Type 1 diabetes

DiMeglio, Linda A.; Evans‐Molina, Carmella; Oram, Richard A.

doi:10.1016/s0140-6736(18)31320-5

Cited by 1,078 publications

(934 citation statements)

References 174 publications

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“…Our finding of DKA being present at diagnosis in a third of patients is in line with previous reports [2]. DKA is a serious clinical problem in newly diagnosed childhood T1D, and our results here show that T1D patients with DKA exhibit significant changes in peripheral blood immune cells.…”

Section: Discussionsupporting

confidence: 93%

“…T1D has been classically described as a T cell-mediated disease [2]; however, an increasing number of studies have shown the importance of other immune cells in disease pathogenesis [6,8,9,14]. In the current study, we examined changes in a wide spectrum of immune cells in children with newly diagnosed T1D using unseparated PBMCs staining panels and HIP-C version 3.3 protocol developed by the COST-ENTIRE consortium.…”

Section: Discussionmentioning

confidence: 99%

“…T1D is one of the most common chronic diseases among children [1], and is caused by the interplay of environmental, immunological and genetic factors [2]. T1D is one of the most common chronic diseases among children [1], and is caused by the interplay of environmental, immunological and genetic factors [2].…”

Section: Introductionmentioning

confidence: 99%

“…Type 1 diabetes (T1D) is an immune-mediated multifactorial disease characterized by the destruction of insulinproducing beta cells in pancreatic islets, which results in almost complete insulin deficit. T1D is one of the most common chronic diseases among children [1], and is caused by the interplay of environmental, immunological and genetic factors [2]. Among several environmental factors, enteroviruses have a potential role [3].…”

Section: Introductionmentioning

confidence: 99%

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A study of 51 subtypes of peripheral blood immune cells in newly diagnosed young type 1 diabetes patients

Oras

Peet

Giese

et al. 2019

Clinical and Experimental Immunology

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Type 1 diabetes (T1D) results from autoimmune destruction of insulinproducing beta cells in pancreatic islets. Various immune cell populations are involved in disease development and natural course. However, to our knowledge, so far there are no comprehensive comparative investigations of all main immune cell populations and their most important subsets at the onset of disease. Therefore, in the current study, we analyzed 51 peripheral blood immune cell populations in 22 young T1D patients and in 25 age-matched controls using a comprehensive polychromatic flow cytometry panel developed for whole blood by the COST Action no. BM0907 ENTIRE (European Network for Translational Immunology Research and Education: From Immunomonitoring to Personalized Immunotherapy) consortium. We found that in T1D patients, frequencies and absolute counts of natural killer (NK) cells, dendritic cells (DC) and T cells, aswell as their respective subsets, were significantly altered compared to controls. Further, we observed that changes in several cell populations (e.g. CD14 + CD16 + non-classical monocytes, plasmablasts) were dependent on the age of the patient. In addition to age-related changes, we also found that alterations in immune cell patterns were associated with parameters such as the presence of ketoacidosis and C-peptide serum levels. Our study provides a foundation for future studies investigating different cell lineages and their role in T1D and illustrates the value of polychromatic flow cytometry for evaluating all main peripheral immune cells and their subsets in whole blood samples.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A study of 51 subtypes of peripheral blood immune cells in newly diagnosed young type 1 diabetes patients

Oras

Peet

Giese

et al. 2019

Clinical and Experimental Immunology

View full text Add to dashboard Cite

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“…Type 1 diabetes (T1D) is a chronic autoimmune disease characterised by the progressive and insidious destruction of β cells . This disease results from immune system breakdown, which is predominately mediated via T helper 1 (Th1) cells, accompanied by the activation and islet infiltration of immune cells, which collaborate to destroy pancreatic β cells and cause overt hyperglycaemia . Current T1D therapy mainly involves exogenous insulin replacement, highlighting the need for immunotherapies to limit the disease and improve clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Cytokines in type 1 diabetes: mechanisms of action and immunotherapeutic targets

et al. 2020

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Cytokines play crucial roles in orchestrating complex multicellular interactions between pancreatic β cells and immune cells in the development of type 1 diabetes (T1D) and are thus potential immunotherapeutic targets for this disorder. Cytokines that can induce regulatory functions—for example, IL‐10, TGF‐β and IL‐33—are thought to restore immune tolerance and prevent β‐cell damage. By contrast, cytokines such as IL‐6, IL‐17, IL‐21 and TNF, which promote the differentiation and function of diabetogenic immune cells, are thought to lead to T1D onset and progression. However, targeting these dysregulated cytokine networks does not always result in consistent effects because anti‐inflammatory or proinflammatory functions of cytokines, responsible for β‐cell destruction, are context dependent. In this review, we summarise the current knowledge on the involvement of well‐known cytokines in both the initiation and destruction phases of T1D and discuss advances in recently discovered roles of cytokines. Additionally, we emphasise the complexity and implications of cytokine modulation therapy and discuss the ways in which this strategy has been translated into clinical trials.

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Assessment of a Day Hospital Management Program for Children With Type 1 Diabetes

et al. 2020

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IMPORTANCE A shift in the setting of care delivery for children with a new diagnosis of type 1 diabetes led to a reorganization of treatment. OBJECTIVE To determine whether a new diagnosis of pediatric diabetes can be successfully managed in a day hospital model. DESIGN, SETTING, AND PARTICIPANTS This quality improvement study used retrospectively collected data on pediatric patients with a new diagnosis of diabetes who completed an inpatient program for education and insulin titration prospectively compared with patients completing a diabetes day hospital program. Baseline data were collected over 12 months (January-December 2015) and intervention data collected over 14 months (March 2016-May 2017). The study was conducted at a single institution and judged as a nonhuman participant project. The referral local base included a 100-mile radius. Patient inclusion was a new diagnosis of diabetes, age 5 years or older, and no biochemical evidence of diabetic ketoacidosis. Ninety-six patients completed the day hospital program and 192 patients completed an inpatient program. EXPOSURES All patients received 2 consecutive days of insulin titration and education in either a day hospital or inpatient setting. MAIN OUTCOMES AND MEASURES Primary outcomes included the mean length of stay, patient charge, and insurance denial/reimbursement rates. The hypothesis was that a day hospital program would be associated with a reduced length of stay, which would directly affect patient charges and insurance denials. RESULTS Among the 96 day hospital patients, the mean (SD) age was 12.2 (4.7) years (range 5-20.3), with no patients experiencing diabetic ketoacidosis or hypernatremia. Among the 192 inpatient patients, the mean (SD) age was 9.4 (4.7) years (range, 1.6-20.1). The mean (SD) length of stay reduction in the day hospital was 46 (14.1) to 14 (5.1) hours. The mean day hospital patient charge was $2800, compared with a mean (SD) baseline carge of $24 103 ($9401). Within the first year, there was a cumulative reduction in patient charges of more than $2.1 million. CONCLUSIONS AND RELEVANCE This study's findings suggest that a diabetes day hospital setting was associated with reductions in length of stay and patient charges, with an increase in insurance reimbursements and a decrease in insurance denials. This study demonstrates an effective way to streamline new-onset diabetes education, which may reduce length of stay and patient charges. Reimbursement rates for patients with a new diagnosis of diabetes increased from 52% to 72% and reimbursement denial rates decreased from 80% to 0%.

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Type 1 diabetes

Cited by 1,078 publications

References 174 publications

A study of 51 subtypes of peripheral blood immune cells in newly diagnosed young type 1 diabetes patients

A study of 51 subtypes of peripheral blood immune cells in newly diagnosed young type 1 diabetes patients

Cytokines in type 1 diabetes: mechanisms of action and immunotherapeutic targets

Assessment of a Day Hospital Management Program for Children With Type 1 Diabetes

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