151
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McKee AM, Al-Hammadi N, Hinyard LJ. Disparities in Utilization and Outcomes With Continuous Subcutaneous Insulin Infusion in Young Adults With Type 1 Diabetes. Endocr Pract 2021; 27:769-775. [PMID: 33991655 DOI: 10.1016/j.eprac.2021.05.001] [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: 01/28/2021] [Revised: 04/29/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate which factors determine utilization patterns and outcomes of continuous subcutaneous insulin infusion (CSII) in young adults with type 1 diabetes. METHODS Utilizing the Optum deidentified electronic health record data set between 2008 to 2018 to perform a retrospective cohort study, we identified 2104 subjects with type 1 diabetes aged 18 to 30 years. We evaluated the effect of race on determining CSII utilization, HbA1c (%), and hospital admission for diabetic ketoacidosis (DKA). Crude and adjusted estimates were computed using logistic regression and linear mixed models. RESULTS There was low CSII utilization among individuals who were Black, Hispanic, male, and those with governmental insurance. These groups also demonstrated higher HbA1c levels. Subjects who were Black, Hispanic, and those with governmental insurance had higher odds of DKA. Even when commercially insured, Black and Hispanic subjects demonstrated higher HbA1c levels, and Black individuals had higher odds of DKA. CONCLUSION In a large electronic health record database in the U.S., there was low CSII utilization overall, particularly in Black and Hispanic minorities, despite CSII showing superior HbA1c control without an increase in DKA events.
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Affiliation(s)
- Alexis M McKee
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine in St. Louis, St. Louis, Missouri.
| | - Noor Al-Hammadi
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri
| | - Leslie J Hinyard
- Department of Health and Clinical Outcomes Research, Saint Louis University School of Medicine, St. Louis, Missouri; Advanced HEAlth Data (AHEAD) Institute, Saint Louis University, St. Louis, Missouri
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152
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Addala A, Chan RY, Vargas J, Weigensberg MJ. Global Well-Being Is Associated With A1C and Frequency of Self-Monitoring of Blood Glucose in Predominately Latinx Youth and Young Adults With Type 1 Diabetes. Diabetes Spectr 2021; 34:202-208. [PMID: 34149262 PMCID: PMC8178714 DOI: 10.2337/ds20-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA
| | - Randall Y. Chan
- Department of Pediatrics, Keck School of Medicine of the University of Southern California and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| | - Jaclyn Vargas
- Department of Pediatrics, Keck School of Medicine of the University of Southern California and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| | - Marc J. Weigensberg
- Department of Pediatrics, Keck School of Medicine of the University of Southern California and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
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153
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Hammersen J, Tittel SR, Warncke K, Fritsch M, Placzek K, Pacaud D, Karges B, Woelfle J, Holl RW. Previous diabetic ketoacidosis as a risk factor for recurrence in a large prospective contemporary pediatric cohort: Results from the DPV initiative. Pediatr Diabetes 2021; 22:455-462. [PMID: 33533571 DOI: 10.1111/pedi.13185] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To assess the role of previous episodes of diabetic ketoacidosis (DKA) and their time-lag as risk factors for recurring DKA in youth with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS In a population-based analysis, data from 29,325 children and adolescents with T1D and at least 5 years of continuous follow-up were retrieved from the "Diabetes Prospective Follow-up" (DPV) multi-center registry in March 2020. Statistical analyses included unadjusted comparisons, logistic and negative binomial regression models. RESULTS Among 29,325 patients with T1D, 86.0% (n = 25,219) reported no DKA, 9.7% (n = 2,833) one, and 4.3% (n = 1,273) more than one episode, corresponding to a DKA rate of 4.4 [95% CI: 4.3-4.6] per 100 patient-years. Female sex, migratory background, higher HbA1c values, higher daily insulin doses, a lower glucose monitoring frequency, and less CGM usage were associated with DKA. In patients with a previous episode, the DKA rate in the most recent year was significantly higher than in patients with no DKA (17.6 [15.9-19.5] vs. 2.8 [2.7-3.1] per 100 patient-years; p < 0.001). Multiple DKAs further increased the recurrence rate. The risk for DKA in the most recent year was higher in patients with an episode in the preceding year than in patients with no previous DKA (OR: 10.0 [95% CI: 8.6-11.8]), and remained significantly elevated 4 years after an episode (OR: 2.3 [1.6-3.1]; p < 0.001). CONCLUSIONS Each episode of DKA is an independent risk factor for recurrence, even 4 years after an event, underlining the importance of a close follow-up after each episode.
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Affiliation(s)
- Johanna Hammersen
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Katharina Warncke
- Department of Pediatrics, Kinderklinik München Schwabing, Technical University of Munich School of Medicine, Munich, Germany
| | - Maria Fritsch
- Department of Pediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Kerstin Placzek
- Pediatric and Adolescent Medicine, University Hospital, Martin-Luther University, Halle, Germany
| | - Danièle Pacaud
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.,Department of Pediatric Diabetes and Endocrinology, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Beate Karges
- Division of Endocrinology and Diabetology, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Pediatrics, Bethlehem Hospital Stolberg, Stolberg, Germany
| | - Joachim Woelfle
- Department of Pediatrics, University Hospital Erlangen, Erlangen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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154
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Müller-Godeffroy E, Mönkemöller K, Lilienthal E, Heidtmann B, Becker M, Feldhahn L, Freff M, Hilgard D, Krone B, Papsch M, Schumacher A, Schwab KO, Schweiger H, Wolf J, Bollow E, Holl R. Zusammenhang von Bildungsstatus und Diabetesoutcomes: Ergebnisse der DIAS-Studie bei Kindern und Jugendlichen mit Typ-1-Diabetes in Deutschland. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1452-8684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Fragestellung Assoziation zwischen Bildungsstand (BldS) der Eltern und diabetesbezogenen Outcomes bei Kindern mit Typ-1-Diabetes in Deutschland und Vergleich mit deren sozioökonomischem Status (SES).
Material und Methode 1781 Kinder und Jugendliche mit Typ-1-Diabetes mellitus unter 18 Jahren aus 13 deutschen Diabeteszentren wurden von Juni 2013 bis Juni 2014 in die Studie eingeschlossen und Assoziationen des familiären BldS mit verschiedenen Diabetesoutcomes analysiert. Die Analyse wurde als Sekundäranalyse anhand des Datensatzes der DIAS-Studie durchgeführt. Diese hatte Assoziationen eines niedrigen SES (gemessen mit einem Index aus BldS, beruflicher Stellung und Haushaltseinkommen der Eltern) mit ungünstigen Diabetes- und Versorgungsoutcomes ermittelt. Die vorliegende Sekundäranalyse untersuchte Assoziationen derselben Outcomes mit dem BldS der Eltern, um zu prüfen, ob sich der BldS als vereinfachter Indikator für die Routinemessung des SES eignet.Die Daten wurden mittels der DPV-Software (Diabetes-Patienten-Verlaufsdokumentation) erfasst, die Analysen erfolgten je nach Verteilungscharakteristika der Outcomes mittels linearer, logistischer, negativ-binomialer oder Poisson-Modellen unter Adjustierung für Alter, Geschlecht, Diabetesdauer, jeweils mit und ohne zusätzliche Adjustierung für Migrationshintergrund.
Ergebnisse Niedriger familiärer BldS war im Vergleich zu mittlerem/hohem BldS mit einer schlechteren glykämischen Einstellung (HbA1c) (8,1 % versus 7,8 %, p < 0,0001/7,6 %, p < 0,0001) und einem geringeren prozentualen Anteil an Insulinpumpennutzung (42,7 % versus 56,3 %, p < 0,0001/52,5 %, p < 0,01) assoziiert. Weiterhin zeigten die Gruppen mit niedrigem im Vergleich zu mittlerem/hohem BldS seltenere tägliche Blutzuckerselbstmessungen, einen höheren Body-Mass-Index und längere stationäre Aufenthalte. Schwere Hypoglykämien und Ketoazidosen traten bei Patienten mit niedrigem BldS nicht häufiger auf. Der BldS der Eltern differenzierte dabei mindestens genauso gut zwischen den sozialen Gruppen wie der mit einem komplexen Indikator gemessene SES.
Zusammenfassung Der BldS der Eltern ist ein bedeutsamer Prädiktor für Gesundheits- und Versorgungsoutcomes bei Kindern mit Typ-1-Diabetes und sollte in der personalisierten Diabetestherapie von Kindern und Jugendlichen mehr Berücksichtigung erfahren. Als kurzer und leicht zu erhebender Indikator bildet er einen guten Näherungswert für die Routineerhebung der individuellen Stellung der Patientinnen und Patienten in der Sozialhierarchie in Diabetes-Standarddokumentationen.
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Affiliation(s)
| | - Kirsten Mönkemöller
- Klinik für Kinder- und Jugendmedizin, Kinderkrankenhaus Amsterdamer Straße, Köln, Germany
| | - Eggert Lilienthal
- St.-Josef-Hospital, Klinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Germany
| | - Bettina Heidtmann
- Pädiatrische Diabetologie und Endokrinologie, Katholisches Kinderkrankenhaus Wilhelmstift gGmbH, Hamburg, Germany
| | - Marianne Becker
- Klinik für Kinder und Jugendliche, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Germany
| | - Lutz Feldhahn
- Klinik für Kinder- und Jugendmedizin Böblingen, Klinikverbund Südwest GmbH, Böblingen, Germany
| | - Markus Freff
- Diabetologische Ambulanz, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | | | - Beate Krone
- Kinderklinik, Klinikum Bremen Nord, Bremen, Germany
| | - Matthias Papsch
- Klinik für Neonatologie, Kinder- und Jugendmedizin, Marienhospital Gelsenkirchen GmbH, Gelsenkirchen, Germany
| | | | - Karl-Otfried Schwab
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Germany
| | | | - Johannes Wolf
- Klinik für Kinder- und Jugendmedizin St. Louise, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Esther Bollow
- ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm, Germany
- Kooperationspartner, Deutsches Zentrum für Diabetesforschung (DZD), Düsseldorf, Germany
| | - Reinhard Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm, Germany
- Kooperationspartner, Deutsches Zentrum für Diabetesforschung (DZD), Düsseldorf, Germany
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155
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Al-Gadi I, Menon S, Lyons SK, DeSalvo DJ. Beyond A1C: A Practical Approach to Interpreting and Optimizing Continuous Glucose Data in Youth. Diabetes Spectr 2021; 34:139-148. [PMID: 34149254 PMCID: PMC8178721 DOI: 10.2337/ds20-0095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Despite significant pharmacological and technological advances in the treatment of type 1 diabetes, the majority of youth in the United States do not meet the American Diabetes Association's recommended A1C goal. Understanding and managing glycemic variability is important in children and adolescents. Because A1C provides an incomplete picture of day-to-day glycemic fluctuations, continuous glucose monitoring (CGM)-derived metrics are a promising addition to address glycemic management challenges in youth with diabetes. In this article, we discuss how to develop practical strategies to optimize the use of CGM in the pediatric population, interpret the valuable data it provides, and develop personalized and actionable treatment goals.
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Affiliation(s)
- Iman Al-Gadi
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sruthi Menon
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Sarah K Lyons
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Daniel J DeSalvo
- Department of Pediatrics, Section of Diabetes and Endocrinology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
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156
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Typ-1-Diabetes im Kindes- und Jugendalter: Ungleiche Chancen für Arm und Reich. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1332-6242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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157
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Scalzo P. From the Association of Diabetes Care & Education Specialists: The Role of the Diabetes Care and Education Specialist as a Champion of Technology Integration. Sci Diabetes Self Manag Care 2021; 47:120-123. [DOI: 10.1177/0145721721995478] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
It is the position of the Association of Diabetes Care & Education Specialists that diabetes care and education specialists should play a central role in establishing and maintaining technology-enabled care in a variety of practice settings to optimize outcomes for people with diabetes and cardiometabolic conditions. The objectives of this position statement are to outline the role of diabetes care and education specialists as leaders in technology integration and to describe the resources and guidance the Association has developed to facilitate success in this role.
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Affiliation(s)
- Patty Scalzo
- From the Association of Diabetes Care & Education Specialists, Chicago, Illinois
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158
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Hershey JA, Morone J, Lipman TH, Hawkes CP. Social Determinants of Health, Goals and Outcomes in High-Risk Children With Type 1 Diabetes. Can J Diabetes 2021; 45:444-450.e1. [PMID: 33863638 DOI: 10.1016/j.jcjd.2021.02.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Despite advances in technology and type 1 diabetes (T1D) care, children from low-income families continue to have suboptimal outcomes and increased health-care utilization. In this study, we describe social determinants of health (SDOH) in high-risk children with T1D, as well as their SDOH-related priority goals, and assess the correlation between SDOH, glycemic control and health-care utilization. METHODS Caregivers of children aged 4 to 18 years with a diagnosis of T1D of >1 year, poor glycemic control (glycated hemoglobin [A1C] ≥9.5%) or high health-care utilization (≥2 diabetes-related hospitalizations, emergency department attendances or missed outpatient appointments in the previous year) were included. Primary caregiver health-related quality of life (HRQOL), self-efficacy (Maternal Self-Efficacy in Diabetes [MSED] scale) and SDOH were assessed. Goals were identified after assessment by a community health worker. RESULTS Fifty-three families were included, most (n=48, 91%) of whom had government insurance. Children had a median age of 13.4 (interquartile range [IQR], 12 to 15.3) years and a median A1C of 11.1% (IQR, 10% to 13%). Almost half of the families (n=24, 45%) reported at least 1 adverse SDOH. One or more adverse SDOH was associated with significantly lower total HRQOL scores (56.6 [IQR, 38.5 to 70.7] vs 77.8 [IQR, 60.8 to 92.4], p=0.004), but not associated with A1C (p=0.3), emergency department visits (p=0.9) or MSED (p=0.5). CONCLUSIONS Screening for adverse SDOH and addressing these barriers to glycemic control is not part of routine T1D care. In children with poorly controlled T1D and high health-care utilization, we have demonstrated a high prevalence of adverse SDOH, which may represent a modifiable factor to improve outcomes in this patient population.
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Affiliation(s)
- Jennifer A Hershey
- Department of Social Work, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Jennifer Morone
- Yale University School of Medicine, New Haven, Connecticut, United States; Veterans Affairs Office of Academic Affiliations, West Haven, Connecticut, United States
| | - Terri H Lipman
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States; University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania, United States
| | - Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States; Department of Pediatrics and Child Health, University College Cork, Cork, Ireland.
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159
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Auzanneau M, Karges B, Neu A, Kapellen T, Wudy SA, Grasemann C, Krauch G, Gerstl EM, Däublin G, Holl RW. Use of insulin pump therapy is associated with reduced hospital-days in the long-term: a real-world study of 48,756 pediatric patients with type 1 diabetes. Eur J Pediatr 2021; 180:597-606. [PMID: 33258970 PMCID: PMC7813690 DOI: 10.1007/s00431-020-03883-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 10/22/2020] [Accepted: 11/20/2020] [Indexed: 10/29/2022]
Abstract
In pediatric diabetes, insulin pump therapy is associated with less acute complications but inpatient pump education may lead to more hospital days. We investigated the number of hospital days associated with pump vs. injection therapy between 2009 and 2018 in 48,756 patients with type 1 diabetes < 20 years of age from the German Diabetes Prospective Follow-up Registry (DPV). Analyses were performed separately for hospitalizations at diagnosis (hierarchical linear models adjusted for sex, age, and migration), and for hospitalizations in the subsequent course of the disease (hierarchical Poisson models stratified by sex, age, migration, and therapy switch). At diagnosis, the length of hospital stay was longer with pump therapy than with injection therapy (mean estimate with 95% CI: 13.6 [13.3-13.9] days vs. 12.8 [12.5-13.1] days, P < 0.0001), whereas during the whole follow-up beyond diagnosis, the number of hospital days per person-year (/PY) was higher with injection therapy than with pump therapy (4.4 [4.1-4.8] vs. 3.9 [3.6-4.2] days/PY), especially for children under 5 years of age (4.9 [4.4-5.6] vs. 3.5 [3.1-3.9] days/PY).Conclusions: Even in countries with hospitalizations at diabetes diagnosis of longer duration, the use of pump therapy is associated with a reduced number of hospital days in the long-term. What is known: • In pediatric diabetes, insulin pump therapy is associated with better glycemic control and less acute complications compared with injection therapy. • However, pump therapy implies more costs and resources for education and management. What is new: • Even in countries where pump education is predominantly given in an inpatient setting, the use of pump therapy is associated with a reduced number of hospital days in the long-term. • Lower rates of hospitalization due to acute complications during the course of the disease counterbalance longer hospitalizations due to initial pump education.
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Affiliation(s)
- Marie Auzanneau
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Andreas Neu
- University Children’s Hospital Tübingen, Tübingen, Germany
| | - Thomas Kapellen
- Department of Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Stefan A. Wudy
- Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | | | - Gabriele Krauch
- Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, University Medicine, Mannheim, Germany
| | | | | | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Albert-Einstein-Allee 41, D-89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Neuherberg, Germany
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160
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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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161
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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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