Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial

Camacho‐Martínez, F.; Rey, Elena Rodriguez; Serrano, Francisco Camacho; Wagner, Adriana M.

doi:10.1016/s0022-3476(94)70190-3

Cited by 1,411 publications

(98 citation statements)

References 39 publications

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“…1). In DCCT study, the BMI increase in women was higher than in men; however, the additional weight includes lean tissue as well as fat [31, 32]. A possible explanation for this difference may be a higher age spectrum in the DCCT group with together with a longer duration of the study.…”

Section: Discussionmentioning

confidence: 99%

Insulin Pump Therapy – Influence on Body Fat Redistribution, Skeletal Muscle Mass and Ghrelin, Leptin Changes in T1D Patients

et al. 2018

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Background: To report changes in body composition and biochemical parameters in patients with type 1 diabetes mellitus (T1D) after switching from multiple daily injection (MDI) to continuous subcutaneous insulin infusion (CSII). Methods: 31 patients switched over from MDI to CSII. Body composition, biochemical parameters, glycaemic variability (GV) and level of physical activity were evaluated before and 6 months on CSII. Results: In both sexes, we found an increase in skeletal muscle mass (SMM), (p = 0.008; 0.008). In men, there was mainly a decrease in visceral fat area (VFA), (p = 0.028) and in women there was decrease of total body fat (TBF), (p = 0.020) and non-significant decrease of VFA (p = 0.098). SMM inversely correlated with VFA in men (p = –0.001) and with TBF in women (p = –0.005 ). GV was decreased generally and correlated inversely with TBF in men only (p = –0.026). Physical activity was increased and correlated inversely with VFA in men (p = –0.002) and in women (p = –0.006). Conclusions: Using CSII in T1D leads to a significant increase of SMM in both sexes to a decrease of VFA in men and to a non-significant decrease of VFA in women. Changes in adipose tissue and SMM were also related to increased physical activity and to decreased GV.

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Section: Discussionmentioning

confidence: 99%

Insulin Pump Therapy – Influence on Body Fat Redistribution, Skeletal Muscle Mass and Ghrelin, Leptin Changes in T1D Patients

et al. 2018

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“…It has been shown that improving Diabetes control decreases the rate of microvascular and macrovascular complications [15]. However, this weight gain can lead to worsening of the cardiovascular risk factors [28].…”

Section: Discussionmentioning

confidence: 99%

“…The intensive treatment group gained an average of 3.3 kg compared with 1.2 kg in the conventional group. After 5 years, the increase in BMI remained significantly greater in the intensive group and the differences in weight were still noted 9 years after DCCT [13, 15]. Holl et.al went further and postulated that along with high insulin doses, other factors that predispose to weight gain are initiation of intensified insulin therapy, tight metabolic control and female gender [16].…”

Section: Introductionmentioning

confidence: 99%

Excess weight gain during insulin pump therapy is associated with higher basal insulin doses

Boucher‐Berry

Parton

Alemzadeh

2016

J Diabetes Metab Disord

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BackgroundWhile higher total daily dose (TDD) of insulin has been associated with excess weight gain on insulin pump therapy, the role of higher total basal dose (TBD) of insulin on weight gain has not been studied. We evaluated the impact of higher TBD on weight gain in relationship to glycosylated hemoglobin (HbA1c), hypoglycemic episodes, and change in body mass index (BMI) z score in a group of pediatric patients with type 1 diabetes mellitus (T1DM).MethodsOne-year data from 91 (54 Female/37 Male) patients (2.3–17.8 years of age), transitioned from basal-bolus regimen to insulin pump therapy were reviewed. Patients were divided into two groups based on changes in BMI z score: Group 1 (no change or decrease) and Group 2 (increase).ResultsThirty-three patients in Group 1 and 58 patients in Group 2. The two groups had similar TDD (0.9 ± 0.2 vs. 0.8 ± 0.2 U/kg/day), however Group 1 had a higher bolus: basal insulin ratio (1.8 ± 0.6 vs. 1.5 ± 0.6, p < 0.05). While Groups 1 and 2 had similar HbA1c values (7.7 ± 0.7 vs. 7.70 ± 0.6 %; p = 0.79) and activity levels (2.2 ± 0.6 vs. 2.2 ± 0.7; p = 0.15), Group 2 had higher rates of hypoglycemic episodes (1.0 ± 0.4 vs. 1.5 ± 0.9, p < 0.01).ConclusionExcess weight gain was associated with lower bolus to basal insulin ratios independent of glycemic control and activity level. Evaluation of bolus and basal insulin doses during insulin therapy is warranted in order to avoid excess weight gain.Electronic supplementary materialThe online version of this article (doi:10.1186/s40200-016-0271-5) contains supplementary material, which is available to authorized users.

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“…In most pediatric centers a major gap between the target of a near-normal HbA 1c , as set by the DCCT [1, 9, 40], and its actual achievement remains, as evidenced by comprehensive documentation [57]. To press towards this goal every effective therapy should be made available to as many pediatric patients as possible.…”

Section: Discussionmentioning

confidence: 99%

“…Numerous studies involving several cohorts with a total of more than 900 pediatric patients on CSII [6, 7,10,11,12, 15,21,22,23,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41] reported a significant improvement in metabolic control, with a decrease of 0.5–1% in HbA 1c . However, when CSII was compared to MDI in randomized crossover trials in children [42] or adolescents [43] and in randomized controlled trials of short duration in diabetic toddlers and young children [5, 13], there was no significant difference in HbA 1c values.…”

Section: Advantages Of Csiimentioning

confidence: 99%

The Use of Insulin Pump Therapy in the Pediatric Age Group

Shalitin

Phillip²

2008

Horm Res Paediatr

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Diabetic children and their caregivers face the never-ceasing challenge of maintaining blood glucose levels as close as possible to the normal range so as to prevent or delay long-term micro- and macrovascular complications, to minimize the risk of severe hypoglycemic episodes, and to improve quality of life. Continuous subcutaneous insulin infusion (CSII) therapy represents a treatment option that can aid in achieving these goals. Granted that insulin secretor responses to physiological stimuli are complex and difficult to duplicate, CSII is the most physiological method of insulin delivery currently available, simulating the pattern of insulin secretion with a continuous adjustable ‘basal’ delivery and superimposed mealtime ‘boluses’. CSII offers greater flexibility and more precise insulin delivery than do multiple daily injections, and thus can reduce the frequency of severe hypoglycemia. However, when CSII was compared to multiple daily injections in randomized crossover or controlled trials in children or adolescents, generally there was no significant difference in HbA_1c. This review briefly summarizes the current state of knowledge regarding the use of CSII in pediatric and adolescent patients with type 1 diabetes mellitus.

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Effect of intensive diabetes treatment on the development and progression of long-term complications in adolescents with insulin-dependent diabetes mellitus: Diabetes Control and Complications Trial

Cited by 1,411 publications

References 39 publications

Insulin Pump Therapy – Influence on Body Fat Redistribution, Skeletal Muscle Mass and Ghrelin, Leptin Changes in T1D Patients

Insulin Pump Therapy – Influence on Body Fat Redistribution, Skeletal Muscle Mass and Ghrelin, Leptin Changes in T1D Patients

Excess weight gain during insulin pump therapy is associated with higher basal insulin doses

The Use of Insulin Pump Therapy in the Pediatric Age Group

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