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Malik FS, Sauder KA, Isom S, Reboussin BA, Dabelea D, Lawrence JM, Roberts A, Mayer-Davis EJ, Marcovina S, Dolan L, Igudesman D, Pihoker C, Lawrence JM, Hung P, Koebnick C, Li X, Lustigova E, Reynolds K, Pettitt DJ, Mayer-Davis EJ, Mottl A, Thomas J, Jackson M, Knight L, Liese AD, Turley C, Bowlby D, Amrhein J, Apperson E, Nelson B, Dabelea D, Bellatorre A, Crume T, Hamman RF, Sauder KA, Shapiro A, Testaverde L, Klingensmith GJ, Maahs D, Rewers MJ, Wadwa P, Daniels S, Kahn MG, Wilkening G, Bloch CA, Powell J, Love-Osborne K, Hu DC, Dolan LM, Shah AS, Standiford DA, Urbina EM, Pihoker C, Hirsch I, Kim G, Malik FA, Merjaneh L, Roberts A, Taplin C, Yi-Frazier J, Beauregard N, Franklin C, Gangan C, Kearns S, Klingsheim M, Loots B, Pascual M, Greenbaum C, Imperatore G, Saydah SH, Linder B, Marcovina SM, Chait A, Clouet-Foraison N, Harting J, Strylewicz G, D'Agostino R, Jensen ET, Wagenknecht LE, Bell RA, Casanova R, Divers J, Goldstein MT, Henkin L, Isom S, Lenoir K, Pierce J, Reboussin B, Rigdon J, South AM, Stafford J, Suerken C, Wells B, Williams C. Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2022; 45:285-294. [PMID: 34995346 PMCID: PMC8914430 DOI: 10.2337/dc21-0507] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002-2007, 2008-2013, and 2014-2019, diabetes durations of 1-4, 5-9, and ≥10 years, and age groups of 1-9, 10-14, 15-19, 20-24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group. RESULTS Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10-14-, 15-19-, and 20-24-year-old age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014-2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014-2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes. CONCLUSIONS Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Katherine A Sauder
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alissa Roberts
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | - Lawrence Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daria Igudesman
- Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, NC
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Standiford DA, Morwessel N, Bishop FK, Thomas JM, Smith E, Crandell J, Driscoll KA, Hunter CM, Kichler JC, Maahs DM, Mayer-Davis EJ, Seid M. Two-step recruitment process optimizes retention in FLEX clinical trial. Contemp Clin Trials Commun 2018; 12:68-75. [PMID: 30294698 PMCID: PMC6169149 DOI: 10.1016/j.conctc.2018.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/22/2018] [Accepted: 09/18/2018] [Indexed: 11/18/2022] Open
Abstract
Introduction The Flexible Lifestyle Empowering Change Study (FLEX) is a multi-site randomized controlled trial to test the efficacy of an adaptive behavioral intervention to promote self-management and improve glycemic control for adolescents with type 1 diabetes mellitus. A two-step recruitment process was used to optimize study retention by facilitating informed decision-making regarding participation. Methods Those who expressed interest at first contact were given more detailed study information followed by telephone calls to the adolescents and their parents to answer questions and explore potential barriers to participation before making a decision regarding study enrollment. Results Of 694 eligible adolescents who were invited to participate, 397 (57.2%) expressed interest when initially contacted (Step 1). Upon completion of the follow-up telephone calls (Step 2), 276 (39.8%) still agreed to participate; and 258 (37.2%) enrolled and completed a baseline visit with a parent/guardian. Completion rates for measurement visits remained high throughout the study, with an end-of-study retention rate of 93.4%; and only 12 (4.7%) families withdrew from the study. Conclusion The two-step recruitment process encourages potential participants to thoughtfully evaluate their willingness to participate, as well as their ability to make a commitment to the full completion of study requirements. When demonstrating the efficacy of a randomized controlled trial, it may be preferable to accept lower recruitment rates in order to optimize retention rates. The additional time and effort required to implement this two-step process is worthwhile. With a high retention rate, we can be more confident that the outcomes of the randomized controlled trial actually reflect the impact of the intervention.
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Affiliation(s)
- Debra A. Standiford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, United States
- Corresponding author. Children's Hospital Medical Center, MLC#10000, 3333 Burnet Avenue, Cincinnati, OH, 45229-3039, United States.
| | - Nancy Morwessel
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, United States
| | - Franziska K. Bishop
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, United States
| | - Joan M. Thomas
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Emily Smith
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, United States
| | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kimberly A. Driscoll
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, United States
| | - Christine M. Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, United States
| | - Jessica C. Kichler
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, United States
| | - David M. Maahs
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, United States
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, United States
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Liese AD, Ma X, Ma X, Mittleman MA, The NS, Standiford DA, Lawrence JM, Pihoker C, Marcovina SM, Mayer-Davis EJ, Puett RC. Dietary quality and markers of inflammation: No association in youth with type 1 diabetes. J Diabetes Complications 2018; 32:179-184. [PMID: 29198994 PMCID: PMC5773064 DOI: 10.1016/j.jdiacomp.2017.10.015] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 10/10/2017] [Accepted: 10/30/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND Systemic inflammation is a key process underlying cardiovascular disease (CVD) development, and CVD risk is significantly elevated in persons with type 1 diabetes (T1D). Youth with T1D exhibit increased levels of inflammation. Studies in persons without diabetes suggest that dietary quality influences inflammation, yet little is known about dietary influences on inflammation in youth with T1D. METHODS This study evaluated the association of four distinct dietary quality indices (Dietary Approaches to Stop Hypertension (DASH), Healthy Eating Index 2010 (HEI2010), modified KIDMED and Total Antioxidant Capacity (TAC)) with biomarkers of inflammation (C-reactive protein (CRP), fibrinogen and interleukin-6 (IL-6)) in a sample of 2520 youth with T1D participating in the SEARCH for Diabetes in Youth Study. RESULTS Average diet quality was moderate to poor, with mean scores of 43 (DASH, range 0-80), 55 (HEI2010, range 0-100), 3.7 (mKIDMED, range 3-12) and 7237 (TAC). None of the four diet quality scores was associated with the selected biomarkers of inflammation in any analyses. Evaluation of a non-linear relationship or interactions with BMI or levels of glycemic control did not alter the findings. Replication of analyses using longitudinal data yielded consistent findings with our cross-sectional results. CONCLUSIONS Biomarkers of inflammation in youth with T1D may not be directly influenced by dietary intake, at least at the levels of dietary quality observed here. More work is needed to understand what physiologic mechanisms specific to persons with T1D might inhibit the generally beneficial influence of high dietary quality on systemic inflammation observed in populations without diabetes.
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Xiaonan Ma
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Xiaoguang Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Zhejiang University, Zhejiang, China
| | - Murray A Mittleman
- Department of Epidemiology, TH Chan Harvard School of Public Health, Boston, MA, USA
| | - Natalie S The
- Department of Health Sciences, Furman University, SC, USA
| | - Debra A Standiford
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | | | | | | | - Robin C Puett
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, MD, USA
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Jaiswal M, Divers J, Dabelea D, Isom S, Bell RA, Martin CL, Pettitt DJ, Saydah S, Pihoker C, Standiford DA, Dolan LM, Marcovina S, Linder B, Liese AD, Pop-Busui R, Feldman EL. Prevalence of and Risk Factors for Diabetic Peripheral Neuropathy in Youth With Type 1 and Type 2 Diabetes: SEARCH for Diabetes in Youth Study. Diabetes Care 2017; 40:1226-1232. [PMID: 28674076 PMCID: PMC5566278 DOI: 10.2337/dc17-0179] [Citation(s) in RCA: 152] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 06/02/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We assessed the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the SEARCH for Diabetes in Youth (SEARCH) study. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) was used to assess DPN in 1,734 youth with T1D (mean ± SD age 18 ± 4 years, T1D duration 7.2 ± 1.2 years, and HbA1c 9.1 ± 1.9%) and 258 youth with T2D (age 22 ± 3.5 years, T2D duration 7.9 ± 2 years, and HbA1c 9.4 ± 2.3%) who were enrolled in the SEARCH study and had ≥5 years of diabetes duration. DPN was defined as an MNSI exam score of >2. Glycemic control over time was estimated as area under the curve for HbA1c. RESULTS The prevalence of DPN was 7% in youth with T1D and 22% in youth with T2D. Risk factors for DPN in youth with T1D were older age, longer diabetes duration, smoking, increased diastolic blood pressure, obesity, increased LDL cholesterol and triglycerides, and lower HDL cholesterol (HDL-c). In youth with T2D, risk factors were older age, male sex, longer diabetes duration, smoking, and lower HDL-c. Glycemic control over time was worse among those with DPN compared with those without for youth with T1D (odds ratio 1.53 [95% CI 1.24; 1.88]) but not for youth with T2D (1.05 [0.7; 1.56]). CONCLUSIONS The high rates of DPN among youth with diabetes are a cause of concern and suggest a need for early screening and better risk factor management. Interventions in youth that address poor glycemic control and dyslipidemia may prevent or delay debilitating neuropathic complications.
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Affiliation(s)
- Mamta Jaiswal
- Department of Neurology, University of Michigan, Ann Arbor, MI
| | - Jasmin Divers
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Catherine L Martin
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
| | | | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Debra A Standiford
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lawrence M Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Santica Marcovina
- Northwest Lipid Metabolism and Diabetes Research Laboratories, Department of Medicine, University of Washington, Seattle, WA
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Angela D Liese
- Department of Epidemiology and Biostatistics and Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Rodica Pop-Busui
- Division of Metabolism, Endocrinology and Diabetes, University of Michigan, Ann Arbor, MI
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI
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Crume TL, Hamman RF, Isom S, Talton J, Divers J, Mayer-Davis EJ, Zhong VW, Liese AD, Saydah S, Standiford DA, Lawrence JM, Pihoker C, Dabelea D. Factors influencing time to case registration for youth with type 1 and type 2 diabetes: SEARCH for Diabetes in Youth Study. Ann Epidemiol 2016; 26:631-7. [PMID: 27664849 DOI: 10.1016/j.annepidem.2016.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 11/15/2022]
Abstract
PURPOSE The development of a sustainable pediatric diabetes surveillance system for the United States requires a better understanding of issues related to case ascertainment. METHODS Using the SEARCH for Diabetes in Youth registry, we examined whether time from diabetes diagnosis to case registration differed by diabetes type, patient demographics, and the type of provider reporting the case to the study. Plots for time from diagnosis to registration were developed, and differences by key variables were examined using the log-rank test. RESULTS Compared with time to registration for type 1 cases, it took 2.6 (95% confidence interval [CI], 2.5-2.6) times longer to register 50% of type 2 diabetes cases, and 2.3 (95% CI, 2.0-2.5) times longer to register 90% of type 2 cases. For type 1 diabetes cases, a longer time to registration was associated with older age, minority race/ethnicity, and cases, where the referring provider was not an endocrinologist. For type 2 diabetes cases, older age, non-Hispanic white race/ethnicity, and cases reported by providers other than an endocrinologist took longer to identify and register. CONCLUSIONS These findings highlight the need for continued childhood diabetes surveillance to identify future trends and influences on changes in prevalence and incidence.
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Affiliation(s)
- Tessa L Crume
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora.
| | - Richard F Hamman
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora
| | - Scott Isom
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Jennifer Talton
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Jasmin Divers
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC
| | - Elizabeth J Mayer-Davis
- School of Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Victor W Zhong
- School of Public Health and School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Hyattsville, MD
| | - Debra A Standiford
- Division of Endocrinology, Children's Hospital Medical Center, Cincinnati, OH
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Catherine Pihoker
- Department of Pediatric Endocrinology, Children's Hospital & Regional Medical Center, University of Washington, Seattle
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora
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Lawrence JM, Imperatore G, Dabelea D, Mayer-Davis EJ, Linder B, Saydah S, Klingensmith GJ, Dolan L, Standiford DA, Pihoker C, Pettitt DJ, Talton JW, Thomas J, Bell RA, D'Agostino RB. Trends in incidence of type 1 diabetes among non-Hispanic white youth in the U.S., 2002-2009. Diabetes 2014; 63:3938-45. [PMID: 24898146 PMCID: PMC4207387 DOI: 10.2337/db13-1891] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The SEARCH for Diabetes in Youth Study prospectively identified youth aged <20 years with physician-diagnosed diabetes. Annual type 1 diabetes (T1D) incidence per 100,000 person-years (95% CI) overall, by age-group, and by sex were calculated for at-risk non-Hispanic white (NHW) youth from 2002 through 2009. Joinpoint and Poisson regression models were used to test for temporal trends. The age- and sex-adjusted incidence of T1D increased from 24.4/100,000 (95% CI 23.9-24.8) in 2002 to 27.4/100,000 (26.9-27.9) in 2009 (P for trend = 0.0008). The relative annual increase in T1D incidence was 2.72% (1.18-4.28) per year; 2.84% (1.12-4.58) per year for males and 2.57% (0.68-4.51) per year for females. After adjustment for sex, significant increases were found for youth aged 5-9 years (P = 0.0023), 10-14 years (P = 0.0008), and 15-19 years (P = 0.004) but not among 0-4-year-olds (P = 0.1862). Mean age at diagnosis did not change. The SEARCH study demonstrated a significant increase in the incidence of T1D among NHW youth from 2002 through 2009 overall and in all but the youngest age-group. Continued surveillance of T1D in U.S. youth to identify future trends in T1D incidence and to plan for health care delivery is warranted.
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Affiliation(s)
- Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, CO
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC School of Medicine, University of North Carolina, Chapel Hill, NC
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Hyattsville, MD
| | | | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH Department of Pediatrics, University of Cincinnati, Cincinnati, OH
| | - Debra A Standiford
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Jennifer W Talton
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Joan Thomas
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC
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Naughton MJ, Yi-Frazier JP, Morgan TM, Seid M, Lawrence JM, Klingensmith GJ, Waitzfelder B, Standiford DA, Loots B. Longitudinal associations between sex, diabetes self-care, and health-related quality of life among youth with type 1 or type 2 diabetes mellitus. J Pediatr 2014; 164:1376-83.e1. [PMID: 24582483 PMCID: PMC4500167 DOI: 10.1016/j.jpeds.2014.01.027] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 11/22/2013] [Accepted: 01/14/2014] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To examine the longitudinal associations between sex, diabetes self-care, and the health-related quality of life (HRQL) of children and adolescents with type 1 or type 2 diabetes. STUDY DESIGN The sample included 910 participants with type 1 and 241 participants with type 2, ages 10-22 years at baseline, from the SEARCH for Diabetes in Youth Study, a longitudinal observational study. The primary outcome measure was the Pediatric Quality of Life Inventory. Repeated measures, mixed-model regression analysis was conducted with the use of data from baseline and at least one follow-up assessment, spanning approximately 4 years. RESULTS HRQL was greater among those with type 1 versus type 2 diabetes. Among participants with type 1, greater (better) Pediatric Quality of Life Inventory total scores over time were related to greater parent education (P = .0007), lower glycated hemoglobin values (P < .0001), and greater physical activity during the past 7 days (P = .0001). There was a significant interaction between sex and age (P < .0001); girls' HRQL remained stable or decreased over time, whereas males' HRQL increased. For participants with type 2 diabetes, there was no significant interaction by age and sex, but lower total HRQL was related to being female (P = .011) and greater body mass index z-scores (P = .014). CONCLUSIONS HRQL in this cohort varied by diabetes type. The interaction between sex and age for type 1 participants, coupled with poorer HRQL among female than male participants with type 2 diabetes, suggests the impacts of diabetes on HRQL differ by sex and should be considered in clinical management. Encouraging physical activity and weight control continue to be important in improving HRQL.
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Affiliation(s)
- Michelle J. Naughton
- Wake Forest Medical School, Division of Public Health Sciences, Department of Social Sciences and Health Policy, Winston-Salem, NC
| | - Joyce P. Yi-Frazier
- University of Washington School of Medicine, Department of Pediatrics, Seattle, WA, USA
| | | | - Michael Seid
- Cincinnati Children’s Hospital Medical Center, Department of Pediatrics, Cincinnati, OH
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | - Beth Waitzfelder
- Kaiser Permanente Center for Health Research Hawaii, Honolulu, HI
| | - Debra A. Standiford
- Cincinnati Children’s Hospital Medical Center, Division of Endocrinology, Cincinnati, OH
| | - Beth Loots
- Seattle Children’s Research Institute, Endocrinology, Seattle, WA
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Dabelea D, Rewers A, Stafford JM, Standiford DA, Lawrence JM, Saydah S, Imperatore G, D’Agostino RB, Mayer-Davis EJ, Pihoker C. Trends in the prevalence of ketoacidosis at diabetes diagnosis: the SEARCH for diabetes in youth study. Pediatrics 2014; 133:e938-45. [PMID: 24685959 PMCID: PMC4074618 DOI: 10.1542/peds.2013-2795] [Citation(s) in RCA: 241] [Impact Index Per Article: 24.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To estimate temporal changes in the prevalence of diabetic ketoacidosis (DKA) at diagnosis of type 1 or type 2 diabetes in youth and to explore factors associated with its occurrence. METHODS Five centers identified incident cases of diabetes among youth aged 0 to 19 years starting in 2002. DKA presence was defined as a bicarbonate level <15 mmol/L and/or a pH <7.25 (venous) or <7.30 (arterial or capillary) or mention of DKA in the medical records. We assessed trends in the prevalence of DKA over 3 time periods (2002-2003, 2004-2005, and 2008-2010). Logistic regression was used to determine factors associated with DKA. RESULTS In youth with type 1 diabetes (n = 5615), the prevalence of DKA was high and stable over time (30.2% in 2002-2003, 29.1% in 2004-2005, and 31.1% in 2008-2010; P for trend = .42). Higher prevalence was associated with younger age at diagnosis (P < .0001), minority race/ethnicity (P = .019), income (P = .019), and lack of private health insurance (P = 008). Among youth with type 2 diabetes (n = 1425), DKA prevalence decreased from 11.7% in 2002-2003 to 5.7% in 2008-2010 (P for trend = .005). Higher prevalence was associated with younger age at diagnosis (P = .001), minority race/ethnicity (P = .013), and male gender (P = .001). CONCLUSIONS The frequency of DKA in youth with type 1 diabetes, although stable, remains high, indicating a persistent need for increased awareness of signs and symptoms of diabetes and better access to health care. In youth with type 2 diabetes, DKA at onset is less common and is decreasing over time.
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Affiliation(s)
- Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Arleta Rewers
- Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado
| | - Jeanette M. Stafford
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Debra A. Standiford
- Department of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ralph B. D’Agostino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | | | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, Washington
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Pettitt DJ, Talton J, Dabelea D, Divers J, Imperatore G, Lawrence JM, Liese AD, Linder B, Mayer-Davis EJ, Pihoker C, Saydah SH, Standiford DA, Hamman RF. Prevalence of diabetes in U.S. youth in 2009: the SEARCH for diabetes in youth study. Diabetes Care 2014; 37:402-8. [PMID: 24041677 PMCID: PMC3898760 DOI: 10.2337/dc13-1838] [Citation(s) in RCA: 302] [Impact Index Per Article: 30.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of diabetes in U.S. youth aged <20 years in 2009 and to estimate the total number of youth with diabetes in the U.S. by age, race/ethnicity, and diabetes type. RESEARCH DESIGN AND METHODS To address one of its primary aims, the SEARCH for Diabetes in Youth Study identified youth aged <20 years on 31 December 2009 with physician-diagnosed diabetes in selected areas of Colorado, Ohio, South Carolina, and Washington, among health plan members of Kaiser Permanente Southern California and among American Indians living on reservations in Arizona and New Mexico. Diabetes was classified as type 1, type 2, or other. Race/ethnicity was by self-report. RESULTS From a population of 3,458,974 youth aged <20 years, 7,695 youth with diabetes were identified (2.22/1,000): 6,668 with type 1 diabetes (1.93/1,000), 837 with type 2 diabetes (0.24/1,000), and 190 (0.05/1,000) with other diabetes types. Prevalence increased with age, was slightly higher in females than males, and was most prevalent in non-Hispanic White and least prevalent in Asian/Pacific Islanders, with Native American and black youth having the highest prevalence of type 2 diabetes. An estimated 191,986 U.S. youth aged <20 years have diabetes; 166,984 type 1 diabetes, 20,262 type 2 diabetes, and 4,740 other types. CONCLUSIONS Diabetes, one of the leading chronic diseases in childhood, affects >190,000 (1 of 433) youth aged <20 years in the U.S., with racial and ethnic disparities seen in diabetes prevalence, overall and by diabetes type.
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10
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Jaiswal M, Lauer A, Martin CL, Bell RA, Divers J, Dabelea D, Pettitt DJ, Saydah S, Pihoker C, Standiford DA, Rodriguez BL, Pop-Busui R, Feldman EL. Peripheral neuropathy in adolescents and young adults with type 1 and type 2 diabetes from the SEARCH for Diabetes in Youth follow-up cohort: a pilot study. Diabetes Care 2013; 36:3903-8. [PMID: 24144652 PMCID: PMC3836139 DOI: 10.2337/dc13-1213] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To estimate the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in a pilot study among youth participating in the SEARCH for Diabetes in Youth study. RESEARCH DESIGN AND METHODS DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI) (examination for foot abnormalities, distal vibration perception, and ankle reflexes). An MNSI exam (MNSIE) score >2 is diagnostic for DPN. RESULTS The MNSIE was completed in 399 subjects, including 329 youth with type 1 diabetes (mean age 15.7 ± 4.3 years, duration 6.2 ± 0.9 years) and 70 with type 2 diabetes (mean age 21.6 ± 4.1 years, duration 7.6 ± 1.8 years). Glycated hemoglobin (A1C) was similar in both groups (8.8 ± 1.8% for type 1 vs. 8.5 ± 2.9% for type 2). The prevalence of DPN was significantly higher in youth with type 2 compared with those with type 1 diabetes (25.7 vs. 8.2%; P < 0.0001). In unadjusted analyses, diabetes type, older age, longer duration of diabetes, increased waist circumference, elevated blood pressure, lower HDL cholesterol, and presence of microalbuminuria (urinary albumin-to-creatinine ratio >30 mg/g) were associated with DPN. The association between diabetes type and DPN remained significant after adjustment for age and sex (odds ratio 2.29 [95% CI 1.05-5.02], P = 0.03). CONCLUSIONS DPN prevalence among youth with type 2 diabetes approached rates reported in adult populations with diabetes. Our findings suggest not only that youth with diabetes are at risk for DPN but also that many already show measurable signs of DPN.
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11
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Puett RC, Lamichhane AP, D Nichols M, Lawson AB, A Standiford D, Liu L, Dabelea D, Liese AD. Neighborhood context and incidence of type 1 diabetes: the SEARCH for Diabetes in Youth study. Health Place 2012; 18:911-6. [PMID: 22464158 DOI: 10.1016/j.healthplace.2012.02.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Revised: 02/12/2012] [Accepted: 02/15/2012] [Indexed: 12/21/2022]
Abstract
Findings regarding type 1 diabetes mellitus (T1DM) and neighborhood-level characteristics are mixed, with few US studies examining the influence of race/ethnicity. We conducted an ecologic study using SEARCH for Diabetes in Youth Study data to explore the association of neighborhood characteristics and T1DM incidence. 2002-2003 incident cases among youth at four SEARCH centers were included. Residential addresses were geocoded to US Census Tract. Standardized incidence ratios tended to increase with increasing education and median household income. Results from Poisson regression mixed models were similar and stable across race/ethnic groups and population density. Our study suggests a relationship of T1DM incidence with neighborhood-level socioeconomic status, independent of individual-level race/ethnic differences.
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Affiliation(s)
- Robin C Puett
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD 20742, USA.
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12
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Black MH, Anderson A, Bell RA, Dabelea D, Pihoker C, Saydah S, Seid M, Standiford DA, Waitzfelder B, Marcovina SM, Lawrence JM. Prevalence of asthma and its association with glycemic control among youth with diabetes. Pediatrics 2011; 128:e839-47. [PMID: 21949144 PMCID: PMC3387907 DOI: 10.1542/peds.2010-3636] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of asthma among youth with types 1 and 2 diabetes and examine associations between asthma and glycemic control. METHODS This was a cross-sectional analysis of data from the SEARCH for Diabetes in Youth study, which included youth diagnosed with type 1 (n = 1683) and type 2 (n = 311) diabetes from 2002 through 2005. Asthma status and medications were ascertained from medical records and self-administered questionnaires, and glycemic control was assessed from hemoglobin A1c measured at the study visit. RESULTS Prevalence of asthma among all youth with diabetes was 10.9% (95% confidence interval [CI]: 9.6%-12.3%). The prevalence was 10.0% (95% CI: 8.6%-11.4%) among youth with type 1 and 16.1% (95% CI: 12.0%-20.2%) among youth with type 2 diabetes and differed according to race/ethnicity. Among youth with type 1 diabetes, those with asthma had higher mean A1c levels than those without asthma, after adjustment for age, gender, race/ethnicity, and BMI (7.77% vs 7.49%; P = .034). Youth with asthma were more likely to have poor glycemic control, particularly those with type 1 diabetes whose asthma was not treated with pharmacotherapy, although this association was attenuated by adjustment for race/ethnicity. CONCLUSIONS Prevalence of asthma may be elevated among youth with diabetes relative to the general US population. Among youth with type 1 diabetes, asthma is associated with poor glycemic control, especially if asthma is untreated. Specific asthma medications may decrease systemic inflammation, which underlies the complex relationship between pulmonary function, BMI, and glycemic control among youth with diabetes.
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Affiliation(s)
- Mary Helen Black
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Andrea Anderson
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Ronny A. Bell
- Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, North Carolina
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado
| | - Catherine Pihoker
- Children's Hospital and Regional Medical Center, Seattle, Washington
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Beth Waitzfelder
- Center for Health Research Hawaii, Kaiser Permanente, Honolulu, Hawaii; and
| | | | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
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13
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Liese AD, Bortsov A, Günther ALB, Dabelea D, Reynolds K, Standiford DA, Liu L, Williams DE, Mayer-Davis EJ, D'Agostino RB, Bell R, Marcovina S. Association of DASH diet with cardiovascular risk factors in youth with diabetes mellitus: the SEARCH for Diabetes in Youth study. Circulation 2011; 123:1410-7. [PMID: 21422385 DOI: 10.1161/circulationaha.110.955922] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND We have shown that adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is related to blood pressure in youth with type 1 and type 2 diabetes mellitus. We explored the impact of the DASH diet on other cardiovascular disease risk factors. METHODS AND RESULTS Between 2001 and 2005, data on total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, low-density lipoprotein particle density, apolipoprotein B, body mass index, waist circumference, and adipocytokines were ascertained in 2130 youth aged 10 to 22 years with physician-diagnosed diabetes mellitus. Dietary intake was assessed by food frequency questionnaire, categorized into the DASH food groups, and assigned an adherence score. Among youth with type 1 diabetes mellitus, higher adherence to the DASH diet was significantly and inversely associated with low-density lipoprotein/high-density lipoprotein ratio and A(1c) in multivariable-adjusted models. Youth in the highest adherence tertile had an estimated 0.07 lower low-density lipoprotein/high-density lipoprotein ratio and 0.2 lower A(1c) levels than those in the lowest tertile adjusted for confounders. No significant associations were observed with triglycerides, low-density lipoprotein particle density, adipocytokines, apolipoprotein B, body mass index Z score, or waist circumference. Among youth with type 2 diabetes mellitus, associations were observed with low-density lipoprotein particle density and body mass index Z score. CONCLUSIONS The DASH dietary pattern may be beneficial in the prevention and management of cardiovascular disease risk in youth with diabetes mellitus.
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Affiliation(s)
- Angela D Liese
- Center for Research in Nutrition and Health Disparities and Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 921 Assembly St, Columbia, SC 29208, USA.
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14
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Paris CA, Imperatore G, Klingensmith G, Petitti D, Rodriguez B, Anderson AM, Schwartz ID, Standiford DA, Pihoker C. Predictors of insulin regimens and impact on outcomes in youth with type 1 diabetes: the SEARCH for Diabetes in Youth study. J Pediatr 2009; 155:183-9.e1. [PMID: 19394043 DOI: 10.1016/j.jpeds.2009.01.063] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Revised: 12/02/2008] [Accepted: 01/21/2009] [Indexed: 02/09/2023]
Abstract
OBJECTIVES To describe the insulin regimens used to treat type 1 diabetes mellitus (T1DM) in youth in the United States, to explore factors related to insulin regimen, and to describe the associations between insulin regimen and clinical outcomes, particularly glycemic control. STUDY DESIGN A total of 2743 subjects participated in the SEARCH for Diabetes in Youth study, an observational population-based study of youth diagnosed with T1DM, conducted at 6 centers. Data collected during a study visit included clinical and sociodemographic information, body mass index, laboratory measures, and insulin regimen. RESULTS Sociodemographic characteristics were associated with insulin regimen. Insulin pump therapy was more frequently used by older youth, females, non-Hispanic whites, and families with higher income and education (P = .02 for females, P < .001 for others). Insulin pump use was associated with the lowest hemoglobin A1C levels in all age groups. A1C levels were >7.5% in >70% of adolescents, regardless of regimen. CONCLUSIONS Youth using insulin pumps had the lowest A1C; A1C was unacceptably high in adolescents. There is a need to more fully assess and understand factors associated with insulin regimens recommended by providers and the influence of race/ethnicity, education, and socioeconomic status on these treatment recommendations and to develop more effective treatment strategies, particularly for adolescents.
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15
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Günther ALB, Liese AD, Bell RA, Dabelea D, Lawrence JM, Rodriguez BL, Standiford DA, Mayer-Davis EJ. Association between the dietary approaches to hypertension diet and hypertension in youth with diabetes mellitus. Hypertension 2009; 53:6-12. [PMID: 19029488 PMCID: PMC7732209 DOI: 10.1161/hypertensionaha.108.116665] [Citation(s) in RCA: 117] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Among youth with diabetes mellitus, elevated blood pressure represents one of the most common comorbidities. Hence, exploring dietary factors that may help prevent or control hypertension in this population is of paramount importance. We investigated whether adherence to the Dietary Approaches to Stop Hypertension (DASH) diet is associated with hypertension in youth with diabetes mellitus from the SEARCH for Diabetes in Youth Study. Between 2001 and 2005, 2830 youth aged 10 to 22 years (2440 with type 1 and 390 with type 2 diabetes mellitus) completed a study visit. For each of the 8 DASH food groups, a score of 10 was assigned when the DASH recommendation was met. Lower intakes were scored proportionately, and the 8 individual scores were summed. The association between the overall DASH score and hypertension was evaluated using multiple logistic regression. The crude prevalence of hypertension was 6.8% for youth with type 1 and 28.2% for youth with type 2 diabetes mellitus. In youth with type 1, a higher adherence to DASH was inversely related to hypertension, independent of demographic, clinical, and behavioral characteristics (tertile 2 versus 1: odds ratio: 0.7, 95% CI: 0.5 to 1.0; 3 versus 1: odds ratio: 0.6, 95% CI: 0.4 to 0.9; P(trend)=0.007). For type 2 diabetes mellitus, the DASH diet was not associated with hypertension (tertile 2 versus 1: odds ratio: 0.8, 95% CI: 0.5 to 1.4; 3 versus 1: odds ratio: 0.9, 95% CI: 0.5 to 1.5; P(trend)=0.6). Prospective observational studies or clinical trials are needed to investigate whether adherence to the DASH guidelines may help prevent hypertension in youth with type 1 diabetes mellitus. In type 2 diabetes mellitus, more research with a larger sample is necessary.
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Affiliation(s)
- Anke LB Günther
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Ronny A Bell
- Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, CO
| | - Jean M Lawrence
- Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | | | | | - Elizabeth J Mayer-Davis
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC
- University of North Carolina at Chapel Hill, Chapel Hill, NC
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16
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Naughton MJ, Ruggiero AM, Lawrence JM, Imperatore G, Klingensmith GJ, Waitzfelder B, McKeown RE, Standiford DA, Liese AD, Loots B. Health-related quality of life of children and adolescents with type 1 or type 2 diabetes mellitus: SEARCH for Diabetes in Youth Study. Arch Pediatr Adolesc Med 2008; 162:649-57. [PMID: 18606936 DOI: 10.1001/archpedi.162.7.649] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the associations between demographic and diabetes management variables and the health-related quality of life (HRQOL) of youths with type 1 or type 2 diabetes mellitus (DM). DESIGN Cross-sectional study. SETTINGS Selected populations in Ohio, Washington, South Carolina, Colorado, Hawaii, and California; health service beneficiaries in 3 American Indian populations; and participants in the Pima Indian Study in Arizona. PARTICIPANTS Two thousand four hundred forty-five participants aged 8 to 22 years in the SEARCH for Diabetes in Youth Study. MAIN OUTCOME MEASURE Pediatric Quality of Life Inventory scores. RESULTS Among youths with type 2 DM, HRQOL was lower compared with those with type 1. Among those with type 1 DM, worse HRQOL was associated with a primary insurance source of Medicaid or another government-funded insurance, use of insulin injections vs an insulin pump, a hemoglobin A(1c) value of at least 9%, and more comorbidities and diabetes complications. There was a significant age x sex interaction, such that, in older groups, HRQOL was lower for girls but higher for boys. For youths with type 2 DM, injecting insulin at least 3 times a day compared with using an oral or no diabetes medication was associated with better HRQOL, and having 2 or more emergency department visits in the past 6 months was associated with worse HRQOL. CONCLUSIONS Youths with types 1 and 2 DM reported HRQOL differences by type of treatment and complications. The significant age x sex interaction suggests that interventions to improve HRQOL should consider gender differences in diabetes adjustment and management in different age groups.
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Affiliation(s)
- Michelle J Naughton
- Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, 2000 W First St, Winston-Salem, NC 27104, USA.
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17
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Lawrence JM, Standiford DA, Loots B, Klingensmith GJ, Williams DE, Ruggiero A, Liese AD, Bell RA, Waitzfelder BE, McKeown RE. Prevalence and correlates of depressed mood among youth with diabetes: the SEARCH for Diabetes in Youth study. Pediatrics 2006; 117:1348-58. [PMID: 16585333 DOI: 10.1542/peds.2005-1398] [Citation(s) in RCA: 208] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE The objective of this study was to determine if depressed mood among youth with diabetes was associated with type and duration of diabetes, mean glycosylated hemoglobin (HbA1c) level, and the frequency of diabetic ketoacidosis (DKA) and hypoglycemic episodes, hospitalizations, and emergency department (ED) visits. METHODS A total of 2672 youth (aged 10-21 years) who had diabetes for a mean duration of 5 years completed a SEARCH study visit, in which their HbA1c was measured and information about their demographic characteristics, diabetes type and duration, and episodes of DKA, hypoglycemia, hospitalizations, and ED visits over the previous 6 months was collected. Their level of depressed mood was measured using the Center for Epidemiologic Studies Depression Scale (CES-D). RESULTS Among these youth, 14% had mildly (CES-D 16-23) and 8.6% had moderately or severely (CES-D > or =24) depressed mood. Females had a higher mean CES-D score than males. After adjusting for demographic factors, and duration of diabetes, we found the prevalence of depressed mood to be higher among males with type 2 diabetes than those with type 1 diabetes and to be higher among females with comorbidities than those without comorbidities. Higher mean HbA1c and frequency of ED visits were associated with depressed mood. The prevalence of depressed mood among youth with diabetes was similar to that of published estimates of depressed mood among youth without diabetes. CONCLUSIONS Physicians and other health care professionals should consider screening youth with diabetes for depressed mood in clinical settings, particularly youth with poor glycemic control, those with a history of frequent ED visits, males with type 2 diabetes, and females with comorbidities.
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Affiliation(s)
- Jean M Lawrence
- Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA 91101, USA.
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18
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Young LA, Kimball TR, Daniels SR, Standiford DA, Khoury PR, Eichelberger SM, Dolan LM. Nocturnal blood pressure in young patients with insulin-dependent diabetes mellitus: correlation with cardiac function. J Pediatr 1998; 133:46-50. [PMID: 9672509 DOI: 10.1016/s0022-3476(98)70176-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Lack of a decline in nocturnal blood pressure is associated with an adverse effect on end organs in adults with insulin-dependent diabetes mellitus (IDDM). The role of the decline in nocturnal blood pressure in young patients with IDDM is not known. We studied 25 white subjects with IDDM (age = 20.8 +/- 3.7 years, mean +/- SD), 8 of whom were female. The duration of IDDM in these subjects was 12.9 +/- 5.4 years (mean +/- SD). We determined the values for glycosylated hemoglobin (HgbA1), 24-hour ambulatory blood pressure, diastolic cardiac function (the ratio of peak E wave to peak A wave velocity (E/A) and indexed peak filling rate ¿PFR/SV¿ by Doppler echocardiography), and albumin excretion rate. The HgbA1 level was 10.9% +/- 1.9% (mean +/- SD; normal range = 4.5%-8.5%). The HgbA1 concentration was inversely correlated (p < 0.005) with the decline in systolic (r = 0.57) and diastolic (r = -0.55) nocturnal blood pressure. Diastolic cardiac dysfunction ¿E/A ratio [r = 0.42, p < 0.03) and PFR/SV (r = 0.52, p < 0.01)¿ correlated with a smaller decrease in nocturnal diastolic blood pressure. An inverse correlation between decline in nocturnal systolic blood pressure and log albumin excretion rate (r = -0.37, p = 0.07) approached statistical significance. We conclude that poor glycemic control adversely affects nocturnal blood pressure and that the latter may play an important role in cardiac and possibly renal dysfunction in early IDDM.
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Affiliation(s)
- L A Young
- Division of Endocrinology, Children's Hospital Research Foundation, Cincinnati, OH 45229, USA
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Albanna II, Eichelberger SM, Khoury PR, Witt SA, Standiford DA, Dolan LM, Daniels SR, Kimball TR. Diastolic dysfunction in young patients with insulin-dependent diabetes mellitus as determined by automated border detection. J Am Soc Echocardiogr 1998; 11:349-55. [PMID: 9571584 DOI: 10.1016/s0894-7317(98)70102-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Diastolic dysfunction is an early harbinger for systolic dysfunction in insulin-dependent diabetes mellitus (IDDM). To determine the role of automated border detection (ABD) in detecting diastolic abnormalities and whether IDDM control correlates with abnormalities, 21 young IDDM patients (22 +/- 4 years old) and 19 control subjects underwent echocardiography. ABD indices included the percent contribution to total left ventricular filling of the three phases of diastole (rapid filling, diastasis, and atrial contraction) and peak filling rate. Doppler indices included E/A ratio and peak filling rate. Rapid filling phase was lower in the IDDM patients compared with control subjects (73% +/- 5% versus 80% +/- 5%, p = 0.0006), and atrial contraction filling was higher (19% +/- 4% versus 14% +/- 3%, p = 0.0003). Doppler indexes showed similar changes. Glycosylated hemoglobin, insulin dosage, and duration of IDDM since puberty were associated with filling abnormalities. Young patients with IDDM have increased atrial contraction and reduced rapid filling phases detected by automatic border detection, and these diastolic abnormalities are related to the diabetic disease process.
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Affiliation(s)
- I I Albanna
- Noninvasive Cardiac Imaging and Hemodynamic Research Laboratory, Children's Hospital Medical Center, Cincinnati, OH 45229, USA
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20
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Drozda DJ, Allen SR, Standiford DA, Turner AM, McCain GC. Personal illness models of diabetes: parents of preadolescents and adolescents. Diabetes Educ 1997; 23:550-7. [PMID: 9355371 DOI: 10.1177/014572179702300506] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this research was to explore personal illness models of parents of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the parents' cognitive representations of the disease. Fifty-five parents of children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Parents attributed the cause of diabetes to genetics coupled with a viral infection. Most believed the diabetes would last a lifetime but they were hopeful for a cure. Parents requested ongoing education for their children, support groups, counseling, one consistent healthcare provider, and intensive insulin therapy. Parents reported that the major problems caused by diabetes were increased structure of daily routines and that their children with diabetes felt different from healthy peers. Parents' fears about diabetes included long-term complications, early death, and severe insulin reactions.
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Affiliation(s)
- D J Drozda
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Drozda, Allen, Turner and Dr McCain)
| | - S R Allen
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Drozda, Allen, Turner and Dr McCain)
| | - D A Standiford
- The Division of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio (Ms Standiford)
| | - A M Turner
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Drozda, Allen, Turner and Dr McCain)
| | - G C McCain
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Drozda, Allen, Turner and Dr McCain)
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Abstract
The purpose of this research study was to explore personal illness models of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the adolescents' cognitive representations of their disease. Sixty children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Although most participants expressed an understanding that their disease would last a lifetime, they were hopeful for a cure. Participants wanted healthcare professionals to provide strategies for controlling blood glucose to prevent future complications. Family and friends who followed the same diet as the adolescent with diabetes were viewed as supportive. The majority of adolescents were responsible for much of their own disease management. Their greatest fears concerned insulin reactions and long-term complications such as amputation of limbs.
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Affiliation(s)
- D A Standiford
- Division of Endocrinology, Children's Hospital Medical Center, Cincinnati, Ohio (Ms Standiford)
| | - A M Turner
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Turner, Allen, Drozda and Dr McCain)
| | - S R Allen
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Turner, Allen, Drozda and Dr McCain)
| | - D J Drozda
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Turner, Allen, Drozda and Dr McCain)
| | - G C McCain
- The Division of Patient Services, Children's Hospital Medical Center, Cincinnati, Ohio (Mss Turner, Allen, Drozda and Dr McCain)
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22
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Standiford DA, Ahlrichs J, Carmicle C, Wells PW. Extended day program: bringing preschool to the hospital. Pediatr Nurs 1993; 19:238-41. [PMID: 8511004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Children who must grow up in a hospital setting due to complex medical and social conditions present health care professionals with unique challenges that include (a) providing an environment to facilitate growth and development, (b) normalizing life experiences, (c) strengthening children's positive self-concepts, (d) promoting independence and exploration, and (e) introducing opportunities for learning experiences. An Extended Day Program, designed by nurses and other professionals to promote optimal development and psychosocial care for long-term hospitalized children, can offer these benefits.
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