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Choe J, Won SH, Choe Y, Park SH, Lee YJ, Lee J, Lee YA, Lim HH, Yoo JH, Lee SY, Kim EY, Shin CH, Kim JH. Temporal Trends for Diabetes Management and Glycemic Control Between 2010 and 2019 in Korean Children and Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2022; 24:201-211. [PMID: 34704794 DOI: 10.1089/dia.2021.0274] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Purpose: There is increasing use of modern devices in the management of patients with type 1 diabetes (T1D). We investigated temporal trends for diabetes management and outcomes in Korean pediatric T1D patients over 10 years. Methods: We retrospectively collected the data from 752 participants (boys: 311, 41.4%) diagnosed with T1D and aged ≤18 years, with ≥1 year of follow-up between 2010 and 2019 in any of the seven study hospitals in Korea. Results: Over the 10-year study period, use of continuous glucose monitoring (CGM) increased from 1.4% to 39.3%. From 2010 to 2019, there was an increased use of multiple daily insulin injections (MDI; 63.9%-77.0%, respectively) and continuous subcutaneous insulin infusion (CSII; 2.1%-14.0%, respectively), but decreased use of conventional insulin therapy (CIT, 33.9%-9.0%, respectively). Mean glycated hemoglobin (HbA1c) decreased from 8.56% to 8.01% (P < 0.001) and was lower in younger patients, boys, and CGM users (P < 0.001). MDI and CSII users had lower mean HbA1c levels than CIT users (P = 0.003). Regarding the acute complications of T1D, CGM use was associated with lower incidences of diabetic ketoacidosis (P = 0.015); CSII users were likely to experience less severe hypoglycemia (P = 0.008). Conclusions: The use of CSII and CGM increased ∼7- and 30-fold, respectively, over the 10-year study period. The glycemic control of pediatric T1D patients in Korea improved from 2010 to 2019, probably because of increased use of T1D technologies.
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Affiliation(s)
- Jaewon Choe
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Seung Hyun Won
- Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Yunsoo Choe
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Sang Hee Park
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
| | - Yun Jeong Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jieun Lee
- Department of Pediatrics, Inje University Ilsan Paik Hospital, Goyang, South Korea
| | - Young Ah Lee
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Han Hyuk Lim
- Department of Pediatrics, Chungnam National University Hospital, Daejeon, South Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University Hospital, Busan, South Korea
| | - Seong Yong Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
- Department of Pediatrics, SMG-SNU Boramae Medical Center, Seoul, South Korea
| | - Eun Young Kim
- Department of Pediatrics, Chosun University Hospital, Gwangju, South Korea
| | - Choong Ho Shin
- Department of Pediatrics, Seoul National University Children's Hospital, Seoul, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
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Esteghamati A, Ismail-Beigi F, Khaloo P, Moosaie F, Alemi H, Mansournia MA, Afarideh M, Janbabaei Molla G, Ghadimi T, Shadnoush M, Kermanchi J, Ghaemi F. Determinants of glycemic control: Phase 2 analysis from nationwide diabetes report of National Program for Prevention and Control of Diabetes (NPPCD-2018). Prim Care Diabetes 2020; 14:222-231. [PMID: 31402326 DOI: 10.1016/j.pcd.2019.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/29/2019] [Accepted: 07/16/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Diabetes is one of the leading causes of morbidity and mortality worldwide, especially among middle and low income nations. Many diabetic complications and comorbidities are attributable to poor glycemic control. The aim of this study was to update and extend the national diabetes reports on the status of comorbidities, diabetes care and complications in Iran. Moreover, we investigated the risk factors of poor glycemic control in the Iranian population. METHODS National database of 99,651 patients with diabetes who attended university-affiliated clinics between April 1, 2017 and February 30, 2018 was used to carry out a cross-sectional study. Stepwise backward selection logistic regression model was used to examine the associated factors of glycemic control. RESULTS In this study 73.0% and 56.5% of the enrolled population with diabetes, had hypertension and hyperlipidemia, respectively. The prevalence of patients who received education for nutrition therapy or diabetes self-management was 16.3% and 23.3% respectively. Poor glycemic control was associated with male gender (OR=1.06, p=0.001), obesity (OR=1.03, p=0.05), duration of diabetes (OR=1.018, p<0.001), smoking (OR=1.08, p=0.041), hypertension (OR=1.53, p<0.001), hyperlipidemia (OR=1.15, p<0.001), insulin therapy (OR=1.26, p<0.001) and combination of insulin and oral anti-diabetic agents compared to oral anti-diabetic agents alone (OR=2.36, p<0.001). CONCLUSION We demonstrated that the prevalence of diabetes comorbidities is high in Iranian population and that a great proportion of Iranian patients with diabetes had not reached the goal of glycemic control. Our findings provide a starting point from which to investigate the obstacles that prevent patients with diabetes from reaching metabolic targets.
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Affiliation(s)
- Alireza Esteghamati
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Faramarz Ismail-Beigi
- Department of Medicine, Biochemistry, Physiology and Biophysics, Division of Clinical and Molecular Endocrinology, Case Western Reserve University, Cleveland, OH, United States
| | - Pegah Khaloo
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Moosaie
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Alemi
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Afarideh
- Endocrinology and Metabolism Research Center (EMRC), Vali-Asr Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ghasem Janbabaei Molla
- Department of Deputy of Curative Affaires of Ministry of Health & Medical Education, Tehran, Iran
| | - Teyyeb Ghadimi
- Department of Surgery, Iran Medical University, Tehran, Iran
| | - Mehdi Shadnoush
- Department of Clinical Nutrition, Shahid Beheshti University of Medical Science, Tehran, Iran
| | - Jamshid Kermanchi
- Disease Management Advisor-Curative Affair Deputy-Ministry of Health and Medical Education, Tehran, Iran
| | - Fatemeh Ghaemi
- Department of Transplantation and Disease, Ministry of Health & Medical Education, Tehran, Iran.
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Alassaf A, Odeh R, Gharaibeh L, Ibrahim S, Ajlouni K. Personal and Clinical Predictors of Poor Metabolic Control in Children with Type 1 Diabetes in Jordan. J Diabetes Res 2019; 2019:4039792. [PMID: 31355293 PMCID: PMC6637667 DOI: 10.1155/2019/4039792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/21/2019] [Accepted: 05/27/2019] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Achieving adequate metabolic control in children with type 1 diabetes is important in slowing the progression of future microvascular and macrovascular complications, but still it is a universal challenge. We aim to investigate possible factors associated with poor metabolic outcomes in Jordan as an example of a country with limited resources. METHODS This is a retrospective chart review study of children with type 1 diabetes. Several clinical and personal characteristics were tested for association with metabolic control reflected by HbA1c levels. Linear logistic regression analysis was used to evaluate possible predictors of metabolic control. One-way ANOVA analysis was used to detect significant differences in HbA1c between categories. RESULTS Significant predictors of metabolic control were found. A one-year increase in age led to an increase in HbA1c by 0.053% (P = 0.044). A decline in HbA1c levels was predicted in children who have precise amount of carbohydrates or who are receiving insulin at school (-0.46% (P = 0.014) and -0.82% (P = 0.004), respectively). When family members other than mothers decided the insulin dose, the HbA1c level increased by 0.74% (P = 0.005). CONCLUSION Poor metabolic control was associated with age, dietary noncompliance, not receiving insulin at school, and absence of direct mother care. Our study is one of the few studies from Middle East evaluating predictors of metabolic control. Global research studies help in giving universal insight towards developing more effective multidisciplinary team approach for diabetes care and education.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Lubna Gharaibeh
- Department of Clinical Pharmacy, The University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, The University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), The University of Jordan, Amman, Jordan
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Mochizuki M, Kikuchi T, Urakami T, Kikuchi N, Kawamura T, Yokomichi H, Hoshino T, Matsuura N, Sasaki N, Sugihara S, Amemiya S. Improvement in glycemic control through changes in insulin regimens: findings from a Japanese cohort of children and adolescents with type 1 diabetes. Pediatr Diabetes 2017; 18:435-442. [PMID: 27460670 DOI: 10.1111/pedi.12409] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/29/2016] [Accepted: 06/07/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Although insulin analogs have dramatically changed diabetes treatment, scarce evidence is available on those effects. We aimed to explore whether glycemic control had improved, the use of insulin analogs had been increased, and hypoglycemic events had decreased over time in Japanese pediatric patients with type 1 diabetes (T1D). METHODS Glycated hemoglobin A1c (HbA1c) values, proportion of insulin regimens, incidence of severe hypoglycemic events, and pubertal increase in HbA1c were compared in three cohorts of childhood-onset Japanese T1D patients (567 subjects in the 1995 cohort, 754 subjects in the 2000 cohort, and 806 subjects in the 2008 cohort). RESULTS Mean HbA1c values tended to decrease [78.5 mmol/mol (9.33%) in the 1995 cohort, 68.2 mmol/mol (8.39%) in the 2000 cohort, and 61.2 mmol/mol (7.75%) in the 2008 cohort; P < .0001]. The proportion of patients who received basal-bolus treatment tended to increase with statistical significance, as did the proportion on insulin analogs. The incidence of severe hypoglycemic events (events/100 patients/y) had decreased (19.1 in the 2000 cohort and 8.7 in the 2008 cohort; P = .02). The pubertal increase in HbA1c tended to decrease [males, 12.0 mmol/mol (1.10%) in 1995, 9.4 mmol/mol (0.85%) in 2008, and 9.4 mmol/mol (0.86%) in 2008; P = .55; females, 14.0 mmol/mol (1.28%) in 1995, 10.3 mmol/mol (0.94%) in 2000, and 4.2 mmol/mol (0.38%) in 2008; P = .0003]. CONCLUSIONS Glycemic control and incidence of severe hypoglycemic events were chronologically improved, especially in female adolescents.
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Affiliation(s)
- Mie Mochizuki
- Department of Pediatrics, University of Yamanashi, Yamanashi, Japan
| | - Toru Kikuchi
- Department of Pediatrics, Saitama Medial University, Saitama, Japan
| | - Tatsuhiko Urakami
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Nobuyuki Kikuchi
- Department of Pediatrics, Yokohama City University Medical Center, Kanagawa, Japan
| | - Tomoyuki Kawamura
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroshi Yokomichi
- Department of Health Sciences, Division of Medicine, Graduate School Department of Interdisciplinary Research, University of Yamanashi, Yamanashi, Japan
| | - Tadao Hoshino
- Institute of Biopathological Medicine, Kanagawa, Japan
| | - Nobuo Matsuura
- Early Childhood Education, Seitoku University, Chiba, Japan
| | - Nozomu Sasaki
- Department of Pediatrics, Saitama Medial University, Saitama, Japan
| | - Shigetaka Sugihara
- Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
| | - Shin Amemiya
- Department of Pediatrics, Saitama Medial University, Saitama, Japan
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Lau YN, Korula S, Chan AK, Heels K, Krass I, Ambler G. Analysis of insulin pump settings in children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2016; 17:319-26. [PMID: 25998469 DOI: 10.1111/pedi.12285] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 04/23/2015] [Accepted: 04/28/2015] [Indexed: 11/28/2022] Open
Abstract
AIM To characterize current insulin pump settings used in young patients with type 1 diabetes mellitus (T1DM) and to assess their relationship to glycemic control. METHODS This retrospective study included patients aged <18 yr old with T1DM >1 yr using a Medtronic pump device. Pump data including number of blood glucose (BG) tests per day, basal and bolus insulin parameters, carbohydrate ratio (CR), and insulin sensitivity factors (ISFs) were averaged over 14 d for statistical analyses. Anthropometric data and recent glycosylated hemoglobin A1c (HbA1c) were recorded. RESULTS A total of 292 patients (144 males and 148 females) were included in the study. Participants had a median age (interquartile range, IQR) of 12.9 yr (10.0-15.1 yr) and pump duration of 2.8 yr (1.5-4.2 yr). No significant differences in median HbA1c (IQR) were observed in preschool [n = 14; HbA1c 7.8% (7.3-8.3%)], prepubertal [n = 105; HbA1c 8.1% (7.7-8.9%)], and adolescent subjects [n = 173; HbA1c 8.4% (7.7-9.0%)]. Adolescents took significantly fewer boluses and BG tests per day compared with younger children (p < 0.05). Age-specific diurnal variation in basal insulin delivery was noted. Additionally, stronger carbohydrate cover and weaker corrections were used in real-life compared with theoretical 500 and 100 rules, respectively. Lower HbA1c was associated with higher number of daily boluses, greater number of BG tests per day, lower average CR/500 rule ratio, and higher average ISF/100 rule ratio adjusted for age (R(2) = 0.22; p < 0.01). CONCLUSION Insulin pump therapy requires continuous adjustments and glycemic targets are achieved by a minority. We believe this is the first study in pediatric cohort looking at association between CR and ISF with glycemic control.
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Affiliation(s)
- Yu Ning Lau
- Pharmacy Department, University of Sydney, Sydney, Australia
| | - Sophy Korula
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Albert K Chan
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Kristine Heels
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
| | - Ines Krass
- Pharmacy Department, University of Sydney, Sydney, Australia
| | - Geoffrey Ambler
- Insitute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Sydney, Australia
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