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New Insights into Type 1 Diabetes
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New Insights into Type 1 Diabetes

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Endocrinology & Metabolism".

Deadline for manuscript submissions: closed (10 September 2024) | Viewed by 10996

Special Issue Editors

Dr. Antonio J. Amor

E-Mail Website
Guest Editor
Diabetes Unit, Endocrinology and Nutrition Department, Hospital Clínic, Villarroel 170, 08036 Barcelona, Spain
Interests: diabetes; type 1 diabetes; insulin resistance; endocrinology; blood glucose; disease prevention; cardiovascular disease; cardiovascular risk; risk factors; vascular ultrasound; atherosclerosis
Dr. Verónica Perea

E-Mail Website
Guest Editor
Endocrinology and Nutrition Department, Hospital Universitari Mútua de Terrassa, 08221 Terrassa, Spain
Interests: diabetes; type 1 diabetes; pregnancy; cardiovascular; metabolic syndrome; glucose metabolism

Special Issue Information

Dear Colleagues,

Type 1 diabetes is a chronic metabolic disease with a worldwide increasing incidence and prevalence. In recent years, some therapies such as automated insulin delivery systems have greatly improved the glucose control of these patients. However, there are also other metabolic derangements, beyond hyperglycemia, that are involved in the risk of chronic complications of these individuals. In this sense, even in those with good glucose control (according to current guidelines), the risk of cardiovascular disease is still two-to-four-fold increased. Other factors such lipoprotein disturbances, insulin resistance-related metabolic derangements or obstetric complications could be involved in the risk of vascular complications of these individuals. Notwithstanding, there are still many gaps in the knowledge of the underlying factors involved in micro/macrovascular complications in this disease.   

The scope of this special issue is to provide an overview of the recent advances in type 1 diabetes, both in the management of hyperglycemia or other cardiovascular risk factors, as well as in the assessment of vascular complications in this disease. Therefore, researchers in the field of type 1 diabetes are encouraged to submit an original article or review to this Special Issue.

Dr. Antonio J. Amor
Dr. Verónica Perea
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • type 1 diabetes
  • insulin resistance
  • cardiovascular disease
  • cardiovascular risk
  • metabolic syndrome
  • continuous glucose monitoring
  • atherosclerosis
  • biomarkers

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Published Papers (5 papers)

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Research

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9 pages, 543 KiB  
Article
Prevalence of Cardiomyopathy in Patients with Type 1 Diabetes Mellitus
by Oscar Daniel Fabila-de la Cruz, Eduardo Salif Luna-Avila, María del Pilar Sotelo-González, Andrés D. Litardo-Mosquera, Oscar Orihuela and Aldo Ferreira-Hermosillo
J. Clin. Med. 2024, 13(18), 5351; https://doi.org/10.3390/jcm13185351 - 10 Sep 2024
Viewed by 2371
Abstract
Background: Diabetic cardiac muscle disease or diabetic cardiomyopathy (DbCM) comprises a set of myocardial lesions that are not associated with coronary atherosclerosis or high blood pressure. It is characterized by fibrosis and hypertrophy, which ultimately results in heart failure. Diastolic dysfunction (DD) has [...] Read more.
Background: Diabetic cardiac muscle disease or diabetic cardiomyopathy (DbCM) comprises a set of myocardial lesions that are not associated with coronary atherosclerosis or high blood pressure. It is characterized by fibrosis and hypertrophy, which ultimately results in heart failure. Diastolic dysfunction (DD) has been shown to be the first manifestation of diabetic cardiomyopathy. Currently, there are few studies on the prevalence of diabetic cardiomyopathy in adult patients diagnosed with type 1 diabetes mellitus (T1D). Methods: The study included 75 adult participants who underwent an echocardiogram. Data on their comorbidities were collected from their medical records and biochemical parameters were analyzed in blood and urine samples. Results: We found that the prevalence of DbCM in our T1D population was more than one-third (34%), which exceeded the prevalence reported in studies with adolescents and that reported in the population without diabetes. Also, we found that the probability of developing DD after 20 years of T1D diagnosis was 78%. Conclusions: Recommendations need to be issued in relation to diabetic cardiomyopathy to carry out secondary prevention in adult patients with T1D. More multicenter studies, which include a larger population, from different regions of the world need to be performed. Full article
(This article belongs to the Special Issue New Insights into Type 1 Diabetes)
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12 pages, 258 KiB  
Article
Metabolic and Clinical Outcomes in Type 1 Diabetes in the COVID-19 Pre- and Post-Vaccination Periods in Spain: The COVID-SED1 Study
by Fernando Gómez-Peralta, Edelmiro Menéndez, Santiago Conde, Pablo Abellán-Galiana, Miguel Brito, Marina Beléndez and Antonio Pérez
J. Clin. Med. 2024, 13(7), 1922; https://doi.org/10.3390/jcm13071922 - 26 Mar 2024
Viewed by 1460
Abstract
Aims: To evaluate the metabolic and clinical outcomes in the Spanish type 1 diabetes mellitus (T1D) population before and after COVID-19 vaccination. Methods: A retrospective observational study was carried out in Spanish public hospitals previously enrolled in the SED1 study. Adults and children [...] Read more.
Aims: To evaluate the metabolic and clinical outcomes in the Spanish type 1 diabetes mellitus (T1D) population before and after COVID-19 vaccination. Methods: A retrospective observational study was carried out in Spanish public hospitals previously enrolled in the SED1 study. Adults and children with T1D were included and their clinical electronic records were reviewed. Clinical, laboratory, and glucometric parameters from continuous glucose monitoring (CGM) data corresponding to the periods before and after administering the first COVID-19 vaccination were analyzed. Results: A total of 26 centers and 228 patients participated in this new phase of the SED1 study and 187 were finally evaluable (mean age 37.5 ± 15.6 years, 56.7% women). Overall, 94.6% of the sample was vaccinated, and this percentage increased with higher levels of education (p-value = 0.027). In the pre- and post-vaccination periods, respectively, the number of patients with acute hyperglycemic decompensation was 6/161 (3.7%) and 7/161 (4.3%) (p = 1) and with acute hypoglycemic decompensation was 6/161 (3.7%) and 6/161 (3.7%) (p = 1). The HbA1c level was lower in the post-vaccination period(mean ± SD, mg/dL): pre-vaccination 7.4 ± 0.9; post-vaccination 7.2 ± 1.0, (−0.19; p-value = 0.0006). A total of 31.9% of patients (95% CI: 24.7–39.7) in the pre-vaccination period and 45.0% (IC95%: 37.1–53.1) in the post-vaccine period had HbA1c < 7% (p-value < 0.001). Glucometrics from CGM data also showed numerical improvements post-vaccination. Conclusions: The COVID-19 vaccination was highly accepted in the Spanish T1D population, with hesitancy about the COVID-19 vaccine being higher in those with lower educational levels. A mildly better glycemic control was observed in the post-vaccination period. Full article
(This article belongs to the Special Issue New Insights into Type 1 Diabetes)
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Review

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24 pages, 287 KiB  
Review
Telemedicine for Managing Type 1 Diabetes in Children and Adolescents Before and After the COVID-19 Pandemic
by Federica Fogliazza, Vanessa Sambati, Brunella Iovane, Pietro Lazzeroni, Maria Elisabeth Street and Susanna Esposito
J. Clin. Med. 2024, 13(23), 7359; https://doi.org/10.3390/jcm13237359 - 3 Dec 2024
Viewed by 1701
Abstract
The COVID-19 pandemic has catalyzed the rapid expansion of telemedicine for managing chronic conditions such as type 1 diabetes (T1D) in children and adolescents. This narrative review aims to explore the role of telemedicine in pediatric T1D management by comparing its use before [...] Read more.
The COVID-19 pandemic has catalyzed the rapid expansion of telemedicine for managing chronic conditions such as type 1 diabetes (T1D) in children and adolescents. This narrative review aims to explore the role of telemedicine in pediatric T1D management by comparing its use before and after the pandemic. We conducted a comprehensive literature review covering studies published between 2000 and 2024, focusing on telemedicine applications in pediatric T1D care. The review includes clinical trials, systematic reviews, and observational studies examining telemedicine’s impact on glycemic control, patient satisfaction, and healthcare delivery. Results reveal that telemedicine has enhanced access to care, improved glycated hemoglobin (HbA1c) levels, and reduced diabetic ketoacidosis and hypoglycemic events. Patients and caregivers expressed high satisfaction, especially when using continuous glucose monitoring and insulin pump technologies integrated with telemedicine platforms. However, challenges such as digital literacy gaps, variability in healthcare provider training, and logistical issues like reimbursement policies persist. The pandemic highlighted the potential of telemedicine to supplement traditional in-person care, showing promise in enhancing patient outcomes and reducing healthcare burdens. Further research is needed to optimize telemedicine models for T1D, addressing barriers to implementation and exploring its long-term cost-effectiveness. This review underscores telemedicine’s evolving role as a complementary approach in managing pediatric T1D, advocating for the development of standardized care protocols to fully integrate digital health solutions into routine clinical practice. Full article
(This article belongs to the Special Issue New Insights into Type 1 Diabetes)
16 pages, 1029 KiB  
Review
Screening for Subclinical Atherosclerosis and the Prediction of Cardiovascular Events in People with Type 1 Diabetes
by Tonet Serés-Noriega, Verónica Perea and Antonio J. Amor
J. Clin. Med. 2024, 13(4), 1097; https://doi.org/10.3390/jcm13041097 - 15 Feb 2024
Cited by 3 | Viewed by 3093
Abstract
People with type 1 diabetes (T1D) have a high cardiovascular disease (CVD) risk, which remains the leading cause of death in this population. Despite the improved control of several classic risk factors, particularly better glycaemic control, cardiovascular morbidity and mortality continue to be [...] Read more.
People with type 1 diabetes (T1D) have a high cardiovascular disease (CVD) risk, which remains the leading cause of death in this population. Despite the improved control of several classic risk factors, particularly better glycaemic control, cardiovascular morbidity and mortality continue to be significantly higher than in the general population. In routine clinical practice, estimating cardiovascular risk (CVR) in people with T1D using scales or equations is often imprecise because much of the evidence comes from pooled samples of people with type 2 diabetes (T2D) and T1D or from extrapolations of studies performed on people with T2D. Given that T1D onsets at a young age, prolonged exposure to the disease and its consequences (e.g., hyperglycaemia, changes in lipid metabolism or inflammation) have a detrimental impact on cardiovascular health. Therefore, it is critical to have tools that allow for the early identification of those individuals with a higher CVR and thus be able to make the most appropriate management decisions in each case. In this sense, atherosclerosis is the prelude to most cardiovascular events. People with diabetes present pathophysiological alterations that facilitate atherosclerosis development and that may imply a greater vulnerability of atheromatous plaques. Screening for subclinical atherosclerosis using various techniques, mainly imaging, has proven valuable in predicting cardiovascular events. Its use enables the reclassification of CVR and, therefore, an individualised adjustment of therapeutic management. However, the available evidence in people with T1D is scarce. This narrative review provides and updated overview of the main non-invasive tests for detecting atherosclerosis plaques and their association with CVD in people with T1D. Full article
(This article belongs to the Special Issue New Insights into Type 1 Diabetes)
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Other

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8 pages, 997 KiB  
Case Report
Changes of Sublingual Microcirculation during the Treatment of Severe Diabetic Ketoacidosis
by Vlasta Krausova, David Neumann, Jaroslav Skvor and Pavel Dostal
J. Clin. Med. 2024, 13(6), 1655; https://doi.org/10.3390/jcm13061655 - 14 Mar 2024
Viewed by 1230
Abstract
Introduction: Diabetic ketoacidosis (DKA) is associated with volume depletion and hemodynamic alterations. Changes in systemic microcirculation during DKA have not been described so far. Methods: In this case report, we describe the evolution of sublingual microcirculatory changes, monitored using sidestream dark field (SDF) [...] Read more.
Introduction: Diabetic ketoacidosis (DKA) is associated with volume depletion and hemodynamic alterations. Changes in systemic microcirculation during DKA have not been described so far. Methods: In this case report, we describe the evolution of sublingual microcirculatory changes, monitored using sidestream dark field (SDF) imaging during the treatment of severe diabetic ketoacidosis in a 13-year-old girl. The patient presented a pH of 6.84, a glycemia level of 27.2 mmol/L, a ketonemia level of 5.6 mmol/L, a base excess of −29.4 mmol/L, hypernatremia, hyperosmolality due to acute gastritis, and a malfunction of the glucose sensor. Sublingual microcirculation measurements using an SDF probe were initiated 60 min after the initiation of treatment, which was then repeated 2, 3, 4, 6, 12, and 24 h after treatment initiation, as well as on the day of discharge. Results: Substantial alterations of microvascular perfusion parameters, both total and small vessel densities, perfused vessel densities, and the DeBacker score, were observed during the first 6 to 12 h of treatment. The degree of microcirculatory alteration was strongly negatively correlated with calculated osmolality, sodium levels, ketone and lactate levels, and blood pressure values. Conclusions: DKA is, in its complexity, associated with a serious microcirculatory alteration. SDF imaging provides insight into the severity of the patient’s microcirculatory alteration and its evolution during treatment. Full article
(This article belongs to the Special Issue New Insights into Type 1 Diabetes)
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