Verenglukoosipitoisuuden seuranta vuonna 2016

English summaryPeer reviewe

Moderna glukosövervakningssystem och hybrid closed loop-insulinpumpar

Diabetes. English summary

Insuliininpuutosdiabetes ja liikunta - miten välttää hypoglykemia?

Vertaisarvioitu. English summary. Näin hoidan.Säännöllisen liikunnan on osoitettu parantavan insuliiniherkkyyttä ja vaikuttavan edullisesti sydän- ja verisuonitautiriskiin. Siksi insuliininpuutosdiabetesta sairastaville suositellaan liikunnan harrastamista. Hypoglykemia on tavallisin liikuntaan liittyvä haittavaikutus, ja etenkin sen pelko voi estää liikunnan harrastamista. Insuliininpuutosdiabeteksen hyvä omahoito mahdollistaa hyvän hoitotasapainon vaihtuvissa arkipäivän tilanteissa, kuten liikunnan yhteydessä. Tämä kuitenkin edellyttää, että insuliininpuutosdiabetesta sairastava ymmärtää eri liikuntamuotojen sekä liikunnan intensiivisyyden ja keston vaikutukset oman elimistönsä reaktioihin ja ennen kaikkea verenglukoosiarvoihinsa. Jatkuva glukoosisensorointi yhdessä kehittyvän insuliinipumpputeknologian ja entistä fysiologisempien insuliinien myötä auttaa insuliininpuutosdiabetesta sairastavan omahoitoa myös liikunnan aikana merkittävästi

Kohti keinohaimaa

• Yhdysvalloissa on markkinoilla ensimmäinen kaupallinen ns. hybridikeinohaima. Se annostelee insuliinia automaattisesti kudosglukoosipitoisuuden mukaan. • Avoimeen koodiin perustuva, käyttäjien ohjelmoima OpenAPS-järjestelmä on myös lähellä sitä, ettei käyttäjän tarvitse annostella ateriainsuliinia. • Tekniikan kehitys muuttaa diabeteshoitajien ja -lääkärien työtä.Peer reviewe

Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD) : a randomized controlled trial

Introduction We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. Research design and methods 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. Results 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. Conclusion There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk.Peer reviewe

The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes

Background Between March 18(th) and May 13(th) 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown. Methods In this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy. Results In our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1-2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3-0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6-4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps. Conclusions The glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.Peer reviewe

Lapsen diabeettinen ketoasidoosi

English summar

Äidin tyypin 1 diabeteksen vaikutus sikiön ja vastasyntyneen terveyteen

Vertaisarvioitu. English summary.Tyypin 1 diabetesta sairastavan naisen raskauteen liittyy merkittävästi suurentunut obstetristen komplikaatioiden ja vastasyntyneen hoidontarpeen riski. Viidesosa tyypin 1 diabetesta sairastavien äitien lapsista joutuu vastasyntyneiden teho-osastolle ja joka toinen lastenosastolle hoitoon synnytyksen jälkeen. Tavallisimpia ongelmia ovat hypoglykemia, makrosomia ja siihen liittyvät synnytysvauriot, vastasyntyneen hengitysongelmat, hyperbilirubinemia ja ennenaikaisuus. Tyypin 1 diabetesta sairastavan naisen raskaus vaatii huolellista suunnittelua ja diabeteksen hoidon optimointia ennen raskautta sekä tiivistä moniammatillista seurantaa raskausaikana. Uudet kansainväliset hoitosuositukset korostavat glukoosipitoisuuden vaihtelun vähentämisen merkitystä. Raskauden suunnittelussa ja raskausajan hoitotavoitteena tuleekin olla riittävä aika glukoositavoitteessa (time in range, TIR). Jatkuvan glukoosiseurannan avulla voidaan vähentää äidin glukoosipitoisuuden vaihtelua ja vastasyntyneen ongelmia.Peer reviewe

First year on commercial hybrid closed-loop system - experience on 111 children and adolescents with type 1 diabetes

Objective The hybrid close-loop system (HCL) is a rapidly emerging treatment method for type 1 diabetes (T1D), but the long-term effectiveness of the system remains unclear. This study investigates the influence of the HCL on glycemic control in children and adolescents with T1D in a real-life setting during the first year on HCL. Research design and methods This retrospective study included all the patients (n = 111) aged 3 to 16 years with T1D who initiated the HCL system between 1st of December 2018 and 1st of December 2019 in the Helsinki University Hospital. Time in range (TIR), HbA1c, mean sensor glucose (SG) value, time below range (TBR), and SG coefficient of variance (CV) were measured at 0, 1, 3, 6, and 12 month. The changes over time were analyzed with a repeated mixed model adjusted with baseline glycemic control. Results After the initiation of HCL, all measures of glycemic control, except HbA1c, improved and the effect lasted throughout the study period. Between 0 and 12 month, TIR increased (beta = -2.5 [95%CI: -3.6 - (-1.3)], p < 0.001), whereas mean SG values (beta = -0.7 [95%CI: -0.9 - (-0.4)]), TBR (beta = -2.5 [95%CI: -3.6 - (-1.3)]), and SG CV (beta = -4.5 [95%CI: -6.3 - [-2.8]) decreased significantly (p < 0.001). Importantly, the changes occurred regardless of the age of the patient. Conclusions Measurements of glycemic control, except HbA1c, improved significantly after the initiation of the HCL system and the favorable effect lasted throughout the follow-up. These results support the view that HCL is an efficacious treatment modality for children and adolescents with T1D of all ages.Peer reviewe