Glycaemic control in type 1 diabetes – effects of diabetes technology and socioeconomic status

The landmark trials DCCT/EDIC trials show how important good glycaemic control is for the prevention of late complications in type 1 diabetes (T1D). According to the American Diabetes Association (ADA) an HbA1c target value of less than 7% should be targeted throughout all age groups to reduce the risk of late complications unless safety issues for individual patients or patients groups indicate higher HbA1c goals. However, most patients have difficulties to reach this target value despite improvements in diabetes therapy options during the last years. Especially the age group between 15 and 25 years have significantly higher HbA1c levels as analysis of data of various countries show [1]. The analysis of an US database, the so-called T1D Exchange registry which contains data of more than 35000 patients with T1D, indicate that glycaemic control in adolescents and young adults seems to get even worse in the past years as from 2012 until 2018 the average HbA1c has increased, particularly in the younger age groups [2].

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Topics: Treating Diabetes, Diabetes Technology

Posted by Dr. Susanne Famulla on Nov 4, 2020 4:00:00 PM

Lipohypertrophy – New insights into an old issue?

Lipohypertrophy (LH) is a common side effect of insulin therapy in patients with diabetes mellitus. The prevalence of lipohypertrophy is high with cross-sectional studies reporting up to 64% of patients being affected, with higher numbers in type 1 diabetes. Predisposing factors for the development of lipohypertrophy include duration of insulin treatment, needle reuse frequency, BMI and incorrect injection and site rotation techniques. Particularly the latter seem to be of major importance as re-education of patients in proper injection site rotation with avoidance of LH tissue was reported to improve glycaemic control [1].

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Topics: Clinical Trials in Diabetes, Diabetes Technology

Posted by Dr. Susanne Famulla on Nov 14, 2019 5:16:00 PM

Pramlintide as adjunct therapy for the treatment of type 1 diabetes

Where are we today?

Insulin treatment for type 1 diabetes mellitus (T1D) has improved over the past decades due to advances in insulin formulations and administration techniques. Nevertheless, optimal glucose control and reaching HbA1c goals remain challenging for many patients. Consequently, the risk of subsequent micro- and macrovascular complications remains high and life expectancy is still reduced in this patient group so that there is an obvious need for improvement of current therapies or the development of new, additional treatments [1]. So what else can be done?


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Topics: Clinical Trials in Diabetes, Treating Diabetes

Posted by Dr. Susanne Famulla on Dec 19, 2018 5:12:00 PM

Vitamin D supplementation – is there a role in type 1 diabetes?

The possible ‘non-calcemic’ effects of Vitamin D in numerous diseases has become a large area of research. Historically, Vitamin D is known for its regulatory role in calcium absorption and bone metabolism but the identification of vitamin D receptor (VDR) expression in more than 30 tissues led to the possibility of pleiotropic effects of vitamin D [Diabetes Forouhi 2008]. In vitro and animal studies suggested an anti-inflammatory and immunomodulatory effect of Vitamin D [The Review of Diabetic Studies, Gregoriu 2017]. Moreover, preclinical studies uncovered a potential regulatory role of Vitamin D in insulin secretion, β-cell survival and calcium flux in pancreatic β-cells [Mitri J, Endocrinol Metab Clin North Am 2014].

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Topics: The Science behind Diabetes

Posted by Dr. Susanne Famulla on May 30, 2018 4:52:37 PM

Lipohypertrophy - The ugly side of insulin injection practice

Lipohypertrophy - Background

Lipohypertrophy (LHT) is a common side effect of long-standing insulin therapy in patients with diabetes mellitus. Lipohypertrophic lesions are characterised by a palpable tumour-like thickening of subcutaneous adipose tissue. Cross-sectional studies from different countries such as Germany, Ethiopia and Spain reported prevalences of LHT ranging between 28% to over 64% predominantly in patients with type 1 diabetes mellitus. Although the exact aetiology of LHT is unclear, factors such as duration of insulin treatment, needle reuse and frequent injection into same tissue areas due to missing or wrong injection site rotation may play an important role in the development of LHTs. In particular the latter factor, incorrect injection and rotation techniques, are widely observed in clinical daily practice. Patients with LHTs often state that insulin administration into same areas make insulin therapy easier due to easy access and/or less pain in the usually chosen injection sites. 

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Topics: Clinical Trials in Diabetes

Posted by Dr. Susanne Famulla on May 6, 2015 1:13:00 PM

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