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Diabetes is a long-term condition that can have a major impact on the life of a child or young person, as well as their family or carers. In addition to insulin therapy, diabetes management should include education, support and access to psychological services, as detailed here and in this guideline. Preparations should also be made for the transition from paediatric to adult services, which have a somewhat different model of care and evidence base.

NICE Guideline - National Collaborating Centre for Women's and Children's Health (UK).

Version: August 2015

Rapid‐acting insulin analogues (artificial insulin such as insulin lispro, insulin aspart, or insulin glulisine) act more quickly than regular human insulin. In people with a specific type of life‐threatening diabetic coma due to uncontrolled diabetes, called diabetic ketoacidosis, prompt administration of intravenous regular insulin is standard therapy. The rapid‐acting insulin analogues, if injected subcutaneously, act faster than subcutaneously administered regular insulin. The need for a continuous intravenous infusion, an intervention that usually requires admission to an intensive care unit, can thereby be avoided. This means that subcutaneously given insulin analogues for diabetic ketoacidosis might be applied in the emergency department and a general medicine ward.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 21, 2016

Type 1 diabetes affects over 370,000 adults in the UK, representing approximately 10% of adults diagnosed with diabetes. Given the complexity of its treatment regimens, successful outcomes depend, perhaps more than with any other long-term condition, on full engagement of the adult with type 1 diabetes in life-long day-by-day self-management. In order to support this, the health service needs to provide informed, expert support, education and training as well as a range of other more conventional biomedical services and interventionsfor the prevention and management of long term complications and disability.

NICE Guideline - National Clinical Guideline Centre (UK).

Version: August 2015

AIM: Diabetic ketoacidosis is a life-threatening complication of Type 1 diabetes. Blood β-hydroxybutyrate testing is now widely available as an alternative to urine acetoacetate testing for detecting ketosis. The aim of this study was to review the effectiveness of capillary or serum β-hydroxybutyrate compared with urine acetoacetate testing in prevention and management of diabetic ketoacidosis.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2013

Cystic fibrosis (CF) is an inherited disease that leads to damage to lungs, pancreas and other organs. Most people with CF die prematurely from lung disease, but survival has improved markedly over the decades and it is estimated that children born with CF now will live to an average age of 50 years. CF-related diabetes (CFRD) is due to damage to the pancreas, which, over time, loses its capacity to produce sufficient insulin. CFRD is becoming more common owing to the improved survival of people with CF.

Health Technology Assessment - NIHR Journals Library.

Version: May 2012

The objective of the study was to study the effects of continuous subcutaneous insulin infusion (CSII) vs multiple-dose insulin (MDI) therapy on glycemic control and pregnancy outcome in diabetic women. Randomized, controlled trials comparing CSII vs MDI in pregnant diabetic women were included after an electronic database search. Studies were rated for quality independently by 2 reviewers in accordance with the Quality of Reporting of Metaanalyses statement. Summary weighted mean difference and odds ratio were estimated for insulin dose, birthweight, gestational age, mode of delivery, hypoglycemic/ketotic episodes, worsening retinopathy, neonatal hypoglycemia, and rates of intrauterine fetal death. Six randomized clinical trials met the inclusion criteria. Pregnancy outcomes and glycemic control were not significantly different among treatment groups. Higher number of ketoacidotic episodes and diabetic retinopathy found in the CSII group did not reach statistical significance. This systematic review does not show any advantage or disadvantage of using CSII over MDI in pregnant diabetic women. Large multicenter, randomized, controlled trials addressing the quality of life/cost effectiveness are required.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2007

INTRODUCTION: Total pancreatectomy (TP) has been associated with substantial metabolic abnormalities and poor glycaemic control limiting its use. Because data reported to date are limited, we evaluated outcomes related to the diabetes mellitus obligated by TP.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

To compare the effectiveness and adverse event profiles of amylin agonists, DPP-4 inhibitors, incretin mimetics, TZDs, and certain combination products for people with type 2 diabetes and for people with type 1 diabetes for pramlintide only.

Drug Class Reviews - Oregon Health & Science University.

Version: February 2011

The study found evidence to suggest that integrated continuous glucose monitoring insulin pump therapy systems are more clinically effective in patients with type 1 diabetes than stand-alone treatments. However, based on the evidence available, these integrated systems are unlikely to be cost-effective in comparison with stand-alone insulin delivery and monitoring. Further research on the clinical effectiveness and cost-effectiveness of these integrated systems in different populations is warranted.

Health Technology Assessment - NIHR Journals Library.

Version: February 2016

Although dapagliflozin, canagliflozin and empagliflozin improve glycaemic control, as monotherapy they are not cost-effective compared with gliclazide or pioglitazone, but may be against sitagliptin.

Health Technology Assessment - NIHR Journals Library.

Version: January 2017

Type 1 diabetes is a disease in which the pancreas has lost its ability to make insulin. A deficit in insulin leads to increases in blood glucose levels, these elevated blood glucose levels can lead to complications which may affect the eyes, kidneys, nerves and the heart and blood vessels. Since there is no cure for type 1 diabetes, patients need to check their blood glucose levels often by fingerprick and use these blood glucose values to decide on their insulin dosages. Fingerpricks are often regarded as cumbersome and uncomfortable by patients. In addition, fingerprick measurements only provide information about a single point in time, so it is difficult to discern trends in decline of rises in blood glucose levels.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: January 18, 2012

The aims of this investigation were to assess the benefit of long-term treatment with insulin aspart, insulin glulisine or insulin lispro, each compared to a treatment with short-acting human insulin, and to conduct a comparative benefit assessment of the 3 above-mentioned RAIs compared with each other, in each case in children and adolescents with diabetes mellitus type 1, focusing on patient-relevant outcomes.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: September 24, 2009

The primary objective of this review was to assess the positive and negative outcomes of tighter blood glucose control ('intensive' glucose control) compared to less intense treatment targets ('conventional' glucose control) in individuals with type 1 diabetes.

Cochrane Database of Systematic Reviews: Plain Language Summaries [Internet] - John Wiley & Sons, Ltd.

Version: February 14, 2014

The aim of this report is to review the clinical and cost-effectiveness, and guidelines of insulin pumps for adults with type 1 diabetes. This report is an update to a previous Rapid Response report, “Continuous Subcutaneous Insulin Infusion for Type 1 Diabetes: Clinical Effectiveness, Cost-Effectiveness, and Guidelines”, published in April 2015. Available from: https://www.cadth.ca/sites/default/files/pdf/htis/apr-2015/RA0750%20Insulin%20Pumps%20for%20Type%201%20Diabetes%20Final.pdf

Rapid Response Report: Summary with Critical Appraisal - Canadian Agency for Drugs and Technologies in Health.

Version: December 10, 2015

The aim of this study was to specify a potential need for updating and supplementation of the existing DMP “diabetes mellitus type 1” by systematically searching for new, topic-relevant, evidence-based guidelines and by synthesizing the guideline recommendations.

Institute for Quality and Efficiency in Health Care: Executive Summaries [Internet] - Institute for Quality and Efficiency in Health Care (IQWiG).

Version: June 24, 2011

This review concluded that the use of real-time continuous glucose monitoring effectively lowered HbA1c in people with type 1 diabetes compared with self monitoring of blood glucose. The conclusions of this well-conducted review are limited by the low quality of the evidence and lack of long-term follow-up.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2012

Our objective was to determine the impact of telemedicine (TM) interventions on the management of type 1 diabetes (T1DM) in youth. We performed a systematic review of randomized trials that evaluated TM interventions involving transmission of blood glucose data followed by unsolicited scheduled clinician feedback. We found no apparent effect of the TM interventions on hemoglobin A1c (HbA1c), severe hypoglycemia, or diabetic ketoacidosis. The limited data available on patient satisfaction, quality of life, and cost also suggested no differences between groups. It is unlikely that TM interventions, as performed in the assessed studies, had a substantial effect on glycemic control or acute complications. However, it remains possible that there are other benefits of TM not adequately reported, that newer TM strategies may be more effective and that interventions may benefit subgroups of youth, such as those with the poor glycemic control, adolescents, or those living in remote areas.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2010

AIMS: This study performed a systematic review and meta-analysis on glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) treated with lispro (LP) versus regular insulin (RI) since before pregnancy.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2011

OBJECTIVE: To assess the benefits and harms of targeting intensive versus conventional glycaemic control in patients with type 1 diabetes mellitus.

Database of Abstracts of Reviews of Effects (DARE): Quality-assessed Reviews [Internet] - Centre for Reviews and Dissemination (UK).

Version: 2014

Prevalence of type 2 diabetes is increasing at an alarming pace, fueled by the rising rates of overweight and obesity in many populations. In the VA healthcare system, the prevalence of diabetes was 20% in fiscal year 2000 and is now estimated at nearly 25%.

Evidence-based Synthesis Program - Department of Veterans Affairs (US).

Version: April 2012

Systematic Reviews in PubMed

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