Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance

Amiel, Stephanie A.; Pursey, N A; Higgins, Bernard; Dawoud, Dalia

doi:10.1136/bmj.h4188

Cited by 37 publications

(43 citation statements)

References 9 publications

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“…TIT could be a suitable metric to facilitate self‐care, as it is related to HbA1c and also corresponds to the goal for preprandial and postprandial glucose levels. The recommended HbA1c target set by NICE (National Institute for Health and Clinical Excellence, UK) is 48 mmol/mol (6.5%), which, according to our results, is equivalent to a TIT value of 50%. We therefore propose that diabetes patients aged 6 to 18 years should aim at keeping their TIT at or above 50% (for the range of 3.9‐7.8 mmol/L, 70‐140 mg/dL).…”

Section: Discussionmentioning

confidence: 99%

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study

et al. 2019

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Background Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real‐time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control. Objective The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c). Subjects and Methods Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70‐140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70‐180 mg/dL). Results During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R2 = 0.69. Conclusion This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.

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Section: Discussionmentioning

confidence: 99%

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study

et al. 2019

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“…The diagnosis of diabetes mellitus is well described1234; however, the monitoring of diabetes with HbA1c (which is common practice) has introduced some uncertainty. Glycaemic control is integral to effective treatment of diabetes 12.…”

Section: What Is the Next Investigation?mentioning

confidence: 99%

“…Glycaemic control is integral to effective treatment of diabetes 12. HbA1c concentration is used as the biomarker for long term glycaemic control as it correlates well with average blood glucose levels over a period of 90-120 days before measurement 34.…”

Section: What Is the Next Investigation?mentioning

confidence: 99%

Monitoring glycaemic control in patients with diabetes mellitus

Sodi

McKay²,

Dampetla

et al. 2018

BMJ

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“…In the United States in 2015, there were approximately 1000 patients awaiting pancreas transplant, with the percentage of active listings at 65%, the highest in decades. 3 Benefits to pancreas transplantation, SPK, and PAK are well described, having both improvements in mortality when compared to those on the waiting list 4 and better overall glycemic control, reducing number of hypoglycemic episodes compared to those on insulin regimens. As diabetes is cited as a major, increasing public health burden, 2 pancreas transplant has been recommended by the American Diabetes Association and other national guidelines as an accepted treatment, particularly when coupled with end-stage renal disease.…”

Section: Introductionmentioning

confidence: 99%

Deceased organ donor factors influencing pancreatic graft transplantation and survival

Sally

Ellis

Hutchens

et al. 2019

Clinical Transplantation

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Criteria for organ acceptance in brain-dead organ donors remain inconsistent, especially when concerning pancreatic transplants. We sought to examine donor-specific predictors of pancreatic graft use and survival to better guide the selection and management of potential donors. A prospective observational study of all donors from ten organ procurement organizations was conducted from March 2012 to January 2015. Critical care endpoints were collected at 4 standardized time points. Data associated with pancreatic transplantation and graft survival rates were first determined using univariate analyses, and then logistic regression was used to identify independent predictors of these two outcomes. From 1819 donors, 238 (13.1%) pancreata were transplanted, and at a mean follow-up of 192 days, 218 (91.6%) grafts had survived. After regression analysis, donor age (OR = 0.89), HgbA1C (OR = 0.07), and achieving the donor management goal (DMG) for ejection fraction at allocation of ≥50% (OR = 3.29) remained as independent predictors of pancreatic utilization.On regression analysis, graft survival was independently predicted by lower donor age (OR = 0.93) and achieving the DMGs for mean arterial pressure (60-110 mm Hg) and glucose (≤180 mg/dL) at separate time points. These results may help guide the management and selection of potential pancreatic donors after brain death. K E Y W O R D Scritical care, donation after brain death, insulin, organ acceptance, organ procurement

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Diagnosis and management of type 1 diabetes in adults: summary of updated NICE guidance

Cited by 37 publications

References 9 publications

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study

Monitoring glycaemic control in patients with diabetes mellitus

Deceased organ donor factors influencing pancreatic graft transplantation and survival

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