Unmet needs in the treatment of type 1 diabetes: why is it so difficult to achieve an improvement in metabolic control?

IF 4.6 2区 医学 Q1 ENDOCRINOLOGY & METABOLISM Nutrition & Diabetes Pub Date : 2024-08-02 DOI:10.1038/s41387-024-00319-w
Francesco Antonio Mazzotta, Lorenzo Lucaccini Paoli, Alessandro Rizzi, Linda Tartaglione, Maria Laura Leo, Valentina Popolla, Annarita Barberio, Luca Viti, Mauro Di Leo, Alfredo Pontecorvi, Dario Pitocco
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Abstract

The development of advanced diabetes technology has permitted persons with type 1 diabetes mellitus to improve metabolic control significantly, particularly with the development of advanced hybrid closed-loop systems which have improved the quality of life by reducing hypoglycemia, decreasing macroangiopathy and microangiopathy-related complications, ameliorating HbA1c and improving glycemic variability. Despite the progression made over the past few decades, there is still significant margin for improvement to be made in terms of attaining appropriate metabolic control. Various factors are responsible for poor glycemic control including inappropriate carbohydrate counting, repeated bouts of hypoglycemia, hypoglycemia unawareness, cutaneous manifestations due to localized insulin use and prolonged use of diabetes technology, psychosocial comorbidities such as eating disorders or 'diabulimia', the coexistence of insulin resistance among people with type 1 diabetes and the inability to mirror physiological endogenous pancreatic insulin secretion appropriately. Hence, the aim of this review is to highlight and overcome the barriers in attaining appropriate metabolic control among people with type 1 diabetes by driving research into adjunctive treatment for coexistent insulin resistance and developing new advanced diabetic technologies to preserve β cell function and mirror as much as possible endogenous pancreatic functions.

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1 型糖尿病治疗中未满足的需求:为何改善代谢控制如此困难?
先进糖尿病技术的发展使 1 型糖尿病患者的代谢控制能力显著提高,特别是先进的混合闭环系统的开发,通过减少低血糖、减少大血管病变和微血管病变相关并发症、改善 HbA1c 和血糖变异性,提高了患者的生活质量。尽管过去几十年来取得了进展,但在实现适当的代谢控制方面仍有很大的改进余地。导致血糖控制不佳的因素有很多,包括不恰当的碳水化合物计算、反复发作的低血糖、低血糖意识不足、局部使用胰岛素和长期使用糖尿病技术导致的皮肤表现、饮食紊乱或 "糖尿病 "等社会心理并发症、1 型糖尿病患者同时存在的胰岛素抵抗以及无法适当反映胰腺内源性胰岛素的生理分泌。因此,本综述旨在通过推动对并存胰岛素抵抗的辅助治疗的研究,以及开发新的先进糖尿病技术来保护β细胞功能并尽可能反映内源性胰岛功能,从而强调并克服 1 型糖尿病患者在实现适当代谢控制方面的障碍。
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来源期刊
Nutrition & Diabetes
Nutrition & Diabetes ENDOCRINOLOGY & METABOLISM-NUTRITION & DIETETICS
CiteScore
9.20
自引率
0.00%
发文量
50
审稿时长
>12 weeks
期刊介绍: Nutrition & Diabetes is a peer-reviewed, online, open access journal bringing to the fore outstanding research in the areas of nutrition and chronic disease, including diabetes, from the molecular to the population level.
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