Smoking and metabolic control in adolescents with type 1 diabetes

Changes in cardiovascular risk factors among children and young adults with type 1 diabetes during the COVID-19 pandemic compared to previous years-Results from the German DPV registry

BACKGROUND

The diverse stages of the COVID-19 pandemic led to several social circumstances that influenced daily life and health behavior.

PURPOSE

To evaluate changes in cardiovascular risk factors and physical activity among children and young adults with type 1 diabetes (T1D) during the COVID-19 pandemic in Germany compared to previous years.

METHODS

A total of 32 785 individuals aged 6-21 years at baseline with T1D from the German diabetes patient follow-up (DPV) registry contributed data on 101 484 person-years between 2016 and 2021. The first treatment year of each individual within this period was considered as baseline. Based on trends from 2016 to 2019, we estimated differences in body mass index-SD score (BMI-SDS), blood pressure (BP-SDS), and lipid levels (non-high-density lipoprotein [non-HDL]) between observed and predicted estimates for the years 2020 and 2021 using linear regression analysis standardized for age, diabetes duration, sex, and migratory background. The proportion doing organized sports and smoking cigarettes was analyzed using multivariable logistic regression models.

RESULTS

BMI-SDS increased constantly from 2016 to 2021 without a significant increase above expected values for 2020/2021. Systolic BP-SDS (difference observed vs. expected with 95% confidence interval, 2020: 0.10 [0.07-0.14], 2021: 0.17 [0.14-0.20]) and non-HDL (2020: 2.7 [1.3-4.1] mg/dl, 2021: 4.1 [2.7-5.5] mg/dl) were significantly increased (all p < .001) in both pandemic years. The proportion of subjects participating in organized sports was reduced from over 70% in prepandemic years to 35%-65% in diverse stages/waves of the COVID-19 pandemic. The percentage smoking cigarettes did not change.

CONCLUSIONS

We describe an increase in BP and atherogenic lipid levels coinciding with a reduction in physical activity but no acceleration of the prepandemic increases in BMI-SDS among young people with T1D during the COVID-19 pandemic.

Typ-1-Diabetes und kardiovaskuläre Risikofaktoren bei Kindern und Jugendlichen

Die langfristigen kardiovaskulären Folgen des Typ-1-Diabetes determinieren die Lebenserwartung betroffener Kinder und Jugendlicher. Risikofaktoren für deren Entwicklung sind eine längere Diabetesdauer bzw. Diabetesmanifestation im frühen Lebensalter, Hypertonie, Rauchen, hoher BMI sowie Fettstoffwechselstörungen. Das Management der kardiovaskulären Risikofaktoren bei Kindern und Jugendlichen mit Typ-1-Diabetes beinhaltet zum einen Screeningsmaßnahmen zur frühzeitigen Aufdeckung der pathologischen Veränderungen und zum anderen eine Lebensstilanpassung im Sinne einer ausgewogenen, normokalorischen Ernährung, regelmäßiger Bewegung sowie ggf. einer medikamentösen lipid- bzw. blutdrucksenkenden Therapie.

Die Leitlinien und Empfehlungen zur standardisierten Erkennung und Behandlung kardiovaskulärer Risikofaktoren bei jungen Menschen mit Typ-1-Diabetes sind bisher uneinheitlich formuliert und werden deshalb nicht immer im klinischen Alltag angewendet bzw. umgesetzt. Dies führt zu einer relevanten Unterversorgung dieser Patientengruppe. Dem gilt es mit mehr Forschungsansätzen und der Entwicklung eines universellen Prozederes zur Diagnostik und Therapie der kardiovaskulären Risikofaktoren entgegenzuwirken.

Sexual Risk Behaviors of Adolescents with Type 1 Diabetes in Comparison with Their Peers

BACKGROUND

Adolescents with type 1 diabetes mellitus (T1D) may differ from peers regarding sexual risk behaviors.

OBJECTIVES

To explore sexual risk behaviors of adolescents with T1D in comparison with peers.

MATERIALS AND METHODS

The subjects were 174 adolescents, 58 adolescents with T1D (mean ± SD age 16.3 ± 2.0 yrs, disease duration 6.7 ± 3.5 yrs and HbA1c:8.0 ± 1.3%) and 116 without (matched 1:2). Anonymous, self-reported questionnaires were used to evaluate sexual education and behaviors.

RESULTS

Fewer adolescents with T1D than those without had a sexual experience (74.1% vs. 87.4%, p = 0.033), with similar age of sexual debut. Among adolescents with T1D, ≥2 risky behaviors were observed less frequently than adolescents without T1D (8.62% vs. 23.27%, p = NS respectively) and in fewer girls than boys in both adolescents with T1D (0% vs. 18.5%, p = NS) and adolescents without T1D (11% vs. 44%, p = 0.022). Adolescents with T1D with ≥2 risky behaviors were older (p = 0.031), younger at first sexual intercourse (p = 0.031), with higher maternal education (p = 0.039). Early sexual debut was associated with higher maternal education (p = 0.014) and HbA1c (p = 0.049). Most adolescents without T1D with ≥2 risky behaviors were boys and older than peers.

CONCLUSIONS

Adolescents with T1D and females were more cautious than adolescents without T1D regarding sex. The associations of increased risky behaviors with male gender, older age, younger age at sexual debut and higher maternal education in adolescents with T1D merit further investigation.

Factors related to glycemic control in children and adolescents with type 1 diabetes mellitus in Isfahan, Iran

PURPOSE

Glycemic control is traditionally evaluated by monitoring of hemoglobin A1c (HbA1c). This study aims to explore factors related to glycemic control among pediatrics with type 1 diabetes mellitus (T1DM).

METHODS

This cross-sectional study was conducted among 454 students aged 6-18 years with T1DM in 2018. Demographic and disease related information were collected by a validated questionnaire. Generalized Linear Models (GLM) were used to investigate the association of explanatory variables with HbA1c concentration.

RESULTS

The mean (SD) age of the participants was 11.7(± 3.3) years. The overall prevalence of suboptimal glycemic control was 85.5% (HbA1c ≥ 7%). Results showed that post pubertal children experienced a significant decrease in HbA1c levels compared to prepubertal children (β =-0.83, p = 0.003). Underweight children had an increase of 1.32% in HBA1c concentration compared with normal weight children (β = 1.32, P = 0.007). We also found that participants with passive smoking had higher HBA1c levels than those without (β = 0.536, P = 0.022).

CONCLUSIONS

The results indicated that age, BMI and passive smoking and were significantly associated with HbA1c levels. It is suggested that glycemic control is related to multiple factors and the interaction of these factors with each other may have positive or negative effects on it which should be investigated in future studies. Improved understanding in this area could lead to prevention of deterioration in glycemic control.

Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes

Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.

The presence of microvascular complications is associated with a poor evolution of metabolic control in patients with type 1 diabetes mellitus

OBJECTIVE

To report the evolution of metabolic control and to assess the clinical and metabolic factors associated with the presence of microvascular complications in patients with type 1 diabetes mellitus (T1DM).

MATERIAL AND METHODS

This was a retrospective, observational study analysing clinical, laboratory, and therapeutic data from a registry of patients with T1DM created in 2010.

RESULTS

Data recorded from 586 patients (males: 50.2%; mean age: 36.1±13.5 years; T1DM duration: 18.0±12.1 years) followed for a mean of 6.0±3.1 years were assessed, and 8133 HbA1c levels (13.2±7.6 measurements/patient) were analysed, with a mean evolutionary HbA1c of 7.9%±1.2%. The mean annual HbA1c level gradually improved from 8.6%±1.6% in 2010 to 7.5%±1.4% in 2019, with 34.3% and 69.0% of patients having HbA1c levels ≤7% and ≤8% respectively. Patients with T1DM duration of <10 years and ≥20 years, non-smokers, CSII users, and those using the insulin/carbohydrate ratio had better current and evolutionary HbA1c levels. The presence of microvascular complications was independently associated with T1DM lasting ≥20 years, the presence of HBP, and evolutionary HbA1c≥7.0%.

CONCLUSION

A progressive but still inadequate improvement in metabolic control over 10 years was seen in patients with T1DM. Poor metabolic control (mean HbA1c over 10 years ≥7%) was independently associated with the presence of microvascular complications.

The importance of low HbA1c during childhood on glycaemic control in adulthood and the risk of late complications

AIM

To evaluate whether a very low glycated haemoglobin A (HbA1c) (<48 mmol/mol, 6.5%) during childhood compared to higher HbA1c values further decreases the risk for microvascular complications.

METHODS

Data were included from the 5116 patients with type 1 diabetes transferred from the Swedish paediatric diabetes quality registry to the Swedish National Diabetes Register (NDR), until 2014. All HbA1c values ever registered in the paediatric registry were used to divide patients into six groups based on the mean HbA1c. Values were compared with HbA1c registered in 2013 and 2014 in NDR, together with data on retinopathy, micro- and macroalbuminuria, age at onset and duration of diabetes.

RESULTS

The group with lowest mean-HbA1c during childhood had also the lowest mean as young adults during 2013 and 2014. The most common complication as young adults was retinopathy. The proportion with macroalbuminuria was 3% in the lowest HbA1c group during childhood and 3.9% in the highest group, and lower in the groups in between. Microalbuminuria had the same pattern. Retinopathy increased with each HbA1c group.

CONCLUSION

Children with the lowest HbA1c values had the lowest HbA1c values as adults. HbA1c was associated with retinopathy but the relationship with albuminuria was not obvious.

The Effects of Risk Behaviors and Orthorexic Behavior on Glycemic Control in Adolescents with Type 1 Diabetes

Objective

Adolescents with chronic disease are as likely to exhibit risk-taking behavior as their peers. The aim was to investigate the risk behaviors of adolescents with type 1 diabetes (T1D) and the effect of orthorexic eating behaviors (OEB) on glycemic control (GC).

Methods

This cross-sectional study was conducted with 107 adolescents with T1D, aged between 13-18 years and attending high school. The Risk Behavior Scale (RBS) and Orthorexic Behavior Scale (ORTO-11) were administered. A high RBS score indicates risky behavior; a low ORTO-11 score suggests a tendency to OEB. Participants hemoglobin A1c (HbA1c) status was used to assess GC: optimal GC (HbA1c ≤7%); or poor GC (HbA1c >7%).

Results

Among females, those with poor GC had significantly lower (p=0.031) ORTO-11 scores than those with optimal GC, which was not the case in males. A significant correlation (r=0.358, p<0.001) was found between HbA1c and total RBS, eating habits subscale, and suicidal tendency subscale scores. Participants with poor GC had significantly higher eating habits subscale, alcohol use, and tobacco use subscale scores (p<0.05). Among females, total RBS and suicidal tendency subscale score was found to be significantly higher in those with poor GC; among males, alcohol subscale score was found to be significantly higher in those with poor GC.

Conclusion

This study is the first to show the effect of the tendency for OEB on GC among female adolescents with T1D. The study showed that, along with inappropriate eating behaviors, adolescents with T1D should also be assessed for other risk behaviors to help achieve optimal GC.

The effect of smoking on the risk of gestational diabetes mellitus and the OGTT profile during pregnancy

OBJECTIVE

To analyze the relationship between smoking and the risk of GDM, as well as with the OGTT profile during pregnancy.

PATIENTS AND METHODS

A total of 7437 pregnant women were studied. OGTT was performed at the 3rd trimester. Women were categorized as non-smokers (A), as those who ceased smoking at pregnancy (B), and as smokers (C).

RESULTS

5434 (73.1%) women were group A, 1191 (16%) group B and 812 (10.9%) group C. The rates of GDM among the groups were: A 33.7%, B 34.2%, C 34.2% (ns). However, the number of individuals requiring insulin treatment was significantly different: A 39.2%, B 47.5%, C 50.6% (p < 0.001). Regarding OGTT, fasting glucose levels were significantly higher in group C (89 ± 13 vs 86 ± 12 mg/dl) compared to A, whereas 3-h glucose values were significantly lower (104 ± 33 vs 112 ± 32 mg/dl) (p < 0.001). Group B demonstrated intermediate glucose concentrations. Similar findings were observed in women without GDM. In women with GDM, higher 1-h glucose levels were measured in group C (210 ± 31 vs 205 ± 28 mg/dl) compared with A (p = 0.024). Further, group C sub-analysis found that those who smoked more than 10 cigarettes showed significantly lower 3-h glucose levels (111 ± 31 vs 128 ± 40 mg/dl) compared to those who smoked less than 10 (p = 0.006). HbA1c in women with GDM was higher in group C (4.6 ± 0.6 vs 4.5 ± 0.6%) compared with A (p = 0.027).

CONCLUSIONS

The present study did not show any correlation between smoking and GDM risk. However, OGTT profile and HbA1c differed according to smoking status in women with and without GDM.

Health-risk Behaviors and Type 1 Diabetes Outcomes in the Transition from Late Adolescence to Early Emerging Adulthood

This study examined within- and between-person associations between health-risk behaviors (smoking, drinking, insulin withholding) and type 1 diabetes (T1D) outcomes (adherence and HbA1c) during the high-risk transition from late adolescence to early emerging adulthood utilizing a 2-year longitudinal study. Beginning in the senior year of high school, participants (n = 197) with T1D completed measures of health-risk behaviors, adherence, and HbA1c annually at three time points. Health-risk behaviors were associated with poorer diabetes outcomes during the transition from late adolescence to early emerging adulthood. These results highlight the importance of monitoring health-risk behaviors regularly and intervening to reduce health-risk behaviors during this important developmental transition.

Oral contraception in adolescents with type 1 diabetes and its association with cardiovascular risk factors. A multicenter DPV study on 24 011 patients from Germany, Austria or Luxembourg

OBJECTIVE

To investigate differences in cardiovascular risk factors and metabolic control in girls with type 1 diabetes with or without use of oral contraceptives (OC) from the multicenter "diabetes prospective follow-up" (DPV) registry.

METHODS

Twenty-four thousand eleven adolescent girls (13 to < 18 years of age) from Germany, Austria or Luxembourg with type 1 diabetes from the DPV registry were included in this cross-sectional study. Multivariable regression models were applied to compare clinical characteristics (hemoglobin A1c [HbA1_C ], blood pressure, serum lipids, body mass index) and lifestyle factors (smoking, physical inactivity, alcohol consumption) between girls with or without OC use. Confounders: age, diabetes duration and migration background.

STATISTICAL ANALYSIS

SAS 9.4.

RESULTS

In girls with type 1 diabetes and OC use, clinical characteristics and lifestyle factors were less favorable compared to non-users. Differences were most pronounced for the prevalence of dyslipidemia (OC-users: 40.0% vs non-users: 29.4; P < .0001) and the number of smokers (OC-users: 25.9% vs non-users: 12.5%; P < .0001). OC use, sociodemographic characteristics and lifestyle factors explained between 1 and 7% of the population variance in serum lipids and blood pressure. The use of OC explained a small additional proportion in all variables considered (<1%).

CONCLUSIONS

OC use in adolescent girls with type 1 diabetes was associated with a poorer cardiovascular risk profile. Biological risk factors were partly explained by a clustering of sociodemographic and lifestyle factors with a small additional contribution of OC use. Prescription of OC should therefore be combined with a screening for cardiovascular risk factors and targeted education.

Smoke exposure and cardio-metabolic profile in youth with type 1 diabetes

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.

Self-reported regular alcohol consumption in adolescents and emerging adults with type 1 diabetes: A neglected risk factor for diabetic ketoacidosis? Multicenter analysis of 29 630 patients from the DPV registry

BACKGROUND

The risk of hypoglycemia increases after alcohol consumption in patients with type 1 diabetes. This study aimed to investigate the association between metabolic control and self-reported alcohol consumption in young patients with type 1 diabetes.

MATERIALS AND METHODS

N = 29 630 patients with type 1 diabetes aged 12 to <30 years (median age 17.0 [14.9, 18.3] years, duration of diabetes 6.8 [3.3, 10.9] years, 53% male) from the German/Austrian DPV registry were analyzed. Patients were categorized into abstainers, low-risk drinkers, and at-risk drinkers. BMI, HbA1c, and rates of severe hypoglycemia (SH) and diabetic ketoacidosis (DKA) were compared between alcohol consumption groups using multivariable hierarchical regression models. The association between alcohol use and smoking status was assessed using χ ² test.

RESULTS

Overall, 10.8% of the patients reported regular alcohol consumption. Proportion of alcohol use as well as the amount of alcohol consumed increased with age and were higher in males than in females (all P < .05). Patients with Turkish migration background reported less alcohol consumption. HbA1c, SH rate, and DKA rate (adjusted for age, gender, duration of diabetes, therapy) were significantly lower in abstainers than in patients drinking alcohol (all P < .05). Smoking status was significantly associated with alcohol consumption (P < .001).

CONCLUSION

Self-reported alcohol consumption is likely to be underreported when collected in face-to-face settings such as doctors' visits. Nevertheless, our data revealed a significant association between higher alcohol consumption and worse glycemic control, in particular higher DKA rates. Information about alcohol-induced complications is of great importance in diabetes education in young people with type 1 diabetes.

Alcohol and cigarette use among adolescents with type 1 diabetes

In this study, we compare the prevalence of alcohol and cigarette use among Polish adolescents with type 1 diabetes mellitus (T1DM) (n = 209), aged 15-18 years, with that of a large cohort of their healthy peers, using standardized questionnaire used in the European School Survey Project on Alcohol and Drugs (ESPAD). The lifetime, previous year, and past 30-day prevalence of alcohol consumption was high among adolescents with T1DM but lower than in the controls (82.8 vs 92.0%, 71.7 vs 85.6%, and 47.5 vs 69.7%, respectively, p < 10^-5). The lifetime and 30-day prevalence of cigarette use was also lower among patients than the controls (54.6 vs 65.5%, p = 0.001 and 27.3 vs 35.9%, p = 0.012, respectively). Patients who admitted smoking exhibited worse metabolic control than non-smokers (p < 0.0001) and had a higher chance of developing diabetic ketoacidosis. The incidence of severe hypoglycemia was higher among those who reported getting drunk in the previous 30 days (p = 0.04) and lifetime smoking (p = 0.01).

CONCLUSIONS

Although alcohol and cigarette consumption is lower than in controls, it is common among teenagers with type 1 diabetes, effecting metabolic control and causing the risk of acute diabetes complications. Better prevention strategies should be implemented in this group of patients in their early teen years. What is Known: • Substance use remains a significant cause of morbidity and mortality among teenagers with type 1 diabetes. • Current medical literature contains inconsistent data on the prevalence of alcohol and cigarette use among adolescents with type 1 diabetes, mostly due to methodological problems with conducting such surveys. What is New: • Methodological approach: we used a validated questionnaire from the European School Survey Project on Alcohol and Other Drugs (ESPAD) and compared the results to a large national control group of 12,114 healthy students who took part in ESPAD in 2011.

Skin autofluorescence is increased in young people with type 1 diabetes exposed to secondhand smoking

Skin autofluorescence is increased in diabetes, rises with age, and predicts diabetes-related complications. Exposure to secondhand smoke, because one or more family members are smokers, further increases skin autofluorescence in children and young adults with type 1 diabetes. Elimination of passive smoking should be a goal in diabetes education. Association between age and skin autofluorescence (SAF), in arbitrary units (AU), in young people with type 1 diabetes exposed (black dots) and not exposed (open dots) to secondhand smoke. Regression lines show correlations between these parameters in exposed (solid line) and not exposed (dashed line) patients.

Associations of demographic and behavioural factors with glycaemic control in young adults with type 1 diabetes mellitus

BACKGROUND

Despite recognised benefits of optimal glycaemic control in patients with type 1 diabetes mellitus (T1DM), good control is still difficult to achieve, particularly for adolescents and young adults. Recognition of factors that may assist early optimisation of glycaemic control is therefore important.

AIMS

We explored associations of demographic, social and behavioural factors with glycosylated haemoglobin (HbA1c) levels in participants with T1DM aged 18-25 years.

METHODS

A cross-sectional analysis was performed on young adults attending a dedicated multidisciplinary clinic at Fremantle Hospital, Western Australia from January to August 2014.

RESULTS

Data from 93 participants were analysed. Mean age was 21.4 ± 2.3 years, and 39.8% of the cohort were female. Longer duration of diabetes was associated with higher HbA1c (r = 0.25, P = 0.04). Men had lower HbA1c than women (8.2 ± 1.6 vs 9.2 ± 2.0%, P = 0.01). Increased frequency of clinic attendance was associated with lower HbA1c (r = -0.27, P = 0.02). Those engaged in work or study had better HbA1c compared with those who were not (8.9 ± 2.1 vs 10.5 ± 2.1%, P = 0.03). Socioeconomic disadvantage, risk-taking behaviour, insulin pump use and distance travelled to clinic were not associated with differences in HbA1c.

CONCLUSION

In young adults with T1DM, geographical separation, socioeconomic disadvantage and risk-taking behaviours did not influence glycaemic control. Longer duration of diabetes identifies young adults at higher risk of poor control, while attendance at a multidisciplinary clinic and engagement in work or study was associated with better glycaemic control. Additional studies are warranted to clarify the role of behavioural interventions to improve diabetes management in young adults.

Relationship of cardiometabolic parameters in non-smokers, current smokers, and quitters in diabetes: a systematic review and meta-analysis

BACKGROUND

Smoking is associated with increased macrovascular and microvascular complications in people with diabetes. In addition to other concomitant vascular perturbations, it also seems to influence the cardiometabolic parameters, which may partly explain the accelerated rate of vascular complications in smokers with diabetes. While smoking cessation is advocated as a universal component of the management of diabetes, there is some anecdotal evidence that HbA1c could increase following smoking cessation. The aim of this review is to explore the relationship between smoking and its cessation on cardiometabolic parameters in diabetes.

METHODS

Searches were conducted on Medline, EMBASE and CINAHL up to March 2016. After screening 6866 studies (Additional file 1), 14 observational studies with a total of 98,978 participants' with either type 1 or type 2 diabetes were selected for review. Narrative synthesis and meta-analyses were carried out to explore the relationship between smoking and its cessation.

RESULTS

Meta-analysis showed that the pooled mean difference of HbA1c between non-smokers and smokers was -0.61% (95% CI -0.88 to -0.33, p < 0.0001). The difference in LDL cholesterol between non-smokers and smokers was -0.11 mmol/l (95% CI -0.21 to -0.01, p = 0.04). The difference in HDL cholesterol between non-smokers and smokers was 0.12 mmol/l (95% CI 0.08-0.15, p < 0.001). However, there was no statistically significant difference in blood pressure between the two groups. The difference in HbA1c between quitters and continued smokers was not statistically significant -0.10% (95% CI -0.42 to 0.21, p = 0.53). However, a narrative synthesis revealed that over a period of 10 years, the HbA1c was comparable between non-smokers and quitters.

CONCLUSION

Non-smokers have a statistically significant lower HbA1c and more favourable lipid profile compared to smokers. Smoking cessation does not lead to an increase in HbA1c in long-term and may reduce vascular complications in diabetes by its favourable impact on lipid profile.

Type 1 diabetes & cardiovascular disease

Individuals with type 1 diabetes mellitus (T1DM) have a high risk of developing cardiovascular disease (CVD), but some risk factors can be mediated by lifestyle modification and medication. NPs should understand evidence-based management approaches to counsel patients with T1DM on appropriate self-management interventions to reduce the likelihood of CVD.

Cardiovascular health in adults with type 1 diabetes

Adults with type 1 diabetes (T1D) are at risk for cardiovascular (CV) disease. Managing CV risk is an important prevention strategy. The American Heart Association has defined 7 factors for ideal CV health. The purpose of this 2016 secondary analysis was to assess the prevalence of 6 CV health factors in a sample of adults ≥18 (n=7153) in the T1D Exchange Clinic registry. CV health factors include: hemoglobin A1c (HbA1c) <7%, BMI<25kg/m2, blood pressure<120/80mmHg, total cholesterol <200mg/dL, non-smoking, and physical activity ≥150min/week. HbA1c<7% was substituted for the AHA health factor of fasting blood glucose. Frequencies of each factor were tabulated for the total sample and for each gender. Logistic regression examined variables associated with achievement of each CV health factor. The mean age was 37.14±17years. Mean HbA1c was 7.9±1.5%, and duration was 19.5±13.5years. The majority (54%) were working full or part-time. Achievement of CV health factors in the whole sample ranged from 27% (HbA1c<7%) to 94% nonsmoking. Achievement of some factors varied by gender. Common variables associated with several CV health factors included gender, education, employment, and T1D duration. This young sample exhibited low levels of some CV health factors, especially HbA1c and physical activity. Providers need to routinely assess and advise on management of all CV risk factors to prevent this common diabetes complication.

Smoking affects the oral glucose tolerance test profile and the relationship between glucose and HbA1c in gestational diabetes mellitus

AIMS

Current smokers in the general population have a lower 2 h plasma glucose after an oral glucose tolerance test (OGTT) and a higher HbA1c than non-smokers, but the relationships between OGTT/HbA1c and smoking status have not been addressed in pregnancy. We analysed glycaemic measurements in women with gestational diabetes mellitus in relation to smoking status.

METHODS

We performed a review of the prospectively collected database of the diabetes and pregnancy clinic. We included women with gestational diabetes mellitus and a singleton pregnancy who delivered between 1986 and 2006. Bivariate and multivariate analyses were used to evaluate patient characteristics in relation to smoking status.

RESULTS

A total of 2361 women met the inclusion criteria: 556 (23.5%) were active smokers, 266 (11.3%) quit during pregnancy and 1539 (65.2%) were non-smokers. Most baseline characteristics were similar across groups. Diagnostic OGTT was performed at a gestational age of [median (25th, 75(th) centiles)] 29 weeks (26, 33). Women who smoked at the beginning of pregnancy had a higher 1-h plasma glucose than non-smokers [11.8 (11, 12.7), 11.6 (11, 12.6) and 11.5 (10.8, 12.5) mmol/l, for active smokers, those who quit during pregnancy and non-smokers, respectively, P < 0.001] and a lower 3-h plasma glucose [7.3 (5.9, 8.4), 7.6 (6.4, 8.7) and 8.0 (6.8, 9.0) mmol/l, respectively, P < 0.001]. HbA1c was higher in women who smoked at the beginning of pregnancy. Multiple regression analysis confirmed the independent association of smoking status with HbA1c and OGTT plasma glucose.

CONCLUSIONS

In women with gestational diabetes mellitus who smoke at the beginning of pregnancy, the shape of the OGTT is consistent with accelerated glucose absorption, and HbA1c is higher than expected for glycaemic values.

Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults

AIMS

To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults.

METHODS

All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals.

RESULTS

Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p<0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p<0.001) and/or macroalbuminuria (p<0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age.

CONCLUSIONS

Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.

Association of diet and lifestyle with glycated haemoglobin in type 1 diabetes participants in the EURODIAB prospective complications study

BACKGROUND/OBJECTIVES

Diet and lifestyle advice for type 1 diabetes (T1DM) patients is based on little evidence and putative effects on glycaemic control. Therefore, we investigated the longitudinal relation between dietary and lifestyle variables and HbA1c levels in patients with type 1 diabetes.

SUBJECTS/METHODS

A 7-year prospective cohort analysis was performed in 1659 T1DM patients (52% males, mean age 32.5 years) participating in the EURODIAB Prospective Complications Study. Baseline dietary intake was assessed by 3- day records and physical activity, smoking status and alcohol intake by questionnaires. HbA1c during follow-up was centrally assessed by immunoassay. Analysis of variance (ANOVA) and restricted cubic spline regression analyses were performed to assess dose-response associations between diet and lifestyle variables and HbA1c levels, adjusted for age, sex, lifestyle and body composition measures, baseline HbA1c, medication use and severe hypoglycaemic attacks.

RESULTS

Mean follow-up of our study population was 6.8 (s.d. 0.6) years. Mean HbA1c level was 8.25% (s.d. 1.85) (or 66.6 mmol/mol) at baseline and 8.27% (s.d. 1.44) at follow-up. Physical activity, smoking status and alcohol intake were not associated with HbA1c at follow-up in multivariable ANOVA models. Baseline intake below the median of vegetable protein (<29 g/day) and dietary fibre (<18 g/day) was associated with higher HbA1c levels. Restricted cubic splines showed nonlinear associations with HbA1c levels for vegetable protein (P (nonlinear)=0.008) and total dietary fibre (P (nonlinear)=0.0009).

CONCLUSIONS

This study suggests that low intake of vegetable protein and dietary fibre are associated with worse glycaemic control in type 1 diabetes.

Longitudinal Correlates of Health Risk Behaviors in Children and Adolescents with Type 2 Diabetes

OBJECTIVES

To characterize, during a 2-year period, the proportion of youth with type 2 diabetes (T2D) enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth study that reported ever at least trying smoking cigarettes and/or drinking alcohol.

STUDY DESIGN

Longitudinal data were examined for participants with T2D ages 10-18 years at baseline. Youth psychosocial, parent/family, environmental, and biological correlates of trying health risk behaviors were tested via cross-sectional multivariate models at each time point. Longitudinal models were explored for selected factors.

RESULTS

Data were obtained from the Treatment Options for Type 2 Diabetes in Adolescents and Youth study's ethnically diverse participants at baseline (N=644), 6-month (N=616), and 24-month (N=543) assessments. The percentage of youth ever trying only smoking remained stable at 4%; only drinking alcohol increased from 17% to 26%, and both smoking and drinking increased from 10% to 18% during the 2-year period. Factors related to trying health risk behaviors were older age, male sex, non-Hispanic white race-ethnicity, lower grades, more depressive symptoms, and stressful life events. Depressive symptoms, stressful life events, and body mass index Z-score (the latter with smoking only) were related to engagement in health risk behaviors over time.

CONCLUSIONS

Youth with T2D who are already at risk for health complications and who reported engaging in activities that further increase the likelihood of life-threatening morbidities were characterized. Although most correlates of trying these risk behaviors are nonmodifiable, intervention efforts may need to focus on potentially modifiable factors, such as depressive symptoms and lower grades.

Health behaviour in children and adolescents with type 1 diabetes compared to a representative reference population

Objective

We provide a population-based overview of health behaviours of children and adolescents with type 1 diabetes in comparison to the general population, and analyse their relevance for glycaemic control and self-rated health status.

Methods

Data from questionnaires of 11- to 17-year-old children and adolescents with diabetes (n = 629) were compared to a representative sample (n = 6,813).

Results

Children and adolescents with type 1 diabetes had a significantly increased odds of infrequent physical activity (adjusted OR 1.56), short overall duration of physical activity per week (OR 1.55, difference -1.3 hours/week), and high daily computer use (OR 2.51). They had a lower odds of active and passive smoking (OR 0.31 and OR 0.29), and high daily television time (OR 0.68). The odds of an at least good and excellent self-rated health status was increased with intense physical activity, and decreased with active smoking and prolonged daily use of computer and television. Active smoking and prolonged daily use of computer were associated with higher HbA1c.

Conclusions

Children and adolescents with type 1 diabetes showed a different profile of health behaviour. Their overall health may improve if their education stresses specifically frequent physical activity with longer overall duration and less frequent television or computer use.

Smoking and arterial stiffness in youth with type 1 diabetes: the SEARCH Cardiovascular Disease Study

OBJECTIVE

To evaluate the effects of smoking on early markers of cardiovascular disease (arterial stiffness) in adolescents with and without type 1 diabetes (T1D) in the SEARCH Cardiovascular Disease Study.

STUDY DESIGN

Participants included 606 youth (18.9 ± 3.3 years, 83% non-Hispanic white; 50% male). Six groups were defined: (1) smokers with T1D (n = 80); (2) former smokers with T1D (n = 88); (3) nonsmokers with T1D (n = 232); (4) smokers without T1D (n = 40); (5) former smokers without T1D former (n = 51); and (6) nonsmokers without T1D (n = 115). Arterial stiffness measurements included pulse wave velocity (PWV), augmentation index, and brachial distensibility. Multivariate linear regression was used to assess the independent and joint effects of T1D and smoking on arterial stiffness.

RESULTS

Nearly 20% of both youth with and without T1D and T1D were smokers. In youth without T1D, smokers had higher trunk and arm PWV. After adjustment for potential confounders, T1D, but not smoking, was an independent predictor of PWV (P < .05). Moreover, smoking status did not modify the association between T1D and increased arterial stiffness.

CONCLUSIONS

We found a high prevalence of smoking among youth with and without T1D; however, smoking status was not independently associated with increased arterial stiffness in youth with T1D.

Lifestyle and cardiometabolic risk in adults with type 1 diabetes: a review

Over the past decades, there has been a major upward shift in the prevalence of cardiometabolic risk (CMR) factors (central obesity, insulin resistance, hypertension and dyslipidemia) in patients with type 1 diabetes, which could have either an additive or a synergistic effect on risk for cardiovascular disease. These metabolic changes are occurring in parallel to the worldwide obesity epidemic and the widespread use of intensive insulin therapy. Poor lifestyle habits (poor diet quality, sedentary behaviours and smoking) are known to be driving factors for increased CMR factors in the general population. The objective of this review is to explore the lifestyle habits of adults with type 1 diabetes and its potential association with CMR factors. Evidence suggests that adherence to dietary guidelines is low in subjects with type 1 diabetes with a high prevalence of patients consuming an atherogenic diet. Sedentary habits are also more prevalent than in the general population, possibly because of the additional contribution of exercise-induced hypoglycemic fear. Moreover, the prevalence of smokers is still significant in the population with type 1 diabetes. All of these behaviours could trigger a cascade of metabolic anomalies that may contribute to increased CMR factors in patients with type 1 diabetes. The intensification of insulin treatment leading to new daily challenges (e.g. carbohydrates counting, increase of hypoglycemia) could contribute to the adoption of poor lifestyle habits. Preventive measures, such as identification of patients at high risk and promotion of lifestyle changes, should be encouraged. The most appropriate therapeutic measures remain to be established.

Differences in cigarette use behaviors by age at the time of diagnosis with diabetes from young adulthood to adulthood: results from the National Longitudinal Study of Adolescent Health

Objectives

Previous observations propose that risk-taking behaviors such as cigarette smoking are prevailing among young people with chronic conditions including diabetes. The purpose of this study was to examine whether cigarette smoking is more prevalent among diabetics than non-diabetics and whether it differs by age at the time of diagnosis with diabetes from young adulthood (YAH) to adulthood (AH).

Methods

We used US panel data from the National Longitudinal Study of Adolescent Health (Add Health Study) during the years 2001 to 2002 (Wave III, YAH) and 2007 to 2008 (Wave IV, AH). Multivariate logistic regression models were applied to estimate odds ratios (ORs) and 95% confidence intervals (CIs) of cigarette use behaviors according to age at the time of diagnosis with diabetes, after adjusting for demographic and selected behavioral factors.

Results

Of 12 175 study participants, 2.6% reported having been diagnosed with diabetes up to AH. Early-onset diabetics (age at diagnosis <13 years) were more likely than non-diabetics to report frequent cigarette smoking (smoking on ≥20 days during the previous 30 days) in YAH (OR, 3.34; 95% CI, 1.27 to 8.79). On the other hand, late-onset diabetics (age at diagnosis ≥13 years) were more likely than non-diabetics to report heavy cigarette smoking (smoking ≥10 cigarettes per day during the previous 30 days) in AH (OR, 1.54; 95% CI, 1.03 to 2.30).

Conclusions

The current study indicated that diabetics are more likely than non-diabetics to smoke cigarettes frequently and heavily in YAH and AH. Effective smoking prevention and cessation programs uniquely focused on diabetics need to be designed and implemented.

Long-term coeliac disease influences risk of death in patients with type 1 diabetes

AIM

The aim of this study was to examine mortality in patients with both type 1 diabetes (T1D) and coeliac disease (CD).

METHODS

Between 1969 and 2008, we identified individuals with CD through biopsy reports from all pathology departments (n = 28) in Sweden. T1D was defined as a diagnosis of diabetes recorded in the Swedish National Patient Register between 1964 and 2009 in individuals aged ≤ 30 years. During follow-up, we identified 960 patients with both T1D and CD. For each individual with T1D and CD, we selected up to five subjects with T1D alone (i.e. no CD), matched for sex, age and calendar period of diagnosis, as the reference group (n = 4608). Using a stratified Cox regression analysis with CD as a time-dependent covariate, we estimated the risk of death in patients with both T1D and CD compared with those with T1D alone.

RESULTS

Stratifying for time since CD diagnosis, CD was not a risk factor for death in patients with T1D during the first 5 years after CD diagnosis [hazard ratio (HR) 0.87, 95% confidence interval (CI) 0.43-1.73], but thereafter the HR for mortality increased as a function of follow-up time (5 to < 10 years, HR 1.44, 95% CI 0.74-2.79; 10 to <15 years, HR 1.88, 95% CI 0.81-4.36). Having a CD diagnosis for ≥ 15 years was associated with a 2.80-fold increased risk of death in individuals with T1D (95% CI 1.28-6.12).

CONCLUSION

A diagnosis of CD for ≥ 15 years increases the risk of death in patients with T1D.

Differentiating disordered affect in children and adolescents with type 1 diabetes

BACKGROUND

There is evidence for increased risk of affective disorders (AD) in adults with type 1 diabetes however, the prevalence and characteristics of AD in young people with the condition is unclear. Comorbid AD in type 1 diabetes is associated with deleterious self-management, sub-optimal clinical indicators, reduced quality of life, poorer physical health, increased complications, increased high risk behaviours in adolescence and young adulthood, and earlier mortality. The present study investigated the prevalence and character of AD in young people with type 1 diabetes.

METHODS

The self-report PH-PANAS-C was employed in a cross-sectional, case-control design to identify and differentiate full-syndrome (FS) and subthreshold (St) levels of AD in 53 participants with type 1 diabetes (case) and 54 age-balanced controls (N=107; 7-18 yrs).

RESULTS

Case participants reported greater AD than controls. When differentiated, only anxiety was significantly more prevalent. Case participants reported less positive affect, and greater negative affect and autonomic arousal. Further, 1:3 case participants presented with St symptoms of AD.

LIMITATIONS

Self-report measures are known to produce moderated responses therefore symptoms may be more severe than reported. There has been some suggestion that responses to somatic items in the PH-PANAS-C may relate to diabetes-specific states rather than affect-related symptoms however, recent evidence has refuted this argument.

CONCLUSIONS

AD, particularly anxiety, represents a significant clinical concern in young people with type 1 diabetes both as a disorder in its own right and as a major impediment to primary care and management of the diabetes. The significant dominance of anxiety-related symptoms and prevalence of subthreshold presentation warrant further investigation.

Smoking is associated with impaired long-term glucose metabolism in patients with type 1 diabetes mellitus

BACKGROUND AND AIMS

Smoking is known to negatively influence glucose metabolism both in healthy subjects and in patients with diabetes. The aim of this study was to compare glycemic control in patients with type 1 diabetes mellitus who were smokers with those who did not smoke during a prospective long-term follow-up.

METHODS AND RESULTS

In a single center, 763 patients with type 1 diabetes mellitus were included, 160 (21.0%) of them were smokers. Patients were treated with intensive insulin therapy according to existing guidelines. Glucose control was monitored quarterly, diabetes related complications and cardiovascular risk factors were assessed at least once a year. Glucose control in smokers was significantly worse than in non-smokers at baseline and during follow-up (mean HbA1c during 5047 patient-years of follow-up 7.9 ± 1.3% in smokers and 7.3 ± 1.1% in non-smokers, p < 0.001) despite a higher insulin dosage in smokers (0.71 ± 0.30 U/kg vs. 0.65 ± 0.31 U/kg in non-smokers, p = 0.046). HDL cholesterol was lower in smokers at baseline (1.53 ± 0.45 vs. 1.68 ± 0.51 in non-smokers, p = 0.048). Diabetes related complications tended to occur with a higher frequency in smokers, with a significant difference in macroalbuminuria (9.8% vs. 4.8% in non-smokers, p = 0.047).

CONCLUSION

Smoking is associated with worse glucose control in patients with type 1 diabetes mellitus despite the same treatment strategies as in non-smokers. Hyperglycemia, therefore, may contribute to an earlier incidence of diabetes related complications in these patients, in addition to direct toxic effects of smoking.

Smoking and other factors associated with short-term partial remission of Type 1 diabetes in adults

AIMS

The duration of partial remission of Type 1 diabetes is associated with the degree of initial metabolic disturbance and features of insulin resistance. Cigarette smoking decreases insulin sensitivity, but its influence on the length of remission is unknown. Therefore, this study assessed the relationship between cigarette smoking and duration of partial remission in adults with newly diagnosed Type 1 diabetes.

METHODS

We recruited 149 patients (48 women and 101 men, aged 16-35 years, median age 25 years), admitted to a teaching hospital with newly diagnosed Type 1 diabetes and followed them for a median period of 1 year and 9 months. We introduced intensive insulin therapy in multiple injections (basal-bolus) in all patients. We defined partial remission as an insulin dose of ≤ 0.3 U/kg body weight/24 h, an HbA(1c) value < 53 mmol/mol (7.0%) and a random serum C-peptide concentration over 0.5 ng/ml. Cigarette smoking was determined by self-report.

RESULTS

Of 149 patients, 68 (46%) fulfilled the criteria for partial remission at 1 year after diagnosis of diabetes. Fewer patients who were in partial remission at 1 year smoked (19/68, 28%) than did patients that were not in partial remission (41/81, 51%). In logistic regression analyses, non-smoking was associated with remission at 1 year independent of age, sex, HbA(1c) and presence of diabetic ketoacidosis, all measured at onset of diabetes (OR 3.32, 95% CI 1.42-7.75, P = 0.005).

CONCLUSION

Relative to individuals in this study who smoked, those who did not smoke at diagnosis of Type 1 diabetes experienced a longer duration of partial remission.

Deterioration of endothelial function and carotid intima-media thickness in Tibetan male adolescents exposed to second-hand smoke

INTRODUCTION

It has been commonly accepted that second-hand smoke (SHS) is associated with atherosclerosis and endothelial dysfunction. There is growing evidence that the changes might begin in childhood. Unfortunately, no study has focused on the early atherosclerosis of Tibetan adolescents exposed to SHS.

AIMS

We aimed to investigate the endothelial function and carotid atherosclerosis in healthy school-aged Tibetan male adolescents.

MATERIALS AND METHODS

All passive smoking participants (SHS) were students were 16 years old and male, and were recruited through middle schools in Lhasa city. In total 624 subjects were accepted after excluding subjects who actively smoked. The adolescents were divided into three groups according to serum cotinine level: high cotinine group (High Group) with 205 boys, intermediate cotinine group (Intermediate Group) with 210 boys, and low cotinine group (Low Group) with 209 boys. Venous blood was sampled for the measurement of cotinine concentration, lipid profile and endothelin-1 (ET-1) quantitation. High-resolution B-mode ultrasonography was performed to evaluate carotid intima-media thickness (cIMT) and intima smoothness. The invasive vascular endothelial function was evaluated through the measurement of flow-mediated dilation (FMD) with B-mode ultrasound and ankle-brachial index (ABI) by using a blood pressure cuff and a Doppler instrument.

RESULTS

No statistical significance was found between groups in total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, ApoA-I, systolic blood pressure, diastolic blood pressure, and heart rate (p>0.05). In the lipid profile, only apolipoprotein B (ApoB) values were different between groups: ApoB in the High Group was higher than in the Low Group (p=0.0164). Plasma ET-1 concentrations in the High Group were also much higher than in the Intermediate and Low Groups (p=0.0112, p<0.001). The cIMT and intima smoothness had deteriorated in the High Group compared with the Low Group (p<0.001 and p<0.05 respectively). FMD and ABI, which indicate vascular endothelial function, was decreased in the High Group compared with the Intermediate and Low Groups (FMD, p<0.001; ABI, p<0.001).

CONCLUSIONS

SHS was associated with sub-clinical carotid atherosclerosis and endothelial dysfunction in Tibetan school-aged male adolescents. Considering the widespread exposure to SHS and the clinical relevance of early atherosclerosis, this result is of public health importance in Tibet, where health education is not satisfactory. Data from our study emphasize the importance of endorsing smoke-free environments for adolescents.

Cigarette smoking among adolescents with type 1 diabetes: strategies for behavioral prevention and intervention

Smoking is the leading preventable cause of death in the U.S. and preventing smoking initiation among adolescents is a public health priority and a central element of comprehensive tobacco control. While cigarette smoking is harmful to all youths, those with special healthcare needs are particularly vulnerable to the negative health consequences of smoking, and adolescents with type 1 diabetes (T1D) urgently stand out as a high-risk group. Available literature suggests the prevalence and risk factors for smoking among adolescents with T1D are strikingly similar to the general population. Moreover, smoking negatively affects T1D management and increases risk for and progression of adverse health outcomes related to T1D. Adolescents with T1D are also influenced by disease-related social and behavioral factors that affect decisions about smoking. Pediatric health care providers (HCPs) are optimally-positioned to screen and counsel adolescents with T1D to avoid smoking, as they have well-established relationships with young patients and regularly scheduled visits surrounding T1D management. However, several barriers inhibit HCPs from screening/counseling adolescents with T1D for smoking on a regular basis. Well-established strategies for behavioral counseling for smoking in the healthcare setting may be effective to prevent and reduce smoking among adolescents with T1D. HCPs who care for these young patients can tailor proven counseling approaches to the context of T1D to address smoking alongside other behavioral factors that are central to disease management. Empirical research is also needed to inform the development and deployment of healthcare-based interventions and maximize their impact within this population.

Determinants of quality of life in adults with type 1 and type 2 diabetes

Background

Limited evidence exists on the determinants of quality of life (QoL) specific to adults with type 1 diabetes (T1D). Further, it appears no study has compared the determinants of QoL between T1D and type 2 diabetes (T2D) groups. The objectives of this study were to examine: (1) determinants of QoL in adults with T1D; and, (2) differences in QoL determinants between T1D and T2D groups.

Methods

The Alberta Longitudinal Exercise and Diabetes Research Advancement (ALEXANDRA) study, a longitudinal study of adults with diabetes in Alberta, Canada. Adults (18 years and older) with T1D (N = 490) and T2D (N = 1,147) provided information on demographics (gender, marital status, education, and annual income), personality (activity trait), medical factors (diabetes duration, insulin use, number of comorbidities, and body mass index), lifestyle behaviors (smoking habits, physical activity, and diet), health-related quality of life (HRQL) and life satisfaction. Multiple regression models identified determinants of HRQL and life satisfaction in adults with T1D. These determinants were compared with determinants for T2D adults reported in a previous study from this population data set. Factors significantly associated with HRQL and life satisfaction in either T1D or T2D groups were further tested for interaction with diabetes type.

Results

In adults with T1D, higher activity trait (personality) score (β = 0.28, p < 0.01), fewer comorbidities (β = -0.27, p < 0.01), lower body mass index (BMI)(β = -0.12, p < 0.01), being a non-smoker (β = -0.14, p < 0.01), and higher physical activity levels (β = 0.16, p < 0.01) were associated with higher HRQL. Having a partner (β = 0.11, p < 0.05), high annual income (β = 0.16, p < 0.01), and high activity trait (personality) score (β = 0.27, p < 0.01) were significantly associated with higher life satisfaction. There was a significant age × diabetes type interaction for HRQL. The T2D group had a stronger positive relationship between advancing age and HRQL compared to the T1D group. No interaction was significant for life satisfaction.

Conclusions

Health services should target medical and lifestyle factors and provide support for T1D adults to increase their QoL. Additional social support for socioeconomically disadvantaged individuals living with this disease may be warranted. Health practitioners should also be aware that age has different effects on QoL between T1D and T2D adults.

Risky business: risk behaviors in adolescents with type 1 diabetes

PURPOSE

The purpose of this article is to review risk behaviors and their health consequences in adolescents with type 1 diabetes. The existing literature on common risk behaviors in adolescents is examined, with a focus on illicit drug use, alcohol use, smoking, unprotected sexual activity, and disordered eating behaviors.

CONCLUSIONS

A review of the literature highlights the lack of studies of risk behaviors in this population. Much of what is known comes from studies with adolescents in the general population or from studies of adults with type 1 diabetes. Known risk and protective factors for risk behaviors and health outcomes are noted. Based on these findings, suggestions are provided for diabetes educators and health care providers to assess for and prevent risk behaviors in adolescents with type 1 diabetes. Directions for future research in this population are indicated, including the need to develop and test standardized prevention programs.

Prevalence of tobacco use and association between cardiometabolic risk factors and cigarette smoking in youth with type 1 or type 2 diabetes mellitus

OBJECTIVES

To examine prevalence of tobacco use and coexistence of cardiometabolic risk factors according to smoking status in youth with diabetes mellitus.

STUDY DESIGN

Youth aged 10 to 22 years who participated in the SEARCH for Diabetes in Youth study (n = 3466) were surveyed about their tobacco use and examined for cardiometabolic risk factors: waist circumference, systolic and diastolic blood pressure, physical activity, and lipid profile.

RESULTS

The prevalence of tobacco use in youth aged 10 to 14 years, 15 to 19 years, and ≥20 years with type 1 diabetes mellitus was 2.7%, 17.1%, and 34.0%, respectively, and the prevalence in youth with type 2 diabetes mellitus was 5.5%, 16.4%, and 40.3%, respectively. Smoking was more likely in youth with annual family incomes <$50 000, regardless of diabetes mellitus type. Cigarette smoking was associated with higher odds of high triglyceride levels and physical inactivity in youth with type 1 diabetes mellitus. Less than 50% of youth aged 10 to 14 years (52.2% of participants) reported having ever been counseled by their healthcare provider to not smoke or to stop smoking.

CONCLUSIONS

Tobacco use is prevalent in youth with diabetes mellitus. Aggressive tobacco prevention and cessation programs should be a high priority to prevent or delay the development of cardiovascular disease.

Mitigating micro-and macro-vascular complications of diabetes beginning in adolescence

Diabetes is a chronic disorder, which manifests when insulin levels or resistance to insulin action becomes insufficient to control systemic glucose levels. Although the number of available agents to manage diabetes continues to expand rapidly, the maintenance of euglycemia by individuals with diabetes remains a substantial challenge. Unfortunately, many patients with type 1 and type 2 diabetes will ultimately experience diabetes complications. These complications result from the toxic effects of chronic hyperglycemia combined with other metabolic derangements that afflict persons with diabetes. This review will present a comprehensive look at the complications of diabetes, the risk factors for their progression, the mechanistic basis for their development, and the clinical approach to screening for, preventing, and treating these sequelae. In addition, since diabetes is commonly diagnosed in childhood, we will provide a special focus on the care of the adolescent patient.