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Marshall A, Lim L, Allyson M, Youde S, Ann N, Nghi B, Townsend N, Monique S, Amy W, Ramjan K, Nyunt O, Hameed S. Letters to the Editor. J Paediatr Child Health 2023; 59:1183-1185. [PMID: 37698087 DOI: 10.1111/jpc.16493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/10/2023] [Accepted: 09/03/2023] [Indexed: 09/13/2023]
Affiliation(s)
- Ailsa Marshall
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Lena Lim
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Macdonald Allyson
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Sharon Youde
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nillsen Ann
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Bui Nghi
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Nicky Townsend
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Stone Monique
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Department of Paediatric Endocrinology, Campbelltown Hospital, Sydney, New South Wales, Australia
| | - Wanaguru Amy
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Kim Ramjan
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | - Ohn Nyunt
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Paediatric Endocrinology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Shihab Hameed
- Department of Paediatric Endocrinology and Diabetes, Royal North Shore Hospital, Sydney, New South Wales, Australia
- School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia
- Department of Paediatric Endocrinology, Sydney Children's Hospital, Sydney, New South Wales, Australia
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Lee MA, Holmes-Walker DJ, Farrell K, Clark-Luccitti A. Impact of continuous glucose monitoring in youth with type 1 diabetes aged 15-21 years. Intern Med J 2023; 53:209-215. [PMID: 33949770 DOI: 10.1111/imj.15347] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/11/2021] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with type 1 diabetes (T1D) aged <21 years are eligible for subsidised continuous glucose monitoring (CGM) products under the Australian National Diabetes Services Scheme. There are few real-world published studies to evaluate the benefits of CGM in young adults. AIMS To perform a real-world observation study among youth with T1D to evaluate CGM use and benefits of CGM. METHODS Patients at the Westmead Hospital Young Adult Diabetes Clinic aged 15-21 years who commenced CGM before July 2018 were followed for 6 months post commencement of CGM. Differences in HbA1c and glucose metrics at baseline and follow up are compared between those commencing CGM and those that did not. RESULTS Forty-four (38%) of 115 eligible patients commenced CGM. Demographic characteristics and baseline HbA1c did not differ significantly between those started on CGM and those that did not. At 6 months, 18 (41%) of 44 patients still used CGM, with discomfort and inconvenience the most common reasons for dropout. In CGM continuers, at 6 months compared with baseline, there was no change in HbA1c (8.2% vs 8.0%; P = 0.8), coefficient of variation of glucose (38% vs 39%; P = 0.5) or percentage time in range (52% vs 58%; P = 0.3). Six-month follow-up HbA1c in CGM non-users deteriorated significantly compared with users. Mean hypoglycaemia fear scores (worry scale) were significantly decreased from baseline at 6 months (33 vs 18; P < 0.01). CONCLUSION There are high rates of discontinuation in CGM use among youth with T1D. At 6 months of CGM use, there was no significant change in glycaemic control, although HbA1c in non-users deteriorated significantly. Worry of hypoglycaemia was significantly decreased among those who continued CGM.
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Affiliation(s)
- Myron Andrew Lee
- Endocrinology and Chemical Pathology Registrar, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia.,Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Deborah Jane Holmes-Walker
- Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia.,Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Kaye Farrell
- Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
| | - Ashley Clark-Luccitti
- Diabetes Transition Support Programme, Department of Diabetes and Endocrinology, Westmead Hospital, New South Wales, Australia
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Hameed DS. Early Glucose abnormalities in cystic fibrosis - how best to measure them, and what is to be done about them? J Cyst Fibros 2023; 22:3-4. [PMID: 36907643 DOI: 10.1016/j.jcf.2023.01.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 01/28/2023] [Indexed: 03/12/2023]
Affiliation(s)
- Dr Shihab Hameed
- Department of Paediatric Endocrinology, Sydney Children's Hospital, Randwick, New South Wales AUSTRALIA; Department of Paediatric Endocrinology and Diabetes Royal North Shore Hospital, St.Leonards, New South Wales, AUSTRALIA; School of Women's and Children's Health, University of New South Wales, Kensington New South Wales, AUSTRALIA; Northern Clinical School, University of Sydney, St.Leonards, New South Wales, AUSTRALIA.
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Zhang L, Xu H, Liu L, Bi Y, Li X, Kan Y, Liu H, Li S, Zou Y, Yuan Y, Gong W, Zhang Y. Related factors associated with fear of hypoglycemia in parents of children and adolescents with type 1 diabetes - A systematic review. J Pediatr Nurs 2022; 66:125-135. [PMID: 35716460 DOI: 10.1016/j.pedn.2022.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022]
Abstract
PROBLEM Fear of hypoglycemia is a significant concern for parents of children/ adolescents with type 1 diabetes. Although some studies have explained the parental fear of hypoglycemia, the related factors were yet to be determined. This systematic review aims to identify the related factors of fear of hypoglycemia in the parents of children and adolescents with type 1 diabetes and provide a theoretical basis for further intervention. ELIGIBILITY CRITERIA PubMed, MEDLINE, EMBASE, Scopus, CINAHL, EBSCO, Web of Science, and Cochrane Library were systematically searched from 2010 to 2021. Studies evaluating the fear of hypoglycemia of parents and its associated factors were included. SAMPLE Twenty-three observational articles met the criteria. RESULTS Significant associations were found between fear of hypoglycemia and specific factors, including motherhood, nocturnal hypoglycemia, and the number of blood glucose monitoring. Psychological factors, including anxiety, depression, pediatric parenting stress, mindfulness, self-efficacy, quality of life, and sleep disorders, were conclusive and associations with parental fear of hypoglycemia. CONCLUSIONS Understanding parental fear of hypoglycemia can help parents prevent potential problems in diabetes management, thus promoting children's growth. According to current evidence, effective targeted interventions based on modifiable relevant factors can be developed to reduce the fear of hypoglycemia in parents while maintaining optimal blood glucose control in children/ adolescents. IMPLICATIONS Health professionals should pay more attention to the mental health of parents, and parents should be involved in the care plan and have the opportunity to discuss their fear of hypoglycemia in the most appropriate way to manage type 1 diabetes.
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Affiliation(s)
- Lu Zhang
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Huiwen Xu
- School of Nursing, Yangzhou University, Yangzhou, China; Nagano College of Nursing, Komagane, Nagano 399-4117, Japan
| | - Lin Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yaxin Bi
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Xiangning Li
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yinshi Kan
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Hongyuan Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Shuang Li
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yan Zou
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Weijuan Gong
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yu Zhang
- School of Nursing, Yangzhou University, Yangzhou, China; Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, China.
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Teasdale SL, Griffin A, Barrett HL, Coutts C, Vitanza M, Headey A. Continuous Glucose Monitoring in Young Adults With Type 1 Diabetes: Impact on Hypoglycemia Confidence and Fear. Diabetes Spectr 2022; 35:322-326. [PMID: 36082015 PMCID: PMC9396722 DOI: 10.2337/ds21-0066] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Fear of hypoglycemia in people with type 1 diabetes has a detrimental effect on glycemic control and quality of life. The association between continuous glucose monitoring (CGM) and hypoglycemia confidence and fear has not previously been assessed in the young adult population. METHODS This was a prospective cohort study using questionnaires to assess the impact of CGM on hypoglycemia confidence (using the Hypoglycemia Confidence Scale [HCS]) and hypoglycemia fear (using the Hypoglycemia Fear Survey II [HFS]) in 40 young adults with a preexisting diagnosis of type 1 diabetes. RESULTS Scores on the HCS were greater at baseline for those with a longer duration of diabetes. Participants with higher general anxiety scores on the Generalized Anxiety Disorder 7-item scale had higher hypoglycemia fear at baseline (total score and worry component, but not behavior component of the HFS). Between baseline and follow-up, HCS scores increased on average by 0.2 (95% CI 0.1-0.4, P = 0.01) on a scale of 1-4. HFS scores decreased by 1.8 (95% CI -3.0 to -0.5, P = 0.006) on a scale of 0-24 for the worry component and by 2.5 (95% CI -4.4 to -0.6, P = 0.01) on a scale of 0-44 for total (worry + behavior components). At follow up, 83% of participants planned to continue using CGM all or most of the time. There was a very high self-reported effect of CGM on life with diabetes (median 8.0 [interquartile range 6.5-10.0], where 10 indicated a very big difference). CONCLUSION Hypoglycemia confidence and fear improve with CGM use in young adults.
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Affiliation(s)
- Stephanie L. Teasdale
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
- Corresponding author: Stephanie L. Teasdale,
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | - Helen L. Barrett
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
- Mater Research Institute, University of Queensland, South Brisbane, Australia
| | - Clare Coutts
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
| | - Margaret Vitanza
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
| | - Alan Headey
- Queensland Diabetes and Endocrine Centre, Mater Misericordiae Hospital, Brisbane, Australia
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Ray MK, McMichael A, Rivera-Santana M, Noel J, Hershey T. Technological Ecological Momentary Assessment Tools to Study Type 1 Diabetes in Youth: Viewpoint of Methodologies. JMIR Diabetes 2021; 6:e27027. [PMID: 34081017 PMCID: PMC8212634 DOI: 10.2196/27027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 03/26/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic childhood diseases, and its prevalence is rapidly increasing. The management of glucose in T1D is challenging, as youth must consider a myriad of factors when making diabetes care decisions. This task often leads to significant hyperglycemia, hypoglycemia, and glucose variability throughout the day, which have been associated with short- and long-term medical complications. At present, most of what is known about each of these complications and the health behaviors that may lead to them have been uncovered in the clinical setting or in laboratory-based research. However, the tools often used in these settings are limited in their ability to capture the dynamic behaviors, feelings, and physiological changes associated with T1D that fluctuate from moment to moment throughout the day. A better understanding of T1D in daily life could potentially aid in the development of interventions to improve diabetes care and mitigate the negative medical consequences associated with it. Therefore, there is a need to measure repeated, real-time, and real-world features of this disease in youth. This approach is known as ecological momentary assessment (EMA), and it has considerable advantages to in-lab research. Thus, this viewpoint aims to describe EMA tools that have been used to collect data in the daily lives of youth with T1D and discuss studies that explored the nuances of T1D in daily life using these methods. This viewpoint focuses on the following EMA methods: continuous glucose monitoring, actigraphy, ambulatory blood pressure monitoring, personal digital assistants, smartphones, and phone-based systems. The viewpoint also discusses the benefits of using EMA methods to collect important data that might not otherwise be collected in the laboratory and the limitations of each tool, future directions of the field, and possible clinical implications for their use.
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Affiliation(s)
- Mary Katherine Ray
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Alana McMichael
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Maria Rivera-Santana
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Jacob Noel
- Department of Psychiatry, Washington University in St. Louis, St. Louis, MO, United States
| | - Tamara Hershey
- Department of Psychiatry, Mallinckrodt Institute of Radiology, Washington University in St. Louis, St. Louis, MO, United States
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Swaney EE, McCombe J, Coggan B, Donath S, O'Connell MA, Cameron FJ. Has subsidized continuous glucose monitoring improved outcomes in pediatric diabetes? Pediatr Diabetes 2020; 21:1292-1300. [PMID: 32829528 DOI: 10.1111/pedi.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In 2017, the Australian Federal Government fully subsidized continuous glucose monitoring (CGM) devices for patients under 21 years of age with T1D with the aim of reducing rates of severe hypoglycaemia (SH) and improving metabolic control. The aim of this study was to reports on metabolic outcomes in youth from a single tertiary centre. METHODS The study design was observational. Data were obtained on youth who commenced CGM between May 2017 and December 2019. RESULTS Three hundred and forty one youth who commenced CGM and had clinical outcome data for a minimum of 4 months. 301, 261, 216, 172, and 125 had outcome data out to 8, 12, 16, 20, and 24 months, respectively. Cessation occurred between 27.9% and 32.8% of patients 12 to 24 months after CGM commencement. HbA1c did not change in patients who continued to use CGM. In the 12 months prior to starting CGM the rate of severe hypoglycaemia events were 5.0 per 100 patient years. The rates of severe hypoglycaemia in those continuing to use CGM at 4, 8, 12, 16, 20, and 24 months, were 5.2, 5.1, 1.6, 6.1, 2.4, and 0 per 100 patient years, respectively. DISCUSSION Our experience of patients either ceasing or underusing CGM is less than reported in other cohorts but is nonetheless still high. There may have been a reduction in rates of severe hypoglycaemia over the 24 months follow up period; however, the absolute numbers of events were so low as to preclude meaningful statistical analysis.
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Affiliation(s)
- Ella Ek Swaney
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julia McCombe
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Brenda Coggan
- The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michele A O'Connell
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fergus J Cameron
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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