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Tsargasova IM, Bashnina EB, Vorokhobina NV, Dubinina TA, Dosovitskaya ER, Platonov VV. Prevalence of hypoglycemic conditions in adolescents with type 1 diabetes mellitus in real clinical practice. DIABETES MELLITUS 2022. [DOI: 10.14341/dm12851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND. Hypoglycemia and fear of hypoglycemia remain critical problems in the treatment of adolescents with type 1 diabetes mellitus (DM1) and are factors limiting proper control of glycemia and preventing the achievement of metabolic compensation of the disease. The use of pump insulin therapy involves the prevention of hypoglycemic conditions.AIM. To analyze the frequency and duration of hypoglycemia episodes, their effect on the metabolic compensation of the disease in adolescents with type 1 diabetes mellitus (DM1) in real clinical practice, depending on the mode/method of insulin administration.MATERIALS AND METHODS. The study involved 117 adolescents with DM1 aged 12 to 19 years (average age 15.5 years). 37 adolescents received therapy by continuous subcutaneous insulin infusion (CSII); 80 adolescents received therapy by multiple insulin injections (MII). The level of glycated hemoglobin (HbA1c) was determined for all adolescents, and its main indicators were evaluated using a 6 days continuous glucose monitoring (CGM) by the «blind» method of a professional system with an iPro 2 sensor (Medtronic MiniMed, USA).RESULTS. Episodes of a decrease in glucose levels <3,9 mmol/l were recorded in 87% of patients (n=102), 63% (n=74) showed a decrease in glucose levels <3,0 mmol/l. Episodes decrease in glucose levels <3,9 mmol/l at night were recorded in 68% of patients (n=80), and with glucose levels <3,9 mmol/l in 46% (n=54). The frequency of episodes of glucose lowering <3,9 mmol/l had no statistically significant differences depending on the methods of insulin administration (by continuous subcutaneous insulin infusion or multiple insulin injections), however, they are more common in adolescents with HbA1c <7,0% (p=0,03). The median time spent by patients in the range of <3,9 mmol/l was 5% per day, and a longer time in this range was observed in patients with HbA1c <7,0% (p=0,006). The median time in the range of <3,0 mmol/l was 1% per day and had no significant differences depending on the level of HbA1c (p=0,559). There were also no significant differences depending on the groups using CSII and MII (p=0,640 and p=0,250).CONCLUSION. Episodes of glucose reduction in the range of <3,9 mmol/l according to CGM data are more common in adolescents with HbA1c target values, regardless of the method of insulin administration. Significantly more time in range of <3,9 mmol/l is spent by adolescents with target values of HbA1c i.е. <7,0% compared with HbA1c ≥7,0%, however, in both groups, a large number of patients had time in the range below the target level was higher than recommended values.
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Affiliation(s)
- I. M. Tsargasova
- North-Western State Medical University named after I.I. Mechnikov
| | - E. B. Bashnina
- North-Western State Medical University named after I.I. Mechnikov
| | | | - T. A. Dubinina
- St. Petersburg children’s municipal multi-specialty clinical center of high medical technology named after K.A.Rauhfus
| | - E. R. Dosovitskaya
- St. Petersburg children’s municipal multi-specialty clinical center of high medical technology named after K.A.Rauhfus
| | - V. V. Platonov
- St. Petersburg children’s municipal multi-specialty clinical center of high medical technology named after K.A.Rauhfus
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2
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Jensen MV, Broadley M, Speight J, Chatwin H, Scope A, Cantrell A, Heller S, de Galan BE, Hendrieckx C, Pouwer F. The impact of hypoglycaemia in children and adolescents with type 1 diabetes on parental quality of life and related outcomes: A systematic review. Pediatr Diabetes 2022; 23:390-405. [PMID: 34981624 DOI: 10.1111/pedi.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
This systematic review aims to summarize and critically evaluate the current evidence regarding the impact of hypoglycaemia in children and adolescents with type 1 diabetes on parental quality of life. MEDLINE, PsycINFO, CINAHL, and the Cochrane Library were searched. Inclusion criteria were: 1) quantitative design, 2) included parents of children or adolescents with type 1 diabetes, 3) assessment of hypoglycemia in children/adolescents with type 1 diabetes, 4) assessment of parent quality of life (or related domains of life), and 5) analysis of the relationship(s) between the child's hypoglycaemia and parents' quality of life. The data were summarised in accordance with Synthesis Without Meta-Analysis Guidelines. Twelve studies were included, reporting data from 1895 parents across six countries. Ten studies were cross-sectional; two included prospective data. Evidence suggested that greater frequency and severity of hypoglycemia was associated with greater parental fear of hypoglycemia, emotional distress and family burden. Children's hypoglycaemia has a negative impact on the well-being of parents, but there is an absence of evidence regarding the impact on their overall quality of life. Research into the hypoglycaemia-specific quality of life of parents is needed to explore the impact on various areas, such as social and physical dimensions.
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Affiliation(s)
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,The Australian Centre for Behavioral Research in Diabetes, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, UK
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christel Hendrieckx
- The Australian Centre for Behavioral Research in Diabetes, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia.,Steno Diabetes Center Odense, Odense, Denmark
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3
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Bratke H, Biringer E, Margeirsdottir HD, Njølstad PR, Skrivarhaug T. Relation of Health-Related Quality of Life with Glycemic Control and Use of Diabetes Technology in Children and Adolescents with Type 1 Diabetes: Results from a National Population Based Study. J Diabetes Res 2022; 2022:8401328. [PMID: 36387938 PMCID: PMC9649325 DOI: 10.1155/2022/8401328] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 10/05/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The primary aim was to analyse the association between diabetes-specific health-related quality of life (HRQOL) and HbA1c in children and adolescents with type 1 diabetes. The secondary aims were to evaluate the associations between diabetes-specific HRQOL and age, sex, diabetes duration, and the use of diabetes technology in diabetes treatment. Research Design and Methods. Children with type 1 diabetes (10-17 years, N = 1,019) and parents (children <10 years, N = 371; 10-17 years, N = 1,070) completed the DISABKIDS diabetes-specific questionnaire (DDM-10) as part of the 2017 data collection for the Norwegian Childhood Diabetes Registry. The DDM-10 consists of two subscales-'impact' and 'treatment'-with six and four items, respectively. In the linear regression models, the items and subscales were outcome variables, while HbA1c, age, sex, diabetes duration, insulin pump use, and continuous glucose monitoring (CGM) system use were predictor variables. RESULTS Lower HbA1c measurements and male sex were associated with higher HRQOL scores on both DDM-10 scales in the age group 10-17 years, but not in children under 10 years. Parents gave lower HRQOL scores than children in the 10-17 age group. Insulin pump and CGM use were not significantly associated with HRQOL on the impact and treatment scale. CONCLUSIONS Low HbA1c and male sex are significantly associated with high HRQOL in children aged 10-17 with type 1 diabetes, but the use of diabetes technology is not positively associated with HRQOL. Differences in child- and parent-reported scores imply that parents might both over- and underestimate their child's HRQOL.
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Affiliation(s)
- Heiko Bratke
- Department of Pediatrics, Haugesund Hospital, Fonna Health Trust, Haugesund, Norway
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Oslo Diabetes Research Centre, Oslo, Norway
- Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
| | - Eva Biringer
- Department of Research and Innovation, Fonna Health Trust, Haugesund, Norway
| | - Hanna D. Margeirsdottir
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
| | - Pål R. Njølstad
- Center for Diabetes Research, Department of Clinical Science, University of Bergen, Bergen, Norway
- Child and Youth Clinic, Haukeland University Hospital, Bergen, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, Oslo, Norway
- Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- University of Oslo, Institute of Clinical Medicine, Faculty of Medicine, Oslo, Norway
- The Norwegian Childhood Diabetes Registry, Division of Childhood and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
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4
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Transitions to Postsecondary Education in Young Adults with Hemoglobinopathies: Perceptions of Patients and Staff. Pediatr Qual Saf 2021; 5:e349. [PMID: 34616965 PMCID: PMC8487776 DOI: 10.1097/pq9.0000000000000349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 07/18/2020] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. The transition from high school to postsecondary education can be challenging for adolescents and young adults (AYAs) with chronic health conditions. AYAs with hemoglobinopathies, including sickle cell disease, are a particularly vulnerable group whose academic performance is impacted by unpredictable disease symptoms. AYA with hemoglobinopathies may require academic accommodations to promote postsecondary success; however, accessing appropriate supports can be complicated.
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5
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Singh A, Dasgupta M, Retherford D, Fiallo-Scharer R, Simpson PM, Panepinto JA. Measurement properties of Patient Reported Outcomes Measurement Information System domains for children with type 1 diabetes. Pediatr Diabetes 2021; 22:335-344. [PMID: 33026680 PMCID: PMC8185634 DOI: 10.1111/pedi.13134] [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: 08/30/2019] [Revised: 09/02/2020] [Accepted: 10/04/2020] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Patient Reported Outcomes Measurement Information System (PROMIS) includes numerous domains to assess functioning among the pediatric population. These domains, however, have not been evaluated for use in children with type 1 diabetes (T1D). The objective of this study was to determine the measurement properties of PROMIS domains (pain behavior, pain quality, physical stress experience, physical activity, strength impact, and profile-25) in children with T1D. METHODS This is a cross-sectional study of children with T1Drecruited from tertiary care facilities. To determine construct validity, we compared PROMIS T-scores between known-groups based on (a) glycemic control, hemoglobin A1c (HbA1c%) and (b) self-reported general health, using t test or analysis of variance. Reliability was determined using Cronbach's alpha and item response theory reliability. We also determined agreement between parent-proxy and child self-report PROMIS scores. RESULTS Our study included 192 children, mean age 12.7 (SD = 2.9) years, eligible to self-report PROMIS surveys. There were significant differences in physical stress experience and pain intensity between children with HbA1c < 10% and those with HbA1c ≥ 10%. There also were significant differences in T-scores for all domains except physical function mobility and strength impact among children with poor/fair, good, very good/excellent general health. All valid domains had reliability >0.70. More than 40% of child-parent pairs were in agreement, with intraclass correlations coefficients (ICC) ranging between 0.41 and 0.63 for all domains, except pain behavior (%agreement = 23%; ICC = 0.29). CONCLUSIONS Most of the PROMIS domains tested are valid, reliable, and able to differentiate children with T1D who report different general health states. There is moderate agreement between child-parent pairs for all domains except pain behavior.
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Affiliation(s)
- Ashima Singh
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Mahua Dasgupta
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Dawn Retherford
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rosanna Fiallo-Scharer
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Pippa M. Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Julie A. Panepinto
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin,Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
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6
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Redondo MJ, Libman I, Maahs DM, Lyons SK, Saraco M, Reusch J, Rodriguez H, DiMeglio LA. The Evolution of Hemoglobin A 1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence. Diabetes Care 2021; 44:301-312. [PMID: 33431422 PMCID: PMC7818324 DOI: 10.2337/dc20-1978] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/08/2020] [Indexed: 02/03/2023]
Abstract
The American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1c (A1C) of <7% (53 mmol/mol) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness and for those who do not have access to analog insulins or advanced diabetes technologies or who cannot monitor blood glucose regularly. Even less stringent A1C targets (e.g., <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the "honeymoon" period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective. Here, we provide a historical perspective of A1C targets in pediatrics and highlight evidence demonstrating detrimental effects of hyperglycemia in children and adolescents, including increased likelihood of brain structure and neurocognitive abnormalities, microvascular and macrovascular complications, long-term effects, and increased mortality. We also review data supporting a decrease over time in overall severe hypoglycemia risk for youth with T1D, partly associated with the use of newer insulins and devices, and weakened association between lower A1C and severe hypoglycemia risk. We present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them. We aim to raise awareness within the community on Standards of Care updates that impact this crucial goal in pediatric diabetes management.
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Affiliation(s)
- Maria J Redondo
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Ingrid Libman
- Division of Pediatric Endocrinology, Diabetes and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
| | - David M Maahs
- Division of Pediatric Endocrinology and Diabetes, Stanford University, Stanford, CA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA
- Health Research and Policy (Epidemiology), Stanford University, Stanford, CA
| | - Sarah K Lyons
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | | | - Jane Reusch
- University of Colorado and Rocky Mountain Regional VA Medical Center, Aurora, CO
| | - Henry Rodriguez
- USF Diabetes and Endocrinology Section, University of South Florida, Tampa, FL
| | - Linda A DiMeglio
- Division of Pediatric Endocrinology and Diabetology and Wells Center for Pediatric Research, Indiana University School of Medicine, Indianapolis, IN
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7
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Raymaekers K, Prikken S, Oris L, Vanhalst J, Moons P, Goossens E, Weets I, Luyckx K. A Person-Centered Perspective on the Role of Peer Support and Extreme Peer Orientation in Youth with Type 1 Diabetes: A Longitudinal Study. Ann Behav Med 2020; 54:893-903. [PMID: 32329794 DOI: 10.1093/abm/kaaa025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Despite clear evidence that peers are crucial for youth development, research on the role of peers for youth with Type 1 diabetes (T1D) is scarce. PURPOSE The present study identified trajectory classes of perceived peer functioning in youth with T1D, based on peer support and extreme peer orientation (EPO). Further, classes were compared with respect to their trajectories of depressive symptoms, diabetes-specific distress, treatment adherence, and HbA1c values. METHODS Five hundred and fifty-nine youth (14-25 years) with T1D completed questionnaires at baseline, 1, 2, and 3 years later. Latent class growth analysis identified classes of perceived peer functioning. Multigroup latent growth curve modelling assessed whether these classes were characterized by different trajectories of general and diabetes-specific functioning. RESULTS A socially normative class (48%) was characterized by trajectories of high support and low EPO over time. A socially reserved class (29%) was characterized by low support and EPO, and a socially oriented class (17%) by high support and EPO. Finally, a socially vulnerable class (6%) was characterized by low support and high EPO. The normative class functioned significantly better over time than the other classes. The vulnerable class functioned significantly worse compared to the reserved class, despite experiencing equally low levels of support. CONCLUSIONS The results underscore the need to take youths' orientation toward the peer context into account alongside support when tapping into the role of peers, because individuals with low levels of support and EPO functioned substantially better than individuals with similar low levels of support but high levels of EPO.
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Affiliation(s)
- Koen Raymaekers
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium
| | - Sofie Prikken
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium
| | - Leen Oris
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium
| | - Janne Vanhalst
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ilse Weets
- Diabetes Research Center/Clinical Biology, Free University Brussels, Brussels, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
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8
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Hung LC, Huang CY, Lo FS, Cheng SF. The Self-Management Experiences of Adolescents with Type 1 Diabetes: A Descriptive Phenomenology Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17145132. [PMID: 32708617 PMCID: PMC7400392 DOI: 10.3390/ijerph17145132] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/11/2020] [Accepted: 07/12/2020] [Indexed: 06/11/2023]
Abstract
Many adolescents with type 1 diabetes experience challenges in achieving good glycemic control and have insufficient understanding in executing interventions for glycemic control. This study aimed to understand self-management experiences of adolescents with type 1 diabetes in Taiwan. In this descriptive phenomenological study, we conducted in-depth interviews with 18 adolescents with type 1 diabetes from the pediatric outpatient clinic of a medical center. Data were analyzed using the Colaizzi's method. Four themes were identified: (1) misconception regarding self-management of blood glucose; (2) conflict between depending on and breaking away from parental assistance for glycemic control; (3) encounter with disruptions in glycemic control regimen due to the presence of schedule changes; and (4) lack of motivation to achieve good glycemic control. The findings indicated that the misconceptions of adolescents with type 1 diabetes about managing glycemic levels resulted from an insufficient understanding of self-management of diabetes. In Taiwan, the heavy emphasis of academic achievement and changes of schedules during breaks tended to disrupt the regimen for glycemic control. Healthcare professionals are encouraged to provide individualized education focusing on the adolescents' misconceptions regarding self-management of diabetes.
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Affiliation(s)
- Li-Chen Hung
- College of Nursing, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan;
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan
| | - Chu-Yu Huang
- School of Nursing, Cedarville University, Cedarville, OH 45314, USA;
| | - Fu-Sung Lo
- Division of Endocrinology, Department of Pediatrics, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan;
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei 11219, Taiwan
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9
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Marker AM, Patton SR, McDonough RJ, Feingold H, Simon L, Clements MA. Implementing clinic-wide depression screening for pediatric diabetes: An initiative to improve healthcare processes. Pediatr Diabetes 2019; 20:964-973. [PMID: 31264763 PMCID: PMC7814422 DOI: 10.1111/pedi.12886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Youth with type 1 diabetes (T1D) endorse high rates of depressive symptoms, which can significantly impair self-management, glycemic control, and quality of life. Current guidelines recommend annual depression screening for all adolescents with T1D, but few models exist to implement screening procedures across clinics in this population. The primary aim of this project was to increase depression screening from 0% to 80% in four clinics, and to describe the structured quality improvement process to reach this goal. METHODS All patients aged 12 to 21 years old with T1D at four participating clinics in a Midwestern hospital system were eligible to participate. Using a two-stage process, patients were administered the Patient Health Questionnaire (PHQ-2 plus PHQ-9 if positive) annually. Rates of depression screening by clinic site, rates of positive depression screens, social worker documentation of follow-up care, and associations with diabetes-related health outcomes were analyzed. RESULTS Over 2 years, average depression screening rates increased from 0% to 75% across all clinics, and 89% of patients with a positive screen met with a social worker for a targeted mental health assessment. At initial screening, 7.6% of patients screened positive for at-risk depressive symptoms on the PHQ-2 and from that group, 6.7% additionally screened positive on the PHQ-9. CONCLUSIONS Annual depression screenings were feasibly implemented across four clinics and the use of real-time data listening and automated processes facilitated successful implementation. Future directions include further automation, targeted training and billing mechanisms, dissemination to non-metropolitan clinics, and further assessment of depression screening tools for adolescents with T1D.
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Affiliation(s)
| | | | | | | | - Lara Simon
- Children's Mercy - Kansas City, Kansas City, Missouri
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10
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Biondi B, Kahaly GJ, Robertson RP. Thyroid Dysfunction and Diabetes Mellitus: Two Closely Associated Disorders. Endocr Rev 2019; 40:789-824. [PMID: 30649221 PMCID: PMC6507635 DOI: 10.1210/er.2018-00163] [Citation(s) in RCA: 217] [Impact Index Per Article: 43.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 10/15/2018] [Indexed: 12/13/2022]
Abstract
Thyroid dysfunction and diabetes mellitus are closely linked. Several studies have documented the increased prevalence of thyroid disorders in patients with diabetes mellitus and vice versa. This review critically discusses the different underlying mechanisms linking type 1 and 2 diabetes and thyroid dysfunction to demonstrate that the association of these two common disorders is unlikely a simple coincidence. We assess the current state of knowledge on the central and peripheral control of thyroid hormone on food intake and glucose and lipid metabolism in target tissues (such as liver, white and brown adipose tissue, pancreatic β cells, and skeletal muscle) to explain the mechanism linking overt and subclinical hypothyroidism to type 2 diabetes and metabolic syndrome. We also elucidate the common susceptibility genes and the pathogenetic mechanisms contributing to the autoimmune mechanism involved in the onset of type 1 diabetes mellitus and autoimmune thyroid disorders. An untreated thyroid dysfunction can impair the metabolic control of diabetic patients, and this association can have important repercussions on the outcome of both of these disorders. Therefore, we offer recommendations for the diagnosis, management, and screening of thyroid disorders in patients with diabetes mellitus, including the treatment of diabetic patients planning a pregnancy. We also discuss the major causes of failure to achieve an optimal management of thyroid dysfunction in diabetic patients and provide recommendations for assessing and treating these disorders during therapy with antidiabetic drugs. An algorithm for a correct approach of these disorders when linked is also provided.
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Affiliation(s)
- Bernadette Biondi
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - George J Kahaly
- Department of Medicine I, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - R Paul Robertson
- Department of Medicine, Division of Endocrinology and Metabolism, University of Washington School of Medicine, Seattle, Washington.,Department of Pharmacology, University of Washington, Seattle, Washington
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11
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Prikken S, Raymaekers K, Oris L, Rassart J, Weets I, Moons P, Luyckx K. A triadic perspective on control perceptions in youth with type 1 diabetes and their parents: Associations with treatment adherence and glycemic control. Diabetes Res Clin Pract 2019; 150:264-273. [PMID: 30904747 DOI: 10.1016/j.diabres.2019.03.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 02/18/2019] [Accepted: 03/14/2019] [Indexed: 10/27/2022]
Abstract
AIMS A family approach was applied to examine youth, maternal, and paternal control perceptions in relation to type 1 diabetes outcomes in adolescents and emerging adults. Mean levels of personal and treatment control were compared among patients and parents. Their associations with diabetes outcomes were examined as well. METHODS The sample included 330 patient-mother-father triads. Patients' (48% male) mean age was 18.25 years (SD = 2.98). All respondents reported on their control perceptions and youth treatment adherence. Physicians provided HbA1c-values. RESULTS Paired-samples t-tests revealed higher personal control in patients compared to parents. Regression analyses examined if control perceptions predicted treatment adherence and HbA1c. Main effects for patient and maternal personal control and two-way interactions showed the best outcomes when both patients and mothers reported high personal control. Main effects of patient, maternal, and paternal treatment control and three-way interaction terms revealed better outcomes in case of high treatment control in patients and at least one parent, while the poorest outcomes were observed in case of low treatment control in all respondents. CONCLUSIONS The findings highlight the importance of parental control perceptions on top of patients' own perceptions. A family perspective on illness perceptions and their associations with diabetes outcomes is encouraged.
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Affiliation(s)
- Sofie Prikken
- KU Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium.
| | | | - Leen Oris
- KU Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium
| | - Jessica Rassart
- KU Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium
| | - Ilse Weets
- Free University Brussels / University Hospital Brussels, Brussels, Belgium
| | - Philip Moons
- KU Leuven, Leuven, Belgium; University of Gothenburg, Gothenburg, Sweden
| | - Koen Luyckx
- KU Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
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12
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Tran L, Mulligan K. A Systematic Review of Self-Management Interventions for Children and Adolescents With Inflammatory Bowel Disease. Inflamm Bowel Dis 2019; 25:685-698. [PMID: 30295786 DOI: 10.1093/ibd/izy299] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Self-management of inflammatory bowel disease is complex. Children and adolescents (CA) with inflammatory bowel disease (IBD) often have difficulty with managing aspects of their condition, resulting in treatment nonadherence and impaired psychosocial function. Self-management interventions are developed to help support patients and their parents/carers to effectively self-manage. The aim of this systematic review was to evaluate the efficacy of self-management interventions in children and adolescents with IBD. METHODS The review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic literature search of the following databases was conducted to identify controlled trials of interventions aiming to enhance IBD self-management in CA: Medline, Embase, Cochrane, CINAHL, and PsychINFO. Two reviewers screened articles for inclusion. RESULTS Nine trials (11 articles) met the inclusion criteria. Most were underpowered, with 7 recruiting fewer than 50 participants. The interventions aimed to enhance psychological well-being (n = 5), medication adherence (n = 3), or calcium intake (n = 1). There was considerable heterogeneity in intervention content and outcomes assessment. Some benefits were reported in disease activity, adherence, and psychological well-being, but findings were inconsistent. CONCLUSIONS Self-management is difficult for CA with IBD; however, this review identified only a small number of interventions to support self-management, most of which were underpowered and only 1 that was conducted outside the United States. Clinical consensus is required on which self-management activities should be recommended to patients and targeted in interventions and which core outcomes should be assessed. Adequately powered trials of interventions are required to identify how best to support self-management in CA with IBD.
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Affiliation(s)
- Lien Tran
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK
| | - Kathleen Mulligan
- Centre for Health Services Research, School of Health Sciences, City, University of London, London, UK.,East London NHS Foundation Trust, London, UK
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Iyengar J, Thomas IH, Soleimanpour SA. Transition from pediatric to adult care in emerging adults with type 1 diabetes: a blueprint for effective receivership. Clin Diabetes Endocrinol 2019; 5:3. [PMID: 30891310 PMCID: PMC6404300 DOI: 10.1186/s40842-019-0078-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/26/2019] [Indexed: 12/12/2022] Open
Abstract
For adolescents and emerging adults, the transition from pediatrics to adult care is fraught with challenges both inside and outside the clinical arena, including assuming independent care for diabetes, working with new adult providers, and overcoming concomitant psychosocial issues, while maintaining work/school-life balance. Not surprisingly, glycemic control in emerging adults with type 1 diabetes is amongst the worst in all age groups. Thus, new and comprehensive strategies are needed by both pediatric and adult diabetes care teams to support young adults during the transition to adult care. In this review, we focus on challenges during the transition period and provide evidence-based recommendations for a receivership model to assist adult diabetes care teams in addressing these concerns. By coordinating efforts with pediatrics providers, identifying strengths and deficiencies in self-care, establishing rapport with young adult patients, directly addressing prevalent psychosocial concerns, and developing a team-based approach to keep patients engaged, adult care teams can prioritize support for the most vulnerable transition patients. Improved strategies to propel emerging adult patients through the transition period towards habits leading to optimal glycemic control could have a major long-term impact on preventing diabetes-related complications.
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Affiliation(s)
- Jennifer Iyengar
- 1Diabetes Transition Program, University of Michigan Health System, Ann Arbor, MI USA.,2Division of Metabolism, Endocrinology & Diabetes and Department of Internal Medicine of the University of Michigan Medical School, 1000 Wall Street, Brehm Tower Suite 5317, Ann Arbor, MI 48105 USA
| | - Inas H Thomas
- 1Diabetes Transition Program, University of Michigan Health System, Ann Arbor, MI USA.,3Division of Endocrinology and Department of Pediatrics and Communicable Disease of the University of Michigan Medical School, Ann Arbor, MI USA
| | - Scott A Soleimanpour
- 1Diabetes Transition Program, University of Michigan Health System, Ann Arbor, MI USA.,2Division of Metabolism, Endocrinology & Diabetes and Department of Internal Medicine of the University of Michigan Medical School, 1000 Wall Street, Brehm Tower Suite 5317, Ann Arbor, MI 48105 USA
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14
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Prikken S, Oris L, Rassart J, Missotten LC, Weets I, Moons P, Goubert L, Luyckx K. Parental illness intrusiveness and youth glycaemic control in type 1 diabetes: intergenerational associations and processes. Psychol Health 2019; 34:438-455. [PMID: 30636450 DOI: 10.1080/08870446.2018.1538451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined associations between the functioning of youth with type 1 diabetes and their parents, including parenting dimensions as intervening mechanisms. The study adds to the existing literature by focusing on (1) the concept of parental illness intrusiveness; (2) the (understudied) periods of adolescence and emerging adulthood; and (3) maternal and paternal functioning. DESIGN Questionnaires were completed by 317 patient-mother dyads and 277 patient-father dyads. All patients (aged 14-25) had type 1 diabetes. The hypothesised model was compared to an alternative model using structural equation modelling. MAIN OUTCOME MEASURES Youth reported on depressive symptoms and treatment adherence; Physicians provided HbA1c-values. Parents reported on illness intrusiveness, depressive symptoms, and their child's treatment adherence. Patients and parents reported on psychological control and overprotection. RESULTS The hypothesised path model had a good fit to the data. Parental illness intrusiveness was positively associated with depressive symptoms and both were positively related to overprotection and psychological control. Psychological control was positively related to patients' depressive symptoms and negatively to treatment adherence. Poorer treatment adherence was associated with worse HbA1c-values. CONCLUSION These findings underscore the relevance of parental illness intrusiveness and emphasise the importance of mothers' and fathers' roles throughout adolescence and emerging adulthood.
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Affiliation(s)
- Sofie Prikken
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | - Leen Oris
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | - Jessica Rassart
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | | | - Ilse Weets
- c Free University Brussels , Brussels , Belgium
| | - Philip Moons
- a KU Leuven , Leuven , Belgium.,d University of Gothenburg , Gothenburg , Sweden
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15
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Silva MRRD, Diniz LM, Santos JBRD, Reis EA, Mata ARD, Araújo VED, Álvares J, Acurcio FDA. Drug utilization and factors associated with polypharmacy in individuals with diabetes mellitus in Minas Gerais, Brazil. CIENCIA & SAUDE COLETIVA 2018; 23:2565-2574. [PMID: 30137126 DOI: 10.1590/1413-81232018238.10222016] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/25/2016] [Indexed: 12/23/2022] Open
Abstract
The objective of this study was to evaluate the use of drugs and the factors associated with polypharmacy in patients with diabetes mellitus (DM) in Minas Gerais. Descriptive analysis of drugs in use and logistic regression to estimate the association between socio-demographic and clinical characteristics with polypharmacy were performed. Of the 2619 respondents, 56.5% were in polypharmacy. Drugs for DM, agent in renin-angiotensin system, and diuretics are the most frequently used. Factors such as age, comorbidities and increased access to health services were associated with polypharmacy. It was observed high prevalence of polypharmacy, which requires a suitable care and better quality of drug use in this population.
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Affiliation(s)
- Michael Ruberson Ribeiro da Silva
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | | | - Jéssica Barreto Ribeiro Dos Santos
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | | | - Adriana Rodrigues da Mata
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | - Vânia Eloisa de Araújo
- Departamento de Odontologia, Pontifícia Universidade Católica de Minas Gerais. Belo Horizonte MG Brasil
| | - Juliana Álvares
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
| | - Francisco de Assis Acurcio
- Departamento de Farmácia Social, Faculdade de Farmácia, Universidade Federal de Minas Gerais (UFMG). Av. Antônio Carlos 6627, Pampulha. 31270-901 Belo Horizonte MG
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Personality Functioning in Adolescents and Emerging Adults With Type 1 Diabetes. J Adolesc Health 2018; 63:792-798. [PMID: 30266568 DOI: 10.1016/j.jadohealth.2018.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/27/2018] [Accepted: 06/27/2018] [Indexed: 11/22/2022]
Abstract
PURPOSE Although prior research has stressed the role of personality in adjusting to type 1 diabetes, longitudinal research is lacking. The objectives of the present study were twofold: (1) to chart the development of patients' personality over a 2-year period; and (2) to examine prospective associations among personality, treatment adherence, glycemic control, and diabetes-specific distress. METHODS Adolescents and emerging adults with type 1 diabetes, aged 14-25 years (Mage = 18.86 years, 54% female), participated in a three-wave longitudinal study spanning 2 years (n = 560 at Time 1). Patients filled out questionnaires on Big Five personality traits, treatment adherence, and diabetes-specific distress. HbA1c values were obtained from treating physicians. We used latent growth curve modeling to examine the development of patients' personality. Cross-lagged path analysis was performed to examine prospective associations among the study variables. RESULTS First, we observed mean-level increases in extraversion, agreeableness, and conscientiousness over the course of the study. Second, we uncovered bidirectional associations between personality and several important indicators of adjustment. Lower conscientiousness and higher extraversion predicted a relative decrease in treatment adherence 1 year later. Poorer treatment adherence, in turn, predicted relative decreases in conscientiousness and agreeableness over time. Furthermore, lower emotional stability predicted a relative increase in distress 1 year later. Higher distress, in turn, predicted a relative decrease in agreeableness over time. Finally, lower conscientiousness predicted poorer glycemic control 1 year later. CONCLUSIONS This study found young patients to move toward a more mature personality and stressed the importance of personality in adjusting to type 1 diabetes.
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Translation and validation of Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 Diabetes Module) in Brazil‐Portuguese language. JORNAL DE PEDIATRIA (VERSÃO EM PORTUGUÊS) 2018. [DOI: 10.1016/j.jpedp.2017.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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18
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Garcia LFDS, Manna TD, Passone CDGB, Oliveira LSD. Translation and validation of Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 Diabetes Module) in Brazil-Portuguese language. J Pediatr (Rio J) 2018; 94:680-688. [PMID: 29144963 DOI: 10.1016/j.jped.2017.09.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 09/22/2017] [Accepted: 09/27/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE The aim of the present study was to create a translated version of the Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 Diabetes Module) in Brazilian Portuguese that was conceptually equivalent to the original American English version and to linguistically validate it in a Brazilian pediatric population with type 1 diabetes mellitus and their parents or caregivers. METHODS The instrument was translated, back-translated, and then administered to 83 children/adolescents (5-18 years) with type 1 diabetes mellitus and their family members and to 25 parents/caregivers of patients aged between 2 and 4 years. The final translated version was tested for reliability by analyzing internal consistency, intraobserver (test-retest) reliability, and concurrent validity. RESULTS Cronbach's alpha coefficient for the total score of the questionnaires of children/adolescents (α=0.85) and their parents (α=0.82) was above the recommended minimum of 0.70 for group comparisons. Intraobserver reliability and concurrent validity exhibited a significant positive correlation (p<0.001), indicating the reliability of the translated instrument. A moderate but significant positive correlation (r=0.40; p<0.001) was demonstrated between the total scores of patient self-report and parent proxy-report scales. There was no significant correlation between glycated hemoglobin (HbA1c) levels and the respective scores in the questionnaires answered by patients and their parents/caregivers. CONCLUSION The analysis of the translated version of the PedsQL™ 3.0 Diabetes Module revealed adequate psychometric characteristics with respect to reliability and validity following administration to a sample of Brazilian children/adolescents with type 1 diabetes mellitus and their caregivers.
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Affiliation(s)
- Leila F Dos S Garcia
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil.
| | - Thais Della Manna
- Universidade de São Paulo (USP), Faculdade de Medicina, Hospital das Clínicas, Instituto da Criança, São Paulo, SP, Brazil; Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil
| | | | - Lygia Spassapan de Oliveira
- Universidade de São Paulo (USP), Faculdade de Medicina, São Paulo, SP, Brazil; Faculdade de Ciências Médicas da Santa Casa de São Paulo (FCMSCSP), São Paulo, SP, Brazil
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Iversen HH, Helland Y, Bjertnaes O, Skrivarhaug T. Parent experiences of diabetes care questionnaire (PEQ-DC): reliability and validity following a national survey in Norway. BMC Health Serv Res 2018; 18:774. [PMID: 30314486 PMCID: PMC6186125 DOI: 10.1186/s12913-018-3591-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 10/01/2018] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Patient experiences are acknowledged as an important aspect of health care quality but no validated instruments have been identified for the measurement of either parent or patient experiences with outpatient paediatric diabetes care. The aim of the current study was to assess the psychometric properties of a new instrument developed to measure parent experiences of paediatric diabetes care at hospital outpatient departments in Norway. METHODS The development of the questionnaire was based on a literature review of existing questionnaires, qualitative interviews with both parents and children/adolescents, expert-group consultations, pretesting of the questionnaire and a pilot study. The national pilot study included parents of 2606 children/adolescents aged 0-17 years with Type 1 Diabetes registered in The Norwegian Childhood Diabetes Registry, a nationwide, population-based registry. Levels of missing data, ceiling effects, factor structure, internal consistency, item discriminant validity and construct validity were assessed. RESULTS A total of 2606 patients were included in the survey, but 80 were excluded due to incorrect addresses. 1399 (55%) parents responded to the questionnaire. Low levels of missing or "not applicable" responses were found for 31 of the 35 items (< 10%), and 27 of 35 items were below the ceiling-effect criterion. Psychometric testing and theoretical considerations identified six scales: Consultation (six items), organisation (five items), equipment (three items), nurse contact (four items), doctor contact (four items) and outcome (five items). All six scales met the 0.7 criterion for Cronbach's alpha (range: 0.71-0.90). As expected, each item had a higher correlation with its hypothesised scale than with any of the other five scales. The construct validity of the Parent Experiences of Diabetes Care Questionnaire (PEQ-DC) was supported by 17 out of 18 associations with variables expected to be related to parent experiences. CONCLUSION The psychometric testing of the PEQ-DC showed good evidence for data quality, internal consistency and construct validity. The instrument includes important aspects of diabetes care at paediatric outpatient departments from the perspective of the parent. The content validity of the PEQ-DC was secured by a rigorous development process, and the instrument was tested following a national survey in Norway, securing generalisability across Norway.
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Affiliation(s)
| | - Ylva Helland
- Norwegian Directorate of Health, PO Box 7000, N-0130 Oslo, Norway
| | - Oyvind Bjertnaes
- Norwegian Institute of Public Health, PO Box 4404, Nydalen, N-0403 Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, The Norwegian Childhood Diabetes Registry, Oslo University Hospital, PO Box 4956, Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, N-0318 Oslo, Norway
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Phelan H, Lange K, Cengiz E, Gallego P, Majaliwa E, Pelicand J, Smart C, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:75-83. [PMID: 30175451 DOI: 10.1111/pedi.12762] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Helen Phelan
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Karin Lange
- Department Medical Psychology OE 5430, Hannover Medical School, Hannover, Germany
| | - Eda Cengiz
- Division of Pediatric Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA.,School of Medicine, Koc University, Istanbul, Turkey
| | - Patricia Gallego
- Department of Pediatrics, Children's Hospital London, Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Edna Majaliwa
- Department of Paediatric and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Julie Pelicand
- Medical School, University of Valparaiso, San Felipe, Chile
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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21
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Klein K, Wheeler M, Yonkaitis CF. College-Bound: Transition Planning Strategies for Students With Type 1 Diabetes. NASN Sch Nurse 2018; 34:17-20. [PMID: 30226793 DOI: 10.1177/1942602x18794891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Transition planning is mandated for students who receive special education services; however, it is not required for students with chronic conditions. Students with chronic conditions nearing graduation would benefit from more intensive attention to their post-high school self-care needs and responsibilities. Students with type 1 diabetes must be able to understand the necessary self-care of one of the most complicated and intensive chronic conditions yet there are no evidence-based strategies for how to help students transition from the support provided at school to independence at graduation. The need for a student with type 1diabetes to independently manage their diabetes is even greater as the student leaves home for college. School nurses, who are also certified diabetes educators, created a support group for seniors with type 1 diabetes. The group focused on life after high school and provided the students with a detailed checklist to help improve knowledge and prepare students for the transition to college. Participants felt better prepared to move on to college armed with their checklist and other resources to help when away from home.
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Affiliation(s)
- Kathleen Klein
- Certified School Nurse, Maine East High School, District 207, Park Ridge, IL
| | | | - Catherine F Yonkaitis
- Director of the School Nurse Certification Program and Clinical Assistant Professor at the University of Illinois at Chicago, Chicago, IL
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Predieri B, Suprani T, Maltoni G, Graziani V, Bruzzi P, Zucchini S, Iughetti L. Switching From Glargine to Degludec: The Effect on Metabolic Control and Safety During 1-Year of Real Clinical Practice in Children and Adolescents With Type 1 Diabetes. Front Endocrinol (Lausanne) 2018; 9:462. [PMID: 30190702 PMCID: PMC6115523 DOI: 10.3389/fendo.2018.00462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Accepted: 07/26/2018] [Indexed: 11/23/2022] Open
Abstract
Background/Objective: Insulin degludec (IDeg) is an ultra-long-acting analog with less daily variability compared to other basal insulins. In this retrospective study we examined 1-year efficacy and safety of IDeg in youth with type 1 diabetes (T1D). Subjects/Methods: Thirty-seven patients [11.7 ± 4.22 years; T1D duration 4.97 ± 3.63 years; once-daily glargine (IGlar) by at least 1 year] were switched to once-daily IDeg because of glycosylated hemoglobin (HbA1c) >7.5% and/or reported physical pain at IGlar injection. Changes in HbA1c, 30-day mean fasting plasma glucose (mean FPG), daily insulin dose, and severe hypoglycemia rates were collected at basal insulin switch (T0), 3-months (T1), 6-months (T2), and 12-months (T3) after IDeg was started. Results: In patients with HbA1c >7.5% at T0 we found a decrease in HbA1c values (%) from 8.46 ± 0.53 to 7.89 ± 0.72 at T1 (p = 0.008) and 7.97 ± 0.89 at T2 (p = 0.035). At T3, 38.9% of patients had HbA1c ≤ 7.5%. Mean FPG levels significantly decreased at T2 (p = 0.043). In the overall study population, we documented an increase in IDeg dose (+12.5% at T3; p < 0.001) and a decrease in mealtime insulin dose (-11.6% at T3; p = 0.001) after switch. HbA1c levels were unchanged. No episode of severe hypoglycemia was reported. Conclusions: Our data in children and adolescents with T1D suggest that IDeg dose should be increased by 12% and mealtime insulin doses should be lowered by 11% for patients who previously received IGlar. IDeg might be considered useful and well tolerated and it seems to improve the glycemic control compared to IGlar, mainly in patients with poor glycemic control.
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Affiliation(s)
- Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Tosca Suprani
- Department of Pediatrics, Bufalini Hospital, Cesena, Italy
| | - Giulio Maltoni
- Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Vanna Graziani
- Department of Pediatrics, Santa Maria Delle Croci Hospital, Ravenna, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Zucchini
- Department of Pediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit, University of Modena and Reggio Emilia, Modena, Italy
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McClain MR, Klingensmith GJ, Anderson B, Berget C, Cain C, Shea J, Campbell K, Pyle L, Raymond JK. Team Clinic: Group Approach to Care of Early Adolescents With Type 1 Diabetes. Diabetes Spectr 2018; 31:273-278. [PMID: 30140144 PMCID: PMC6092886 DOI: 10.2337/ds17-0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Georgeanna J. Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Barbara Anderson
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Jacqueline Shea
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Kristen Campbell
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Jennifer K. Raymond
- Los Angeles Children’s Hospital, University of Southern California, Keck School of Medicine, Los Angeles, CA
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Abstract
PURPOSE OF REVIEW This article reviews recent publications on the effect of type 1 diabetes (T1D) on fracture risk, bone mineral density (BMD), bone structure, and bone tissue quality. Possible fracture prevention strategies for patients with T1D have also been reviewed. RECENT FINDINGS T1D is associated with substantially elevated fracture risk and modestly low BMD at the femoral neck. However, BMD alone does not explain higher observed fracture risk in T1D. T1D also affects bone macro- and microstructure, characterized by thinner cortices and trabecular bone changes such as thinner and more widely spaced trabeculae. Structural bone deficit is pronounced in the presence of microvascular complications. Tissue-level changes, such as accumulation of advanced glycation endproducts, detrimental alterations of the mineral phase because of low bone turnover, and occlusion of vascular channels in bone by mineralized tissue, are implicated in pathophysiology of bone fragility in T1D. There are no guidelines on screening and prevention of osteoporotic fractures in T1D. SUMMARY More studies are needed to understand the influence of T1D on structural bone quality and tissue material properties. There is a need for a prospective study to evaluate better screening strategies for diagnosis and treatment of osteoporosis in T1D.
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Affiliation(s)
- Viral N. Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - R. Dana Carpenter
- Department of Mechanical Engineering, University of Colorado Denver, San Francisco, California, USA
| | - Virginia L. Ferguson
- Department of Mechanical Engineering, University of Colorado Boulder, San Francisco, California, USA
| | - Ann V. Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, USA
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25
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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.
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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
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Kime NH, Waldron S, Webster E, Lange K, Zinken K, Danne T, Aschemeier B, Sumnik Z, Cinek O, Raposo JF, Vazeou A, Bratina N, Campbell F. Pediatric diabetes training for healthcare professionals in Europe: Time for change. Pediatr Diabetes 2018; 19:578-585. [PMID: 28880485 DOI: 10.1111/pedi.12573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/21/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Training for healthcare professionals (HCPs) in Europe who care for children and young people (CYP) with type 1 diabetes and their families is variable depending on the country. Building on the work of SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) and using the German Certified Diabetes Educators (CDEs) curriculum, a European collaboration of pediatric diabetes experts aimed to (1) establish current core elements that should be included in a pediatric diabetes education training course and (2) create a template for a European CDE's training curriculum. METHODS A qualitative methodology incorporating a survey questionnaire, focus group discussions, individual semi-structured interviews and workshops was employed to explore participants' experiences and opinions. HCPs-pediatric consultants, diabetes nurses, dietitians and psychologists, national and local diabetes leads, academic and education leads and children, and young people with diabetes and families took part in the study. The total number of participants equaled 186. RESULTS A template for a European Certified Diabetes Educator Curriculum (EU-CDEC) was developed based on the themes that emerged from the participants' expertise and experiences. This provides a model for HCPs' pediatric diabetes training provision. CONCLUSIONS There is a severe shortage of high quality, standardized training for HCPs across the majority of European countries. Lack of trained HCPs for CYP with diabetes will result in the delivery of suboptimal care and impact on health, wellbeing and clinical and psychological outcomes. The EU-CDEC template can be used to increase access to high quality training provision for all HCPs across Europe and worldwide.
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Affiliation(s)
- Nicky Helen Kime
- Carnegie School of Sport, Leeds Beckett University, Leeds, England
| | - Sheridan Waldron
- Children and Young People's Diabetes Centre, St. James's University Hospital, Leeds, England
| | | | - Karin Lange
- Medizinische Psychologie 5430, Medizinische Hochschule Hannover, Hannover, Germany
| | - Katarzyna Zinken
- Ward KD-A, Crisis and Diagnostics, ZPP Mannheim am Zentralinstitut für seelische Gesundheit, Mannheim, Germany
| | - Thomas Danne
- Diabeteszentrum für Kinder und Jugendliche AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Bärbel Aschemeier
- Diabeteszentrum für Kinder und Jugendliche AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | | | - Andriani Vazeou
- A' Department of Pediatrics, Diabetes Center, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Natasa Bratina
- Department for Endocrinology, Diabetes and Metabolic Diseases, University Childrens Hospital Ljubljana, Ljubljana, Slovenia
| | - Fiona Campbell
- Children and Young People's Diabetes Centre, St. James's University Hospital, Leeds, England
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27
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Erie C, Van Name MA, Weyman K, Weinzimer SA, Finnegan J, Sikes K, Tamborlane WV, Sherr JL. Schooling diabetes: Use of continuous glucose monitoring and remote monitors in the home and school settings. Pediatr Diabetes 2018; 19:92-97. [PMID: 28303678 PMCID: PMC5601025 DOI: 10.1111/pedi.12518] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 02/10/2017] [Accepted: 02/15/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Despite significant advances in type 1 diabetes (T1D) management, achieving targeted glycemic control in pediatric patients remains a struggle. Continuous glucose monitoring (CGM) with remote access holds the promise to address this challenge by allowing caregivers to monitor glucose, even when the child is not directly under their supervision. OBJECTIVE To explore real-time and remote CGM practices in homes and schools, including caregiver expectations regarding this technology. SUBJECTS Parents and daytime caregivers. METHODS Respondents answered an anonymous survey assessing characteristics of CGM use. Cross-sectional data were collected and analyzed using quantitative and qualitative methods. RESULTS Thirty-three parents and 17 daytime caregivers responded. Threshold alerts (alerts when patients reached certain pre-set high or low limits) were used most frequently, followed by rate of change alerts. Most parents and daytime caregivers responded to low- and high-threshold CGM alerts by confirming with a glucose meter prior to treatment; while about one-third endorsed treating lows without a confirmatory test. Most parents expected their child's daytime caregiver to respond to CGM alerts and daytime caregivers felt the parent's expectations of them were reasonable. All parents and most caregivers reported decreased overall worry/stress. Parents felt positive about CGM use and daytime caregivers felt comfortable with CGM. CONCLUSION The positive and collaborative management reported by parents and daytime caregivers sets the stage for CGM to play an important role in the management of children with T1D both in the home and in the school settings.
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Affiliation(s)
- Christine Erie
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, Florida
| | | | - Kate Weyman
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Stuart A Weinzimer
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Jennifer Finnegan
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Kristin Sikes
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | | | - Jennifer L Sherr
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut
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28
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Zoni S, Verga ME, Hauschild M, Aquarone-Vaucher MP, Gyuriga T, Ramelet AS, Dwyer AA. Patient Perspectives on Nurse-led Consultations Within a Pilot Structured Transition Program for Young Adults Moving From an Academic Tertiary Setting to Community-based Type 1 Diabetes Care. J Pediatr Nurs 2018; 38:99-105. [PMID: 29357987 DOI: 10.1016/j.pedn.2017.11.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 11/27/2017] [Accepted: 11/28/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE We aimed to evaluate patient self-management activities, patient perceptions of the therapeutic relationship and satisfaction with nurse-led consultations as part of a structured, pilot program transitioning young adults with type 1 diabetes (T1DM) to adult-oriented community-based practices. DESIGN AND METHODS A descriptive, cross-sectional study of patients receiving nurse-led consultations. Patients provided sociodemographic/health information, glycated hemoglobin (HbA1c) measures and completed questionnaires assessing self-management (Revised Self-Care Inventory) and the therapeutic relationship (Caring Nurse-Patient Interaction - short scale). HbA1c values were compared to guideline recommendations. RESULTS Twenty patients participated. HbA1c was ≤7.5% in 3/14 (21%) and 5/14 (36%) exhibited poor glycemic control (≥9.5%). The greatest concordance for self-care was in relation to insulin therapy (4.5±0.5) while patients reported the lowest adherence to diet recommendations (2.9±0.8). Overall satisfaction with nurse-led consultations was high (4±0.5 out of 5). Patients considered diabetes knowledge and technical competence as very important and were most pleased with the humanistic aspects of nursing care. Respect for privacy was deemed the most important (and most frequently observed) nursing attitude/behavior during consultations. CONCLUSIONS Young adults found the nurse-led consultations with therapeutic education to develop T1DM self-care skills are an important complement to medical management during transition. PRACTICE IMPLICATIONS Patient autonomy and privacy should be respected during this developmental period. Nurses taking a humanistic approach towards accompanying and supporting the patient can enhance the therapeutic relationship during transition and promote continuity of care. Transition nurses can use technical competence and therapeutic education to empower patients for self-management.
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Affiliation(s)
- Sandra Zoni
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland
| | - Marie-Elise Verga
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Haute école de santé Fribourg, Fribourg Switzerland
| | - Michael Hauschild
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Marie-Paule Aquarone-Vaucher
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Teresa Gyuriga
- Centre Hospitalier Universitaire Vaudois (CHUV) Pediatric Endocrinology, Diabetes and Metabolism Service of the Department of Maternal and Child Health, Lausanne, Switzerland
| | - Anne-Sylvie Ramelet
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Department of Maternal and Child Health, Lausanne, Switzerland
| | - Andrew A Dwyer
- University of Lausanne Institute of Higher Education and Research in Healthcare, Lausanne, Switzerland; Centre Hospitalier Universitaire Vaudois (CHUV) Endocrinology, Diabetes and Metabolism Service, Lausanne, Switzerland.
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29
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Sundberg F, Barnard K, Cato A, de Beaufort C, DiMeglio LA, Dooley G, Hershey T, Hitchcock J, Jain V, Weissberg-Benchell J, Rami-Merhar B, Smart CE, Hanas R. ISPAD Guidelines. Managing diabetes in preschool children. Pediatr Diabetes 2017; 18:499-517. [PMID: 28726299 DOI: 10.1111/pedi.12554] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 05/14/2017] [Accepted: 05/31/2017] [Indexed: 01/09/2023] Open
Affiliation(s)
- Frida Sundberg
- The Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Katharine Barnard
- Faculty of Health and Social Sciences, Bournemouth University, Bournemouth, UK
| | - Allison Cato
- Neurology Division, Nemours Children's Health System, Jacksonville, Florida
| | - Carine de Beaufort
- Clinique Pediatrique, Centre Hospitalier de Luxembourg (CHL), Luxembourg, Luxembourg.,Department of Pediatrics, UZ Brussels, Jette, Belgium
| | - Linda A DiMeglio
- Department of Pediatrics, Section of Pediatric Endocrinology/Diabetology, Indiana University School of Medicine, Indianapolis, Indiana
| | | | - Tamara Hershey
- Psychiatry Department, Washington University School of Medicine, St. Louis, Missouri.,Radiology Department, Washington University School of Medicine, St. Louis, Missouri
| | | | - Vandana Jain
- Pediatric Endocrinology Division, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Chicago, Illinois.,Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Carmel E Smart
- Department of Endocrinology, John Hunter Children's Hospital and University of Newcastle, Newcastle, Australia
| | - Ragnar Hanas
- Institute of Clinical Sciences, Department of Pediatrics, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.,Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden
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30
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Butler AM, Weller BE, Yi-Frazier JP, Fegan-Bohm K, Anderson B, Pihoker C, Hilliard ME. Diabetes-Specific and General Life Stress and Glycemic Outcomes in Emerging Adults With Type 1 Diabetes: Is Race/Ethnicity a Moderator? J Pediatr Psychol 2017; 42:933-940. [PMID: 28645198 PMCID: PMC5896631 DOI: 10.1093/jpepsy/jsx092] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 05/08/2017] [Accepted: 05/25/2017] [Indexed: 11/14/2022] Open
Abstract
Objective This study examines whether race/ethnicity moderates relationships of (a) diabetes stress and general life stressors with (b) diabetes outcomes of glycemic control and diabetic ketoacidosis (DKA) among emerging adults (aged 18-25 years) with type 1 diabetes (T1D). Method Using a T1D Exchange Registry sample of non-Hispanic White, African American, and Hispanic emerging adults (N = 3,440), multiple group analyses were used to determine whether race/ethnicity moderates the relationships between stress and diabetes outcomes. Results The relationships between the two stress types and glycemic control did not differ between African American and non-Hispanic Whites. However, as compared with non-Hispanic Whites, the association between higher diabetes-specific stress and poorer glycemic control was significantly stronger for Hispanics, and Hispanics had poorer glycemic control when they experienced a relatively fewer number of general life stressors than non-Hispanic Whites. The relationships between the type of stress (diabetes-specific and general stress) and DKA did not differ across racial/ethnic groups. Conclusions Future research should evaluate possible mechanisms that contribute to the different relationships of stress with glycemic control among Hispanics compared with non-Hispanic Whites.
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Affiliation(s)
| | - Bridget E. Weller
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine
| | - Joyce P. Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children’s Research Institute
| | | | | | - Catherine Pihoker
- Center for Clinical and Translational Research, Seattle Children’s Research Institute
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31
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Brown SA, Breton MD, Anderson SM, Kollar L, Keith-Hynes P, Levy CJ, Lam DW, Levister C, Baysal N, Kudva YC, Basu A, Dadlani V, Hinshaw L, McCrady-Spitzer S, Bruttomesso D, Visentin R, Galasso S, Del Favero S, Leal Y, Boscari F, Avogaro A, Cobelli C, Kovatchev BP. Overnight Closed-Loop Control Improves Glycemic Control in a Multicenter Study of Adults With Type 1 Diabetes. J Clin Endocrinol Metab 2017; 102:3674-3682. [PMID: 28666360 PMCID: PMC5630248 DOI: 10.1210/jc.2017-00556] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/22/2017] [Indexed: 11/19/2022]
Abstract
CONTEXT Closed-loop control (CLC) for the management of type 1 diabetes (T1D) is a novel method for optimizing glucose control, and strategies for individualized implementation are being developed. OBJECTIVE To analyze glycemic control in an overnight CLC system designed to "reset" the patient to near-normal glycemic targets every morning. DESIGN Randomized, crossover, multicenter clinical trial. PARTICIPANTS Forty-four subjects with T1D requiring insulin pump therapy. INTERVENTION Sensor-augmented pump therapy (SAP) at home vs 5 nights of CLC (active from 23:00 to 07:00) in a supervised outpatient setting (research house or hotel), with a substudy of 5 nights of CLC subsequently at home. MAIN OUTCOME MEASURE The percentage of time spent in the target range (70 to 180 mg/dL measured using a continuous glucose monitor). RESULTS Forty subjects (age, 45.5 ± 9.5 years; hemoglobin A1c, 7.4% ± 0.8%) completed the study. The time in the target range (70 to 180 mg/dL) significantly improved in CLC vs SAP over 24 hours (78.3% vs 71.4%; P = 0.003) and overnight (85.7% vs 67.6%; P < 0.001). The time spent in a hypoglycemic range (<70 mg/dL) decreased significantly in the CLC vs SAP group over 24 hours (2.5% vs 4.3%; P = 0.002) and overnight (0.9% vs 3.2%; P < 0.001). The mean glucose level at 07:00 was lower with CLC than with SAP (123.7 vs 145.3 mg/dL; P < 0.001). The substudy at home, involving 10 T1D subjects, showed similar trends with an increased time in target (70 to 180 mg/dL) overnight (75.2% vs 62.2%; P = 0.07) and decreased time spent in the hypoglycemic range (<70 mg/dL) overnight in CLC vs SAP (0.6% vs 3.7%; P = 0.03). CONCLUSION Overnight-only CLC increased the time in the target range over 24 hours and decreased the time in hypoglycemic range over 24 hours in a supervised outpatient setting. A pilot extension study at home showed a similar nonsignificant trend.
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Affiliation(s)
- Sue A Brown
- Center for Diabetes Technology, Division of Endocrinology, University of Virginia, Charlottesville, Virginia 22903
| | - Marc D Breton
- Center for Diabetes Technology, Division of Endocrinology, University of Virginia, Charlottesville, Virginia 22903
| | - Stacey M Anderson
- Center for Diabetes Technology, Division of Endocrinology, University of Virginia, Charlottesville, Virginia 22903
| | - Laura Kollar
- Center for Diabetes Technology, Division of Endocrinology, University of Virginia, Charlottesville, Virginia 22903
| | | | - Carol J Levy
- Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - David W Lam
- Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Camilla Levister
- Icahn School of Medicine at Mount Sinai, New York, New York 10029
| | - Nihat Baysal
- Rensselaer Polytechnic Institute, Troy, New York 12180
| | | | | | | | | | | | - Daniela Bruttomesso
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padua, Padua 35122, Italy
| | - Roberto Visentin
- Department of Information Engineering, University of Padua, Padua 35122, Italy
| | - Silvia Galasso
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padua, Padua 35122, Italy
| | - Simone Del Favero
- Department of Information Engineering, University of Padua, Padua 35122, Italy
| | - Yenny Leal
- Department of Information Engineering, University of Padua, Padua 35122, Italy
| | - Federico Boscari
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padua, Padua 35122, Italy
| | - Angelo Avogaro
- Unit of Metabolic Diseases, Department of Internal Medicine, University of Padua, Padua 35122, Italy
| | - Claudio Cobelli
- Department of Information Engineering, University of Padua, Padua 35122, Italy
| | - Boris P Kovatchev
- Center for Diabetes Technology, Division of Endocrinology, University of Virginia, Charlottesville, Virginia 22903
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Impact of monitoring health-related quality of life in clinical practice in children with type 1 diabetes mellitus. Qual Life Res 2017; 26:3267-3277. [DOI: 10.1007/s11136-017-1682-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 01/09/2023]
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Parikh K, Berry J, Hall M, Mussman GM, Montalbano A, Thomson J, Morse R, Wilson KM, Shah SS. Racial and Ethnic Differences in Pediatric Readmissions for Common Chronic Conditions. J Pediatr 2017; 186:158-164.e1. [PMID: 28438375 DOI: 10.1016/j.jpeds.2017.03.046] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 02/13/2017] [Accepted: 03/20/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To compare the timing and magnitude of variation of pediatric readmission rates across race/ethnicity for selected chronic conditions: asthma, diabetes, seizures, migraines, and depression. STUDY DESIGN Retrospective analysis of hospitalizations at 48 children's hospitals in the 2013 Pediatric Health Information System database for children (ages 0-18 years) admitted for asthma (n = 36 910), seizure (n = 35 361), diabetes (n = 12 468), migraine (n = 5882), and depression (n = 5132). Generalized linear models with a random effect for hospital were used to compare the likelihood of readmission by patients' race/ethnicity, adjusting for severity of illness, age, payer, and medical complexity. Adjusted readmission rates were calculated by week over 1 year. RESULTS Significant variation in adjusted readmission rates by race/ethnicity existed for conditions aside from depression. Disparities for diabetes and asthma emerged at 3 and 4 weeks, respectively; they remained divergent up to 1 year with the highest 1-year readmission rates in non-Hispanic blacks vs other race/ethnicities (diabetes: 21.7% vs 13.4%, P < .001; asthma: 21.4% vs 14.6%, P < .001). Disparities for migraines and seizure emerged at 6 and 7 weeks, respectively; they remained up to 1 year, with the highest 1-year readmission rates in non-Hispanic whites vs other race/ethnicities (migraine: 17.3% vs 13.6%, P < .001; seizure: 23.9% vs 21.9%, P < .001). CONCLUSIONS Readmission disparities behave differently across chronic conditions. They emerge more quickly after discharge for children hospitalized with asthma or diabetes than for seizures or migraines. The highest readmission rates were not consistently observed for 1 particular race/ethnicity. Study findings can impact pediatric chronic disease management to improve care for children with these conditions.
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Affiliation(s)
- Kavita Parikh
- Division of Hospitalist Medicine, Department of Pediatrics, Children's National Medical Center and George Washington School of Medicine, Washington, DC.
| | - Jay Berry
- Division of General Pediatrics, Children's Hospital, Harvard Medical School, Boston, MA
| | - Matt Hall
- Children's Hospital Association, Lenexa, KS
| | - Grant M Mussman
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Amanda Montalbano
- Children's Mercy Hospitals and Clinics and University of Missouri-Kansas City School of Medicine, Kansas City, MO
| | - Joanna Thomson
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rustin Morse
- Children's Health System of Texas and University of Texas Southwestern, Dallas, TX
| | - Karen M Wilson
- Children's Hospital Colorado and the University of Colorado School of Medicine, Aurora, CO
| | - Samir S Shah
- Divisions of Hospital Medicine and Infectious Diseases, Cincinnati Children's Hospital Medical Center, and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
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34
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Rica I, Mingorance A, Gómez-Gila AL, Clemente M, González I, Caimari M, García-Cuartero B, Barrio R. Achievement of metabolic control among children and adolescents with type 1 diabetes in Spain. Acta Diabetol 2017; 54:677-683. [PMID: 28421336 DOI: 10.1007/s00592-017-0991-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 04/02/2017] [Indexed: 12/27/2022]
Abstract
AIMS To assess metabolic control in a paediatric T1D population in Spain and analyse the rate of severe acute decompensations and chronic complications. METHODS Data from patients treated at eight paediatric diabetes units with experienced diabetes teams between June and December 2014 were analysed in an observational prospective study. Variables included: age, sex, diabetes duration, number of follow-up visits/year, anthropometrical data, insulin treatment modalities, mean annual HbA1c and the prevalence of acute and chronic complications. SPSS statistics 21.0 was used. RESULTS A total of 853 patients (49.7% female) with a mean age of 12.1 ± 3.7 years were included. Anthropometric data were normal. Mean diabetes duration was 8 ± 3.4 years. Mean outpatient follow-up was 4.7 ± 0.04 visits/year. Twenty-five per cent were on continuous subcutaneous insulin infusion (CSII). Mean HbA1c was 7.3 ± 1% (56 ± 8 mmol/mol) and 66.6% had HbA1c < 7.5% (58 mmol/mol). HbA1c value correlated negatively with age at onset and positively with years of diabetes, number of visits/year and current age (F = 7.06; p = 0.01). Patients on CSII (n = 213) were younger, attended the outpatient clinic more frequently, were diagnosed earlier, had better metabolic control and had presented more severe hypoglycaemic episodes the previous year. The rate of severe decompensation (episodes/100 patients/year) was ketoacidosis 1.5 and severe hypoglycaemia 4.5. The prevalence of chronic complications was very low. CONCLUSIONS Our data describe the good compliance of paediatric T1D patients treated at eight paediatric units in Spain following international standards of metabolic control.
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Affiliation(s)
- Itxaso Rica
- Paediatric Endocrinology, Hospital Universitario de Cruces, CIBERDEM, CIBERER, BIOCRUCES, Plaza Cruces s/n, 48903, Barakaldo, Bizkaia, Spain
| | - Andrés Mingorance
- Paediatric Endocrinology, Hospital General Universitario de Alicante, Pintor Baeza 11, 03010, Alicante, Spain
| | - Ana Lucía Gómez-Gila
- Paediatric Endocrinology Unit. Paediatric Service, Hospital Infantil, HHUU Virgen Rocío, Avda Marques Luca de Tena s/n, Seville, Spain
| | - María Clemente
- Paediatric Endocrinology Unit, Paediatric Service, Growth and Development Research Unit, Vall d'Hebron Research Institute (VHIR), Hospital Vall d'Hebron, CIBERER, Instituto de Salud Carlos III, Ps. Vall d´Hebron 119-129, 08035, Barcelona, Spain.
| | - Isabel González
- Paediatric Endocrinology, Hospital Infantil La Paz, Pº Castellana 261, 28046, Madrid, Spain
| | - María Caimari
- Paediatric Endocrinology, Hospital Universitario Son Espases, Carretera Valldemosa, 79, 07010, Palma de Mallorca, Spain
| | - Beatriz García-Cuartero
- Paediatric Endocrinology Unit, Severo Ochoa University Hospital, 28911, Leganés, Madrid, Spain
| | - Raquel Barrio
- Paediatric Endocrinology and Diabetes Unit, Ramón y Cajal University Hospital, Cta. Colmenar Viejo 9, 100, 28034, Madrid, Spain
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Castensøe-Seidenfaden P, Jensen AK, Smedegaard H, Hommel E, Husted GR, Pedersen-Bjergaard U, Teilmann G. Clinical, behavioural and social indicators for poor glycaemic control around the time of transfer to adult care: a longitudinal study of 126 young people with diabetes. Diabet Med 2017; 34:667-675. [PMID: 28099760 DOI: 10.1111/dme.13318] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2017] [Indexed: 01/09/2023]
Abstract
AIMS To describe and compare changes in glycaemic control in young people with Type 1 diabetes over time between the last 2 years in paediatric care and the first 2 years in adult care and to identify risk factors for poor glycaemic control. METHODS Our retrospective cohort study followed participants aged 14-22 years from 2 years before to 2 years after transfer from paediatric to adult care. Changes in glycaemic control were calculated using repeated measurements. We adjusted for gender, age at diabetes onset, age at transfer, duration of diabetes at transfer, gap (amount of time) between last paediatric and first adult visit, comorbidity, learning disability and/or mental health conditions and family structure. We examined associations between acute hospital admissions, low visit attendance rate, loss to follow-up and baseline HbA1c level. RESULTS Among 126 participants, the mean HbA1c level was 80 mmol/mol (9.4%) pre-transfer but decreased by an average of 3 mmol/mol (0.3%) each year post-transfer (P = 0.005). Young people with a learning disability and/or a mental health condition had worse glycaemic control (P = 0.041) and the mean HbA1c of those with divorced parents was 14 mmol/mol (1.2%) higher (P = 0.014). Almost one-third of participants were admitted to the hospital for acute diabetes care. Low visit attendance rate, high baseline HbA1c level, learning disability and/or mental health conditions and divorced parents predicted acute hospital admissions. CONCLUSIONS Glycaemic control improved significantly after transfer to adult care, but the mean HbA1c level remained high. Future interventions should focus on young people with divorced parents, those with a learning disability and/or mental health condition and those who do not attend clinical visits to improve HbA1c levels and thereby reduce hospitalization rates.
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Affiliation(s)
| | - A K Jensen
- Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Research, Nordsjaellands Hospital, Hillerød, Denmark
| | - H Smedegaard
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
| | - E Hommel
- Steno Diabetes Centre, Gentofte, Denmark
| | - G R Husted
- Steno Diabetes Centre, Gentofte, Denmark
| | - U Pedersen-Bjergaard
- Department of Cardiology, Nephrology and Endocrinology, Nordsjaellands Hospital, Hillerød, Denmark
| | - G Teilmann
- Paediatric and Adolescent Department, Nordsjaellands Hospital, Hillerød, Denmark
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Selvan C, Thukral A, Dutta D, Ghosh S, Chowdhury S. Impact of Self-monitoring of Blood Glucose Log Reliability on Long-term Glycemic Outcomes in Children with Type 1 Diabetes. Indian J Endocrinol Metab 2017; 21:382-386. [PMID: 28553591 PMCID: PMC5434719 DOI: 10.4103/ijem.ijem_342_16] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Logbooks of self-monitoring of blood glucose (SMBG) are useful in the modulation of insulin regimens, which aid in achieving glycemic control in type 1 diabetes mellitus (T1DM). However, discrepancies in SMBG charting may impede its utility. This study aimed to assess the accuracy of log entries and its impact on long-term glycemic control. METHODS SMBG in logbooks was compared with readings in glucometer memory and discrepancies between the two were evaluated in 101 children with T1DM. The relationship between these discrepancies and glycated hemoglobin (HbA1c) over 44 months was assessed. RESULTS Errors in glucose charting were observed in 32.67% children. The most common observed error was omission (42.42%), followed by fabrication (27.27%), erroneous (18.18%), and others (12.12%). Age was not significantly different among children having accurate versus inaccurate SMBG logs. During follow-up of 44 months, children with accurate SMBG logs consistently had lower HbA1c as compared to children having inaccurate logs, which was statistically significant at 4, 16, 20, and 28 months' follow-up. The same was reflected in the proportion of children achieving HbA1c <7% and 7%-9%. Of the 14 children who had omissions, 9 had omission of high values only, 3 patients had omission of low values only, 1 had omission of both high and low values, and 1 had omission of normal values. Among logs with fabrication, parents were responsible in 2 of 9 incidents. In the remaining 7, it was the child himself/herself. Children with fabrication consistently had the highest HbA1c values among the different types of inaccurate blood glucose chartings, which was statistically significant at 32 and 36 months of follow-up. CONCLUSIONS Reliability of SMBG logs is a significant problem among children with T1DM at our center. Children with accurate logs of SMBG readings were more likely to have better glycemic control on long-term follow-up.
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Affiliation(s)
- Chitra Selvan
- Department of Endocrinology, M.S. Ramaiah Medical College, Bengaluru, Karnataka, India
| | - Anubhav Thukral
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Deep Dutta
- Department of Endocrinology, Post Graduate Institute of Medical Education and Research, Dr. Ram Manohar Lohia Hospital, New Delhi, India
| | - Sujoy Ghosh
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
| | - Subhankar Chowdhury
- Department of Endocrinology and Metabolism, Institute of Postgraduate Medical Education and Research, Seth Sukhlal Karnani Memorial Hospital, Kolkata, West Bengal, India
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Jonsdottir B, Larsson C, Carlsson A, Forsander G, Ivarsson SA, Lernmark Å, Ludvigsson J, Marcus C, Samuelsson U, Örtqvist E, Larsson HE. Thyroid and Islet Autoantibodies Predict Autoimmune Thyroid Disease at Type 1 Diabetes Diagnosis. J Clin Endocrinol Metab 2017; 102:1277-1285. [PMID: 28388722 PMCID: PMC5460724 DOI: 10.1210/jc.2016-2335] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 10/07/2016] [Indexed: 12/30/2022]
Abstract
CONTEXT Screening of autoimmune thyroid disease in children with type 1 diabetes is important but varies between clinics. OBJECTIVE To determine the predictive value of thyroid autoantibodies, thyroid function, islet autoantibodies, and HLA-DQ at diagnosis of type 1 diabetes for autoimmune thyroid disease during follow-up. SETTING Forty-three Swedish pediatric endocrinology units. DESIGN, PATIENTS, AND MAIN OUTCOME MEASURES At diagnosis of type 1 diabetes, autoantibodies against thyroid peroxidase (TPOAb), thyroglobulin (TGAb), glutamic acid decarboxylase (GADA), insulin, insulinoma-associated protein-2, and 3 variants of zinc transporter 8 (ZnT8W/R/QA) HLA-DQA1-B1 genotypes and thyroid function were analyzed in 2433 children. After 5.1 to 9.5 years, information on thyroxine treatment was gathered from the Swedish National Board of Health and Welfare's Prescribed Drug Register. RESULTS Thyroxine was prescribed to 6% of patients. In patients <5 years of age, female sex [hazard ratio (HR) = 4.60; P = 0.008] and GADA (HR = 5.80; P = 0.02) were predictors. In patients 5 to 10 years old, TPOAb (HR = 20.56; P < 0.0001), TGAb (HR = 3.40; P = 0.006), and thyroid-stimulating hormone (TSH) (HR = 3.64; P < 0.001) were predictors, whereas in 10 to 15 year olds, TPOAb (HR = 17.00; P < 0.001) and TSH (HR = 4.11; P < 0.001) predicted thyroxine prescription. CONCLUSION In addition to TPOAb and TSH, GADA at diagnosis of type 1 diabetes is important for the prediction of autoimmune thyroid disease in children <5 years of age.
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Affiliation(s)
- Berglind Jonsdottir
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Christer Larsson
- Department of Laboratory Medicine, Lund University, SE-211 85 Lund, Sweden
| | - Annelie Carlsson
- Department of Pediatrics, Lund University, Skåne University Hospital, SE-211 85 Lund, Sweden
| | - Gun Forsander
- Department of Pediatrics, The Queen Silvia Children's Hospital, SE-416 86 Gothenburg, Sweden
| | - Sten Anders Ivarsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Åke Lernmark
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
| | - Johnny Ludvigsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University Hospital, SE-58183 Linköping, Sweden
| | - Claude Marcus
- Division of Pediatrics, Department of Clinical Science, Intervention and Technology, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University Hospital, SE-58183 Linköping, Sweden
| | - Eva Örtqvist
- Pediatric Endocrinology Unit, Department of Women's and Children's Health, Karolinska Institute, SE-171 77 Stockholm, Sweden
| | - Helena Elding Larsson
- Department of Clinical Sciences, Lund University, Skåne University Hospital, SE-205 02 Malmö, Sweden
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McIntosh B, Khatchadourian K, Amed S. British Columbian Healthcare Providers' Perspectives on Facilitators and Barriers to Adhering to Pediatric Diabetes Treatment Guidelines. Can J Diabetes 2017; 41:224-240. [DOI: 10.1016/j.jcjd.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
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Hannon TS, Dugan TM, Saha CK, McKee SJ, Downs SM, Carroll AE. Effectiveness of Computer Automation for the Diagnosis and Management of Childhood Type 2 Diabetes: A Randomized Clinical Trial. JAMA Pediatr 2017; 171:327-334. [PMID: 28192551 PMCID: PMC5972516 DOI: 10.1001/jamapediatrics.2016.4207] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Importance Type 2 diabetes (T2D) is increasingly common in young individuals. Primary prevention and screening among children and adolescents who are at substantial risk for T2D are recommended, but implementation of T2D screening practices in the pediatric primary care setting is uncommon. Objective To determine the feasibility and effectiveness of a computerized clinical decision support system to identify pediatric patients at high risk for T2D and to coordinate screening for and diagnosis of prediabetes and T2D. Design, Setting, and Participants This cluster-randomized clinical trial included patients from 4 primary care pediatric clinics. Two clinics were randomized to the computerized clinical decision support intervention, aimed at physicians, and 2 were randomized to the control condition. Patients of interest included children, adolescents, and young adults 10 years or older. Data were collected from January 1, 2013, through December 1, 2016. Interventions Comparison of physician screening and follow-up practices after adding a T2D module to an existing computer decision support system. Main Outcomes and Measures Electronic medical record (EMR) data from patients 10 years or older were reviewed to determine the rates at which pediatric patients were identified as having a body mass index (BMI) at or above the 85th percentile and 2 or more risk factors for T2D and underwent screening for T2D. Results Medical records were reviewed for 1369 eligible children (712 boys [52.0%] and 657 girls [48.0%]; median [interquartile range] age, 12.9 [11.2-15.3]), of whom 684 were randomized to the control group and 685 to the intervention group. Of these, 663 (48.4%) had a BMI at or above the 85th percentile. Five hundred sixty-five patients (41.3%) met T2D screening criteria, with no difference between control and intervention sites. The T2D module led to a significant increase in the percentage of patients undergoing screening for T2D (89 of 283 [31.4%] vs 26 of 282 [9.2%]; adjusted odds ratio, 4.6; 95% CI, 1.5-14.7) and a greater proportion attending a scheduled follow-up appointment (45 of 153 [29.4%] vs 38 of 201 [18.9%]; adjusted odds ratio, 1.8; 95% CI, 1.5-2.2). Conclusions and Relevance Use of a computerized clinical decision support system to automate the identification and screening of pediatric patients at high risk for T2D can help overcome barriers to the screening process. The support system significantly increased screening among patients who met the American Diabetes Association criteria and adherence to follow-up appointments with primary care clinicians. Trial Registration clinicaltrials.gov Identifier: NCT01814787.
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Affiliation(s)
- Tamara S Hannon
- Indiana Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Tamara M Dugan
- Indiana Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Chandan K Saha
- Department of Biostatistics, Indiana University School of Medicine, Indianapolis
| | - Steven J McKee
- Indiana Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Stephen M Downs
- Indiana Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
| | - Aaron E Carroll
- Indiana Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis
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Dunger DB. Banting Memorial Lecture 2016 Reducing lifetime risk of complications in adolescents with Type 1 diabetes. Diabet Med 2017; 34:460-466. [PMID: 27973749 DOI: 10.1111/dme.13299] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/08/2016] [Indexed: 12/19/2022]
Abstract
Adolescence is a challenging period of life for any young person, and for those with Type 1 diabetes, physiological and psychological factors can result in a deterioration in glycaemic control. In young people with Type 1 diabetes, puberty may be an additional risk factor impacting on the lifetime risk for renal and cardiovascular complications. Our longitudinal studies have identified that increases in urinary albumin excretion through childhood are associated with the development of microalbuminuria and a generalized endotheliopathy linked to cardiovascular risk. Screening of participants recruited to the Adolescent type 1 Diabetes cardio-renal Intervention Trial (AdDIT) confirms that these early changes in albumin excretion are related to both diabetic nephropathy and cardiovascular risk; in part, independent of glycaemic control. Thus, as well as current attempts to improve glycaemic control through enhanced targeted insulin delivery, pumps, sensors and closed loop, we have explored the role of angiotensin-converting enzyme inhibitors and statins in providing cardio-renal protection during adolescence.
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Affiliation(s)
- D B Dunger
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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41
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Schwandt A, Hermann JM, Rosenbauer J, Boettcher C, Dunstheimer D, Grulich-Henn J, Kuss O, Rami-Merhar B, Vogel C, Holl RW. Longitudinal Trajectories of Metabolic Control From Childhood to Young Adulthood in Type 1 Diabetes From a Large German/Austrian Registry: A Group-Based Modeling Approach. Diabetes Care 2017; 40:309-316. [PMID: 28007778 DOI: 10.2337/dc16-1625] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 11/23/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Worsening of glycemic control in type 1 diabetes during puberty is a common observation. However, HbA1c remains stable or even improves for some youths. The aim is to identify distinct patterns of glycemic control in type 1 diabetes from childhood to young adulthood. RESEARCH DESIGN AND METHODS A total of 6,433 patients with type 1 diabetes were selected from the prospective, multicenter diabetes patient registry Diabetes-Patienten-Verlaufsdokumentation (DPV) (follow-up from age 8 to 19 years, baseline diabetes duration ≥2 years, HbA1c aggregated per year of life). We used latent class growth modeling as the trajectory approach to determine distinct subgroups following a similar trajectory for HbA1c over time. RESULTS Five distinct longitudinal trajectories of HbA1c were determined, comprising group 1 = 40%, group 2 = 27%, group 3 = 15%, group 4 = 13%, and group 5 = 5% of patients. Groups 1-3 indicated stable glycemic control at different HbA1c levels. At baseline, similar HbA1c was observed in group 1 and group 4, but HbA1c deteriorated in group 4 from age 8 to 19 years. Similar patterns were present in group 3 and group 5. We observed differences in self-monitoring of blood glucose, insulin therapy, daily insulin dose, physical activity, BMI SD score, body-height SD score, and migration background across all HbA1c trajectories (all P ≤ 0.001). No sex differences were present. Comparing groups with similar initial HbA1c but different patterns, groups with higher HbA1c increase were characterized by lower frequency of self-monitoring of blood glucose and physical activity and reduced height (all P < 0.01). CONCLUSIONS Using a trajectory approach, we determined five distinct longitudinal patterns of glycemic control from childhood to early adulthood. Diabetes self-care, treatment differences, and demographics were related to different HbA1c courses.
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Affiliation(s)
- Anke Schwandt
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany .,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Julia M Hermann
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Joachim Rosenbauer
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology and Diabetology, Centre of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany
| | | | | | - Oliver Kuss
- German Center for Diabetes Research (DZD), Neuherberg, Germany.,Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Christian Vogel
- Department of Pediatrics, Children's Hospital Chemnitz, Chemnitz, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry (ZIBMT), University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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Bode BW, Kaufman FR, Vint N. An Expert Opinion on Advanced Insulin Pump Use in Youth with Type 1 Diabetes. Diabetes Technol Ther 2017; 19:145-154. [PMID: 28135116 DOI: 10.1089/dia.2016.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Among children and adolescents with type 1 diabetes mellitus, the use of insulin pump therapy has increased since its introduction in the early 1980s. Optimal management of type 1 diabetes mellitus depends on sufficient understanding by patients, their families, and healthcare providers on how to use pump technology. The goal for the use of insulin pump therapy should be to advance proficiency over time from the basics taught at the initiation of pump therapy to utilizing advanced settings to obtain optimal glycemic control. However, this goal is often not met, and appropriate understanding of the full features of pump technology can be lacking. The objective of this review is to provide an expert perspective on the advanced features and use of insulin pump therapy, including practical guidelines for the successful use of insulin pump technology, and other considerations specific to patients and healthcare providers.
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Affiliation(s)
- Bruce W Bode
- 1 Atlanta Diabetes Associates , Atlanta, Georgia
| | - Francine R Kaufman
- 2 The Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles , Los Angeles, California
- 3 Medtronic , Northridge, California
| | - Nan Vint
- 4 Lilly USA, LLC, Lilly Corporate Center , US Medical Affairs, Indianapolis, Indiana
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Strich D, Balagour L, Shenker J, Gillis D. Lower Basal Insulin Dose is Associated with Better Control in Type 1 Diabetes. J Pediatr 2017; 182:133-136. [PMID: 27974167 DOI: 10.1016/j.jpeds.2016.11.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Revised: 10/03/2016] [Accepted: 11/08/2016] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To test the hypothesis that lower basal insulin doses may be paradoxically associated with better diabetic control, we assessed the association between the basal insulin dose and hemoglobin A1c (HbA1c) level in a group of children and young adults with type 1 diabetes. STUDY DESIGN This was a retrospective study of 89 patients with type 1 diabetes (mean age, 14.67 ± 4.8 years; range, 3-29 years) treated in a single outpatient clinic. Forty-six of the 89 patients were treated with continuous subcutaneous insulin infusion, and the other 43 were treated with multiple daily injections (glargine as basal insulin). The daily basal insulin dose was taken either as downloaded from the insulin pump or as registered in the chart at the most recent clinic visit. Glucose data were taken from computerized registration of downloaded patient glucometers. The mean time between data download and HbA1c determination was 0.9 ± 0.78 months. HbA1c level and basal insulin dose were entered with other variables in a multivariable linear regression model. RESULTS There was a significant correlation between injection of less total daily basal insulin and lower HbA1c level (Pearson correlation, 0.441; P < .001). Optimal HbA1c level was associated with use of 0.28 ± 0.08 U/kg/day of basal insulin (35 ± 10% basal/total). CONCLUSION With lower basal insulin levels, lower HbA1C was achieved despite the same total bolus dose. The optimal basal dose as determined by this study is similar to that found in fasting individuals of similar age.
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Affiliation(s)
- David Strich
- Clalit Health Services, Jerusalem District, Israel; Department of Pediatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Lucy Balagour
- Department of Medical Students, Hadassah-Hebrew University School of Medicine, Jerusalem, Israel
| | | | - David Gillis
- Department of Pediatrics and Pediatric Endocrine Unit, Hadassah-Hebrew University Medical Center, Jerusalem, Israel.
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Miller D, Mamilly L, Fourtner S, Rosen-Carole C. ABM Clinical Protocol #27: Breastfeeding an Infant or Young Child with Insulin-Dependent Diabetes. Breastfeed Med 2017; 12:72-76. [PMID: 28135112 DOI: 10.1089/bfm.2017.29035.djm] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of The Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Diana Miller
- 1 Pediatric Endocrinology, University at Buffalo , Buffalo, New York.,2 Division of General Pediatrics, Maternal Fetal Medicine and General Pediatrics, University of Rochester , Rochester, New York
| | - Leena Mamilly
- 1 Pediatric Endocrinology, University at Buffalo , Buffalo, New York
| | - Shannon Fourtner
- 1 Pediatric Endocrinology, University at Buffalo , Buffalo, New York
| | - Casey Rosen-Carole
- 3 Division of Neonatology, Maternal Fetal Medicine and General Pediatrics, University of Rochester , Rochester, New York
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Schultz AT, Smaldone A. Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes. J Adolesc Health 2017; 60:133-146. [PMID: 27939878 DOI: 10.1016/j.jadohealth.2016.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16-23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (-.11 [95% confidence interval: -.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.
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Affiliation(s)
- Alan T Schultz
- Columbia University School of Nursing, New York, New York
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York; College of Dental Medicine, Columbia University Medical Center, New York, New York.
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King KM, King PJ, Nayar R, Wilkes S. Perceptions of Adolescent Patients of the "Lived Experience" of Type 1 Diabetes. Diabetes Spectr 2017; 30:23-35. [PMID: 28270712 PMCID: PMC5309904 DOI: 10.2337/ds15-0041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The care and management of adolescents with type 1 diabetes presents numerous challenges that are inherent to the fears, attitudes, and perceptions of their illness. This qualitative study aimed to explore the "lived experience" of individuals with type 1 diabetes. In-depth interviews were conducted with 20 patients diagnosed with type 1 diabetes in their adolescent years to elicit their views, perceptions, and concerns regarding living with diabetes. All interviews were conducted and analyzed using the principles of grounded theory. Five categories defining the patients' lived experience were elicited: Barriers, Develop Skills, Manage Emotion, Social World, and Health Care Professionals. The problems experienced by adolescents with type 1 diabetes are multifactorial. Existentially, type 1 diabetes affects their daily activities and impinges on their academic achievement and personal aspirations. They have great difficulty coping with their health status and highlight a lack of empathy from health care professionals (HCPs). Their major fear is of hypoglycemia, resulting in their subsequent focus of preventing hypoglycemic episodes. Indeed, regardless of consequence, blood glucose levels are often deliberately kept above recommended levels, which serves to decrease the effectiveness of their health care management. This study shows that the quality of care provided for adolescent patients with type 1 diabetes is failing to meet their expectations and falls short of the essential standards commensurate with current health care policy. Improvements in long-term care management for these patients require changes in both patients' and professionals' understanding of the disease and of the ways it is managed.
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Affiliation(s)
| | | | - Rahul Nayar
- Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Scott Wilkes
- University of Sunderland, Sunderland, Tyne and Wear, UK
- Coquet Medical Group, Amble Health Centre, Amble, Northumberland, UK
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Garyu JW, Meffre E, Cotsapas C, Herold KC. Progress and challenges for treating Type 1 diabetes. J Autoimmun 2016; 71:1-9. [PMID: 27210268 PMCID: PMC4903889 DOI: 10.1016/j.jaut.2016.04.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Accepted: 04/24/2016] [Indexed: 02/09/2023]
Abstract
It has been more than 30 years since the initial trials of Cyclosporin A to treat patients with new onset Type 1 diabetes (T1D). Since that time, there have been insights into genetic predisposition to the disease, the failures of immune tolerance, and mechanisms that cause the immune mediated β cell destruction. The genetic loci associated affect lymphocyte development and tolerance mechanisms. Discoveries related to the roles of specific immune responses gene such as the major histocompatibility complex, PTPN22, CTLA-4, IL-2RA, as well as the mechanisms of antigen presentation in the thymus have suggested ways in which autoreactivity may follow changes in the functions of these genes that are associated with risk. Antigens that are recognized by the immune system in patients with T1D have been identified. With this information, insights into the novel cellular mechanisms leading to the initiation and orchestration of β cell killing have been developed such as the presentation of unique antigens within the islets. Clinical trials have been performed, some of which have shown efficacy in improving β cell function but none have been able to permanently prevent loss of insulin secretion. The reasons for the lack of long term success are not clear but may include the heterogeneity of the immune response and in individual responses to immune therapies, recurrence of autoimmunity after the initial effects of the therapies, or even intrinsic mechanisms of β cell death that proceeds independently of immune attack after initiation of the disease. In this review, we cover developments that have led to new therapeutics and characteristics of patients who may show the most benefits from therapies. We also identify areas of incomplete understanding that might be addressed to develop more effective therapeutic strategies.
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Affiliation(s)
- Justin W Garyu
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Eric Meffre
- Department of Immunobiology, Yale University, New Haven, CT, USA
| | - Chris Cotsapas
- Department of Neurology, Yale University, New Haven, CT, USA
| | - Kevan C Herold
- Department of Immunobiology, Yale University, New Haven, CT, USA; Department of Internal Medicine, Yale University, New Haven, CT, USA
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Hilliard ME, Oser SM, Close KL, Liu NF, Hood KK, Anderson BJ. From Individuals to International Policy: Achievements and Ongoing Needs in Diabetes Advocacy. Curr Diab Rep 2015; 15:59. [PMID: 26194156 PMCID: PMC4581582 DOI: 10.1007/s11892-015-0636-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Diabetes impacts tens of millions of people in the United States of America and 9 % of the worldwide population. Given the public health implications and economic burden of diabetes, the needs of people with diabetes must be addressed through strategic and effective advocacy efforts. Diabetes advocacy aims to increase public awareness about diabetes, raise funds for research and care, influence policy impacting people with diabetes, and promote optimal individual outcomes. We present a framework for diabetes advocacy activities by individuals and at the community, national, and international levels and identify challenges and gaps in current diabetes advocacy. Various groups have organized successful diabetes advocacy campaigns toward these goals, and lessons for further advancing diabetes advocacy can be learned from other health-related populations. Finally, we discuss the role of healthcare providers and mental/behavioral health professionals in advocacy efforts that can benefit their patients and the broader population of people with diabetes.
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Affiliation(s)
- Marisa E. Hilliard
- Baylor College of Medicine, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Sean M. Oser
- Pennsylvania State University College of Medicine, 500 University Drive, HP-21, Hershey, PA 17033, USA
| | - Kelly L. Close
- The diaTribe Foundation, 804 Haight Street, San Francisco, CA 94117, USA
| | - Nancy F. Liu
- The diaTribe Foundation, 804 Haight Street, San Francisco, CA 94117, USA
| | - Korey K. Hood
- Stanford University School of Medicine, 780 Welch Road, MC 5208, Palo Alto, CA 94305-5208, USA
| | - Barbara J. Anderson
- Baylor College of Medicine, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
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