Efficacy of automatic bolus calculator with automatic speech recognition in patients with type 1 diabetes: A randomized cross-over trial.

BACKGROUND: Patients using an insulin pump as part of their diabetes treatment need to calculate insulin bolus doses to compensate for a meal. Some patients do not modify their meal boluses according to changes in the amount and composition of food products in a meal. The lack of correct meal boluses leads to unstable, and therefore harmful, blood glucose levels. The aim of the present study was to test a system supporting bolus determination based on a voice description of a meal. METHODS: The bolus calculator developed (VoiceDiab) consists of a smartphone application and three remote servers for automatic speech recognition, text analysis, and insulin dosage calculation. Forty-four people with type 1 diabetes (T1D) treated with continuous subcutaneous insulin infusion finished the randomized cross-over study. Patients were randomly allocated to the group in which the VoiceDiab system supported bolus calculation or to an unsupported group, in which patients or their caregivers calculated boluses. After a 14-day washout period, patients from the supported group were switched to the unsupported group, whereas those in the unsupported group were switched to the supported group. RESULTS: There was a significant difference between the supported and unsupported groups in the percentage of patients with 2-h postprandial glycemia within the 70-180 mg/dL range (58.6% vs 46.6%, respectively; P = 0.031). CONCLUSIONS: The VoiceDiab system improves postprandial glucose control without increasing the time in hyperglycemia or hypoglycemia. Therefore, it may be useful in the treatment of patients with diabetes on intensive insulin therapy.

The First Use of Bolus Calculator With Speech Analyzer.

BACKGROUND: The insulin therapy in type 1 diabetes involves a wide array of restrictions in patients and their families. One of those is a difficulty in estimation of the insulin dose programmed for each meal. The purpose of the study is an assessment of functionalities related to the expert system VoiceDiab-a calculator of meal boluses. METHODS: The sample group composed of 54 patients, aged 3-52, all suffering from type 1 diabetes, treated with the insulin pump, taking part in the clinics RCT (for adults and a pediatrician), with a randomized allocation to a surveyed group and cross-over. The research methodology was based upon questionnaires and open-ended questions. RESULTS: 40% of respondents recognized the application's usefulness as high (18 of 47), giving it 10 points, and easy to use (70%). Disadvantages of this app comprised lack of some products in the application database (n = 23), troubles with the mobile range ( n = 4), and no option of a manual data input for processing purposes (n = 23). Advantages, that have been mentioned the most frequently included facilitation of measurements (n = 7), enhanced life quality of the patient (n = 8), and a guarantee of prompt and thorough calculations (n = 22). Of the surveyed individuals, 50% reached their diet, while 100% gave a top grade to the application, claiming it had contributed to a more efficient metabolic control. CONCLUSION: The pilot scheme of the expert system VoiceDiab has potential to become an application, facilitating dosing of the meal insulin and improving the comfort and safety of insulin administering. However, it needs to be modified, as mentioned by the users who have tested the system.

A Randomized Controlled Study of an Insulin Dosing Application That Uses Recognition and Meal Bolus Estimations.

BACKGROUND: Throughout the insulin pump therapy, decisions of prandial boluses programming are taken by patients individually a few times every day, and, moreover, this complex process requires numerical skills and knowledge in nutrition components estimation. The aim of the study was to determine the impact of the expert system, supporting the patient's decision on meal bolus programming, on the time in range of diurnal glucose excursion in patients treated with continuous subcutaneous insulin infusion (CSII). METHODS: The crossover, randomized study included 12 adults, aged 19 to 53, with type 1 diabetes mellitus, duration ranging from 7 to 30 years. Patients were educated in complex food counting, including carbohydrate units (CU) and fat-protein units (FPU). Subsequently, they were randomly allocated to the experimental group (A), which used the expert software named VoiceDiab, and the control group (B), using a manual method of meal-bolus estimation. RESULTS: It was found that 66.7% of patients within the A group statistically reported a relevant increase in the percentage (%) of sensor glucose (SG) in range (TIR 70-180 mg/dl), compared to the B group. TIR (median) reached 53.9% in the experimental group (A) versus 44% within the control group (B), P < .05. The average difference in the number of hypoglycemia episodes was not statistically significant (-0.2%, SD 11.6%, P = .93). The daily insulin requirement in both groups was comparable-the average difference in total daily insulin dose between two groups was 0.26 (SD 7.06 IU, P = .9). CONCLUSION: The expert system in meal insulin dosing allows improvement in glucose control without increasing the rates of hypoglycemia or the insulin requirement.

Good practice recommendations on paediatric training programmes for health care professionals in the EU.

Part of the SWEET Project: EU (European Union), Better Control in Paediatric and Adolescent Diabetes: Working to Create Centres of Reference, was specifically to examine the training of health care professionals (HCPs) across the EU. Several types of information were collected during 2009, and these included a literature search, workshops of the SWEET members, examination of the data collected by the Hvidøre Study Group and the Diabetes Attitudes, Wishes, and Needs (DAWN) Youth initiative, and a questionnaire distributed to SWEET members and professional colleagues who cared for children and young people (CYP) with diabetes. It was clear from the information collected that there was no European or global consensus either on a curriculum for the training of the paediatric diabetes multidisciplinary team (MDT) or individual professions in paediatric diabetes. A minority of countries had well-established training but, for the majority, there was little standardisation or accreditation. Moreover, most countries did not have available courses for training the diabetes MDT and training was not mandatory. Of the courses that were available more were accredited for doctors and nurses but fewer for the other professions. As a consequence, the majority of HCP posts in paediatric diabetes do not demand prior experience in the specialty. Standardised accredited training and continuous professional development (CPD) opportunities are severely limited. The SWEET Project supports a standardised, accredited approach to training and CPD of the MDT and for individual professions. As a consequence, a curriculum for the training of the MDT was developed, and this is now ready for implementation.

The effect of bolus and food calculator Diabetics on glucose variability in children with type 1 diabetes treated with insulin pump: the results of RCT.

BACKGROUND: The calculation of prandial insulin dose is a complex process in which many factors should be considered. High glucose variability during the day, arising from difficulties which include errors made in food counting and inappropriate insulin adjustments, influence hemoglobin A1c levels. During this study, in children using insulin pumps to manage type 1 diabetes, we compared 2-h postprandial blood glucose levels (BGL) and glucose variability when calorie tables and mental calculation were used, to when Diabetics software was used. METHODS: This 3-month, randomized, open-label study involved 48 children aged 1-18 yr. Patients were educated in food counting system used in the Warsaw Pump Therapy School (WPTS) where the carbohydrate unit (CU) and the fat-protein unit (FPU) are taken into account. The children were randomly allocated to an experimental group (A) who used diabetics software and a control group (B) who used caloric tables and mental calculations. RESULTS: We observed significant differences (p < 0.05) between the groups in 2-h postprandial BGL's and the glucose variability parameters mean(T), SD(T), % BGL in the target range 70-180 mg/dL, and high blood glucose index HBGI. We did not observe statistically significant differences in hypoglycemic events or low blood glucose index (LBGI) nor in HbA1c or insulin requirements. CONCLUSIONS: The use of the Diabetics software by patients educated at the WPTS is safe and reduces 2-h postprandial BGL's and glucose variability.

[Prospective Polish insulin pump therapy programme in children with type 1 diabetes]. / Ogolnopolski program leczenia dzieci z cukrzycca typu 1 przy zastosowaniu pomp insulinowych.

BACKGROUND: Continuous subcutaneous insulin infusion (CSII) in pre-pubertal children with type 1 diabetes (T1DM) has been introduced in Polish Diabetic Centres since 2000. Due to the lack of education and treatment standards for CSII we have initiated the National Prospective Pump Programme (OPPLP) in the 16 Diabetic Centres in Poland. AIM: The aim of this programme was to prepare the paediatric diabetic centres for implementation of insulin pump treatment in children and assessment of the effectiveness of this treatment as compared to multiple daily injections. METHOD: The Programme has been conducted in 16 centres in two stages - the first from 2003 to2005 - included the education of Health Care Providers (HCP), and the second clinical data collection of patients and evaluation of treatment effectiveness on the basis of estimation of HbA1c in the Central Laboratory. Electronic net-work system - enCapture with central server was used. RESULTS: The HCP' education as well as the data collection system were assessed positively. CONCLUSION: The OPPLP can be the basis of a National Register of children with T1DM. The Register could be used also for cost effectiveness assessment of the patients with T1DM treatment.

[Type 1 diabetes-associated autoimmune diseases: screening, diagnostic principles and management]. / Choroby autoimmunologiczne w cukrzycy typu 1 - badania przesiewowe, diagnostyka I leczenie.

Type 1 diabetes (T1DM) is often associated with autoimmune diseases such as: autoimmune thyroid disease (ATD), celiac disease (CD), autoimmune gastritis (AIG), pernicious anemia (PA) and vitiligo. Autoimmune thyroid disease is the most prevalent endocrinopathy among diabetic patients. Hypothyroidism, celiac disease or Addison's disease in patients with type 1 diabetes may deteriorate glycemic control and can lead to an increased rate of hypoglycemia. Autoimmune gastritis, pernicious anemia and celiac disease can cause malabsorption and anemia which additionally impair the quality of life in patients with T1DM. The presence of organ-specific autoantibodies can be used to screen patients who are at higher risk of developing autoimmune diseases. Such procedure can help to identify patients, who need to undergo treatment in order to decrease the rate of possible complications in the future. In this clinical review we present current opinions in terms of diagnosis, management and screening in the most common type 1 diabetes-associated autoimmune diseases.

[Quality of treatment in children with type 1 diabetes based on the Polish Prospective Pump Programme]. / Jakosc leczenia dzieci z cukrzyca typu 1 w oparciu o ogolnopolski prospektywny program leczenia przy uzyciu pomp insulinowych.

BACKGROUND: In pediatric patients with type 1 diabetes mellitus, the value of HbA1c is a predictor of the risk of late systemic complications in adulthood. In the last years significant changes in the method of treatment in pre-pubertal children with T1DM have taken place. However, there is lack of precise data concerning the results of metabolic control of this group of patients. THE AIM: was to assess the impact of the Polish Prospective Insulin Pump Programme (OPPLP) on the quality of metabolic control in prepubertal children with T1DM. The OPPLP included also education for diabetological staff (HPC) from the Polish Diabetic Centres as well as standardization of continuous subcutaneous insulin infusion (CSII) implementation procedures. MATERIAL AND METHODS: Population studies were conducted in the years: 2005-2008. 920 patients were enrolled at age from 1.2 to 14.6 years (median 8.5 years). 71.75 % of patients were in pre-pubertal age. 734 patients received CSII therapy. The cross sectional, prospective study, conducted according to the protocol of the OPPLP with clinical data collection from 2005 to 2008. We analyzed the data obtained during 1657 visits and assessed 1657 blood samples for HbA1c value in the Central Laboratory. The clinical data were recorded in the electronic net-database. RESULTS: In whole group the median of HbA1c was 7.46 % (min. 5% - max. 12.1%); 60.1% patients has HbA1c below 7.5%. The quality of treatment was comparable among the centres: med. HbA1c ranged from min. 6.5% to max. 8.0%. During the period from 2005 to 2008 effective results were obtained in glycemic control: med. HbA1c: 2005 - 7.6%, 2006 - 7.2%, 2007 - 7.0% and 2008 - 7.5%. Slightly higher HbA1c was observed in children with longer duration of diabetes (r=0.17, p<0.005). CONCLUSIONS: The OPPLP, including HCP education, enabled optimalization of metabolic control in the prepubertal children switched pump therapy. Moreover, the programme brought about an even level of treatment between the Polish Diabetic Centres irrespective of their size. It is important to continue the programme and to develop a country level register of children with T1DM.

[The impact of dysglycemia on brain function in children with type 1 diabetes mellitus]. / Wplyw nieprawidlowych glikemii na osrodkowy uklad nerwowy dzieci z cukrzyca typu 1.

Diabetes is a metabolic disease defined by increased blood glucose level above the references value. Insulin therapy is mandatory for all patients with type 1 diabetes melitus (T1DM). However, the insulin therapy is also the potential factor of hyperglycemia as well as hypoglycemia condition called dysglycemia. Moreover, T1DM leads to late organ changes such as retinopathy and nephropathy primarily due to diabetic angiopathy. Neuropathy is one of diabetic complications which can occur from the beginning of the disease. The pathogenesis of diabetic neuropathy, a structural and morphological abnormality, has been well described. In adults with T1DM diagnosed in childhood more frequent incidence of epilepsy, abnormal EEG and impaired cognitive functions were diagnosed. In children with type I diabetes further in depth studies are needed concerning the structural and functional damage of the central nervous system (cns). Research studies carried out in children have shown that the metabolic and morphological cns changes are the result of both hypo- and hyperglycemia.

Sensor augmented pump therapy from onset of type 1 diabetes: late follow-up results of the Pediatric Onset Study.

AIM: To evaluate the metabolic control and ß-cell function 1 yr after the end of the European multicentre randomized Pediatric Onset Study. METHODS: Of 154 study patients, 131 were re-examined 24 months after type 1 diabetes onset (49.6% boys, age at onset 8.9 ± 4.3 yrs). Of which, 62 patients belonged to the primary group of the main study applying a sensor-augmented pump system during the first yr and 69 patients to the control group performing conventional insulin pump therapy with self-monitoring blood glucose. HbA1c, fasting blood glucose, and C-peptide were centrally measured (Clinical Trail Registration Number: ISRCTN05450731). RESULTS: At 24 months, i.e., 1 yr after the end of the interventional study, 52.4% of the patients used the sensor-augmented pump system, 46.0% conventional pump, and 1.6% multiple daily injections. HbA1c was 7.6 ± 1.3% in the primary and 7.7 ± 1.2% in the control group (p = 0.493). Frequent sensor use during the first yr was associated with statistically insignificant lowering of the HbA1c at 24 months (p = 0.236) as compared with irregular or no sensor use (7.4 ± 1.0% vs. 7.7 ± 1.3%). Although fasting C-peptide was not clearly different between the primary and control group (0.13 ± 0.17 vs. 0.09 ± 0.10 nmol/L, p = 0.121), patients with frequent sensor use had significantly less C-peptide loss within 24 months (C-peptide reduction 0.02 ± 0.18 vs. 0.07 ± 0.11 nmol/L, p = 0.046). There was no difference between the groups regarding daily insulin requirements. CONCLUSION: Sensor-augmented pump therapy from onset of diabetes may lead to better long-term glycemic control and help to preserve endogenous ß-cell function, if patients comply with frequent use of continuous glucose monitoring.

[TNF-α and soluble receptor TNF-α type 1 in children with diabetes mellitus type 1]. / TNF-α i rozpuszczalna forma receptora TNF-α typu 1 u dzieci z cukrzyca typu 1

INTRODUCTION: TNF-α, and its soluble form sTNFR1, as proinflammatory hormone plays a great role in pathogenesis of auto immunological diseases, insulin resistance, both carbohydrates and fat metabolism and development of late complications in type 1 diabetes mellitus (DMT1) patients. AIM OF THE STUDY: To asses TNF-α and sTNFR1 levels in children with DMT1 and to analyze the correlation with anthropometric parameters, metabolic control and the influence of the kind of insulin therapy. MATERIAL AND METHODS: 67 patients, aged from 3.71 to 14.81 years (mean±SD: 10.33±2.21). All the children were prepubertal (T ≰2), suffering for DMT1, without any coexisting diseases. The duration of the disease varied from 1.83 to 9 years (mean±SD: 4,0±1,6), and the age at diagnosis oscillated between 1.84 to 10.81 years. All the patients were divided into subgroups according to the kind of therapy which was not changed in the last 6 months. 15 agematched healthy children were included into the study. There were no statistically significant differences between the groups as to the metabolic control, age, weight, height and BMI. RESULTS: TNF-α levels in the study group ranged from 0.30 to 14.20 ng/ml (mean±1.62 ± 0.41 pg/ml) and were lower than in the control group: from 0.20 to 19.00 pg/ml (mean±SD: 1.67±1.41 pg/ml) (p >0.05). The highest TNF-α levels were observed in the insulin pump group, lower in the multiple insulin injection group and in the conventional insulin therapy group. The sTNFR1 in the study group ranged from 707.00 to 1646.00 pg/ml (mean±SD: 1028.18±181.24 pg/ml) and was higher than in the control group: 613.0 to 1310.00 pg/ml (mean±SD: 978.00±203.03 pg/ml) (p >0.05). The highest sTNFR1 levels were observed in the insulin pump group, lower in the multiple insulin injection group and the lowest in the conventional insulin therapy group. CONCLUSIONS: TNF-α levels are lower in DMT1 children, correlate only with height and do not depend on the kind of insulin therapy. sTNFR1 levels are higher in children with DMT1, correlate with anthropometric parameters and do not depend on the kind of insulin therapy.

Does the fat-protein meal increase postprandial glucose level in type 1 diabetes patients on insulin pump: the conclusion of a randomized study.

BACKGROUND: Our study examines the hypothesis that in addition to sugar starch-type diet, a fat-protein meal elevates postprandial glycemia as well, and it should be included in calculated prandial insulin dose accordingly. The goal was to determine the impact of the inclusion of fat-protein nutrients in the general algorithm for the mealtime insulin dose calculator on 6-h postprandial glycemia. SUBJECTS AND METHODS: Of 26 screened type 1 diabetes patients using an insulin pump, 24 were randomly assigned to an experimental Group A and to a control Group B. Group A received dual-wave insulin boluses for their pizza dinner, consisting of 45 g/180 kcal of carbohydrates and 400 kcal from fat-protein where the insulin dose was calculated using the following algorithm: n Carbohydrate Units×ICR+n Fat-Protein Units×ICR/6 h (standard+extended insulin boluses), where ICR represents the insulin-to-carbohydrate ratio. For the control Group B, the algorithm used was n Carbohydrate Units×ICR. The glucose, C-peptide, and glucagon concentrations were evaluated before the meal and at 30, 60, 120, 240, and 360 min postprandial. RESULTS: There were no statistically significant differences involving patients' metabolic control, C-peptide, glucagon secretion, or duration of diabetes between Group A and B. In Group A the significant glucose increment occurred at 120-360 min, with its maximum at 240 min: 60.2 versus -3.0 mg/dL (P=0.04), respectively. There were no significant differences in glucagon and C-peptide concentrations postprandial. CONCLUSIONS: A mixed meal effectively elevates postprandial glycemia after 4-6 h. Dual-wave insulin bolus, in which insulin is calculated for both the carbohydrates and fat proteins, is effective in controlling postprandial glycemia.

Long-acting insulin analogue detemir compared with NPH insulin in type 1 diabetes: a systematic review and meta-analysis.

INTRODUCTION: Although numerous studies showed an improvement in glycemic control in type 1 diabetic patients treated with long-acting insulin analogue detemir compared with Neutral Protamine Hagedorn (NPH) insulin, the beneficial effects of insulin detemir has not been confirmed by all investigators. OBJECTIVES: The aim of the study was to compare the effect of treatment with detemir insulin vs. NPH insulin on metabolic control, hypoglycemic episodes, and body weight gain in patients with type 1 diabetes by means of a systematic review and a meta-analysis. METHODS: The following electronic databases were searched up to November 2010: MEDLINE, EMBASE, and the Cochrane Library. Additional references were obtained from the reviewed articles. Only randomized controlled trials of at least 12-week duration with basal-bolus regimen therapies using detemir insulin vs. NPH insulin were included. RESULTS: The analysis included 10 studies involving 3825 patients with type 1 diabetes. Combined data from all trials showed a statistically significant reduction in hemoglobin A1c (HbA1c) (weighted mean difference: [WMD] -0.073, 95% CI -0.135 to -0.011, P = 0.021) in the detemir group compared with the NPH group. There was also a significant reduction of fasting plasma glucose (FPG) (WMD - 0.977 mmol/l, 95% CI -1.395 to -0.558, P <0.001), all-day hypoglycemic episodes (relative risk [RR] 0.978, 95% CI 0.961-0.996), severe hypoglycemic episodes (RR 0.665, 95% CI 0.547-0.810), nocturnal hypoglycemic episodes (RR 0.877, 95% CI 0.816-0.942), as well as smaller body weight gain (WMD -0.779 kg, 95% CI -0.992 to -0.567) in patients using detemir insulin compared with those using NPH insulin. CONCLUSIONS: Basal-bolus treatment with insulin detemir, as compared with NPH insulin, provided a minor benefit in terms of the HbA1c value and significantly reduced FPG in type 1 diabetic patients. Treatment with detemir insulin was also superior to NPH insulin in reducing the risk of all-day, nocturnal, and severe hypoglycemic episodes, with the added benefit of reduced weight gain.

[Insulin resistance in children]. / Insulinoopornosc u dzieci.

Insulin resistance is characterized by decreased tissue sensitivity to insulin. The hallmark of insulin resistance is decreased tissue glucose uptake despite normal or elevated insulin concentration. There has been an upward trend in the incidence of insulin resistance in developed countries, although in pediatric population it is difficult to assess. Both genetic and environmental factors play an important role in the etiology of insulin resistance, namely increased diet caloricity and decreased physical activity. Gradually, this leads to adipose tissue build-up. The role of visceral adipose tissue is of particular importance, mainly due to its significant endocrine activity, leading to adverse metabolic effects. The most important consequences of insulin resistance in children include increased incidence of type 2 diabetes, atherogenic dyslipidemia and arterial hypertension, which lead to increased cardiovascular risk. Children with insulin resistance can develop nonalcoholic steatohepatitis and sleep apnea syndrome. In case of female pediatric patients a higher incidence of polycystic ovary syndrome (PCOS) is observed. Furthermore, the authors reviewed opinions on risk factors for insulin resistance, as well as direct and indirect insulin resistance assessment methods. The article presents the principles of primary and secondary prevention of insulin resistance in children, with particular allowance for dietary recommendations and recommendations to increase physical activity, and, in selected cases, current guidelines on pharmacological treatment.

[Assessment of physical fitness in children and teenagers with type 1 diabetes]. / Ocena sprawnosci fizycznej dzieci i mlodziezy chorej na cukrzyce.

INTRODUCTION: Physical activity is regarded as one of the four basic factors influencing the concentration of glucose in the blood of diabetic patients. Despite this, concerns about hypoglycaemia and exposure of chronically ill children to excessive fatigue mean that their physical activity is frequently inadequate. Until now, physical endurance of diabetes mellitus patients has been assessed more frequently than their physical fitness. AIM OF THE STUDY: An attempt to assess physical fitness of a group of children and teenagers suffering from type 1 diabetes (DM1). MATERIALS AND METHODS: Physical fitness was assessed in 40 children with DM1: mean age for girls (n=20) was 10.58±2.63 years old (7.03-16.11), and for boys (n=20) 12.25±2.62 years old (7.23-16.52). Physical fitness was assessed on the basis of the result of 8 out of 9 tests from the European test of physical fitness (Eurofit) set. The results of individual trials were expressed as percentile measurements read against percentile grids designed by Stupnicki, Przeweda and Milde. RESULTS: When compared against healthy peers, girls with DM1 achieved significantly lower scores in balance maintenance, long jump and hand grip tests. Boys with DM1 were fitter than girls with DM1 in tests assessing balance, hand grip and agility, yet they were less fit than their healthy peers in balance and hand grip tests. CONCLUSIONS: Physical fitness of children and teenagers suffering from DM1 differs between the sexes. In boys it was assessed as being close to that of their healthy peers, while in girls it was assessed as being inadequate. It is likely that the girls' poorer physical fitness results from both their state of health and environmental conditions, which were not defined in this study. It seems that diabetic girls should be especially encouraged to take part in regular physical exercise, since it is regarded as one of the key components of correct therapeutic procedures in diabetes.

A review of the "bolus guide," a new insulin bolus dosing support tool based on selection of carbohydrate ranges.

In this issue of Journal of Diabetes Science and Technology, Shapira and colleagues present new concepts of carbohydrate load estimation in intensive insulin therapy. By using a mathematical model, they attempt to establish how accurately carbohydrate food content should be maintained in order to keep postprandial blood glucose levels in the recommended range. Their mathematical formula, the "bolus guide" (BG), is verified by simulating prandial insulin dosing and responding to proper blood glucose levels. Different variants such as insulin sensitivity factor, insulin-to-carbohydrate ratio, and target blood glucose were taken into this formula in establishing the calculated proper insulin dose. The new approach presented here estimates the carbohydrate content by rearranging the carbohydrate load instead of the simple point estimation that the current bolus calculators (BCs) use. Computerized estimations show that the BG directives, as compared to a BC, result in more glucose levels above 200 mg/dl and thus indicate less hypoglycemia readings.

Bolus calculator with nutrition database software, a new concept of prandial insulin programming for pump users.

Bolus calculators are effective tools in controlling blood glucose levels in patients treated with insulin. Diabetics is a new software devised for patients to facilitate and improve self-managing for prandial insulin dosing and for better controlling food intake. This device contains two integral parts: a nutrition database and a bolus calculator. The algorithm is based on a formula in which carbohydrate (CHO) and either fat and/or protein (FP) products are engulfed in insulin. The insulin dose setting is programmed individually for CHO in a normal bolus (N-W) and for FP in a square-wave bolus (S-W). The device calculates the dose of insulin for N-W or S-W, suggests the optimal kind of bolus, and indicates the timing in hours for an S-W bolus. In addition, this calculator, which contains a nutrition database and insulin dosing software, helps determine the correct type of necessary boluses for selected foods.

Equal metabolic control but superior caregiver treatment satisfaction with insulin aspart in preschool children.

BACKGROUND: The aim of this study was to compare the metabolic outcomes, safety, and caregiver treatment satisfaction of basal-bolus multiple daily injection (MDI) therapy with mealtime insulin aspart (IAsp) or human insulin (HI) (both with basal NPH insulin), or of continuous subcutaneous infusion (CSII) with IAsp in preschool-age children with type 1 diabetes mellitus. METHODS: After a 3-week HI MDI run-in, 61 children <7 years old were randomized to IAsp MDI or HI MDI or allocated to IAsp CSII for 26 weeks. Efficacy measures were glycated hemoglobin (A1C) and overall metabolic control at study end point. Safety evaluation included hypoglycemia and adverse events. Caregiver treatment satisfaction was evaluated using a World Health Organization questionnaire with 7-point scale answers. RESULTS: A1C level and overall metabolic control remained unchanged in all groups. Minor hypoglycemic episodes were equivalent between groups; few major hypoglycemic events occurred. Caregivers of children receiving IAsp CSII documented a greater increase in treatment satisfaction total scores (P = 0.04 vs. HI MDI and IAsp MDI group) and expressed satisfaction with the frequency of hypoglycemic events. CONCLUSIONS: After 26 weeks of treatment with IAsp CSII, IAsp MDI, or HI MDI, all metabolic control parameters remained unchanged and equivalent. Caregiver treatment satisfaction was higher in parents who chose IAsp CSII pump therapy for their children.

[Leptin and soluble leptin receptor in children with type 1 diabetes mellitus]. / Leptyna i rozpuszczalna forma receptora leptyny u dzieci z cukrzyca typu 1.

INTRODUCTION: Leptin and soluble form of leptin receptor play a great role in both carbohydrate and fat metabolism which is very important in diabetes mellitus type (DMT1) patients. AIM OF THE STUDY: To asses leptin and soluble leptin receptor levels in children with DMT1 and to analyze correlation with anthropometric parameters, metabolic control and the influence of various kinds of insulin therapy. MATERIAL AND METHODS: 67 patients, aged from 3.71 to 14.81 years, mean ± SD: 10.33 ± 2.21) and 15 age-matched healthy children were included into the study. All children were prepubertal (T <2), suffering for DMT1 for more than two years, without any coexisting diseases. All patients were divided into subgroups according to the kind of therapy. There were no statistically significant differentials between groups as to the metabolic control, age, weight, height and BMI. RESULTS: Leptin levels in the study group range from 1.27 to 59.90 ng/ml (mean ± SD: 11.34 ± 9.42 ng/ml) and were higher than in control group: from 1.46 to 26, ng/ml (mean ± SD: 8.23 ± 7.62 ng/ml) (p >0.05). The highest leptin levels were observed in multiple insulin injection group, lower in pump group and the lowest conventional insulin therapy group. Soluble leptin receptor levels in study group range from 30.50 to 101.00 ng/ml (mean ± SD: 48.65 ± 13.26 ng/ ml) and were significantly higher than in control group: 27.50 to 61.00 ng/ml (mean ± SD: 39.37 ± 9.23 ng/ml) (p <0.01). The highest soluble leptin receptor levels were observed in the multiple insulin injection group, lower in pump group and the lowest conventional insulin therapy group. CONCLUSIONS: leptin levels are higher in DMT1 children, correlate with anthropometrics parameters, age, age at the beginning of diabetes and depend on the kind of insulin therapy. Soluble leptin receptor levels are significantly higher in children with DMT1, correlate with anthropometrics parameters, metabolic control, age, age at the beginning of diabetes, duration of diabetes and depend on the kind of insulin therapy.