Long-term glycemic control and factors, associated with response to pump insulin therapy in children

Лаптев, Д. Н.; Emel'yanov, Andrey Olegovich; Медведева, Е Д; Pereverzeva, S. V.

doi:10.14341/dm12530

Cited by 4 publications

(1 citation statement)

References 12 publications

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“…Снижение концентрации НbА1с сопровождается статистически значимым увеличением числа пациентов с оптимальным гликемическим контролем [ 2 ][ 3 ]. При переводе пациентов на помповую инсулинотерапию при регулярном использовании НМГ также отмечается лучший ответ [ 4 ].…”

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Legal issues of the use of continuous glucose monitoring in children with type 1 diabetes

Malievskiy,

Yulchurin

2023

Probl Endokrinol (Mosk)

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Continuous glucose monitoring is an effective method of monitoring glycaemia, allowing to achieve optimal glycemic control and reduce the risk of complications of type 1 diabetes mellitus in children. After the approval of the new «Standard of medical care for children with type 1 diabetes (diagnosis and treatment)» (registered with the Ministry of Justice of Russia on 02/18/2021 No. 62543), hundreds of lawsuits were initiated in many regions of the country against regional public authorities in the field of healthcare and medical organizations demanding free supply of systems for continuous monitoring of blood glucose levels and/or sensors to them. This article analyzes the current legislation regarding the validity of the claims for free supply of disabled children with type 1 diabetes with continuous glucose monitoring.

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Legal issues of the use of continuous glucose monitoring in children with type 1 diabetes

Malievskiy,

Yulchurin

2023

Probl Endokrinol (Mosk)

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Prevalence of hypoglycemic conditions in adolescents with type 1 diabetes mellitus in real clinical practice

et al. 2022

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BACKGROUND. Hypoglycemia and fear of hypoglycemia remain critical problems in the treatment of adolescents with type 1 diabetes mellitus (DM1) and are factors limiting proper control of glycemia and preventing the achievement of metabolic compensation of the disease. The use of pump insulin therapy involves the prevention of hypoglycemic conditions.AIM. To analyze the frequency and duration of hypoglycemia episodes, their effect on the metabolic compensation of the disease in adolescents with type 1 diabetes mellitus (DM1) in real clinical practice, depending on the mode/method of insulin administration.MATERIALS AND METHODS. The study involved 117 adolescents with DM1 aged 12 to 19 years (average age 15.5 years). 37 adolescents received therapy by continuous subcutaneous insulin infusion (CSII); 80 adolescents received therapy by multiple insulin injections (MII). The level of glycated hemoglobin (HbA1c) was determined for all adolescents, and its main indicators were evaluated using a 6 days continuous glucose monitoring (CGM) by the «blind» method of a professional system with an iPro 2 sensor (Medtronic MiniMed, USA).RESULTS. Episodes of a decrease in glucose levels <3,9 mmol/l were recorded in 87% of patients (n=102), 63% (n=74) showed a decrease in glucose levels <3,0 mmol/l. Episodes decrease in glucose levels <3,9 mmol/l at night were recorded in 68% of patients (n=80), and with glucose levels <3,9 mmol/l in 46% (n=54). The frequency of episodes of glucose lowering <3,9 mmol/l had no statistically significant differences depending on the methods of insulin administration (by continuous subcutaneous insulin infusion or multiple insulin injections), however, they are more common in adolescents with HbA1c <7,0% (p=0,03). The median time spent by patients in the range of <3,9 mmol/l was 5% per day, and a longer time in this range was observed in patients with HbA1c <7,0% (p=0,006). The median time in the range of <3,0 mmol/l was 1% per day and had no significant differences depending on the level of HbA1c (p=0,559). There were also no significant differences depending on the groups using CSII and MII (p=0,640 and p=0,250).CONCLUSION. Episodes of glucose reduction in the range of <3,9 mmol/l according to CGM data are more common in adolescents with HbA1c target values, regardless of the method of insulin administration. Significantly more time in range of <3,9 mmol/l is spent by adolescents with target values of HbA1c i.е. <7,0% compared with HbA1c ≥7,0%, however, in both groups, a large number of patients had time in the range below the target level was higher than recommended values.

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Factors associated with high glucose variability in patients with type 1 diabetes

2022

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BACKGROUND: High glucose variability (GV) is recognized as a risk factor for vascular diabetic complications and hypoglycemia. Factors affecting GV in patients with diabetes needed to be clarified.AIM: To determine the factors associated with high GV in adult patients with type 1 diabetes.MATERIALS AND METHODS: We conducted a single center cross-sectional observational study. In-patients with type 1 diabetes aged 18 to 65 years on basal bolus insulin therapy were included. Day-time and nocturnal Coefficient of Variation (CV), Mean Amplitude of Glycemic Excursions (MAGE), Mean Absolute Glucose (MAG) were calculated from continuous glucose monitoring data. The values of CV, MAGE, MAG within the upper quartile were considered high.RESULTS: The study included 400 individuals, including 111 on continuous subcutaneous insulin infusion (CSII). Patients with high GV had lower fasting and postprandial C-peptide levels and higher insulin doses. According to ROC analysis, daily insulin dose >0.69 U/kg and estimated glomerular filtration rate (eGFR) ≥90.5 ml/min×1.73 m2 were associated with high nocturnal CV values. Dose of basal insulin >0.292 U/kg and bolus insulin >0.325 U/day were associated with nocturnal MAGE. Body mass index (BMI) ≤23.2 kg/m2, waist circumference ≤80.5 cm, daily insulin dose ≥0.69 U/kg, HbA1c ≥8.3%, eGFR ≥89.5 ml/ min×1.73m2 increased risk of high MAG at night. High day-time CV values were associated with daily insulin dose ≥0.675 U/kg and daily dose of BI ≥0.286 U/kg. The risk of high MAGE was increased with HbA1c ≥8.24% and basal insulin dose ≥0.286 U/kg. BMI ≤23.2 kg/m2, waist circumference ≤80.5 cm, daily insulin dose ≥0.69 U/kg, daily dose of bolus and basal insulin ≥0.325 and ≥0.29 U/kg respectively, and HbA1c ≥8.33% were the risk factors for high day-time MAG. Patients on CSII had lower MAGE (p<0.001) and MAG (p=0.008) compared to those on multiple daily injections.CONCLUSION: In type 1 diabetes, high GV is associated with undetectable residual insulin secretion, normal or reduced body weight, preserved kidney function, supraphysiological doses of insulin, and non-target HbA1c. Patients on CSII have a lower GV than those on multiple daily injections.

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Long-term glycemic control and factors, associated with response to pump insulin therapy in children

Cited by 4 publications

References 12 publications

Legal issues of the use of continuous glucose monitoring in children with type 1 diabetes

Legal issues of the use of continuous glucose monitoring in children with type 1 diabetes

Prevalence of hypoglycemic conditions in adolescents with type 1 diabetes mellitus in real clinical practice

Factors associated with high glucose variability in patients with type 1 diabetes

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