Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison

McKnight, John; Wild, Sarah H.; Lamb, Maxine; Cooper, Matthew N.; Jones, Timothy W.; Davis, Elizabeth A.; Hofer, Sabine E.; Fritsch, Maria; Schober, Edith; Svensson, Jannet; Almdal, Thomas; Young, Robert J.; Warner, Justin; Delemer, Brigitte; Souchon, Pierre‐François; Holl, Reinhard W.; Karges, Wölfram; Kieninger, Dorothee; Tigas, Stelios; Bargiota, Αlexandra; Sampanis, Christos; Cherubini, Valentino; Gesuita, Rosaria; Strēle, Ieva; Pildava, Santa; Coppell, Kirsten J; Magee, Greg; Cooper, John G.; Dinneen, Séan F.; Eeg‐Olofsson, Katarina; Svensson, Ann Marie; Guðbjörnsdóttir, Soffia; Veeze, Henk J.; Aanstoot, Henk‐Jan; Khalangot, Mykola; Tamborlane, William V.; Miller, Kellee M.

doi:10.1111/dme.12676

Cited by 301 publications

(287 citation statements)

References 17 publications

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“…5 Despite a high T1D diabetes burden, Sweden has a high standard of care for the type 1 population. 6 The Swedish National Diabetes Register (NDR) offers an excellent opportunity to study individuals with T1D; 95% of all individuals with T1D have been entered in the register, which includes detailed clinical data collected from each appointment at the local health care provider. In 2013, 1 in 4 women and 1 in 5 men used CSII.…”

Section: Special Sectionmentioning

confidence: 99%

Indications for Insulin Pump Therapy in Type 1 Diabetes and Associations With Glycemic Control

Jendle

Rawshani

Svensson

et al. 2016

J Diabetes Sci Technol

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Background: Real-world data regarding indications for use of insulin pump remain sparse. We investigated characteristics among individuals with type 1 diabetes (T1D) in relation to indication for use of insulin pump (CSII). Comparison was made with T1D subjects using multiple daily injections (MDI). Methods:We included all individuals with T1D who had at least 1 registration in the National Diabetes Register during 2014-2015. Among 46 874 individuals, we excluded 2350 due to missing data. We examined 35 725 on MDI and 8799 on CSII regarding characteristics in relation to insulin delivery method, as well as association between insulin delivery and glycemic control (HbA1c) and presence of albuminuria.Results: Unadjusted mean (SD) HbA1c was 63.84 (15.07) mmol/mol (7.99 [1.38]%) and 63.75 (13.19) mmol/mol (7.99 [1.21]%) in the MDI and CSII group, respectively. MDI and CSII users were on average 48.8 and 41.5 years old, respectively. MDI users were on average 26 years old and CSII users 17 years old at the time of diabetes diagnosis. Overall, a higher proportion of CSII users were females (53.5%). As compared with MDI, use of CSII was associated with up to 7.84 mmol/ mol (0.72%) lower HbA1c in a multivariable adjusted model. Use of CSII was, however, not associated with risk of having albuminuria. Conclusions:CSII was used more frequently in younger individuals, early-onset diabetes, and problematic glycemic control. The use of CSII was associated with lower HbA1c among CSII users except from those who started CSII due to high HbA1c.

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Section: Special Sectionmentioning

confidence: 99%

Indications for Insulin Pump Therapy in Type 1 Diabetes and Associations With Glycemic Control

Jendle

Rawshani

Svensson

et al. 2016

J Diabetes Sci Technol

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“…The use of these drugs appears to be increasing in young people with T1D despite not being approved 1,[27][28][29][30] . This case illustrates the risk of using these promising drugs when long-term safety studies are lacking.…”

Section: Discussionmentioning

confidence: 99%

Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso

Ramírez

Román

2017

Rev. chil. pediatr.

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Introduction: Dapagliflozin, an insulin-independent sodium-glucose cotransporter 2 inhibitor (SGLT2-I) induces glycosuria and reduces hyperglycemia in adults with type 2 diabetes. Objective: To present an "euglycemic" diabetic ketosis in an adolescent with type 1 diabetes (T1D) receiving dapagliflozin, to alert about the risk of a drug not approved in children nor in T1D. Case report: A 17 years old adolescent with T1D during 9 years, was started on dapagliflozin 10 mg/day to reduce insulin dose and weight. During 11 months on treatment, capillary ketones were undetectable and she exhibited a reduction in body mass index 23.9 to 21.1 kg/m 2 , basal insulin 40 to 17 U, glycated hemoglobin 8.3 to 7.5%, capillary glucose 175 to 161 mg/dl and glucose variability (standard deviation) 85 to 77. Suddenly nausea and vomits appeared. The patient was on an insulin pump and well calibrated continuous glucose monitoring, showing stable glucose levels under 200 mg/dl, and an insulin bolus was delivered. Vomiting without hyperglycemia persisted; three hours later, she was severely dehydrated and fainting, with ketones 4.6 nmol/l and glucose 224 mg/dl. She received IV saline fluids, ondansetron, carbohydrates and several insulin boluses. Hydration and general condition improved soon, however despite several insulin doses, ketosis continued for 24 hours. It is remarkable that the pump was working well and the cannula was not changed. After the ketosis was resolved, she continued using the same cannula with good metabolic control. Conclusion: Euglycemic ketosis is a life-threatening condition that must be suspected.

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“…We have shown that glycaemic control as measured by HbA1c is not good in Scotland and compares unfavourably with many other developed countries. 9 The surveys from 2010-2013 reported unchanged results for Scotland, with some variation between NHS Boards, and we have investigated this further by reviewing data from most diabetes centres. Initial analysis revealed a variation between diabetes centres of 14-33% having an HbA1c <58 mmol/mol and 20-42% having an HbA1c >75 mmol/mol.…”

Section: Type 1 Diabetesmentioning

confidence: 99%

The Scottish Diabetes Improvement Plan 2014

McKnight

2015

Br J Diabetes

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Multiple initiatives are underway to optimise diabetes care in Scotland, led by the Scottish Diabetes Group. These include annual nationwide diabetes surveys, a campaign to increase awareness of signs and symptoms of type 1 diabetes in children ('4Ts'), and a Diabetes Improvement Plan, built around eight key priorities: prevention and early detection of diabetes and its complications; type 1 diabetes care; person-centred care; equality of access; supporting and developing staff; inpatient diabetes care; improving information; and innovation. There is a strong emphasis on empowerment of patients, training and education for staff and patients, and innovative use of data (including provision for healthcare professionals to access their patients' data). Other work is aimed at reducing disparities in outcomes related to ethnicity or socieoeconomic status. Much remains to do, but the introduction of continuous subcutaneous insulin infusion for more patients across NHS Scotland has been of benefit, with early indications that HbA1c might be decreasing slightly in those patients with type 1 diabetes in Scotland. These initiatives take place against a backdrop of an increasing prevalence of diabetes in Scotland, and we hope that these initiatives will build on previous frameworks to promote safe, effective person-centred care across NHS Scotland. Br J Diabetes Vasc Dis 2015;15:131-134

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Glycaemic control of Type 1 diabetes in clinical practice early in the 21st century: an international comparison

Abstract: These results suggest that there are substantial variations in glycaemic control among people with Type 1 diabetes between the data sources and that there is room for improvement in all populations, especially in young adults.

Cited by 301 publications

References 17 publications

Indications for Insulin Pump Therapy in Type 1 Diabetes and Associations With Glycemic Control

Indications for Insulin Pump Therapy in Type 1 Diabetes and Associations With Glycemic Control

Cetosis normoglicémica en adolescente con diabetes tipo 1 recibiendo insulina y dapaglifozina: Reporte de un caso

The Scottish Diabetes Improvement Plan 2014

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