Improved Metabolic Control in Pediatric Patients with Type 1 Diabetes: A Nationwide Prospective 12-Year Time Trends Analysis

Dovč, Klemen; Telic, Sasa Starc; Lusa, Lara; Bratanič, Nevenka; Žerjav-Tanšek, Mojca; Kotnik, Primož; Stefanija, Magdalena Avbelj; Battelino, Tadej; Bratina, Nataša

doi:10.1089/dia.2013.0182

Cited by 67 publications

(57 citation statements)

References 28 publications

(44 reference statements)

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“…The incidence of SH and DKA were similar to the reported in Slovenian registry [24], (with the same incidence of SH and 1.90 events/100 patient-years of DKA in their case vs. 1.69 in ours). In this case, the comparison with the T1D Exchange registry is not possible because data are reported in a different way.…”

Section: Discussionsupporting

confidence: 90%

Achievement of metabolic control goals set by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes in pediatric patients with type 1 diabetes from Spain

Enes

Martín-Frías

Álvarez

et al. 2015

Diabetes Research and Clinical Practice

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Section: Discussionsupporting

confidence: 90%

Achievement of metabolic control goals set by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes in pediatric patients with type 1 diabetes from Spain

Enes

Martín-Frías

Álvarez

et al. 2015

Diabetes Research and Clinical Practice

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“…Habituation of the day to day approach to managing chronic disease can make any long-lasting change difficult [34]. Studies involving paediatric and adolescent individuals with type 1 diabetes indicate that age, sex, body mass index, socioeconomic factors, physical activity levels, frequency of glucose monitoring and personality traits can also influence temporal HbA 1c trends [16,[35][36][37]. It may be that a combination of these endogenous and exogenous factors contributes to the phenomenon of tracking and that both need to be addressed for effective long-term glycaemic control.…”

Section: Discussionmentioning

confidence: 99%

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

et al. 2018

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Aims/hypothesis Our objectives were to explore whether the phenomenon of HbA 1c 'tracking' occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking. Methods A total of 4525 individuals diagnosed with type 1 diabetes between 1 January 1995 and 1 May 2015 were identified from The Health Improvement Network (THIN) database. Mixed models were applied to assess the variability of HbA 1c levels over time with random effects on general practices (primary care units) and individuals within practices. Results 4525 individuals diagnosed with type 1 diabetes were identified in THIN over the study period. The greatest difference in mean HbA 1c measurement (−7.0 [95% CI −8.0, −6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0-1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA 1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years. In the stratified analysis using sex and age group there was considerable heterogeneity with adult onset type 1 diabetes appearing to track earlier and at a lower mean HbA 1c . Conclusions/interpretation In individuals with type 1 diabetes, glycaemic control measured by HbA 1c settles onto a long-term 'track' and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA 1c tracking level for the next 10 years.

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“…Between 20 January and 16 June 2016, 25 children and adolescents with type 1 diabetes were invited to participate, through the Slovenian National Diabetes Registry [25], and 20 (9 female) were randomised. They all completed the study and provided data for analysis (study flow diagram is presented in Fig.…”

Section: Resultsmentioning

confidence: 99%

Closed-loop glucose control in young people with type 1 diabetes during and after unannounced physical activity: a randomised controlled crossover trial

et al. 2017

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Aims/hypothesis Hypoglycaemia during and after exercise remains a challenge. The present study evaluated the safety and efficacy of closed-loop insulin delivery during unannounced (to the closed-loop algorithm) afternoon physical activity and during the following night in young people with type 1 diabetes. Methods A randomised, two-arm, open-label, in-hospital, crossover clinical trial was performed at a single site in Slovenia. The order was randomly determined using an automated web-based programme with randomly permuted blocks of four. Allocation assignment was not masked. Children and adolescents with type 1 diabetes who were experienced insulin pump users were eligible for the trial. During four separate in-hospital visits, the participants performed two unannounced exercise protocols: moderate intensity (55% of V Á O 2max ) and moderate intensity with integrated highintensity sprints (55/80% of V Á O 2max ), using the same study device either for closed-loop or open-loop insulin delivery. We investigated glycaemic control during the exercise period and the following night. The closed-loop insulin delivery was applied from 15:00 h on the day of the exercise to 13:00 h on the following day.Results Between 20 January and 16 June 2016, 20 eligible participants (9 female, mean age 14.2 ± 2.0 years, HbA 1c 7.7 ± 0.6% [60.0 ± 6.6 mmol/mol]) were included in the trial and performed all trial-mandated activities. The median proportion of time spent in hypoglycaemia below 3.3 mmol/l was 0.00% for both treatment modalities (p = 0.7910). Use of the closed-loop insulin delivery system increased the proportion of time spent within the target glucose range of 3.9-10 mmol/l when compared with open-loop delivery: 84.1% (interquartile range 70.0-85.5) vs 68.7% (59.0-77.7), respectively (p = 0.0057), over the entire study period. This was achieved with significantly less insulin delivered via the closed-loop (p = 0.0123). Conclusions/interpretation Closed-loop insulin delivery was safe both during and after unannounced exercise protocols in the in-hospital environment, maintaining glucose values mostly within the target range without an increased risk of hypoglycaemia.Trial registration Clinicaltrials.gov NCT02657083 Funding

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Improved Metabolic Control in Pediatric Patients with Type 1 Diabetes: A Nationwide Prospective 12-Year Time Trends Analysis

Cited by 67 publications

References 28 publications

Achievement of metabolic control goals set by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes in pediatric patients with type 1 diabetes from Spain

Achievement of metabolic control goals set by the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes in pediatric patients with type 1 diabetes from Spain

Clinically meaningful and lasting HbA1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis

Closed-loop glucose control in young people with type 1 diabetes during and after unannounced physical activity: a randomised controlled crossover trial

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