Stankutė, Ingrida

Aim: To explore the underlying factors contributing to undiagnosed diabetes through a deep review of existing literature and identify potential strategies to enhance early diagnosis. Objectives: 1. To review and synthesize existing literature on the prevalence and risk factors associated with undiagnosed diabetes. 2. To identify and understand common reasons why diabetes is not diagnosed on time, including healthcare system limitations, patient-related issues, and social challenges. 3. To analyze how the delayed diagnosis of diabetes affects patients, specifically regarding complications and quality of life. Background: Diabetes mellitus is a growing global health challenge. Despite major advances in diagnosis and treatment, nearly one in two adults with diabetes worldwide remains undiagnosed, delaying early intervention and increasing the risk of complications. Methods: A comprehensive literature review was conducted using the PubMed database. The search strategy focused on articles published in English over the last 10 years, using keywords related to the prevalence, risk factors, and consequences of undiagnosed and delayed diagnosed diabetes. After screening the search results, 25 relevant articles were selected for this literature review. Research results: The reviewed literature indicates that undiagnosed diabetes remains a major global public health challenge. Underdiagnosis is more common in younger adults and socially vulnerable groups, including individuals with lower socioeconomic status and lower educational. Delayed diagnosis is influenced by the often-asymptomatic early stage of type 2 diabetes and missed opportunities for screening in routine care. Prolonged untreated hyperglycemia is associated with advanced microvascular complications, increased mortality risk, and substantial economic burden due to higher healthcare utilization and more intensive treatment needs. Conclusions: Undiagnosed diabetes remains a major public health challenge, and symptom-based diagnosis alone is insufficient for early detection. Earlier identification requires targeted screening, improved follow-up of abnormal glucose results, and efforts to reduce socioeconomic and educational barriers. Recommendations: Implement structured risk-based screening in primary care for high-risk populations. Establish clear follow-up for abnormal glucose and glycated hemoglobin (HbA1c) results. Strengthen awareness of the asymptomatic nature of early diabetes, especially in vulnerable and underserved groups.

Autorius: Grytė Leonavičiūtė Pavadinimas: Vaikų cukrinio diabeto kontrolės dinamika pakeitus gydymą iš neautomatizuotų insulino pompų į automatizuotas (2022-2024 m.) Tikslas: Įvertinti gydymo keitimo: iš neautomatizuotos į automatizuotą insulino pompą (Medtronic MiniMed 780G), poveikį glikemijos kontrolei vaikams, sergantiems 1 tipo cukriniu diabetu. Uždaviniai: Įvertinti trumpalaikių (laiko tikslinėse glikemijos ribose (TIR) bei hiperglikemijų) diabeto kontrolės rodiklių pokyčius prieš ir po gydymo keitimo. Įvertinti trumpalaikių diabeto kontrolės rodiklių (hipoglikemijų) pokyčius prieš ir po gydymo keitimo. Įvertinti ilgalaikių diabeto kontrolės rodiklių (HbA1c) pokyčius 6 mėn. prieš ir po gydymo keitimo. Metodika: Buvo atliktas retrospektyvinis tyrimas, įtraukiant vaikus ir paauglius, sergančius 1 tipo cukriniu diabetu, kuriems buvo įdiegta Medtronic 780G insulino pompa su nuolatine gliukozės monitoravimo (NGM) sistema. Duomenys apie HbA1c, TIR, hiperglikemijų bei hipoglikemijų dažnumą buvo surinkti 6 mėn. prieš uždedant pompą, užsidėjimo dieną bei 6 mėn. po pompos uždėjimo. Gauti duomenys buvo išanalizuoti naudojant IBM SPSS Statistics v29.0 programą. Tyrimo rezultatai: Atlikto tyrimo duomenimis 6 mėn. po automatizuotos insulino pompos įdiegimo neoptimalaus HbA1c (t.y. >7 %) sumažėjo nuo 54,28 % iki 25,0 % (p=0,020), o neoptimalaus TIR (t.y. >70 %) padidėjo nuo 31,58 % iki 84,22 % (p < 0,001). Hiperglikemijų dažnis sumažėjo nuo 50,0 % iki 16,66 % (p < 0,001). Hipoglikemijų dažnis sumažėjo nuo 68,42 % iki 15,78 % (p < 0,001). Išvados: Įvertinus trumpalaikių (TIR, hiperglikemijų bei hipoglikemijų) diabeto kontrolės rodiklių pokyčius prieš ir po gydymo keitimo matomas ryškus jų pagerėjimas 6 mėn. po Medtronic 780G uždėjimo. Automatizuota insulino pompa taip pat pagerino ir ilgalaikius vaikų diabeto kontrolės kriterijus, t.y. HbA1c. Rekomendacijos: Rekomenduojama tęsti ilgalaikius tyrimus, norint įvertinti NGM ir insulino pompų įdiegimo ilgalaikį poveikį vaikams. Taip pat svarbu garantuoti technologijų prieinamumą nepriklausomai nuo socioekonomių veiksnių bei skatinti psichosocialinę pagalbą, kad pagerėtų vaikų, sergančių 1 tipo cukriniu diabetu, bei jų tėvų gyvenimo kokybė.

Aim: The thesis would assess whether vegetarian as well as vegan diets in children have any impact on the following therapeutic concerns: Growth and development, vitamin availability, bone health and structural deformation. Objectives:

1. Growth and development. Nutrition may affect: (a) body weight; (b) body height and (c) other anthropometric measures (i.e., noninvasive quantitative data). These parameters would be compared to published global statistics, representing populations that do not restrict their nutritional habits.
2. Vitamin availability. The limited variety of foods available for vegetarians and vegans raises the question of whether sufficient essential vitamins are provided to the body on a daily basis. Clearly, the risk of low dietary vitamin intake is a plausible scenario. We, therefore shall evaluate whether the body levels of two prominent vitamins (Vitamin D and Vitamin B12), represent the commonly observed values in non-vegetarian or non-vegan communities.
3. Bone health and structural deformation. Unlike vegetarians, vegans, totally avoid consumption of dairy products. Since the latter represent a rich source for calcium (Ca2+), it is essential to explore whether vegans (but not vegetarians) should be encouraged to consume supplements containing this metal to preserve bone integrity and circumvent other medicinal complications such as: Structural bone distortions.

Title: “Correlations of Childhood Body Mass Index and Adulthood Fertility” Aim: To investigate the relation between different childhood BMIs and adulthood fertility. Objectives:

1. To review different age groups and analyze the changes in BMI during childhood.
2. To analyze the pathophysiology of infertility due to abnormal BMI.
3. To compare the relation and incidence of adulthood infertility with underweight and overweight during childhood. Methodology: The primary literature search began in early 2024 and was updated in May 2024. After initial filters, 274 articles were identified. Screening titles and abstracts led to the review of 91 full-text articles. Ultimately, 26 relevant studies were selected for this review. Results: The literature review indicates a notable relationship between childhood Body Mass Index (BMI) and fertility outcomes in adulthood. Being underweight in adolescence, especially between the ages of 11 and 15, increases the chances of requiring infertility treatments later in life. Early obesity in childhood is a reliable predictor of continued obesity throughout adolescence and into adulthood. Being overweight, especially before age 12, significantly raises the risk of infertility in adulthood. Conclusions: This research highlights that irregular BMI during childhood, whether underweight or overweight, significantly affects fertility outcomes in adulthood. It stresses the importance of early BMI evaluation and timely intervention as critical strategies to prevent infertility. The findings indicate that childhood obesity poses a greater and broader fertility risk than being underweight. Therefore, promoting balanced nutrition and regular exercise during childhood is crucial for maintaining fertility potential in later life. The study emphasizes the significance of managing BMI from an early age to enhance reproductive health outcomes.

Sofija Rasa Kusaitė. „Inkretinų terapijos panaudojimas 1 tipo cukrinio diabeto ir monogeninio diabeto gydymui vaikų amžiuje”. Tikslas: įvertinti inkretinų (į gliukagoną panašus peptidas 1 (GLP-1 ) ir dipeptilpeptidazės-4 inhibitoriai (DPP-4 inhibitoriai)) terapijos pritaikymą, vaistų saugumą, svorio kontrolę, gydant 1 tipo cukrinį diabetą (1 t. CD) ar monogeninį diabetą (MD) vaikų amžiuje.
Darbo uždaviniai:

1. Apžvelgti inkretinų terapijos veiksmingumą, gerinant glikemijos kontrolę vaikams ir paaugliams, sergantiems 1 t. CD ir MD.
2. Nustatyti inkretinų terapijos poveikį svorio valdymui, vaikams ir paaugliams, sergantiems 1 t. CD ir MD, turintiems antsvorio arba nutukusiems.
3. Apžvelgti inkretinų terapijos saugumo profilį vaikų populiacijoje, įskaitant nepageidaujamo poveikio dažnį ir sunkumą. Tyrimo metodai: šiame tyrime atlikta literatūros apžvalga. Paieška atlikta duomenų bazėje PubMed. Remtasi PRISMA literatūros apžvalgos reikalavimais. Tinkami straipsniai buvo 2015 – 2025 metų laikotarpio. Šioje apžvalgoje naudoti raktiniai žodžiai ir jų kombinacijos anglų kalba: „GLP-1” arba „DPP-4 inhibitors” ir „treatment for type 1 diabetes” arba „treatment for diabetes type 1” arba „treatment for T1D”, bei „GLP-1” arba „DPP-4 inhibitors” arba „incretin” ir „treatment for monogenic diabetes” arba „treatment for genetic diabetes”. Tyrimo rezultatai: remiantis raktiniais žodžiais buvo rasta 98 mokslinės publikacijos, nagrinėjančios 1 t. CD, galutinai į tyrimą įtraukti 4 straipsniai. Taip pat nagrinėjant raktinius žodžius susijusius su MD rastos 67 mokslinės publikacijos iš jų atrinkti 3 straipsniai. Atrinktos publikacijos atitiko straipsnių įtraukimo ir atmetimo kriterijus, juose analizuojamas inkretinų panaudojimas, gydant vaikus ir paauglius sergančius MD ir 1 t. CD. Tyrimo išvados:
4. Inkretinų panaudojimas leido reikšmingai pagerinti glikemijos kontrolę HbA1c mažėjimas nuo 7,23–8 % iki 5,6–7,4% vaikams ir paaugliams sergantiems 1 t. CD ir HbA1c mažėjimas nuo 5,5–12,1 % iki 4,5–7 % vaikams ir paaugliams, sergantiems MD
5. 1 t. CD atveju poveikis svoriui nevienareikšmis: kai kuriems pacientams pastebėtas žymus svorio sumažėjimas, kitiems pokyčiai minimalūs arba jų nebuvo. MD atveju buvo pastebėtas svorio mažėjimas, kitiems svorio pokyčiai nestebėti.
6. Inkretinų terapija vaikams ir paaugliams buvo saugi ir gerai toleruojama, dažniausiai pasireiškė lengvi virškinimo trakto sutrikimai. Rimtų nepageidaujamų reakcijų dažniausiai nestebėta. Raktiniai žodžiai: inkretinai, vaikai, paaugliai, monogeninis diabetas, pirmo tipo cukrinis diabetas.

Background: Incretins, gut-derived peptide hormones play a huge role in glucose metabolism; causing increase in insulin secretion, decrease in glucagon production and control of satiety [1]. This interplay between incretins and glucose regulation underscores the potential opportunity in diabetes management, it lays the groundwork on how incretin-based treatments can be customized to fit the unique needs that arise from the different ways diabetes impacts an individual's health [2]. As specific type of diabetes owns individual pathophysiology, different effects of incretin by themselves and as medications could be expected. In Type 2 Diabetes (T2D) incretin analogues are used strongly as a therapy to increase insulin secretion, owning to the fact that beta cells are still alive and producing insulin [3] .Whereas, in Type 1 Diabetes (T1D) autoimmune destruction of beta cells determines the dependency on treatment with exogenous insulin, therefore, incretins could not directly cause increase of insulin, but could benefit in satiety control and weight management. In monogenic diabetes (MD), single gene mutations affect insulin production and/or secretion, therefore, the utility of incretins as medications depend on specific gene defect [4]. The effects of incretin and incretin-based therapies specifically for neonatal diabetes mellitus (NDM) or maturity onset diabetes of the young (MODY) hasn't been extensively studied or detailed [5].

Aim: To perform a systematic data analysis on incretin hormone levels in serum and effects on glucose metabolism in individuals with T1D, MODY, and NDM. Objectives:

1. To review and summarize the physiological function of incretins.
2. Systematically review incretin levels response to oral glucose tolerance test (OGTT) and their effect on glucose metabolism in individuals with T1D.
3. Systemically review incretin levels response to OGTT and their effect on glucose metabolism in NDM patients.
4. To introduce monogenic types of diabetes, review incretin levels' response to OGTT and their effects on glucose metabolism in individuals with MODY type of diabetes.

Methodology: The methodology is firstly to choose and select appropriate and furthermore reject unnecessary information providing articles from medical databases such as PubMed, Clinical Key, ScienceDirect etc. Eleven articles concerning T1D were selected. Meanwhile, a total of four articles were chosen for NDM. Finally, six articles were picked to assess the impact of incretins on MODY diabetes. The systematic reviews were reported with PRISMA set.

Results: This systematic review aimed to analyze incretin hormone levels and their effects on glucose metabolism in individuals with T1D, NDM and MODY. In T1D, research showed a reduced incretin effect despite similar postprandial GLP-1 and GIP levels compared to healthy controls. Patients with residual beta cell function, indicated by detectable C-peptide, had lower GLP-1 levels than C-peptide-negative individuals, suggesting a link between residual beta cell function and GLP-1 secretion. The impaired incretin effect in T1D seems primarily linked to defective insulin secretion rather than altered hormone levels. For NDM, research suggested that KATP channel mutations, such as those linked to KCNJ11-PNDM, do not significantly impact incretin secretion. However, individuals with RFX6 mutations showed markedly reduced GLP-1 and GIP levels. The combination of GLP-1 receptor agonists and sulfonylureas (SU) provided promising benefits in glycemic management for patients with KCNJ11-related NDM. In MODY, HNF1A-diabetes (MODY 3) exhibited a reduced incretin effect despite normal GLP-1 and GIP secretion, while GCK-diabetes (MODY 2) maintained a normal incretin effect. GLP-1 receptor agonists and DPP-4 inhibitors showed potential in improving beta cell function and glucose metabolism in MODY subtypes.

Conclusion: 1. This review emphasizes the extensive physiological roles of incretins, showing their profound effects on metabolism, particularly glucose homeostasis, and extending to cardiovascular, digestive, and bone health. 2. In T1D, incretin levels are commonly reduced, yet some patients maintain residual secretion, especially GLP-1, from functional intestinal L-cells. This complexity in T1D's pathogenesis suggests that measuring incretin levels could inform more tailored therapeutic strategies.3. Studies on NDM indicate that serum incretin levels do not increase post-meal, despite enhanced insulin secretion after tailored treatments. This points to a possible role of incretin signalling disruption in NDM's pathogenesis, requiring further investigation to clarify incretins' specific functions.4. The diversity of MODY and scant targeted research allow only limited insights into GCK and HNF1A diabetes. GCK- MODY patients have incretin levels similar to healthy individuals, indicating normal incretin and beta-cell responsiveness. Conversely, individuals with HNF1A-MODY experience diminished incretin effects and insulin secretion, highlighting the need for customized diagnostic and therapeutic approaches.

Aim: The study aims to analyze the literature about the effect of COVID-19 pandemic for diabetes patient’s glycemic control and to review the relationship between glycemic control and COVID-19. Objectives: The objectives of the literature review are the following:

1. To analyze the effect of COVID-19 pandemic over Hemoglobin A1c (HbA1c) type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM).
2. To establish the association between glycemic control and COVID-19 severity in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) patients.
3. To establish a correlation between inflammatory markers such as TLR4 and ACE2 receptors. Methods: Literature research was conducted in PubMed and MEDLINE. The following keywords and terms were used and combined during the search of articles: “diabetes”, “hba1c”, “covid”, “pandemic”, “SARS-CoV- 2”, “lockdown”, “glycemic control”, “value”, “inflammation”, “medication”, “effect”, “ACE2”, “TLR”. A total of 50 articles were used in this review and 193 studies were selected and analyzed according to the inclusion and exclusion criteria, being less than 10 years old. Results: The COVID-19 pandemic effect was present all around the world. Patients with diabetes have been profoundly impacted. Overall, T1DM experienced significant improvements in glycemic control, in contrast, T2DM showed a deterioration in glycemic control. T1DM patients were at increased risk for hospital death in patients with increased glucose measuring. Individuals with uncontrolled T2DM faced more severe COVID-19 symptoms, these patients were more likely to require mechanical ventilation, had extended hospital stays, and experienced higher mortality rates compared to those with controlled T2DM. Conclusion: The COVID-19 pandemic has profoundly impacted diabetic patients. Glycemic control plays an important role in disease severity. Patients with poor glycemic control are prone to experience more severe reactions to SARS-CoV-2 infection.