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Wersäll JH, Ekelund J, Åkesson K, Hanas R, Adolfsson P, Ricksten SE, Forsander G. Relative poverty is associated with increased risk of diabetic ketoacidosis at onset of type 1 diabetes in children. A Swedish national population-based study in 2014-2019. Diabet Med 2024; 41:e15283. [PMID: 38213059 DOI: 10.1111/dme.15283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 12/21/2023] [Accepted: 12/29/2023] [Indexed: 01/13/2024]
Abstract
AIMS The aim of the study was to estimate the effect of household relative poverty on the risk of diabetic ketoacidosis at diagnosis of children with type 1 diabetes using an international standard measurement of relative poverty. METHODS A national population-based retrospective study was conducted. The Swedish National Diabetes Register (NDR) was linked with data from Sweden's public statistical agency (Statistics Sweden). Children who were diagnosed with new-onset type 1 diabetes in the period of 2014-2019 were common identifiers. The definition of diabetic ketoacidosis was venous pH <7.30 or a serum bicarbonate level <18 mmol/L. The exposure variable was defined according to the standard definition of the persistent at-risk-of-poverty rate used by the statistical office of the European Union (Eurostat) and several other European public statistical agencies. Univariate and multi-variable analyses were used to calculate the effect of relative poverty on the risk of diabetic ketoacidosis. RESULTS Children from households with relative poverty had a 41% higher risk of diabetic ketoacidosis (1.41, CI 1.12-1.77, p = 0.004) and more than double the risk of severe diabetic ketoacidosis (pH <7.10) (RR 2.10, CI 1.35-3.25, p = 0.001), as compared to children from households without relative poverty. CONCLUSIONS Relative poverty significantly increases the risk of diabetic ketoacidosis at onset of type 1 diabetes in children, even in a high-income country with publicly reimbursed health care.
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Affiliation(s)
- Johan H Wersäll
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Karin Åkesson
- Division of Paediatrics, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ragnar Hanas
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Peter Adolfsson
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sven-Erik Ricksten
- Institute of Clinical Sciences, Department of Anaesthesiology and Intensive Care, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gun Forsander
- Institute of Clinical Sciences, Department of Paediatrics, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kofoed PE, Lisbjerg S, Thomsen J. The perception of patients, mothers and healthcare professionals regarding introduction of home visits for adolescents with type 1 diabetes. J Eval Clin Pract 2024; 30:140-145. [PMID: 37583095 DOI: 10.1111/jep.13899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 08/17/2023]
Abstract
BACKGROUND AND OBJECTIVES Despite advancements in diabetes management, a subgroup of patients does not achieve an acceptable level of metabolic control. To achieve treatment goals for high-risk patients, a higher frequency of contact with healthcare professionals is essential. However, socioeconomic challenges often lead to nonattendance at the outpatient clinic. Therefore, home visits were introduced as a supplement/an alternative to consultations at the paediatric diabetes clinic. The aim of this study was to uncover the perception of patients, mothers and healthcare professionals regarding home visits versus consultations at the outpatient clinic in order to being able to improve the services offered. METHODS Semistructured interviews with patients, mothers and healthcare professionals were conducted to explore the experiences and perspectives of the concept at two paediatric diabetes clinics in Denmark. Paired t tests were used to compare the glycated hemoglobin A1c (HbA1c) levels at the start of the intervention with HbA1c 1 year before and HbA1c at the end of the intervention. RESULTS Both patients, mothers and healthcare professionals found consultations in familiar surroundings to result in stronger relationships between healthcare professionals and families, creating greater opportunities to discuss personal issues aimed at improving the outcome of diabetes. Furthermore, home visits facilitated finding alternative methods of helping patients and the families integrating diabetes into everyday life. CONCLUSION Overall, home visits were found to contribute toward creating a more constructive relationship. However, it was still a challenge to keep the scheduled appointments, and during this short study, no improvement in metabolic control could be observed.
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Affiliation(s)
- Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
- Institute of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Lisbjerg
- Department of Paediatrics and Adolescent Medicine, Nordsjaellands Hospital, Hillerød, Denmark
| | - Jane Thomsen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital, University Hospital of Southern Denmark, Kolding, Denmark
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Lomax KE, Taplin CE, Abraham MB, Smith GJ, Haynes A, Zomer E, Ellis KL, Clapin H, Zoungas S, Jenkins AJ, Harrington J, de Bock MI, Jones TW, Davis EA. Socioeconomic status and diabetes technology use in youth with type 1 diabetes: a comparison of two funding models. Front Endocrinol (Lausanne) 2023; 14:1178958. [PMID: 37670884 PMCID: PMC10476216 DOI: 10.3389/fendo.2023.1178958] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 07/31/2023] [Indexed: 09/07/2023] Open
Abstract
Background Technology use, including continuous glucose monitoring (CGM) and insulin pump therapy, is associated with improved outcomes in youth with type 1 diabetes (T1D). In 2017 CGM was universally funded for youth with T1D in Australia. In contrast, pump access is primarily accessed through private health insurance, self-funding or philanthropy. The study aim was to investigate the use of diabetes technology across different socioeconomic groups in Australian youth with T1D, in the setting of two contrasting funding models. Methods A cross-sectional evaluation of 4957 youth with T1D aged <18 years in the national registry was performed to determine technology use. The Index of Relative Socio-Economic Disadvantage (IRSD) derived from Australian census data is an area-based measure of socioeconomic status (SES). Lower quintiles represent greater disadvantage. IRSD based on most recent postcode of residence was used as a marker of SES. A multivariable generalised linear model adjusting for age, diabetes duration, sex, remoteness classification, and location within Australia was used to determine the association between SES and device use. Results CGM use was lower in IRSD quintile 1 in comparison to quintiles 2 to 5 (p<0.001) where uptake across the quintiles was similar. A higher percentage of pump use was observed in the least disadvantaged IRSD quintiles. Compared to the most disadvantaged quintile 1, pump use progressively increased by 16% (95% CI: 4% to 31%) in quintile 2, 19% (6% to 33%) in quintile 3, 35% (21% to 50%) in quintile 4 and 51% (36% to 67%) in the least disadvantaged quintile 5. Conclusion In this large national dataset, use of diabetes technologies was found to differ across socioeconomic groups. For nationally subsidised CGM, use was similar across socioeconomic groups with the exception of the most disadvantaged quintile, an important finding requiring further investigation into barriers to CGM use within a nationally subsidised model. User pays funding models for pump therapy result in lower use with socioeconomic disadvantage, highlighting inequities in this funding approach. For the full benefits of diabetes technology to be realised, equitable access to pump therapy needs to be a health policy priority.
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Affiliation(s)
- Kate E Lomax
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Mary B Abraham
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
| | - Grant J Smith
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Aveni Haynes
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Katrina L Ellis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
| | - Helen Clapin
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Alicia J Jenkins
- Diabetes and Vascular Medicine, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
- NHMRC Clinical Trials Centre, The University of Sydney, Sydney, NSW, Australia
| | - Jenny Harrington
- Division of Endocrinology, Women's and Children's Health Network, North Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
| | - Timothy W Jones
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, WA, Australia
- Children's Diabetes Centre, Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
- Division of Paediatrics within the Medical School, The University of Western Australia, Perth, WA, Australia
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Francis-Oliviero F, Driollet B, Alla F. Pediatric health professionals' perceptions of social health inequalities and proportionate universalism in a French academic hospital: a qualitative study. Eur J Pediatr 2023:10.1007/s00431-023-05005-0. [PMID: 37171520 PMCID: PMC10176283 DOI: 10.1007/s00431-023-05005-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
To describe healthcare professionals' perceptions of social health inequalities in the context of pediatric chronic disease and their insights regarding proportionate universalism as a potential solution to reduce them. Semi-directive interviews were conducted with healthcare professionals from different pediatric chronic disease departments of a single French academic hospital. This qualitative study was based on an inductive thematic analysis; an interview topic guide was used for the interviews and the analysis. In this study, we highlighted three main themes: the healthcare professionals' perceptions of social health inequalities in their practices, their beliefs regarding the causality of those inequalities, and potential solutions proposed by healthcare professionals to reduce them. Healthcare professionals very often associated inequalities with socio-economic precariousness or geographical disparities but were not familiar with the notion of a social gradient. Paradoxically, while they claimed not to differentiate among patients in their practice, they did report adapting care, depending on the social situation. For healthcare professionals, inequalities were the result of misunderstood problems, a lack of family support, a failure of the prevention system, and a lack of financial resources. CONCLUSION We still need to develop solutions to tackle those inequalities at every level of the healthcare system, and healthcare professionals must be more actively involved in this effort. One approach is to adapt public health principles such as proportionate universalism to individual care. WHAT IS KNOWN • Social health inequalities exist in pediatric care and a social gradient has been shown in many clinical situations. • Exploring health professionals' perceptions of social health inequalities can lead to solutions to tackle them. WHAT IS NEW • Pediatricians and pediatric nurses were not fully aware of the social gradient of health. • Although they claimed not to differentiate between patients in their practice, healthcare professionals did adapt care when complicated social situations arose.
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Affiliation(s)
- Florence Francis-Oliviero
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France.
- Pôle de Santé Publique, Service d'Information Médicale, CHU de Bordeaux, Bordeaux, France.
| | - Bénédicte Driollet
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France
| | - François Alla
- Centre INSERM U1219, University of Bordeaux, ISPED, Bordeaux Population Health, Bordeaux, France
- Pôle de Santé Publique, Service de Soutien Méthodologique et d'Innovation en Prévention, CHU de Bordeaux, Bordeaux, France
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Sherr JL, Schoelwer M, Dos Santos TJ, Reddy L, Biester T, Galderisi A, van Dyk JC, Hilliard ME, Berget C, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Insulin delivery. Pediatr Diabetes 2022; 23:1406-1431. [PMID: 36468192 DOI: 10.1111/pedi.13421] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 09/24/2022] [Indexed: 12/11/2022] Open
Affiliation(s)
- Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, Yale University, New Haven, Connecticut, USA
| | - Melissa Schoelwer
- Center for Diabetes Technology, University of Virginia, Charlottesville, Virginia, USA
| | | | - Leenatha Reddy
- Department of Pediatrics Endocrinology, Rainbow Children's Hospital, Hyderabad, India
| | - Torben Biester
- AUF DER BULT, Hospital for Children and Adolescents, Hannover, Germany
| | - Alfonso Galderisi
- Department of Woman and Child's Health, University of Padova, Padova, Italy
| | | | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Cari Berget
- Barbara Davis Center, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Linda A DiMeglio
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Ladd JM, Sharma A, Rahme E, Kroeker K, Dubé M, Simard M, Plante C, Blais C, Brownell M, Rodd C, Nakhla M. Comparison of Socioeconomic Disparities in Pump Uptake Among Children With Type 1 Diabetes in 2 Canadian Provinces With Different Payment Models. JAMA Netw Open 2022; 5:e2210464. [PMID: 35507342 PMCID: PMC9069256 DOI: 10.1001/jamanetworkopen.2022.10464] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Insulin pumps improve glycemic control and quality of life in children with type 1 diabetes (T1D). Canada's provinces have implemented universal pediatric programs to improve access. However, these programs provide differing financial coverage, allowing for unique cross-jurisdictional comparisons. OBJECTIVE To evaluate possible socioeconomic status (SES) disparities in pump uptake in Québec, where pumps are fully funded, with those in Manitoba, where pumps are partially funded. DESIGN, SETTING, AND PARTICIPANTS Using health administrative databases and a clinical registry, parallel, population-based cohort studies of children with diabetes were conducted from April 1, 2011, in Québec, and April 1, 2012, in Manitoba, until March 31, 2017. In analysis conducted from July 1, 2019, to November 30, 2021, multivariable Cox proportional hazards regression models were applied to study the association between pump uptake and SES, defined using validated area-based material and social deprivation indices. Children aged 1 to 17 years with T1D were identified using a validated definition in administrative data (Québec) and a clinical registry (Manitoba). Those using pumps before the initiation of provincial programs were excluded. EXPOSURES Socioeconomic status. MAIN OUTCOMES AND MEASURES Insulin pump uptake. RESULTS A total of 2919 children with T1D were identified in Québec: 1550 male (53.1%), mean (SD) age at diagnosis, 8.3 (4.4) years, and 1067 (36.6%) were using a pump. In Manitoba, 636 children were identified: 364 male (57.2%), mean (SD) age at diagnosis, 8.8 (4.4) years, and 106 (16.7%) were using a pump. In Québec, the mean age at diagnosis of T1D was lower in children using the pump compared with those not using a pump (7.6 [4.1] vs 8.7 [4.5] years); sex distribution was similar (562 [52.7%] vs 988 [53.3%] male). No differences in mean (SD) age at diagnosis (8.8 [4.4] vs 8.8 [4.3] years) or sex (57 [53.8%] vs 307 [57.9%] male) were noted in both groups in Manitoba. Increasing material deprivation was associated with decreased pump uptake in both Québec (adjusted hazard ratio [aHR] 0.89; 95% CI, 0.85-0.93) and Manitoba (aHR, 0.70; 95% CI, 0.60-0.82). Inclusion of ethnic concentration did not change this association. Socioeconomic disparities in pump uptake were greater in Manitoba than Québec (P = .006 by t test; Cochran Q, 8.15; P = .004; I2 = 87.7%; 95% CI, 52.5%-96.8%). CONCLUSIONS AND RELEVANCE The results of this study suggest that the program of full coverage for pumps available in Québec partially mitigates observed SES disparities in uptake and may be a model to improve access for all children with T1D.
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Affiliation(s)
- Jennifer M. Ladd
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
| | - Atul Sharma
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elham Rahme
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Kristine Kroeker
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Marjolaine Dubé
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Marc Simard
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
- Faculty of Medicine, Laval University, Québec City, Québec, Canada
| | - Céline Plante
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
| | - Claudia Blais
- Institut National de Santé Publique du Québec, Québec City, Québec, Canada
- Faculty of Pharmacy, Laval University, Québec City, Québec, Canada
| | - Marni Brownell
- Department of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Celia Rodd
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
- Children’s Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Meranda Nakhla
- The Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Department of Pediatrics, McGill University, Montreal, Québec, Canada
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Tauschmann M, Schwandt A, Prinz N, Becker M, Biester T, Hess M, Holder M, Karges B, Näke A, Kuss O, von Sengbusch S, Holl RW. Three-variate trajectories of metabolic control, body mass index, and insulin dose: Heterogeneous response to initiation of pump therapy in youth with type 1 diabetes. Pediatr Diabetes 2022; 23:330-340. [PMID: 35084795 PMCID: PMC9303587 DOI: 10.1111/pedi.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) in youths with type 1 diabetes (T1D) is often associated with lower HbA1c, lower total daily insulin dose (TDD), and lower body mass index (BMI) compared with multiple daily injections (MDI). Individual responses to CSII are diverse. The aim was to identify unique three-variate patterns of HbA1c, BMI standard deviation score (SDS), and TDD after switching to CSII. METHODS Five thousand one hundred and thirty-three youths (≤20 years; 48% boys; median age at pump start 12.5 years) with T1D duration ≥3 years at CSII initiation were selected from the multicenter DPV registry. We applied group-based multitrajectory modeling to identify groups of individuals following similar trajectories. Measurements were aggregated quarterly during a 3-year follow-up period. Trajectory variables were changes of HbA1c, BMI-SDS, and TDD from baseline (delta = quarterly aggregated values at each time point [i] minus the respective baseline value). RESULTS Four groups of diverging Delta-HbA1c, Delta-BMI-SDS, and Delta-TDD patterns were identified. All showed improvements in HbA1c during the first 3 months. Group 1 (12%) was characterized by modest HbA1c increase thereafter, TDD reduction, and stable BMI-SDS. In Group 2 (39%), increasing HbA1c, decreasing BMI-SDS, and stable TDD were found. By contrast, sustainably improved HbA1c, increasing BMI-SDS, and stable TDD were observed in Group 3 (32%). Group 4 (17%) was characterized by increasing levels for HbA1c, BMI-SDS, and TDD. Between-group differences in baseline HbA1c, BMI-SDS, TDD as well as in sex ratio, age at diabetes onset and at pump start were observed. CONCLUSIONS Definite trajectories of glycemic control, BMI, and TDD over 3 years after CSII initiation were identified in youths with T1D allowing a more personalized treatment recommendation.
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Affiliation(s)
- Martin Tauschmann
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Anke Schwandt
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Nicole Prinz
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Marianne Becker
- DECCPClinique Pédiatrique Centre Hospitalier de LuxembourgLuxembourgLuxembourg
| | - Torben Biester
- Diabetes‐Center for Children and AdolescentsChildren's Hospital "Auf der Bult"HannoverGermany
| | - Melanie Hess
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland
| | - Martin Holder
- Klinikum Stuttgart, OlgahospitalDepartment of Pediatric Endocrinology and DiabetologyStuttgartGermany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Andrea Näke
- Children's Hospital Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany,Institute of Biometrics and Epidemiology, German Diabetes CentreLeibniz Centre for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent MedicineUniversity Hospital Schleswig‐Holstein, Campus LuebeckLuebeckGermany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
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Dennig MJ, Sommer G, Zingg T, Flück CE, Boettcher C. Stable Metabolic Control but Increased Demand for Professional Support in Children with Type 1 Diabetes in the Past Ten Years in Bern/Switzerland: A Quality Control Study. J Diabetes Res 2022; 2022:3170558. [PMID: 36034586 PMCID: PMC9402297 DOI: 10.1155/2022/3170558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Lower HbA1c targets and increasingly complex diabetes management with substantially increasing costs dominate today's type 1 diabetes therapy in children and adolescents. OBJECTIVE To evaluate metabolic control in children and adolescents with type 1 diabetes and assess associated factors, evaluate determinants for frequency of healthcare contacts, and compare actual with historical data. METHOD This cross-sectional observational study collected data on 178 children and adolescents with type 1 diabetes treated at the University Children's Hospital in Bern. RESULTS Mean HbA1c was 7.9% (63 mmol/mol), 33.1% (59/178) of children reached the target of HbA1c < 7.5% (<59 mmol/mol), and 18.0% (32/178) had an HbA1c value < 7.0% (<53 mmol/mol). Compared to historical data, stable HbA1c levels appeared with a doubled proportion of individuals using insulin pumps. Metabolic control was worse with a longer duration of diabetes and younger age at diagnosis but better when parents came from a Western European country. Age at the consultation, use of diabetes technology and native language influenced the number of healthcare contacts. Younger patients, patients using CSII, and patients without an official Swiss language as mother tongue had more consultations with a healthcare professional than older and native language individuals. CONCLUSION The metabolic targets in childhood and adolescent type 1 diabetes are still unmet despite a shift towards more technology. Our study documents a higher demand for support and supervision in specific patient groups. An investment to increase healthcare contacts could help combat the increase in total diabetes cost and significantly improve metabolic control.
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Affiliation(s)
- Michelle J. Dennig
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Grit Sommer
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
- Department of BioMedical Research, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tanja Zingg
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Christa E. Flück
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
- Department of BioMedical Research, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudia Boettcher
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
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9
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Delagrange M, Dalla-Vale F, Salet R, Asensio-Weiss V, Moulin P, Cabaret B, Colmel C, Morin C, Talvard M, LeTallec C. Impact of deprivation on glycaemic control in youth with type 1 diabetes in the southwestern region of France. Pediatr Diabetes 2021; 22:796-806. [PMID: 33205845 DOI: 10.1111/pedi.13156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 09/09/2020] [Accepted: 11/11/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES The objective of this multicenter cross-sectional study was to determine predictors of poor glycaemic control in children with type 1 diabetes mellitus (T1DM), particularly with respect to socioeconomic status (SES). METHODS Our study population consisted of 1154 children who attended T1DM follow-up consultation with a pediatric diabetes specialist. Clinical and demographic data were retrieved retrospectively from patients' records. Individual deprivation was defined by an EPICES (Evaluation of the Deprivation and Inequalities of Health in Healthcare Centers) score ≥ 30. Patients were assigned to quintiles of the European Deprivation Index (EDI) based on their area deprivation scores. We used multivariable linear regression models to detect potential associations between glycaemic control and indicators of low SES. RESULTS In total, 33% (n = 376) of patients had an EPICES score ≥ 30 and 23% (n = 268) were in the 5th EDI quintile. Multivariable linear regression analysis showed that poor glycaemic control was associated with both individual (β 0.38; 95%CI 0.26-0.5; p < 0.001) and area deprivation (β 0.26; 95%CI 0.08-0.43; p = 0.004). Demographic factors, body mass index (BMI) and insulin regimen were also independently associated with poor glycaemic control (p < 0.001). Interestingly, access to diabetes technologies was not related to SES or either glycaemic control. CONCLUSION Low SES is associated with a higher risk of poor glycaemic control, independently of insulin regimen. BMI, age at the time of consultation, duration of diabetes, and insulin regimen. Also have an impact on HbA1c. These parameters need to be considered when developing novel treatment strategies for children with T1DM to better target at-risk patients.
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Affiliation(s)
- Marine Delagrange
- Pediatric Diabetology Unit, Toulouse University Hospital, Toulouse, France
| | - Fabienne Dalla-Vale
- Montpellier University Hospital, Pediatric Diabetology Unit, Arnaud De Villeneuve Hospital, Saint-Pierre Institute, Palavas-les-Flots, France
| | - Randa Salet
- Pediatric Diabetology Unit, Nîmes University Hospital, Nîmes, France
| | | | - Pierre Moulin
- Pediatric Unit, Montauban Hospital, Montauban, France
| | - Blandine Cabaret
- Bigorre Hospital, Boulevard de Lattre de Tassigny, Tarbes, France
| | - Corinne Colmel
- Toulouse, Childhood, Adolescence, Diabetes Association, Association Enfance, Adolescence & Diabète; EAD, Toulouse, France
| | - Carole Morin
- Pediatric Diabetology Unit, Toulouse University Hospital, Toulouse, France
| | - Maeva Talvard
- Pediatric Diabetology Unit, Toulouse University Hospital, Toulouse, France
| | - Claire LeTallec
- Pediatric Diabetology Unit, Toulouse University Hospital, Toulouse, France.,Toulouse, Childhood, Adolescence, Diabetes Association, Association Enfance, Adolescence & Diabète; EAD, Toulouse, France
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10
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Welters A, Tittel SR, Laubner K, Laimer M, Tschöpe D, Mader JK, Merger S, Milek S, Kummer S, Holl RW. Long-term trends of BMI and cardiometabolic risk factors among adults with type 1 diabetes: An observational study from the German/Austrian DPV registry. Diabetes Res Clin Pract 2021; 178:108973. [PMID: 34302914 DOI: 10.1016/j.diabres.2021.108973] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 07/14/2021] [Accepted: 07/19/2021] [Indexed: 11/27/2022]
Abstract
AIMS To analyse time-trends in BMI, obesity and cardiometabolic risk in adults with type 1 diabetes (T1DM) from the Diabetes Prospective Follow-up registry DPV. METHODS Data from 62,519 individuals with T1DM (age ≥ 18 years, BMI ≥ 18.5 kg/m2) were analysed. Multivariable regression models were used to determine time-trends in BMI, obesity and cardiometabolic risk and to identify predictors for increasing BMI. Results were compared to the NCD Risk Factor Collaboration (NCD-RisC) data for Germany. RESULTS Between 1999 and 2018 mean BMI increased from 25.0 kg/m2 to 26.2 kg/m2 in individuals with T1DM. This trend was most pronounced in young and middle-aged individuals (>21-55 years of age) and in those with higher baseline BMI. Insulin dose and diabetes duration were associated with increasing BMI. Between 1999 and 2016, the prevalence of obesity increased 1.8-fold in individuals with T1DM and 1.4-fold among the German population, respectively (NCD-RisC). Approximately 50-70% of individuals with obesity were insufficiently treated for hypertension and/or dyslipidaemia. CONCLUSION In adults with T1DM the prevalence of obesity is increasing at a faster pace than in the German population. BMI needs to be closely monitored, particularly during young adulthood, and cardiovascular risk factors need to be controlled better to prevent CVD and premature death.
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Affiliation(s)
- Alena Welters
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty and University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany.
| | - Sascha R Tittel
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany; German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Katharina Laubner
- Division of Endocrinology and Diabetology, Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany
| | - Markus Laimer
- Department of Diabetes, Endocrinology, Clinical Nutrition and Metabolism, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Diethelm Tschöpe
- Diabeteszentrum am Herz- und Diabeteszentrum Nordrhein-Westfalen, Ruhr Universität Bochum, Bad Oeynhausen, Germany
| | - Julia K Mader
- Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Sigrun Merger
- Clinic for Endocrinology, Diabetology, Metabolism and Nutrition Medicine, Clinic Coburg, German; University of Split, Croatia
| | - Susanne Milek
- Diabetes Practice and Training Centre Dr. med. Karsten Milek, Hohenmoelsen, Germany
| | - Sebastian Kummer
- Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty and University Children's Hospital Düsseldorf, Heinrich Heine University, Düsseldorf, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany; German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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11
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Müller-Godeffroy E, Mönkemöller K, Lilienthal E, Heidtmann B, Becker M, Feldhahn L, Freff M, Hilgard D, Krone B, Papsch M, Schumacher A, Schwab KO, Schweiger H, Wolf J, Bollow E, Holl R. Zusammenhang von Bildungsstatus und Diabetesoutcomes: Ergebnisse der DIAS-Studie bei Kindern und Jugendlichen mit Typ-1-Diabetes in Deutschland. DIABETOL STOFFWECHS 2021. [DOI: 10.1055/a-1452-8684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Zusammenfassung
Fragestellung Assoziation zwischen Bildungsstand (BldS) der Eltern und diabetesbezogenen Outcomes bei Kindern mit Typ-1-Diabetes in Deutschland und Vergleich mit deren sozioökonomischem Status (SES).
Material und Methode 1781 Kinder und Jugendliche mit Typ-1-Diabetes mellitus unter 18 Jahren aus 13 deutschen Diabeteszentren wurden von Juni 2013 bis Juni 2014 in die Studie eingeschlossen und Assoziationen des familiären BldS mit verschiedenen Diabetesoutcomes analysiert. Die Analyse wurde als Sekundäranalyse anhand des Datensatzes der DIAS-Studie durchgeführt. Diese hatte Assoziationen eines niedrigen SES (gemessen mit einem Index aus BldS, beruflicher Stellung und Haushaltseinkommen der Eltern) mit ungünstigen Diabetes- und Versorgungsoutcomes ermittelt. Die vorliegende Sekundäranalyse untersuchte Assoziationen derselben Outcomes mit dem BldS der Eltern, um zu prüfen, ob sich der BldS als vereinfachter Indikator für die Routinemessung des SES eignet.Die Daten wurden mittels der DPV-Software (Diabetes-Patienten-Verlaufsdokumentation) erfasst, die Analysen erfolgten je nach Verteilungscharakteristika der Outcomes mittels linearer, logistischer, negativ-binomialer oder Poisson-Modellen unter Adjustierung für Alter, Geschlecht, Diabetesdauer, jeweils mit und ohne zusätzliche Adjustierung für Migrationshintergrund.
Ergebnisse Niedriger familiärer BldS war im Vergleich zu mittlerem/hohem BldS mit einer schlechteren glykämischen Einstellung (HbA1c) (8,1 % versus 7,8 %, p < 0,0001/7,6 %, p < 0,0001) und einem geringeren prozentualen Anteil an Insulinpumpennutzung (42,7 % versus 56,3 %, p < 0,0001/52,5 %, p < 0,01) assoziiert. Weiterhin zeigten die Gruppen mit niedrigem im Vergleich zu mittlerem/hohem BldS seltenere tägliche Blutzuckerselbstmessungen, einen höheren Body-Mass-Index und längere stationäre Aufenthalte. Schwere Hypoglykämien und Ketoazidosen traten bei Patienten mit niedrigem BldS nicht häufiger auf. Der BldS der Eltern differenzierte dabei mindestens genauso gut zwischen den sozialen Gruppen wie der mit einem komplexen Indikator gemessene SES.
Zusammenfassung Der BldS der Eltern ist ein bedeutsamer Prädiktor für Gesundheits- und Versorgungsoutcomes bei Kindern mit Typ-1-Diabetes und sollte in der personalisierten Diabetestherapie von Kindern und Jugendlichen mehr Berücksichtigung erfahren. Als kurzer und leicht zu erhebender Indikator bildet er einen guten Näherungswert für die Routineerhebung der individuellen Stellung der Patientinnen und Patienten in der Sozialhierarchie in Diabetes-Standarddokumentationen.
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Affiliation(s)
| | - Kirsten Mönkemöller
- Klinik für Kinder- und Jugendmedizin, Kinderkrankenhaus Amsterdamer Straße, Köln, Germany
| | - Eggert Lilienthal
- St.-Josef-Hospital, Klinik für Kinder- und Jugendmedizin, Ruhr-Universität Bochum, Germany
| | - Bettina Heidtmann
- Pädiatrische Diabetologie und Endokrinologie, Katholisches Kinderkrankenhaus Wilhelmstift gGmbH, Hamburg, Germany
| | - Marianne Becker
- Klinik für Kinder und Jugendliche, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Germany
| | - Lutz Feldhahn
- Klinik für Kinder- und Jugendmedizin Böblingen, Klinikverbund Südwest GmbH, Böblingen, Germany
| | - Markus Freff
- Diabetologische Ambulanz, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | | | - Beate Krone
- Kinderklinik, Klinikum Bremen Nord, Bremen, Germany
| | - Matthias Papsch
- Klinik für Neonatologie, Kinder- und Jugendmedizin, Marienhospital Gelsenkirchen GmbH, Gelsenkirchen, Germany
| | | | - Karl-Otfried Schwab
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Freiburg, Germany
| | | | - Johannes Wolf
- Klinik für Kinder- und Jugendmedizin St. Louise, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Esther Bollow
- ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm, Germany
- Kooperationspartner, Deutsches Zentrum für Diabetesforschung (DZD), Düsseldorf, Germany
| | - Reinhard Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, Ulm, Germany
- Kooperationspartner, Deutsches Zentrum für Diabetesforschung (DZD), Düsseldorf, Germany
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12
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Liu S, Kuja-Halkola R, Larsson H, Lichtenstein P, Ludvigsson JF, Svensson AM, Gudbjörnsdottir S, Tideman M, Serlachius E, Butwicka A. Poor glycaemic control is associated with increased risk of neurodevelopmental disorders in childhood-onset type 1 diabetes: a population-based cohort study. Diabetologia 2021; 64:767-777. [PMID: 33454829 PMCID: PMC7940269 DOI: 10.1007/s00125-020-05372-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/09/2020] [Indexed: 12/16/2022]
Abstract
AIMS/HYPOTHESIS The aim of this study was to investigate the effect of childhood-onset type 1 diabetes on the risk of subsequent neurodevelopmental disorders, and the role of glycaemic control in this association. We hypothesised that individuals with poor glycaemic control may be at a higher risk of neurodevelopmental disorders compared with the general population, as well as compared with individuals with type 1 diabetes with adequate glycaemic control. METHODS This Swedish population-based cohort study was conducted using data from health registers from 1973 to 2013. We identified 8430 patients with childhood-onset type 1 diabetes (diagnosed before age 18 years) with a median age of diabetes onset of 9.6 (IQR 5.9-12.9) and 84,300 reference individuals from the general population, matched for sex, birth year and birth county. Cox models were used to estimate the effect of HbA1c on the risk of subsequent neurodevelopmental disorders, including attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorders (ASD) and intellectual disability. RESULTS During a median follow-up period of 5.6 years, 398 (4.7%) individuals with type 1 diabetes received a diagnosis of any neurodevelopmental disorder compared with 3066 (3.6%) in the general population, corresponding to an adjusted HR (HRadjusted) of 1.31 (95% CI 1.18, 1.46) after additionally adjusting for other psychiatric morbidity prior to inclusion, parental psychiatric morbidity and parental highest education level. The risk of any neurodevelopmental disorder increased with HbA1c levels and the highest risk was observed in patients with mean HbA1c >8.6% (>70 mmol/mol) (HRadjusted 1.90 [95% CI 1.51, 2.37]) compared with reference individuals without type 1 diabetes. In addition, when compared with patients with diabetes with HbA1c <7.5% (<58 mmol/mol), patients with HbA1c >8.6% (>70 mmol/mol) had the highest risk of any neurodevelopmental disorder (HRadjusted 3.71 [95% CI 2.75, 5.02]) and of specific neurodevelopmental disorders including ADHD (HRadjusted 4.16 [95% CI 2.92, 5.94]), ASD (HRadjusted 2.84 [95% CI 1.52, 5.28]) and intellectual disability (HRadjusted 3.93 [95% CI 1.38, 11.22]). CONCLUSIONS/INTERPRETATION Childhood-onset type 1 diabetes is associated with an increased risk of neurodevelopmental disorders, with the highest risk seen in individuals with poor glycaemic control. Routine neurodevelopmental follow-up visits should be considered in type 1 diabetes, especially in patients with poor glycaemic control.
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Affiliation(s)
- Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden.
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Jonas F Ludvigsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Department of Pediatrics, Örebro University Hospital, Örebro, Sweden
- Division of Epidemiology and Public Health, School of Medicine, University of Nottingham, Nottingham, UK
- Department of Medicine, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ann-Marie Svensson
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Soffia Gudbjörnsdottir
- Swedish National Diabetes Register, Centre of Registers, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Magnus Tideman
- School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Eva Serlachius
- Child and Adolescent Psychiatry, Stockholm Health Care Service, Region Stockholm, Sweden
| | - Agnieszka Butwicka
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
- Child and Adolescent Psychiatry, Stockholm Health Care Service, Region Stockholm, Sweden
- Department of Child Psychiatry, Medical University of Warsaw, Warsaw, Poland
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13
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Grudziąż-Sękowska J, Zamarlik M, Sękowski K. Assessment of Selected Aspects of the Quality of Life of Children with Type 1 Diabetes Mellitus in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042107. [PMID: 33671503 PMCID: PMC7926510 DOI: 10.3390/ijerph18042107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 12/18/2022]
Abstract
Type 1 diabetes mellitus (T1D) is, next to obesity and asthma, the most common chronic disease in children in Poland. T1D is not only a medical challenge, but it also affects all areas of a sick child's life and family functionality. New forms of therapy facilitate the daily management of the disease, but their availability is limited and partly dependent on socioeconomic status. This study aimed to assess the incidence and interrelationships between the child's health condition and the applied therapy model, and selected aspects of the child's family functionality and access to health and care services. The survey involved 206 child and youth caregivers with T1D who are members of Facebook support groups. The analysis of the obtained results revealed the existence of links between family income level and the type of insulin therapy applied. Children from families with a better financial situation (subjective and objective) were more likely to have additional medical consultations and make more frequent control visits. In families with a higher level of income, the T1D-induced restriction of child activity was less frequent. Living outside of urban centers was associated with a reduced availability of care or educational facilities adapted to take care of a child with T1D. No statistically significant correlations were observed between demographic and economic factors and the child's health status expressed by the occurrence of complications. The incidence of the latter, however, affected the child's family situation.
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Affiliation(s)
- Justyna Grudziąż-Sękowska
- Centre of Postgraduate Medical Education, School of Public Health, 01-813 Warsaw, Poland
- Correspondence: ; Tel.: +48-225-601-150
| | - Monika Zamarlik
- Faculty of Health Sciences, Institute of Public Health, Jagiellonian University, 31-007 Kraków, Poland;
| | - Kuba Sękowski
- Doctoral School, Law College, Kozminski University, 03-301 Warsaw, Poland;
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14
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[Is it possible to prevent diabetic ketoacidosis at diagnosis of pediatric type 1 diabetes? Lessons from the COVID-19 pandemic]. Monatsschr Kinderheilkd 2021; 169:451-460. [PMID: 33437098 PMCID: PMC7791536 DOI: 10.1007/s00112-020-01108-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/08/2020] [Indexed: 11/11/2022]
Abstract
Hintergrund Die diabetische Ketoacidose (DKA) ist ein lebensbedrohlicher Notfall bei Manifestation eines Diabetes mellitus Typ 1 (DM1) bei Kindern und Jugendlichen, häufig bei verspäteter Diagnosestellung oder vorheriger Fehldiagnose. Während der Zeit des „Coronavirus-disease-2019(COVID-19)-Lockdowns“ in Deutschland stellten sich weniger Patienten in Notfallambulanzen und Arztpraxen vor. Fragestellung Hat sich der Anteil der DKA bei Manifestation eines DM1 in der pädiatrischen Population in diesem Zeitraum verändert, und welche Gruppen sind besonders gefährdet, eine DKA zu erleiden? Material und Methoden Die DKA-Häufigkeit in der Zeit vom 13.03.2020 bis 13.05.2020 wurde bei Patienten <18 Jahren mit DM1-Manifestation in pädiatrischen Diabeteszentren untersucht. Die Diabeteszentren dokumentierten ihre Einschätzung, ob durch COVID-19 die Vorstellung verzögert war. Um den Einfluss von Risikofaktoren auf die DKA-Häufigkeit zu analysieren, erfolgte ein Vergleich der Daten aus dem Jahr 2020 mit denselben Zeiträumen der Jahre 2018 und 2019 mit linearen und logistischen Regressionsmodellen. Ergebnisse Die Daten von 532 Patienten aus 216 Diabeteszentren zeigten, dass das Risiko für eine DKA im Vergleich zu den Jahren 2018/2019 um 84,7 % und für eine schwere DKA um 45,3 % erhöht war. Kinder <6 Jahren waren mit einer Steigerung einer DKA um 141,6 % bzw. einer schweren DKA um 97,0 % besonders betroffen. Migrationshintergrund war ein COVID-19-unabhängiger Risikofaktor. Insgesamt wurden 31 % der Patienten verspätet vorgestellt, oder ihre Diagnose wurde zuvor verkannt. Diskussion In der Zeit des „COVID-19-Lockdowns“ war die Häufigkeit der DKA bei DM1-Manifestation für Kinder und Jugendliche signifikant erhöht. Alter <6 Jahre, Migrationshintergrund und verzögerte Vorstellung waren die Hauptrisikofaktoren.
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15
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Souza MAD, Freitas RWJFD, Lima LSD, Santos MAD, Zanetti ML, Damasceno MMC. Health-related quality of life of adolescents with type 1 diabetes mellitus. Rev Lat Am Enfermagem 2019; 27:e3210. [PMID: 31826155 PMCID: PMC6896811 DOI: 10.1590/1518-8345.2961.3210] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Accepted: 08/01/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the health-related quality of life of adolescents with type 1 diabetes mellitus, associating it with socio-demographic, clinical and biochemical variables. METHOD Cross-sectional study with 92 adolescents with type 1 diabetes mellitus. A form containing socio-demographic, clinical and biochemical variables was used, as well as the Diabetes Quality of Life for Youths questionnaire. Descriptive statistics and logistic regression were used for analysis. RESULTS Regarding socio-demographic variables, economic class showed statistically significant differences in relation to total Health Related Quality of Life (p-value =0.02) and the impact domain (p-value =0.009). However, the impact domain was more compromised. Diabetes-related complications (p-value =0.004), number of hospitalizations (p-value =0.01), number of daily insulin injections (p-value =0.02), glycated hemoglobin (p-value =0.002) and triglycerides (p-value =0.03) were associated with greater impairment of quality of life related to total health and greater dissatisfaction. CONCLUSION Single male adolescents with lower level of education and high glycated hemoglobin levels were more likely to have lower health-related quality of life.
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Affiliation(s)
- Maria Amélia de Souza
- Universidade Federal de Pernambuco, Centro Acadêmico de Vitória, Vitória de Santo Antão, PE, Brazil
| | | | | | - Manoel Antônio Dos Santos
- Universidade de São Paulo, Faculdade de Filosofia, Ciências e Letras de Ribeirão Preto, Ribeirão Preto, SP, Brazil
| | - Maria Lúcia Zanetti
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto, PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP, Brazil
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