1
|
Harnois-Leblanc S, McNealis V, Friedrich MG, Bigras JL, Van Hulst A, Nuyt AM, Barnett TA, Benedetti A, Mathieu ME, Drapeau V, Sylvestre MP, Henderson M. Role of Physical Activity and Sedentary Behaviors on Vascular and Myocardial Structure and Function in Type 1 Diabetes. J Pediatr 2024:114196. [PMID: 39019321 DOI: 10.1016/j.jpeds.2024.114196] [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: 02/29/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/19/2024]
Abstract
OBJECTIVE To estimate associations between physical activity and sedentary behaviors and early markers of cardiovascular diseases (CVD) in adolescents with and without type 1 diabetes. STUDY DESIGN Cross-sectional data stem from CARDEA, a study investigating early CVD development in 100 adolescents with type 1 diabetes recruited at Sainte-Justine University Hospital Diabetes Clinic and 97 healthy adolescents without diabetes (14-18 years), in Montréal, Canada. Outcomes included arterial stiffness by pulse-wave velocity, endothelial function (VTI) by flow-mediated dilation test, and cardiac magnetic resonance imaging markers. Moderate-to-vigorous physical activity (MVPA) and sedentary time were estimated by accelerometry and leisure screen time by questionnaire. We estimated multivariable linear regression models stratified by group. RESULTS In adolescents with type 1 diabetes, 10-minutes daily increase in MVPA was associated with 3.69 g/m (95% CI: -1.16; 8.54) higher left ventricular (LV) mass/height and 1-h increase in device-measured sedentary time with 0.68 mm (0.20; 1.16) higher wall thickness but only in those with glycated hemoglobin ≤7.5%. In healthy adolescents, a 10-minute increase in MVPA was associated with 1.32 g/m (-0.03; 2.66) higher LV mass/height. Every 1-hour increase in sedentary time was associated with -1.82 cm (-3.25; -0.39) lower VTI, -2.99 g/m (-5.03; -0.95) lower LV mass/height, and -0.47 mm (-0.82; -0.12) lower wall thickness. CONCLUSIONS Being active and limiting sedentary time appears beneficial for cardiac structure and endothelial function in healthy adolescents; however adequate glycemic control combined with higher levels of MVPA may be required for adolescents with type 1 diabetes to overcome the impact of diabetes.
Collapse
Affiliation(s)
- Soren Harnois-Leblanc
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; Department of Preventive and Social Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada; Research Center of the Montreal Hospital University Center, Montreal, QC, Canada
| | - Vanessa McNealis
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Matthias G Friedrich
- McGill University Health Centre, Montreal, QC, Canada; Department of Medicine and Diagnostic Radiology, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Jean-Luc Bigras
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | | | - Anne Monique Nuyt
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Tracie A Barnett
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; Department of Family Medicine, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Andrea Benedetti
- Department of Epidemiology, Biostatistics and Occupational Health, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Marie-Eve Mathieu
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; School of Kinesiology and Physical Activity Sciences, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Vicky Drapeau
- Department of Kinesiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Marie-Pierre Sylvestre
- Department of Preventive and Social Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada; Research Center of the Montreal Hospital University Center, Montreal, QC, Canada
| | - Mélanie Henderson
- Research Center of Sainte-Justine University Hospital, Montreal, QC, Canada; Department of Preventive and Social Medicine, School of Public Health, University of Montreal, Montreal, QC, Canada; Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, QC, Canada.
| |
Collapse
|
2
|
Farthing P, Bally J, Rennie DC. Perceptions Related to Death in Adolescents and Their Parents During the Management of Type 1 Diabetes: A Thematic Analysis. J Pediatr Health Care 2024; 38:586-594. [PMID: 38661590 DOI: 10.1016/j.pedhc.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Type 1 diabetes (T1D) is associated with an increased risk of premature death compared to those without T1D, yet perceptions of dying have not been well studied. The purpose of this secondary analysis of existing data was to explore the fears of adolescents with T1D and their parents related to the possibility of death due to T1D. METHOD A reflexive thematic analysis was used to examine data from interviews conducted with adolescents with T1D and their parents who participated in a primary grounded theory study of interdependence in T1D management. FINDINGS Three themes were generated from the data including: (1) Facing the Reality of Death, (2) Fearing Highs and Lows, and (3) Finding a Way through Fears. Participants indicated they see death as a consequence of failing to optimally manage T1D. CONCLUSION Additional investigation is needed to explore the fear of death in adolescents with T1D and any fear their parents may have of their adolescents' mortality.
Collapse
Affiliation(s)
- Pamela Farthing
- Pamela Farthing, Saskatchewan Polytechnic, School of Nursing, Saskatoon, Canada..
| | - Jill Bally
- Jill Bally, Associate Professor, College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Donna C Rennie
- Donna C. Rennie, Professor Emeritus, College of Nursing, University of Saskatchewan, Saskatoon, Canada
| |
Collapse
|
3
|
Ahmed N, Ingelmo P. The endocrinologist gap: Managing diabetes patients in absence of a specialist. Paediatr Anaesth 2024. [PMID: 38887922 DOI: 10.1111/pan.14948] [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: 03/10/2024] [Revised: 05/27/2024] [Accepted: 06/10/2024] [Indexed: 06/20/2024]
Abstract
The treatment of pediatric patients with diabetes is frequently orchestrated within a multidisciplinary framework at tertiary, specialized institutions. In situations where emergent surgery is indicated or when a procedure is scheduled in a facility devoid of an endocrinology service, the onus of managing perioperative glycemic levels may rest with the attending anesthesiologist. The objective of this review is to furnish a comprehensive examination of the anesthetic considerations and perioperative governance of pediatric patients with diabetes. Furthermore, this paper delineates a streamlined protocol for perioperative glycemic control, tailored to both major and minor surgical interventions.
Collapse
Affiliation(s)
- Nabeel Ahmed
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Pablo Ingelmo
- Division of Pediatric Anesthesia, Montreal Children's Hospital, Montreal, Quebec, Canada
- Department of Anesthesia, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
4
|
Köse S, Geçkil E, Sabetsarvestani R, Bolat S. Examining the interplay of self-efficacy and emotional autonomy on diabetic control index. J Pediatr Nurs 2024; 78:60-65. [PMID: 38875849 DOI: 10.1016/j.pedn.2024.06.003] [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: 01/16/2024] [Revised: 06/06/2024] [Accepted: 06/06/2024] [Indexed: 06/16/2024]
Abstract
AIM This study aims to explore the relationship between self-efficacy, emotional autonomy, and diabetic control index in adolescents with type 1 diabetes. METHODS From January to September 2023, this cross-sectional study involved 112 adolescents aged 14-18 with type 1 diabetes who were seeking medical check-ups at the Medical Faculty Hospital in Konya, Turkey. Data collection included demographic information, the Diabetes Management Self-Efficacy Scale for Adolescents with Type 1 Diabetes, the Emotional Autonomy Scale, and diabetic control index values based on their most recent Hemoglobin A1c levels measurement. Data analysis was performed using SPSS statistical software, with statistical significance set at a p-value <0.05. RESULTS The results showed a good overall self-efficacy score, indicating a balanced level of confidence in diabetes management. The emotional autonomy findings revealed a moderate level of independence, emphasizing a healthy process of differentiation from parents while acknowledging them as individuals. The ability of adolescents to openly discuss their diabetes may be associated with more favorable glycemic outcomes. However, high emotional autonomy was significantly associated with high Hemoglobin A1c levels. CONCLUSION This study highlights positive outcomes in adolescent diabetes management, with strong self-efficacy and balanced emotional autonomy. Open communication about diabetes correlates with favorable glycemic outcomes, but caution is necessary as high emotional autonomy is linked to elevated Hemoglobin A1c levels. The importance of receiving parental support in managing diabetes, especially in adolescents with high emotional autonomy should be highlighted.
Collapse
Affiliation(s)
- Semra Köse
- Necmettin Erbakan University, Faculty of Nursing, Konya, Turkey
| | - Emine Geçkil
- Necmettin Erbakan University, Faculty of Nursing, Konya, Turkey.
| | | | - Serpil Bolat
- Necmettin Erbakan University, Faculty of Nursing, Konya, Turkey
| |
Collapse
|
5
|
Geddie H, Visekruna S, Lawrence S, Sherifali D, Bassilious E. Type 1 Diabetes in Ontario Schools: Policy and Practice. Can J Diabetes 2024; 48:218-226. [PMID: 38262529 DOI: 10.1016/j.jcjd.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 01/02/2024] [Accepted: 01/12/2024] [Indexed: 01/25/2024]
Abstract
OBJECTIVES Type 1 diabetes (T1D) is a challenging chronic condition. Young children with T1D require daily support to manage their condition while at school. In 2018, Ontario established a provincial policy to ensure safe and equitable school participation for children with diabetes. Despite this, children and parents describe very different school experiences. In this qualitative study we describe the interpretation and implementation of school board policy related to the care of children with T1D from the perspective of school educators (principals/teachers). METHODS Policy documents were reviewed employing a qualitative descriptive research design using directed qualitative content analysis. Semistructured interviews were conducted with 13 teachers and principals from 10 publicly funded elementary schools across the Hamilton and Toronto District School Boards in 2021. RESULTS There are major differences in how policies regarding T1D are being implemented in schools. This includes how school staff are educated about T1D, and how they interpret and act on blood glucose information. Although educators often play an active role in supporting children, many face barriers, including competing priorities, fear, lack of information, and lack of support. Facilitators include effective communication/collaboration, actionable information, time, and a diabetes "champion." In some instances, access to nursing support could help to resolve barriers or create care gaps. CONCLUSIONS School board policy provides high-level guidance on how to support children with T1D in school, but gaps remain. We provide specific recommendations regarding policy, staff education/training, roles and responsibilities, and future research.
Collapse
Affiliation(s)
- Hannah Geddie
- Division of Endocrinology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
| | - Sanja Visekruna
- School of Nursing, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Lawrence
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario, Canada
| | - Diana Sherifali
- School of Nursing, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Ereny Bassilious
- Division of Endocrinology, Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Andellini M, Castaldo R, Cisuelo O, Franzese M, Haleem MS, Ritrovato M, Pecchia L, Schiaffini R. Are the variations in ECG morphology associated to different blood glucose levels? implications for non-invasive glucose monitoring for T1D paediatric patients. Diabetes Res Clin Pract 2024; 212:111708. [PMID: 38754787 DOI: 10.1016/j.diabres.2024.111708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Revised: 04/24/2024] [Accepted: 05/13/2024] [Indexed: 05/18/2024]
Abstract
AIMS Recent clinical trials and real-world studies highlighted those variations in ECG waveforms and HRV recurrently occurred during hypoglycemic and hyperglycemic events in patients with diabetes. However, while several studies have been carried out for adult age, there is lack of evidence for paediatric patients. The main aim of the study is to identify the correlations of variations in ECG Morphology waveforms with blood glucose levels in a paediatric population. METHODS T1D paediatric patients who use CGM were enrolled. They wear an additional non-invasive wearable device for recording physiological data and respiratory rate. Glucose metrics, ECG parameters and HRV features were collected, and Wilcoxon rank-sum test and Spearman's correlation analysis were used to explore if different levels of blood glucose were associated to ECG morphological changes. RESULTS Results showed that hypoglycaemic events in paediatric patients with T1D are strongly associated with variations in ECG morphology and HRV. CONCLUSIONS Results showed the opportunity of using the ECG as a non-invasive adding instrument to monitor the hypoglycaemic events through the integration of the ECG continuous information with CGM data. This innovative approach represents a promising step forward in diabetes management, offering a more comprehensive and effective means of detecting and responding to critical changes in glucose levels.
Collapse
Affiliation(s)
- Martina Andellini
- University of Warwick, School of Engineering, Coventry, UK; Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
| | | | - Owain Cisuelo
- University of Warwick, School of Engineering, Coventry, UK
| | | | - Muhammad Salman Haleem
- University of Warwick, School of Engineering, Coventry, UK; Queen Mary University of London, School of Electronic Engineering and Computer Science, UK
| | | | - Leandro Pecchia
- University of Warwick, School of Engineering, Coventry, UK; Fondazione Policlinico Universitario Campus Bio-Medico, Via Alvaro del Portillo, 200, 00128 Roma, Italy; University Campus Bio-Medico of Rome, Via Alvaro del Portillo 21, 00128 Roma, Italy
| | | |
Collapse
|
7
|
Stojanova A, Harrison MA, Mitsakakis N, Thawer Z, Kirolos N, Stevens L, Paul J, Richardson C, Zuijdwijk C, Goldbloom EB, Lawrence S, Robinson ME, Ahmet A. Implementation of the Mind Youth Questionnaire (MY-Q) for routine health-related quality of life screening of adolescents with type 1 diabetes in a large tertiary care center. J Pediatr Endocrinol Metab 2024; 37:462-466. [PMID: 38630246 DOI: 10.1515/jpem-2023-0461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 02/05/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Prevalence of diabetes distress and mental health comorbidities among adolescents with type 1 diabetes (T1D) is high. Despite recommendations for routine psychosocial risk assessment, there is little guidance for their implementation. This study aims to describe the implementation and baseline outcomes of the Mind Youth Questionnaire (MY-Q), a validated psychosocial screening tool for health-related quality of life (QoL) including mood, among adolescents living with T1D. METHODS Adolescents aged 13-18 years completed the MY-Q from October 1, 2019-April 1, 2023. Baseline characteristics, MY-Q results including categories flagged positive (noting possible areas of concern), debrief duration, and frequency of social work or mental health referral were collected and analyzed using descriptive statistics. RESULTS A total of 343 adolescents (mean age 15.3 years; 52 % female) completed a baseline MY-Q. Median overall MY-Q debrief time (IQR) was 10.0 min (6.0, 20.0). About 290 (84.5 %) adolescents had at least one of seven categories flagged, most commonly "Family" (61 %). About 30 % of adolescents had "Mood" flagged, and 2.9 % of adolescents were referred to mental health following debrief. CONCLUSIONS Without the need for additional resources, implementation of the MY-Q in a pediatric tertiary care diabetes clinic successfully identified QoL issues and mental health concerns among adolescents with T1D.
Collapse
Affiliation(s)
| | - Mary-Ann Harrison
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
| | - Nicholas Mitsakakis
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
| | - Zoyah Thawer
- Division of Pediatric Endocrinology and Metabolism, 8204 Vancouver Island Health Authority , Victoria, BC, Canada
| | - Nardin Kirolos
- Faculty of Medicine, 12366 University of Toronto , Toronto, ON, Canada
| | - Liz Stevens
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Jolianne Paul
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Christine Richardson
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Ellen B Goldbloom
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Sarah Lawrence
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Marie-Eve Robinson
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Alexandra Ahmet
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
| |
Collapse
|
8
|
Güneş Kaya D, Arslan N, Ayyıldız F, Bayramoğlu E, Turan H, Ercan O. The potential of the Mediterranean diet to improve metabolic control and body composition in youths with Type 1 Diabetes Mellitus. BMC Endocr Disord 2024; 24:63. [PMID: 38724988 PMCID: PMC11080120 DOI: 10.1186/s12902-024-01593-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/26/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND A chronic autoimmune disease with an increasing incidence rate, type 1 diabetes mellitus (T1DM) is typified by the degeneration of the pancreatic beta cells. Diabetes management is significantly impacted by nutrition. Although it has been demonstrated that following the Mediterranean diet (MD) improves metabolic control with type 2 diabetes in children and adults, its effects on children with T1DM have not received much attention. OBJECTIVE Therefore, the purpose of this study was to assess whether adherence to Mediterranean diet is associated with better metabolic control and body composition in youths with Type 1 Diabetes Mellitus. The study recruited T1DM patients aged 6-18 years at İstanbul University Cerrahpaşa Medical Faculty Hospital's Pediatric Endocrinology and Diabetes Outpatient Clinic for follow-up. METHODS In addition to demographic variables, some anthropometric measurements, body composition and biochemical parameters such as: Trygliceride(TG), Total cholesterol (TC), High density lipoprotein cholesterol (HDL-C), Low density lipoprotein cholesterol (LDL-C), (Aspartate aminotransferase) AST, Alanine transaminase (ALT) and glycated hemoglobin (HbA1c) was analyzed. The time in range (TIR) is a value obtained from continuous glucose monitoring. KIDMED was used to assess the participants' adherence with the MD. RESULTS Good adherence to the MD resulted in much larger height SDS than poor adherence. Poor adherence to MD resulted in higher body fat than moderate and good adherence. There is positivite correlation between TIR and KIDMED score. Adherence to MD is negatively associated with HbA1c. The regression anaylsis showed that a one-point rise in the KIDMED score would result in a 0.314-unit reduction in the HbA1c value (p < 0.01). CONCLUSIONS In conclusion, this study found that adhering to MD led to improved anthropometric measurements, biochemistry, and diabetes outcomes. Awareness among children, adolescents with T1DM, and their parents about the benefits of MD compliance for glycemic and metabolic control should be raised.
Collapse
Affiliation(s)
- Didem Güneş Kaya
- Istanbul University Cerrahpasa- Cerrahpasa Faculty of Medicine, Pediatrics, İstanbul, Turkey
| | - Neslihan Arslan
- Faculty of Health Sciences, Department of Nutrition and Dietetics, Erzurum Technical University, Yakutiye, Erzurum, Turkey.
| | - Feride Ayyıldız
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Gazi University, Emek, Ankara, Turkey
| | - Elvan Bayramoğlu
- Istanbul University Cerrahpasa - Cerrahpasa Faculty of Medicine, Pediatric Endocrinology, İstanbul, Turkey
| | - Hande Turan
- Istanbul University Cerrahpasa - Cerrahpasa Faculty of Medicine, Pediatric Endocrinology, İstanbul, Turkey
| | - Oya Ercan
- Istanbul University Cerrahpasa - Cerrahpasa Faculty of Medicine, Pediatric Endocrinology, İstanbul, Turkey
| |
Collapse
|
9
|
AlOzairi A, Irshad M, AlKandari J, AlSaraf H, Al-Ozairi E. Prevalence and predictors of diabetes distress and depression in people with type 1 diabetes. Front Psychiatry 2024; 15:1367876. [PMID: 38585475 PMCID: PMC10995252 DOI: 10.3389/fpsyt.2024.1367876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 03/11/2024] [Indexed: 04/09/2024] Open
Abstract
Background People living with diabetes often encounter psychosocial challenges, including diabetes distress and depression. Despite this, little research has focused on the co-occurrence of these conditions. This study aimed to explore the prevalence of depressive symptoms and diabetes distress in people with type 1 diabetes in Kuwait and to identify clinical and demographic factors associated with these conditions. Methods A total of 832 people with type 1 diabetes (females: 54.1%, mean age: 29 ± 8.5 years), were invited to participate in Dose Adjustment for Normal Eating (DAFNE) course. Diabetes distress was measured using the Problem Areas in Diabetes (PAID) scale and depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Depressive symptoms were defined as PHQ-9 scores ≥10. Data on biomedical outcomes, lifestyle factors, and sociodemographic information were collected. Results The prevalence rates of diabetes distress and depressive symptoms were 27.8% and 38.3%, respectively. Notably, 19.6% of people experienced both conditions. In the regression analysis, PAID scale and PHQ-9 scores were significantly associated, patients with higher score on depressive symptoms scale were more likely to suffer diabetes distress (B= 2.65, p < 0.001). Female sex (odds ratio [OR]= 2.2, 95% CI= 1.5, 3.2), higher hemoglobin A1c levels (OR= 1.6, 95% CI= 1.0, 2.5), obesity (OR= 1.7, 95% CI= 1.1, 2.8), inactivity (OR= 2.4, 95% CI= 1.6, 3.6), microvascular complications (OR= 2.8, 95% CI= 1.5, 5.4), and lipohypertrophy (OR= 1.7, 95% CI= 1.1, 2.5) were associated with greater odds for the co-occurrence of diabetes distress and depressive symptoms (p< 0.05 for all). Conclusion The majority of people with type 1 diabetes in Kuwait experience both diabetes distress and depressive symptoms. The strong correlation between diabetes distress and depressive symptoms suggests mutual predictability. The co-occurrence of both symptoms is associated with many sociodemographic and clinical factors.
Collapse
Affiliation(s)
- Abdullah AlOzairi
- Department of Psychological Medicine, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
| | | | - Jumana AlKandari
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Husain AlSaraf
- Amiri Hospital, Ministry of Health, Kuwait City, Kuwait
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Ebaa Al-Ozairi
- DAFNE Unit, Dasman Diabetes Institute, Kuwait City, Kuwait
| |
Collapse
|
10
|
McNiven M, Thevaranjan N, Yau D, Robertson J, Oluwole O, Buse J, Inman M. Dried Blood Spot Test for Glycated Hemoglobin Measurement in Pediatric Diabetes Care. Can J Diabetes 2024; 48:74-81. [PMID: 37839678 DOI: 10.1016/j.jcjd.2023.10.401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/14/2023] [Accepted: 10/08/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND The dried blood spot (DBS) card is a novel collection method for measuring glycated hemoglobin (A1C) in individuals with diabetes mellitus. The potential benefits of DBS specimens compared with traditional phlebotomy include a reduction in required total blood volume, reduced procedural pain, and an ability for self-initiated collection. DBS cards for A1C measurement have been validated in the adult population, but there is a paucity of pediatric data. METHODS The aim of this study was to validate the use of A1C measurement by DBS cards in comparison to venous A1C and to identify potential barriers to implementing this novel approach. Venous and DBS card A1C samples were collected simultaneously from 62 patients at their local laboratory and transported to the central provincial lab for analysis. Correlation analyses compared venous and DBS A1C with data rescaling performed to account for the DBS-venous interassay difference. RESULTS Mean venous A1C was 7.49% and DBS A1C was 7.26%, with an interassay difference of 0.23%. Data showed a strong, positive correlation between A1C collection methods (r=0.86, p<0.001); this was further strengthened at lower A1C values (A1C <7.5%, r=0.87, p<0.0001). A stronger relationship emerged when the data were rescaled to account for the DBS-venous interassay difference (r=0.8935, p<0.0001). CONCLUSIONS Given the potential feasibility, practicality, accessibility, cost-effectiveness, and performance characteristics of the DBS A1C, especially at lower A1C values hovering around the diagnostic threshold for diabetes, this study provides supporting evidence for consideration of the use of DBS A1C testing in pediatric diabetes care.
Collapse
Affiliation(s)
- Mallory McNiven
- Department of Pediatrics, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Netusha Thevaranjan
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Daphne Yau
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - James Robertson
- Department of Pediatrics, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Oluwafemi Oluwole
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Joshua Buse
- Department of Pathology and Laboratory Medicine, University of Saskatchewan, Regina, Saskatchewan, Canada
| | - Mark Inman
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
| |
Collapse
|
11
|
Steiman De Visser H, Fast I, Brunton N, Arevalo E, Askin N, Rabbani R, Abou-Setta AM, McGavock J. Cardiorespiratory Fitness and Physical Activity in Pediatric Diabetes: A Systemic Review and Meta-Analysis. JAMA Netw Open 2024; 7:e240235. [PMID: 38393727 PMCID: PMC10891480 DOI: 10.1001/jamanetworkopen.2024.0235] [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: 09/15/2023] [Accepted: 12/22/2023] [Indexed: 02/25/2024] Open
Abstract
Importance It is unclear whether cardiorespiratory fitness (CRF) and physical activity are lower among youths with type 1 diabetes (T1D) and type 2 diabetes (T2D) compared with youths without diabetes. Objective To describe the magnitude, precision, and constancy of the differences in CRF and physical activity among youths with and without diabetes. Data Sources MEDLINE, Embase, CINAHL, and SPORTDiscus were searched from January 1, 2000, to May 1, 2022, for eligible studies. Study Selection Observational studies with measures of CRF and physical activity in children and adolescents aged 18 years or younger with T1D or T2D and a control group were included. Data Extraction and Synthesis Data extraction was completed by 2 independent reviewers. A random-effects meta-analysis model was used to estimate differences in main outcomes. The pooled effect estimate was measured as standardized mean differences (SMDs) with 95% CIs. The Preferred Reporting Items for Systematic Review and Meta-Analyses guideline was followed. Main Outcomes and Measures The main outcomes were objectively measured CRF obtained from a graded maximal exercise test and subjective or objective measures of physical activity. Subgroup analyses were performed for weight status and measurement type for outcome measures. Results Of 7857 unique citations retrieved, 9 studies (755 participants) with measures of CRF and 9 studies (1233 participants) with measures of physical activity for youths with T2D were included; for youths with T1D, 23 studies with measures of CRF (2082 participants) and 36 studies with measures of PA (12 196 participants) were included. Random-effects models revealed that directly measured CRF was lower in youths with T2D (SMD, -1.06; 95% CI, -1.57 to -0.56; I2 = 84%; 9 studies; 755 participants) and in youths with T1D (SMD, -0.39; 95% CI, -0.70 to -0.09; I2 = 89%; 22 studies; 2082 participants) compared with controls. Random-effects models revealed that daily physical activity was marginally lower in youths with T1D (SMD, -0.29; 95% CI, -0.46 to -0.11; I2 = 89%; 31 studies; 12 196 participants) but not different among youths with T2D (SMD, -0.56; 95% CI, -1.28 to 0.16; I2 = 91%; 9 studies; 1233 participants) compared with controls. When analyses were restricted to studies with objective measures, physical activity was significantly lower in youths with T2D (SMD, -0.71; 95% CI, -1.36 to -0.05; I2 = 23%; 3 studies; 332 participants) and T1D (SMD, -0.67; 95% CI, -1.17 to -0.17; I2 = 93%; 12 studies; 1357 participants) compared with controls. Conclusions and Relevance These findings suggest that deficits in CRF may be larger and more consistent in youths with T2D compared with youths with T1D, suggesting an increased risk for cardiovascular disease-related morbidity in adolescents with diabetes, particularly among those with T2D. The findings reinforce calls for novel interventions to empower youths living with diabetes to engage in regular physical activity and increase their CRF.
Collapse
Affiliation(s)
| | - Isaak Fast
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Brunton
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Edward Arevalo
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Nicole Askin
- Neil John MacLean Library, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rasheda Rabbani
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Ahmed M. Abou-Setta
- George & Fay Yee Centre for Healthcare Innovation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan McGavock
- Children’s Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, Manitoba, Canada
- Diabetes Action Canada, Toronto, Ontario, Canada
| |
Collapse
|
12
|
Fox D, Zhang Q, Islam N, Chen L, Leung J, Bone J, Amed S. Defining a Childhood Type 1 Diabetes Cohort, Clinical Practice Measures, and Outcomes Within Administrative Data in British Columbia. Can J Diabetes 2024; 48:26-35.e1. [PMID: 37652283 DOI: 10.1016/j.jcjd.2023.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/21/2023] [Accepted: 08/22/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We used administrative data to 1) establish a cohort of individuals with childhood-onset type 1 diabetes (T1D) in British Columbia (BC), and 2) define T1D-related clinical practice measures. METHODS We applied a validated diabetes case-finding definition and differentiating algorithm to linked administrative data (1992-1993 to 2019-2020). Cases were removed when they did not meet inclusion criteria for childhood-onset T1D. Clinical practice measures were defined based on clinical practice guidelines. RESULTS We developed an administrative cohort that included 5,901 individuals with childhood-diagnosed T1D between April 1, 1996, and March 31, 2020. The mean age was 22.31 (standard deviation 8.21) years. Clinical practice measures derived included diabetes outpatient visits (N=4,935) and glycated hemoglobin tests (N=4,935), and screening for thyroid function (N=4,457), retinopathy (N=1,602), and nephropathy (N=2,369). CONCLUSIONS We established an administrative cohort of ∼6,000 individuals with childhood-onset T1D with 20+ years of follow-up data that can be used to describe the association between clinical practice measures and clinical outcomes.
Collapse
Affiliation(s)
- Danya Fox
- Division of Endocrinology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Qian Zhang
- Biostatistics, Clinical Research Support Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Nazrul Islam
- Faculty of Medicine, University of Southampton, Southampton, United Kingdom; Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Leo Chen
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joseph Leung
- Division of Endocrinology, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey Bone
- Biostatistics, Clinical Research Support Unit, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Division of Endocrinology, Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
| |
Collapse
|
13
|
Alshammri F, Geddie H, Sawalha N, Kim G, McAssey K, Morrison KM. Factors Associated With the Development of Dyslipidemia Among Pediatric Patients With Diabetes: A Single-centre-based Study. Can J Diabetes 2023; 47:611-617. [PMID: 37392858 DOI: 10.1016/j.jcjd.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/02/2023] [Accepted: 06/20/2023] [Indexed: 07/03/2023]
Abstract
OBJECTIVES The prevalence of pediatric diabetes is increasing. Dyslipidemia is an important modifiable cardiovascular disease risk factor often present in children with diabetes. In this study, we evaluated the adherence to Diabetes Canada 2018 lipid screening guidelines in a pediatric diabetes program to determine the prevalence of dyslipidemia in youth with diabetes and to identify risk factors related to dyslipidemia. METHODS This retrospective chart review included patients at McMaster Children's Hospital with diabetes (types 1 and 2), who were at least 12 years of age as of January 1, 2019. Extracted data included age, sex, family history of diabetes or dyslipidemia, date of diagnosis, body mass index, glycemia monitoring system used, lipid profile, glycated hemoglobin (A1C), and thyroid-stimulating hormone values at the time the lipid profile was measured. Statistical methods included descriptive statistics and logistic regression modelling. RESULTS Of the 305 patients included, 61% had a lipid profile measured according to guidelines, 29% had lipid screening completed outside of the recommended window, and 10% had no lipid profile on record. Among screened patients, 45% had dyslipidemia, most commonly hypertriglyceridemia (35%). Dyslipidemia was highest amongst those with type 2 diabetes, obesity, older age, short duration of diabetes, higher A1C, and those who used capillary blood glucose for monitoring (p<0.05). CONCLUSIONS A high proportion of patients were screened for dyslipidemia, but many outside the recommended window. Dyslipidemia is highly prevalent in this patient population and was associated with the presence of obesity, but 44% of patients without obesity also had dyslipidemia.
Collapse
Affiliation(s)
- Fahd Alshammri
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Hannah Geddie
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Noor Sawalha
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Gloria Kim
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Karen McAssey
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Katherine M Morrison
- Department of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada.
| |
Collapse
|
14
|
Abdulhussein FS, Pinkney S, Görges M, van Rooij T, Amed S. Designing a Collaborative Patient-Centered Digital Health Platform for Pediatric Diabetes Care in British Columbia: Formative Needs Assessment by Caregivers of Children and Youths Living With Type 1 Diabetes and Health Care Providers. JMIR Pediatr Parent 2023; 6:e46432. [PMID: 37440296 PMCID: PMC10375277 DOI: 10.2196/46432] [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: 02/16/2023] [Revised: 05/18/2023] [Accepted: 06/12/2023] [Indexed: 07/14/2023] Open
Abstract
BACKGROUND Digital health apps are becoming increasingly available for people living with diabetes, yet data silos continue to exist. This requires health care providers (HCPs) and patients to use multiple digital platforms to access health data. OBJECTIVE In this study, we gathered the perspectives of caregivers of children and youths living with type 1 diabetes (T1D) and pediatric diabetes HCPs in the user-centered design of TrustSphere, a secure, single-point-of-access, integrative digital health platform. METHODS We distributed web-based surveys to caregivers of children and youths living with T1D and pediatric diabetes HCPs in British Columbia, Canada. Surveys were designed using ordinal scales and had free-text questions. Survey items assessed key challenges, perceptions about digital trust and security, and potential desirable features for a digital diabetes platform. RESULTS Similar challenges were identified between caregivers of children and youths living with T1D (n=99) and HCPs (n=49), including access to mental health support, integration of diabetes technology and device data, and the ability to collaborate on care plans with their diabetes team. Caregivers and HCPs identified potential features that directly addressed their challenges, such as more accessible diabetes data and diabetes care plans. Caregivers had more trust in sharing their child's data digitally than HCPs. Most caregivers and HCPs stated that an integrative platform for T1D would support collaborative patient care. CONCLUSIONS Caregiver and HCP perspectives gathered in this study will inform the early prototype of an integrative digital health platform. This prototype will be presented and iterated upon through a series of usability testing sessions with caregivers and HCPs to ensure the platform meets end users' needs.
Collapse
Affiliation(s)
- Fatema S Abdulhussein
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Susan Pinkney
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| | - Matthias Görges
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Anesthesiology Pharmacology & Therapeutics, University of British Columbia, Vancouver, BC, Canada
| | - Tibor van Rooij
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
- Department of Computer Science, University of British Columbia, Vancouver, BC, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital Research Institute, Vancouver, BC, Canada
| |
Collapse
|
15
|
Gripp KE, Trottier ED, Thakore S, Sniderman J, Lawrence S. Les recommandations en vigueur pour la prise en charge de l'acidocétose diabétique pédiatrique. Paediatr Child Health 2023; 28:128-138. [PMID: 37151921 PMCID: PMC10156930 DOI: 10.1093/pch/pxac120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/20/2022] [Indexed: 05/09/2023] Open
Abstract
Pour traiter l'acidocétose diabétique pédiatrique, il faut porter une attention particulière aux liquides et aux électrolytes pour limiter le risque de complications, telles qu'une lésion cérébrale, associée à une morbidité et une mortalité élevées. L'incidence d'œdème cérébral en cas d'acidocétose diabétique n'a pas diminué malgré les protocoles visant la limitation des liquides qui s'appuient sur la restriction de la réanimation liquidienne initiale. Selon de nouvelles données probantes, l'administration précoce de liquides isotoniques n'entraîne pas de risque supplémentaire et peut améliorer les résultats cliniques chez certains patients. Les protocoles et les directives cliniques sont adaptés et axés particulièrement sur la surveillance et le remplacement initiaux et continus des liquides et des électrolytes. Il est maintenant recommandé de commencer par une réanimation à l'aide de liquides isotoniques chez tous les patients dans les 20 à 30 minutes suivant leur arrivée à l'hôpital, suivie par la réplétion du déficit volumique sur une période de 36 heures, en association avec une perfusion d'insuline et des suppléments d'électrolytes, ainsi qu'avec la surveillance et la prise en charge attentives d'une éventuelle lésion cérébrale.
Collapse
Affiliation(s)
- Karen E Gripp
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Evelyne D Trottier
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Sidd Thakore
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Jonathan Sniderman
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| | - Sarah Lawrence
- Société canadienne de pédiatrie, comité des soins aigus, Ottawa (Ontario)Canada
| |
Collapse
|
16
|
Gripp KE, Trottier ED, Thakore S, Sniderman J, Lawrence S. Current recommendations for management of paediatric diabetic ketoacidosis. Paediatr Child Health 2023; 28:128-138. [PMID: 37151932 PMCID: PMC10156932 DOI: 10.1093/pch/pxac119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 06/20/2022] [Indexed: 05/09/2023] Open
Abstract
Treatment of paediatric diabetic ketoacidosis (DKA) includes careful attention to fluids and electrolytes to minimize the risk of complications such as cerebral injury (CI), which is associated with high morbidity and mortality. The incidence of cerebral edema in paediatric DKA has not decreased despite the use of fluid-limiting protocols based on restricting early fluid resuscitation. New evidence suggests that early isotonic fluid therapy does not confer additional risk and may improve outcomes in some patients. Protocols and clinical practice guidelines are being adjusted, with a particular focus on recommendations for initial and ongoing fluids and electrolyte monitoring and replacement. Initial isotonic fluid resuscitation is now recommended for all patients in the first 20 to 30 minutes after presentation, followed by repletion of volume deficit over 36 hours in association with an insulin infusion, electrolyte supplementation, and careful monitoring for and management of potential CI.
Collapse
Affiliation(s)
- Karen E Gripp
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Evelyne D Trottier
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Sidd Thakore
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Jonathan Sniderman
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| | - Sarah Lawrence
- Canadian Paediatric Society, Acute Care Committee, Ottawa, Ontario, Canada
| |
Collapse
|
17
|
Stanley JR, Clarke ABM, Shulman R, Mahmud FH. Mediating Effects of Technology-Based Therapy on the Relationship Between Socioeconomic Status and Glycemic Management in Pediatric Type 1 Diabetes. Diabetes Technol Ther 2023; 25:186-193. [PMID: 36409503 DOI: 10.1089/dia.2022.0388] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Socioeconomic disparities exist related to accessibility and uptake of diabetes technologies that impact glycemic management. The aims of this study were to describe diabetes technology use (continuous subcutaneous insulin infusion [CSII] and continuous glucose monitoring [CGM]) in children with type 1 diabetes (T1D) and assess the mediating effects of each technology on the relationship between socioeconomic status (SES) and glycemic management. Methods: Single-center retrospective cross-sectional study of children aged 0-18 years (n = 813) with T1D and valid postal codes between 2018 and 2020. Extracted data were linked to validated census-based material deprivation (MD) quintiles. Exposures included MD and technology use (CSII, CGM), whereas the primary outcome was glycemic management (HbA1c). Results: Of 813 patients included, 379 (46.6%) and 246 (30.3%) individuals used CGM and CSII, respectively. Real-time CGM (rtCGM) and CSII were associated with both MD and HbA1c, but intermittently scanned CGM (isCGM) was not. There was a difference in HbA1c of +1.17% between patients from the most (Q5) and least deprived (Q1) MD quintile (P < 0.0001), and significant mediating effects for rtCGM and CSII use, but not isCGM. rtCGM use and CSII use accounted for 0.14% (P < 0.0001) and 0.25% (P < 0.0001) of the difference in HbA1c between patients from Q1 and Q5 quintiles (indirect effects), representing 12.0% and 23.1% of this difference, respectively. Conclusions: CSII and rtCGM use partially mediated the significant discrepancies observed with SES and glycemic management, highlighting potential benefits of broader access to these technologies to improve diabetes outcomes and help mitigate the negative impact of deprivation on diabetes management.
Collapse
Affiliation(s)
- Joshua R Stanley
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Rayzel Shulman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| |
Collapse
|
18
|
The effect of type 1 diabetes mellitus on voice in pediatric patients. Eur Arch Otorhinolaryngol 2023; 280:269-275. [PMID: 35829805 DOI: 10.1007/s00405-022-07543-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/04/2022] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this prospective case-control study was to determine the effect on the voice of type 1 diabetes mellitus (T1DM) in paediatric patients. MATERIALS AND METHODS The study included patients aged 6-18 years followed up for at least 1 year because of T1DM, and a control group of age and gender-matched healthy volunteers. Following an Ear, Nose, and Throat (ENT) examination, all subjects underwent flexible endoscopic laryngeal examination. Fasting venous blood samples were taken in the morning for the examination of fasting blood glucose (FBG), HgbA1C, and kidney, liver, and thyroid function tests. Data were recorded from the patient files of age, gender, comorbidities, and the development of diabetes-related complications. Voice recordings were taken and the Voice Handicap Index (VHI)-10 form was completed. The patients and control group were compared in respect of the parameters of fundamental frequency, jitter, shimmer, and acoustic voice quality index (AVQI). RESULTS Evaluation was made of 64 children and adolescents as 32 in the patient group (Group 1) and 32 healthy control subjects (Group 2). Group 1 comprised 17 females and 15 males with a mean age of 12.75 ± 3.23 years. Group 2 comprised 17 females and 15 males with a mean age of 12.75 ± 3.33 years. In Group 1, mean disease duration was 5.21 ± 3.17 years (range, 1-13 years), the FBG value was mean 216.6 ± 122.3 mg/dl, mean HgbA1c was 10.7 ± 2.8, as ≤ 7 in 4 patients, 7-9 in 4, and > 9 in 24. Maximum phonation time (MPT) was determined as 10.66 ± 3.6 secs in Group 1 and 12.11 ± 4.43 in Group 2. VHI was determined as 2.33 ± 3 in Group 1 and 2.31 ± 2.77 in Group 2. No statistically significant difference was determined between the groups was determined in respect of acoustic analysis, perturbation parameters, AVQI and body mass index. CONCLUSIONS This study is the first to have investigated the effects of T1DM on the voice in paediatric patients. The study results showed that the AVQI value was higher in the patient group but not to a statistically significant level. Therefore, there is a need for further studies with larger samples. The current study can be of guidance for further studies in this field.
Collapse
|
19
|
Lindholm Olinder A, DeAbreu M, Greene S, Haugstvedt A, Lange K, Majaliwa ES, Pais V, Pelicand J, Town M, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents. Pediatr Diabetes 2022; 23:1229-1242. [PMID: 36120721 PMCID: PMC10107631 DOI: 10.1111/pedi.13418] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sverige
| | - Matthew DeAbreu
- Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada
| | | | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Edna S Majaliwa
- Department of Paediatrics and child health, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Departement of peadiatrics and child health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Vanita Pais
- Department of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Pelicand
- Pediatric Diabetology Unit, San Camilo Hospital, Medicine School, Universidad de Valparaiso, San Felipe, Chile.,Childhood, Adolescence & Diabetes, Toulouse Hospital, Toulouse, France
| | - Marissa Town
- Children with Diabetes and Department of Pediatric Endocrinology, Stanford University, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
| |
Collapse
|
20
|
Pacaud D, Romanchuk KG, Virtanen H, Ferdousi M, Nettel-Aguirre A, Mah JK, Tavakoli M, Zochodne DW, Malik RA. Corneal nerve and nerve conduction abnormalities in children with type 1 diabetes. Pediatr Diabetes 2022; 23:1665-1673. [PMID: 36131228 DOI: 10.1111/pedi.13419] [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: 05/05/2022] [Revised: 09/08/2022] [Accepted: 09/17/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE In vivo corneal confocal microscopy (CCM) is a novel, rapid, and non-invasive technique that identifies early small fiber damage and can predict the progression and development of clinical neuropathy in adults with type 1 diabetes. However, its usefulness in children is not well established. This study compared corneal confocal microscopy with neuropathic symptoms, signs, and objective measures of neuropathy for the diagnosis of diabetic neuropathy in children with type 1 diabetes. RESEARCH DESIGN AND METHODS A total of 83 children with type 1 diabetes and 83 healthy participants of similar age underwent assessment of neuropathy symptoms, signs, nerve conduction studies, quantitative sensory and autonomic function testing, and in vivo CCM. RESULTS Only of 3/83 (4%) children with type 1 diabetes had subclinical neuropathy. However, corneal nerve fiber density (p = 0.001), branch density (p = 0.006), fiber length (p = 0.002), tibial motor nerve amplitude and conduction velocity, and sural sensory nerve amplitude and conduction velocity (all p < 0.004) were lower in participants with type 1 diabetes than in the controls. Vibration, cooling, and warm perception thresholds and deep breathing heart rate variability were not found to be different (all p > 0.05) between children with type 1 diabetes and healthy controls. Multivariate regression analysis identified a possible association between body mass index and decreased corneal nerves. CONCLUSIONS Decreased corneal nerves and abnormal nerve conduction were found in children with type 1 diabetes. CCM may allow rapid objective detection of subclinical diabetic neuropathy in children and adolescents with type 1 diabetes.
Collapse
Affiliation(s)
- Danièle Pacaud
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Kenneth G Romanchuk
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Heidi Virtanen
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Maryam Ferdousi
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK
| | - Alberto Nettel-Aguirre
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Centre for Health and Social Analytics, NIASRA, University of Wollongong, Wollongong, New South Wales, Australia
| | - Jean K Mah
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Pediatric Diabetes, Pediatric Neurology and Pediatric Ophthalmology divisions, Alberta Children's Hospital, Calgary, Alberta, Canada.,Alberta Children's Hospital Research Institute, Calgary, Alberta, Canada
| | - Mitra Tavakoli
- Centre for Endocrinology and Diabetes, Institute of Human Development, University of Manchester, Manchester, UK.,Exeter Centre of Excellence for Diabetes Research, NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Douglas W Zochodne
- Division of Neurology, Department of Medicine and the Neuroscience and Mental Health Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Rayaz A Malik
- Division of Cardiovascular Sciences, Cardiac Centre, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,NIHR/Wellcome Trust Clinical Research Facility, Manchester, UK.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| |
Collapse
|
21
|
Farthing P, Bally J, Rennie DC, Dietrich Leurer M, Holtslander L, Nour MA. Type 1 diabetes management responsibilities between adolescents with T1D and their parents: An integrative review. J SPEC PEDIATR NURS 2022; 27:e12395. [PMID: 36116027 DOI: 10.1111/jspn.12395] [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: 12/22/2021] [Revised: 08/10/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022]
Abstract
PURPOSE Diabetes self-management for adolescents with type 1 diabetes (T1D) is a complex and multifaceted process that requires careful consideration of a supportive or shared approach to care. The purpose of this review was to synthesize the qualitative and quantitative evidence regarding the nature of adolescent-parent interactions and relationships in the context of T1D management. Of particular interest was the role of interdependence in this relationship. METHODS An integrative review of the literature was conducted between January 2021 and April 2021 using Whittemore and Knafl's (2005) methodological strategies. RESULTS Eleven studies published between 2003 and 2018 met the review criteria. Thematic analysis identified the following three themes related to parent-adolescent relationships in care including the Effectiveness of Parental Involvement and T1D Management, Shared Responsibility and T1D Task Management, and Gaining Independence in T1D Management. This review highlights the importance of both parent and adolescent shared involvement in T1D management. In particular, parental involvement appears necessary for improved glycemic control, better adherence to the T1D management regime, and for practicing self-management in adolescents with T1D. PRACTICE IMPLICATIONS Better understanding of the parent-child interaction in diabetes care will provide important information to aid family nurses to identify, support, and help maintain the sharing of T1D management responsibilities between parents and their adolescents.
Collapse
Affiliation(s)
- Pamela Farthing
- Saskatchewan Polytechnic, School of Nursing, Saskatoon, Saskatchewan, Canada
| | - Jill Bally
- College of Nursing University of Saskatchewan, Saskatchewan, Canada
| | - Donna C Rennie
- College of Nursing University of Saskatchewan, Saskatchewan, Canada
| | | | - Lorraine Holtslander
- College of Nursing University of Saskatchewan, Saskatchewan, Canada.,University of the Witwatersrand, Johannesburg, South Africa
| | - Munier A Nour
- College of Nursing University of Saskatchewan, Saskatchewan, Canada
| |
Collapse
|
22
|
Geuens S, Leyen K, Raymaekers K, Prikken S, Willen J, Goemans N, De Waele L, Lemiere J, Luyckx K. Illness Perceptions and Illness Identity in Adolescents and Emerging Adults With Neuromuscular Disorders. Clin Child Psychol Psychiatry 2022:13591045221125631. [PMID: 36112900 DOI: 10.1177/13591045221125631] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND Neuromuscular disorders (NMD) are intrusive medical conditions with implications for psychosocial development. OBJECTIVES This paper explores illness perceptions and illness identity dimensions of youth with NMD. First, we compare illness identity outcomes and illness perceptions of NMD patients with a comparison group of adolescents with type 1 diabetes mellitus (DM). Second, we report about the relationships between NMD-related variables and illness perceptions and illness identity. METHODS Scores on the Brief Illness Perception Questionnaire and the Illness Identity Questionnaire were compared between a group of NMD patients (N = 59; 12-22 years) and an age- and gender-matched group of DM patients (N = 118). NMD-related variables included time since diagnosis, prognosis, wheelchair use, and physical limitations. RESULTS Youth with NMD scored significantly higher on two of the four illness identity dimensions than youth with DM. NMD patients reported significantly less positive illness perceptions, experienced more physical symptoms, and had a lower score on understanding of their illness. Within the NMD group, wheelchair-users have a better understanding of their disease than those who are not wheelchair-bound. CONCLUSIONS The present study is the first to investigate illness identity and illness perceptions in NMD. More research is needed to provide insight in the identity formation process of the growing group of adolescents with NMDs.
Collapse
Affiliation(s)
- Sam Geuens
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Leuven, Belgium
| | - Kathelijne Leyen
- School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium
| | - Koen Raymaekers
- School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium.,60182FWO Vlaanderen (Research Foundation Flanders), Leuven, Belgium
| | - Sofie Prikken
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium.,60182FWO Vlaanderen (Research Foundation Flanders), Leuven, Belgium
| | - Joanna Willen
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium
| | - Nathalie Goemans
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Leuven, Belgium
| | - Liesbeth De Waele
- Child Neurology, 60182University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, 26657KU Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Child Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, 26657KU Leuven, Leuven, Belgium.,UNIBS, 60182University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
23
|
Rivetti G, Hursh BE, Miraglia Del Giudice E, Marzuillo P. Acute and chronic kidney complications in children with type 1 diabetes mellitus. Pediatr Nephrol 2022; 38:1449-1458. [PMID: 35896816 PMCID: PMC10060299 DOI: 10.1007/s00467-022-05689-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/05/2022] [Accepted: 07/05/2022] [Indexed: 01/09/2023]
Abstract
Children with type 1 diabetes mellitus (T1DM) have an increased risk of developing kidney involvement. Part of the risk establishes at the beginning of T1DM. In fact, up to 65% of children during T1DM onset may experience an acute kidney injury (AKI) which predisposes to the development of a later chronic kidney disease (CKD). The other part of the risk establishes during the following course of T1DM and could be related to a poor glycemic control and the subsequent development of diabetic kidney disease. In this review, we discuss the acute and chronic effects of T1DM on the kidneys, and the implications of these events on the long-term prognosis of kidney function.
Collapse
Affiliation(s)
- Giulio Rivetti
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Brenden E Hursh
- Department of Pediatrics, Division of Endocrinology, British Columbia Children's Hospital and University of British Columbia, 4480 Oak Street, Vancouver, BC, V6H 3V4, Canada
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy
| | - Pierluigi Marzuillo
- Department of Woman, Child and of General and Specialized Surgery, Università degli Studi della Campania "Luigi Vanvitelli", Via Luigi De Crecchio 2, 80138, Naples, Italy.
| |
Collapse
|
24
|
Ladd JM, Sharma A, Rahme E, Kroeker K, Dubé M, Simard M, Plante C, Blais C, Brownell M, Rodd C, Nakhla M. Comparison of Socioeconomic Disparities in Pump Uptake Among Children With Type 1 Diabetes in 2 Canadian Provinces With Different Payment Models. JAMA Netw Open 2022; 5:e2210464. [PMID: 35507342 PMCID: PMC9069256 DOI: 10.1001/jamanetworkopen.2022.10464] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Insulin pumps improve glycemic control and quality of life in children with type 1 diabetes (T1D). Canada's provinces have implemented universal pediatric programs to improve access. However, these programs provide differing financial coverage, allowing for unique cross-jurisdictional comparisons. OBJECTIVE To evaluate possible socioeconomic status (SES) disparities in pump uptake in Québec, where pumps are fully funded, with those in Manitoba, where pumps are partially funded. DESIGN, SETTING, AND PARTICIPANTS Using health administrative databases and a clinical registry, parallel, population-based cohort studies of children with diabetes were conducted from April 1, 2011, in Québec, and April 1, 2012, in Manitoba, until March 31, 2017. In analysis conducted from July 1, 2019, to November 30, 2021, multivariable Cox proportional hazards regression models were applied to study the association between pump uptake and SES, defined using validated area-based material and social deprivation indices. Children aged 1 to 17 years with T1D were identified using a validated definition in administrative data (Québec) and a clinical registry (Manitoba). Those using pumps before the initiation of provincial programs were excluded. EXPOSURES Socioeconomic status. MAIN OUTCOMES AND MEASURES Insulin pump uptake. RESULTS A total of 2919 children with T1D were identified in Québec: 1550 male (53.1%), mean (SD) age at diagnosis, 8.3 (4.4) years, and 1067 (36.6%) were using a pump. In Manitoba, 636 children were identified: 364 male (57.2%), mean (SD) age at diagnosis, 8.8 (4.4) years, and 106 (16.7%) were using a pump. In Québec, the mean age at diagnosis of T1D was lower in children using the pump compared with those not using a pump (7.6 [4.1] vs 8.7 [4.5] years); sex distribution was similar (562 [52.7%] vs 988 [53.3%] male). No differences in mean (SD) age at diagnosis (8.8 [4.4] vs 8.8 [4.3] years) or sex (57 [53.8%] vs 307 [57.9%] male) were noted in both groups in Manitoba. Increasing material deprivation was associated with decreased pump uptake in both Québec (adjusted hazard ratio [aHR] 0.89; 95% CI, 0.85-0.93) and Manitoba (aHR, 0.70; 95% CI, 0.60-0.82). Inclusion of ethnic concentration did not change this association. Socioeconomic disparities in pump uptake were greater in Manitoba than Québec (P = .006 by t test; Cochran Q, 8.15; P = .004; I2 = 87.7%; 95% CI, 52.5%-96.8%). CONCLUSIONS AND RELEVANCE The results of this study suggest that the program of full coverage for pumps available in Québec partially mitigates observed SES disparities in uptake and may be a model to improve access for all children with T1D.
Collapse
Affiliation(s)
- Jennifer M. Ladd
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Atul Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elham Rahme
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Kristine Kroeker
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marjolaine Dubé
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Marc Simard
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
- Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | - Céline Plante
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Claudia Blais
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Celia Rodd
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meranda Nakhla
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| |
Collapse
|
25
|
Silva C, Zhang Q, Bone JN, Amed S. Anthropometric Measurements and Laboratory Investigations in Children and Youth With Type 1 Diabetes Before and During the COVID-19 Pandemic. Can J Diabetes 2022; 46:S1499-2671(22)00087-9. [PMID: 35987748 PMCID: PMC9009070 DOI: 10.1016/j.jcjd.2022.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 03/08/2022] [Accepted: 04/08/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim in this study was to compare rates of anthropometric, blood pressure (BP) and glycated hemoglobin (A1C) measurements and laboratory screening for hypothyroidism, nephropathy and dyslipidemia in children and youth with type 1 diabetes (T1D), 1 year before and after the onset of COVID-19. METHODS Clinical data were analyzed from a voluntary registry of children and youth with T1D followed at the BC Children's Hospital between March 2019 and 2021. Logistic and Poisson mixed-effect models were used. RESULTS Four hundred forty patients, with median (interquartile range) age and time since diagnosis 12.7 (9.5 to 15.4) and 4.7 (2.6 to 7.9) years, respectively, were included. Clinic visits were all in-person before March 2020, and 99% via telemedicine afterward. The number of visits per patient was 2 (2 to 3), with a 6% increase during the pandemic (relative risk [RR], 1.06; 95% confidence interval [CI], 1.01 to 1.10). There was a substantial decrease in height, weight and BP measurements (RR, 0.32; 95% CI, 0.28 to 0.36; RR, 0.34, 95% CI, 0.31 to 0.38; RR, 0.005, 95% CI, 0.002 to 0.014, respectively); only 49% of patients had anthropometric and 1% BP data during the pandemic year, compared with >97% before the pandemic. A1C measurements dropped from 3 (2 to 4) to 1 (1 to 2) per patient per year (RR, 0.53; 95% CI, 0.48 to 0.57). Rates of screening investigations were suboptimal before the pandemic, and these rates continued to decline. CONCLUSIONS Shifting to telemedicine allowed ongoing care during the pandemic, but the frequency of anthropometric, BP and A1C measurements decreased dramatically. A combined telemedicine/in-person model may be needed to ensure adequate care for this population.
Collapse
Affiliation(s)
- Carolina Silva
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Qian Zhang
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Research Informatics, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia and British Columbia Children's Hospital, Vancouver, British Columbia, Canada.
| |
Collapse
|
26
|
Giruparajah M, Everett K, Shah BR, Austin PC, Fuchs S, Shulman R. Introduction of publicly funded pharmacare and socioeconomic disparities in glycemic management in children and youth with type 1 diabetes in Ontario, Canada: a population-based trend analysis. CMAJ Open 2022; 10:E519-E526. [PMID: 35700995 PMCID: PMC9343121 DOI: 10.9778/cmajo.20210214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND We evaluated the impact of publicly funded pharmacare (Ontario Health Insurance Plan [OHIP]+), which was introduced in Ontario on Jan. 1, 2018, for youth less than 25 years of age, on temporal trends in hemoglobin A1c (HbA1c, a measure of glycemic management) and the differential effect on the change in temporal trends in HbA1c according to socioeconomic status (SES). METHODS We conducted a trend analysis using administrative data sets. We included youth aged 21 years, 9 months or younger, residing in Ontario on Jan. 1, 2016, with diabetes diagnosed before age 15 years and before Jan. 1, 2015. We used claims for insulin to measure pharmacare use. We evaluated the change in HbA1c (%) per 90 days before (Jan. 1, 2016, to Dec. 31, 2017) the introduction of and during (Apr. 1, 2018, to Mar. 31, 2019) OHIP+ coverage, and the difference in the change in HbA1c according to SES, using segmented regression analysis. RESULTS Of 9641 patients, 7041 (73.0%) made an insulin claim. We found a negligible difference in the temporal change in HbA1c during compared with before OHIP+ coverage that was not statistically significant (β estimate -0.0002, 95% confidence interval [CI] -0.0004 to 0.0000). The size of the effect was slightly greater in those individuals with the lowest SES than in those with the highest SES (β estimate -0.0008, 95% CI -0.0015 to -0.0001). INTERPRETATION We found that the effect of OHIP+ on the change in HbA1c was slightly greater for youth in the lowest SES than for those in the highest SES. Our findings suggest that publicly funded pharmacare may be an effective policy tool to combat worsening socioeconomic disparities in diabetes care and outcomes.
Collapse
Affiliation(s)
- Mohana Giruparajah
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Karl Everett
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Baiju R Shah
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Peter C Austin
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Shai Fuchs
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Rayzel Shulman
- Division of Endocrinology (Giruparajah, Fuchs, Shulman), The Hospital for Sick Children; ICES (Everett, Shah, Austin, Shulman); Institute for Health Policy, Management and Evaluation (Austin), University of Toronto; Department of Medicine (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.
| |
Collapse
|
27
|
Glennie JL, Berard L, Levrat-Guillen F. Sensor-Based Technology: Bringing Value to People with Diabetes and the Healthcare System in an Evolving World. Clinicoecon Outcomes Res 2022; 14:75-90. [PMID: 35177913 PMCID: PMC8843785 DOI: 10.2147/ceor.s346736] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 01/15/2022] [Indexed: 02/06/2023]
Affiliation(s)
| | - Lori Berard
- Nurse Consultant, Pink Pearls Inc, Winnipeg, Manitoba, Canada
| | - Fleur Levrat-Guillen
- Abbott Diabetes Care, Maidenhead, UK
- Correspondence: Fleur Levrat-Guillen, Abbott Laboratories Ltd, Abbott House, Vanwall Business Park, Maidenhead, Berkshire, SL6 4XE, UK, Tel +44 7584108032, Email
| |
Collapse
|
28
|
Favel K, Mammen C, Panagiotopoulos C. Albuminuria screening in children with type 1 diabetes prior to and during the COVID-19 pandemic. Pediatr Res 2022; 92:1370-1373. [PMID: 35115710 PMCID: PMC8812360 DOI: 10.1038/s41390-022-01971-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 01/17/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Albuminuria is an important risk factor for adverse renal and cardiovascular outcomes in type 1 diabetes (T1D). We sought to describe: (1) adherence to albuminuria screening prior to and during the COVID-19 pandemic and (2) occurrence of abnormal urine albumin-creatinine ratio (ACR) tests in children with T1D. METHODS This cohort study involved children aged 18 years or younger with T1D followed in the diabetes clinic at a pediatric tertiary center. Data was collected from 2016 to 2020. Adherence was defined by Diabetes Canada (DC) Guidelines for T1D in Children and Adolescents (2018). RESULTS Of the 165 children who met DC criteria for screening; 88 (32%) were male and the median age at diagnosis was 5.8 years. Twenty-eight (17%) children had not completed a single ACR test, and 30 (18%) completed all eligible ACR tests. Test completion decreased from 66% in 2019 to 45% in 2020. Of the 345 ACR tests completed, 40 (11%) were abnormal (>2.5 mg/mmol) and 29 abnormal ACR tests (72%) were not repeated. CONCLUSION Adherence to albuminuria screening in this pediatric diabetes clinic is suboptimal with deterioration during the COVID-19 pandemic. Patient/physician and program-level strategies to improve adherence will play an important role in quality improvement. IMPACT Albuminuria screening is an important part of pediatric diabetes care. In our study, pediatric albuminuria screening adherence was suboptimal at 66% in 2019 and deteriorated during the pandemic to 45% in 2020. Program and patient-level adherence to clinical guidelines and barriers to accessing diabetes care during the pandemic merit further study.
Collapse
Affiliation(s)
- Kristen Favel
- Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children's Hospital, 4480 Oak Street, V6H 3V4, Vancouver, BC, Canada.
| | - Cherry Mammen
- grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Nephrology, University of British Columbia, BC Children’s Hospital, 4480 Oak Street, V6H 3V4 Vancouver, BC Canada
| | - Constadina Panagiotopoulos
- grid.17091.3e0000 0001 2288 9830Department of Pediatrics, Division of Endocrinology, University of British Columbia, BC Children’s Hospital, 4480 Oak Street, V6H 3V4 Vancouver, BC Canada
| |
Collapse
|
29
|
Ayub A, Ng C, Portales-Casamar E, Metzger D, Amed S. Towards Building a Provincial Diabetes Registry of Children & Youth Living with Diabetes in British Columbia, Canada. Can J Diabetes 2021; 46:346-352.e1. [DOI: 10.1016/j.jcjd.2021.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 08/27/2021] [Accepted: 11/15/2021] [Indexed: 10/19/2022]
|
30
|
Ryan PM, Zahradnik M, Konnyu KJ, Rader T, Halasy M, Shulman R, Ivers N, Hawkes CP, Grimshaw JM. Effectiveness of quality improvement strategies for type 1 diabetes in children and adolescents: a systematic review protocol. HRB Open Res 2021. [DOI: 10.12688/hrbopenres.13223.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introduction: Optimal glycaemic control is often a challenge in children and adolescents with type 1 diabetes (T1D). Implementation of patient, clinician or organisation-targeted quality improvement (QI) strategies has been proven to be beneficial in terms of improving glycaemic outcomes in adults living with diabetes. This review aims to assess the effectiveness of such QI interventions in improving glycaemic control, care delivery, and screening rates in children and adolescents with T1D. Methods and analysis: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases will be searched for relevant studies up to January 2021. Trial registries, ClinicalTrials.gov and ICTRP, will also be explored for any ongoing trials of relevance. We will include trials which examine QI strategies as defined by a modified version of the Cochrane Effective Practice and Organisation of Care 2015 Taxonomy in children (<18 years) with a diagnosis of T1D. The primary outcome to be assessed is glycated haemoglobin (HbA1c), although a range of secondary outcomes relating to clinical management, adverse events, healthcare engagement, screening rates and psychosocial parameters will also be assessed. Our primary intention is to generate a best-evidence narrative to summarise and synthesise the resulting studies. If a group of studies are deemed to be highly similar, then a meta-analysis using a random effects model will be considered. Cochrane Risk of Bias 1.0 tool will be applied for quality assessment. All screening, data extraction and quality assessment will be performed by two independent researchers. Dissemination: The results of this review will be disseminated through peer-reviewed publication in order to inform invested partners (e.g., Paediatric Endocrinologists) on the potential of QI strategies to improve glycaemic management and other related health outcomes in children with T1D, thereby guiding best practices in the outpatient management of the disorder. PROSPERO registration number: CRD42021233974 (28/02/2021).
Collapse
|
31
|
Rakotoambinina B, Hiffler L, Gomes F. Pediatric thiamine deficiency disorders in high-income countries between 2000 and 2020: a clinical reappraisal. Ann N Y Acad Sci 2021; 1498:57-76. [PMID: 34309858 PMCID: PMC9290709 DOI: 10.1111/nyas.14669] [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] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 06/21/2021] [Accepted: 07/05/2021] [Indexed: 12/20/2022]
Abstract
Often thought to be a nutritional issue limited to low- and middle-income countries (LMICs), pediatric thiamine deficiency (PTD) is perceived as being eradicated or anecdotal in high-income countries (HICs). In HICs, classic beriberi cases in breastfed infants by thiamine-deficient mothers living in disadvantaged socioeconomic conditions are thought to be rare. This study aims to assess PTD in HICs in the 21st century. Literature searches were conducted to identify case reports of PTD observed in HICs and published between 2000 and 2020. The analyzed variables were age, country, underlying conditions, clinical manifestations of PTD, and response to thiamine supplementation. One hundred and ten articles were identified, totaling 389 PTD cases that were classified into four age groups: neonates, infants, children, and adolescents. Eleven categories of PTD-predisposing factors were identified, including genetic causes, lifestyle (diabetes, obesity, and excessive consumption of sweetened beverages), eating disorders, cancer, gastrointestinal disorders/surgeries, critical illness, and artificial nutrition. TD-associated hyperlactatemia and Wernicke encephalopathy were the most frequent clinical manifestations. The circumstances surrounding PTD in HICs differ from classic PTD observed in LMICs and this study delineates its mutiple predisposing factors. Further studies are required to estimate its magnitude. Awareness is of utmost importance in clinical practice.
Collapse
Affiliation(s)
- Benjamin Rakotoambinina
- Cellular Nutrition Research GroupLagny sur MarneFrance
- LRI Isotopic Medicine Physiology LabUniversity of AntananarivoAntananarivoMadagascar
| | | | - Filomena Gomes
- The New York Academy of SciencesNew YorkNew York
- NOVA Medical SchoolUniversidade NOVA de LisboaLisboaPortugal
| |
Collapse
|
32
|
Nakhla M, Shulman R, Dimeglio L. Mental Health Matters: Limited Support Remains a Barrier to Optimal Care for Youth With Diabetes. Can J Diabetes 2021; 45:379-380. [PMID: 34176609 PMCID: PMC8543039 DOI: 10.1016/j.jcjd.2021.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 05/05/2021] [Accepted: 05/10/2021] [Indexed: 01/09/2023]
Affiliation(s)
- Meranda Nakhla
- Department of Pediatrics, Division of Endocrinology, Montreal Children's Hospital, Montreal, Québec, Canada; Center of Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada.
| | - Rayzel Shulman
- Department of Pediatrics, Division of Endocrinology, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada; Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Linda Dimeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, United States
| |
Collapse
|
33
|
Bakır E, Çavuşoğlu H, Mengen E. Effects of the Information-Motivation-Behavioral Skills Model on Metabolic Control of Adolescents with Type 1 Diabetes in Turkey: Randomized Controlled Study. J Pediatr Nurs 2021; 58:e19-e27. [PMID: 33371976 DOI: 10.1016/j.pedn.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the effects of information-motivation-behavioral skills model interventions given by nurses during home visits on the knowledge levels, personal and social motivation levels, behavioral skills, and HbA1C levels of adolescents with poor glycemic control. DESIGN AND METHODS The present study was designed as randomized controlled trial. 50 adolescents with type 1 diabetes were equally divided into study and control groups. Socio-Demographic Form, Diabetes Information Evaluation Form, The Child Attitude Toward Illness Scale, The Multidimensional Scale of Perceived Social Support, and Diabetes Management Self-Efficacy Scale were utilized in data collection. The scales were administered at the beginning of the study and six months later. HbA1c levels of adolescents were evaluated in the third and sixth months. Multiple home visits and phone calls were made to each participant in the intervention group. Interventions to improve the information-motivation-behavioral skills model-based knowledge, personal and social motivation, and behavioral skills were applied during the home visits. RESULTS As a result of information-motivation-behavioral skills model-based interventions, knowledge levels (p<0.001), personal motivation levels (p = 0.001), social motivation levels (p = 0.004), and behavioral skills (p<0.001) of the study group improved. Additionally, HbA1c levels decreased significantly in the third (p<0.001) and sixth months (p<0.001). CONCLUSION Information-Motivation-Behavioral Skills Model-based intervention effectively improved glycemic control among adolescents with type 1 diabetes. PRACTICE IMPLICATIONS Nurses should develop strategies to increase personal motivation, social motivation, and behavioral skills to training programs planned for adolescents with type 1 diabetes.
Collapse
Affiliation(s)
- Elif Bakır
- Pediatric Nursing Department, Hacettepe University, Turkey.
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Hacettepe University, Turkey.
| | - Eda Mengen
- Department of Pediatric Endocrinology, Turkey.
| |
Collapse
|
34
|
Fel S, Rochette E, Walther G, Echaubard S, Pereira B, Merlin E, Terral D, Duché P. Maximal Fat Oxidation During Exercise Is Already Impaired in Pre-pubescent Children With Type 1 Diabetes Mellitus. Front Physiol 2021; 12:664211. [PMID: 33897473 PMCID: PMC8062964 DOI: 10.3389/fphys.2021.664211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/19/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: We evaluated substrate utilization during submaximal exercise, together with glycemic responses and hormonal counter-regulation to exercise, in children with type 1 diabetes mellitus (T1DM). Methods: Twelve pre-pubescent children with T1DM and 12 healthy children were matched by sex and age. Participants completed a submaximal incremental exercise test to determine their fat and carbohydrate oxidation rates by indirect calorimetry. Levels of glycemia, glucagon, cortisol, growth hormone, noradrenaline, adrenaline, and insulin were monitored until 120 min post-exercise. Results: Absolute peak oxygen uptake (VO2 peak) was significantly lower in the children with T1DM than in the healthy controls (1131.4 ± 102.5 vs. 1383.0 ± 316.6 ml.min−1, p = 0.03). Overall carbohydrate and lipid oxidation rates were the same in the two groups, but for exercise intensities, higher than 50% of VO2 peak, fat oxidation rate was significantly lower in the children with T1DM. The absolute maximal lipid oxidation rate was significantly lower in the T1DM children (158.1 ± 31.6 vs. 205.4 ± 42.1 mg.min−1, p = 0.005), and they reached a significantly lower exercise power than the healthy controls (26.4 ± 1.2 vs. 35.4 ± 3.3 W, p = 0.03). Blood glucose responses to exercise were negatively correlated with pre-exercise blood glucose concentrations (r = −0.67; p = 0.03). Conclusion: Metabolic and hormonal responses during sub-maximal exercise are impaired in young children with T1DM.
Collapse
Affiliation(s)
- Solenne Fel
- Pédiatrie Générale et Multidisciplinaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuelle Rochette
- Pédiatrie Générale et Multidisciplinaire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, Clermont-Ferrand, France.,Laboratoire IAPS, Université de Toulon, Toulon, France
| | | | - Stéphane Echaubard
- Pédiatrie Générale et Multidisciplinaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Délégation de la Recherche Clinique et Innovations, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Etienne Merlin
- Pédiatrie Générale et Multidisciplinaire, CHU Clermont-Ferrand, Clermont-Ferrand, France.,INSERM, CIC 1405, Unité CRECHE, Université Clermont Auvergne, Clermont-Ferrand, France.,INRA, UMR 1019 UNH, ECREIN, Université Clermont Auvergne, Clermont-Ferrand, France
| | - Daniel Terral
- Pédiatrie Générale et Multidisciplinaire, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascale Duché
- Laboratoire IAPS, Université de Toulon, Toulon, France
| |
Collapse
|
35
|
Sellers EAC, Pacaud D. Diabetic ketoacidosis at presentation of type 1 diabetes in children in Canada during the COVID-19 pandemic. Paediatr Child Health 2021; 26:208-209. [PMID: 34127934 PMCID: PMC8083512 DOI: 10.1093/pch/pxab017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Type 1 diabetes is a common chronic illness in childhood. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes. Early recognition of symptoms of diabetes and immediate initiation of treatment are important factors in preventing DKA at first presentation. We describe the numbers of children presenting with DKA at initial diagnosis across eight Canadian paediatric centres during the COVID-19 pandemic (March 15, 2020 to July 31, 2020) and compare this to the same time period in 2019. Comparing the pre-COVID to the COVID-19 time period, presentation in DKA increased from 36.4% to 55.0% (P<0.0001) and presentation in severe DKA from 37.0% to 48.3% (P=0.044). These findings are concerning and emphasize the importance of awareness of the signs and symptoms of diabetes. In addition, these findings raise concern about access to appropriate and timely care during the COVID-19 pandemic.
Collapse
Affiliation(s)
- Elizabeth A C Sellers
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Danièle Pacaud
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
36
|
Thawer Z, Gregoire K, Coo H, Saleh DS. Variability in Emergency Management of Pediatric Diabetic Ketoacidosis. Can J Diabetes 2021; 45:757-760. [PMID: 34112617 DOI: 10.1016/j.jcjd.2021.03.003] [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: 12/26/2020] [Revised: 02/27/2021] [Accepted: 03/09/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Our aim in this study was to identify pediatric patients presenting in diabetic ketoacidosis (DKA) who received initial treatment inconsistent with current guidelines, and then to track associated complications. METHODS This retrospective chart review examined 47 pediatric patients admitted to our institution with DKA, including those transferred from community hospitals. Primary outcome measures were exposure to treatment-related risk factors for cerebral edema (CE), including administration of an intravenous (IV) insulin bolus, IV bicarbonate, insulin within 1 hour of IV fluid start and non-NPO (nil per os) status. RESULTS Seventy-five percent of patients were exposed to at least one management practice that deviated from guidelines. Thirty-four percent of patients were exposed to a treatment-related risk factor for CE, with a significantly higher prevalence in those presenting to community centres (52% vs 19%; p=0.02). There were no radiologically confirmed cases of CE. CONCLUSIONS Despite the presence of multiple, evidence-based guidelines, a significant proportion of children---and especially those who present to community centres---are exposed to practices that increase CE risk.
Collapse
Affiliation(s)
- Zoyah Thawer
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada; Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
| | - Keith Gregoire
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Helen Coo
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | | |
Collapse
|
37
|
Lukewich J, Buote R, Asghari S, Aubrey-Bassler K, Knight J, Mathews M. Adults with diabetes mellitus in Newfoundland and Labrador: a population-based, cross-sectional analysis. CMAJ Open 2020; 8:E895-E901. [PMID: 33355275 PMCID: PMC7759100 DOI: 10.9778/cmajo.20190233] [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] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Although the province of Newfoundland and Labrador has the highest rates of chronic disease in Canada, the current state of many chronic diseases in the province, including diabetes mellitus, has not been well explored. We profiled the demographic characteristics associated with, and the management of, diabetes in Newfoundland and Labrador, including any rural-urban differences. METHODS We performed a population-based, cross-sectional analysis using data from the provincial Chronic Disease Registry for fiscal year 2015/16. Patients in the study sample were 20 years of age or older, with documented identifiers for age, sex and geographic location. We examined demographic characteristics, results of screening and diabetes clinical tests (glycated hemoglobin [HbA1c], low-density lipoprotein [LDL] cholesterol and urine albumin-to-creatinine ratio) and hospitalization rates. We described and compared demographic, clinical and hospitalization variables across urban and rural residents of the province. RESULTS The study sample consisted of 66 325 individuals with diabetes in Newfoundland and Labrador (mean age 64.1 yr; 56.3% rural residents). Larger proportions of rural than urban residents with diabetes were aged 65 to 79 years (41.2% v. 37.5%), were female (50.2% v. 48.7%) and were identified as having the disease by laboratory tests only (19.6% v. 13.1%). Rural residents had worse clinical test outcomes than their urban counterparts, specifically with respect to HbA1c (mean and standard deviation [SD], 7.41% [SD 1.49] v. 7.26% [SD 1.50]) and LDL cholesterol (mean 2.46 [SD 0.95] v. mean 2.36 [SD 0.94] mmol/L). A total of 13.7% of individuals were admitted to hospital during the cohort year, with slightly more rural residents admitted for renal disease (standardized difference 0.021, 95% confidence interval 0.005 to 0.036). INTERPRETATION For many individuals with diabetes in Newfoundland and Labrador, recommended targets for diabetes management are not being met, and residents in rural areas have poorer clinical outcomes. To inform the development and implementation of targeted provincial strategies for chronic disease management, further research is needed to determine how outcomes relate to the availability of primary health care services.
Collapse
Affiliation(s)
- Julia Lukewich
- Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont.
| | - Richard Buote
- Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont
| | - Shabnam Asghari
- Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont
| | - Kris Aubrey-Bassler
- Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont
| | - John Knight
- Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont
| | - Maria Mathews
- Faculty of Nursing (Lukewich), Division of Community Health and Humanities (Buote, Knight), Discipline of Family Medicine (Asghari), and Primary Healthcare Research Unit, Faculty of Medicine (Aubrey-Bassler, Knight), Memorial University of Newfoundland; Center for Rural Health Studies (Asghari); Health Analytics and Information Services (Knight), Newfoundland and Labrador Centre for Health Information, St. John's, NL; Department of Family Medicine (Mathews), Schulich School of Medicine & Dentistry, London, Ont
| |
Collapse
|
38
|
Chronic illness and transition from paediatric to adult care: a systematic review of illness specific clinical guidelines for transition in chronic illnesses that require specialist to specialist transfer. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractIntroductionA quarter of a century has passed since the importance of transition from paediatric to adult care for chronically ill adolescents was highlighted by the American Society of Adolescent Health and Medicine. Despite discussions, the development of generic guidelines and some cohorting of age groups in paediatric speciality care, adolescents continue, unacceptably, to fall through the care gaps with negative clinical outcomes. Government bodies and international organisations have developed clinical practice guidelines (CPGs) for specific chronic physical illness although it remains unclear as to what extent these discuss transition from paediatric to adult care. This study systematically reviewed scientific and grey literature to determine how effectively transition has been incorporated into chronic illness specific CPGs.MethodsFive bibliographical databases; Medline, Embase, PsycINFO, CINAHL and Web of Science plus an extensive grey literature search from the internet were used to identify published guidelines between 2008 and 2018 using key words adolescents, transition, guidelines, together with the names of over 20 chronic physical illnesses which require specialist to specialist care after transitioning from paediatric care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. In addition a measure of trustworthiness for CPGs was included. Guidelines were benchmarked against a published set of Australian transition principles embodying the comprehensive recommendations from National Institute for health and Care Excellence (NICE) transition guidelines discussing key transition aspects on: a systematic and formal transition process; early preparation; transition coordinators, good communication and collaboration between health professionals; individualised transition plan, enhancing self-management and active follow up after transition.ResultsInitially, 1055 articles were identified from the literature searches. Eight hundred and sixty eight articles were selected for title and abstract review. One hundred and seventy eight articles were included for full text review. Ultimately, 25 trustworthy CPGs were identified and included across 14 chronic physical illnesses. Five articles exclusively discussed illness specific transition recommendations and two included all the seven key transition principles. Three provided a minimal discussion of transition to adult care due to lack of high level evidence. Follow up and evaluation was the least addressed principle with recommendations in only seven CPGs.ConclusionsA limited number of chronic physical illnesses have illness specific CPGs that address transition from paediatric to adult care. The CPGs’ content emphasises the need for empirical data in order to develop quality transition recommendations for adolescents with chronic physical illness to ensure long term engagement and retention within health services.
Collapse
|
39
|
Insulin Pump Therapy Improves Quality of Life of Young Patients With Type 1 Diabetes Enrolled in a Government-Funded Insulin Pump Program: A Qualitative Study. Can J Diabetes 2020; 45:395-402. [PMID: 33109446 DOI: 10.1016/j.jcjd.2020.08.101] [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: 04/20/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Nova Scotia Insulin Pump Program (NSIPP) subsidizes the cost of insulin pump therapy for young patients (≤25 years) with type 1 diabetes. The first NSIPP evaluation focused on clinical outcomes rather than quality of life. Existing research on insulin pumps and quality of life is mostly survey based, with limited first-voice experiences. In this qualitative study, we examined patient and parent perspectives on how insulin pumps affect quality of life in the context of a government-funded program. METHODS In this investigation, we used a phenomenological approach, guided by a conceptual model. In-depth semistructured telephone interviews (median, 37 minutes) were completed with NSIPP enrollees and/or their parents. Saturation was reached after 23 interviews. Verbatim transcripts were coded independently by 2 researchers. Coding discrepancies were discussed and resolved using concept mapping to clarify relationships between codes and to identify main themes. RESULTS There were 2 main themes: 1) NSIPP financial support was necessary for those without private insurance and 2) control over life and diabetes with subthemes of social experiences and worry. Participants expressed this theme differently depending on their stage of life. For example, some children experienced shame and even hid their pump, whereas teens were more self-confident with the discreetness of pumps and young adults wore their pump with pride. CONCLUSIONS Insulin pump therapy, subsidized through the NSIPP, led to improved quality of life, which was experienced differently depending on stage of life.
Collapse
|
40
|
Goldstein BI, Korczak DJ. Links Between Child and Adolescent Psychiatric Disorders and Cardiovascular Risk. Can J Cardiol 2020; 36:1394-1405. [DOI: 10.1016/j.cjca.2020.06.023] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 06/28/2020] [Accepted: 06/29/2020] [Indexed: 12/27/2022] Open
|
41
|
Eledrisi MS, Elzouki AN. Management of Diabetic Ketoacidosis in Adults: A Narrative Review. SAUDI JOURNAL OF MEDICINE & MEDICAL SCIENCES 2020; 8:165-173. [PMID: 32952507 PMCID: PMC7485658 DOI: 10.4103/sjmms.sjmms_478_19] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/20/2020] [Accepted: 06/02/2020] [Indexed: 12/20/2022]
Abstract
Diabetic ketoacidosis (DKA) is the most common hyperglycemic emergency and causes the greatest risk for death in patients with diabetes mellitus. DKA more commonly occurs among those with type 1 diabetes, yet almost a third of the cases occur among those with type 2 diabetes. Although mortality rates from DKA have declined to low levels in general, it continues to be high in many developing countries. DKA is characterized by hyperglycemia, metabolic acidosis and ketosis. Proper management of DKA requires hospitalization for aggressive intravenous fluids, insulin therapy, electrolyte replacement as well as identification and treatment of the underlying precipitating event along with frequent monitoring of patient's clinical and laboratory states. The most common precipitating causes for DKA include infections, new diagnosis of diabetes and nonadherence to insulin therapy. Clinicians should be aware of the occurrence of DKA in patients prescribed sodium-glucose co-transporter 2 inhibitors. Discharge plans should include appropriate choice and dosing of insulin regimens and interventions to prevent recurrence of DKA. Future episodes of DKA can be reduced through patient education programs focusing on adherence to insulin and self-care guidelines during illness and improved access to medical providers. New approaches such as extended availability of phone services, use of telemedicine and utilization of public campaigns can provide further support for the prevention of DKA.
Collapse
Affiliation(s)
- Mohsen S Eledrisi
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Abdel-Naser Elzouki
- Department of Medicine, Hamad Medical Corporation, Doha, Qatar.,Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar
| |
Collapse
|
42
|
Haddadi D, Rosolowsky E, Pacaud D, McKeen J, Young K, Madrick B, Domaschuk L, Sargious P, Conroy S, Senior PA. Revision of Alberta's Provincial Insulin Pump Therapy Criteria for Adults and Children With Type 1 Diabetes: Process, Rationale and Framework for Evaluation. Can J Diabetes 2020; 45:228-235.e4. [PMID: 33046399 DOI: 10.1016/j.jcjd.2020.08.097] [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: 11/25/2019] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Insulin pump therapy is a valuable, but costly approach, with public funding in Alberta for eligible individuals since 2013. The Provincial Insulin Pump Therapy Program Clinical Advisory Committee has revised and updated the clinical criteria, integrating current literature, best practice and feedback from clinicians. The objective was to develop criteria that would: 1) optimize safety and effectiveness of insulin pump therapy, while 2) carefully stewarding resources available to care for people with type 1 diabetes. METHODS The Clinical Advisory Committee comprised health-care professionals with expertise in pump therapy and included adult and pediatric endocrinologists, an internist, a pediatrician, certified pump trainers, diabetes educators and clinic managers. The group meets regularly by teleconference. Decisions are made by consensus. RESULTS Indications for insulin pump therapy for adults and children with insulin-deficient diabetes were divided into 4 hierarchical levels: 1) problematic hypoglycemia, inability to achieve acceptable control or progressive complications; 2) unpredictable activity, dawn phenomenon or children for whom use of multiple daily injections is not appropriate; 3) individual preference and 4) clinical exception, with priority given to indications with clear evidence of benefit. The criteria emphasize the importance of: 1) adequate education in diabetes self-management; 2) adequate trial of flexible insulin therapy with modern analogues and 3) evidence of active, safe diabetes self-management. Tools to facilitate effective and efficient annual review and surveillance were developed incorporating biological, behavioural evaluation and self-reflection to provide a framework for program evaluation. The recommendations were implemented in January 2019. CONCLUSIONS The process and revised criteria may be valuable for jurisdictions considering how to develop and implement a publicly funded insulin pump program.
Collapse
Affiliation(s)
- Dalal Haddadi
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada
| | - Elizabeth Rosolowsky
- Division of Pediatric Endocrinology, University of Alberta, Edmonton, Alberta, Canada
| | - Danièle Pacaud
- Division of Pediatric Endocrinology, University of Calgary, Calgary, Alberta, Canada
| | - Julie McKeen
- Division of Endocrinology and Metabolism, University of Calgary, Calgary, Alberta, Canada
| | - Kim Young
- Nutrition Services, Alberta Health Services, Calgary, Alberta, Canada
| | - Bev Madrick
- Endocrinology & Metabolism Program, Alberta Health Services, Calgary, Alberta, Canada
| | - Lorelei Domaschuk
- Provincial Insulin Pump Therapy Program, Alberta Health Services, Lacombe, Alberta, Canada
| | - Peter Sargious
- Diabetes, Obesity, Nutrition Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Sue Conroy
- Provincial Clinical Programs, Alberta Health Services, Calgary, Alberta, Canada
| | - Peter A Senior
- Division of Endocrinology and Metabolism, University of Alberta, Edmonton, Alberta, Canada.
| | | |
Collapse
|
43
|
Mahmud FH, Clarke ABM, Joachim KC, Assor E, McDonald C, Saibil F, Lochnan HA, Punthakee Z, Parikh A, Advani A, Shah BR, Perkins BA, Zuijdwijk CS, Mack DR, Koltin D, De Melo EN, Hsieh E, Mukerji G, Gilbert J, Bax K, Lawson ML, Cino M, Beaton MD, Saloojee NA, Lou O, Gallego PH, Bercik P, Houlden RL, Aronson R, Kirsch SE, Paterson WG, Marcon MA. Screening and Treatment Outcomes in Adults and Children With Type 1 Diabetes and Asymptomatic Celiac Disease: The CD-DIET Study. Diabetes Care 2020; 43:1553-1556. [PMID: 32345653 DOI: 10.2337/dc19-1944] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 03/25/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe celiac disease (CD) screening rates and glycemic outcomes of a gluten-free diet (GFD) in patients with type 1 diabetes who are asymptomatic for CD. RESEARCH DESIGN AND METHODS Asymptomatic patients (8-45 years) were screened for CD. Biopsy-confirmed CD participants were randomized to GFD or gluten-containing diet (GCD) to assess changes in HbA1c and continuous glucose monitoring over 12 months. RESULTS Adults had higher CD-seropositivity rates than children (6.8% [95% CI 4.9-8.2%, N = 1,298] vs. 4.7% [95% CI 3.4-5.9%, N = 1,089], P = 0.035) with lower rates of prior CD screening (6.9% vs. 44.2%, P < 0.0001). Fifty-one participants were randomized to a GFD (N = 27) or GCD (N = 24). No HbA1c differences were seen between the groups (+0.14%, 1.5 mmol/mol; 95% CI -0.79 to 1.08; P = 0.76), although greater postprandial glucose increases (4-h +1.5 mmol/L; 95% CI 0.4-2.7; P = 0.014) emerged with a GFD. CONCLUSIONS CD is frequently observed in asymptomatic patients with type 1 diabetes, and clinical vigilance is warranted with initiation of a GFD.
Collapse
Affiliation(s)
- Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kariym C Joachim
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Esther Assor
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte McDonald
- Division of Endocrinology and Metabolism, St. Joseph's Health Care, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Heather A Lochnan
- Department of Endocrinology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Zubin Punthakee
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Amish Parikh
- Division of Endocrinology, Trillium Health Partners, Toronto, Ontario, Canada
| | - Andrew Advani
- Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Baiju R Shah
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Caroline S Zuijdwijk
- Division of Endocrinology and Metabolism, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dror Koltin
- Division of Endocrinology, Trillium Health Partners, Toronto, Ontario, Canada
| | - Emilia N De Melo
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Eugene Hsieh
- Department of Pathology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Division of Endocrinology, Women's College Hospital, Toronto, Ontario, Canada
| | - Jeremy Gilbert
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Kevin Bax
- Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Margaret L Lawson
- Division of Endocrinology and Metabolism, University of Ottawa, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Maria Cino
- Division of Gastroenterology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Melanie D Beaton
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Navaaz A Saloojee
- Department of Gastroenterology, The Ottawa Hospital, Ottawa, Ontario, Canada
| | | | - Patricia H Gallego
- Division of Endocrinology, Children's Hospital, London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Premysl Bercik
- Department of Gastroenterology, McMaster University, Hamilton, Ontario, Canada
| | - Robyn L Houlden
- Department of Endocrinology, Kingston General Hospital, Kingston, Ontario, Canada
| | | | - Susan E Kirsch
- Division of Endocrinology, Markham-Stouffville Hospital, Markham, Ontario, Canada
| | - William G Paterson
- Department of Gastroenterology, Kingston General Hospital, Kingston, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
44
|
Shulman R, Zenlea I, Shah BR, Clarson C, Harrington J, Landry A, Punthakee Z, Palmert MR, Mukerji G, Austin PC, Parsons J, Ivers N. Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group. BMC Health Serv Res 2019; 19:885. [PMID: 31766999 PMCID: PMC6878686 DOI: 10.1186/s12913-019-4690-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/28/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. METHODS This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. DISCUSSION There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. TRIAL REGISTRATION ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.
Collapse
Affiliation(s)
- Rayzel Shulman
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada. .,SickKids Research Institute, Toronto, Canada. .,ICES, Toronto, Canada. .,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Pediatrics, University of Toronto, Toronto, Canada.
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Missisauga, Canada
| | - Baiju R Shah
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Canada.,Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Cheril Clarson
- Children's Hospital, London Health Sciences Centre, London, Ontario, Canada.,Lawson Health Research Institute, London, Ontario, Canada
| | - Jennifer Harrington
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada
| | - Alanna Landry
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,Markham Stouffville Hospital, Markham, Canada
| | | | - Mark R Palmert
- Division of Endocrinology, The Hospital for Sick Children, Toronto, ON, Canada.,SickKids Research Institute, Toronto, Canada.,Department of Pediatrics, University of Toronto, Toronto, Canada.,Department of Physiology, University of Toronto, Toronto, Ontario, Canada
| | - Geetha Mukerji
- Department of Medicine, University of Toronto, Toronto, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada
| | - Peter C Austin
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Janet Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Noah Ivers
- ICES, Toronto, Canada.,Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Women's College Institute for Health System Solutions and Virtual Care, Toronto, Ontario, Canada.,Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
45
|
Perry GML. 'Fat's chances': Loci for phenotypic dispersion in plasma leptin in mouse models of diabetes mellitus. PLoS One 2019; 14:e0222654. [PMID: 31661517 PMCID: PMC6818960 DOI: 10.1371/journal.pone.0222654] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 09/04/2019] [Indexed: 01/29/2023] Open
Abstract
Background Leptin, a critical mediator of feeding, metabolism and diabetes, is expressed on an incidental basis according to satiety. The genetic regulation of leptin should similarly be episodic. Methodology Data from three mouse cohorts hosted by the Jackson Laboratory– 402 (174F, 228M) F2 Dilute Brown non-Agouti (DBA/2)×DU6i intercrosses, 142 Non Obese Diabetic (NOD/ShiLtJ×(NOD/ShiLtJ×129S1/SvImJ.H2g7) N2 backcross females, and 204 male Nonobese Nondiabetic (NON)×New Zealand Obese (NZO/HlLtJ) reciprocal backcrosses–were used to test for loci associated with absolute residuals in plasma leptin and arcsin-transformed percent fat (‘phenotypic dispersion’; PDpLep and PDAFP). Individual data from 1,780 mice from 43 inbred strains was also used to estimate genetic variances and covariances for dispersion in each trait. Principal findings Several loci for PDpLep were detected, including possibly syntenic Chr 17 loci, but there was only a single position on Chr 6 for PDAFP. Coding SNP in genes linked to the consensus Chr 17 PDpLep locus occurred in immunological and cancer genes, genes linked to diabetes and energy regulation, post-transcriptional processors and vomeronasal variants. There was evidence of intersexual differences in the genetic architecture of PDpLep. PDpLep had moderate heritability (hs2=0.29) and PDAFP low heritability (hs2=0.12); dispersion in these traits was highly genetically correlated r = 0.8). Conclusions Greater genetic variance for dispersion in plasma leptin, a physiological trait, may reflect its more ephemeral nature compared to body fat, an accrued progressive character. Genetic effects on incidental phenotypes such as leptin might be effectively characterized with randomization-detection methodologies in addition to classical approaches, helping identify incipient or borderline cases or providing new therapeutic targets.
Collapse
Affiliation(s)
- Guy M. L. Perry
- Department of Biology, University of Prince Edward Island, Charlottetown, PEI, Canada
- * E-mail:
| |
Collapse
|
46
|
Ho J, Nicolucci AC, Virtanen H, Schick A, Meddings J, Reimer RA, Huang C. Effect of Prebiotic on Microbiota, Intestinal Permeability, and Glycemic Control in Children With Type 1 Diabetes. J Clin Endocrinol Metab 2019; 104:4427-4440. [PMID: 31188437 DOI: 10.1210/jc.2019-00481] [Citation(s) in RCA: 84] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 06/06/2019] [Indexed: 02/07/2023]
Abstract
CONTEXT Patients with type 1 diabetes (T1D) have lower microbiota diversity and distinct gut microbial profiles that have been linked to changes in intestinal permeability. Prebiotics are nondigestible carbohydrates that alter gut microbiota and could potentially improve glycemic control and reduce intestinal permeability and thereby insulin sensitivity. OBJECTIVE To determine the effect of prebiotics on glycemic control, gut microbiota, and intestinal permeability in children with T1D. DESIGN A randomized, placebo-controlled trial in children 8 to 17 years of age with T1D using placebo or prebiotic oligofructose-enriched inulin for 12 weeks. Baseline, 3-month, and 6-month assessments included HbA1c, C-peptide, gut microbiota, intestinal permeability, frequency of diabetic ketoacidosis (DKA), and severe hypoglycemia. RESULTS Forty-three subjects were randomized and 38 completed the study. The groups were similar at baseline: prebiotic (N = 17), age 12.5 years (SD of 2.8), HbA1c 8.02% (SD of 0.82); placebo (N = 21), age 12.0 years (SD of 2.6), HbA1c 8.08% (SD of 0.91). No significant differences were found in the frequency of DKA or severe hypoglycemia. At 3-months, C-peptide was significantly higher (P = 0.029) in the group who received prebiotics, which was accompanied by a modest improvement in intestinal permeability (P = 0.076). There was a significant increase in the relative abundance of Bifidobacterium within the prebiotic group at 3 months that was no longer present after the 3-month washout. The placebo group had significantly higher relative abundance of Streptococcus, Roseburia inulinivorans, Terrisporobacter, and Faecalitalea compared with the prebiotic group at 3 months. CONCLUSION Prebiotics are a potentially novel, inexpensive, low-risk treatment addition for T1D that may improve glycemic control. Further larger-scale trials are needed.
Collapse
Affiliation(s)
- Josephine Ho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alissa C Nicolucci
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Heidi Virtanen
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alana Schick
- International Microbiome Centre, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jon Meddings
- Department of Internal Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Raylene A Reimer
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Carol Huang
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Biochemistry and Molecular Biology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| |
Collapse
|
47
|
Lawrence SE. The Use of Clinical Pathways and Order Sets in the Management of Diabetic Ketoacidosis. Can J Diabetes 2019; 43:295-296. [DOI: 10.1016/j.jcjd.2019.05.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
48
|
Marcovecchio ML, Dalton RN, Daneman D, Deanfield J, Jones TW, Neil HAW, Dunger DB. A new strategy for vascular complications in young people with type 1 diabetes mellitus. Nat Rev Endocrinol 2019; 15:429-435. [PMID: 30996294 DOI: 10.1038/s41574-019-0198-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Diabetes vascular complications, including cardiovascular disease, diabetic nephropathy and retinopathy, have a negative effect on the long-term prognosis of young people with type 1 diabetes mellitus (T1DM). Poor glycaemic control and consequent increased HbA1c levels are major risk factors for the development of vascular complications. HbA1c levels are the main focus of current management strategies; however, the recommended target is rarely achieved in adolescents. Thus, a clear need exists for improved biomarkers to identify high-risk young people early and to develop new intervention strategies. Evidence is accumulating that early increases in urinary albumin excretion could be predictive of adolescents with T1DM who are at an increased risk of developing vascular complications, independent of HbA1c levels. These findings present an opportunity to move towards the personalized care of adolescents with T1DM, which takes into consideration changes in albumin excretion and other risk factors in addition to HbA1c levels.
Collapse
Affiliation(s)
| | - R Neil Dalton
- Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Denis Daneman
- Department of Paediatrics, The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada
| | - John Deanfield
- Vascular Physiology Unit, Institute of Cardiovascular Science, University College London, London, UK
| | - Timothy W Jones
- Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
| | - H Andrew W Neil
- Oxford Centre for Diabetes, Endocrinology and Metabolism, University of Oxford, Oxford, UK
| | - David B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK.
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.
| | | |
Collapse
|
49
|
Botros S, Islam N, Hursh B. Insulin pump therapy, pre-pump hemoglobin A 1c and metabolic improvement in children with type 1 diabetes at a tertiary Canadian children's hospital. Pediatr Diabetes 2019; 20:427-433. [PMID: 30779269 DOI: 10.1111/pedi.12834] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Indications for insulin pump therapy (IPT) in children with type 1 diabetes (T1D) are relatively non-specific and therefore subject to provider discretion. Health professionals' perceptions of which people will have difficulty with IPT, for example, those with higher hemoglobin A1c (HbA1c ), may not be correct. This study examined the effect of IPT on HbA1c , and the role of pre-pump HbA1c on this effect. METHODS All children with T1D started on IPT at British Columbia Children's Hospital from January 2011 through June 2016 were included if they had HbA1c values available both before and after IPT (n = 125). Generalized estimating equations was used to estimate the effects of IPT on HbA1c , stratified by pre-pump HbA1c levels (good: <7.5% [<58 mmol/mol], moderate: 7.5%-9.0% [58-75 mmol/mol], poor: >9.0% [>75 mmol/mol]). RESULTS After adjusting for potential confounders, mean HbA1c decreased by 0.48% [5.2 mmol/mol] (95% confidence interval: -0.64, -0.33% [-7.0, -3.6 mmol/mol]; P < 0.0001) after IPT initiation. The adjusted mean HbA1c decreased by 0.14% [1.5 mmol/mol] (-0.35, 0.07% [-3.8, 0.8 mmol/mol]; P = 0.188), 0.54% [5.9 mmol/mol] (-0.74, -0.34% [-8.1, -3.7 mmol/mol]; P < 0.0001), and 1.08% [11.8 mmol/mol] (-1.69, -0.46% [-18.5, -5.0 mmol/mol]; P = 0.0006) after pump initiation in the good, moderate, and poor pre-pump metabolic control groups, respectively. CONCLUSIONS Pre-pump HbA1c appears to play a significant role in the effects of IPT on HbA1c , with the largest decrease in HbA1c seen in the poor pre-pump HbA1c group. Eligibility and consideration for IPT should be expanded to routinely include these children.
Collapse
Affiliation(s)
- Sandra Botros
- Endocrinology and Diabetes Unit, BC Children's Hospital, Vancouver, British Columbia, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Nazrul Islam
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK.,Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Brenden Hursh
- Endocrinology and Diabetes Unit, BC Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
50
|
Johnston K, Wheeler G, Rosolowsky E. A Comparison of Structured Education Programs for Pediatric Patients With Type 1 Diabetes: Multiple Daily Injection Therapy Delivered by Group Workshop vs. Self-Study Course. Can J Diabetes 2019; 43:290-293. [DOI: 10.1016/j.jcjd.2018.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
|