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Abstract: Regular physical activity and exercise (PA) are cornerstones of diabetes care for individuals with type 1 diabetes. In recent years, the availability of automated insulin delivery (AID) systems has improved the ability of people with type 1 diabetes to achieve the recommended glucose target ranges. PA provides additional health benefits but can cause glucose fluctuations, which challenges current AID systems. While an increasing number of clinical trials and reviews are being published on different AID systems and PA, it seems prudent at this time to collate this information and develop a position statement on the topic. This joint European Association for the Study of Diabetes (EASD)/International Society for Pediatric and Adolescent Diabetes (ISPAD) position statement reviews current evidence on AID systems and provides detailed clinical practice points for managing PA in children, adolescents and adults with type 1 diabetes using AID technology. It discusses each commercially available AID system individually and provides guidance on its use in PA. Additionally, it addresses different glucose responses to PA and provides stratified therapy options to maintain glucose levels within the target ranges for these age groups.
Keywords: automated insulin delivery, continuous glucose monitoring, exercise, glucose, insulin pump, physical activity, position statement, type 1 diabetes
Published in DiRROS: 23.04.2026; Views: 188; Downloads: 151
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Abstract: Ultra-rapid-acting insulin analogs (URAA) are a further development and refinement of rapid-acting insulin analogs. Because of their adapted formulation, URAA provide an even faster pharmacokinetics and thus an accelerated onset of insulin action than conventional rapid-acting insulin analogs, allowing for a more physiologic delivery of exogenously applied insulin. Clinical trials have confirmed the superiority of URAA in controlling postprandial glucose excursions, with a safety profile that is comparable to the rapid-acting insulins. Consequently, many individuals with diabetes mellitus may benefit from URAA in terms of prandial glycemic control. Unfortunately, there are only few available recommendations from authoritative sources for use of URAA in clinical practice. Therefore, this expert consensus report aims to define populations of people with diabetes mellitus for whom URAA may be beneficial and to provide health care professionals with concrete, practical recommendations on how best to use URAA in this context
Keywords: ultra-rapid-acting insulin, URLi, faster aspart, insulin therapy, type I diabetes, type 2 diabetes
Published in DiRROS: 22.04.2026; Views: 159; Downloads: 118
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Abstract: Background and aims: In contrast to extensively studied hypercholesterolemia, knowledge of hypocholesterolemia is limited. This study aims to assess the prevalence, clinical characteristics, and genetics of children and adolescents with hypocholesterolemia. Methods: This national prospective cross-sectional cohort study was part of Slovenia's universal opt-out cholesterol screening program. The first part assessed hypocholesterolemia prevalence among 3538 children aged 5 years, randomly selected at the mandatory check-up. The second part included analysis of demographic and clinical data and genetic testing of 71 individuals with suspected hypocholesterolemia (total cholesterol [TC] < 3.0 mmol/L [116.0 mg/dL]) referred to the Lipid Clinic of University Children's Hospital Ljubljana. Results: The prevalence of hypocholesterolemia among 3538 children was 2.66 % (95 % CI: 2.13-3.19 %). Among the 71 genetically tested individuals with suspected hypocholesterolemia, those with pathogenic variants had lower TC (2.58 ± 0.44 mmol/L vs. 2.85 ± 0.42 mmol/L [99.77 ± 17.02 mg/dL vs. 110.20 ± 16.24 mg/dL]; p = 0.037) and low-density lipoprotein cholesterol (1.00 ± 0.40 mmol/L vs. 1.33 ± 0.40 mmol/L [38.67 ± 15.47 mg/dL vs. 51.43 ± 15.47 mg/dL]; p = 0.014) compared to those without such variants. Genetic testing identified pathogenic alterations in 15 subjects, including 4 novel loss-of-function variants in the APOB gene. All but one subject were asymptomatic. Conclusions: This study provides new clinical and genetic insights into hypocholesterolemia. Asymptomatic patients with hypocholesterolemia may not require further evaluation, but additional research is needed to understand hypocholesterolemia better.
Keywords: APOB, children, hypocholesterolemia, next-generation sequencing, prevalence
Published in DiRROS: 09.04.2026; Views: 180; Downloads: 140
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Abstract: The development of automated insulin delivery systems has seen tremendous improvements from individual components to interoperable system combinations of devices and new drugs besides insulin. The components have become progressively smaller, more accurate, and more user friendly. This article summarizes the history of the artificial pancreas from the earliest concepts to fully functional systems to research into further improvements in the future. The authors include many of the developers of this technology who received research support from the National Institute of Diabetes and Digestive and Kidney Diseases at various stages to develop these systems.
Keywords: automated insulin delivery, artificial pancreas, NIDDK, AID
Published in DiRROS: 24.03.2026; Views: 195; Downloads: 141
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Abstract: Background: Cigarette smoking is a well-established risk factor for diabetes, but the relationship between e-cigarette use and diabetes remains uncertain. Evidence to date has been drawn almost entirely from North America and Asia, with little information from European populations. Methods: We conducted a cross-sectional study of 17,854 adults aged 16 years and older from the 2017, 2018, 2019, and 2021 waves of the nationally representative Scottish Health Survey. Diabetes status was based on self-report of doctor-diagnosed diabetes. Participants were classified into six mutually exclusive categories of smoking and e-cigarette use: never users of either cigarettes or e-cigarettes, ex-smokers (former smokers who never used e-cigarettes), current exclusive cigarette smokers, current exclusive e-cigarette users, current dual users, and former e-cigarette users. Weighted prevalence estimates and survey-weighted binary logistic regression models were used to examine associations, adjusting for age group, sex, education, deprivation quintile, ethnicity, alcohol use, physical activity, and hypertension. Results: Diabetes prevalence was highest among ex-smokers (11.3 %, 95 % CI: 10.1-12.5). Prevalence was 5.7 % (95 % CI: 5.2-6.2) among never users of either cigarettes or e-cigarettes, 6.2 % (95 % CI: 4.9-7.9) among current exclusive cigarette smokers, 4.9 % (95 % CI: 3.4-7.1) among current exclusive e-cigarette users, 8.3 % (95 % CI: 5.8-11.8) among current dual users, and 5.1 % (95 % CI: 4.1-6.3) among former e-cigarette users. In adjusted models, ex-smokers had 35 % higher odds of diabetes compared with never users of either cigarettes or e-cigarettes (OR = 1.35, 95 % CI = 1.14-1.60, p < 0.001), whereas current exclusive smokers (OR = 0.78, 95 % CI = 0.58-1.03, p = 0.084), current exclusive e-cigarette users (OR = 0.81, 95 % CI = 0.53-1.22, p = 0.309), current dual users (OR = 1.49, 95 % CI = 0.94-2.38, p = 0.091), and former e-cigarette users (OR = 1.00, 95 % CI = 0.78-1.29, p = 0.973) were not significantly different from never users. Sensitivity analyses restricting ex-smokers to those with ≥5 years since cessation and limiting the sample to adults aged ≥45 years reproduced the same pattern of results. Conclusions: In this nationally representative study of Scottish adults, excess diabetes prevalence was observed among ex-smokers, a pattern that may reflect both reverse causation if individuals quit smoking after diagnosis and the lasting metabolic effects of cumulative smoking exposure. Neither current nor former e-cigarette use was associated with diabetes, and the observed variation in prevalence appeared linked to smoking history rather than e-cigarette use. However, because vaping is relatively recent, further longitudinal research is needed to clarify any long-term risks.
Keywords: cigarette smoking, cross-sectional study, diabetes, e-cigarettes, Scotland, tobacco
Published in DiRROS: 23.03.2026; Views: 195; Downloads: 145
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