1
|
Comparison of Glycosylated Haemoglobin, Blood Pressure, and Anthropometric Measurements Depending on Gender and Bodyweight State in Adolescents. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121922. [PMID: 36553365 PMCID: PMC9777222 DOI: 10.3390/children9121922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 12/13/2022]
Abstract
Background/Objective: The greatest anthropometric and physiological changes occur during adolescence. Assessment of growth patterns is necessary to prevent future health risks. Aims: To describe the values of glycosylated haemoglobin (HbA1c), systolic (SBP) and diastolic (DBP) blood pressure, triceps skinfold, and abdominal circumference according to gender and age (between 12 and 17 years), as well as explore the differences between body weight conditions. Methods: A descriptive cross-sectional study was carried out, including 4130 adolescents between 12 and 17 years old. SBP and DBP, HbA1c, triceps skinfold, and abdominal circumference were evaluated. Results: Significant differences were observed between males and females for HbA1c (p < 0.001), SBP (p < 0.001), triceps curl (p < 0.001), and abdominal circumference (p < 0.001), independently of the age group. Regardless of gender and age groups, significant differences were observed between overweight/obese and normal-weight adolescents in SBP (p < 0.001), DBP (p < 0.001 to 0.009), triceps skinfold (p < 0.001), and abdominal perimeter (p < 0.001). Conclusions: Our findings revealed higher SBP, DBP, triceps skinfold, and abdominal circumference in overweight/obese adolescents compared to normal-weight adolescents in both genders.
Collapse
|
2
|
Monaghan M, Bryant BL, Inverso H, Moore HR, Streisand R. Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research. Curr Diab Rep 2022; 22:247-256. [PMID: 35435615 PMCID: PMC9013975 DOI: 10.1007/s11892-022-01465-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/14/2022] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions. RECENT FINDINGS Rates of type 1 diabetes (T1D) in young children (ages 1-7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child's diabetes management. T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.
Collapse
Affiliation(s)
- Maureen Monaghan
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
- grid.253615.60000 0004 1936 9510George Washington University School of Medicine, Washington, DC USA
| | - Breana L. Bryant
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Hailey Inverso
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Hailey R. Moore
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
| | - Randi Streisand
- grid.239560.b0000 0004 0482 1586Children’s National Hospital, 111 Michigan Ave NW, Washington, DC 20010 USA
- grid.253615.60000 0004 1936 9510George Washington University School of Medicine, Washington, DC USA
| |
Collapse
|
3
|
Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
|
4
|
Barola A, Tiwari P, Bhansali A, Grover S, Dayal D. Cross-cultural adaptation and psychometric evaluation of Hindi version of Diabetes Self-Management Profile-Self Report in Indian type 1 diabetes patients. Pediatr Diabetes 2021; 22:101-111. [PMID: 32585071 DOI: 10.1111/pedi.13071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 05/26/2020] [Accepted: 06/19/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND No validated measures exist for evaluating diabetes self-management in Indian type 1 diabetes (T1D) patients. OBJECTIVE To cross culturally adapt and evaluate the psychometric properties of Hindi version of Diabetes Self-Management Profile-Self Report (DSMP-SR-Hindi) in Indian T1D patients. METHODS Total 160 T1D patients and their parents participated in the study. The mean age of patients was 13.5 ± 2.5 years and HbA1c was 8.6 ± 2.2%. RESULTS Exploratory factor analysis employing principle axis factoring with promax rotation was conducted. Monte Carlo parallel analysis identified three sub-scales instead of five sub-scales proposed in original version. Because of underlying ceiling and floor effects and insufficient loadings, five items were eliminated. Consequently, final Hindi version of DSMP-SR contained 19 items from DSMP-SR-24. Internal consistencies were adequate for overall scale (Cronbach's α = 0.835), identified sub-scales (Cronbach's α = 0.702-0.802) and comparable between genders. DSMP-19 total scores (r = -0.74) and three subscales correlated significantly with HbA1c (SMBG and Corrective Adjustments [r = -0.58], Exercise [r = -0.48], and Conformity to Diet and Insulin Routine [r = -0.64]). For every one SD improvement (11.2 marks) in DSMP-SR-Hindi score, odds of falling into poor glycaemic group (HbA1c > 7.5%) dropped to 0.242 times (95% CI 0.144-0.405; P < .001). CONCLUSIONS DSMP-SR-Hindi is a reliable and valid self-report measure of diabetes self-management behavior in Indian T1D patients. The revealed three subscales are reliable to use in isolation and across the genders. It will help in monitoring patient's progress in stepwise manner, ranging from their basic understanding of prescribed regimen to taking advance corrective actions in face of altered needs.
Collapse
Affiliation(s)
- Anjana Barola
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar (Mohali), India
| | - Pramil Tiwari
- Department of Pharmacy Practice, National Institute of Pharmaceutical Education and Research (NIPER), S.A.S. Nagar (Mohali), India
| | - Anil Bhansali
- Department of Endocrinology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Sandeep Grover
- Department of Psychiatry, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| | - Devi Dayal
- Department of Paediatrics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India
| |
Collapse
|
5
|
Dong W, Wan EYF, Bedford LE, Wu T, Wong CKH, Tang EHM, Lam CLK. Prediction models for the risk of cardiovascular diseases in Chinese patients with type 2 diabetes mellitus: a systematic review. Public Health 2020; 186:144-156. [PMID: 32836004 DOI: 10.1016/j.puhe.2020.06.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/23/2020] [Accepted: 06/07/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Diabetes mellitus (DM) is a serious public health issue worldwide, and DM patients have higher risk of cardiovascular diseases (CVDs), which is the leading cause of DM-related deaths. China has the largest DM population, yet a robust model to predict CVDs in Chinese DM patients is still lacking. This systematic review is carried out to summarize existing models and identify potentially important predictors for CVDs in Chinese DM patients. STUDY DESIGN Systematic review. METHODS Medline and Embase were searched for data from April 1st, 2011 to May 31st, 2018. A study was eligible if it developed CVD (defined as total CVD or any major cardiovascular component) risk prediction models or explored potential predictors of CVD specifically for Chinese people with type 2 DM. Standardized forms were utilized to extract information, appraise applicability, risk of bias, and availabilities. RESULTS Five models and 29 studies focusing on potential predictors were identified. Models for a primary care setting, or to predict total CVD, are rare. A number of common predictors (e.g. age, sex, diabetes duration, smoking status, glycated hemoglobin (HbA1c), blood pressure, lipid profile, and treatment modalities) were observed in existing models, in which urine albumin:creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR) are highly recommended for the Chinese population. Variability of blood pressure (BP) and HbA1c should be included in prediction model development as novel factors. Meanwhile, interactions between age, sex, and risk factors should also be considered. CONCLUSIONS A 10-year prediction model for CVD risk in Chinese type 2 DM patients is lacking and urgently needed. There is insufficient evidence to support the inclusion of other novel predictors in CVDs risk prediction functions for routine clinical use.
Collapse
Affiliation(s)
- W Dong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - E Y F Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China; Department of Pharmacology and Pharmacy, The University of Hong Kong, L02-56, 2/F, Laboratory Block, 21 Sassoon Road, Pokfulam, Hong Kong, China.
| | - L E Bedford
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - T Wu
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - C K H Wong
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - E H M Tang
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - C L K Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, 3/F, Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| |
Collapse
|
6
|
Trefz P, Obermeier J, Lehbrink R, Schubert JK, Miekisch W, Fischer DC. Exhaled volatile substances in children suffering from type 1 diabetes mellitus: results from a cross-sectional study. Sci Rep 2019; 9:15707. [PMID: 31673076 PMCID: PMC6823423 DOI: 10.1038/s41598-019-52165-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 10/10/2019] [Indexed: 02/06/2023] Open
Abstract
Monitoring metabolic adaptation to type 1 diabetes mellitus in children is challenging. Analysis of volatile organic compounds (VOCs) in exhaled breath is non-invasive and appears as a promising tool. However, data on breath VOC profiles in pediatric patients are limited. We conducted a cross-sectional study and applied quantitative analysis of exhaled VOCs in children suffering from type 1 diabetes mellitus (T1DM) (n = 53) and healthy controls (n = 60). Both groups were matched for sex and age. For breath gas analysis, a very sensitive direct mass spectrometric technique (PTR-TOF) was applied. The duration of disease, the mode of insulin application (continuous subcutaneous insulin infusion vs. multiple daily insulin injection) and long-term metabolic control were considered as classifiers in patients. The concentration of exhaled VOCs differed between T1DM patients and healthy children. In particular, T1DM patients exhaled significantly higher amounts of ethanol, isopropanol, dimethylsulfid, isoprene and pentanal compared to healthy controls (171, 1223, 19.6, 112 and 13.5 ppbV vs. 82.4, 784, 11.3, 49.6, and 5.30 ppbV). The most remarkable differences in concentrations were found in patients with poor metabolic control, i.e. those with a mean HbA1c above 8%. In conclusion, non-invasive breath testing may support the discovery of basic metabolic mechanisms and adaptation early in the progress of T1DM.
Collapse
Affiliation(s)
- Phillip Trefz
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany.
| | - Juliane Obermeier
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Ruth Lehbrink
- Department of Pediatrics, Rostock University Medical Centre, Rostock, Germany
| | - Jochen K Schubert
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | - Wolfram Miekisch
- Department of Anesthesiology and Intensive Care Medicine, Rostock Medical Breath Research Analytics and Technologies (ROMBAT), Rostock University Medical Centre, Rostock, Germany
| | | |
Collapse
|
7
|
Yayan EH, Zengin M, Erden Karabulut Y, Akıncı A. The relationship between the quality of life and depression levels of young people with type I diabetes. Perspect Psychiatr Care 2019; 55:291-299. [PMID: 30614548 DOI: 10.1111/ppc.12349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 11/11/2018] [Accepted: 12/09/2018] [Indexed: 01/09/2023] Open
Abstract
PURPOSE The aim of this study is to examine the relationship between the quality of life and depression levels of the youth with type I diabetes. DESIGN AND METHODS: The study was a cross-sectional descriptive study. FINDINGS It was found that there is a negative correlation between participants' HbA1c levels and quality of life, and a positive correlation between HbA1c levels and depression. It was determined that quality of life and depression are significant predictors of HbA1c (R 2 = 0.72, P < 0.01). PRACTICE IMPLICATIONS The depression levels of the young people with increased and their metabolic control was affected negatively as the quality of life levels decreased. Depression measurements should be made during the routine control of youth with diabetes who have difficulty in maintaining metabolic control.
Collapse
Affiliation(s)
- Emriye Hilal Yayan
- Department of Child Health and Disease Nursing, Health Sciences of Faculty, İnönü University, Malatya, Turkey
| | - Mürşide Zengin
- Department of Nursing, School of Health, Adıyaman University, Adıyaman, Turkey
| | | | - Ayşehan Akıncı
- Department of Pediatric Endocrinology, İnönü University, Turgut Özal Medical Center, Malatya, Turkey
| |
Collapse
|
8
|
Crossen S, Glaser N, Sauers-Ford H, Chen S, Tran V, Marcin J. Home-based video visits for pediatric patients with poorly controlled type 1 diabetes. J Telemed Telecare 2019; 26:349-355. [PMID: 30871408 DOI: 10.1177/1357633x19828173] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Management of type 1 diabetes (T1D) is labor-intensive, requiring multiple daily blood glucose measurements and insulin injections. Patients are seen quarterly by providers, but evidence suggests more frequent contact is beneficial. Current technology allows secure, remote sharing of diabetes data and video-conferencing between providers and patients in their home settings. METHODS Home-based video visits were provided for six months to pediatric T1D patients with poor glycemic control, indicated by a hemoglobin A1c (HbA1c) ≥8% at enrollment. Video visits were conducted every 4-8 weeks in addition to regularly scheduled clinic visits. Dates of clinic visits and HbA1c values were abstracted from the medical record at baseline and six months. Patients were surveyed at video visits regarding technical issues, and after six months a standardized survey was administered to assess satisfaction with video-based care. RESULTS A total of 57 patients enrolled and 36 completed six months of video visits. Patients completing six months averaged 4.0 video visits (SD 1.1). Their frequency of in-person care also increased from 3.2 clinic visits/year at baseline to 3.7 clinic visits/year during the study (P = 0.04). Mean HbA1c reduction among patients completing six months was 0.8% (95% CI 0.2-1.4%); 94% of these patients were "very satisfied" while 6% were "somewhat satisfied" with the experience. DISCUSSION This study demonstrates that home-based video visits are feasible and satisfactory for pediatric patients with poorly controlled T1D. Furthermore, use of video visits can improve frequency of subspecialty care and resulting glycemic control in this population.
Collapse
Affiliation(s)
- Stephanie Crossen
- Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA
| | - Nicole Glaser
- Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA
| | | | - Shelby Chen
- Center for Health and Technology, University of California, CA, USA
| | - Victoria Tran
- Division of Pediatric Endocrinology and Diabetes, University of California, CA, USA
| | - James Marcin
- Center for Health and Technology, University of California, CA, USA
| |
Collapse
|
9
|
Fischer KI, Barthel D, Otto C, Ravens-Sieberer U, Thyen U, Klein M, Walter O, Rose M, Nolte S. Minimal Associations Between Clinical Data and Children's Self-Reported Health-Related Quality of Life in Children With Chronic Conditions-A Cross-Sectional Study. Front Pediatr 2019; 7:17. [PMID: 30805321 PMCID: PMC6370724 DOI: 10.3389/fped.2019.00017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 01/15/2019] [Indexed: 12/31/2022] Open
Abstract
Introduction: The improvement-or at least maintenance-of health-related quality of life (HRQoL) in children and adolescents is one of the main aims of chronic disease care. This study examines HRQoL of children and adolescents with three different chronic conditions (i.e., diabetes mellitus, asthma, juvenile arthritis) using the computer-adaptive test Kids-CAT, comprising five HRQoL domains: physical well-being, psychological well-being, parent relations, social support and peers, and school well-being. Further, associations between HRQoL and distinct clinical data and medical assessments are investigated to explore how much variability of the five domains can be explained by these variables. Methods: Cross-sectional data of the Kids-CAT study was analyzed. The Kids-CAT was used in two outpatient clinics in northern Germany gathering data on self-reported HRQoL in n = 309 children and adolescents aged 7-17 years. Additionally, general patient information, clinical data, and pediatrician-reported medical assessments were measured. Multiple regression analyses were conducted to explore associations between HRQoL and selected variables (i.e., disease duration, co-morbidity, disease control, overall health status). Results: Overall, self-reported HRQoL in all five domains were comparable to data of an age- and sex-matched reference population. Results of regression analyses indicated that the investigated variables only minimally explain variance in the five Kids-CAT domains. Sociodemographic, clinical data, and medical assessments explained 18.4% of the variance in physical well-being, 10.7% in psychological well-being, and < 10% of the variance in parent relations, social support and peers, and school well-being. Conclusion: Sociodemographic data, disease duration, co-morbidity, and medical assessments, such as disease control or pediatrician-assessed overall health status show low association with HRQoL of children and adolescents with chronic conditions. Data on self-reported HRQoL delivers valuable information on children's well-being and can improve healthcare professionals' understanding of the subjective well-being of their young patients. The implementation of tools like the Kids-CAT can facilitate the identification of potential problem areas, which should enable healthcare professionals to better address specific healthcare needs. Clinical Trial Registration: identifier: DRKS00006326 (retrospectively registered); Date of registry: August 1st, 2014.
Collapse
Affiliation(s)
- Kathrin I Fischer
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Psychosomatic Medicine, Berlin, Germany
| | - Dana Barthel
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christiane Otto
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ulrike Ravens-Sieberer
- Research Unit Child Public Health, Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ute Thyen
- Department of Pediatric and Adolescent Medicine, Universität zu Lübeck, Lübeck, Germany
| | - Marcus Klein
- Department of General Pediatrics, Christian-Albrechts-Universität, Kiel, Germany
| | - Otto Walter
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Psychosomatic Medicine, Berlin, Germany
| | - Matthias Rose
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Psychosomatic Medicine, Berlin, Germany.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | - Sandra Nolte
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Medical Department, Division of Psychosomatic Medicine, Berlin, Germany.,Public Health Innovation, Population Health Strategic Research Centre, School of Health and Social Development, Deakin University, Geelong, VIC, Australia
| |
Collapse
|
10
|
Abstract
Diabetes educators are well positioned to help optimize care of the student with diabetes within the school setting.
Collapse
|
11
|
Spaans E, van Hateren KJJ, Groenier KH, Bilo HJG, Kleefstra N, Brand PLP. Mealtime insulin bolus adherence and glycemic control in adolescents on insulin pump therapy. Eur J Pediatr 2018; 177:1831-1836. [PMID: 30238153 DOI: 10.1007/s00431-018-3256-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/13/2018] [Accepted: 09/14/2018] [Indexed: 10/28/2022]
Abstract
Poor self-management contributes to insufficient glycemic control in adolescents with type 1 diabetes (T1DM). We assessed the effects on glycemic control of adherence to self-measurement of blood glucose (SMBG) and insulin boluses in 90 adolescents with T1DM on insulin pump therapy over a 2-month period. We compared the number of insulin boluses and SMBGs around main meals to the "gold standard" of optimal diabetes management (SMBGs and a bolus before each main meal and SMBG before bedtime). The mean (95% CI) HbA1c levels were 2.9(1.7 to 4.0) mmol/mol lower for every additional insulin bolus and 3.1(1.6 to 4.5) mmol/mol lower for every additional SMBG. Patients performing SMBG and bolusing around each main meal had considerably lower HbA1c levels than those unable to do (95% CI for difference 4.3 to 10.4 mmol/mol and 11.5 to 20.1 mmol/mol respectively). For each additional mealtime bolus/day, the odds ratio of achieving target HbA1c levels of <58 mmol/mol was 6.73 (95% CI 2.94-15.38), after adjustment for gender, age, diabetes duration, and affective responses to SMBG in a multiple logistic regression model.Conclusion: Glycemic control in adolescents with T1DM on insulin pump therapy is strongly dependent on adherence to insulin boluses around mealtimes. What is Known: • In mixed groups of children and adolescents, insulin bolus frequency and self-monitoring of blood glucose (SMBG) frequency were determinants of HbA1c levels. • Adherence to insulin boluses and SMBG is particularly challenging in adolescents. What is New: • In adolescents on insulin pump therapy, each additional insulin bolus, particularly around mealtime, was significantly associated with approximately 3 mmol/mol lower HbA1c levels. • This beneficial effect of mealtime bolusing was strongest for the evening meal.
Collapse
Affiliation(s)
- Engelina Spaans
- Diabetes Center, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands. .,Isala Women and Children's Hospital, Zwolle, The Netherlands.
| | | | - Klaas H Groenier
- Diabetes Center, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands.,Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Henk J G Bilo
- Diabetes Center, Isala, P.O. Box 10400, 8000 GK, Zwolle, The Netherlands.,Department of General Practice, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Nanne Kleefstra
- Langerhans Medical Research Group, Ommen, The Netherlands.,Department of Internal Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| | - Paul L P Brand
- Isala Women and Children's Hospital, Zwolle, The Netherlands.,UMCG Postgraduate School of Medicine, University of Groningen and University Medical Center Groningen, Groningen, The Netherlands
| |
Collapse
|
12
|
Predictors of health-related quality of life in chronically ill children and adolescents over time. J Psychosom Res 2018; 109:63-70. [PMID: 29580563 DOI: 10.1016/j.jpsychores.2018.03.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 02/01/2018] [Accepted: 03/09/2018] [Indexed: 01/27/2023]
Abstract
OBJECTIVE This study aims at identifying predictors of generic health-related quality of life (HRQoL) in chronically ill children and adolescents over time. The newly developed computer-adaptive test Kids-CAT was used to assess five dimensions of HRQoL. METHODS Longitudinal data from the Kids-CAT study on children and adolescents with asthma, diabetes and juvenile arthritis (n = 248; aged 7-17 years) were assessed at three measurement points over six months. Individual growth modeling served to investigate effects of sociodemographic, disease- and health-related as well as psychosocial factors on HRQoL dimensions Physical Well-Being (WB), Psychological WB, Parent Relations, Social Support & Peers, and School WB over time. RESULTS Besides effects of sociodemographic variables on HRQoL dimensions Social Support & Peers as well as School WB, we found that a longer duration of the disease was associated with better Physical WB. Lower scores were found for patients with juvenile arthritis compared to those with diabetes in HRQoL dimensions Physical WB and Social Support & Peers. Disease control was positively related to Physical and Psychological WB over time. Mental health problems were negatively associated with four, and subjective health complaints with all five HRQoL dimensions over time. Parental mental health was positively related to the patients' HRQoL score in Parent Relations over time. CONCLUSIONS HRQoL as a multidimensional construct is associated with a wide range of different factors. Pediatricians should consider potential mental health problems and subjective health complaints in their patients. Finally, parental HRQoL can affect HRQoL in chronically ill children and adolescents.
Collapse
|
13
|
Mohammad JM, Robabeh S, Shahin K, Saeed T, Maryam A. Auditory function and motor proficiency in type 1 diabetic children: A case-control study. Int J Pediatr Otorhinolaryngol 2018; 109:7-12. [PMID: 29728188 DOI: 10.1016/j.ijporl.2018.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Revised: 03/16/2018] [Accepted: 03/16/2018] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate the auditory and motor functions in children with insulin dependent diabetes mellitus (IDDM). METHODS This case-control study, 65 diabetic children, receiving care in Diabetes Center of 17 Sharivar Hospital, were enrolled. 130 controls were matched to cases by age and sex. The authors performed audio-vestibular tests, including pure tone audiometry (PTA), distortion product otoacoustic emission (DPOAE), auditory brainstem response (ABR), bedside head-impulse test and dynamic visual acuity test. Motor function was evaluated using of Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2). RESULTS The results showed higher thresholds of air conduction PTA and a prolonged peak latency of wave V (ABR) in diabetic children as compared to controls (all Ps < 0.001). The odds of normal response in DPOAE of cases decreased by 0.44-0.82 - fold. Although clinical vestibular outcomes were worse in cases, differences were not significant. In BOT-2, the cases had statistically significant lower scores (standard score = -0.58, P < 0.05) than the controls for the Total Motor Composite. Also diabetic girls had more skill motor impairment compared to boys with IDDM. CONCLUSION Based on our study, metabolic disturbances present in Type I diabetes cause disturbances in different parts of auditory and balance functions.
Collapse
Affiliation(s)
- Jalali Mir Mohammad
- Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Soleimani Robabeh
- Kavosh Behavioral, Cognitive and Addiction Research Center, Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Koohmanai Shahin
- 17 Sharivar Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Tizno Saeed
- Otolaryngologic Resident, Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| | - Akbari Maryam
- Otolaryngologic Resident, Rhino-Sinus Ear Skull Base Research Center, Amiralmomenin Hospital, Guilan University of Medical Sciences, Rasht, Iran.
| |
Collapse
|
14
|
Hornung RJ, Reed PW, Mouat F, Jefferies C, Gunn AJ, Hofman PL. Angiotensin-converting enzyme-inhibitor therapy in adolescents with type 1 diabetes in a regional cohort: Auckland, New Zealand from 2006 to 2016. J Paediatr Child Health 2018; 54:493-498. [PMID: 29271523 DOI: 10.1111/jpc.13814] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Revised: 09/25/2017] [Accepted: 10/23/2017] [Indexed: 11/28/2022]
Abstract
AIM To review indications and use of angiotensin-converting enzyme-inhibitor (ACEI) therapy for the treatment of persistent microalbuminuria (MA) and/or hypertension (HTN) in adolescents with type 1 diabetes mellitus (T1DM). METHODS Retrospective chart review of adolescent patients with T1DM seen within the paediatric diabetes service in Auckland, New Zealand, from 2006 to 2016. MA, HTN, patient demographic characteristics and ACEI prescribing and monitoring indices were examined. RESULTS Five hundred adolescents with T1DM were included. There were 26 patients (5%) with MA and/or HTN. MA alone was present in 16, HTN alone in 3 and both HTN and MA in 7. The 5-year MA/HTN-free rate was 98%, and the 10-year MA/HTN-free rate was 93%. Longer disease duration and earlier diagnosis were predictors of MA/HTN. There was no significant difference in standard clinical indices between study patients and others. ACEI was prescribed for 17 of 26 patients for either HTN or MA. Within 6 weeks of ACEI commencement, less than half of the subjects had repeat serum creatinine and MA screens and no record of repeat blood pressure measurement. Despite this, all patients had 3-monthly reviews within outpatient clinics where adjustments of ACEI doses were made. CONCLUSION In our regional adolescent population with T1DM, there were low rates of both MA and/or HTN. In those who required treatment with ACEI, clinical monitoring post-commencement of therapy was inconsistent. Local consensus guidelines for the management of persistent MA in children and adolescents with diabetes mellitus were developed in response to this study.
Collapse
Affiliation(s)
- Rosalie J Hornung
- Paediatric Diabetes and Endocrinology Service, Starship Children's Health, Auckland, New Zealand
| | - Peter W Reed
- Starship Children's Health Children's Research Centre, Auckland District Health Board, Auckland, New Zealand
| | - Fran Mouat
- Paediatric Diabetes and Endocrinology Service, Starship Children's Health, Auckland, New Zealand
| | - Craig Jefferies
- Paediatric Diabetes and Endocrinology Service, Starship Children's Health, Auckland, New Zealand
| | - Alistair J Gunn
- Paediatric Diabetes and Endocrinology Service, Starship Children's Health, Auckland, New Zealand.,Department of Physiology,, University of Auckland, Auckland, New Zealand
| | - Paul L Hofman
- Paediatric Diabetes and Endocrinology Service, Starship Children's Health, Auckland, New Zealand.,Liggins Institute, University of Auckland, Auckland, New Zealand
| |
Collapse
|
15
|
Wan EYF, Fong DYT, Fung CSC, Yu EYT, Chin WY, Chan AKC, Lam CLK. Development of a cardiovascular diseases risk prediction model and tools for Chinese patients with type 2 diabetes mellitus: A population-based retrospective cohort study. Diabetes Obes Metab 2018; 20:309-318. [PMID: 28722290 DOI: 10.1111/dom.13066] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 07/11/2017] [Accepted: 07/13/2017] [Indexed: 01/03/2023]
Abstract
AIMS Evidence-based cardiovascular diseases (CVD) risk prediction models and tools specific for Chinese patients with type 2 diabetes mellitus (T2DM) are currently unavailable. This study aimed to develop and validate a CVD risk prediction model for Chinese T2DM patients. METHODS A retrospective cohort study was conducted with 137 935 Chinese patients aged 18 to 79 years with T2DM and without prior history of CVD, who had received public primary care services between January 1, 2010 and December 31, 2010. Using the derivation cohort over a median follow-up of 5 years, the interaction effect between predictors and age were derived using Cox proportional hazards regression with a forward stepwise approach. Harrell's C statistic and calibration plot were used on the validation cohort to assess the discrimination and calibration of the models. The web calculator and chart were developed based on the developed models. RESULTS For both genders, predictors for higher risk of CVD were older age, smoking, longer diabetes duration, usage of anti-hypertensive drug and insulin, higher body mass index, haemoglobin A1c (HbA1c), systolic and diastolic blood pressure, a total cholesterol to high-density lipoprotein-cholesterol (TC/HDL-C) ratio and urine albumin to creatinine ratio, and lower estimated glomerular filtration rate. Interaction factors with age demonstrated a greater weighting of TC/HDL-C ratio in both younger females and males, and smoking status and HbA1c in younger males. CONCLUSION The developed models, translated into a web calculator and color-coded chart, served as evidence-based visual aids that facilitate clinicians to estimate quickly the 5-year CVD risk for Chinese T2DM patients and to guide intervention.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
- Department of Surgery, School of Nursing, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Daniel Yee Tak Fong
- Department of Surgery, School of Nursing, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| |
Collapse
|
16
|
Abstract
Diabetes educators are well positioned to help optimize care of the student with diabetes within the school setting.
Collapse
|
17
|
Šimunović M, Paradžik M, Škrabić R, Unić I, Bućan K, Škrabić V. Cataract as Early Ocular Complication in Children and Adolescents with Type 1 Diabetes Mellitus. Int J Endocrinol 2018; 2018:6763586. [PMID: 29755521 PMCID: PMC5883981 DOI: 10.1155/2018/6763586] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Accepted: 01/28/2018] [Indexed: 12/19/2022] Open
Abstract
Cataract is a rare manifestation of ocular complication at an early phase of T1DM in the pediatric population. The pathophysiological mechanism of early diabetic cataract has not been fully understood; however, there are many theories about the possible etiology including osmotic damage, polyol pathway, and oxidative stress. The prevalence of early diabetic cataract in the population varies between 0.7 and 3.4% of children and adolescents with T1DM. The occurrence of diabetic cataract in most pediatric patients is the first sign of T1DM or occurs within 6 months of diagnosis of T1DM. Today, there are many experimental therapies for the treatment of diabetic cataract, but cataract surgery continues to be a gold standard in the treatment of diabetic cataract. Since the cataract is the leading cause of visual impairment in patients with T1DM, diabetic cataract requires an initial screening as well as continuous surveillance as a measure of prevention and this should be included in the guidelines of pediatric diabetes societies.
Collapse
Affiliation(s)
- Marko Šimunović
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Martina Paradžik
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Roko Škrabić
- School of Medicine, University of Split, Šoltanska 2, Split, Croatia
| | - Ivana Unić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Kajo Bućan
- Department of Ophthalmology, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| | - Veselin Škrabić
- Department of Pediatrics, University Hospital Centre Split, Spinčićeva 1, 21000 Split, Croatia
| |
Collapse
|
18
|
Wan EYF, Fung CSC, Jiao FF, Yu EYT, Chin WY, Fong DYT, Wong CKH, Chan AKC, Chan KHY, Kwok RLP, Lam CLK. Five-Year Effectiveness of the Multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) on Diabetes-Related Complications and Health Service Uses-A Population-Based and Propensity-Matched Cohort Study. Diabetes Care 2018; 41:49-59. [PMID: 29138274 DOI: 10.2337/dc17-0426] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 09/23/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the 5-year effectiveness of a multidisciplinary Risk Assessment and Management Programme-Diabetes Mellitus (RAMP-DM) in primary care patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A 5-year prospective cohort study was conducted with 121,584 Chinese primary care patients with type 2 DM who were recruited between August 2009 and June 2011. Missing data were dealt with multiple imputations. After excluding patients with prior diabetes mellitus (DM)-related complications and one-to-one propensity score matching on all patient characteristics, 26,718 RAMP-DM participants and 26,718 matched usual care patients were followed up for a median time of 4.5 years. The effect of RAMP-DM on nine DM-related complications and all-cause mortality were evaluated using Cox regressions. The first incidence for each event was used for all models. Health service use was analyzed using negative binomial regressions. Subgroup analyses on different patient characteristics were performed. RESULTS The cumulative incidence of all events (DM-related complications and all-cause mortality) was 23.2% in the RAMP-DM group and 43.6% in the usual care group. RAMP-DM led to significantly greater reductions in cardiovascular disease (CVD) risk by 56.6% (95% CI 54.5, 58.6), microvascular complications by 11.9% (95% CI 7.0, 16.6), mortality by 66.1% (95% CI 64.3, 67.9), specialist attendance by 35.0% (95% CI 33.6, 36.4), emergency attendance by 41.2% (95% CI 39.8, 42.5), and hospitalizations by 58.5% (95% CI 57.2, 59.7). Patients with low baseline CVD risks benefitted the most from RAMP-DM, which decreased CVD and mortality risk by 60.4% (95% CI 51.8, 67.5) and 83.6% (95% CI 79.3, 87.0), respectively. CONCLUSIONS This naturalistic study highlighted the importance of early optimal DM control and risk factor management by risk stratification and multidisciplinary, protocol-driven, chronic disease model care to delay disease progression and prevent complications.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Fang Fang Jiao
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Daniel Yee Tak Fong
- School of Nursing, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Carlos King Ho Wong
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Karina Hiu Yen Chan
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| | - Ruby Lai Ping Kwok
- Primary and Community Services Department, Hospital Authority Head Office, Hong Kong Hospital Authority, Hong Kong, People's Republic of China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Ap Lei Chau Clinic, Ap Lei Chau, The University of Hong Kong, Hong Kong, People's Republic of China
| |
Collapse
|
19
|
Mackey ER, O'Brecht L, Holmes CS, Jacobs M, Streisand R. Teens with Type 1 Diabetes: How Does Their Nutrition Measure Up? J Diabetes Res 2018; 2018:5094569. [PMID: 30258854 PMCID: PMC6146652 DOI: 10.1155/2018/5094569] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/18/2018] [Accepted: 07/25/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To characterize the intake of macronutrient and fiber in adolescents with type 1 diabetes (T1D) and examine their association with health indicators. METHODS Baseline data from an RCT were examined. Adolescent-parent dyads (n = 257, mean age 12 ± 1.2 years, 49.4% girls) reported dietary intake via two separate 24-hour recall interviews during a two-week period. Demographic and medical variables were abstracted from questionnaires and medical charts. RESULTS Controlling for demographic and diet variables, a higher percentage of daily energy intake from fats was associated with poorer HbA1c. In contrast, an association between higher percent of energy intake from proteins and carbohydrates was found with higher systolic and diastolic BP, respectively. CONCLUSIONS Many early adolescents with T1D did not meet diabetes nutritional guidelines. Lower adherence to nutritional guidelines, specifically more than recommended energy intake from fats, was associated with poorer HbA1c. Addressing nutritional guidelines and increasing adherence as part of treatment may improve health outcomes for youth with T1D.
Collapse
Affiliation(s)
- Eleanor Race Mackey
- Children's National Health System, Psychology, Washington, DC, USA
- University of Toronto, Toronto, Ontario, Canada
| | | | - Clarissa S. Holmes
- Virginia Commonwealth University, Pediatrics, Richmond, VA, USA
- Georgetown University, Psychiatry, Washington, DC, USA
| | - Marni Jacobs
- Children's National Health System, Psychology, Washington, DC, USA
- University of Toronto, Toronto, Ontario, Canada
| | - Randi Streisand
- Children's National Health System, Psychology, Washington, DC, USA
- University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
20
|
Gomes MB, Rodacki M, Pavin EJ, Cobas RA, Felicio JS, Zajdenverg L, Negrato CA. The impact of ethnicity, educational and economic status on the prescription of insulin therapeutic regimens and on glycemic control in patients with type 1 diabetes. A nationwide study in Brazil. Diabetes Res Clin Pract 2017; 134:44-52. [PMID: 28951342 DOI: 10.1016/j.diabres.2017.09.013] [Citation(s) in RCA: 14] [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: 12/19/2016] [Revised: 09/01/2017] [Accepted: 09/19/2017] [Indexed: 02/06/2023]
Abstract
AIMS Establish the relationship between demographic, educational and economic status on insulin therapeutic regimens (ITRs) and on glycemic control in patients with type 1 diabetes. METHODS This was a cross-sectional, multicenter study with 1760 patients conducted between August 2011 and August 2014 in 10 Brazilian cities. RESULTS Patients were stratified according to ITRs as follows: only NPH insulin (group 1, n=80(4.5%)); only long-acting insulin analogs (group 2, n=6(0.3%)); continuous subcutaneous insulin infusion (CSII) (group 3, n=62(3.5%)); NPH plus regular insulin (group 4, n=710(40.3%)); NPH plus ultra-rapid insulin analogs (group 5, n=259(14.8%)); long-acting insulin analogs plus regular insulin (group 6, n=25(4.4%)) and long-acting plus ultra-rapid insulin analogs (group 7, n=618 (35.1%)). As group A (provided free of charge by the government) we considered groups 1 and 4, and as group B (obtained through lawsuit or out-of-pocket) groups 2, 3 and 7. Multivariate logistic analysis showed that independent variables related to group B were older age, more years of school attendance, higher economic status and ethnicity (Caucasians). The independent variables related to better glycemic control were older age, higher adherence to diet, higher frequency of self-monitoring of blood glucose, more years of school attendance and belonging to group B. CONCLUSIONS In Brazilian National Health Care System, prescriptions of insulin analogs or CSII are more frequent in Caucasian patients with type 1 diabetes, with higher economic status and more years ofschool attendance. Among these variables years of school attendance was the only one associated with better glycemic control.
Collapse
Affiliation(s)
- Marilia Brito Gomes
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Brazil
| | - Melanie Rodacki
- Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Brazil
| | - Elizabeth João Pavin
- Endocrinology Division, Department of Internal Medicine, Faculty of Medical Sciences, University of Campinas, São Paulo, Brazil
| | - Roberta Arnoldi Cobas
- Department of Internal Medicine, Diabetes Unit, State University Hospital of Rio de Janeiro, Brazil
| | - João S Felicio
- University Hospital João de Barros Barreto, Federal University of Pará, Endocrinology Division, Belém, Pará, Brazil
| | - Lenita Zajdenverg
- Diabetes and Nutrition Section, Department of Internal Medicine, Federal University of Rio de Janeiro, Brazil
| | - Carlos Antonio Negrato
- Bauru's Diabetics Association, Department of Internal Medicine, Bauru, São Paulo, Brazil.
| |
Collapse
|
21
|
Wan EYF, Fong DYT, Fung CSC, Yu EYT, Chin WY, Chan AKC, Lam CLK. Classification Rule for 5-year Cardiovascular Diseases Risk using decision tree in Primary Care Chinese Patients with Type 2 Diabetes Mellitus. Sci Rep 2017; 7:15238. [PMID: 29127341 PMCID: PMC5681694 DOI: 10.1038/s41598-017-15579-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 10/30/2017] [Indexed: 12/31/2022] Open
Abstract
Cardiovascular disease(CVD) is the leading cause of mortality among patients with type 2 diabetes mellitus(T2DM), and a risk classification model for CVD among primary care diabetic patients is pivotal for risk-based interventions and patient information. This study developed a simple tool for a 5-year CVD risk prediction for primary care Chinese patients with T2DM. A retrospective cohort study was conducted on 137,935 primary care Chinese T2DM patients aged 18-79 years without history of CVD between 1 January 2010 and 31 December 2010. New events of CVD of the cohort over a median follow up of 5 years were extracted from the medical records. A classification rule of 5-year CVD risk was obtained from the derivation cohort and validated in the validation cohort. Significant risk factors included in decision tree were age, gender, smoking status, diagnosis duration, obesity, unsatisfactory control on haemoglobin A1c and cholesterol, albuminuria and stage of chronic kidney disease, which categorized patients into five 5-year CVD risk groups(<5%; 5-9%; 10-14%; 15-19% and ≥20%). Taking the group with the lowest CVD risk, the hazard ratios varied from 1.92(1.77,2.08) to 8.46(7.75,9.24). The present prediction model performed comparable discrimination and better calibration from the plot compared to other current existing models.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | | | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, the University of Hong Kong, 3/F Ap Lei Chau Clinic, 161 Main Street, Ap Lei Chau, Hong Kong, China
| |
Collapse
|
22
|
Wan EYF, Yu EYT, Fung CSC, Chin WY, Fong DYT, Chan AKC, Lam CLK. Do We Need a Patient-Centered Target for Systolic Blood Pressure in Hypertensive Patients With Type 2 Diabetes Mellitus? Hypertension 2017; 70:1273-1282. [PMID: 29038204 DOI: 10.1161/hypertensionaha.117.10034] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 07/31/2017] [Accepted: 09/18/2017] [Indexed: 01/09/2023]
Abstract
The current trend on diabetes mellitus management advocates replacing the paradigm from a uniform to an individualized patient-centered systolic blood pressure (SBP), but there is no consensus on the achieved treatment goals of SBP level. The study aimed at evaluating the association between SBP and the risk of cardiovascular diseases (CVD) and all-cause mortality for diabetic patients to identify patient-centered treatment targets. A retrospective study was conducted on 95 086 Chinese adult primary care patients with type 2 diabetes mellitus and hypertension. Using the average of the annual SBP records (updated SBP) over a median follow-up of 5.9 years, the risks of overall CVD, all-cause mortality, and their composite associated with SBP were evaluated using Cox proportional hazards regression. Subgroup analysis was performed on the incidence of CVD by stratifying patient's baseline characteristics. The SBP range for the lowest risk of CVD and all-cause mortality was 130 to 134 mm Hg among type 2 diabetes mellitus population. A J-shaped curvilinear relationship was identified between SBP and risk of CVD and all-cause mortality, irrespective of patients' characteristics. The findings showed that all patients with SBP <125 mm Hg or ≥140 mm Hg had an increased risk of CVD and mortality. This large territory-wide study showed the level of achieved SBP of 125 to 139 mm Hg in pharmacological therapy, irrespective of patients' characteristics, suggested that the SBP treatment goal of <140 mm Hg and individualized SBP target may not be necessary in diabetic management.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong
| | - Esther Yee Tak Yu
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong.
| | - Colman Siu Cheung Fung
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong
| | - Weng Yee Chin
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong
| | - Daniel Yee Tak Fong
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong
| | - Anca Ka Chun Chan
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong
| | - Cindy Lo Kuen Lam
- From the Department of Family Medicine and Primary Care (E.Y.F.W., E.Y.T.Y., C.S.C.F., W.Y.C., A.K.C.C., C.L.K.L.) and School of Nursing (D.Y.T.F.), The University of Hong Kong
| |
Collapse
|
23
|
Wan EYF, Fung CSC, Yu EYT, Chin WY, Fong DYT, Chan AKC, Lam CLK. Effect of Multifactorial Treatment Targets and Relative Importance of Hemoglobin A1c, Blood Pressure, and Low-Density Lipoprotein-Cholesterol on Cardiovascular Diseases in Chinese Primary Care Patients With Type 2 Diabetes Mellitus: A Population-Based Retrospective Cohort Study. J Am Heart Assoc 2017; 6:e006400. [PMID: 28862945 PMCID: PMC5586469 DOI: 10.1161/jaha.117.006400] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Accepted: 06/12/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND The relative effect of hemoglobin A1c, blood pressure, and low-density lipoprotein-cholesterol (LDL-C) ("ABC" factors) on the prevention of cardiovascular diseases (CVD) among patients with type 2 diabetes mellitus is poorly understood. This study aimed to evaluate the association of key clinical parameters on CVD risk using a multifactorial optimal control approach in Chinese primary care patients with type 2 diabetes mellitus. METHODS AND RESULTS A population-based retrospective cohort study was conducted on 144 271 Chinese type 2 diabetes mellitus primary care patients, aged 18 to 79 and without prior clinical diagnosis of CVD in 2008-2011. Cox regressions were conducted to examine the association between the combinations of ABC targets (hemoglobin A1c <7%, blood pressure <130/90 mm Hg, and LDL-C <2.6 mmol/L) and risks of CVD (overall), coronary heart disease, stroke, and heart failure. Achieving more ABC targets incrementally reduced the incidence of total CVD and individual disease including coronary heart disease, stroke, and heart failure, irrespective of other patient characteristics. Compared with suboptimal control in all ABC levels, achieving any 1, 2, and all 3 ABC targets reduced the relative risk of CVD by 13% to 42%, 31% to 52%, and 55%, respectively. Among those achieving only 1 ABC target, LDL-C reduction was associated with the greatest CVD risk reduction (42%), followed by blood pressure reduction (18%), and hemoglobin A1c reduction (13%). CONCLUSIONS To achieve the greatest risk reduction for the incidence of CVD, the ultimate goal of treatment should be to achieve target control of hemoglobin A1c, blood pressure, and LDL-C. If it is not possible to achieve all 3 targets, efforts should be prioritized on treating the LDL-C to minimize CVD risk.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Weng Yee Chin
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | | | - Anca Ka Chun Chan
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, The University of Hong Kong, Ap Lei Chau, Hong Kong
| |
Collapse
|
24
|
DeBoer MD, Valdez R, Chernavvsky DR, Grover M, Burt Solorzano C, Herbert K, Patek S. The Impact of Frequency and Tone of Parent-Youth Communication on Type 1 Diabetes Management. Diabetes Ther 2017; 8:625-636. [PMID: 28405895 PMCID: PMC5446384 DOI: 10.1007/s13300-017-0259-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess the impact of frequency and tone of parent-youth communication on glycemic control as measured by the Family Communication Inventory (FCI). Adolescence provides a unique set of diabetes management challenges, including suboptimal glycemic control. Continued parental involvement in diabetes management is associated with improved HbA1c outcomes; however, diabetes-related conflict within the family can have adverse effects. Although it is clear that communication plays an important role in diabetes outcomes, the specific impact of frequency and tone of such communication is largely understudied. METHODS A total of 110 youths with type 1 diabetes and their parents completed questionnaires assessing diabetes-related adherence, family conflict, and family communication (i.e., frequency and tone) during a routine clinic visit. Routine testing of HbA1c was performed. RESULTS Youth- and parent-reported frequency of communication were unrelated to HbA1c. Instead, greater discrepancies between parents and children on reported frequency of communication (most commonly parents reporting frequent and youth reporting less frequent communication) corresponded with poorer glycemic control and increased family conflict. More positive tone of communication as rated by youth was associated with lower HbA1c. CONCLUSIONS Diabetes-related communication is more complex than conveyed simply by how often children and their parents communicate. Tone of communication and discrepancies in a family's perception of the frequency of communication were better than frequency as predictors of glycemic control. The FCI appears to capture the frequency and tone of diabetes-related communication, though larger-scale studies are warranted to inform future use of this scale.
Collapse
Affiliation(s)
- Mark D DeBoer
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Daniel R Chernavvsky
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Monica Grover
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Kirabo Herbert
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen Patek
- Department of Systems and Information Engineering, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| |
Collapse
|
25
|
Hilliard ME, Powell PW, Anderson BJ. Evidence-based behavioral interventions to promote diabetes management in children, adolescents, and families. ACTA ACUST UNITED AC 2017; 71:590-601. [PMID: 27690487 DOI: 10.1037/a0040359] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
As members of multidisciplinary diabetes care teams, psychologists are well-suited to support self-management among youth with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) and their families. Psychological and behavioral interventions can promote adherence to the complex and demanding diabetes care regimen, with the goals of promoting high quality of life, achieving optimal glycemic control, and ultimately preventing disease-related complications. This article reviews well-researched contemporary behavioral interventions to promote optimal diabetes family- and self-management and health outcomes in youth with T1D, in the context of key behavioral theories. The article summarizes the evidence base for established diabetes skills training programs, family interventions, and multisystemic interventions, and introduces emerging evidence for technology and mobile health interventions and health care delivery system interventions. Next steps in behavioral T1D intervention research include tailoring interventions to meet individuals' and families' unique needs and strengths, and systematically evaluating cost-effectiveness to advocate for dissemination of well-developed interventions. Although in its infancy, this article reviews observational and intervention research for youth with T2D and their families and discusses lessons for future research with this population. Interventions for youth with T2D will need to incorporate family members, consider cultural and family issues related to health behaviors, and take into account competing priorities for resources. As psychologists and behavioral scientists, we must advocate for the integration of behavioral health into routine pediatric diabetes care in order to effectively promote meaningful change in the behavioral and medical well-being of youth and families living with T1D and T2D. (PsycINFO Database Record
Collapse
|
26
|
Wan EYF, Fung CSC, Yu EYT, Fong DYT, Chen JY, Lam CLK. Association of Visit-to-Visit Variability of Systolic Blood Pressure With Cardiovascular Disease and Mortality in Primary Care Chinese Patients With Type 2 Diabetes-A Retrospective Population-Based Cohort Study. Diabetes Care 2017; 40:270-279. [PMID: 27899498 DOI: 10.2337/dc16-1617] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/09/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate the impact of visit-to-visit variability (VVV) of systolic blood pressure (SBP) on cardiovascular disease (CVD) and mortality among primary care Chinese patients with type 2 diabetes mellitus (T2DM). RESEARCH DESIGN AND METHODS A retrospective cohort study was conducted in 124,105 Chinese adult primary care patients with T2DM and without prior diagnosed CVD from August 2008 to December 2009. The VVV of SBP was evaluated using SDs of SBP over 24 months. The risks of CVD and all-cause mortality associated with variability in SBP were evaluated using Cox proportional hazards regression. Subgroup analysis was conducted by the stratification of age, sex, duration of diabetes, the presence of chronic kidney disease, baseline SBP and trend, and the number and class of antihypertensive drugs. RESULTS A positive linear relationship between the VVV of SBP and the first incidence of CVD and all-cause mortality was identified over a median follow-up time of 39.5 months. Patients with a low SD of SBP of <5 mmHg had the lowest risks of CVD and all-cause mortality, and patients with an SD of SBP of ≥10 mmHg had significantly higher risks. For every 1 SD increase in the SD of SBP, the risks of CVD, all-cause mortality, and the composite of both events increased by 2.9% (95% CI 2.4-3.4%), 4.0% (95% CI 3.5-4.6%), and 3.4% (95% CI 3.0-3.8%), respectively. A direct linear relationship was also observed in all selected subgroups. CONCLUSIONS SBP variability, irrespective of the mean SBP level, is a potential predictor for the development of CVD and all-cause mortality in patients with diabetes. In addition to monitoring BP targets for their patients with diabetes, clinicians should also remain vigilant about the visit-to-visit fluctuation of BP.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Colman Siu Cheung Fung
- Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Esther Yee Tak Yu
- Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong
| | | | - Julie Yun Chen
- Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, University of Hong Kong, Ap Lei Chau, Hong Kong
| |
Collapse
|
27
|
Management of Children With Diabetes in the School Setting. DIABETES EDUCATOR 2017; 43:34-39. [PMID: 28118126 DOI: 10.1177/0145721716683812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Diabetes educators are well positioned to help optimize care of the student with diabetes within the school setting.
Collapse
|
28
|
Karges B, Kapellen T, Wagner VM, Steigleder-Schweiger C, Karges W, Holl RW, Rosenbauer J. Glycated hemoglobin A1c as a risk factor for severe hypoglycemia in pediatric type 1 diabetes. Pediatr Diabetes 2017; 18:51-58. [PMID: 26712064 DOI: 10.1111/pedi.12348] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Revised: 11/12/2015] [Accepted: 11/23/2015] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess the risk of severe hypoglycemia related to glycated hemoglobin A1c (HbA1c) levels in a population-based cohort of pediatric type 1 diabetes patients during two time periods since 1995. METHODS The association between HbA1c levels and severe hypoglycemia (defined as requiring assistance from another person) or hypoglycemic coma (loss of consciousness or seizures) was analyzed by multivariable regression analysis in children and adolescents with type 1 diabetes from the DPV Diabetes Prospective Follow-up in Germany and Austria in 1995-2003 (n = 15 221 patients) and 2004-2012 (n = 22 318 patients). RESULTS Mean adjusted rates of severe hypoglycemia and hypoglycemic coma decreased from 19.18 [95% confidence interval (CI), 17.95-20.48] and 4.36 (3.93-4.83) per 100 patient-years in 1995-2003 to 15.01 (14.18-15.88) and 2.15 (1.94-2.39) in 2004-2012, respectively (p < 0.001). From the first to the second period, the relative risk (RR) for severe hypoglycemia and hypoglycemic coma per 1% lower HbA1c decreased from 1.22 (1.15-1.30) to 1.06 (1.01-1.12) and from 1.27 (1.15-1.40) to 1.04 (0.94-1.16), respectively. Risk of severe hypoglycemia and coma declined most in patients with HbA1c levels of 6-6.9% (RR 0.70 and 0.43, respectively) and with HbA1c of 7-7.9% (RR 0.63 and 0.38, respectively). Mean HbA1c levels fell from 8.4% in 1995-2003 to 8.2% in 2004-2012, while the use of insulin pumps, short- and long-acting insulin analogs, and glucose monitoring increased (p < 0.001). CONCLUSIONS In contrast to 1995-2003, low HbA1c has become a minor risk factor for severe hypoglycemia and coma in pediatric patients with type 1 diabetes in the 2004-2012 period.
Collapse
Affiliation(s)
- Beate Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany.,Department of Gynecological Endocrinology and Reproductive Medicine, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany.,Department of Pediatrics, Bethlehem Hospital, Stolberg, Germany
| | - Thomas Kapellen
- Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | - Verena M Wagner
- Department of Pediatrics, University of Lübeck, Lübeck, Germany
| | | | - Wolfram Karges
- Division of Endocrinology and Diabetes, Medical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Aachen, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
| | - Joachim Rosenbauer
- Institute for Biometrics and Epidemiology, Leibniz Center at University of Düsseldorf, German Center for Diabetes Research (DZD), Düsseldorf, Germany
| | | |
Collapse
|
29
|
Katz ML, Kollman CR, Dougher CE, Mubasher M, Laffel LMB. Influence of HbA1c and BMI on Lipid Trajectories in Youths and Young Adults With Type 1 Diabetes. Diabetes Care 2017; 40:30-37. [PMID: 27797924 PMCID: PMC5180464 DOI: 10.2337/dc16-0430] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 09/28/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess the influence of HbA1c and BMI (measured as BMI z score [zBMI]) on LDL, HDL, and non-HDL trajectories as youths with type 1 diabetes age into early adulthood. RESEARCH DESIGN AND METHODS Dynamic, retrospective cohort study examining changes in lipid values in 572 youths with type 1 diabetes followed longitudinally for a median of 9.3 years. Through longitudinal modeling, we describe the relationship of HbA1c and zBMI on lipid values as subjects age after adjusting for other relevant factors, including lipid-lowering medication use. RESULTS The median number of lipid assessments was 7 (range 2-39). Every 1% increase in HbA1c was associated with an ∼2-6 mg/dL increase in LDL levels, with a greater increase in LDL levels as subjects progressed from prepubertal to postpubertal age ranges. A 1-SD increase in BMI was associated with a mean LDL increase of 2.1 mg/dL when subjects were 10 years old and increased to a mean of 8.2 mg/dL when subjects were 19 years old. The association between changes in HbA1c level and zBMI and changes in non-HDL levels as youths aged were similar to the associations found with LDL. The influence of HbA1c and zBMI on HDL levels was small and not dependent on age. CONCLUSIONS Changes in HbA1c level and zBMI modestly impact LDL and non-HDL cholesterol and have greater impacts as children age. Addressing elevations in HbA1c and zBMI as children enter into adolescence and beyond may lead to improvements in lipid levels.
Collapse
Affiliation(s)
- Michelle L Katz
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
| | | | - Carly E Dougher
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
| | | | - Lori M B Laffel
- Section on Genetics and Epidemiology, Joslin Diabetes Center, Boston, MA
| |
Collapse
|
30
|
Abstract
The skeleton is adversely affected by type 1 diabetes (T1D). Patients with T1D of both sexes have an increased risk of fracture that begins in childhood and extends across the entire lifespan. T1D is characterized by mild to modest deficits in bone density, structure, and microarchitecture. Current evidence suggests that the observed bone deficits in T1D are the result of impaired bone formation rather than increased bone resorption. There is emerging data that bone quality is impaired in T1D, which may explain the findings that fracture risk is elevated out of proportion to the degree of bone mineral deficit. In this review, we summarize the current knowledge regarding the epidemiology of skeletal health in T1D. Given the high individual and societal burden of osteoporotic fracture, there is an urgent need to better understand the etiology of T1D-related bone disease so that clinical strategies to prevent fracture can be developed.
Collapse
Affiliation(s)
- David R Weber
- Division of Pediatric Endocrinology, University of Rochester, 601 Elmwood Ave, Box 690, Rochester, NY, 14642, USA.
| | - George Schwartz
- Division of Pediatric Nephrology, University of Rochester, 601 Elmwood Ave, Box 690, Rochester, NY, 14642, USA
| |
Collapse
|
31
|
Dayton KA, Silverstein J. What the Primary Care Provider Needs to Know to Diagnose and Care for Adolescents with Type 1 Diabetes. J Pediatr 2016; 179:249-255.e1. [PMID: 27663214 DOI: 10.1016/j.jpeds.2016.08.077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2016] [Revised: 07/06/2016] [Accepted: 08/23/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Kristin A Dayton
- University of Florida Shands Children's Hospital, Division of Pediatric Endocrinology, Gainesville, FL.
| | - Janet Silverstein
- University of Florida Shands Children's Hospital, Division of Pediatric Endocrinology, Gainesville, FL
| |
Collapse
|
32
|
Tabatabaei-Malazy O, Nikfar S, Larijani B, Abdollahi M. Drugs for the treatment of pediatric type 2 diabetes mellitus and related co-morbidities. Expert Opin Pharmacother 2016; 17:2449-2460. [PMID: 27819155 DOI: 10.1080/14656566.2016.1258057] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
|
33
|
Katz LL, Anderson BJ, McKay SV, Izquierdo R, Casey TL, Higgins LA, Wauters A, Hirst K, Nadeau KJ. Correlates of Medication Adherence in the TODAY Cohort of Youth With Type 2 Diabetes. Diabetes Care 2016; 39:1956-1962. [PMID: 27352955 PMCID: PMC5079608 DOI: 10.2337/dc15-2296] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Accepted: 05/01/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify factors that predict medication adherence and to examine relationships among adherence, glycemic control, and indices of insulin action in TODAY (Treatment Options for Type 2 Diabetes in Adolescents and Youth). RESEARCH DESIGN AND METHODS A total of 699 youth 10-17 years old with recent-onset type 2 diabetes and ≥80% adherence to metformin therapy for ≥8 weeks during a run-in period were randomized to receive one of three treatments. Participants took two study pills twice daily. Adherence was calculated by pill count from blister packs returned at visits. High adherence was defined as taking ≥80% of medication; low adherence was defined as taking <80% of medication. Depressive symptoms, insulin sensitivity (1/fasting insulin), insulinogenic index, and oral disposition index (oDI) were measured. Survival analysis examined the relationship between medication adherence and loss of glycemic control. Generalized linear mixed models analyzed trends in adherence over time. RESULTS In this low socioeconomic cohort, high and low adherence did not differ by sex, age, family income, parental education, or treatment group. Adherence declined over time (72% high adherence at 2 months, 56% adherence at 48 months, P < 0.0001). A greater percentage of participants with low adherence had clinically significant depressive symptoms at baseline (18% vs. 12%, P = 0.0415). No adherence threshold predicted the loss of glycemic control. Longitudinally, participants with high adherence had significantly greater insulin sensitivity and oDI than those with low adherence. CONCLUSIONS In the cohort, the presence of baseline clinically significant depressive symptoms was associated with subsequent lower adherence. Medication adherence was positively associated with insulin sensitivity and oDI, but, because of disease progression, adherence did not predict long-term treatment success.
Collapse
Affiliation(s)
- Lorraine Levitt Katz
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, and Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Barbara J Anderson
- Baylor College of Medicine, Houston, TX.,Texas Children's Hospital, Houston, TX
| | | | - Roberto Izquierdo
- State University of New York Upstate Medical University, Syracuse, NY
| | - Terri L Casey
- University Hospitals Case Medical Center, Cleveland, OH
| | - Laurie A Higgins
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA
| | - Aimee Wauters
- University of Texas Health Science Center, San Antonio, TX
| | - Kathryn Hirst
- George Washington University Biostatistics Center, Rockville, MD
| | | | | |
Collapse
|
34
|
Paruk IM, Ganie Y, Maharaj S, Pirie FJ, Naidoo VG, Nkwanyana NM, Dinnematin HL, Ramdial PK, Motala AA. High prevalence of antithyroid peroxidase and antiparietal cell antibodies among patients with type 1 diabetes mellitus attending a tertiary diabetes centre in South Africa. Postgrad Med J 2016; 93:338-343. [PMID: 27742863 DOI: 10.1136/postgradmedj-2016-134420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 09/16/2016] [Accepted: 09/21/2016] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Data on the prevalence of autoimmune thyroid disease (AITD) and gastric autoimmunity in type 1 diabetes mellitus (T1DM) in Africa are limited. The aim of this study was to assess the prevalence of antithyroid peroxidase (TPO-A) and antiparietal cell antibody (PCA) in patients with T1DM at a tertiary diabetes clinic in Durban, South Africa. RESEARCH DESIGN AND METHODS This was a cross-sectional observational study among subjects attending the adult T1DM clinic at Inkosi Albert Luthuli Hospital. Information about history and clinical examination was collected. Blood tests included glutamic acid decarboxylase antibody (GADA), TPO-A, PCA, vitamin B12, folate, ferritin, thyroid stimulating hormone (TSH), free thyroxine, lipids and HbA1c. RESULTS A total of 202 (M:F, 90:112) patients were recruited. The ethnic composition was African (black) (56.4%; n=114), Indian (31.7%; n=64), white (4.5%; n=9) and coloured (mixed race) (7.4%; n=15). Mean age and mean duration of diabetes were 26.4±11.4 and 10.7±9.1 years, respectively. Mean body mass index was 21.6±6.3 kg/m2. GADA was positive in 63.37% (n=128). The prevalence of TPO-A was 18.9% (n=39) and PCA 8.9% (n=17). The prevalence of overt hypothyroidism, subclinical hypothyroidism and Graves' disease was 10.9%, 2.5% and 1.5%, respectively; vitamin B12 deficiency was noted in 3.5% (n=7) and iron deficiency in 19.3% (n=39). CONCLUSIONS Among patients with T1DM in this study, there was a high prevalence of coexistent AITD and gastric autoimmunity. Screening for hypothyroidism and thyroid autoimmunity should be undertaken in all patients at initial presentation. However, to assess the feasibility and optimal timing of subsequent testing in the African setting with limited resources, more collaborative research with longitudinal studies is required.
Collapse
Affiliation(s)
- Imran M Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Yasmeen Ganie
- Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
| | - Sureka Maharaj
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Fraser J Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Vasudevan G Naidoo
- Department of Gastroenterology and Hepatology, University of KwaZulu-Natal, Durban, South Africa
| | | | - Hilary L Dinnematin
- Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Pratistadevi K Ramdial
- Department of Anatomical Pathology, University of KwaZulu-Natal, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
35
|
Abstract
Youth with type 1 diabetes are at risk for developing cardiovascular disease, and regular physical activity is strongly recommended as one strategy for prevention, as well as for good glycemic control. Despite recommendations, families in this pediatric population face unique barriers to physical activity, including fear of hypoglycemia. Moreover, families are not routinely counseled in the specific health and psychosocial benefits of following physical activity recommendations for youth with type 1 diabetes. To bridge this gap, the recent literature regarding physical activity in children with type 1 diabetes is reviewed with particular focus on young children. A discussion of the limitations of the current body of research, and recommendations for objectively measured physical activity are provided. Specific recommendations for clinical practice are given, including provider endorsements for regular physical activity for longer than 60 minutes, at least three times a week.
Collapse
Affiliation(s)
- Carrie Tully
- Center for Translational Research, Children's National Medical Center, 111 N. Michigan Avenue, NW, Washington, DC, 20010, USA.
| | - Laura Aronow
- Center for Translational Research, Children's National Medical Center, 111 N. Michigan Avenue, NW, Washington, DC, 20010, USA
| | - Eleanor Mackey
- Center for Translational Research, Children's National Medical Center, 111 N. Michigan Avenue, NW, Washington, DC, 20010, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Randi Streisand
- Center for Translational Research, Children's National Medical Center, 111 N. Michigan Avenue, NW, Washington, DC, 20010, USA
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| |
Collapse
|
36
|
Raman S, Dai H, DeLurgio SA, Williams DD, Lind M, Patton SR, Spertus JA, Kosiborod M, Clements MA. High hemoglobin A1c variability is associated with early risk of microalbuminuria in children with T1D. Pediatr Diabetes 2016; 17:398-406. [PMID: 26377593 PMCID: PMC6541408 DOI: 10.1111/pedi.12300] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/02/2015] [Accepted: 07/02/2015] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To test the hypothesis that HbA1c variability, as measured by standard deviation (SD), is associated with increased risk for incident microalbuminuria and persistent microalbuminuria in pediatric type 1 diabetes (T1D). METHODS A retrospective analysis using data from electronic health records was performed on 1195 patients from a pediatric diabetes clinic network in the Midwest USA from 1993 to 2009 with ≥1 yr of T1D, ≥4 total HbA1c values, ≥2 HbA1c values/yr, ≥1 urine microalbumin. Microalbuminuria, the main outcome was defined as albumin excretion rate ≥20 mcg/min or 2 of 3 consecutive urine microalbumin/creatinine ≥30 mg/gm. Patients who had persistently high microalbumin or who were treated with an angiotensin-converting-enzyme inhibitor within 1 yr were considered to have persistent microalbuminuria. Sex, race, age, diagnosis age, and duration were covariates. RESULTS Median numbers of per-patient HbA1c and microalbumin results were 14 and 3, respectively. Median intrapersonal mean HbA1c and SD were 8.62% (70.72 mol/mol) and 1.47% (16.07 mmol/mol), respectively. The median interquartile range (IQR) of diagnosis age was 9.4 yr (6.26-12.02) and diabetes duration was 4.97 yr (2.93-7.64). A total of 172 patients (14.4%) developed microalbuminuria; 55 (4.6%) had persistent microalbuminuria. Patients with higher SD of HbA1c had shorter time to microalbuminuria. In time-dependent Cox Proportional Hazard models, updated SD of HbA1c was significantly associated with microalbuminuria [univariate hazard ratio (HR) 1.48 (1.25-1.76); multivariable HR 1.28 (1.04-1.58)], whereas updated mean HbA1c was not [univariate HR 1.08 (0.97-1.22); multivariable HR 1.05 (0.92-1.2)]. Patients with persistent microalbuminuria had similar HRs. CONCLUSIONS HbA1c variability is independently associated with development of microalbuminuria in children with T1D, highlighting the importance of maintaining stable glycemic control in pediatric patients.
Collapse
Affiliation(s)
- Sripriya Raman
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,University of Kansas Medical Center, Kansas City, KS, USA
| | - Hongying Dai
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,Department of Research Development and Clinical Investigations, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Stephen A. DeLurgio
- Department of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - David D. Williams
- Department of Health Services and Outcomes Research, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA
| | - Marcus Lind
- Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden,Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | | | - John A. Spertus
- Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA,Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Mikhail Kosiborod
- Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA,Cardiovascular Services, Saint Luke’s Mid America Heart Institute, Kansas City, MO, USA
| | - Mark A. Clements
- Department of Pediatrics, Children’s Mercy Hospitals and Clinics, Kansas City, MO, USA,Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, USA,University of Kansas Medical Center, Kansas City, KS, USA
| |
Collapse
|
37
|
Wan EYF, Fung CSC, Fong DYT, Lam CLK. Association of variability in hemoglobin A1c with cardiovascular diseases and mortality in Chinese patients with type 2 diabetes mellitus - A retrospective population-based cohort study. J Diabetes Complications 2016; 30:1240-7. [PMID: 27318537 DOI: 10.1016/j.jdiacomp.2016.05.024] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 04/12/2016] [Accepted: 05/26/2016] [Indexed: 02/06/2023]
Abstract
AIMS This study aimed to investigate the association between variability in HbA1c and incidence of cardiovascular disease (CVD) event and mortality among Chinese primary care patients with Type 2 diabetes mellitus (T2DM). METHODS A retrospective cohort study was conducted on 91,866 T2DM patients aged ≥18years without any history of CVD. Variability in HbA1c, was measured by standard deviation (SD), associated with the risks of CVD and all-cause mortality were evaluated using Cox proportional hazards regression analysis by age groups ( 65 and ≥ 65 years old)." to "Variability in HbA1c was measured by standard deviation (SD) The association between Variability in HbA1c and the incidence of CVD and all-cause mortality were evaluated using Cox proportional hazards regression analysis by age groups ( 65 and ≥ 65 years old). RESULTS Over a median follow-up of 58.5months, our study identified a positive linear relationship between variability in HbA1c and incidence of CVD and all-cause mortality in the younger and older groups. For every 1-SD increase in HbA1c, the risk of CVD events in the older group only increased by 15.2% (95% CI: 1.026-1.293), and the risks of all-cause mortality in both age groups increased by 49.5% (95% CI: 1.154-1.936) and 77.8% (95% CI: 1.563-2.024), respectively. CONCLUSIONS The HbA1c variability independently of the mean HbA1c level may provide additional valuable information as a potential predictor for the development of CVD and all-cause mortality in diabetic patients, particularly for the elderly patients.
Collapse
Affiliation(s)
- Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong; School of Nursing, the University of Hong Kong, Hong Kong.
| | | | | | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, the University of Hong Kong, Hong Kong.
| |
Collapse
|
38
|
Serkel-Schrama IJP, de Vries J, Nieuwesteeg AM, Pouwer F, Nyklíček I, Speight J, de Bruin EI, Bögels SM, Hartman EE. The Association of Mindful Parenting with Glycemic Control and Quality of Life in Adolescents with Type 1 Diabetes: Results from Diabetes MILES-The Netherlands. Mindfulness (N Y) 2016; 7:1227-1237. [PMID: 27642376 PMCID: PMC5010614 DOI: 10.1007/s12671-016-0565-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The objective of this study was to examine associations between the mindful parenting style of parents of adolescents (aged 12-18) with type 1 diabetes mellitus (T1DM), and the glycaemic control and quality of life (QoL) of the adolescents. Chronic health conditions, such as T1DM, that require demanding treatment regimens, can negatively impact adolescents' quality of life. Therefore, it is important to determine whether mindful parenting may have a positive impact in these adolescents. Age, sex and duration of T1DM were examined as potential moderators. Parents (N = 215) reported on their own mindful parenting style (IM-P-NL) and the adolescents' glycaemic control. Parents and the adolescents with T1DM (N = 129) both reported on adolescents' generic and diabetes-specific QoL (PedsQL™). The results showed that a more mindful parenting style was associated with more optimal hemoglobin A1c (HbA1c) values for boys. For girls, a more mindful parenting style was associated with not having been hospitalized for ketoacidosis. For both boys and girls, a more mindful parenting style was associated with better generic and diabetes-specific proxy-reported QoL. In conclusion, mindful parenting style may be a factor in helping adolescents manage their T1DM. Mindful parenting intervention studies for parents of adolescents with T1DM are needed to examine the effects on adolescents' glycaemic control and their quality of life.
Collapse
Affiliation(s)
| | - Jolanda de Vries
- Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Anke M. Nieuwesteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Frans Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Ivan Nyklíček
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC Australia
| | - Esther I. de Bruin
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Susan M. Bögels
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther E. Hartman
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| |
Collapse
|
39
|
Liu W, Yang XJ. The Effect of Metformin on Adolescents with Type 1 Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int J Endocrinol 2016; 2016:3854071. [PMID: 27478438 PMCID: PMC4960345 DOI: 10.1155/2016/3854071] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 05/21/2016] [Accepted: 06/05/2016] [Indexed: 02/08/2023] Open
Abstract
Background. The effect of metformin in combination with insulin in adolescents with type 1 diabetes (T1DM) is controversial. Methods and Results. The PubMed and EMBASE online databases were searched. Five double-blind randomized controlled trials (RCTs) that included 301 adolescents with T1DM were identified. Metformin plus insulin was associated with reduced hemoglobin A1C levels, total daily insulin dosage, body mass index (BMI), and body weight. However, the subgroup analysis demonstrated that HbA1c levels were not significantly changed in overweight/obese adolescents and were significantly reduced in the general patients. On the contrary, BMI and body weight were significantly reduced in overweight/obese adolescents but not in the general patients. Metformin was associated with higher incidence of adverse events. Conclusions. Among adolescents with T1DM, administering adjunctive metformin therapy in addition to insulin was associated with improved HbA1c levels, total daily insulin dosage, BMI, and body weight. However, there may be differences in the effects of this regimen between overweight/obese and nonobese adolescents. The risk of an adverse event may be increased with metformin treatment. These results provide strong evidence supporting future high-quality, large-sample trials.
Collapse
Affiliation(s)
- Wei Liu
- Department of Cardiology, Guizhou Provincial People's Hospital, Guizhou 550002, China
| | - Xiao-Jie Yang
- Department of Endocrinology, Guizhou Provincial People's Hospital, Guizhou 550002, China
| |
Collapse
|
40
|
Ersig AL, Tsalikian E, Coffey J, Williams JK. Stressors in Teens with Type 1 Diabetes and Their Parents: Immediate and Long-Term Implications for Transition to Self-Management. J Pediatr Nurs 2016; 31:390-6. [PMID: 26831378 DOI: 10.1016/j.pedn.2015.12.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 01/21/2023]
Abstract
UNLABELLED Teens with Type 1 diabetes and their parents experience every day and illness-related stress; however, understanding of how these stressors relate to the transition to adulthood is limited. The purpose of this study was to identify stressors of teens with Type 1 diabetes (T1DM) and their parents related to the impending transition to adulthood. DESIGN AND METHODS This study used open-ended questions to identify every day and illness-related stressors among 15 teens with T1DM and 25 parents seen in one pediatric diabetes clinic. Qualitative descriptive analysis identified themes in interview transcripts. RESULTS The primary teen stressor related to impending transition centered on ineffective self-management, often when they were taking over responsibility for T1DM management. Parents' concerns included immediate and long-term negative outcomes of teen self-management as well as financial resources and health insurance for the teen. Teens and parents both expressed specific concerns about outcomes and prevention of nocturnal hypoglycemia, and identified uncertainties related to teen health and diabetes-focused health care when no longer living in the parent's home. CONCLUSIONS Teens with Type 1 diabetes and their parents understand that independent teen self-management is a component of transition to adulthood, but worry about teen self-management outcomes. Concerns specific to health care transition included health insurance, T1DM resources, and teens' abilities to handle new situations. PRACTICE IMPLICATIONS Identifying current and future self-management concerns of individuals and families can facilitate targeted education and interventions to support successful transition to adulthood.
Collapse
Affiliation(s)
- Anne L Ersig
- College of Nursing, The University of Iowa, Iowa City, IA.
| | - Eva Tsalikian
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
| | - Julie Coffey
- University of Iowa Carver College of Medicine, Stead Family Department of Pediatrics, Iowa City, IA
| | | |
Collapse
|
41
|
Reitblat L, Whittemore R, Weinzimer SA, Tamborlane WV, Sadler LS. Life With Type 1 Diabetes. DIABETES EDUCATOR 2016; 42:408-17. [DOI: 10.1177/0145721716647489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose The purpose of this study was to describe the experience of Hispanic adolescents with type 1 diabetes (T1DM) from the perspectives of adolescents and their diabetes clinicians. Methods Nine Hispanic adolescents with T1DM and 7 clinicians at a tertiary academic medical center participated in in-depth individual semistructured interviews. Adolescents were purposively sampled to obtain a range in age and metabolic control. Based on interpretive descriptive methodology, data were coded and combined into themes, which were constructed separately for the 2 groups and then compared across groups. Data were analyzed concurrently with data collection. Results Adolescents and clinicians reported similar themes related to (1) cultural aspects of living with T1DM; (2) finding the balance of: food, insulin, and exercise; being “perfect at diabetes” versus being a “normal teenager”; and being independent versus needing support, and (3) ways to improve life for Hispanic adolescents with T1DM. Although there were some key cultural distinctions, Hispanic adolescents with T1DM and their clinicians described life and daily management issues as being similar to those of their non-Hispanic peers. Conclusions Hispanic adolescents with T1DM have unique experiences and beliefs that affect their living with T1DM, but in many respects, their experiences are similar to those of their non-Hispanic peers with T1DM. Hispanic adolescents with T1DM want their clinicians to learn about their personal lives. Preferably, clinicians and parents should speak the same language. If not possible, interpreters should be used instead of having adolescents translate during clinic appointments.
Collapse
Affiliation(s)
- Lital Reitblat
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut (Dr Reitblat, Dr Weinzimer, Dr Tamborlane)
- Yale School of Nursing, Orange, Connecticut (Dr Whittemore, Dr Weinzimer, Dr Sadler)
| | - Robin Whittemore
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut (Dr Reitblat, Dr Weinzimer, Dr Tamborlane)
- Yale School of Nursing, Orange, Connecticut (Dr Whittemore, Dr Weinzimer, Dr Sadler)
| | - Stuart A. Weinzimer
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut (Dr Reitblat, Dr Weinzimer, Dr Tamborlane)
- Yale School of Nursing, Orange, Connecticut (Dr Whittemore, Dr Weinzimer, Dr Sadler)
| | - William V. Tamborlane
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut (Dr Reitblat, Dr Weinzimer, Dr Tamborlane)
- Yale School of Nursing, Orange, Connecticut (Dr Whittemore, Dr Weinzimer, Dr Sadler)
| | - Lois S. Sadler
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut (Dr Reitblat, Dr Weinzimer, Dr Tamborlane)
- Yale School of Nursing, Orange, Connecticut (Dr Whittemore, Dr Weinzimer, Dr Sadler)
| |
Collapse
|
42
|
Acerini C. The rise of technology in diabetes care. Not all that is new is necessarily better. Pediatr Diabetes 2016; 17:168-73. [PMID: 26854003 DOI: 10.1111/pedi.12366] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2016] [Accepted: 01/06/2016] [Indexed: 12/18/2022] Open
Abstract
Health-care technologies have brought many benefits to the medical profession and to patients. The introduction of the continuous subcutaneous insulin infusion (CSII) pump and continuous glucose monitoring (CGM) devices offers patients with type 1 diabetes (T1D) the opportunity to optimize their blood glucose control and are increasingly being championed as a routine treatment approach for young people. However, the current evidence base does not convincingly support arguments for the generalized application of CSII and CGM into routine clinical practice. The 'patient-medical device interface' is clearly a complex paradigm, and central to its success is the degree of adherence, understanding, and engagement demonstrated by the patient with the technology. The introduction CSII/CGM technologies into the daily routine care of the patient imposes both psychological and 'time-effort' burdens that many patients and families with T1D will find demanding. The current application of these devices cannot therefore be considered a panacea for the self-management of T1D, and raises a number of challenging problems, including those of a practical, health-economic, and ethical nature that need to be fully resolved before it and other emerging technologies can be considered to have achieved this status.
Collapse
Affiliation(s)
- Carlo Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| |
Collapse
|
43
|
Kumar RB, Goren ND, Stark DE, Wall DP, Longhurst CA. Automated integration of continuous glucose monitor data in the electronic health record using consumer technology. J Am Med Inform Assoc 2016; 23:532-7. [PMID: 27018263 PMCID: PMC4901382 DOI: 10.1093/jamia/ocv206] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Accepted: 12/08/2015] [Indexed: 01/04/2023] Open
Abstract
The diabetes healthcare provider plays a key role in interpreting blood glucose trends, but few institutions have successfully integrated patient home glucose data in the electronic health record (EHR). Published implementations to date have required custom interfaces, which limit wide-scale replication. We piloted automated integration of continuous glucose monitor data in the EHR using widely available consumer technology for 10 pediatric patients with insulin-dependent diabetes. Establishment of a passive data communication bridge via a patient’s/parent’s smartphone enabled automated integration and analytics of patient device data within the EHR between scheduled clinic visits. It is feasible to utilize available consumer technology to assess and triage home diabetes device data within the EHR, and to engage patients/parents and improve healthcare provider workflow.
Collapse
Affiliation(s)
- Rajiv B Kumar
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA Department of Clinical Informatics, Stanford Children's Health, Palo Alto, CA, USA
| | - Nira D Goren
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA
| | - David E Stark
- Biomedical Informatics Training Program, Stanford School of Medicine, Palo Alto, CA, USA
| | - Dennis P Wall
- Department of Pediatrics, Stanford School of Medicine, Palo Alto, CA, USA
| | - Christopher A Longhurst
- Department of Biomedical Informatics, UC San Diego, La Jolla, CA, USA; formerly at 1,2,3 when work was submitted
| |
Collapse
|
44
|
Brancaglioni BDCA, Rodrigues GC, Damião EBC, Queiroz MS, Nery M. Children and adolescents living with diabetes and celiac disease. Rev Gaucha Enferm 2016; 37:e53787. [PMID: 26982681 DOI: 10.1590/1983-1447.2016.01.53787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2015] [Accepted: 09/30/2015] [Indexed: 11/22/2022] Open
Abstract
Objective To understand the experience of children and adolescents living with type 1 diabetes and celiac disease. Method This is a qualitative exploratory-descriptive study. The participants were 3 children and 2 adolescents. The data were collected by means of semi-structured interviews between January and September 2012 at the participant's residence or at the diabetic outpatient clinic of the Hospital das Clinicas, Faculty of Medicine, University of Sao Paulo in São Paulo, Brazil. The content analysis technique was used to process the data. Results The key aspect of the illness experience of the patients was their diet, but with different meanings. The children had difficulty following the diet, while the adolescents reported that they had greater difficulty coping with the social and affective aspects of their diet. Conclusion The results reinforce the importance of nurses who seek strategies, together with the patients and their families, that help minimize the difficulties of these patients, especially with regard to managing the diet imposed by both diseases.
Collapse
Affiliation(s)
| | | | - Elaine Buchhorn Cintra Damião
- Departamento de Enfermagem Materno-Infantil e Psiquiátrica, Escola de Enfermagem, Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Márcia Silva Queiroz
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brasil
| | - Márcia Nery
- Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, São Paulo, Brasil
| |
Collapse
|
45
|
Li L, Jick S, Breitenstein S, Michel A. Prevalence of Diabetes and Diabetic Nephropathy in a Large U.S. Commercially Insured Pediatric Population, 2002-2013. Diabetes Care 2016; 39:278-84. [PMID: 26681728 DOI: 10.2337/dc15-1710] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 10/26/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of diabetes and diabetic nephropathy in a large population of U.S. commercially insured patients aged <18 years from 2002 to 2013. RESEARCH DESIGN AND METHODS Using the U.S. MarketScan Commercial Claims and Encounters Database, we identified 96,171 pediatric patients with diabetes and 3,161 pediatric patients with diabetic nephropathy during 2002-2013. We estimated prevalence of pediatric diabetes overall, by diabetes type, age, and sex, and prevalence of pediatric diabetic nephropathy overall, by age, sex, and diabetes type. RESULTS The annual prevalence of diabetes in the whole pediatric population increased from 1.86 to 2.82 per 1,000 during 2002-2013: 1.48 to 2.32 per 1,000 for type 1 diabetes and 0.38 to 0.67 per 1,000 for type 2 diabetes in 2002-2006 and then 0.56 to 0.49 per 1,000 thereafter. The annual prevalence of diabetic nephropathy in pediatric patients with diabetes increased from 1.16 to 3.44% for all cases and 0.83 to 2.32% for probable cases only in 2002-2013. Prevalence of diabetes and diabetic nephropathy was highest in patients aged 12 to <18 years. While prevalence of type 1 diabetes was higher in male than in female youth, prevalence of type 2 diabetes and diabetic nephropathy was higher in female than in male youth. There was no difference in prevalence of diabetic nephropathy by diabetes type. CONCLUSIONS The prevalence of diabetes and diabetic nephropathy increased in the U.S. MarketScan commercially insured pediatric population from 2002 to 2013. The prevalence of diabetes and diabetic nephropathy markedly increased starting at age 12 years.
Collapse
Affiliation(s)
- Lin Li
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA
| | - Susan Jick
- Boston Collaborative Drug Surveillance Program, Boston University School of Public Health, Lexington, MA
| | | | | |
Collapse
|
46
|
de Oliveira S, da Cunha Nascimento D, Tibana RA, de Oliveira SL, de Sousa Neto IV, Falleiros RKMM, Miranda LG, Pedrosa HC, Navalta JW, Pereira GB, Prestes J. Elevated glycated hemoglobin levels impair blood pressure in children and adolescents with type 1 diabetes mellitus. Diabetol Metab Syndr 2016; 8:4. [PMID: 26759608 PMCID: PMC4709890 DOI: 10.1186/s13098-015-0118-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 12/23/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Deregulation of glycemic and glycated hemoglobin (HbA1) levels accelerate the progression of cardiovascular complications in type 1 diabetes mellitus (T1DM). The aim of this study was to investigate the association between HbA1 and changes in blood pressure of children and adolescents with T1DM. METHODS A total of 60 children and adolescents were recruited and allocated into two groups (prehypertension and control group). Blood pressure and HbA1 were measured by the oscillometric method and high-performance liquid chromatography, respectively. RESULTS The prehypertensive group had (P < 0.05) higher disease duration, body weight, Z score for body weight, systolic blood pressure (SBP), diastolic blood pressure (DBP) and a higher HbA1 when compared with the control children and adolescents. Multiple regression to predict alterations in DBP from HbA1 adjusted for age, disease duration, and body mass index demonstrated a positive relationship with DBP (P < 0.05). A 1 % increase in HbA1 was associated with 1.73 mmHg increase in DBP. CONCLUSIONS High levels of HbA1 may be associated with increased blood pressure in T1DM. A tight control of HbA1 levels may provide long-term cardiovascular protection in children and adolescents with T1DM.
Collapse
Affiliation(s)
- Sandra de Oliveira
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| | - Dahan da Cunha Nascimento
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| | - Ramires Alsamir Tibana
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| | - Samuel Lima de Oliveira
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| | - Ivo Vieira de Sousa Neto
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| | - Roberta Kelly Menezes Maciel Falleiros
- />Endocrinology Unity—Research Polo Foundation for Teaching and Research in Health Sciences—Regional Hospital of Taguatinga, Federal District, Brasilia, Brazil
| | - Leonardo Garcia Miranda
- />Endocrinology Unity—Research Polo Foundation for Teaching and Research in Health Sciences—Regional Hospital of Taguatinga, Federal District, Brasilia, Brazil
| | - Hermelinda Cordeiro Pedrosa
- />Endocrinology Unity—Research Polo Foundation for Teaching and Research in Health Sciences—Regional Hospital of Taguatinga, Federal District, Brasilia, Brazil
| | | | - Guilherme Borges Pereira
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| | - Jonato Prestes
- />Department of Physical Education, Graduation Program on Physical Education—Catholic University of Brasilia (UCB), Q.S 7, lote 1—Bloco G—Aguas Claras, Taguatinga, Federal District, Brasilia, DF 71966-700 Brazil
| |
Collapse
|
47
|
Affiliation(s)
- Maureen Dever
- St. Christopher's Hospital for Children, Section of Endocrinology and Diabetes, Philadelphia, PA; Drexel University, Philadelphia, PA.
| |
Collapse
|
48
|
Wood CL, Clements SA, McFann K, Slover R, Thomas JF, Wadwa RP. Use of Telemedicine to Improve Adherence to American Diabetes Association Standards in Pediatric Type 1 Diabetes. Diabetes Technol Ther 2016; 18:7-14. [PMID: 26295939 DOI: 10.1089/dia.2015.0123] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND The American Diabetes Association (ADA) recommends that children with type 1 diabetes (T1D) see a multidisciplinary team and have hemoglobin A1c (A1C) levels measured every 3 months. Patients in rural areas may not follow guidelines because of limited specialty care access. We hypothesized that videoconferencing would result in equivalent A1C compared with in-person visits and increased compliance with ADA recommendations. MATERIALS AND METHODS The Barbara Davis Center (BDC) (Aurora, CO) telemedicine program provides diabetes care to pediatric patients in Casper and Cheyenne, WY, via remote consultation with annual in-person visits. Over 27 months, 70 patients were consented, and 54 patients completed 1 year in the study. RESULTS Patients were 70% male, with a mean age of 12.1 ± 4.1 years and T1D duration of 5.4 ± 4.1 years. There was no significant change between baseline and 1-year A1C levels for patients with data at both time points. Patients saw diabetes specialists an average of 2.0 ± 1.3 times per year in the year prior to starting telemedicine and 2.9 ± 1.3 times (P < 0.0001) in the year after starting telemedicine. Patients and families missed significantly less school and work time to attend appointments. CONCLUSIONS Our study suggests telemedicine is equivalent to in-person visits to maintain A1C, whereas families increase the number of visits in line with ADA recommendations. Patients and families miss less school and work. Decreased financial burden and increased access may improve overall diabetes care and compliance for rural patients. Further study is needed to detect long-term differences in complications screenings and the financial impact of telemedicine on pediatric diabetes care.
Collapse
Affiliation(s)
- Colleen L Wood
- 1 Department of Pediatrics, Children's Hospital Colorado , Aurora, Colorado
| | - Scott A Clements
- 2 Department of Pediatrics, University of Utah , Salt Lake City, Utah
| | - Kim McFann
- 3 Colorado School of Public Health , Aurora, Colorado
| | - Robert Slover
- 4 Barbara Davis Center for Diabetes, University of Colorado School of Medicine , Aurora, Colorado
| | - John F Thomas
- 1 Department of Pediatrics, Children's Hospital Colorado , Aurora, Colorado
- 3 Colorado School of Public Health , Aurora, Colorado
| | - R Paul Wadwa
- 4 Barbara Davis Center for Diabetes, University of Colorado School of Medicine , Aurora, Colorado
| |
Collapse
|
49
|
Braun M, Tomasik B, Wrona E, Fendler W, Jarosz-Chobot P, Szadkowska A, Zmysłowska A, Wilson J, Mlynarski W. The Stricter the Better? The Relationship between Targeted HbA1c Values and Metabolic Control of Pediatric Type 1 Diabetes Mellitus. J Diabetes Res 2016; 2016:5490258. [PMID: 26881252 PMCID: PMC4736392 DOI: 10.1155/2016/5490258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Accepted: 12/14/2015] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION It remains unclear how HbA1c recommendations influence metabolic control of paediatric patients with type 1 diabetes mellitus. To evaluate this we compared reported HbA1c with guideline thresholds. MATERIALS AND METHODS We searched systematically MEDLINE and EMBASE for studies reporting on HbA1c in children with T1DM and grouped them according to targeted HbA1c obtained from regional guidelines. We assessed the discrepancies in the metabolic control between these groups by comparing mean HbA1c extracted from each study and the differences between actual and targeted HbA1c. RESULTS We included 105 from 1365 searched studies. The median (IQR) HbA1c for the study population was 8.30% (8.00%-8.70%) and was lower in "6.5%" than in "7.5%" as targeted HbA1c level (8.20% (7.85%-8.57%) versus 8.40% (8.20%-8.80%); p = 0.028). Median difference between actual and targeted HbA1c was 1.20% (0.80%-1.70%) and was higher in "6.5%" than in "7.5%" (1.70% (1.30%-2.07%) versus 0.90% (0.70%-1.30%), resp.; p < 0.001). CONCLUSIONS Our study indicates that the 7.5% threshold results in HbA1c levels being closer to the therapeutic goal, but the actual values are still higher than those observed in the "6.5%" group. A meta-analysis of raw data from national registries or a prospective study comparing both approaches is warranted as the next step to examine this subject further.
Collapse
Affiliation(s)
- Marcin Braun
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Bartlomiej Tomasik
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Ewa Wrona
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Przemyslawa Jarosz-Chobot
- Department of Pediatrics, Endocrinology and Diabetology, Medical University of Silesia, Medykow 16, 40-752 Katowice, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Agnieszka Zmysłowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
| | - Jayne Wilson
- Cancer Research UK Clinical Trials Unit, School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, Birmingham B15 2TT, UK
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, Sporna 36/50, 91-738 Lodz, Poland
- *Wojciech Mlynarski:
| |
Collapse
|
50
|
Van Allen J, Steele RG, Nelson MB, Peugh J, Egan A, Clements M, Patton SR. A Longitudinal Examination of Hope and Optimism and Their Role in Type 1 Diabetes in Youths. J Pediatr Psychol 2015; 41:741-9. [PMID: 26628250 DOI: 10.1093/jpepsy/jsv113] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2015] [Accepted: 10/28/2015] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES To test the longitudinal associations between hope and optimism and health outcomes (i.e., HbA1c and self-monitored blood glucose [SMBG]) among youths with Type 1 diabetes mellitus (T1DM) over a 6-month period. METHODS A total of 110 participants (aged 10-16 years) completed study measures at Time 1, and 81 completed measures at Time 2. Analyses examined hope and optimism as predictors of change in health outcomes, and examined SMBG as a mediator of the relationship between hope and optimism, and HbA1c. RESULTS Change in hope, but not optimism, was associated with change in SMBG and HbA1c. Change in SMBG mediated the relationship between change in hope and HbA1c, but not between optimism and HbA1c. CONCLUSIONS It may be beneficial to assess hope in pediatric T1DM patients to identify youths who may be at risk for poor diabetes management, and to test the benefit of hope-based intervention efforts in clinical studies.
Collapse
Affiliation(s)
- Jason Van Allen
- Clinical Psychology Program, Department of Psychological Sciences, Texas Tech University,
| | - Ric G Steele
- Clinical Child Psychology Program, University of Kansas
| | | | - James Peugh
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Anna Egan
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City
| | - Mark Clements
- Division of Endocrinology and Diabetes, Department of Pediatrics, Children's Mercy Kansas City, and
| | - Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center
| |
Collapse
|