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Laffel LM, Danne T, Klingensmith GJ, Tamborlane WV, Willi S, Zeitler P, Neubacher D, Marquard J. Efficacy and safety of the SGLT2 inhibitor empagliflozin versus placebo and the DPP-4 inhibitor linagliptin versus placebo in young people with type 2 diabetes (DINAMO): a multicentre, randomised, double-blind, parallel group, phase 3 trial. Lancet Diabetes Endocrinol 2023; 11:169-181. [PMID: 36738751 PMCID: PMC10851109 DOI: 10.1016/s2213-8587(22)00387-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [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] [Received: 10/26/2022] [Revised: 12/07/2022] [Accepted: 12/15/2022] [Indexed: 02/04/2023]
Abstract
BACKGROUND The incidence of type 2 diabetes in young people is increasing, but treatments remain limited. We aimed to assess the efficacy and safety of an empagliflozin dosing regimen versus placebo and linagliptin versus placebo on glycaemic control in young people with type 2 diabetes. METHODS In this double-blind, placebo-controlled trial done in 108 centres in 15 countries, participants with type 2 diabetes (aged 10-17 years; HbA1c 6·5-10·5% [48-91 mmol/mol]) who had been previously treated with metformin or insulin were randomly assigned (1:1:1) to oral empagliflozin 10 mg, oral linagliptin 5 mg, or placebo. Participants in the empagliflozin group who did not have HbA1c below 7·0% (<53 mmol/mol) by week 12 underwent a second double-blinded randomisation (1:1) at week 14, either remaining on 10 mg or increasing to 25 mg. Participants in the placebo group were randomly reassigned (1:1:1) in a double-blinded manner at week 26 to linagliptin 5 mg or one of the empagliflozin doses (10 mg or 25 mg). Investigators were masked throughout the trial and received assignments of blinded medication kits through interactive response technology for all participants at the initial randomisation and for the re-randomisations at weeks 14 and 26. The primary outcome was change from baseline in HbA1c at 26 weeks. For empagliflozin, results were based on a pooled analysis for all participants on empagliflozin. Safety was assessed until week 52. This trial is registered with ClinicalTrials.gov, NCT03429543. FINDINGS Between April 26, 2018, and May 26, 2022, of 262 screened participants, 158 (60%) were randomly assigned to treatment (53 [34%] to placebo, 52 [33%] to empagliflozin 10 mg, and 53 [34%] to linagliptin). For the primary outcome, the adjusted mean HbA1c change from baseline at week 26 was -0·84% [-9·2 mmol/mol] in the empagliflozin pooled group versus placebo (95% CI -1·50 to -0·19 [-16·4 to -2·1]; p=0·012); the corresponding change from baseline for linagliptin versus placebo was -0·34% [-3·8 mmol/mol; 95% CI -0·99 to 0·30 [-10·8 to 3·3]; p=0·29). Adverse events occurred in 34 (64%) participants in the placebo group, 40 (77%) in the empagliflozin pooled group, and 37 (71%) in the linagliptin group, up to week 26. Of these, severe adverse events were reported in two (4%) participants in the placebo group, one (2%) in the empagliflozin pooled group, and one (2%) in the linagliptin group. Hypoglycaemia was the most frequently reported adverse event with higher rates for those on active drug treatment compared with placebo. No severe hypoglycaemia cases were reported. INTERPRETATION Empagliflozin provided clinically relevant placebo-corrected reductions in HbA1c, whereas linagliptin did not, and might offer a new treatment option for young people with type 2 diabetes. FUNDING The Boehringer Ingelheim and Eli Lilly and Company Alliance.
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Affiliation(s)
- Lori M Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Thomas Danne
- Auf der Bult Kinder-und Jugendkrankenhaus, Hannover, Germany
| | | | | | - Steven Willi
- Perelman School of Medicine at the University of Pennsylvania and Children's Hospital of Philadelphia, PA, USA
| | | | | | - Jan Marquard
- Boehringer Ingelheim Pharmaceuticals, Ridgefield, CT, USA
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Wolf RM, Cheng P, Gal RL, Beaulieu LC, Kollman C, Isganaitis E, Magge S, Mastrandrea LD, Klingensmith GJ, Tamborlane W, Van Name M. Youth with type 2 diabetes have a high rate of treatment failure after discontinuation of insulin: A Pediatric Diabetes Consortium study. Pediatr Diabetes 2022; 23:439-446. [PMID: 35138021 DOI: 10.1111/pedi.13325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 01/17/2022] [Accepted: 02/01/2022] [Indexed: 12/01/2022] Open
Abstract
Insulin is commonly used to reverse gluco-toxicity in youth with newly diagnosed type 2 diabetes (T2D), but many are subsequently weaned off insulin. We analyzed Pediatric Diabetes Consortium (PDC) data to determine how long glycemic control is maintained after termination of initial insulin treatment. Youth with T2D who had previously been on insulin but were on either an intensive lifestyle intervention alone or metformin alone upon enrollment in the PDC T2D Registry were studied (N = 183). The primary outcome was time to treatment failure, defined by need to restart insulin or metformin or another diabetes medication. Data were analyzed using logistic regression to assess risk factors for treatment failure. Of the 183 participants studied (mean age 15 years, diabetes duration 1.7 years), 54% experienced treatment failure (median follow-up time 1.7 years). In the subgroup on metformin monotherapy (N = 140), 45% subsequently required restart of insulin. Moreover, of participants in the subgroup treated with an intensive lifestyle intervention alone (N = 43), 81% restarted insulin or were treated with metformin or other diabetes medication. In both groups, median time to treatment failure was 1.2 years. Higher HbA1c at enrollment was significantly associated with treatment failure (p < 0.001). Youth with T2D who are initially treated with insulin have a high rate of treatment failure when switched to intensive lifestyle alone or metformin alone. Our data highlight the severe and progressive nature of youth onset T2D, hence patients should be monitored closely for deteriorating glycemic control after being weaned off insulin.
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Affiliation(s)
- Risa M Wolf
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Peiyao Cheng
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida, USA
| | | | - Craig Kollman
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Elvira Isganaitis
- Joslin Diabetes Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Sheela Magge
- The Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Lucy D Mastrandrea
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA
| | - Georgeanna J Klingensmith
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado, USA
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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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Bacha F, Cheng P, Gal RL, Beaulieu LC, Kollman C, Adolph A, Shoemaker AH, Wolf R, Klingensmith GJ, Tamborlane WV. Racial and Ethnic Disparities in Comorbidities in Youth With Type 2 Diabetes in the Pediatric Diabetes Consortium (PDC). Diabetes Care 2021; 44:dc210143. [PMID: 34475033 DOI: 10.2337/dc21-0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 01/19/2021] [Accepted: 06/25/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND Type 2 diabetes in the U.S. is more prevalent in youth of minority racial-ethnic background, but disparities in health outcomes have not been examined in this population. RESEARCH DESIGN AND METHODS We examined racial-ethnic differences in the initial presentation and subsequent comorbidities in 1,217 youth with type 2 diabetes (63% girls) enrolled in the Pediatric Diabetes Consortium (PDC) Registry from February 2012 to June 2018. Demographic and clinical data were collected from medical records and participant self-report. RESULTS Overall, the mean age at presentation was 13.4 ± 2.4 years, and BMI was 35.0 ± 9.4 kg/m2. HbA1c was higher and C-peptide was lower in non-Hispanic Black (NHB) and Hispanic (H) youth compared with non-Hispanic White (NHW) youth. NHB were three times as likely to present in diabetic ketoacidosis (19%) versus NHW (6.3%) and H (7.5%), and NHB and H both had a worse HbA1c trajectory compared with NHW peers. Microalbuminuria was documented in 11%, hypertension in 34%, and dyslipidemia in 42% of Registry participants, with no significant difference among racial-ethnic groups. Nonalcoholic fatty liver disease (NAFLD) was diagnosed in 9% and 11% of H and NHW, respectively, versus 2% in NHB. CONCLUSIONS NHB and H youth with type 2 diabetes presented with worse metabolic control and had persistently worse HbA1c trajectories compared with NHW. Comorbidities exist in a large percentage of these youth independent of race-ethnicity, except for NAFLD being less prevalent in NHB. Greater efforts are needed to mitigate racial-ethnic disparities at diagnosis and in the management of youth with type 2 diabetes.
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Affiliation(s)
| | | | | | | | | | | | | | - Risa Wolf
- The Johns Hopkins Hospital, Baltimore, MD
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, CO
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Majidi S, Reid MW, Fogel J, Anderson B, Klingensmith GJ, Cain C, Berget C, Raymond JK. Psychosocial outcomes in young adolescents with type 1 diabetes participating in shared medical appointments. Pediatr Diabetes 2021; 22:787-795. [PMID: 33838078 DOI: 10.1111/pedi.13212] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [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: 08/10/2020] [Revised: 03/20/2021] [Accepted: 04/06/2021] [Indexed: 12/11/2022] Open
Abstract
For youth with type 1 diabetes (T1D), the early adolescent period is associated with worsening diabetes management and high rates of negative psychosocial issues, including depressive symptoms and family conflict. Alternative clinical models may help improve both diabetes and psychosocial outcomes. Our study aims to investigate whether Team Clinic, a shared medical appointment model developed specifically for adolescents with T1D, will improve psychosocial outcomes for middle school-aged youth. Youth with T1D, 11-13 years of age, and their caregivers, participated in a randomized controlled trial comparing Team Clinic to traditional clinic visits (control group). Diabetes characteristics were obtained at every visit. Participants and caregivers completed depression screening and family conflict questionnaires at baseline and end of study. Changes in mean scores on clinical and psychosocial outcomes from baseline to end of study were compared between groups using linear mixed-effects models. Eighty-six youth (51% female; 74% White; 10% Hispanic) completed at least one visit during the 12-month study period. At the end of the study, control group participants reported increases in Emotional Problems compared to Team Clinic participants, including higher levels of Negative Mood/Physical Symptoms (p = 0.02). Team Clinic participants reported reduced family conflict surrounding diabetes at study end, compared to control group participants (p = 0.03). Caregivers did not report change in depressive symptoms or family conflict during the study. Hemoglobin A1C levels did not change over time in either group. Participation in Team Clinic was associated with improved psychosocial outcomes in middle school-aged participants with T1D.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Mark W Reid
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Jennifer Fogel
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Barbara Anderson
- Baylor College of Medicine/Texas Children's Hospital, Houston, Texas, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Jennifer K Raymond
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
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Malik FS, Stafford JM, Reboussin BA, Klingensmith GJ, Dabelea D, Lawrence JM, Mayer-Davis E, Saydah S, Corathers S, Pihoker C. Receipt of recommended complications and comorbidities screening in youth and young adults with type 1 diabetes: Associations with metabolic status and satisfaction with care. Pediatr Diabetes 2020; 21:349-357. [PMID: 31797506 PMCID: PMC7597528 DOI: 10.1111/pedi.12948] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/17/2019] [Revised: 10/26/2019] [Accepted: 11/01/2019] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES This study sought to: (a) assess the prevalence of diabetes complications and comorbidities screening as recommended by the American Diabetes Association (ADA) for youth and young adults (YYAs) with type 1 diabetes (T1D), (b) examine the association of previously measured metabolic status related to diabetes complications with receipt of recommended clinical screening, and (c) examine the association of satisfaction with diabetes care with receipt of recommended clinical screening. METHODS The study included 2172 SEARCH for Diabetes in Youth participants with T1D (>10 years old, diabetes duration >5 years). Mean participant age was 17.7 ± 4.3 years with a diabetes duration of 8.1 ± 1.9 years. Linear and multinomial regression models were used to evaluate associations. RESULTS Sixty percent of participants reported having three or more hemoglobin A1c (HbA1c) measurements in the past year. In terms of diabetes complications screening, 93% reported having blood pressure measured, 81% having an eye examination, 71% having lipid levels checked, 64% having a foot exam, and 63% completing albuminuria screening in accordance with ADA recommendations. Youth known to have worse glycemic control in the past had higher odds of not meeting HbA1c screening criteria (OR 1.11, 95% CI = 1.05, 1.17); however, after adjusting for race/ethnicity, this was no longer statistically significant. Greater satisfaction with diabetes care was associated with increased odds of meeting screening criteria for most of the ADA-recommended measures. CONCLUSIONS Efforts should be made to improve diabetes complications screening efforts for YYAs with T1D, particularly for those at higher risk for diabetes complications.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Jeanette M. Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | | | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jean M. Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Elizabeth Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, NC
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Georgia
| | - Sarah Corathers
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
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Songer TJ, Haymond MW, Glazner JE, Klingensmith GJ, Laffel LM, Zhang P, Hirst K. Healthcare and associated costs related to type 2 diabetes in youth and adolescence: the TODAY clinical trial experience. Pediatr Diabetes 2019; 20:702-711. [PMID: 31119838 PMCID: PMC6690436 DOI: 10.1111/pedi.12869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 11/29/2018] [Revised: 04/22/2019] [Accepted: 05/21/2019] [Indexed: 12/16/2022] Open
Abstract
The economic issues related to medical treatments in youth with type 2 diabetes (T2D) are rarely reported and thus not fully understood. The Treatment Options for type 2 Diabetes in Adolescents and Youth clinical trial of youth recently diagnosed with T2D collected healthcare and related cost information from the largest cohort studied to date. Costs related to medical treatments and expenses faced by caregivers were identified over a 2-year period from 496 participants. Data were collected by surveys and diaries to document frequency of use of diabetes care (excluding study laboratory tests), non-diabetes care services and treatments, caregiver time, and expenses related to exercise and dietary activities recommended for patients. Economic costs were derived by applying national cost values to the reported utilization frequency data. Annual medical costs in the first year varied by the treatment group, averaging $1798 in those assigned to metformin alone (M), $2971 to combination drug therapy with metformin + rosiglitazone (M + R), and $2092 to metformin + an intensive lifestyle and behavior change program (M + L). Differences were primarily due to costs related to combination drug therapy. Adult caregiver support costs were higher for participants in the lifestyle program, which was delivered in weekly sessions in the first 6 months. Expenses for purchases to enhance diet and exercise change did not vary by treatment assignment. In year 2, medication costs increased in M and M + L due to the initiation of insulin in subjects who failed to maintain glycemic control on the assigned treatment. Data are reported for use by researchers and those providing healthcare to this vulnerable patient population.
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Affiliation(s)
- Thomas J. Songer
- University of Pittsburgh, Department of Epidemiology, Pittsburgh PA
USA 15261
| | - Morey W. Haymond
- Baylor College of Medicine, Children’s Nutrition Research
Center, Department of Pediatrics, Houston TX USA 77030
| | | | - Georgeanna J. Klingensmith
- University of Colorado, Department of Pediatrics, Barbara Davis
Center for Childhood Diabetes, Aurora CO USA 80045
| | - Lori M. Laffel
- Harvard Medical School, Joslin Diabetes Center, Adolescent and
Young Adult Section, Section on Clinical, Behavioral and Outcomes Research,
Boston MA USA 02215
| | - Ping Zhang
- Centers for Disease Control & Prevention, Division of Diabetes
Translation, Atlanta GA USA 30333
| | - Kathryn Hirst
- George Washington University Biostatistics Center, Rockville MD USA
20852
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Bakhach M, Reid MW, Pyatak EA, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes. Diabetes Educ 2019; 45:420-430. [PMID: 31244396 DOI: 10.1177/0145721719858080] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D). METHODS YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale. RESULTS Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes. CONCLUSION Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.
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Affiliation(s)
- Marwan Bakhach
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Mark W Reid
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - John Fred Thomas
- Department of Telehealth, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Epidemiology, School of Public Health, University of Colorado, Aurora, Colorado
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
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Pascual AB, Pyle L, Nieto J, Klingensmith GJ, Gonzalez AG. Novel, culturally sensitive, shared medical appointment model for Hispanic pediatric type 1 diabetes patients. Pediatr Diabetes 2019; 20:468-473. [PMID: 30938029 DOI: 10.1111/pedi.12852] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 09/20/2018] [Revised: 03/12/2019] [Accepted: 03/20/2019] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND/OBJECTIVE Latino patients with type 1 diabetes (T1D) face cultural and language barriers leading to poor outcomes. Shared medical appointments (SMAs) are recognized as effective models of care. Our aim is to develop a culturally sensitive, cost effective SMA program for Latino T1D. SUBJECTS Spanish speaking Latinos 1 to 20 years with T1D (n = 88) and their families. METHODS Routine care alternating with SMAs that included group education was provided. Teens, ages >11 received the SMA separate from parents. Younger children were seen together. Hemoglobin A1c (HbA1c), behavioral questionnaires, and use of diabetes technology were measured at baseline and every 3 to 6 months. RESULTS 57.7% of children and 77.27% of teens completed the 2 years of the Program. There was a significant association between age and change in HbA1c from baseline to year 1 (P = .001) and baseline to year 2 (P = <.0001). For participants <12 years, there was a significant improvement in HbA1c from baseline to year 1 (P = .0146) and from year 1 to year 2 (P = .0069). Participants ≥12 years, had an increase in HbA1c from year 1 to year 2 (P = .0082). Technology use increased significantly from baseline to year 2 for participants <12 years of age (19%-60%, P = .0455) and for participants who were ≥12 years of age (10%-23%, P = .0027). Participants reported a 98% satisfaction rate. CONCLUSIONS The culturally sensitive SMA proved to be an appreciated, feasible, and effective alternative to care for Latinos with T1D.
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Affiliation(s)
| | - Laura Pyle
- Barbara Davis Center, University of Colorado, Aurora, Colorado
| | - Jazmin Nieto
- Barbara Davis Center, University of Colorado, Aurora, Colorado
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10
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Tamborlane WV, Chang P, Kollman C, Klingensmith GJ, Ruedy K, Gal RL, Van Name M, Bacha F, Willi S, Beck RW. Eligibility for clinical trials is limited for youth with type 2 diabetes: Insights from the Pediatric Diabetes Consortium T2D Clinic Registry. Pediatr Diabetes 2018; 19:1379-1384. [PMID: 30175440 DOI: 10.1111/pedi.12763] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 04/06/2018] [Revised: 08/20/2018] [Accepted: 08/28/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND/OBJECTIVE Restrictive eligibility criteria have hampered enrollment into trials for new drugs for youth with type 2 diabetes (T2D). We utilized Pediatric Diabetes Consortium (PDC) T2D Registry enrollment data to estimate the percentage of patients who would be excluded from current T2D trials based on out-of-range HbA1c levels. We also examined whether well-controlled patients could be included because baseline HbA1c would rise during a 6 to 12-month study if assigned to control group. METHODS Clinical characteristics and HbA1c levels were collected from 956 T2D patients aged 10 to <18 years upon Registry enrollment. HbA1c levels were also analyzed in 6-month intervals during the first 30 months of T2D duration. RESULTS There was an approximately 2:1 ratio of females to males; the majority were obese and from economically disadvantaged minority families. On enrollment in the Registry, 53% of patients would be excluded from current trials because HbA1c levels were either <6.5% (<48 mmol/mol) (37%) or >10.5% (>91 mmol/mol) (16%). Furthermore, in patients with HbA1c levels <6.5% (<48 mmol/mol) and T2D duration between 6 and 30 months, mean HbA1c levels increased by 0.6% (6 mmol/mol) and 0.9% (10 mmol/mol) over the subsequent 6 and 12 months, respectively. CONCLUSIONS Eligibility criteria for current clinical trials still exclude a large proportion of pediatric T2D patients because of HbA1c levels. Including patients with HbA1c <6.5% (<48 mmol/mol) would enhance recruitment and allow comparisons of the investigational treatment with placebo-assigned subjects in whom HbA1c levels would on average increase during the 6 to 12 months of the trial.
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Affiliation(s)
| | | | | | - Georgeanna J Klingensmith
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, Colorado
| | | | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | - Michelle Van Name
- Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut
| | - Fida Bacha
- USDA/ARS Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas.,Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Steven Willi
- The Children's Hospital of Philadelphia, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida
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11
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Battelino T, Deeb LC, Ekelund M, Kinduryte O, Klingensmith GJ, Kocova M, Kovarenko M, Shehadeh N. Efficacy and safety of a fixed combination of insulin degludec/insulin aspart in children and adolescents with type 1 diabetes: A randomized trial. Pediatr Diabetes 2018; 19:1263-1270. [PMID: 30014589 DOI: 10.1111/pedi.12724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [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: 01/29/2018] [Revised: 05/30/2018] [Accepted: 07/10/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Insulin degludec/insulin aspart (IDegAsp) is a fixed soluble co-formulation of basal and bolus insulin. OBJECTIVE To evaluate efficacy and safety of IDegAsp in pediatric patients with type 1 diabetes (T1D). SUBJECTS Children and adolescents (aged 1 to <18 years) with T1D. METHODS A 16-week, phase 3b, treat-to-target, parallel-group, open-label, non-inferiority trial was conducted at 63 sites in 14 countries from October 2013 to November 2014. Patients were randomized 1:1 (age stratified: 1-<6 years; 6-<12 years; 12-<18 years) to IDegAsp once daily (OD) plus insulin aspart (IAsp) for remaining meals (IDegAsp + IAsp), or IDet OD or twice daily plus mealtime IAsp (IDet + IAsp). The primary end-point was HbA1c change from baseline at week 16. RESULTS A total of 362 participants were randomized to IDegAsp + IAsp (n = 182) or IDet + IAsp (n = 180). HbA1c decreased from baseline to week 16 by 0.3% in both groups (estimated treatment difference: -0.04%-points [-0.23; 0.15]95%CI (-0.45 mmol/mol [-2.51; 1.60]95%CI ), confirming non-inferiority. There were no significant differences between treatment groups in fasting or self-measured plasma glucose. Confirmed hypoglycemia rates did not significantly differ between groups. There was a significant reduction in basal and total insulin dose with IDegAsp + IAsp vs IDet + IAsp (post hoc analysis). Mean number of injections/day was 3.6 and 4.9 with IDegAsp + IAsp and IDet + IAsp, respectively (post hoc analysis). A non-significant higher rate of severe hypoglycemia was observed with IDegAsp + IAsp vs IDet + IAsp. The most frequent adverse events in both groups were hypoglycemia, headache, and nasopharyngitis. CONCLUSIONS IDegAsp + IAsp was non-inferior to IDet + IAsp regarding HbA1c, had similar hypoglycemia rates and required fewer injections.
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Affiliation(s)
- Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolism, UMC - University Children's Hospital, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Larry C Deeb
- Florida State University College of Medicine, Tallahassee, Florida
| | | | | | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Mirjana Kocova
- Department of Endocrinology & Genetics, University Pediatric Clinic- Skopje, Skopje, Republic of Macedonia
| | - Margarita Kovarenko
- Pediatric Department, Novosibirsk State Medical University of The Ministry of Healthcare of the Russian Federation, Novosibirsk, Russia
| | - Naim Shehadeh
- Rambam Health Care Campus, Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
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12
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Klingensmith GJ, Lanzinger S, Tamborlane WV, Hofer SE, Cheng P, de Beaufort C, Gal RL, Reinehr T, Kollman C, Holl RW. Adolescent type 2 diabetes: Comparing the Pediatric Diabetes Consortium and Germany/Austria/Luxemburg Pediatric Diabetes Prospective registries. Pediatr Diabetes 2018; 19:1156-1163. [PMID: 29923263 DOI: 10.1111/pedi.12712] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 01/29/2018] [Revised: 05/25/2018] [Accepted: 06/07/2018] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To examine and compare the clinical characteristics and treatment of youth with type 2 diabetes (T2D) in two registries: one in Europe and one in the United States. METHODS Youth with onset of T2D at 10 to 18 years of age with current age <20 years and an office visit after diabetes duration >1 year were identified in the European (Prospective Diabetes Follow-up, DPV) and the United States (Pediatric Diabetes Consortium, PDC) databases. Demographic, physical and clinical characteristics and treatment at diagnosis as well as physical characteristics, treatment, laboratory data, and diabetes adverse events at most recent visit were analyzed from both registries. RESULTS At diagnosis, the majority were female and obese; 70% of DPV vs 34% of PDC youth were diagnosed by targeted diabetes testing. PDC youth were younger, 12 vs 13 years (P < 0.001), had a greater body mass index-SDS, 3.07 vs 2.74 (P < 0.001), a higher hemoglobin A1c (HbA1c), 9.9% vs 7.1% (P < 0.001), were more likely to present in DKA, 7.5% vs 1.3% (P < 0.001) and more likely to be treated with insulin, 62% vs 32% (P < 0.001); insulin treatment difference was not significant when adjusted for HbA1c. At follow-up, DPV youth had shorter diabetes duration, 2.1 vs 3.2 years (P < 0.001), lower HbA1c, 6.5% vs 7.8% (P < 0.001), were less likely to be treated with insulin, 36% vs 56%, (P < 0.001), and were more likely to have dyslipidemia and hypertension than PDC youth. PDC youth had a higher rate of microalbuminuria. CONCLUSIONS Both DPV and PDC youth have multiple risks for diabetes complications. Understanding reasons for persistently higher HbA1c in PDC youth requires further study.
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Affiliation(s)
- Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado
| | - Stefanie Lanzinger
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Carine de Beaufort
- Division of Pediatric Endocrinology, Clinique Pediatrique de Luxembourg, Luxembourg City, Luxembourg
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida
| | - Thomas Reinehr
- Department of Pediatric Endocrinology, Diabetes, and Nutrition Medicine, Vestische Kinder- und Jugendklinik, University of Witten/Herdecke, Datteln, Germany
| | | | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
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13
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Bacha F, Cheng P, Gal RL, Kollman C, Tamborlane WV, Klingensmith GJ, Manseau K, Wood J, Beck RW. Initial Presentation of Type 2 Diabetes in Adolescents Predicts Durability of Successful Treatment with Metformin Monotherapy: Insights from the Pediatric Diabetes Consortium T2D Registry. Horm Res Paediatr 2018; 89:47-55. [PMID: 29131017 DOI: 10.1159/000481687] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 04/21/2017] [Accepted: 09/21/2017] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND/AIMS Many adolescents with type 2 diabetes (T2D) have rapid deterioration of glycemic control on metformin monotherapy within 2 years of diagnosis. METHODS Enrollment data from the Pediatric Diabetes Consortium T2D Registry were used to categorize 276 youth with a T2D duration ≥2 years into two groups: (1) participants with HbA1c <7.5% on metformin monotherapy (group 1, n = 75) and (2) participants treated with insulin ± metformin (group 2, n = 201). The characteristics of the groups were compared. RESULTS At enrollment, groups 1 and 2 did not differ in age (16.2 vs. 16.8 years) or BMI percentile (99 vs. 98%); group 2 had higher HbA1c (9.9% [85 mmol/mol] vs. 5.9% [41 mmol/mol], p < 0.001). Lower HbA1c and metformin monotherapy at diagnosis were associated with a greater likelihood of adequate control with metformin alone (p < 0.001). In multivariable analysis, HbA1c at diagnosis (p = 0.001) and diabetes duration (p = 0.009) were associated with adequate control on metformin. The HbA1c trajectory after diagnosis was worse in group 2. CONCLUSION Durable metabolic control of T2D with metformin monotherapy is most likely in youth presenting with lower HbA1c and with shorter diabetes duration, independent of age, race-ethnicity, and BMI. Elevated HbA1c levels in those on insulin therapy highlight the importance of early diagnosis and a better understanding of glycemic control barriers.
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Affiliation(s)
- Fida Bacha
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Peiyao Cheng
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - William V Tamborlane
- Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Katherine Manseau
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Jamie Wood
- University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, Florida, USA
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14
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McClain MR, Klingensmith GJ, Anderson B, Berget C, Cain C, Shea J, Campbell K, Pyle L, Raymond JK. Team Clinic: Group Approach to Care of Early Adolescents With Type 1 Diabetes. Diabetes Spectr 2018; 31:273-278. [PMID: 30140144 PMCID: PMC6092886 DOI: 10.2337/ds17-0063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Georgeanna J. Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Barbara Anderson
- Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Jacqueline Shea
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, CO
| | - Kristen Campbell
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
| | - Laura Pyle
- Department of Pediatrics, School of Medicine, University of Colorado, Aurora, CO
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado, Aurora, CO
| | - Jennifer K. Raymond
- Los Angeles Children’s Hospital, University of Southern California, Keck School of Medicine, Los Angeles, CA
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15
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Redondo MJ, Libman I, Cheng P, Kollman C, Tosur M, Gal RL, Bacha F, Klingensmith GJ, Clements M. Response to Comment on Redondo et al. Racial/Ethnic Minority Youth With Recent-Onset Type 1 Diabetes Have Poor Prognostic Factors. Diabetes Care 2018;41:1017-1024. Diabetes Care 2018; 41:e125-e126. [PMID: 29934487 DOI: 10.2337/dci18-0017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
| | - Ingrid Libman
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Fida Bacha
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Mark Clements
- Children's Mercy Kansas City, Kansas City, MO.,University of Missouri-Kansas City, Kansas City, MO
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16
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Redondo MJ, Libman I, Cheng P, Kollman C, Tosur M, Gal RL, Bacha F, Klingensmith GJ, Clements M. Racial/Ethnic Minority Youth With Recent-Onset Type 1 Diabetes Have Poor Prognostic Factors. Diabetes Care 2018; 41:1017-1024. [PMID: 29496742 DOI: 10.2337/dc17-2335] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [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: 11/07/2017] [Accepted: 02/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare races/ethnicities for characteristics, at type 1 diabetes diagnosis and during the first 3 years postdiagnosis, known to influence long-term health outcomes. RESEARCH DESIGN AND METHODS We analyzed 927 Pediatric Diabetes Consortium (PDC) participants <19 years old (631 non-Hispanic white [NHW], 216 Hispanic, and 80 African American [AA]) diagnosed with type 1 diabetes and followed for a median of 3.0 years (interquartile range 2.2-3.6). Demographic and clinical data were collected from medical records and patient/parent interviews. Partial remission period or "honeymoon" was defined as insulin dose-adjusted hemoglobin A1c (IDAA1c) ≤9.0%. We used logistic, linear, and multinomial regression models, as well as repeated-measures logistic and linear regression models. Models were adjusted for known confounders. RESULTS AA subjects, compared with NHW, at diagnosis, were in a higher age- and sex-adjusted BMI percentile (BMI%), had more advanced pubertal development, and had higher frequency of presentation in diabetic ketoacidosis, largely explained by socioeconomic factors. During the first 3 years, AA subjects were more likely to have hypertension and severe hypoglycemia events; had trajectories with higher hemoglobin A1c, BMI%, insulin doses, and IDAA1c; and were less likely to enter the partial remission period. Hispanics, compared with NHWs, had higher BMI% at diagnosis and over the three subsequent years. During the 3 years postdiagnosis, Hispanics had higher prevalence of dyslipidemia and maintained trajectories of higher insulin doses and IDAA1c. CONCLUSIONS Youth of minority race/ethnicity have increased markers of poor prognosis of type 1 diabetes at diagnosis and 3 years postdiagnosis, possibly contributing to higher risk of long-term diabetes complications compared with NHWs.
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Affiliation(s)
| | - Ingrid Libman
- Division of Pediatric Endocrinology and Diabetes, Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Pittsburgh, PA
| | | | | | - Mustafa Tosur
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | | | - Fida Bacha
- Baylor College of Medicine, Texas Children's Hospital, Houston, TX
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Mark Clements
- Children's Mercy Kansas City, Kansas City, MO.,University of Missouri-Kansas City, Kansas City, MO
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17
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Reid MW, Krishnan S, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. CoYoT1 Clinic: Home Telemedicine Increases Young Adult Engagement in Diabetes Care. Diabetes Technol Ther 2018; 20:370-379. [PMID: 29672162 DOI: 10.1089/dia.2017.0450] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) experience poor glycemic control, disengagement in care, and are often lost to the medical system well into their adult years. Diabetes providers need a new approach to working with the population. The goal of this study was to determine whether an innovative shared telemedicine appointment care model (CoYoT1 Clinic [pronounced as "coyote"; Colorado Young Adults with T1D]) for young adults with T1D improves care engagement, satisfaction, and adherence to American Diabetes Association (ADA) guidelines regarding appointment frequency. SUBJECTS AND METHODS CoYoT1 Clinic was designed to meet the diabetes care needs of young adults (18-25 years of age) with T1D through home telemedicine. Visits occurred every 3 months over the 1-year study (three times by home telemedicine and one time in-person). Outcomes were compared to patients receiving treatment as usual (control). RESULTS Compared with controls, CoYoT1 patients attended significantly more clinic visits (P < 0.0001) and increased their number of clinic visits from the year before the intervention. Seventy-four percent of CoYoT1 patients were seen four times over the 12-month study period, meeting ADA guidelines, but none in the control group met the ADA recommendation. CoYoT1 patients used diabetes technologies more frequently and reported greater satisfaction with care compared with controls. CONCLUSIONS Delivering diabetes care by home telemedicine increases young adults' adherence to ADA guidelines and usage of diabetes technologies, and improves retention in care when compared to controls. Home telemedicine may keep young adults engaged in their diabetes care during this challenging transition period.
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Affiliation(s)
- Mark W Reid
- 1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Subramanian Krishnan
- 1 Department of Surgery, Division of Ophthalmology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
| | - Cari Berget
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - Cindy Cain
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - John Fred Thomas
- 3 Department of Telehealth, School of Medicine, University of Colorado , Aurora, Colorado
- 4 Department of Psychiatry, School of Medicine, University of Colorado , Aurora, Colorado
- 5 Department of Epidemiology, School of Public Health, University of Colorado , Aurora, Colorado
| | - Georgeanna J Klingensmith
- 2 Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado , Aurora, Colorado
| | - Jennifer K Raymond
- 6 Department of Pediatrics, Division of Endocrinology, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California , Los Angeles, California
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18
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Shoemaker A, Cheng P, Gal RL, Kollman C, Tamborlane WV, Klingensmith GJ, Clements MA, Hannon TS, Heptulla R, Less J, Wood J. Predictors of Loss to Follow-Up among Children with Type 2 Diabetes. Horm Res Paediatr 2018; 87:377-384. [PMID: 28505610 DOI: 10.1159/000475595] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 01/20/2017] [Accepted: 04/10/2017] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Youth with type 2 diabetes (T2D) have poor compliance with medical care. This study aimed to determine which demographic and clinical factors differ between youth with T2D who receive care in a pediatric diabetes center versus youth lost to follow-up for >18 months. METHODS Data were analyzed from 496 subjects in the Pe-diatric Diabetes Consortium registry. Enrollment variables were selected a priori and analyzed with univariable and multivariable logistic regression models. RESULTS After a median of 1.3 years from enrollment, 55% of patients were lost to follow-up. The final model included age, race/ethnicity, parent education, and estimated distance to study site. The odds ratio (99% confidence interval) of loss to follow-up was 2.87 (1.34, 6.16) for those aged 15 to <18 years versus those aged 10 to <13 years and 6.57 (2.67, 16.15) for those aged ≥18 years versus those aged 10 to <13 years. Among patients living more than 50 miles from the clinic, the odds ra tio of loss to follow-up was 3.11 (1.14, 8.49) versus those living within 5 miles of the site. CONCLUSION Older adolescents with T2D are more likely to be lost to follow-up, but other socioeconomic factors were not significant predictors of clinic follow-up.
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Affiliation(s)
- Ashley Shoemaker
- Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Peiyao Cheng
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Robin L Gal
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - William V Tamborlane
- Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | | | - Tamara S Hannon
- Indiana University School of Medicine, Indianapolis, Indiana, USA
| | | | - Joane Less
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Jamie Wood
- University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
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- Vanderbilt University School of Medicine, Nashville, Tennessee, USA.,Jaeb Center for Health Research, Tampa, Florida, USA.,Department of Pediatric Endocrinology, Yale University, New Haven, Connecticut, USA.,Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, Colorado, USA.,Children's Mercy Kansas City, Kansas City, Missouri, USA.,Indiana University School of Medicine, Indianapolis, Indiana, USA.,Albert Einstein College of Medicine, Bronx, New York, USA.,University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA.,University Hospital Cleveland Medical Center, Cleveland, Ohio, USA
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19
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Berget C, Lindwall J, Shea JJ, Klingensmith GJ, Anderson BJ, Cain C, Raymond JK. Team Clinic: An Innovative Group Care Model for Youth with Type 1 Diabetes-Engaging Patients and Meeting Educational Needs. J Nurse Pract 2017; 13:e269-e272. [PMID: 28993721 DOI: 10.1016/j.nurpra.2017.03.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The purpose of this pilot was to implement an innovative group care model, "Team Clinic", for adolescents with type 1 diabetes and assess patient and provider perspectives. Ninety-one intervention patients and 87 controls were enrolled. Ninety-six percent of intervention adolescents endorsed increased support and perceived connecting with peers as important. The medical providers and staff also provided positive feedback stating Team Clinic allowed more creativity in education and higher quality of care. Team Clinic may be a promising model to engage adolescents and incorporate education and support into clinic visits in a format valued by patients and providers.
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Affiliation(s)
- Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Jennifer Lindwall
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Jacqueline J Shea
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Barbara J Anderson
- Baylor College of Medicine/Texas Children's Hospital, Professor of Pediatrics, Associate Head Psychology Section, 1 Baylor Plaza, Houston, TX, 77030
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
| | - Jennifer K Raymond
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Department of Pediatrics, 1775 Aurora Court, Aurora, CO, 80045
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20
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Klingensmith GJ, Connor CG, Ruedy KJ, Beck RW, Kollman C, Haro H, Wood JR, Lee JM, Willi SM, Cengiz E, Tamborlane WV. Presentation of youth with type 2 diabetes in the Pediatric Diabetes Consortium. Pediatr Diabetes 2016; 17:266-73. [PMID: 25951940 DOI: 10.1111/pedi.12281] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [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] [Received: 09/16/2014] [Revised: 04/06/2015] [Accepted: 04/07/2015] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE Type 2 diabetes (T2D) in youth is recognized as a pediatric disease, but few reports describe the characteristics during diagnosis. We describe the clinical presentation of 503 youth with T2D. METHODS The Pediatric Diabetes Consortium (PDC) T2D Clinic Registry enrolled T2D participants from eight pediatric diabetes centers in the USA. Clinical and laboratory characteristics at the time of diagnosis were analyzed. RESULTS In total 67% presented with symptoms of diabetes and confirming laboratory data, but 33% were identified by testing at risk children, 11% presented with diabetic ketoacidosis (DKA), and 2% with hyperglycemic hyperosmolar state (HHS). The mean age was 13.1 ± 2.3 yr (range, 4.6-19.8 yr) with 38 (8%) less than 10 yr of age at diagnosis. The majority was female (65%), Hispanic (54%) and had a family history of T2D (92%). The median body mass index (BMI) z-score was 2.3 (interquartile range 2.0-2.6). Fewer than half (46%) lived with both parents, only 30% had parents with education beyond high school, and 43% lived in a household with an income of <$25 000 per year. In the initial month after diagnosis, almost all (92%) were treated with insulin (30%), metformin (31%), or a combination of insulin and metformin (32%); 7% were treated with lifestyle modification alone. CONCLUSIONS The demographics of T2D in youth indicate significant social vulnerability which may affect outcomes. Metformin and insulin were the initial treatment in most youth. Importantly, T2D may occur at younger ages than previously thought and should be considered in all high-risk children presenting with diabetes.
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Affiliation(s)
- Georgeanna J Klingensmith
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
| | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Heidi Haro
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
| | - Jamie R Wood
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Joyce M Lee
- Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, USA
| | - Steven M Willi
- Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Eda Cengiz
- Pediatric Endocrinology, Yale University, New Haven, CT, USA
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Gregg B, Connor CG, Cheng P, Ruedy KJ, Beck RW, Kollman C, Schatz D, Cengiz E, Tamborlane WV, Klingensmith GJ, Lee JM. C-peptide levels in pediatric type 2 diabetes in the Pediatric Diabetes Consortium T2D Clinic Registry. Pediatr Diabetes 2016; 17:274-80. [PMID: 25940861 DOI: 10.1111/pedi.12280] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [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: 01/16/2015] [Revised: 03/25/2015] [Accepted: 04/07/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe C-peptide levels in a large cohort of children with type 2 diabetes T2D and examine associations with demographic and clinical factors. METHODS The Pediatric Diabetes Consortium (PDC) T2D Registry has collected clinical and biologic data from youth with T2D cared for at eight US Pediatric Diabetes Centers. In this study, we assessed C-peptide levels in 331 youth with T2D (mean age, 16.1 ± 2.5 yr; median T2D duration, 2.4 yr). RESULTS Median (interquartile range) for 90 fasted C-peptide measurements was 3.5 ng/mL (2.3-4.8 ng/mL) [1.2 nmol/L (0.8-1.6 nmol/L)] and for 241 random non-fasted C-peptide measurements were 4.2 ng/mL (2.6-7.0 ng/mL) [1.4 nmol/L (0.9-2.3 nmol/L)]. C-peptide levels were lower with insulin therapy (p < 0.001), lower body mass index (p < 0.001), hemoglobin A1c (HbA1c) ≥9% (p < 0.001), and T2D duration ≥ 6 yr (p = 0.04). Among those with duration ≥6 yr being treated with insulin and with a HbA1c level ≥9.0% (75 mmol/L), 75% of the fasted and 80% of the non-fasted C-peptide values were above 0.2 nmol/L. CONCLUSIONS In youth with T2D, a decline in C-peptide is associated with deterioration of metabolic control and the need for insulin treatment. C-peptide levels decrease over time. However, even insulin-treated patients with 6 or more years of T2D and elevated HbA1c levels retain substantial endogenous insulin secretion.
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Affiliation(s)
- Brigid Gregg
- Department of Pediatric Endocrinology, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL, USA
| | | | - Desmond Schatz
- Pediatric Endocrinology, University of Florida, Gainesville, FL, USA
| | - Eda Cengiz
- Pediatric Endocrinology, Yale University, New Haven, CT, USA
| | | | - Georgeanna J Klingensmith
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA
| | - Joyce M Lee
- Department of Pediatric Endocrinology, Mott Children's Hospital, University of Michigan, Ann Arbor, MI, USA.,Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, USA
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22
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Simmons K, McFann K, Taki I, Liu E, Klingensmith GJ, Rewers MJ, Frohnert BI. Reduced Bone Mineral Density Is Associated with Celiac Disease Autoimmunity in Children with Type 1 Diabetes. J Pediatr 2016; 169:44-8.e1. [PMID: 26561381 PMCID: PMC4849876 DOI: 10.1016/j.jpeds.2015.10.024] [Citation(s) in RCA: 18] [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] [Received: 06/12/2015] [Revised: 08/24/2015] [Accepted: 10/07/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To evaluate the association between bone mineral density (BMD), glycemic control (hemoglobin A1c [HbA1c]), and celiac autoimmunity in children with type 1 diabetes mellitus (T1D) and in an appropriate control population. STUDY DESIGN BMD was assessed cross-sectionally in 252 children with T1D (123 positive for anti-tissue transglutaminase antibody [tTGA] and 129 matched children who were negative for tTGA). In addition, BMD was assessed in 141 children without diabetes who carried T1D-associated HLD-DR, DQ genotypes (71 positive for tTGA and 70 negative). RESULTS Children with T1D who were positive for tTGA had significantly worse BMD L1-L4 z-score compared with children with T1D who were negative for tTGA (-0.45 ± 1.22 vs 0.09 ± 1.10, P = .0003). No differences in growth measures, urine N-telopeptides, 25-hydroxyvitamin D, ferritin, thyroid stimulating hormone, or HbA1c were found. However, both higher HbA1c (β = -1.25 ± 0.85, P = .0016) and tTGA (β = -0.13 ± 0.05, P = .0056) were significant and independent predictors of lower BMD in multivariate analyses. No differences in BMD or other variables measured were found between children without diabetes who were positive vs negative for tTGA. CONCLUSIONS The results suggest a synergistic effect of hyperglycemia and celiac autoimmunity on low BMD.
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Affiliation(s)
- Kimber Simmons
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA, 80045
| | - Kim McFann
- Colorado School of Public Health, University of Colorado, Aurora, CO, USA, 80045
| | - Iman Taki
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA, 80045
| | - Edwin Liu
- Department of Pediatrics, University of Colorado, Aurora, CO, USA, 80045
| | | | - Marian J. Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA, 80045
| | - Brigitte I. Frohnert
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO, USA, 80045
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Klingensmith GJ, Pyle L, Nadeau KJ, Barbour LA, Goland RS, Willi SM, Linder B, White NH. Pregnancy Outcomes in Youth With Type 2 Diabetes: The TODAY Study Experience. Diabetes Care 2016; 39:122-9. [PMID: 26628417 PMCID: PMC4686849 DOI: 10.2337/dc15-1206] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [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] [Received: 06/05/2015] [Accepted: 09/21/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We evaluated pregnancy outcomes, maternal and fetal/neonatal, during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. RESEARCH DESIGN AND METHODS The TODAY study was a randomized controlled trial comparing three treatment options for youth with type 2 diabetes. Informed consent included the requirement for contraception, including abstinence; this was reinforced at each visit. Following informed consent, self-reported data related to the mother's prenatal care and delivery and the infant's health were retrospectively collected. When permitted, maternal medical records and infant birth records were reviewed. RESULTS Of the 452 enrolled female participants, 46 (10.2%) had 63 pregnancies. Despite continued emphasis on adequate contraception, only 4.8% of the pregnant participants reported using contraception prior to pregnancy. The mean age at first pregnancy was 18.4 years; the mean diabetes duration was 3.17 years. Seven pregnancies were electively terminated; three pregnancies had no data reported. Of the remaining 53 pregnancies, 5 (9.4%) resulted in early pregnancy loss, and 7 (13%) resulted in loss with inadequate pregnancy duration data. Two pregnancies ended in stillbirth, at 27 and 37 weeks, and 39 ended with a live-born infant. Of the live-born infants, six (15.4%) were preterm and eight (20.5%) had a major congenital anomaly. CONCLUSIONS Despite diabetes-specific information recommending birth control and the avoidance of pregnancy, 10% of the study participants became pregnant. Pregnancies in youth with type 2 diabetes may be especially prone to result in congenital anomalies. Reasons for the high rate of congenital anomalies are uncertain, but may include poor metabolic control and extreme obesity.
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Affiliation(s)
- Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes and Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Laura Pyle
- The Biostatistics Center, George Washington University, Rockville, MD
| | - Kristen J Nadeau
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO
| | - Linda A Barbour
- Department of Medicine, Division of Endocrinology, and Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Colorado School of Medicine, Aurora, CO
| | - Robin S Goland
- Naomi Berrie Diabetes Center, Columbia University, New York, NY
| | - Steven M Willi
- Department of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Barbara Linder
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD
| | - Neil H White
- Division of Endocrinology & Diabetes, Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
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24
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Driscoll KA, Volkening LK, Haro H, Ocean G, Wang Y, Jackson CC, Clougherty M, Hale DE, Klingensmith GJ, Laffel L, Deeb LC, Siminerio LM. Are children with type 1 diabetes safe at school? Examining parent perceptions. Pediatr Diabetes 2015; 16:613-20. [PMID: 25266418 DOI: 10.1111/pedi.12204] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [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: 05/21/2014] [Revised: 07/02/2014] [Accepted: 07/25/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To describe parent perceptions of children's diabetes care at school including: availability of licensed health professionals; staff training; logistics of provision of care; and occurrence and treatment of hypo- and hyperglycemia; and to examine parents' perceptions of their children's safety and satisfaction in the school environment. RESEARCH DESIGN AND METHODS A survey was completed by parents of children with type 1 diabetes from permissive (trained, non-medical school personnel permitted to provide diabetes care; N = 237) and non-permissive (only licensed health care professionals permitted to provide diabetes care; N = 198) states. RESULTS Most parents reported that schools had nurses available for the school day; teachers and coaches should be trained; nurses, children, and parents frequently provided diabetes care; and hypo- and hyperglycemia occurred often. Parents in permissive states perceived children to be as safe and were as satisfied with care as parents in non-permissive states. CONCLUSIONS Training non-medical staff will probably maximize safety of children with diabetes when a school nurse is not available.
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Affiliation(s)
- Kimberly A Driscoll
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Lisa K Volkening
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - Heidi Haro
- Barbara Davis Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CL, USA
| | - Gesnyr Ocean
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Yuxia Wang
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | | | - Marilyn Clougherty
- Children's Hospital of Pittsburgh, Pediatric Endocrinology, Pittsburgh, PA, USA
| | - Daniel E Hale
- Department of Pediatrics, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center, Department of Pediatrics, University of Colorado School of Medicine, Aurora, CL, USA
| | - Lori Laffel
- Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - Larry C Deeb
- Department of Behavioral Sciences and Social Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Linda M Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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25
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Silverstein J, Cheng P, Ruedy KJ, Kollman C, Beck RW, Klingensmith GJ, Wood JR, Willi S, Bacha F, Lee J, Cengiz E, Redondo MJ, Tamborlane WV. Depressive Symptoms in Youth With Type 1 or Type 2 Diabetes: Results of the Pediatric Diabetes Consortium Screening Assessment of Depression in Diabetes Study. Diabetes Care 2015; 38:2341-3. [PMID: 26459274 DOI: 10.2337/dc15-0982] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [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: 05/08/2015] [Accepted: 09/09/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the frequency of depressive symptoms and the diagnosis and management of depression in youth with type 1 diabetes (T1D) and type 2 diabetes (T2D) enrolled in the Pediatric Diabetes Consortium T1D and T2D registries. RESEARCH DESIGN AND METHODS The Children's Depression Inventory (CDI) 2 Self-Report (Short) version was completed by 261 T1D and 339 T2D youth aged 10-17 years. RESULTS Symptoms of depression were identified in 13% of T1D and 22% of T2D (P = 0.007) participants; of these, only 4% of T1D and 9% of T2D youth were treated by a therapist within the prior 12 months. Depressive symptoms were associated with lower family income (P = 0.006) and obesity (P = 0.002) in T1D but not T2D youth. CONCLUSIONS Depressive symptoms are more frequent than diagnosed depression in youth with T1D or T2D. These results underscore the need for regular depression screening and appropriate referral for youth with diabetes.
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Affiliation(s)
| | | | | | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics, University of Colorado, Aurora, CO
| | - Jamie R Wood
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA
| | - Steven Willi
- Children's Hospital of Philadelphia, Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Fida Bacha
- U.S. Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
| | - Joyce Lee
- Department of Pediatric Endocrinology, Mott Children's Hospital, University of Michigan, Ann Arbor, MI
| | - Eda Cengiz
- Pediatric Endocrinology, Yale University, New Haven, CT
| | - Maria J Redondo
- Pediatric Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX
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Affiliation(s)
- Georgeanna J Klingensmith
- University of Colorado School of Medicine, Barbara Davis Center for Childhood Diabetes , and Children's Hospital Colorado, Aurora, Colorado
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27
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Affiliation(s)
- Arleta Rewers
- Department of Pediatrics, University of Colorado School of Medicine, Aurora
| | - Fran Dong
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Denver
| | - Robert H Slover
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Denver
| | | | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Denver
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28
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Willi SM, Miller KM, DiMeglio LA, Klingensmith GJ, Simmons JH, Tamborlane WV, Nadeau KJ, Kittelsrud JM, Huckfeldt P, Beck RW, Lipman TH. Racial-ethnic disparities in management and outcomes among children with type 1 diabetes. Pediatrics 2015; 135:424-34. [PMID: 25687140 PMCID: PMC4533245 DOI: 10.1542/peds.2014-1774] [Citation(s) in RCA: 258] [Impact Index Per Article: 28.7] [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: 12/29/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Previous research has documented racial/ethnic disparities in diabetes treatments and outcomes. It remains controversial whether these disparities result from differences in socioeconomic status (SES) or other factors. We examined racial/ethnic disparities in therapeutic modalities and diabetes outcomes among the large number of pediatric participants in the T1D Exchange Clinic Registry. METHODS The cohort included 10 704 participants aged <18 years with type 1 diabetes for ≥1 year (48% female; mean age: 11.9 ± 3.6 years; diabetes duration: 5.2 ± 3.5 years). Diabetes management and clinical outcomes were compared among 8841 non-Hispanic white (white) (83%), 697 non-Hispanic black (black) (7%), and 1166 Hispanic (11%) participants. The population included 214 high-income black and Hispanic families. RESULTS Insulin pump use was higher in white participants than in black or Hispanic participants (61% vs 26% and 39%, respectively) after adjusting for gender, age, diabetes duration, and SES (P < .001). Mean hemoglobin A1c was higher (adjusted P < .001) in black participants than in white or Hispanic participants (9.6%, 8.4%, and 8.7%). More black participants experienced diabetic ketoacidosis and severe hypoglycemic events in the previous year than white or Hispanic participants (both, P < .001). There were no significant differences in hemoglobin A1c, diabetic ketoacidosis, or severe hypoglycemia between white and Hispanic participants after adjustment for SES. CONCLUSIONS Even after SES adjustment, marked disparities in insulin treatment method and treatment outcomes existed between black versus Hispanic and white children within this large pediatric cohort. Barriers to insulin pump use and optimal glycemic control beyond SES should be explored in all ethnic groups.
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Affiliation(s)
- Steven M. Willi
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | | | | | - Kristen J. Nadeau
- University of Colorado Denver and Children’s Hospital Colorado, Denver, Colorado
| | - Julie M. Kittelsrud
- Avera McKennan Hospital and University Health Center, Sioux Falls, South Dakota; and
| | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, Florida
| | - Terri H. Lipman
- Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
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Steck AK, Dong F, Taki I, Hoffman M, Klingensmith GJ, Rewers MJ. Response to comment on Steck et al. Early hyperglycemia detected by continuous glucose monitoring in children at risk for type 1 diabetes. Diabetes care 2014;37:2031-2033. Diabetes Care 2015; 38:e48. [PMID: 25715429 DOI: 10.2337/dc14-2876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Fran Dong
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Iman Taki
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Michelle Hoffman
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | | | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
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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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Steck AK, Dong F, Taki I, Hoffman M, Klingensmith GJ, Rewers MJ. Early hyperglycemia detected by continuous glucose monitoring in children at risk for type 1 diabetes. Diabetes Care 2014; 37:2031-3. [PMID: 24784826 PMCID: PMC4067399 DOI: 10.2337/dc13-2965] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We explore continuous glucose monitoring (CGM) as a new approach to defining early hyperglycemia and diagnosing type 1 diabetes in children with positive islet autoantibodies (Ab+). RESEARCH DESIGN AND METHODS Fourteen Ab+ children, free of signs or symptoms of diabetes, and nine antibody-negative (Ab-) subjects, followed by the Diabetes Autoimmunity Study in the Young, were asked to wear a Dexcom SEVEN CGM. RESULTS The Ab+ subjects showed more hyperglycemia, with 18% time spent above 140 mg/dL, compared with 9% in Ab- subjects (P = 0.04). Their average maximum daytime glucose value was higher, and they had increased glycemic variability. The mean HbA1c in the Ab+ subjects was 5.5% (37 mmol/mol). Among Ab+ subjects, ≥18-20% CGM time spent above 140 mg/dL seems to predict progression to diabetes. CONCLUSIONS CGM can detect early hyperglycemia in Ab+ children who are at high risk for progression to diabetes. Proposed CGM predictors of progression to diabetes require further validation.
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Affiliation(s)
- Andrea K Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Fran Dong
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Iman Taki
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Michelle Hoffman
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | | | - Marian J Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
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Cengiz E, Connor CG, Ruedy KJ, Beck RW, Kollman C, Klingensmith GJ, Tamborlane WV, Lee JM, Haller MJ. Pediatric diabetes consortium T1D New Onset (NeOn) study: clinical outcomes during the first year following diagnosis. Pediatr Diabetes 2014; 15:287-93. [PMID: 23944865 PMCID: PMC3844085 DOI: 10.1111/pedi.12068] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 03/01/2013] [Revised: 06/27/2013] [Accepted: 06/28/2013] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE There have been few prospective, multicenter studies investigating the natural history of type 1 diabetes (T1D) from the time of diagnosis. The objective of this report from the Pediatric Diabetes Consortium (PDC) T1D New Onset (NeOn) study was to assess the natural history and clinical outcomes in children during the first year after diagnosis of T1D. RESEARCH DESIGN AND METHODS Clinical measures from the first year following diagnosis were analyzed for 857 participants (mean age 9.1 yr, 51% female, 66% non-Hispanic White) not participating in an intervention study who had a HbA1c result at 12 months. RESULTS Mean HbA1c ± SD was 102 ± 25 mmol/mol (11.4 ± 2.3%) at diagnosis, 55 ± 12 mmol/mol (7.2 ± 1.1%) at 3 months, 56 ± 15 mmol/mol (7.3 ± 1.3%) at 6 months and 62 ± 16 mmol/mol (7.8 ± 1.5%) at 12 months from diagnosis. A severe hypoglycemic (SH) event occurred in 31 (4%) participants (44 events, 5.2 events per 100 person-years). Diabetic ketoacidosis (DKA) not including diagnosis occurred in 10 (1%) participants (13 events, 1.5 events per 100 person-years). CONCLUSIONS After onset of T1D, mean HbA1c reaches its nadir at 3-6 months with a gradual increase through 12 months. SH and DKA are uncommon but still occur during the first year with T1D. Data from large cohorts, such as the PDC T1D NeOn study, provide important insights into the course of T1D during the first year following diagnosis, which will help to inform the development of models to target future interventions.
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Affiliation(s)
- Eda Cengiz
- Yale University, Pediatric Endocrinology, New Haven, CT, US, 06520
| | | | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, FL, US, 33647
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, FL, US, 33647
| | - Georgeanna J. Klingensmith
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Department of Pediatrics, Aurora, CO, US, 80045
| | | | - Joyce M. Lee
- Department of Pediatric Endocrinology, Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, US, 48109,Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, US, 48109
| | - Michael J. Haller
- University of Florida, Pediatric Endocrinology, Gainesville, FL, US, 32605
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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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Majidi S, Wadwa RP, Bishop FK, Klingensmith GJ, Rewers M, McFann K, Maahs DM. The effect of insurance status and parental education on glycemic control and cardiovascular disease risk profile in youth with Type 1 Diabetes. J Diabetes Metab Disord 2014; 13:59. [PMID: 24955334 PMCID: PMC4064822 DOI: 10.1186/2251-6581-13-59] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 05/03/2014] [Indexed: 01/22/2023]
Abstract
BACKGROUND Adult studies have shown a correlation between low socioeconomic status and Type 1 Diabetes complications, but studies have not been done in children to examine the effect of socioeconomic status on risk for future complications. This study investigates the relationship between insurance status and parental education and both glycemic control and cardiovascular disease (CVD) risk factors in youth with type 1 diabetes. METHODS A cross-sectional study of 295 youth with established type 1 diabetes who underwent examination with fasting blood draw and reported insurance status and parental education. RESULTS Youth with type 1 diabetes and public insurance had higher hemoglobin A1c (HbA1c), body mass index, hs-CRP, and blood pressure (p < 0.05) than those with private insurance. Insulin regimen varied between insurance groups, and differences in HbA1c and CVD risk factors, except for diastolic blood pressure (DBP), were no longer evident after controlling for insulin regimen. Parental education was not associated with HbA1c or CVD risk factors. CONCLUSIONS Youth with type 1 diabetes and public insurance have worse glycemic control and elevated CVD risk factors compared to those with private insurance, but this was no longer seen when insulin regimen was controlled for. Further research is needed to look at differences between those with public insurance and private insurance that contribute to differences in type 1 diabetes outcomes, and to identify modifiable risk factors in pediatric patients in order to focus earlier interventions to decrease and prevent future diabetes complications.
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Affiliation(s)
- Shideh Majidi
- Department of Pediatrics, Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045, USA ; Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
| | - R Paul Wadwa
- Department of Pediatrics, Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045, USA ; Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
| | - Franziska K Bishop
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
| | - Georgeanna J Klingensmith
- Department of Pediatrics, Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045, USA ; Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
| | - Marian Rewers
- Department of Pediatrics, Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045, USA ; Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
| | - Kim McFann
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
| | - David M Maahs
- Department of Pediatrics, Children's Hospital Colorado, 13123 E. 16th Ave, Aurora, CO 80045, USA ; Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, 1775 Aurora Ct, Aurora, CO 80045, USA
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Badaru A, Klingensmith GJ, Dabelea D, Mayer-Davis EJ, Dolan L, Lawrence JM, Marcovina S, Beavers D, Rodriguez BL, Imperatore G, Pihoker C. Correlates of treatment patterns among youth with type 2 diabetes. Diabetes Care 2014; 37:64-72. [PMID: 24026554 PMCID: PMC3867996 DOI: 10.2337/dc13-1124] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [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 describe treatment regimens in youth with type 2 diabetes and examine associations between regimens, demographic and clinical characteristics, and glycemic control. RESEARCH DESIGN AND METHODS This report includes 474 youth with a clinical diagnosis of type 2 diabetes who completed a SEARCH for Diabetes in Youth study visit. Diabetes treatment regimen was categorized as lifestyle alone, metformin monotherapy, any oral hypoglycemic agent (OHA) other than metformin or two or more OHAs, insulin monotherapy, and insulin plus any OHA(s). Association of treatment with demographic and clinical characteristics (fasting C-peptide [FCP], diabetes duration, and self-monitoring of blood glucose [SMBG]), and A1C was assessed by χ(2) and ANOVA. Multiple linear regression models were used to evaluate independent associations of treatment regimens and A1C, adjusting for demographics, diabetes duration, FCP, and SMBG. RESULTS Over 50% of participants reported treatment with metformin alone or lifestyle. Of the autoantibody-negative youth, 40% were on metformin alone, while 33% were on insulin-containing regimens. Participants on metformin alone had a lower A1C (7.0 ± 2.0%, 53 ± 22 mmol/mol) than those on insulin alone (9.2 ± 2.7%, 77 ± 30 mmol/mol) or insulin plus OHA (8.6 ± 2.6%, 70 ± 28 mmol/mol) (P < 0.001). These differences remained significant after adjustment (7.5 ± 0.3%, 58 ± 3 mmol/mol; 9.1 ± 0.4%, 76 ± 4 mmol/mol; and 8.6 ± 0.4%, 70 ± 4 mmol/mol) (P < 0.001) and were more striking in those with diabetes for ≥2 years (7.9 ± 2.8, 9.9 ± 2.8, and 9.8 ± 2.6%). Over one-half of those on insulin-containing therapies still experience treatment failure (A1C ≥8%, 64 mmol/mol). CONCLUSIONS Approximately half of youth with type 2 diabetes were managed with lifestyle or metformin alone and had better glycemic control than individuals using other therapies. Those with longer diabetes duration in particular commonly experienced treatment failures, and more effective management strategies are needed.
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Klingensmith GJ, Aisenberg J, Kaufman F, Halvorson M, Cruz E, Riordan ME, Varma C, Pardo S, Viggiani MT, Wallace JF, Schachner HC, Bailey T. Evaluation of a combined blood glucose monitoring and gaming system (Didget®) for motivation in children, adolescents, and young adults with type 1 diabetes. Pediatr Diabetes 2013; 14:350-7. [PMID: 21699639 DOI: 10.1111/j.1399-5448.2011.00791.x] [Citation(s) in RCA: 25] [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: 11/27/2022] Open
Abstract
The purpose of this study was to assess the performance and acceptability of a blood glucose meter coupled with a gaming system for children, adolescents, and young adults with type 1 diabetes. During an in-clinic visit, duplicate blood samples were tested by subjects (N = 147; aged 5-24 yr) and health care providers (HCPs) to evaluate the accuracy and precision of the Didget® system. Subjects' meter results were compared against Yellow Springs Instruments (YSI) reference results and HCP results using least squares regression and error grid analyses. Precision was measured by average within-subject and within-HCP coefficient of variation (CV). During the home-use component of this study, subjects (n = 58) tested their blood glucose at least two to three times daily for 3-5 d to evaluate routine use of the system. Subjects' meter results showed significant correlations with both YSI (r(2) = 0.94; p < 0.001 for regression slope) and HCP results (r(2) = 0.96; p < 0.001). Average within-subject and within-HCP CVs were 5.9 and 7.2%, respectively. Overall satisfaction was assessed by subjects, their parents or guardians, and HCP surveys. Subject satisfaction with the Didget® system was good to excellent; most subjects found the system easy to use, motivating, and helpful for building good blood glucose monitoring habits. Most HCPs agreed that the system fulfilled a need in diabetes management. In conclusion, the Didget® system was precise and clinically accurate in the hands of children, adolescents, and young adults with type 1 diabetes.
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Affiliation(s)
- Georgeanna J Klingensmith
- Department of Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Aurora, CO 80045, USA.
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Kaminski BM, Klingensmith GJ, Beck RW, Tamborlane WV, Lee J, Hassan K, Schatz D, Kollman C, Redondo MJ. Body mass index at the time of diagnosis of autoimmune type 1 diabetes in children. J Pediatr 2013; 162:736-740.e1. [PMID: 23092524 DOI: 10.1016/j.jpeds.2012.09.017] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 02/17/2012] [Revised: 07/24/2012] [Accepted: 09/07/2012] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To describe the body mass index (BMI) distribution of children developing autoimmune type 1 diabetes (T1D) compared with the general population and to assess factors associated with BMI at T1D onset. STUDY DESIGN Children age 2-<19 years enrolled in the Pediatric Diabetes Consortium at 7 US pediatric diabetes centers at T1D onset were included. Eligibility for analysis required a diagnosis of T1D, ≥1 positive diabetes autoantibody, and availability of BMI within 14 days of diagnosis. BMI at diagnosis was compared with the general population as described by the 2000 Centers for Disease Control. Regression analysis was used to assess the association between BMI and various participant characteristics. RESULTS BMI scores for the 490 participants were slightly lower than the 2000 Centers for Disease Control population (P = .04). The median BMI percentile for age and sex was 48(th), 11% of the children were overweight (BMI ≥85(th) and <95(th) percentile), 8% obese (BMI ≥95(th) and <99(th) percentile), and 2% severely obese (≥99(th) percentile), percentages that were comparable across age and sex groups. Higher BMI Z-scores were associated with African American and Hispanic race/ethnicity (P = .001) and lower hemoglobin A1c (P < .001), and diabetic ketoacidosis, age, and Tanner stage were not associated. CONCLUSIONS Although the BMI distribution in children developing autoimmune T1D was lower than that of the general population, 21% of children were obese or overweight. Youth who are overweight, obese, racial/ethnic minority, and/or present without diabetic ketoacidosis should not be presumed to have type 2 diabetes because many patients with autoantibody-positive T1D present with the same clinical characteristics.
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Pihoker C, Badaru A, Anderson A, Morgan T, Dolan L, Dabelea D, Imperatore G, Linder B, Marcovina S, Mayer-Davis E, Reynolds K, Klingensmith GJ. Insulin regimens and clinical outcomes in a type 1 diabetes cohort: the SEARCH for Diabetes in Youth study. Diabetes Care 2013; 36:27-33. [PMID: 22961571 PMCID: PMC3526205 DOI: 10.2337/dc12-0720] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [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 examine the patterns and associations of insulin regimens and change in regimens with clinical outcomes in a diverse population of children with recently diagnosed type 1 diabetes. RESEARCH DESIGN AND METHODS The study sample consisted of youth with type 1 diabetes who completed a baseline SEARCH for Diabetes in Youth study visit after being newly diagnosed and at least one follow-up visit. Demographic, diabetes self-management, physical, and laboratory measures were collected at study visits. Insulin regimens and change in regimen compared with the initial visit were categorized as more intensive (MI), no change (NC), or less intensive (LI). We examined relationships between insulin regimens, change in regimen, and outcomes including A1C and fasting C-peptide. RESULTS Of the 1,606 participants with a mean follow-up of 36 months, 51.7% changed to an MI regimen, 44.7% had NC, and 3.6% changed to an LI regimen. Participants who were younger, non-Hispanic white, and from families of higher income and parental education and who had private health insurance were more likely to be in MI or NC groups. Those in MI and NC groups had lower baseline A1C (P = 0.028) and smaller increase in A1C over time than LI (P < 0.01). Younger age, continuous subcutaneous insulin pump therapy, and change to MI were associated with higher probability of achieving target A1C levels. CONCLUSIONS Insulin regimens were intensified over time in over half of participants but varied by sociodemographic domains. As more intensive regimens were associated with better outcomes, early intensification of management may improve outcomes in all children with diabetes. Although intensification of insulin regimen is preferred, choice of insulin regimen must be individualized based on the child and family's ability to comply with the prescribed plan.
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Affiliation(s)
- Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA, USA.
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Spiegel G, Bortsov A, Bishop FK, Owen D, Klingensmith GJ, Mayer-Davis EJ, Maahs DM. Randomized nutrition education intervention to improve carbohydrate counting in adolescents with type 1 diabetes study: is more intensive education needed? J Acad Nutr Diet 2012; 112:1736-46. [PMID: 22975086 PMCID: PMC3487717 DOI: 10.1016/j.jand.2012.06.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [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] [Received: 02/10/2011] [Accepted: 05/17/2012] [Indexed: 11/25/2022]
Abstract
BACKGROUND Youth with type 1 diabetes do not count carbohydrates accurately, yet it is an important strategy in blood glucose control. OBJECTIVE The study objective was to determine whether a nutrition education intervention would improve carbohydrate counting accuracy and glycemic control. DESIGN We conducted a randomized, controlled nutrition intervention trial that was recruited from February 2009 to February 2010. SUBJECTS Youth (12 to 18 years of age, n = 101) with type 1 diabetes were screened to identify those with poor carbohydrate counting accuracy, using a previously developed carbohydrate counting accuracy test covering commonly consumed foods and beverage items presented in six mixed meals and two snacks. All participants (n = 66, age = 15 ± 3 years, 41 male, diabetes duration = 6 ± 4 years, hemoglobin A1c [HbA1c] = 8.3% ± 1.1%) were randomized to the control or intervention group at the baseline visit. The intervention group attended a 90-minute class with a registered dietitian/certified diabetes educator and twice kept 3-day food records, which were used to review carbohydrate counting progress. MAIN OUTCOME MEASURES Carbohydrate counting accuracy (measured as described) and HbA1c were evaluated at baseline and 3 months to determine the effectiveness of the intervention. STATISTICAL ANALYSES PERFORMED t Tests, Spearman correlations, and repeated measures models were used. RESULTS At baseline, carbohydrate content was over- and underestimated in 16 and 5 of 29 food items, respectively. When foods were presented as mixed meals, participants either significantly over- or underestimated 10 of the 9 meals and 4 snacks. After 3 months of follow-up, HbA1c decreased in both the intervention and control groups by -0.19% ± 0.12% (P = 0.12) and -0.08% ± 0.11% (P = 0.51), respectively; however, the overall intervention effect was not statistically significant for change in HbA1c or carbohydrate counting accuracy. CONCLUSIONS More intensive intervention might be required to improve adolescents' carbohydrate counting accuracy and nutrition management of type 1 diabetes. Additional research is needed to translate nutrition education into improved health outcomes.
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Affiliation(s)
- Gail Spiegel
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics University of Colorado Denver, 1775 Aurora Court, MS A140, PO Box 6511, Aurora, CO 80045
| | - Andrey Bortsov
- Department of Anesthesiology, The University of North Carolina at Chapel Hill N2201 UNC Hospitals CB 7010, Chapel Hill, NC 27599-7010 Phone: 919.843.5353 Fax: 919.966.7193
- Center for Research in Nutrition and Health Disparities University of South Carolina, Columbia, SC 29208
| | - Franziska K. Bishop
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics University of Colorado Denver, 1775 Aurora Court, MS A140, PO Box 6511 Aurora, CO 80045 Phone: 303.724.6764 Fax: 303.724.6779
| | - Darcy Owen
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics University of Colorado Denver, 1775 Aurora Court, MS A140, PO Box 6511 Aurora, CO 80045 Phone: 303.724.6702 Fax: 303.724.6779
| | - Georgeanna J. Klingensmith
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics University of Colorado Denver, 1775 Aurora Court, MS A140, PO Box 6511 Aurora, CO 80045 Phone: 303.724.6717 Fax: 303.724.6779
| | - Elizabeth J. Mayer-Davis
- Departments of Nutrition and Medicine School of Public Health and School of Medicine 2211 McGavran-Greenberg Hall CB 7461 University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7461 Phone: 919.966.1991 Fax: 919.966.7216
| | - David M. Maahs
- Barbara Davis Center for Childhood Diabetes, Department of Pediatrics University of Colorado Denver, 1775 Aurora Court, MS A140, PO Box 6511, Aurora, CO 80045 Phone: 303.724.6706 Fax: 303.724.6779
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Hummel K, McFann KK, Realsen J, Messer LH, Klingensmith GJ, Chase HP. The increasing onset of type 1 diabetes in children. J Pediatr 2012; 161:652-7.e1. [PMID: 22578579 DOI: 10.1016/j.jpeds.2012.03.061] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [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: 11/16/2011] [Revised: 02/02/2012] [Accepted: 03/29/2012] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To identify trends in the recent onset of type 1 diabetes (T1D) in Colorado youth seen at the Barbara Davis Center (BDC) and compare these changes over time. STUDY DESIGN A retrospective chart review was performed of patients ages 0-20 years at diagnosis of T1D and type 2 diabetes who were seen at the BDC, were living within Colorado at diagnosis, and were seen within 1 month of diagnosis between 1996 and 2010. The review included age of onset, sex, month and season of onset, islet autoantibodies, diabetes type, hemoglobin A1c level, and body mass index. RESULTS Newly diagnosed youth with diabetes (n = 2841) were seen at the BDC between 1996 and 2010. Of these, 2686 (94.4%) had T1D. The number of newly diagnosed youth increased over the 15 years by 5.71% per year when adjusted for population (P < .0001). When analyzed in 5-year periods, the average number of new onset T1D cases, age-adjusted to the population, increased by 9.46% per year from 1996-2000 to 2001-2005. The increase was only 4.86% per year from 2001-2005 to 2006-2010. Islet autoimmune markers appeared to correlate with changes in T1D new onset cases. CONCLUSION T1D in youth increased significantly from the late 1990s-2005 and has increased at a lesser rate more recently. Data suggests that even though T1D has increased in all age groups, the greatest increase was in the 5-9 year age category.
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Affiliation(s)
- Kevin Hummel
- University of Colorado Medical Center, Barbara Davis Center for Childhood Diabetes, Aurora, CO 80045, USA
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Baker PR, Nanduri P, Gottlieb PA, Yu L, Klingensmith GJ, Eisenbarth GS, Barker JM. Predicting the onset of Addison's disease: ACTH, renin, cortisol and 21-hydroxylase autoantibodies. Clin Endocrinol (Oxf) 2012; 76:617-24. [PMID: 22066755 PMCID: PMC4963152 DOI: 10.1111/j.1365-2265.2011.04276.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [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: 12/31/2022]
Abstract
CONTEXT Autoantibodies to 21-hydroxylase (21OH-AA) precede onset of autoimmune Addison's disease (AD). Progression to AD can take months to years, and early detection of metabolic decompensation may prevent morbidity and mortality. OBJECTIVE To define optimal methods of predicting progression to overt AD (defined by subnormal peak cortisol response to Cosyntropin) in 21OH-AA+ individuals. DESIGN, SETTING AND PARTICIPANTS Individuals were screened for 21OH-AA at the Barbara Davis Center from 1993 to 2011. Subjects positive for 21OH-AA (n = 87) were tested, and the majority prospectively followed for the development of Addison's disease, including seven diagnosed with AD upon 21OH-AA discovery (discovered), seven who progressed to AD (progressors) and 73 nonprogressors. MAIN OUTCOME MEASURED Plasma renin activity (PRA), ACTH, baseline cortisol, peak cortisol and 21OH-AA were measured at various time points relative to diagnosis of AD or last AD-free follow-up. RESULTS Compared with nonprogressors, in the time period 2 months-2 years prior to the onset of AD, progressors were significantly more likely to have elevated ACTH (11-22 pM, P < 1E-4), with no significant differences in mean PRA (P = 0·07) or baseline cortisol (P = 0·08), and significant but less distinct differences seen with 21OH-AA levels (P < 1E-4) and poststimulation cortisol levels (P = 6E-3). CONCLUSION Moderately elevated ACTH is a more useful early indicator of impending AD than 21OH-AA, PRA or peak cortisol, in the 2 months-2 years preceding the onset of AD.
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Affiliation(s)
- Peter R. Baker
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Priyaanka Nanduri
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Peter A. Gottlieb
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Liping Yu
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | | | - George S. Eisenbarth
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, USA
| | - Jennifer M. Barker
- Department of Pediatric Endocrinology, University of Colorado Denver, Aurora, CO, USA
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Wood JR, Kaminski BM, Kollman C, Beck RW, Hall CA, Yun JP, Cengiz E, Haller MJ, Hassan K, Klingensmith GJ, Tamborlane WV. Accuracy and precision of the Axis-Shield Afinion hemoglobin A1c measurement device. J Diabetes Sci Technol 2012; 6:380-6. [PMID: 22538150 PMCID: PMC3380782 DOI: 10.1177/193229681200600224] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [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] [Indexed: 11/16/2022]
Abstract
BACKGROUND The Afinion HbA1c (Axis-Shield) is a newer point-of-care device for measurement of hemoglobin A1c (A1C) using a boronate affinity method unlike the more commonly used DCA immunoassay method (Siemens Medical Solutions Diagnostics). The Afinion's accuracy and precision, when compared with high-performance liquid chromatography (HPLC) and DCA methods, have not been established in pediatric practice settings. METHODS Capillary blood was collected from 700 subjects with diabetes mellitus at seven Pediatric Diabetes Consortium sites. Each subject's A1C was measured locally using Afinion and DCA devices, and by a central laboratory (University of Minnesota) using a Tosoh HPLC method. In addition, repeated measurements on six whole blood samples provided by the National Glycohemoglobin Standardization Program (NGSP) were taken at three clinical centers using the Afinion and DCA methods and centrally using the Tosoh HPLC method to assess the precision of each device. RESULTS The coefficient of variation for measurements of whole blood samples for precision analysis was 2% for Afinion, 3% for DCA, and 1% for HPLC. In the patient samples measured at the seven clinic sites, the Afinion generated higher A1C results than the HPLC (mean difference = +0.15; p < 0.001), while the DCA produced lower values (mean difference = -0.19; p < 0.001). The absolute differences with HPLC were similar for the Afinion and DCA (median 0.2%) with a slight advantage for the Afinion when compared with DCA (p < 0.001 by rank test). The DCA tended to read lower than HPLC, particularly at high A1C levels (p < 0.001), while the Afinion's accuracy did not vary by A1C. CONCLUSIONS When compared to the central laboratory HPLC method, the differences between the results of the Afinion and DCA devices are clinically insignificant, and the Afinion and DCA have similar accuracy and precision when used in pediatric practice settings.
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Affiliation(s)
- Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, California, USA.
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Bortsov AV, Liese AD, Bell RA, Dabelea D, D'Agostino RB, Hamman RF, Klingensmith GJ, Lawrence JM, Maahs DM, McKeown R, Marcovina SM, Thomas J, Williams DE, Mayer-Davis EJ. Sugar-sweetened and diet beverage consumption is associated with cardiovascular risk factor profile in youth with type 1 diabetes. Acta Diabetol 2011; 48:275-282. [PMID: 21249401 PMCID: PMC4669040 DOI: 10.1007/s00592-010-0246-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 09/27/2010] [Accepted: 12/08/2010] [Indexed: 10/18/2022]
Abstract
The prevalence of cardiovascular disease (CVD) risk factors among youth with type 1 diabetes is high and associated with age, gender, and race/ethnicity. It has also been shown that youth with type 1 diabetes often do not follow dietary recommendations. The objective of this cross-sectional observational study was to explore the association of sugar-sweetened and diet beverage intake with A1c, plasma lipids, adiponectin, leptin, systolic, and diastolic blood pressure in youth with type 1 diabetes. We examined data from 1,806 youth age 10-22 years with type 1 diabetes, of which 22% were minority (10% Hispanic, 8% African Americans, 4% other races) and 48% were female. Sugar-sweetened beverage, diet beverage, and mineral water intake was assessed with a food frequency questionnaire. After adjustment for socio-demographic and clinical covariates, physical activity and total energy intake, high sugar-sweetened beverage intake (at least one serving per day vs. none), was associated with higher levels of total cholesterol, LDL cholesterol, and plasma triglycerides, but not with A1c. High diet beverage intake was associated with higher A1c, total cholesterol, LDL cholesterol, and triglycerides. These associations were partially confounded by body mass index, saturated fat and total fiber intake. High sugar-sweetened beverage intake may have an adverse effect on CVD risk in youth with type 1 diabetes. Diet beverage intake may be a marker of unhealthy lifestyle which, in turn, is associated with worse metabolic control and CVD risk profile in these youth. Youth with diabetes should be encouraged to minimize sugar-sweetened beverage intake.
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Affiliation(s)
- Andrey V Bortsov
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA.
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, 29208, USA.
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Dana Dabelea
- University of Colorado Health Sciences Center, Denver, CO, 80262, USA
| | - Ralph B D'Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, 27157, USA
| | - Richard F Hamman
- University of Colorado Health Sciences Center, Denver, CO, 80262, USA
| | - Georgeanna J Klingensmith
- University of Colorado Health Sciences Center, Denver, CO, 80262, USA
- University of Colorado Barbara Davis Center, Denver, CO, 80262, USA
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, 91101, USA
| | - David M Maahs
- University of Colorado Health Sciences Center, Denver, CO, 80262, USA
- University of Colorado Barbara Davis Center, Denver, CO, 80262, USA
| | - Robert McKeown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA
| | - Santica M Marcovina
- Northwest Lipid Research Laboratories, Department of Medicine, University of Washington, Seattle, WA, 98109, USA
| | - Joan Thomas
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, 27599, USA
| | - Desmond E Williams
- Division of Diabetes Translation, Centers for Disease Control and Prevention/NCCDPHP, Atlanta, GA, 30341, USA
| | - Elizabeth J Mayer-Davis
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 800 Sumter Street, Columbia, SC, 29208, USA
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, 27599, USA
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Dabelea D, Pihoker C, Talton JW, D'Agostino RB, Fujimoto W, Klingensmith GJ, Lawrence JM, Linder B, Marcovina SM, Mayer-Davis EJ, Imperatore G, Dolan LM. Etiological approach to characterization of diabetes type: the SEARCH for Diabetes in Youth Study. Diabetes Care 2011; 34:1628-33. [PMID: 21636800 PMCID: PMC3120176 DOI: 10.2337/dc10-2324] [Citation(s) in RCA: 141] [Impact Index Per Article: 10.8] [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 describe an etiologic approach to classification of diabetes types in youth based on the 1997 American Diabetes Association (ADA) framework, using data from the SEARCH for Diabetes in Youth Study. RESEARCH DESIGN AND METHODS SEARCH conducted a comprehensive assessment of 2,291 subjects aged <20 years with recently diagnosed diabetes. Using autoimmunity (at least one of two diabetes autoantibodies) and insulin sensitivity (equation validated against hyperinsulinemic-euglycemic clamps) as the main etiologic markers, we described four categories along a bidimensional spectrum: autoimmune plus insulin-sensitive (IS), autoimmune plus insulin-resistant (IR), nonautoimmune plus IS, and nonautoimmune plus IR. We then explored how characteristics, including genetic susceptibility to autoimmunity (HLA genotypes), insulin deficiency, and clinical factors varied across these four categories. RESULTS Most subjects fell into either the autoimmune plus IS (54.5%) or nonautoimmune plus IR categories (15.9%) and had characteristics that align with traditional descriptions of type 1 or type 2 diabetes. The group classified as autoimmune plus IR (19.5%) had similar prevalence and titers of diabetes autoantibodies and similar distribution of HLA risk genotypes to those in the autoimmune plus IS group, suggesting that it includes individuals with type 1 diabetes who are obese. The group classified as nonautoimmune plus IS (10.1%) likely includes individuals with undetected autoimmunity but may also include those with monogenic diabetes and thus requires further testing. CONCLUSIONS The SEARCH study offers researchers and clinicians a practical application for the etiologic classification of diabetes type and at the same time identifies a group of youths who would benefit from further testing.
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Affiliation(s)
- Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver, Aurora, Colorado, USA.
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Schweiger BM, Snell-Bergeon JK, Roman R, McFann K, Klingensmith GJ. Menarche delay and menstrual irregularities persist in adolescents with type 1 diabetes. Reprod Biol Endocrinol 2011; 9:61. [PMID: 21548955 PMCID: PMC3100251 DOI: 10.1186/1477-7827-9-61] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [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] [Received: 01/31/2011] [Accepted: 05/06/2011] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Menarche delay has been reported in adolescent females with type 1 diabetes (T1DM), perhaps due to poor glycemic control. We sought to compare age at menarche between adolescent females with T1DM and national data, and to identify factors associated with delayed menarche and menstrual irregularity in T1DM. METHODS This was a cross-sectional study and females ages 12- 24 years (n = 228) with at least one menstrual period were recruited during their outpatient diabetes clinic appointment. The National Health and Nutrition Examination Survey (NHANES) 2001-2006 data (n = 3690) for females 12-24 years were used as a control group. RESULTS Age at menarche was later in adolescent females with T1DM diagnosed prior to menarche (12.81 +/- 0.09 years) (mean+/- SE) (n = 185) than for adolescent females diagnosed after menarche (12.17 0.19 years, p = 0.0015) (n = 43). Average age of menarche in NHANES was 12.27 +/- 0.038 years, which was significantly earlier than adolescent females with T1DM prior to menarche (p < 0.0001) and similar to adolescent females diagnosed after menarche (p = 0.77). Older age at menarche was negatively correlated with BMI z-score (r = -0.23 p = 0.0029) but not hemoglobin A1c (A1c) at menarche (r = 0.01, p = 0.91). Among 181 adolescent females who were at least 2 years post menarche, 63 (35%) reported usually or always irregular cycles. CONCLUSION Adolescent females with T1DM had a later onset of menarche than both adolescent females who developed T1DM after menarche and NHANES data. Menarche age was negatively associated with BMI z-score, but not A1c. Despite improved treatment in recent decades, menarche delay and high prevalence of menstrual irregularity is still observed among adolescent females with T1DM.
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Affiliation(s)
- Bahareh M Schweiger
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, The Children's Hospital Aurora, Colorado, USA
| | - Janet K Snell-Bergeon
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, The Children's Hospital Aurora, Colorado, USA
| | - Rossana Roman
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, The Children's Hospital Aurora, Colorado, USA
| | - Kim McFann
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, The Children's Hospital Aurora, Colorado, USA
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, The Children's Hospital Aurora, Colorado, USA
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Triolo TM, Armstrong TK, McFann K, Yu L, Rewers MJ, Klingensmith GJ, Eisenbarth GS, Barker JM. Additional autoimmune disease found in 33% of patients at type 1 diabetes onset. Diabetes Care 2011; 34:1211-3. [PMID: 21430083 PMCID: PMC3114477 DOI: 10.2337/dc10-1756] [Citation(s) in RCA: 124] [Impact Index Per Article: 9.5] [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 We sought to define the prevalence of nonislet, organ-specific autoantibodies at diagnosis of type 1 diabetes and to determine the prevalence of comorbid autoimmune diseases. RESEARCH DESIGN AND METHODS Children (n = 491) diagnosed with type 1 diabetes at the Barbara Davis Center for Childhood Diabetes were screened for autoimmune thyroid disease (thyroid peroxidase autoantibodies [TPOAb]), celiac disease (tissue transglutaminase autoantibodies [TTGAb]), and Addison disease (21-hydroxylase autoantibodies [21OHAb]). RESULTS Of the 491 children, 161 had at least one nonislet autoantibody, and of these, 122 (24.8%) were positive for TPOAb, and 15 of the 122 (12.3%) had autoimmune thyroid disease. There were 57 (11.6%) who were positive for TTGAb, of whom 14 (24.6%) had celiac disease. Five (1.0%) were positive for 21OHAb, of whom one had Addison disease. CONCLUSIONS Many autoantibody-positive subjects present with additional autoimmune disorders. Detection of these autoantibodies at type 1 diabetes onset may prevent complications associated with delayed diagnosis of these disorders.
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Affiliation(s)
- Taylor M Triolo
- Barbara Davis Center for Childhood Diabetes, Aurora, Colorado, USA.
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Bortsov A, Liese AD, Bell RA, Dabelea D, D’Agostino RB, Hamman RF, Klingensmith GJ, Lawrence JM, Maahs DM, McKeown R, Marcovina SM, Thomas J, Mayer-Davis EJ. Correlates of dietary intake in youth with diabetes: results from the SEARCH for diabetes in youth study. J Nutr Educ Behav 2011; 43:123-129. [PMID: 21276755 PMCID: PMC3055946 DOI: 10.1016/j.jneb.2009.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 10/30/2009] [Accepted: 12/06/2009] [Indexed: 05/30/2023]
Abstract
OBJECTIVE To explore demographic, socioeconomic, diabetes-related, and behavioral correlates of dietary intake of dairy, fruit, vegetables, sweetened soda, fiber, calcium, and saturated fat in youth with diabetes. METHODS Cross-sectional study of youth 10-22 years old with type 1 (T1DM, n = 2,176) and type 2 diabetes (T2DM, n = 365). Association of dietary intake, demographics, socioeconomic status, behavioral, and diabetes-related measures was explored with quantile regression. RESULTS T1DM males had lower consumption of vegetables, fruit, and fiber, and higher consumption of soda and saturated fat than females (P < .01). African Americans had lower dairy and higher soda intake than non-Hispanic T1DM whites (P < .01). Soda consumption was higher in older T2DM youth than in younger participants (P < .01). Lifestyle and physical activity patterns were also significantly associated with dietary intake. CONCLUSIONS AND IMPLICATIONS Identified demographic and behavioral correlates may help dietitians to focus on groups of youth with diabetes who have lower adherence to a healthful diet. Diet counseling groups may be tailored according to these major determinants.
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Affiliation(s)
- Andrey Bortsov
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
| | - Ronny A Bell
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27157
| | - Dana Dabelea
- University of Colorado Health Sciences Center, Denver, CO, USA 80262
| | - Ralph B D’Agostino
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC, USA 27157
| | - Richard F Hamman
- University of Colorado Health Sciences Center, Denver, CO, USA 80262
| | - Georgeanna J Klingensmith
- University of Colorado Health Sciences Center, Denver, CO, USA 80262
- University of Colorado Barbara Davis Center, Denver, CO, USA 80262
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA 91101
| | - David M Maahs
- University of Colorado Health Sciences Center, Denver, CO, USA 80262
- University of Colorado Barbara Davis Center, Denver, CO, USA 80262
| | - Robert McKeown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
| | - Santica M Marcovina
- Northwest Lipid Research Laboratories, Department of Medicine, University of Washington, Seattle, WA, USA 98109
| | - Joan Thomas
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
- Center for Research in Nutrition and Health Disparities, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
| | - Elizabeth J Mayer-Davis
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA 29208
- Department of Nutrition, University of North Carolina, Chapel Hill, NC, USA 27599
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Simmons JH, Klingensmith GJ, McFann K, Rewers M, Ide LM, Taki I, Liu E, Hoffenberg EJ. Celiac autoimmunity in children with type 1 diabetes: a two-year follow-up. J Pediatr 2011; 158:276-81.e1. [PMID: 20817171 PMCID: PMC2999645 DOI: 10.1016/j.jpeds.2010.07.025] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [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: 11/02/2009] [Revised: 06/09/2010] [Accepted: 07/16/2010] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To determine the benefits of screening for celiac autoimmunity via immunoglobulin A transglutaminase autoantibodies (TG) in children with type 1 diabetes (T1D). STUDY DESIGN We followed up 79 screening-identified TG+ and 56 matched TG- children with T1D for 2 years to evaluate growth, bone mineral density, nutritional status, and diabetes control. TG+ subjects self-selected to gluten-free or gluten-containing diet. RESULTS Of the initial cohort, 80% were available for reexamination after 2 years. TG+ subjects had consistently lower weight z-scores and higher urine N-telopeptides than TG- subjects, but similar measures of bone density and diabetes outcomes. TG+ children who remained on a gluten-containing diet had lower insulin-like growth factor binding protein 3 z-scores compared with TG+ subjects who reported following a gluten-free diet. Children who continued with high TG index throughout the study had lower bone mineral density z-scores, ferritin, and vitamin D 25OH levels, compared with the TG- group. CONCLUSIONS No significant adverse outcomes were identified in children with T1D with screening-identified TG+ who delay therapy with a gluten-free diet for 2 years. Children with persistently high levels of TG may be at greater risk. The optimal timing of screening and treatment for celiac disease in children with T1D requires further investigation.
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Affiliation(s)
- Jill H Simmons
- Department of Pediatrics, Division of Endocrinology and Diabetes, Vanderbilt Children’s Hospital, Nashville, TN
| | | | - Kim McFann
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - Marian Rewers
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - Lisa M Ide
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - Iman Taki
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO
| | - Edwin Liu
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Aurora, CO, Department of Pediatrics, University of Colorado Denver, Aurora, CO
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