Prevention of hypoglycemia by intermittent-scanning continuous glucose monitoring device combined with structured education in patients with type 1 diabetes mellitus : A randomized, crossover trial

Aims: We conducted a randomized, crossover trial to compare intermittent-scanning continuous glucose monitoring (isCGM) device with structured education (Intervention) to self-monitoring of blood glucose (SMBG) (Control) in the reduction of time below range. Methods: This crossover trial involved 104 adults with type 1 diabetes mellitus (T1DM) using multiple daily injections. Participants were randomly allocated to either sequence Intervention/Control or sequence Control/Intervention. During the Intervention period which lasted 84 days, participants used the first-generation FreeStyle Libre (Abbott Diabetes Care, Alameda, CA, USA) and received structured education on how to prevent hypoglycemia based on the trend arrow and by frequent sensor scanning (≥10 times a day). Confirmatory SMBG was conducted before dosing insulin. The Control period lasted 84 days. The primary endpoint was the decrease in the time below range (TBR; <70 mg/dL). Results: The time below range was significantly reduced in the Intervention arm compared to the Control arm (2.42 ± 1.68 h/day [10.1 %±7.0 %] vs 3.10 ± 2.28 h/day [12.9 %±9.5 %], P = 0.012). The ratio of high-risk participants with low blood glucose index >5 was significantly reduced (8.6 % vs 23.7 %, P < 0.001). Conclusions: The use of isCGM combined with structured education significantly reduced the time below range in patients with T1DM

Association Study of the Effect of WFS1 Polymorphisms on Risk of Type 2 Diabetes in Japanese Population

Mutations of WFS1 gene cause Wolfram syndrome, which is a rare autosomalrecessive disorder characterized by juvenile diabetes mellitus, optic atrophy, deafnessand diabetes insipidus. The product encoded by WFS1 gene, wolframin, could beinvolved in ER stress response causing β-cell loss through impaired cell cycleprogression and increased apoptosis. Recently, polymorphisms in the WFS1 gene werestrongly associated with type 2 diabetes in Caucasians. The aim of the present studywas to examine whether the variants of WFS1 are associated with risk of type 2diabetes in Japanese individuals. Four single nucleotide polymorphisms, rs6446482,rs12511742, rs1801208 (R456H) and rs734312 (H611R) were genotyped in a total of 536diabetic patients and 398 nondiabetic control subjects. Among the four variants,rs12511742 showed a marginal association with susceptibility to type 2 diabetes (oddsratio = 1.32, 95% confidence interval = 1.02-1.71, P = 0.033). Carriers of the risk alleleat rs12511742 exhibited lower pancreas β-cell function (P = 0.017). However, thisassociation disappeared after adjustment for sex, age and BMI (Adjusted P = 0.24).Although we found no evidence for a substantial effect of WFS1 polymorphisms on riskof type 2 diabetes or clinical characteristics of diabetic subjects in Japanese population,this gene is still a good candidate for a type 2 diabetes susceptibility gene, potentially,through impaired insulin secretion

Association of Serum MCP-1 Concentration and MCP-1 Polymorphism with Insulin Resistance in Japanese Individuals with Obese type 2 Diabetes

Monocyte chemoattractant protein-1 (MCP-1, also known as CCL2) secreted byadipocytes is a member of the CC chemokine family and plays a pivotal role in theinflammatory process. A polymorphism, the -2518 A/G of MCP-1 gene, has beenassociated with type 2 diabetes, type 1 diabetes, parameters of insulin resistance andobesity. Therefore, we investigated the effects of MCP-1 single nucleotidepolymorphisms (SNPs) on the susceptibility to type 2 diabetes or insulin resistance inthe Japanese population. We also assessed the correlation between serum MCP-1concentration and other clinical characteristics in Japanese type 2 diabetic subjects.The serum MCP-1 concentration was significantly correlated with HOMA-IR and thevisceral fat area, but not with BMI. Although there was no association between thisSNP and type 2 diabetes, the -2518A/G polymorphism was associated with the serumMCP-1 concentration. In subgroup analysis, Japanese obese diabetic -2518AA carriershad a higher MCP-1 concentration and increased insulin resistance than obese diabetic-2518G carriers. These data indicated that the MCP-1 polymorphism was associatedwith insulin resistance in Japanese obese diabetic subjects and that MCP-1 wasimplicated in the pathogenesis of insulin resistance, especially associated with obesity,in humans

Protective and risk factors of impaired awareness of hypoglycemia in patients with type 1 diabetes: a cross-sectional analysis of baseline data from the PR-IAH study

Abstract Background Hypoglycemia in type 1 diabetes (T1D) is associated with mortality and morbidity, especially when awareness of hypoglycemia is impaired. This study aimed to investigate the protective and risk factors for impaired awareness of hypoglycemia (IAH) in adults with T1D. Methods This cross-sectional study enrolled 288 adults with T1D (mean age, 50.4 ± 14.6 years; male, 36.5%; diabetes duration, 17.6 ± 11.2 years; mean HbA1c level, 7.7 ± 0.9%), who were divided into IAH and non-IAH (control) groups. A survey was conducted to assess hypoglycemia awareness using the Clarke questionnaire. Diabetes histories, complications, fear of hypoglycemia, diabetes distress, hypoglycemia problem-solving abilities, and treatment data were collected. Results The prevalence of IAH was 19.1%. Diabetic peripheral neuropathy was associated with an increased risk of IAH (odds ratio [OR] 2.63; 95% confidence interval [CI] 1.13–5.91; P = 0.014), while treatment with continuous subcutaneous insulin infusion and hypoglycemia problem-solving perception scores were associated with a decreased risk of IAH (OR, 0.48; 95% CI, 0.22–0.96; P = 0.030; and OR, 0.54; 95% CI, 0.37–0.78; P = 0.001, respectively). There was no difference in continuous glucose monitoring use between the groups. Conclusion We identified protective factors in addition to risk factors for IAH in adults with T1D. This information may help manage problematic hypoglycemia. Trial registration University hospital Medical Information Network (UMIN) Center: UMIN000039475). Approval date 13 February 2020