Goran Petrovski

Is There a Difference in Pregnancy and Glycemic Outcome in Patients with Type 1 Diabetes on Insulin Pump with Constant or Intermittent Glucose Monitoring? A Pilot Study

BACKGROUND The aim of the study is to describe glycemic and insulin outcomes by trimester and maternal and fetal outcome in patients with type 1 diabetes using an insulin pump with constant or intermittent continuous glucose monitoring (CGM). METHODS Twenty-five women with type 1 diabetes with newly diagnosed pregnancy were treated with insulin pump therapy (Medtronic 722, Medtronic Minimed, Northridge, CA) for at least 1 year. Insulin pump and CGM (Medtronic Paradigm Real-Time) were implemented at least 3 months before conception. Patients were randomized in two groups: constant CGM group, 12 patients on insulin pump with glucose sensor, 24 h/day; and intermittent CGM group, 13 patients on insulin pump with intermittent glucose sensor, 14 days/month. The following parameters were analyzed: glycosylated hemoglobin (HbA1c), mean blood glucose, insulin requirement (in IU/kg/day), weight gain, severe hypoglycemic events, diabetic ketoacidosis, macrosomia, cesarean section, and neonatal hypoglycemia. RESULTS Both groups achieved good glucose control during their pregnancies (P<0.05): 6.78±1.3% and 6.92±0.9% at the beginning of the study compared with 6.14±0.9% (constant CGM group) and 6.23±0.6% (intermittent CGM group) at the end of the study (last HbA1c before delivery). There was no significant decrease of HbA1c between the two groups. The constant CGM group had a significantly lower A1c in the first trimester compared with the intermittent CGM group. Maternal and fetal outcome did not show a significant difference between the two groups. CONCLUSIONS Insulin pump therapy together with constant or intermittent CGM can improve diabetes control and pregnancy outcome in type 1 diabetes. The quality of the glucose profile at conception was the important factor for pregnancy outcome.

Use of real time continuous glucose monitoring and intravenous insulin in type 1 diabetic mothers to prevent respiratory distress and hypoglycaemia in infants

BackgroundPregnancy in Type 1 diabetic patients is a precarious condition, both for mother and fetus with increased the risk of prematurity and, immediately after delivery with risk of respiratory distress syndrome and hypoglycaemia in newborns. A strict control and monitoring of diabetes throughout pregnancy is important in reducing the impact of the disease on the fetus and newborn. In recent years many new technologies have been introduced to ameliorate diabetes monitoring, where the last is the Real-time Continuous Glucose Monitoring System (RT-CGMS).MethodsIn the last three years, 72 h continuous glucose monitoring system (RT-CGMS) (Medtronic, CA) was performed in 18 pregnant women with Type 1 diabetes in two moments of pregnancy: during treatment with betamethasone to prevent respiratory distress and during delivery. In both cases insulin was administered intravenous and the dose was changed on the basis of glycaemia.ResultsThe results present the use of this new technique during two topics moments of pregnancy of type 1 diabetes patients when is very important intensively to monitor diabetes and to obtain the well being of the fetus. No infant experimented hypoglycaemia or respiratory distress syndrome at the moment and in the first hours after the birth.ConclusionWe wish to stress the importance reducing glycaemia during administration of betamethasone and during labor. It is conceivable that the scarce attention paid to monitoring glucose levels in diabetic mothers during labor in gynaecological world may be due to the difficulty in glucose monitoring with the devices until now available. Hopefully, our anecdotal account may prompt improvements with RT-CGMS, and may lead to a better approach to the problem, thereby changing the prognosis of infants born to diabetic mothers.

Social Media and Diabetes: Can Facebook and Skype Improve Glucose Control in Patients With Type 1 Diabetes on Pump Therapy? One-Year Experience

Health care providers are faced with enormous numbers of patients and visits due to the increase in diabetes prevalence (1). As the world is changing, traditional health care services should be adapted for the new era of technology and Internet. Patients use Internet to seek, meet, and interact with a community of patients with similar problems; to share clinical information; and to provide and receive support (2,3). Facebook, with over 1.2 billion registered users worldwide, (4) has specific groups for disease information. The Facebook group “Diabetes Macedonia” was formed in 2008. It is a closed group that helps patients to share diabetes information and experience. The enormous growth of new users (1,430 patients, family members, and others by September 2014) led to the development of a structured platform by health …

Successful desensitization in patient with type 2 diabetes with an insulin allergy using insulin pump and glargine.

Insulin allergy is rare, but they can occur in patients starting insulin therapy. There are different insulin desensitization protocols where insulin is diluted and given to the patient in small doses for a period of couple of days. We report the case of patient with type 2 diabetes with insulin allergy, where desensitization was performed using insulin pump (Medtronic Minimed Veo) with glargine.

Effects of Hormone Replacement Therapy on Insulin Resistance in Postmenopausal Diabetic Women

BACKGROUND: Insulin resistance (IR) is closely associated with diabetes mellitus. On the other hand, increased visceral fat in menopause is also associated with IR, which makes postmenopausal diabetic women in a big risk for cardiovascular diseases. There are conflicting reports about the effects on hormone replacement therapy (HRT) on IR. AIM: The aim of the study was to investigate the effects of HRT on IR. METHODS: A total of 40 postmenopausal women with type 2 diabetes were enrolled and followed for 12 months. Half of them were assigned to take HRT, while the other half made the control group. Fasting plasma glucose (FPG) and insulinemia were measured in both groups at baseline and after 12 months. IR was represented by Homeostatic model assessment for IR (HOMA-IR). RESULTS: HRT was associated with significant decrease in HOMA-IR, FPG and insulinemia in the examined group. There was no significant reduction in FPG and no significant increase in insulinemia levels and HOMA-IR values in control group after 12 months. CONCLUSION: HRT was associated with statistically signifficant increase of insulin sensitivity. Larger clinical trials will be necessary to understand whether HRT may improve insulin resistance and glucose homeostasis in women with diabetes, especially when given shortly after entering menopause.

Impact of Facebook on Glucose Control in Type 1 Diabetes: A Three-Year Cohort Study

Background As the world is changing, traditional health care services should be adapted for the new era of technology and the Internet. One of the possible ways for communication between health care providers and patients is social media. There are several benefits of social media in health: increased interactions with others; more available and shared information; increased accessibility; social or emotional support. Objective The aim of this study was to evaluate the results of Facebook and CareLink software as a possible Internet tool to improve diabetes control in type 1 diabetes patients using a sensor augmented pump. Methods A total of 67 adolescents with type 1 diabetes and in the age range of 14-23 years were randomized in 2 groups: (1) Traditional group and (2) Internet group. In the traditional group, 34 patients were treated using standard medical protocol with regular clinic visits, where data were uploaded at the clinic and interventions (pump settings-basal bolus insulin and education) were delivered to the patient. In the Internet group, 33 patients were treated using Facebook and CareLink software (Medtronic Diabetes) on a monthly basis, where the data were uploaded by the patient at home and interventions (same as traditional group) were delivered via Facebook (written reports and chats). Both the traditional and Internet group had regular visits every 3 months with standard medical protocol. Glycosylated hemoglobin (HbA1c) was obtained before and every 3 months during the study for a 3-year-period. Results The improvement in glucose control was found in both groups: 7.9% (SD 1.4) [62.8 mmol/mol (SD 12.9)] to 6.9% (SD 1.2) [51.9 mmol/mol (SD 10.8)] in the traditional group, and 7.8% (SD 1.8) [61.7 mmol/mol (SD 17.2)] to 6.7% (SD 1.8) [49.7 mmol/mol (SD 17.3)] in the Internet group). Significant improvement of HbA1c (P<.05) was found in favor of the Internet group. Conclusions Social media such as Facebook as a tool can assist in standard medical care to improve glucose control in a long term period in adolescents with type 1 diabetes using insulin pump therapy.

Effectiveness of insulin glargine in type 2 diabetes mellitus patients failing glycaemic control with premixed insulin: Adriatic countries data meta-analysis

AimsType 2 diabetes mellitus (T2DM) is a progressive disease, often requiring exogenous insulin therapy and treatment intensification. Despite new therapies, most patients do not reach the recommended HbA1c targets, among them a significant proportion of patients on premixed insulins. The aim was to summarize published data in Adriatic countries on effectiveness of insulin glargine based therapy in type 2 diabetic patients suboptimally controlled on premix insulin.MethodsA meta-analysis was carried out in major medical databases up to April 2014, focusing on Adriatic region. We searched observational studies with duration of at least 6 months, evaluating effectiveness and safety of insulin glargine (IGlar), in combination with OAD or bolus insulin in patients with T2 failing premixed insulin therapy. Outcomes included values of HbA1c, fasting blood glucose and two hours post-prandial glucose concentration as well as changes in body mass index after at least 6 months of study duration.ResultsThree prospective, observational, multicentric trials (698 patients in total) were included. The basal bolus regimen with glargine significantly reduced HbA1c (Mean Difference, MD=2.27, CI [1.76, 2.78]), fasting glucose (MD=5.15, CI [4.86, 5.44]) and 2-hours postprandial glucose concentration (MD=6.94, CI [6.53, 7.34]). No significant changes were found in BMI after switching from premixes to IGlar based treatment.ConclusionInsulin glargine based therapy following premix failure is efficacious and safe option of type 2 diabetes treatment intensification.

Glucose control during kidney transplantation in type 1 diabetes patient on sensor augmented pump: a case report

The worldwide incidence of type 1 diabetes (T1D) is quite variable and increasing by approximately 3% each year globally, where in high-income countries, 7–12% of all diabetes population is estimated to have type 1 diabetes [1]. Diabetes is the leading cause of end-stage renal disease (ESRD) in the Western world and long-term complications due to diabetes are a major cause of disability and reduced quality of life. Continuous subcutaneous insulin infusion (CSII) is an established model for mimicking physiological insulin delivery, which can assist in achieving near-normal glucose levels with minimizing the risk of hypoglycemia and preventing or delaying diabetes complications. The Center for insulin pump and glucose sensor at University Clinic of Endocrinology in Skopje has managed more than 180 patients with CSII over the last 10 years. Our recent publication assessing long-term CSII treatment reported improved and sustained glucose control with a reduction of HbA1c levels by − 1.1% (− 12.0 mmol/mol) [2]. CSII is predominantly intended for use in the outpatient setting, but these patients can be encountered in other clinical settings. One clinical scenario that may challenge patients and practitioners is the management of CSII therapy during surgery. Consensus guidelines on CSII and perioperative phase of surgical care do not exist. Patients may be at risk for medical errors at different stages of surgical management without a systematic approach for glucose monitoring, insulin dose adjustment and CSII features. CSII can be safely continued during surgery, but the scarcity of published reports limits the conclusions that can be drawn about the current use or safety of insulin pumps for patients undergoing surgery [3]. T1D patients with chronic renal failure, besides the dialysis treatment, have the following therapy options: kidney transplant from a living donor, simultaneous pancreas kidney transplant or deceased donor kidney transplant. Patient survival after kidney transplant has been improving for all age ranges in comparison to the dialysis treatment. Retrospective analyses compared life expectancy [in life years (LY)] and quality-adjusted life expectancy [in quality-adjusted life-years (QALY)] of these different treatment strategies. Results indicate that kidney transplant from a living donor is associated with the greatest life expectancy (18.30 LY) and quality-adjusted life expectancy (10.00 QALY) for T1D patients with chronic renal failure [4]. Isolated kidney transplant from a living donor is a transplant modality with a shortest awaiting time (preparation of the living donor). Immunosuppressive regimen may be tailored according to the human leucocytes antigens (HLA) compatibility. In this case report, we show the utility of using the sensor augmented pump (SAP) in the perioperative phase of a patient with T1D undergoing an isolated kidney transplantation.

Investigating the HbA1c Assessment Methods for a Smart and Connected Diabetes System

Texas A&M University at Qatar has partnered with two local Qatari hospitals, Hamad Hospital and Sidra Hospital, to design an insulin pump that will transfer patients’ data to an online server in real time. HbA1c is one of the most common forms of measurement for diagnosing diabetes. The fact that there are variations of the formula to be found was considered unusual. This poster is intended to evaluate different methods of calculating A1c and propose improvements. Using a mixed method including literature review and stakeholder interviews we document the challenges involved in utilizing the new assessment in an innovative testbed.

Are We Ready to Treat Our Diabetes Patients Using Social Media? Yes, We Are

Aims: The aim of the study was to evaluate Facebook group as possible communication tool to improve glucose control in adolescents and young people with type 1 diabetes (T1D). Methods: This retrospective and cross-sectional study included 728 T1D patients (age 11-25) on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) treated at the center for insulin pump and glucose sensor in Skopje from January 2012 to December 2017. Data were collected through the electronic medical record system and cross-sectional analysis (telephone, social media (Facebook and Viber) or email). Patients were analyzed in two groups: (a) non-Internet group, with 398 patients treated using standard medical protocol with regular clinic visits; (b) Internet group, with 330 patients who, besides standard medical protocol, were active members of a national closed Facebook group on diabetes. Both the non-Internet and Internet groups had regular visits every 2-3 months. Patients from the Internet group were members of the closed Facebook group “Diabetes Macedonia” and had an opportunity to interact with questions, answers, and comments on diabetes care. An additional analysis was performed of the Internet group on combined use of Facebook and Viber. Average HbA1c levels were compared in both groups. Results: Each patient from the Facebook group had 1.5 ± 3.5 posts per day. Hba1c was significantly lower in patients from the Internet group (7.1 ± 3.2%; 54 ± 35 mmol/mol) compared to patients from the non-Internet group (7.6 ± 2.8%; 60 ± 31 mmol/mol). Conclusions: Social media like Facebook and Viber can be additional communication tool in adolescents and young people with T1D and can significantly lower HbA1c compared to patients without social media use. CSII patients are more likely to use both social media (Facebook and Viber) compared with MDI patients (Facebook only).