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El Kantar Y, Durán S, Lanes R, Paoli M. Evaluación del desempeño cognitivo en escolares y adolescentes con diabetes mellitus tipo 1. INVESTIGACIÓN CLÍNICA 2023. [DOI: 10.54817/ic.v64n1a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
The study aimedto evaluate the cognitive functioning of children and adolescents with type 1 diabetes mellitus (T1DM) recruited from the IAHULA Endocrinology Outpatient Unit and to compare it to that of non-diabetics as to investigate the influence on cognition of factors re-lated to the disease. An analytical, cross-sectional observational study was carried out on a group of 30 patients with T1DM between 8 and 16 years of age and on a control group of 30 individuals matched by age, gender, education, and socioeconomic status. Interrogation and review of medi-cal records to obtain data on the clinical characteristics and treatment of T1DM were conducted. The WISC IV test was then applied to evaluate cognition and intellectual coefficient (IQ). The average age of the diabetic patients was 13.27±2.31 years, and half of them were male. Lower scores were found in the different domains of the WISC IV in the group with T1DM (p<0.01). The IQ was found to be lower in children with T1DM than in con-trols (75.47±13.87 vs. 88.57±11.06; p=0.0001). Likewise, a higher fre-quency of IQ scores below the 10th percentile was observed in the diabetic children (63.3% vs. 33.3%; p=0.02; Odds ratio: 3.45; 95%CI: 1.19-9.99). It was concluded that T1DM negatively impacts the cognitive performance of children and adolescents. Cognitive evaluation of these patients is recom-mended, as it could affect their daily life.
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Affiliation(s)
- Yusmary El Kantar
- Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela
| | - Samy Durán
- Oficina Estadal Antidrogas, Mérida, Venezuela
| | - Roberto Lanes
- Unidad de Endocrinología Pediátrica, Hospital de Clínicas Caracas, Caracas, Venezuela
| | - Mariela Paoli
- Servicio de Endocrinología del Instituto Autónomo Hospital Universitario de Los Andes (IAHULA), Mérida, Venezuela
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2
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Cao Y, Zhu L, Chen Z, Zhanquan L, Xie W, Liang M. The effect of different intensity physical activity on cardiovascular metabolic health in obese children and adolescents: An isotemporal substitution model. Front Physiol 2023; 14:1041622. [PMID: 36875026 PMCID: PMC9975553 DOI: 10.3389/fphys.2023.1041622] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 01/16/2023] [Indexed: 02/17/2023] Open
Abstract
Objective: This study's purpose was to investigate the effects of different intensities of physical activity on cardiovascular metabolism in obese children and adolescents based on an isochronous replacement model. Methods: A total of 196 obese children and adolescents (mean age, 13.44 ± 1.71 years) who met the inclusion criteria and attended a summer camp from July 2019 to August 2021 were recruited for this study, and all subjects wore a GT3X + triaxial motion accelerometer uniformly around the waist to record physical activity levels. We collected the subjects' height, weight, and cardiovascular risk factors such as waist circumference, hip circumference, fasting lipids, blood pressure, fasting insulin, and fasting glucose before and after 4 weeks of camp and constructed cardiometabolic risk score (CMR-z). We analyzed the effects of different intensities of physical activity on cardiovascular metabolism in obese children using isotemporal substitution model (ISM). Results: After 4 weeks, cardiovascular risk factors such as body weight, waist circumference, triglyceride, and total cholesterol were reduced in adolescents with obesity (p <0.01), and CMR-z was also reduced (p <0.01). ISM analysis revealed that all sedentary behavior (SB) replacement with 10 min of light physical activity (LPA) reduced CMR-z [β = -0.10, 95% CI (-0.20, -0.01)]; 10-min of moderate physical activity (MPA) replacement of SB reduced CMR-z [β = -0.32, 95% CI (-0.63, -0.01)]; 10-min of vigorous physical activity (VPA) replacement of SB reduced CMR-z [β = -0.39, 95% CI (-0.66, -0.12)]. Conclusion: Replacement of SB with 10 min of LPA, MPA, and VPA were all effective in improving cardiovascular risk health, respectively, but MPA or VPA was more effective.
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Affiliation(s)
- Youxiang Cao
- Graduate Department of Guangzhou Sport University, Guangzhou, China
| | - Lin Zhu
- School of Sport and Health, Guangzhou Sport University, Guangzhou, China.,Key Laboratory of Education Department of Guangdong Province, Guangzhou, China
| | - Zekai Chen
- Graduate Department of Guangzhou Sport University, Guangzhou, China
| | - Li Zhanquan
- Graduate Department of Guangzhou Sport University, Guangzhou, China
| | - Weijun Xie
- Graduate Department of Guangzhou Sport University, Guangzhou, China
| | - Manna Liang
- Graduate Department of Guangzhou Sport University, Guangzhou, China
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3
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Sow A, Boiro D, Sow PS, Niang B, Mbaye A, Barrage AL, Fall AL, Dieye S, Sow NF, Gueye M, Mbaye MN, Ndiaye O. Insulin therapy in childhood type 1 diabetes: Knowledge and practice in Senegal. Arch Pediatr 2021; 28:307-310. [PMID: 33715933 DOI: 10.1016/j.arcped.2021.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 12/29/2020] [Accepted: 02/09/2021] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Childhood type 1 diabetes (T1D) is a chronic condition with serious repercussions on both the quality of life of the child and the family. Insulin therapy is the cornerstone of optimal blood sugar control. The main objective of our study was to assess the level of knowledge of physicians about insulin therapy in diabetes. METHODS This was a multicenter survey over a period of 5 months (from March 5 to August 2, 2018). It took place in five reference university hospital centers in the Dakar region. RESULT The number of doctors interviewed in our study was 82, 47.6% of whom were confirmed pediatricians or pediatricians in the process of specialization. The number of years of experience in the field of diabetes was on average 3 years. Fast-acting regular insulins were recommended by 75.6% of doctors and mixtures of insulin (intermediate and rapid-acting) by 50% of doctors. Overall, 91% of doctors recommend a variation in insulin injection sites. The "basal bolus" treatment regimen with insulin analogs was recommended by 50% of doctors, while 31.7% recommended it with human insulin. Regarding adapting insulin doses for leisure and sports activities, more than half (54.9%) of the doctors had to reduce the doses. CONCLUSION This study enabled us to assess the level of knowledge of insulin therapy among doctors caring for children with diabetes in Senegal, which proved to be limited. We recommend the reinforcement and follow-up of training on the management of T1D for providers at the different facilities.
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Affiliation(s)
- A Sow
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal.
| | - D Boiro
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - P S Sow
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - B Niang
- Albert-Royer National Children's Hospital, Cheikh-Anta-Diop Avenue, 25755 Dakar, Senegal
| | - A Mbaye
- Albert-Royer National Children's Hospital, Cheikh-Anta-Diop Avenue, 25755 Dakar, Senegal
| | - A L Barrage
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - A L Fall
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - S Dieye
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - N F Sow
- Albert-Royer National Children's Hospital, Cheikh-Anta-Diop Avenue, 25755 Dakar, Senegal
| | - M Gueye
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - M Ndour Mbaye
- Abass-Ndao Hospital Center, Cheikh Anta Diop Avenue, 25755 Dakar, Senegal
| | - O Ndiaye
- Albert-Royer National Children's Hospital, Cheikh-Anta-Diop Avenue, 25755 Dakar, Senegal
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4
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Dorando E, Haak T, Pieper D. Continuous Glucose Monitoring for Glycemic Control in Children and
Adolescents Diagnosed with Diabetes Type 1: A Systematic Review and
Meta-Analysis. Exp Clin Endocrinol Diabetes 2020; 130:61-72. [DOI: 10.1055/a-1268-0967] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Aim The aim of this meta-analysis was to evaluate the impact of
continuous glucose monitoring (CGM) systems on short- and long-term glycemic
control in children and adolescents diagnosed with diabetes type 1.
Methods The review was registered in PROSPERO (CRD42019135152). We partly
updated a formerly published systematic review and searched several databases
(Ovid MEDLINE, Embase, CENTRAL, and Clinicaltrials.gov) in May 2019. Summary
measures were estimated as relative risks (RR) and standardized mean differences
(SMD). The primary endpoint of our analysis was frequency of hypoglycemic
events. Quality of evidence was evaluated using the GRADE approach.
Results Eleven studies with a total number of 818 patients were included
in our review. Meta-analyses indicated a potential benefit of CGM systems
regarding the relative risk of a severe hypoglycemic event (RR 0.78; 95%
CI 0.29 to 2.04) and mean level of HbA1c at end of study (SMD -0.23; 95%
CI -0.46 to 0.00). Certainty of evidence for effect estimates of these
meta-analyses was low due to risk of selection bias and imprecision of the
included studies. Qualitative analyses of the secondary outcomes of user
satisfaction and long-term development of blood glucose supported these
findings.
Conclusion CGM systems may improve glycemic control in children and
adolescents diagnosed with diabetes type 1, but the imprecision of effects is
still a problem. Only a few studies examined and reported data for pediatric
populations in sufficient detail. Further research is needed to clarify
advantages and disadvantages of CGM systems in children and adolescents.
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Affiliation(s)
- Elena Dorando
- University Witten/Herdecke, Institute for Research in Operative
Medicine, Cologne
- University of Cologne, Institute of Health Economics and Clinical
Epidemiology, Cologne
| | - Thomas Haak
- Diabetes Center Mergentheim, Bad Mergentheim
| | - Dawid Pieper
- University Witten/Herdecke, Institute for Research in Operative
Medicine, Cologne
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Saxby N, Beggs S, Kariyawasam N, Battersby M, Lawn S. Do guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review. Chronic Illn 2020; 16:239-252. [PMID: 30244592 DOI: 10.1177/1742395318799844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. METHODS Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE 'Guideline Quality Checklist', and mapping of the supporting evidence. RESULTS Fifteen guidelines were identified: asthma (n=7) and type 1 diabetes mellitus (n=7), CF (n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration (n=15), chronic condition self-management education (n= 17), clinicians' skills (n= 4); personalized action plans (n=3), problem-solving (n=2); and the assessment of children's chronic condition self-management needs (n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool (n=2), and adolescence (n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines' recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. DISCUSSION Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.
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Affiliation(s)
- Nicole Saxby
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia.,Tasmanian Cystic Fibrosis Service, Tasmanian Health Service, Hobart, Tasmania
| | - Sean Beggs
- Tasmanian Cystic Fibrosis Service, Tasmanian Health Service, Hobart, Tasmania
| | - Nadish Kariyawasam
- eHealth Services Research Group, University of Tasmania, Hobart, Tasmania
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
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Fox LA, Pfeffer E, Stockman J, Shapiro S, Dully K. Medical Neglect in Children and Adolescents with Diabetes Mellitus. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2020; 13:259-269. [PMID: 33088382 PMCID: PMC7561625 DOI: 10.1007/s40653-018-0215-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Diabetes mellitus was a fatal disease for thousands of years, but the discovery of insulin in 1921 and major substantial improvements in care have made living with diabetes a chronic rather than fatal disease for many people, including children and adolescents. Diabetes mellitus is a lifestyle-altering diagnosis for the entire family. In some families, children and adolescents do not get the daily care they depend upon. This article reviews the consequences of medical neglect of children with diabetes and the optimal community response to concerns of medical neglect of diabetes. Criteria for placement in foster or substitute care are suggested.
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Affiliation(s)
- Larry A. Fox
- Northeast Florida Pediatric Diabetes Center, Jacksonville, FL USA
- Division of Endocrinology, Metabolism and Diabetes, Nemours Children’s Health System, Jacksonville, FL USA
| | - Erin Pfeffer
- Division of Endocrinology, Metabolism and Diabetes, Nemours Children’s Health System, Jacksonville, FL USA
| | | | - Sandra Shapiro
- Division of Forensic Pediatrics, First Coast Child Protection Team, University of Florida College of Medicine, 4539 Beach Boulevard, Jacksonville, FL 32207 USA
| | - Kathleen Dully
- Division of Forensic Pediatrics, First Coast Child Protection Team, University of Florida College of Medicine, 4539 Beach Boulevard, Jacksonville, FL 32207 USA
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Iscan TA, Ozsin-Ozler C, Ileri-Keceli T, Guciz-Dogan B, Alikasifoglu A, Uzamis-Tekcicek M. Oral health and halitosis among type 1 diabetic and healthy children. J Breath Res 2020; 14:036008. [PMID: 32340013 DOI: 10.1088/1752-7163/ab8d8b] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
AIM To evaluate the oral health status, oral health related habits and halitosis of children with and without type 1 diabetes. MATERIALS AND METHODS In this study the oral health status of children with and without type 1 diabetes were evaluated by using different indices (dmft/DMFT, International Caries Detection and Assessment System(ICDAS) II, pufa, gingival and periodontal indices). Halitosis was determined by organoleptic assessment and sulfur monitoring. RESULTS One hundred children with the age range between 6-13 years, 50 type 1 diabetics (24 boys,26 girls) with mean age (±sd) of 10.3 ± 2.1 years and 50 healthy (30 boys, 20 girls) with mean age (±sd) of 9.9 ± 1.5 years, participated in the study. The median values of dmft and dmfs was lower in children with type 1 diabetes, while for DMFT and DMFS indices were similar with the healthy group. Cavitated caries lesions were observed in 60.0% of children with diabetes and in 58.0% of healthy children. According to the ICDAS II index, 42.0% of children with diabetes and 56.0% of healthy children had severe decay. The mean plaque index was statistically significantly less in diabetic children (p = 0.04). In 12.0% of children with type 1 diabetes and in 18.0% of healthy children, volatile sulfur compounds (VSC) were determined to be ≥150 ppb and the most diagnosed score was 1 in both groups. In diabetic children with the cut off value of 7.5% HbA1c, there was no statistically significant difference in oral health indices results and VSC scores. CONCLUSION Findings of the present study are insufficient to support a significant effect of diabetes on increasing the risk of oral and periodontal diseases. Nonetheless, it is important to emphasize the importance of oral and dental health, regular oral care and dental visits both to the patients with type 1 diabetes and their parents.
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Affiliation(s)
- Tayyibe Aslihan Iscan
- Department of Pediatric Dentistry, Hacettepe University Faculty of Dentistry, Ankara, Turkey
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8
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Dixe MDACR, Gordo CMGDO, Catarino HBP, Kraus T, Menino EPDSG. Effects of an education program on knowledge and self-perception of school personnel in preparing to care for type 1 diabetes students. EINSTEIN-SAO PAULO 2020; 18:eAO5101. [PMID: 32130327 PMCID: PMC7032886 DOI: 10.31744/einstein_journal/2020ao5101] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 10/03/2019] [Indexed: 12/01/2022] Open
Abstract
Objective To assess the academic and professional background of school personnel; to assess the impact of the Diabetes + Support given by School Personnel to Children with Type 1 Diabetes Program on the school personnel’s knowledge and confidence to support students with type 1 diabetes; to compare their level of knowledge with the academic and professional variables of the school personnel. Methods A quasi-experimental pre-test/post-test study design without a Control Group. Study with a sample of 129 (before intervention – T0) and 113 (after intervention – T1) pre-school to secondary school personnel from participating schools, with at least one student with type 1 diabetes. The project was approved by the Ethics Committee of the Portuguese Ministry of Education. Results Most school personnel included in the study were teachers (51.2%). After training, they were more confident than before to support children with type 1 diabetes (p<0.05). Regarding knowledge levels, the differences between T0 (10.8±2.8; P 50 =11) and T1 (13.7±2.1; P 50 =11) were statistically significant (p<0.001). Of the 113 school personnel who participated in the final assessment, 89 (78.85%) increased their level of knowledge. Conclusion The program was effective to enhance knowledge and boost confidence to support students with diabetes.
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Affiliation(s)
| | | | - Helena Borges Pereira Catarino
- Center for Innovative Care and Health Technology , Escola Superior de Saúde , Instituto Politécnico de Leiria , Leiria , PT , Portugal
| | - Teresa Kraus
- Center for Innovative Care and Health Technology , Escola Superior de Saúde , Instituto Politécnico de Leiria , Leiria , PT , Portugal
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9
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Prahalad P, Zaharieva DP, Addala A, New C, Scheinker D, Desai M, Hood KK, Maahs DM. Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control-The 4T Study. Front Endocrinol (Lausanne) 2020; 11:360. [PMID: 32733375 PMCID: PMC7363838 DOI: 10.3389/fendo.2020.00360] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 05/07/2020] [Indexed: 12/12/2022] Open
Abstract
Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. Mean HbA1c in other nations has been successfully modified following benchmarking and quality improvement methods. In this review, we describe the novel 4T approach-teamwork, targets, technology, and tight control-to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, specifically continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life.
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Affiliation(s)
- Priya Prahalad
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- *Correspondence: Priya Prahalad
| | - Dessi P. Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - Christin New
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
| | - David Scheinker
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Department of Management Science and Engineering, Stanford University, Stanford, CA, United States
| | - Manisha Desai
- Quantitative Sciences Unit, Division of Biomedical Informatics Research, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford, CA, United States
| | - Korey K. Hood
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford, CA, United States
| | - David M. Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, Stanford, CA, United States
- Stanford Diabetes Research Center, Stanford, CA, United States
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Yang D, Yan J, Deng H, Yang X, Luo S, Zheng X, Lv J, Liang W, Hong M, Wu Z, Yao B, Weng J, Xu W. Effects of Metformin Added to Insulin in Adolescents with Type 1 Diabetes: An Exploratory Crossover Randomized Trial. J Diabetes Res 2020; 2020:7419345. [PMID: 33457425 PMCID: PMC7785393 DOI: 10.1155/2020/7419345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/08/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To comprehensively assess the effects of metformin added to insulin on metabolic control, insulin sensitivity, and cardiovascular autonomic function in adolescents with type 1 diabetes. MATERIALS AND METHODS This was an exploratory, crossover, randomized trial conducted in adolescents with type 1 diabetes aged 12-18 years old. Participants were randomly received metformin (≤1000 mg/d) added to insulin for 24 weeks followed by insulin monotherapy for a subsequent 24 weeks or vice versa. Blood pressure, body mass index, insulin dose, estimated insulin sensitivity, glycated hemoglobin A1c (HbA1c), and lipid profiles were measured, with a 72-hour continuous glucose monitoring and 24-hour Holter monitoring performed at baseline, 24, and 50 weeks for the assessments of glucose variability and heart rate variability. RESULTS Seventeen patients with mean ± SD age 14.4 ± 2.3 years, body mass index 18.17 ± 1.81 kg/m2, median (IQR) diabetes duration 4.50 (3.58, 6.92) years, and HbA1c 9.0% (8.5%, 9.4%) were enrolled. The between-group difference in HbA1c of 0.28% (95% CI -0.39 to 0.95%) was not significant (P = 0.40). Changes in body mass index, insulin dose, blood pressure, lipid profiles, and estimated insulin sensitivity were similar for metformin add-on vs. insulin monotherapy. Glucose variability also did not differ. Compared with insulin monotherapy, metformin add-on significantly increased multiple heart rate variability parameters. CONCLUSIONS Metformin added to insulin did not improve metabolic control or glucose variability in lean/normal-weight adolescents with type 1 diabetes. However, metformin added to insulin significantly increased heart rate variability, suggesting that metformin might improve cardiovascular autonomic function in this population.
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Affiliation(s)
- Daizhi Yang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
| | - Jinhua Yan
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
| | - Hongrong Deng
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
| | - Xubin Yang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
| | - Sihui Luo
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of USTC, Division of Life Sciences of Medicine, University of Science and Technology of China, Anhui 230026, China
| | - Xueying Zheng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of USTC, Division of Life Sciences of Medicine, University of Science and Technology of China, Anhui 230026, China
| | - Jing Lv
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Wen Liang
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Department of Endocrinology and Metabolism, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
| | - Mengjie Hong
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Department of Cardiovascular Medicine, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen 518107, China
| | - Zekai Wu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
| | - Bin Yao
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
| | - Jianping Weng
- Department of Endocrinology and Metabolism, The First Affiliated Hospital of USTC, Division of Life Sciences of Medicine, University of Science and Technology of China, Anhui 230026, China
| | - Wen Xu
- Department of Endocrinology and Metabolism, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
- Guangdong Provincial Key Laboratory of Diabetology, Guangzhou 510630, China
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11
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Sandler CN, Garvey KC. A Practice in Maturation: Current Perspectives on the Transition from Pediatric to Adult Care for Young Adults with Diabetes. Curr Diab Rep 2019; 19:126. [PMID: 31728765 DOI: 10.1007/s11892-019-1247-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
PURPOSE OF REVIEW This review of available literature and resources highlights the challenges in transition from pediatric to adult care for young adults with diabetes, summarizes practical recommendations for facilitating the process, and identifies areas for improvement in current transition practice. RECENT FINDINGS Observational studies highlight suboptimal transition preparation counseling, gaps between pediatric and adult care, and increased post-transition hemoglobin A1c and acute care utilization. Studies showing improved outcomes with later age at transition allows for an extended focus on transition preparation with an eye toward developmental maturity. Interventional studies suggest varying benefits of transition coordinators and support programs. The period of transition from pediatric to adult care is a time of in which patients are at high risk for adverse outcomes and loss to follow-up; however, careful attention to planning the process and tracking patient readiness along with skilled care coordination can contribute to transition success. The durability of interventional models, as well as generalizability to varied clinical settings, must be further tested.
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Affiliation(s)
- Courtney N Sandler
- Division of Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, 221 Longwood Avenue, Boston, MA, 02115, USA.
- Boston Children's Hospital, 333 Longwood Avenue, Boston, MA, 02115, USA.
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12
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Weatherly J, Kishnani S, Aye T. Challenges with Patient Adoption of Automated Integration of Blood Glucose Meter Data in the Electronic Health Record. Diabetes Technol Ther 2019; 21:671-674. [PMID: 31335195 PMCID: PMC6812727 DOI: 10.1089/dia.2019.0178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Providers often encourage patients with type 1 diabetes (T1D) to contact them with blood glucose (BG) values between visits. However, patients and families find it cumbersome to share their BG values with clinical providers, creating a barrier to communication. Although many phone applications exist to help patients track BG values, most do not integrate with the electronic health record (EHR). Recent advances in technology can integrate the glucose meter (GM) data into the EHR. This pilot and feasibility study aimed to understand how an automated integration system of GM data into the EHR and remote monitoring by health care providers would impact patient-provider communication. Patients or parents of patients with T1D (n = 32, average hemoglobin A1c [HgbA1c]: 8.5%, SD: 1.7, average age: 13.9 years, SD: 3.8) who owned an Apple iPod® or iPhone® (5s or higher) participated, and their number of contacts through telephone calls or MyChart™ messages between clinic visits was recorded during each of the three phases: run-in, intervention, and learned. Twenty-eight families completed all phases, and despite guided review of BG trends and automated integration of BG values, the number of patient-initiated calls (P = 0.23) and HgbA1c values (P = 0.08) did not improve, nor was there a clinically significant change in the number of BG checks per day. Barriers to adoption and effectiveness of this technology exist, and patient motivation is still needed.
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Affiliation(s)
- Jake Weatherly
- Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California
| | - Saniya Kishnani
- Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California
| | - Tandy Aye
- Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, California
- Address correspondence to: Tandy Aye, MD, Pediatric Endocrinology and Diabetes, Stanford University School of Medicine, 300 Pasteur Drive G313, Stanford, CA 94305
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13
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Baker AC, Wiebe DJ, Kelly CS, Munion A, Butner JE, Swinyard MT, Murray M, Berg CA. Structural model of patient-centered communication and diabetes management in early emerging adults at the transfer to adult care. J Behav Med 2019; 42:831-841. [PMID: 30680592 PMCID: PMC6656634 DOI: 10.1007/s10865-019-00012-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 01/14/2019] [Indexed: 12/26/2022]
Abstract
Early emerging adulthood (ages 18-25) is a time of risk for type 1 diabetes (T1D) when relationships with parents and providers are changing. We examined whether individuals' high-quality relationships with mothers are associated with greater perceptions of patient-centered communication (PCC) with their doctor and whether PCC is associated with better adherence and glycemic control through diabetes-related self-efficacy. Additionally, we tested whether associations of PCC with self-efficacy and diabetes outcomes are stronger among those who had transferred to adult care. One-year post-high school, 217 individuals with T1D (60% women, 53% in adult care) reported perceptions of maternal relationship quality, PCC, self-efficacy, and adherence. Glycemic control was measured via HbA1c assay kits. Structural equation modeling indicated good model fit and revealed indirect paths linking higher maternal relationship quality to better adherence through higher PCC, and higher PCC to better HbA1c through adherence. Transfer status moderated the link between PCC and self-efficacy, suggesting PCC may be especially important when emerging adults transfer to adult care.
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Affiliation(s)
- Ashley C Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd SSM, Merced, CA, 95343, USA.
| | - Deborah J Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Rd SSM, Merced, CA, 95343, USA
| | - Caitlin S Kelly
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Ascher Munion
- Department of Psychology, University of Utah, Salt Lake City, USA
| | | | - Michael T Swinyard
- Mountain Vista Medicine, University of Utah School of Medicine, Salt Lake City, USA
| | - Mary Murray
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
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14
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Marker AM, Noser AE, Clements MA, Patton SR. Shared Responsibility for Type 1 Diabetes Care Is Associated With Glycemic Variability and Risk of Glycemic Excursions in Youth. J Pediatr Psychol 2019; 43:61-71. [PMID: 28541572 DOI: 10.1093/jpepsy/jsx081] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 04/24/2017] [Indexed: 12/12/2022] Open
Abstract
Objective We examined how parent and youth responsibility for type 1 diabetes (T1D) care is related to adherence and glycemic outcomes, namely, glycemic variability and risk of glycemic excursions. Methods One hundred thirty-five parent-youth dyads (10-16 years old; diagnosed with T1D for at least 6 months) participated in this study. Percent responsibility of T1D care attributed to the youth, parent, or shared was measured using the Diabetes Family Responsibility Questionnaire. We collected youth's hemoglobin A1c (HbA1c) and glucometer downloads to examine relationships between responsibility and HbA1c, frequency of blood glucose monitoring (self-monitoring blood glucose, SMBG), risk of glycemic excursions, and actual glycemic variability using bivariate correlations and path analysis. Results Participants reported shared responsibility for almost half of T1D self-care tasks. Bivariate correlations showed shared responsibility was associated with less variability, whereas parent responsibility was associated with greater glycemic variability and risk for glycemic excursions. Youth responsibility was associated with lower frequency of SMBG. The path analyses confirmed our correlational findings (ps<.05) and better characterized interactions with age for youth-reported responsibility. Conclusions Our results support the hypothesis that shared T1D responsibility is associated with better diabetes outcomes in youth.
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Affiliation(s)
- Arwen M Marker
- Center for Children's Healthy Lifestyles and Nutrition.,University of Kansas
| | - Amy E Noser
- Center for Children's Healthy Lifestyles and Nutrition.,University of Kansas
| | - Mark A Clements
- Center for Children's Healthy Lifestyles and Nutrition.,Pediatric Endocrinology, Children's Mercy Hospitals and Clinics
| | - Susana R Patton
- Center for Children's Healthy Lifestyles and Nutrition.,Department of Pediatrics, University of Kansas Medical Center
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15
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Rami-Merhar B, Fröhlich-Reiterer E, Hofer SE. [Diabetes mellitus in childhood and adolescence (Update 2019)]. Wien Klin Wochenschr 2019; 131:85-90. [PMID: 30980149 DOI: 10.1007/s00508-018-1420-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In contrast to adults, type 1 diabetes mellitus (T1D) is the most frequent form of diabetes in childhood and adolescence (>95%). After diagnosis the management of children and adolescents with T1D should take place in highly specialized pediatric units experienced in pediatric diabetology and not in private practices. The lifelong substitution of insulin is the cornerstone of treatment whereby modalities need to be individually adapted for patient age and the family routine. Diabetes education is essential in the management of patients with diabetes and their families and needs to be performed by a multidisciplinary team consisting of a pediatric endocrinologist, diabetes educator, dietitian, psychologist and social worker. The Austrian working group for pediatric endocrinology and diabetes (APEDÖ) recommends a metabolic goal of HbA1c ≤7.0%, International Federation for Clinical Chemistry (IFCC) <53 mmol/mol, for all pediatric age groups without the presence of severe hypoglycemia. Age-related physical, cognitive and psychosocial development, avoidance of acute diabetes-related complications (severe hypoglycemia, diabetic ketoacidosis) and prevention of diabetes-related late complications to ensure high quality of life are the main goals of diabetes treatment in all pediatric age groups.
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Affiliation(s)
- Birgit Rami-Merhar
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Wien, Wien, Österreich
| | - Elke Fröhlich-Reiterer
- Universitätsklinik für Kinder- und Jugendheilkunde, Medizinische Universität Graz, Graz, Österreich
| | - Sabine E Hofer
- Department für Pädiatrie 1, Medizinische Universität Innsbruck, Anichstraße 35, 6020, Innsbruck, Österreich.
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16
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Thalange N, Biester T, Danne T. Clinical Use of Degludec in Children and Adolescents with T1D: A Narrative Review with Fictionalized Case Reports. Diabetes Ther 2019; 10:1219-1237. [PMID: 31187420 PMCID: PMC6612349 DOI: 10.1007/s13300-019-0641-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
The use of insulin in children and adolescents with type 1 diabetes (T1D) is a challenge because of the heterogeneity of these patients and their lifestyles, with consequent unpredictability in blood glucose levels. A new ultra-long-acting basal insulin, insulin degludec (degludec), has the potential to mitigate some of these challenges, notably variability in the glucose-lowering action of the basal insulin component of an insulin regimen, and consequent risks of hypo- and hyperglycemia. However, the protracted half-life and steady state pharmacokinetics of degludec potentially bring some new challenges. In particular, the adjustment of therapy in response to commonly encountered clinical situations might require a different approach when degludec is used in place of other currently used basal insulins in this challenging patient population. The purpose of this article is to guide clinicians through a series of case histories in the use of this insulin. These include, but are not limited to, how to initiate, titrate, switch from other basal insulin or pump therapy; how to alleviate difficulties arising as a result of unpredictable lifestyle/habits; and how to maintain treatment following diabetic ketoacidosis. The guidance presented in this review illustrates that degludec is a good option for a diverse range of children and adolescents with T1D, providing much needed flexibility in the treatment of this challenging patient population.Funding Novo Nordisk.
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Affiliation(s)
- Nandu Thalange
- Al Jalila Children's Specialty Hospital, Al Jaddaf, Dubai, United Arab Emirates.
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Hannover, Germany
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Hannover, Germany
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17
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Gaffney A, Christopher A, Katz A, Chateau D, McDougall C, Bor D, Himmelstein D, Woolhandler S, McCormick D. The Incidence of Diabetic Ketoacidosis During "Emerging Adulthood" in the USA and Canada: a Population-Based Study. J Gen Intern Med 2019; 34:1244-1250. [PMID: 31065950 PMCID: PMC6614229 DOI: 10.1007/s11606-019-05006-6] [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: 10/26/2018] [Revised: 12/20/2018] [Accepted: 03/20/2019] [Indexed: 03/17/2023]
Abstract
BACKGROUND As children with diabetes transition to adulthood, they may be especially vulnerable to diabetic ketoacidosis (DKA). Cross-national comparisons may inform efforts to avoid this complication. OBJECTIVE To compare DKA hospitalization rates in the USA and Manitoba, Canada, during the vulnerable years known as "emerging adulthood." DESIGN Cross-sectional study using inpatient administrative databases in the USA (years 1998-2014) and Manitoba, Canada (years 2003-2013). PARTICIPANTS Individuals aged 12-30 years hospitalized with DKA, identified using ICD-9 (USA) or ICD-10 codes (Manitoba). MAIN MEASURES DKA hospitalization rates per 10,000 population by age (with a focus on those aged 15-17 vs. 19-21). Admissions were characterized by gender, socioeconomic status, year of hospitalization, and mortality during hospitalization. KEY RESULTS The DKA rate was slightly higher in the USA among those aged 15-17: 4.8 hospitalizations/10,000 population vs. 3.7/10,000 in Manitoba. Among those aged 19-21, the DKA hospitalization rate rose 90% in the USA to 9.2/10,000, vs. 23% in Manitoba, to 4.5/10,000. In both the USA and Manitoba, rates were higher among those from poorer areas, and among adolescent girls compared with adolescent boys. DKA admissions rose gradually during the period under study in the USA, but not in Manitoba. CONCLUSIONS In years of "emerging adulthood," the Canadian healthcare system appears to perform better than that of the USA in preventing hospitalizations for DKA. Although many factors likely contribute to this difference, universal and seamless coverage over the lifespan in Canada may contribute.
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Affiliation(s)
- Adam Gaffney
- Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02138, USA.
| | - Andrea Christopher
- Boise Veterans Affairs Medical Center, University of Washington School of Medicine, Seattle, USA.
| | - Alan Katz
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Chelsey McDougall
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - David Bor
- Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02138, USA
| | - David Himmelstein
- Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02138, USA.,City University of New York at Hunter College, New York, USA
| | - Steffie Woolhandler
- Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02138, USA.,City University of New York at Hunter College, New York, USA
| | - Danny McCormick
- Cambridge Health Alliance/Harvard Medical School, 1493 Cambridge Street, Cambridge, MA, 02138, USA
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18
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Dhada BL, Blackbeard DR. Caregivers of children with diabetes mellitus: challenges of caring for and perceptions of consultations in a South African public sector context. S Afr Fam Pract (2004) 2019. [DOI: 10.1080/20786190.2019.1606491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- BL Dhada
- Department of Paediatrics & Child Health, Grey’s Hospital, Pietermaritzburg, South Africa
- Department of Paediatrics & Child Health, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - DR Blackbeard
- Department of Clinical Psychology, Grey’s Hospital, Pietermaritzburg, South Africa
- Department of Psychiatry, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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19
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Chung ST, Onuzuruike AU, Magge SN. Cardiometabolic risk in obese children. Ann N Y Acad Sci 2019; 1411:166-183. [PMID: 29377201 DOI: 10.1111/nyas.13602] [Citation(s) in RCA: 99] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2017] [Revised: 12/29/2017] [Accepted: 12/31/2017] [Indexed: 02/06/2023]
Abstract
Obesity in childhood remains a significant and prevalent public health concern. Excess adiposity in youth is a marker of increased cardiometabolic risk (CMR) in adolescents and adults. Several longitudinal studies confirm the strong association of pediatric obesity with the persistence of adult obesity and the future development of cardiovascular disease, diabetes, and increased risk of death. The economic and social impact of childhood obesity is further exacerbated by the early onset of the chronic disease burden in young adults during their peak productivity years. Furthermore, rising prevalence rates of severe obesity in youth from disadvantaged and/or minority backgrounds have prompted the creation of additional classification schemes for severe obesity to improve CMR stratification. Current guidelines focus on primary obesity prevention efforts, as well as screening for clustering of multiple CMR factors to target interventions. This review summarizes the scope of the pediatric obesity epidemic, the new severe obesity classification scheme, and examines the association of excess adiposity with cardiovascular and metabolic risk. We will also discuss potential questions for future investigation.
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Affiliation(s)
- Stephanie T Chung
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland.,Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Anthony U Onuzuruike
- Section on Ethnicity and Health, National Institute of Diabetes, Digestive and Kidney Diseases, NIH, Bethesda, Maryland
| | - Sheela N Magge
- Division of Pediatric Endocrinology and Diabetes, Children's National Health System, George Washington University School of Medicine and Health Sciences, Washington, DC
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20
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Vetrani C, Bozzetto L, Giorgini M, Cavagnuolo L, Di Mattia E, Cipriano P, Mangione A, Todisco A, Inghilterra G, Giacco A, Annuzzi G, Rivellese AA. Fibre-enriched buckwheat pasta modifies blood glucose response compared to corn pasta in individuals with type 1 diabetes and celiac disease: Acute randomized controlled trial. Diabetes Res Clin Pract 2019; 149:156-162. [PMID: 30779970 DOI: 10.1016/j.diabres.2019.02.013] [Citation(s) in RCA: 4] [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: 10/26/2018] [Revised: 01/08/2019] [Accepted: 02/13/2019] [Indexed: 11/25/2022]
Abstract
AIM People with type 1 diabetes and celiac disease (T1D&CD) have high blood glucose variability. Processed gluten-free foods have shown to induce a worse metabolic profile whereas naturally gluten-free foods may represent healthier options. On the other hand, dietary fibre has shown to reduce postprandial glycemic excursions in individuals with diabetes. Thus, we evaluated the acute effect of fibre-enriched buckwheat (FBP) and corn pasta (CP) on postprandial blood glucose response (PP-BGR). METHODS Ten adult patients with T1D&CD consumed two meals with the same amount of carbohydrate while differing only for pasta type (FBP or CP) preceded by the same insulin bolus. Participants utilized continuous glucose monitoring (CGM) and data over 6 h after meal were analyzed. RESULTS PP-BGR differed between the two meals, being significantly lower in the first period (0-3 h) after the CP than the FBP meal (iAUC: -38 ± 158 vs. 305 ± 209 mmol/L · 180 min, p = 0.040), whereas significantly higher in the second period (3-6 h) after the CP than the FBP meal (iAUC: 432 ± 153 vs. 308 ± 252 mmol/L · 180 min, p = 0.030). Overall, a less variable postprandial profile was observed after FBP than CP consumption. CONCLUSIONS In individuals with T1D&CD, the acute consumption of FBP induces significant differences in PP-BGR compared with CP that may be clinically relevant.
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Affiliation(s)
- Claudia Vetrani
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Marisa Giorgini
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Luisa Cavagnuolo
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Elpidio Di Mattia
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Paola Cipriano
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Anna Mangione
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | | | | | - Angela Giacco
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Giovanni Annuzzi
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Angela A Rivellese
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
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21
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Al Zahrani AM, Al Shaikh A. Glycemic Control in Children and Youth With Type 1 Diabetes Mellitus in Saudi Arabia. CLINICAL MEDICINE INSIGHTS-ENDOCRINOLOGY AND DIABETES 2019; 12:1179551418825159. [PMID: 30718968 PMCID: PMC6348502 DOI: 10.1177/1179551418825159] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 12/21/2018] [Indexed: 12/11/2022]
Abstract
Objective: To determine the glycemic control and cardio-metabolic complications of children and adolescents with type 1 diabetes mellitus (T1DM) attending a tertiary care diabetes clinic in Saudi Arabia. Methods: We conducted a retrospective cross-sectional study of children and adolescents with T1DM attending King Abdulaziz Medical City-Jeddah from 2010 to 2013. We assessed their glycemic control and diabetes management. Vitamin D status was compared with glycemic control and gender differences. Results: We identified 301 subjects (53.5% females); mean age was 13.9 ± 3.8 years. The mean duration of diabetes was 7.7 ± 3.7 years, body mass index (BMI) was 21.1 ± 4.5 kg/m2, and hemoglobin A1c (HbA1c) was 9.6% ± 1.9% in both genders. There were modest gender-specific differences in Saudi patients with T1DM, with males having more symptoms than females. Mean age at diagnosis of T1DM was slightly younger in males (6.01 ± 3.65 years) than in females (6.33 ± 3.45 years). Education was the most common reason for admission in males (32.9%), whereas diabetic ketoacidosis (DKA) was the most common reason in females (38.8%). Frequency of symptomatic hypoglycemic attacks was relatively higher in males (47.1%) than in females (42.9%). The majority of our patients (83%) were on intensive insulin regimen, having 4 injections or more per day. The remaining (17%) were on conventional insulin therapy. Only 26.2% had satisfactory HbA1c (⩽8%). The mean level of 25-hydroxyvitamin D was 35.15 ± 15.9 nmol/L and cholesterol was 4.75 ± 1.1 nmol/L. Vitamin D deficiency (25-hydroxyvitamin D ⩽ 37.5 nmol/L) was detected in 63.6% males and 67.7% females. No significant correlation between HbA1c and vitamin D deficiency was observed. Conclusions: Metabolic control among Saudi children with T1DM is less satisfactory compared with other countries. The high prevalence of vitamin D deficiency in this population supports the recommendation of vitamin D supplementation in T1DM subjects. Further studies in a larger cohort are needed to confirm our findings.
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Affiliation(s)
- Abdullah M Al Zahrani
- Department of Family Medicine, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
| | - Adnan Al Shaikh
- Endocrine Division, Department of Pediatrics, King Saud bin Abdulaziz University for Health Sciences, King Abdulaziz Medical City, Jeddah, Saudi Arabia
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22
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Popovic N, Lipovac M, Radunovic M, Ugarte J, Isusquiza E, Beristain A, Moreno R, Aranjuelo N, Popovic T. Fractal characterization of retinal microvascular network morphology during diabetic retinopathy progression. Microcirculation 2019; 26:e12531. [PMID: 30659745 DOI: 10.1111/micc.12531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/23/2018] [Accepted: 01/15/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The study aimed to characterize morphological changes of the retinal microvascular network during the progression of diabetic retinopathy. METHODS Publicly available retinal images captured by a digital fundus camera from DIARETDB1 and STARE databases were used. The retinal microvessels were segmented using the automatic method, and vascular network morphology was analyzed by fractal parametrization such as box-counting dimension, lacunarity, and multifractals. RESULTS The results of the analysis were affected by the ability of the segmentation method to include smaller vessels with more branching generations. In cases where the segmentation was more detailed and included a higher number of vessel branching generations, increased severity of diabetic retinopathy was associated with increased complexity of microvascular network as measured by box-counting and multifractal dimensions, and decreased gappiness of retinal microvascular network as measured by lacunarity parameter. This association was not observed if the segmentation method included only 3-4 vessel branching generations. CONCLUSIONS Severe stages of diabetic retinopathy could be detected noninvasively by using high resolution fundus photography and automatic microvascular segmentation to the high number of branching generations, followed by fractal analysis parametrization. This approach could improve risk stratification for the development of microvascular complications, cardiovascular disease, and dementia in diabetes.
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Affiliation(s)
- Natasa Popovic
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | - Mirko Lipovac
- Faculty of Medicine, University of Montenegro, Podgorica, Montenegro
| | | | | | | | | | | | | | - Tomo Popovic
- Faculty for Information Systems and Technologies, University of Donja Gorica, Podgorica, Montenegro
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23
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Vallianou N, Stratigou T, Koutroumpi S, Vlassopoulou B, Tsagarakis S, Ioannidis G. Autoimmune thyroiditis in patients with type 1 diabetes mellitus: A long-term follow-up study. Diabetes Metab Syndr 2019; 13:608-611. [PMID: 30641774 DOI: 10.1016/j.dsx.2018.11.048] [Citation(s) in RCA: 4] [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: 10/23/2018] [Accepted: 11/13/2018] [Indexed: 02/07/2023]
Abstract
AIMS In type 1 diabetes mellitus and autoimmune thyroiditis, there seems to be common genetic loci. The purpose of the present study was to determine whether patients with type 1 diabetes had increased prevalence of autoimmune thyroiditis, and which factors were influencing the co-existence of these two clinical entities. PATIENTS AND METHODS A cohort of 256 patients, 18-79 years of age, a median duration of diabetes of 20 years and a mean follow-up duration of 13 years were included in the study. RESULTS Of the 256 patients with type 1 diabetes, 150 participants (58.6%) were women and 106 (41.4%) were men. One hundred and fifty-nine patients (64.6%) did not have autoimmune thyroiditis, whereas 97 (35.4%) had autoimmune thyroiditis, as was documented by the presence of anti-thyroid antibodies (anti-TPO and/or anti-TG). Of the 97 patients with both diabetes type 1 and autoimmune thyroiditis, 64 (66%) were women and 33 (34%) were men. Among the 97 patients who had both diabetes type 1 and autoimmune thyroiditis, 87 had abnormal levels of both anti-TPO and anti-TG, while 7 patients had subnormal levels of solely anti-TPO and only 3 patients had abnormal levels of only anti-TG. CONCLUSIONS There was a slightly higher prevalence of autoimmune thyroiditis among our patients with type 1 diabetes mellitus. Also, female sex was predominant, when compared to male sex, among the adult participants of this study. Therefore, regular screening of thyroid function and thyroid autoantibodies may be suggested for all patients with type 1 diabetes.
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Affiliation(s)
- Natalia Vallianou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece.
| | - Theodora Stratigou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Stavroula Koutroumpi
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Barbara Vlassopoulou
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - Stylianos Tsagarakis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
| | - George Ioannidis
- Department of Endocrinology, Diabetes and Metabolism, Evangelismos Hospital, Athens, Greece
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24
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Tungsrirut N, Sanguanrungsirikul S, Pootong T, Kulprachakarn K, Ongprasert K, Rerkasem K. The maternal and offsprings’ characteristics associated with HOMA-IR in young adults: a prospective cohort study. Int J Diabetes Dev Ctries 2018. [DOI: 10.1007/s13410-018-0696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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25
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Cameron FJ, Garvey K, Hood KK, Acerini CL, Codner E. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence. Pediatr Diabetes 2018; 19 Suppl 27:250-261. [PMID: 29900653 DOI: 10.1111/pedi.12702] [Citation(s) in RCA: 88] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 05/28/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Fergus J Cameron
- Royal Children's Hospital, Melbourne, Australia.,Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Katharine Garvey
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California
| | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de Medicina, University of Chile, Santiago, Chile
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Smart CE, Annan F, Higgins LA, Jelleryd E, Lopez M, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Nutritional management in children and adolescents with diabetes. Pediatr Diabetes 2018; 19 Suppl 27:136-154. [PMID: 30062718 DOI: 10.1111/pedi.12738] [Citation(s) in RCA: 113] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 07/16/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Carmel E Smart
- Department of Paediatric Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia.,School of Health Sciences, University of Newcastle, Newcastle, NSW, Australia
| | | | | | | | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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Tully C, Ahrabi-Nejad C, Birch LL, Mackey E, Streisand R. Feasibility of Including Behavioral Feeding Training Within a Parent Intervention for Young Children With Type 1 Diabetes. J Clin Psychol Med Settings 2018; 26:220-227. [PMID: 30209675 DOI: 10.1007/s10880-018-9577-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Young children with T1D frequently display challenging eating behaviors interfering with diabetes management. The current study explored the feasibility and acceptability of a behavioral parent feeding training session with young children with type 1 diabetes. As part of a larger intervention pilot focused on healthy eating and physical activity, 9 young children (Mage = 4.22) with type 1 diabetes (T1D) and their mothers participated in a novel/non-preferred food training session. Parents were taught strategies and then were given an opportunity to use the strategies with their child. The paradigm was video recorded and content was coded for parent and child behavior. Feasibility was high, and all parents rated the feeding session as acceptable. All parents demonstrated using at least one behavioral feeding skill (M = 3.38, SD = 1.60). All 9 (100%) children touched at least one of their non-preferred foods (M = 2.05, SD = 0.75), and 5 (56%) ate at least one novel/non-preferred food (M = 1.65, SD = 0.87). Parents of young children with T1D demonstrated use of parenting skills after receiving brief instructions, with more children than not trying at least one novel/non-preferred food.
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Affiliation(s)
- Carrie Tully
- Children's National Health System, Center for Translational Science, 111 Michigan Avenue, NW, Washington, DC, 20010, USA. .,The George Washington University School of Medicine & Health Sciences, Washington, DC, USA.
| | - Corrine Ahrabi-Nejad
- Children's National Health System, Center for Translational Science, 111 Michigan Avenue, NW, Washington, DC, 20010, USA
| | - Leann L Birch
- Department of Foods and Nutrition, The University of Georgia, Athens, GA, USA
| | - Eleanor Mackey
- Children's National Health System, Center for Translational Science, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.,The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Randi Streisand
- Children's National Health System, Center for Translational Science, 111 Michigan Avenue, NW, Washington, DC, 20010, USA.,The George Washington University School of Medicine & Health Sciences, Washington, DC, USA
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Kochummen E, Marwa A, Umpaichitra V, Perez-Colon S, Chin VL. Screening for autoimmune thyroiditis and celiac disease in minority children with type 1 diabetes. J Pediatr Endocrinol Metab 2018; 31:879-885. [PMID: 29949512 DOI: 10.1515/jpem-2017-0254] [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: 06/29/2017] [Accepted: 06/01/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Hashimoto's thyroiditis (HT) and celiac disease (CD) are commonly associated with type 1 diabetes (T1DM). There is no consensus on screening, however, the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) recommend testing for thyroid function (TFT), thyroid antibodies and anti-tissue transglutaminase antibodies (TTG) IgA soon after diagnosis. TFT should be repeated every 1-2 years while TTG IgA should be tested for within 2 and 5 years. We hypothesize that the rate of HT and CD in our T1DM children is lower, so screening may need to be revised to reflect their underlying risk. METHODS An Institutional Review Board (IRB)-approved retrospective chart review was conducted on children with T1DM in the past 10 years. Age, sex, race, A1C, TFT, thyroid and celiac antibodies were obtained. t-Tests, the Wilcoxon-Mann-Whitney test and stepwise regression were performed. RESULTS Of 222 children with T1DM, with a mean age of 15.8±5.53 years, followed for 6.1±4.0 years, 53% female, mean A1C 11.1±1.9% and 87% African American (AA). Three had Graves' disease (1.3%), three had HT (1.3%) and 97% were euthyroid. TFT were assessed on average every 1.3 years and thyroid antibodies every 2.5 years. Positive thyroid antibody was found in 11%, negative in 57% and unknown in 32%. The positive antibody group had higher mean A1C and TSH. No biopsy confirmed cases of CD (0%) were found when screened every 2.3 years. CONCLUSIONS The number of individuals who screened positive for hypothyroid HT and CD was lower than expected in our population. Further studies are needed to assess the optimal screening frequency for HT and CD in minority children with T1DM.
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Affiliation(s)
- Elna Kochummen
- Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA
| | - Albara Marwa
- Department of Pediatrics, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA
| | - Vatcharapan Umpaichitra
- Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA
| | - Sheila Perez-Colon
- Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital Center, Brooklyn, NY, USA
| | - Vivian L Chin
- Assistant Professor of Pediatrics, Division of Pediatric Endocrinology, SUNY Downstate Medical Center and Kings County Hospital Center, 450 Clarkson Avenue, Box# 49, Brooklyn, NY 11203, USA
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29
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Maiorino MI, Bellastella G, Casciano O, Petrizzo M, Gicchino M, Caputo M, Sarnataro A, Giugliano D, Esposito K. Gender-differences in glycemic control and diabetes related factors in young adults with type 1 diabetes: results from the METRO study. Endocrine 2018; 61:240-247. [PMID: 29455365 DOI: 10.1007/s12020-018-1549-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 01/29/2018] [Indexed: 01/06/2023]
Abstract
PURPOSE To describe gender differences concerning glycemic control, cardiovascular risk factors, diabetic complications, concomitant pathologies, and circulating endothelial progenitor cells (EPCs), in a population of young adults with type 1 diabetes. METHODS We collected data from 300 consecutively patients (168 males and 132 females), aged 18-30 years, among those admitted at Diabetes Unit of University of Campania "Luigi Vanvitelli" (Naples, Italy) from March 2012 to January 2017. Circulating levels of seven EPCs phenotypes were determined by flow cytometry. RESULTS As compared to men, women with type 1 diabetes had a significantly higher HbA1c levels (%, 8.4 ± 1.3 vs. 8.1 ± 1.3, P = 0.020), body mass index (Kg/m2, 24.8 ± 4.2 vs. 23.9 ± 3.9, P = 0.034), HDL-cholesterol (mg/dL, 61.7 ± 13.7 vs. 54.7 ± 13.9, P < 0.001), and a lower count of both CD133+KDR+ and CD34+KDR+CD133+ EPCs (P = 0.022, P < 0.001, respectively). A higher proportion of women had overweight/obesity, and thyroiditis; smoking and sexual dysfunctions were more prevalent in men than in women. CONCLUSIONS Young adults with type 1 diabetes present gender differences with regard to glycemic control, prevalence of some cardiovascular risk factors, sexual dysfunctions and circulating levels of EPCs, most often to the detriment of women.
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Affiliation(s)
- Maria Ida Maiorino
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy.
| | - Giuseppe Bellastella
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ofelia Casciano
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Michela Petrizzo
- Diabetes Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Maurizio Gicchino
- Diabetes Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Mariangela Caputo
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Annalisa Sarnataro
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Dario Giugliano
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Unit of Endocrinology and Metabolic Diseases, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Katherine Esposito
- Diabetes Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, Diabetes Unit, University of Campania "Luigi Vanvitelli", Naples, Italy
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Albert Pérez E, Mateu Olivares V, Martínez-Espinosa RM, Molina Vila MD, Reig García-Galbis M. New Insights about How to Make an Intervention in Children and Adolescents with Metabolic Syndrome: Diet, Exercise vs. Changes in Body Composition. A Systematic Review of RCT. Nutrients 2018; 10:E878. [PMID: 29986479 PMCID: PMC6073719 DOI: 10.3390/nu10070878] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Revised: 06/22/2018] [Accepted: 07/02/2018] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To record which interventions produce the greatest variations in body composition in patients ≤19 years old with metabolic syndrome (MS). METHOD search dates between 2005 and 2017 in peer reviewed journals, following the PRISMA method (Preferred Reporting Items for Systematic reviews and Meta-Analyses). The selection criteria were: diagnostic for MS or at least a criterion for diagnosis; randomized clinical trials, ≤19 years of age; intervention programs that use diet and/or exercise as a tool (interventions showing an interest in body composition). RESULTS 1781 clinical trials were identified under these criteria but only 0.51% were included. The most frequent characteristics of the selected clinical trials were that they used multidisciplinary interventions and were carried out in America. The most utilized parameters were BMI (body mass index) in kg/m² and BW (body weight) in kg. CONCLUSIONS Most of the clinical trials included had been diagnosed through at least 2 diagnostic criteria for MS. Multidisciplinary interventions obtained greater changes in body composition in patients with MS. This change was especially prevalent in the combinations of dietary interventions and physical exercise. It is proposed to follow the guidelines proposed for patients who are overweight, obese, or have diabetes type 2, and extrapolate these strategies as recommendations for future clinical trials designed for patients with MS.
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Affiliation(s)
| | | | - Rosa María Martínez-Espinosa
- Division of Biochemistry and Molecular Biology, Department of Agrochemistry and Biochemistry, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
- Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
| | - Mariola D Molina Vila
- Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
- Department of Mathematics, Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
| | - Manuel Reig García-Galbis
- Members of the Research Group of Applied Biochemistry (AppBiochem), Faculty of Sciences, University of Alicante, 03690 Alicante, Spain.
- Department of Nutrition and Dietetics, Faculty of Health Sciences, University of Atacama, Avda Copayapu 2862, III Region, Copiapo 1530000, Chile.
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Tsadik AG, Atey TM, Nedi T, Fantahun B, Feyissa M. Effect of Insulin-Induced Lipodystrophy on Glycemic Control among Children and Adolescents with Diabetes in Tikur Anbessa Specialized Hospital, Addis Ababa, Ethiopia. J Diabetes Res 2018; 2018:4910962. [PMID: 30116742 PMCID: PMC6079411 DOI: 10.1155/2018/4910962] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Revised: 05/07/2018] [Accepted: 05/24/2018] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Lipodystrophy is one of the clinical complications of insulin injection that affects insulin absorption and leads to poor glycemic control. OBJECTIVE To assess insulin-induced lipodystrophy and glycemic control. METHODS A cross sectional study was done on 176 diabetic children and adolescents who inject insulin for a minimum of one year. First, anthropometric and clinical characteristics of the patients were recorded in questionnaire, and then observation and palpation techniques were used in assessing lipodystrophy. RESULT Out of the total 176 participants, 103 (58.5%) had insulin-induced lipodystrophy, of them 100 (97.1%) had lipohypertrophy and 3 (2.9%) had lipoatrophy. Being younger, failure to rotate the injection site every week and multiple reuse of insulin syringe had significant influence in development of insulin-induced lipohypertrophy. Lipohypertrophy in turn was associated with the use of higher dose of insulin and nonoptimal glycemic control. CONCLUSION Findings of this study revealed that in spite of using recombinant human insulin, the magnitude of the lipohypertrophy still remained high. Therefore, a routine workup of insulin-injecting patients for such complication is necessary, especially in the individuals who have a nonoptimal glycemic control.
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Affiliation(s)
- Afewerki Gebremeskel Tsadik
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Tesfay Mehari Atey
- Department of Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Mekelle University, Mekelle, Tigray, Ethiopia
| | - Teshome Nedi
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bereket Fantahun
- Department of Pediatrics, School of Medicine, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Mamo Feyissa
- Department of Pharmacology and Clinical Pharmacy, School of Pharmacy, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Melvin A, Redahan L, Hatunic M, McQuaid SE. Microvascular diabetes complications in a specialist young adult diabetes service. Ir J Med Sci 2018; 188:129-134. [PMID: 29732503 DOI: 10.1007/s11845-018-1827-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 04/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIMS The provision of medical care to young adults with type 1 diabetes mellitus is challenging. The aim of this study was to determine the rates of microvascular complications and their progression among patients with type 1 diabetes mellitus attending a specialist young adult diabetes service in Ireland. METHODS A retrospective review of 62 (male 56.5%) patients with type 1 diabetes mellitus attending the young adult diabetes service at our institution was undertaken. Data was recorded across two time points, clinic registration and at 5 years following initial contact. RESULTS The mean ± SD age at first attendance was 17.4 ± 2.0 years. Mean ± SD duration of diabetes was 6.3 ± 3.9 years with most patients treated using multiple daily insulin injections (75.8%). diabetic retinopathy rate at first attendance was 17.7% and after 5 years was 37.1% (p = 0.003). The majority of cases were background retinopathy. The prevalence of diabetic kidney disease was 6.4% and this remained unchanged at follow-up. Mean ± SD HbA1c improved from 76.1 ± 22.4 mmol/mol (9.1 ± 4.2%) to 69.1 ± 14.9 mmol/mol (8.5 ± 3.5%), p = 0.044. Duration of diabetes was the only clinical variable associated with retinopathy risk at 5 years on multiple regression analysis (p = 0.037). CONCLUSIONS Diabetic retinopathy is prevalent in young adults with type 1 diabetes attending specialist secondary care diabetes services. Duration of diabetes was the strongest determinant of retinopathy risk.
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Affiliation(s)
- Audrey Melvin
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland.
| | - Lynn Redahan
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Mensud Hatunic
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
| | - Siobhán E McQuaid
- Department of Diabetes and Endocrinology, Mater Misericordiae University Hospital and University College Dublin, Dublin, Ireland
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Hilliard ME, De Wit M, Wasserman RM, Butler AM, Evans M, Weissberg-Benchell J, Anderson BJ. Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers. Pediatr Diabetes 2018; 19:534-543. [PMID: 28940936 PMCID: PMC5862727 DOI: 10.1111/pedi.12575] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 01/09/2023] Open
Abstract
Multiple sources of burden for youth with type 1 diabetes (T1D) impact key outcomes including quality of life, self-management, and glycemic control. Professional diabetes organizations recommend diabetes care providers screen for psychosocial and behavioral challenges and implement strategies to support youth with T1D. The purpose of this article is to review the literature and recommend practical strategies medical providers can use for screening and behavioral support for youth with diabetes and their families. As part of their routine medical care, diabetes care providers are well-positioned to identify and intervene to address emotional distress related to the burdens of living with diabetes. In collaboration with multidisciplinary team members, including psychologists and mental health professionals, medical providers may be able to successfully implement brief behavioral strategies for screening and providing emotional support.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Maartje De Wit
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rachel M Wasserman
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ashley M Butler
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Meredyth Evans
- Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jill Weissberg-Benchell
- Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Barbara J Anderson
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Tully CB, Toaff M, Herbert L, DiPietro L, Henderson C, Cogen F, Streisand R. Acceptability and Feasibility of Examining Physical Activity in Young Children with Type 1 Diabetes. J Pediatr Health Care 2018; 32:231-235. [PMID: 29290409 PMCID: PMC5911185 DOI: 10.1016/j.pedhc.2017.10.004] [Citation(s) in RCA: 5] [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] [Received: 08/16/2017] [Revised: 10/04/2017] [Accepted: 10/22/2017] [Indexed: 12/18/2022]
Abstract
Physical activity is important but may be difficult to evaluate in young children (YC) with Type 1 diabetes (T1D) because of parents' fears of hypoglycemia, difficulties engaging YC in physical activity, and use of assessment devices. This study aimed to explore the acceptability and feasibility of an in-lab exercise session for YC with T1D. Ten YC ages 3 through7 years with T1D participated in a 20-minute exercise session while wearing blinded continuous glucose monitors and accelerometers. High acceptability was found for participation in the exercise session; high feasibility and acceptability were reported for the assessments. Although most children completed the session, it did not produce moderate to vigorous physical activity. YC were found to spend most of their day sedentary, and they had frequent blood glucose excursions. Findings support the feasibility of conducting a more extensive examination of the relationship among blood glucose levels and physical activity in YC with T1D.
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Prahalad P, Tanenbaum M, Hood K, Maahs DM. Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes. Diabet Med 2018; 35:419-429. [PMID: 29356074 DOI: 10.1111/dme.13588] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/09/2023]
Abstract
With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life.
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Affiliation(s)
- P Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - M Tanenbaum
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - K Hood
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - D M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
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Hilliard ME, Eshtehardi SS, Minard CG, Saber R, Thompson D, Karaviti LP, Rojas Y, Anderson BJ. Strengths-Based Behavioral Intervention for Parents of Adolescents With Type 1 Diabetes Using an mHealth App (Type 1 Doing Well): Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc 2018. [PMID: 29535081 PMCID: PMC5871739 DOI: 10.2196/resprot.9147] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Supportive parent involvement for adolescents’ type 1 diabetes (T1D) self-management promotes optimal diabetes outcomes. However, family conflict is common and can interfere with collaborative family teamwork. Few interventions have used explicitly strengths-based approaches to help reinforce desired management behaviors and promote positive family interactions around diabetes care. Objective The aim of this protocol was to describe the development of a new, strengths-based behavioral intervention for parents of adolescents with T1D delivered via a mobile-friendly Web app called Type 1 Doing Well. Methods Ten adolescent-parent dyads and 5 diabetes care providers participated in a series of qualitative interviews to inform the design of the app. The 3- to 4-month pilot intervention will involve 82 parents receiving daily prompts to use the app, in which they will mark the diabetes-related strength behaviors (ie, positive attitudes or behaviors related to living with or managing T1D) their teen engaged in that day. Parents will also receive training on how to observe diabetes strengths and how to offer teen-friendly praise via the app. Each week, the app will generate a summary of the teen’s most frequent strengths from the previous week based on parent reports, and parents will be encouraged to praise their teen either in person or from a library of reinforcing text messages (short message service, SMS). Results The major outcomes of this pilot study will include intervention feasibility and satisfaction data. Clinical and behavioral outcomes will include glycemic control, regimen adherence, family relationships and conflict, diabetes burden, and health-related quality of life. Conclusions This strengths-based, mobile health (mHealth) intervention aims to help parents increase their awareness of and efforts to support their adolescents’ engagement in positive diabetes-related behaviors. If efficacious, this intervention has the potential to reduce the risk of family conflict, enhance collaborative family teamwork, and ultimately improve diabetes outcomes. Trial Registration ClinicalTrials.gov NCT02877680; https://clinicaltrials.gov/ct2/show/NCT02877680 (Archived by WebCite at http://www.webcitation.org/6xTAMN5k2)
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Affiliation(s)
- Marisa E Hilliard
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Sahar S Eshtehardi
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Rana Saber
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Debbe Thompson
- Children's Nutrition Research Center, Agricultural Research Service, United States Department of Agriculture, Houston, TX, United States.,Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Lefkothea P Karaviti
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Yuliana Rojas
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Barbara J Anderson
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
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Hwang GB, Yoon JS, Park KJ, Lee HS, Hwang JS. Prevalence of autoimmune thyroiditis in patients with type 1 diabetes: a long-term follow-up study. Ann Pediatr Endocrinol Metab 2018; 23:33-37. [PMID: 29609447 PMCID: PMC5894561 DOI: 10.6065/apem.2018.23.1.33] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 09/29/2017] [Accepted: 10/24/2017] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Type 1 diabetes mellitus (DM) is associated with autoimmune diseases such as thyroiditis. Therefore, we aimed to investigate the prevalence of autoimmune thyroiditis in patients with type 1 DM. METHODS A total of 102 patients who were diagnosed and followed up (mean age, 8.1±4.0 years) in Ajou University Hospital were enrolled in this study. All the patients were evaluated for beta cell autoimmunity, including insulin autoantibody, glutamic acid decarboxylase antibodies (GADA), and islet cell antibody. Moreover, autoantibodies to thyroid peroxidase and thyroglobulin were assessed at initial diagnosis and annually thereafter. RESULTS The mean patient age (49 men and 53 women) was 19.2±4.8 years. The prevalence of at least one thyroid antibody was 30.4%. Patients with thyroid anti-bodies had a significantly higher frequency of GADA at the time of the diagnosis. Autoimmune thyroiditis was more prevalent in the older age group. GADA was a significant risk factor for development of thyroid autoantibodies after diagnosis of type 1 DM (odds ratio, 4.45; 95% confidence interval, 1.399-14.153). CONCLUSIONS In patients with type 1 DM, the prevalence of autoimmune thyroiditis was higher than in the general population. Moreover, GADA positivity at diagnosis was associated with thyroid autoimmunity.
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Affiliation(s)
| | | | | | - Hae Sang Lee
- Address for correspondence: Hae Sang Lee https://orcid.org/0000-0002-9684-4042 Department of Pediatrics, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 16499, Korea Tel: +82-31-219-4454 Fax: +82-31-219-5169 E-mail:
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Maiorino MI, Bellastella G, Casciano O, Cirillo P, Simeon V, Chiodini P, Petrizzo M, Gicchino M, Romano O, Caruso P, Giugliano D, Esposito K. The Effects of Subcutaneous Insulin Infusion Versus Multiple Insulin Injections on Glucose Variability in Young Adults with Type 1 Diabetes: The 2-Year Follow-Up of the Observational METRO Study. Diabetes Technol Ther 2018; 20:117-126. [PMID: 29303370 DOI: 10.1089/dia.2017.0334] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Type 1 diabetic patients have high instability of daily glucose levels. The aim of this study was to evaluate the long-term effects of continuous subcutaneous insulin infusion (CSII) therapy, compared with multiple daily injections of insulin (MDI), on glucose variability, in young type 1 diabetic patients transitioned to the adult diabetes care. METHODS Patients aged 18-30 years and considered eligible for insulin pump therapy were included in the study. Ninety-eight patients who started CSII therapy and 125 who remained in MDI completed a 2-year follow-up. Glucose variability was assessed with continuous glucose monitoring using blood glucose standard deviation (BGSD), mean amplitude of glycemic excursion (MAGE), continuous overall net glycemic action (CONGA-2 h), low blood glucose index, high blood glucose index, and average daily risk range. RESULTS MAGE and BGSD decreased in both groups, with adjusted differences at 2 years of -0.74 mM (95% confidence interval [CI] -1.22 to -0.26, P = 0.003) and -0.3 (CI -0.52 to -0.1, P = 0.005) favoring the pump-therapy group. No significant differences between groups in the other variability indexes were observed. HbA1c decreased in both groups without significant difference (0.05%, -0.26, 0.35, P = 0.77); fasting glucose, insulin dose, and overall hypoglycemia (daily, nocturnal, and severe) decreased more in patients with CSII, compared with those with MDI. CONCLUSIONS Among young adults with type 1 diabetes transitioning from the pediatric care, the use of CSII is associated with lower glucose variability, fasting glycemia, and overall hypoglycemic events than MDI during a 2-year period of follow-up.
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Affiliation(s)
- Maria Ida Maiorino
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Giuseppe Bellastella
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Ofelia Casciano
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Paolo Cirillo
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Vittorio Simeon
- 2 Medical Statistics Unit, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Paolo Chiodini
- 2 Medical Statistics Unit, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Michela Petrizzo
- 3 Diabetes Unit, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Maurizio Gicchino
- 3 Diabetes Unit, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Ornella Romano
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Paola Caruso
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Dario Giugliano
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
| | - Katherine Esposito
- 1 Unit of Endocrinology and Metabolic Diseases, Department of Medical, Surgical, Neurological, Metabolic Sciences and Aging, University of Campania "Luigi Vanvitelli ," Naples, Italy
- 3 Diabetes Unit, University of Campania "Luigi Vanvitelli ," Naples, Italy
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Sultan S, El-Hourani M, Rondeau É, Garnier N. Categorizing factors of adherence to parenteral treatment in growth hormone deficiencies and hemophilia: What should be the targets for future research? Patient Prefer Adherence 2018; 12:2039-2063. [PMID: 30349200 PMCID: PMC6188171 DOI: 10.2147/ppa.s177624] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Adherence to treatment regimens in growth hormone dysregulations and hemophilia is related to better outcome and fewer complications over time. Subcutaneous growth hormone injection and intravenous blood factor replacement therapies are parenteral treatments with a comparable regimen calling for similar behavioral processes. Although we have lists of possible factors influencing adherence in these conditions, the evidence is scattered. The objective of this study was to systematically review empirical studies linking factors of adherence with measures of adherence. To categorize the factors, we used a taxonomy from the diabetes literature. We used four major electronic databases to identify articles. We synthesized 27 articles dated 2011-2017 corresponding to inclusion criteria. Results showed a consistent proportion of 20%-25% participants with adherent issues. Strong arguments pointed to the transition to self-care in pediatrics as a vulnerability period (7/27 reports). We found the domains of individual factors (<30% reports), relational factors (<13%), health care (<30%), to be understudied in comparison with that of demographic or clinical context (>74%), and practical issues (>37%). The results suggest that future research should focus on modifiable factors of adherence, with appropriate measurement and intervention strategies. One central methodological limitation of reviewed reports was the lack of longitudinal designs, and the quasi absence of behavioral trial targeting modifiable factors of adherence. A new research agenda should be set in these rare diseases as higher adherence should translate into improved outcome and better quality of life for patients and their families.
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Affiliation(s)
- Serge Sultan
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, Québec, Canada,
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada,
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada,
| | - Mira El-Hourani
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada,
| | - Émélie Rondeau
- Department of Hematology-Oncology, CHU Sainte-Justine, Montréal, Québec, Canada,
| | - Nicolas Garnier
- Pfizer Canada Inc, Rare Disease Unit, Medical Affairs, Kirkland, Québec, Canada
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Lindner LME, Rathmann W, Rosenbauer J. Inequalities in glycaemic control, hypoglycaemia and diabetic ketoacidosis according to socio-economic status and area-level deprivation in Type 1 diabetes mellitus: a systematic review. Diabet Med 2018; 35:12-32. [PMID: 28945942 DOI: 10.1111/dme.13519] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 12/20/2022]
Abstract
AIM The aim of this systematic review was to examine the associations of individual-level as well as area-level socio-economic status and area-level deprivation with glycaemic control, hypoglycaemia and diabetic ketoacidosis in people with Type 1 diabetes mellitus. METHODS Ovid MEDLINE was searched to identify relevant cohort, case-control or cross-sectional studies published between January 2000 and June 2015. Search results were screened by title, abstract and keywords to identify eligible publications. Decisions on inclusion or exclusion of full texts were made independently by two reviewers. The Newcastle-Ottawa Scale was used to estimate the methodological quality of included studies. Quality assessment and extracted data of included studies were synthesized narratively and reported according to the PRISMA statement. RESULTS Literature search in Ovid MEDLINE identified 1345 eligible studies. Twenty studies matched our inclusion and exclusion criteria. Two articles were additionally identified through hand search. According to the Newcastle-Ottawa Scale, most of the studies were of average quality. Results on associations of socio-economic status and area-level deprivation with glycaemic control and hypoglycaemia were contradictory between studies. By contrast, lower socio-economic status and higher area-level deprivation were associated with a higher risk for diabetic ketoacidosis in all except one study. CONCLUSIONS Lower socio-economic status and higher area-level deprivation are associated with a higher risk of experiencing diabetic ketoacidosis in people with Type 1 diabetes mellitus. Access to care for socially deprived people needs to be expanded to overcome impairing effects on the course of the condition and to reduce healthcare disparities.
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Affiliation(s)
- L M E Lindner
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - W Rathmann
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
| | - J Rosenbauer
- Institute for Biometrics and Epidemiology, German Diabetes Centre, Leibniz Centre for Diabetes Research at Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
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Hilliard ME, Tully C, Monaghan M, Wang J, Streisand R. Design and development of a stepped-care behavioral intervention to support parents of young children newly diagnosed with type 1 diabetes. Contemp Clin Trials 2017; 62:1-10. [PMID: 28821468 PMCID: PMC5641251 DOI: 10.1016/j.cct.2017.08.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/10/2017] [Accepted: 08/14/2017] [Indexed: 11/30/2022]
Abstract
One of the most common chronic conditions of childhood, the prevalence of type 1 diabetes (T1D) in young children is increasing. Early childhood development complicates optimal T1D management and glycemic outcomes. Parents are at risk for elevated psychological distress, especially immediately following diagnosis. Few empirically supported interventions are available to support parents and promote optimal T1D management during this vulnerable period. This paper reports on the development and study design of First STEPS: Study of Type 1 in Early childhood and Parenting Support. The aim of this trial is to evaluate the efficacy of a stepped care behavioral intervention for parents of young children over the first year following a new T1D diagnosis. The stepped care design provides participants with up to three intensity levels, or steps, of clinical behavioral intervention support based on need, compared to usual care. Intervention steps include peer parent coaching, telephone-based behavioral support, personalized psychological assessment and recommendations, and intensive assessment of T1D glycemic management with recommendations. Primary outcomes include children's glycemic control and parents' psychosocial functioning. Secondary outcomes include children's behavioral and psychosocial functioning. Exploratory analyses will evaluate demographic, disease-specific, and psychosocial factors related to progression in and response to each step of the intervention.
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Affiliation(s)
- Marisa E Hilliard
- Texas Children's Hospital and Baylor College of Medicine, Houston, TX, United States
| | - Carrie Tully
- Children's National Health System, Washington, DC, United States
| | - Maureen Monaghan
- Children's National Health System, Washington, DC, United States; George Washington University, School of Medicine, Washington, DC, United States
| | - Jichuan Wang
- Children's National Health System, Washington, DC, United States; George Washington University, School of Medicine, Washington, DC, United States
| | - Randi Streisand
- Children's National Health System, Washington, DC, United States; George Washington University, School of Medicine, Washington, DC, United States.
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Factors associated with diabetic nephropathy in children, adolescents, and adults with type 1 diabetes. J Formos Med Assoc 2017; 116:924-932. [PMID: 29070437 DOI: 10.1016/j.jfma.2017.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 09/12/2017] [Accepted: 09/28/2017] [Indexed: 12/12/2022] Open
Abstract
BACKBROUD/PURPOSE Microalbuminuria and macroalbuminuria are markers of diabetic nephropathy (DN). The purpose of this study was to unravel the risk factors for DN in the young patients with type 1 diabetes (T1D). METHODS 341 patients (160 males) with T1D diagnosed at the age 7.6 ± 4.0 years with disease duration 11.5 ± 6.5 years were assessed. Among them, 185 were young adults (aged 18.0-36.2 years). Urinary albumin creatinine ratio (UACR) was checked on morning spot urine. Microalbuminuria and macroalbuminuria were defined as a UACR of 30-300 mg/g and >300 mg/g, respectively, in at least 2 consecutive specimens. RESULTS 50 (14.7%) patients were classified as microalbuminuria and 13 (3.8%) as macroalbuminuria. In all patients, multivariate logistic regression revealed that the most significant risk factors were average HbA1c (%), OR (95% CI) = 1.76 (1.37-2.25), P = 0.002); and male sex, OR = (odd ratio 2.31 (1.19-4.46), P = 0.013). In adult patients, the most significant factors were average HbA1c, OR = 1.74 (1.32-2.31), P = 0.003; and systolic blood pressure, OR = 1.06 (1.01-1.11), P = 0.011. Survival analysis showed average HbA1c levels significantly influenced the development of DN. CONCLUSION The most important risk factors for DN were average HbA1c and age. When microalbuminuria is detected, proper treatment with ACEIs or ARBs and improving glycemic control can delay progression of DN.
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Use of the Hage framework for theory construction: Factors affecting glucose control in the college-aged student with type 1 diabetes. Appl Nurs Res 2017; 37:61-66. [DOI: 10.1016/j.apnr.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/29/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
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Steinke TJ, O'Callahan EL, York JL. Role of a registered dietitian in pediatric type 1 and type 2 diabetes. Transl Pediatr 2017; 6:365-372. [PMID: 29184817 PMCID: PMC5682368 DOI: 10.21037/tp.2017.09.05] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Type 1 and type 2 diabetes are complex, chronic diseases that are best managed by a multidisciplinary care team. Type 1 diabetes is most commonly diagnosed in the pediatric population, although the prevalence of type 2 diabetes in youth is increasing rapidly. A registered dietitian (RD) is a critical member of the diabetes team who provides focused nutrition education from diagnosis and throughout routine follow-up care. Specifically in the pediatric population, the RD also assesses growth and development, as well as eating behaviors, food choices and meal patterns. Based on a review of research, ongoing support from an RD improves glycemic control and delays onset of diabetes complications. In addition, dietitian-led nutrition education helps better manage lipid levels and aids in weight management. A sample model describing RD involvement in a pediatric diabetes care team is discussed in further detail.
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Affiliation(s)
- Tracie J Steinke
- Section of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elena L O'Callahan
- Section of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Jennifer L York
- Section of Endocrinology, Nationwide Children's Hospital, Columbus, OH, USA
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Jacobsen LM, Haller MJ, Parish A, Gurka MJ, Levine SR, Wasserfall C, Campbell-Thompson M, Kaddis J, Pugliese A, Atkinson MA, Schatz DA. High Illicit Drug Abuse and Suicide in Organ Donors With Type 1 Diabetes. Diabetes Care 2017; 40:e122-e123. [PMID: 28679687 DOI: 10.2337/dc17-0996] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/13/2017] [Indexed: 02/03/2023]
Affiliation(s)
- Laura M Jacobsen
- Department of Pediatrics, University of Florida, Gainesville, FL.,Diabetes Institute, University of Florida, Gainesville, FL
| | - Michael J Haller
- Department of Pediatrics, University of Florida, Gainesville, FL.,Diabetes Institute, University of Florida, Gainesville, FL
| | - Alice Parish
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - Matthew J Gurka
- Department of Health Outcomes and Policy, University of Florida, Gainesville, FL
| | - S Robert Levine
- Department of Pediatrics, University of Florida, Gainesville, FL
| | - Clive Wasserfall
- Diabetes Institute, University of Florida, Gainesville, FL.,Department of Pathology, University of Florida, Gainesville, FL
| | - Martha Campbell-Thompson
- Diabetes Institute, University of Florida, Gainesville, FL.,Department of Pathology, University of Florida, Gainesville, FL
| | - John Kaddis
- Department of Information Sciences, City of Hope National Medical Center, Duarte, CA
| | | | - Mark A Atkinson
- Department of Pediatrics, University of Florida, Gainesville, FL.,Diabetes Institute, University of Florida, Gainesville, FL.,Department of Pathology, University of Florida, Gainesville, FL
| | - Desmond A Schatz
- Department of Pediatrics, University of Florida, Gainesville, FL .,Diabetes Institute, University of Florida, Gainesville, FL
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McCormick A, Farmer J, Perlman S, Delatycki M, Wilmot G, Matthews K, Yoon G, Hoyle C, Subramony SH, Zesiewicz T, Lynch DR, McCormack SE. Impact of diabetes in the Friedreich ataxia clinical outcome measures study. Ann Clin Transl Neurol 2017; 4:622-631. [PMID: 28904984 PMCID: PMC5590524 DOI: 10.1002/acn3.439] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 06/12/2017] [Accepted: 06/19/2017] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE Friedreich ataxia (FA) is a progressive neuromuscular disorder caused by GAA triplet repeat expansions or point mutations in the FXN gene. FA is associated with increased risk of diabetes mellitus (DM). This study assessed the age-specific prevalence of FA-associated DM and its impact on neurologic outcomes. RESEARCH DESIGN AND METHODS Participants were 811 individuals with FA from 12 international sites in a prospective natural history study (FA Clinical Outcome Measures Study, FACOMS). Physical function was assessed, using validated instruments. Multivariable regression analyses examined the independent association of DM with outcomes. RESULTS Mean age of participants was 30.1 years (SD 15.3, range: 7-82), 50% were female, and 94% were non-Hispanic white. 9% (42/459) of adults and 3% (10/352) of children had DM. Individuals with FA-associated DM were older (P < 0.001), had longer GAA repeat length on the least affected FXN allele (P = 0.037), and more severe FA (P = 0.0001). Of individuals with DM, 65% (34/52) were taking insulin. Even after accounting statistically for both age and GAA repeat length, DM was independently associated with greater FA symptom burden (P = 0.010), reduced capacity to perform activities of daily living (P = 0.021), and a decrease of 0.33 SDs on a composite performance measure (95% CI: -0.56-0.11, P = 0.004); the relative impact of DM was most apparent in younger individuals. CONCLUSIONS DM-associated FA has an independent adverse impact on well-being in affected individuals, particularly at younger ages. In future, evidence-based approaches for identification and management of FA-related DM may improve both health and function.
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Affiliation(s)
- Ashley McCormick
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania19104
| | - Jennifer Farmer
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania19104
- Department of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania19104
- Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania19104
| | - Susan Perlman
- Department of NeurologyUniversity of California Los AngelesLos AngelesCalifornia90095
| | - Martin Delatycki
- Department of GeneticsMurdoch Children's Research InstituteVictoriaAustralia
| | - George Wilmot
- Department of NeurologyEmory University School of MedicineAtlantaGeorgia30322
| | - Katherine Matthews
- Department of NeurologyUniversity of Iowa Carver College of MedicineIowa CityIowa52242
| | - Grace Yoon
- Clinical and Metabolic GeneticsHospital for Sick ChildrenTorontoCanada
| | - Chad Hoyle
- Department of NeurologyOhio State University College of MedicineColumbusOhio43210
| | - Sub H. Subramony
- Department of NeurologyUniversity of FloridaCollege of MedicineGainesvilleFlorida32610
| | | | - David R. Lynch
- Division of NeurologyChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania19104
- Department of NeurologyPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania19104
- Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania19104
| | - Shana E. McCormack
- Department of PediatricsPerelman School of Medicine at the University of PennsylvaniaPhiladelphiaPennsylvania19104
- Division of Endocrinology and DiabetesChildren's Hospital of PhiladelphiaPhiladelphiaPennsylvania19104
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Cross-cultural adaption and psychometric properties of the Chinese version of the Diabetes Behavior Rating Scale: a pilot study. SCIENCE CHINA-LIFE SCIENCES 2017; 61:310-317. [DOI: 10.1007/s11427-016-9070-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Accepted: 05/18/2017] [Indexed: 11/26/2022]
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