Differently in T2D its use is still a matter of debate because clinical trials in well-selected patient groups are lacking and less convincing evidence is available. The effectiveness of continuous glucose monitoring (CGM) in the management of type 1 diabetic patients is well known.
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The PRISMA study (Prospective, Randomized Trial on Intensive Self-Monitoring Blood Glucose Management Added Value in Noninsulin-Treated Type 2 Diabetes Mellitus Patients), to our knowledge the largest study of the effects of SMBG in patients with T2D, confirms the clinical usefulness and overall safety of using structured SMBG to provide guidance in the prescription of diabetes medications and lifestyle changes in non insulin-treated T2D. Regarding glucose monitoring, recent studies utilizing self monitoring blood glucose (SMBG) as an integral component of diabetes care showed improvement in mean glucose, glycemic variability, metabolic risk factors, depression and diabetes-related distress, and health behaviors. Finally, protection of beta cell function in T2D using CSII has been reported.
CSII induces reduction of plasma ox-LDL in T2D patients as compared to patients on MDI suggesting that CSII may have an impact on factors associated with progression to complications. A study tested the hypothesis that improved glucose control, rather than insulin dose, is central to reduced oxi-dative stress in patients with T2D following CSII. Oxidative stress is a detrimental feature of diabetes implicated in the progression of the disease and its complications. That this treatment is superior to CSII monotherapy in terms of glucose variability. Another recent study looking at newly diagnosed T2D patients via the use of either CSII or CSII + sitagliptin therapy in controlling glucose variability and to prevent secondary complications of T2D showed The results showed that CSII significantly improved selected glucometrics, compared with MDI, without increasing the risk of hypoglycemia. The OpT2mise randomized trial was designed to compare the effects of continuous subcutaneous insulin infusion (CSII) and multiple daily injection (MDI) on glucose profiles in patients with T2D. The value and the utility of applying technology in the management of patients with poorly controlled insulin-treated type 2 diabetes (T2D) remain controversial. Progress in our understanding of the genetics and natural history of the disease, incidence and prevalence, complications, quality of life, neurocognitive impact and response to therapy among others are critical to the design of disease modifying therapies.Clear data have emerged there are differences between adult-onset and pediatric-onset Type 1 disease.Īdvances in our understanding of the natural history of Type 1 Diabetes throughout the lifespan have led to recent publications related to broader acceptance of a classification system for the presymptomatic stages of Type 1 diabetes and, importantly, more defined pathways for the development of disease modifying therapies in children.ĬSII AND OTHER TECHNOLOGIES FOR PREVENTING BETA CELL FAILURE IN TYPE 2 DIABETES Studies aimed at both preventing the disease in at-risk pre-Type 1 subjects as well as intervening not only in new-onset cases, but also in established disease have been conducted over the past 30 years.
Changing the course of the disease by preventing or slowing down beta cell destruction rather than managing hyperglycemia would significantly impact the burden.
Glycemic targets both in children (and adolescents especially) as well as adults are met only by a minority of patients. Type 1a (autoimmune) diabetes remains a tremendous burden both to individuals and society. DOI: 10.1089/dia.2016.2525ĭEVELOPING DISEASE-MODIFYING THERAPIES IN CHILDREN WITH TYPE 1 DIABETES Abstracts from ATTD 2016 9th International Conference on Advanced Technologies & Treatments for DiabetesĭIABETES TECHNOLOGY & THERAPEUTICS Volume 18, Supplem© Mary Ann Liebert, Inc.