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Janssens A, Drachmann D, Barnes-Cullen K, Carrigg A, Christesen HT, Futers B, Lavery YO, Palms T, Petersen JS, Shah P, Thornton P, Wolfsdorf J. An auto-ethnographic study of co-produced health research in a patient organisation: unpacking the good, the bad, and the unspoken. RESEARCH INVOLVEMENT AND ENGAGEMENT 2024; 10:76. [PMID: 39044294 PMCID: PMC11265487 DOI: 10.1186/s40900-024-00609-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 07/08/2024] [Indexed: 07/25/2024]
Abstract
BACKGROUND In rare diseases, limited access to services and rare disease experts may force families to act as medical advocates for their child; they can volunteer to support clinician-initiated research or initiate and lead research themselves. Ketotic Hypoglycemia International (KHI) is a new, global organization for families affected by idiopathic ketotic hypoglycemia (IKH) and is run solely by volunteers. Doing research together, families and international experts in a collaborative process such as at KHI, also referred to as patient and public involvement and engagement (PPIE) or extreme citizen science, is often praised for its positive effects on the research and the stakeholders involved. METHODS We used auto-ethnographic narratives from parents and medical professionals in KHI to report on their experiences with co-produced health research. All co-authors wrote down their experiences in relation to three topics: time invested, work invested and power dynamics. RESULTS Whilst the parents and health care professionals felt a new hope for (their) children with IKH, they also felt pressure to contribute time or to be flexible in how and when they dedicated time towards the organization. The power dynamics were characterised by a change in the relationship between the parents and medical experts; the parent being taught by the expert shifted to the expert learning from the lived experience of the parent. Both parents and medical experts struggled with maintaining boundaries and safeguarding their mental health. CONCLUSION Our findings call for the need to secure and prioritize funding for patient organizations, to enable them to create the sustainable architecture required for meaningful PPIE within these organizations. The morals and often deeply personal reasons for engaging with voluntary work in health research, can lead to overstepping of boundaries. As a result of our research, we call for the development of ethics of care guidelines within collaborative health research.
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Affiliation(s)
- Astrid Janssens
- Julius Center for Health Sciences and Primary Care, Bioethics & Health Humanities, University Medical Center Utrecht, Utrecht, The Netherlands.
- Department of Public Health, User Perspective and Community-Based Interventions, University of Southern Denmark, Odense, Denmark.
- Centre for Research with Patients and Relatives, Odense University Hospital, Odense, Denmark.
| | - Danielle Drachmann
- Department of Public Health, User Perspective and Community-Based Interventions, University of Southern Denmark, Odense, Denmark
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- Patient-Centered Research, Evidera, London, UK
| | | | - Austin Carrigg
- Ketotic Hypoglycemia International, Skanderborg, Denmark
| | - Henrik Thybo Christesen
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Hans Christian Andersen Children's Hospital, Odense University Hospital, Odense, Denmark
| | - Becky Futers
- Ketotic Hypoglycemia International, Skanderborg, Denmark
| | - Yvette Ollada Lavery
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- Medical Ethics Committee, UCI Health, Orange, CA, USA
| | - Tiffany Palms
- Ketotic Hypoglycemia International, Skanderborg, Denmark
| | - Jacob Sten Petersen
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- Novo Nordisk, Dicerna, Lexington, USA
| | - Pratik Shah
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- The Royal London Children's Hospital, Barts Health NHS Trust, London, UK
| | - Paul Thornton
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- Cook Children's Medical Center, Fort Worth, Texas, USA
| | - Joseph Wolfsdorf
- Ketotic Hypoglycemia International, Skanderborg, Denmark
- Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Metwalley KA, Farghaly HS. Idiopathic ketotic hypoglycemia in children: an update. Ann Pediatr Endocrinol Metab 2024; 29:152-155. [PMID: 38291759 PMCID: PMC11220389 DOI: 10.6065/apem.2346156.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/06/2023] [Accepted: 10/04/2023] [Indexed: 02/01/2024] Open
Abstract
Idiopathic ketotic hypoglycemia (IKH) is defined as bouts of hypoglycemia with increased blood or urine ketones in certain children after prolonged fasting or during illness. IKH is divided into physiological IKH, which is most frequently observed in normal children with intercurrent acute illness, and pathological IKH, which occurs in children who lack counter-regulatory hormones, have a metabolic disease, or have Silver-Russell syndrome. The typical patient is a young child between the ages of 10 months and 6 years. Episodes nearly always occur in the morning after overnight fasting. Symptoms include those of neuroglycopenia, ketosis, or both. IKH may be diagnosed after ruling out various metabolic and hormonal conditions associated with ketotic hypoglycemia. Sufficient amounts of carbohydrates and protein, avoidance of prolonged fasting, and increased frequency of food ingestion are the main modes of treating IKH. It is crucial to understand the pathogenesis of IKH and to distinguish physiological IKH from pathological IKH. In this mini-review, we present a brief summary of IKH in terms of its definition, types, clinical presentation, diagnosis, and therapeutic approach in children.
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Affiliation(s)
| | - Hekma Saad Farghaly
- Department of Pediatrics, Faculty of Medicine, Assiut University, Assiut, Egypt
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Wolfsdorf JI, Derks TGJ, Drachmann D, Shah P, Thornton PS, Weinstein DA. Idiopathic Pathological Ketotic Hypoglycemia: Finding the Needle in a Haystack. Horm Res Paediatr 2024:1-12. [PMID: 38513624 DOI: 10.1159/000538483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 03/17/2024] [Indexed: 03/23/2024] Open
Abstract
Sick children often have a decreased appetite and experience vomiting and diarrhea; however, hypoglycemia (plasma glucose concentration ≤50 mg/dL or 2.8 mmol/L) is rare. Ketotic hypoglycemia (KH) is the most common cause of hypoglycemia presenting to an Emergency Department in a previously healthy child between 6 months and 6 years of age. Ketosis and hypoglycemia are now well understood to be normal physiologic responses of young children to prolonged fasting.There is now substantial evidence that the term KH describes a variety of conditions including both the lower end of the normal distribution of fasting tolerance in young children as well as numerous rare disorders that impair fasting adaptation. Recent advances in molecular genetic testing have led to the discovery of these rare disorders. Idiopathic pathological KH is a diagnosis of exclusion that describes rare children who have abnormally limited fasting tolerance, experience recurrent episodes of KH, or develop symptoms of hypoglycemia despite elevated ketone levels, and in whom an explanation cannot be found despite extensive investigation. This review provides an approach to distinguishing between physiological KH and pathological KH and includes recommendations for management.
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Affiliation(s)
- Joseph I Wolfsdorf
- Division of Endocrinology, Boston Children's Hospital, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
| | - Terry G J Derks
- Section of Metabolic Diseases, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Danielle Drachmann
- Ketotic Hypoglycemia International, Skanderborg, Denmark, Patient-Centered Research, Evidera, London, UK
| | - Pratik Shah
- Paediatric Endocrinology and Diabetes, The Royal London Children's Hospital, Barts Health NHS Trust and Honorary Senior Lecturer, Queen Mary University London, London, UK
| | - Paul S Thornton
- Division of Endocrinology and Diabetes and the Congenital Hyperinsulinism Center, Cook Children's Medical Center and Department of Pediatrics, Burnett School of Medicine, Texas Christian University, Fort Worth, Texas, USA
| | - David A Weinstein
- Department of Pediatrics, University of Connecticut Health Center, Farmington, Connecticut, USA
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Jiang MR, Ahmet A, Lawrence S, Bassal M, Speckert M, Geraghty MT, Somerville S. Hypoglycemia Associated With PEG-asparaginase and 6-MP Therapy During Treatment of Acute Lymphoblastic Leukemia in Pediatric Patients: A Case Series. J Pediatr Hematol Oncol 2024; 46:e121-e126. [PMID: 38411659 DOI: 10.1097/mph.0000000000002818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Accepted: 12/23/2023] [Indexed: 02/28/2024]
Abstract
BACKGROUND Asparaginases are a mainstay treatment for pediatric acute lymphoblastic leukemia (ALL). Recent reports identified hypoglycemia associated with asparaginases. Other reports describe hypoglycemia associated with 6-mercaptopurine (6-MP), another fundamental ALL therapy. Little is known about the risk of hypoglycemia associated with ALL therapy, an adverse event that puts children at risk of decreased level of consciousness, seizures, and possibly negative neurocognitive sequelae. METHODS We performed a retrospective chart review of 6 children with hypoglycemia during ALL treatment in our institution from May 2016 to August 2019. Timing and duration of hypoglycemia relative to polyethylene glycol (PEG)-asparaginase, 6-MP, and corticosteroids were determined. Laboratory values of the critical sample were collected. RESULTS The median age was 2.75 (interquartile range: 1.88 to 3.63) years. Three patients had trisomy 21. The onset of hypoglycemia was 5 to 19 days after the most recent PEG-asparaginase administration or 6 to 7 months after initiating daily 6-MP. Sixteen hypoglycemic events were documented, and 9/16 had a critical sample drawn. Six events were hypoketotic, associated with PEG-asparaginase. Three were ketotic, associated with 6-MP. Two patients required treatment with diazoxide and cornstarch. CONCLUSIONS Hypoglycemia associated with PEG-asparaginase occurred later and lasted longer than previous reports with l-asparaginase, with the likely mechanism being hyperinsulinism. 6-MP was associated with ketotic hypoglycemia.
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Affiliation(s)
- Mary R Jiang
- Department of Pediatrics, Division of Endocrinology
| | | | | | - Mylene Bassal
- Department of Pediatrics, Division of Hematology/Oncology
| | | | - Michael T Geraghty
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
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Zhang B, Zhao Y. Novel variant of ETFDH leading to multiple acyl-CoA dehydrogenase deficiency by promoting protein degradation via ubiquitin proteasome pathway. Clin Chim Acta 2022; 530:104-112. [DOI: 10.1016/j.cca.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 11/03/2022]
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