What is new in Diabetes Mellitus modified

What is new in DM modified

1. in DM Type1 ? YASSIN M ALSALEH

2. Flash Glucometer

3. Continuous glucose monitoring CGM

4. Understanding glucose variability in a patient is extremely important. some research suggests that variable blood sugars may be more damaging than consistently high blood sugars.

5. FreeStyle Libre

6. Dexcom G5

7. MIAOMIAO

8. The Eversense CGM System First Implantable Continuous Glucose Monitor Receives FDA Approval for Type 1 and Type 2 Diabetes. approved for age 18 and older. can be used for 90 days with the same sensor. 

9. (Non invasive ear lobe glucometer ( EGM 1000

10. Medrotonic 670 G Automated basal insulin delivery based on sensor data Suspend before low: automatically stopping insulin 30 minutes before pre-selected low limits are reached, then automatically restarts insulin once glucose levels recover

11. SUSPEND BEFORE LOW

12. 780G advanced hybrid closed loop (AHCL) system 

13. the new pump system, which would automate bolus deliveries based on “user experiences, or is predicted to experience, prolonged high glucose levels based on their sensor reading.” -The 780G is intended to also automate basal insulin delivery , mimicking the abilities of the 670G. -The trial will enroll up to 350 adult and pediatric patients with type 1 diabetes to use the device over a three-month period -- The trial is estimated to be completed in January 2020, with results presented in July 2020.

14. T:slim insulin pump

15. omnipod

16. V-Go

17. Insulin jet injectors

18. I - PORT

19. Hypoglycemia management

20. FDA Approves First Ready-to-Use Liquid Stable Glucagon

21. Glucagon nasal powder BAQSIMI 

22. Humalog junior half-unit doses

23. Insulin degludec

24. Insulin degludec ( IDeg ) is an ultralong acting basal insulin. Type 1 Diabetes Mellitus in children and adolescents aged 1-17 yr . <1 year: Safety and efficacy not established Not recommended for pediatric patients requiring <5 units of insulin degludec

25. IDeg has unique pharmacokinetic and pharmacodynamic properties which allow once a daily dosage, at any time of the day. Its use is associated with a significantly lower risk of hypoglycemia The rate of nocturnal hypoglycemia was significantly 25% lower with degludec than glargine .

26. Ultra rapid lispro ( URLi )

27. Ultra rapid lispro ( URLi ) reduces postprandial glucose excursions vs lispro in patients with type 1 diabetes at multiple meal-to-dose timing intervals

28. In type 1 diabetes (PRONTO-T1D study), compared to Humalog, URLi : Reduced post-meal blood glucose levels by 28 mg/dl at one hour and 31 mg/dl at two hours Did not have a difference in A1C (7.21% vs. 7.29%) Did not have a significant difference in severe hypoglycemia, but reduced hypoglycemia events past the four-hour mark

29. Early Glargine (Lantus) in DKA Management in Children With Type 1 Diabetes

30. Conclusion—Co-administration of glargine early in the course of DKA treatment is well tolerated and convenient for discharge planning; however, this approach is associated with an increased risk of hypokalemia.

31. This could potentially lead to a shorter ICU length of stay and reduced costs in the treatment of DKA. However, this approach may be associated with an increased risk of hypokalemia. The current literature on this management approach is incomplete, due to its many limitations (retrospective nature, small sample size, nonrandomized design). Additional prospective randomized studies are needed on this new therapeutic approach in the management patients with DKA.

32. 2019

33. BACKGROUND Metformin is the regulatory-approved treatment of choice for most youth with type 2 diabetes early in the disease. However, early loss of glycemic control has been observed with metformin monotherapy. Whether liraglutide added to metformin (with or without basal insulin treatment) is safe and effective in youth with type 2 diabetes is unknown.

34. Cost side effects

35. Results were as follows: Mean glycated hemoglobin levels at week 26 (the primary endpoint) decreased by 0.64% with liraglutide but increased by 0.42% with placebo (estimated treatment difference, −1.06%;  P <0.001); the effect was even greater with liraglutide versus placebo at 52 weeks (−0.50% vs. 0.80%; ETD, −1.30%). Glycated hemoglobin levels below 7% were achieved more often with liraglutide than with placebo (63.7% vs, 36.5%;  P <0.001); the difference was observed whether or not patients were receiving insulin. Fasting plasma glucose levels were significantly less at both 26 and 52 weeks with liraglutide. Adverse events (mostly gastrointestinal) were more common with liraglutide. Incidence of hypoglycemia was greater with liraglutide ; however, only one severe hypoglycemic episode occurred (in the placebo group) during the study

36. DM Prevention

37. Our study has limitations; it is observational and not experimental. Because there may be differences in people who are vaccinated versus those who are not, potential confounding factors may be responsible for these findings. Another limitation is that we cannot discern whether the rotavirus vaccine is associated with a lower lifetime risk of developing type 1 diabetes or whether it merely delays the onset of the disease. Longer longitudinal studies are necessary for evaluation.

38. Type 1 diabetes (T1D) is an autoimmune disease that is generally considered to be T cell-driven. Teplizumab is a nonactivating , Fc-modified, anti-CD3 monoclonal antibody thought to attenuate activated autoreactive T cells mediating β-cell death. 

39. April, 2019

40. The C-peptide responses to a mixed-meal tolerance test were similar overall in the drug vs control group of participants but were significantly improved, with less loss of C-peptide, in drug-treated responders identified at 1 year. However, the improvements in C-peptide response were not associated with lower HbA 1c  levels or insulin use. These findings suggest there is reduced decline in C-peptide and persistent immunological responses up to 7 years after diagnosis of diabetes in individuals who respond to teplizumab .

41. Safety is another important consideration: teplizumab is an anti-CD3 MAb , EBV reactivation . Lymphopenia .

42. August 15, 2019

43. BACKGROUND Type 1 diabetes is a chronic autoimmune disease that leads to destruction of insulin-producing beta cells and dependence on exogenous insulin for survival. Some interventions have delayed the loss of insulin production in patients with type 1 diabetes, but interventions that might affect clinical progression before diagnosis are needed. METHODS We conducted a phase 2, randomized, placebo-controlled, double-blind trial of teplizumab (an Fc receptor–nonbinding anti-CD3 monoclonal antibody) involving relatives of patients with type 1 diabetes who did not have diabetes but were at high risk for development of clinical disease. Patients were randomly assigned to a single 14-day course of teplizumab or placebo, and follow-up for progression to clinical type 1 diabetes was performed with the use of oral glucose-tolerance tests at 6-month intervals. RESULTS A total of 76 participants (55 [72%] of whom were ≤18 years of age) underwent randomization — 44 to the teplizumab group and 32 to the placebo group. The median time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group; the disease was diagnosed in 19 (43%) of the participants who received teplizumab and in 23 (72%) of those who received placebo. The hazard ratio for the diagnosis of type 1 diabetes (teplizumab vs. placebo) was 0.41 (95% confidence interval, 0.22 to 0.78; P=0.006 by adjusted Cox proportional-hazards model). The annualized rates of diagnosis of diabetes were 14.9% per year in the teplizumab group and 35.9% per year in the placebo group. There were expected adverse events of rash and transient lymphopenia. TIGIT+KLRG1+CD8+ T cells were more common in the teplizumab group than in the placebo group. Among the participants who were HLA-DR3–negative, HLA-DR4–positive, or anti–zinc transporter 8 antibody–negative, fewer participants in the teplizumab group than in the placebo group had diabetes diagnosed. CONCLUSIONS Teplizumab delayed progression to clinical type 1 diabetes in high-risk participants.

44. Teplizumab delayed progression to clinical type 1 diabetes in high-risk participants. A total of 76 participants (55 [72%] of whom were ≤18 years of age) underwent randomization — 44 to the teplizumab group and 32 to the placebo group. The median time to the diagnosis of type 1 diabetes was 48.4 months in the teplizumab group and 24.4 months in the placebo group ; the disease was diagnosed in 19 (43%) of the participants who received teplizumab and in 23 (72%) of those who received placebo

45. teplizumab

46. The in vivo study of BCG vaccinations is comprised of adult T1D subjects receiving BCG, receiving placebo vaccinations and simultaneously studied reference type 1 diabetic subjects followed with the same standard of care

47. The 8 year long followed and BCG-treated T1Ds showed a reduction in HbA1c levels of greater than 10% after year 03, 18% at year 04, and the HbA1c remained low for the next 5 years (p = 0.0002 at year 8) In contrast, the placebo group (n = 3) and the reference T1D groups (n = 40) had consistently higher HbA1c over the entire monitoring period of 8 years and 5 years, respectively .. The efficacy of BCG was also apparent with raw HbA1c values, which show the BCG-treated TIDs by year 8 declined to a HbA1c value of 6.65%

48.   They report the 8 year follow-up results from only 3 people with Type 1 diabetes who had the vaccine and 3 who did not. This is far too small a number of people studied to suggest this should be considered a potential treatment for people living with Type 1 diabetes.”

49. New Implants Could Treat Diabetes