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Owusu BA, Doku DT. Living with type 1 diabetes and schooling among young people in Ghana: a truism of health selection, inadequate support, or artefactual explanation of educational inequalities? BMC Public Health 2024; 24:1137. [PMID: 38654212 DOI: 10.1186/s12889-024-18590-y] [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: 04/27/2023] [Accepted: 04/14/2024] [Indexed: 04/25/2024] Open
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) is mostly diagnosed among young people. Despite the evidence that T1DM is disruptive, and affects individuals' health and cognitive ability, there is dearth of knowledge on the impact of T1DM on schooling in LMICs including Ghana. In this research, we explored the impact of T1DM on the schooling of young people living with the disease, and discussed the results within health selection, social support, and artefactual perspectives of inequality. METHODS Data were extracted from a qualitative project on T1DM lived experiences in southern Ghana. The study participants were young persons living with T1DM (n = 28) and their caregivers (n = 12). They were purposively recruited to participate in the study using maximum variation and snowball sampling techniques and interviewed in their support group centres, homes, or healthcare facilities using semi-structured interview guides. A computer-assisted qualitative data analysis was performed using QSR NVivo 14 software, and the results were categorised into themes. RESULTS Three themes were identified from the transcripts. These themes were school and classroom attendance, choice of school, and school/academic performance. T1DM was a major reason for patients' limited contact hours with teachers, school drop-out, preference for day schools rather than boarding, opting for vocational training instead of continuation of formal education, limited concentration at school, and delayed educational progression. CONCLUSION T1DM impacted the schooling of young people living with the disease. The mechanisms of these impacts, and young peoples lived experiences are not artefactual, but rather support discourses on health selection and inadequate social support for young people living with the disease. The results call for the need to develop educational and social interventions to address these barriers. The full implementation of the Inclusive Education Policy (IEP) may contribute to reducing educational and social inequalities caused by ill-health.
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Affiliation(s)
| | - David Teye Doku
- Department of Population and Health, University of Cape Coast, Cape Coast, Ghana
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2
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Granados A, Carrillo Iregui A. Type 1 Diabetes Management in the Hospital Setting. Pediatr Rev 2024; 45:201-209. [PMID: 38556511 DOI: 10.1542/pir.2022-005645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
The incidence of diabetes in children and adolescents has increased during the past decades, with a 1.9% increase per year in type 1 diabetes mellitus (T1DM). Patients with diabetes have a greater risk of hospitalizations compared with those without diabetes. Clear evidence has emerged in the past decade that supports appropriate glycemic control in the hospital setting to improve clinical outcomes and reduce the risk of hospital complications and mortality. Determining the appropriate insulin regimen in patients with T1DM in the hospital depends on the clinical status, type of outpatient insulin regimen (multiple daily injections versus pump therapy), glycemic control before admission, nutritional status, procedures, and enteral versus parenteral nutrition. Due to the complexity of the inpatient management of diabetes, institutions should have an inpatient diabetes management team that includes dietitians, diabetes educators, nurses, pharmacists, social workers, and endocrinologists. The use of inpatient diabetes teams has been demonstrated to be beneficial in the management of patients with T1DM.
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Affiliation(s)
- Andrea Granados
- Division of Pediatric Endocrinology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
| | - Adriana Carrillo Iregui
- Division of Pediatric Endocrinology, Department of Pediatrics, Nicklaus Children's Hospital, Miami, FL
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3
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Tomic D, Craig ME, Magliano DJ, Shaw JE. Reasons for hospitalisation in youth with type 1 diabetes, 2010-2019. Diabet Med 2024; 41:e15218. [PMID: 37652152 DOI: 10.1111/dme.15218] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/02/2023]
Abstract
AIMS To determine the incidence of hospitalisation for all diagnoses among Australian youth with type 1 diabetes. METHODS We linked Australians aged under 20 years with type 1 diabetes on the National Diabetes Services Scheme (n = 45,685) to hospital admission data from 2010 to 2019. We determined relative risks (RR) of hospitalisation among those with type 1 diabetes in the states of Victoria and Queensland (n = 21,898) compared to the general population for 2010-2017 using Poisson regression. RESULTS Australian youth with type 1 diabetes had increased risk for almost all reasons for hospitalisation compared to the general population, especially infections such as anogenital herpesviral infections (RR 54.83, 95% CI 33.21-90.53), and mental health disorders including personality disorders (RR 9.70, 95% CI 8.02-11.72). Among those with type 1 diabetes, over 60% of hospitalisations were directly related to diabetes, almost half of which were for ketoacidosis. Approximately 15% of ketoacidosis admissions occurred within 3 months of diabetes diagnosis. One quarter of those with admissions for ketoacidosis were readmitted for ketoacidosis within 12 months. Residence in areas of high socio-economic disadvantage was an independent risk factor for admission and readmission for ketoacidosis. CONCLUSIONS Youth with type 1 diabetes are susceptible to a wide range of complications. Clinicians should consider screening and prevention for conditions such as infections and mental health disorders. Targeted support and education around glycaemic management should be considered in those at high risk for ketoacidosis admission including those living in areas of high socio-economic disadvantage.
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Affiliation(s)
- Dunya Tomic
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Maria E Craig
- School of Medicine, University of New South Wales, Kensington, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
- Discipline of Child and Adolescent Health, University of Sydney, Sydney, Australia
| | - Dianna J Magliano
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jonathan E Shaw
- Baker Heart and Diabetes Institute, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Ip EJ, Doroudgar S, Salehi A, Salehi F, Najmi M. Diabulimia: A Risky Trend Among Adults with Type 1 Diabetes Mellitus. Endocr Pract 2023; 29:849-854. [PMID: 37567472 DOI: 10.1016/j.eprac.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
OBJECTIVE Poor adherence leads to worse glycemic control and increased complications in patients with type 1 diabetes mellitus (T1DM). Diabulimia characterizes patients with T1DM who skip or use less insulin for weight loss purposes. The study objectives were to determine: (1) the prevalence of diabulimia among adult patients with T1DM, (2) compare patients with and without diabulimia, and (3) identify factors that may place individuals at higher risk of diabulimia. METHODS A 40-item, web-based survey was administered to 21 T1DM discussion boards, Listservs, and social media outlets. The survey assessed demographics, diabetes management, psychiatric diagnoses, and screened for diabulimia. Individuals who reported intentionally skipping or using less insulin than directed for the purpose of weight loss or to prevent weight gain in the past 12 months were classified as having diabulimia. RESULTS Of the 225 participants who completed the survey, 8.9% had diabulimia. Patients with diabulimia had elevated hemoglobin A1C (A1C) levels (8.4% vs 6.9%; P = .014), higher rates of a diabetes-related emergency department visits or hospitalization (30.0% vs 13.2%; P = .042), and higher rates of a major depressive disorder diagnosis (40.0% vs 11.5%; P < .001) than patients without diabulimia. Factors associated with diabulimia included high A1C levels (odds ratio, 1.43; 95% CI [1.08-1.91]; P = .014) and a major depressive disorder diagnosis (odds ratio, 4.87; 95% CI [1.31-18.22]; P = .018). CONCLUSION Approximately 1 in 11 adult patients with T1DM screened positive for diabulimia. Higher A1C levels and a diagnosis of major depressive disorder were associated with diabulimia.
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Affiliation(s)
- Eric J Ip
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California; Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Shadi Doroudgar
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Aava Salehi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California
| | - Fojan Salehi
- Department of Internal Medicine, Kaiser Permanente Mountain View Medical Offices, Mountain View, California
| | - Mitra Najmi
- Department of Clinical Sciences, Touro University California College of Pharmacy, Vallejo, California.
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Sellers EAC, McLeod L, Prior HJ, Dragan R, Wicklow BA, Ruth C. Hospitalization and comorbidity in children with type 2 diabetes. Pediatr Diabetes 2022; 23:660-667. [PMID: 35643934 DOI: 10.1111/pedi.13369] [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: 03/15/2022] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe hospitalization rates and reasons for hospitalization in children with type 2 diabetes (T2D) and to compare these rates to a matched cohort without diabetes and to children with type 1 diabetes (T1D). METHODS Population-based cohorts of 528 children (7-18 years of age) with prevalent T2D, 1519 matched control children without diabetes and 778 children with T1D were identified from a clinical registry and linked to health care records to assess hospitalizations and reasons for hospitalizations using ICD-9CM and ICD-10CA codes. RESULTS Children with T2D are more likely than their matched controls and children with T1D to be admitted to hospital in the year prior to diagnosis {RR 2.83 (1.77, 4.53) p < 0.0001 and 8.05 (4.05, 16.00) p < 0.0001, respectively}, in the first year post diagnosis {RR 3.19 (2.08, 4.89) p < 0.0001 and 3.04 (1.86, 4.98) p < 0.0001, respectively} and in the 5 year post diagnosis period {RR 1.99 (1.56, 2.53) p < 0.0001 and 1.91 (1.48, 2.46) p < 0.0001, respectively}. Mental illness was the most common cause for hospital admission in both children with T2D and their matched controls. CONCLUSIONS This differs from children with T1D where endocrine causes constitute the most common reason for hospital admission. This analysis provides novel data on hospitalization rates and diagnoses in the increasing population of children with T2D. This information is important to inform health care programming and health policy planning to best meet the needs of this population.
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Affiliation(s)
- Elizabeth A C Sellers
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorraine McLeod
- First Nations Health & Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy A Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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Turbow SD, Uppal TS, Haw JS, Chehal P, Fernandes G, Shah M, Rajpathak S, Ali MK, Narayan KMV. Trends and Demographic Disparities in Diabetes Hospital Admissions: Analyses of Serial Cross-Sectional National and State Data, 2008-2017. Diabetes Care 2022; 45:1355-1363. [PMID: 35380629 PMCID: PMC9210860 DOI: 10.2337/dc21-1837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/06/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To analyze national and state-specific trends in diabetes-related hospital admissions and determine whether disparities in rates of admission exist between demographic groups and geographically dispersed states. RESEARCH DESIGN AND METHODS We conducted serial cross-sectional analyses of the National Inpatient Sample (2008, 2011, 2014, and 2016) and State Inpatient Databases for Arizona, Florida, Kentucky, Iowa, Maryland, Nebraska, New Jersey, New York, North Carolina, Utah, and Vermont for 2008, 2011, 2014, and 2016/2017 among adult patients with type 1 and type 2 diabetes-related ICD codes (ICD-9 [250.XX] or ICD-10 [E10.XXX, E11.XXX, and E13.XXX]. We measured hospitalization rates for people with diabetes (all-cause hospitalizations) and for admissions with a primary diagnosis of diabetes or diabetes-related complications (diabetes-specific hospitalizations) per 10,000 people per year. RESULTS Nationally, all-cause and diabetes-specific hospitalizations declined by 3.1% (95% CI -5.5, -0.7) and 19.1% (95% CI -21.6, -16.6), respectively, over 2008 to 2016. The analysis of individual states showed that diabetes-specific admissions in individuals ≥65 years old declined during this time (16.3-48.8% decrease) but increased among patients 18-29 years old (10.5-81.5% increase) and that rural diabetes-specific admissions decreased in just over half of the included states (15.2-69.2% decrease). There were no differences in changes in admission rates among different racial/ethnic groups. CONCLUSIONS Overall, rates of diabetes-related hospitalizations decreased over 2008 to 2016/2017, but there were large state-level differences across subgroups of patients. The rise in diabetes hospitalizations among young adults is a cause for concern. These state- and subpopulation-level differences highlight the need for state-level policies and interventions to address disparities in diabetes health care use.
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Affiliation(s)
- Sara D Turbow
- Division of General Internal Medicine, Department of Medicine, School of Medicine, Emory University, Atlanta, GA.,Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Tegveer S Uppal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - J Sonya Haw
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, GA
| | - Puneet Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, GA
| | | | - Megha Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA
| | | | - Mohammed K Ali
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, GA.,Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA
| | - K M Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA.,Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, GA
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Patel S, Farkash C, Simmons D. Type 1 diabetes management and hospitalisation in the over 25's at an Australian outer urban diabetes clinic. BMC Endocr Disord 2022; 22:143. [PMID: 35641973 PMCID: PMC9158186 DOI: 10.1186/s12902-022-01057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service. METHODS Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. RESULTS Among the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of < 53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. CONCLUSIONS A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a "wait for acute event" rather than "complication prevention" model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.
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Affiliation(s)
- Shivani Patel
- Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia
| | - Celine Farkash
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia.
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia.
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Higgins H, Gupta N. Characterizing social and policy determinants of hospital length of stay among paediatric inpatients with diabetes using linked population-based data. Int J Popul Data Sci 2022; 6:1678. [PMID: 34970634 PMCID: PMC8678978 DOI: 10.23889/ijpds.v6i1.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Evidence is limited on the non-medical factors influencing hospital length of stay (LOS) among paediatric inpatients with diabetes, notably potential social and policy correlates. This study aimed to characterize the associations of socioeconomic status and health policy environment with diabetes-attributable LOS to help inform accountability monitoring of a provincial comprehensive diabetes strategy aiming to minimize time in hospital among this high-risk population. Data and methods This retrospective population-based study drew on multiple linked administrative and geospatial databases among all children aged 18 and under with a diabetes-related hospitalization in the province of New Brunswick, Canada, during the four-year period following implementation of an insulin pump funding program. Multiple linear regression was used to assess the role of access to the public insulin pump resourcing scheme and relative neighbourhood deprivation as predictors of days spent in acute care, controlling for age, sex, and place of residence. Results Among the paediatric inpatient population (N = 386), 21% had accessed social resources made available through the insulin pump funding policy and 42% resided in the most materially deprived neighbourhoods. Diabetes-related hospital stays averaged 3.87 days. Paediatric inpatients having accessed resources through the social insurance policy spent significantly fewer days in hospital (1.34 days less [95% CI: 0.63–2.05]) than those who had not, all else being equal. Observed differences in LOS by neighbourhood socioeconomic deprivation were not found to be statistically significant in the multivariate analysis. Conclusion Findings from this context of universal medical coverage suggested that public policy for supplemental financing of assistive technologies among children with diabetes may be associated with reduced burden to the hospital system. The causes of socioenvironmental disparities in LOS require further investigation to inform interventions to mitigate preventable patient-level variations in hospital-based health outcomes.
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Affiliation(s)
- Heather Higgins
- University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
| | - Neeru Gupta
- University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
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Mejia-Otero JD, Adhikari S, White PC. Risk factors for hospitalization in youth with type 1 diabetes: Development and validation of a multivariable prediction model. Pediatr Diabetes 2020; 21:1268-1276. [PMID: 32737942 DOI: 10.1111/pedi.13090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 06/18/2020] [Accepted: 07/28/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To develop a multivariable prediction model to identify patients with type 1 diabetes at increased risk of hospitalization for diabetic ketoacidosis or hyperglycemia with ketosis in the 12 months following assessment. METHODS Retrospective review of clinical data from patients with type 1 diabetes less than 17 years old at a large academic children's hospital (5732 patient years, 652 admissions). Data from the previous 12 months were assessed on October 15, 2015, 2016, 2017, and 2018, and used to predict hospitalization in the following 12 months using generalized estimating equations. Variables that were significant predictors of hospitalization in univariate analyses were entered into a multivariable model. 2014 to 2016 data were used as a training dataset, and 2017 to 2019 data for validation. Discrimination of the model was assessed with receiver operator characteristic curves. RESULTS Admission in the preceding year, hemoglobin (Hb)A1c, non-commercial insurance, female sex, and non-White race were all individual predictors of hospitalization, but age, duration of diabetes and number of office visits in the preceding year were not. In multivariable analysis with threshold P < .0033, admissions in the previous 12 months, HbA1c, and non-commercial insurance remained as significant predictors. The model identified a subset of ~8% of the patients with a collective 42% risk of hospitalization, thus increased 5-fold compared with the 8% risk of hospitalization in the remaining 93% of patients. Similar results were obtained with the validation dataset. CONCLUSION Our multivariable prediction model identified patients at increased risk of admission in the 12 months following assessment.
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Affiliation(s)
- Juan D Mejia-Otero
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA.,Division of Pediatric Endocrinology, University of Arkansas Medical School, Little Rock, Arkansas, USA
| | - Soumya Adhikari
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Perrin C White
- Division of Pediatric Endocrinology, Department of Pediatrics, UT Southwestern Medical Center, Dallas, Texas, USA
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Fleming M, Fitton CA, Steiner MFC, McLay JS, Clark D, King A, Lindsay RS, Mackay DF, Pell JP. Educational and Health Outcomes of Children Treated for Type 1 Diabetes: Scotland-Wide Record Linkage Study of 766,047 Children. Diabetes Care 2019; 42:1700-1707. [PMID: 31308017 PMCID: PMC6706279 DOI: 10.2337/dc18-2423] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Accepted: 06/17/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study was conducted to determine the association between childhood type 1 diabetes and educational and health outcomes. RESEARCH DESIGN AND METHODS Record linkage of nine Scotland-wide databases (diabetes register, dispensed prescriptions, maternity records, hospital admissions, death certificates, annual pupil census, school absences/exclusions, school examinations, and unemployment) produced a cohort of 766,047 singleton children born in Scotland who attended Scottish schools between 2009 and 2013. We compared the health and education outcomes of schoolchildren receiving insulin with their peers, adjusting for potential confounders. RESULTS The 3,330 children (0.47%) treated for type 1 diabetes were more likely to be admitted to the hospital (adjusted hazard ratio [HR] 3.97, 95% CI 3.79-4.16), die (adjusted HR 3.84, 95% CI 1.98-7.43), be absent from school (adjusted incidence rate ratio [IRR] 1.34, 95% CI 1.30-1.39), and have learning difficulties (adjusted odds ratio [OR] 1.19, 95% CI 1.03-1.38). Among children with type 1 diabetes, higher mean HbA1c (particularly HbA1c in the highest quintile) was associated with greater absenteeism (adjusted IRR 1.75, 95% CI 1.56-1.96), increased school exclusion (adjusted IRR 2.82, 95% CI 1.14-6.98), poorer attainment (adjusted OR 3.52, 95% CI 1.72-7.18), and higher risk of unemployment (adjusted OR 2.01, 95% CI 1.05-3.85). CONCLUSIONS Children with type 1 diabetes fare worse than their peers in respect of education and health outcomes, especially if they have higher mean HbA1c. Interventions are required to minimize school absence and ensure that it does not affect educational attainment.
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Affiliation(s)
- Michael Fleming
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, U.K.
| | | | | | - James S McLay
- Department of Child Health, University of Aberdeen, Aberdeen, U.K
| | - David Clark
- Information Services Division, Edinburgh, U.K
| | - Albert King
- ScotXed, Scottish Government, Edinburgh, U.K
| | - Robert S Lindsay
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K
| | - Daniel F Mackay
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, U.K
| | - Jill P Pell
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, U.K
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11
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Jawaid A, Sohaila A, Mohammad N, Rabbani U. Frequency, clinical characteristics, biochemical findings and outcomes of DKA at the onset of type-1 DM in young children and adolescents living in a developing country - an experience from a pediatric emergency department. J Pediatr Endocrinol Metab 2019; 32:115-119. [PMID: 30699071 DOI: 10.1515/jpem-2018-0324] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/05/2018] [Indexed: 11/15/2022]
Abstract
Background As per the International Society for Pediatrics and Adolescent Diabetes (ISPAD) census, diabetic ketoacidosis (DKA) is the most frequent cause of diabetes-related death. In developing countries, DKA-related mortality rate ranges from 6% to 24% (Onyiriuka AN, Ifebi E. Ketoacidosis at diagnosis of type 1 diabetes in children and adolescents: frequency and clinical characteristics. J Diabetes Metab Disord 2013;12:47) in contrast to 0.15%-0.31% in the Western world (Poovazhagi V. Risk factors for mortality in children with diabetic ketoacidosis from developing countries. World J Diabetes 2014;5:932-93.). In developing countries like Pakistan, the situation is more perplexing owing to uncertain or under-reported statistics about the spectrum of the disease and its prevalence, coupled with limited access to medical care and experts as well as less awareness. These limitations restrict our ability to develop interventions that are patient-centered. Our main objective was to determine the severity, clinical features, bio-chemical findings and outcomes of DKA in children aged 1 month to 16 years. Subjects and methods This retrospective study included the analysis of medical and laboratory records from patients' medical charts and the electronic database of all children aged 1 month to 16 years with newly diagnosed type-1 diabetes mellitus (T1DM) complicated with ketoacidosis, who presented to the emergency department (ED) at the Aga Khan University Hospital (AKUH), between January 2009 and December 2014. Results Diabetes mellitus complicated with DKA was the predominant diagnosis (n=113 [75.83%]) among endocrine diseases in children visiting the ED. Our study witnessed an increase in the incidence of DKA particularly after 5 years of age, with more severity in females. In our study, the mortality rate was 3.4%. Conclusions Considering the high incidence and mortality rate, it is emphasized that DKA should be considered in differential diagnosis. An awareness campaign for both general pediatricians and physicians as well as for the public is needed for better outcomes.
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Affiliation(s)
- Amna Jawaid
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Arjumand Sohaila
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Nadia Mohammad
- Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Unaib Rabbani
- Saudi Board Family Medicine, Ministry of Health, Qassim, Saudi Arabia
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12
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Doubova SV, Ferreira-Hermosillo A, Pérez-Cuevas R, Barsoe C, Gryzbowski-Gainza E, Valencia JE. Socio-demographic and clinical characteristics of type 1 diabetes patients associated with emergency room visits and hospitalizations in Mexico. BMC Health Serv Res 2018; 18:602. [PMID: 30075779 PMCID: PMC6091092 DOI: 10.1186/s12913-018-3412-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 07/23/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND To describe the demographic and clinical characteristics of Type 1 diabetes (T1D) patients affiliated with the Mexican Institute of Social Security (IMSS) and ascertain the socio-demographic and clinical risk factors associated with emergency room (ER) visits and diabetes-related hospitalizations. METHODS We conducted secondary data analysis of a cross-sectional study. The study included T1D patients 18 years of age and older who in 2016 attended follow-up visits at the endocrinology department of two IMSS tertiary care hospitals in Mexico City. The study variables included demographics, acute and chronic complications, and healthcare services utilization. Multiple Poisson and negative binomial regressions served to determine the association between the study covariates and the dependent variables: ER visits and diabetes-related hospitalizations. RESULTS The study included 192 patients, of which 29.2% were men; average age was 32.3 years, with only 13.6% controlled (glycosylated hemoglobin (HbA1C) < 7%); the mean HbA1C was 9.2, and 64.6% presented chronic complications. During 2016, 39.0% visited ER services, and 33.9% were hospitalized. The common risk factors for ER visits and hospitalization were older age at the beginning of diabetes, severe acute complications, chronic microvascular and macrovascular complications, and other comorbidities. Female sex, high school education, depression, and repeated visits to the endocrinologist were associated with ER visits, whereas active smoking and the interaction between diabetes duration > 10 years and HbA1c > 9.0% were additional risk factors for hospitalization. CONCLUSION The poor clinical conditions of T1D patients contribute to explain the escalating demand for health services for diabetes patients at the IMSS. The identification of risk factors enables focalizing interventions to improve the health outcomes of T1D patients and reduce the proportion of ER visits and hospital admissions.
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Affiliation(s)
- Svetlana V. Doubova
- Epidemiology and Health Services Research Unit, CMN Siglo XXI, Mexican Institute of Social Security, Av. Cuauhtemoc 330, Col. Doctores, 06720 Mexico City, Mexico
| | - Aldo Ferreira-Hermosillo
- Unidad de Investigación en Endocrinología Experimental, Hospital de Especialidades del CMN siglo XXI, Mexico City, Mexico
| | - Ricardo Pérez-Cuevas
- Center for Health Systems Research, National Institute of Public Health, Universidad No. 655 Colonia Santa María Ahuacatitlán, 62100 Cuernavaca, Mexico
| | - Casper Barsoe
- Diabetes Health Economics & Reimbursement, Medtronic, Devonshire St 18000, Northridge, CA 91325-1219 USA
| | | | - Juan E. Valencia
- Diabetes Health Economics & Reimbursement, Medtronic, NW 41st Street 9850, Miami, FL 33178 USA
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13
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Lennerz BS, Barton A, Bernstein RK, Dikeman RD, Diulus C, Hallberg S, Rhodes ET, Ebbeling CB, Westman EC, Yancy WS, Ludwig DS. Management of Type 1 Diabetes With a Very Low-Carbohydrate Diet. Pediatrics 2018; 141:peds.2017-3349. [PMID: 29735574 PMCID: PMC6034614 DOI: 10.1542/peds.2017-3349] [Citation(s) in RCA: 75] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2018] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events. We obtained confirmatory data from diabetes care providers and medical records. RESULTS Of 316 respondents, 131 (42%) were parents of children with T1DM, and 57% were of female sex. Suggestive evidence of T1DM (based on a 3-tier scoring system in which researchers took into consideration age and weight at diagnosis, pancreatic autoimmunity, insulin requirement, and clinical presentation) was obtained for 273 (86%) respondents. The mean age at diagnosis was 16 ± 14 years, the duration of diabetes was 11 ± 13 years, and the time following a VLCD was 2.2 ± 3.9 years. Participants had a mean daily carbohydrate intake of 36 ± 15 g. Reported mean HbA1c was 5.67% ± 0.66%. Only 7 (2%) respondents reported diabetes-related hospitalizations in the past year, including 4 (1%) for ketoacidosis and 2 (1%) for hypoglycemia. CONCLUSIONS Exceptional glycemic control of T1DM with low rates of adverse events was reported by a community of children and adults who consume a VLCD. The generalizability of these findings requires further studies, including high-quality randomized controlled trials.
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Affiliation(s)
- Belinda S. Lennerz
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | - Anna Barton
- Richmond Diabetes and Endocrinology, Bon Secours Medical Group, Richmond, Virginia
| | | | | | | | - Sarah Hallberg
- Virta Health and Indiana University Health, School of Medicine, Indiana University, Indianapolis, Indiana; and
| | | | - Cara B. Ebbeling
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
| | | | | | - David S. Ludwig
- Division of Endocrinology, and,New Balance Foundation Obesity Prevention Center, Boston Children’s Hospital and Harvard Medical School, Harvard University, Boston, Massachusetts
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Bohn B, Schwandt A, Ihle P, Icks A, Rosenbauer J, Karges B, Holl RW. Hospital admission in children and adolescents with or without type 1 diabetes from Germany: An analysis of statutory health insurance data on 12 million subjects. Pediatr Diabetes 2018; 19:721-726. [PMID: 29226514 DOI: 10.1111/pedi.12621] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/07/2017] [Accepted: 11/16/2017] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To compare the chance of hospital admissions in children and adolescents with type 1 diabetes (T1D) to that without T1D from Germany. METHODS Data were provided by the German information system for health care data which contains information on all patients with a statutory health insurance. The years 2009 and 2011 were considered. Children and adolescents (0 to ≤19 years of age; n = 12 030 242) were included. Unadjusted odds ratios (ORs) with 95% confidence interval (95% CI) were used to compare the hospitalization rate for patients with (n = 26 444) or without T1D (12 003 798). T1D was identified by documented insulin treatment and by ICD-code E10/14. Results were stratified by age-group (0-5; >5-10; >10-15, >15-19 years) and gender. RESULTS In all age-groups, the hospitalization chance in patients with T1D was higher compared to that of their peers (database 2011). The highest OR was observed in >5 to 10-year-old patients (OR 8.1; 95% CI: 7.7-8.5), followed by patients >10 to 15 years (OR 7.4; 95% CI: 7.1-7.7) and patients ≤5 years (OR 5.3; 95% CI: 4.8-5.7). The lowest OR was present in patients >15 to 19 years (OR 4.0; 95% CI: 3.9-4.2). Overall, OR for hospital admission were higher in girls with T1D compared to boys. The most frequent reasons for hospitalization in T1D were "T1D without complications" (68.4%) and "T1D with ketoacidosis" (18.6%). CONCLUSIONS Children and adolescents with T1D in Germany had a 4 to 8 times higher hospitalization chance compared to children without T1D. The OR in T1D patients compared to peers were higher in girls than in boys. High rates of elective hospital admission in Germany may contribute to these results.
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Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
| | - Peter Ihle
- PMV Research Group at the Department of Child and Adolescent Psychiatry and Psychotherapy, University of Cologne, Cologne, Germany
| | - Andrea Icks
- German Center for Diabetes Research (DZD), Munich, Germany.,Faculty of Medicine, Institute of Health Services Research and Health Economics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute of Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at University of Düsseldorf, Düsseldorf, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Munich, Germany.,German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at University of Düsseldorf, Düsseldorf, Germany
| | - Beate Karges
- German Center for Diabetes Research (DZD), Munich, Germany.,Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, Aachen, Germany.,Department of Pediatrics, Bethlehem Hospital, Stolberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich, Germany
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15
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Apperley LJ, Ng SM. Socioeconomic Deprivation, Household Education, and Employment are Associated With Increased Hospital Admissions and Poor Glycemic Control in Children With Type 1 Diabetes Mellitus. Rev Diabet Stud 2017; 14:295-300. [PMID: 29145539 DOI: 10.1900/rds.2017.14.295] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Socioeconomic deprivation, obesity, and emotional discomfort are important determinants of health inequalities and poor glycemic control in children and young people with type 1 diabetes mellitus (T1D). OBJECTIVES The aims of this study were to evaluate the incidence of hospital admissions of T1D children in relation to socioeconomic deprivation, and to determine the effects of social deprivation, body mass index (BMI), and patient-reported emotional well-being on glycemic control. METHODS All hospital admissions of T1D patients aged 1-18 years were identified during 2007 and 2012. Admission cause and glycemic control were related to social deprivation, BMI, and psychological, emotional well-being. Indices of Multiple Deprivation (IMD) 2010 were applied to the United Kingdom data. The associations were calculated using the Spearman's rank correlation coefficient. RESULTS A significant correlation was found between hospital admission rates and overall deprivation scores (r = -0.18, p = 0.04). Patients living in deprived areas were more likely to selfpresent to the accident and emergency department (r = -0.24, p = 0.02). Poor glycemic control (n = 124) was significantly associated with lower levels of education (r = -0.22, p = 0.02) and unemployment (r = -0.19, p = 0.04). Significance was not reached for level of income (r = -0.16, p = 0.07) and overall deprivation (r = -0.17, p = 0.06). Glycemic control was not found to be associated with BMI, standard deviation scores (SDS), or emotional well-being. CONCLUSION Early intervention and education from primary care and specialist diabetes teams within the community in deprived areas may be effective in reducing hospital admissions for diabetes-related problems and improving glycemic control.
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Affiliation(s)
- Louise J Apperley
- Department of Paediatrics, Southport and Ormskirk NHS Trust, Wigan Road, Ormskirk, L39 2AZ. United Kingdom
| | - Sze M Ng
- Department of Paediatrics, Southport and Ormskirk NHS Trust, Wigan Road, Ormskirk, L39 2AZ. United Kingdom
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16
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Abstract
PURPOSE OF REVIEW The purpose of this article was to review recent guideline recommendations on glycemic target, glucose monitoring, and therapeutic strategies, while providing practical recommendations for the management of medical and surgical patients with type 1 diabetes (T1D) admitted to critical and non-critical care settings. RECENT FINDINGS Studies evaluating safety and efficacy of insulin pump therapy, continuous glucose monitoring, electronic glucose management systems, and closed loop systems for the inpatient management of hyperglycemia are described. Due to the increased prevalence and life expectancy of patients with type 1 diabetes, a growing number of these patients require hospitalization every year. Inpatient diabetes management is complex and is best provided by a multidisciplinary diabetes team. In the absence of such resource, providers and health care staff must become familiar with the features of this condition to avoid complications such as severe hyperglycemia, ketoacidosis, hypoglycemia, or glycemic variability. We reviewed most recent guidelines and relevant literature in the topic to provide practical recommendations for the inpatient management of patients with T1D.
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17
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Deeb A, Yousef H, Abdelrahman L, Tomy M, Suliman S, Attia S, Al Suwaidi H. Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis. J Diabetes Res 2016; 2016:3917806. [PMID: 27294150 PMCID: PMC4886092 DOI: 10.1155/2016/3917806] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 04/23/2016] [Accepted: 04/24/2016] [Indexed: 11/30/2022] Open
Abstract
Introduction. Diabetic Ketoacidosis (DKA) is a serious complication that can be life-threatening. Management of DKA needs admission in a specialized center and imposes major constraints on hospital resources. Aim. We plan to study the impact of adapting a diabetes-educator care model on reducing the frequency of hospital admission of children and adolescents presenting with DKA. Method. We have proposed a model of care led by diabetes educators for children and adolescents with diabetes. The team consisted of highly trained nurses. The model effectiveness is measured by comparing the rate of hospital admission for DKA over 4-year period to the baseline year prior to implementing the model. Results. There were 158 admissions for DKA over a 5-year period. Number of patients followed up in the outpatient diabetes clinics increased from 37 to 331 patients at the start and the end of the study years. Admission rate showed a downward trend over the five-year period. Percentage of admission for DKA is reduced from 210% to 1.8% (P 0.001). Conclusion. Diabetes educator care model is an effective and a sustainable measure to reduce hospital admission for DKA in children and adolescents.
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Affiliation(s)
- Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
- *Asma Deeb:
| | - Hana Yousef
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Layla Abdelrahman
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Mary Tomy
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Shaker Suliman
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Salima Attia
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
| | - Hana Al Suwaidi
- Paediatric Endocrinology Department, Mafraq Hospital, P.O. Box 2951, Abu Dhabi, UAE
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18
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Moving the Journey Towards Independence: Adolescents Transitioning to Successful Diabetes Self-Management. J Pediatr Nurs 2015; 30:648-60. [PMID: 26190456 PMCID: PMC5116197 DOI: 10.1016/j.pedn.2015.06.005] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/01/2015] [Accepted: 06/07/2015] [Indexed: 11/20/2022]
Abstract
PURPOSE To gain a greater understanding of adolescent's experiences living with Type 1 diabetes mellitus (T1DM) and create a theoretical paradigm. METHODS Grounded theory as described by Glaser was used. Fifteen in-depth interviews were conducted with adolescent's ages 11-15 with T1DM. Symbolic interactionism is the theoretical framework for grounded theory. Data were collected; transcribed, coded, and analyzed simultaneously using constant comparative analysis and findings were grounded in the words of participants. RESULTS A theoretical model was created with the concept of "normalizing". Normalizing was defined as the ability to integrate diabetes into one's daily life to make diabetes 'part of me'. Phase four of the model, and the focus of this manuscript was "Moving the Journey towards Independence" and included: 1) taking over care, 2) experiencing conflict with parents, and 3) realizing diabetes is hard. The major task for adolescents in this phase was separating from parents to independently manage diabetes. The normalizing task for this phase was: "taking on the burden of care". Adolescents described challenges with independent care and increased parental conflict including: fearing needles, forgetting insulin, feeling embarrassed and believing that diabetes was a burden in their life. Additionally, juggling the multiple responsibilities of home, school and work along with managing a chronic illness during adolescence is challenging. CONCLUSIONS Transitioning to diabetes self-management is a challenge for adolescents. This model advances understanding of the moving processes in adolescents transitioning; additionally, hypotheses are presented that may be used for developing interventions to promote success in self-management.
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Sayers A, Thayer D, Harvey JN, Luzio S, Atkinson MD, French R, Warner JT, Dayan CM, Wong SF, Gregory JW. Evidence for a persistent, major excess in all cause admissions to hospital in children with type-1 diabetes: results from a large Welsh national matched community cohort study. BMJ Open 2015; 5:e005644. [PMID: 25869680 PMCID: PMC4420955 DOI: 10.1136/bmjopen-2014-005644] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To estimate the excess in admissions associated with type1 diabetes in childhood. DESIGN Matched-cohort study using anonymously linked hospital admission data. SETTING Brecon Group Register of new cases of childhood diabetes in Wales linked to hospital admissions data within the Secure Anonymised Information Linkage Databank. POPULATION 1577 Welsh children (aged between 0 and 15 years) from the Brecon Group Register with newly-diagnosed type-1 diabetes between 1999-2009 and 7800 population controls matched on age, sex, county, and deprivation, randomly selected from the local population. MAIN OUTCOME MEASURES Difference in all-cause hospital admission rates, 30-days post-diagnosis until 31 May 2012, between participants and controls. RESULTS Children with type-1 diabetes were followed up for a total of 12,102 person years and were at 480% (incidence rate ratios, IRR 5.789, (95% CI 5.34 to 6.723), p<0.0001) increased risk of hospital admission in comparison to matched controls. The highest absolute excess of admission was in the age group of 0-5 years, with a 15.4% (IRR 0.846, (95% CI 0.744 to 0.965), p=0.0061) reduction in hospital admissions for every 5-year increase in age at diagnosis. A trend of increasing admission rates in lower socioeconomic status groups was also observed, but there was no evidence of a differential rate of admissions between men and women when adjusted for background risk. Those receiving outpatient care at large centres had a 16.1% (IRR 0.839, (95% CI 0.709 to 0.990), p=0.0189) reduction in hospital admissions compared with those treated at small centres. CONCLUSIONS There is a large excess of hospital admissions in paediatric patients with type-1 diabetes. Rates are highest in the youngest children with low socioeconomic status. Factors influencing higher admission rates in smaller centres (eg, "out of hours resources") need to be explored with the aim of targeting modifiable influences on admission rates.
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Affiliation(s)
- Adrian Sayers
- School of Clinical Sciences, University of Bristol, Southmead Hospital, Bristol, UK
| | - Daniel Thayer
- Centre for Health Information Research and Evaluation, College of Medicine, Swansea University, Swansea, UK
| | - John N Harvey
- Wrexham Academic Unit, Bangor University, Wrexham, Bangor, UK
| | - Stephen Luzio
- Diabetes Research Group, College of Medicine, Swansea University, Swansea, UK
| | - Mark D Atkinson
- Centre for Health Information Research and Evaluation, College of Medicine, Swansea University, Swansea, UK
| | - Robert French
- Centre for Multi-level Modelling, University of Bristol, Bristol, UK
| | - Justin T Warner
- Department of Child Health, University Hospital of Wales, Cardiff, UK
| | - Colin M Dayan
- Diabetes Research Group, Institute of Molecular & Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Susan F Wong
- Diabetes Research Group, Institute of Molecular & Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - John W Gregory
- Diabetes Research Group, Institute of Molecular & Experimental Medicine, School of Medicine, Cardiff University, Cardiff, UK
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20
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Lu CL, Shen HN, Chen HF, Li CY. Epidemiology of childhood Type 1 diabetes in Taiwan, 2003 to 2008. Diabet Med 2014; 31:666-73. [PMID: 24499185 DOI: 10.1111/dme.12407] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/12/2013] [Accepted: 01/31/2014] [Indexed: 01/08/2023]
Abstract
AIMS To report the annual incidence rate and the socio-demographic and clinical characteristics of childhood Type 1 diabetes in Taiwan in the period 2003-2008. METHODS A total of 1306 incident cases of childhood (0-14 years) Type 1 diabetes were identified from Taiwan's National Health Insurance claim datasets from the period 2003-2008. The temporal trend of the incidence rate of Type 1 diabetes and the features of hospitalizations in the first year after diagnosis were investigated. The associations of patient characteristics, child population density and the urbanization level of the residential areas with the risk of Type 1 diabetes were assessed using Poisson regression analysis. RESULTS The annual incidence rate was stable, irrespective of age and gender, with a mean annual incidence rate of 5.3 per 100 000 children. Girls were more likely than boys to develop Type 1 diabetes (6.0 vs 4.7 per 100 000 children) and the incidence rate increased with age. There was no apparent geographic variation in the incidence rates. Despite the 60% decrease in the rate of admission (from 11.0 to 5.8%) over the study period, ketoacidosis remained the major diabetes complication leading to admission for childhood Type 1 diabetes. The multivariate analysis suggested that female gender and older age were significant predictors of the incidence of Type 1 diabetes, whereas the population density of children and the urbanization levels of the residential areas were not. CONCLUSIONS Girls and older children should receive particular attention when formulating preventive strategies targeting Type 1 diabetes. Additionally, clinicians should still carefully optimize the management of children with Type 1 diabetes to further reduce the occurrence of ketoacidosis.
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Affiliation(s)
- C-L Lu
- Department of Medical Research, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chia-Yi City, Taiwan; Department and Institute of Public Health, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
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21
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Impact of elective hospital admissions on glycaemic control in adolescents with poorly controlled type 1 diabetes. DIABETES & METABOLISM 2013; 39:505-10. [DOI: 10.1016/j.diabet.2013.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 04/22/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022]
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Tiberg I, Carlsson A, Hallström I. A Methodological Description of a Randomised Controlled Trial Comparing Hospital-Based Care and Hospital-Based Home Care when a Child is Newly Diagnosed with Type 1 Diabetes. Open Nurs J 2011; 5:111-9. [PMID: 22371819 PMCID: PMC3263442 DOI: 10.2174/18744346011050100111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/23/2011] [Accepted: 09/28/2011] [Indexed: 01/22/2023] Open
Abstract
AIM AND OBJECTIVE To describe the study design of a randomised controlled trial with the aim of comparing two different regimes for children with newly diagnosed type 1 diabetes; hospital-based care and hospital-based home care. BACKGROUND Procedures for hospital admission and sojourn in connection with diagnose vary greatly worldwide and the existing evidence is insufficient to allow for any conclusive determination of whether hospital-based or home-based care is the best alternative for most families. Comparative studies with adequate power and outcome measurements, as well as measurements of cost-effectiveness are needed. DESIGN The study design was based on the Medical Research Council framework for complex interventions. After two to three days with hospital-based care, children between the ages of 3 and 16 were randomised to receive either continued hospital-based care for a total of 1-2 weeks or hospital-based home care, which refers to specialist care in a home-based setting. The trial started in March 2008 at a University Hospital in Sweden and was closed in September 2011 when a sufficient number of children according to power calculation, were included. The primary outcome was the child's metabolic control during the following two years. Secondary outcomes were set to evaluate the family and child situation as well as the organisation of care. DISCUSSION Childhood diabetes requires families and children to learn to perform multiple daily tasks. Even though intervention in health care is complex with several interacting components entailing practical and methodological difficulties, there is nonetheless, a need for randomised controlled trials in order to evaluate and develop better systems for the learning processes of families that can lead to long-term improvement in adherence and outcome. TRIAL REGISTRATION Trial Register NCT00804232.
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Affiliation(s)
- Irén Tiberg
- Division of Nursing, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
- Department of Paediatrics, Lund University Hospital, SE-221 85 Lund, Sweden
- The Swedish Institute for Health Sciences, Lund University, Sweden
| | - Annelie Carlsson
- Department of Paediatrics, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Inger Hallström
- Division of Nursing, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
- The Swedish Institute for Health Sciences, Lund University, Sweden
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Norton-Westwood D, Robertson-Malt S, Anderson R. A randomized controlled trial to assess the impact of an Admission Service on patient and staff satisfaction. Int J Nurs Pract 2010; 16:461-71. [DOI: 10.1111/j.1440-172x.2010.01870.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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O'Hagan M, Harvey JN. Glycemic control in children with type 1 diabetes in wales: influence of the pediatric diabetes specialist nurse. Diabetes Care 2010; 33:1724-6. [PMID: 20435792 PMCID: PMC2909049 DOI: 10.2337/dc09-2304] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether glycemic control is improving in diabetic children in Wales and to identify factors associated with improvement. RESEARCH DESIGN AND METHODS Data were collected in 2001 and 2006. RESULTS Over time A1C was reduced from 9.08 +/- 1.66 to 8.88 +/- 1.63% (P = 0.012). There were differences among centers (P < 0.001) and differential changes over time (interaction P < 0.001). Since 2001 five centers had appointed a pediatric diabetes specialist nurse (PDSN). A1C improved in these centers from 9.59 +/- 1.88 to 8.72 +/- 1.61% (P < 0.001). Glycemic control was worse in children aged >10 years compared with younger patients (P < 0.001). Improvement occurred in those aged >10 years. Age (P = 0.003) and insulin dose (P < 0.001) were positively and independently associated with A1C. Thus, any influence of PDSNs was not achieved through increased insulin prescription. CONCLUSIONS Improvement in glycemic control has occurred. Worse control is associated with greater prescribed insulin dose in older children. Appointment of PDSNs was associated with improved glycemic control among adolescents.
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Affiliation(s)
- Malachy O'Hagan
- Department of Pediatrics, Bro Morgannwg NHS Trust, Swansea, U.K
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25
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Rigby MR. The role of the physician-scientist in bridging basic and clinical research in type 1 diabetes. Curr Opin Endocrinol Diabetes Obes 2010; 17:131-42. [PMID: 20160647 DOI: 10.1097/med.0b013e32833759d2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW In a relatively short time, advances in both basic science and clinical medicine have revolutionized the way we understand disease processes and suggested novel approaches that may be able to be used to treat or cure some of the most relevant human afflictions. In type 1 diabetes, one unintended consequence of this has been the polarization of the investigational groups (i.e., immunologists and endocrinologists) interested in developing novel therapies for this condition. This review will examine how and why such polarization exists, and why past and current approaches to develop critically needed translational investigators may be falling short. RECENT FINDINGS Despite significant efforts to increase the number of individuals trained in both basic science and clinical medicine, the number of academic physician-scientists is on the decline. Increased demands from academic institutions coupled with severe difficulty in securing extramural funding are probably playing important roles in this concerning trend. SUMMARY Type 1 diabetes will continue to be a significant strain on individuals, their families and society until a cure is found. More than ever, there is a critical need to support appropriately trained translational investigators who can best facilitate bringing the promise of basic research to clinical reality.
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Affiliation(s)
- Mark R Rigby
- Department of Pediatrics, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
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Estrada CL, Danielson KK, Drum ML, Lipton RB. Hospitalization subsequent to diagnosis in young patients with diabetes in Chicago, Illinois. Pediatrics 2009; 124:926-34. [PMID: 19706582 PMCID: PMC2888679 DOI: 10.1542/peds.2008-3826] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES Rehospitalization after a diabetes diagnosis in youth signals the failure of outpatient management. We examined risk factors for rehospitalization among young patients with diabetes. PATIENTS AND METHODS We queried 535 participants diagnosed before 18 years of age from the Chicago Childhood Diabetes Registry. Demographic, social, and clinical data were used in logistic models of diabetes-related rehospitalization, as well as, among those rehospitalized, frequent (> or = once per 2 years' duration) versus infrequent rehospitalization rates. RESULTS Mean (range) duration was 5.1 years (0.1-19.2 years). The sample was 55% non-Hispanic black, 11% non-Hispanic white, 26% Hispanic, and 7% other/mixed race; 86% had presumed type 1 diabetes; and 47% were underinsured. Overall, 46% reported rehospitalization for diabetes. In multivariable logistic regression, ever being rehospitalized was significantly associated with diabetes duration (per year, odds ratio [OR]: 1.26; P < .01), female gender (OR: 1.67; P = .01), underinsurance (versus private insurance; OR: 1.79; P < .01), presumed phenotype (non-type 1 diabetes versus type 1; OR: 0.32; P < .01), and diagnosis at a community hospital (versus tertiary care facility; OR: 1.96; P < .01) and tended to be higher for those of nonwhite race (OR: 1.94; P = .07). Among those rehospitalized, multivariable associations with frequent rehospitalization were presumed phenotype (non-type 1 diabetes versus type 1; OR: 2.74; P = .04), head of household not working (versus employed; OR: 1.88; P = .02), and younger age at questionnaire (per year; OR: 0.94; P = .01). CONCLUSIONS Rehospitalization is common in young patients with diabetes, especially for those with limited resources, indicating the need for improved outpatient services. Comprehensive initial education and support available to young patients with diabetes diagnosed at tertiary care facilities and their families may have lasting protective effects.
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Affiliation(s)
- Carmela L. Estrada
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Kirstie K. Danielson
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois
| | - Melinda L. Drum
- Department of Health Studies, University of Chicago, Chicago, Illinois
| | - Rebecca B. Lipton
- Institute for Endocrine Discovery and Clinical Care, University of Chicago, Chicago, Illinois, Department of Health Studies, University of Chicago, Chicago, Illinois
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Weber C, Kocher S, Neeser K, Joshi SR. Prevention of diabetic ketoacidosis and self-monitoring of ketone bodies: an overview. Curr Med Res Opin 2009; 25:1197-207. [PMID: 19327102 DOI: 10.1185/03007990902863105] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) is associated with significant morbidity and mortality. Self-monitoring of ketone bodies by diabetes patients can be done using blood or urine. We compared the two self-monitoring methods and summarized recent developments in the epidemiology and management of DKA. METHODS MEDLINE and EMBASE were searched for relevant publications addressing the epidemiology, management and prevention of DKA up to 2009. The current, relevant publications, along with the authors' clinical and professional experience, were used to synthesize this narrative review. FINDINGS Despite considerable advances in diabetes therapy, key epidemiological figures related to DKA remained nearly unchanged during the last decades at a global level. Prevention of DKA - especially in sick day management - relies on intensive self-monitoring of blood glucose and subsequent, appropriate therapy adjustments. Self-monitoring of ketone bodies during hyperglycemia can provide important, complementary information on the metabolic state. Both methods for self-monitoring of ketone bodies at home are clinically reliable and there is no published evidence favoring one method with respect to DKA prevention. CONCLUSIONS DKA is still a severe complication potentially arising during prolonged hyperglycemic episodes with possibly fatal consequences. Education of patients and their social environment to promote frequent testing - especially during sick days - and to lower their glucose levels, as well as to recognize the early symptoms of hyperglycemia and DKA is of paramount importance in preventing the development of severe DKA. Both methods for self-monitoring of ketone bodies are safe and clinically reliable.
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Affiliation(s)
- Christian Weber
- IMIB Institute for Medical Informatics and Biostatistics, Basel, Switzerland
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