Abstract
To determine whether continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) therapy from near-diagnosis of type 1 diabetes is associated with reduced glycaemic variability (GV) and altered microRNA (miRNAs) expression. Adolescents (74% male) within 3-months of diabetes diagnosis (n = 27) were randomized to CSII (n = 12) or MDI. HbA1c, 1-5-Anhydroglucitol (1,5-AG), high sensitivity C-peptide and a custom TaqMan qPCR panel of 52 miRNAs were measured at baseline and follow-up (median (LQ-UQ); 535 (519–563) days). There were no significant differences between groups in baseline or follow-up HbA1c or C-peptide, nor baseline miRNAs. Mean ± SD 1,5-AG improved with CSII vs. MDI (3.1 ± 4.1 vs. − 2.2 ± − 7.0 mg/ml respectively, P = 0.029). On follow-up 11 miRNAs associated with diabetes vascular complications had altered expression in CSII-users. Early CSII vs. MDI use is associated with lower GV and less adverse vascular-related miRNAs. Relationships with future complications are of interest.
Highlights
In Type 1 diabetes continuous subcutaneous insulin infusion (CSII) use is associated with reduced chronic complications compared to multiple daily insulin injections (MDI)[1]
There were no significant differences in baseline characteristics between CSII and multiple daily injections (MDI) groups: (mean (SD)) age 14.1 (1.3) years, male (n (%)) 20 (74), BMI (median (IQR)) 20.0 (18.9–21.6) kg/m2, HbA1c median (IQR) 12.4 (10.3–14.0)% (112 (89–130) mmol/mol) or 1-5-AG (median (IQR)) 3.1 (2.0–5.7) μg/ml)
There were no differences in HbA1c coefficient of variation (CV) or standard deviation (SD) between groups. 1,5-AG increased with CSII (3.1 ± 4.1 mg/ml CSII vs. − 2.2 ± 7.0 mg/ml MDI, P = 0.029), which remained significant after adjustment for follow-up duration
Summary
In Type 1 diabetes continuous subcutaneous insulin infusion (CSII) use is associated with reduced chronic complications compared to multiple daily insulin injections (MDI)[1]. Mechanisms may relate to reduced insulin dose, glycaemic variability (GV), inflammation and oxidative stress. Circulating microRNAs (miRNAs) released in response to cellular damage may be biomarkers of diabetes and its complications[2]. The impact of early CSII therapy on miRNA expression in type 1 diabetes has not been investigated. We assess whether CSII compared to MDI therapy within 3-months of type 1 diabetes diagnosis is associated with differences in glycaemia, GV, C-peptide, and miRNA expression
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