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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Blair J, McKay A, Ridyard C, Thornborough K, Bedson E, Peak M, Didi M, Annan F, Gregory JW, Hughes D, Gamble C. Continuous subcutaneous insulin infusion versus multiple daily injections in children and young people at diagnosis of type 1 diabetes: the SCIPI RCT. Health Technol Assess 2019; 22:1-112. [PMID: 30109847 DOI: 10.3310/hta22420] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The risk of developing long-term complications of type 1 diabetes (T1D) is related to glycaemic control and is reduced by the use of intensive insulin treatment regimens: multiple daily injections (MDI) (≥ 4) and continuous subcutaneous insulin infusion (CSII). Despite a lack of evidence that the more expensive treatment with CSII is superior to MDI, both treatments are used widely within the NHS. OBJECTIVES (1) To compare glycaemic control during treatment with CSII and MDI and (2) to determine safety and cost-effectiveness of the treatment, and quality of life (QoL) of the patients. DESIGN A pragmatic, open-label randomised controlled trial with an internal pilot and 12-month follow-up with 1 : 1 web-based block randomisation stratified by age and centre. SETTING Fifteen diabetes clinics in hospitals in England and Wales. PARTICIPANTS Patients aged 7 months to 15 years. INTERVENTIONS Continuous subsutaneous insulin infusion or MDI initiated within 14 days of diagnosis of T1D. DATA SOURCES Data were collected at baseline and at 3, 6, 9 and 12 months using paper forms and were entered centrally. Data from glucometers and CSII were downloaded. The Health Utilities Index Mark 2 was completed at each visit and the Pediatric Quality of Life Inventory (PedsQL, diabetes module) was completed at 6 and 12 months. Costs were estimated from hospital patient administration system data. OUTCOMES The primary outcome was glycosylated haemoglobin (HbA1c) concentration at 12 months. The secondary outcomes were (1) HbA1c concentrations of < 48 mmol/mol, (2) severe hypoglycaemia, (3) diabetic ketoacidosis (DKA), (4) T1D- or treatment-related adverse events (AEs), (5) change in body mass index and height standard deviation score, (6) insulin requirements, (7) QoL and (8) partial remission rate. The economic outcome was the incremental cost per quality-adjusted life-year (QALY) gained. RESULTS A total of 293 participants, with a median age of 9.8 years (minimum 0.7 years, maximum 16 years), were randomised (CSII, n = 149; MDI, n = 144) between May 2011 and January 2015. Primary outcome data were available for 97% of participants (CSII, n = 143; MDI, n = 142). At 12 months, age-adjusted least mean squares HbA1c concentrations were comparable between groups: CSII, 60.9 mmol/mol [95% confidence interval (CI) 58.5 to 63.3 mmol/mol]; MDI, 58.5 mmol/mol (95% CI 56.1 to 60.9 mmol/mol); and the difference of CSII - MDI, 2.4 mmol/mol (95% CI -0.4 to 5.3 mmol/mol). For HbA1c concentrations of < 48 mmol/mol (CSII, 22/143 participants; MDI, 29/142 participants), the relative risk was 0.75 (95% CI 0.46 to 1.25), and for partial remission rates (CSII, 21/86 participants; MDI, 21/64), the relative risk was 0.74 (95% CI 0.45 to 1.24). The incidences of severe hypoglycaemia (CSII, 6/144; MDI, 2/149 participants) and DKA (CSII, 2/144 participants; MDI, 0/149 participants) were low. In total, 68 AEs (14 serious) were reported during CSII treatment and 25 AEs (eight serious) were reported during MDI treatment. Growth outcomes did not differ. The reported insulin use was higher with CSII (mean difference 0.1 unit/kg/day, 95% CI 0.0 to 0.2 unit/kg/day; p = 0.01). QoL was slightly higher for those randomised to CSII. From a NHS perspective, CSII was more expensive than MDI mean total cost (£1863, 95% CI £1620 to £2137) with no additional QALY gains (-0.006 QALYs, 95% CI -0.031 to 0.018 QALYs). LIMITATIONS Generalisability beyond 12 months is uncertain. CONCLUSIONS No clinical benefit of CSII over MDI was identified. CSII is not a cost-effective treatment in patients representative of the study population. FUTURE WORK Longer-term follow-up is required to determine if clinical outcomes diverge after 1 year. A qualitative exploration of patient and professional experiences of MDI and CSII should be considered. TRIAL REGISTRATION Current Controlled Trials ISRCTN29255275 and EudraCT 2010-023792-25. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 22, No. 42. See the NIHR Journals Library website for further project information. The cost of insulin pumps and consumables supplied by F. Hoffman-La Roche AG (Basel, Switzerland) for the purpose of the study were subject to a 25% discount on standard NHS costs.
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Affiliation(s)
- Joanne Blair
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrew McKay
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Colin Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Keith Thornborough
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emma Bedson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Matthew Peak
- Department of Research, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Francesca Annan
- Paediatric and Adolescent Division, University College Hospital, London, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
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Blair JC, McKay A, Ridyard C, Thornborough K, Bedson E, Peak M, Didi M, Annan F, Gregory JW, Hughes DA, Gamble C. Continuous subcutaneous insulin infusion versus multiple daily injection regimens in children and young people at diagnosis of type 1 diabetes: pragmatic randomised controlled trial and economic evaluation. BMJ 2019; 365:l1226. [PMID: 30944112 PMCID: PMC6446076 DOI: 10.1136/bmj.l1226] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To compare the efficacy, safety, and cost utility of continuous subcutaneous insulin infusion (CSII) with multiple daily injection (MDI) regimens during the first year following diagnosis of type 1 diabetes in children and young people. DESIGN Pragmatic, multicentre, open label, parallel group, randomised controlled trial and economic evaluation. SETTING 15 paediatric National Health Service (NHS) diabetes services in England and Wales. The study opened to recruitment in May 2011 and closed in January 2017. PARTICIPANTS Patients aged between 7 months and 15 years, with a new diagnosis of type 1 diabetes were eligible to participate. Patients who had a sibling with the disease, and those who took drug treatments or had additional diagnoses that could have affected glycaemic control were ineligible. INTERVENTIONS Participants were randomised, stratified by age and treating centre, to start treatment with CSII or MDI within 14 days of diagnosis. Starting doses of aspart (CSII and MDI) and glargine or detemir (MDI) were calculated according to weight and age, and titrated according to blood glucose measurements and according to local clinical practice. MAIN OUTCOME MEASURES Primary outcome was glycaemic control (as measured by glycated haemoglobin; HbA1c) at 12 months. Secondary outcomes were percentage of patients in each treatment arm with HbA1c within the national target range, incidence of severe hypoglycaemia and diabetic ketoacidosis, change in height and body mass index (as measured by standard deviation scores), insulin requirements (units/kg/day), partial remission rate (insulin dose adjusted HbA1c <9), paediatric quality of life inventory score, and cost utility based on the incremental cost per quality adjusted life year (QALY) gained from an NHS costing perspective. RESULTS 294 participants were randomised and 293 included in intention to treat analyses (CSI, n=144; MDI, n=149). At 12 months, mean HbA1c was comparable with clinically unimportant differences between CSII and MDI participants (60.9 mmol/mol v 58.5 mmol/mol, mean difference 2.4 mmol/mol (95% confidence interval -0.4 to 5.3), P=0.09). Achievement of HbA1c lower than 58 mmol/mol was low among the two groups (66/143 (46%) CSII participants v 78/142 (55%) MDI participants; relative risk 0.84 (95% confidence interval 0.67 to 1.06)). Incidence of severe hypoglycaemia and diabetic ketoacidosis were low in both groups. Fifty four non-serious and 14 serious adverse events were reported during CSII treatment, and 17 non-serious and eight serious adverse events during MDI treatment. Parents (but not children) reported superior PedsQL scores for those patients treated with CSII compared to those treated with MDI. CSII was more expensive than MDI by £1863 (€2179; $2474; 95% confidence interval £1620 to £2137) per patient, with no additional QALY gains (difference -0.006 (95% confidence interval -0.031 to 0.018)). CONCLUSION During the first year following type 1 diabetes diagnosis, no clinical benefit of CSII over MDI was identified in children and young people in the UK setting, and treatment with either regimen was suboptimal in achieving HbA1c thresholds. CSII was not cost effective. TRIAL REGISTRATION Current Controlled Trials ISRCTN29255275; European Clinical Trials Database 2010-023792-25.
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Affiliation(s)
- Joanne C Blair
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Andrew McKay
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Colin Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Keith Thornborough
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Emma Bedson
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
| | - Matthew Peak
- Department of Research, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool L12 2AP, UK
| | - Francesca Annan
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - John W Gregory
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Dyfrig A Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - Carrol Gamble
- Clinical Trials Research Centre, University of Liverpool, Liverpool, UK
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Ishtiak-Ahmed K, Carstensen B, Pedersen-Bjergaard U, Jørgensen ME. Incidence Trends and Predictors of Hospitalization for Hypoglycemia in 17,230 Adult Patients With Type 1 Diabetes: A Danish Register Linkage Cohort Study. Diabetes Care 2017; 40:226-232. [PMID: 27899494 DOI: 10.2337/dc16-0862] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Accepted: 11/02/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to examine nationwide incidence trends and predictors of hospitalization for hypoglycemia (HH) in the adult population with type 1 diabetes in Denmark. RESEARCH DESIGN AND METHODS All 17,230 patients with type 1 diabetes aged 16 years and above registered in the Danish Adult Diabetes Database (DADD) from 2006 were followed to 2012 by linkage of registers. Incidence rates of HH were modeled by Poisson regression by calendar time, taking sex, age, diabetes duration, clinical variables, and previous HH into account. RESULTS A total of 2,369 events of HH occurred among 1,735 patients with type 1 diabetes of HH during 70,002 patient-years (mean follow-up 3.7 years). A decrease in incidence rate was observed with calendar time with an 8.4% (4.9-11.7%) annual decrease. Predictors of HH included previous HH, age, diabetes duration, albuminuria, and HbA1c. CONCLUSIONS This study revealed a decreasing trend in incidence of HH in patients with type 1 diabetes. Previous HH, longer diabetes duration, macroalbuminuria, and HbA1c were associated with increased risk of HH in type 1 diabetes, and attention to those factors is warranted in both clinical and public health aspects.
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Affiliation(s)
- Kazi Ishtiak-Ahmed
- Steno Diabetes Centre, Gentofte, Denmark.,Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulrik Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjællands Hospital Hillerød, Hillerød, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Marit E Jørgensen
- Steno Diabetes Centre, Gentofte, Denmark .,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Martin D, Dossier C, Godot C, Taupin P, Elie C, Gagnayre R, Choleau C, Cahané M, Fermanian J, Robert JJ. Questionnaire de connaissance de l’AJD pour les enfants et les adolescents ayant un diabète de type 1. ACTA ACUST UNITED AC 2016. [DOI: 10.1051/tpe/2016006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Fredheim S, Johansen A, Thorsen SU, Kremke B, Nielsen LB, Olsen BS, Lyngsøe L, Sildorf SM, Pipper C, Mortensen HB, Johannesen J, Svensson J. Nationwide reduction in the frequency of severe hypoglycemia by half. Acta Diabetol 2015; 52:591-9. [PMID: 25528006 DOI: 10.1007/s00592-014-0697-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 12/05/2014] [Indexed: 12/23/2022]
Abstract
AIMS To examine contemporary rates of severe hypoglycemia (SH) and identify the effect of predictors of SH in a pediatric type 1 diabetes population. METHODS The national diabetes register provided data on children residing in Denmark from 2008 to 2013 in this register-based population study. Robust Poisson regression models were applied. RESULTS The study population [n = 2,715 (50.9 % boys), mean (SD) age at onset; 8.1 (4.0) years, diabetes duration; 5.6 (4.9) years] comprised 7,390 person-years of data and 561 events of SH. The overall incidence of SH was 7.6 per 100 person-years. The incidence rate peaked with 16.0 per 100 person-years in 2008 reaching a nadir of 4.9 in 2011. Overall, insulin pump reduced the rate of SH with 27 % compared to any pen treatment (P = 0.003). When stratifying pen treatment, premixed insulin increased the rate of SH by 1.9-fold (P = 0.0015) and NPH increased the rate by 1.6-fold (P = 0.003) versus pump treatment, whereas long-acting insulin analogues were comparable with pump treatment (P = 0.1485). We found no association of SH with glycemic control (P > 0.05). CONCLUSIONS A nationwide halving in rates of severe hypoglycemia was observed during the study period independent of the prevailing average HbA1c level. Changes in diabetes care and successful educational programs may have influenced the lower incidence rate of severe hypoglycemia.
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Affiliation(s)
- S Fredheim
- Department of Pediatrics, Herlev Hospital, Arkaden, Turkisvej 14, 2730, Herlev, Copenhagen, Denmark,
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Blair J, Gregory JW, Hughes D, Ridyard CH, Gamble C, McKay A, Didi M, Thornborough K, Bedson E, Awoyale L, Cwiklinski E, Peak M. Study protocol for a randomised controlled trial of insulin delivery by continuous subcutaneous infusion compared to multiple daily injections. Trials 2015; 16:163. [PMID: 25873144 PMCID: PMC4410001 DOI: 10.1186/s13063-015-0658-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 03/17/2015] [Indexed: 12/19/2022] Open
Abstract
Background Intensive insulin therapy with continuous subcutaneous insulin infusion (CSII) devices or multiple daily injections (MDI) reduces the risk of long-term vascular complications of type I diabetes (TID). Both treatments are used routinely, but there is little evidence to demonstrate superiority of either treatment. If CSII treatment reduces the risk of long-term complications or is associated with an improved quality of life (QoL), the additional cost of this therapy may be compensated for by a reduction in long-term health expenditure. If there is no demonstrable difference between treatments, health-care resources may be better invested elsewhere. This study aims to address this gap in knowledge. Methods/design This is a pragmatic, randomised controlled trial (RCT). Fifteen centres, selected to represent a population with a broad demographic, will recruit 316 patients, newly diagnosed with TID, aged between 7 months and 15 years. Exclusion criteria include additional pathologies or treatments likely to affect glycaemic control and a first-degree relative with TID. Randomisation to CSII or MDI is stratified for age, gender and recruiting centre. The randomised treatment starts within 15 days of diagnosis. Patients will be trained to adjust their insulin dose according to carbohydrate intake and blood glucose level. Study visits coincide with routine clinic appointments at 3, 6, 9 and 12 months when data relating to routine clinical assessments, adverse events and concomitant medications are collected. Health utilities questionnaires are completed at each visit and a diabetes-specific QoL questionnaire (PedsQL) at diagnosis, 6 and 12 months. The primary outcome is glycaemic control (HbA1c) at 12 months. Secondary outcome measures include QoL, insulin use, growth and weight gain, adverse events and a health economics appraisal. Discussion This is the first adequately powered RCT comparing CSII and MDI in a non-selected population, treated according to standard practice guidelines. It will produce data that are meaningful to individual patients and local and national policymakers. Trial registration The study was registered with the European Clinical Trials Database on 4 November 2010, reference 2010-023792-25.
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Affiliation(s)
- Jo Blair
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK.
| | - John W Gregory
- Department of Child Health, School of Medicine, Cardiff University, Cardiff, CF14 4XN, Wales, UK.
| | - Dyfrig Hughes
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ, UK.
| | - Colin H Ridyard
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, LL57 2PZ, UK.
| | - Carrol Gamble
- Liverpool Clinical Trials Research Centre, Liverpool, L12 2AP, UK.
| | - Andrew McKay
- Liverpool Clinical Trials Research Centre, Liverpool, L12 2AP, UK.
| | - Mohammed Didi
- Department of Endocrinology, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK.
| | - Keith Thornborough
- Department of Diabetes, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK.
| | - Emma Bedson
- Liverpool Clinical Trials Research Centre, Liverpool, L12 2AP, UK.
| | - Lola Awoyale
- Liverpool Clinical Trials Research Centre, Liverpool, L12 2AP, UK.
| | - Emma Cwiklinski
- Liverpool Clinical Trials Research Centre, Liverpool, L12 2AP, UK.
| | - Matthew Peak
- Department of Research, Alder Hey Children's NHS Foundation Trust, Liverpool, L12 2AP, UK. .,School of Health, University of Central Lancashire, Lancaster, PR1 2HE, UK.
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Koller D, Khan N, Barrett S. Pediatric perspectives on diabetes self-care: a process of achieving acceptance. QUALITATIVE HEALTH RESEARCH 2015; 25:264-75. [PMID: 25267509 DOI: 10.1177/1049732314551057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
We conducted this qualitative study to explore children's and adolescents' perspectives about diabetes self-care, their knowledge of diabetes, and their emotions associated with having the disease. Drawing on the new sociological approach that acknowledges children's competence in discussing complex issues that concern them, we conducted individual interviews with a cross-sectional sample of 48 patients between the ages of 5 and 18 years. We recruited participants from a diabetes outpatient clinic within a large pediatric hospital in one of Canada's major urban centers. In this article, we present data from the following major themes: self-care, knowledge, and emotions. Through an in-depth analysis of these integrated themes, we offer validation that emotional support, along with disease education, provides supportive conditions for engaging in self-care and a process of acceptance.
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Affiliation(s)
| | - Noshin Khan
- Ryerson University, Toronto, Ontario, Canada
| | - Shaun Barrett
- The Hospital for Sick Children, Toronto, Ontario, Canada
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Nabors LA, Kichler JC, Burbage ML, Swoboda CM, Andreone TL. Children's Learning and Goal-Setting at a Diabetes Camp. Diabetes Spectr 2014; 27:257-63. [PMID: 25647047 PMCID: PMC4231935 DOI: 10.2337/diaspect.27.4.257] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Objective. This study provides information about children's learning and goal attainment related to change in their self-management skills during a diabetes camp. Design and methods. One hundred and thirty-one children completed an evaluation for the first year (year 1), and 68 children completed an evaluation for the second year (year 2). All of the children had type 1 diabetes. During both years, parents provided information about goals for their child before camp started. Children's learning about diabetes self-management, as well as their satisfaction with camp, was assessed at the end of the camp session. In the evaluation for year 2, a goal-setting intervention was also developed, and its effectiveness was assessed through both physicians' and children's reports. Results. Children learned new information during camp about recognizing and managing the signs of hypo- and hyperglycemia and about counting carbohydrates and rotating insulin pump sites. Children were better able to recall their self-management goals in year 2. In terms of benefiting from camp, boys reported learning more than girls about diabetes management, whereas girls were more likely than boys to report that greater opportunities to express feelings were of value. Conclusions. Goal-setting was successful in improving children's recall of their self-management goals. Children benefited from the supportive and educational camp atmosphere. Future research should assess the benefits of camp across multiple camp settings and determine whether educational benefits have long-term effects on children's goal-setting and knowledge and whether these benefits lead to psychosocial improvements.
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George MM, Copeland KC. Current treatment options for type 2 diabetes mellitus in youth: today's realities and lessons from the TODAY study. Curr Diab Rep 2013; 13:72-80. [PMID: 23065368 PMCID: PMC3545061 DOI: 10.1007/s11892-012-0334-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The incidence of type 2 diabetes in children and adolescents has increased over the last 2 decades, paralleled by an increase in obesity over the same time period. Although the value of lifestyle modification in obese youth is unquestioned, scant evidence for optimal treatment of type 2 diabetes in this age group exists. Despite recent therapeutic drug trials, metformin and insulin are the only medicines currently approved by the U.S. Food and Drug Administration for the treatment of type 2 diabetes in youth. Because of recently amended pharmaceutical regulations, however, it is likely that more antidiabetic medications soon will be added to the armamentarium of therapeutic options for youth with type 2 diabetes. Additionally, the recently published TODAY study comparing safety and efficacy of three treatment regimens in maintaining glycemic control in youth with type 2 diabetes has shed new light on the problem.
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Affiliation(s)
- Minu M George
- Department of Pediatrics, Section of Diabetes & Endocrinology, The University of Oklahoma College of Medicine, 1200 Children's Ave, Oklahoma City, OK 73104, USA
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Abstract
Type 2 diabetes mellitus (T2DM) has increased dramatically throughout the world in recent years. This increase has also affected the young, such that over the last decade, the rise in the number of children and youth with T2DM has been labeled an epidemic. The main reason for this epidemic is the spurt in childhood obesity worldwide. This is linked to the global economic growth and changes in lifestyle and dietery habits. It is important that we recognize this epidemic of T2DM early, and institute national and global measures to contain it. T2DM in childhood can be controlled to a large extent through lifestyle modification measures. It is important that we screen this disease condition, and identify the at-risk cases.
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Desarrollo de un programa educativo estructurado en diabetes para pacientes pediátricos. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1134-3230(10)63016-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Cooper H, Cooper J, Milton B. Technology-based approaches to patient education for young people living with diabetes: a systematic literature review. Pediatr Diabetes 2009; 10:474-83. [PMID: 19490492 DOI: 10.1111/j.1399-5448.2009.00509.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Helen Cooper
- Faculty of Health and Social Care, University of Chester, Chester, CH1 4BJ UK.
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Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. Type 2 diabetes in children and adolescents. Pediatr Diabetes 2009; 10 Suppl 12:17-32. [PMID: 19754615 DOI: 10.1111/j.1399-5448.2009.00584.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Arlen L Rosenbloom
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32608, USA.
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Pihoker C, Forsander G, Wolfsdorf J, Klingensmith GJ. The delivery of ambulatory diabetes care to children and adolescents with diabetes. Pediatr Diabetes 2009; 10 Suppl 12:58-70. [PMID: 19754619 DOI: 10.1111/j.1399-5448.2009.00585.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, Children's Hospital, Regional Medical Center, University of Washington, Seattle, WA, USA
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Tschiedel B, Cé GV, Geremia C, Mondadori P, Speggiorin S, Puñales MKC. [Establishment of a collaborative work team management for type 1 diabetes mellitus patient]. ACTA ACUST UNITED AC 2009; 52:219-32. [PMID: 18438532 DOI: 10.1590/s0004-27302008000200009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Accepted: 12/20/2007] [Indexed: 11/22/2022]
Abstract
This article will provide the necessary information to establish a childhood and adolescence management center that would promote the integration and coordination of interdisciplinary members as healthcare teams. It will also show how Instituto da Criança com Diabetes from Rio Grande do Sul (ICD) was built, structured and how it works. The aim of this program is to decrease the frequency of hospitalization in acute cases, to decrease chronic complications and to qualify human resources. So far 1315 outpatients and day-care hospital patients, mostly type 1 diabetes, have been seeing free of charge in Public Health Service (PHS), in a partnership with Grupo Hospitalar Conceição (GHC) and the Ministry of Health. Among other activities an educational program (consisting of 45-minute daily classes) is given to the patient and his family. From 2004 to 2007 it could be seen a decrease from 7,5% to 2,7% in the diabetes related hospitalization concerning these patients. Clinical guidelines followed by the interdisciplinary ICD team will also be presented in this essay.
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Affiliation(s)
- Balduino Tschiedel
- Instituto da Criança com Diabetes, Hospital da Criança Conceição, Porto Alegre, RS, Brasil.
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Pihoker C, Forsander G, Wolfsdorf J, Klingensmith GJ. The delivery of ambulatory diabetes care: structures, processes, and outcomes of ambulatory diabetes care. Pediatr Diabetes 2008; 9:609-20. [PMID: 19067893 DOI: 10.1111/j.1399-5448.2008.00480.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, Children's Hospital, Regional Medical Center, University of Washington, Seattle, WA, USA
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Rosenbloom AL, Silverstein JH, Amemiya S, Zeitler P, Klingensmith GJ. ISPAD Clinical Practice Consensus Guidelines 2006-2007. Type 2 diabetes mellitus in the child and adolescent. Pediatr Diabetes 2008; 9:512-26. [PMID: 18694453 DOI: 10.1111/j.1399-5448.2008.00429.x] [Citation(s) in RCA: 103] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Affiliation(s)
- Arlan L Rosenbloom
- Division of Endocrinology, Department of Pediatrics, University of Florida College of Medicine, Gainesville, FL 32608, USA.
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Leite SAO, Zanim LM, Granzotto PCD, Heupa S, Lamounier RN. Pontos básicos de um programa de educação ao paciente com diabetes melito tipo 1. ACTA ACUST UNITED AC 2008; 52:233-42. [DOI: 10.1590/s0004-27302008000200010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Accepted: 02/10/2008] [Indexed: 11/21/2022]
Abstract
O número de portadores de diabetes melito tipo 1 (DM1) está aumentando globalmente, entretanto, a maior parte dos pacientes apresenta controle glicêmico insatisfatório. Esta revisão na literatura foi realizada com três questões de pesquisa: Quais as recomendações e diretrizes de educação em diabetes existentes? Existem evidências para recomendar a adaptação de determinado programa segundo a faixa etária dos pacientes? Os programas de educação são efetivos na melhora dos níveis de HbA1c? Foram revisados 40 artigos, publicados entre 2000 e 2007, sobre educação em DM1 em crianças, adolescentes, adultos e usuários de bomba de infusão contínua de insulina, além de incluir o resumo das diretrizes da IDF, da ADA, da SBD, da AADE, do IDC, e outras peculiaridades para o contexto de saúde pública e privada. O portador de diabetes e sua família devem ser treinados a fazer decisões efetivas de autocuidado em sua rotina diária. O aprimoramento do paciente no automanejo aproxima o valor da HbA1c ao adequado para sua faixa etária. A educação individual e a em grupo apresentam equivalência na melhora do controle metabólico. Existe uma correlação positiva entre o tempo de educação e o controle da glicemia.
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Lange K, Sassmann H, von Schütz W, Kordonouri O, Danne T. Prerequisites for age-appropriate education in type 1 diabetes: a model programme for paediatric diabetes education in Germany. Pediatr Diabetes 2007; 8 Suppl 6:63-71. [PMID: 17727387 DOI: 10.1111/j.1399-5448.2007.00277.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Continuous diabetes education for children, adolescents and their parents are widely accepted as an integral part of every type 1 diabetes therapy. Especially in paediatric diabetes care age-appropriate, demand-oriented and individualized practical information and skills training are mandatory for achieving good metabolic control and psychosocial well-being. A paediatric multidisciplinary diabetes team experienced in an intensified insulin therapy with a differential substitution of prandial and basal insulin needs (MDI or CSII) and in child psychology is required to initiate and maintain lifelong diabetes self-management. In Germany an education programme for children aged 6-12 years and another programme for adolescents and young adults have previously been evaluated in multicenter studies. Programmes were considered with respect to applicability, acceptance by target groups and efficacy (knowledge, competence, quality of life and glycaemic control). Furthermore, a programme specifically designed for parents of children affected was evaluated. Contents, modular structures, developmental psychological background and didactic concepts of all above mentioned programmes are presented in detail. Apart from teaching insulin therapy according to current guidelines special emphasis is laid on translating this knowledge into everyday self-management behaviour. In addition, emotional coping with the chronic disease and its psychosocial consequences is supported. In the context of the Disease-Management-Program for Type 1 Diabetes in Germany these programmes for young people were certified and reimbursed nationwide by health insurances.
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Affiliation(s)
- Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany.
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