Insulin Pump Therapy in Preschool Children with Type 1 Diabetes Mellitus Improves Glycemic Control and Decreases Glucose Excursions and the Risk of Hypoglycemia

Jeha, George S; Karaviti, Lefkothea; Anderson, Barbara J.; Smith, Elise; Donaldson, Susan; McGirk, Toniean S.; Haymond, Morey W.

doi:10.1089/dia.2005.7.876

Cited by 67 publications

(48 citation statements)

References 17 publications

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“…In particular, Inouye et al 27 demonstrated that recurrent hypoglycemia in rats with diabetes increases glucose consumption. Combining the assumption that these researchers' result would hold for type 1 diabetes patients with the well-established connection between hypoglycemia and glucose variability [28][29][30] provides a probable explanation for our findings.…”

Section: Discussionsupporting

confidence: 75%

Hypoglycemia Risk and Glucose Variability Indices Derived from Routine Self-Monitoring of Blood Glucose Are Related to Laboratory Measures of Insulin Sensitivity and Epinephrine Counterregulation

Pitsillides

Anderson

Kovatchev

2011

Diabetes Technology & Therapeutics

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Background: The widely held assumptions that in type 1 diabetes glucose variability may correlate with insulin sensitivity and impaired epinephrine counterregulation have not been studied directly. Here we investigate possible relationships between outpatient measures of glucose variability and risk for hypoglycemia with physiological characteristics: insulin sensitivity and hypoglycemia counterregulation. Methods: Thirty-four subjects with type 1 diabetes (14 women, 20 men; 37 AE 2.1 years old; glycosylated hemoglobin [HbA1c], 7.6 AE 0.21%) performed self-monitoring of blood glucose (SMBG) for a month, followed by an inpatient hyperinsulinemic euglycemic and hypoglycemic clamp. SMBG field data were used to calculate measures of glucose variability and risk of hypoglycemia, while the clamp procedure was used to evaluate insulin sensitivity and epinephrine response during induced hypoglycemia. Spearman partial correlations adjusted for age, duration of diabetes, body mass index, gender, and HbA1c were used to assess the relationship between the field indices of glucose variability and the physiological characteristics of diabetes. Results: Two glucose variability measures correlated positively (P < 0.01) with insulin sensitivity: the Average Daily Risk Range (ADRR) (r ¼ 0.5) and the Glycemic Lability Index (r ¼ 0.48). The Low Blood Glucose Index, a measure of the risk for hypoglycemia, and the ADRR correlated negatively with maximum epinephrine response during hypoglycemia: r ¼ À0.46, P < 0.01 and r ¼ À0.4, P ¼ 0.03, respectively. Conclusions: Higher insulin sensitivity and lower epinephrine response during hypoglycemia are related to increased glucose variability (as quantified by the ADRR), irrespective of HbA1c and other patient characteristics. Lower epinephrine relates to risk for hypoglycemia as well.

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Section: Discussionsupporting

confidence: 75%

Hypoglycemia Risk and Glucose Variability Indices Derived from Routine Self-Monitoring of Blood Glucose Are Related to Laboratory Measures of Insulin Sensitivity and Epinephrine Counterregulation

Pitsillides

Anderson

Kovatchev

2011

Diabetes Technology & Therapeutics

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“…Insulin pumps lead not only to the improved glycemic profiles but in comparison with conventional medications, also limit the degree of hypoglycemia 23 . In our recent study we concluded that for this form of treatment, it is better to give priority to short duration insulin analogues (such as insulin aspart, Novorapid) than human insulin Actrapid 25 .…”

Section: Discussionmentioning

confidence: 99%

Benefits of Three-Month Continuous Glucose Monitoring for Persons With Diabetes Using Insulin Pumps and Sensors

Peterson¹,

Zapletalová²,

Kudlová³

et al. 2009

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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“…В аналогичных нерандомизированных крупных исследова-ниях, проведенных в мире и в РФ [11][12][13] с включением большого числа пациентов, также показано улучшение метаболического контроля заболевания -снижение НbA 1с и потребности в инсу-лине. Кроме того, было продемонстрировано снижение уровней среднесуточной гликемии и вариабельности ее показателей с уве-личением продолжительности эугликемии в динамических на-блюдениях при назначении помповой инсулинотерапии.…”

Section: результаты и их обсуждениеunclassified

Insulin pump therapy of type 1 diabetes mellitus in children and adolescents in the Moscow region

et al. 2009

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Aim. To assess dynamics of glycated hemoglobin levels and insulin doses per kg bw in children and adolescents with poorly controlled type 1 diabetes mellitus using insulin pumps. Materials and methods. Retrospective analysis of HbA1c levels and insulin doses per kg bw in children aged 2-17 years with DM1 (mean duration 5.3?3.1) before and 18 months after onset of insulin pump therapy (Medtronic Minimed 712 and 722) with a short-acting insulin analog Novopramid (Novo Nordisk) or Humalog (Ely Lilly) given to 55 (52,4%) and 50 (47,6%) of the patients respectively. НbА1с level and mean daily insulin dose per kg bw were determined when a patient visited the doctors office every 3 months. Results. Insulin pump therapy in patients with initially poorly controlled DM1 resulted in a decrease of HbA1c from 9.8?0.8 to 7,8?0,5% within 18 months after its beginning (p

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Insulin Pump Therapy in Preschool Children with Type 1 Diabetes Mellitus Improves Glycemic Control and Decreases Glucose Excursions and the Risk of Hypoglycemia

Abstract: CSII in preschool children is feasible and safe. Pump therapy reduced the glycemic excursions and decreased hypoglycemia duration and frequency.

Cited by 67 publications

References 17 publications

Hypoglycemia Risk and Glucose Variability Indices Derived from Routine Self-Monitoring of Blood Glucose Are Related to Laboratory Measures of Insulin Sensitivity and Epinephrine Counterregulation

Hypoglycemia Risk and Glucose Variability Indices Derived from Routine Self-Monitoring of Blood Glucose Are Related to Laboratory Measures of Insulin Sensitivity and Epinephrine Counterregulation

Benefits of Three-Month Continuous Glucose Monitoring for Persons With Diabetes Using Insulin Pumps and Sensors

Insulin pump therapy of type 1 diabetes mellitus in children and adolescents in the Moscow region

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