prohlížeč
• inzulin glargin MeSH

BACKGROUND: Therapy with sulfonylurea is preferable to insulin in the majority of individuals with KCNJ11 mutations, but not all of these people achieve target levels of HbA1c in long-term follow-up. We aimed to compare sulfonylurea therapy with insulin treatment in two sulfonylurea-sensitive individuals with a KCNJ11 mutation who had poorly controlled permanent neonatal diabetes mellitus. CASE REPORT: We report on two individuals with a KCNJ11 mutation (p.R201H) who are currently aged 35 (SVK1) and 21 years (SVK2). These individuals were switched from insulin to sulfonylurea in 2005. Data from the first 4 (SVK2) and 8 years (SVK1) of the follow-up showed improved diabetes control and increased quality of life for both individuals. During the following years, however, both individuals failed to retain good diabetes control (HbA1c ≤ 53 mmol/mol; 7.0%). We therefore changed the therapy to a combination of insulin and sulfonylurea in both individuals, or to insulin monotherapy in SVK1, and compared the effects on HbA1c with those of sulfonylurea monotherapy. HbA1c levels in both individuals worsened after adding insulin to sulfonylurea [67 mmol/mol (8.3%) vs 77 mmol/mol (9.2%) in SVK1 and 106 mmol/mol (11.8%) vs 110±19 mmol/mol (12.2±1.7%) in SVK2], and after switching to only insulin therapy in SVK1 [57 mmol/mol (7.4%) vs 62 mmol/mol (7.8%)] when compared with sulfonylurea monotherapy. DISCUSSION: Our data show that sulfonylurea monotherapy might be preferable to insulin in people with permanent neonatal diabetes mellitus sensitive to sulfonylurea even when HbA1c is above target.

• MeSH
• diabetes mellitus krev   farmakoterapie   genetika   MeSH
• dospělí MeSH
• draslíkové kanály dovnitř usměrňující genetika   MeSH
• glibenklamid terapeutické užití   MeSH
• glykovaný hemoglobin metabolismus   MeSH
• hypoglykemika terapeutické užití   MeSH
• inzulin terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• lidé MeSH
• mladý dospělý MeSH
• mutace genetika   MeSH
• náhrada léků MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• srovnávací studie MeSH
• Názvy látek
• draslíkové kanály dovnitř usměrňující MeSH
• glibenklamid MeSH
• glykovaný hemoglobin MeSH
• hypoglykemika MeSH
• inzulin MeSH
• Kir6.2 channel MeSH Prohlížeč

BACKGROUND: Advances in paediatric type 1 diabetes management and increased use of diabetes technology have led to improvements in glycaemia, reduced risk of severe hypoglycaemia, and improved quality of life. Since 1993, progressively lower HbA1c targets have been set. The aim of this study was to perform a longitudinal analysis of HbA1c, treatment regimens, and acute complications between 2013 and 2022 using data from eight national and one international paediatric diabetes registries. METHODS: In this longitudinal analysis, we obtained data from the Australasian Diabetes Data Network, Czech National Childhood Diabetes Register, Danish Registry of Childhood and Adolescent Diabetes, Diabetes Prospective Follow-up Registry, Norwegian Childhood Diabetes Registry, England and Wales' National Paediatric Diabetes Audit, Swedish Childhood Diabetes Registry, T1D Exchange Quality Improvement Collaborative, and the SWEET initiative. All children (aged ≤18 years) with type 1 diabetes with a duration of longer than 3 months were included. Investigators compared data from 2013 to 2022; analyses performed on data were pre-defined and conducted separately by each respective registry. Data on demographics, HbA1c, treatment regimen, and event rates of diabetic ketoacidosis and severe hypoglycaemia were collected. ANOVA was performed to compare means between registries and years. Joinpoint regression analysis was used to study significant breakpoints in temporal trends. FINDINGS: In 2022, data were available for 109 494 children from the national registries and 35 590 from SWEET. Between 2013 and 2022, the aggregated mean HbA1c decreased from 8·2% (95% CI 8·1-8·3%; 66·5 mmol/mol [65·2-67·7]) to 7·6% (7·5-7·7; 59·4mmol/mol [58·2-60·5]), and the proportion of participants who had achieved HbA1c targets of less than 7% (<53 mmol/mol) increased from 19·0% to 38·8% (p<0·0001). In 2013, the aggregate event rate of severe hypoglycaemia rate was 3·0 events per 100 person-years (95% CI 2·0-4·9) compared with 1·7 events per 100 person-years (1·0-2·7) in 2022. In 2013, the aggregate event rate of diabetic ketoacidosis was 3·1 events per 100 person-years (95% CI 2·0-4·8) compared with 2·2 events per 100 person-years (1·4-3·4) in 2022. The proportion of participants with insulin pump use increased from 42·9% (95% CI 40·4-45·5) in 2013 to 60·2% (95% CI 57·9-62·6) in 2022 (mean difference 17·3% [13·8-20·7]; p<0·0001), and the proportion of participants using continuous glucose monitoring (CGM) increased from 18·7% (95% CI 9·5-28·0) in 2016 to 81·7% (73·0-90·4) in 2022 (mean difference 63·0% [50·3-75·7]; p<0·0001). INTERPRETATION: Between 2013 and 2022, glycaemic outcomes have improved, parallel to increased use of diabetes technology. Many children had HbA1c higher than the International Society for Pediatric and Adolescent Diabetes (ISPAD) 2022 target. Reassuringly, despite targeting lower HbA1c, severe hypoglycaemia event rates are decreasing. Even for children with type 1 diabetes who have access to specialised diabetes care and diabetes technology, further advances in diabetes management are required to assist with achieving ISPAD glycaemic targets. FUNDING: None. TRANSLATIONS: For the Norwegian, German, Czech, Danish and Swedish translations of the abstract see Supplementary Materials section.

• MeSH
• diabetes mellitus 1. typu * epidemiologie   krev   farmakoterapie   MeSH
• dítě MeSH
• glykovaný hemoglobin * analýza   MeSH
• hypoglykemie epidemiologie   MeSH
• hypoglykemika * terapeutické užití   MeSH
• kojenec MeSH
• krevní glukóza * analýza   MeSH
• lidé MeSH
• longitudinální studie MeSH
• mladiství MeSH
• předškolní dítě MeSH
• registrace * statistika a číselné údaje   MeSH
• regulace glykemie statistika a číselné údaje   metody   MeSH
• výsledek terapie MeSH
• Check Tag
• dítě MeSH
• kojenec MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• předškolní dítě MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• glykovaný hemoglobin * MeSH
• hemoglobin A1c protein, human MeSH Prohlížeč
• hypoglykemika * MeSH
• krevní glukóza * MeSH

Given the progressive nature of type 2 diabetes (T2D), most individuals with the disease will ultimately undergo treatment intensification. This usually involves the stepwise addition of a new glucose-lowering agent or switching to a more complex insulin regimen. However, complex treatment regimens can result in an increased risk of hypoglycaemia and high treatment burden, which may impact negatively on both therapeutic adherence and overall quality of life. Individuals with good glycaemic control may also be overtreated with unnecessarily complex regimens. Treatment simplification aims to reduce individual treatment burden, without compromising therapeutic effectiveness or safety. Despite data showing that simplifying therapy can achieve good glycaemic control without negatively impacting on treatment efficacy or safety, it is not always implemented in clinical practice. Current clinical guidelines focus on treatment intensification, rather than simplification. Where simplification is recommended, clear guidance is lacking and mostly focused on treatment of the elderly. An expert, multidisciplinary panel evaluated the current treatment landscape with respect to guidance, published evidence, recommendations and approaches regarding simplification of complex insulin regimens. This article outlines the benefits of treatment simplification and provides practical recommendations on simplifying complex insulin treatment strategies in people with T2D using illustrative cases.

• Klíčová slova
• Antidiabetic drug, Glycaemic control, Insulin therapy, Primary care, Type 2 diabetes,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH

Type 1 diabetic (T1D) patients suffer from insulinopenia and hyperglycaemia. Studies have shown that if a patient's hyperglycaemic environment is not compensated, it leads to complex immune dysfunctions. Similarly, T1D mothers with poor glycaemic control exert a negative impact on the immune responses of their newborns. However, questions concerning the impact of other metabolic disturbances on the immune system of T1D mothers (and their newborns) have been raised. To address these questions, we examined 28 T1D women in reproductive age for the relationship between various metabolic, clinical, and immune parameters. Our study revealed several unexpected correlations which are indicative of a much more complex relationship between glucose and lipid factors (namely, glycosylated haemoglobin Hb1Ac, the presence of one but not multiple chronic diabetic complications, and atherogenic indexes) and proinflammatory cytokines (IL-1alpha and TNF-alpha). Regulatory T cell counts correlated with HbA1c, diabetic neuropathy, lipid spectra parameters, and IL-6 levels. Total T-helper cell count was interconnected with BMI and glycaemia variability correlated with lipid spectra parameters, insulin dose, and vitamin D levels. These and other correlations revealed in this study provide broader insight into the association of various metabolic abnormalities with immune parameters that may impact T1D mothers or their developing child.

• MeSH
• cytokiny imunologie   MeSH
• diabetes mellitus 1. typu komplikace   farmakoterapie   imunologie   metabolismus   MeSH
• diabetické neuropatie etiologie   imunologie   MeSH
• dospělí MeSH
• glykovaný hemoglobin metabolismus   MeSH
• HDL-cholesterol metabolismus   MeSH
• hypoglykemika aplikace a dávkování   MeSH
• interleukin-1alfa imunologie   MeSH
• interleukin-6 imunologie   MeSH
• inzulin aplikace a dávkování   MeSH
• LDL-cholesterol metabolismus   MeSH
• lidé MeSH
• mladý dospělý MeSH
• počet lymfocytů MeSH
• produkty pokročilé glykace metabolismus   MeSH
• regulační T-lymfocyty imunologie   MeSH
• T-lymfocyty pomocné-indukující imunologie   MeSH
• TNF-alfa imunologie   MeSH
• triglyceridy metabolismus   MeSH
• vitamin D metabolismus   MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladý dospělý MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• Názvy látek
• cytokiny MeSH
• glykovaný hemoglobin MeSH
• HDL-cholesterol MeSH
• hemoglobin A1c protein, human MeSH Prohlížeč
• hypoglykemika MeSH
• IL1A protein, human MeSH Prohlížeč
• IL6 protein, human MeSH Prohlížeč
• interleukin-1alfa MeSH
• interleukin-6 MeSH
• inzulin MeSH
• LDL-cholesterol MeSH
• produkty pokročilé glykace MeSH
• TNF protein, human MeSH Prohlížeč
• TNF-alfa MeSH
• triglyceridy MeSH
• vitamin D MeSH

INTRODUCTION: iGlarLixi, the once-daily fixed-ratio combination of insulin glargine 100 U/ml and lixisenatide, robustly improves glycaemic control in adults with type 2 diabetes irrespective of previous treatment [oral antihyperglycaemic drugs (OADs), basal insulin or glucagon-like peptide-1 receptor agonists (GLP-1 RAs)]. Sodium-glucose co-transporter-2 inhibitors (SGLT2is) are a recommended treatment option for people with type 2 diabetes with cardiovascular disease, kidney disease and/or heart failure because of their cardio- and renoprotective benefits. Herein, we assessed the effects of concomitant iGlarLixi and SGLT2i therapy. METHODS: We conducted subgroup analyses according to SGLT2i use in: (1) adults with suboptimally controlled type 2 diabetes on GLP-1 RAs and OADs switching to iGlarLixi in the 26-week LixiLan-G randomised controlled trial (RCT; NCT02787551) and (2) adults switching to or adding iGlarLixi in a 6-month, retrospective real-world evidence (RWE) observational study using data from the US Optum-Humedica electronic medical records database. Changes in HbA1c and hypoglycaemia prevalence and event rates were assessed. RESULTS: There were no major differences in baseline characteristics for those who initiated iGlarLixi while already using SGLT2i (n = 346) and those initiating iGlarLixi without concomitant SGLT2i therapy (n = 1285). HbA1c reductions from baseline to time of assessment and hypoglycaemia prevalence and event rates were similar for iGlarLixi users regardless of SGLT2i therapy. CONCLUSION: Evidence from an RCT and an RWE analysis supports the efficacy/effectiveness and safety of iGlarLixi when used concomitantly with SGLT2i. TRIAL REGISTRATION: NCT02787551.

People with type 2 diabetes require glucose-lowering drugs to attain and maintain blood glucose control, with many eventually requiring injectable therapies. iGlarLixi combines two injectable therapies (basal insulin glargine and a glucagon-like peptide-1 receptor agonist, lixisenatide) into a single fixed-ratio daily injection and has previously been shown to provide robust improvements in blood glucose control. However, previous studies have not assessed the potential effect that simultaneous use of sodium-glucose co-transporter-2 inhibitor (SGLT2i) therapy may have on iGlarLixi therapy. This is of interest because SGLT2is are a widely used oral blood-glucose-lowering therapy that also have a beneficial effect in people with type 2 diabetes who have cardiovascular or kidney disease or have risk factors for the development or progression of these conditions. Therefore, this study assessed whether there were relevant differences in terms of blood glucose control and safety when initiating iGlarLixi in people treated with SGLT2i versus initiating iGlarLixi in people not receiving SGLT2i. Results showed that iGlarLixi provided similarly good glucose control and safety profiles, regardless of whether SGLT2is were used or not, thereby supporting the simultaneous use of these two therapies.

• Klíčová slova
• Basal insulin, GLP-1 analogue, Glycaemic control, Hypoglycaemia, SGLT2 inhibitor, Type 2 diabetes, iGlarLixi,
• Publikační typ
• časopisecké články MeSH

AIM: To compare open-source AndroidAPS (AAPS) and commercially available Control-IQ (CIQ) automated insulin delivery (AID) systems in a prospective, open-label, single-arm clinical trial. METHODS: Adults with type 1 diabetes who had been using AAPS by their own decision entered the first 3-month AAPS phase then were switched to CIQ for 3 months. The results of this treatment were compared with those after the 3-month AAPS phase. The primary endpoint was the change in time in range (% TIR; 70-80 mg/dL). RESULTS: Twenty-five people with diabetes (mean age 34.32 ± 11.07 years; HbA1c 6.4% ± 3%) participated in this study. CIQ was comparable with AAPS in achieving TIR (85.72% ± 7.64% vs. 84.24% ± 8.46%; P = .12). Similarly, there were no differences in percentage time above range (> 180 and > 250 mg/dL), mean sensor glucose (130.3 ± 13.9 vs. 128.3 ± 16.9 mg/dL; P = .21) or HbA1c (6.3% ± 2.1% vs. 6.4% ± 3.1%; P = .59). Percentage time below range (< 70 and < 54 mg/dL) was significantly lower using CIQ than AAPS. Even although participants were mostly satisfied with CIQ (63.6% mostly agreed, 9.1% strongly agreed), they did not plan to switch to CIQ. CONCLUSIONS: The CODIAC study is the first prospective study investigating the switch between open-source and commercially available AID systems. CIQ and AAPS were comparable in achieving TIR. However, hypoglycaemia was significantly lower with CIQ.

• Klíčová slova
• continuous glucose monitoring, glycaemic control, hypoglycaemia, insulin pump therapy, type 1 diabetes,
• MeSH
• diabetes mellitus 1. typu * farmakoterapie   MeSH
• dospělí MeSH
• glykovaný hemoglobin MeSH
• hypoglykemika terapeutické užití   MeSH
• inzulin terapeutické užití   MeSH
• inzulinové infuzní systémy MeSH
• inzuliny * MeSH
• krevní glukóza MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• prospektivní studie MeSH
• selfmonitoring glykemie metody   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mladý dospělý MeSH
• Publikační typ
• časopisecké články MeSH
• klinické zkoušky MeSH
• Názvy látek
• glykovaný hemoglobin MeSH
• hypoglykemika MeSH
• inzulin MeSH
• inzuliny * MeSH
• krevní glukóza MeSH

Periodontal disease (PD), a widespread non-communicable disease, affects over 90% of the global population with no known cure. Current management strategies focus on the stabilisation of disease progression, which is successfully achieved to a limited extent. Yet the never-ending battle between bacteria and the gingiva involves a complex interplay between genetic, microbial and environmental factors, demanding innovative approaches to improve the prevention and stabilisation of this disease. Glucose is the body's source of energy and research has shown that dysregulation of the glucose metabolism impacts PD establishment and progression, as well as the development of systemic non-communicable diseases. Metformin, a drug known for its efficacy in diabetes treatment via controlling glucose metabolism, also demonstrated cardioprotective effects, increased longevity, and anti-inflammatory properties. Metformin has been used in gel format in clinical trials for non-surgical treatment of PD, however, its systemic use in normoglycemic individuals with PD is less explored. A recent study presented compelling evidence of metformin's preventive potential, impacting PD and markers of systemic health involved in metabolic health linked to improvement of lifespan. Therefore, this review discusses the aspects of ageing as a concept in the periodontium and the potential benefits of modulating glucose metabolism through metformin to prevent PD, indirectly preventing systemic conditions involved in multi-morbidity, addressing a critical gap in current management. It also examines the choice between implementation of behaviour change and/or medication as a strategy to add to current oral hygiene strategies. Finally, it discusses the ethical implications of prescribing systemic medication in dentistry.

• Klíčová slova
• ageing, glycaemic control, metformin, multimorbidity prevention, periodontal disease, preventive medicine,
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH