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Gangqiang G, Hua C, Hongyu S. Risk predictors of glycaemic control in children and adolescents with type 1 diabetes: A systematic review and meta-analysis. J Clin Nurs 2024; 33:2412-2426. [PMID: 38661073 DOI: 10.1111/jocn.17110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 02/09/2024] [Accepted: 03/01/2024] [Indexed: 04/26/2024]
Abstract
OBJECTIVES To conduct systematic evaluation of the risk predictors of glycaemic control in children and adolescents with type 1 diabetes mellitus. METHODS Cohort studies on risk predictors of glycaemic control in children and adolescents with type 1 diabetes were retrieved from CNKI, PubMed, Web of Science, Embase databases, etc. from the construction of the repository to 3 February 2023. Literature screening was conducted according to inclusion and exclusion criteria, then data extraction of region, sample size, age, follow-up time, risk predictors, outcome indicators, etc., and quality evaluation of The Newcastle-Ottawa Scale were conducted by two researchers while the third researcher makes decisions if there are disagreements. Finally, Revman5.4 and StataMP17 were used for meta-analysis. RESULTS A total of 29 studies were included, and the results showed that insulin pump [Weighed mean difference (WMD) = -.48, 95% CI (-.73, -.24), p < .01], high-frequency sensor monitoring, early use of insulin pumps, prospective follow-up male, white race, large body mass index-standardised scoring, conscientiousness, agreeableness of mothers, eicosapentaenoic acid, leucine and protein (p < .05) were beneficial for reducing HbA1c levels in children and adolescents with diabetes. Ketoacidosis [WMD = .39, 95% CI (.28, .50), p < .01], selective admission, higher HbA1c level at one time (p < .01), higher glutamate decarboxylase antibody at 1 month after diagnosis, lower socio-economic status, non-living with biological parents, non-two-parent family, family disorder, family history of diabetes and high carbohydrate intake (p < .05) increased HbA1c levels in children and adolescents with diabetes. CONCLUSION For children and adolescents with type 1 diabetes mellitus, the use of insulin pump, high-frequency sensor monitoring, prospective follow-up, good family support and reasonable diet are conducive to blood glucose control, while selective admission and DKA are not. Disease characteristics and demographic characteristics of children are closely related to subsequent blood glucose control, and the relationship between diagnosis age and blood glucose control needs to be further explored.
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Affiliation(s)
- Gao Gangqiang
- School of Nursing, Peking University, Beijing, China
| | - Chen Hua
- School of Nursing, Peking University, Beijing, China
| | - Sun Hongyu
- School of Nursing, Peking University, Beijing, China
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Ghazaiean M, Najafi B, Zamanfar D, Alipour MJ. Risk factors for suboptimal glycemic control in pediatrics with type 1 diabetes mellitus: a cross-sectional study. Sci Rep 2024; 14:7492. [PMID: 38553464 PMCID: PMC10980686 DOI: 10.1038/s41598-024-57205-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
The objective of this research is to analyze the influence of various factors on glycemic control in pediatrics with type 1 diabetes mellitus (T1DM). The study, a cross-sectional analysis, involved 221 T1DM patients below 18 years old who visited our clinic between 2011 and 2020, predating the COVID-19 outbreak. Out of the initial pool, 204 participants were chosen based on specific criteria. By computing odds ratios and 95% confidence intervals, we determined the correlation between these factors and achieving optimal glycemic control (HbA1c < 7.5%). Of the 204 individuals, 55.9% (113 patients) were female. The average age at diagnosis was 6.93 ± 3.9 years. Mean HbA1c (A1C) level of optimal and suboptimal groups were 6.97, 95% CI 6.84 to 7.1 and 8.86, 95% CI 8.68 to 9.03, respectively (p-value < 0.001). Fifty patients had optimal glycemic control and 154 people experienced suboptimal glycemic control during the follow-up that the prevalence of each of them was 24.51, 95% CI 18.7 to 31 and 75.49, 95% CI 68.99 to 81.22, respectively. In the assessment of risk factors associated with suboptimal glycemic control, patients aged 10-14 years had the highest likelihood of experiencing suboptimal glycemic control (crude odds ratio [COR] 3.12, 95% CI 1.04 to 9.3), followed by duration of diabetes (COR 2.85, 95% CI 1.2 to 6.8), which both were significant. By utilizing multivariable logistic regression analysis, a noteworthy finding emerged. It was revealed that patients aged 10-14 years exhibited a significant association with suboptimal glycemic control, [adjusted odds ratio (AOR) 4.85, 95% CI 1.32 to 17.7]. Additionally, a statistically significant correlation was identified between individuals with a body mass index (BMI) falling within the ≥ 95th percentile category and suboptimal glycemic control, Cramer's V = 0.21, p-value = 0.01. Our research has revealed a significant correlation between patients aged 10-14 years and obese individuals (BMI ≥ 95th) with suboptimal glycemic control. It is crucial to consider these factors as they can offer valuable insights during diagnosis, highlighting the increased risk of long-term suboptimal glycemic control.
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Affiliation(s)
- Mobin Ghazaiean
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Gut and Liver Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Behnam Najafi
- Gastrointestinal Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Daniel Zamanfar
- Department of Pediatric Endocrinology, Diabetes Research Center of Mazandaran, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mohammad Javad Alipour
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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Monzon AD, Majidi S, Clements MA, Patton SR. The Relationship Between Parent Fear of Hypoglycemia and Youth Glycemic Control Across the Recent-Onset Period in Families of Youth with Type 1 Diabetes. Int J Behav Med 2024; 31:64-74. [PMID: 36745325 DOI: 10.1007/s12529-023-10159-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND This study aims to examine the relationship between parents' fear of hypoglycemia (FH) over a 1-year period and child glucose metrics in 126 families of youth recently diagnosed with type 1 diabetes (T1D). METHODS Parents completed the Hypoglycemia Fear Survey for Parents (HFS-P) and uploaded 14 days of glucose data at a baseline, 6-month, and 12-month assessment. RESULTS Parents' HFS-P total and worry scores increased to a clinically meaningful degree from baseline to 6-month assessment, while multilevel models revealed within- and between-person variability in parents' HFS-P worry and behavior scores over time associated with child glycemia. Specifically, a significant negative relationship for within-person worry scores suggested that when parents reported higher than their average worry scores, their children recorded fewer glucose values in the target range, while within-person behavior scores suggested that when parents reported lower than their average behavior scores, their children recorded more values above the target range. There was also a negative relationship for between-person behavior scores with child glycated hemoglobin and a positive relationship for between-person behavior scores with child glucose values in the target range. CONCLUSIONS In the recent-onset period of T1D, parental FH worry and behavior associated with child glycemia possibly due to changes in parents' perceptions of their child's hypoglycemia risk. The clinically meaningful increases in parent FH in the recent-onset period and the negative association for between-person behavior scores with child glycated hemoglobin suggest that clinics should consider screening parents for FH, especially among parents of children with lower glycemic levels.
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Affiliation(s)
- Alexandra D Monzon
- Center for Healthcare Delivery Science, Nemours Children's Health, Orlando, FL, USA
| | - Shideh Majidi
- Division of Endocrinology, Children's National Hospital, Washington, DC, USA
| | - Mark A Clements
- Division of Endocrinology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville, FL, USA.
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Leishman DJ, Oppler SH, Stone LLH, O’Brien TD, Ramachandran S, Willenberg BJ, Adams AB, Hering BJ, Graham ML. Targeted mapping and utilization of the perihepatic surface for therapeutic beta cell replacement and retrieval in diabetic non-human primates. FRONTIERS IN TRANSPLANTATION 2024; 3:1352777. [PMID: 38993753 PMCID: PMC11235263 DOI: 10.3389/frtra.2024.1352777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 01/09/2024] [Indexed: 07/13/2024]
Abstract
Introduction Successful diabetes reversal using pancreatic islet transplantation by various groups illustrates the significant achievements made in cell-based diabetes therapy. While clinically, intraportal islet delivery is almost exclusively used, it is not without obstacles, including instant blood-mediated inflammatory reaction (IBMIR), relative hypoxia, and loss of function over time, therefore hindering long-term success. Here we demonstrate the perihepatic surface of non-human primates (NHPs) as a potential islet delivery site maximizing favorable characteristics, including proximity to a dense vascular network for adequate oxygenation while avoiding IBMIR exposure, maintenance of portal insulin delivery, and relative ease of accessibility through minimally invasive surgery or percutaneous means. In addition, we demonstrate a targeted mapping technique of the perihepatic surface, allowing for the testing of multiple experimental conditions, including a semi-synthetic hydrogel as a possible three-dimensional framework to improve islet viability. Methods Perihepatic allo-islet cell transplants were performed in immunosuppressed cynomolgus macaques using a targeted mapping technique to test multiple conditions for biocompatibility. Transplant conditions included islets or carriers (including hydrogel, autologous plasma, and media) alone or in various combinations. Necropsy was performed at day 30, and histopathology was performed to assess biocompatibility, immune response, and islet viability. Subsequently, single-injection perihepatic allo-islet transplant was performed in immunosuppressed diabetic cynomolgus macaques. Metabolic assessments were measured frequently (i.e., blood glucose, insulin, C-peptide) until final graft retrieval for histopathology. Results Targeted mapping biocompatibility studies demonstrated mild inflammatory changes with islet-plasma constructs; however, significant inflammatory cell infiltration and fibrosis were seen surrounding sites with the hydrogel carrier affecting islet viability. In diabetic NHPs, perihepatic islet transplant using an autologous plasma carrier demonstrated prolonged function up to 6 months with improvements in blood glucose, exogenous insulin requirements, and HbA1c. Histopathology of these islets was associated with mild peri-islet mononuclear cell infiltration without evidence of rejection. Discussion The perihepatic surface serves as a viable site for islet cell transplantation demonstrating sustained islet function through 6 months. The targeted mapping approach allows for the testing of multiple conditions simultaneously to evaluate immune response to biomaterials at this site. Compared to traditional intraportal injection, the perihepatic site is a minimally invasive approach that allows the possibility for graft recovery and avoids IBMIR.
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Affiliation(s)
- David J. Leishman
- Preclinical Research Center, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Scott H. Oppler
- Preclinical Research Center, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Laura L. Hocum Stone
- Preclinical Research Center, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Timothy D. O’Brien
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, United States
| | - Sabarinathan Ramachandran
- Preclinical Research Center, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Bradley J. Willenberg
- Department of Internal Medicine, University of Central Florida College of Medicine, Orlando, FL, United States
| | - Andrew B. Adams
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Bernhard J. Hering
- Schulze Diabetes Institute, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
| | - Melanie L. Graham
- Preclinical Research Center, Department of Surgery, University of Minnesota, Minneapolis, MN, United States
- Department of Veterinary Population Medicine, University of Minnesota, St. Paul, MN, United States
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Aljawarneh YM, Wood GL, Wardell DW, Al-Jarrah MD. The associations between physical activity, health-related quality of life, regimen adherence, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study. Prim Care Diabetes 2023:S1751-9918(23)00068-2. [PMID: 37080862 DOI: 10.1016/j.pcd.2023.04.003] [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: 10/07/2022] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Adolescents with Type 1 Diabetes (T1D) display a greater than two-fold higher risk of developing diabetes-related complications compared with their healthy peers and the risk increases markedly as glycated hemoglobin (HbA1c) increases. The majority of the known factors associated with improved glycemic control in adolescents with T1D are geared toward Western populations. Therefore, this study examined the associations between Physical Activity (PA), Health-Related Quality of Life (HRQoL), and regimen adherence on glycemic control in a Middle Eastern population of adolescents with T1D METHODS: The study utilized a cross-sectional design of Jordanian adolescents (aged 12-18) with T1D (n = 74). Self-reported measures used were the Pediatric Quality of Life-Diabetes Module, the International Physical Activity Questionnaire, and the Summary of Diabetes Self-Care Activities. HbA1c values were obtained from the medical records. Correlation analyses were conducted using Pearson's and Spearman's correlation tests. Multiple regression analyses were conducted to determine if HRQoL, PA, and regimen adherence predict glycemic control. RESULTS Only 14.8 % of the participants demonstrated good glycemic control (HbA1c ≤ 7.5 %). Participants with poor control had a statistically significant lower mean PA of MET-minutes/week (3531.9 ± 1356.75 vs. 1619.81 ± 1481.95, p < .001) compared to those with good control. The total sample was found to demonstrate low HRQoL (47.70 ± 10.32). Participants were within the acceptable range of PA (1885.38 ± 1601.13) MET-minutes/week. HbA1c significantly inversely correlated with PA (r = -0.328, p = .010) and regimen adherence (r = -0.299, p = .018). The regression analysis revealed that PA significantly predicted glycemic control (β = -0.367, p < .01) as adherence (β = -0.409, p < .01) and disease duration did (β = 0.444, p < .01). CONCLUSION Better glycemic control was significantly associated with higher PA and regimen adherence levels. The correlation between PA and glycemic control depends highly on the level of regimen adherence or arguably, adherence acts as a buffer in the correlation between PA and glycemic control. There was no significant association between glycemic control and HRQoL.
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Affiliation(s)
- Yousef M Aljawarneh
- School of Nursing at Higher Colleges of Technology, Fujairah 1626, United Arab Emirates.
| | - Geri LoBiondo Wood
- Nursing Program at The University of Texas Health Science Center-Houston, Cizik School of Nursing, 6901 Bertner Avenue, Ste. 580, Houston, TX 77030, USA
| | - Diane W Wardell
- School of Nursing at The University of Texas Health Science Center-Houston, 6901 Bertner Avenue, Ste. 615, Houston, TX 77030, USA
| | - Muhammed D Al-Jarrah
- Department of Rehabilitation Sciences at The Jordan University of Science and Technology, 3030 Ar-Ramtha, Jordan
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An Integrated Care Model to Support Adolescents With Diabetes-related Quality-of-life Concerns: An Intervention Study. Can J Diabetes 2023; 47:3-10. [PMID: 35843836 DOI: 10.1016/j.jcjd.2022.05.004] [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: 08/04/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim in this study was to determine whether participating in an integrated stepped care model for adolescents with type 1 diabetes (T1D) would lead to improvements in overall quality of life (QoL), diabetes-related quality of life (DRQoL) and glycated hemoglobin (A1C) levels compared with usual care. METHODS A nonrandomized, 2-group, pre/post, delayed-intervention design was used for this study. The Mind Youth Questionnaire (MY-Q) was used to assess QoL and DRQoL. Adolescents attending the diabetes clinic using the stepped care model formed the intervention group (n=77). These adolescents completed the MY-Q, and the identified concerns were discussed and addressed with them by their care team as part of the care model. Adolescents attending a pediatric diabetes clinic on another site completed the MY-Q as a comparison group (n=39), results were not shared with their care team, and they received the standard care. RESULTS There were 116 adolescents between 13 to 17 years of age, who completed the MY-Q on 2 occasions. Baseline data were obtained on the first occasion, and, on the second occasion, an average of 12 months later, there was a follow-up assessment. At follow-up, adolescents in the intervention group had a significantly higher overall QoL and reported significantly fewer concerns on DRQoL domains than those in the comparison group. Participation in the intervention group, however, did not lead to improvements in A1C. CONCLUSION This study shows that implementing an integrated stepped care model within an interprofessional pediatric diabetes clinic can lead to the improvement of adolescents' overall QoL and DRQoL.
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7
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Monzon AD, Patton SR, Clements M. An Examination of the Glucose Management Indicator in Young Children with Type 1 Diabetes. J Diabetes Sci Technol 2022; 16:1505-1512. [PMID: 34098763 PMCID: PMC9631514 DOI: 10.1177/19322968211023171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous studies utilizing glucose data from continuous glucose monitors (CGM) to estimate the Glucose Management Indicator (GMI) have not included young children or determined appropriate GMI formulas for young children with type 1 diabetes (T1D). METHODS We extracted CGM data for 215 children with T1D (0-6 years) from a repository. We defined sampling periods ranging from the 3-27 days prior to an HbA1c measurement and compared a previously established GMI formula to a young child-specific GMI equation based on the sample's CGM data. We examined associations between HbA1c, GMI values, and other CGM metrics for each sampling period. RESULTS The young child-specific GMI formula and the published GMI formula did not evidence significant differences when using 21-27 days of CGM data. The young child-specific GMI formula demonstrated higher correlations to laboratory HbA1c when using 18 or fewer days of CGM data. Overall, the GMI estimate and HbA1c values demonstrate a strong relationship in young children with T1D. CONCLUSIONS Future research studies may consider utilizing the young child-specific GMI formula if the data collection period for CGM values is under 18 days. Further, researchers and clinicians may consider changing the default number of days of data used to calculate glycemic metrics in order to maximize validity of CGM-derived metrics.
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Affiliation(s)
| | - Susana R. Patton
- Center for Healthcare Delivery Science,
Nemours Children’s Health System, Jacksonville, FL, USA
| | - Mark Clements
- Children’s Mercy Hospital,
Endocrine/Diabetes Clinical Research, Kansas City, MO, USA
- Mark Clements, MD, PhD, Children’s Mercy
Hospital, Endocrine/Diabetes Clinical Research, 2401 Gillham Road, Kansas City,
MO 64108, USA.
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Al-Qahtani SM, Shati AA, Alqahtani YA, AlAsmari AA, Almahdi MA, Al Hassan AA, Alhassany AM, Shathan RA, Aldosari RM, AlQahtani AS, Khalil SN. Factors Affecting Glycemic Control among Saudi Children with Type 1 Diabetes Mellitus in Aseer Region, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811558. [PMID: 36141857 PMCID: PMC9517271 DOI: 10.3390/ijerph191811558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 06/01/2023]
Abstract
Glycemic control in children with type 1 diabetes mellitus (T1DM) is affected by many factors that may be influenced by their lives and community. To identify the factors associated with glycemic control among children with T1DM in Aseer Region, southwestern Saudi Arabia, a cross-sectional interview study was conducted between 1 July and 30 September 2021, with a representative sample of Saudi children aged between 6 months and 15 years with T1DM or their caregivers visiting the diabetes center at Aseer Region. Newly diagnosed cases (<12 months) were excluded from the study. The study included 171 T1DM pediatric patients aged between 18 months and 15 years. The glycated hemoglobin (HbA1c) level ranged between 6.10% and 15.10% (mean HbA1c = 10.39% ± 1.86%). High HbA1c levels (≥7.5%) were observed in most patients (94.7%). Only two significant factors were found: (1) use of carbohydrate counting; 81.8% of children using carbohydrate counts had high HbA1c levels, compared to 96.6% of children not using carbohydrate counts (p = 0.017), and (2) duration of the disease; 91.5% of children with disease duration of ≤3 years had high levels of HbA1c, compared to 98.7% of children with disease duration exceeding 3 years (p = 0.035). Most children with T1DM in Aseer Region had poor glycemic control. Only two factors were associated with better glycemic control: shorter disease duration and use of carbohydrate counting. Therefore, advising diabetic patients to be on a carbohydrate counting program might improve DM control.
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Affiliation(s)
- Saleh M. Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
| | - Ali A. AlAsmari
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Mohammed A. Almahdi
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Amjad A. Al Hassan
- Department of Pediatrics, Armed Forces Hospital-Southern Region, Khamis Mushyate 62413, Saudi Arabia
| | - Ali M. Alhassany
- Department Medicine, King Fahad Hospital, Al-Baha 65732, Saudi Arabia
| | - Rana A. Shathan
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Rawa M. Aldosari
- Department of Pediatric Emergency, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Abdullah S. AlQahtani
- Department of Emergency Medicine, Khamis Mushyate General Hospital, Khamis Mushyate 62433, Saudi Arabia
| | - Shamsun Nahar Khalil
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
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Sękowski K, Grudziąż-Sękowska J, Goryński P, Pinkas J, Jankowski M. Epidemiological Analysis of Diabetes-Related Hospitalization in Poland before and during the COVID-19 Pandemic, 2014-2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10030. [PMID: 36011665 PMCID: PMC9407838 DOI: 10.3390/ijerph191610030] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
Diabetes is one of the most common chronic diseases worldwide. The study aimed to present an epidemiological analysis of hospitalization related to diabetes mellitus in Poland between 2014 and 2020 as well as to analyze changes in diabetes-related hospital admissions before and during the COVID-19 pandemic. This study is a retrospective analysis of the national registry dataset of hospital discharge reports on diabetes-related hospitalizations in Poland between 2014 and 2020. The number of diabetes-related hospitalizations varied from 76,220 in 2016 to 45,159 in 2020. The hospitalization rate per 100,000 has decreased from 74.6 in 2019 to 53.0 in 2020 among patients with type 1 diabetes (percentage change: -28.9%). An even greater drop was observed among patients with type 2 diabetes: from 99.4 in 2019 to 61.6 in 2020 (percentage change: -38%). Both among patients with type 1 and type 2 diabetes, a decrease in hospitalization rate was higher among females than males (-31.6% vs. -26.7% and -40.9% vs. -35.2% respectively). When compared to 2019, in 2020, the in-hospital mortality rate increased by 66.7% (60.0% among males and 65.2% among females) among patients hospitalized with type 1 diabetes and by 48.5% (55.2% among females and 42.1% among males) among patients hospitalized with type 2 diabetes. Markable differences in hospitalization rate, duration of hospitalization, as well as in-hospital mortality rate by gender, were observed, which reveal health inequalities.
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Affiliation(s)
- Kuba Sękowski
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | | | - Paweł Goryński
- Department of Population Health Monitoring and Analysis, National Institute of Public Health-National Institute of Hygiene, 00-791 Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
| | - Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland
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Patton SR, Monzon AD, Noser AE, Clements MA. Physical Activity, Glycemic Variability, and Parental Hypoglycemia Fear in Preschoolers With Type 1 Diabetes. Pediatr Exerc Sci 2022; 34:135-140. [PMID: 35045389 PMCID: PMC9896511 DOI: 10.1123/pes.2021-0046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 10/29/2021] [Accepted: 12/15/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The authors examined associations between preschoolers' daily glycemic variability, parents' report of hypoglycemia fear, and preschoolers' daily moderate to vigorous physical activity (MVPA) and sedentary behavior (SB) in 25 families of preschoolers with type 1 diabetes. METHODS Parents completed a valid measure of hypoglycemia fear, and their child wore an accelerometer for up to 7 days. Parents provided glucose data from their child's devices. The authors used multiple regression and multilevel modeling to analyze their data. RESULTS Preschoolers (mean age 4.2 [1.7] y; 50% boys) engaged in a mean of 154.5 (59.6) and 339.2 (85.1) minutes of MVPA and SB per day, respectively, and parents reported relatively low levels of hypoglycemia worry and avoidance behaviors. Preschoolers' SB (r = .19, P = .02) and MVPA (r = -.20, P = .01) levels were significantly correlated with parental hypoglycemia worry scores but not with parents' hypoglycemia behavior scores (P = .15 and P = .92, respectively). While multilevel models did not show an association between MVPA and preschoolers' glycemic variability, preschoolers who engaged in more daily SB experienced higher glycemic variability (P = .04). CONCLUSIONS Research exploring MVPA, SB, and parental hypoglycemia fear in preschoolers with type 1 diabetes could have important clinical implications because it may reveal modifiable treatment targets that can impact preschoolers' health and activity patterns.
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Affiliation(s)
- Susana R. Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, KS
| | | | - Amy E. Noser
- Child Clinical Psychology Program, University of Kansas, Lawrence, KS
| | - Mark A. Clements
- Division of Endocrinology, Children’s Mercy Hospital, Kansas City MO
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Parent-Child Conflict Moderates the Relationship Between Executive Functioning and Child Disruptive Behaviors in Youth with T1D. J Clin Psychol Med Settings 2022; 29:357-364. [PMID: 34985630 PMCID: PMC9893479 DOI: 10.1007/s10880-021-09838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2021] [Indexed: 02/04/2023]
Abstract
Executive function (EF) skills, parent-child conflict, and high blood glucose (BG) may impact child externalizing behaviors. We examined these child and parent factors in families of 5-9 year olds with recent-onset type 1 diabetes (T1D). Parents (N = 125) reported child EF, child externalizing behaviors, and conflict regarding T1D-specific tasks. We used self-monitoring BG uploads to calculate the percentage of time children had high BG (> 180 mg/dl). We entered data into a moderated path analysis using MPlus8. The path analysis revealed a positive direct effect for parent-reported child EF and child externalizing behavior (p < .01). Further, T1D-specific conflict moderated the positive association between parent-reported child EF and child externalizing behaviors (p < .05). Early screening of child EF, externalizing behavior, and family conflict may be particularly important in the recent-onset period of T1D. The introduction of T1D-related conflict after diagnosis may impact child externalizing behavior and limited child EF skills that pre-date diagnosis.
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Ali N, Longson J, Myszka R, Park K, Low GKK, Leong GM, Bhurawala H, Liu A. Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes.
Methods
A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered.
Results
Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p<0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p<0.01) in the IRG vs. ERG group.
Conclusions
Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.
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Affiliation(s)
- Naushad Ali
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Julie Longson
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Rickie Myszka
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Kris Park
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary K. K. Low
- Research Operations , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary M. Leong
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Habib Bhurawala
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Anthony Liu
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
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13
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Sherr JL, Schwandt A, Phelan H, Clements MA, Holl RW, Benitez-Aguirre PZ, Miller KM, Woelfle J, Dover T, Maahs DM, Fröhlich-Reiterer E, Craig ME. Hemoglobin A1c Patterns of Youth With Type 1 Diabetes 10 Years Post Diagnosis From 3 Continents. Pediatrics 2021; 148:peds.2020-048942. [PMID: 34315809 PMCID: PMC8785705 DOI: 10.1542/peds.2020-048942] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/26/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Distinct hemoglobin A1c (HbA1c) trajectories during puberty are identified in youth with established type 1 diabetes (T1D). We used data from 3 international registries to evaluate whether distinct HbA1c trajectories occur from T1D onset. METHODS Participants were <18 years old at diagnosis with at least 1 HbA1c measured within 12 months post diagnosis, along with ≥3 duration-year-aggregated HbA1c values over 10 years of follow-up. Participants from the Australasian Diabetes Data Network (n = 7292), the German-Austrian-Luxembourgian-Swiss diabetes prospective follow-up initiative (Diabetes Patienten Verlaufsdokumentation) (n = 39 226) and the US-based Type 1 Diabetes Exchange Clinic Registry (n = 3704) were included. With group-based trajectory modeling, we identified unique HbA1c patterns from the onset of T1D. RESULTS Five distinct trajectories occurred in all 3 registries, with similar patterns of proportions by group. More than 50% had stable HbA1c categorized as being either low stable or intermediate stable. Conversely, ∼15% in each registry were characterized by stable HbA1c >8.0% (high stable), and ∼11% had values that began at or near the target but then increased (target increase). Only ∼5% of youth were above the target from diagnosis, with an increasing HbA1c trajectory over time (high increase). This group differed from others, with higher rates of minority status and an older age at diagnosis across all 3 registries (P ≤ .001). CONCLUSIONS Similar postdiagnostic HbA1c patterns were observed across 3 international registries. Identifying the youth at the greatest risk for deterioration in HbA1c over time may allow clinicians to intervene early, and more aggressively, to avert increasing HbA1c.
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Affiliation(s)
- Jennifer L. Sherr
- Division of Pediatric Endocrinology, Department of Pediatrics,
Yale School of Medicine, Yale University, New Haven, Connecticut
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, Zentralinstitut
für Biomedizinische Technik, Ulm University, Ulm, Germany,German Centre for Diabetes Research, Munich-Neuherberg,
Germany
| | - Helen Phelan
- John Hunter Children’s Hospital, Newcastle,
Australia,Division of Child and Adolescent Health, The University of
Sydney, Sydney, Australia
| | - Mark A. Clements
- Children’s Mercy Hospital, Kansas City, Missouri,Department of Pediatrics, University of Missouri-Kansas City,
Kansas City, Missouri
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical Biometry, Zentralinstitut
für Biomedizinische Technik, Ulm University, Ulm, Germany,German Centre for Diabetes Research, Munich-Neuherberg,
Germany
| | - Paul Z. Benitez-Aguirre
- Division of Child and Adolescent Health, The University of
Sydney, Sydney, Australia,Children’s Hospital at Westmead, Sydney, Australia
| | | | - Joachim Woelfle
- Children’s Hospital, University of Erlangen, Erlangen,
Germany
| | - Thomas Dover
- Ipswich Hospital, Brisbane, Australia,Mater Hospitals, Brisbane, Australia
| | - David M. Maahs
- Stanford Diabetes Research Center,Division of Endocrinology and Diabetes, Department of
Pediatrics, School of Medicine, Stanford University, Stanford, California
| | - Elke Fröhlich-Reiterer
- Department of Pediatrics and Adolescent Medicine, Medical
University of Graz, Graz, Austria
| | - Maria E. Craig
- Division of Child and Adolescent Health, The University of
Sydney, Sydney, Australia,Children’s Hospital at Westmead, Sydney, Australia
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14
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Lee YJ, Yoo S, Yi S, Kim S, Lee C, Cho J, Ahn S, Choi S, Hwang H, Lee YA, Shin CH, Yoon HJ, Kim K, Song E, Choi JH, Yoo HW, Kim YH, Oh JS, Kang EA, Baek GK, Kim JH. Trajectories in glycated hemoglobin and body mass index in children and adolescents with diabetes using the common data model. Sci Rep 2021; 11:14614. [PMID: 34272437 PMCID: PMC8285411 DOI: 10.1038/s41598-021-94194-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 07/07/2021] [Indexed: 01/17/2023] Open
Abstract
We evaluated trajectories of glycated hemoglobin (HbA1c) levels and body mass index z-scores (BMIz) for 5 years after diagnosis among Korean children and adolescents with type 1 diabetes (T1D) or type 2 diabetes (T2D) using the common data model. From the de-identified database of three hospitals, 889 patients < 15 years of age diagnosed with T1D or T2D (393 boys, 664 T1D patients) were enrolled. Diagnosis was defined as first exposure to antidiabetic drug at each center. Compared with T2D patients, T1D patients had lower BMIz at diagnosis (- 0.4 ± 1.2 vs. 1.5 ± 1.4, p < 0.001) and 3 months (- 0.1 ± 1.0 vs. 1.5 ± 1.5, p < 0.001), and higher HbA1c levels at diagnosis (10.0 ± 2.6% vs. 9.5 ± 2.7%, p < 0.01). After 3 months, HbA1c levels reached a nadir of 7.6% and 6.5% in T1D and T2D patients, respectively, followed by progressive increases; only 10.4% of T1D and 29.7% of T2D patients achieved the recommended HbA1c target (< 7.0%) at 60 months. T1D patients showed consistent increases in BMIz; T2D patients showed no significant change in BMIz during follow-up. Peri-pubertal girls with T1D had higher HbA1c and BMIz values. Achieving optimal glycemic control and preventing obesity should be emphasized in pediatric diabetes care.
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Affiliation(s)
- Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Soyoung Yi
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Seok Kim
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Chunggak Lee
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Jihoon Cho
- Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Soyeon Ahn
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Sunkyu Choi
- Division of Statistics, Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Hee Hwang
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.,Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, Korea.,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Hyung-Jin Yoon
- Department of Biomedical Engineering, Seoul National University College of Medicine, Seoul, Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine and Advanced Technology, Seoul National University Hospital, Seoul, Korea.,Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Eunhye Song
- Department of Data Science Research, Innovative Medical Technology Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Jin Ho Choi
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Han Wook Yoo
- Department of Pediatrics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Hak Kim
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Division of Cardiology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Health Innovation Big Data Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ji Seon Oh
- Department of Information Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Eun-Ae Kang
- Health Innovation Big Data Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Ga Kyoung Baek
- Health Innovation Big Data Center, Asan Institute of Life Sciences, Asan Medical Center, Seoul, Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea. .,Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea.
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15
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Marker AM, Monzon AD, Goggin K, Clements MA, Patton SR. Parent Perspectives on Educational and Psychosocial Intervention for Recent-Onset Type 1 Diabetes in Their School-Age Child: A Qualitative Study. Diabetes Spectr 2021; 34:166-174. [PMID: 34149257 PMCID: PMC8178719 DOI: 10.2337/ds20-0058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The recent-onset period of type 1 diabetes (T1D) in early school-age children should include comprehensive, parent-focused T1D education as well as family-centered resources and support to help with adjustment. Here, we present parent/caregiver perspectives on specific areas of concern during the recent-onset period of T1D and their preferred timing for different topics related to T1D education. METHODS Parents/caregivers of 5- to 9-year-old children with T1D completed a card-sorting task and qualitative interview to describe ongoing areas of concern and preferred educational topics during the first year after T1D diagnosis. RESULTS Thirteen parents/caregivers (aged 35.1 ± 6.9 years) of a child with T1D (aged 8.9 ± 0.8 years, 11.3 ± 7.0 months post-diagnosis) completed the card-sorting task, and 11 completed the qualitative interview. Parents/caregivers endorsed four preferred stages of education: basic education and T1D survival skills during month 1 post-diagnosis, application and practice of T1D skills from months 1-3, access to community supports to cope with anxiety and distress from months 3-6, and support to build autonomy and manage burnout beyond month 6 post-diagnosis. Parents/caregivers endorsed four main themes for ongoing concerns: anxiety, autonomy, distress, and support. CONCLUSION Parents endorsed four time points for education and psychosocial services within the first year of a T1D diagnosis. Parents/caregivers may benefit the most from psychosocial interventions 3-6 months post-diagnosis, once they have had sufficient time to develop basic T1D management skills. These findings support the need for regular parent psychosocial screening and access to scalable psychosocial interventions in the first year post-diagnosis of T1D.
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Affiliation(s)
| | | | - Kathy Goggin
- Children’s Mercy–Kansas City, Kansas City, MO
- University of Missouri Kansas City, Kansas City, MO
| | - Mark A. Clements
- Children’s Mercy–Kansas City, Kansas City, MO
- University of Missouri Kansas City, Kansas City, MO
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16
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Ogugua CF, Chikani UN, Okiche CY, Ibekwe UM. Sociodemographic determinants of glycaemic control among children with type 1 diabetes in South Eastern Nigeria. Pan Afr Med J 2021; 38:250. [PMID: 34104298 PMCID: PMC8164434 DOI: 10.11604/pamj.2021.38.250.19790] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 02/12/2021] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION diabetic complications have been identified as the major causes of morbidity and mortality in persons with type 1 diabetes mellitus (T1DM). Lack of appropriate glycaemic control is a significant risk factor for the onset and progression of long term complications of diabetes. Identifying the determinants of good glycaemic control is therefore imperative. METHODS this was a cross-sectional, hospital-based study of children aged 3-18 years with T1DM. Subjects were consecutively enrolled after obtaining consent from their parents and assent from children aged ≥7 years. A questionnaire was completed recording their clinical history and sociodemographic variables. Their HbA1c was estimated and values ≤7.5% was defined as the cut-off for optimal glycaemic control. RESULTS seventy-one children with T1DM were enrolled for the study. Thirty-eight (53.5%) of them were males. Mean age (years) was 13.7±4. Mean age at onset of diabetes was 11.6 years (range: 3-16 years), mean duration of diabetes was 24.4 months (range: 4-84 months), mean HbA1c value was 10.5% (range: 6.4%-14%); a multivariate logistic regression analysis was performed to identify determinants of optimal glycaemic control. Only caregivers' involvement in diabetes management P<0.016, odd ratio 13.03 (95% CI: 1.60-105.95) was identified as determinant of good glycaemic control. CONCLUSION our data suggest that of all the sociodemographic factors studied, caregivers' involvement in diabetes management was the only strong determinant for optimal glycaemic control.
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Affiliation(s)
- Chinwe Flora Ogugua
- Paediatric Endocrinology Unit, Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugo Nnenna Chikani
- Paediatric Endocrinology Unit, Department of Paediatrics, University of Nigeria, Ituku Ozalla Campus, Enugu, Nigeria
| | - Chikosolu Yvonne Okiche
- Paediatric Endocrinology Unit, Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
| | - Ugochi Maryann Ibekwe
- Paediatric Endocrinology Unit, Department of Paediatrics, Alex Ekwueme Federal University Teaching Hospital Abakaliki, Abakaliki, Nigeria
- Department of Paediatrics, Ebonyi State University, Abakaliki, Ebonyi, Nigeria
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17
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Hennessy LD, De Lange M, Wiltshire EJ, Jefferies C, Wheeler BJ. Youth and non-European ethnicity are associated with increased loss of publicly funded insulin pump access in New Zealand people with type 1 diabetes. Diabet Med 2021; 38:e14450. [PMID: 33131079 DOI: 10.1111/dme.14450] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/23/2020] [Accepted: 10/29/2020] [Indexed: 12/21/2022]
Abstract
AIMS Continuous subcutaneous insulin infusion (CSII) has been publicly funded in New Zealand for people living with type 1 diabetes since 2012. The aim of the current study was to investigate the loss of access, once obtained, to public-funded CSII. The frequency and socio-demographics of access, and loss, to CSII spanning the period 2012 to 2018 were examined. METHODS Nationally held data collections including the New Zealand Virtual Diabetes Register were used to calculate the overall and subgroup proportions using and ceasing CSII. A logistic regression model was used to estimate odds ratios for pump use for the predictor variables (sex, age group, ethnicity and deprivation index) and to calculate odds ratios for pump cessation for the same demographic factors. RESULTS Once CSII access is obtained, approximately 4% per year cease CSII in a subsequent year. This cessation of publicly funded CSII was not distributed equally among the population, showing over-representation in youth (aged 10-29 years) and non-Europeans, in particular Māori and Pasifika. Compounding this, it remains less likely for people with diabetes to initially access publicly funded CSII in New Zealand if they are non-European and more socio-economically deprived. CONCLUSIONS In New Zealand, Māori and Pasifika, as well as youth, are over-represented in the cessation of CSII in comparison with Europeans and all other age groups. These groups are also less likely to gain initial access to public funding. Efforts to understand and reduce these disparities are needed, including review of current public funding access criteria.
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Affiliation(s)
| | - Michel De Lange
- Biostatistics Centre, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
| | - Craig Jefferies
- Paediatric Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - Benjamin J Wheeler
- Paediatric Endocrinology, Southern District Health Board, Dunedin, New Zealand
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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18
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Wagner G, Zeiler M, Karwautz A, Schneider A, Rami-Merhar B, Berger G. Personality, Coping and Developmental Conditions in Female Adolescents and Young Adults with Type 1 Diabetes: Influence on Metabolic Control and Quality of Life. Front Psychiatry 2021; 12:809015. [PMID: 35356383 PMCID: PMC8960069 DOI: 10.3389/fpsyt.2021.809015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To assess personality factors, coping, developmental conditions and quality of life in female adolescents and young adults with type 1 diabetes (T1D) and high vs.low HbA1c. METHODS Patients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included. HIGH-A1c was defined as HbA1c > 7.5%, LOW-A1c as HbA1c ≤ 7.5% and compared to a sample of 56 age-matched female healthy controls. Self-rating questionnaires were used to assess psychosocial factors: Children's Depression Inventory (CDI); Junior Temperament and Character Inventory (J-TCI); Eating Disorders Inventory-2 (EDI-2); KIDCOPE; Subjective Family Image Test (SFIT) and Inventory of Life Quality in Children and Adolescents(ILC). RESULTS T1D patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum BMI, higher depression score, and higher frequency of diabetic ketoacidosis in the last year. They showed significantly higher levels of fatigue, lower levels of taking responsibility, lower ability to set goals and lower self-acceptance, as well as higher levels of ineffectiveness, lower levels of emotional attachment within the family, in particular with the fathers, and used negative coping strategies more often compared to patients with LOW-A1c. Furthermore, they reported significantly higher burden of illness and lower quality of life. CONCLUSIONS Disadvantageous personality and coping styles as well as developmental conditions should be addressed in the treatment of female adolescents with T1D with management problems.
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Affiliation(s)
- Gudrun Wagner
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andrea Schneider
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf, Vienna, Austria
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19
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McConville A, Noser AE, Clements MA, Patton SR. Mealtime insulin BOLUS score increases prior to clinic visits in youth with type 1 diabetes. BMJ Open Diabetes Res Care 2020; 8:8/1/e001348. [PMID: 32665313 PMCID: PMC7365425 DOI: 10.1136/bmjdrc-2020-001348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Revised: 05/01/2020] [Accepted: 05/18/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Multiple studies confirm the occurrence of 'white coat adherence' (WCA), a term describing an increase in engagement with self-care tasks just prior to a scheduled clinic appointment, across cohorts with multiple chronic conditions. In youth with type 1 diabetes (T1D), research also shows an increase in self-monitoring blood glucose frequency ahead of youths' clinic visits. While studies show preliminary evidence for the occurrence of WCA in youth with T1D, no study has examined the effect of WCA and mealtime insulin dosing behaviors in youth with T1D. The frequency of mealtime insulin bolusing score (BOLUS) is an objective measure of mealtime insulin use in youth with T1D that could be vulnerable to WCA. To fill this gap in the literature and further our understanding of WCA in pediatric diabetes, we determined whether WCA also impacts BOLUS scores in youth with T1D. RESEARCH DESIGN AND METHODS We extracted insulin pump records and HbA1c levels from a clinical database for 459 youth with T1D (Mage=12.5±2.9 years). We calculated mean BOLUS scores for 6-5, 4-3, and 2-0 weeks prior to youths' routine clinic visits. We used multilevel modeling to examine patterns of BOLUS scores prior to clinic visits and tested for age differences. RESULTS Multilevel modeling showed a significant increase in BOLUS scores in the weeks prior to youths' clinic appointments (β=0.07, p<0.001). On average, adolescents had lower BOLUS scores than school-age children (β=-0.35, p<0.001). Post hoc analyses showed that adolescents consistently had lower BOLUS scores than children across assessments (p's<0.001). CONCLUSIONS Youth with T1D increase their mealtime insulin use prior to clinic appointments. The BOLUS may be a viable target for intervention to drive improved glycemic control. Whether increased tendency to WCA is associated with reduced risk of diabetic complications remains to be determined.
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Affiliation(s)
- Andrew McConville
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Amy E Noser
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas, USA
| | - Mark A Clements
- Division of Endocrinology, Department of Pediatrics, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
- University of Missouri-Kansas City, Kansas City, Missouri, USA
- University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Susana R Patton
- Nemours Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
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20
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Monzon AD, Marker AM, Noser AE, Clements MA, Patton SR. Associations Between Objective Sleep Behaviors and Blood Glucose Variability in Young Children With Type 1 Diabetes. Ann Behav Med 2020; 55:144-154. [PMID: 32542309 DOI: 10.1093/abm/kaaa040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Young children with Type 1 diabetes (T1D) are at risk for extreme blood glucose variability, a risk factor for suboptimal glycated hemoglobin A1c (HbA1c) and long-term health complications. We know that a reciprocal relationship exists between sleep and glycemic outcomes in older youth with T1D; however, little research has examined objective sleep in young children (<7 years) with T1D. PURPOSE This study examines bidirectional associations between sleep behaviors and glycemic variability in young children with T1D. METHODS Thirty-nine young children with T1D (Mage 4.33 ± 1.46 years; MHbA1c 8.10 ± 1.06%) provided accelerometry data to objectively measure sleep onset latency, number of nighttime awakenings, and total sleep time. We also assessed HbA1c, average blood glucose, and glycemic variability (i.e., standard deviation of blood glucose from device downloads). We evaluated bidirectional relationships using multilevel modeling in SAS, with weekday/weekend as a Level 2 moderator. RESULTS Children averaged 8.5 ± 1.44 hr of sleep per night, but only 12.8% met current sleep recommendations. Children experienced more nighttime awakenings, higher blood glucose, and more glycemic variability on weekends. Sleep onset latency and nighttime awakenings predicted greater glycemic variability on weekends, and weekend glycemic variability predicted increased nighttime awakenings. CONCLUSIONS Most young children with T1D did not meet sleep recommendations. Young children experienced more nighttime awakenings, higher blood glucose, and increased glycemic variability on weekends only, when routines may be less predictable. Findings suggest that one way families of young children with T1D may be able to decrease glycemic variability is to keep consistent routines on weekdays and weekends.
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Affiliation(s)
- Alexandra D Monzon
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Arwen M Marker
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Amy E Noser
- Clinical Child Psychology Program, University of Kansas, Lawrence, KS, USA
| | - Mark A Clements
- Children's Mercy Hospital, Endocrine/Diabetes Clinical Research, Kansas City, MO, USA
| | - Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, FL, USA
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21
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Mazarello Paes V, Barrett JK, Dunger DB, Gevers EF, Taylor‐Robinson DC, Viner RM, Stephenson TJ. Factors predicting poor glycemic control in the first two years of childhood onset type 1 diabetes in a cohort from East London, UK: Analyses using mixed effects fractional polynomial models. Pediatr Diabetes 2020; 21:288-299. [PMID: 31782879 PMCID: PMC7028081 DOI: 10.1111/pedi.12950] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 10/15/2019] [Accepted: 11/14/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND/OBJECTIVE Poor early glycemic control in childhood onset type 1 diabetes (T1D) is associated with future risk of acute and chronic complications. Our aim was to identify the predictors of higher glycated hemoglobin (HbA1c) within 24 months of T1D diagnosis in children and adolescents. METHODS Mixed effects models with fractional polynomials were used to analyze longitudinal data of patients <19 years of age, followed from T1D diagnosis for up to 2 years, at three diabetes clinics in East London, United Kingdom. RESULTS A total of 2209 HbA1c observations were available for 356 patients (52.5% female; 64.4% non-white), followed from within 3 months of diagnosis during years 2005 to 2015, with a mean ± SD of 6.2 ± 2.5 HbA1c observations/participant. The mean age and HbA1c at diagnosis were 8.9 ± 4.3 years and 10.7% ±4.3% (or expressed as mmol/mol HbA1c mean ± SD 92.9 ± 23.10 mmol/mol) respectively. Over the 2 years following T1D diagnosis, HbA1c levels were mostly above the National Institute for Health, Care and Excellence (NICE), UK recommendations of 7.5% (<58 mmol/mol). Significant (P < .05) predictors of poorer glycemic control were: Age at diagnosis (12-18 years), higher HbA1c at baseline (>9.5%, ie, >80 mmol/mol), clinic site, non-white ethnicity, and period (pre-year 2011) of diagnosis. Additionally in univariable analyses, frequency of clinic visits, HbA1c at diagnosis, and type of insulin treatment regimen showed association with poor glycemic control (P < .05). CONCLUSIONS Major risk factors of poorer glycemic control during 3-24 months following childhood onset T1D are: diagnosis prior to 2011, higher HbA1c levels at baseline, age at diagnosis, non-white ethnicity, and clinic site.
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Affiliation(s)
- Veena Mazarello Paes
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child Health, University College LondonLondonUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | - David B. Dunger
- Department of PaediatricsUniversity of CambridgeCambridgeUK,Wellcome Trust—MRC Institute of Metabolic SciencesUniversity of CambridgeCambridgeUK
| | - Evelien F. Gevers
- Centre for Endocrinology, William Harvey Research InstituteQueen Mary UniversityLondonUK,Department of Paediatric EndocrinologyBarts Health NHS Trust, Royal London Children's HospitalLondonUK
| | | | - Russell M. Viner
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child Health, University College LondonLondonUK,The Royal College of Paediatrics and Child HealthLondonUK
| | - Terence J. Stephenson
- Population, Policy and Practice Research and Teaching DepartmentUCL Great Ormond Street Institute of Child Health, University College LondonLondonUK
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22
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Correya TA, Ashraf AP, Griffin R, Aslibekyan S, Kim HD, Middleton S, McCormick K. Temporal trends in incidence of pediatric type 1 diabetes in Alabama: 2000-2017. Pediatr Diabetes 2020; 21:40-47. [PMID: 31591761 DOI: 10.1111/pedi.12927] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The incidence of type 1 diabetes has increased in the United States and worldwide. We hypothesized that trends in the annual incidence rates of childhood-onset type 1 diabetes in the state of Alabama would be different by race and sex. METHODS We performed a retrospective observational cohort study, analyzing children with type 1 diabetes (n = 3770) managed at the Children's Hospital of Alabama between 2000 and 2017. We compared crude incidence rates using negative binomial regression models and analyzed differences in annual trends of age-adjusted incidence by race and sex using joinpoint regression. RESULTS The crude type 1 diabetes incidence rate was estimated at 16.7 per 100 000 children <19 years of age in Alabama. Between 2000 and 2007, there was an increase in age-adjusted incidence of type 1 diabetes with an annual percent change (APC) of 10% from 2000 to 2007 and a 1.7% APC decrease from 2007 to 2017. The age-adjusted incidence for Whites and Blacks increased with an average annual percentage change (AAPC) of 4.4% and 2.8%, respectively. A nearly 11% increasing trend in age-adjusted incidence was observed for both races, though the increase plateaued in 2006 for Whites and 2010 for Blacks. CONCLUSIONS Following significantly increasing annual trends for both races, the age-adjusted rate remained statistically stable for Whites and decreased significantly for Blacks. Longer-sustained trend increases for Blacks resulted in type 1 diabetes incidence tripling compared to the doubling of the rate for Whites.
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Affiliation(s)
- Tanya A Correya
- Science and Technology Honors, University of Alabama at Birmingham, Birmingham, Alabama
| | - Ambika P Ashraf
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell Griffin
- Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama
| | - Stella Aslibekyan
- Department of Epidemiology, UAB School of Public Health, Birmingham, Alabama
| | - Hae Dong Kim
- Georgia Campus- Philadelphia College of Osteopathic Medicine, Suwanee, Georgia
| | - Sydney Middleton
- University of Alabama School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Kenneth McCormick
- Division of Pediatric Endocrinology, University of Alabama at Birmingham, Birmingham, Alabama
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23
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Marker AM, Monzon AD, Nelson EL, Clements MA, Patton SR. An Intervention to Reduce Hypoglycemia Fear in Parents of Young Kids with Type 1 Diabetes Through Video-Based Telemedicine (REDCHiP): Trial Design, Feasibility, and Acceptability. Diabetes Technol Ther 2020; 22:25-33. [PMID: 31517512 PMCID: PMC6945796 DOI: 10.1089/dia.2019.0244] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background: Fear of hypoglycemia (FH) is common in parents of young children with type 1 diabetes (T1D) and problematically linked to maladaptive behaviors to avoid low blood glucose, parenting stress, and burnout. This study examined the feasibility and acceptability of a novel group-based telemedicine intervention to reduce FH in parents of young children with T1D. Materials and Methods: Forty-three families of a young child with T1D (1-6 years of age; diagnosed with T1D for at least 6 months) enrolled in the study and 36 completed the Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP) intervention. We assessed intervention feasibility with rates of attrition, intervention attendance, and fidelity to the treatment manual. We assessed acceptability with treatment satisfaction surveys and qualitative interviews (from a subset of completers; n = 10) about intervention acceptability, facilitators, and challenges. Results: Study attrition was 21%, including long-term follow-up (16% before or during the treatment phase). On average, parents attended 94% of intervention sessions and fidelity to the treatment manual was 89%. Intervention completers reported high satisfaction with the treatment groups (89% average satisfaction rating). Parent-reported positive influencers of the REDCHiP intervention were increased knowledge, fear awareness, coping strategies, confidence, behavioral parenting strategies, and support, whereas intervention challenges included feeling fearful or overwhelmed, family stress, lack of trust, and difficulty connecting with other group members. Conclusions: The REDCHiP intervention demonstrated initial feasibility and acceptability. Next steps include determining the intervention's impact on objective parent and child outcomes (e.g., glycemic control, parental FH, and parental stress/distress) as well as large-scale efficacy testing.
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Affiliation(s)
- Arwen M. Marker
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
| | - Alexandra D. Monzon
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
| | - Eve-Lynn Nelson
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Mark A. Clements
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
- Division of Endocrinology and Diabetes, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
| | - Susana R. Patton
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
- Address correspondence to: Susana R. Patton, PhD, ABPP, CDE, Center Director/Principal Research Scientist, CHDS-FL , Nemours Children's Clinic, 807 Children's Way, Jacksonville, FL 32207
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24
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Clements MA, Schwandt A, Donaghue KC, Miller K, Lück U, Couper JJ, Foster N, Schröder C, Phelan H, Maahs D, Prinz N, Craig ME. Five heterogeneous HbA1c trajectories from childhood to adulthood in youth with type 1 diabetes from three different continents: A group-based modeling approach. Pediatr Diabetes 2019; 20:920-931. [PMID: 31418521 DOI: 10.1111/pedi.12907] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/30/2019] [Accepted: 08/05/2019] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES Only a fraction of youth meet established targets for glycemic control; many experience deteriorating control over time. We compared trajectories of hemoglobin A1c (HbA1c) among youth from three trans-continental type 1 diabetes (T1D) registries and identified clinical variables associated with the odds of following increasing vs stable trajectories. RESEARCH DESIGN AND METHODS Analyses included longitudinal data from 15 897 individuals age 8 to 18 with T1D for at least 2 years and HbA1c measurements in at least 5 years during the observation period. Cohorts were selected from Australasian Diabetes Data Network (ADDN; Australia), German/Austrian/Luxembourgian Diabetes-Patienten-Verlaufsdokumentation initiative (DPV; Germany/Austria/Luxembourga), and the T1D Exchange Clinic Network (T1DX; US) clinic registries. Group-based trajectory modeling and multivariable logistic regression identified unique HbA1c trajectories and their predictors. RESULTS Five heterogeneous trajectories of glycemic control in each registry were identified: low, intermediate, high stable; intermediate and high increasing. The overall HbA1c level for each trajectory group tended to be lowest in the DPV, higher in the ADDN, and highest in the T1DX. The absolute level of HbA1c and the proportion of individuals within each trajectory varied across registries: 17% to 22% of individuals followed an increasing trajectory. Compared with maintaining a stable trajectory, following an increasing trajectory was significantly associated with ethnic minority status, lower height z-score, higher BMI z-score, insulin injection therapy, and the occurrence of severe hypoglycemia; however, these factors were not consistent across the three registries. CONCLUSIONS We report the first multinational registry-based comparison of glycemic control trajectories among youth with T1D from three continents and identify possible targets for intervention in those at risk of an increasing HbA1c trajectory.
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Affiliation(s)
- Mark A Clements
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Mercy Hospital, Kansas City, Missouri.,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, Missouri
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Kim C Donaghue
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, New South Wales, Australia
| | | | - Ursula Lück
- Medical Centre, University St. Pölten, St. Pölten, Austria
| | - Jennifer J Couper
- Womens and Childrens Hospital and Robinson Research Institute, University of Adelaide, Adelaide, South Australia
| | | | - Carmen Schröder
- Department of Pediatrics, University of Greifswald, Greifswald, Germany
| | - Helen Phelan
- John Hunter Children's Hospital, Newcastle, Australia
| | - David Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Palo Alto, California
| | - Nicole Prinz
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia.,University of Sydney, New South Wales, Australia.,University of New South Wales, Sydney, New South Wales, Australia
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25
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Marker AM, Patton SR, McDonough RJ, Feingold H, Simon L, Clements MA. Implementing clinic-wide depression screening for pediatric diabetes: An initiative to improve healthcare processes. Pediatr Diabetes 2019; 20:964-973. [PMID: 31264763 PMCID: PMC7814422 DOI: 10.1111/pedi.12886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Youth with type 1 diabetes (T1D) endorse high rates of depressive symptoms, which can significantly impair self-management, glycemic control, and quality of life. Current guidelines recommend annual depression screening for all adolescents with T1D, but few models exist to implement screening procedures across clinics in this population. The primary aim of this project was to increase depression screening from 0% to 80% in four clinics, and to describe the structured quality improvement process to reach this goal. METHODS All patients aged 12 to 21 years old with T1D at four participating clinics in a Midwestern hospital system were eligible to participate. Using a two-stage process, patients were administered the Patient Health Questionnaire (PHQ-2 plus PHQ-9 if positive) annually. Rates of depression screening by clinic site, rates of positive depression screens, social worker documentation of follow-up care, and associations with diabetes-related health outcomes were analyzed. RESULTS Over 2 years, average depression screening rates increased from 0% to 75% across all clinics, and 89% of patients with a positive screen met with a social worker for a targeted mental health assessment. At initial screening, 7.6% of patients screened positive for at-risk depressive symptoms on the PHQ-2 and from that group, 6.7% additionally screened positive on the PHQ-9. CONCLUSIONS Annual depression screenings were feasibly implemented across four clinics and the use of real-time data listening and automated processes facilitated successful implementation. Future directions include further automation, targeted training and billing mechanisms, dissemination to non-metropolitan clinics, and further assessment of depression screening tools for adolescents with T1D.
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Affiliation(s)
| | | | | | | | - Lara Simon
- Children's Mercy - Kansas City, Kansas City, Missouri
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26
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Baker AC, Wiebe DJ, Kelly CS, Munion A, Butner JE, Swinyard MT, Murray M, Berg CA. Structural model of patient-centered communication and diabetes management in early emerging adults at the transfer to adult care. J Behav Med 2019; 42:831-841. [PMID: 30680592 PMCID: PMC6656634 DOI: 10.1007/s10865-019-00012-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/14/2019] [Indexed: 12/26/2022]
Abstract
Early emerging adulthood (ages 18-25) is a time of risk for type 1 diabetes (T1D) when relationships with parents and providers are changing. We examined whether individuals' high-quality relationships with mothers are associated with greater perceptions of patient-centered communication (PCC) with their doctor and whether PCC is associated with better adherence and glycemic control through diabetes-related self-efficacy. Additionally, we tested whether associations of PCC with self-efficacy and diabetes outcomes are stronger among those who had transferred to adult care. One-year post-high school, 217 individuals with T1D (60% women, 53% in adult care) reported perceptions of maternal relationship quality, PCC, self-efficacy, and adherence. Glycemic control was measured via HbA1c assay kits. Structural equation modeling indicated good model fit and revealed indirect paths linking higher maternal relationship quality to better adherence through higher PCC, and higher PCC to better HbA1c through adherence. Transfer status moderated the link between PCC and self-efficacy, suggesting PCC may be especially important when emerging adults transfer to adult care.
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Affiliation(s)
- Ashley C Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd SSM, Merced, CA, 95343, USA.
| | - Deborah J Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd SSM, Merced, CA, 95343, USA
| | - Caitlin S Kelly
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Ascher Munion
- Department of Psychology, University of Utah, Salt Lake City, USA
| | | | - Michael T Swinyard
- Mountain Vista Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Mary Murray
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
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27
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Aeppli TRJ, Mahler FL, Konrad D. Future glycemic control of children diagnosed with type 1 diabetes mellitus at toddler and preschool/school age. J Pediatr Endocrinol Metab 2019; 32:929-933. [PMID: 31323008 DOI: 10.1515/jpem-2019-0152] [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: 03/29/2019] [Accepted: 05/16/2019] [Indexed: 11/15/2022]
Abstract
Background The main objective of this study was to compare future glycemic control in children diagnosed with type 1 diabetes mellitus (T1DM) at toddler age and preschool/school age. In addition, we aimed to examine risk factors known to be associated with future glycated hemoglobin A1c (HbA1c) levels in children diagnosed with T1DM. Methods This is a retrospective cohort study of 85 patients diagnosed with T1DM at toddler age (group 1; 0-2.9 years; n = 36) or preschool/school age (group 2; 5-6.9 years; n = 49) who were followed up at the University Children's Hospital in Zurich for at least 10 consecutive years or until the age of 15 years. Results The mean HbA1c level in the first year after diagnosis had a highly predictive value about glycemic control in the following 6 years. In addition, a longer duration of T1DM was associated with higher HbA1c values. HbA1c values did not differ significantly within 11 years after diagnosis between children in the two age groups. Neither was a difference found when comparing the two groups in respect to their chronological age, although a trend was noted (p = 0.09). This trend is very likely due to a longer duration of diabetes in group 1. Conclusions HbA1c level in the first year predicts glycemic control for the next 6 years and deterioration of HbA1c values can be noted with longer duration of T1DM. Moreover, our study demonstrated similar future glycemic control in patients diagnosed with T1DM at toddler age and preschool/school age.
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Affiliation(s)
- Tim R J Aeppli
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland
| | - Fiona L Mahler
- Department of Endocrinology and Diabetology, University Children's Hospital, Zurich, Switzerland.,Department of Clinical Psychology, University Children's Hospital, Zurich, Switzerland
| | - Daniel Konrad
- Children's Research Centre, University Children's Hospital, Zurich, Switzerland.,Department of Pediatric Endocrinology and Diabetology, University Children's Hospital, Steinwiesstrasse 75, CH-8032 Zurich, Switzerland
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28
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Mazarello Paes V, Barrett JK, Taylor‐Robinson DC, Chesters H, Charalampopoulos D, Dunger DB, Viner RM, Stephenson TJ. Effect of early glycemic control on HbA1c tracking and development of vascular complications after 5 years of childhood onset type 1 diabetes: Systematic review and meta-analysis. Pediatr Diabetes 2019; 20:494-509. [PMID: 30932298 PMCID: PMC6701989 DOI: 10.1111/pedi.12850] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 03/25/2019] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVE A systematic review and meta-analysis was conducted to investigate if glycemic control measured by glycated hemoglobin (HbA1c) levels near diagnosis are predictive of future glycemic outcomes and vascular complications in childhood onset type 1 diabetes (T1D). METHODS Evidence was gathered using electronic databases (MEDLINE, EMBASE, Web of Science, CINAHL, Scopus, and Cochrane Library up to February 2017) and snowballing techniques. Studies investigating the association between the exposure "early glycemic control" and main outcome: "tracking of early control" and secondary outcome: risk of future complications; in children and young people aged 0 to 19 years at baseline; were systematically double-reviewed, quality assessed, and outcome data extracted for synthesis and meta-analysis. FINDINGS Five studies (N = 4227 participants) were eligible. HbA1c levels were sub-optimal throughout the study period but tended to stabilize in a "track" by 6 months after T1D diagnosis. The group with low HbA1c <53 mmol/mol (<7%) at baseline had lower long-term HbA1c levels than the higher HbA1c group. The estimated standardized mean difference between the sub groups showed a reduction of HbA1c levels on average by 1.6% (range -0.95% to -2.28%) from baseline. Only one study investigated the association between early glycemic control and development of vascular complications in childhood onset T1D. INTERPRETATIONS Glycemic control after the first few months of childhood onset T1D, remains stable but sub-optimal for a decade. The low and high HbA1c levels at baseline seem to "track" in their respective tracks during the 10-year follow-up, however, the initial difference between groups narrows over time. PROSPERO CRD42015024546 http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015024546.
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Affiliation(s)
- Veena Mazarello Paes
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK,Department of PaediatricsUniversity of CambridgeCambridgeUK
| | | | | | - Heather Chesters
- Great Ormond Street Institute of Child HealthUniversity College LondonLondonUK
| | | | - David B. Dunger
- Department of PaediatricsUniversity of CambridgeCambridgeUK,Wellcome Trust/MRC Institute of Metabolic Sciences, University of CambridgeCambridgeUK
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29
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Patton SR, Noser AE, Youngkin EM, Majidi S, Clements MA. Early Initiation of Diabetes Devices Relates to Improved Glycemic Control in Children with Recent-Onset Type 1 Diabetes Mellitus. Diabetes Technol Ther 2019; 21:379-384. [PMID: 31166808 PMCID: PMC6602098 DOI: 10.1089/dia.2019.0026] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: To test whether the addition of an insulin pump or continuous glucose monitor (CGM) related to reduced glycated hemoglobin A1c (HbA1c) in large cohort of children, 5-9 years old, and within 1 year of their type 1 diabetes (T1D) diagnosis. Research Design and Methods: The study uses data from families of children with recent-onset T1D and who were between 5 and 9 years old. Study analyses used children's HbA1c values at baseline and at the 6-month follow-up. Parents reported on family demographics and children's T1D device use in their daily management (e.g., insulin pump or CGM). Children's mean T1D duration was 4.70 ± 3.28 months at baseline, so the 6-month assessment point was ∼12 months postdiagnosis. Results: One hundred-eleven families participated. At baseline, child mean age was 7.51 ± 1.37 years, and mean child HbA1c was 7.65% ± 1.40%. In addition, 17% of children used an insulin pump, and 17.1% of children used CGM. Six months later, 35.1% of children had started an insulin pump and 25.2% had started CGM. Repeated measures analyses of variance results showed a smaller overall HbA1c between baseline and 6 months for children using an insulin pump versus children not on a pump. For CGM, results showed that children starting a CGM during this window had a significantly lower HbA1c level than children who had not started on CGM. Conclusions: The study results suggest that early initiation of either an insulin pump or CGM in children newly diagnosed with T1D may help to improve child HbA1c levels within the first 12 months of diabetes.
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Affiliation(s)
- Susana R. Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
| | - Amy E. Noser
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
- Clinical Child Psychology Program, University of Kansas, Lawrence, Kansas
| | - Erin M. Youngkin
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Shideh Majidi
- Division of Endocrinology, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, Colorado
| | - Mark A. Clements
- Center for Children's Healthy Lifestyles and Nutrition, Children's Mercy Kansas City, Kansas City, Missouri
- Division of Endocrinology and Diabetes, Department of Pediatrics, Children's Mercy Kansas City, Kansas City, Missouri
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30
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Piechowiak K, Szypowska A. Physiological factors influencing diabetes control in type 1 diabetes children with insulin pumps from diagnosis. Diabetes Metab Res Rev 2019; 35:e3086. [PMID: 30325106 DOI: 10.1002/dmrr.3086] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 10/10/2018] [Accepted: 10/12/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim of this study was to identify the physiological factors influencing diabetes control in children with type 1 diabetes (T1D) using continuous subcutaneous insulin infusion (CSII) from diabetes diagnosis. METHODS This study focused on 163 children (81 boys) initiated with CSII within 2 weeks after T1D recognition and treated for at least 3 years. We analysed fasting C-peptide, GADA, ICA, IA2A, BMI z-score, total daily dose, and basal insulin. Patients were divided into groups according to their metabolic control: 7.5% > HbA1c ≥ 7.5% at the end of the study. RESULTS At the end of the follow-up, patients with HbA1c <7.5%, had a lower HbA1c level at diagnosis (11.7% vs 12.6%; P = 0.018), lower HbA1c level at both the first-year (6.7% vs 7.3%; P = 0.000) and the second-year (6.8% vs.7.7%; P = 0.000) follow-up, and a lower GADA level (P = 0.001). A multiple logistic regression analysis showed that HbA1c at diagnosis (P = 0.012), HbA1c at first year (P = 0.000), HbA1c at second year (P = 0.000), age at diagnosis (P = 0.047), GADA (P = 0.031), and basal insulin at third year (P = 0.032), influenced HbA1c <7.5% at the third year of follow-up. At the end of the study, 76% of patients started with CSII at the age <10 years and 49% of subjects initiated with CSII at the age ≥10 years achieved HbA1c ≤7.5%. CONCLUSIONS This study shows that for those who initiated CSII at T1D onset, younger age, less intense autoimmune process, a low HbA1c at recognition, and good diabetes control during the first year of treatment were associated with long-term optimal glycaemic control.
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31
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Alassaf A, Odeh R, Gharaibeh L, Ibrahim S, Ajlouni K. Personal and Clinical Predictors of Poor Metabolic Control in Children with Type 1 Diabetes in Jordan. J Diabetes Res 2019; 2019:4039792. [PMID: 31355293 PMCID: PMC6637667 DOI: 10.1155/2019/4039792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Achieving adequate metabolic control in children with type 1 diabetes is important in slowing the progression of future microvascular and macrovascular complications, but still it is a universal challenge. We aim to investigate possible factors associated with poor metabolic outcomes in Jordan as an example of a country with limited resources. METHODS This is a retrospective chart review study of children with type 1 diabetes. Several clinical and personal characteristics were tested for association with metabolic control reflected by HbA1c levels. Linear logistic regression analysis was used to evaluate possible predictors of metabolic control. One-way ANOVA analysis was used to detect significant differences in HbA1c between categories. RESULTS Significant predictors of metabolic control were found. A one-year increase in age led to an increase in HbA1c by 0.053% (P = 0.044). A decline in HbA1c levels was predicted in children who have precise amount of carbohydrates or who are receiving insulin at school (-0.46% (P = 0.014) and -0.82% (P = 0.004), respectively). When family members other than mothers decided the insulin dose, the HbA1c level increased by 0.74% (P = 0.005). CONCLUSION Poor metabolic control was associated with age, dietary noncompliance, not receiving insulin at school, and absence of direct mother care. Our study is one of the few studies from Middle East evaluating predictors of metabolic control. Global research studies help in giving universal insight towards developing more effective multidisciplinary team approach for diabetes care and education.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lubna Gharaibeh
- Department of Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
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Cameron FJ, Garvey K, Hood KK, Acerini CL, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence. Pediatr Diabetes 2018; 19 Suppl 27:250-261. [PMID: 29900653 DOI: 10.1111/pedi.12702] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/28/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fergus J Cameron
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de Medicina, University of Chile, Santiago, Chile
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Agarwal S, Khokhar A, Castells S, Marwa A, Hagerty D, Dunkley L, Cooper J, Chin V, Umpaichitra V, Perez-Colon S. Role of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes. J Natl Med Assoc 2018; 111:37-45. [PMID: 30129485 DOI: 10.1016/j.jnma.2018.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 05/02/2018] [Accepted: 05/23/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE With the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population. METHODS A total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study. Study questionnaires assessing patient knowledge and other variables were distributed and patient charts were reviewed retrospectively to obtain relevant clinical data. T-tests, one-way ANOVA and spearman correlation were used for analysis. RESULTS Mean A1c in our study was 10.5% and mean knowledge score was 10.1 out of 14. There was no significant correlation (r = 0.12, p = 0.26) between A1c and patients' knowledge scores. Patients with more frequent blood sugar (BS) monitoring (3-4 times/day) had 2 points lower A1c (9.6 vs 11.6 %, 95% CI 0.2-3.7, p = 0.03) than those with 2 or less times/day. No significant difference in A1c between 3-4 checks/day vs >4 checks/day BS checks. Most patients reported 'forgetfulness' (19%) followed by 'too time consuming' (17.9%) as barriers to daily BS monitoring. There was no significant difference in A1c between pen or pump users (10.5 vs 10.2 %, p = 0.55). Surprisingly, those with home supervision had higher A1c than those without (10.7 vs 9.6 %, p = 0.04) while there was no significant difference between those with or without nurse supervision at school (10.6 vs 9.8 %, p = 0.33). Those reporting happy mood interestingly had higher A1c than those with sad/depressed mood (10.7 vs 9.4 %, p = 0.04). On multiple linear regression analysis, frequency of BS checks, home supervision and mood were the most significant predictors of A1c and altogether explained 20% of the variability in A1c. CONCLUSION Frequent BS monitoring is associated with lower A1c. Supervision at home and school did not improve A1c, but it was self-reported information. Mood did not affect A1c contrary to that reported in other studies.
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Affiliation(s)
- Swashti Agarwal
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | | | | | - Albara Marwa
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Dawn Hagerty
- SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | | | - Vivian Chin
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital Center, Brooklyn, NY, USA
| | - Vatcharapan Umpaichitra
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital Center, Brooklyn, NY, USA
| | - Sheila Perez-Colon
- SUNY Downstate Medical Center, Brooklyn, NY, USA; Kings County Hospital Center, Brooklyn, NY, USA
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Nirantharakumar K, Mohammed N, Toulis KA, Thomas GN, Narendran P. Clinically meaningful and lasting HbA 1c improvement rarely occurs after 5 years of type 1 diabetes: an argument for early, targeted and aggressive intervention following diagnosis. Diabetologia 2018; 61:1064-1070. [PMID: 29478098 PMCID: PMC6448997 DOI: 10.1007/s00125-018-4574-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Accepted: 12/20/2017] [Indexed: 01/01/2023]
Abstract
AIMS/HYPOTHESIS Our objectives were to explore whether the phenomenon of HbA1c 'tracking' occurs in individuals with type 1 diabetes, how long after diagnosis does tracking take to stabilise, and whether there is an effect of sex and age at diagnosis on tracking. METHODS A total of 4525 individuals diagnosed with type 1 diabetes between 1 January 1995 and 1 May 2015 were identified from The Health Improvement Network (THIN) database. Mixed models were applied to assess the variability of HbA1c levels over time with random effects on general practices (primary care units) and individuals within practices. RESULTS 4525 individuals diagnosed with type 1 diabetes were identified in THIN over the study period. The greatest difference in mean HbA1c measurement (-7.0 [95% CI -8.0, -6.1] mmol/mol [0.6%]) was seen when comparing measurements made immediately after diagnosis (0-1 year since diagnosis) with those at 10 or more years (the reference category). The mean difference in HbA1c for the successive periods compared with 10 or more years after diagnosis declined and was no longer statistically significant after 5 years. In the stratified analysis using sex and age group there was considerable heterogeneity with adult onset type 1 diabetes appearing to track earlier and at a lower mean HbA1c. CONCLUSIONS/INTERPRETATION In individuals with type 1 diabetes, glycaemic control measured by HbA1c settles onto a long-term 'track' and this occurs on average by 5 years following diagnosis. Age at diagnosis modifies both the rate at which individuals settle into their track and the absolute HbA1c tracking level for the next 10 years.
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Affiliation(s)
- Krishnarajah Nirantharakumar
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Nuredin Mohammed
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Konstantinos A Toulis
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - G Neil Thomas
- Public Health, Epidemiology and Biostatistics, Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Parth Narendran
- Department of Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
- Institute of Immunology and Immunotherapy, Research College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Mazarello Paes V, Charalampopoulos D, Edge J, Taylor-Robinson D, Stephenson T, Amin R. Predictors of glycemic control in the first year of diagnosis of childhood onset type 1 diabetes: A systematic review of quantitative evidence. Pediatr Diabetes 2018; 19:18-26. [PMID: 28488346 DOI: 10.1111/pedi.12530] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2016] [Revised: 02/28/2017] [Accepted: 03/28/2017] [Indexed: 12/14/2022] Open
Abstract
Early glycemic control is associated with reduced future vascular complications risk in type 1 diabetes (T1D). The aim of this study was to systematically review evidence on the predictors of glycemic control within 12 months of diagnosis of childhood onset T1D. Inclusion criteria for the electronic search were: interventional and observational studies that assessed and quantified an association between the predictor and glycemic control within 12 months of diagnosis of childhood onset T1D. A total of 17 915 articles were identified from 6 databases and 20 studies were finally included in the analysis. Harvest plots and narrative synthesis were used to summarize data from intervention (n = 0), prospective/retrospective cohort (n = 15), and cross-sectional (n = 5) studies. Significant predictors of poorer glycemic control 0 to 3 months after diagnosis were older age and female gender. Non-white ethnicity, diabetes autoantibody positivity, measures of deprivation, and non-private health insurance were potential predictors. Predictors of poorer glycemic control 4 to 12 months after diagnosis were: older age, non-white ethnicity, a single parent family, high hemoglobin A1c (HbA1c) levels at diagnosis, longer T1D duration, and non-intensive insulin therapy. Potential predictors included: family with health issues, clinical factors, and comorbidities at diagnosis. Most significant predictors of poor glycemic control within 12 months of diagnosis of childhood onset T1D are non-modifiable. These factors need to be recognized and addressed through individualized and multidisciplinary diabetes care. Further research is required to confirm the association of potential predictors with early glycemic control.
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Affiliation(s)
- Veena Mazarello Paes
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Dimitrios Charalampopoulos
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Julie Edge
- Department of Paediatric Endocrinology and Diabetes, University of Oxford, Oxford, UK
| | - David Taylor-Robinson
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK.,Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Terence Stephenson
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rakesh Amin
- Children's Policy Research Unit, Great Ormond Street Institute of Child Health, University College London, London, UK
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Nilsson J, Åkesson K, Hanberger L, Samuelsson U. High HbA1c at onset cannot be used as a predictor for future metabolic control for the individual child with type 1 diabetes mellitus. Pediatr Diabetes 2017; 18:848-852. [PMID: 28117535 DOI: 10.1111/pedi.12498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 12/02/2016] [Accepted: 12/15/2016] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND To study how metabolic control at onset of type 1 diabetes correlates to metabolic control and clinical parameters during childhood until transition from pediatric care to adult diabetes care. MATERIALS AND METHODS Data at onset, three months, one, three, and five years after diagnosis and at transition, on HbA1c and clinical parameters, on 8084 patients in the Swedish pediatric quality registry, SWEDIABKIDS, were used. Of these patients, 26% had been referred to adult diabetes care by 2014. RESULTS Children with HbA1c < 72 mmol/mol (8.7%) (20% of patients, low group) at diagnosis continued to have good metabolic control during childhood, in contrast to children with HbA1c > 114 mmol/mol (12.6%) (20% of patients, high group) at diagnosis, who continued to have high HbA1c at follow-up. For the individual, there was no significant correlation between high HbA1c at onset and during follow-up. During follow-up, children in the high group were more often smokers, less physically active, and more often had retinopathy than children in the low group (P < .01, .01, .03 respectively). CONCLUSION High HbA1c at onset was associated with high HbA1c during follow-up on a group level, but it cannot be used as a predictor of future metabolic control on an individual level. These results emphasize the important work done by the diabetes team in the first years after diagnosis. It is important to continuously set high goals for the achievement of tight metabolic control, in order to decrease the risk of microvascular complications.
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Affiliation(s)
- John Nilsson
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden
| | - Karin Åkesson
- Department of Paediatrics, Ryhov County Hospital, Jönköping, Sweden.,Futurum-Academy for Health and Care, Jönköping County Council and Jönköping Academy for improvement of Health and Welfare, Jönköping University, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes Research Centre, Linköping University Hospital, Linköping, Sweden
| | - Lena Hanberger
- Department of Medicine and Health Sciences, Division of Nursing, Linköping University, Linköping, Sweden
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes Research Centre, Linköping University Hospital, Linköping, Sweden
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Trajectories of Glycemic Change in a National Cohort of Adults With Previously Controlled Type 2 Diabetes. Med Care 2017; 55:956-964. [PMID: 28922296 DOI: 10.1097/mlr.0000000000000807] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Individualized diabetes management would benefit from prospectively identifying well-controlled patients at risk of losing glycemic control. OBJECTIVES To identify patterns of hemoglobin A1c (HbA1c) change among patients with stable controlled diabetes. RESEARCH DESIGN Cohort study using OptumLabs Data Warehouse, 2001-2013. We develop and apply a machine learning framework that uses a Bayesian estimation of the mixture of generalized linear mixed effect models to discover glycemic trajectories, and a random forest feature contribution method to identify patient characteristics predictive of their future glycemic trajectories. SUBJECTS The study cohort consisted of 27,005 US adults with type 2 diabetes, age 18 years and older, and stable index HbA1c <7.0%. MEASURES HbA1c values during 24 months of observation. RESULTS We compared models with k=1, 2, 3, 4, 5 trajectories and baseline variables including patient age, sex, race/ethnicity, comorbidities, medications, and HbA1c. The k=3 model had the best fit, reflecting 3 distinct trajectories of glycemic change: (T1) rapidly deteriorating HbA1c among 302 (1.1%) youngest (mean, 55.2 y) patients with lowest mean baseline HbA1c, 6.05%; (T2) gradually deteriorating HbA1c among 902 (3.3%) patients (mean, 56.5 y) with highest mean baseline HbA1c, 6.53%; and (T3) stable glycemic control among 25,800 (95.5%) oldest (mean, 58.5 y) patients with mean baseline HbA1c 6.21%. After 24 months, HbA1c rose to 8.75% in T1 and 8.40% in T2, but remained stable at 6.56% in T3. CONCLUSIONS Patients with controlled type 2 diabetes follow 3 distinct trajectories of glycemic control. This novel application of advanced analytic methods can facilitate individualized and population diabetes care by proactively identifying high risk patients.
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Kelly CS, Berg CA, Ramsey MA, Baker AC, Donaldson DL, Swinyard MT, Lindsay R, Murray M, Wiebe DJ. Relationships and the development of transition readiness skills into early emerging adulthood for individuals with type 1 diabetes. CHILDRENS HEALTH CARE 2017; 47:308-325. [PMID: 30906104 PMCID: PMC6426132 DOI: 10.1080/02739615.2017.1354294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The study examined how 'transition readiness' skills develop from relationship processes with parents, friends, and healthcare providers. During their senior year of high school and one year later, participants (N = 217) with type 1 diabetes completed measures of transition readiness skills (Self-Management; Self-Advocacy), adherence, HbA1c, and relationships with providers (patient-centered communication), parents (monitoring/knowledge), and friends (knowledge/helpfulness) surrounding diabetes. Self-Management skills increased across time. Higher friend knowledge/helpfulness during emerging adulthood was associated with increased Self-Management skills. Adherence improved when relationships with providers and friends matched transition readiness skills, indicating that these relationships may facilitate transition skills in early emerging adulthood.
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Affiliation(s)
- Caitlin S. Kelly
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Meagan A. Ramsey
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Ashley C. Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, CA
| | - David L. Donaldson
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | | | - Rob Lindsay
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Mary Murray
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT
| | - Deborah J. Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, CA
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van Esdonk MJ, Tai B, Cotterill A, Charles B, Hennig S. Prediction of glycaemic control in young children and adolescents with type 1 diabetes mellitus using mixed-effects logistic regression modelling. PLoS One 2017; 12:e0182181. [PMID: 28767734 PMCID: PMC5540397 DOI: 10.1371/journal.pone.0182181] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/13/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Glycaemic control in children and adolescents with type 1 diabetes mellitus can be challenging, complex and influenced by many factors. This study aimed to identify patient characteristics that were predictive of satisfactory glycaemic control in the paediatric population using a logistic regression mixed-effects (population) modelling approach. METHODS The data were obtained from 288 patients aged between 1 and 22 years old recorded retrospectively over 3 years (1852 HbA1c observations). HbA1c status was categorised as 'satisfactory' or 'unsatisfactory' glycaemic control, using an a priori cut-off value of HbA1c ≥ 9% (75 mmol/mol), as used routinely by the hospital's endocrine paediatricians. Patients' characteristics were tested as covariates in the model as potential predictors of glycaemic control. RESULTS There were three patient characteristics identified as having a significant influence on glycaemic control: HbA1c measurement at the beginning of the observation period (Odds Ratio (OR) = 0.30 per 1% HbA1c increase, 95% confidence interval (CI) = 0.20-0.41); Age (OR = 0.88 per year increase, 95% CI = 0.80-0.94), and fractional disease duration (disease duration/age, OR = 0.80 per 0.10 increase, 95% CI = 0.66-0.93) were collectively identified as factors contributing significantly to lower the probability of satisfactory glycaemic control. CONCLUSIONS The study outcomes may prove useful for identifying paediatric patients at risk of having unsatisfactory glycaemic control, and who could require more extensive monitoring, support, or targeted interventions.
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Affiliation(s)
- Michiel Joost van Esdonk
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Bonnie Tai
- Pharmacy Department, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Andrew Cotterill
- Lady Cilento Children’s Hospital, South Brisbane and Queensland Paediatric Endocrinology, Woolloongabba, Queensland, Australia
| | - Bruce Charles
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Woolloongabba, Queensland, Australia
| | - Stefanie Hennig
- School of Pharmacy, Pharmacy Australia Centre of Excellence (PACE), The University of Queensland, Woolloongabba, Queensland, Australia
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Niba LL, Aulinger B, Mbacham WF, Parhofer KG. Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon. BMC Res Notes 2017; 10:207. [PMID: 28606170 PMCID: PMC5469010 DOI: 10.1186/s13104-017-2534-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those diagnosed have a dramatically reduced life expectancy (less than one year). The purpose of this study was to identify the predictors of glucose control in children and adolescents with type 1 diabetes. METHODS This hospital based cross-sectional study involved 76 children/adolescents (35 boys and 41 girls, mean age of 15.1 ± 3.1 years) with type 1 diabetes included in the "Changing Diabetes in Children" (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region of Cameroon. Data on glycosylated haemoglobin (HbA1c) was obtained from hospital records of participants. Information on socio-demographic characteristics and diabetes related practices were obtained from participants using a structured questionnaire. Odds ratios (OR) were calculated using logistic regression models to assess the association between determinants and good glyceamic control. RESULTS The study population had a mean HbA1c of 10.3 ± 2.9%. Bivariate analysis indicated that having a mother as the primary caregiver (OR 0.07, 95% CI 0.02-0.2), being on 2 daily insulin injections (OR 0.2, 95% CI 0.1-0.5) and good blood glucose monitoring (BGM) adherence (OR 0.1, 95% CI 0.04-0.3) were significantly (p < 0.001) associated with better HbA1c. Minimal/moderate caregiver involvement in BGM (OR 7.7, 95% CI 2.7-22.0) and insulin injection (OR 14.9, 95% CI 4.8-46.5) were significantly (p < 0.001) associated with poor outcome. Multivariate analysis showed that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002-0.189) was an independent predictor of good glucose control. CONCLUSIONS This study has shown that the mother's involvement in the diabetes management of their children and minimal/moderate caregiver involvement in the task of insulin injection are the most important determinants for good and poor glucose control respectively. It is currently unclear whether the direct involvement of the mother is causal or whether "mother as a primary caregiver" is just an indicator for a setting in which good diabetes treatment is possible.
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Affiliation(s)
- Loveline L. Niba
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Biochemistry, Catholic University of Cameroon (CATUC), P.O. Box 782, Bamenda, Cameroon
| | - Benedikt Aulinger
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
| | - Wilfred F. Mbacham
- Department of Physiology and Biochemistry, Faculty of Medicine, University of Yaoundé I, P.O. Box 8094, Yaoundé, Cameroon
| | - Klaus G. Parhofer
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
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Jin M, An Q, Wang L. Chronic conditions in adolescents. Exp Ther Med 2017; 14:478-482. [PMID: 28672956 PMCID: PMC5488599 DOI: 10.3892/etm.2017.4526] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/22/2017] [Indexed: 12/20/2022] Open
Abstract
The health problems related to the nervous system are on rise in young infants leading to high mortality amongst this age group. A chronic medical condition (CC) is present in this age group to the tune of 10–20%. We searched the electronic database PubMed for pre-clinical as well as clinical controlled trials reporting variable chronic conditions especially in pediatric patients. Most of these reports revealed that type 1 diabetes mellitus is the most common CC in young infants. In female patients, metabolic control is often disturbed during CC in this age group. Poor metabolism regulation often results in long-term complications, including cognitive disorders. In cognitive disorders, memory loss and learning problems are the most among adolescents. Executive problems are observed to be associated with low physical activities. The review article concludes that knowledge about factors influencing treatment adherence is crucial in chronically ill infants. Further, we should focus on protective factors in order to prevent health risk behavior.
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Affiliation(s)
- Mingwei Jin
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Qi An
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Lei Wang
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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Clements MA, Staggs VS. A Mobile App for Synchronizing Glucometer Data: Impact on Adherence and Glycemic Control Among Youths With Type 1 Diabetes in Routine Care. J Diabetes Sci Technol 2017; 11:461-467. [PMID: 28745097 PMCID: PMC5505434 DOI: 10.1177/1932296817691302] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Many individuals with type 1 diabetes (T1D) upload and review blood glucose data between clinic visits. Mobile phone applications that receive data from a "connected" glucometer and that support pattern management are available and have the capacity to make data upload and review less burdensome. Whether mobile apps can improve diabetes self-management among individuals with type 1 diabetes remains unknown. METHOD We analyzed retrospective data on 81 youths with T1D who were trained to use a glucometer-connected mobile app in their self-management. To assess the effect of glucometer synchronization ("sync") rate on hemoglobin A1c (HbA1c), mean blood glucose (mBG), and daily frequency of SMBG, we regressed those clinical outcomes on the frequency of glucometer syncs with the mobile app after controlling for other clinical care variables. RESULTS Median age was 14.0 (IQR 10.4-15.9) years, median duration of diabetes was 4.9 (2.7, 7.5) years, and median baseline HbA1c was 8.6% (7.9, 9.8). The sample was 49% male and 86% white. Youths with T1D synchronized glucometer data with the mobile app an average of 0.22 times per week (range 0-2.25). The glucometer sync rate did not have a statistically significant association with HbA1c or mean BG; in contrast, data sync frequency was associated with the frequency of self-monitoring of blood glucose (SMBG) such that each additional sync was associated with a 2.3-fold increase in SMBG frequency ( P < .01). CONCLUSION A glucometer-connected mobile app may increase an individual's engagement with other aspects of care (eg, SMBG frequency). Whether diabetes device-connected mobile apps can improve glycemic control remains to be determined.
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Affiliation(s)
- Mark A. Clements
- Children’s Mercy Hospital, Center for Children’s Healthy Lifestyles & Nutrition, University of Missouri–Kansas City, University of Kansas Medical Center, Kansas City, MO, USA
- Mark A. Clements, MD, PhD, CPI, FAAP, Children’s Mercy Hospital, Center for Children’s Healthy Lifestyles & Nutrition, University of Missouri–Kansas City, University of Kansas Medical Center, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
| | - Vincent S. Staggs
- Children’s Mercy Hospital, University of Missouri–Kansas City, Health Services & Outcomes Research, Kansas City, MO, USA
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Acevedo-Calado M, James EA, Morran MP, Pietropaolo SL, Ouyang Q, Arribas-Layton D, Songini M, Liguori M, Casu A, Auchus RJ, Huang S, Yu L, Michels A, Gianani R, Pietropaolo M. Identification of Unique Antigenic Determinants in the Amino Terminus of IA-2 (ICA512) in Childhood and Adult Autoimmune Diabetes: New Biomarker Development. Diabetes Care 2017; 40:561-568. [PMID: 28174261 PMCID: PMC5360285 DOI: 10.2337/dc16-1527] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Accepted: 01/11/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The characterization of diverse subtypes of diabetes is a dynamic field of clinical research and an active area of discussion. The objective of this study was to identify new antigenic determinants in the neuroendocrine autoantigen IA-2 (ICA512) and assess whether circulating autoantibodies directed to new IA-2 epitopes identify autoimmune diabetes in young and adult populations with diabetes. RESEARCH DESIGN AND METHODS Clinically diagnosed patients with type 2 diabetes (n = 258; diabetes duration: 0.01-31 years) were evaluated using a new biomarker detecting autoantibodies directed to the extracellular domain of the neuroendocrine autoantigen IA-2 (IA-2ec). The proportion of IA-2ec autoantibodies was also evaluated in newly diagnosed patients with type 1 diabetes (n = 150; diabetes duration: 0.04-0.49 years). In addition, IA-2 (intracellular domain), GAD65, and zinc transporter 8 autoantibodies were assayed. RESULTS IA-2ec autoantibodies were detected in patients with type 1 diabetes and, surprisingly, in 5% of patients with type 2 diabetes without serologic responses to other IA-2 antigenic epitopes or other islet autoantigens. We also assessed the ability of IA-2ec-derived peptides to elicit CD4+ T-cell responses by stimulating peripheral blood mononuclear cells from patients with type 1 diabetes (n = 18) and HLA-matched healthy subjects (n = 13) with peptides and staining with the peptide/DQ8-specific tetramers, observing disease-associated responses to previously unreported epitopes within IA-2ec. CONCLUSIONS We developed a new antibody biomarker identifying novel antigenic determinants within the N terminus of IA-2. IA-2ec autoantibodies can be detected in patients with type 1 diabetes and in a subgroup of adult autoimmune patients with type 2 diabetes phenotype negative for conventional islet autoantibody testing. These observations suggest that islet autoimmunity may be more common in clinically diagnosed type 2 diabetes than previously observed.
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Affiliation(s)
- Maria Acevedo-Calado
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Eddie A James
- Benaroya Research Institute, University of Washington, Seattle, WA
| | - Michael P Morran
- Department of Medicinal Chemistry, College of Pharmacy, University of Toledo, Toledo, OH
| | - Susan L Pietropaolo
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Qin Ouyang
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX
| | | | - Marco Songini
- Diabetes Clinic, Department of Internal Medicine, and Laboratory of Microbiology & Immunology, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Marco Liguori
- Diabetes Clinic, Department of Internal Medicine, and Laboratory of Microbiology & Immunology, Azienda Ospedaliera G. Brotzu, Cagliari, Italy
| | - Anna Casu
- Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione, Palermo, Italy
| | - Richard J Auchus
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI
| | - Shuai Huang
- Department of Industrial and Systems Engineering, University of Washington, Seattle, WA
| | - Liping Yu
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Aaron Michels
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Roberto Gianani
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX.,Rocky Vista University College of Osteopathic Medicine, Parker, CO
| | - Massimo Pietropaolo
- Division of Diabetes, Endocrinology and Metabolism, Department of Medicine, Baylor College of Medicine, Houston, TX
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Schwandt A, Hermann JM, Rosenbauer J, Boettcher C, Dunstheimer D, Grulich-Henn J, Kuss O, Rami-Merhar B, Vogel C, Holl RW. Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach. Diabetes Care 2017; 40:309-316. [PMID: 28007778 DOI: 10.2337/dc16-1625] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/23/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood. RESEARCH DESIGN AND METHODS A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration ≥2 years, HbA1c aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA1c over time. RESULTS Five distinct longitudinal trajectories of HbA1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA1c levels. At baseline, similar HbA1c was observed in group 1 and group 4, but HbA1c deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA1c trajectories (all P ≤ 0.001). No sex differences were present. Comparing groups with similar initial HbA1c but different patterns, groups with higher HbA1c increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01). CONCLUSIONS Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA1c courses.
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Affiliation(s)
- Anke Schwandt
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany .,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Julia M Hermann
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | | | | | - Oliver Kuss
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Vogel
- Department of Pediatrics, Children's Hospital Chemnitz, Chemnitz, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Paz R, Rouhanian M, Vogt K. Glycemic control and sponsor rank of military dependents with type 1 diabetes mellitus. Pediatr Diabetes 2016; 17:449-57. [PMID: 26315782 DOI: 10.1111/pedi.12306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Disparities in glycemic control are reported in children with type 1 diabetes related to differences in access to health care and socioeconomic status. In the US military, rank is an indicator of socioeconomic status, but all have complete health care access without cost. OBJECTIVE We sought to determine if glycemic control in children with type 1 diabetes differs if their sponsor (parent) is an officer vs. enlisted military service member. METHODS We performed a cross-sectional retrospective chart review of children with type 1 diabetes >1 yr duration whose parent is a military service member. RESULTS A total of 281 subjects met study criteria, 136 (48.4%) having an enlisted and 145 (51.6%) having an officer sponsor. The groups differed by race with 38.2% black in the enlisted and 9% black in the officer group (p < 0.001). The median enlisted average hemoglobin A1c (HbA1c) over the most recent year of available data was significantly higher than the officer group (9.2 vs. 8.4%, p < 0.001). The difference remained significant when controlled for age and race. Diabetes-related hospitalizations were greater in the enlisted group (39.0 vs. 19.3%, p < 0.001). More subjects in the officer group were on insulin pumps (54.5 vs. 28.7%, p < 0.001). CONCLUSION Dependent children of enlisted service members with type 1 diabetes have higher HbA1c levels, more diabetes-related hospitalizations, and are less likely to use insulin pumps than children of officers. These differences are likely linked to socioeconomic status and education levels given the universal access to health care within the military system.
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Affiliation(s)
- Rachael Paz
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Minoo Rouhanian
- Biostatistics Section, Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Karen Vogt
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
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Clements MA, Foster NC, Maahs DM, Schatz DA, Olson BA, Tsalikian E, Lee JM, Burt-Solorzano CM, Tamborlane WV, Chen V, Miller KM, Beck RW. Hemoglobin A1c (HbA1c) changes over time among adolescent and young adult participants in the T1D exchange clinic registry. Pediatr Diabetes 2016; 17:327-36. [PMID: 26153338 DOI: 10.1111/pedi.12295] [Citation(s) in RCA: 162] [Impact Index Per Article: 20.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 06/04/2015] [Accepted: 06/09/2015] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE Hemoglobin A1c (HbA1c) levels among individuals with type 1 diabetes (T1D) influence the longitudinal risk for diabetes-related complications. Few studies have examined HbA1c trends across time in children, adolescents, and young adults with T1D. This study examines changes in glycemic control across the specific transition periods of pre-adolescence-to-adolescence and adolescence-to-young adulthood, and the demographic and clinical factors associated with these changes. RESEARCH DESIGN AND METHODS Available HbA1c lab results for up to 10 yr were collected from medical records at 67 T1D Exchange clinics. Two retrospective cohorts were evaluated: the pre-adolescent-to-adolescent cohort consisting of 85 016 HbA1c measurements from 6574 participants collected when the participants were 8-18 yr old and the adolescent-to-young adult cohort, 2200 participants who were 16-26 yr old at the time of 17 279 HbA1c measurements. RESULTS HbA1c in the 8-18 cohort increased over time after age 10 yr until ages 16-17; followed by a plateau. HbA1c levels in the 16-26 cohort remained steady from 16-18, and then gradually declined. For both cohorts, race/ethnicity, income, health insurance, and pump use were all significant in explaining individual variations in age-centered HbA1c (p < 0.001). For the 8-18 cohort, insulin pump use, age of onset, and health insurance were significant in predicting individual HbA1c trajectory. CONCLUSIONS Glycemic control among patients 8-18 yr old worsens over time, through age 16. Elevated HbA1c levels observed in 18 yr-olds begin a steady improvement into early adulthood. Focused interventions to prevent deterioration in glucose control in pre-adolescence, adolescence, and early adulthood are needed.
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Affiliation(s)
- Mark A Clements
- Pediatrics (Endocrinology), Children's Mercy Hospitals and Clinics, Kansas City, MO, 64018, USA
| | - Nicole C Foster
- Jaeb Center for Health Research, T1D Exchange, Tampa, FL, 33647, USA
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, 80045, USA
| | - Desmond A Schatz
- University of Florida College of Medicine, Division of Endocrinology, Gainesville, FL, 32610, USA
| | - Beth A Olson
- Park Nicollet International Diabetes Center, Minneapolis, MN, 55416, USA
| | - Eva Tsalikian
- University of Iowa Children's Hospital, Department of Pediatrics, Iowa City, IA, 52242, USA
| | - Joyce M Lee
- Pediatric Endocrinology, University of Michigan, Department of Pediatrics and Communicable Diseases, Ann Arbor, MI, 48109, USA
| | | | | | - Vincent Chen
- Jaeb Center for Health Research, T1D Exchange, Tampa, FL, 33647, USA
| | - Kellee M Miller
- Jaeb Center for Health Research, T1D Exchange, Tampa, FL, 33647, USA
| | - Roy W Beck
- Jaeb Center for Health Research, T1D Exchange, Tampa, FL, 33647, USA
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