151
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Keenan ME, Berlin KS, Cook JL, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Choquette AE, Alemzadeh R, Eddington AR. Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes. J Pediatr Psychol 2021; 46:241-250. [PMID: 33398334 DOI: 10.1093/jpepsy/jsaa124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 12/04/2020] [Accepted: 12/04/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Following the Journal of Pediatric Psychology's special edition on health disparities, calling for Phase 2 research exploring mechanisms of racial groups in health disparities, this study aims to explore social information processing predictors of longitudinal hemoglobin A1c (HbA1c) trajectories in a racially diverse group of adolescents. The social information processing model of glycemic control in type 1 diabetes (T1D) posits that adolescents who make negative attributions about reactions of friends are likely to find adherence difficult in social situations, have increased stress, and have suboptimal glycemic control. METHODS One hundred eighty-four youth with T1D completed self-report measures and HbA1c at three time points within 1 year was extracted from medical records. Growth mixture modeling empirically derived classes of HbA1c trajectories and explored predictive relationships of social information processing variables, demographics, and diabetes characteristics. RESULTS Three classes emerged: High Decelerating, Mid-High Accelerating, and Near-Optimal Accelerating. Black/African American participants were highly likely to be in the High and Mid-High groups. Higher anticipated adherence difficulties in social situations predicted increased odds of being in the Mid-High versus Near-Optimal HbA1c group. Increased diabetes stress predicted increased odds of being in the High versus Near-Optimal and Mid-High groups. CONCLUSIONS Continuing research on mechanisms behind this health disparity is necessary with more representation from varied racial and ethnic groups. Equal access to diabetes technology and psychosocial treatments are recommended and implications for clinical intervention development are discussed.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | | | | | | | | | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center
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152
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Dimentstein K, Valenzuela JM. JPP Student Journal Club Commentary: Predictors of HbA1c Trajectories in Predominantly Black Adolescents With Type 1 Diabetes. J Pediatr Psychol 2021; 46:251-253. [PMID: 33706366 DOI: 10.1093/jpepsy/jsab024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 02/23/2021] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Karen Dimentstein
- Department of Clinical and School Psychology, Nova Southeastern University
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153
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Lipman TH, Smith JA, Patil O, Willi SM, Hawkes CP. Racial disparities in treatment and outcomes of children with type 1 diabetes. Pediatr Diabetes 2021; 22:241-248. [PMID: 33871154 DOI: 10.1111/pedi.13139] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 08/31/2020] [Accepted: 09/23/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE The aim of this study was to assess racial disparities in treatments and outcomes between Non-Hispanic black (NHB), Hispanic and Non-Hispanic white (NHW) children with type 1 diabetes (T1D). METHODS We reviewed electronic health records of children (<18 years) attending a large, pediatric tertiary care diabetes center in the United States between October 1, 2018, and December 31, 2019. Health care utilization (appointment attendance, ED visits, hospitalizations), technology use (insulin pumps, continuous glucose monitors [CGM]) and hemoglobin A1c (HbA1c) were examined for each race/ethnicity and stratified by insurance type (private/government) as a proxy for socioeconomic status (SES). RESULTS Of 1331 children (47% female) with a median (IQR) age of 14.2 (11.5, 16.3) years and T1D duration of 5.8 (3.8, 9) years; 1026 (77%) were NHW, 198 (15%) NHB, and 107 (8%) Hispanic. Government insurance was used by 358 (27%) children, representing 60% of NHB and 53% of Hispanic, but only 18% of NHW children. NHB children had higher HbA1c, more ED visits and hospitalizations, and were less likely to be treated with insulin pumps or CGM than NHW children (P < .001 for all). There were no racial disparities with regard to the number of appointments attended. CONCLUSIONS Racial disparities in technology use and diabetes outcomes persist in children with T1D, regardless of insurance status. To ensure equitable care, pediatric healthcare providers should remain cognizant of racial disparities in diabetes treatment. The impact of provider and patient factors should be explored when studying the etiology of these health disparities.
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Affiliation(s)
- Terri H Lipman
- Department of Family and Community Health, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, USA.,Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Jennifer A Smith
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Oona Patil
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, USA
| | - Steven M Willi
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, USA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
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154
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LePage AK, Wise JB, Bell JJ, Tumin D, Smith AW. Distance from the endocrinology clinic and diabetes control in a rural pediatric population. J Pediatr Endocrinol Metab 2021; 34:187-193. [PMID: 33544546 DOI: 10.1515/jpem-2020-0332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/27/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina. METHODS We retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review period. RESULTS The analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c. CONCLUSIONS Patients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits.
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Affiliation(s)
- Ana K LePage
- Department of Psychology, East Carolina University,GreenvilleNC, USA
| | - J Benjamin Wise
- Brody School of Medicine at East Carolina University, GreenvilleNC, USA
| | - Jennifer J Bell
- Department of Pediatrics, Baylor College of Medicine, HoustonTX, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, GreenvilleNC, USA
| | - Aimee W Smith
- Department of Psychology, East Carolina University,GreenvilleNC, USA
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155
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Verma R, Thomas CG, West M, Prichett L, Glancey C, Tracey J, Arcara KM, Magge SN, Wolf RM. Communication frequency between visits is associated with improved glycemic control in pediatric diabetes. J Pediatr Endocrinol Metab 2021; 34:177-182. [PMID: 33544539 DOI: 10.1515/jpem-2020-0529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 11/05/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Children with diabetes are advised to see their diabetes team every 3 months, with interim communication to address insulin dose adjustments. Despite increasing digital accessibility, there is limited data on whether provider-patient communication frequency is associated with glycemic control in pediatric diabetes. We assessed patterns of communication between diabetes clinic visits and whether communication frequency via electronic messaging (EM) and telephone was associated with glycemic control in pediatric diabetes. METHODS Retrospective chart review of 267 children with type 1 (T1DM) and type 2 diabetes (T2DM) over a 1-year period (July 2018-June 2019) at an urban academic pediatric diabetes center. Association between frequency of communication (via EM and telephone) and HbA1c was analyzed using regression analysis. RESULTS Of 267 participants, 224 (84%) had T1DM, 43 (16%) had T2DM, mean age 11.6 years (SD 4), mean duration of diabetes 3.5 years (SD 3.4), and mean HbA1c 73.8 ± 23 mmol/mol (8.9 ± 2.2%). Most participants (82%) communicated with their diabetes team at least once per year, with a mean number of overall communications of 10.3 ± 13.6 times. Communications were via EM (48%), phone (40%), or both (53%). Participants with more frequent communication had lower HbA1c values (p=0.007), even when controlling for age, sex, provider, and number of clinic visits per year. We determined that a threshold of three communications per year was associated with a lower HbA1c (p=0.006). CONCLUSIONS More frequent communication with the diabetes team between visits is associated with improved glycemic control. Initiatives to contact diabetes patients between clinic visits may impact their overall glycemic control.
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Affiliation(s)
- Rohini Verma
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Chrystal G Thomas
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Margaret West
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Laura Prichett
- Biostatistics, Epidemiology and Data Management (BEAD) Core, Johns Hopkins School of Medicine, Baltimore, USA
| | - Christine Glancey
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Julia Tracey
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Kristin M Arcara
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Sheela N Magge
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
| | - Risa M Wolf
- Division of Pediatric Endocrinology, Johns Hopkins University School of Medicine, Baltimore, USA
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156
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Butler AM, Hilliard ME, Titus C, Rodriguez E, Al-Gadi I, Cole-Lewis Y, Thompson D. Barriers and Facilitators to Involvement in Children's Diabetes Management Among Minority Parents. J Pediatr Psychol 2021; 45:946-956. [PMID: 31995219 DOI: 10.1093/jpepsy/jsz103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/11/2019] [Accepted: 12/21/2019] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE This study aimed to describe parents' perceptions of the factors that facilitate or are barriers to their involvement in children's type 1 diabetes (T1D) management among African American and Latino parents. METHODS African American and Latino parents (N = 28) of 5- to 9-year-old children with T1D completed audio-recorded, semi-structured interviews that were transcribed and analyzed using thematic analysis. Themes were identified that aligned with the theoretically-derived Capability-Opportunity-Motivation-Behavior (COM-B) framework. RESULTS Parents described Capability-based facilitators of parent involvement, including positive stress management, religious/spiritual coping, organizational/planning skills, and diabetes knowledge. Capability-based barriers included child and parent distress. Interpersonal relationships, degree of flexibility in work environments, and access to diabetes technologies were both Opportunity-based facilitators and barriers; and Opportunity-based barriers consisted of food insecurity/low financial resources. Parents' desire for their child to have a "normal" life was described as both a Motivation-based facilitator and barrier. CONCLUSIONS African American and Latino families described helpful and unhelpful factors that spanned all aspects of the COM-B model. Reinforcing or targeting families' unique psychological, interpersonal, and environmental strengths and challenges in multilevel interventions has potential to maximize parental involvement in children's diabetes management.
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Affiliation(s)
| | | | | | | | - Iman Al-Gadi
- Baylor College of Medicine/Texas Children's Hospital
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157
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Redondo MJ, Libman I, Maahs DM, Lyons SK, Saraco M, Reusch J, Rodriguez H, DiMeglio LA. The Evolution of Hemoglobin A 1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence. Diabetes Care 2021; 44:301-312. [PMID: 33431422 PMCID: PMC7818324 DOI: 10.2337/dc20-1978] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/08/2020] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1c (A1C) of <7% (53 mmol/mol) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness and for those who do not have access to analog insulins or advanced diabetes technologies or who cannot monitor blood glucose regularly. Even less stringent A1C targets (e.g., <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the "honeymoon" period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective. Here, we provide a historical perspective of A1C targets in pediatrics and highlight evidence demonstrating detrimental effects of hyperglycemia in children and adolescents, including increased likelihood of brain structure and neurocognitive abnormalities, microvascular and macrovascular complications, long-term effects, and increased mortality. We also review data supporting a decrease over time in overall severe hypoglycemia risk for youth with T1D, partly associated with the use of newer insulins and devices, and weakened association between lower A1C and severe hypoglycemia risk. We present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them. We aim to raise awareness within the community on Standards of Care updates that impact this crucial goal in pediatric diabetes management.
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Affiliation(s)
- Maria J Redondo
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ingrid Libman
- Division of Pediatric Endocrinology, Diabetes and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - David M Maahs
- Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Sarah K Lyons
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Jane Reusch
- University of Colorado and Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Henry Rodriguez
- USF Diabetes and Endocrinology Section, University of South Florida, Tampa, FL
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
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158
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Elkon-Tamir E, Lebenthal Y, Laurian I, Dorfman A, Chorna E, Interator H, Israeli G, Rosen G, Eyal O, Oren A, Brener A. Type 1 diabetes outcomes of children born in Israel of Eritrean asylum seekers. Acta Diabetol 2021; 58:145-152. [PMID: 32915299 DOI: 10.1007/s00592-020-01597-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 08/12/2020] [Indexed: 02/03/2023]
Abstract
AIMS Disparities in health outcomes in pediatric type 1 diabetes (T1D) based on race/ethnicity and socioeconomic position (SEP) have been reported. We compared T1D characteristics between Eritrean status-less children living in Israel and native-born Israeli children. METHODS This observational study compared 7 Eritrean and 28 Israeli children (< 8 years old at T1D diagnosis) who were diagnosed in a single diabetes center during 2015-2019. Sociodemographic and diabetes-related data from diagnosis until the last clinic visit were retrieved from their medical files. RESULTS At diagnosis, the mean age was 4.8 ± 2.2 years, 17 (48.6%) had diabetic ketoacidosis with a mean HbA1c level of 10.5 ± 2.1% (91.3 mmol/mol) and 29 (82.9%) had ≥ 2 pancreatic autoantibodies. The mean T1D duration of follow-up was 2.7 ± 1.4 years. Overall glycemic control during follow-up (> 6 months from diagnosis, mean number of samples 10.6 ± 5.2) was good, with mean, best, and peak HbA1c levels of 7.4 ± 0.8% (57.4 mmol/mol), 6.7 ± 0.7% (49.7 mmol/mol), and 8.1 ± 1.1% (65 mmol/mol), respectively. Thirty-two children (91.4%) used continuous glucose monitoring devices (CGMs), and the mean time from diagnosis to CGM initiation was 10.8 ± 14.1 months. CGM metrics: time CGM active: 95.4 ± 3.8%, mean glucose level: 170.0 ± 27.0 mg/dl (9.4 mmol/L), time-in-range: 56.4 ± 14.7%, time-below-range: 5.5 ± 5.7%, and time-above-range: 38.6 ± 16.1%. Diabetes-related parameters at diagnosis and during follow-up were similar between groups. Eritrean children had significantly lower SEPs (P < 0.001) and parental education levels (P < 0.001). Correlations between SEP and diabetes parameters and SEP and growth parameters were not significant. CONCLUSIONS Eritrean status-less children in Israel achieved glycemic targets similar to those of Israeli children, perhaps reflecting uniformity in the standard of care and CGM usage.
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Affiliation(s)
- Erella Elkon-Tamir
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Irina Laurian
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Nursing Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anna Dorfman
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Nursing Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Efrat Chorna
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- Social Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Hagar Interator
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
- The Nutrition and Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Galit Israeli
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gil Rosen
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Eyal
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- Pediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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159
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Lai CW, Lipman TH, Willi SM, Hawkes CP. Racial and Ethnic Disparities in Rates of Continuous Glucose Monitor Initiation and Continued Use in Children With Type 1 Diabetes. Diabetes Care 2021; 44:255-257. [PMID: 33177169 DOI: 10.2337/dc20-1663] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/21/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Racial/ethnic disparities in continuous glucose monitor (CGM) use exist among children with type 1 diabetes. It is not known whether differential rates of device initiation or sustained use are the cause of this disparity. Our objective was to compare CGM initiation rates and continued use among non-Hispanic White (NHW), non-Hispanic Black (NHB), and Hispanic children. RESEARCH DESIGN AND METHODS We conducted a retrospective review including children with type 1 diabetes attending the Children's Hospital of Philadelphia between 1 January 2015 and 31 December 2018. RESULTS Of 1,509 eligible children, 726 (48%) started CGM during the study period. More NHW (54%) than NHB (31%) and Hispanic (33%) children started CGM (P < 0.001). One year after starting, fewer NHB (61%) than NHW (86%) and Hispanic (85%) children were using CGM (P < 0.001). CONCLUSIONS Lower CGM use in NHB children was due to lower rates of device initiation and higher rates of discontinuation. Interventions to address both of these barriers are needed to reduce disparities in CGM use.
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Affiliation(s)
- Charlene W Lai
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Terri H Lipman
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,School of Nursing, University of Pennsylvania, Philadelphia, PA
| | - Steven M Willi
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA .,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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160
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Totka JP, Snethen JA, Cox ED. Youth and Parent Health-Related Quality of Life and Association With Glycemic Outcomes in Preadolescents and Adolescents With Type 1 Diabetes. J Pediatr Health Care 2021; 35:64-73. [PMID: 32928601 DOI: 10.1016/j.pedhc.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We explored differences in Health-Related Quality of Life (HRQOL) and the youth's glycosylated hemoglobin (A1c) of preadolescent and adolescent youths with type 1 diabetes (T1D) by individual (age, sex, race) and family (socioeconomic status) factors, and associations between youths' HRQOL, their parents' HRQOL, and youth's A1c. METHOD Correlational secondary analysis of baseline data from a randomized controlled trial testing a developmental intervention for youths with T1D and their parents from two diabetes clinics. RESULTS Better adolescent HRQOL was associated with better glycemic control. Better preadolescent HRQOL was associated with better parent HRQOL. Non-White adolescents had worse HRQOL than White adolescents; whereas Non-White preadolescents had worse glycemic control than White preadolescents. DISCUSSION Addressing HRQOL may promote better glycemic control in adolescents with T1D. For preadolescents with T1D, parent HRQOL support may impact preadolescent HRQOL and improve glycemic control moving into adolescence. Further study is warranted for non-White youths with T1D HRQOL and A1c outcomes.
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161
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Addala A, Auzanneau M, Miller K, Maier W, Foster N, Kapellen T, Walker A, Rosenbauer J, Maahs DM, Holl RW. A Decade of Disparities in Diabetes Technology Use and HbA 1c in Pediatric Type 1 Diabetes: A Transatlantic Comparison. Diabetes Care 2021; 44:133-140. [PMID: 32938745 PMCID: PMC8162452 DOI: 10.2337/dc20-0257] [Citation(s) in RCA: 158] [Impact Index Per Article: 52.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 08/07/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE As diabetes technology use in youth increases worldwide, inequalities in access may exacerbate disparities in hemoglobin A1c (HbA1c). We hypothesized that an increasing gap in diabetes technology use by socioeconomic status (SES) would be associated with increased HbA1c disparities. RESEARCH DESIGN AND METHODS Participants aged <18 years with diabetes duration ≥1 year in the Type 1 Diabetes Exchange (T1DX, U.S., n = 16,457) and Diabetes Prospective Follow-up (DPV, Germany, n = 39,836) registries were categorized into lowest (Q1) to highest (Q5) SES quintiles. Multiple regression analyses compared the relationship of SES quintiles with diabetes technology use and HbA1c from 2010-2012 to 2016-2018. RESULTS HbA1c was higher in participants with lower SES (in 2010-2012 and 2016-2018, respectively: 8.0% and 7.8% in Q1 and 7.6% and 7.5% in Q5 for DPV; 9.0% and 9.3% in Q1 and 7.8% and 8.0% in Q5 for T1DX). For DPV, the association between SES and HbA1c did not change between the two time periods, whereas for T1DX, disparities in HbA1c by SES increased significantly (P < 0.001). After adjusting for technology use, results for DPV did not change, whereas the increase in T1DX was no longer significant. CONCLUSIONS Although causal conclusions cannot be drawn, diabetes technology use is lowest and HbA1c is highest in those of the lowest SES quintile in the T1DX, and this difference for HbA1c broadened in the past decade. Associations of SES with technology use and HbA1c were weaker in the DPV registry.
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Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA
| | - Marie Auzanneau
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | | | - Werner Maier
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Helmholtz Zentrum München - German Research Center for Environmental Health, Institute of Health Economics and Health Care Management, Neuherberg, Germany
| | | | - Thomas Kapellen
- University of Leipzig, Department of Women and Child Health, Hospital for Children and Adolescents, Leipzig, Germany
| | - Ashby Walker
- Health Equity Initiatives, UF Diabetes Institute, University of Florida, Gainesville, FL
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany
- Leibniz Center for Diabetes Research at Heinrich Heine University, Institute for Biometrics and Epidemiology, German Diabetes Center, Düsseldorf, Germany
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford, CA
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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162
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Lipman TH, Hawkes CP. Racial and Socioeconomic Disparities in Pediatric Type 1 Diabetes: Time for a Paradigm Shift in Approach. Diabetes Care 2021; 44:14-16. [PMID: 33444165 DOI: 10.2337/dci20-0048] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Terri H Lipman
- University of Pennsylvania School of Nursing, Philadelphia, PA .,Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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163
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc21-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc21-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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164
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Reddy AR, Badolato GM, Chamberlain JM, Goyal MK. Disparities Associated with Sepsis Mortality in Critically Ill Children. J Pediatr Intensive Care 2020; 11:147-152. [DOI: 10.1055/s-0040-1721730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Accepted: 11/04/2020] [Indexed: 10/22/2022] Open
Abstract
AbstractDisparities in health care related to socioeconomic status and race/ethnicity are well documented in adult and neonatal sepsis, but they are less characterized in the critically ill pediatric population. This study investigated whether socioeconomic status and/or race/ethnicity is associated with mortality among children treated for sepsis in the pediatric intensive care unit (PICU). A retrospective cohort study was conducted using information from 48 children's hospitals included in the Pediatric Health Information System database. We included visits by children ≤ 21 years with All Patients Refined Diagnosis-Related Groups (APR-DRG) diagnosis codes of septicemia and disseminated infections that resulted in PICU admission from 2010 to 2016. Multivariable logistic regression was used to measure the effect of race/ethnicity and socioeconomic status (insurance status and median household income for zip code) on mortality after adjustment for age, gender, illness severity, and presence of complex chronic condition. Among the 14,276 patients with sepsis, the mortality rate was 6.8%. In multivariable analysis, socioeconomic status, but not race/ethnicity, was associated with mortality. In comparison to privately insured children, nonprivately insured children had increased odds of mortality (public: adjusted odds ratio [aOR]: 1.2 [1.0, 1.5]; uninsured: aOR: 2.1 [1.2, 3.7]). Similarly, children living in zip codes with the lowest quartile of annual household income had higher odds of mortality than those in the highest quartile (aOR: 1.5 [1.0, 2.2]). These data suggest the presence of socioeconomic, but not racial/ethnic, disparities in mortality among children treated for sepsis. Further research is warranted to understand why such differences exist and how they may be addressed.
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Affiliation(s)
- Anireddy R. Reddy
- Department of Pediatrics, Children’s National Medical Center, Washington, District of Columbia, United States
| | - Gia M. Badolato
- Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
| | - James M. Chamberlain
- Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
| | - Monika K. Goyal
- Department of Pediatric Emergency Medicine, Children’s National Medical Center, Washington, District of Columbia, United States
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165
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Sutherland MW, Ma X, Reboussin BA, Mendoza JA, Bell BA, Kahkoska AR, Sauder KA, Lawrence JM, Pihoker C, Liese AD. Socioeconomic position is associated with glycemic control in youth and young adults with type 1 diabetes. Pediatr Diabetes 2020; 21:1412-1420. [PMID: 32902080 PMCID: PMC8054269 DOI: 10.1111/pedi.13112] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 08/28/2020] [Accepted: 09/02/2020] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Health inequities persist in youth and young adults (YYA) with type 1diabetes in achieving optimal glycemic control. The purpose of this study was to assess the contribution of multiple indicators of social need to these inequities. RESEARCH DESIGN AND METHODS Two hundred and twenty two YYA withtype 1 diabetes enrolled in the SEARCH Food Insecurity Study in South Carolina and Washington between the years 2013 and 2015 were included. Latent class analysis was used to identify socioeconomic profiles based on household income, parental education, health insurance, household food insecurity, and food assistance. Profiles were evaluated in relation to glycemic control using multivariable linear and logistic regression, with HbA1c > 9%(75 mmol/mol) defined as high-risk glycemic control. RESULTS Two profiles were identified: a lower socioeconomic profile included YYA whose parents had lower income and/or education, and were more likely to be uninsured, receive food assistance, and be food insecure. A higher socioeconomic profile included YYA whose circumstances were opposite to those in the lower socioeconomic profile. Those with a lower socioeconomic profile were more likely to have high-risk glycemic control relative to those with a higher socioeconomic profile (OR = 2.24, 95%CI = 1.16-4.33). CONCLUSIONS Lower socioeconomic profiles are associated with high-risk glycemic control among YYA with type 1 diabetes. This supports recommendations that care providers of YYA with type 1 diabetes assess individual social needs in tailoring diabetes management plans to the social context of the patient.
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Affiliation(s)
- Melanie W. Sutherland
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Xiaonan Ma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Jason A. Mendoza
- Department of Pediatrics and Nutritional Sciences Program, University of Washington; Cancer Prevention Program, Fred Hutchinson Cancer Research Center; and Seattle Children’s Research Institute, Seattle, WA
| | - Bethany A. Bell
- College of Social Work, University of South Carolina, Columbia, SC
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine A. Sauder
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Angela D. Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
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166
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The Effect of Ethnicity in the Rate of Beta-Cell Functional Loss in the First 3 Years After Type 1 Diabetes Diagnosis. J Clin Endocrinol Metab 2020. [PMID: 32502242 DOI: 10.1210/clinem/dgaa348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We set forth to compare ethnicities for metabolic and immunological characteristics at the clinical diagnosis of type 1 diabetes (T1D) and assess the effect of ethnicity on beta-cell functional loss within 3 years after clinical diagnosis. RESEARCH METHODS AND DESIGN We studied participants in TrialNet New Onset Intervention Trials (n = 624, median age = 14.4 years, 58% male, 8.7% Hispanic) and followed them prospectively for 3 years. Mixed meal tolerance tests (MMTT) were performed within 6 months following clinical diagnosis and repeated semiannually. Unless otherwise indicated, analyses were adjusted for age, sex, BMI Z-score, and diabetes duration. RESULTS At T1D clinical diagnosis, Hispanics, compared with non-Hispanic whites (NHW), had a higher frequency of diabetic ketoacidosis (DKA) (44.7% vs 25.3%, OR = 2.36, P = 0.01), lower fasting glucose (97 vs 109 mg/dL, P = 0.02) and higher fasting C-peptide (1.23 vs 0.94 ng/mL, P = 0.02) on the first MMTT, and higher frequency of ZnT8 autoantibody positivity (n = 201, 94.1% vs 64%, OR = 7.98, P = 0.05). After exclusion of participants in experimental arms of positive clinical trials, C-peptide area under the curve (AUC) trajectories during the first 3 years after clinical diagnosis were not significantly different between Hispanics and NHW after adjusting for age, sex, BMI-z score, and DKA (n = 413, P = 0.14). CONCLUSION Despite differences in the metabolic and immunological characteristics at clinical diagnosis of T1D between Hispanics and NHW, C-peptide trajectories did not differ significantly in the first 3 years following clinical diagnosis after adjustment for body mass index and other confounders. These findings may inform the design of observational studies and intervention trials in T1D.
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167
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Lee YJ, Lee YA, Kim JH, Chung HR, Gu MJ, Kim JY, Shin CH. The durability and effectiveness of sensor-augmented insulin pump therapy in pediatric and young adult patients with type 1 diabetes. Ann Pediatr Endocrinol Metab 2020; 25:248-255. [PMID: 33401881 PMCID: PMC7788343 DOI: 10.6065/apem.2040048.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/19/2020] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Despite the prevalent use of insulin pump therapy worldwide, few studies have been conducted among young patients with type 1 diabetes (T1D) in Korea. We investigated the durability and effectiveness of insulin pump therapy among Korean pediatric and young adult patients with T1D. METHODS This study included 54 patients with T1D diagnosed at pediatric ages (range, 1.1-14.1 years) who initiated insulin pump therapy during 2016-2019 at Seoul National University Children's Hospital and Seoul National University Bundang Hospital. Clinical and biochemical data, including anthropometric measurements, insulin dose, and glycated hemoglobin (HbA1c) levels were obtained from T1D diagnosis to last follow-up. RESULTS Forty-four patients (81.5%) continued insulin pump therapy with a median pump use duration of 2.9 years (range, 0.2-3.5 years); 10 discontinued the therapy within 12 months (<1 month, n=6; 1-6 months, n=1; and 6-12 months, n=3) due to physical interferences or financial problems. Older age (≥10 years of age) and longer diabetes duration (≥2 years) at the initiation of pump therapy were associated with discontinuation (P<0.05 for both). For patients continuing pump therapy, HbA1c levels significantly decreased after 1 year of therapy (from 8.9% to 8.1%, P<0.001) without changes in the body mass index z-scores or insulin dose. Although 4 patients experienced diabetic ketoacidosis, all recovered without complications. CONCLUSION Insulin pump therapy was effective in improving glycemic control in T1D patients during 12 months of treatment. Early initiation of insulin pump therapy after T1D diagnosis was helpful for continuing therapy.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hye Rim Chung
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Min Jeong Gu
- Pediatric Diabetes Education Unit, Seoul National University Children’s Hospital, Seoul, Korea
| | - Ji Young Kim
- Department of Food Nutrition Service and Nutrition Care, Seoul National University Children's Hospital, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea,Address for correspondence: Choong Ho Shin, MD, PhD Department of Pediatrics, Seoul National University Children's Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-2072-3357 Fax: +82-743-3455 E-mail:
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168
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Faulds ER, Hoffman RP, Grey M, Tan A, Tubbs-Cooley H, Militello LK, Happ MB. Self-management among pre-teen and adolescent diabetes device users. Pediatr Diabetes 2020; 21:1525-1536. [PMID: 32985060 DOI: 10.1111/pedi.13131] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 09/08/2020] [Accepted: 09/23/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Despite increased diabetes device use, few adolescents with type 1 diabetes (T1D) meet glycemic targets. We examine associations between utilization of insulin pumps and continuous glucose monitoring (CGM) and glycemic control. RESEARCH DESIGN AND METHODS This prospective cohort study included 80 youths (10-18 years of age) with T1D. Multiple linear regression and linear mixed models (LMM) were used to estimate the effects of device self-management on HbA1c and daily time in range (70-180 mg/dL), respectively. RESULTS Every blood glucose (BG) input/day was associated with a 0.2% decrease in HbA1c (95% CI: -0.297, -0.013), each bolus/day was associated with a 0.2% decrease (-0.327, -0.057), and use of CGM was associated with a 0.5% decrease (-1.00, -0.075). Among CGM users (n = 45) every 10% increase in CGM use was associated with a 0.3% decrease in HbA1c (-0.390, -0.180). In LMM accounting for within subject and between subject variability, there was a negative association between BG input/day frequency (coefficient = -1.880, [-2.640, -1.117]) and time in range. Residual random effects for CGM users were large showing time in range varied between youth with a SD of 15.0% (3 hours and 36 minutes) (SE 2.029, [11.484, 19.530]). Time in range varied significantly from day-to-day with SD of 18.6% (4 hours and 40 minutes) (SE0.455, [17.690, 19.473]). CONCLUSIONS Device self-management behaviors among youth are significantly associated with both HbA1c and time in range. Our findings showing an association between reduced time in range and increased self-management behaviors is novel and deserves further investigation.
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Affiliation(s)
- Eileen R Faulds
- The Ohio State University College of Nursing, The Ohio State University Medical Center, Columbus, Ohio, USA
| | - Robert P Hoffman
- Division of Pediatric Endocrinology Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio, USA
| | - Margaret Grey
- Yale University School of Nursing, New Haven, Connecticut, USA
| | - Alai Tan
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | | | - Lisa K Militello
- The Ohio State University College of Nursing, Columbus, Ohio, USA
| | - Mary Beth Happ
- The Ohio State University College of Nursing, Columbus, Ohio, USA
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169
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Hessner MJ, Cabrera SM. Broadening Our Understanding Type 1 Diabetes Heterogeneity by Exploring Effects of Race/Ethnicity on Disease Trajectory. J Clin Endocrinol Metab 2020; 105:5857715. [PMID: 32542394 PMCID: PMC7531905 DOI: 10.1210/clinem/dgaa375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/11/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Martin J Hessner
- The Max McGee Diabetes Research Center, Children’s Research Institute of Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Susanne M Cabrera
- The Max McGee Diabetes Research Center, Children’s Research Institute of Children’s Wisconsin, Milwaukee, Wisconsin
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
- Correspondence and Reprint Requests: Susanne Cabrera, MD, Department of Pediatrics, Section of Endocrinology and Diabetes, Medical College of Wisconsin, 8701 Watertown Plank Road, Milwaukee, WI 53226, USA. E-mail:
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170
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Fegan-Bohm K, Minard CG, Anderson BJ, Butler AM, Titus C, Weissberg-Benchell J, Hilliard ME. Diabetes distress and HbA1c in racially/ethnically and socioeconomically diverse youth with type 1 diabetes. Pediatr Diabetes 2020; 21:1362-1369. [PMID: 32893939 DOI: 10.1111/pedi.13108] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/29/2020] [Accepted: 08/22/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Diabetes distress, the emotional burden of caring for the chronic demands of diabetes, has not been well described in children and preadolescents with type 1 diabetes (T1D). This gap is particularly evident among youth of lower socioeconomic status (SES) and/or racial/ethnic minorities. Since these groups are more likely to have disparities in health outcomes and healthcare related to their diabetes, factors that could potentially improve glycemic and other diabetes-related outcomes should be studied closely. OBJECTIVE We hypothesized that (a) diabetes distress levels would be elevated in children with markers of lower SES and those of racial/ethnic minorities, and (b) higher HbA1c would be predicted by higher diabetes distress levels, when controlling for race/ethnicity, SES, and clinical covariates. METHODS One hundred and eighty-seven youth age 9 to 13 with T1D completed age-appropriate Problem Areas in Diabetes (PAID) questionnaires using a web-based portal during routine diabetes care visits. RESULTS PAID scores were significantly elevated in youth who had surrogate markers of lower SES and who were from racial/ethnic minority backgrounds. In multivariate models including race/ethnicity or the SES variables and controlling for clinical covariates, the factor most predictive of higher HbA1c was elevated PAID score. CONCLUSIONS Diabetes distress is elevated in a younger population of children with T1D who are from racial/ethnic minority backgrounds or have markers of lower SES. Interventions that target distress and/or expand the safety net in these populations could potentially improve glycemic outcomes.
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Affiliation(s)
- Kelly Fegan-Bohm
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Courtney Titus
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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171
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Mejia-Otero JD, Adhikari S, White PC. Risk factors for hospitalization in youth with type 1 diabetes: Development and validation of a multivariable prediction model. Pediatr Diabetes 2020; 21:1268-1276. [PMID: 32737942 DOI: 10.1111/pedi.13090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To develop a multivariable prediction model to identify patients with type 1 diabetes at increased risk of hospitalization for diabetic ketoacidosis or hyperglycemia with ketosis in the 12 months following assessment. METHODS Retrospective review of clinical data from patients with type 1 diabetes less than 17 years old at a large academic children's hospital (5732 patient years, 652 admissions). Data from the previous 12 months were assessed on October 15, 2015, 2016, 2017, and 2018, and used to predict hospitalization in the following 12 months using generalized estimating equations. Variables that were significant predictors of hospitalization in univariate analyses were entered into a multivariable model. 2014 to 2016 data were used as a training dataset, and 2017 to 2019 data for validation. Discrimination of the model was assessed with receiver operator characteristic curves. RESULTS Admission in the preceding year, hemoglobin (Hb)A1c, non-commercial insurance, female sex, and non-White race were all individual predictors of hospitalization, but age, duration of diabetes and number of office visits in the preceding year were not. In multivariable analysis with threshold P < .0033, admissions in the previous 12 months, HbA1c, and non-commercial insurance remained as significant predictors. The model identified a subset of ~8% of the patients with a collective 42% risk of hospitalization, thus increased 5-fold compared with the 8% risk of hospitalization in the remaining 93% of patients. Similar results were obtained with the validation dataset. CONCLUSION Our multivariable prediction model identified patients at increased risk of admission in the 12 months following assessment.
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Affiliation(s)
- Juan D Mejia-Otero
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Endocrinology, University of Arkansas Medical School, Little Rock, Arkansas, USA
| | - Soumya Adhikari
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Perrin C White
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
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172
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Addala A, Maahs DM, Scheinker D, Chertow S, Leverenz B, Prahalad P. Uninterrupted continuous glucose monitoring access is associated with a decrease in HbA1c in youth with type 1 diabetes and public insurance. Pediatr Diabetes 2020; 21:1301-1309. [PMID: 32681582 PMCID: PMC8103618 DOI: 10.1111/pedi.13082] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/22/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE Continuous glucose monitor (CGM) use is associated with improved glucose control. We describe the effect of continued and interrupted CGM use on hemoglobin A1c (HbA1c) in youth with public insurance. METHODS We reviewed 956 visits from 264 youth with type 1 diabetes (T1D) and public insurance. Demographic data, HbA1c and two-week CGM data were collected. Youth were classified as never user, consistent user, insurance discontinuer, and self-discontinuer. Visits were categorized as never-user visit, visit before CGM start, visit after CGM start, visit with continued CGM use, visit with initial loss of CGM, visit with continued loss of CGM, and visit where CGM is regained after loss. Multivariate regression adjusting for age, sex, race, diabetes duration, initial HbA1c, and body mass index were used to calculate adjusted mean and delta HbA1c. RESULTS Adjusted mean HbA1c was lowest for the consistent user group (HbA1c 8.6%;[95%CI 7.9,9.3]). Delta HbA1c (calculated from visit before CGM start) was lower for visit after CGM start (-0.39%;[95%CI -0.78,-0.02]) and visit with continued CGM use (-0.29%;[95%CI -0.61,0.02]), whereas it was higher for visit with initial loss of CGM (0.40%;[95%CI -0.06,0.86]), visit with continued loss of CGM (0.46%;[95%CI 0.06,0.85]), and visit where CGM is regained after loss (0.57%;[95%CI 0.06,1.10]). CONCLUSIONS Youth with public insurance using CGM have improved HbA1c, but only when CGM use is uninterrupted. Interruptions in use, primarily due to gaps in insurance coverage of CGM, were associated with increased HbA1c. These data support both initial and ongoing coverage of CGM for youth with T1D and public insurance.
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Affiliation(s)
- Ananta Addala
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | - David M. Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford University, Stanford, California
| | - David Scheinker
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford University, Stanford, California
- Department of Management Science and Engineering, Stanford University, Stanford, California
| | - Solana Chertow
- School of Arts and Sciences, Washington University in St. Louis, St. Louis, Missaouri
| | - Brianna Leverenz
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Priya Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
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173
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Lipman TH, Willi SM, Lai CW, Smith JA, Patil O, Hawkes CP. Insulin Pump Use in Children with Type 1 Diabetes: Over a Decade of Disparities. J Pediatr Nurs 2020; 55:110-115. [PMID: 32889433 DOI: 10.1016/j.pedn.2020.08.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 08/06/2020] [Accepted: 08/07/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE Racial disparities have been shown in outcomes and treatment of children with type 1 diabetes (T1D). The purpose of this study was to examine temporal trends in insulin pump use among non-Hispanic white (NHW), non-Hispanic black (NHB) and Hispanic children attending a large urban diabetes center. . This study was a retrospective chart review of insulin pump usage by race (NHW/ NHB) in 2005, and race/ethnicity (NHW/NHB/Hispanic) in 2011-2019. Demographic data (age, sex, diabetes duration, SES) and most recent hemoglobin A1c were also abstracted in 2011-2019. RESULTS In 2005, NHW children were twice as likely to use an insulin pump as NHB children. From 2011 to 2019, the odds ratio increased to 2.5 for NHW compared to NHB children. The odds of Hispanic children using insulin pumps were also higher than NHB. Insurance status (government versus private), a surrogate for SES, had very little influence on these trends, with NHW children consistently more likely than NHB children to be treated with insulin pumps in 2011, 2013, 2017, 2019 (p < 0.001). CONCLUSIONS We have demonstrated that racial disparities in insulin pump use have persisted over the past 15 years, and are not determined by SES. This inequity in diabetes treatment may be playing a role in the poorer glycemic control and higher rates of diabetes complications in NHB children. PRACTICE IMPLICATIONS Healthcare providers should be cognizant of racial and ethnic disparities in the treatment of children with T1D. Standardized treatment protocols may reduce unconscious bias in prescribing.
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Affiliation(s)
- Terri H Lipman
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA; University of Pennsylvania School of Nursing, PA, USA; Perelman School of Medicine, University of Pennsylvania, PA, USA.
| | - Steven M Willi
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, PA, USA
| | - C W Lai
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA
| | - Jennifer A Smith
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA
| | - Oona Patil
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, PA, USA
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174
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Mello D, Wiebe D. The Role of Socioeconomic Status in Latino Health Disparities Among Youth with Type 1 Diabetes: a Systematic Review. Curr Diab Rep 2020; 20:56. [PMID: 32974793 DOI: 10.1007/s11892-020-01346-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/10/2020] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW Type 1 diabetes (T1D) incidence is growing faster among Latino than non-Latino White youth, but ethnic disparities in self-management behaviors and HbA1c are unclear. Socioeconomic status (SES) is a key factor in T1D, which may confound or contribute to disparities in Latino pediatric T1D management. A systematic review examined whether ethnic differences in pediatric T1D outcomes occur and are independent of socioeconomic status (SES). RECENT FINDINGS Latino youth displayed lower self-management and higher HbA1c in approximately half of the identified studies prior to including SES in analyses. Ethnic differences in self-management were found for objective (i.e., frequency of blood glucose checks), but not subjective measures. Ethnic differences were often eliminated when SES was statistically controlled. SES moderated some differences, suggesting complex sociocultural processes. Articles varied widely in SES measures and the analytic methods used to evaluate ethnic disparities. Pediatric Latino T1D disparities are inconsistent and at least partially dependent on the SES context. Recommendations for future research to systematically evaluate SES and Latino T1D disparities are made.
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Affiliation(s)
- Daniel Mello
- Psychological Sciences, University of California, Merced, 5200 N. Lake Road, Merced, CA, 95343, USA.
| | - Deborah Wiebe
- Psychological Sciences, University of California, Merced, 5200 N. Lake Road, Merced, CA, 95343, USA
- University of California, Merced, CA, USA
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175
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Walker AF, Hu H, Cuttriss N, Anez-Zabala C, Yabut K, Haller MJ, Maahs DM. The Neighborhood Deprivation Index and Provider Geocoding Identify Critical Catchment Areas for Diabetes Outreach. J Clin Endocrinol Metab 2020; 105:5872808. [PMID: 32676640 PMCID: PMC7418444 DOI: 10.1210/clinem/dgaa462] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/13/2020] [Indexed: 01/19/2023]
Abstract
PURPOSE In designing a Project ECHO™ type 1 diabetes (T1D) program in Florida and California, the Neighborhood Deprivation Index (NDI) was used in conjunction with geocoding of primary care providers (PCPs) and endocrinologists in each state to concurrently identify areas with low endocrinology provider density and high health risk/poverty areas. The NDI measures many aspects of poverty proven to be critical indicators of health outcomes. METHODS The data from the 2013-2017 American Community Survey (ACS) 5-year estimates were used to create NDI maps for California and Florida. In addition, geocoding and 30-minute drive-time buffers were performed using publicly available provider directories for PCPs and endocrinologists in both states by Google Geocoding API and the TravelTime Search Application Programming Interface (API). RESULTS Based on these findings, we defined high-need catchment areas as areas with (1) more than a 30-minute drive to the nearest endocrinologist but within a 30-minute drive to the nearest PCP; (2) an NDI in the highest quartile; and (3) a population above the median (5199 for census tracts, and 1394 for census block groups). Out of the 12 181 census tracts and 34 490 census block groups in California and Florida, we identified 57 tracts and 215 block groups meeting these criteria as high-need catchment areas. CONCLUSION Geospatial analysis provides an important initial methodologic step to effectively focus outreach efforts in diabetes program development. The integration of the NDI with geocoded provider directories enables more cost-effective and targeted interventions to reach the most vulnerable populations living with T1D.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida
- Correspondence and Reprint Requests: Ashby F. Walker, University of Florida Diabetes Institute; 1275 Center Drive, Box 1000309, Gainesville, FL 32610, USA. E-mail:
| | - Hui Hu
- Department of Epidemiology, University of Florida, Gainesville, Florida
| | - Nicolas Cuttriss
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | | | - Katarina Yabut
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Michael J Haller
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida
- Department of Pediatrics, University of Florida, Gainesville, Florida
- Stanford Diabetes Research Center, Stanford, California
| | - David M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, California
- Stanford Diabetes Research Center, Stanford, California
- Health Research and Policy (Epidemiology), Stanford University, Stanford, California
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176
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Butler AM, Weller BE, Rodgers CRR, Teasdale AE. Type 1 diabetes self-management behaviors among emerging adults: Racial/ethnic differences. Pediatr Diabetes 2020; 21:979-986. [PMID: 32506739 DOI: 10.1111/pedi.13061] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/26/2020] [Accepted: 05/30/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Emerging adulthood is a vulnerable period for poor blood glucose control and self-management behaviors (SMBs) among individuals with type 1 diabetes. Racial/ethnic minority young adults have poorer glycemic outcomes than non-Hispanic whites; however, little is known about possible racial/ethnic differences in frequency of SMBs among emerging adults (EAs). OBJECTIVE To examine racial/ethnic differences in SMBs and to determine associations between SMBs and blood glucose control. METHODS A sample of EAs (ages 18-25 years; N = 3456) from the type 1 diabetes exchange registry was used to conduct multivariate analyses to examine (a) racial/ethnic differences in SMBs and (b) associations between SMBs and blood glucose control for each racial/ethnic group. RESULTS Compared to non-Hispanic whites, African Americans and Hispanics less frequently took an insulin bolus for snacks, less frequently checked blood glucose with a meter, and were more likely to not use insulin to carbohydrate ratios. African Americans also less frequently checked blood glucose prior to mealtime boluses and more frequently missed insulin doses. SMBs that were associated with blood glucose control across groups were frequency of checking blood glucose at mealtime, missing an insulin dose, and checking blood glucose with a meter. CONCLUSIONS Promoting two SMBs: checking blood glucose and taking insulin doses as needed among African American EAs may be important to address racial disparities in glycemic outcomes. Future research should evaluate possible social and contextual mechanisms contributing to low engagement in these behaviors among African Americans to inform strategies to address racial differences in glycemic outcomes.
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Affiliation(s)
- Ashley M Butler
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
| | - Bridget E Weller
- School of Social Work, Western Michigan University, Kalamazoo, Michigan, USA
| | - Caryn R R Rodgers
- Albert Einstein College of Medicine, Jack and Pearl Resnick Campus, Bronx, New York, USA
| | - Ashley E Teasdale
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, USA
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177
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Miller KM, Beck RW, Foster NC, Maahs DM. HbA1c Levels in Type 1 Diabetes from Early Childhood to Older Adults: A Deeper Dive into the Influence of Technology and Socioeconomic Status on HbA1c in the T1D Exchange Clinic Registry Findings. Diabetes Technol Ther 2020; 22:645-650. [PMID: 31905008 PMCID: PMC7640747 DOI: 10.1089/dia.2019.0393] [Citation(s) in RCA: 98] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Objective: The T1D Exchange Clinic Registry figure of HbA1c levels according to age has become a classic picture of how average HbA1c varies from childhood to elderly. To further assess the course of HbA1c across the life span in T1D, we created similar figures stratified by device use and socioeconomic status (SES). Methods: Mean HbA1c was plotted versus age for 21,253 T1D Exchange Clinic Registry participants with an HbA1c measurement between January 1, 2016 and March 31, 2018 according to device use, race/ethnicity, and measures of SES. Results: Across the age range from childhood to elderly, continuous glucose monitoring (CGM) use without an insulin pump had better average HbA1c than pump without CGM; and among CGM users, pump and injection users had similar HbA1c levels. Any device use (pump or CGM) was associated with better HbA1c levels than no device use across the age range. Lower SES and African American race were associated with higher HbA1c across the age range. Across all device use, SES, and race/ethnicity factors, average HbA1c levels were highest in adolescents and young adults. Conclusion: Although the plot of average HbA1c from early childhood to elderly shifts according to device use and SES factors, the shape of the plots remains reasonably constant with highest HbA1c levels in adolescents and young adults. These findings emphasize the importance of targeting adolescence and early adulthood as the ages with the greatest need for improving diabetes management irrespective of device use and SES.
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Affiliation(s)
- Kellee M. Miller
- Jaeb Center for Health Research, Tampa, Florida
- Address correspondence to: Kellee M. Miller, PhD, Jaeb Center for Health Research, 15310 Amberly Drive, Suite 350, Tampa, FL 33647
| | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida
| | | | - David M. Maahs
- Department of Pediatrics - Endocrinology and Diabetes, Stanford University, Stanford California
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178
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Porter M, Channa R, Wagner J, Prichett L, Liu TYA, Wolf RM. Prevalence of diabetic retinopathy in children and adolescents at an urban tertiary eye care center. Pediatr Diabetes 2020; 21:856-862. [PMID: 32410329 PMCID: PMC8248280 DOI: 10.1111/pedi.13037] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/07/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Diabetic retinopathy (DR) is a serious complication that can progress to sight-threatening disease. The prevalence of DR in youth with diabetes has been reported to be 3.8% to 20%. OBJECTIVE We aimed to evaluate the prevalence of DR among youth with diabetes at a large ophthalmologic referral center. Secondary goals were to determine the risk factors for DR and severity of disease. METHODS Retrospective chart review of 343 patients with diabetes, <21 years of age, seen at a tertiary referral eye care center from 2013 to 2018. RESULTS The study included 343 patients, of which 293 had type 1 diabetes (T1D) and 50 had type 2 diabetes (T2D). Thirteen of 343 patients had DR, with an overall incidence of 3.8% (3.4% in T1D and 6% T2D). DR severity included nine with mild non-proliferative, three moderate non-proliferative, and one with proliferative DR. Patients with hemoglobin A1c (HbA1c) > 8% had a higher risk of DR (P = .049). In this cohort, none of the patients with an HbA1c <8% had DR. In the multivariate analysis, a higher systolic blood pressure was marginally associated with risk for DR (P = .07). CONCLUSIONS We found lower prevalence of DR in youth with diabetes than previously reported. The incidence of DR was higher among patients with T2D and occurred with a shorter duration of disease, as compared with T1D. While the incidence of DR in youth with T1D is low, with the increasing incidence of T2D in adolescents and early risk for DR, early screening must be emphasized.
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Affiliation(s)
- Mark Porter
- Pediatric Endocrine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Roomasa Channa
- Ophthalmology, Wilmer Eye Institute at the Johns Hopkins University, Baltimore, Maryland
| | - Jessica Wagner
- Epidemiology and Data Management (BEAD) Core, Johns Hopkins School of Medicine Biostatistics, Baltimore, Maryland
| | - Laura Prichett
- Epidemiology and Data Management (BEAD) Core, Johns Hopkins School of Medicine Biostatistics, Baltimore, Maryland
| | - Tin Yan Alvin Liu
- Ophthalmology, Wilmer Eye Institute at the Johns Hopkins University, Baltimore, Maryland
| | - Risa M. Wolf
- Pediatric Endocrine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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179
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Gomes MB, Calliari LE, Santos DC, Muniz LH, Porto LC, Silva DA, Negrato CA. Genomic ancestry and glycemic control in adolescents with type 1 diabetes: A multicenter study in Brazil. Pediatr Diabetes 2020; 21:727-734. [PMID: 32335987 DOI: 10.1111/pedi.13031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 04/03/2020] [Accepted: 04/14/2020] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To determine the influence of genomic ancestry (GA) and self-reportedcolor-race (SRCR) on glycemic control in adolescents with type 1 diabetes (T1D) in an admixed population. RESEARCH DESIGN AND METHODS This multicenter nationwide study was conducted in 14 public clinics in 10 Brazilian cities. We estimated global and individual African, European, and Native Amerindian GA proportions using a panel of 46 AIM-INDEL markers. From 1760 patients, 367 were adolescents (20.9%): 184 female (50.1%), aged 16.4 ± 1.9 years, age at diagnosis 8.9 ± 4.3 years, duration of diabetes 8.1 ± 4.3 years, years of study 10.9 ± 2.5 and HbA1c of 9.6 ± 2.4%. RESULTS Patients SRCR as White: 176 (48.0%), Brown: 159 (43.3%), Black: 19(5.2%), Asians: 5 (1.4%) and Amerindians: 8 (2.2%). The percentage of European GA prevailed in all groups: White (71.1), Brown (58.8), Black (49.6), Amerindians (46.1), and Asians (60.5). Univariate correlation was noted between A1c and African GA, r = 0.11, P = .03; years of study, r = -0.12 P = .010, and having both private and public health care insurance (r = -0.20, P < .001). After adjustments, the multivariate logistic analysis showed that SRCR or GA did not influence glycemic control. CONCLUSIONS A high percentage of European GA was noted in our patients, even in those who self-reported as non-White, confirming the highly admixed ethnicity of the Brazilian population. Better glycemic control was associated with having both types of health care; however, there was no association between glycemic control with GA or SRCR. Future prospective studies with other admixed populations are necessary to confirm our findings.
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Affiliation(s)
- Marília B Gomes
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis Eduardo Calliari
- Diabetes Outpatient Clinic, Pediatric Endocrine Unit, Santa Casa School of Medical Sciences, São Paulo, Brazil
| | - Deborah C Santos
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiza H Muniz
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luis C Porto
- Histocompatibility and Cryopreservation Laboratory (HLA), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayse A Silva
- Department of Internal Medicine, Diabetes Unit, State University of Rio de Janeiro, Rio de Janeiro, Brazil.,DNA Diagnostic Laboratory (LDD), State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos A Negrato
- Medical Doctor Program, University of São Paulo-School of Dentistry, São Paulo, Brazil
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180
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Agarwal S, Kanapka LG, Raymond JK, Walker A, Gerard-Gonzalez A, Kruger D, Redondo MJ, Rickels MR, Shah VN, Butler A, Gonzalez J, Verdejo AS, Gal RL, Willi S, Long JA. Racial-Ethnic Inequity in Young Adults With Type 1 Diabetes. J Clin Endocrinol Metab 2020; 105:dgaa236. [PMID: 32382736 PMCID: PMC7457963 DOI: 10.1210/clinem/dgaa236] [Citation(s) in RCA: 107] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/05/2020] [Indexed: 12/13/2022]
Abstract
CONTEXT Minority young adults (YA) currently represent the largest growing population with type 1 diabetes (T1D) and experience very poor outcomes. Modifiable drivers of disparities need to be identified, but are not well-studied. OBJECTIVE To describe racial-ethnic disparities among YA with T1D and identify drivers of glycemic disparity other than socioeconomic status (SES). DESIGN Cross-sectional multicenter collection of patient and chart-reported variables, including SES, social determinants of health, and diabetes-specific factors, with comparison between non-Hispanic White, non-Hispanic Black, and Hispanic YA and multilevel modeling to identify variables that account for glycemic disparity apart from SES. SETTING Six diabetes centers across the United States. PARTICIPANTS A total of 300 YA with T1D (18-28 years: 33% non-Hispanic White, 32% non-Hispanic Black, and 34% Hispanic). MAIN OUTCOME Racial-ethnic disparity in HbA1c levels. RESULTS Non-Hispanic Black and Hispanic YA had lower SES, higher HbA1c levels, and much lower diabetes technology use than non-Hispanic White YA (P < 0.001). Non-Hispanic Black YA differed from Hispanic, reporting higher diabetes distress and lower self-management (P < 0.001). After accounting for SES, differences in HbA1c levels disappeared between non-Hispanic White and Hispanic YA, whereas they remained for non-Hispanic Black YA (+ 2.26% [24 mmol/mol], P < 0.001). Diabetes technology use, diabetes distress, and disease self-management accounted for a significant portion of the remaining non-Hispanic Black-White glycemic disparity. CONCLUSION This study demonstrated large racial-ethnic inequity in YA with T1D, especially among non-Hispanic Black participants. Our findings reveal key opportunities for clinicians to potentially mitigate glycemic disparity in minority YA by promoting diabetes technology use, connecting with social programs, and tailoring support for disease self-management and diabetes distress to account for social contextual factors.
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Affiliation(s)
- Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
| | | | | | | | - Andrea Gerard-Gonzalez
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | | | - Maria J Redondo
- Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Michael R Rickels
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Ashley Butler
- Baylor College of Medicine, Texas Children’s Hospital, Houston, TX
| | - Jeffrey Gonzalez
- Fleischer Institute for Diabetes and Metabolism, New York-Regional Center for Diabetes Translational Research, Division of Endocrinology, Albert Einstein College of Medicine, Bronx, NY
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY
| | | | | | - Steven Willi
- Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Judith A Long
- Institute for Diabetes, Obesity & Metabolism, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
- Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA
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181
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Santos DC, de Melo LGN, Pizarro MH, Barros BSV, Negrato CA, Porto LC, Silva DA, Drummond KRG, Muniz LH, Mattos TCL, Pinheiro AA, Mallmann F, Leal FSL, Malerbi FK, Morales PH, Gomes MB. Genomic ancestry as a risk factor for diabetic retinopathy in patients with type 1 diabetes from an admixed population: a nested case-control study in Brazil. Acta Diabetol 2020; 57:937-945. [PMID: 32125531 DOI: 10.1007/s00592-020-01498-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 02/06/2020] [Indexed: 10/24/2022]
Abstract
AIMS The influence of genetic factors on the development and progression of diabetic retinopathy is still unclear. Previous studies showed controversial results. We aimed to characterize the relationship between genomic ancestry and self-reported color/race with severe diabetic retinopathy in patients with type 1 diabetes belonging to a highly admixed population. METHODS This study was a nested case-control based on data collected from a large cross-sectional, nationwide survey conducted in clinics from all five geographic regions of Brazil. For the present study, we included 414 individuals. Cases (n = 176) were considered if they had severe non-proliferative or proliferative diabetic retinopathy, and controls (n = 238) were type 1 diabetes patients without retinopathy, matched for diabetes duration by a range of 5 years. Indirect ophthalmoscopy was performed, and individual genomic ancestry was inferred using a panel of 46 ancestry informative markers. RESULTS The backward stepwise logistic regression analysis showed that African genomic ancestry (OR 3.9, p = 0.045), HbA1c (OR 1.24, p = 0.001), glomerular filtration rate (OR 0.98, p < 0.001) and hypertension (OR 2.52, p < 0.001) were associated with severe diabetic retinopathy after adjusting for clinical and demographic data. Self-reported color/race was not statistically associated with diabetic retinopathy. CONCLUSIONS Genomic ancestry, as well as clinical variables such as hypertension, impaired glomerular filtration rate and poor diabetes control (HbA1c), was important risk factor for the development of severe diabetic retinopathy. Further studies are needed, especially in highly admixed populations, to better understand the role of genomic ancestry and possible genes that might be associated with the development and/or progression of diabetic retinopathy.
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Affiliation(s)
- Deborah Conte Santos
- Department of Internal Medicine, Diabetes Unit, Rio de Janeiro State University (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, Rio de Janeiro, CEP 20551-030, Brazil.
| | | | - Marcela Haas Pizarro
- Department of Internal Medicine, Diabetes Unit, Rio de Janeiro State University (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, Rio de Janeiro, CEP 20551-030, Brazil
| | - Bianca S V Barros
- Department of Internal Medicine, Diabetes Unit, Rio de Janeiro State University (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, Rio de Janeiro, CEP 20551-030, Brazil
| | | | - Luís Cristóvão Porto
- Histocompatibility and Cryopreservation Laboratory (HLA), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | - Dayse A Silva
- DNA Diagnostic Laboratory (LDD), Rio de Janeiro State University (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Luiza Harcar Muniz
- Department of Internal Medicine, Diabetes Unit, Rio de Janeiro State University (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, Rio de Janeiro, CEP 20551-030, Brazil
| | | | | | - Felipe Mallmann
- Department of Ophthalmology, Federal University of Rio Grande Do Sul, Porto Alegre, Brazil
| | | | - Fernando Korn Malerbi
- Department of Endocrinology and Ophthalmology, Federal University of São Paulo, São Paulo, Brazil
| | | | - Marília Brito Gomes
- Department of Internal Medicine, Diabetes Unit, Rio de Janeiro State University (UERJ), Boulevard 28 de Setembro, 77- 3º andar - Vila Isabel, Rio de Janeiro, Rio de Janeiro, CEP 20551-030, Brazil
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182
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DiMeglio LA, Kanapka LG, DeSalvo DJ, Anderson BJ, Harrington KR, Hilliard ME, Laffel LM, Tamborlane WV, Van Name MA, Wadwa RP, Willi SM, Woerner S, Wong JC, Miller KM. Time spent outside of target glucose range for young children with type 1 diabetes: a continuous glucose monitor study. Diabet Med 2020; 37:1308-1315. [PMID: 32096282 PMCID: PMC9065795 DOI: 10.1111/dme.14276] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2020] [Indexed: 12/19/2022]
Abstract
AIM To assess the associations between demographic and clinical characteristics and sensor glucose metrics in young children with type 1 diabetes, using masked, continuous glucose monitoring data from children aged 2 to < 8 years. RESEARCH DESIGN AND METHODS The analysis included 143 children across 14 sites in the USA, enrolled in a separate clinical trial. Eligibility criteria were: age 2 to <8 years; type 1 diabetes duration ≥3 months; no continuous glucose monitoring use for past 30 days; and HbA1c concentration 53 to <86 mmol/mol (7.0 to <10.0%). All participants wore masked continuous glucose monitors up to 14 days. RESULTS On average, participants spent the majority (13 h) of the day in hyperglycaemia (>10.0 mmol/l) and a median of ~1 h/day in hypoglycaemia (<3.9 mmol/l). Participants with minority race/ethnicity and higher parent education levels spent more time in target range, 3.9-10.0 mmol/l, and less time in hyperglycaemia. More time in hypoglycaemia was associated with minority race/ethnicity and younger age at diagnosis. Continuous glucose monitoring metrics were similar in pump and injection users. CONCLUSIONS Given that both hypo- and hyperglycaemia negatively impact neurocognitive development, strategies to increase time in target glucose range for young children are needed.
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Affiliation(s)
- L A DiMeglio
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - L G Kanapka
- Jaeb Center for Health Research, Tampa, FL, USA
| | - D J DeSalvo
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - B J Anderson
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - K R Harrington
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - M E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - L M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
| | | | | | - R P Wadwa
- Barbara Davis Center for Childhood Diabetes, Aurora, CO, USA
| | - S M Willi
- Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - S Woerner
- Indiana University School of Medicine, Indianapolis, IN, USA
| | - J C Wong
- University of California San Francisco, San Francisco, CA, USA
| | - K M Miller
- Jaeb Center for Health Research, Tampa, FL, USA
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183
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Nefs G, Albright-Pierce MR, Kanc K, Feinn R, Wagner J. Diabetes Self-Management Decrements Mediate the Relation of Stressful Life Events and Hemoglobin A1c-Differences by Race/Ethnicity in Adolescents. J Adolesc Health 2020; 67:282-285. [PMID: 32265085 DOI: 10.1016/j.jadohealth.2020.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Revised: 01/03/2020] [Accepted: 02/03/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE The aim of the study was to establish whether suboptimal self-management explains the relationship between stressful life events and hemoglobin A1c (HbA1c) in adolescents with type 1 diabetes and whether these relationships differ across race/ethnicity. METHODS Participants were 6,368 adolescents enrolled in the U.S. T1D Exchange registry. The outcome, HbA1c, was chart-based; predictors and covariates were self-reported. Moderated mediation was tested using Mplus, adjusting for gender, age, insulin treatment modality, and socioeconomic status. RESULTS Higher frequency of missed insulin doses and lower frequency of daily self-monitoring of blood glucose partially explained the relationship between past-year stressful life events and higher HbA1c. Mediation by self-monitoring of blood glucose was detected for those who identified as white non-Hispanic and Hispanic, but not for those who identified as African American. CONCLUSIONS In adolescents, there is some evidence for a behavioral mechanism in the stressor-HbA1c relationship. African American youth may be more resilient against some detrimental behavioral effects of stressors.
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Affiliation(s)
- Giesje Nefs
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Medical and Clinical Psychology, Center of Research on Psychological and Somatic disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Diabeter, National Treatment and Research Center for Children, Adolescents and Young Adults With Type 1 Diabetes, Rotterdam, The Netherlands.
| | | | - Karin Kanc
- jazindiabetes (Diabetes&Me), Private Diabetes Centre, Ljubljana, Slovenia
| | - Richard Feinn
- Medical Sciences, School of Medicine, Quinnipiac University, Hamden, Connecticut
| | - Julie Wagner
- Department of Behavioral Sciences and Community Health, University of Connecticut Schools of Medicine and Dental Medicine, Farmington, Connecticut
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184
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Nwosu BU, Yeasmin S, Ayyoub S, Rupendu S, Villalobos-Ortiz TR, Jasmin G, Parajuli S, Zahedi B, Zitek-Morrison E, Alonso LC, Barton BA. Continuous glucose monitoring reduces pubertal hyperglycemia of type 1 diabetes. J Pediatr Endocrinol Metab 2020; 33:865-872. [PMID: 32634109 PMCID: PMC9064487 DOI: 10.1515/jpem-2020-0057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 05/08/2020] [Indexed: 11/15/2022]
Abstract
Background Physiologic hyperglycemia of puberty is a major contributor to poor glycemic control in youth with type 1 diabetes (T1D). This study's aim was to determine the effectiveness of continuous glucose monitoring (CGM) to improve glycemic control in pubertal youth with T1D compared to a non-CGM cohort after controlling for age, sex, BMI, duration, and insulin delivery methodology. The hypothesis is that consistent CGM use in puberty improves compliance with diabetes management, leading to increased percentage (%) time in range (TIR70-180 mg/dL) of glycemia, and lowering of HbA1c. Methods A longitudinal, retrospective, case-controlled study of 105 subjects consisting of 51 T1D controls (60.8% male) age 11.5 ± 3.8 y; and 54 T1D subjects (48.1% male) age 11.1 ± 5.0 y with confirmed CGM use for 12 months. Pubertal status was determined by Tanner staging. Results were adjusted for baseline HbA1c and diabetes duration. Results HbA1c was similar between the controls and the CGM group at baseline: 8.2 ± 1.1% vs 8.3 ± 1.2%, p=0.48 respectively; but was significantly lower in the CGM group 12 months later, 8.2 ± 1.1% vs. 8.7 ± 1.4%, p=0.035. Longitudinal change in HbA1c was similar in the prepubertal cohort between the control- and CGM groups: -0.17 ± 0.98% vs. 0.38 ± 1.5%, p=0.17. In contrast, HbA1c increased with advancing age and pubertal status in the pubertal controls but not in the pubertal CGM group: 0.55 ± 1.4 vs -0.22 ± 1.1%, p=0.020. Percent TIR was inversely related to HbA1c in the CGM group, r=-0.6, p=0.0004, for both prepubertal and pubertal subjects. Conclusions CGM use significantly improved glycemic control in pubertal youth with T1D compared to non-CGM users.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA
| | - Shamima Yeasmin
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sanaa Ayyoub
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Shwetha Rupendu
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Tony R. Villalobos-Ortiz
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Gabrielle Jasmin
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sadichchha Parajuli
- Department of Pediatrics, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Bita Zahedi
- Department of Medicine, Division of Endocrinology, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Emily Zitek-Morrison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Laura C. Alonso
- Weill Cornell Division of Endocrinology, Diabetes and Metabolism, New York, NYUSA
| | - Bruce A. Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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185
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Wilson T, Bevan G, Gray M, Day C, McManners J. Developing a culture of stewardship: how to prevent the Tragedy of the Commons in universal health systems. J R Soc Med 2020; 113:255-261. [PMID: 32663426 DOI: 10.1177/0141076820913421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tim Wilson
- Nuffield Department of Primary Health Sciences, Oxford OX2 6GG, UK
| | - Gwyn Bevan
- London School Economics, London WC2A 2AE, UK
| | - Muir Gray
- Nuffield Department of Surgery, Oxford OX3 9DU, UK
| | - Clara Day
- University Hospitals Birmingham, Birmingham B15 2GW, UK
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186
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Nicholl MC, Valenzuela JM, Lit K, DeLucia C, Shoulberg AM, Rohan JM, Shroff Pendley J, Dolan L, Delamater AM. Featured Article: Comparison of Diabetes Management Trajectories in Hispanic versus White Non-Hispanic Youth with Type 1 Diabetes across Early Adolescence. J Pediatr Psychol 2020; 44:631-641. [PMID: 30916748 DOI: 10.1093/jpepsy/jsz011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Ethnic minority youth with type 1 diabetes (T1D) often have poorer glycemic control and lower rates of adherence compared to White Non-Hispanic (WNH) youth. Variables such as family conflict, autonomy support, and youth regimen responsibility have been shown to change over adolescence and impact diabetes management. However, these factors have been investigated in predominantly White samples. Few studies have examined potential differences in these variables and their trajectories for Hispanic youth over early adolescence. METHODS Youth with T1D (178 WNH and 33 Hispanic youth participants), as well as their maternal caregivers (174 WNH and 32 Hispanic maternal caregivers), completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency at 4 timepoints over a 3-year period. RESULTS At baseline, Hispanic youth had significantly poorer glycemic control, more family conflict, and fewer blood glucose checks on average compared to WNH youth. Similar to WNH youth, Hispanic youth have increasing independence for regimen tasks and decreasing parent autonomy support during this developmental period. However, while Hispanic youth had worsening diabetes management during early adolescence (as did WNH youth), Hispanic parents reported a more gradual change in youth's diabetes management over early adolescence. CONCLUSIONS This study presents an important contribution to the existing literature on youth with T1D. Findings suggest potential strengths and targets for Hispanic youth navigating diabetes management during the adolescent period. It is important to continue to investigate the trajectories of ethnic minority youth with diabetes.
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Affiliation(s)
- Meg C Nicholl
- Department of Pediatrics, Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jessica M Valenzuela
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Keith Lit
- Department of Psychology, Jackson Health System, Miami, FL, USA
| | - Christian DeLucia
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Amanda M Shoulberg
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Rohan
- Division of Hematology and Oncology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Jennifer Shroff Pendley
- Division of Behavioral Health, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Lawrence Dolan
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Endocrinology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
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187
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Chalew S, Kamps J, Jurgen B, Gomez R, Hempe J. The relationship of glycemic control, insulin dose, and race with hypoglycemia in youth with type 1 diabetes. J Diabetes Complications 2020; 34:107519. [PMID: 32303406 PMCID: PMC8978593 DOI: 10.1016/j.jdiacomp.2019.107519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/25/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION Black youth with T1D have been reported to experience more episodes of hypoglycemia than white patients, despite blacks having higher levels of HbA1c. We hypothesized that black patients may be prescribed higher daily doses of insulin putting them at greater higher risk for hypoglycemia. METHODS We performed a retrospective analysis of data from a study of social and environmental factors influencing HbA1c in a biracial pediatric population with T1DM. Changes in patient insulin dose were made at clinic visit based on their self-monitored glucose (SMG) data. Insulin dose (units/kg/d) was compared with HbA1c, reported hypoglycemic episodes and occurrence of low blood glucose from SMG data. RESULTS Age, duration of diabetes and BMI-z were similar for black and white patients. Black patients had higher levels of HbA1c and mean blood glucose (MBG). HbA1c was higher in blacks even after adjustment for MBG. Reported insulin dose increased with increasing HbA1c (ρ = 0.30, p = 0.0052) or MBG (ρ = 0.36, p < 0.0008). There was no difference in insulin dose between blacks and whites. Reported hypoglycemia was inversely associated with HbA1c and MBG, but there was no racial difference. Occurrence of low glucoses from meter data was slightly higher in whites (p = 0.047). CONCLUSION Insulin dose increased with increasing HbA1c or MBG for both groups. Occurrence of hypoglycemia was inversely related to glycemic control. There was slightly higher occurrence low glucose meter readings in white patients. Reported racial disparities in occurrence of hypoglycemia and insulin dosing may be due to clinic specific factors.
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Affiliation(s)
- Stuart Chalew
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, New Orleans, LA, United States of America.
| | - Jodi Kamps
- Department of Psychology, Children's Hospital of New Orleans, New Orleans, LA, United States of America
| | - Brittney Jurgen
- Department of Psychology, Children's Hospital of New Orleans, New Orleans, LA, United States of America
| | - Ricardo Gomez
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
| | - James Hempe
- Division of Endocrinology and Diabetes, Children's Hospital of New Orleans and The Louisiana State University Health Sciences Center, New Orleans, LA, United States of America
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188
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Marshall CJ, Rodriguez HP, Dyer W, Schmittdiel JA. Racial and Ethnic Disparities in Diabetes Care Quality among Women of Reproductive Age in an Integrated Delivery System. Womens Health Issues 2020; 30:191-199. [PMID: 32340896 DOI: 10.1016/j.whi.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/24/2023]
Abstract
BACKGROUND Diabetes is increasingly prevalent among women of reproductive age, yet little is known about quality of diabetes care for this population at increased risk of diabetes complications and poor maternal and infant health outcomes. Previous studies have identified racial/ethnic disparities in diabetes care, but patterns among women of reproductive age have not been examined. METHODS This retrospective cohort study analyzed 2016 data from Kaiser Permanente Northern California, a large integrated delivery system. Outcomes were quality of diabetes care measures-glycemic testing, glycemic control, and medication adherence-among women ages 18 to 44 with type 1 or type 2 diabetes (N = 9,923). Poisson regression was used to estimate the association between patient race/ethnicity and each outcome, adjusting for other patient characteristics and health care use. RESULTS In this cohort, 83% of participants had type 2 diabetes; 31% and 36% of women with type 2 and type 1 diabetes, respectively, had poor glycemic control (hemoglobin A1c of ≥9%), and approximately one-third of women with type 2 diabetes exhibited nonadherence to diabetes medications. Compared with non-Hispanic White women with type 2 diabetes, non-Hispanic Black women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) and Hispanic women (adjusted risk ratio, 1.2; 95% confidence interval, 1.1-1.3) were more likely to have poor control. Findings among women with type 1 diabetes were similar. CONCLUSIONS Our findings indicate opportunities to decrease disparities and improve quality of diabetes care for reproductive-aged women. Elucidating the contributing factors to poor glycemic control and medication adherence in this population, particularly among Black, Hispanic, and Asian women, should be a high research and practice priority.
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Affiliation(s)
- Cassondra J Marshall
- School of Public Health, University of California, Berkeley, Berkeley, California.
| | - Hector P Rodriguez
- School of Public Health, University of California, Berkeley, Berkeley, California
| | - Wendy Dyer
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Julie A Schmittdiel
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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189
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Joiner KL, DeJonckheere M, Whittemore R, Grey M. Perceptions and experiences of living with type 1 diabetes among Latino adolescents and parents with limited English proficiency. Res Nurs Health 2020; 43:263-273. [PMID: 32281136 DOI: 10.1002/nur.22019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 03/12/2020] [Accepted: 03/28/2020] [Indexed: 11/07/2022]
Abstract
We explored perceptions and experiences of living with type 1 diabetes mellitus (T1DM) among U.S. Latino adolescents (age 12-19 years) with T1DM and parents with limited English proficiency. We used a qualitative descriptive approach with semi-structured interviews of adolescents together with their parents. Interview data were reviewed, coded, and combined into themes about participant experiences with T1DM. Twenty-four adolescents (mean age: 15.4 years) and 23 parents participated. Analysis resulted in three themes: (a) Understanding and adapting to T1DM (i.e., initial fear and misunderstandings of T1DM; adolescents' reflections on living with a chronic health condition); (b) Coming to terms with social and environmental influences on T1DM self-management (i.e., T1DM as disruptive to school and social activities; dealing with stigma and judgments related to diabetes); and, (c) Integrating T1DM self-management expectations with components of Latino cultures (i.e., orientation toward family well-being; parent concerns about cultural preferences that influence food choices, positive influence of spirituality and religiousness; parental views of their current health care in comparison to that available in their place of birth). Adolescents and their parents reported experiences that are universal to adolescents with T1DM in addition to challenges that are unique to Latinos. Efforts aimed at improving T1DM self-management during adolescence with this population need to be tailored to meet the unique social and cultural contexts and delivered in a culturally and linguistically congruent manner.
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Affiliation(s)
- Kevin L Joiner
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | | | | | - Margaret Grey
- School of Nursing, Yale University, Orange, Connecticut
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190
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Valenzuela JM, Records SE, Mueller KA, Martin MT, Wolf RM. Racial Ethnic Disparities in Youth With Type 1 Diabetes Participating in Diabetes Summer Camps. Diabetes Care 2020; 43:903-905. [PMID: 31974104 DOI: 10.2337/dc19-1502] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 12/31/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Diabetes camps are beneficial for campers and include benefits such as increases in diabetes knowledge, glycemic control, and psychological functioning. Racial/ethnic minority youth are likely to have poorer disease management and glycemic control. We hypothesized that minority youth with type 1 diabetes have reduced participation in diabetes summer camps. RESEARCH DESIGN AND METHODS We analyzed deidentified data from 5,256 campers with type 1 diabetes who participated in a network of 48 American Diabetes Association-affiliated summer camps in 2018, and we compared participation rates by racial/ethnic category to the most recent SEARCH for Diabetes in Youth study prevalence rates. RESULTS Camper demographics were significantly different than in the general population of children with type 1 diabetes (P < 0.001). Minority youth were more likely to attend day camp, be first-time campers, and request financial aid, and they were less likely to be on insulin pump therapy or use continuous glucose monitors. CONCLUSIONS Racial/ethnic minority youth with diabetes are underrepresented in diabetes camps nationwide.
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191
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Flokas ME, Zeymo A, Mete M, Anhalt H, Rother KI, Gourgari E. Overweight and obese children with optimal control in the T1D Exchange Registry: How are they different from lean children with optimal control? J Diabetes Complications 2020; 34:107513. [PMID: 32007420 PMCID: PMC7524582 DOI: 10.1016/j.jdiacomp.2019.107513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 12/17/2019] [Indexed: 01/08/2023]
Abstract
AIMS Increased adiposity is a risk factor for suboptimal diabetes control and cardiovascular disease (CVD) complications. Our goal was to identify modifiable behavioral characteristics of overweight and obese pediatric patients with type 1 diabetes mellitus (T1DM) who achieve optimal glycemic control and to evaluate their CVD risk compared to lean patients. Our hypothesis was that optimally controlled obese and overweight participants require more total daily insulin and are at higher CVD risk compared to optimally controlled lean participants. METHODS We analyzed a cohort of 9263 participants with T1DM aged <21 years in the T1D Exchange Registry. Optimal diabetes control was defined as HbA1c ≤ 7.5% (58 mmol/mol). We compared factors that influence glycemic control in lean, overweight and obese participants with optimal vs. suboptimal control, using logistic regression. RESULTS Age, race, overweight status, continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) use were important variables influencing glycemic control. In the optimally controlled cohort, 27% of participants were overweight or obese versus 30% in the suboptimally controlled cohort (P < 0.001). Overweight and obese participants with optimal control were not significantly different from lean participants in terms of CSII use, total daily insulin dosage per kg of bodyweight, glucose checks per day, boluses with bedtime snack, use of CGM, but had higher LDL cholesterol and triglycerides, and lower HDL cholesterol (P < 0.05). CONCLUSIONS There were no differences in modifiable behavioral characteristics between the obese, overweight and lean optimally controlled participants. However, predictors of cardiovascular disease were higher in the overweight and obese group.
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Affiliation(s)
- Myrto Eleni Flokas
- New York Presbyterian Brooklyn Methodist Hospital, Brooklyn, NY, United States of America
| | - Alexander Zeymo
- Department of Biostatistics and Bioinformatics, Medstar Health Research Institute, Hyattsville, MD, United States of America
| | - Mihriye Mete
- Department of Biostatistics and Bioinformatics, Medstar Health Research Institute, Hyattsville, MD, United States of America
| | - Henry Anhalt
- Medical Affairs, Science 37, Playa Vista, CA, United States of America
| | - Kristina I Rother
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health (NIH), Bethesda, MD, United States of America
| | - Evgenia Gourgari
- Department of Pediatrics, Georgetown University, Washington, DC, United States of America; National Institute of Child Health and Human Development, NIH, Bethesda, MD, United States of America.
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192
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Katsimardou A, Imprialos K, Stavropoulos K, Sachinidis A, Doumas M, Athyros VG. Treatment strategies for hypertension in patients with type 1 diabetes. Expert Opin Pharmacother 2020; 21:1241-1252. [PMID: 32066278 DOI: 10.1080/14656566.2020.1729124] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is a chronic, autoimmune disease that is characterized by total absence of insulin production. Hypertension is a common comorbidity in T1DM with complex pathophysiology, while it is also a well-recognized risk factor for the development of cardiovascular disease (CVD), as well as other microvascular diabetic complications. AREAS COVERED The purpose of this review is to present the current definitions, epidemiological data and prevalence rates of hypertension in T1DM, as well as to describe current therapeutic options. EXPERT OPINION Hypertension affects around a third of the type 1 diabetic population, with higher prevalence rates in older individuals with longer disease duration. Although hypertension affects a substantial proportion of T1DM individuals, blood pressure control rates are disappointingly low. Alongside lifestyle modification, antihypertensive treatment should be initiated in those with blood pressure above 140/90 mmHg, with a systolic blood pressure target of 130 mmHg and lower, if tolerated. In those with established CVD or diabetic nephropathy, systolic blood pressure targets below 130 mmHg should be pursued. Initial pharmacotherapy should consist of a renin-angiotensin-aldosterone system inhibitor. There is an urgent need for good quality data regarding proper antihypertensive treatment initiation, optimal BP targets and optimal antihypertensive treatment for better clinical outcomes.
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Affiliation(s)
| | | | | | | | - Michalis Doumas
- Department of Internal Medicine, Aristotle University , Thessaloniki, Greece
| | - Vasilios G Athyros
- Department of Internal Medicine, Aristotle University , Thessaloniki, Greece
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193
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Gomes MB, Muniz LH, Melo LGN, Pizarro MH, Barros BSV, Santos DC, Negrato CA. Health literacy and glycemic control in patients with diabetes: a tertiary care center study in Brazil. Diabetol Metab Syndr 2020; 12:11. [PMID: 32042313 PMCID: PMC6998814 DOI: 10.1186/s13098-020-0519-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 01/24/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The primary objective of our study was to determine which factors influence health literacy (HL) in patients with type 1 diabetes (T1D) and type 2 diabetes (T2D), and the secondary one was to evaluate the influence of HL on glycemic control. METHODS This was an observational, cross-sectional study with 347 patients (144 with T1D and 203 with T2D), conducted between December 2014/December 2017. Data were obtained from medical records and/or questionnaire. The short test of Functional Health Literacy (S-TOFHLA) was used to evaluate HL. RESULTS Age and years of school attendance were the most important variables associated with better performance in S-TOFHLA mainly in patients with T1D. A correlation between age and years of school attendance with S-TOFHLA score was observed in both groups of patients. After an unadjusted analysis, more patients with T1D presented adequate HL [119 (82.6%) vs 87 (44.8%, p < 0.001)]. Patients with T1D had higher scores than patients with T2D (84.4 ± 21.4 vs 61.6 ± 26.8 points, p < 0.001), respectively. This difference did not persist after adjustment for age and years of school attendance (73.04 ± 2.14 ± vs 70.04 ± 1.76 points) respectively, p = 0.348). No difference was found in HbA1c levels according to S-TOFHLA. All patients with T1D and HbA1c levels < 7.0% (53 mmol/mol) had adequate HL. CONCLUSIONS A considerable number of patients with either T1D or T2D did not have adequate HL. Overall, age and years of school attendance were the most important variables associated with better performance of S-TOFHLA. Although no difference was found in HbA1c levels according to S-TOFHLA, patients with T1D who self-reported as White, with more years of school attendance, and higher HL score reached more frequently a good glycemic control. Finally, in addition to therapeutic regimens, approaches on diabetes management should also include patients' HL evaluation along with psychological and social aspects.
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Affiliation(s)
- Marilia B. Gomes
- Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Luiza Harcar Muniz
- Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Laura Gomes Nunes Melo
- Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Marcela Haas Pizarro
- Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Deborah Conte Santos
- Diabetes Unit, Department of Internal Medicine, State University Hospital of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Carlos Antonio Negrato
- Medical Doctor Program, University of São Paulo-School of Dentistry, Bauru, São Paulo, Brazil
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194
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Corathers SD, DeSalvo DJ. Therapeutic Inertia in Pediatric Diabetes: Challenges to and Strategies for Overcoming Acceptance of the Status Quo. Diabetes Spectr 2020; 33:22-30. [PMID: 32116450 PMCID: PMC7026749 DOI: 10.2337/ds19-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite significant advances in therapies for pediatric type 1 diabetes, achievement of glycemic targets remains elusive, and management remains burdensome for patients and their families. This article identifies common challenges in diabetes management at the patient-provider and health care system levels and proposes practical approaches to overcoming therapeutic inertia to enhance health outcomes for youth with type 1 diabetes.
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Affiliation(s)
- Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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195
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Kane NS, Hoogendoorn CJ, Commissariat PV, Schulder TE, Gonzalez JS. Glycemic control and self-rated health among ethnically diverse adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:69-76. [PMID: 31589350 PMCID: PMC7362987 DOI: 10.1111/pedi.12928] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/06/2019] [Accepted: 09/24/2019] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE Patient-reported outcomes have received increased attention as treatment outcomes and indicators of wellbeing. A1c has been criticized as lacking patient-centered relevance because individuals are often unaware of their A1c, and studies also often fail to show a benefit of intensive control on quality of life. The goal of the present study was to examine self-rated health (SRH) in relation to diabetes self-care behaviors, socioeconomic factors, treatment regimen characteristics, and glycemic control among predominately Hispanic and African American adolescents with type 1 diabetes (T1D). METHODS Adolescents with T1D (N = 84) were recruited for a cross-sectional study evaluating psychosocial factors and identity development. SRH, self-care behaviors, treatment regimen, and demographic variables were collected through self-report while glycemic control (A1c) was determined through chart review. RESULTS Participants were predominantly racial and ethnic minorities (48% Hispanic, 27% African American; 52% female, M age 15.9, M diabetes duration 6.8, M A1c 10% [86 mmol/mol]). Significant bivariate relationships emerged between SRH and sex, A1c, self-care behavior, and insulin delivery method. Covariate-adjusted regression models showed only A1c was significantly and independently related to SRH. Mediation analyses illustrated a significant indirect effect for A1c between self-care and SRH. CONCLUSION These findings suggest glycemic control is associated with self-ratings of health among ethnically diverse adolescents with T1D. SRH appears to be an appropriate patient-reported outcome that is sensitive to glycemic control in this population.
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Affiliation(s)
- Naomi S. Kane
- War Related Illness and Injury Study Center (WRIISC), VA New Jersey Health Care System, East Orange, New Jersey,Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | | | - Persis V. Commissariat
- Pediatric, Adolescent, and Young Adult Section, Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Talia E. Schulder
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York
| | - Jeffrey S. Gonzalez
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, New York,Department of Medicine (Endocrinology) and Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York,The Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine, Bronx, New York,The New York Regional Center for Diabetes Translation Research (NY-CDTR), Albert Einstein College of Medicine, Bronx, New York
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196
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Munion AK, Butner JE, Kelly CS, Wiebe DJ, Turner SL, Lansing AH, Berg CA. The separation in coordination between social- and self-regulation for emerging adults with type 1 diabetes. J Behav Med 2020; 43:892-903. [PMID: 31974750 DOI: 10.1007/s10865-020-00134-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
To examine how self-regulation and social-regulation surrounding type 1 diabetes (T1D) management are coordinated during early emerging adulthood and whether classes of coordination relate to HbA1c and executive functioning (EF). Emerging adult participants (N = 212) with T1D (M age = 18.8 years, SD = .40) completed a 14-day diary to capture components of self-regulation and social-regulation. A mixture multi-level latent coordination model first determined the separate but coordinated factor structure of self- and social-regulation, then determined the number of distinct classes of coordination and how those classes linked to HbA1c and EF. The best-fitting model included three coordinative factors (self, mother, and father) of regulation and two distinct classes. The class with lower HbA1c and higher EF had more stable self- and social-regulation, more connections between self- and social-regulation and reflected more adaptive patterns, consistent with medical management goals. Social connection with parents may aid in regulation during this at-risk transitional time of emerging adulthood.
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Affiliation(s)
- A K Munion
- Department of Psychology, University of Utah, Salt Lake City, USA.
| | | | - Caitlin S Kelly
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Deborah J Wiebe
- Psychological Sciences, University of California-Merced, Merced, USA
| | - Sara L Turner
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Amy Hughes Lansing
- Department of Psychology, University of Utah, Salt Lake City, USA.,Department of Psychology, University of Nevada-Reno, Reno, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
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197
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee (https://doi.org/10.2337/dc20-SPPC), are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction (https://doi.org/10.2337/dc20-SINT). Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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198
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Wagner JA, Petry NM, Weyman K, Tichy E, Cengiz E, Zajac K, Tamborlane WV. Glucose management for rewards: A randomized trial to improve glucose monitoring and associated self-management behaviors in adolescents with type 1 diabetes. Pediatr Diabetes 2019; 20:997-1006. [PMID: 31271239 PMCID: PMC6786915 DOI: 10.1111/pedi.12889] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2019] [Revised: 06/04/2019] [Accepted: 06/18/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This randomized, controlled trial evaluated a monetary-based reinforcement intervention for increasing self-monitoring of blood glucose (SMBG) among youth with poorly controlled type 1 diabetes. METHODS After a 2-week baseline, 60 participants were randomized to enhanced usual care (EUC) or Reinforcers. The Reinforcers group earned monetary rewards for SMBG and associated behaviors such as uploading glucose meters. Reinforcers were withdrawn at 24 weeks. A follow-up evaluation occurred at 36 weeks. RESULTS Participants in the reinforcers group increased the proportion of days they completed ≥4 SMBG from 14.6% at baseline to 64.4%, 47.5%, and 37.8% at 6, 12, and 24 weeks, respectively. In contrast, EUC participants declined from 22.7% at baseline to 17.5%, 10.5%, and 11.1% (Ps < .01 vs EUC at all time points). Group differences were attenuated but remained significant after withdrawal of reinforcers. Effect sizes for SMBG were very large during reinforcement and large after withdrawal of reinforcers. In the reinforcers group, mean A1c dropped from 9.5% ± 1.2% at baseline to 9.0% ± 1.3% at week 6 and 9.0% ± 1.4% at week 12. For EUC, A1c was 9.2% ± 0.2% at baseline and ranged from 9.2% ± 1.5% to 9.6% ± 1.6% throughout the study (P < .05 vs EUC). Group differences in A1c were no longer significant at weeks 24 and 36. Effect sizes for A1c were small during reinforcement and also after withdrawal of reinforcement. CONCLUSIONS Monetary-based reinforcement of adolescents with type 1 diabetes caused durable increases in SMBG. Modification of the reinforcement structure may be needed to sustain improved metabolic control in this challenging age group.
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Affiliation(s)
- Julie A. Wagner
- University of Connecticut School of Dental Medicine,University of Connecticut School of Medicine
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199
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Marker AM, Patton SR, McDonough RJ, Feingold H, Simon L, Clements MA. Implementing clinic-wide depression screening for pediatric diabetes: An initiative to improve healthcare processes. Pediatr Diabetes 2019; 20:964-973. [PMID: 31264763 PMCID: PMC7814422 DOI: 10.1111/pedi.12886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Youth with type 1 diabetes (T1D) endorse high rates of depressive symptoms, which can significantly impair self-management, glycemic control, and quality of life. Current guidelines recommend annual depression screening for all adolescents with T1D, but few models exist to implement screening procedures across clinics in this population. The primary aim of this project was to increase depression screening from 0% to 80% in four clinics, and to describe the structured quality improvement process to reach this goal. METHODS All patients aged 12 to 21 years old with T1D at four participating clinics in a Midwestern hospital system were eligible to participate. Using a two-stage process, patients were administered the Patient Health Questionnaire (PHQ-2 plus PHQ-9 if positive) annually. Rates of depression screening by clinic site, rates of positive depression screens, social worker documentation of follow-up care, and associations with diabetes-related health outcomes were analyzed. RESULTS Over 2 years, average depression screening rates increased from 0% to 75% across all clinics, and 89% of patients with a positive screen met with a social worker for a targeted mental health assessment. At initial screening, 7.6% of patients screened positive for at-risk depressive symptoms on the PHQ-2 and from that group, 6.7% additionally screened positive on the PHQ-9. CONCLUSIONS Annual depression screenings were feasibly implemented across four clinics and the use of real-time data listening and automated processes facilitated successful implementation. Future directions include further automation, targeted training and billing mechanisms, dissemination to non-metropolitan clinics, and further assessment of depression screening tools for adolescents with T1D.
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Affiliation(s)
| | | | | | | | - Lara Simon
- Children's Mercy - Kansas City, Kansas City, Missouri
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200
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Affiliation(s)
- Terri H Lipman
- University of Pennsylvania School of Nursing, United States of America; Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America.
| | - Jennifer A Smith
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, PA, United States of America; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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