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Mazzotta FA, Lucaccini Paoli L, Rizzi A, Tartaglione L, Leo ML, Popolla V, Barberio A, Viti L, Di Leo M, Pontecorvi A, Pitocco D. Unmet needs in the treatment of type 1 diabetes: why is it so difficult to achieve an improvement in metabolic control? Nutr Diabetes 2024; 14:58. [PMID: 39095349 PMCID: PMC11297181 DOI: 10.1038/s41387-024-00319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 07/17/2024] [Accepted: 07/23/2024] [Indexed: 08/04/2024] Open
Abstract
The development of advanced diabetes technology has permitted persons with type 1 diabetes mellitus to improve metabolic control significantly, particularly with the development of advanced hybrid closed-loop systems which have improved the quality of life by reducing hypoglycemia, decreasing macroangiopathy and microangiopathy-related complications, ameliorating HbA1c and improving glycemic variability. Despite the progression made over the past few decades, there is still significant margin for improvement to be made in terms of attaining appropriate metabolic control. Various factors are responsible for poor glycemic control including inappropriate carbohydrate counting, repeated bouts of hypoglycemia, hypoglycemia unawareness, cutaneous manifestations due to localized insulin use and prolonged use of diabetes technology, psychosocial comorbidities such as eating disorders or 'diabulimia', the coexistence of insulin resistance among people with type 1 diabetes and the inability to mirror physiological endogenous pancreatic insulin secretion appropriately. Hence, the aim of this review is to highlight and overcome the barriers in attaining appropriate metabolic control among people with type 1 diabetes by driving research into adjunctive treatment for coexistent insulin resistance and developing new advanced diabetic technologies to preserve β cell function and mirror as much as possible endogenous pancreatic functions.
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Affiliation(s)
- Francesco Antonio Mazzotta
- Department of Endocrinology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lorenzo Lucaccini Paoli
- Department of Endocrinology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
| | - Alessandro Rizzi
- Diabetes Care Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Linda Tartaglione
- Diabetes Care Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Laura Leo
- Department of Endocrinology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Valentina Popolla
- Diabetes Care Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Annarita Barberio
- Department of Internal Medicine, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Luca Viti
- Diabetes Care Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Mauro Di Leo
- Diabetes Care Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Alfredo Pontecorvi
- Department of Endocrinology, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Dario Pitocco
- Diabetes Care Unit, Catholic University of the Sacred Heart, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
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Amorim D, Miranda F, Santos A, Graça L, Rodrigues J, Rocha M, Pereira MA, Sousa C, Felgueiras P, Abreu C. Assessing Carbohydrate Counting Accuracy: Current Limitations and Future Directions. Nutrients 2024; 16:2183. [PMID: 39064626 PMCID: PMC11279647 DOI: 10.3390/nu16142183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 06/25/2024] [Accepted: 07/05/2024] [Indexed: 07/28/2024] Open
Abstract
Diabetes mellitus is a prevalent chronic autoimmune disease with a high impact on global health, affecting millions of adults and resulting in significant morbidity and mortality. Achieving optimal blood glucose levels is crucial for diabetes management to prevent acute and long-term complications. Carbohydrate counting (CC) is widely used by patients with type 1 diabetes to adjust prandial insulin bolus doses based on estimated carbohydrate content, contributing to better glycemic control and improved quality of life. However, accurately estimating the carbohydrate content of meals remains challenging for patients, leading to errors in bolus insulin dosing. This review explores the current limitations and challenges in CC accuracy and emphasizes the importance of personalized educational programs to enhance patients' abilities in carbohydrate estimation. Existing tools for assessing patient learning outcomes in CC are discussed, highlighting the need for individualized approaches tailored to each patient's needs. A comprehensive review of the relevant literature was conducted to identify educational programs and assessment tools dedicated to training diabetes patients on carbohydrate counting. The research aims to provide insights into the benefits and limitations of existing tools and identifies future research directions to advance personalized CC training approaches. By adopting a personalized approach to CC education and assessment, healthcare professionals can empower patients to achieve better glycemic control and improve diabetes management. Moreover, this review identifies potential avenues for future research, paving the way for advancements in personalized CC training and assessment approaches and further enhancing diabetes management strategies.
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Affiliation(s)
- Débora Amorim
- Applied Digital Transformation Laboratory (Adit-LAB), Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
| | - Francisco Miranda
- Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Center for Research and Development in Mathematics and Applications (CIDMA), Department of Mathematics, University of Aveiro, 3810-193 Aveiro, Portugal
- proMetheus, Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
| | - Andreia Santos
- School of Health of the Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Alvares, 4900-347 Viana do Castelo, Portugal; (A.S.); (P.F.)
| | - Luís Graça
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health of the Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Alvares, 4900-347 Viana do Castelo, Portugal; (L.G.); (M.R.); (M.A.P.); (C.S.)
| | - João Rodrigues
- Center for Translational Health and Medical Biotechnology Research (TBIO)/Health Research Network (RISE-Health), School of Health of the Polytechnic Institute of Porto, Rua Dr. António Bernardino de Almeida 400, 4200-072 Porto, Portugal;
| | - Mara Rocha
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health of the Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Alvares, 4900-347 Viana do Castelo, Portugal; (L.G.); (M.R.); (M.A.P.); (C.S.)
| | - Maria Aurora Pereira
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health of the Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Alvares, 4900-347 Viana do Castelo, Portugal; (L.G.); (M.R.); (M.A.P.); (C.S.)
| | - Clementina Sousa
- Health Sciences Research Unit: Nursing (UICISA: E), School of Health of the Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Alvares, 4900-347 Viana do Castelo, Portugal; (L.G.); (M.R.); (M.A.P.); (C.S.)
| | - Paula Felgueiras
- School of Health of the Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Alvares, 4900-347 Viana do Castelo, Portugal; (A.S.); (P.F.)
| | - Carlos Abreu
- Applied Digital Transformation Laboratory (Adit-LAB), Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Polytechnic Institute of Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal;
- Center for MicroElectroMechanical Systems (CMEMS-UMINHO), University of Minho, Campus Azurém, 4800-058 Guimarães, Portugal
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Uliana GC, da Costa JC, Quaresma AR, da Fonseca AA, Ohaze KB, Alves LSC, Gomes DL. Factor Associated with Adherence to the Protein and Fat Counting Strategy by Adults with Type 1 Diabetes Mellitus. Nutrients 2024; 16:1930. [PMID: 38931283 PMCID: PMC11206765 DOI: 10.3390/nu16121930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2024] [Revised: 05/22/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Carbohydrate counting is one of the dietary strategies used for the management of type 1 diabetes (T1DM), and counting proteins and fats allows individuals to achieve better glycemic and metabolic control, reducing glycemic variability and long-term complications. The aim of this paper is to analyze the factors associated with adherence to the protein- and fat-counting strategy in adults with T1DM. This cross-sectional study was conducted from November 2021 to June 2022 through an online questionnaire. We applied Pearson's Chi-square test with adjusted residual analysis and a binomial logistic regression test using SPSS software, version 24.0, considering p < 0.05 as indicative of statistical significance. There was an association between performing protein and lipid counting and having a higher education level, income exceeding three minimum wages, and having adequate glycated hemoglobin. Performing protein and lipid counting increased the chances of having adequate HbA1c by 4.3 times. Protein and lipid counting was a predictor of having adequate HbA1c. The results suggest that considering the practice of counting proteins and fats is important as a strategy to optimize glycemic control.
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Affiliation(s)
- Gabriela Correia Uliana
- Postgraduate Program in Neurosciences and Behavior, Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075-110, Brazil;
| | - Juliana Carvalho da Costa
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil; (J.C.d.C.); (A.R.Q.); (A.A.d.F.); (K.B.O.); (L.S.C.A.)
| | - Ayla Rocha Quaresma
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil; (J.C.d.C.); (A.R.Q.); (A.A.d.F.); (K.B.O.); (L.S.C.A.)
| | - Arthur Andrade da Fonseca
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil; (J.C.d.C.); (A.R.Q.); (A.A.d.F.); (K.B.O.); (L.S.C.A.)
| | - Kaory Brito Ohaze
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil; (J.C.d.C.); (A.R.Q.); (A.A.d.F.); (K.B.O.); (L.S.C.A.)
| | - Layla Sandia Cezário Alves
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil; (J.C.d.C.); (A.R.Q.); (A.A.d.F.); (K.B.O.); (L.S.C.A.)
| | - Daniela Lopes Gomes
- Postgraduate Program in Neurosciences and Behavior, Nucleus of Behavior Theory Research, Federal University of Pará, Belém 66075-110, Brazil;
- Faculty of Nutrition, Federal University of Pará, Belém 66075-110, Brazil; (J.C.d.C.); (A.R.Q.); (A.A.d.F.); (K.B.O.); (L.S.C.A.)
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Lubasinski N, Thabit H, Nutter PW, Harper S. What Is the Tech Missing? Nutrition Reporting in Type 1 Diabetes. Nutrients 2024; 16:1690. [PMID: 38892623 PMCID: PMC11174934 DOI: 10.3390/nu16111690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Revised: 05/23/2024] [Accepted: 05/28/2024] [Indexed: 06/21/2024] Open
Abstract
INTRODUCTION Type 1 Diabetes (T1D) presents self-management challenges, requiring an additional 180 daily decisions to regulate blood glucose (BG) levels. Despite the potential, T1D-focused applications have a 43% attrition rate. This work delves into the willingness of people living with T1D (PwT1D) to use technology. METHOD An online questionnaire investigated the current practices for carbohydrate estimation, nutritional tracking, and attitudes towards technology engagement, along with hypothetical scenarios and preferences regarding technology use. RESULTS Thirty-nine responses were collected from PwT1D (n = 33) and caregivers (n = 6). Nutrition reporting preferences varied, with 50% favoring 'type and scroll' while 30% preferred meal photographing. Concerning the timing of reporting, 33% reported before meals, 55% after, and 12% at a later time. Improved Time in Range (TIR) was a strong motivator for app use, with 78% expressing readiness to adjust insulin doses based on app suggestions for optimizing TIR. Meal descriptions varied; a single word was used in 42% of cases, 23% used a simple description (i.e., "Sunday dinner"), 30% included portion sizes, and 8% provided full recipes. CONCLUSION PwT1D shows interest in using technology to reduce the diabetes burden when it leads to an improved TIR. For such technology to be ecologically valid, it needs to strike a balance between requiring minimal user input and providing significant data, such as meal tags, to ensure accurate blood glucose management without overwhelming users with reporting tasks.
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Affiliation(s)
- Nicole Lubasinski
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| | - Hood Thabit
- Diabetes, Endocrine & Metabolism Centre, Manchester Royal Infirmary, Manchester University NHS, Manchester M13 9WL, UK;
- Division of Diabetes, Endocrinology and Gastroenterology, School of Medical Science, The University of Manchester, Manchester M13 9PL, UK
| | - Paul W. Nutter
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
| | - Simon Harper
- Department of Computer Science, The University of Manchester, Manchester M13 9PL, UK; (P.W.N.); (S.H.)
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Pedersen ZO, Jacobsen SS, Ewers B, Grabowski D. Exploring Family Perspectives on a Group-Based Hands-on Advanced Carbohydrate Counting Education Program for Children and Adolescents with Type 1 Diabetes: A Qualitative Study. Nutrients 2024; 16:1618. [PMID: 38892551 PMCID: PMC11174676 DOI: 10.3390/nu16111618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
The care needs of children and adolescents with type 1 diabetes and their families are frequently approached as if they were identical to those of adults, overlooking the distinct challenges young people may face. It has been stated that children and adolescents often find conventional conversations with diabetes specialists tiresome and unpleasant. The present study focuses on familial experiences of an advanced carbohydrate counting program tailored to children and adolescents. The data encompass semi-structured interviews with families who participated in a group-based child-centered advanced carbohydrate counting program. The analysis revealed five themes: (1) peer-to-peer interaction is an essential determinant of sharing and learning; (2) illness perception significantly influences dietary intake; (3) normalization of diabetes in everyday life eases the disease burden; (4) repetition of dietary knowledge is important for retention; and (5) creating a safe and playful learning environment is crucial to engaging children and adolescents in their own treatment. The present findings suggest that it would be beneficial to explore and consider alternative teaching approaches that are adapted to a more interactive and engaging learning environment that is specifically tailored to children and adolescents. This entails moving away from traditional individual approaches.
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Affiliation(s)
- Zandra Overgaard Pedersen
- Steno Diabetes Center Copenhagen, Department of Diabetes Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (S.S.J.); (B.E.)
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Sabine Schade Jacobsen
- Steno Diabetes Center Copenhagen, Department of Diabetes Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (S.S.J.); (B.E.)
| | - Bettina Ewers
- Steno Diabetes Center Copenhagen, Department of Diabetes Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (S.S.J.); (B.E.)
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark;
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Maguolo A, Mazzuca G, Smart CE, Maffeis C. Postprandial glucose metabolism in children and adolescents with type 1 diabetes mellitus: potential targets for improvement. Eur J Clin Nutr 2024; 78:79-86. [PMID: 37875611 DOI: 10.1038/s41430-023-01359-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 10/05/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023]
Abstract
The main goal of therapeutic management of type 1 Diabetes Mellitus (T1DM) is to maintain optimal glycemic control to prevent acute and long-term diabetes complications and to enable a good quality of life. Postprandial glycemia makes a substantial contribution to overall glycemic control and variability in diabetes and, despite technological advancements in insulin treatments, optimal postprandial glycemia is difficult to achieve. Several factors influence postprandial blood glucose levels in children and adolescents with T1DM, including nutritional habits and adjustment of insulin doses according to meal composition. Additionally, hormone secretion, enteroendocrine axis dysfunction, altered gastrointestinal digestion and absorption, and physical activity play important roles. Meal-time routines, intake of appropriate ratios of macronutrients, and correct adjustment of the insulin dose for the meal composition have positive impacts on postprandial glycemic variability and long-term cardiometabolic health of the individual with T1DM. Further knowledge in the field is necessary for management of all these factors to be part of routine pediatric diabetes education and clinical practice. Thus, the aim of this report is to review the main factors that influence postprandial blood glucose levels and metabolism, focusing on macronutrients and other nutritional and lifestyle factors, to suggest potential targets for improving postprandial glycemia in the management of children and adolescents with T1DM.
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Affiliation(s)
- Alice Maguolo
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy.
| | - Giorgia Mazzuca
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
| | - Carmel E Smart
- School of Health Sciences, University of Newcastle, Callaghan, NSW, Australia
- Department of Paediatric Diabetes and Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Claudio Maffeis
- Section of Pediatric Diabetes and Metabolism, Department of Surgery, Dentistry, Pediatrics, and Gynecology, University of Verona, Verona, Italy
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Kjærulff EM, Kingod N, Tiemensma MD, Wahlberg A. Calibrating logics: How adolescents and young adults calibrate often-competing logics in their daily self-management of type 1 diabetes. Health (London) 2024; 28:40-57. [PMID: 35841156 DOI: 10.1177/13634593221113211] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Adolescents and young adults with type 1 diabetes must manage a demanding chronic condition in their daily lives, but adequate self-management remains a major challenge. In this article, we explore the logics invoked in shaping daily type 1 diabetes self-management among adolescents and young adults and propose an analytical view of self-management as a matter of 'calibrating logics'. Drawing on Annemarie Mol's concept of logic, our analysis of in-depth interviews with 21 adolescents and young adults with type 1 diabetes suggested that three main logics collectively shaped their self-management: biomedical, embodied and social. Biomedical logics appeared in the form of routinised insulin therapy, frequent blood glucose testing, and carbohydrate counting, all of which emphasise controlling blood glucose levels. Embodied logics emerged as refined practices such as 'thinking insulin units' and 'listening' to blood glucose fluctuations. Finally, social logics were at play when discreet or postponed self-management practices were used to adjust to social situations. While these logics may complement each other, study participants invoked how these logics often competed in daily life, generating tensions. We therefore propose viewing self-management as a matter of calibrating logics in which often-competing logics are at play. This can provide nuanced insights into the effort and challenges related to the daily self-management of type 1 diabetes for adolescents and young adults, in contrast to the prevailing dichotomy of adherence versus nonadherence to prescribed treatment regimens.
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Affiliation(s)
| | - Natasja Kingod
- Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Jelleryd E, Brorsson AL, Smart CE, Käck U, Lindholm Olinder A. Carbohydrate Counting, Empowerment and Glycemic Outcomes in Adolescents and Young Adults with Long Duration of Type 1 Diabetes. Nutrients 2023; 15:4825. [PMID: 38004219 PMCID: PMC10675281 DOI: 10.3390/nu15224825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 11/26/2023] Open
Abstract
The complex treatment for diabetes type 1 (T1D) includes insulin dosing for every meal, which requires education and experience to achieve optimal outcomes. Advanced carbohydrate counting (ACC) is the recommended method. We studied ACC as part of a standard treatment with the aim to explore its associations with glycemic control and empowerment in adolescents and young adults. We used national registry data on glycemic outcomes, a study-specific questionnaire regarding the use of ACC and the Gothenburg Young Persons Empowerment Scale (GYPES) to measure empowerment. A total of 111 participants (10-28 years of age, diabetes duration >9 years, mean HbA1c of 55.4 mmol/mol) answered the questionnaire. We found that most participants (79.3%) who learn ACC, at onset or later, continue to use the method. A higher level of empowerment was associated with lower HbA1c (p = 0.021), making patient empowerment an important factor in achieving optimal glycemic outcomes. No associations were found between ACC and empowerment or glycemic outcomes. A mixed strategy, only using ACC sometimes when insulin dosing for meals, was associated with the lowest empowerment score and highest HbA1c and should warrant extra education and support from the diabetes team to reinforce a dosing strategy.
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Affiliation(s)
- Elisabeth Jelleryd
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Women’s Health and Allied Health Professionals Theme, Medical Unit Clinical Nutrition, Karolinska University Hospital, 17176 Stockholm, Sweden
| | - Anna Lena Brorsson
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, 14152 Stockholm, Sweden;
| | - Carmel E. Smart
- Department of Endocrinology, John Hunter Children’s Hospital, Newcastle, NSW 2305, Australia;
- School of Health Sciences, University of Newcastle, Newcastle, NSW 2300, Australia
| | - Ulrika Käck
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, 11883 Stockholm, Sweden; (U.K.); (A.L.O.)
- Sachs’ Children and Youth Hospital, Södersjukhuset, 11883 Stockholm, Sweden
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H Ibrahim SM, Shahat EA, Amer LA, Aljohani AK. The Impact of Using Carbohydrate Counting on Managing Diabetic Patients: A Review. Cureus 2023; 15:e48998. [PMID: 38111457 PMCID: PMC10726644 DOI: 10.7759/cureus.48998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2023] [Indexed: 12/20/2023] Open
Abstract
Carbohydrate counting (CC) is a meal planning practice for diabetic patients, focusing on tracking the amount of carbohydrates in grams consumed at meals to manage blood glucose (BG) levels. The purpose of this narrative review is to evaluate the impact of CC in helping people with diabetes manage their condition. It reveals that CC offers superior glycemic control and flexibility compared to other food planning techniques. Specifically, when applied to children and teenage patients diagnosed with type 1 diabetes mellitus (T1DM), CC demonstrates the potential for substantial improvements in metabolic control without any adverse effects on weight or increased insulin requirements. In the context of T1DM, the combination of CC and the use of automated bolus calculators (ABCs) contributes to lowering glycated hemoglobin (HbA1c) levels. Furthermore, the study highlights that CC also holds promise in the management of type 2 diabetes mellitus (T2DM). In T2DM patients, adhering to a low glycemic index (GI) diet has proven to be more effective in controlling HbA1c and fasting BG levels compared to a higher GI diet or standard dietary control. This research underscores the evolving significance of CC as a pivotal component in diabetes management, attributed to increased awareness and education among patients. CC emerges as a versatile tool that can benefit individuals with various forms of diabetes by enhancing their glycemic control and overall quality of life. The findings affirm the impact of CC in improving patient outcomes, solidifying its status as a vital strategy in the multifaceted landscape of diabetes care.
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Affiliation(s)
| | | | - Lamar A Amer
- Medicine and Surgery, Taibah University, Medina, SAU
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Sharma R, Upadhyay B, Lal N, Sagar R, Jain V. Carbohydrate Counting vs. Fixed Meal Plan in Indian Children with Type 1 Diabetes Mellitus: A Randomized Controlled Trial. Indian J Pediatr 2023:10.1007/s12098-023-04850-z. [PMID: 37787966 DOI: 10.1007/s12098-023-04850-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 08/17/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES To study the impact of carbohydrate counting vs. fixed-meal plan on glycemic control, quality of life (QoL) and diabetes-related emotional distress in children with Type 1 diabetes mellitus (T1DM). METHODS Children aged 6-18 y with T1DM of duration >1 y were eligible for the study if they were on multiple daily injections of insulin and regularly monitoring blood glucose. Those with celiac disease, hypothyroidism, any underlying chronic renal/liver/systemic disease or HbA1c >13% were excluded. Both groups received education on diabetes management and healthy diet. In the intervention arm, parents were taught to quantify carbohydrate content and modify insulin doses according to insulin-carbohydrate ratio. The control arm had dietary prescription according to recommended dietary allowance and food exchange list. Standard validated questionnaires were used to assess the QoL and emotional distress related to diabetes. RESULTS One hundred twenty five patients (61 intervention, 64 controls) were enrolled and 91.8% and 84.3%, respectively, completed 6-mo follow-up. There was a reduction in HbA1c in both the groups, but was not statistically significant within or between groups {Intervention: 8.9 (1.4) to 8.6 (1.5) vs. control: 9.1 (1.6) to 8.8 (1.9), [95% CI 8.3-9.3 vs. 8.3-9.0, intention to treat (ITT), p = 0.63]}. There was a significant reduction in diabetes distress in the intervention group; DAWN Problem Areas in Diabetes Questionnaire (PAID) score with a median (interquartile range) of 21 (11-33) vs. control: 27 (20-40), (p = 0.04). CONCLUSIONS Patients in the carbohydrate-counting group demonstrated lower diabetes distress scores and less emotional burnout compared to fixed-meal plan over a 6 mo period though overall glycemic control was comparable between groups.
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Affiliation(s)
- Rajni Sharma
- Division of Pediatric Endocrinology, Department of Pediatrics, Mother and Child Block, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Babita Upadhyay
- Division of Pediatric Endocrinology, Department of Pediatrics, Mother and Child Block, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Nitika Lal
- Division of Pediatric Endocrinology, Department of Pediatrics, Mother and Child Block, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India
| | - Rajesh Sagar
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Vandana Jain
- Division of Pediatric Endocrinology, Department of Pediatrics, Mother and Child Block, All India Institute of Medical Sciences (AIIMS), New Delhi, 110029, India.
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11
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Uliana GC, Camara LN, Paracampo CCP, da Costa JC, Gomes DL. Characteristics of carbohydrate counting practice associated with adequacy of glycated hemoglobin in adults with type 1 diabetes mellitus in Brazil. Front Endocrinol (Lausanne) 2023; 14:1215792. [PMID: 37766694 PMCID: PMC10519792 DOI: 10.3389/fendo.2023.1215792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
Background The Carbohydrate Counting (CC) is directly associated with achieving glycemic control by people with Type 1 Diabetes Mellitus (T1DM). Therefore, this study aims to analyze characteristics of the CC practice associated with the adequacy of glycated hemoglobin (HbA1c) in adults with T1DM in Brazil. Methods The study was cross-sectional, carried out using an online form with questions about knowledge of CC, clinical, anthropometric, sociodemographic data, follow-up with health professionals and understanding of the concepts of CC. Pearson's chi-square test and binomial logistic regression analysis (p<0.05) were applied. Results 173 adults participated, of which 57.2% had increased HbA1c (≥7%). Having the diabetes duration <10 years (p=0.006), performing the CC at lunch (p=0.040) and dinner (p=0.018), using specific applications to perform the CC (p=0.001), having learned to perform CC with a nutritionist (p=0.037) and knowing how to correctly define the concepts of food bolus (p=0.001), correction bolus (p<0.001) and insulin/carbohydrate ratio (p<0.001) was associated with having adequate HbA1c (<7%). Participants who were undergoing CC practice were 3.273 times more likely to have adequate HbA1c and participants with diabetes duration <10 years were 2.686 times more likely to have adequate HbA1c. Conclusion It was concluded that variables transversal to CC favor adequate HbA1c values in adults with T1DM and that practicing CC and having a diabetes duration of less than 10 years are predictive factors of having adequate HbA1c.
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Affiliation(s)
| | | | | | | | - Daniela Lopes Gomes
- Nucleus of Behavior Theory Research, Federal University of Pará, Belém, Brazil
- Faculty of Nutrition, Federal University of Pará, Belém, Brazil
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12
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Wiyono L, Ghitha N, Clarisa D, Larasati A. Carbohydrate counting implementation on pediatric type 1 diabetes mellitus: systematic review and meta-analysis. Ann Pediatr Endocrinol Metab 2023; 28:206-214. [PMID: 37798895 PMCID: PMC10556441 DOI: 10.6065/apem.2244242.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/06/2023] [Accepted: 04/20/2023] [Indexed: 10/07/2023] Open
Abstract
PURPOSE Type 1 diabetes mellitus, which is the most common type of diabetes among children, is not curable but can be managed well without a negative effect on quality of life. One of the treatments of type 1 diabetes mellitus is carbohydrate counting. This systematic review and meta-analysis sought to evaluate the efficacy of carbohydrate counting with regard to hemoglobin A1c (HbA1c) reduction in children with type 1 diabetes mellitus. METHODS Nine studies were assessed, with the primary outcome being glycemic control (HbA1c changes). We searched the following electronic databases: ProQuest, PubMed, Scopus, and ScienceDirect. The quality of studies included was assessed using the risk of bias for randomized control trials and the JBI Critical Appraisal Checklist for observational and cross-sectional studies. Quantitative analyses were made and extrapolated into a forest plot. RESULTS A total of 1,693 articles were identified. Four reviewers independently screened titles and abstracts. Of the 36 articles screened, 34 articles were found to be eligible. Of these, 25 studies were excluded because of unsuitable outcomes and study designs. Nine articles were included in the final analysis. Meta-analysis showed that there was a reduction in HbA1c in the carbohydrate counting group as compared to the control group. The cumulative effect of carbohydrate counting on HbA1c was a mean difference of -0.55 (95% confidence interval, -0.81 to -0.28, P<0.001). All of the studies exhibited similar results with the mean difference reduction favoring the interventional group. However, the heterogeneity analysis revealed an I2 value of 88%, implying high heterogeneity in the meta-analysis. CONCLUSION The meta-analysis showed evidence favoring the use of carbohydrate counting in the management of type 1 diabetes mellitus.
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Affiliation(s)
- Lowilius Wiyono
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Nida Ghitha
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Dina Clarisa
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Anjani Larasati
- Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
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13
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Ait-Taleb Lahsen H, Ragala MEA, El Abed H, Hajjaj S, El Makhtari R, Benani S, El Hilaly J, Zarrouq B, Halim K. Educational needs of type 1 diabetes mellitus T1DM children and adolescents in Morocco: A qualitative study. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2023; 12:114. [PMID: 37397112 PMCID: PMC10312424 DOI: 10.4103/jehp.jehp_54_23] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 02/06/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Type 1 Diabetes Mellitus T1DM is a chronic disease, mainly observed in children or young adults, with a significantly increased incidence in young children. To enable diabetic children and adolescents to lead a healthy life and manage their disease effectively, right from diagnosis, they must benefit from therapeutic patient education TPE whose first stage is an educational diagnosis. This study aimed to identify the educational needs of T1DM children and adolescents through an educational diagnosis. METHODS AND MATERIAL A qualitative study was conducted with T1DM children and adolescents, aged 8 to 18, at the pediatric department. This qualitative study was conducted through semi-structured face-to-face individual interviews based on a guide with 20 participants in 2022. The internationally recognized ethical research principles were respected and ethical approval was obtained. Data analysis were carried out according to the principles of the reflexive approach of thematic analysis. RESULTS The interviews' thematic analysis revealed five educational themes: Knowledge about T1DM and its complications risks, measures and attitudes for disease monitoring and therapy management, crisis and short-term complications management, diet and physical activity management, and adaptation of daily life to the disease and treatment constraints. CONCLUSIONS The educational diagnosis is an essential TPE step to identify the educational needs of children and adolescents with T1DM, and to set up if needed, an educational program allowing them to develop the required skills. Hence, the health policy in Morocco should integrate the TPE approach systematically in T1DM patients' care.
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Affiliation(s)
- Hanaâ Ait-Taleb Lahsen
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Higher Institute of Nursing and Technical Health Professions, Fez, Morocco
| | - Mohammed El Amine Ragala
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- High School Teachers-Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Hanane El Abed
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Higher Institute of Nursing and Technical Health Professions, Fez, Morocco
| | - Safaa Hajjaj
- Department of Pediatric, Prefectural Hospital Center Ibn Al-Khatib, Fez, Morocco
| | - Rajae El Makhtari
- Department of Pediatric, Prefectural Hospital Center Ibn Al-Khatib, Fez, Morocco
| | - Sarah Benani
- Department of Pediatric, Prefectural Hospital Center Ibn Al-Khatib, Fez, Morocco
| | - Jaouad El Hilaly
- Laboratory of Pedagogical and Didactic Engineering of Sciences and Mathematics, Regional Center of Education and Training (CRMEF), Fez, Morocco
| | - Btissame Zarrouq
- High School Teachers-Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
- Laboratory of Epidemiology and Research in Health Sciences, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Karima Halim
- LSNAMOPEQ, FSDM Sidi Mohamed Ben Abdellah University, Fez, Morocco
- High School Teachers-Training College (Ecole Normale Superieure), Sidi Mohamed Ben Abdellah University, Fez, Morocco
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14
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Diaz JVR, Figueroa J, Felner EI. A pilot study of mealtime insulin administration and parental stress in youth with new-onset type 1 diabetes. Diabet Med 2023; 40:e15039. [PMID: 36617389 DOI: 10.1111/dme.15039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
AIMS To compare the stress level in parents of children with new-onset type 1 diabetes receiving a fixed insulin dose for a fixed range of carbohydrates (CHOs) to parents of children receiving a precise insulin dose for a precise number of CHOs using an insulin-to-carbohydrate ratio (ICR). METHODS Twenty-four participants (8-14 years) were randomized to receive a fixed dose of insulin for a fixed range of CHOs (FD group) or a precise dose of insulin for a precise number of carbohydrates using an ICR (ICR group). The primary endpoint was parental stress measured with the parental stress survey (PSS) 1 to 4 months after diagnosis. Secondary endpoints included glycemic variability, glycated haemoglobin (HbA1C ) and safety. RESULTS Compared to parents of children in the ICR group, those from the FD group reported less stress during the first 4 months after diagnosis (p = 0.022). Glycemic variability and HbA1C were similar in both groups. None of the patients from either group required an emergency department visit or hospitalization. CONCLUSIONS In comparison to precise insulin dosing using an ICR, fixed insulin dosing for a fixed range of CHOs may be less stressful for parents to learn and employ when initially taught diabetes management skills for their child with new-onset type 1 diabetes.
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Affiliation(s)
- Jacqueline V Reyes Diaz
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
- Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia, United States
| | - Janet Figueroa
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Eric I Felner
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
- Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia, United States
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15
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Pi L, Shi X, Wang Z, Zhou Z. Effect of smartphone apps on glycemic control in young patients with type 1 diabetes: A meta-analysis. Front Public Health 2023; 11:1074946. [PMID: 37064701 PMCID: PMC10097897 DOI: 10.3389/fpubh.2023.1074946] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 03/02/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectivesAchieving glycemic control is a great challenge for young patients with type 1 diabetes (T1D), especially during the transition from childhood to adulthood. As various smartphone apps have been developed to improve glycemic control in T1D, we performed a meta-analysis of randomized controlled trials to assess the effect of smartphone apps on glycemic control in young patients with T1D.MethodsWe systematically searched PubMed, Embase, and the Cochrane Library for randomized controlled trials comparing combined usual care and smartphone app treatment to usual care alone. This meta-analysis is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The primary outcomes were the weighted difference in means (WMD) of HbA1c change from baseline and the person-years incidence of mild hypoglycemia or severe hypoglycemia between intervention and control groups. We assessed pooled data by use of a random-effects model.ResultsOf 1,190 identified studies, nine were eligible and included in our analysis (N = 748 participants). Relative to the control, using smartphone apps yielded a non-significant reduction in glycated hemoglobin (HbA1c) (WMD = −0.26, 95% CI: −0.56 to 0.05; p = 0.10) and no increased frequency of mild hypoglycemia (WMD = 1.87, 95% CI: −1.52 to 5.27; p = 0.49) or severe hypoglycemia (WMD = −0.04, 95% CI: −0.35 to 0.27; p = 0.80). In further subgroup analysis, compared with the recording-style app group, the auxiliary-style app group exhibited a significant reduction in HbA1c (WMD = −0.83, 95% CI: −1.10 to −0.56, p < 0.001).ConclusionThe current pooled data analysis did not reveal a significant reduction in HbA1c in young patients with T1D undergoing treatment with smartphone apps and usual care in combination. However, auxiliary-style apps with insulin or carbo calculators were beneficial in reducing HbA1c.
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16
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AlBabtain SA, AlAfif NO, AlDisi D, AlZahrani SH. Manual and Application-Based Carbohydrate Counting and Glycemic Control in Type 1 Diabetes Subjects: A Narrative Review. Healthcare (Basel) 2023; 11:healthcare11070934. [PMID: 37046861 PMCID: PMC10094622 DOI: 10.3390/healthcare11070934] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 03/18/2023] [Accepted: 03/20/2023] [Indexed: 04/14/2023] Open
Abstract
Type 1 diabetes (T1DM) is the most common chronic disease in young adults and children, which is treated with insulin, usually given as basal and boluses. Carbohydrate counting (CHOC) helps patients to determine the correct meal doses. The aim of this review is to study the effect of CHOC on glucose control, body weight, insulin dose and quality of life (QoL). The literature search was conducted using PubMed from January 2010 to October 2022. Studies included in this review are limited to randomized controlled studies involving an intervention group undergoing CHOC and a control group following the usual practice, measuring glycosylated hemoglobin (HbA1c) as a parameter of glucose control and involving only T1DM subjects. A total of ten articles were found to fulfill the criteria involving 1034 patients. Most of the studies showed a positive impact of CHOC on glucose control, especially in adults, where five out of six studies were statistically positive. However, in pediatrics, only two out of four showed a positive outcome. In all four studies using mobile applications, CHOC was better at controlling glucose. No difference was seen between the CHOC group and the control regarding the risk of severe hypoglycemia. In fact, two studies have shown lower hypoglycemia rates. No change in weight was observed in most of the studies (six out of eight). In subjects with T1DM, CHOC might provide better glucose control than traditional care without a significant increment in severe hypoglycemia or weight gain. Mobile application-based models showed promising results in glucose control.
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Affiliation(s)
- Sara A AlBabtain
- Clinical Nutrition Administration, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh 11525, Saudi Arabia
| | - Nora O AlAfif
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Dara AlDisi
- Department of Community Health Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia
| | - Saad H AlZahrani
- Obesity, Endocrine and Metabolism Center, King Fahad Medical City, Riyadh 11525, Saudi Arabia
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17
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Cengiz E, Danne T, Ahmad T, Ayyavoo A, Beran D, Ehtisham S, Fairchild J, Jarosz-Chobot P, Ng SM, Paterson M, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Insulin treatment in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1277-1296. [PMID: 36537533 DOI: 10.1111/pedi.13442] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Affiliation(s)
- Eda Cengiz
- University of California San Francisco (UCSF) Pediatric Diabetes Program, UCSF School of Medicine, San Francisco, California, USA
| | - Thomas Danne
- Auf Der Bult, Diabetes Center for Children and Adolescents, Hannover, Germany
| | - Tariq Ahmad
- Pediatric Endocrinology, UCSF Benioff Children's Hospital Oakland, Oakland, California, USA
| | - Ahila Ayyavoo
- Department of Pediatrics, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore, India
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Faculty of Medicine University of Geneva and Geneva University Hospitals, Faculty of Medicine Diabetes Centre, Geneva, Switzerland
| | - Sarah Ehtisham
- Division of Pediatric Endocrinology, Mediclinic City Hospital, Dubai, UAE
| | - Jan Fairchild
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, North Adelaide, Australia
| | | | - Sze May Ng
- Paediatric Department, Southport and Ormskirk NHS Trust, Southport, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Megan Paterson
- John Hunter Children's Hospital, HRMC, New South Wales, Australia
| | - Ethel Codner
- Institute of Maternal and Child Research (IDIMI), School of Medicine, University of Chile, Santiago, Chile
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18
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Cadario F. Vitamin D and ω-3 Polyunsaturated Fatty Acids towards a Personalized Nutrition of Youth Diabetes: A Narrative Lecture. Nutrients 2022; 14:nu14224887. [PMID: 36432570 PMCID: PMC9699239 DOI: 10.3390/nu14224887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
After the discovery of insulin, nutrition has become central in the management of diabetes in order to limit glycemic rise after meals, optimize metabolic control, and prevent complications. Over the past one hundred years, international scientific societies have consecutively refined nutritional needs and optimized food intake for the treatment of diabetes. In particular, over the past century, nutrition applied with pumps for the administration of insulin and continuous glucose monitoring have allowed substantial advancement in the treatment of type 1 diabetes mellitus. The role of some substances, such as vitamin D and n-3 polyunsaturated fatty acids, have been proposed without univocal conclusions, individually or in combination, or in the diet, to improve the nutrition of type 1 and type 2 diabetes. This second condition, which is highly associated with overweight, should be prevented from childhood onwards. Personalized nutrition could bypass the problem, reaching a scientific conclusion on the individual subject. This article focuses on childhood and adolescent diabetes, aims to provide a narrative summary of nutrition over the past century, and promotes the concept of personalized nutrition to pediatricians and pediatric diabetologists as a possible tool for the treatment of type 1 diabetes and the prevention of type 2 diabetes.
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Affiliation(s)
- Francesco Cadario
- Division of Pediatrics, University of Piemonte Orientale, 28100 Novara, Italy;
- Diabetes Research Institute Federation, Miami, FL 33163, USA
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19
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Dimitriades ME, Pillay K. Carbohydrate counting in type 1 diabetes mellitus: dietitians’ perceptions, training and barriers to use. SOUTH AFRICAN JOURNAL OF CLINICAL NUTRITION 2022. [DOI: 10.1080/16070658.2021.1979764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Affiliation(s)
- Megan Esmè Dimitriades
- Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Kirthee Pillay
- Dietetics and Human Nutrition, University of KwaZulu-Natal, Pietermaritzburg, South Africa
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20
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Snow S, Thivierge M, Seel M, Brown E, Akhtar Y, Wolf RM. A Brief Nutrition Questionnaire for Children With Newly Diagnosed Type 1 Diabetes. Clin Diabetes 2022; 41:192-197. [PMID: 37092164 PMCID: PMC10115615 DOI: 10.2337/cd22-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Carbohydrate counting is an important component of type 1 diabetes management that is taught at the time of diagnosis. We implemented and validated a nutrition quiz to assess fundamental carbohydrate counting and nutrition knowledge in newly diagnosed patients. An interactive standard assessment for newly diagnosed type 1 diabetes patients was feasible and reliable to implement for patients and caregivers, but participants with public insurance scored lower overall. This assessment may help to identify nutrition knowledge gaps and provide opportunities for timely education, and providers should place additional focus on nutrition education for patients with public insurance.
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Affiliation(s)
- Shani Snow
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins Hospital, Baltimore, MD
| | - Meredith Thivierge
- Department of Pediatric Nutrition, Johns Hopkins Hospital, Baltimore, MD
| | - Maureen Seel
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins Hospital, Baltimore, MD
- Department of Pediatric Nutrition, Johns Hopkins Hospital, Baltimore, MD
| | - Elizabeth Brown
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins Hospital, Baltimore, MD
| | - Yasmin Akhtar
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins Hospital, Baltimore, MD
| | - Risa M. Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins Hospital, Baltimore, MD
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21
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Al-Qahtani SM, Shati AA, Alqahtani YA, AlAsmari AA, Almahdi MA, Al Hassan AA, Alhassany AM, Shathan RA, Aldosari RM, AlQahtani AS, Khalil SN. Factors Affecting Glycemic Control among Saudi Children with Type 1 Diabetes Mellitus in Aseer Region, Southwestern Saudi Arabia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph191811558. [PMID: 36141857 PMCID: PMC9517271 DOI: 10.3390/ijerph191811558] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/04/2022] [Accepted: 09/13/2022] [Indexed: 06/01/2023]
Abstract
Glycemic control in children with type 1 diabetes mellitus (T1DM) is affected by many factors that may be influenced by their lives and community. To identify the factors associated with glycemic control among children with T1DM in Aseer Region, southwestern Saudi Arabia, a cross-sectional interview study was conducted between 1 July and 30 September 2021, with a representative sample of Saudi children aged between 6 months and 15 years with T1DM or their caregivers visiting the diabetes center at Aseer Region. Newly diagnosed cases (<12 months) were excluded from the study. The study included 171 T1DM pediatric patients aged between 18 months and 15 years. The glycated hemoglobin (HbA1c) level ranged between 6.10% and 15.10% (mean HbA1c = 10.39% ± 1.86%). High HbA1c levels (≥7.5%) were observed in most patients (94.7%). Only two significant factors were found: (1) use of carbohydrate counting; 81.8% of children using carbohydrate counts had high HbA1c levels, compared to 96.6% of children not using carbohydrate counts (p = 0.017), and (2) duration of the disease; 91.5% of children with disease duration of ≤3 years had high levels of HbA1c, compared to 98.7% of children with disease duration exceeding 3 years (p = 0.035). Most children with T1DM in Aseer Region had poor glycemic control. Only two factors were associated with better glycemic control: shorter disease duration and use of carbohydrate counting. Therefore, advising diabetic patients to be on a carbohydrate counting program might improve DM control.
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Affiliation(s)
- Saleh M. Al-Qahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
| | - Ayed A. Shati
- Department of Child Health, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
| | - Youssef A. Alqahtani
- Department of Child Health, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
| | - Ali A. AlAsmari
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Mohammed A. Almahdi
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Amjad A. Al Hassan
- Department of Pediatrics, Armed Forces Hospital-Southern Region, Khamis Mushyate 62413, Saudi Arabia
| | - Ali M. Alhassany
- Department Medicine, King Fahad Hospital, Al-Baha 65732, Saudi Arabia
| | - Rana A. Shathan
- Department of Pediatrics, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Rawa M. Aldosari
- Department of Pediatric Emergency, Abha Maternity and Children Hospital, Abha 62562, Saudi Arabia
| | - Abdullah S. AlQahtani
- Department of Emergency Medicine, Khamis Mushyate General Hospital, Khamis Mushyate 62433, Saudi Arabia
| | - Shamsun Nahar Khalil
- Department of Family & Community Medicine, College of Medicine, King Khalid University, Abha 62223, Saudi Arabia
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22
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical Activity and Nutrition Interventions for Type 1 Diabetes: A Meta-analysis. Pediatrics 2022; 150:188758. [PMID: 35953465 DOI: 10.1542/peds.2022-056540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current evidence is lacking on physical activity and nutrition-based interventions focusing on the management of type 1 diabetes mellitus (T1DM) and health-related quality of life among children. To assess the effects of physical activity interventions and nutrition-based interventions for children with T1DM. METHODS Data sources include the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, CINAHL through January 2022. Study selection includes randomized controlled trials of children aged 18 years and below with T1DM comparing either a physical activity intervention, a nutrition-based intervention, or hybrid physical activity and nutrition-based intervention with placebo or no-treatment control. Data were pooled using a random-effects model. Primary outcomes were hemoglobin A1c (HbA1c), and health-related quality of life. RESULTS Eighteen trials were included. Physical activity compared with the no-treatment group showed a lack of effect on HbA1c (mean difference = -0.58, 95% confidence interval -1.20 to 0.05; P value = .07). Nutrition-based intervention compared with no-treatment control for HbA1c level revealed a lack of effect (mean difference = -0.61, 95% confidence interval -1.48 to 0.26; P value = .17). Limitations include paucity of studies and low quality of evidence caused by the risk of bias. CONCLUSIONS Despite the lack of significant evidence, the generally favorable results highlight the potential of such interventions in enhancing glycemic control and health-related quality of life. Additionally, promising results from a single physical activity-nutrition-based hybrid intervention in terms of glycemic control indicate the plausible effectiveness of a mixed intervention.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies.,National University Health System, Singapore
| | | | - Evelyn C Law
- Departments of Pediatrics.,National University Health System, Singapore.,Translational Neuroscience Program, Agency for Science, Technology, and Research, Singapore Institute for Clinical Sciences, Singapore
| | - John C M Wong
- Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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23
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Granado-Casas M, Solà I, Hernández M, Rojo-López MI, Julve J, Mauricio D. Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review. Nutr Diabetes 2022; 12:24. [PMID: 35459205 PMCID: PMC9033775 DOI: 10.1038/s41387-022-00201-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment. OBJECTIVES Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes. METHODS The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance. RESULTS From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI. CONCLUSIONS Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.
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Affiliation(s)
- Minerva Granado-Casas
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041, Barcelona, Spain
- Center for Biomedical Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Lleida, Spain
- Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marina Idalia Rojo-López
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Josep Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain.
- Faculty of Medicine, University of Vic (UVIC/UCC), Vic, Spain.
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Pancheva R, Zhelyazkova D, Ahmed F, Gillon-Keren M, Usheva N, Bocheva Y, Boyadzhieva M, Valchev G, Yotov Y, Iotova V. Dietary Intake and Adherence to the Recommendations for Healthy Eating in Patients With Type 1 Diabetes: A Narrative Review. Front Nutr 2022; 8:782670. [PMID: 34977126 PMCID: PMC8716953 DOI: 10.3389/fnut.2021.782670] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/25/2021] [Indexed: 01/11/2023] Open
Abstract
Background: Medical nutrition therapy is essential for all people with diabetes, of any type or severity. Compliance with the recommended nutrition is an integral part of the treatment of type 1 diabetes (T1D). It remains unclear to what extent the dietary intake of patients with type 1 diabetes adheres to the recommendations for healthy eating. Objective: The primary aim of our study is to collect and analyze published articles on the nutrition of T1D patients in comparison with the general population and recommendations. Research Strategy and Methods: A literature search for articles, published between January 2006 and July 2021 was conducted, using electronic databases (PubMed and Google Scholar) for all available publications in English and Bulgarian. The process of study selection, identification, screening, eligibility and inclusion followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) recommendations for a flowchart. Based on the keywords search, 425 titles were retrieved, of which 27 were selected based on title and abstract. All papers were crosschecked and reviewed for selection by 3 independent reviewers. As a result, 19 titles were eligible and met inclusion criteria for a full review. Results: Energy intake tends to be lower in T1D patients or comparable to controls and in most cases within the general recommendations. The percentage of calories from protein is within the recommendations for children, adolescents and adults. Only two studies showed that T1D patients consume significantly less than the recommendation for total fat intake (<35E%). The median intake of carbohydrates is in the lower end of the recommended 45 to 60E%. The median intake of dietary fiber adjusted for total energy is too low for T1D patients and the general population. Conclusion: Study findings suggested a lack of knowledge or misunderstanding of diabetes dietary management. Patients with T1D, who are being consulted with a dietician as a part of their treatment plan may have better compliance to their recommended diet and as a result, are likely to have better health outcomes. Nutritional therapy should focus not only on glycemic control and pure carbohydrate counting but also on healthy eating and complication prevention.
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Affiliation(s)
- Rouzha Pancheva
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Desislava Zhelyazkova
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Fatme Ahmed
- Department of Hygiene and Epidemiology, Medical University of Varna, Varna, Bulgaria
| | - Michal Gillon-Keren
- Institute of Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Nataliya Usheva
- Department of Social Medicine and Health Care Organization, Medical University of Varna, Varna, Bulgaria
| | - Yana Bocheva
- Department of Clinical Laboratory, Medical University of Varna, Varna, Bulgaria
| | - Mila Boyadzhieva
- Department of Internal Diseases II, Medical University of Varna, Varna, Bulgaria
| | - Georgi Valchev
- Department of Imaging Diagnostics, Interventional Radiology and Radiotherapy, Medical University of Varna, Varna, Bulgaria
| | - Yoto Yotov
- Department of Internal Diseases I, Medical University of Varna, Varna, Bulgaria
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, Varna, Bulgaria
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Ullah A, Graue M, Haugstvedt A. Adolescent's Experiences with Diabetes Self-Management and the Use of Carbohydrate Counting in Their Everyday Life with Type 1 Diabetes. Patient Prefer Adherence 2022; 16:887-896. [PMID: 35411133 PMCID: PMC8994650 DOI: 10.2147/ppa.s354696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/26/2022] [Indexed: 12/02/2022] Open
Abstract
AIM The aim of this study was to describe adolescents' experiences with diabetes self-management and the use of carbohydrate counting as a tool for calculating insulin doses in everyday life with type 1 diabetes. METHODS We used a qualitative study design. Individual interviews were conducted with 14 adolescents (seven boys and seven girls, aged 16-18 years) with type 1 diabetes by using a semi-structured interview guide. We used purposive sampling, recruiting the participants from one paediatric outpatient clinic in Norway. Thematic analysis was used for the data analysis. FINDINGS We identified two main themes, each comprising three subthemes: (1) "Diabetes treatment is difficult but can be well adapted" with subthemes "Diabetes influences my entire life, with a lot of fuss and takes time", "Having diabetes turned out to be manageable", and "Need some help and support, but not too much"; (2) "Carbohydrate counting is useful but often not used" with subthemes "One counts the carbs, then the pump calculates the insulin doses", "Carbohydrate counting gives better blood glucose, but I do not always bother to use it", and "After a while, one just uses one's own experience.". CONCLUSION The study showed that adolescents with type 1 diabetes experienced that the diabetes treatment influenced their entire life in a substantial manner. Nevertheless, the demands of the disease and the treatment tasks were perceived very differently. Some articulated that carbohydrate counting was appreciated as a suitable tool for dosing insulin and optimizing glycaemic control. Others did not use carbohydrate counting at all and described to use their own experience. The findings support the importance of individualizing diabetes follow-up and adapt the training in treatment tools to everyone's situation and preferences.
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Affiliation(s)
- Aisha Ullah
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Paediatrics, Innlandet Hospital, Elverum, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Correspondence: Anne Haugstvedt, Email
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Hamaguchi M, Yoshimura Y, Nakajima H, Tanaka T, Hasegawa G, Ishii M, Okada H, Mitsuhashi K, Kitagawa N, Okamura T, Hashimoto Y, Majima S, Senmaru T, Ushigome E, Nakanishi N, Asano M, Yamazaki M, Fukui M. Insulin dose reduction in dapagliflozin combination therapy for type 1 diabetes mellitus: the RISING-STAR study. J Clin Biochem Nutr 2022; 71:158-164. [PMID: 36213793 PMCID: PMC9519412 DOI: 10.3164/jcbn.22-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 01/29/2022] [Indexed: 12/03/2022] Open
Abstract
To clarify the frequency of hypoglycemia in patients with type 1 diabetes mellitus receiving dapagliflozin combination therapy to reduce their basal insulin dose. Sixty subjects were assigned to two groups according to their basal insulin-to-total daily dose (TDD) ratio: group A (basal insulin/TDD <40%) and group B (≥40%). Reduction of the basal insulin dose was instituted in group B, but not in group A. The number of hypoglycemic events per day and ketosis frequency were the primary and secondary endpoints, respectively. The hypoglycemia frequency before and after the intervention was 0.23 and 0.26 times/day in group A and 0.19 and 0.23 times/day in group B, respectively, with no significant difference between the groups. The total insulin dose reduction was approximately 10% in both groups. Ketosis frequency increased significantly after the intervention (from 0.013 to 0.086 times/day in group A and 0.013 to 0.059 times/day in group B). Time-in-range, mean amplitude of glycemic excursion, and glycated hemoglobin A1c improved in both groups. No significant difference in hypoglycemia frequency was observed between patients with and without reduction of the basal insulin dose. The combination therapy improved glycemic control and patient satisfaction regarding hyperglycemia. Nevertheless, adequate attention to ketosis is crucial.
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Affiliation(s)
- Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Yuta Yoshimura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Hanako Nakajima
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Toru Tanaka
- Department of Diabetes and Endocrinology, Japanese Red Cross Kyoto Daiichi Hospital
| | - Goji Hasegawa
- Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital
| | | | - Hiroshi Okada
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital
| | | | | | - Takuro Okamura
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Saori Majima
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Takafumi Senmaru
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Naoko Nakanishi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Mai Asano
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine
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27
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Hegab AM. Diurnal Variation of Real-Life Insulin Sensitivity Factor Among Children and Adolescents With Type 1 Diabetes Using Ultra-Long-Acting Basal Insulin Analogs. Front Pediatr 2022; 10:854972. [PMID: 35350271 PMCID: PMC8957904 DOI: 10.3389/fped.2022.854972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 02/14/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Estimation of insulin sensitivity factor (ISF) is essential for correction insulin doses calculation. This study aimed to assess real-life ISF among children and adolescents with type 1 diabetes using ultra-long-acting basal insulin analogs and to detect factors associated with ISF among those patients. METHODS This prospective observational study was conducted at Sohag University Hospital, Egypt, and included 93 participants aged 6-18 years, diagnosed with T1DM for at least 1 year and using insulin glargine 300 Units/mL or insulin degludec 100 Units/mL as basal insulin. The ISF, insulin-to-carbohydrate ratio (ICR) and insulin doses were initially assessed then adjusted as required. The participants were regularly contacted throughout the follow-up period. Glycemic control parameters were assessed after 3 months. RESULTS The ISF showed diurnal variation with higher correction dose requirements for the morning than for the rest of the day (p < 0.001). This pattern of diurnal variation was found in participants with different pubertal stages and in participants using either type of ultra-long acting basal insulin analogs. There was no significant difference between the ISF calculated according to the 1800 rule [1800/Total daily insulin dose (TDD)] and the morning ISF (p = 0.25). The 1800 rule-calculated ISF was significantly lower than the actual ISF for the afternoon (p < 0.001) and the evening (p < 0.001). ISF at different times of the day were significantly correlated with age, body mass index, pubertal stage, diabetes duration, TDD, and ICR. Multiple regression analysis revealed that ICR was the most significant factor associated with ISF. Linear regression analysis revealed that the ISF (in mg/dL) for any time of the day could be estimated as 5.14 × ICR for the same time of the day (coefficient = 5.14, 95% confidence interval: 5.10-5.19, R 2 = 0.95, p < 0.001). CONCLUSION Diurnal variation of ISF that had to be considered for proper calculation of correction doses. This diurnal variation was found in children and adolescents with different pubertal stages. The 1800 rule was appropriate for the morning correction doses but not in the afternoon or the evening. The TDD and the ICR could be used for ISF estimation.
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Affiliation(s)
- Ahmed M Hegab
- Department of Pediatrics, Faculty of Medicine, Sohag University, Sohag, Egypt
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28
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Furthner D, Lukas A, Schneider AM, Mörwald K, Maruszczak K, Gombos P, Gomahr J, Steigleder-Schweiger C, Weghuber D, Pixner T. The Role of Protein and Fat Intake on Insulin Therapy in Glycaemic Control of Paediatric Type 1 Diabetes: A Systematic Review and Research Gaps. Nutrients 2021; 13:nu13103558. [PMID: 34684559 PMCID: PMC8537759 DOI: 10.3390/nu13103558] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 10/02/2021] [Accepted: 10/05/2021] [Indexed: 11/16/2022] Open
Abstract
Carbohydrate counting (CHC) is the established form of calculating bolus insulin for meals in children with type 1 diabetes (T1DM). With the widespread use of continuous glucose monitoring (CGM) observation time has become gapless. Recently, the impact of fat, protein and not only carbohydrates on prolonged postprandial hyperglycaemia have become more evident to patients and health-care professionals alike. However, there is no unified recommendation on how to calculate and best administer additional bolus insulin for these two macronutrients. The aim of this review is to investigate: the scientific evidence of how dietary fat and protein influence postprandial glucose levels; current recommendations on the adjustment of bolus insulin; and algorithms for insulin application in children with T1DM. A PubMed search for all articles addressing the role of fat and protein in paediatric (sub-)populations (<18 years old) and a mixed age population (paediatric and adult) with T1DM published in the last 10 years was performed. Conclusion: Only a small number of studies with a very low number of participants and high degree of heterogeneity was identified. While all studies concluded that additional bolus insulin for (high) fat and (high) protein is necessary, no consensus on when dietary fat and/or protein should be taken into calculation and no unified algorithm for insulin therapy in this context exists. A prolonged postprandial observation time is necessary to improve individual metabolic control. Further studies focusing on a stratified paediatric population to create a safe and effective algorithm, taking fat and protein into account, are necessary.
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Affiliation(s)
- Dieter Furthner
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
| | - Andreas Lukas
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
| | - Anna Maria Schneider
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Katharina Mörwald
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Katharina Maruszczak
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Petra Gombos
- Department of Paediatric and Adolescent Surgery, Paracelsus Medical University, 5020 Salzburg, Austria;
| | - Julian Gomahr
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
| | | | - Daniel Weghuber
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
- Department of Paediatrics, Paracelsus Medical University, 5020 Salzburg, Austria;
- Correspondence: ; Tel.: +43-(0)-5-7255-57518
| | - Thomas Pixner
- Department of Paediatric and Adolescent Medicine, Salzkammergutklinikum Voecklabruck, 4840 Voecklabruck, Austria; (D.F.); (A.L.); (T.P.)
- Obesity Research Unit, Paracelsus Medical University, 5020 Salzburg, Austria; (A.M.S.); (K.M.); (K.M.); (J.G.)
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29
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Hamaguchi M, Hashimoto Y, Tanaka T, Hasegawa G, Ishii M, Okada H, Mitsuhashi K, Kitagawa N, Ushigome E, Yamazaki M, Fukui M. Multicenter, Open-Label, 2-Arm, Pilot Trial for Safe Reduction of Basal Insulin Dose Combined with SGLT2 Inhibitor in Type 1 Diabetes Mellitus: Study Protocol for a RISING-STAR Trial. Clin Med Insights Endocrinol Diabetes 2021; 14:11795514211040539. [PMID: 34602832 PMCID: PMC8482353 DOI: 10.1177/11795514211040539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/23/2021] [Indexed: 01/27/2023] Open
Abstract
Background: The safe method of instructing insulin dose reduction in combination with
SGLT2 inhibitors, dapagliflozin for patients with type 1 diabetes mellitus
has not been clarified. In this study, we conducted a stratified, 2-arm,
parallel comparative study with the primary endpoint of decreasing the
frequency of hypoglycemia by instructing basal insulin dose reduction. Methods: The study has a multicenter, open-label, 2-arm design; 60 type 1 diabetes
mellitus patients are being recruited from 7 hospitals. Study subjects have
been stratified into 2 groups based on the ratio of basal insulin daily dose
(Basal) to total daily insulin dose (TDD). The subjects whose Basal/TDD
ratio is <0.4 are instructed not to reduce Basal but to reduce bolus
insulin dose by 10% (group A), and subjects with a Basal/TDD ratio >0.4
will be instructed to reduce Basal by 10% (group B). The primary outcome is
the daily frequency of hypoglycemia during the intervention period (SGLT2
inhibitor administration), as determined by self-monitoring of blood
glucose. We aimed to confirm a greater reduction in frequency of
hypoglycemia in group B (reduced Basal), than in group A (non-reduction of
Basal and reduced insulin effect levels by 10%). Baseline hypoglycemia was
set at 7 ± 6 times/month. The minimum sample size required to achieve a
significance of .05 for a 1-sided t-test with a statistical
power at 80% is determined. When the sample size is 26 patients in 1 group,
the percentage increase in hypoglycemia exceeds 60%, and the sample size is
considered sufficient. Discussion: In this pilot study, we assumed that, given a sufficient Basal, hypoglycemia
would be more frequent in patients with type 1 diabetes when combined with
SGLT2 inhibitors, provided the Basal was not reduced.
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Affiliation(s)
- Masahide Hamaguchi
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Yoshitaka Hashimoto
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toru Tanaka
- Department of Diabetes and Endocrinology, Japanese Red Cross Kyoto Daiichi Hospital, Kyoto, Japan
| | - Goji Hasegawa
- Division of Metabolism, Nephrology and Rheumatology, Japanese Red Cross Kyoto Daini Hospital, Kyoto, Japan
| | - Michiyo Ishii
- Department of Internal Medicine, Otsu City Hospital, Otsu, Japan
| | - Hiroshi Okada
- Department of Diabetes and Endocrinology, Matsushita Memorial Hospital, Moriguchi, Japan
| | - Kazuteru Mitsuhashi
- Department of Diabetes and Internal Medicine, Fukuchiyama City Hospital, Fukuchiyama, Japan
| | - Noriyuki Kitagawa
- Department of Diabetology, Kameoka Municipal Hospital, Kameoka, Japan
| | - Emi Ushigome
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masahiro Yamazaki
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Michiaki Fukui
- Department of Endocrinology and Metabolism, Kyoto Prefectural University of Medicine, Kyoto, Japan
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30
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Yen PM, Young AS. Review of Modern Insulin Pumps and the Perioperative Management of the Type 1 Diabetic Patient for Ambulatory Dental Surgery. Anesth Prog 2021; 68:180-187. [PMID: 34606570 DOI: 10.2344/anpr-68-03-16] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 08/08/2021] [Indexed: 01/25/2023] Open
Abstract
The use of continuous insulin pump systems for effective management of glycemic control in the patient with type 1 diabetes mellitus (T1DM) is steadily increasing. Although the types of devices and their respective manufacturers vary, insulin pumps all utilize similar underlying concepts based on the delivery of exogenous insulin to patients with T1DM in manners that more closely approximate the normal biologic function and performance of the pancreas. As insulin pumps becomes more commonplace and their use more widespread, the sedation or anesthesia provider must ensure familiarity with the basic knowledge of pump function and the various perioperative management considerations. This review provides a concise overview of the pathophysiology of T1DM, introduces foundational aspects of common insulin pump systems, and discusses several general recommendations regarding the perioperative management of insulin pumps during dental surgeries.
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Affiliation(s)
- Philip M Yen
- Assistant Clinical Professor, Department of Orofacial Sciences, UCSF School of Dentistry, San Francisco, California
| | - Andrew S Young
- Adjunct Assistant Professor of Clinical Dentistry, Division of Endodontics, Orthodontics and General Practice Residency, Herman Ostrow School of Dentistry of USC, Los Angeles, California
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31
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Fureman AL, Lilja M, Lind T, Särnblad S, Bladh M, Samuelsson U. Comparing continuous subcutaneous insulin infusion and multiple daily injections in children with Type 1 diabetes in Sweden from 2011 to 2016-A longitudinal study from the Swedish National Quality Register (SWEDIABKIDS). Pediatr Diabetes 2021; 22:766-775. [PMID: 33929074 DOI: 10.1111/pedi.13217] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 03/18/2021] [Accepted: 04/06/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE This study aimed to compare metabolic control measured as hemoglobin A1c (HbA1c), the risk of severe hypoglycemia, and body composition measured as body mass index standard deviation scores (BMI-SDS) in a nationwide sample of children and adolescents with Type 1 diabetes with continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDI), respectively. RESEARCH DESIGN AND METHODS Longitudinal data from 2011 to 2016 were extracted from the Swedish National Quality Register (SWEDIABKIDS) with both cross-sectional (6 years) and longitudinal (4 years) comparisons. Main end points were changes in HbA1c, BMI-SDS, and incidence of severe hypoglycemia. RESULTS Data were available from 35,624 patient-years (54% boys). In general, HbA1c decreased approximately 0.5% (2-5 mmol/mol) from 2011 to 2016 (ptrend < 0.001) and the use of CSII increased in both sexes and all age groups. Mean HbA1c was 0.1% (0.7-1.5 mmol/mol) lower in the CSII treated group. Teenagers, especially girls, using CSII tended to have higher BMI-SDS. There was no difference in the number of hypoglycemias between CSII and MDI over the years 2011-2016. CONCLUSIONS There was a small decrease in HbA1c with CSII treatment but of little clinical relevance. Overall, mean HbA1c decreased in both sexes and all age groups without increasing the episodes of severe hypoglycemia, indicating that other factors than insulin method contributed to a better metabolic control.
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Affiliation(s)
- Anna-Lena Fureman
- Department of Clinical Sciences, Pediatrics, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Mikael Lilja
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development, Östersund Hospital, Umeå University, Umeå, Sweden
| | - Torbjörn Lind
- Department of Clinical Sciences, Pediatrics, Umeå University, Umeå, Sweden
| | - Stefan Särnblad
- Department of Pediatrics, Örebro University, Hospital and School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Marie Bladh
- Department of Obstetrics and Gynecology and Biomedical and Clinical Sciences, Linköping University Hospital, Linköping University, Linköping, Sweden
| | - Ulf Samuelsson
- Division of Pediatrics, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
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Impact of Fat Intake on Blood Glucose Control and Cardiovascular Risk Factors in Children and Adolescents with Type 1 Diabetes. Nutrients 2021; 13:nu13082625. [PMID: 34444784 PMCID: PMC8401117 DOI: 10.3390/nu13082625] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/08/2021] [Accepted: 07/12/2021] [Indexed: 12/18/2022] Open
Abstract
Nutrition therapy is a cornerstone of type 1 diabetes (T1D) management. Glycemic control is affected by diet composition, which can contribute to the development of diabetes complications. However, the specific role of macronutrients is still debated, particularly fat intake. This review aims at assessing the relationship between fat intake and glycemic control, cardiovascular risk factors, inflammation, and microbiota, in children and adolescents with T1D. High fat meals are followed by delayed and prolonged hyperglycemia and higher glycated hemoglobin A1c levels have been frequently reported in individuals with T1D consuming high amounts of fat. High fat intake has also been associated with increased cardiovascular risk, which is higher in people with diabetes than in healthy subjects. Finally, high fat meals lead to postprandial pro-inflammatory responses through different mechanisms, including gut microbiota modifications. Different fatty acids were proposed to have a specific role in metabolic regulation, however, further investigation is still necessary. In conclusion, available evidence suggests that a high fat intake should be avoided by children and adolescents with T1D, who should be encouraged to adhere to a healthy and balanced diet, as suggested by ISPAD and ADA recommendations. This nutritional choice might be beneficial for reducing cardiovascular risk and inflammation.
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Joubert M, Meyer L, Doriot A, Dreves B, Jeandidier N, Reznik Y. Prospective Independent Evaluation of the Carbohydrate Counting Accuracy of Two Smartphone Applications. Diabetes Ther 2021; 12:1809-1820. [PMID: 34028700 PMCID: PMC8266981 DOI: 10.1007/s13300-021-01082-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2021] [Accepted: 05/12/2021] [Indexed: 10/25/2022] Open
Abstract
INTRODUCTION Smartphone applications (apps) have been designed that help patients to accurately count their carbohydrate intake in order to optimize prandial insulin dose matching. Our aim was to evaluate the accuracy of two carbohydrate (carb) counting apps. METHODS Medical students, in the role of mock patients, evaluated meals using two smartphone apps: Foodvisor® (which uses automatic food photo recognition technology) and Glucicheck® (which requires the manual entry of carbohydrates with the help of a photo gallery). The macronutrient quantifications obtained with these two apps were compared to a reference quantification. RESULTS The carbohydrate content of the entire meal was underestimated with Foodvisor® (Foodvisor® quantification minus gold standard quantification = - 7.2 ± 17.3 g; p < 0.05) but reasonably accurately estimated with Glucicheck® (Glucicheck® quantification minus gold standard quantification = 1.4 ± 13.4 g; ns). The percentage of meals with an absolute error in carbohydrate quantification above 20 g was greater for Foodvisor® compared to Glucicheck® (30% vs 14%; p < 0.01). CONCLUSION The carb counting accuracy was slightly better when using Glucicheck® compared to Foodvisor®. However, both apps provided a lower mean absolute carb counting error than that usually made by T1D patients in everyday life, suggesting that such apps may be a useful adjunct for estimating carbohydrate content.
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Affiliation(s)
| | - Laurent Meyer
- Diabetes Care Unit, Strasbourg University Hospital, Strasbourg, France
| | - Aline Doriot
- Diabetes Care Unit, Caen University Hospital, Caen, France
| | - Bleuenn Dreves
- Diabetes Care Unit, Caen University Hospital, Caen, France
| | | | - Yves Reznik
- Diabetes Care Unit, Caen University Hospital, Caen, France
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Buck S, Krauss C, Waldenmaier D, Liebing C, Jendrike N, Högel J, Pfeiffer BM, Haug C, Freckmann G. Evaluation of Meal Carbohydrate Counting Errors in Patients with Type 1 Diabetes. Exp Clin Endocrinol Diabetes 2021; 130:475-483. [PMID: 34034353 DOI: 10.1055/a-1493-2324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Correct estimation of meal carbohydrate content is a prerequisite for successful intensified insulin therapy in patients with diabetes. In this survey, the counting error in adult patients with type 1 diabetes was investigated. METHODS Seventy-four patients with type 1 diabetes estimated the carbohydrate content of 24 standardized test meals. The test meals were categorized into 1 of 3 groups with different carbohydrate content: low, medium, and high. Estimation results were compared with the meals' actual carbohydrate content as determined by calculation based on weighing. A subgroup of the participants estimated the test meals for a second (n=35) and a third time (n=22) with a mean period of 11 months between the estimations. RESULTS During the first estimation, the carbohydrate content was underestimated by -28% (-50, 0) of the actual carbohydrate content. Particularly meals with high mean carbohydrate content were underestimated by -34% (-56, -13). Median counting error improved significantly when estimations were performed for a second time (p<0.001). CONCLUSIONS Participants generally underestimated the carbohydrate content of the test meals, especially in meals with higher carbohydrate content. Repetition of estimation resulted in significant improvements in estimation accuracy and is important for the maintenance of correct carbohydrate estimations. The ability to estimate the carbohydrate content of a meal should be checked and trained regularly in patients with diabetes.
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Affiliation(s)
- Sina Buck
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Collin Krauss
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Delia Waldenmaier
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Christina Liebing
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Nina Jendrike
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Josef Högel
- Universitätsklinikum Ulm, Institut für Humangenetik, Ulm, Germany
| | | | - Cornelia Haug
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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Akkermansia, a Possible Microbial Marker for Poor Glycemic Control in Qataris Children Consuming Arabic Diet-A Pilot Study on Pediatric T1DM in Qatar. Nutrients 2021; 13:nu13030836. [PMID: 33806427 PMCID: PMC7999932 DOI: 10.3390/nu13030836] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 02/23/2021] [Accepted: 02/24/2021] [Indexed: 12/12/2022] Open
Abstract
In Qatar, Type 1 Diabetes mellitus (T1DM) is one of the most prevalent disorders. This study aimed to explore the gut microbiome's relation to the continuous subcutaneous insulin infusion (CSII) therapy, dietary habits, and the HbA1c level in the pediatric T1DM subjects in Qatar. We recruited 28 T1DM subjects with an average age of 10.5 ± 3.53 years. The stool sample was used to measure microbial composition by 16s rDNA sequencing method. The results have revealed that the subjects who had undergone CSII therapy had increased microbial diversity and genus Akkermansia was significantly enriched in the subjects without CSII therapy. Moreover, genus Akkermansia was higher in the subjects with poor glycemic control (HbA1c > 7.5%). When we classified the subjects based on dietary patterns and nationality, Akkermansia was significantly enriched in Qataris subjects without the CSII therapy consuming Arabic diet than expatriates living in Qatar and eating a Western/mixed diet. Thus, this pilot study showed that abundance of Akkermansia is dependent on the Arabic diet only in poorly controlled Qataris T1DM patients, opening new routes to personalized treatment for T1DM in Qataris pediatric subjects. Further comprehensive studies on the relation between the Arabic diet, ethnicity, and Akkermansia are warranted to confirm this preliminary finding.
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical activity interventions and nutrition-based interventions for children and adolescents with type 1 diabetes mellitus. Hippokratia 2021. [DOI: 10.1002/14651858.cd013858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Evelyn C Law
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
- Translational Neuroscience Programme; Agency for Science, Technology and Research Singapore Institute for Clinical Sciences; Singapore Singapore
| | - John CM Wong
- Department of Psychological Medicine; Yong Loo Lin School of Medicine, National University of Singapore; Singapore Singapore
| | - Kah Yin Loke
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Wilson Wai San Tam
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
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The impact of high-fat and high-protein meal of adolescents with type 1 diabetes mellitus receiving intensive insulin therapy on postprandial blood glucose level: a randomized, crossover, breakfast study. Int J Diabetes Dev Ctries 2021. [DOI: 10.1007/s13410-020-00836-1] [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: 10/22/2022] Open
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Pais V, Patel BP, Ghayoori S, Hamilton JK. "Counting Carbs to Be in Charge": A Comparison of an Internet-Based Education Module With In-Class Education in Adolescents With Type 1 Diabetes. Clin Diabetes 2021; 39:80-87. [PMID: 33551557 PMCID: PMC7839608 DOI: 10.2337/cd20-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Carbohydrate counting is an essential component of type 1 diabetes education but can be difficult for adolescents to learn. Because adolescents are avid users of technology, an Internet-based education module was compared with an in-class education session in terms of carbohydrate counting accuracy in adolescents with type 1 diabetes. Adolescent participants displayed increased carbohydrate counting accuracy after attending an in-class education session compared with an Internet-based education module. These results suggest that online education is best reserved as an adjunctive therapy to in-class teaching in this population.
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Affiliation(s)
- Vanita Pais
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Barkha P. Patel
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Sholeh Ghayoori
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jill K. Hamilton
- Division of Endocrinology, Department of Paediatrics, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Nutritional Sciences, University of Toronto, Toronto, Ontario, Canada
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Pedrinho LR, Shibukawa BMC, Rissi GP, Uema RTB, Merino MDFGL, Higarashi IH. Brinquedo terapêutico para crianças com Diabetes Mellitus tipo I: intervenções no domicílio. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Descrever o uso do brinquedo terapêutico no cuidado domiciliar de crianças com Diabetes Mellitus tipo 1. Método Estudo qualitativo do tipo Estudo de Caso, realizado com crianças com diagnóstico de Diabetes Mellitus tipo 1, residentes no interior do Paraná. Os dados foram coletados em 2018, por meio de entrevista com as mães, sessões de brinquedo terapêutico com as crianças e anotações no diário de campo. A análise dos dados foi realizada seguindo os preceitos da análise de conteúdo. Resultados As crianças simularam situações cotidianas com o brinquedo terapêutico com naturalidade, evidenciando que cuidados com a glicemia e aplicação da insulina fazem parte da rotina. Contudo, demonstram sinais de insatisfação com a própria saúde, traçando comparações com crianças que não apresentam a doença e demonstrando suas angústias quando submetidas a procedimentos dolorosos. Conclusão A utilização do brinquedo terapêutico permitiu a abertura de um canal efetivo de comunicação entre criança e profissional, possibilitando ao pesquisador compreender a percepção das crianças sobre sua condição de saúde e desenvolver orientações e cuidados direcionados. Implicações para a prática Ao utilizar o brinquedo terapêutico, recurso de intervenção na assistência de enfermagem, como tecnologia de cuidado, amplia-se as possibilidades de atuação da enfermagem pediátrica, auxiliando crianças em condições crônicas.
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Alfonsi JE, Choi EEY, Arshad T, Sammott SAS, Pais V, Nguyen C, Maguire BR, Stinson JN, Palmert MR. Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial. JMIR Mhealth Uhealth 2020; 8:e22074. [PMID: 33112249 PMCID: PMC7657721 DOI: 10.2196/22074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 09/06/2020] [Accepted: 09/14/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. OBJECTIVE Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. METHODS Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. RESULTS Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. CONCLUSIONS Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. TRIAL REGISTRATION ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142.
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Affiliation(s)
- Jeffrey E Alfonsi
- Department of Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
- Inner Analytics Inc, Toronto, ON, Canada
| | | | - Taha Arshad
- Division of Endocrinology, Hospital for Sick Children, Toronto, ON, Canada
| | | | - Vanita Pais
- Division of Endocrinology, Hospital for Sick Children, Toronto, ON, Canada
| | - Cynthia Nguyen
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bryan R Maguire
- Biostatistics Design and Analysis Unit, SickKids Research Institute, Toronto, ON, Canada
| | - Jennifer N Stinson
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Mark R Palmert
- Division of Endocrinology, Hospital for Sick Children, Toronto, ON, Canada
- Departments of Pediatrics and Physiology, University of Toronto, Toronto, ON, Canada
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Kostopoulou E, Livada I, Partsalaki I, Lamari F, Skiadopoulos S, Rojas Gil AP, Spiliotis BE. The role of carbohydrate counting in glycemic control and oxidative stress in patients with type 1 diabetes mellitus (T1DM). Hormones (Athens) 2020; 19:433-438. [PMID: 32221838 DOI: 10.1007/s42000-020-00189-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 03/11/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Oxidative stress is closely related to type 1 diabetes mellitus (T1DM), playing a key role in the pathogenesis of the disease and progression of complications. It is characterized by loss of equilibrium between oxidative factors and antioxidant protective mechanisms. Several markers have been used to assess both components of oxidative status; two of which are malondialdehyde (MDA) and ferric reducing antioxidant power (FRAP). METHODS We investigated glycated hemoglobin (HbA1c), lipid profile, MDA, and FRAP in 35 patients with T1DM, aged 2-23 years, at the end of two 4-month observational periods: period A: standard insulin dosing per meal, and period B: proper prandial insulin dosing based on the amount of carbohydrates contained in each meal. RESULTS At the end of period B, (i) glucose control (HbA1c) was improved; (ii) oxidative stress, estimated by MDA, showed a tendency to decrease; and (iii) antioxidant capacity, estimated by FRAP, was significantly increased compared with that of period A. No significant differences were observed in the lipid profile of the patients between the two periods. CONCLUSION Proper insulin dosing based on carbohydrate counting (CC) may have an impact on the antioxidant defensive mechanisms of patients with T1DM through the attainment of a better glycemic profile. There are also indications that it may reduce MDA, an important biomarker of oxidative stress and a significant mediator of complications in T1DM. Therefore, prompt dietetic intervention using CC as early as possible after the diagnosis of T1DM is important for achieving optimal glycemic control and improved oxidative status.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504, Patras, Greece.
| | - Ioulia Livada
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Ioanna Partsalaki
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Fotini Lamari
- Laboratory of Pharmacognosy and Chemistry of Natural Products, Department of Pharmacy, University of Patras, 26504, Patras, Greece
| | - Spyros Skiadopoulos
- Department of Medical Physics, School of Medicine, University of Patras, 26504, Patras, Greece
| | - Andrea Paola Rojas Gil
- Faculty of Health Sciences, Department of Nursing, University of Peloponnese, Tripoli, Greece
| | - Bessie E Spiliotis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, School of Medicine, University of Patras, 26504, Patras, Greece
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Bayram S, Kızıltan G, Akın O. Effect of adherence to carbohydrate counting on metabolic control in children and adolescents with type 1 diabetes mellitus. Ann Pediatr Endocrinol Metab 2020; 25:156-162. [PMID: 32871653 PMCID: PMC7538303 DOI: 10.6065/apem.1938192.096] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/18/2020] [Accepted: 03/02/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Carbohydrate counting provides better glycemic control and flexibility than other food planning methods. Consistent adherence to such a complex method is difficult, especially for youth. However, studies that determine adherence to this method and whether it alters metabolic control are limited. The aim of the current study was to determine adherence to this method and investigate its effect on metabolic control, anthropometric measurements, insulin dose, and energy intake. METHODS In this prospective cross-sectional study, 53 children and adolescents with type 1 diabetes mellitus aged 2 to18 years and receiving intensive insulin therapy were trained and followed for 6 months. Demographics, anthropometrics, insulin requirements, hemoglobin A1c (HbA1c), fasting lipids, and food records at baseline and study conclusion were evaluated. At the end of the study patients were divided into adherer and nonadherer groups according to carbohydrate estimate deviations from standardized daily sample menus and calculations for accurate insulin doses. More than 10-g variation in daily consumed carbohydrate amount or failure to decide bolus insulin dose was defined as a nonadherer. RESULTS The mean HbA1c, low-density lipoprotein cholesterol, and body mass index standard deviation score changed after the carbohydrate counting training while the mean HbA1c between groups was significant (P<0.05). Total daily insulin doses increased, and the mean high-density lipoprotein cholesterol levels decreased in both groups. There were significant correlations between HbA1c and carbohydrate deviation scores as well as HbA1c and caregiver's education level. CONCLUSION Since adherence to carbohydrate counting may affect metabolic control, health professionals should evaluate and monitor carbohydrate counting skills of caregivers and patients in order to improve efficiency.
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Affiliation(s)
- Sinem Bayram
- Department of Nutrition and Dietetics, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - Gül Kızıltan
- Department of Nutrition and Dietetics, Faculty of Health Science, Baskent University, Ankara, Turkey
| | - Onur Akın
- Department of Nutrition and Dietetics, Gulhane Education and Research Hospital, Faculty of Health Science, Baskent University, Ankara, Turkey
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Aanstoot HJ, Rodriguez H, Weinzimer S, Vint N, Koeneman L. Precision Dosing of Rapid-Acting Insulin Matters. Diabetes Technol Ther 2020; 22:346-351. [PMID: 32125891 DOI: 10.1089/dia.2019.0374] [Citation(s) in RCA: 3] [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] [Indexed: 12/16/2022]
Abstract
Despite several molecular and technological advances in insulin therapy and insulin delivery, global evidence highlights inadequate glycemic control in populations with type 1 diabetes (T1D) and type 2 diabetes (T2D). In this review, we discuss the importance of more precise dosing of insulin as one of the approaches to improve glycemic control while reducing hypoglycemic events. This report is based on the expert opinion of authors and literature search of articles relevant to the past and present insulin delivery devices in diabetes management, especially half-unit insulin pens. We describe the various factors that facilitate better glycemic control, focusing on the impact of appropriate insulin delivery device selection on diabetes management. Precision dosing of insulin is a lesser-studied factor that contributes toward better glycemic control. Insulin pens have consistently outperformed syringes as delivery devices due to their greater accuracy and precision of dosing, ease-of-use, and patient preference. These advantages make them better suited to administer insulin in hypoglycemia-prone insulin-sensitive people with T1D, particularly younger children and geriatric patients. Half-unit insulin pens further extend this benefit by delivering half-unit doses of insulin accurately. They may contribute to better management of diabetes by allowing flexible dosing for mealtimes and physical activities even in erratic diet situations or illnesses by offering corrective doses in small increments. They are ideal delivery devices for insulin-sensitive people with T1D who require greater accuracy and precision in insulin delivery to achieve more stringent glycemic control.
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Affiliation(s)
- Henk-Jan Aanstoot
- Diabeter, Center for Pediatric and Adolescent Diabetes Care and Research, Rotterdam, the Netherlands
| | - Henry Rodriguez
- USF Diabetes and Endocrinology Center, University of South Florida, Tampa, Florida
| | - Stuart Weinzimer
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Nan Vint
- Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana
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Almogbel E. Impact of insulin pump therapy on glycemic control among adult Saudi type-1 diabetic patients. An interview-based case-control study. J Family Med Prim Care 2020; 9:1013-1019. [PMID: 32318460 PMCID: PMC7114031 DOI: 10.4103/jfmpc.jfmpc_869_19] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 12/13/2019] [Accepted: 12/27/2019] [Indexed: 12/14/2022] Open
Abstract
Context: Diabetes is associated with several potential preventable complications like the efficacy of insulin pump over multiple daily insulin injections (MDI) in glycemic control. Aims: To assess the outcomes of insulin pump as compared to insulin injection therapy. Setting and Design: Case-control study conducted among adult type-1 diabetic patients using insulin pump therapy and alternative insulin injection therapy from the University Diabetes Center (UDC), King Saud University, Riyadh, Saudi Arabia during 1st June–30th October, 2017. Materials and Methods: Interview-based questionnaires were used on of 200 subjects using insulin therapy and control (conventional and MDI). Results of each were compared. Statistical Analysis Used: t-test was used for continuous variables and Chi-square test was used for categorical variables. P value less than 0.05 was considered statistically significant. Results: Patients on pump therapy showed a non-significant higher mean of hypoglycemic episodes per week and a lower mean of diabetic ketoacidosis (DKA) episodes per year as compared to the injection therapy patients 1.97 vs. 1.77 and 0.35 vs. 0.37, respectively. However, statistically significant differences were found between the pump and MDI, the pump and conventional, and the MDI and conventional when HbA1c levels were tested. Conclusion: Among adult patients with type-1 diabetes, insulin pump as compared to insulin injection was associated with better glycemic control. However, for acute complications, non-significant higher mean of hypoglycemic episodes per week and a lower mean of DKA episodes per year were reported in pump therapy as compared to the injection therapy patients.
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Affiliation(s)
- Ebtehal Almogbel
- Department of Family and Community Medicine, College of Medicine, Qassim University, Buraidah, Kingdom of Saudi Arabia
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FRITZ CK, LEÃO AAPD, DIAS MRMG, DEMARTINI ADAC, NESI-FRANÇA S. Influence of food consumption in the glycemic profile of children and adolescents with type 1 diabetes Mellitus. REV NUTR 2020. [DOI: 10.1590/1678-9865202033e190220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
ABSTRACT Objective To review the dietary intake of children and adolescents with type 1 diabetes Mellitus and its association with the glycemic profile. Methods Longitudinal observational study. Dietary intake was measured using a three-day dietary record and the glycemic profile with a continuous glucose monitoring (range between 70 and 180mg/dL) and serum glycated hemoglobin levels (ideal <7.5%). Anthropometric data, insulin therapy, and carbohydrate counting were collected. Results The sample included 34 individuals with type 1 diabetes Mellitus aged 13.6±2.1 years. The majority of the population was eutrophic (76.4%). The entire sample used the basal-bolus insulin regimen, with mean insulin dose of 1.0±0.2U/kg/day; for 44.1% of the sample the carbohydrate counting method was used. Macronutrients intake was adequate in only 8.8% of the individuals, the highest frequency of inadequacy was related to carbohydrates (p=0.07). Inadequate glycemic control with hyperglycemia episodes and high mean glycated hemoglobin (9.7%) was observed in all individuals (61.3±18.5%). Carbohydrate counting was responsible for maintaining the percentage of time that the patient had interstitial blood glucose values within the range >40% (p<0.001) and maintaining the percentage of time in hyperglycemia <50% (p<0.001). Conclusion The majority of individuals were eutrophic, but presented inadequate dietary intake and glycemic control. The method of counting carbohydrates positively influenced the glycemic profile.
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Hegab AM. Prospective evaluation of insulin-to-carbohydrate ratio in children and adolescents with type 1 diabetes using multiple daily injection therapy. Pediatr Diabetes 2019; 20:1087-1093. [PMID: 31433557 DOI: 10.1111/pedi.12911] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 06/28/2019] [Accepted: 08/17/2019] [Indexed: 12/01/2022] Open
Abstract
AIM Assessment of insulin-to-carbohydrate ratio (ICR) in children and adolescents with type 1 diabetes mellitus (T1DM) using multiple daily injection (MDI) therapy. METHODS This prospective observational study was conducted over a 2-year period at Sohag University Hospital, Egypt. Children and adolescents aged 4 to 17 years, diagnosed with T1DM for at least 1 year, with fasting serum C-peptide levels <0.24 ng/dL and whose parents accepted to shift their management to flexible MDI using carbohydrate counting, were included. Participants were initially hospitalized for estimation of ICR and insulin doses, then followed-up monthly for further adjustments. Insulin doses, ICR, and glycemic control parameters were assessed after 3 months. RESULTS The study included 201 participants, 110 (54.7%) of them were males. The median age was 9.5 years (interquartile range: 7-12.5 years). Bolus insulin requirements estimated by the 500 rule were significantly lower than the actual doses used by the study participants for all meals (P < .001). Bolus insulin requirement for morning meal was significantly higher compared to other meals (P < .001). Linear regression analyses between ICR for different meals and the reciprocal of total daily dose (TDD) in 96 participants with optimum glycemic control revealed that ICR could be calculated as 301 to 309/TDD for morning meal (R2 = 0.97, P < .001), 317 to 331/TDD for afternoon meal (R2 = 0.96, P < .001), and 362 to 376/TDD for evening meal (R2 = 0.98, P < .001). CONCLUSIONS Bolus insulin requirements showed diurnal variation. Using 301 to 309/TDD, 317 to 331/TDD, and 362 to 376/TDD formulas would be more appropriate than the 500 rule for initial estimation of ICR for morning, afternoon, and evening meals, respectively.
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Affiliation(s)
- Ahmed M Hegab
- Pediatrics Department, Faculty of Medicine, Sohag University, Egypt
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Fortins RF, Lacerda EMDA, Silverio RNC, do Carmo CN, Ferreira AA, Felizardo C, do Nascimento BF, Luescher JL, Padilha PDC. Predictor factors of glycemic control in children and adolescents with type 1 diabetes mellitus treated at a referral service in Rio de Janeiro, Brazil. Diabetes Res Clin Pract 2019; 154:138-145. [PMID: 31150723 DOI: 10.1016/j.diabres.2019.05.027] [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] [Received: 01/05/2019] [Revised: 05/12/2019] [Accepted: 05/22/2019] [Indexed: 01/01/2023]
Abstract
AIM To evaluate the predictive factors of glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS Cross-sectional study at a referral service in Rio de Janeiro, Brazil. Sociodemographic, anthropometric, clinical, and dietary factors were evaluated. Food consumption was evaluated by 24 h dietary recall and the NOVA system was adopted for classifying the foods according to the extent and purpose of industrial processing. The predictive factors were evaluated by multivariate linear regression, adopting p < 0.05. RESULTS One hundred and twenty children and adolescents participated, with a mean age of 11.74 years (±2.88) and HbA1c of 8.13% (±1.26). The mean diabetes duration was 6.68 years (±3.33) and the insulin used was 1.05 units per kilogram of ideal weight (IU/kg of ideal weight; ±0.46) About 80% (n = 96) used carbohydrate counting and it was verified that 24.27% (±17.89) of the participants' total calories came from ultraprocessed foods. For each year of diagnosis with T1DM and for each IU/kg of weight used, HbA1c increased by 0.087% (β = 0.087, p = 0.007) and 0.651%, respectively (β = 0.651; p = <0.001). Use of carbohydrate counting was associated with a 1.058% reduction in HbA1c (β = -1.058; p = 0.001). CONCLUSION Disease duration and insulin dose were directly reflected in HbA1c concentrations, while carbohydrate counting showed an inverse association.
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Affiliation(s)
- Roberta Ferreira Fortins
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Elisa Maria de Aquino Lacerda
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil.
| | - Raquel Nascimento Chanca Silverio
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Cleber Nascimento do Carmo
- Fundação Oswaldo Cruz, Departamento de Epidemiologia e Métodos Quantitativos em Saúde, Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Brazil.
| | - Aline Alves Ferreira
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil.
| | - Carolina Felizardo
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Bárbara Folino do Nascimento
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Jorge Luiz Luescher
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Puericultura e Pediatria Martagão Gesteira, Rua Bruno Lobo, 50, Cidade Universitária, Rio de Janeiro, RJ, Brazil
| | - Patrícia de Carvalho Padilha
- Universidade Federal do Rio de Janeiro, Centro de Ciências da Saúde, Instituto de Nutrição Josué de Castro, Av. Carlos Chagas Filho, 373 - bloco J, Cidade Universitária, Rio de Janeiro, RJ, Brazil.
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Tiberg I, Hansson H, Hallström I, Carlsson A. Implementation of discharge recommendations in type 1 diabetes depends on specialist nurse follow-up. Acta Paediatr 2019; 108:1515-1520. [PMID: 30565294 DOI: 10.1111/apa.14704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/13/2018] [Accepted: 12/14/2018] [Indexed: 11/28/2022]
Abstract
AIM This paper presents an implementation study following previous research including a randomised controlled trial (RCT) of hospital-based home care (HBHC), referring to specialist care in a home-based setting. The aim was to evaluate whether the effects sustained when rolled out into wider practice. METHODS In 2013-2014, 42 children newly diagnosed type 1 diabetes were included in the study at a university hospital in Sweden and followed for two years. Measurements of child safety, effects of services, resource use and service quality were included. Descriptive statistics were used to present the results and then discussed in relation to the same intervention of HBHC previously evaluated in an RCT. RESULTS Shorter in-hospital stay was partially implemented but increased support after discharge by the diabetes nurse was not. The results indicated that the implemented HBHC was equally effective in terms of child outcomes two years from diagnosis but less effective in terms of parents' outcome. The results furthermore indicated that the quality of services decreased. CONCLUSION The suggested overall conclusion was that the implemented HBHC services were safe but had become less effective, at least in relation to the HBHC provided under controlled circumstances.
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Affiliation(s)
- I Tiberg
- Department of Health Sciences; Lund University; Lund Sweden
| | - H Hansson
- Pediatrics and Adolescent Medicine; The Juliane Marie Centre; The University Hospital; Copenhagen Rigshospitalet; Copenhagen Denmark
| | - I Hallström
- Department of Health Sciences; Lund University; Lund Sweden
| | - A Carlsson
- Department of Paediatrics; Skåne University Hospital in Lund; Lund Sweden
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El-Sappagh S, Ali F, Hendawi A, Jang JH, Kwak KS. A mobile health monitoring-and-treatment system based on integration of the SSN sensor ontology and the HL7 FHIR standard. BMC Med Inform Decis Mak 2019; 19:97. [PMID: 31077222 PMCID: PMC6511155 DOI: 10.1186/s12911-019-0806-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 03/31/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Mobile health (MH) technologies including clinical decision support systems (CDSS) provide an efficient method for patient monitoring and treatment. A mobile CDSS is based on real-time sensor data and historical electronic health record (EHR) data. Raw sensor data have no semantics of their own; therefore, a computer system cannot interpret these data automatically. In addition, the interoperability of sensor data and EHR medical data is a challenge. EHR data collected from distributed systems have different structures, semantics, and coding mechanisms. As a result, building a transparent CDSS that can work as a portable plug-and-play component in any existing EHR ecosystem requires a careful design process. Ontology and medical standards support the construction of semantically intelligent CDSSs. METHODS This paper proposes a comprehensive MH framework with an integrated CDSS capability. This cloud-based system monitors and manages type 1 diabetes mellitus. The efficiency of any CDSS depends mainly on the quality of its knowledge and its semantic interoperability with different data sources. To this end, this paper concentrates on constructing a semantic CDSS based on proposed FASTO ontology. RESULTS This realistic ontology is able to collect, formalize, integrate, analyze, and manipulate all types of patient data. It provides patients with complete, personalized, and medically intuitive care plans, including insulin regimens, diets, exercises, and education sub-plans. These plans are based on the complete patient profile. In addition, the proposed CDSS provides real-time patient monitoring based on vital signs collected from patients' wireless body area networks. These monitoring include real-time insulin adjustments, mealtime carbohydrate calculations, and exercise recommendations. FASTO integrates the well-known standards of HL7 fast healthcare interoperability resources (FHIR), semantic sensor network (SSN) ontology, basic formal ontology (BFO) 2.0, and clinical practice guidelines. The current version of FASTO includes 9577 classes, 658 object properties, 164 data properties, 460 individuals, and 140 SWRL rules. FASTO is publicly available through the National Center for Biomedical Ontology BioPortal at https://bioportal.bioontology.org/ontologies/FASTO . CONCLUSIONS The resulting CDSS system can help physicians to monitor more patients efficiently and accurately. In addition, patients in rural areas can depend on the system to manage their diabetes and emergencies.
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Affiliation(s)
- Shaker El-Sappagh
- Department of Information and Communication Engineering, Inha University, Incheon, South Korea
- Information Systems Department, Faculty of Computer and Informatics, Benha University, Banha, Egypt
| | - Farman Ali
- Department of Information and Communication Engineering, Inha University, Incheon, South Korea
| | - Abdeltawab Hendawi
- Computer Science, University of Virginia, Charlottesville, USA
- Faculty of Computers and Information, Cairo University, Giza, Egypt
| | - Jun-Hyeog Jang
- Department of Biochemistry, School of Medicine, Inha University, Incheon, 400-712, South Korea
| | - Kyung-Sup Kwak
- Department of Information and Communication Engineering, Inha University, Incheon, South Korea.
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Efficacy of traditional Chinese medication Tangminling pill in Chinese patients with type 2 diabetes. Biosci Rep 2019; 39:BSR20181729. [PMID: 30948503 PMCID: PMC6488948 DOI: 10.1042/bsr20181729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 03/24/2019] [Accepted: 03/31/2019] [Indexed: 12/23/2022] Open
Abstract
The morbidity of type 2 diabetes mellitus (T2DM) has been increasing rapidly worldwide. Tangminling pill, consisting of ten Chinese herbal medications, is usually prescribed for T2DM in mainland China. Whether treatment with Tangminling can improve clinical outcomes of T2DM patients was still debated. Four studies comparing Tangminling vs. placebo treatment in T2DM patients were included and 767 T2DM patients were enrolled in our analyses. Tangminling treatment exhibited better efficacy than placebo in reducing hemoglobin A1c (HbA1c) (1.11 vs. 0.32%; pooled weighted mean difference [WMD]: 0.80; 95% confidence interval [CI]: 0.65–0.96; P<0.001), fasting plasma glucose (0.82 vs. −0.40 mM; WMD: 1.10; 95% CI: 0.56–1.64; P<0.001), 2-h postprandial glucose (2-hr PG) (2.81 vs. 1.11 mM; WMD: 1.80; 95% CI: 1.72–1.88; P<0.001), homeostatic model assessment-β level (4.28 vs. 0.41; WMD: 0.44; 95% CI: 0.27–0.61; P<0.001), waist circumference (WC) (1.04 vs. 0.36 cm; WMD: 0.78; 95% CI: 0.37–1.19; P<0.001) and body weight index (0.37 vs. 0.11 kg/m2; WMD: 0.30; 95% CI: −0.00 to 0.61; P=0.05). Tangminling pill might reduce glucose level and body weight and improve β-cell function in T2DM patients. Our study highlights the important role of Tangminling pill in the management of T2DM.
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