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Schoelwer MJ, DeBoer MD, Breton MD. Use of diabetes technology in children. Diabetologia 2024:10.1007/s00125-024-06218-0. [PMID: 38995398 DOI: 10.1007/s00125-024-06218-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 05/23/2024] [Indexed: 07/13/2024]
Abstract
Children with type 1 diabetes and their caregivers face numerous challenges navigating the unpredictability of this complex disease. Although the burden of managing diabetes remains significant, new technology has eased some of the load and allowed children with type 1 diabetes to achieve tighter glycaemic management without fear of excess hypoglycaemia. Continuous glucose monitor use alone improves outcomes and is considered standard of care for paediatric type 1 diabetes management. Similarly, automated insulin delivery (AID) systems have proven to be safe and effective for children as young as 2 years of age. AID use improves not only blood glucose levels but also quality of life for children with type 1 diabetes and their caregivers and should be strongly considered for all youth with type 1 diabetes if available and affordable. Here, we review key data on the use of diabetes technology in the paediatric population and discuss management issues unique to children and adolescents.
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Affiliation(s)
| | - Mark D DeBoer
- Department of Pediatrics, University of Virginia, Charlottesville, VA, USA
| | - Marc D Breton
- Center for Diabetes Technology, University of Virginia, Charlottesville, VA, USA.
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2
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Lin YK, Hepworth E, de Zoysa N, McCurley J, Vajravelu ME, Ye W, Piatt GA, Amiel SA, Fisher SJ, Pop-Busui R, Aikens JE. Relationships of hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring glycemic profiles with anxiety and depression symptoms in adults with type 1 diabetes using continuous glucose monitoring systems. Diabetes Res Clin Pract 2024; 209:111596. [PMID: 38428746 PMCID: PMC10960959 DOI: 10.1016/j.diabres.2024.111596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
AIMS To evaluate relationships of hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles with anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM. METHODS A cross-sectional survey and data collections were completed with 196 T1D adults who used CGM (59% also used automated insulin delivery devices (AIDs)). We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Analysis included simple and multiple linear regression analyses. RESULTS Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs were independently associated with higher anxiety symptoms (P < 0.05), with similar trends in both subgroups using and not using AIDs. Lower hypoglycemia awareness were independently associated with greater depression symptoms (P < 0.05). In participants not using AIDs, more time in hypoglycemia was related to less anxiety and depression symptoms (P < 0.05). Being female and younger were independently associated with higher anxiety symptoms, while being younger was also independently associated with greater depression symptoms (P < 0.05). CONCLUSION Our findings revealed relationships of impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia with anxiety and depression symptoms in T1D adults who use CGMs.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jessica McCurley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK
| | - Simon J Fisher
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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Kuei Lin Y, Hepworth E, de Zoysa N, McCurley J, Ellen Vajravelu M, Ye W, Piatt GA, Amiel SA, Fisher SJ, Pop-Busui R, Aikens JE. Associations Between Hypoglycemia Awareness, Hypoglycemia Beliefs, and Continuous Glucose Monitoring Glycemic Profiles and Anxiety and Depression Symptoms in Adults with Type 1 Diabetes Using Advanced Diabetes Technologies. Diabetes Res Clin Pract 2023:111059. [PMID: 38104898 DOI: 10.1016/j.diabres.2023.111059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
AIMS To evaluate relationships between hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles and anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM or automated insulin delivery devices. METHODS A cross-sectional survey and data collections were completed with 196 T1D adults who used advanced diabetes technologies. We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data were processed via regression analyses and receiver operating characteristic analyses. RESULTS Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs, female, and younger age were independently associated with higher anxiety symptoms (P<0.05). Lower hypoglycemia awareness, less time in hypoglycemia, and younger age were independently associated with greater depression symptoms (P<0.05). Age of <50 years had 77.8% sensitivity and 48.8% specificity in detecting elevated anxiety symptoms. Spending ≥35% of time with glucose levels >180 mg/dL on CGMs had 85.7% sensitivity and 54.3% specificity in detecting elevated depression symptoms. CONCLUSION Our findings revealed relationships between impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia and anxiety and depression symptoms in T1D adults who use advanced diabetes technologies.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jessica McCurley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK
| | - Simon J Fisher
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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Prahalad P, Maahs DM. Roadmap to Continuous Glucose Monitoring Adoption and Improved Outcomes in Endocrinology: The 4T (Teamwork, Targets, Technology, and Tight Control) Program. Diabetes Spectr 2023; 36:299-305. [PMID: 37982062 PMCID: PMC10654131 DOI: 10.2337/dsi23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Glucose monitoring is essential for the management of type 1 diabetes and has evolved from urine glucose monitoring in the early 1900s to home blood glucose monitoring in the 1980s to continuous glucose monitoring (CGM) today. Youth with type 1 diabetes struggle to meet A1C goals; however, CGM is associated with improved A1C in these youth and is recommended as a standard of care by diabetes professional organizations. Despite their utility, expanding uptake of CGM systems has been challenging, especially in minoritized communities. The 4T (Teamwork, Targets, Technology, and Tight Control) program was developed using a team-based approach to set consistent glycemic targets and equitably initiate CGM and remote patient monitoring in all youth with new-onset type 1 diabetes. In the pilot 4T study, youth in the 4T cohort had a 0.5% improvement in A1C 12 months after diabetes diagnosis compared with those in the historical cohort. The 4T program can serve as a roadmap for other multidisciplinary pediatric type 1 diabetes clinics to increase CGM adoption and improve glycemic outcomes.
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Affiliation(s)
- Priya Prahalad
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
| | - David M. Maahs
- Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
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Prahalad P, Hardison H, Odugbesan O, Lyons S, Alwazeer M, Neyman A, Miyazaki B, Cossen K, Hsieh S, Eng D, Roberts A, Clements MA, Ebekozien O. Benchmarking Diabetes Technology Use Among 21 U.S. Pediatric Diabetes Centers. Clin Diabetes 2023; 42:27-33. [PMID: 38230344 PMCID: PMC10788667 DOI: 10.2337/cd23-0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
The American Diabetes Association's Standards of Care in Diabetes recommends the use of diabetes technology such as continuous glucose monitoring systems and insulin pumps for people living with type 1 diabetes. Unfortunately, there are multiple barriers to uptake of these devices, including local diabetes center practices. This study aimed to examine overall change and center-to-center variation in uptake of diabetes technology across 21 pediatric centers in the T1D Exchange Quality Improvement Collaborative. It found an overall increase in diabetes technology use for most centers from 2021 to 2022 with significant variation.
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Affiliation(s)
- Priya Prahalad
- Stanford Children’s Health, Lucile Packard Children’s Hospital, Stanford, CA
| | | | | | - Sarah Lyons
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | | | - Anna Neyman
- UH Rainbow Babies & Children’s Hospital, Cleveland, OH
| | | | | | - Susan Hsieh
- Cook Children’s, Endocrinology, Fort Worth, TX
| | - Donna Eng
- Pediatric Endocrinology, Spectrum Health, Helen DeVos Children’s Hospital, Grand Rapids, MI
| | | | | | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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Quattrin T, Mastrandrea LD, Walker LSK. Type 1 diabetes. Lancet 2023; 401:2149-2162. [PMID: 37030316 DOI: 10.1016/s0140-6736(23)00223-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/03/2022] [Accepted: 01/26/2023] [Indexed: 04/10/2023]
Abstract
Type 1 diabetes is a chronic disease caused by autoimmune destruction of pancreatic β cells. Individuals with type 1 diabetes are reliant on insulin for survival. Despite enhanced knowledge related to the pathophysiology of the disease, including interactions between genetic, immune, and environmental contributions, and major strides in treatment and management, disease burden remains high. Studies aimed at blocking the immune attack on β cells in people at risk or individuals with very early onset type 1 diabetes show promise in preserving endogenous insulin production. This Seminar will review the field of type 1 diabetes, highlighting recent progress within the past 5 years, challenges to clinical care, and future directions in research, including strategies to prevent, manage, and cure the disease.
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Affiliation(s)
- Teresa Quattrin
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA.
| | - Lucy D Mastrandrea
- Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Diabetes Center, John R Oishei Children's Hospital, Buffalo, NY, USA
| | - Lucy S K Walker
- Institute of Immunity and Transplantation, Division of Infection and Immunity, University College London, London, UK
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Dovc K, Lanzinger S, Cardona-Hernandez R, Tauschmann M, Marigliano M, Cherubini V, Preikša R, Schierloh U, Clapin H, AlJaser F, Pelicand J, Shukla R, Biester T. Association of Achieving Time in Range Clinical Targets With Treatment Modality Among Youths With Type 1 Diabetes. JAMA Netw Open 2023; 6:e230077. [PMID: 36808243 PMCID: PMC9941889 DOI: 10.1001/jamanetworkopen.2023.0077] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
IMPORTANCE Continuous glucose monitoring (CGM) devices have demonstrated efficacy in adults and more recently in youths and older adults with type 1 diabetes. In adults with type 1 diabetes, the use of real-time CGM compared with intermittently scanned CGM was associated with improved glycemic control, but there are limited data available for youths. OBJECTIVE To assess real-world data on achievement of time in range clinical targets associated with different treatment modalities in youths with type 1 diabetes. DESIGN, SETTING, AND PARTICIPANTS This multinational cohort study included children, adolescents, and young adults younger than 21 years (hereinafter referred to collectively as youths) with type 1 diabetes for a duration of at least 6 months who provided CGM data between January 1, 2016, and December 31, 2021. Participants were enrolled from the international Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Data from 21 countries were included. Participants were divided into 4 treatment modalities: intermittently scanned CGM with or without insulin pump use and real-time CGM with or without insulin pump use. EXPOSURES Type 1 diabetes and the use of CGM with or without an insulin pump. MAIN OUTCOMES AND MEASURES Proportion of individuals in each treatment modality group achieving recommended CGM clinical targets. RESULTS Among the 5219 participants (2714 [52.0%] male; median age, 14.4 [IQR, 11.2-17.1] years), median duration of diabetes was 5.2 (IQR, 2.7-8.7) years and median hemoglobin A1c level was 7.4% (IQR, 6.8%-8.0%). Treatment modality was associated with the proportion of individuals achieving recommended clinical targets. Adjusted for sex, age, diabetes duration, and body mass index standard deviation score, the proportion achieving the recommended greater than 70% time in range target was highest with real-time CGM plus insulin pump use (36.2% [95% CI, 33.9%-38.4%]), followed by real-time CGM plus injection use (20.9% [95% CI, 18.0%-24.1%]), intermittently scanned CGM plus injection use (12.5% [95% CI, 10.7%-14.4%]), and intermittently scanned CGM plus insulin pump use (11.3% [95% CI, 9.2%-13.8%]) (P < .001). Similar trends were observed for less than 25% time above (real-time CGM plus insulin pump, 32.5% [95% CI, 30.4%-34.7%]; intermittently scanned CGM plus insulin pump, 12.8% [95% CI, 10.6%-15.4%]; P < .001) and less than 4% time below range target (real-time CGM plus insulin pump, 73.1% [95% CI, 71.1%-75.0%]; intermittently scanned CGM plus insulin pump, 47.6% [95% CI, 44.1%-51.1%]; P < .001). Adjusted time in range was highest among real-time CGM plus insulin pump users (64.7% [95% CI, 62.6%-66.7%]). Treatment modality was associated with the proportion of participants experiencing severe hypoglycemia and diabetic ketoacidosis events. CONCLUSIONS AND RELEVANCE In this multinational cohort study of youths with type 1 diabetes, concurrent use of real-time CGM and an insulin pump was associated with increased probability of achieving recommended clinical targets and time in range target as well as lower probability of severe adverse events compared with other treatment modalities.
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Affiliation(s)
- Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany
- German Center for Diabetes Research (DZD), Munich–Neuherberg, Germany
| | | | - Martin Tauschmann
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital of Verona, Verona, Italy
- Department of Surgery, Dentistry, Paediatrics and Gynaecology, University of Verona, Verona, Italy
| | - Valentino Cherubini
- Division of Pediatric Diabetology, Department of Women’s and Children’s Health, Salesi Hospital, Ancona, Italy
| | - Romualdas Preikša
- Institute and Clinic of Endocrinology, Lithuanian University of Health Sciences, Kaunas
| | - Ulrike Schierloh
- Department of Pediatric Diabetes and Endocrinology, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| | - Helen Clapin
- Department of Diabetes and Endocrinology, Perth Children’s Hospital, Perth, Australia
| | - Fahed AlJaser
- Department of Pediatrics, Amiri Hospital, Ministry of Health, Dasman, Kuwait
| | - Julie Pelicand
- Pediatric and Adolescent Diabetes Program, Department of Pediatrics, San Camilo Hospital, San Felipe, Chile
- Medicine School, Universidad de Valparaiso, San Felipe, Chile
| | - Rishi Shukla
- Department of Diabetes and Endocrinology, Center for Diabetes & Endocrine Diseases, Kanpur, India
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Zhang L, Xu H, Liu L, Bi Y, Li X, Kan Y, Liu H, Li S, Zou Y, Yuan Y, Gong W, Zhang Y. Related factors associated with fear of hypoglycemia in parents of children and adolescents with type 1 diabetes - A systematic review. J Pediatr Nurs 2022; 66:125-135. [PMID: 35716460 DOI: 10.1016/j.pedn.2022.05.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 05/09/2022] [Accepted: 05/27/2022] [Indexed: 12/16/2022]
Abstract
PROBLEM Fear of hypoglycemia is a significant concern for parents of children/ adolescents with type 1 diabetes. Although some studies have explained the parental fear of hypoglycemia, the related factors were yet to be determined. This systematic review aims to identify the related factors of fear of hypoglycemia in the parents of children and adolescents with type 1 diabetes and provide a theoretical basis for further intervention. ELIGIBILITY CRITERIA PubMed, MEDLINE, EMBASE, Scopus, CINAHL, EBSCO, Web of Science, and Cochrane Library were systematically searched from 2010 to 2021. Studies evaluating the fear of hypoglycemia of parents and its associated factors were included. SAMPLE Twenty-three observational articles met the criteria. RESULTS Significant associations were found between fear of hypoglycemia and specific factors, including motherhood, nocturnal hypoglycemia, and the number of blood glucose monitoring. Psychological factors, including anxiety, depression, pediatric parenting stress, mindfulness, self-efficacy, quality of life, and sleep disorders, were conclusive and associations with parental fear of hypoglycemia. CONCLUSIONS Understanding parental fear of hypoglycemia can help parents prevent potential problems in diabetes management, thus promoting children's growth. According to current evidence, effective targeted interventions based on modifiable relevant factors can be developed to reduce the fear of hypoglycemia in parents while maintaining optimal blood glucose control in children/ adolescents. IMPLICATIONS Health professionals should pay more attention to the mental health of parents, and parents should be involved in the care plan and have the opportunity to discuss their fear of hypoglycemia in the most appropriate way to manage type 1 diabetes.
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Affiliation(s)
- Lu Zhang
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Huiwen Xu
- School of Nursing, Yangzhou University, Yangzhou, China; Nagano College of Nursing, Komagane, Nagano 399-4117, Japan
| | - Lin Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yaxin Bi
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Xiangning Li
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yinshi Kan
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Hongyuan Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Shuang Li
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yan Zou
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yuan Yuan
- Affiliated Hospital of Yangzhou University, Yangzhou, China
| | - Weijuan Gong
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Yu Zhang
- School of Nursing, Yangzhou University, Yangzhou, China; Jiangsu Key Laboratory of Integrated Traditional Chinese and Western Medicine for Prevention and Treatment of Senile Diseases, Yangzhou, China.
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Patton SR, Maahs D, Prahalad P, Clements MA. Psychosocial Needs for Newly Diagnosed Youth with Type 1 Diabetes and Their Families. Curr Diab Rep 2022; 22:385-392. [PMID: 35727439 PMCID: PMC9211050 DOI: 10.1007/s11892-022-01479-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/07/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE OF REVIEW To synthesize findings from studies published within the last 5 to 10 years and recruiting families of children with new-onset type 1 diabetes (T1D). RECENT FINDINGS Children can establish glycated hemoglobin (HbA1c) trajectories in the new-onset period that may persist for up to a decade. Demographic factors, family conflict, and diabetic ketoacidosis at the time of diagnosis may be risk factors for sub-optimal child HbA1c, while new immune modulating therapies and a treatment approach that combines advanced technologies and remote patient monitoring may improve child HbA1c. Nonetheless, recent trials in the new-onset period have largely overlooked how treatments may impact families' psychosocial functioning and longitudinal observational studies have been limited. The new-onset period of T1D is an important time for research and clinical intervention, though gaps exist specific to families' psychosocial needs. Filling these gaps is essential to inform clinical management and standard of care guidelines and improve outcomes.
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Affiliation(s)
- Susana R. Patton
- grid.472715.20000 0000 9331 5327Center for Healthcare Delivery Science, Nemours Children’s Health, 807 Children’s Way, Jacksonville, FL 32207 USA
| | - David Maahs
- grid.168010.e0000000419368956Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA 94304 USA
- grid.168010.e0000000419368956Stanford Diabetes Research Center, Stanford University, Stanford, CA 94304 USA
- grid.168010.e0000000419368956Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA 94304 USA
| | - Priya Prahalad
- grid.168010.e0000000419368956Department of Pediatrics, Division of Pediatric Endocrinology, Stanford University, Stanford, CA 94304 USA
- grid.168010.e0000000419368956Stanford Diabetes Research Center, Stanford University, Stanford, CA 94304 USA
| | - Mark A. Clements
- grid.239559.10000 0004 0415 5050Department of Pediatrics, Division of Endocrinology and Diabetes, Children’s Mercy Kansas City, 2401 Gilham Road, Kansas City, MO 64108 USA
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Alkhaled L, O’Riordan M, MacLeish S, Hazen R, Wood JR. Psychological Characteristics and Goals of Caregivers Choosing Continuous Glucose Monitoring for Children With Type 1 Diabetes. Diabetes Spectr 2022; 35:111-117. [PMID: 35308154 PMCID: PMC8914595 DOI: 10.2337/ds21-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) can improve glycemic outcomes in pediatric type 1 diabetes management. However, its impact on the psychosocial functioning of caregivers is less well described. The objectives of this pilot study were to explore caregiver reasons for adding CGM to their child's type 1 diabetes management, parental psychosocial function before initiating CGM, and the relationship between the two. METHODS Thirty-two families with a child with type 1 diabetes from Rainbow Babies and Children's Hospital diabetes clinics who were initiating CGM were recruited over 3 months. Before CGM initiation, the caregivers completed the Fear of Hypoglycemia Scale, State-Trait Anxiety Inventory, Problem Areas in Diabetes Scale, and a questionnaire assessing their primary reason for starting CGM. Participant characteristics and questionnaire results were summarized with descriptive statistics. Participants were grouped by reason for starting CGM, and results were compared among groups using ANOVA and reporting the global F test. RESULTS Fifty percent of respondents indicated that they were starting CGM to optimize glycemic control. The majority of parents (71.8%) expressed worry about helplessness during a hypoglycemic episode. There were no statistically significant differences in patient characteristics or questionnaire results between groups. Forty-three percent of participating families started using CGM during the study's 8-month follow-up period. The main reason (64%) for not starting CGM was not having the chance to start the process of obtaining a CGM system. There were no statistically significant differences between children who did and did not start CGM. CONCLUSION Caregivers have different reasons for starting CGM for their child with type 1 diabetes. Further studies are needed to understand whether these reasons are related to differences in psychosocial functioning. Despite interest in starting CGM, there remain barriers to implementation.
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Affiliation(s)
- Lina Alkhaled
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
- Corresponding author: Lina Alkhaled,
| | | | - Sarah MacLeish
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
| | - Rebecca Hazen
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
| | - Jamie R. Wood
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
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11
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Yoo JH, Kim G, Lee HJ, Sim KH, Jin SM, Kim JH. Effect of structured individualized education on continuous glucose monitoring use in poorly controlled patients with type 1 diabetes: A randomized controlled trial. Diabetes Res Clin Pract 2022; 184:109209. [PMID: 35065101 DOI: 10.1016/j.diabres.2022.109209] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/26/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
Abstract
AIM We aimed to evaluate the efficacy of structured individualized education combined with real-time continuous glucose monitoring (rt-CGM) on glycemic outcomes in adults with type 1 diabetes. METHODS This was a single-center, 3-month, randomized controlled trial of 47 adults with type 1 diabetes with HbA1c ≥ 7.0% (53 mmol/mol). Study participants were assigned randomly (1:1) to a structured education group or control group. The control group received the same education as the intervention group in a 3-month extension study. The primary outcome was the mean difference in time in range (TIR 70-180 mg/dL [3.9-10.0 mmol/L]) between groups. RESULTS TIR was higher for the education group than the control group (63.4% vs. 44.5%), resulting in a between-group difference of 15.3% (95% CI 7.9 to 22.8, p < 0.001) at week 12. HbA1c decreased 0.5% (5.5 mmol/mol) more in the intervention group than the control group at week 12 (-0.1 to -1.0, p < 0.001). In the extension period, TIR increased significantly (8.9% [2.2 to 15.6], p = 0.01) in educated control group. CONCLUSIONS In adults with type 1 diabetes, rt-CGM use with individualized education resulted in better TIR than rt-CGM alone, highlighting the importance of personalized structured education when using rt-CGM. (ClinicalTrials.gov, number NCT03794934).
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Affiliation(s)
- Jee Hee Yoo
- Division of Endocrinology and Metabolism, Department of Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju 26426, Republic of Korea; Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Gyuri Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea
| | - Hyun Jung Lee
- Department of Dietetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Kang Hee Sim
- Diabetes Education Unit, Diabetes Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Sang-Man Jin
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea
| | - Jae Hyeon Kim
- Division of Endocrinology and Metabolism, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea; Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Seoul, Republic of Korea.
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12
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Addala A, Zaharieva DP, Gu AJ, Prahalad P, Scheinker D, Buckingham B, Hood KK, Maahs DM. Clinically Serious Hypoglycemia Is Rare and Not Associated With Time-in-range in Youth With New-onset Type 1 Diabetes. J Clin Endocrinol Metab 2021; 106:3239-3247. [PMID: 34265059 PMCID: PMC8530719 DOI: 10.1210/clinem/dgab522] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Indexed: 02/06/2023]
Abstract
CONTEXT Early initiation of continuous glucose monitoring (CGM) is advocated for youth with type 1 diabetes (T1D). Data to guide CGM use on time-in-range (TIR), hypoglycemia, and the role of partial clinical remission (PCR) are limited. OBJECTIVE Our aims were to assess whether 1) an association between increased TIR and hypoglycemia exists, and 2) how time in hypoglycemia varies by PCR status. METHODS We analyzed 80 youth who were started on CGM shortly after T1D diagnosis and were followed for up to 1-year post diagnosis. TIR and hypoglycemia rates were determined by CGM data and retrospectively analyzed. PCR was defined as (visit glycated hemoglobin A1c) + (4*units/kg/day) less than 9. RESULTS Youth were started on CGM 8.0 (interquartile range, 6.0-13.0) days post diagnosis. Time spent at less than 70 mg/dL remained low despite changes in TIR (highest TIR 74.6 ± 16.7%, 2.4 ± 2.4% hypoglycemia at 1 month post diagnosis; lowest TIR 61.3 ± 20.3%, 2.1 ± 2.7% hypoglycemia at 12 months post diagnosis). No events of severe hypoglycemia occurred. Hypoglycemia was rare and there was minimal difference for PCR vs non-PCR youth (54-70 mg/dL: 1.8% vs 1.2%, P = .04; < 54mg/dL: 0.3% vs 0.3%, P = .55). Approximately 50% of the time spent in hypoglycemia was in the 65 to 70 mg/dL range. CONCLUSION As TIR gradually decreased over 12 months post diagnosis, hypoglycemia was limited with no episodes of severe hypoglycemia. Hypoglycemia rates did not vary in a clinically meaningful manner by PCR status. With CGM being started earlier, consideration needs to be given to modifying CGM hypoglycemia education, including alarm settings. These data support a trial in the year post diagnosis to determine alarm thresholds for youth who wear CGM.
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Affiliation(s)
- Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Correspondence: Ananta Addala, DO, MPH, Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA 94305, USA.
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
| | - Angela J Gu
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
| | - Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Department of Management Science and Engineering, Stanford University, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Bruce Buckingham
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - Korey K Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, California, USA
- Stanford Diabetes Research Center, Stanford, California, USA
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