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Merlo EM, Tutino R, Myles LAM, Lia MC, Minasi D. Alexithymia, intolerance to uncertainty and mental health difficulties in adolescents with Type 1 diabetes mellitus. Ital J Pediatr 2024; 50:99. [PMID: 38755698 PMCID: PMC11100042 DOI: 10.1186/s13052-024-01647-4] [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: 07/20/2023] [Accepted: 04/07/2024] [Indexed: 05/18/2024] Open
Abstract
BACKGROUND Type 1 Diabetes Mellitus (T1DM) represents a serious chronic condition affecting a wide number of people. Discussion of the physical issues associated with T1DM pervades the literature, however, there is less discussion of the psychological consequences. Mental health difficulties, alexithymia and uncertainty are present in this population, and known to be harmful for the onset, maintenance and worsening of T1DM. This study aimed to evaluate the presence of these phenomena in people with T1DM. METHODS 105 participants aged between 11 and 17 years old (M: 13.88; SD: 2.16) affected by T1DM were included in the sample. To assess the presence of mental health difficulties, SAFA scales (Depression, Anxiety and Somatic symptoms) were included in the protocol together with TAS-20 and IUS-12, which evaluate the presence and role of alexithymia and intolerance to uncertainty in the sample, respectively. RESULTS A concerning presence of anxiety, depression and somatic symptoms was found in the sample. Mental health difficulties appeared to be consistently present in the sample, often overcoming pathological thesholds. Alexithymia and uncertainty were also common, highlighting their role in T1DM. CONCLUSIONS Active mental health difficulties together with high rates of alexithymia and intolerance to uncertainty were prevalent in the sample of adolescents with diabetes.
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Affiliation(s)
- Emanuele Maria Merlo
- Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy.
| | - Rita Tutino
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | | | - Maria Carmela Lia
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
| | - Domenico Minasi
- Pediatric Unit of Ospedali Riuniti Presidium, Grande Ospedale Metropolitano Bianchi Melacrino Morelli, Reggio Calabria, Italy
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Yeheyis T, Hoyiso D, Ekubazgi KW, Chura GK, Alemayehu Y. The Pattern of Initial Presentation of Diabetes, Treatment Outcome and Its Predictors Among Diabetic Pediatrics Attended Service at Selected Public Hospitals of Southern Ethiopia: A Multi-Center Study. Risk Manag Healthc Policy 2023; 16:2485-2495. [PMID: 38024493 PMCID: PMC10676097 DOI: 10.2147/rmhp.s437361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/17/2023] [Indexed: 12/01/2023] Open
Abstract
Background Diabetes mellitus is the most common metabolic disorder in the pediatric population. Globally the incidence of diabetes increased from 11.3 million (95% UI 10.6-12.1) in 1990 to 22.9 million (21.1-25.4) in 2017, with a 102.9% increase and there was a 3% increase in diabetes mortality rates by age between 2000 and 2019. Objective This study aims to assess the pattern of initial presentation of pediatric diabetes mellitus, treatment outcome, and its predictors among pediatrics who attended service at selected public hospitals in southern Ethiopia from 2015 to 2019. Methods A cross-sectional study was conducted among 422 randomly selected pediatrics from October 1st, 2021 to December 30, 2021, and participants were selected randomly from 8 randomly selected public hospitals in southern Ethiopia after proportional to client flow allocation of samples. Data was extracted from clients' charts using a data extraction checklist. Statistical Package for Social Sciences (SPSS) version 24, and logistic regression analysis were applied to determine the presence of an association between dependent and independent variables, and significance was declared at p-value <0.05. Results In this study, most (74.6%) of the pediatrics initially presented with Diabetic ketoacidosis (DKA). This study found that Two-thirds (67.1%) of the respondents in the study had a good treatment outcome. In this study residence, presenting signs and symptoms; poly symptoms and weight loss, history of hospitalization, and comorbidity were predictors of treatment outcome of pediatric diabetes mellitus. Conclusion Diabetes mellitus with Diabetic ketoacidosis is the predominant pattern of initial presentation in the study. The magnitude of poor treatment outcomes of diabetes mellitus among pediatrics in this study is high and unacceptable Residence, signs, and symptoms at initial presentation, history of hospitalization, and comorbidity were found to be significant independent predictors of treatment outcome of pediatric diabetes mellitus.
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Affiliation(s)
- Tomas Yeheyis
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Dawit Hoyiso
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
| | - Kinfe Woldu Ekubazgi
- School of medicine, College of Medicine and health sciences, Hawassa University, Hawassa, Ethiopia
| | - Gemechu Kediro Chura
- Department of Nursing, College of medicine and health sciences, Meda Welabu University, Shashemene, Ethiopia
| | - Yonas Alemayehu
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, Hawassa, Ethiopia
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Filho OCDSB, Peres WAF, Spinelli RR, Peniche BX, Silverio RN, da Costa VM, Luescher JL, Ribeiro SML, Vicente BM, Cunha LVSD, Padilha PDC. Evaluation of the dietary inflammatory index in children and adolescents with type 1 diabetes mellitus and its relationship with nutritional status and metabolic control. Nutrition 2023; 113:112082. [PMID: 37321044 DOI: 10.1016/j.nut.2023.112082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 04/30/2023] [Accepted: 05/13/2023] [Indexed: 06/17/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the association of the dietary inflammatory index (DII) with the nutritional status and metabolic control of children and adolescents with type 1 diabetes mellitus. METHODS This was a cross-sectional study that examined data of children and adolescents ages 7 to 16 y diagnosed with type 1 diabetes mellitus. Dietary intake was assessed using a 24-h dietary recall, from which the DII was calculated. The outcomes were body mass index, lipid profiles (low-density lipoprotein cholesterol and non-high-density lipoprotein cholesterol), and glycated hemoglobin. The DII was evaluated in tertiles and in a continuous way. Multiple linear regression was adopted in the analysis, with P < 0.05 considered significant. RESULTS Overall, 120 children and adolescents with a mean age of 11.7 (± 2.8) y were included, 53.3% (n = 64) of whom were girls. Excess weight was present in 31.7% participants (n = 38). The average DII was +0.25, ranging from -1.11 to +2.67. Higher values of selenium (P = 0.011), zinc (P = 0.001), fiber (P < 0.001), and other micronutrients were observed in the first tertile of the DII (diet with more antiinflammatory potential). The DII appeared as a predictor of body mass index (P = 0.002; β = 0.23; 95% confidence interval [CI], 0.39-1.75) and non-high-density lipoprotein cholesterol (P = 0.034; β = 0.19; 95% CI, -13.5 to 0.55). There was a tendency for DII to be associated with glycemic control (P = 0.09; β = 0.19; 95% CI, -0.04 to 0.51). CONCLUSIONS The inflammatory potential of the diet was associated with increased body mass index and aspects related to metabolic control in children and adolescents with type 1 diabetes mellitus.
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Affiliation(s)
| | | | - Renata Ribeiro Spinelli
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | - Beatriz Xavier Peniche
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | | | - Veronica Medeiros da Costa
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | - Jorge Luiz Luescher
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil
| | | | | | | | - Patricia de Carvalho Padilha
- Instituto de Puericultura e Pediatria Martagão Gesteira, Universidade Federal do Rio de Janeiro (IPPMG/UFRJ), Rio de Janeiro, Brazil; Instituto de Nutrição Josué de Castro, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
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Pecoli PFG, Rosa ADS, Gabbay MAL, Dib SA. Psycho-Behavioral Characteristics Perceived as Facilitators by Brazilian Adults with Type 1 Diabetes Mellitus in a Public Health Service. Healthcare (Basel) 2023; 11:2300. [PMID: 37628498 PMCID: PMC10454162 DOI: 10.3390/healthcare11162300] [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: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/27/2023] Open
Abstract
Type 1 diabetes imposes a complex and challenging routine on patients and caregivers. Therefore, considering individual experiences and personal facilitators to promote assertive interventions is crucial. However, no studies have addressed these perspectives in the Brazilian adult population. We aimed to identify psycho-behavioral characteristics perceived as facilitators for coping with the condition. We used a biographical method to conduct semi-structured, face-to-face, in-depth interviews for each participant. Transcripts were analyzed using inductive thematic analysis. Participants (n = 22) were aged 18-57 years (mean: 30.2; standard deviation (SD): 8.7), and the duration since diagnosis was approximately 20.6 years (SD: 4.6). A total of 12 (54.4%) were women, 13 (59.1%) used insulin pumps, 14 (63.6%) had at least a college degree, and 13 (59.1%) had HbA1C (glycated hemoglobin) levels above 58 mmol/mol (7.5%). Five major themes emerged: (1) peer learning, (2) ownership, (3) welcoming experiences, (4) equity, and (5) reframing the path (P.O.W.E.R.). All themes appeared in the lived experiences shared by participants with HbA1C levels below 58 mmol/mol (7.5%). Improved glycemic control can be achieved, and the challenges encountered in diabetes care within similar socioeconomic contexts can be addressed by an interdisciplinary care team that takes P.O.W.E.R. into consideration when providing person-centered care strategies.
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Affiliation(s)
| | | | - Mônica Andrade Lima Gabbay
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
| | - Sérgio Atala Dib
- Diabetes and Endocrinology Center, Internal Medicine Department, Universidade Federal de São Paulo, São Paulo 04039-032, Brazil
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Senbanjo IO, Akinola IJ, Umar UI, Anyabolu CH, Abolurin OO, Adekoya AO, Adeniyi OF, Adepoju AA, Salisu MA, Gwarzo GD, Olorunmoteni OE, Ugowe OJ, Suwaid S, Ashubu OO, Fetuga MB, Oduwole AO. Children and adolescents with type 1 diabetes mellitus in Nigeria: clinical characteristics and compliance with care. J Pediatr Endocrinol Metab 2022; 35:1377-1384. [PMID: 36148598 DOI: 10.1515/jpem-2022-0290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 09/01/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The prevalence of type 1 diabetes mellitus (T1DM) is increasing in most developed and developing countries. This study described the clinical characteristics and compliance with care among Nigerian children and adolescents with T1DM. METHODS This was a cross-sectional descriptive multi-center study of children seen at the paediatric endocrinology clinic of seven selected tertiary health facilities in Nigeria. Information was collected on socio-demographics, clinical characteristics and compliance of the children with dietary recommendations and insulin therapy. Compliance with dietary recommendations and insulin therapy was graded as either good or poor based on defined criteria. RESULTS The mean age of children was 13.1 ± 4.7 years. The mean age of children at the diagnosis of T1DM was 9.9 ± 4.2 years. Sixty-nine (60%) children were female while about half (47.8%) of the children were from the lower socioeconomic class. Compliance with insulin administration was good in 39.1% of the children and was significantly associated with the father's (p=0.001) and mother's educational status (p=0.024) while compliance with dietary recommendations was good in 20.0% of the children and was significantly associated with mother's educational status (p=0.034) and family socioeconomic class (p=0.010). Only the mother's level of education was independently and significantly associated with compliance to recommendations on insulin therapy (OR 4.2, 95% CI=1.5-11.6, p=0.007). CONCLUSIONS The compliance of children with dietary recommendations and insulin therapy was poor. Efforts should be strengthened at all healthcare facilities to educate parents on the need for compliance with management guidelines.
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Affiliation(s)
- Idowu O Senbanjo
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Ibironke J Akinola
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Umar I Umar
- Department of Paediatrics, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | - Chineme H Anyabolu
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | | | - Adesola O Adekoya
- Department of Paediatrics, Babcock University Teaching Hospital, Ilishan-Remo, Nigeria
| | - Olufunmilayo F Adeniyi
- Department of Paediatrics, College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
| | - Akinlolu A Adepoju
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Mohammad A Salisu
- Department of Paediatrics and Child Health, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
| | - Garba D Gwarzo
- Department of Paediatrics, Aminu Kano University Teaching Hospital, Kano, Nigeria
| | | | - Osagie J Ugowe
- Department of Paediatrics, Obafemi Awolowo University Teaching Hospital, Ile-Ife, Nigeria
| | - Salma Suwaid
- Department of Paediatrics, Murtala Mohammed Specialist Hospital, Kano, Nigeria
| | - Oluwakemi O Ashubu
- Department of Paediatrics, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | - Musili B Fetuga
- Departments of Paediatrics, Obafemi Awolowo College of Health Sciences, Olabisi Onabanjo University, Sagamu, Nigeria
| | - Abiola O Oduwole
- Department of Paediatrics, College of Medicine, University of Lagos, Akoka, Lagos, Nigeria
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Corrêa CDC, Maximino LP, Abramides DVM, Weber SAT. Oral language skills in Brazilian children with obstructive sleep apnea. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 128:104300. [PMID: 35810542 DOI: 10.1016/j.ridd.2022.104300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 05/22/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obstructive sleep apnea (OSA) is associated with a negative impact on neurocognitive development in children. Receptive/expressive oral language is a complex process, with limited investigations on the repercussion of OSA. This study aimed to analyze receptive and expressive oral language skills in children with obstructive sleep apnea (OSA). METHODOLOGY This study included 52 children (27 females, 51.92 %) with a mean age of 7 ± 2 years (age range of 4-11 years), which underwent type 3 polysomnography (PSG). The participants were divided into N-OSA (n = 16) and OSA (n = 36) groups based on the apnea-hypopnea index. The speech-language therapist evaluated hearing and oral language for phonology, expressive semantics, syntax, receptive semantics (Peabody Image Vocabulary Test), pragmatics, and understanding of verbal instructions (Token Test). RESULTS Oral language assessments showed a difference in the pragmatics subsystem (p = 0.047), with positive correlation between OSA severity and oral language functions such as pragmatics and syntax (desaturation index, p = 0.045). CONCLUSION Obstructive sleep apnea (OSA) had a negative impact on oral language skills, including the syntax and pragmatics subsystems.
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Affiliation(s)
| | - Luciana Paula Maximino
- Department of Speech-Language Pathology at Dentistry School of Bauru (FOB-USP), Bauru, SP, Brazil.
| | | | - Silke Anna Theresa Weber
- Department of Ophthalmology and Otorhinolaryngology, Botucatu Medical School, UNESP, Botucatu, SP, Brazil.
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Lohiya NN, Kajale NA, Lohiya NN, Khadilkar VV, Gondhalekar K, Khadilkar A. Diabetes distress in Indian children with type 1 diabetes mellitus and their mothers. J Pediatr Endocrinol Metab 2021; 34:209-216. [PMID: 33180040 DOI: 10.1515/jpem-2020-0339] [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: 06/08/2020] [Accepted: 09/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children and their mothers, who are usually the primary caregivers, are likely to be distressed due to type 1 diabetes (T1DM). OBJECTIVES (1) To assess diabetes-specific distress (DD) perceived by children and adolescents with T1DM and their mothers and association of distress between children and mothers. (2) To study the association of diabetes distress with glycemic control and disease duration. SUBJECTS Children and adolescents with T1DM over eight years and their mothers. METHODS Clinical data were recorded. DD was assessed by Problem Associated in Diabetes-Pediatric (PAID-Peds) (range 0-80) and Problem Associated in Diabetes-Parents Revised (PAID-PR) (range 0-72) questionnaires (higher scores indicate higher distress); administered to children and mothers, respectively. Sub-dimensions in questionnaires included diabetes-related emotional problems, and treatment-, food-, and social support-related problems. Correlation analysis (Spearman's) was performed, and a paired t-test was used to compare PAID-Peds and PAID-PR (SPSS 25). RESULTS Mean PAID-Peds and PAID-PR scores in 67 children and mothers were 24.4 ± 18.1 and 31.9 ± 21.5, respectively (p=0.009), and a significant correlation was noted between their scores (R=0.45, p=0.001). PAID-Peds score was positively associated with HbA1c (R=0.25, p=0.04). Diabetes-related emotional problems of mothers and children (R=0.38, p=0.003), treatment problems (R=0.5, p=0.001), and food problems (R=0.24, p=0.05) correlated positively. Subdimension scores were significantly different in children and mothers except in the social support domain. CONCLUSION DD was higher in mothers than children; higher distress in children was associated with poor metabolic control. Evaluation of DD needs to be performed in children with T1DM.
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Affiliation(s)
- Nirali N Lohiya
- Developmental and Behavioural Pediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Neha A Kajale
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Nikhil N Lohiya
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Vaman V Khadilkar
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
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Grudziąż-Sękowska J, Zamarlik M, Sękowski K. Assessment of Selected Aspects of the Quality of Life of Children with Type 1 Diabetes Mellitus in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042107. [PMID: 33671503 PMCID: PMC7926510 DOI: 10.3390/ijerph18042107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. T1D is not only a medical challenge, but it also affects all areas of a sick child's life and family functionality. New forms of therapy facilitate the daily management of the disease, but their availability is limited and partly dependent on socioeconomic status. This study aimed to assess the incidence and interrelationships between the child's health condition and the applied therapy model, and selected aspects of the child's family functionality and access to health and care services. The survey involved 206 child and youth caregivers with T1D who are members of Facebook support groups. The analysis of the obtained results revealed the existence of links between family income level and the type of insulin therapy applied. Children from families with a better financial situation (subjective and objective) were more likely to have additional medical consultations and make more frequent control visits. In families with a higher level of income, the T1D-induced restriction of child activity was less frequent. Living outside of urban centers was associated with a reduced availability of care or educational facilities adapted to take care of a child with T1D. No statistically significant correlations were observed between demographic and economic factors and the child's health status expressed by the occurrence of complications. The incidence of the latter, however, affected the child's family situation.
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Affiliation(s)
- Justyna Grudziąż-Sękowska
- Centre of Postgraduate Medical Education, School of Public Health, 01-813 Warsaw, Poland
- Correspondence: ; Tel.: +48-225-601-150
| | - Monika Zamarlik
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University, 31-007 Kraków, Poland;
| | - Kuba Sękowski
- Doctoral School, Law College, Kozminski University, 03-301 Warsaw, Poland;
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Shah N, Khadilkar A, Gondhalekar K, Khadilkar V. Prevalence of dyslipidemia in Indian children with poorly controlled type 1 diabetes mellitus. Pediatr Diabetes 2020; 21:987-994. [PMID: 32506728 DOI: 10.1111/pedi.13063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/09/2020] [Accepted: 05/31/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Children with type 1 diabetes having dyslipidemia are at increased risk of developing premature atherosclerosis and cardiovascular disease. The present study aims to determine the prevalence of dyslipidemia and its predictors in poorly controlled Indian children with type 1 diabetes. METHODS The cross-sectional study included 235 children and youth (3-18 years) with type 1 diabetes having disease duration of at least 1 year. Demographic data and laboratory findings were obtained from patients' records. RESULTS The prevalence of dyslipidemia in our study was 47.2% with abnormal low-density lipoprotein cholesterol being the most common lipid abnormality. Poor glycemic control and higher thyroid stimulating hormone values were important predictors of likelihood of dyslipidemia and hypertriglyceridemia. Despite a low percentage of overweight and obese children in our study, body fat percentage was a significant predictor of likelihood of high total cholesterol and abnormal high-density lipoprootein. Interestingly, 28 children under the age of 10 years were found to have dyslipidemia, which constitutes 11.9% of the total study group. CONCLUSIONS We found a high prevalence of dyslipidemia in children with type 1 diabetes including children under age of 10 years, which emphasize the need for early screening and regular monitoring of lipid profile in these children.
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Affiliation(s)
- Nikhil Shah
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India.,Interdiscplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, 411007, India
| | - Ketan Gondhalekar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India
| | - Vaman Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411001, India.,Interdiscplinary School of Health Sciences, Savitribai Phule University, Pune, Maharashtra, 411007, India
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Guo J, Yang J, Wiley J, Ou X, Zhou Z, Whittemore R. Perceived stress and self-efficacy are associated with diabetes self-management among adolescents with type 1 diabetes: A moderated mediation analysis. J Adv Nurs 2019; 75:3544-3553. [PMID: 31441523 DOI: 10.1111/jan.14179] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 07/15/2019] [Accepted: 08/03/2019] [Indexed: 02/06/2023]
Abstract
AIMS The aims of this study were to: (a) determine if self-efficacy mediates the relationship between perceived stress and diabetes self-management in adolescents with type 1 diabetes (T1D); and (b) explore whether perceived stress moderated the self-efficacy and diabetes self-management relationship. DESIGN Non-experimental, descriptive correlational design, conducted from January-December 2016. METHODS Guided by the Adaptation to Diabetes framework, data on demographic and clinical characteristics, perceived stress, self-efficacy and diabetes self-management were collected. Descriptive analyses and regression analyses were generated by SPSS Version 22. Structural equation modelling was implemented with the MPlus program. RESULTS There was no direct effect of perceived stress on diabetes self-management; however, self-efficacy mediated the relationship between perceived stress and diabetes self-management. Adolescents who had high self-efficacy and low perceived stress demonstrated better diabetes care activities and diabetes communication than would be predicted from the main effects of self-efficacy and perceived stress alone. CONCLUSIONS Decreasing perceived stress and improving self-efficacy are important strategies to improve diabetes self-management in adolescents with T1D. IMPACT Adolescents with T1D experience considerable stress with daily self-management demands. This study highlights the mediating role of self-efficacy on perceived stress and diabetes self-management. Assessment of perceived stress and self-efficacy in self-management tasks in adolescents with T1D may help nurses individualize self-management education and support. Incorporating strategies to promote stress management and self-efficacy in diabetes education may also improve diabetes self-management.
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Affiliation(s)
- Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Jundi Yang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - James Wiley
- School of Nursing, University of California San Francisco, San Francisco, California
| | - Xiancai Ou
- School of Business, XingJian College of Science and Liberal Arts of Guangxi University, Nanning, Guangxi Province, China
| | - Zhiguang Zhou
- Diabetes Center, Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University, Changsha, China
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Piechowiak K, Szypowska A. Physiological factors influencing diabetes control in type 1 diabetes children with insulin pumps from diagnosis. Diabetes Metab Res Rev 2019; 35:e3086. [PMID: 30325106 DOI: 10.1002/dmrr.3086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to identify the physiological factors influencing diabetes control in children with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) from diabetes diagnosis. METHODS This study focused on 163 children (81 boys) initiated with CSII within 2 weeks after T1D recognition and treated for at least 3 years. We analysed fasting C-peptide, GADA, ICA, IA2A, BMI z-score, total daily dose, and basal insulin. Patients were divided into groups according to their metabolic control: 7.5% > HbA1c ≥ 7.5% at the end of the study. RESULTS At the end of the follow-up, patients with HbA1c <7.5%, had a lower HbA1c level at diagnosis (11.7% vs 12.6%; P = 0.018), lower HbA1c level at both the first-year (6.7% vs 7.3%; P = 0.000) and the second-year (6.8% vs.7.7%; P = 0.000) follow-up, and a lower GADA level (P = 0.001). A multiple logistic regression analysis showed that HbA1c at diagnosis (P = 0.012), HbA1c at first year (P = 0.000), HbA1c at second year (P = 0.000), age at diagnosis (P = 0.047), GADA (P = 0.031), and basal insulin at third year (P = 0.032), influenced HbA1c <7.5% at the third year of follow-up. At the end of the study, 76% of patients started with CSII at the age <10 years and 49% of subjects initiated with CSII at the age ≥10 years achieved HbA1c ≤7.5%. CONCLUSIONS This study shows that for those who initiated CSII at T1D onset, younger age, less intense autoimmune process, a low HbA1c at recognition, and good diabetes control during the first year of treatment were associated with long-term optimal glycaemic control.
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Calcaterra V, Winickoff JP, Klersy C, Schiano LM, Bazzano R, Montalbano C, Musella V, Regalbuto C, Larizza D, Cena H. Smoke exposure and cardio-metabolic profile in youth with type 1 diabetes. Diabetol Metab Syndr 2018; 10:53. [PMID: 29989097 PMCID: PMC6035465 DOI: 10.1186/s13098-018-0355-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/28/2018] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND To evaluate the relationship between smoking and metabolic parameters in patients affected by type 1 diabetes (T1D). PATIENTS AND METHODS We enrolled 104 children and young adults (50 females and 54 males) with T1D (aged 16.4 ± 8.6 years). The subjects were divided into three groups according to their smoking habits: no smoking (NS), passive smoking (PS), active smoking (AS). The physical examination of the participants included nutritional status assessment by anthropometry and pubertal stage according to Marshall and Tanner as well as blood pressure measurement. In all patients, metabolic blood assays including fasting blood glucose, insulin, total cholesterol, high-density lipoprotein cholesterol, and triglycerides were measured. Insulin resistance was determined by glucose disposal rate (eGDR). Physical activity was also recorded. RESULTS Significant differences in biochemical and functional parameters among the three groups were demonstrated, in particular for systolic (p = 0.002) and diastolic pressure (p = 0.02) and eGDR (p = 0.039). No differences in daily insulin dose (p = 0.75) and glycated hemoglobin (p = 0.39) were observed. AS group had significantly higher blood pressure (p < 0.05) and lower eGDR (p ≤ 0.001) compared to NS and PS. Significant difference was also detected between PS and NS in systolic and diastolic (p = 0.02) pressure and eGDR (p = 0.01). In a multivariable model adjusted for age, gender, BMI and physical activity, smoking habits did not maintain any independent association with metabolic parameters. CONCLUSION This is the first study in a Mediterranean population, looking at tobacco smoke and cardio-metabolic factors in youth with T1D. The relationship between smoking and unfavorable metabolic profile was demonstrated. On the basis of these findings, smoking tobacco should be considered an important modifiable risk factor for young patients with diabetes mellitus, highlighting the need for intensified smoking prevention and cessation programs.
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Affiliation(s)
- Valeria Calcaterra
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Jonathan P. Winickoff
- Department of Pediatrics, Harvard Medical School, MassGeneral Hospital for Children, Boston, MA USA
| | - Catherine Klersy
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Luca Maria Schiano
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Rossella Bazzano
- Department of Public Health, Experimental and Forensic Medicine, Laboratory of Dietetics and Clinical Nutrition, University of Pavia, Pavia, Italy
| | - Chiara Montalbano
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Valeria Musella
- Biometry & Clinical Epidemiology, Scientific Direction, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Corrado Regalbuto
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Daniela Larizza
- Pediatric and Adolescent Unit, Department of Internal Medicine and Therapeutics, University of Pavia, Pavia, Italy
- Pediatric Endocrinology Unit, Department of Maternal and Children’s Health, Fondazione IRCCS Policlinico San Matteo, P.Le Golgi n.2, 27100 Pavia, Italy
| | - Hellas Cena
- Department of Public Health, Experimental and Forensic Medicine, Laboratory of Dietetics and Clinical Nutrition, University of Pavia, Pavia, Italy
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