Improvement in glycemic control through changes in insulin regimens: findings from a Japanese cohort of children and adolescents with type 1 diabetes

Mochizuki, M.; Kikuchi, Toru; Urakami, Tatsuhiko; Kikuchi, Nobuyuki; Kawamura, Tomoyuki; Yokomichi, Hiroshi; Hoshino, Takao; Matsuura, Nobuo; Sasaki, Nozomu; Sugihara, Shigetaka; Amemiya, Shin

doi:10.1111/pedi.12409

Cited by 16 publications

(22 citation statements)

References 45 publications

(43 reference statements)

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“…Furthermore, a Japanese analysis of data from 2127 children and adolescents with type 1 diabetes reported that mean HbA1c decreased from 9.33% to 7.75% between 1995 and 2008 ( P < .0001) with a reduction in SH incidence from 19.1 to 8.7 per 100 PY ( P = .02) over the same period. These findings correspond with an increase in the use of insulin analogs (from 0% in 1995 to 94.7% in 2008; P < .0001) and basal‐bolus therapy (from 34.4% to 83.5%, respectively; P < .0001) …”

Section: Discussionsupporting

confidence: 65%

“…12,32,34,48,49 In the largest of these studies, a 10 These findings correspond with an increase in the use of insulin analogs (from 0% in 1995 to 94.7% in 2008; P < .0001) and basal-bolus therapy (from 34.4% to 83.5%, respectively; P < .0001). 65 Further support for lack of an association between reduced HbA1c and SH risk comes from a large analysis of registry data from several regions. 66 21 and interactive programs and camps 20 ) reported low rates of SH.…”

Section: Extent Of Metabolic Controlmentioning

confidence: 99%

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Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Cherubini¹,

Rabbone

Lombardo

et al. 2019

Pediatr Diabetes

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Background/Objective In 1993, the Diabetes Control and Complications Trial (DCCT) found that intensive antihyperglycemic therapy was effective in the primary and secondary prevention of microvascular complications in patients with type 1 diabetes (T1D) but was associated with a 3‐fold greater rate of severe hypoglycemia (SH) than conventional therapy. The aim of this analysis was to determine whether, in the real‐world setting, the incidence of SH in pediatric patients with T1D has changed since 1993. Methods A systematic literature search of PubMed for prospective or retrospective observational studies (≥250 participants) on SH epidemiology or related topics in pediatric patients with T1D, published between October 1993 and June 2016, identified 35 articles (involving >55 000 participants). SH incidence data were analyzed in approximate 5‐year blocks: 1993‐2000, 2001‐2005, 2006‐2010, and 2011‐2016. Information on factors that might influence the incidence of SH was also collected. Results A trend for a marked reduction in the incidence of SH in the post‐DCCT setting (from 62.0 per 100 patient‐years to 1.21‐30 per 100 patient‐years) was apparent. Factors that could have influenced this temporal trend in SH incidence included the increased use of new types of, and methods of administering, insulin, in particular rapid‐acting insulin analogs and continuous subcutaneous insulin infusion. Conclusions SH in pediatric patients with T1D has declined in incidence since the DCCT but remains a common problem. The optimal use of new insulin therapies/regimens/technologies, improved education, and dedicated specialized management teams are needed to help reduce the risk of SH in this population.

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Section: Discussionsupporting

confidence: 65%

Section: Extent Of Metabolic Controlmentioning

confidence: 99%

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Cherubini¹,

Rabbone

Lombardo

et al. 2019

Pediatr Diabetes

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“…In addition, in Japan, approximately 5% of diabetes is type 1, 25 and classically, most of type 1 diabetes occurs during childhood 26 . Because glycaemic control of type 1 diabetes usually becomes exacerbated in puberty, 4 pre-pubertal onset type 1 diabetes is expected to cause more chance of vascular complications 27 . Disease duration is also critically associated with vascular complications in type 1 diabetes 28 .…”

Section: Discussionmentioning

confidence: 99%

“…However, this report lacked information on complications, comorbidities and glycaemic control at various profiles for age, BMI, blood pressure, serum cholesterol level and smoking and drinking habits. Although recent data have been published about detailed profiles of Japanese type 1 diabetic patients, the data were limited to those in paediatric practice 4 . Additionally, because other reports of Japanese patients were from residents in a single region, broadening applicability to real-world practice may be difficult.…”

Section: Introductionmentioning

confidence: 99%

Serum glucose, cholesterol and blood pressure levels in Japanese type 1 and 2 diabetic patients: BioBank Japan

Yokomichi

Nagai

Hirata

et al. 2017

Journal of Epidemiology

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BackgroundEvidence of characteristics of Japanese patients with diabetes from a large-scale population is necessary. Few studies have compared glycaemic controls, complications and comorbidities between type 1 and 2 diabetic patients. This paper focuses on illustrating a clinical picture of Japanese diabetic patients and comparing glycaemic control and prognoses between type 1 and 2 diabetes using multi-institutional data.MethodsThe BioBank Japan Project enrolled adult type 1 and 2 diabetic patients between fiscal years 2003 and 2007. We have presented characteristics, controls of serum glucose, cholesterol and blood pressure, prevalence of complications and comorbidities and survival curves. We have also shown glycaemic controls according to various individual profiles of diabetic patients.ResultsA total of 558 type 1 diabetic patients and 30,834 type 2 diabetic patients participated in this study. The mean glycated haemoglobin A1c was higher in type 1 diabetes than in type 2 diabetes. In the type 1 diabetic patients, the glycated haemoglobin A1c had no consistent trend according to age and body mass index. The Kaplan–Meier estimates represented a longer survival time from baseline with type 1 diabetes than with type 2 diabetes. Compared with type 1 diabetic patients, type 2 diabetic patients had double the prevalence of macrovascular complications.ConclusionsThis work has revealed detailed plasma glucose levels of type 1 and 2 diabetic patients according to age, body mass index, blood pressure, serum cholesterol levels and smoking and drinking habits. Our data have also shown that the prognosis is worse for type 2 diabetes than for type 1 diabetes in Japan.

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“…Much of the variation can be explained by personal preference and experience of the respective diabetes team. As outcome comparisons through benchmarking and registries are implemented more widely in pediatric diabetes—it is anticipated that more guidance of regimens associated with better long‐term prognosis will become available …”

Section: Introductionmentioning

confidence: 99%

ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes

et al. 2018

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Improvement in glycemic control through changes in insulin regimens: findings from a Japanese cohort of children and adolescents with type 1 diabetes

Abstract: Glycemic control and incidence of severe hypoglycemic events were chronologically improved, especially in female adolescents.

Cited by 16 publications

References 45 publications

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Incidence of severe hypoglycemia and possible associated factors in pediatric patients with type 1 diabetes mellitus in the real‐life, post‐DCCT setting: a systematic review

Serum glucose, cholesterol and blood pressure levels in Japanese type 1 and 2 diabetic patients: BioBank Japan

ISPAD Clinical Practice Consensus Guidelines 2018: Insulin treatment in children and adolescents with diabetes

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