scholarly journals Increasing plasma glucose before the development of type 1 diabetes ‐ the TRIGR study

2021 ◽  
Author(s):  
Johnny Ludvigsson ◽  
David Cuthbertson ◽  
Dorothy J. Becker ◽  
Olga Kordonouri ◽  
Bärbel Aschemeier ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Glucose

89-LB: The Effect of GIP on Plasma Glucose in a Setting of Prandial Insulin Overdose and Physical Activity after Meal Intake in Patients with Type 1 Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 89-LB ◽  
Author(s):  
BJØRN HOE ◽  
SEBASTIAN M. NGUYEN HEIMBÜRGER ◽  
LÆRKE S. GASBJERG ◽  
MADS B. LYNGGAARD ◽  
BOLETTE HARTMANN ◽  
...  
Keyword(s):  
Physical Activity ◽  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Prandial Insulin ◽  
Meal Intake ◽  
Insulin Overdose

Correlation of serum vitamin D level with ketoacidosis in Chinese children with type 1 diabetes mellitus

2021 ◽  
Author(s):  
Jianbo Shu ◽  
Xinhui Wang ◽  
Mingying Zhang ◽  
Xiufang Zhi ◽  
Jun Guan ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Vitamin D ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Plasma Glucose ◽  
Serum Vitamin ◽  
Chinese Children ◽  
Serum Vitamin D ◽  
Significant Difference

Abstract Objective: Diabetic ketoacidosis is a common complication in children with type 1 diabetes mellitus. The purposes of the present study were to explore clinical correlates of serum vitamin D level in Chinese children with type 1 diabetes.Methods: A total of 143 inpatients (boys/girls = 60/83) were recruited from Tianjin Children’s Hospital. Their demographic and clinical characteristics were collected. These patients were divided into the non-DKA group(n=43) and DKA group(n=100).Results: The positive ZnT8-ab was significantly higher in DKA patients compared with non-DKA patients (p=0.038). There was a negative correlation between plasma glucose and the concentration of vitamin D(r =−0.188, p=0.024), although there was no significant difference in vitamin D between two groups of T1DM patients with or without DKA (p=0.317). The multiple logistic regression revealed that sex(male) and BMI were independent risk factors to predict the deficiency or insufficiency of Vitamin D in T1DM children. When BMI is lower than 16 kg/m2 according to the cut-off value of the ROC curve, it provides some implications of Vitamin D deficiency or insufficiency in TIDM children ( 95%CI:0.534~0.721, P=0.014). Conclusions: Our results suggested that positive ZnT8-ab was associated with a greater risk of DKA at T1DM onset. Additionally, neither vitamin D levels nor the proportion of patients with different levels of vitamin D differed between the two groups inT1DM children with or without DKA. Furthermore, Vitamin D level was negatively correlated with plasma glucose, lower BMI and male children with T1DM were prone to be deficient or insufficient of Vitamin D.

scholarly journals Day-to-Day Variations in Fasting Plasma Glucose Do Not Influence Gastric Emptying in Subjects With Type 1 Diabetes

2020 ◽  
Author(s):  
Lea Aigner ◽  
Björn Becker ◽  
Sonja Gerken ◽  
Daniel R. Quast ◽  
Juris J. Meier ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Gastric Emptying ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Healthy Subjects ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Chronic Hyperglycemia ◽  
Fasting Plasma

<b>Objective:</b> Acute experimental variations in glycemia decelerate (hyperglycemia) or accelerate (hypoglycemia) gastric emptying. Whether spontaneous variations in fasting plasma glucose (FPG) have a similar influence on gastric emptying is yet unclear. <p><b>Research design and methods:</b> Gastric emptying of a mixed meal was prospectively studied three times in 20 patients with type 1 diabetes and 10 healthy subjects with normal glucose tolerance using a <sup>13</sup>C-CO<sub>2</sub> octanoate breath test with Wagner-Nelson analysis. The velocity of gastric emptying was related to fasting plasma glucose (FPG) measured before the test (grouped as low, intermediate, or high). In addition, gastric emptying data from 255 patients with type 1 diabetes studied for clinical indications were compared by tertiles of baseline FPG. </p> <p><b>Results:</b> Despite marked variations in FPG (by 4.8 (3.4; 6.2) mmol/l), gastric emptying did not differ between the three prospective examinations in patients with type 1 diabetes (D T<sub>1/2</sub> between highest and lowest FPG: 1 [95 % CI: -35; 37] min; p = 0.90). The coefficient of variation for T<sub>1/2 </sub>determined three times was 21.0 %. Similar results at much lower variations in FPG were found in healthy subjects. In the cross-sectional analysis, gastric emptying did not differ between the tertiles of FPG (D T<sub>1/2</sub> between highest and lowest FPG: 7 [95 % CI: - 10; 23] min; p = 0.66), when FPG varied by 7.2 (6.7; 7.8) mmol/l. However, higher HbA<sub>1c</sub> was significantly related to slower gastric emptying.</p> <p><b>Conclusions:</b> Day-to-day variations in FPG not induced by therapeutic measures do not influence gastric emptying significantly. These findings are in contrast with those obtained after rapidly clamping plasma glucose in the hyper- or hypoglycemic concentrations range and challenge the clinical importance of short-term glucose fluctuations for gastric emptying in type 1-diabetic patients. Rather, chronic hyperglycemia is associated with slowed gastric emptying.</p>

scholarly journals Prolonged Honeymoon Period in a Thai Patient With Adult-Onset Type 1 Diabetes Mellitus - Metabolic Flexibility in Autoimmune Diabetes?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A460-A461
Author(s):  
Yotsapon Thewjitcharoen ◽  
Ekgaluck Wanothayaroj ◽  
Waralee Chatchomchuan ◽  
Haruethai Jaita ◽  
Soontaree Nakasatien ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Beta Cell ◽  
Plasma Glucose ◽  
Carbohydrate Intake ◽  
Regular Exercise ◽  
Thai Patient ◽  
Low Carbohydrate ◽  
New Onset

Abstract Background: ‘Honeymoon’ period among people with type 1 diabetes mellitus (T1DM) refers to the period of time (mostly less than 1 year) which beta-cell is still able to produce insulin to maintain good glycemic control shortly following the development of diabetes. This phenomenon remained incompletely understood but previous studies showed that absence of diabetic ketoacidosis (DKA) at initial presentation, short duration of symptoms, older age at presentation, and strenuous exercise could be potential factors. Herein, we report a 24-year old Thai patient with T1DM who has been in sustained complete remission for more than 5 years while he is maintaining low carbohydrate intake and regular exercise. Clinical Case: A 24-year-old male presented with a 6-month history of polyuria, polydipsia and weight loss of 15 kilograms (baseline BMI at 27.8 kg/m2). His initial laboratory data showed plasma glucose 398 mg/dL and A1C 9.3%. No ketonemia was found. He was diagnosed with stage 3 of Type 1 DM based on clinical presentation and positive pancreatic auto-antibodies (anti-GAD and anti-IA2). Euthyroid Hashimoto’s thyroiditis was also diagnosed based on his enlarged thyroid gland and positive thyroid auto-antibodies. He was started on basal-bolus insulin regimen for only 2 month and then A1C reversed to 5.9% within 2 months. Insulin was gradually withdrawn and completely stopped. Mixed meal stimulation test (MMST) was firstly evaluated at the second year of his diagnosis. The result revealed stimulated C-peptide at 5.5 ng/dL. Next-generation sequencing panel for monogenic diabetes revealed negative results. The patient maintains healthy lifestyle habit with low carbohydrate intake and regular exercise 5–6 times per week. His body weight was maintained at 60–63 kilograms during the past 4 years. His A1C was maintained between 5.0 to 6.0% without any anti-diabetic medication for more than 5 years. Repeated MMST in every 6–12 months still revealed preserved beta-cell functions and normal stimulated plasma glucose. Interestingly, repeated pancreatic auto-antibodies at 3 years after diagnosis showed negative anti-GAD and anti-IA2, but positive anti-ZnT8. The patient was advised to maintain his bodyweight and healthy behavior together with closely regular OPD follow-up. Conclusion: Restored beta-cell function with completely insulin withdrawal in new-onset T1DM has been reported in very few cases which have some common factors as in our patient (low carbohydrate intake with regular exercise). Delaying autoimmune activity by reducing metabolic load in newly diagnosed T1DM might play a role in maintaining a honeymoon period and could lead to an innovative therapeutic option in new-onset T1DM.

scholarly journals Dasiglucagon: A Next-Generation Glucagon Analog for Rapid and Effective Treatment of Severe Hypoglycemia Results of Phase 3 Randomized Double-Blind Clinical Trial

2021 ◽  
Author(s):  
Thomas R Pieber ◽  
Ronnie Aronson ◽  
Ulrike Hövelmann ◽  
Julie Willard ◽  
Leona Plum-Mörschel ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Severe Hypoglycemia ◽  
Next Generation ◽  
Double Blind ◽  
Intravenous Glucose ◽  
Subcutaneous Dose ◽  
Double Blind Clinical Trial ◽  
Glucose Recovery

OBJECTIVE To evaluate the efficacy and safety of dasiglucagon – a ready-to-use, next-generation glucagon analog in aqueous formulation for subcutaneous dosing – for treatment of severe hypoglycemia in adults with type 1 diabetes. <p>RESEARCH DESIGN AND METHODS This randomized, double-blind trial included 170 adult participants with type 1 diabetes, each randomized to receive a single subcutaneous dose of dasiglucagon 0.6 mg, placebo, or reconstituted glucagon 1 mg (2:1:1 randomization) during controlled insulin-induced hypoglycemia. The primary endpoint was time to plasma glucose recovery, defined as an increase of ≥20 mg/dL from baseline without rescue intravenous glucose. The primary comparison was dasiglucagon versus placebo; reconstituted lyophilized glucagon was included as reference.</p> <p>RESULTS Median (95% CI) time to recovery was 10 (10, 10) minutes for dasiglucagon compared to 40 (30, 40) minutes for placebo (<i>P</i><0.001); the corresponding result for reconstituted glucagon was 12 (10, 12) minutes. In the dasiglucagon group, plasma glucose recovery was achieved within 15 minutes in all but one participant (99%), superior to placebo (2%; <i>P</i><0.001) and similar to glucagon (95%). Similar outcomes were observed for the other investigated time points at 10, 20 and 30 minutes after dosing. The most frequent side effects were nausea and vomiting, as expected for glucagon treatment.</p> <p>CONCLUSIONS Dasiglucagon provided rapid and effective reversal of hypoglycemia in adults with type 1 diabetes, with safety and tolerability similar to that reported for reconstituted glucagon injection. The ready-to-use, aqueous formulation of dasiglucagon offers the potential to provide a rapid and reliable treatment for severe hypoglycemia.</p>

scholarly journals Effects of incretin-based therapies on β-cell function in type 1 diabetes mellitus: a systematic review and meta-analysis

2021 ◽  
Vol 49 (12) ◽  
pp. 030006052110663
Author(s):  
Yucheng Wu ◽  
Yu Lu ◽  
Shufang Yang ◽  
Qingqing Zhang
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Fasting Plasma Glucose ◽  
Cell Function ◽  
Meta Analysis ◽  
Β Cell ◽  
C Peptide ◽  
Β Cell Function

Aim To assess the effects of incretin-based therapies on β-cell function in patients with type 1 diabetes mellitus (T1DM). Methods We searched the PubMed, Cochrane Library, Embase, and Web of Knowledge databases for eligible randomized clinical trials published up to July 2021. The inclusion criteria were patients with T1DM or latent autoimmune diabetes in adults, patients treated with dipeptidyl peptidase-4 inhibitors or glucagon like peptide-1 receptor agonists, and outcomes included one of the following: fasting plasma glucose, fasting C-peptide, postprandial C-peptide, C-peptide area under the curve (AUC), homeostasis model assessment for β cell function, and insulin resistance. The effects were analyzed using a random effect model with STATA 11.0. Results Eight trials including 427 participants were included in the final analysis. A pooled analysis found no significant difference in fasting plasma glucose, fasting C-peptide, postprandial C-peptide, or C-peptide AUC between patients treated with incretin-based therapies and placebo. The two trials that reported changes in 2-hour postprandial C-peptide and two of the four trials that reported changes in C-peptide AUC reported increases after incretin-based therapies. Conclusion This meta-analysis showed that incretin-based therapies did not preserve β-cell function in patients with T1DM.

Circulating Tissue Factor Procoagulant Activity (TF-PCA) Is Elevated in Type 1 Diabetes Mellitus: Differential Regulation of TF-PCA in Type 1 and Type 2 Diabetes

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 540-540
Author(s):  
Anamika Singh ◽  
Guenther Boden ◽  
Carol Homko ◽  
Jay Gunawardana ◽  
A. Koneti Rao
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Tissue Factor ◽  
Plasma Glucose ◽  
Cardiovascular Events ◽  
Plasma Adiponectin ◽  
Control Subjects

Abstract Abstract 540 Background: Type 1 diabetes mellitus (T1DM) is a hypercoagulable state associated with increased acute cardiovascular events. Potential risk factors for this include alterations in coagulation and fibrinolytic systems. Tissue factor (TF) is the principal initiator of blood coagulation. Several studies show that there is a circulating pool of TF in blood, which is thrombogenic, and elevated in thrombotic states. We have shown (J Clin Endo Metab 2007, 92:4352-8) that circulating TF procoagulant activity (TF-PCA) is elevated in patients with Type 2 DM (T2DM) and increases further with acute combined hyperglycemia-hyperinsulinemia and selective hyperinsulinemia. There is currently no information on circulating TF-PCA levels and TF responses to hyperglycemia and/or hyperinsulinemia in patients with T1DM who are at comparable risk for cardiovascular events as T2DM patients. Objective: To investigate circulating TF-PCA and other coagulation factors under basal conditions and in response to acute selective hyperglycemia, selective hyperinsulinemia and combined hyperglycemia and hyperinsulinemia in T1DM. Methods: Three study protocols were used: 1) acute correction of hyperglycemia (with IV insulin) followed by 24 h of hyperglycemia, 2) 24 h of selective hyperinsulinemia and 3) 24 h of combined hyperinsulinemia and hyperglycemia. Studies were performed in 9 T1DM patients and 7 non-diabetic subjects. T1DM patients were on a basal/bolus insulin regimen (insulin glargine, 15–70 units at night) or Novolog 70/30 mix twice daily (45-50 units). Circulating membrane bound TF-PCA was measured in whole blood lysates by a two-stage clotting assay (Key et al, Blood; 1998:91). Results: Basal TF-PCA (64.7 ± 6.0 vs. 24.6 ± 1.2 U/ml, p < 0.001) and plasma factor VIIa (104 ± 24 vs. 38 ± 8 mU/ml, p < 0.03), the activated form of factor VII, were higher in T1DM (n=9) than in non-diabetic controls (n= 7) indicating a chronic procoagulant state. Plasma FVIIc, FVIII, thrombin-antithrombin complexes (TAT) and soluble vascular cell adhesion molecule-1 (sVCAM-1) were not significantly different between patients and controls. When control subjects and T1DM patients were combined, HbA1C correlated with TF-PCA (r=0.71, p=0.0001, n=23). Plasma adiponectin was elevated in T1DM patients compared to control subjects (12.4 ± 1.9 vs 6.7 ± 2.0 μg/ml, p < 0.05). Acutely normalizing hyperglycemia in T1DM patients over 3–15 h did not decrease TF-PCA. There were also no changes in plasma FVIIc and FVIII. To explore effects of acutely raising plasma glucose, glucose was raised from 103 ± 8 to ∼ 300 mg/dl by infusion of 20% dextrose and maintained for 24 hours. Insulin concentrations were kept at basal concentrations (6 and 13 μU/ml) by IV infusion. In our previous studies in non-diabetic subjects (Diabetes 2006, 55,202-8) and in T2DM patients (J Clin Endo Metab 2007, 92,4352-8), raising glucose and insulin together produced a marked increase in circulating TF-PCA. We therefore raised glucose to ∼ 250 mg/dl and insulin to ∼ 100 μU/ml together in 8 T1DM patients. Raising glucose levels alone or in combination with insulin decreased circulating TF-PCA by 26% (p < 0.02) and 37% (p < 0.01), respectively, which is in striking contrast to the elevations noted in non-diabetic controls and T2DM patients. To explore effects of selective hyperinsulinemia, plasma insulin levels were raised in 3 T1DM patients by IV infusion of regular insulin from 15 ± 0.2 to ∼ 75 μU/ml and maintained for 24 hours while plasma glucose was kept at ∼ 100 mg by infusion of 20% dextrose. Again, in contrast to our studies in T2DM patients and healthy subjects we found no increase in TF-PCA Conclusions: Circulating TF-PCA and FVIIa levels are elevated in T1DM patients indicating a potential prothrombotic state. The studies on acutely induced hyperinsulinemia and hyperglycemia indicate that the regulation of TF expression is different in T1DM and T2DM. This may be due to multiple mechanisms, including a differential effect of insulin on monocytes TF expression in T1DM and T2DM, and due to differences in plasma adiponectin, which has been shown to inhibit TF expression and is elevated in T1DM. Additional studies are needed to obtain insights into the mechanisms regulating the differential expression of TF in the two forms of diabetes. Disclosures: No relevant conflicts of interest to declare.

scholarly journals OGTT and random plasma glucose in the prediction of type 1 diabetes and time to diagnosis

Diabetologia ◽  
2015 ◽  
Vol 58 (8) ◽  
pp. 1787-1796 ◽  
Author(s):  
Olli Helminen ◽  
Susanna Aspholm ◽  
Tytti Pokka ◽  
Jorma Ilonen ◽  
Olli Simell ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Plasma Glucose ◽  
Time To Diagnosis
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