Background and Aims: It is well-known that diabetes self-management is important for glycemic out... more Background and Aims: It is well-known that diabetes self-management is important for glycemic outcome, also among insulin pump users. We aimed to explore which factors were independently associated with HbA1c. Methods: Adult insulin pump users (18+) with type 1 diabetes from the Capital Region of Denmark completed an online questionnaire covering aspects of insulin pump self-management. HbA1c and demographics were collected from medical records and national registries. Backward selected linear regression models were used to investigate associations between HbA1c and each aspect of self-management, adjusted for one another, CGM/isCGM, sex, age, marital status and educational level. Results: In total, 770 individuals responded; 60% were female, median age was 49 (p25-p75: 36-60) and ranged from 18-86 years, median HbA1c was 56mmol/mol (p25-p75: 50-62) and ranged from 25-135, and 93% used bolus calculator for meal bolus and/or correction. Self-adjustment of pump settings showed the str...
We aimed to evaluate the glycemic effect and detect any predictors of improved time-in-range (TIR... more We aimed to evaluate the glycemic effect and detect any predictors of improved time-in-range (TIR) in persons with type 1 diabetes after initiating hybrid closed-loop (HCL) treatment with MiniMed 670G in a 12-month retrospective observational study. Before starting HCL-treatment, the 62 participants followed a Steno-developed training program; 7 participants (6.5%) discontinued the HCL-therapy; the remaining 55 (58% female) had an age (mean±SD) of 45.6±12.6 years and diabetes duration of 28.2±10.9 years. After 12 months' HCL-therapy, HbA1c decreased from 7.4+0.7% to 7.1+0.5%, TIR increased from 59.3±13.5% to 72±9.3%, time in 54-70 mg/dL (3.0-3.9 mmol/L) decreased from 2.4±2.0% to 1.4±1.0%, and time in 180-250 mg/dL (10.0-13.9 mmol/L) decreased from 26.4±8.3% to 20.8±5.5%, all p<0.001. Improvement in TIR was significantly associated with lower total daily insulin dose, higher amount of total carbohydrate, and more time spent in Auto Mode. Our findings support the promising results on glycemic outcomes seen with HCL treatment.
Diabetic medicine : a journal of the British Diabetic Association, 2014
ABSTRACT Individuals with diabetes struggle with depression, anxiety, distress and other psycholo... more ABSTRACT Individuals with diabetes struggle with depression, anxiety, distress and other psychological problems more often and to a greater degree than do those without a chronic illness. In addition, there is an association between psychological problems and poor diabetes outcomes, such as risk of hyperglycaemia and frequent omission of prescribed medication [1,2]. Unaddressed psychological problems among people with diabetes may therefore have serious clinical consequences. Nevertheless, healthcare professionals do not identify psychological problems in two out of three patients with diabetes [3,4].This article is protected by copyright. All rights reserved.
The purpose of our prospective study was to evaluate the long-term effect of aggressive antihyper... more The purpose of our prospective study was to evaluate the long-term effect of aggressive antihypertensive treatment on glomerular filtration rate and albuminuria in young female and male patients with insulin-dependent diabetes mellitus with diabetic nephropathy and blood pressure greater than 90 mm Hg. Eight patients received treatment with metoprolol (200-400 mg/day), hydralazine (100-200 mg/day), and furosemide (80-500 mg/day). The untreated control group consisted of eight patients matched for age (mean 32 years), diabetes duration (mean 17 years), and sex (two female and six male patients). All patients except one had diabetic retinopathy. Glomerular filtration rate was measured after a single intravenous injection of 51Cr-labeled ethylenediaminetetraacetic acid. Urinary albumin concentration was determined with a radial immunodiffusion method. The investigations were performed two to four times per year in each patient. The mean observation period was 59 and 27 months in the tr...
The effects of strict metabolic control (multiple insulin injections for 1 week) on urinary album... more The effects of strict metabolic control (multiple insulin injections for 1 week) on urinary albumin excretion, glomerular filtration rate and extracellular fluid volume was evaluated in long-term Type 1 diabetic patients with (n = 9) and without (n = 10) incipient nephropathy. Investigations were carried out in poor (blood glucose 15 (interquartile range, 13-18) mmol l-1) and good metabolic control (5 (4-8) mmol l-1). In patients with incipient nephropathy glomerular filtration rate was 125 (SD 26) (poor control) vs 125 (20) ml min-1 (good control), urinary albumin excretion 60 (range 37-247) vs 60 (13-359) mg 24 h-1, fractional albumin clearance 6.1 (0.9-67.6) vs 6.7 (2.1-65.4) x 10(-6), extracellular fluid volume 13.4 (2.3) vs 14.3 (2.8) l (p less than 0.10). Apart from an increase in extracellular fluid volume during improved metabolic control (12.2 (1.6) vs 13.6 (2.5) l, p less than 0.02) all the above mentioned variables remained unchanged in the patients with normal urinary albumin excretion. In conclusion, strict metabolic control for 2-7 days has no effect on urinary albumin excretion and glomerular filtration rate in long-term Type 1 diabetic patients with or without incipient diabetic nephropathy.
BACKGROUND Carbohydrate counting and use of automated bolus calculators (ABCs) can help reduce Hb... more BACKGROUND Carbohydrate counting and use of automated bolus calculators (ABCs) can help reduce HbA1c in type 1 diabetes but only limited evidence exists in type 2 diabetes. We evaluated the efficacy of advanced carbohydrate counting (ACC) and use of an ABC compared with manual insulin bolus calculation (MC) in persons with type 2 diabetes. MATERIALS AND METHODS A 24-week open-label, randomised clinical study was conducted in 79 persons with type 2 diabetes treated with basal-bolus insulin (mean age 62.5±9.6 years, HbA1c 8.7±1.0% (72±11 mmol/mol), diabetes duration 18.7±7.6 years). Participants were randomised 1:1 into two groups: ABC group received training in ACC and use of an ABC; MC group received training in ACC and manual calculation of insulin bolus. Participants wore blinded continuous glucose monitors (CGM) for six days at baseline and at study end. Primary endpoint was change in HbA1c. RESULTS After 24 weeks HbA1c decreased 0.8% (8.8 mmol/mol) in ABC group and 0.8% (9.0 mmol/mol) in MC group with no between-group difference (P=0.96) and without increase in time in hypoglycaemic range (Sensor glucose (SG)<3.9 mmol/L). Glycaemic variability decreased significantly in both groups whereas the total insulin dose and BMI remained unchanged during the study. Treatment satisfaction increased significantly in both groups after 24 weeks. CONCLUSION ACC is an effective, low-cost tool to reduce HbA1c and glycaemic variability in persons with basal-bolus insulin treated type 2 diabetes without increase in hypoglycaemia or BMI. Similar effects were seen with use of an ABC and with use of manual bolus calculation.
Background and Aims: It is well-known that diabetes self-management is important for glycemic out... more Background and Aims: It is well-known that diabetes self-management is important for glycemic outcome, also among insulin pump users. We aimed to explore which factors were independently associated with HbA1c. Methods: Adult insulin pump users (18+) with type 1 diabetes from the Capital Region of Denmark completed an online questionnaire covering aspects of insulin pump self-management. HbA1c and demographics were collected from medical records and national registries. Backward selected linear regression models were used to investigate associations between HbA1c and each aspect of self-management, adjusted for one another, CGM/isCGM, sex, age, marital status and educational level. Results: In total, 770 individuals responded; 60% were female, median age was 49 (p25-p75: 36-60) and ranged from 18-86 years, median HbA1c was 56mmol/mol (p25-p75: 50-62) and ranged from 25-135, and 93% used bolus calculator for meal bolus and/or correction. Self-adjustment of pump settings showed the str...
We aimed to evaluate the glycemic effect and detect any predictors of improved time-in-range (TIR... more We aimed to evaluate the glycemic effect and detect any predictors of improved time-in-range (TIR) in persons with type 1 diabetes after initiating hybrid closed-loop (HCL) treatment with MiniMed 670G in a 12-month retrospective observational study. Before starting HCL-treatment, the 62 participants followed a Steno-developed training program; 7 participants (6.5%) discontinued the HCL-therapy; the remaining 55 (58% female) had an age (mean±SD) of 45.6±12.6 years and diabetes duration of 28.2±10.9 years. After 12 months' HCL-therapy, HbA1c decreased from 7.4+0.7% to 7.1+0.5%, TIR increased from 59.3±13.5% to 72±9.3%, time in 54-70 mg/dL (3.0-3.9 mmol/L) decreased from 2.4±2.0% to 1.4±1.0%, and time in 180-250 mg/dL (10.0-13.9 mmol/L) decreased from 26.4±8.3% to 20.8±5.5%, all p<0.001. Improvement in TIR was significantly associated with lower total daily insulin dose, higher amount of total carbohydrate, and more time spent in Auto Mode. Our findings support the promising results on glycemic outcomes seen with HCL treatment.
Diabetic medicine : a journal of the British Diabetic Association, 2014
ABSTRACT Individuals with diabetes struggle with depression, anxiety, distress and other psycholo... more ABSTRACT Individuals with diabetes struggle with depression, anxiety, distress and other psychological problems more often and to a greater degree than do those without a chronic illness. In addition, there is an association between psychological problems and poor diabetes outcomes, such as risk of hyperglycaemia and frequent omission of prescribed medication [1,2]. Unaddressed psychological problems among people with diabetes may therefore have serious clinical consequences. Nevertheless, healthcare professionals do not identify psychological problems in two out of three patients with diabetes [3,4].This article is protected by copyright. All rights reserved.
The purpose of our prospective study was to evaluate the long-term effect of aggressive antihyper... more The purpose of our prospective study was to evaluate the long-term effect of aggressive antihypertensive treatment on glomerular filtration rate and albuminuria in young female and male patients with insulin-dependent diabetes mellitus with diabetic nephropathy and blood pressure greater than 90 mm Hg. Eight patients received treatment with metoprolol (200-400 mg/day), hydralazine (100-200 mg/day), and furosemide (80-500 mg/day). The untreated control group consisted of eight patients matched for age (mean 32 years), diabetes duration (mean 17 years), and sex (two female and six male patients). All patients except one had diabetic retinopathy. Glomerular filtration rate was measured after a single intravenous injection of 51Cr-labeled ethylenediaminetetraacetic acid. Urinary albumin concentration was determined with a radial immunodiffusion method. The investigations were performed two to four times per year in each patient. The mean observation period was 59 and 27 months in the tr...
The effects of strict metabolic control (multiple insulin injections for 1 week) on urinary album... more The effects of strict metabolic control (multiple insulin injections for 1 week) on urinary albumin excretion, glomerular filtration rate and extracellular fluid volume was evaluated in long-term Type 1 diabetic patients with (n = 9) and without (n = 10) incipient nephropathy. Investigations were carried out in poor (blood glucose 15 (interquartile range, 13-18) mmol l-1) and good metabolic control (5 (4-8) mmol l-1). In patients with incipient nephropathy glomerular filtration rate was 125 (SD 26) (poor control) vs 125 (20) ml min-1 (good control), urinary albumin excretion 60 (range 37-247) vs 60 (13-359) mg 24 h-1, fractional albumin clearance 6.1 (0.9-67.6) vs 6.7 (2.1-65.4) x 10(-6), extracellular fluid volume 13.4 (2.3) vs 14.3 (2.8) l (p less than 0.10). Apart from an increase in extracellular fluid volume during improved metabolic control (12.2 (1.6) vs 13.6 (2.5) l, p less than 0.02) all the above mentioned variables remained unchanged in the patients with normal urinary albumin excretion. In conclusion, strict metabolic control for 2-7 days has no effect on urinary albumin excretion and glomerular filtration rate in long-term Type 1 diabetic patients with or without incipient diabetic nephropathy.
BACKGROUND Carbohydrate counting and use of automated bolus calculators (ABCs) can help reduce Hb... more BACKGROUND Carbohydrate counting and use of automated bolus calculators (ABCs) can help reduce HbA1c in type 1 diabetes but only limited evidence exists in type 2 diabetes. We evaluated the efficacy of advanced carbohydrate counting (ACC) and use of an ABC compared with manual insulin bolus calculation (MC) in persons with type 2 diabetes. MATERIALS AND METHODS A 24-week open-label, randomised clinical study was conducted in 79 persons with type 2 diabetes treated with basal-bolus insulin (mean age 62.5±9.6 years, HbA1c 8.7±1.0% (72±11 mmol/mol), diabetes duration 18.7±7.6 years). Participants were randomised 1:1 into two groups: ABC group received training in ACC and use of an ABC; MC group received training in ACC and manual calculation of insulin bolus. Participants wore blinded continuous glucose monitors (CGM) for six days at baseline and at study end. Primary endpoint was change in HbA1c. RESULTS After 24 weeks HbA1c decreased 0.8% (8.8 mmol/mol) in ABC group and 0.8% (9.0 mmol/mol) in MC group with no between-group difference (P=0.96) and without increase in time in hypoglycaemic range (Sensor glucose (SG)<3.9 mmol/L). Glycaemic variability decreased significantly in both groups whereas the total insulin dose and BMI remained unchanged during the study. Treatment satisfaction increased significantly in both groups after 24 weeks. CONCLUSION ACC is an effective, low-cost tool to reduce HbA1c and glycaemic variability in persons with basal-bolus insulin treated type 2 diabetes without increase in hypoglycaemia or BMI. Similar effects were seen with use of an ABC and with use of manual bolus calculation.
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