Intensive Diabetes Management Research Articles

2023 Diabetic Kidney Disease Fact Sheet in Korea.

To investigate the prevalence, incidence, comorbidities, and management status of diabetic kidney disease (DKD) and diabetes-related end-stage kidney disease (ESKD) in South Korea. We used the Korea National Health and Nutrition Examination Survey data (2019 to 2021, n=2,665) for the evaluation of prevalence, comorbidities, control rate of glycemia and comorbidities in DKD, and the Korean Health Insurance Service-customized database (2008 to 2019, n=3,950,857) for the evaluation of trends in the incidence and prevalence rate of diabetes-related ESKD, renin-angiotensin system (RAS) blockers and sodium glucose cotransporter 2 (SGLT2) inhibitors use for DKD, and the risk of atherosclerotic cardiovascular disease (ASCVD) and mortality according to DKD stages. DKD was defined as albuminuria or low estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 in patients with diabetes mellitus. The prevalence of DKD was 25.4% (albuminuria, 22.0%; low eGFR, 6.73%) in patients with diabetes mellitus aged ≥30 years. Patients with DKD had a higher rate of comorbidities, including hypertension, dyslipidemia, and central obesity; however, their control rates were lower than those without DKD. Prescription rate of SGLT2 inhibitors with reduced eGFR increased steadily, reaching 5.94% in 2019. Approximately 70% of DKD patients were treated with RAS blockers. The prevalence rate of diabetesrelated ESKD has been steadily increasing, with a higher rate in older adults. ASCVD and mortality were significantly associated with an in increase in DKD stage. DKD is prevalent among Korean patients with diabetes and is an independent risk factor for cardiovascular morbidity and mortality, which requiring intensive management of diabetes and comorbidities. The prevalence of diabetes-related ESKD has been increasing, especially in the older adults, during past decade.

Diabetic Ketoacidosis at Diagnosis in Youth with Type 1 Diabetes Is Associated with a Higher Hemoglobin A1c Even with Intensive Insulin Management.

Introduction: Diabetic ketoacidosis (DKA) at diagnosis is associated with short- and long-term complications. We assessed the relationship between DKA status and hemoglobin A1c (A1c) levels in the first year following type 1 diabetes (T1D) diagnosis. Research Design and Methods: The Pilot Teamwork, Targets, Technology, and Tight Control (4T) study offered continuous glucose monitoring to youth with T1D within 1 month of diagnosis. A1c levels were compared between historical (n = 271) and Pilot 4T (n = 135) cohorts stratified by DKA status at diagnosis (DKA: historical = 94, 4T = 67 versus without DKA: historical = 177, 4T = 68). A1c was evaluated using locally estimated scatter plot smoothing. Change in A1c from 4 to 12 months postdiagnosis was evaluated using a linear mixed model. Results: Median age was 9.7 (interquartile range [IQR]: 6.6, 12.7) versus 9.7 (IQR: 6.8, 12.7) years, 49% versus 47% female, 44% versus 39% non-Hispanic White in historical versus Pilot 4T. In historical and 4T cohorts, DKA at diagnosis demonstrated higher A1c at 6 (0.5% [95% confidence interval (CI): 0.21-0.79; P < 0.01] and 0.38% [95% CI: 0.02-0.74; P = 0.04], respectively), and 12 months (0.62% [95% CI: -0.06 to 1.29; P = 0.07] and 0.39% [95% CI: -0.32 to 1.10; P = 0.29], respectively). The highest % time in range (TIR; 70-180 mg/dL) was seen between weeks 15-20 (69%) versus 25-30 (75%) postdiagnosis for youth with versus without DKA in Pilot 4T, respectively. Conclusions: Pilot 4T improved A1c outcomes versus the historical cohort, but those with DKA at diagnosis had persistently elevated A1c throughout the study and intensive diabetes management did not mitigate this difference. DKA prevention at diagnosis may translate into better glycemic outcomes in the first-year postdiagnosis. Clinical Trial Registration: clinicaltrials.gov: NCT04336969.

694-P: Differences in Diabetes-Related Stigma by Demographic Group and Intensity of Diabetes Management

The social stigma surrounding diabetes refers to the negative attitudes, discrimination, or prejudice someone may face due to their diabetes. For many people with diabetes (PWD), stigma is a major challenge and often results in significant negative consequences, such as poor psychological well-being and worse clinical outcomes. This study aimed to identify groups who may be at greater risk of experiencing stigma. From October-December 2022, 10,338 adults living with diabetes in the United States, Canada, France, Germany, Italy, Netherlands, Sweden, and United Kingdom took an online survey assessing stigma associated with diabetes. Stigma was measured using four items about concealing or difficulty disclosing one's diabetes as well as diabetes-related embarrassment and isolation. These four items were averaged to create a composite variable on degree of stigma experienced (α = 0.87, M = 1.82, SD = 0.89). Subsequent responses were analyzed by various demographic factors and diabetes management strategies using SPSS. Stigma levels differ by intensity of diabetes management; respondents with more demanding diabetes management regimens experience greater levels of stigma. CGM users (p&amp;lt;0.001) and insulin users (p&amp;lt;0.001) experience more stigma than non-users, and PWD taking multiple daily injections experience more stigma than pump users (p=0.027). Stigma also varies across several demographic factors. French respondents report the highest stigma score, while German respondents report the lowest. Further, people with T1D experience more stigma than those with T2D (p&amp;lt;0.001). This research reveals differences in diabetes-related stigma by country and diabetes type and suggests that stigma becomes more prevalent with more intensive diabetes management. Additional research is needed to further explore experiences of stigma and identify methods of support, especially for at-risk groups. Disclosure A.Zeng: Employee; dQ&amp;A. E.Lin: Employee; dQ&amp;A. E.Cox: Employee; dQ&amp;A. E.Xu: Employee; dQ&amp;A. T.Bell: Employee; dQ&amp;A. T.L.Bristow: Employee; dQ&amp;A.

981-P: Transition from Standard Time to Daylight Saving Time and Vice Versa—Effects on FGM Metrics in Patients with Autoimmune Diabetes

Circadian rhythm variations, including transition from standard time (ST) to daylight saving time (DST), are associated with measurable effects on health. It is not known whether the transition from ST to DST and vice versa could affect glucose control in patients with autoimmune diabetes on intensive insulin treatment. This was a single center observational study. All FGM users sharing their glucose readings on the LibreView platform were evaluated for eligibility. Pittsburgh Sleep Quality Index (PSQI) questionnaire was administered to all patients on the day before and one week after the transition to DST. In addition, FGM metrics from two weeks before and two weeks after DST transition were acquired. Seven months later, the same evaluation was performed for the transition from DST to ST. Thirty-six patients with autoimmune diabetes were included for transition from ST to DST; sixty-five patients for transition from DST to ST. After DST transition, 16 patients reported worsening of PSQI, along with significant increase of GMI, mean glucose and TAR level 1, and reduction of TIR and CV. Conversely, FGM metrics were unchanged in the 20 patients who reported no variation or amelioration of PSQI. On the contrary, after returning to ST, no variation in FGM metrics was recorded neither for the 16 patients who reported worsening of PSQI, nor for the 49 patients with no variation or amelioration of PSQI. Consistently, after transition to DST, at linear regression analyses PSQI variation was found to be significantly related with variation of mean glucose, GMI, TIR, TAR level 2 and TBR level 1. On the other hand, after returning to ST, no relation between variations of PSQI and FGM metrics was detected. These results were confirmed for 22 patients whose data were collected for both transitions. In conclusion, transition from ST to DST, but not vice versa, is associated with glucose control derangement and could require a more intensive diabetes management. Disclosure L.Di gioia: None. S.Di molfetta: Consultant; Roche Diabetes Care, Ascensia Diabetes Care, Lilly Diabetes, Movi SpA. F.Giordano: None. M.Caporusso: None. G.Sorice: None. A.Cignarelli: Speaker's Bureau; Eli Lilly and Company, Novo Nordisk, Sanofi. A.Natalicchio: Other Relationship; AstraZeneca, Novo Nordisk, Sanofi, Boehringer-Ingelheim, Lilly. L.Laviola: Advisory Panel; A. Menarini Diagnostics, Boehringer Ingelheim Inc., Eli Lilly and Company, Novo Nordisk, Roche Diabetes Care, Sanofi, Other Relationship; Medtronic, Speaker's Bureau; Abbott, Terumo Corporation. F.Giorgino: Advisory Panel; Boehringer-Ingelheim, Amarin Corporation, Medtronic, Roche Diabetes Care, Sanofi, Bayer Inc., Novo Nordisk, Consultant; Novo Nordisk, Lilly, Research Support; Lilly, Roche Diabetes Care, AlfaSigma, Speaker's Bureau; Abbott, Boehringer-Ingelheim, Lilly, Sanofi, Medscape.

1163-P: The Arrival of a New Sibling May Be Associated with a Deterioration in Glycemic Control for Children with Type 1 Diabetes

Introduction: Caring for young children with Type 1 diabetes comes with significant burden for parents. We hypothesised that pregnancy and the arrival of a new sibling may be associated with a deterioration in control of type 1 diabetes for older siblings with type 1 diabetes. Research Design and Methods: We identified young children currently under the care of the John Hunter Children's Hospital Paediatric Diabetes team who had welcomed a younger sibling since their diagnosis using our prospective Paediatric Diabetes database. We reviewed the HbA1c pre and post the arrival of a new sibling. Results: 38 children (20 male) had become older siblings since diagnosis of type 1 diabetes. 5 children were excluded as no data were available prior to pregnancy. Mean age of children at diagnosis was 3.5 years. Mean age at arrival of sibling was 6years with mean duration of diabetes at that time of 3.4 years. 15 of eligible participants were using insulin pump therapy. Mean HbA1c during pregnancy was 51mmol/mol (6.8%) compared to 54mmol/mol (7.1%) following delivery (p&amp;lt;0.05). 67% of children had HbA1c &amp;lt;53mmol/mol (7%) during pregnancy compared to 53% following delivery. Conclusion: The arrival of a new sibling was associated with a significant increase in HbA1c. This may be due to the high care burden of type 1 diabetes on parents which cannot be met when also attempting to attend to the needs of a newborn. Programs to assist new parents may help children with young siblings to continue to meet glycaemic targets. Despite the young age of the cohort of children prior to delivery of a new sibling, 67% were able to meet the ADA glycaemic target of &amp;lt;7%. This indicates that the goals of intensive management of diabetes are achievable even in the toddler, preschool and early primary school years. Disclosure P.E.Lopez: None. B.R.King: None. C.E.Smart: None. A.Sinclair: None. M.Neylan: None. R.Seckold: None. M.A.Paterson: None.

Effect of Tight Glycemic Control on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes

Near normalization of glucose levels instituted immediately after diagnosis of type 1 diabetes has been postulated to preserve pancreatic beta cell function by reducing glucotoxicity. Previous studies have been hampered by an inability to achieve tight glycemic goals. To determine the effectiveness of intensive diabetes management to achieve near normalization of glucose levels on preservation of pancreatic beta cell function in youth with newly diagnosed type 1 diabetes. This randomized, double-blind, clinical trial was conducted at 6 centers in the US (randomizations from July 20, 2020, to October 13, 2021; follow-up completed September 15, 2022) and included youths with newly diagnosed type 1 diabetes aged 7 to 17 years. Random assignment to intensive diabetes management, which included use of an automated insulin delivery system (n = 61), or standard care, which included use of a continuous glucose monitor (n = 52), as part of a factorial design in which participants weighing 30 kg or more also were assigned to receive either oral verapamil or placebo. The primary outcome was mixed-meal tolerance test-stimulated C-peptide area under the curve (a measure of pancreatic beta cell function) 52 weeks from diagnosis. Among 113 participants (mean [SD] age, 11.8 [2.8] years; 49 females [43%]; mean [SD] time from diagnosis to randomization, 24 [5] days), 108 (96%) completed the trial. The mean C-peptide area under the curve decreased from 0.57 pmol/mL at baseline to 0.45 pmol/mL at 52 weeks in the intensive management group, and from 0.60 to 0.50 pmol/mL in the standard care group (treatment group difference, -0.01 [95% CI, -0.11 to 0.10]; P = .89). The mean time in the target range of 70 to 180 mg/dL, measured with continuous glucose monitoring, at 52 weeks was 78% in the intensive management group vs 64% in the standard care group (adjusted difference, 16% [95% CI, 10% to 22%]). One severe hypoglycemia event and 1 diabetic ketoacidosis event occurred in each group. In youths with newly diagnosed type 1 diabetes, intensive diabetes management, which included automated insulin delivery, achieved excellent glucose control but did not affect the decline in pancreatic C-peptide secretion at 52 weeks. ClinicalTrials.gov Identifier: NCT04233034.

Effect of Verapamil on Pancreatic Beta Cell Function in Newly Diagnosed Pediatric Type 1 Diabetes

In preclinical studies, thioredoxin-interacting protein overexpression induces pancreatic beta cell apoptosis and is involved in glucotoxicity-induced beta cell death. Calcium channel blockers reduce these effects and may be beneficial to beta cell preservation in type 1 diabetes. To determine the effect of verapamil on pancreatic beta cell function in children and adolescents with newly diagnosed type 1 diabetes. This double-blind, randomized clinical trial including children and adolescents aged 7 to 17 years with newly diagnosed type 1 diabetes who weighed 30 kg or greater was conducted at 6 centers in the US (randomized participants between July 20, 2020, and October 13, 2021) and follow-up was completed on September 15, 2022. Participants were randomly assigned 1:1 to once-daily oral verapamil (n = 47) or placebo (n = 41) as part of a factorial design in which participants also were assigned to receive either intensive diabetes management or standard diabetes care. The primary outcome was area under the curve values for C-peptide level (a measure of pancreatic beta cell function) stimulated by a mixed-meal tolerance test at 52 weeks from diagnosis of type 1 diabetes. Among 88 participants (mean age, 12.7 [SD, 2.4] years; 36 were female [41%]; and the mean time from diagnosis to randomization was 24 [SD, 4] days), 83 (94%) completed the trial. In the verapamil group, the mean C-peptide area under the curve was 0.66 pmol/mL at baseline and 0.65 pmol/mL at 52 weeks compared with 0.60 pmol/mL at baseline and 0.44 pmol/mL at 52 weeks in the placebo group (adjusted between-group difference, 0.14 pmol/mL [95% CI, 0.01 to 0.27 pmol/mL]; P = .04). This equates to a 30% higher C-peptide level at 52 weeks with verapamil. The percentage of participants with a 52-week peak C-peptide level of 0.2 pmol/mL or greater was 95% (41 of 43 participants) in the verapamil group vs 71% (27 of 38 participants) in the placebo group. At 52 weeks, hemoglobin A1c was 6.6% in the verapamil group vs 6.9% in the placebo group (adjusted between-group difference, -0.3% [95% CI, -1.0% to 0.4%]). Eight participants (17%) in the verapamil group and 8 participants (20%) in the placebo group had a nonserious adverse event considered to be related to treatment. In children and adolescents with newly diagnosed type 1 diabetes, verapamil partially preserved stimulated C-peptide secretion at 52 weeks from diagnosis compared with placebo. Further studies are needed to determine the longitudinal durability of C-peptide improvement and the optimal length of therapy. ClinicalTrials.gov Identifier: NCT04233034.

Glucose and Calcium Profile in Infants of Diabetic and Nondiabetic mothers- A Comparative Study

Background: Diabetes is one of the commonest and most important metabolic disorders that affect the health of pregnant women and infants. Diabetic mellitus is one of the most common metabolic disorders complicating pregnancy. The neonatal mortality rate is over five times that of nondiabetic mothers and is higher irrespective of birth weight and gestational age. There has been significant improvement in the outcome of diabetic pregnancies largely due to better metabolic control before and during pregnancy and vigorous neonatal care in developed countries. The management in our country still poses a major challenge.&#x0D; Methods: This case-control study was designed to find out the association between an infant's hypoglycemia and hypocalcemia with maternal diabetes. For the research, a total of 300 neonates were selected, where cases were selected from infants of diabetic mothers, and the control group was selected from infants of nondiabetic mothers. The mothers were interviewed by specific questionnaire, selected neonates were examined, and some biochemical tests were done to find out the outcome.&#x0D; Results: The study included 300 neonates of diabetic and nondiabetic mothers. The mean age of the Mothers of these neonates was 25.36 (SD±5.50) years. Among diabetic mothers 115(76%) had GDM and 36(23.8%) had PGDM. It is revealed that 83 (55%) of 150 mothers took insulin as the treatment. Hypoglycemia in neonates of diabetic and nondiabetic mothers right after birth at their first ½ hour of age 111 (37%). Hypoglycemia was found in 94 (62.3%) of infants of the diabetic mother than only 17(11.4%) in infants of the nondiabetic mother. Where the p-value is &lt;0.001, which explains developing hypoglycemia in the infant of a diabetic mother is higher than nondiabetic mother. The number of hypocalcemic infants of the diabetic mother was 34 (22.5%), while hypocalcemic infants of the nondiabetic mother were only 8 (5.4%), which is significantly (p-value &lt;0.001) lower.&#x0D; Conclusions: Hypoglycemia and hypocalcemia in infants were directly associated with the presence of diabetes during pregnancy. In spite of intensive management of maternal diabetes, the infants of diabetic mothers continue to be a high-risk population. Among the pregnancies complicated by diabetes, GDM continues to have a major contribution. Hypoglycemia remains the most common biochemical abnormality, followed by hypocalcemia. Therefore, this pregnancy complication will require increased re- sources to manage appropriate glycemic control during pregnancy and reduce adverse perinatal outcomes.&#x0D; TAJ 2022; 35: No-2: 93-102

Advancements and future directions in the teamwork, targets, technology, and tight control-the 4T study: improving clinical outcomes in newly diagnosed pediatric type 1 diabetes.

The benefits of intensive diabetes management have been established by the Diabetes Control and Complications Trial. However, challenges with optimizing glycemic management in youth with type 1 diabetes (T1D) remain across pediatric clinics in the United States. This article will review our Teamwork, Targets, Technology, and Tight Control (4T) study that implements emerging diabetes technology into clinical practice with a team approach to sustain tight glycemic control from the onset of T1D and beyond to optimize clinical outcomes. During the 4T Pilot study and study 1, our team-based approach to intensive target setting, education, and remote data review has led to significant improvements in hemoglobin A1c throughout the first year of T1D diagnosis in youth, as well as family and provider satisfaction. The next steps include refinement of the current 4T study 1, developing a business case, and broader implementation of the 4T study. In study 2, we are including a more pragmatic cadence of remote data review and disseminating exercise education and activity tracking to both English- and Spanish-speaking families. The overall goal is to create and implement a translatable program that can facilitate better outcomes for pediatric clinics across the USA.

Continuous glucose monitoring overview: features and evidence.

The prevalence of diabetes is growing in the United States at an alarming rate. Early and intensive diagnosis and management of diabetes can reduce the economic burden and improve the societal burden of long-term diabetes-related complications. Healthcare providers practicing in the primary care setting are on the front line of screening, diagnosis, and managing a large majority of persons with diabetes.Until recently, blood glucose monitoring, along with timely A1C measurements, has been the recommended means by which patients can best achieve their prescribed metabolic targets. However, supplies and testing can be costly and burdensome, affecting patient compliance and medication adherence. The recent introduction of integrated diabetes technology including continuous glucose monitoring (CGM) has had a tremendous impact on treating patients to their prescribed glycemic targets safely and efficiently while minimizing their risk of developing treatment-emergent hypoglycemia. Patients who utilize CGM are able to reduce their risk of hospitalizations, minimize work absenteeism, lower their A1C, lower their risk of hypoglycemia, as well as long-term microvascular and macrovascular complications.The American Diabetes Association updated its evidence-based Standards of Medical Care in Diabetes in 2022 around the use of CGM, as has the American Association of Clinical Endocrinology. Because these devices can have a positive effect on the management of persons with diabetes, managed care and healthcare providers should allow technological integration for theirpatients.

Weight gain trajectories and obesity rates in intensive and conventional treatments of type 1 diabetes from the DCCT compared with a control population without diabetes.

Obesity is a significant health issue for participants with type 1 diabetes undergoing intensive diabetes management. The temporal pattern and factors associated with weight gain after treatment initiation remain poorly understood including how weight gain in participants with and without type I diabetes compare. Our aim was to compare weight gain in those receiving intensive (INT) and conventional (CONV) type 1 diabetes treatment to a population without diabetes. Participants included men and women of 18years and older in the Diabetes Control and Complications Trial (DCCT) randomized to INT (n=562) or CONV (n=568) and a prospective, observational cohort without diabetes from the Coronary Artery Development in Young Adults (CARDIA, controls) study (n=2446). Body mass index (BMI) trajectories and obesity prevalence were compared between groups and candidate metabolic and therapeutic moderators investigated. Annual weight gain with INT peaked 1.3years after initiation and was greater than both CONV and controls before and after this peak. Obesity prevalence with INT was lower than controls at baseline, was similar to controls at 2years and surpassed controls by 5years. Obesity rates with CONV remained below controls at all time points. Greater annual weight gain in the DCCT was associated with lower haemoglobin A1c , higher insulin dose and family history of type 2 diabetes. Greater weight gain accompanying INT therapy occurs in two stages, leads to similar or greater obesity rates than controls after 2years and is primarily modified by glucose control and family history, supportive of a therapeutic-genetic influence on weight trajectories.

Degree of Control of Type II DM in Kirkuk City Using HbA1c

Background: Diabetes mellitus is a major cause of morbidity and mortality. In the Arab region, the overall prevalence of DM in the Kingdom of Saudi Arabia is (23.7%) among people with age between 30 and 70 years. The prevalence of diabetes in the United Arab Emirates, Bahrain, and Kuwait were (20.1%), (14.9%) and (12.8%), respectively. Several large clinical trials have demonstrated that tight blood glucose control correlates with a reduction in the microvascular complications of diabetes. The American Diabetes Association (ADA) has designated HbA1c level of ≤ (7%) as a goal of optimal blood glucose control, and the American Association of Clinical Endocrinologist has further recommended HbA1c level of ≤ (6.5%). Despite the evidence from large randomized controlled trials establishing the benefit of intensive diabetes management in reducing microvascular and macrovascular complications, high proportion of patients remain poorly controlled. Poor and inadequate glycemic control among patients with type 2 diabetes constitutes a major public health problem and major risk factor for the development of diabetes complications. Glycemic control remains the major therapeutic objective for prevention of target organ damage and other complications arising from diabetes. Aim of the study: To estimate the proportion of the patients with poor glycemic control and determine factors associated with poor glycemic control among patients with type 2 diabetes in Kirkuk city. Materials and Methods:A cross-sectional study conducted on 500 patients with type 2 DM, were randomly selected who were attended outpatient clinic in Azadi teaching hospital or private clinic over a period of 12month in 2014. A pre-structured questionnaire sought information about sociodemographic, clinical characteristics, self-care management behaviors, medication adherence, and attitude towards diabetes. Weight, and height were measured. Available last readings of hemoglobin A1c(HbA1c), were abstracted from patients' records. Poor glycemic control was defined as HbA1c ˃ (7%). Results:Of the total 500 patients, (74.2%) had HbA1c ˃ (7%). In the multivariate analysis, increased duration of diabetes,increased Body Mass Index(BMI),low education level,hypertension,type of treatment, non-adherence to diabetes self- care management behavior,poor medication adherence, were significantly associated with increased odds of poor glycemic control.(pvalue<0.005). Conclusions and recommendations: Results indicate that duration of diabetes, age, obesity and morbidity are risk factors for poor glycemic control. Patients with these characteristics may need additional therapies and targeted interventions to improve glycemic control. Regular checking of RBS, adherence to treatment, 30 minute exercise and followinghealthy diet are important attitude of patients towards DM for good glycemic control. An educational program that emphasizes lifestyle modification with importance of adherence totreatment regimen, regular exercise and dietary regimen would be of great benefit in glycemic control.

Pediatric Smart Insulin Pen Use: The Next Best Thing.

In the pediatric population, insulin pump therapy, or CSII, is often considered the gold standard for intensive diabetes management. Insulin pump technology offers families and caregivers many beneficial features including a calculator for insulin dosing and the ability to review diabetes management data to provide data-driven diabetes management. However, for those who find CSII challenging or choose to use multiple daily injections (MDI) there is an option that offers similar features called the Smart Insulin Pen (SIP). Even though SIP technology provides a safe and data-driven diabetes self-management tool for the pediatric population using MDI, there is limited pediatric specific literature. This article will describe current options, data-driven diabetes management, benefits, challenges and clinical use of SIP technology in the pediatric population.

Tip 1 Diyabetli Okul Öncesi Dönem Çocuklarda Yatmadan Önce Süt İçmenin Gece Glukoz Seyrine Etkisi: Vaka Sunumları

Tip 1 diyabet (T1D) tanılı küçük çocuklar diyabet yönetimi ve glisemik değişkenlik bakımından ayrı bir yere sahiptir. Küçük çocuklar (&lt;7 yaş), hipoglisemi ve hipergliseminin daha sık görülmesi, hipoglisemi bulgularını ifade edememeleri, rezidüel beta hücre fonksiyonunun az olması, ciddi hipoglisemi atakları ve kronik hiperglisemiye bağlı uzun dönemde nörokognitif etkilenmenin daha fazla olması gibi birçok zorlukla karşı karşıyadır. Bu zorluklar ebeveynlere endişe olarak yansımakta ve birçok ebeveyn gece hipoglisemisi korkusu nedeniyle glukoz değeri ne olursa olsun rutin bir şekilde çocuğa gece ara öğünü vermektedir. Ülkemizde çocukların gece uyumadan önce ve sabah süt içme alışkanlıkları olması sebebiyle süt sık tüketilen bir seçenek olmaktadır. Kliniğimizde izlenen küçük yaş grubu çocukların Sürekli Glukoz İzlem (SGİ) verilerinde süt içirip uyutmanın gece boyunca hiperglisemiye neden olduğu, süt vermenin bırakılması durumunda ise gece glukoz seyrinin hedef aralıkta (70-180 mg/dL) kalma oranının arttığı gözlenmiştir. Bu yazıda kliniğimizde izlenen 3-5 yaş arasındaki iki olgunun tıbbi beslenme tedavisi ve gece ara öğününde verilen sütün SGİ verilerine yansıması paylaşılacaktır.

SAT-LB029 Patient Participation Is Determined by Referral Source in an Intensive Diabetes Management Program

The HAC program was created for patients with high HbA1C values and consists of frequent visits, intensive pharmacologic management, and patient education. In this retrospective study, our primary objective was to determine if there are patient characteristics associated with participation in the program. We hypothesized that younger patients with shorter disease duration and lower HbA1C values would have higher rates of participation. The patients we evaluated were scheduled to begin the program between March and November 2018. Data regarding age, ethnicity, patient reported disease duration, HbA1C, and referral source were collected. We compared patients who participated in the program (Participants) and those who missed their first appointment or only attended one appointment (Non-participants). All Participants attended at least 2 appointments. A total of 30 patients were included, 19 patients in the Participant group and 11 patients in the Non-participant group. The Participant group had an average pre-enrollment HbA1C of 11.8% (8.7%-15.5%), average patient reported disease duration of 16.9 years (0.5-55 years), and average age of 55 years (32-78 years). 10/19 of patients in the Participant group were referred from an outpatient endocrinology clinic, 5/19 were referred from an inpatient endocrine service, and 4/19 were referred from a primary care setting. The Non-participant group had an average pre-enrollment HbA1C of 12.5% (10.2%-14.6%); average patient reported disease duration of 13.5 years (5-35 years), and average age of 53 years (32-65 years). 5/11 of patients in the Non-participant group were referred from an outpatient endocrinology clinic, 1/11 were referred from an inpatient medicine service, and 5/11 were referred from a primary care setting. There were 10 patients in the Participant group and 7 patients in the Non-participant group who had an HbA1C drawn 3 months after their initial enrollment. The Participant group’s HbA1C had a significant reduction to 8.6% (7.2%-10.5%) (p=0.0017). The average HbA1C in the Non-participant group did not change after 3 months and was 12.1% (9.3%-14.0%) Our program of intensive diabetes management, similar to what has been demonstrated in other studies, improved the glycemic outcomes in enrolled patients. In our HAC program, age, disease duration, and baseline HbA1C were not determinants of participation or improvement in glycemic control. More Participants were referred by an outpatient or inpatient endocrinology service. Patients’ motivation to participate may have been influenced by expectations set by the provider, acute illness, or the patient-provider relationship. Further studies to understand the impact of provider-patient relationships may help to optimize patient engagement in intensive diabetes management programs. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.

Connecting the Dots: Validation of Time in Range Metrics With Microvascular Outcomes.

The landmark Diabetes Control and Complications Trial (DCCT) identified the relationship between intensive diabetes management for those with type 1 diabetes (T1D) and a delay in the onset or progression of microvascular complications, shifting the paradigm of clinical care for this chronic medical condition (1). Importantly, the data from that trial continue to have a lasting legacy as they can now be analyzed to inform present-day questions. An example of this comes from the article by Beck et al. in this issue of Diabetes Care (2) that concisely states the primary implication of the article in its title, “Validation of Time in Range as an Outcome Measure for Diabetes Clinical Trials.” In recent years, and with increasing use of continuous glucose monitoring (CGM), the ability to classify sensor glucose levels into various ranges has been feasible. Yet, some have questioned the validity of using these measures as a surrogate outcome measure in ongoing and future clinical trials. Indeed, some have called for a “modern-day” DCCT assessing whether CGM and a greater time in range (TIR) would result in fewer microvascular end points compared with self-monitoring of blood glucose (with intermittent masked CGM). Unfortunately, the duration of time, funds required, and ethical concerns given clinical equipoise regarding the benefits of the technology would make completion of a rigorous randomized controlled trial a near-impossible feat. Recognizing the wealth of data that the DCCT affords, Beck et al. (2) found a creative solution to assess the hypothesis of whether TIR could serve as an outcome measure for future trials. Specifically, they capitalized on the glucose values captured seven times daily every 3 months during the course of the 6+ years of the DCCT. This allowed them to calculate the percent TIR of glucose values between 70 and 180 mg/dL and show a robust …

"I kind of gave up on it after a while, became too hard, closed my eyes, didn't want to know about it"-adults with type 1 diabetes mellitus describe defeat in the context of low social support.

BackgroundType 1 diabetes mellitus (T1DM) is a lifelong condition that requires diligent self‐management to avoid complications. Living with T1DM is a considerable challenge and the inability to follow a prescribed regimen is often termed non‐compliance. However, this fails to acknowledge that for some people the barriers to glycaemic control may be insurmountable.ObjectiveThis qualitative study explores the structural determinants, social context and lived experience of T1DM with 17 adults to understand influences on patterns of self‐care, engagement with and trust in health‐care services, and health outcomes.ResultsTheir stories tell us that strong social support is vital to disease adaptation and ongoing management. When social support is absent, the story is one of struggling with intensive diabetes management alone and difficulty controlling blood glucose levels. When confronted with suboptimal glycaemic control, participants isolated from social support developed combative relationships with health‐care providers and disengaged from health care. Their subsequent slide to chronic comorbid illness is steep and this study reveals the heartache and loss experienced when difficult life circumstances and low levels of social support have led to irreparable kidney damage.ConclusionPatterns of poor glycaemic control viewed in the health‐care encounter without an understanding of the context or life circumstances in which they are occurring can lead to an inability to engage with health‐care services. Disengagement from services and the absence of specialist care further isolates people, leaving them managing their diabetes alone with limited success.

Management of Hypoglycemia in Patients with Type 2 Diabetes

The rate limiting step of intensive diabetes management for patients with diabetes is treatment induced hypoglycemia. Thus, hypoglycemia remains a significant barrier in optimizing glycemic control and reducing long-term diabetes related complications including cardiovascular death, stroke, and all cause-mortality [1]. Cardiovascular (CV) events are the leading cause of death among patients with diabetes. The risk of CV death is twice that of patients without diabetes [2]. Severe hypoglycemia (resulting in cognitive impairment) can occur across a broad spectrum of A1C levels. Patients achieving near-normal glycemia

IDMVis: Temporal Event Sequence Visualization for Type 1 Diabetes Treatment Decision Support.

Type 1 diabetes is a chronic, incurable autoimmune disease affecting millions of Americans in which the body stops producing insulin and blood glucose levels rise. The goal of intensive diabetes management is to lower average blood glucose through frequent adjustments to insulin protocol, diet, and behavior. Manual logs and medical device data are collected by patients, but these multiple sources are presented in disparate visualization designs to the clinician-making temporal inference difficult. We conducted a design study over 18 months with clinicians performing intensive diabetes management. We present a data abstraction and novel hierarchical task abstraction for this domain. We also contribute IDMVis: a visualization tool for temporal event sequences with multidimensional, interrelated data. IDMVis includes a novel technique for folding and aligning records by dual sentinel events and scaling the intermediate timeline. We validate our design decisions based on our domain abstractions, best practices, and through a qualitative evaluation with six clinicians. The results of this study indicate that IDMVis accurately reflects the workflow of clinicians. Using IDMVis, clinicians are able to identify issues of data quality such as missing or conflicting data, reconstruct patient records when data is missing, differentiate between days with different patterns, and promote educational interventions after identifying discrepancies.

IGFBP2 Is Increased after Gastric Bypass in Humans—Potential Impact on Hepatic Metabolism

To identify molecular mechanisms contributing to postoperative metabolic improvements after Roux-en-Y gastric bypass (RYGB), we performed comprehensive proteomic analysis of fasting human plasma samples obtained from the SLIMM-T2D longitudinal clinical trial, which randomized obese individuals with T2D to RYGB surgery or a one-year intensive medical diabetes and weight management (DWM) program, and followed them for 3 years. Somalogic proteomic analysis was performed on plasma collected in the fasting state at baseline and during longitudinal follow-up, and proteins differentially abundant in RYGB vs. DWM at each time point were identified. The protein with highest magnitude of differential abundance at 3 years was insulin-like growth factor binding protein 2 (IGFBP2), upregulated by 2.2-fold in RYGB vs. DWM (p=4.37E-06); differences were confirmed by ELISA. IGFBP2 inversely correlated at 3 years with BMI (r=-0.74, p=5.31E-05) and HbA1c (r=-0.68, p=0.00004). Notably, IGFBP2 levels were increased at the first postoperative study visit (10% weight loss) following RYGB or at similar weight loss for the DWM group, suggesting an early weight-independent contribution. IGFBP2 is predominantly expressed in liver and upregulated after RYGB in mice (2.8-fold at 8 weeks, GSE68812). To identify IGFBP2-dependent mechanisms contributing to improved hepatic metabolism, we overexpressed mouse IGFBP2 or control vector in mouse AML12 hepatocytes, achieving a 6-fold increase in IGFPB2 protein. qPCR revealed 15-30% downregulation of lipogenic genes (e.g., Fasn, Srebp1) with a 2-fold increase in expression of genes regulating fatty acid oxidation (e.g., Ppara, Ppargc1a). Analysis of metabolism (Seahorse flux analyzer) revealed increased fatty acid oxidation (3-fold, p&amp;lt;0.01 for IGFBP2 vs. control). In conclusion, increased IGFBP2 expression may contribute to improved hepatic lipid oxidative metabolism, and thus induce systemic metabolic improvement after RYGB surgery. Disclosure Y. Yuchi: None. W. Cai: None. T. Takagi: None. H. Pan: None. J. Dreyfuss: None. K. Foster: None. A.H. Vernon: None. D.C. Simonson: Advisory Panel; Self; GI Windows, Inc.. Stock/Shareholder; Self; GI Windows, Inc.. Stock/Shareholder; Spouse/Partner; Phase V Technologies, Inc. A. Goldfine: Employee; Self; Novartis AG. A. Hoeflich: None. M.E. Patti: Research Support; Self; Janssen Pharmaceuticals, Inc.. Other Relationship; Self; Xeris Pharmaceuticals, Inc.. Research Support; Self; Ethicon US, LLC., Coviden, MedImmune. Other Relationship; Self; Novo Nordisk Inc., XOMA Corporation, AstraZeneca, Nestlé. Research Support; Self; Dexcom, Inc.. Consultant; Self; Eiger BioPharmaceuticals.