Pediatric Type 1 Diabetes: Mechanisms and Impact of Technologies on Comorbidities and Life Expectancy

Urbano, Flavia; Farella, Ilaria; Brunetti, Giacomina; Faienza, Maria Felicia

doi:10.3390/ijms241511980

Cited by 3 publications

(2 citation statements)

References 204 publications

(232 reference statements)

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“…This metabolic condition occurs through the autoimmune destruction of the pancreatic beta cells and a subsequent severe impairment of insulin production [6]. Insulin administration represents the only effective treatment for patients with T1DM [7]. Although multiple insulin delivery systems, such as daily subcutaneous injections, continuous subcutaneous insulin infusions or insulin pumps, are available, most T1DM patients fail to achieve effective management of their blood glucose levels [8].…”

Section: Introductionmentioning

confidence: 99%

Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study

Dan,

Mocanu,

Bălășoiu

et al. 2024

Diagnostics

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Objectives: In the current study, we investigated the correlations between retinal microvascular parameters using optical coherence tomography angiography (OCTA) and clinical parameters for a group of 69 young patients with type 1 diabetes mellitus (T1DM). Materials and Methods: This retrospective, exploratory study enrolled 69 patients between 5 years old and 30 years old who met the inclusion criteria. All the study participants underwent a comprehensive ophthalmic examination and OCTA scans for the evaluation of the retinal microcirculation. The retinal OCTA parameters were correlated with the following clinical parameters: the patient’s age at the onset of the disease, the duration of T1DM, the BMI at the time of enrollment in the study, the HbA1C values at onset, the mean values of HbA1C over the period of monitoring the disease and the degree of DKA at onset. Results: For the study group, the foveal avascular zone (FAZ) area and perimeter correlated positively with the mean value of HbA1C (Pearson correlation, Sig.2-Tailed Area: 0.044; perimeter: 0.049). The total vessel density in the superficial capillary plexus (SCP) correlated negatively with the duration of T1DM, based on the superior and inferior analyzed areas (Spearman correlation, Sig.2-Tailed SCP in total region: 0.002; SCP in the superior region: 0.024; SCP in the inferior region: 0.050). The foveal thickness also correlated negatively with the levels of diabetic ketoacidosis (DKA) at onset (Spearman correlation, Sig.2-Tailed: 0.034) and the levels of HbA1C at onset (Spearman correlation, Sig.2-Tailed: 0.047). Further on, the study patients were distributed into two groups according to the duration of the disease: group 1 included 32 patients with a duration of T1DM of less than 5 years, and group 2 included 37 patients with a duration of T1DM of more than 5 years. Independent t-tests were used to compare the OCTA retinal parameters for the two subgroups. While the FAZ-related parameters did not show significant statistical differences between the two groups, the vessel densities in both the SCP and DCP were significantly lower in group 2. Conclusions: Our data suggest that specific alterations in OCTA imaging biomarkers correlate with various clinical parameters: the FAZ area and perimeter increase with higher mean values of HbA1C, leading to poor metabolic control. Moreover, the SCP total vessel density decreases as the duration of T1DM increases. Regarding the vessel densities in the SCP and the DCP, they decrease with a duration of the disease of more than 5 years.

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Section: Introductionmentioning

confidence: 99%

Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study

Dan,

Mocanu,

Bălășoiu

et al. 2024

Diagnostics

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“…[ 1 , 2 ] The disease requires insulin therapy and ongoing health support. [ 3 ] The most important and controllable criterion in reducing the complications of diabetes is glycemic control. [ 4 ] The International Society of Pediatric and Adolescent Diabetes (ISPAD) guidelines suggested a glycated hemoglobin (HbA1c) level of <7% in patients with T1DM to prevent long-term complications.…”

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confidence: 99%

Effect of Glycemic Control on Platelet Indices in Children with Type 1 Diabetes Mellitus

Yucel

2024

Sisli Etfal

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Objectives The aim of this study is to compare children diagnosed with type 1 diabetes mellitus (T1DM) with healthy controls in terms of some laboratory parameters and platelet indices. Methods This study is retrospective. We used glycated hemoglobin (HbA1c) values to classify patients as <7% (good) and ≥7% (poor). The platelet mass (PM) value was calculated from the hemogram data (PM=PLTxMPV). Results The study included a total of 87 patients who had been diagnosed with T1DM and 120 healthy participants. Fasting glucose, urea, creatinine, hemoglobin (HGB), red blood cell (RBC), mean platelet volume (MPV) and platelet distribution width (PDW) were significantly higher in the patient group than in the healthy control group. Platelet (PLT), plateletcrit (PCT) and PM were significantly lower in the poor glycemic control than in the good glycemic control and healthy groups. The PDW in the healthy control group was statistically significantly lower than in the good and poor glycemic control groups. In the group with poor glycemic control, there was a positive and significant correlation between the MPV and the level of HbA1c (r=0.401, p<0.05). Conclusion To sum up, our results show that the MPV and the PDW are significantly higher in children with T1DM than in healthy control. In the group with poor glycemic control, PLT levels were significantly lower than in the other two groups, leading to a decrease in PCT and PM levels. Further studies are needed to understand whether the decrease in PLT levels is due to the hyperactivity and rapid turnover of PLT.

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Alternative therapeutic strategies in diabetes management

Annicchiarico,

Barile,

Buccoliero

et al. 2024

World J Diabetes

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Diabetes is a heterogeneous metabolic disease characterized by elevated blood glucose levels resulting from the destruction or malfunction of pancreatic β cells, insulin resistance in peripheral tissues, or both, and results in a non-sufficient production of insulin. To adjust blood glucose levels, diabetic patients need exogenous insulin administration together with medical nutrition therapy and physical activity. With the aim of improving insulin availability in diabetic patients as well as ameliorating diabetes comorbidities, different strategies have been investigated. The first approaches included enhancing endogenous β cell activity or transplanting new islets. The protocol for this kind of intervention has recently been optimized, leading to standardized procedures. It is indicated for diabetic patients with severe hypoglycemia, complicated by impaired hypoglycemia awareness or exacerbated glycemic lability. Transplantation has been associated with improvement in all comorbidities associated with diabetes, quality of life, and survival. However, different trials are ongoing to further improve the beneficial effects of transplantation. Furthermore, to overcome some limitations associated with the availability of islets/pancreas, alternative therapeutic strategies are under evaluation, such as the use of mesenchymal stem cells (MSCs) or induced pluripotent stem cells for transplantation. The cotransplantation of MSCs with islets has been successful, thus providing protection against proinflammatory cytokines and hypoxia through different mechanisms, including exosome release. The use of induced pluripotent stem cells is recent and requires further investigation. The advantages of MSC implantation have also included the improvement of diabetes-related comorbidities, such as wound healing. Despite the number of advantages of the direct injection of MSCs, new strategies involving biomaterials and scaffolds have been developed to improve the efficacy of mesenchymal cell delivery with promising results. In conclusion, this paper offered an overview of new alternative strategies for diabetes management while highlighting some limitations that will need to be overcome by future approaches.

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Pediatric Type 1 Diabetes: Mechanisms and Impact of Technologies on Comorbidities and Life Expectancy

Cited by 3 publications

References 204 publications

Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study

Correlations between Retinal Microvascular Parameters and Clinical Parameters in Young Patients with Type 1 Diabetes Mellitus: An Optical Coherence Tomography Angiography Study

Effect of Glycemic Control on Platelet Indices in Children with Type 1 Diabetes Mellitus

Alternative therapeutic strategies in diabetes management

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