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Mattsson, S., Jendle, J. & Adolfsson, P. (2019). Carbohydrate Loading Followed by High Carbohydrate Intake During Prolonged Physical Exercise and Its Impact on Glucose Control in Individuals With Diabetes Type 1-An Exploratory Study. Frontiers in Endocrinology, 10, Article ID 571.
Open this publication in new window or tab >>Carbohydrate Loading Followed by High Carbohydrate Intake During Prolonged Physical Exercise and Its Impact on Glucose Control in Individuals With Diabetes Type 1-An Exploratory Study
2019 (English)In: Frontiers in Endocrinology, ISSN 1664-2392, E-ISSN 1664-2392, Vol. 10, article id 571Article in journal (Refereed) Published
Abstract [en]

Background: Prolonged physical exercise (PE) is a challenge in type 1 diabetes with an increased incidence of both hypoglycemia and hyperglycemia.

Purpose: To evaluate the impact of two consecutive days of carbohydrate (CHO) loading, followed by high intermittent CHO-intake during prolonged PE, facilitated by a proactive use of Real-Time Continuous Glucose Monitoring (rtCGM), on glucose control in individuals with type 1 diabetes.

Methods: Ten physically active individuals with type 1 diabetes were invited to participate in a 3-day long sports camp with the objective to evaluate CHO-loading and high intermittent CHO-intake during prolonged PE. 1.5 months later the same procedure was evaluated in relation to a 90 km cross-country skiing race (Vasaloppet). Participants were instructed to act proactively using rtCGM with predictive alerts to maintain sensor glucose values within target range, defined as 72-180 mg/dl (4-10 mmol/l).

Results: Mean glucose values during CHO-loading were: day 1; 140.4 +/- 45.0 mg/dl (7.8 +/- 2.5 mmol/l) and day 2; 120.6 +/- 41.4 mg/dl (6.7 +/- 2.3 mmol/l). Mean sensor glucose at start of PE was 126.0 +/- 25.2 mg/dl (7.0 +/- 1.4 mmol/l) and throughout PE 127.8 +/- 25.2 mg/dl (7.1 +/- 1.4 mmol/l). Percentage of time spent in range (TIR) respective time spent in hypoglycemia was: CHO-loading 74.7/10.4% and during PE 94.3/0.6%.

Conclusions: High intermittent CHO-intake during prolonged PE combined with proactive use of rtCGM is associated with good glycemic control during prolonged exercise in individuals with diabetes type 1. However, the time spent in hypoglycemia during the 2-days of CHO-loading was 10.4% and therefore a lower insulin dose might be suggested to reduce the time spent in hypoglycemia.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2019
Keywords
blood glucose, carbohydrates, continuous glucose monitoring, insulin, physical activity, time in range, type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-76051 (URN)10.3389/fendo.2019.00571 (DOI)000482015800001 ()
Funder
Novo Nordisk
Available from: 2019-09-05 Created: 2019-09-05 Last updated: 2019-09-05Bibliographically approved
Jendle, J. & Adolfsson, P. (2019). Continuous Glucose Monitoring Diving and Diabetes: An Update of the Swedish Recommendations. Journal of Diabetes Science and Technology
Open this publication in new window or tab >>Continuous Glucose Monitoring Diving and Diabetes: An Update of the Swedish Recommendations
2019 (English)In: Journal of Diabetes Science and Technology, E-ISSN 1932-2968Article in journal (Refereed) Epub ahead of print
Abstract [en]

Divers travel to different countries to explore various diving sites worldwide. In 2005, the Divers Alert Network (DAN) published their guidelines for recreational diving and diabetes mellitus. However, although years have passed, there is still no consensus in the form of international guidelines on diabetes and diving. Large differences are noted with regard to the regulations in different countries. Furthermore, the diabetes technology has evolved rapidly and is not reflected in current international guidelines. This is potentially both a medical and an insurance problem for a diver with diabetes. We present a short summary of the recently updated Swedish recommendations for recreational divers with type 1 diabetes mellitus, focusing on the use of continuous glucose monitoring and continuous subcutaneous insulin infusion during such circumstances.

Place, publisher, year, edition, pages
Diabetes Technology Society, 2019
Keywords
diabetes, disability, fitness to dive, recreational diving, safety
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-74522 (URN)10.1177/1932296819826584 (DOI)30712367 (PubMedID)
Available from: 2019-05-29 Created: 2019-05-29 Last updated: 2019-06-13Bibliographically approved
Jendle, J., de Portu, S. & Roze, S. (2019). Cost effectiveness analysis of MiniMed 670G system versus continuous subcutaneous insulin infusion, in individuals with type 1 diabetes. In: : . Paper presented at ATTD 2019, Berlin, Germany, 20-23 February, 2019.
Open this publication in new window or tab >>Cost effectiveness analysis of MiniMed 670G system versus continuous subcutaneous insulin infusion, in individuals with type 1 diabetes
2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-76864 (URN)
Conference
ATTD 2019, Berlin, Germany, 20-23 February, 2019
Available from: 2019-10-01 Created: 2019-10-01 Last updated: 2019-10-01Bibliographically approved
Jendle, J., Pöhlmann, J., de Portu, S., Smith-Palmer, J. & Roze, S. (2019). Cost-Effectiveness Analysis of the MiniMed 670G Hybrid Closed-Loop System Versus Continuous Subcutaneous Insulin Infusion for Treatment of Type 1 Diabetes. Diabetes Technology & Therapeutics, 21(3), 110-118
Open this publication in new window or tab >>Cost-Effectiveness Analysis of the MiniMed 670G Hybrid Closed-Loop System Versus Continuous Subcutaneous Insulin Infusion for Treatment of Type 1 Diabetes
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2019 (English)In: Diabetes Technology & Therapeutics, ISSN 1520-9156, E-ISSN 1557-8593, Vol. 21, no 3, p. 110-118Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Hybrid closed-loop (HCL) systems combine continuous glucose monitoring with continuous subcutaneous insulin infusion (CSII) to continuously self-adjust basal insulin delivery. Relative to CSII, HCL improves glycemic control and reduces the risk of hypoglycemia but has higher acquisition costs. The aim of this analysis was to assess the cost-effectiveness of the MiniMed™ 670G HCL system versus CSII in people with type 1 diabetes (T1D) in Sweden.

METHODS: Cost-effectiveness analysis, from a societal perspective, was performed over patient lifetimes using the IQVIA CORE Diabetes Model. Clinical data were sourced from a study comparing the MiniMed 670G system with CSII in people with T1D. Cost data, expressed in 2018 Swedish krona (SEK), were obtained from Swedish reference prices and published literature.

RESULTS: The MiniMed 670G system was associated with a quality-adjusted life-year (QALY) gain of 1.90 but higher overall costs versus CSII, leading to an incremental cost-effectiveness ratio (ICER) of SEK 164,236 per QALY gained. Use of the HCL system resulted in a lower cumulative incidence of diabetes-related complications. Higher HCL system acquisition costs were partially offset by reduced complication costs and productivity losses. In people with T1D poorly controlled at baseline, the MiniMed 670G system was associated with 2.25 incremental QALYs versus CSII, yielding an ICER of SEK 15,830 per QALY gained.

CONCLUSIONS: The MiniMed 670G system was associated with clinical benefits and quality-of-life improvements in people with T1D relative to CSII. At a willingness-to-pay threshold of SEK 300,000 per QALY gained, this HCL system likely represents a cost-effective treatment option for people with T1D in Sweden.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2019
Keywords
Cost-effectiveness, Hybrid closed-loop insulin delivery, MiniMed 670G, Sweden, Type 1 diabetes
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-72778 (URN)10.1089/dia.2018.0328 (DOI)000463914500003 ()30785311 (PubMedID)2-s2.0-85062587273 (Scopus ID)
Note

Funding Agency:

Medtronic International Trading Sarl 

Available from: 2019-02-25 Created: 2019-02-25 Last updated: 2019-06-19Bibliographically approved
Jendle, J., Edelman, S., Dandona, P., Mathieu, C., Thoren, F., Scheerer, J., . . . Langkilde, A. (2019). Dapagliflozin as an adjunct to insulin on urinary albumin-to creatinine ratio over 52 weeks in adults with type 1 diabetes. In: : . Paper presented at ATTD 2019, Berlin, Germany, 20-23 February, 2019.
Open this publication in new window or tab >>Dapagliflozin as an adjunct to insulin on urinary albumin-to creatinine ratio over 52 weeks in adults with type 1 diabetes
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2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-76865 (URN)
Conference
ATTD 2019, Berlin, Germany, 20-23 February, 2019
Available from: 2019-10-01 Created: 2019-10-01 Last updated: 2019-10-01Bibliographically approved
Jendle, J., Edelman, S., Dandona, P., Mathieu, C., Thoren, F. A., Scheerer, M. F., . . . Langkilde, A. M. (2019). EFFECT OF ADDING DAPAGLIFLOZIN AS AN ADJUNCT TO INSULIN ON URINARY ALBUMIN-TO-CREATININE RATIO OVER 52 WEEKS IN ADULTS WITH TYPE 1 DIABETES. Paper presented at Advanced Technologies & Treatments for Diabetes Conference (ATTD), Berlin, Germany, February 20–23, 2019. Diabetes Technology & Therapeutics, 21(Suppl. 1), A136-A137
Open this publication in new window or tab >>EFFECT OF ADDING DAPAGLIFLOZIN AS AN ADJUNCT TO INSULIN ON URINARY ALBUMIN-TO-CREATININE RATIO OVER 52 WEEKS IN ADULTS WITH TYPE 1 DIABETES
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2019 (English)In: Diabetes Technology & Therapeutics, ISSN 1520-9156, E-ISSN 1557-8593, Vol. 21, no Suppl. 1, p. A136-A137Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Mary Ann Liebert, 2019
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-73964 (URN)10.1089/dia.2019.2525.abstracts (DOI)000463914000307 ()
Conference
Advanced Technologies & Treatments for Diabetes Conference (ATTD), Berlin, Germany, February 20–23, 2019
Available from: 2019-04-29 Created: 2019-04-29 Last updated: 2019-04-29Bibliographically approved
Lahtela, J., Edelman, S., Jendle, J., Dandona, P., Mathieu, C., Thorén, F., . . . Langkilde, A. (2019). Effect of adding dapagliflozin as an adjunct to insulin on urinary albumin-to-creatinine ratio over 52 weeks in adults with type 1 diabetes. In: : . Paper presented at 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD 2019), Barcelona, Spain, September 16-20, 2019 (pp. S342-S342). Springer, 62
Open this publication in new window or tab >>Effect of adding dapagliflozin as an adjunct to insulin on urinary albumin-to-creatinine ratio over 52 weeks in adults with type 1 diabetes
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2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background and aims: Dapagliflozin (DAPA), as an adjunct to insulin, was reported to improve glycaemic control, reduce body weight, and was well tolerated (DEPICT-1 and 2 studies) in adults with inadequately controlled type 1 diabetes (T1D; HbA1c: 58-91 mmol/mol [7.5-10.5%]).

Materials and methods: In this pooled post hoc analysis of the DEPICT-1 and -2 studies, the effect of DAPA on urinary albumin-to-creatinine ratio (UACR) was evaluated in individuals with T1D with baseline micro or macroalbuminuria.

Results: UACR was recorded at baseline for 548, 565, and 532 individuals treated with DAPA 5 mg, DAPA 10 mg, and placebo, respectively; baseline albuminuria was found in 80, 84, and 87 of these individuals in the respective arms. Of these 251 individuals, baseline renal function measured as estimated glomerular filtration rate (eGFR) was normal (eGFR≥90 ml min-1[1.73 m]-2) in 93, mildly impaired in (eGFR≥60-<90 ml min-1[1.73 m]-2) 131, and moderately impaired in 27 individuals (eGFR <60 ml min-1[1.73 m]-2). Changes in eGFR were similar across the treatment arms (data not shown). Dose-dependent decrease in UACR was observed with DAPA treatment at Weeks 12, 18, 24, and 52 (Figure). At Week 52, the differences in UACR between DAPA 10 mg vs placebo and DAPA 5 mg vs placebo were−31.1% (95% CI:−49.9,−5.2) and−13.3 (95% CI:−37.2, 19.8), respectively.

Conclusion: Treatment with DAPA, as an adjunct to insulin, provided a dose-dependent benefit in reducing UACR, suggesting renoprotective effects in individuals with T1D with baseline albuminuria.

Place, publisher, year, edition, pages
Springer, 2019
Series
Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-76981 (URN)000485303803042 ()
Conference
55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD 2019), Barcelona, Spain, September 16-20, 2019
Funder
AstraZeneca
Available from: 2019-10-02 Created: 2019-10-02 Last updated: 2019-10-15Bibliographically approved
Nyström, T., Santos-Pardo, I., Fang, X., Cao, Y., Hedberg, F. & Jendle, J. (2019). Heart rate variability in type 2 diabetic subjects randomized to liraglutide or glimepiride treatment, both in combination with metformin: A randomized, open, parallel-group study. Endocrinology, Diabetes & Metabolism, 2(2), Article ID e00058.
Open this publication in new window or tab >>Heart rate variability in type 2 diabetic subjects randomized to liraglutide or glimepiride treatment, both in combination with metformin: A randomized, open, parallel-group study
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2019 (English)In: Endocrinology, Diabetes & Metabolism, ISSN 2398-9238, Vol. 2, no 2, article id e00058Article in journal (Refereed) Published
Abstract [en]

Aims: Reduced heart rate variability (HRV) and increased heart rate (HR) are associated with cardiovascular (CV) mortality. In the Liraglutide Effect and Action in Diabetes outcome trial, it was demonstrated a lower rate of CV events in type 2 diabetes (T2D) patients treated with liraglutide compared to placebo. We aimed to investigate the effects of liraglutide compared with glimepiride treatment in T2D patients on the CV risk parameters HR and HRV.

Methods: This was a post hoc study whereas sixty-two T2D individuals (45 males) were randomized to once daily 1.8 mg liraglutide or once daily 4 mg glimepiride, both in combination with 1 g metformin. HR and measurement of sympathetic activity, that is standard deviation (SD) of beat-to-beat (NN) intervals (SDNN), was assessed by 24-hour Holter monitoring system. Parasympathetic activity was analysed by root mean square of successive differences (RMSSD) in NN intervals and high-frequency (HF), low-frequency (LF) and very low-frequency power.

Results: Baseline clinical characteristics for liraglutide (n = 33) and glimepiride (n = 29) groups were well matched. There was a persistent increase in diurnal HR followed by a significantly increased HR at daytime 5.4 beats per minute, P = 0.011 in the liraglutide-treated group. There was no treatment change between groups in SDNN and RMSSD, or in HF and LF frequency power analysis.

Conclusions: Liraglutide treatment increased diurnal variation in hourly mean HR followed by an increase in mean daytime HR, independently of changes in sympathetic or parasympathetic activity.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
automatic nervous system, cardiac autonomic neuropathy, glimepiride, heart rate variability, liraglutide, type 2 diabetes mellitus
National Category
Medical and Health Sciences Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-74521 (URN)10.1002/edm2.58 (DOI)31008366 (PubMedID)
Note

Funding agencies:

Swedish Heart and Lung foundation

Stockholm County Council and Karolinska Institutet

Novo Nordisk A/S

Available from: 2019-05-29 Created: 2019-05-29 Last updated: 2019-06-10Bibliographically approved
Feher, M., Fadini, G., Krarup Hansen, T., Jendle, J., Merchante, A., Koefoed, M., . . . de Valk, H. (2019). Hypoglycaemia, irrespective of the definition used, is reduced when switching to insulin degludec from other basal insulins in routine clinical care: The ReFLeCT study. In: : . Paper presented at 55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD 2019), Barcelona, Spain, September 16-20, 2019 (pp. S385-S385). Springer, 2
Open this publication in new window or tab >>Hypoglycaemia, irrespective of the definition used, is reduced when switching to insulin degludec from other basal insulins in routine clinical care: The ReFLeCT study
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2019 (English)Conference paper, Poster (with or without abstract) (Other academic)
Abstract [en]

Background and aims: ReFLeCT was a multicentre, prospective, observational study designed to investigate the safety and effectiveness of switching to insulin degludec (degludec) from other basal insulins in patients with type 1 (T1D) or type 2 diabetes (T2D). Few studies had prospectively collected hypoglycaemia data from patient diaries following a switch to degludec in everyday clinical practice. These additional analyses from the ReFLeCT study aimed to assess the effects of switching to degludec according to different hypoglycaemia definitions.

Materials and methods: ReFLeCT comprised a 4-week baseline period (pre-switch basal insulin) and a 12-month follow-up period (degludec treatment). The primary endpoint of overall hypoglycaemia reported in patient diaries was reduced during follow-up vs baseline in T1D and T2D with improvement of glycaemic control, as previously reported. Here, hypoglycaemia data from ReFLeCT were analysed using pre-specified and updated (post hoc) American Diabetes Association (ADA) hypoglycaemia definitions. Definitions consisted of: documented asymptomatic and symptomatic, pseudo, probable symptomatic, and Level 1, 2 and 3 (severe) hypoglycaemia (Fig). Hypoglycaemic events were analysed using fully adjusted, negative binomial regression models.

Results: In T1D (n=556) and T2D (n=611), estimated rate ratios across the previous and the updated ADA hypoglycaemia definitions were significantly lower during the 12-month follow-up vs the baseline period, except for asymptomatic hypoglycaemia in T1D and Level 3 hypoglycaemia in T2D (due to a low number of severe hypoglycaemic events, no comparable statistics were performed) (Fig). Event rates per patient year were also lower for all definitions during the 12-month follow-up vs the baseline period, except for Level 3 hypoglycaemia in T2D, which marginally increased, although this was likely due to the low number of events in this group.

Conclusion: In patients with T1D and T2D, switching to degludec from other basal insulins in routine clinical care is associated with lower rates of hypoglycaemia across a broad range of hypoglycaemia definitions, in combination with improved glycaemic control.

Place, publisher, year, edition, pages
Springer, 2019
Series
Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-76878 (URN)000485303803121 ()
Conference
55th Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD 2019), Barcelona, Spain, September 16-20, 2019
Available from: 2019-10-01 Created: 2019-10-01 Last updated: 2019-10-15Bibliographically approved
Jendle, J., Birkenfeld, A. L., Polonsky, W. H., Silver, R., Uusinarkaus, K., Hansen, T., . . . Davies, M. J. (2019). Improved treatment satisfaction in patients with type 2 diabetes treated with once-weekly semaglutide in the SUSTAIN trials. Diabetes, obesity and metabolism, 21(10), 2315-2326
Open this publication in new window or tab >>Improved treatment satisfaction in patients with type 2 diabetes treated with once-weekly semaglutide in the SUSTAIN trials
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2019 (English)In: Diabetes, obesity and metabolism, ISSN 1462-8902, E-ISSN 1463-1326, Vol. 21, no 10, p. 2315-2326Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate treatment satisfaction with semaglutide, a once-weekly glucagon-like peptide-1 receptor agonist, versus placebo/active comparators in theSUSTAIN clinical trial programme.

METHODS: In SUSTAIN 2-5 and 7, the Diabetes Treatment Satisfaction Questionnaire was used to evaluate patient-perceived treatment satisfaction, hyperglycaemia and hypoglycaemia. Post hoc subgroup analyses were conducted to explore the effects of gastrointestinal adverse events (GI AEs), weight loss (>= 5%) or achieving glycaemic (HbA1c < 7%) targets on treatment satisfaction.

RESULTS: Overall treatment satisfaction increased from baseline to end of treatment with all treatments across trials. Improvements were significantly greater with semaglutide versus comparators/placebo in SUSTAIN 2-5 (all P < 0.05), and generally greater in patients who achieved versus did not achieve weight loss and glycaemic targets, often with greater improvements with semaglutide 1.0 mg versus comparator/placebo in both weight loss groups. In SUSTAIN 7, improvements in overall treatment satisfaction were generally similar between semaglutide and dulaglutide, irrespective of weight loss or glycaemic control. In SUSTAIN 7, changes in overall treatment satisfaction score were generally lower in patients with versus without GI AEs at week 16 (except dulaglutide 0.75 mg), but similar by week 40. Perceived hyperglycaemia was significantly reduced from baseline to end of treatment with semaglutide versus all comparators/placebo (all P < 0.05). No differences between treatments were observed for perceived hypoglycaemia.

CONCLUSIONS: Semaglutide was associated with significantly greater (SUSTAIN 2-5) or similar (SUSTAIN 7) improvements in overall treatment satisfaction versus comparators/placebo. Improvements in overall treatment satisfaction were generally greater in patients achieving versus not achieving treatment targets. Clinicaltrials.gov: NCT01930188 (SUSTAIN 2), NCT01885208 (SUSTAIN 3), NCT02128932 (SUSTAIN 4), NCT02305381 (SUSTAIN 5) and NCT02648204 (SUSTAIN 7). EudraCT: 2012-004827-19 (SUSTAIN 2), 2012-004826-92 (SUSTAIN 3), 2013-004392-12 (SUSTAIN 4), 2013-004502-26 (SUSTAIN 5) and 2014-005375-91 (SUSTAIN 7).

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
GLP-1 analogue, hypoglycaemia, incretin therapy, type 2 diabetes, weight control
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:oru:diva-74751 (URN)10.1111/dom.13816 (DOI)000475146900001 ()31215727 (PubMedID)2-s2.0-85068890656 (Scopus ID)
Funder
Novo Nordisk
Available from: 2019-06-20 Created: 2019-06-20 Last updated: 2019-10-07Bibliographically approved
Organisations
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ORCID iD: ORCID iD iconorcid.org/0000-0003-1025-1682

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