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Glucagon-like peptide-1 receptor agonists as a possible intervention to delay the onset of type 1 diabetes:A new horizon

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World Journal of Diabetes 2024年第2期15卷 133-136页

作者： Mahmoud Nassar Ajay Chaudhuri Husam Ghanim Paresh Dandona Department of Internal Medicine Division of EndocrinologyDiabetes and MetabolismJacobs School of Medicine and Biomedical SciencesUniversity of BuffaloBuffaloNY 14221United States

Type 1 diabetes(T1D)is a chronic autoimmune condition that destroys insulinproducing beta cells in the pancreas,leading to insulin deficiency and hyperglycemia.The management of T1D primarily focuses on exogenous insulin replacement to control blood glucose levels.However,this approach does not address the underlying autoimmune process or prevent the progressive loss of beta cells.Recent research has explored the potential of glucagon-like peptide-1 receptor agonists(GLP-1RAs)as a novel intervention to modify the disease course and delay the onset of T1D.GLP-1RAs are medications initially developed for treating type 2 diabetes.They exert their effects by enhancing glucose-dependent insulin secretion,suppressing glucagon secretion,and slowing gastric emptying.Emerging evidence suggests that GLP-1RAs may also benefit the treatment of newly diagnosed patients with T1D.This article aims to highlight the potential of GLP-1RAs as an intervention to delay the onset of T1D,possibly through their potential immunomodulatory and anti-inflammatory effects and preservation of beta-cells.This article aims to explore the potential of shifting the paradigm of T1D management from reactive insulin replacement to proactive disease modification,which should open new avenues for preventing and treating T1D,improving the quality of life and long-term outcomes for individuals at risk of T1D.

关键词： Type 1 diabetes Semaglutide Glucagon-like peptide-1 receptor agonists insulin therapy Autoimmune response Blood glucose monitoring Β-cell preservation Early screening Teplizumab Randomized controlled trials

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Autologous hematopoietic stem cell transplantation and conventional insulin therapy in the treatment of children with newly diagnosed type I diabetes： long term follow-up

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Chinese Medical Journal 2014年第14期127卷 2618-2622页

作者： Gu Yi Gong Chunxiu Peng Xiaoxia Wei Liya Su Chang Qin Miao Wang Xi'ou Department of Endocrinology Genetics and Metabolism Beijing Children's Hospital Capital Medical University Beijing 100045 China Center of Clinical Epidemiology and Evidence Based Medicine Beijing Children's Hospital Capital Medical University Beijing 100045 China

Background It has been indicated that autologous hematopoietic stem cell transplantation （AHST） is a promising treatment to adults with type 1 diabetes, however, the application of AHST therapy to children with type 1 diabetes still needs more data. The aim of this study was to assess the clinical effect of immune intervention combined with AHST and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes. Methods This 1：2 matched case-control study was comprised of 42 children who were newly diagnosed with type 1 diabetes in the Department of Endocrinology, Beijing Children＇s Hospital from 2009-2010. The case group included 14 patients, who were treated with AHST within the first 3 months after being diagnosed with diabetes at request of their parents during 2009-2010. The control group included 28 patients with newly diagnosed type 1 diabetes at the same period of hospitalization. We compared the baseline and follow-up data of them, including ketoacidosis onset, clinical variables （glycosylated hemoglobin （HbAlc）, insulin dosage and serum C-peptide）. Results The clinical characteristics of the patients was comparable between the case group and the control group. At 6-12 months （（10.7±4.2） months） after AHST treatment, we found 11 patients in the case group did not stop the insulin therapy, three cases stopped insulin treatment for 2, 3 and 11 months, respectively. No diabetic ketoacidosis （DKA） occurred after transplantation in all the patients in the case group. HbAlc in the control group was significant lower than that in the case group （P 〈0.01）, while the insulin dosage and serum C-peptide were not significant different between the two groups （P 〉0.05）. In order to eliminate the honeymoon effect, we performed final follow-up at the 3-5 years （（4.2±1.8） years） after AHST treatment, and found that HbAlc in the control group was still lower than that in the case group （P 〈0.01）; however, the insulin dosage and serum C-peptide were not significantly different between the tw

关键词： autologous hematopoietic stem cell transplantation insulin therapy children type 1 diabetes

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Assessment of insulin therapy in 281 Children and Adolescents with Type 1 Diabetes in Senegal

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Open Journal of Pediatrics 2022年第1期12卷 283-292页

作者： Djibril Boiro Amadou Sow Aliou Abdoulaye Ndongo Idrissa Basse Lamine Thiam Ndiogou Seck Cheha Fatoumia Babacar Niang Modou Guéye Maïmouna Ndour Mbaye Ousmane Ndiaye Abass Ndao Hospital Dakar Senegal Aristide Le Dantec Hospital Dakar Senegal Diamniadio Children’s Hospital Dakar Senegal Ziguinchor Peace Hospital Dakar Senegal Saint Louis Regional Hospital Dakar Senegal Albert Royer Children’s Hospital Dakar Senegal

Introduction: In Senegal, with the CDIC “Changing Diabetes In children” project, insulin has been made free. The objective of this study was to evaluate the accessibility and modalities of insulin therapy in the management of type 1 diabetes. Methodology: This was a retrospective study including patients followed for type 1 diabetes (T1DM) in hospital between April 2018 and December 2020. Results: 281 patients were included. The mean age was 14.22 years. The mean age at diagnosis was 11.28 years. Ketoacidosis was the main mode of discovery of diabetes at 51.6%. Premix and rapid insulins were most commonly used at 84.7% and 82.9% respectively, most often in combination. The most commonly used treatment regimen was three injections/day in 82.5% of cases. The average daily insulin dose was 0.62 IU/Kg/dr. Of the patients, 219 (78%) were self-monitoring of blood glucose. The average number of blood glucose checks was 1.78 per day. 76 patients (27%) went days without an insulin injection and up to 7 days in 51% of cases. The main reasons were forgetfulness, therapeutic errors and stock-outs. Hypoglycaemia was observed in 14.2%. The average glycated haemoglobin was 10%. Conclusion: Despite the efforts made, there are still challenges to improve access to insulin. The reinforcement of therapeutic education on insulin therapy is essential for a better quality of life of diabetic children and adolescents.

关键词： Diabetes Children insulin therapy Senegal

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Diabetes among Muslims during Ramadan:A narrative review

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世界临床病例杂志 2023年第26期11卷 6031-6039页

作者： Rohan Kumar Ochani Asim Shaikh Simran Batra Gauri Pikale Salim Surani Internal Medicine SUNY Upstate Medical University HospitalSyracuseNY 13210United States Medicine Aga Khan UniversitySindhKarachi 74500Pakistan Internal Medicine Dow University of Health SciencesSindhKarachi 74200Pakistan Internal Medicine Chicago Medical School at Rosalind Franklin UniversityChicagoIL 60064United States Medicine and Pharmacology Texas A and M UniversityCollege StationTX 77843United States Medicine Aga Khan UniversityNairobi 00100Kenya

Fasting during the month of Ramadan is one of the five fundamental principles of Islam,and it is obligatory for healthy Muslim adults and adolescents.During the fasting month,Muslims usually have two meals a day,suhur(before dawn)and iftar(after dusk).However,diabetic patients may face difficulties when fasting,so it is important for medical staff to educate them on safe fasting practices.Prolonged strict fasting can increase the risk of hypoglycemia and diabetic ketoacidosis,but with proper knowledge,careful planning,and medication adjustment,diabetic Muslim patients can fast during Ramadan.For this review,a literature search was conducted using PubMed and Google Scholar until May 2023.Articles other than the English language were excluded.Current strategies for managing blood sugar levels during Ramadan include a combination of patient education on nutrition,regular monitoring of blood glucose,medications,and insulin therapy.insulin therapy can be continued during fasting if properly titrated to the patients’needs,and finger prick blood sugar levels should be assessed regularly.If certain symptoms such as hypoglycemia,hyperglycemia,dehydration,or acute illness occur,or blood glucose levels become too high(>300 mg/dL)or too low(insulin formulations such as pegylated insulin and medications like tirzepatide,a dual agonist of gastric-inhibitory peptideand glucagonlike-peptide 1 receptors,have shown promise in managing blood sugar levels during Ramadan.Non-insulin dependent medications like sodium-glucose-cotransporter-2 inhibitors,including the Food and Drug Administration-approved ertugliflozin,are also being used to provide additional cardiovascular benefits in patients with type 2 diabetes.

关键词： Ramadan Fasting Diabetes Complications insulin therapy Newer advances Hypoglyccemia

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insulin pumps in children-a systematic review

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World Journal of Clinical Pediatrics 2022年第6期11卷 463-484页

作者： Mohammed Al-Beltagi Nermin Kamal Saeed Adel Salah Bediwy Reem Elbeltagi Department of Pediatrics Faculty of MedicineTanta UniversityTanta 31511AlgharbiaEgypt Department of Pediatrics University Medical CenterKing Abdulla Medical CityArabian Gulf UniversityManama 26671ManamaBahrain Department of Pediatrics University Medical CenterDr.Sulaiman Al Habib Medical GroupManamaBahrainManama 26671ManamaBahrain Medical Microbiology Section Department of PathologySalmaniya Medical ComplexMinistry of HealthKingdom of BahrainManama 12ManamaBahrain Department of Microbiology Irish Royal College of SurgeonBahrainBusaiteen 15503MuharraqBahrain Department of Chest Disease Faculty of MedicineTanta UniversityTanta 31527AlghrabiaEgypt Department of Chest Disease University Medical CenterKing Abdulla Medical CityArabian Gulf UniversityDr.Sulaiman Al Habib Medical GroupManama 26671ManamaBahrain Department of Medicine The Royal College of Surgeons in Ireland-BahrainBusiateen 15503MuharraqBahrain

BACKGROUND insulin pump therapy is a real breakthrough in managing diabetes Mellitus,particularly in children. It can deliver a tiny amount of insulin and decreases the need for frequent needle injections. It also helps to maintain adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.Children are suitable candidates for pump therapy as they need a more freestyle and proper metabolic control to ensure adequate growth and development.Therefore, children and their caregivers should have proper education and training and understand the proper use of insulin pumps to achieve successful pump therapy. The pump therapy continuously improves to enhance its performance and increase its simulation of the human pancreas. Nonetheless, there is yet a long way to reach the desired goal.AIM To review discusses the history of pump development, its indications, types, proper use, special conditions that may enface the children and their families while using the pump, its general care,and its advantages and disadvantages.METHODS We conducted comprehensive literature searches of electronic databases until June 30, 2022,related to pump therapy in children and published in the English language.RESULTS We included 118 articles concerned with insulin pumps, 61 were reviews, systemic reviews, and meta-analyses, 47 were primary research studies with strong design, and ten were guidelines.CONCLUSION The insulin pump provides fewer needles and can provide very tiny insulin doses, a convenient and more flexible way to modify the needed insulin physiologically, like the human pancreas, and can offer adequate and optimal glycemic control to reduce the risk of metabolic derangements in different tissues.

关键词： insulin pump Children Diabetes mellitus Keto-acidosis Continuous glucose monitoring insulin therapy

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Effect of nicotinamide on newly diagnosed type 1 diabetic children

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Acta Pharmacologica Sinica 2006年第6期27卷 724-727页

作者： Madeeha KAMAL Abdul-JabbarAlABBASY AhoodAlMUSLEMANI Abdulbari BENER Department of Pediatrics Salmaniya Medical ComplexManamaBahrain School of Health Department of PediatricsHamad Medical CorporationDohaQatar Department of Pediatrics.Salmaniya Medical Complex ManamaBahrain Department of Medical Statistics and Epidemiology Hamad General HospitalHamad Medical CorporationDohaQatar Department of Evidence for Population Health Unit School of Epidemiology and Health SciencesUniversity of ManchesterManchester.UK

Aim:To determine whether a low dose of nicotinamide(NA)therapy for pediatricpatients with type 1 diabetes,initiated within the first 24 h of diagnosis,prolongsthe"honeymoon"period and lowers their insulin requirements.Methods:Allchildren(n=66)with newly diagnosed type 1 diabetes admitted to Salmaniya MedicalComplex between 1998 and 2000,received NA 1-2 mg/kg per day,in addition tosc insulin bid.The patients were followed for 24 months(NA group).Findings inthis group were compared with records from a similarly diagnosed control group(n=37),who were admitted to the same hospital between 1995 and 1997 and did notreceive NA treatment.The insulin dose per kg bodyweight required at baselineand at 3-monthly intervals up to 2 years after diagnosis was determined.Results:At baseline,the two groups did not differ with respect to age,ethnic background,weight,insulin dose per kg bodyweight or glucose levels on admission.However,NA group had lower insulin requirements than control group at each 3-monthinterval up to 2 years after diagnosis.Conclusion:Our study results suggest thateven low doses of oral NA given to children with newly diagnosed type 1 diabetesmay reduce insulin requirements and prolong the"honeymoon"period.

关键词： type 1 diabetes nicotinamide insulin therapy insulin dose glycated hemoglobin A

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Overcoming of insulin autoantibody mediated insulin resistance in a Chinese elderly patient with multi-organ dysfunction by withdrawal of insulin injection:a case report and review of literature

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South China Journal of Cardiology 2010年第2期11卷 112-116页

作者：金文胜许卫国尹卓娜谢志泉王小会张亚松 Department of Endocrinology and Metabolism The forth department of Gerontology Clinical Labortory Guangzhou General Hospital of PLA

insulin autoantibody (IAA) mediated insulin resistance (AMIR) is very rare in human insulin era.Here we report a typical case of a 90-year-old Chinese man who suffered from heart and renal dysfunction,lung infection and very poor blood glucose control,and meanwhile injected with higher than 200 U human insulin for his diabetes.His IAA was posi-tive with high affinity to insulin,as insulin antigen-antibody binding rate was 52% in vitro.Serum insulin level and the binding rate decreased dramatically with cession of insulin injection; also blood glucose profile restored to response to pre-vious dose insulin injection and remained during follow-up.Both the reason for the IAA formation and the solution to the AMIR were discussed in detail.

关键词： insulin autoantibody insulin resistance diabetes type 2 insulin therapy

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