scholarly journals Integration of Routine Parameters of Glycemic Variability in a Simple Screening Method for Partial Remission in Children with Type 1 Diabetes

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Nina Nielens ◽  
Olivier Pollé ◽  
Annie Robert ◽  
Philippe A. Lysy
Keyword(s):  
Type 1 Diabetes ◽  
Partial Remission ◽  
Cell Function ◽  
Screening Method ◽  
Glycemic Variability ◽  
Clinical Feature ◽  
Alternative Formula ◽  
Definition Of ◽  
Glycemic Target

Although different criteria were used to define partial remission in type 1 diabetes, the IDAA1C formula has prevailed as it correlates with stimulated C-peptide levels. Our retrospective study evaluated clinical variables associated with the occurrence of IDAA1C-defined partial remission in a series of 239 pediatric patients. Diabetic ketoacidosis and age at diagnosis, but no other clinical feature, influenced the occurrence of remission. We then evaluated whether parameters of glycemic variability used in clinical routine may reliably define partial remission, as these would alleviate confounding factors related to insulin treatment. Using multiple linear regression, we observed that HbA1C levels and percentage of normoglycemia were efficient and sufficient to predict partial remission. These parameters were entered into a formula, called glycemic target-adjusted HbA1C (GTAA1C), that corresponded to HbA1C(%) − (3 × % of normoglycemic values(70–180 mg/dL)). With a threshold of 4.5, this alternative formula predicted partial remission with a sensitivity and a specificity of 72.3% and 92%, respectively, and yielded strong correlation with IDAA1C levels and BETA-2 score, which is a correlate of β-cell function after islet transplantation. We propose GTAA1C, based on routine and objective markers of glycemic variability, as a valid alternative for definition of partial remission in type 1 diabetes.

scholarly journals Smoking is Associated With Increased Risk of Not Achieving Glycemic Target, Increased Glycemic Variability, and Increased Risk of Hypoglycemia for People With Type 1 Diabetes

2020 ◽  
pp. 193229682092225
Author(s):  
Morten Hasselstrøm Jensen ◽  
Simon Lebech Cichosz ◽  
Irl B. Hirsch ◽  
Peter Vestergaard ◽  
Ole Hejlesen ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Linear Models ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Treatment Intensification ◽  
Increased Risk ◽  
Glycemic Target ◽  
Inadequate Glycemic Control

Background: The prevalence of smoking and diabetes is increasing in many developing countries. The aim of this study was to investigate the association of smoking with inadequate glycemic control and glycemic variability with continuous glucose monitoring (CGM) data in people with type 1 diabetes. Methods: Forty-nine smokers and 320 nonsmokers were obtained from the Novo Nordisk Onset 5 trial. After 16 weeks of treatment with continuous subcutaneous insulin infusion, risk of not achieving glycemic target and glycemic variability from six CGM measures was investigated. Analyzes were carried out with logistic regression models (glycemic target) and general linear models (glycemic variability). Finally, CGM median profiles were examined for the identification of daily glucose excursions. Results: A 4.7-fold (95% confidence interval: 1.5-15.4) increased risk of not achieving glycemic target was observed for smokers compared with nonsmokers. Increased time in hyperglycemia, decreased time in range, increased time in hypoglycemia (very low interstitial glucose), and increased fluctuation were observed for smokers compared with nonsmokers from CGM measures. CGM measures of coefficient of variation and time in hypoglycemia were not statistically significantly different. Examination of CGM median profiles revealed that risk of morning hypoglycemia is increased for smokers. Conclusions: In conclusion, smoking is associated with inadequate glycemic control and increased glycemic variability for people with type 1 diabetes with especially risk of morning hypoglycemia. It is important for clinicians to know that if the patient has type 1 diabetes and is smoking, a preemptive action to treat high glycated hemoglobin levels should not necessarily be treatment intensification due to the risk of hypoglycemia.

scholarly journals SGLT2 Inhibition Increases Fasting Glucagon but Does Not Restore the Counterregulatory Hormone Response to Hypoglycemia in Participants with Type 1 Diabetes

2021 ◽  
Author(s):  
Schafer C. Boeder ◽  
Justin M. Gregory ◽  
Erin R. Giovannetti ◽  
Jeremy H. Pettus
Keyword(s):  
Type 1 Diabetes ◽  
Cell Function ◽  
Sglt2 Inhibitor ◽  
Treatment Phase ◽  
Glycemic Variability ◽  
Hormone Response ◽  
Double Blind ◽  
Sodium Glucose Cotransporter ◽  
Sglt2 Inhibition

Individuals with type 1 diabetes have an impaired glucagon counterregulatory response to hypoglycemia. Sodium-glucose cotransporter (SGLT) inhibitors increase glucagon concentrations. We evaluated whether SGLT inhibition restores the glucagon counterregulatory hormone response to hypoglycemia. Adults with type 1 diabetes (<i>n</i> = 22) were treated with the SGLT2 inhibitor dapagliflozin (5 mg daily) or placebo for 4 weeks in a randomized, double-blind, crossover study. After each treatment phase, participants underwent a hyperinsulinemic hypoglycemic clamp. Basal glucagon concentrations were 32% higher following dapagliflozin versus placebo, with a median within-participant difference of 2.75 pg/mL (95% CI 1.38-12.6). However, increased basal glucagon levels did not correlate with decreased rates of hypoglycemia, and thus do not appear to be protective in avoiding hypoglycemia. During hypoglycemic clamp, SGLT2 inhibition did not change counterregulatory hormone concentrations, time to recovery from hypoglycemia, hypoglycemia symptoms, or cognitive function. Thus, despite raising basal glucagon concentrations, SGLT inhibitor treatment did not restore the impaired glucagon response to hypoglycemia. We propose that clinical reduction in hypoglycemia associated with these agents is a result of changes in diabetes care (e.g., lower insulin doses or improved glycemic variability) as opposed to a direct, physiologic effect of these medications on alpha cell function.

The unfavorable impact of DR9/DR9 genotype on the frequency and quality of partial remission in type 1 diabetes

2021 ◽  
Author(s):  
Yan Chen ◽  
Ying Xia ◽  
Zhiguo Xie ◽  
Ting Zhong ◽  
Rong Tang ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Partial Remission ◽  
Cell Function ◽  
Age Of Onset ◽  
Human Leukocyte ◽  
Adult Onset ◽  
C Peptide ◽  
Β Cell Function ◽  
Remission Phase

Abstract Context Partial remission (PR) is a specific stage in type 1 diabetes (T1D). Although human leukocyte antigen (HLA) class II loci are the strongest genetic determinants in T1D, the relationship between PR and HLA remains unclear. Objective To investigate the association between PR status and HLA genotypes in T1D patients. Methods A total of 237 T1D patients were included. PR was defined according to C-peptide ≥300 pmol/L. The frequency of PR and peak C-peptide levels during remission phase were compared according to HLA status. Clinical characteristics including age of onset and diabetes autoantibodies were collected. All analyses were duplicated when subjects were divided into childhood- and adult-onset T1D. Results The median follow-up time was 24 months, 65.8% (156/237) of T1D patients went into PR. DR9/DR9 carriers had lower PR rate (44.2% vs. 70.6%, P=0.001) and less likely to enter PR (OR=0.218, 95% CI: 0.098-0.487, P&lt;0.001) than the non-DR9/DR9 carriers, observed in both childhood- and adult-onset T1D. Besides, the peak C-peptide during PR phase was also lower in DR9/DR9 carriers, more notable in adult-onset T1D. When compared with non-DR9/DR9 carriers, T1D with DR9/DR9 genotype presented an older age of onset and a lower positivity of zinc transporter 8 antibody (ZnT8A), and the lower trend of ZnT8A was only found in adult-onset T1D (P=0.049). Conclusions T1D carrying susceptible DR9/DR9 are less prone to undergo PR. Additionally, the recovery extent of β-cell function during the PR phase tends to be lower in adults carrying DR9/DR9, which might be associated with ZnT8A.

scholarly journals Post-exercise glycemic control in type 1 diabetes is associated with residual ꞵ-cell function

2020 ◽  
Author(s):  
Guy S Taylor ◽  
Kieran Smith ◽  
Tess E Capper ◽  
Jadine H Scragg ◽  
Ayat Bashir ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Acute Exercise ◽  
Cell Function ◽  
Glycemic Variability ◽  
Free Living ◽  
Continuous Glucose Monitor ◽  
Post Exercise ◽  
C Peptide ◽  
The Impact

Objective<b> </b> <p>To investigate the impact of residual ꞵ-cell function on continuous glucose monitor (CGM) outcomes following acute exercise in people with Type 1 diabetes.</p> <p>Research<b> </b>Design and Methods<b> </b></p> <p>Thirty participants with type 1 diabetes for ≥3 years were recruited. Firstly, participants wore a blinded CGM for 7 days of free-living data capture. Secondly, a 3 hour mixed meal test, assessed stimulated C-peptide and glucagon. Peak C-peptide was used to allocate participants into undetectable (Cpep<sub>und</sub> <3 pmol/L), low (Cpep<sub>low</sub> 3–200 pmol/L) or high C-peptide groups (Cpep<sub>high</sub> >200 pmol/L). Finally, participants completed 45 minutes of incline treadmill walking at 60%VO<sub>2peak</sub> followed by a further 48 hours’ CGM capture.</p> <p>Results<b> </b></p> <p>CGM parameters were comparable across groups during the free-living observation week. In the 12 (12hr) and 24 hours (24hr) post-exercise periods the Cpep<sub>high</sub> group had significantly greater amount of time spent with glucose 3.9-10 mmol/L (12hr: 73.5±27.6%, 24hr: 76.3±19.2%) compared to Cpep<sub>low</sub> (12hr: 43.6±26.1%, p=0.027, 24hr: 52.3±25.0%, p=0.067) or Cpep<sub>und</sub> (40.6±17.0%, p=0.010, 24hr: 51.3±22.3%, p=0.041). Time spent in hyperglycemia (12hr and 24hr glucose >10 and >13.9 mmol/L, p<0.05) and glycemic variability (12hr and 24hr SD, p<0.01) were significantly lower in the Cpep<sub>high</sub> group compared to Cpep<sub>und</sub> and Cpep<sub>low</sub>. Change in CGM outcomes from pre to 24hr post-exercise was divergent: Cpep<sub>und</sub> and Cpep<sub>low</sub> experienced worsening (glucose 3.9-10 mmol/L: -9.1% and -16.2% respectively), with Cpep<sub>high</sub> experiencing improvement (+12.1%)(p=0.017). </p> <p>Conclusions<b> </b></p> <p>Residual ꞵ-cell function may partially explain the inter-individual variation in the acute glycemic benefits of exercise in individuals with type 1 diabetes. Quantifying C-peptide could aid in providing personalized and targeted support for exercising patients.</p>

scholarly journals SGLT2 Inhibition Increases Fasting Glucagon but Does Not Restore the Counterregulatory Hormone Response to Hypoglycemia in Participants with Type 1 Diabetes

2021 ◽  
Author(s):  
Schafer C. Boeder ◽  
Justin M. Gregory ◽  
Erin R. Giovannetti ◽  
Jeremy H. Pettus
Keyword(s):  
Type 1 Diabetes ◽  
Cell Function ◽  
Sglt2 Inhibitor ◽  
Treatment Phase ◽  
Glycemic Variability ◽  
Hormone Response ◽  
Double Blind ◽  
Sodium Glucose Cotransporter ◽  
Sglt2 Inhibition

Individuals with type 1 diabetes have an impaired glucagon counterregulatory response to hypoglycemia. Sodium-glucose cotransporter (SGLT) inhibitors increase glucagon concentrations. We evaluated whether SGLT inhibition restores the glucagon counterregulatory hormone response to hypoglycemia. Adults with type 1 diabetes (<i>n</i> = 22) were treated with the SGLT2 inhibitor dapagliflozin (5 mg daily) or placebo for 4 weeks in a randomized, double-blind, crossover study. After each treatment phase, participants underwent a hyperinsulinemic hypoglycemic clamp. Basal glucagon concentrations were 32% higher following dapagliflozin versus placebo, with a median within-participant difference of 2.75 pg/mL (95% CI 1.38-12.6). However, increased basal glucagon levels did not correlate with decreased rates of hypoglycemia, and thus do not appear to be protective in avoiding hypoglycemia. During hypoglycemic clamp, SGLT2 inhibition did not change counterregulatory hormone concentrations, time to recovery from hypoglycemia, hypoglycemia symptoms, or cognitive function. Thus, despite raising basal glucagon concentrations, SGLT inhibitor treatment did not restore the impaired glucagon response to hypoglycemia. We propose that clinical reduction in hypoglycemia associated with these agents is a result of changes in diabetes care (e.g., lower insulin doses or improved glycemic variability) as opposed to a direct, physiologic effect of these medications on alpha cell function.

scholarly journals Post-exercise glycemic control in type 1 diabetes is associated with residual ꞵ-cell function

2020 ◽  
Author(s):  
Guy S Taylor ◽  
Kieran Smith ◽  
Tess E Capper ◽  
Jadine H Scragg ◽  
Ayat Bashir ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Acute Exercise ◽  
Cell Function ◽  
Glycemic Variability ◽  
Free Living ◽  
Continuous Glucose Monitor ◽  
Post Exercise ◽  
C Peptide ◽  
The Impact

Objective<b> </b> <p>To investigate the impact of residual ꞵ-cell function on continuous glucose monitor (CGM) outcomes following acute exercise in people with Type 1 diabetes.</p> <p>Research<b> </b>Design and Methods<b> </b></p> <p>Thirty participants with type 1 diabetes for ≥3 years were recruited. Firstly, participants wore a blinded CGM for 7 days of free-living data capture. Secondly, a 3 hour mixed meal test, assessed stimulated C-peptide and glucagon. Peak C-peptide was used to allocate participants into undetectable (Cpep<sub>und</sub> <3 pmol/L), low (Cpep<sub>low</sub> 3–200 pmol/L) or high C-peptide groups (Cpep<sub>high</sub> >200 pmol/L). Finally, participants completed 45 minutes of incline treadmill walking at 60%VO<sub>2peak</sub> followed by a further 48 hours’ CGM capture.</p> <p>Results<b> </b></p> <p>CGM parameters were comparable across groups during the free-living observation week. In the 12 (12hr) and 24 hours (24hr) post-exercise periods the Cpep<sub>high</sub> group had significantly greater amount of time spent with glucose 3.9-10 mmol/L (12hr: 73.5±27.6%, 24hr: 76.3±19.2%) compared to Cpep<sub>low</sub> (12hr: 43.6±26.1%, p=0.027, 24hr: 52.3±25.0%, p=0.067) or Cpep<sub>und</sub> (40.6±17.0%, p=0.010, 24hr: 51.3±22.3%, p=0.041). Time spent in hyperglycemia (12hr and 24hr glucose >10 and >13.9 mmol/L, p<0.05) and glycemic variability (12hr and 24hr SD, p<0.01) were significantly lower in the Cpep<sub>high</sub> group compared to Cpep<sub>und</sub> and Cpep<sub>low</sub>. Change in CGM outcomes from pre to 24hr post-exercise was divergent: Cpep<sub>und</sub> and Cpep<sub>low</sub> experienced worsening (glucose 3.9-10 mmol/L: -9.1% and -16.2% respectively), with Cpep<sub>high</sub> experiencing improvement (+12.1%)(p=0.017). </p> <p>Conclusions<b> </b></p> <p>Residual ꞵ-cell function may partially explain the inter-individual variation in the acute glycemic benefits of exercise in individuals with type 1 diabetes. Quantifying C-peptide could aid in providing personalized and targeted support for exercising patients.</p>

Short and long-term glycemic variability associated with severe hypoglycemia and retinopathy in type 1 diabetes mellitus

2020 ◽  
Author(s):  
Martín Borja Sanz ◽  
Gimeno Sergio Roman ◽  
Peteiro Miranda Carlos Miguel ◽  
Ortez Toro Jose Jorge ◽  
Ana Agudo ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Severe Hypoglycemia ◽  
Glycemic Variability ◽  
Short And Long Term

294-OR: Type 1 Diabetes Patients with Residual Beta-Cell Function Display Improved Time in Euglycemia and Less Glycaemic Fluctuation after Exercise

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 294-OR
Author(s):  
GUY S. TAYLOR ◽  
KIERAN SMITH ◽  
JADINE SCRAGG ◽  
AYAT BASHIR ◽  
RICHARD A. ORAM ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Beta Cell ◽  
Beta Cell Function ◽  
Cell Function ◽  
Diabetes Patients
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