Insulin secretion declines rapidly after diagnosis of type 1 diabetes, followed by a slower rate of change. Previous studies have demonstrated that the C-peptide decline begins before the clinical diagnosis. Changes in insulin secretion in the same individuals studied from preclinical stages through and after clinical diagnosis have not been previously reported. RESEARCH DESIGN AND METHODSAntibody-positive relatives undergo sequential oral glucose tolerance testing (OGTT) as part of TrialNet's Pathway to Prevention study and continue both OGTT and mixed-meal tolerance testing (MMTT) as part of the Long-term Investigational Follow-up in TrialNet study if they develop type 1 diabetes. We analyzed glucose and C-peptide data obtained from 80 TrialNet subjects who had OGTT before and after clinical diagnosis. Separately, we compared C-peptide response to OGTT and MMTT in 127 participants after diagnosis. RESULTSC-peptide did not change significantly until 6 months before the clinical diagnosis of type 1 diabetes and continued to decline postdiagnosis, and the rates of decline for the first 6 months postdiagnosis were similar to the 6 months prediagnosis. There were no significant differences in MMTT and OGTT C-peptide responses in paired tests postdiagnosis. CONCLUSIONSThis is the first analysis of C-peptide levels in longitudinally monitored patients with type 1 diabetes studied from before diagnosis and continuing to the postdiagnosis period. These data highlight the discordant timing between accelerated b-cell dysfunction and the current glucose thresholds for clinical diagnosis. To preserve b-cell function, disease-modifying therapy should start at or before the acute decline in C-peptide.While it is now understood that type 1 diabetes develops over time from a genetic predisposition to the development of b-cell autoimmunity with measurable pancreatic autoantibodies (stage 1 disease) to dysglycemia (stage 2 disease) and then to a clinical diagnosis of type 1 diabetes (stage 3 disease) (1,2), little is known about sequential changes in insulin secretion and glucose homeostasis that occur as individuals progress through these stages.
Aim - Patients with diabetes have increased morbidity and mortality from COVID-19. Case reports describe patients with simultaneous COVID-19 and diabetic acidosis (DKA), however there is limited data on the prevalence, predictors and outcomes of DKA in these patients. Methods - Patients with COVID-19 were identified from the electronic medical record. DKA was defined by standardized criteria. Proportional hazard regression models were used to determine risk factors for, and mortality from DKA in COVID-19. Results - Of 2366 patients admitted for COVID-19, 157 (6.6%) patients developed DKA, 94% of whom had antecedent type 2 diabetes, 0.6% had antecedent type 1 diabetes, and 5.7% patients had no prior diagnosis of diabetes. Patients with DKA had increased hospital length of stay and in-patient mortality. Higher HbA1c predicted increased risk of incident DKA (HR 1.47 per 1% increase, 95% CI 1.40-1.54). Risk factors for mortality included older age (HR 1.07 per 5 years, 95% CI 1.06 - 1.08) and need for pressors (HR 2.33, 95% CI 1.82-2.98). Glucocorticoid use was protective in patients with and without DKA. Conclusion - The combination of DKA and COVID-19 is associated with greater mortality, driven by older age and COVID-19 severity.
Self-management education for adults with type 2 diabetes (T2DM) improves knowledge, skills and motivation; yet, new strategies to more effectively educate patients and improve adoption of insulin therapy are still needed. We conducted a prospective, non-randomized multi-center pilot, using a novel Patient Experience Cloud to deliver microlearning education focused on survival skills, insulin injection technique, and lifestyle management. Content was culturally relevant and tailored to minority patients with T2DM who recently initiated insulin treatment to enhance engagement. Consented T2DM adults, ages 20 to 70 years, were presented an online library of 56 education videos (1-4 minutes each). Pre and post surveys of self-reported attitudes towards insulin and patient activation measures (using the validated PAM scale) were obtained. The study enrolled 201 patients: 78 non-Hispanic whites (NHWs), 74 African Americans (AAs), 39 Hispanic whites (HWs) and 10 Other. Of these, 181 (90%) were engaged (defined as completing baseline surveys and watching 4+ videos). The number of videos viewed differed by race, p=0.012; with median number of 23 for AAs, 13 for NHWs and 5 for HWs. One week later, 83 participants (41%) continued engagement via viewing and completion of post questionnaires. Highest engagement was seen among AAs (51%) vs. 40% of NHWs and 26% of HWs. Overall attitudes towards insulin improved significantly, with a mean change of 0.29 points (on a 6 point Likert scale, 95% CI 0.02 to 0.56, p=0.03). Similarly, the PAM score increased significantly after viewing (by 0.17 point on a 4 point scale, 95% CI 0.to 0.26, p<0.001), independent of race. After viewing culturally tailored microlearning delivered via a cloud platform, patient attitudes towards insulin and activation measures for self-care improved significantly. This novel approach should be further investigated for its ability to improve adherence to insulin and glycemic outcomes. Disclosure M.M. Bogun: Other Relationship; Self; Mytonomy. N.E. Jelesoff: None. C.M. Nassar: None. C.R. Thacker: Other Relationship; Self; Amylin Pharmaceuticals, AstraZeneca, Mytonomy. J. Camacho Rivera: Research Support; Self; Mytonomy. C.J. Bourges: None. K. Sethi: None. L. Egbuonu-Davis: Employee; Self; Sanofi. A.C. Beal: Employee; Self; Sanofi. Board Member; Self; AcademyHealth. D.A. Greenwood: Advisory Panel; Self; Novo Nordisk A/S. Consultant; Self; Verily Life Sciences LLC.. Speaker's Bureau; Self; Becton, Dickinson and Company. Employee; Self; Mytonomy, Inc. Advisory Panel; Self; American Association of Diabetes Educators. H. Chatha: Employee; Self; Mytonomy. Employee; Spouse/Partner; Medstar Health. A. Kataria: Stock/Shareholder; Self; Mytonomy, Inc. Stock/Shareholder; Spouse/Partner; Mytonomy, Inc. D.B. McNeill: None. R. Goland: None. M.F. Magee: Research Support; Self; Sanofi, Eli Lilly and Company, MedStar Health Research Institute. Advisory Panel; Self; Merck & Co., Inc.. Research Support; Self; PRIMED. Speaker's Bureau; Self; IMNE, American Diabetes Association. Advisory Panel; Self; Endocrine Society. Speaker's Bureau; Self; Sanofi. Research Support; Self; MedStar Health.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.