Recent Advances in Type 1 Diabetes

Background/Objectives: Nocturnal glycemic variability in pediatric type 1 diabetes (T1D) disrupts caregiver sleep and quality of life; advanced hybrid closed-loop (AHCL) systems may be associated with reduced caregiver burden by providing more stable overnight glucose control. We aimed to evaluate changes in caregiver-reported sleep quality and continuous glucose monitoring (CGM) targets three months after transition to an AHCL system. Methods: We conducted a prospective single-center real-world study in a tertiary pediatric diabetes unit that included children aged 6–17 years with T1D who switched from continuous subcutaneous insulin infusion (MiniMed) and intermittently scanned CGM (FreeStyle Libre 2) to an AHCL system (MiniMed 780G) with Guardian 4 sensor. Caregivers completed the Pittsburgh Sleep Quality Index (PSQI) at baseline and after 3 months; CGM metrics (TIR 70–180 mg/dL, TAR1 180–250 mg/dL, TAR2 > 250 mg/dL, TBR1 54–70 mg/dL, TBR2 < 54 mg/dL) were extracted at the same time points. Analyses used Shapiro–Wilk, Wilcoxon signed-rank, Spearman correlations, and McNemar tests (α = 0.05). Results: Twenty-two caregivers completed baseline PSQI; 16 provided PSQI data at three months. The proportion with PSQI > 5 decreased from 56.3% to 18.8% (p = 0.034), and 81.3% showed lower global PSQI at 3 months (p = 0.018). The largest mean improvements were observed in daytime dysfunction (−0.94), subjective sleep quality (−0.81), and sleep duration (−0.63), with slight increases in sleep disturbance (+0.13) and sleep-medication use (+0.13). The proportion of participants meeting international CGM consensus targets improved: the percentage achieving TIR > 70% increased from 26.7% to 80.0% (p = 0.008); those meeting TAR > 180 mg/dL < 30% increased from 26.7% to 80.0% (p = 0.008); and those meeting TAR2 > 250 mg/dL < 5% increased from 20.0% to 53.3% (p = 0.008). Hypoglycemia-related targets showed no significant change, and no episodes of symptomatic or level 3 hypoglycemia were reported. Exploratory analyses suggested that poorer PSQI at 3 months was associated with greater Δ TBR1, and increases in TAR2 with higher sleep disturbance and sleep-medication use. Conclusions: Transition to an AHCL system was associated with improvements in caregiver-reported sleep and attainment of CGM consensus targets within three months. Residual nocturnal hyperglycemia was associated with features of ongoing sleep disturbance, highlighting the potential relevance of individualized alert settings, sleep-focused education, and inclusion of objective sleep measures in future studies. Full article

Background/Objective: Type 1 diabetes (T1D) is a complex autoimmune disease characterized by the destruction of insulin-producing pancreatic beta cells. The TAB2/SUMO4 locus has been implicated in T1D susceptibility through a biochemical mechanism involving NFκB. Given that alterations in NFκB activity have been linked to the etiology of T1D, this study evaluated the association between single nucleotide polymorphisms (SNPs) in the TAB2/SUMO4 region (rs6942381, rs237027, rs237025, and rs7896) and T1D in a population from southern Brazil. Methods: Two T1D groups, each comprising 150 with childhood-onset (aged ≤14 years) and 150 with adulthood-onset (aged >18 years) were compared with healthy controls (165 children aged ≤14 years and 150 adults aged >18 years, respectively). Genotyping of SNPs in the TAB2/SUMO4 region was performed using real-time PCR. Results: All polymorphisms were in Hardy–Weinberg equilibrium. The genotype and allele frequencies of the studied polymorphisms in the TAB2/SUMO4 region did not differ among groups in either children or adults. The MAF of the children and adults controls are respectively for rs6942381 49.1% (95% CI 44–54%) and 48.0% (95% CI 42–52%), rs237027 12.4% (95% CI 9–16%) and 11.7% (95% CI 8–15%), rs237025 45.5% (95% CI 40–51%) and 46.0% (95% CI 41–52%) and rs7896 18.2% (95% CI 14–22%) and 24.3% (95% CI 19–29%). The haplotype frequencies were also similar between groups. The observed minor allele frequencies were similar to those reported in European populations. Conclusions: TAB2/SUMO4 locus polymorphisms (rs6942381, rs237027, rs237025, and rs7896) were not associated with childhood- or adulthood-onset T1D in the studied population. Full article

Background/Objectives: Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition often managed exclusively with insulin. However, the search for adjuvant therapies has gained attention, including dipeptidyl peptidase-4 inhibitors (DPP4i) and sodium-glucose cotransporter 2 inhibitors (SGLT2i), despite limited evidence in pediatric populations. To evaluate the impact of DPP4i, alone or combined with SGLT2i, on glycemic control (HbA1c), lipid profile (ApoB and ApoA-I), and renal function (eGFR and albuminuria) in children, adolescents, and young adults with T1DM, this study was conducted. Methods: This cohort study analyzed data from 76 patients with T1DM aged under 25, followed for 4 to 20 months. Patients were grouped based on exposure to DPP4i alone, DPP4i + SGLT2i, or no additional therapy. Glycemic, lipid, and renal parameters were assessed at baseline and follow-up. Results: A significant reduction in HbA1c was observed in the overall sample (p < 0.001), regardless of treatment group, suggesting a positive effect of interdisciplinary care. There were no statistically significant differences in HbA1c variation among the groups. ApoB decreased significantly over time (p < 0.001), and ApoA-I levels were initially higher in the DPP4i + SGLT2i group. A significant reduction in albuminuria was identified in the DPP4i-only group compared to controls (p = 0.029), indicating a potential renoprotective effect. No significant changes in eGFR were observed. The use of DPP4i, with or without SGLT2i, was not associated with significant improvements in glycemic or lipid outcomes compared to standard therapy. However, DPP4i monotherapy was associated with a reduction in albuminuria, suggesting a possible benefit for renal protection. Conclusions: These findings highlight the need for larger, randomized studies to confirm the therapeutic role of these agents in young individuals with T1DM. Full article

Objectives: Families play a pivotal role in the care of adolescents with chronic illnesses, such as type 1 diabetes (T1D). This study’s aim was to evaluate family functioning in families of adolescents with T1D and to assess its relationship with metabolic control. Methods: Fifty-eight adolescents and young adults diagnosed with T1D, aged 14–21 years, and 116 healthy adolescents (controls) matched for age, gender and socioeconomic status were included in this study. The participants’ mean age was 15.9 years (±1.6 years). The demographics and family functioning were reported by the participants. The McMaster Family Assessment Device (FAD) measured family functioning across six dimensions. Results: In problem-solving and behavioral involvement, T1D adolescents self-reported similar scores to healthy controls. On the contrary, in the domains of communication (p = 0.048), family roles (p = 0.045), affective responsiveness (p = 0.048), affective involvement (p = 0.043) and general functioning (p = 0.044), the T1D group scored lower than the controls, indicating better family functioning. Furthermore, within the T1D group, better metabolic control, assessed by glycated hemoglobin (HbA1c), was associated with a trend toward improved affective responsiveness, although this did not reach statistical significance (p = 0.091). Conclusions: Our findings highlight the importance of family functioning among adolescents with T1D and point toward distinct family processes that can be addressed in the context of routine care to enhance wellbeing and facilitate T1D management. Full article

Background: Although technology has improved the quality of diabetes management, it may also introduce subjective burdens and reveal barriers to its use. The primary aim of this research was to investigate the association between the use of advanced diabetes technology, such as continuous glucose monitoring, insulin pumps, mobile applications, and diabetes distress in adults with type 1 diabetes mellitus (T1DM). Methods: This multicenter, cross-sectional study conducted across Southeastern European countries included 499 adults with T1DM. All participants signed informed consent and completed the 20-item Problem Areas in Diabetes (PAID) Questionnaire. A total score of 40 or above was classified as high diabetes distress. Statistical analyses were performed using ANOVA, χ2 test, and logistic regression. Results: The mean age of participants was 49.11 ± 13.99 years, with a mean HbA1c value of 7.9 ± 1.46%. The mean PAID total score was 29.19 ± 19.51. High levels of diabetes distress were found in 28.86% of the participants. About 20% of participants used advanced diabetes technologies. Significant predictors of diabetes distress were gender, BMI, and HbA1c. After accounting for these predictors, advanced technology use was associated with a 42% lower likelihood of experiencing high levels of diabetes distress compared to those who used blood glucose meters. Conclusions: Diabetes distress remains a frequent issue among individuals with T1DM. However, patients using advanced diabetes technologies exhibited less distress. Our findings highlight the importance of a comprehensive approach to T1DM management that integrates technological advancements and psychosocial support. Full article

Background/Objectives: This study investigated the relationship between glycemic control and increased glomerular filtration rate (eGFR), as assessed by serum creatinine and the CKiD equation in children and adolescents with T1DM. Methods: This cross-sectional observational study involved 80 T1DM patients (4–19 years) attending the Interdisciplinary Center for Diabetes. Biochemical, anthropometric, and skeletal muscle mass parameters were evaluated. The GFR was estimated using the CKiD equation expressed in mL/min/1.73 m². Results: Our results showed that nearly 19.0% of the included patients presented increased values for eGFR, and most had poor glycemic control. Patients with HbA1c levels above 8% presented eGRF > 130. There was a positive correlation between hyperglycemia, elevated HbA1c, and fat percentage with higher eGRF values. In addition, the reduction in lean mass and skeletal muscle mass was related to elevated eGRF. Conclusions: Our study indicates that children and adolescents with T1DM who have elevated HbA1c, lower lean mass, and less than five years of diagnosis of diabetes are more likely to present higher eGRF values. Full article

Background/Objectives: Chronic somatic diseases are significant risk factors for the development of mental disorders. Type 1 diabetes mellitus (T1D) is the most common chronic endocrine pathology in children. Treatment requires nutrition management, physical activity, lifelong insulin therapy, and proper self-monitoring of blood glucose. It is complicated and therefore may result in a variety of psychosocial problems for children, adolescents, and their families. Considering the rapidly growing incidence of type 1 diabetes in the pediatric population of Latvia, it is important to detect and prevent the risks of anxiety and depression in families with children suffering from type 1 diabetes. Methods: This was a quantitative interdisciplinary cross-sectional study to determine the prevalence of anxiety and depression in adolescents with T1D and their parents. Two tools were used to detect the presence of symptoms of anxiety and depression: the Generalized Anxiety Disorder Scale-7 (GAD-7) and the Patient Health Questionnaire 9 (PHQ-9) scale. Results: A total of 812 respondents were eligible for screening. Anxiety and depression symptoms were seen significantly more frequently in the study group than in the control group. The study found negative effects of anxiety and depression on the compensation of diabetes. Conclusions: Adolescents with type 1 diabetes and their parents are more predisposed to anxiety and depression symptoms than somatic healthy children and their parents, thus worsening disease control and prognosis. Full article

Background/Objectives: Regular physical exercise is strongly recommended for individuals with type 1 diabetes mellitus (T1DM) because of its beneficial effects on cardiovascular fitness, insulin sensitivity, metabolic control, and overall health. Nevertheless, participation in physical activity remains limited, largely due to the fear of exercise-induced hypoglycemia and glycemic instability. Glycemic responses to exercise in T1DM are influenced by the interaction between exercise modality, circulating insulin levels, nutritional status, and diabetes technologies. Continuous aerobic exercise, resistance training, high-intensity interval exercise, and mixed intermittent activities elicit distinct metabolic and hormonal responses, resulting in heterogeneous glycemic trajectories. This narrative review aimed to provide a clinically oriented synthesis of the physiological mechanisms underlying exercise-related glycemic fluctuations in T1DM and to discuss integrated insulin- and carbohydrate-based strategies to support safer participation in physical activity in the context of modern diabetes technologies. Methods: A structured narrative review was conducted using PubMed/MEDLINE, Scopus, and complementary searches in Google Scholar to identify experimental studies, observational studies, systematic reviews, consensus statements, and clinical guidelines focused on exercise-related glycemic responses in individuals with T1DM. Only articles published in English were considered. Evidence was selected and synthesized according to relevance to exercise modality, insulin therapy strategies, carbohydrate management, and diabetes technologies, including continuous glucose monitoring, continuous subcutaneous insulin infusion, and automated insulin delivery systems. The final narrative synthesis was based on 44 selected studies, reviews, consensus statements, and guidance documents considered most relevant to the objectives of this narrative review. Results: Available evidence indicates that continuous moderate-intensity aerobic exercise is most consistently associated with progressive glucose declines and increased risk of hypoglycemia, particularly when performed in the presence of elevated insulin on board. In contrast, resistance exercise and short-duration high-intensity or anaerobic exercise more frequently induce stable glycemia or transient hyperglycemia through adrenergic stimulation and increased hepatic glucose output. Mixed and intermittent exercise modalities often produce more variable responses depending on exercise sequencing, nutritional status, and insulin exposure. Across studies, integrated adjustment of basal and prandial insulin doses together with individualized carbohydrate supplementation emerged as the most effective strategy to reduce exercise-related glycemic instability. Continuous glucose monitoring and insulin pump technologies improved glucose trend awareness and management flexibility; however, physical exercise remains a challenging condition for current automated insulin delivery algorithms and still requires active user-driven decision-making. Conclusions: Exercise management in T1DM should be based on an individualized interpretation of exercise modality, glucose trends, insulin exposure, and nutritional context rather than on fixed glucose thresholds alone. Combining anticipatory insulin adjustments, tailored carbohydrate strategies, and appropriate use of diabetes technologies may substantially reduce glycemic variability and improve confidence toward physical activity participation. Structured education and individualized clinical guidance remain essential to translate physiological knowledge into effective real-world exercise management. Full article