Podaż węglowodanów w diecie i kontrola glikemii u pacjentów leczonych za pomocą mieszanek insuliny ludzkiej

  Introduction. The treatment with pre-mixed human insulins (PMHI) is globally one of the most popular models of insulin therapy. Achieving good glycaemic control on PMHI may, however, be difficult, mostly due to inconsistent calorie and carbohydrate intake. The aim of the study was to examine the impact of dietary modification on glucose levels in patients with type 2 diabetes mellitus (T2DM) treated with PMHI. Materials and methods. In this prospective cross-over analysis we studied 8 T2DM PMHI treated individuals (mean HbA1c 8.4%). We exposed patients to 2 diets, both based on steady calorie/carbohydrate content: „A” — 50% calories from carbohydrates, 30% from fat, 20% from protein, „B”— 40% from carbohydrates, 30% from fat and 30% from protein. The study was performed in home settings, all the meals were delivered to the patients. Each patient was exposed to diet A for 9 days, than after 7 days of wash-out to 9 days of diet B. Glucose patterns were assessed with continuous glucose monitoring system (CGMS, iPro, Medtronic, USA). Results. Switching from diet A to diet B resulted in a decrease in mean glucose levels (CGMS data) from 145 mg/dL to 133 mg/dL (p = 0.0001), SD reduction from 51 to 42 mg/dL (p = 0.0429), and a decrease in time spent above the target of 180 mg/dL from 18% to 11% (p = 0.0006). Conclusions. The study demonstrates that consistent and repeatable carbohydrate (CH) and calorie intake with moderate restriction of CHs helps to improve glycaemic control in this group of patients.    Wstęp. Leczenie mieszankami insuliny ludzkiej (PMHI, pre-mixed human insulin) jest na całym świecie jednym z najpopularniejszych modeli insulinoterapii. Jednak osiągnięcie dobrej kontroli glikemii u osób stosujących PMHI może być trudne, głównie ze względu na zmienne spożycie węglowodanów i podaż kalorii. Badanie przeprowadzono w celu oceny wpływu modyfikacji diety na stężenia glukozy u chorych na cukrzycę typu 2 (T2DM, type 2 diabetes mellitus) stosujących PMHI. Materiał i metody. Do tego prospektywnego badania przeprowadzonego w układzie naprzemiennym włączono 8 chorych na T2DM leczonych PMHI (średnie stężenie HbA1c 8,4%). U chorych zastosowano 2 diety, obie cechujące się stałą zawartością kalorii/węglowodanów: dieta A — 50% kalorii pochodzi z węglowodanów, 30% — z tłuszczów, 20% — z białek; dieta B — 40% kalorii pochodzi z węglowodanów, 30% — z tłuszczów i 30% — z protein. Badanie prowadzono w warunkach domowych, dostarczano chorym wszystkie posiłki. Każdy chory stosował dietę A przez 9 dni, a następnie po 7-dniowym okresie wypłukiwania przez 9 dni stosował dietę B. Profile glukozy oceniano przy użyciu systemu ciągłego monitorowania glikemii (CGMS, continuous glucose monitoring system, iPro, Medtronic, USA). Wyniki. Zmiana z diety A na dietę B spowodowała zmniejszenie średnich stężeń glukozy (dane z system CGMS) ze 145 mg/dl do 133 mg/dl (p = 0,0001), redukcję SD z 51 do 42 mg/dl (p = 0,0429) oraz skrócenie czasu, w którym glikemia utrzymywała się powyżej progowej wartości 180 mg/dl z 18% do 11% (p = 0,0006). Wnioski. W badaniu wykazano, że zapewnienie odpowiedniej i powtarzalnej podaży węglowodanów i kalorii z umiarkowanym ograniczeniem węglowodanów umożliwia poprawę kontroli glikemii u chorych na cukrzycę typu 2.

Continuous glucose monitoring and insulin pump therapy in pregnant women with type 1 diabetes mellitus

Objectives: We examined the impact of continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring systems (CGM) during pregnancy in women with pre-gestational type 1 diabetes (T1DM) on glycemic control and subsequent adverse outcomes.Material and methods: In this observational, one-center study we analyzed records of consecutive 109 T1DM pregnancies (2016–2017). The final analyzed group consisted of 81 singleton pregnancies who met inclusion and exclusion criteria. We searched for the association between the use of CSII with or without CGM and pregnancy planning with glycated hemoglobin A1c (HbA1c) through pregnancy and after delivery as well as maternal and infant outcomes.Results: Patients using CSII and CGM vs CSII without CGM and MDI (multiple daily injections) users had the lowest HbA1c levels during and after pregnancy (5.3%, 5.3%, 5.2% and 5,5% in the 1st, 2nd, 3rd trimester and postpartum visit, p = 0.003, p = 0.030, p = 0.039 and p = 0.002, respectively). Patients treated with insulin pumps with CGM and additional functions of automatic insulin delivery suspension on low glucose level (SLG) or predictive low glucose suspend (PLGS) during the third trimester and after pregnancy achieved a significantly lower HbA1c than the other CSII patients. We did not find any differences between the study groups in gestational age at delivery, preterm births, birth weight or macrosomia risk. Despite very good glycemic control, the risk of macrosomia remained high (19.7%).Conclusions: The use of pumps equipped with CGM, especially with automatic insulin delivery suspension, may improve glycemic control in pregnant T1DM women. The proportion of macrosomia remained high

Sleep characteristics in type 1 diabetes and associations with glycemic control: systematic review and meta-analysis

AbstractObjectivesThe association between inadequate sleep and type 2 diabetes has garnered much attention, but little is known about sleep and type 1 diabetes (T1D). Our objectives were to conduct a systematic review and meta-analysis comparing sleep in persons with and without T1D, and to explore relationships between sleep and glycemic control in T1D.MethodsStudies were identified from Medline and Scopus. Studies reporting measures of sleep in T1D patients and controls, and/or associations between sleep and glycemic control, were selected.ResultsA total of 22 studies were eligible for the meta-analysis. Children with T1D had shorter sleep duration (mean difference [MD] = −26.4 minutes; 95% confidence interval [CI] = −35.4, −17.7) than controls. Adults with T1D reported poorer sleep quality (MD in standardized sleep quality score = 0.51; 95% CI = 0.33, 0.70), with higher scores reflecting worse sleep quality) than controls, but there was no difference in self-reported sleep duration. Adults with TID who reported sleeping >6 hours had lower hemoglobin A1c (HbA1c) levels than those sleeping ≤6 hours (MD = −0.24%; 95% CI = −0.47, −0.02), and participants reporting good sleep quality had lower HbA1c than those with poor sleep quality (MD = −0.19%; 95% CI = −0.30, −0.08). The estimated prevalence of obstructive sleep apnea (OSA) in adults with TID was 51.9% (95% CI = 31.2, 72.6). Patients with moderate-to-severe OSA had a trend toward higher HbA1c (MD = 0.39%, 95% CI = −0.08, 0.87).ConclusionT1D was associated with poorer sleep and high prevalence of OSA. Poor sleep quality, shorter sleep duration, and OSA were associated with suboptimal glycemic control in T1D patients

Qualitative Parameters of the Colonic Flora in Patients with HNF1A-MODY Are Different from Those Observed in Type 2 Diabetes Mellitus

Background. Type 2 diabetes mellitus (T2DM) is determined by genetic and environmental factors. There have been many studies on the relationship between the composition of the gastrointestinal bacterial flora, T2DM, and obesity. There are no data, however, on the gut microbiome structure in monogenic forms of the disease including Maturity Onset Diabetes of the Young (MODY). Methods. The aim of the investigation was to compare the qualitative parameters of the colonic flora in patients with HNF1A-MODY and T2DM and healthy individuals. 16S sequencing of bacterial DNA isolated from the collected fecal samples using the MiSeq platform was performed. Results. There were significant between-group differences in the bacterial profile. At the phylum level, the amount of Proteobacteria was higher ( = 0.0006) and the amount of Bacteroidetes was lower ( = 0.0005) in T2DM group in comparison to the control group. In HNF1A-MODY group, the frequency of Bacteroidetes was lower than in the control group ( = 0.0143). At the order level, Turicibacterales was more abundant in HNF1A-MODY group than in T2DM group. Conclusions. It appears that there are differences in the gut microbiome composition between patients with HNF1A-MODY and type 2 diabetes. Further investigation on this matter should be conducted

Assessment of Newly Proposed Clinical Criteria to Identify HNF1A MODY in Patients with an Initial Diagnosis of Type 1 or Type 2 Diabetes Mellitus

The most common form of maturity-onset diabetes of the young (MODY) is caused by mutations in the hepatocyte nuclear factor 1A (HNF1A) gene. However, most HNF1A mutation-carriers are initially misdiagnosed with type 1 (T1DM) or type 2 (T2DM) diabetes mellitus; hence, they often receive nonoptimal treatment. The aim of our study was to test newly proposed clinical criteria for the identification of HNF1A MODY in patients with a diagnosis of T1DM or T2DM. To achieve this, the following criteria to preselect patients for screening were used: for T1DM: TDIR (total daily insulin requirement) > 0.3 IU of insulin/kg and the percentage of basal insulin > 30% of TDIR; for T2DM: sulphonylurea- (SU-) based oral treatment (monotherapy or combined with Metformin) > 15 years and BMI < 30 kg/m2. We reviewed the clinical data of 140 patients with T1DM and 524 clinically diagnosed with T2DM. On the basis of these criteria, we found a HNF1A mutation in 1 out of 2 individuals with a diagnosis of T1DM and 1 out of 11 selected individuals with a diagnosis of T2DM. We believe that the simplicity of the proposed criteria might prove useful in clinical practice, as an alternative to more time-consuming classical diagnostic techniques

Comparison of Glomerular Filtration Rate Estimation from Serum Creatinine and Cystatin C in HNF1A-MODY and Other Types of Diabetes

Introduction. We previously showed that in HNF1A-MODY the cystatin C-based glomerular filtration rate (GFR) estimate is higher than the creatinine-based estimate. Currently, we aimed to replicate this finding and verify its clinical significance. Methods. The study included 72 patients with HNF1A-MODY, 72 with GCK-MODY, 53 with type 1 diabetes (T1DM), 70 with type 2 diabetes (T2DM), and 65 controls. Serum creatinine and cystatin C levels were measured. GFR was calculated from creatinine and cystatin C using the CKD-EPI creatinine equation (eGRF-cr) and CKD-EPI cystatin C equation (eGFR-cys), respectively. Results. Cystatin C levels were lower (p<0.001) in the control (0.70±0.13 mg/L), HNF1A (0.75±0.21), and GCK (0.72±0.16 mg/L) groups in comparison to those with either T1DM (0.87±0.15 mg/L) or T2DM (0.9±0.23 mg/L). Moreover, eGFR-cys was higher than eGRF-cr in HNF1A-MODY, GCK-MODY, and the controls (p=0.004; p=0.003; p<0.0001). This corresponded to 8.9 mL/min/1.73 m2, 9.7 mL/min/1.73 m2, and 16.9 mL/min/1.73 m2 of difference. Additionally, T1DM patients had higher eGFR-cr than eGFR-cys (11.6 mL/min/1.73 m2; p=0.0004); no difference occurred in T2DM (p=0.91). Conclusions. We confirmed that eGFR-cys values in HNF1A-MODY patients are higher compared to eGFR-cr. Some other differences were also described in diabetic groups. However, none of them appears to be clinically relevant

Comparison of Glomerular Filtration Rate Estimation from Serum Creatinine and Cystatin C in HNF1A-MODY and Other Types of Diabetes

Introduction. We previously showed that in HNF1A-MODY the cystatin C-based glomerular filtration rate (GFR) estimate is higher than the creatinine-based estimate. Currently, we aimed to replicate this finding and verify its clinical significance. Methods. The study included 72 patients with HNF1A-MODY, 72 with GCK-MODY, 53 with type 1 diabetes (T1DM), 70 with type 2 diabetes (T2DM), and 65 controls. Serum creatinine and cystatin C levels were measured. GFR was calculated from creatinine and cystatin C using the CKD-EPI creatinine equation (eGRF-cr) and CKD-EPI cystatin C equation (eGFR-cys), respectively. Results. Cystatin C levels were lower ( &lt; 0.001) in the control (0.70 ± 0.13 mg/L), HNF1A (0.75 ± 0.21), and GCK (0.72 ± 0.16 mg/L) groups in comparison to those with either T1DM (0.87 ± 0.15 mg/L) or T2DM (0.9 ± 0.23 mg/L). Moreover, eGFR-cys was higher than eGRF-cr in HNF1A-MODY, GCK-MODY, and the controls ( = 0.004; = 0.003; &lt; 0.0001). This corresponded to 8.9 mL/min/1.73 m 2 , 9.7 mL/min/1.73 m 2 , and 16.9 mL/min/1.73 m 2 of difference. Additionally, T1DM patients had higher eGFRcr than eGFR-cys (11.6 mL/min/1.73 m 2 ; = 0.0004); no difference occurred in T2DM ( = 0.91). Conclusions. We confirmed that eGFR-cys values in HNF1A-MODY patients are higher compared to eGFR-cr. Some other differences were also described in diabetic groups. However, none of them appears to be clinically relevant