Early versus delayed insulin pump therapy in children with newly diagnosed type 1 diabetes: results from the multicentre, prospective diabetes follow-up DPV registry

Kamrath, Clemens; Tittel, Sascha R.; Kapellen, Thomas; Berge, Thekla von dem; Heidtmann, Bettina; Nagl, Katrin; Menzel, Ulrike; Pötzsch, Simone; Konrad, Katja; Holl, Reinhard W.

doi:10.1016/s2352-4642(20)30339-4

Cited by 30 publications

(21 citation statements)

References 29 publications

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“…The researchers reported that children who were started on CSII at T1D onset achieved long-term optimal glycemic control [ 22 ]. A study based on Diabetes-Patienten-Verlaufsdokumentation (DPV) registry provided evidence for improved clinical outcomes associated with the early initiation (within the first 6 months) versus later implementation of insulin pump therapy in children with type 1 diabetes [ 23 ]. Seemingly, the early implementation of CSII might mitigate the negative consequences and all the burden of DKA at diabetes onset.…”

Section: Discussionmentioning

confidence: 99%

Is diabetic ketoacidosis a good predictor of 5-year metabolic control in children with newly diagnosed type 1 diabetes?

et al. 2021

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Background The study aimed to evaluate whether the presence of DKA at diabetes diagnosis was associated with poorer metabolic control during a 5-year follow-up. Methods The study included children treated due to newly diagnosed T1D complicated with DKA between 2010 and 2014 with a complete 5-year follow-up. In every case we performed individual matching for age, gender and BMI with a person without DKA (nDKA) on recognition. We collected data regarding treatment modality, HbA1C, total daily insulin dose, basal insulin and BMI-SDS. Results 85 children at the median age of 7.93 years had DKA at diabetes diagnosis. The median pH was 7.19.Continuous subcutaneous insulin infusion (CSII) was used in 87% of participants in each group. No differences in HbA1C level (7,3%vs7,2%;p = .413) were noted after 5 years of disease duration. The severity of ketoacidosis exerted no significant effect on HbA1C. The method of insulin delivery at baseline was significantly associated with HbA1C levels after 5 years of observation, βCSII = − 1.46,95%CI[− 2.01 to − 0.92],p < .001. Conclusions The presence of DKA at diabetes diagnosis is not associated with deteriorated long-term metabolic control in children using modern technologies. The early implementation of CSII into diabetes treatment may change the effect of DKA and lead to a long-term HbA1C improvement.

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Section: Discussionmentioning

confidence: 99%

Is diabetic ketoacidosis a good predictor of 5-year metabolic control in children with newly diagnosed type 1 diabetes?

et al. 2021

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“…Die Vorteile der Insulinpumpentherapie (Dosierbarkeit 20-fach feiner als bei Pens, kontinuierliche Abgabe einer bis zu halbstündlich einstellbaren Basalrate, Rechenunterstützung durch integrierten Computer) mit denen eines Glukosesensors (kein Stechen bei Notwendigkeit, sondern immer aktuelle Messwerte, Alarmfunktionen, Trendanzeige) zu kombinieren, ist also naheliegend. Außerdem werden bei Verwendung einer Insulinpumpe weniger akute Komplikationen beobachtet [7], und deren frühe Anwendung erwies sich als vorteilhaft [8].…”

Section: Nutzungsgrad Der Technischen Möglichkeiten Und Neuerungen Besonders Hochunclassified

AID(„automated insulin delivery“)-Systeme in der Diabetologie

et al. 2021

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“…Current data show the superiority of clinical outcomes when starting pump CSII directly at onset compared with later during the course of the disease. 35 In pediatrics, insulin pump therapy is becoming established as the standard method of insulin substitution in countries with economic resources to pay for diabetes technology. 36 In countries or regions with low socioeconomic status, the use of diabetes technology is still modest, with the consequence that HbA1c levels are high.…”

Section: Rediscovering Intensified Insulin Therapymentioning

confidence: 99%

100 Years of insulin: Lifesaver, immune target, and potential remedy for prevention

Ziegler

Danne

Daniel

et al. 2021

Med

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In this review, we bring our personal experiences to showcase insulin from its breakthrough discovery as a life-saving drug 100 years ago to its uncovering as the autoantigen and potential cause of type 1 diabetes and eventually as an opportunity to prevent autoimmune diabetes. The work covers the birth of insulin to treat patients, which is now 100 years ago; the development of human insulin, insulin analogs, devices, and the way into automated insulin delivery; the realization that insulin is the primary autoimmune target of type 1 diabetes in children; novel approaches of immunotherapy using insulin for immune tolerance induction; the possible limitations of insulin immunotherapy; and an outlook on how modern vaccines could remove the need for another 100 years of insulin therapy. INSULIN SAVES LIVESThe birthday of insulin Studying medicine in his home town of Berlin, Germany, Thomas Danne was always fascinated by the story of insulin. It started in Berlin in 1869, when a medical student, Paul Langerhans, described in his dissertation the pancreatic islet cells named after him. 1 In 1909, de Meyer gave the name ''insulin'' to the unknown substance formed in Langerhans' islets. 2 In 1921, two Canadians, Frederick Banting, a surgeon with a vision but no formal research training, and Charles Best, a medicine student, made it happen. 3 The birthday of insulin on January 11, 1922, was also the beginning of pediatric diabetology, when 14-year-old Leonard Thompson, diagnosed with diabetes in 1919, was treated at Toronto General Hospital with the extract prepared by Banting and Best. However, the researchers considered it a complete failure, since the glucose decreased only from 440 to 320 mg/dL, ketones remained present, and the local outcome was sterile abscess in the buttocks. 4 James Collip refined the extraction progress, and on January 23-24, 1922, his extract normalized the glucose and made the ketones disappear. On February 5, 1922, Banting and Best published the article ''The internal secretion of the pancreas.'' 5 Banting and his boss and head of the laboratory, J.R.R. Macleod, were rewarded with the Nobel

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Early versus delayed insulin pump therapy in children with newly diagnosed type 1 diabetes: results from the multicentre, prospective diabetes follow-up DPV registry

Cited by 30 publications

References 29 publications

Is diabetic ketoacidosis a good predictor of 5-year metabolic control in children with newly diagnosed type 1 diabetes?

Is diabetic ketoacidosis a good predictor of 5-year metabolic control in children with newly diagnosed type 1 diabetes?

AID(„automated insulin delivery“)-Systeme in der Diabetologie

100 Years of insulin: Lifesaver, immune target, and potential remedy for prevention

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