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Klages KL, Berlin KS, Cook JL, Keenan ME, Semenkovich K, Banks GG, Rybak TM, Ankney RL, Decker KM, Whitworth JR, Corkins MR. Examining Risk Factors of Health-Related Quality of Life Impairments Among Adolescents with Inflammatory Bowel Disease. Behav Med 2021; 47:140-150. [PMID: 34048329 DOI: 10.1080/08964289.2019.1676193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 10/24/2022]
Abstract
Inflammatory Bowel Disease (IBD) is a chronic, costly, and burdensome disease that is typically diagnosed during adolescence. Despite the use of effective treatments, rates of relapse and intestinal inflammation remain high and put patients at risk for long term physical and psychosocial health complications. Given the costs associated with IBD, it is critical to examine potential risk factors of poor health-related quality of life (HRQoL) among patients for the enhancement and further development of interventions. As such, the aim of the current study was to examine how sociodemographic and disease characteristics, psychosocial problems, and adherence behaviors impact HRQoL among a sample of youth with IBD. 107 adolescents with IBD and their caregiver completed self- and parent-report measures as part of a psychosocial screening service. Medical records were reviewed to obtain information regarding diagnosis, insurance, medication use, illness severity, and disease activity. Results revealed lower HRQoL scores among adolescents with more psychosocial problems (Est. = -3.08; p < .001), greater disease severity (Est. = -.40; p = .001), and those who identified as Black (Est. = -.38; p < .05). Greater disease severity (Est. = .13 p = .004), use of nonpublic insurance (Est. = .32 p = .004), and fewer psychosocial problems (Est. = -.13 p = .04) were associated with greater adherence behaviors. These findings suggest that implementing individually tailored, evidence-based psychological interventions focused on coping with psychosocial problems and symptoms may be important in enhancing adherence behaviors and HRQoL among adolescents with IBD.
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Affiliation(s)
| | - Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Sciences Center
| | | | | | | | | | | | | | | | - John R Whitworth
- Department of Pediatrics, University of Tennessee Health Sciences Center
| | - Mark R Corkins
- Department of Pediatrics, University of Tennessee Health Sciences Center
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2
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Berlin KS, Klages KL, Banks GG, Rybak TM, Ankney RL, Semenkovich K, Keenan ME, Ellis DA, Diaz-Thomas AM, Alemzadeh R, Eddington AR. Toward the Development of a Culturally Humble Intervention to Improve Glycemic Control and Quality of Life among Adolescents with Type-1 Diabetes and Their Families. Behav Med 2021; 47:99-110. [PMID: 31580213 DOI: 10.1080/08964289.2019.1660299] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 10/25/2022]
Abstract
Type-1 Diabetes (T1D) is a prevalent and costly disorder associated with substantial morbidity that differentially impacts low-income and/or minority adolescents and their families. The primary study objective was to develop a guiding model to inform culturally humble interventions for Mid-southern youth with T1D presenting with multiple correlates of suboptimal glycemic control and their families. In order to develop a clinic specific guiding model, conceptualizations of health, the need/type of intervention thought to be most helpful, the optimal structure, and strategies to improve the cultural/regional fit was ascertained from (A) youth with T1D (n = 13) and caregivers (n = 11) via qualitative interviews and, (B) pediatric endocrinologists and nurse practitioners (n = 6), and (C) nurses, diabetes educators, dietitians, and social workers (n = 9) via focus groups. Qualitative themes were synthesized to guide the treatment development model whereby Quality of Life and Glycemic Control would be directly enhanced by interventions to promote Coping, Support, Education, and Improved Psychosocial Functioning and indirectly through improved Adherence and T1D Autonomy delivered in a culturally humble way that affirms youths' T1D identify. These finding suggest that existing evidence-based treatments may provide a great fit for low-income, and/or minority youth with T1D and their families living in the mid-south, provided these interventions are delivered in culturally humble manner.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
| | | | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | | | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine
| | | | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center
| | - Angelica R Eddington
- Department of Psychology, The University of Memphis.,Department of Pediatrics, University of Tennessee Health Science Center
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3
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Berlin KS, Keenan ME, Cook JL, Ankney RL, Klages KL, Semenkovich K, Rybak TM, Banks GG, Alemzadeh R, Eddington AR. Measuring psychological flexibility in youth with type 1 diabetes. Pediatr Diabetes 2020; 21:1566-1574. [PMID: 32915520 DOI: 10.1111/pedi.13110] [Citation(s) in RCA: 9] [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: 04/30/2020] [Revised: 08/11/2020] [Accepted: 09/02/2020] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To determine reliability and validity of the acceptance and action diabetes questionnaire (AADQ) and the diabetes acceptance and action scale for children and adolescents (DAAS), measures of diabetes-specific psychological flexibility. METHODS One hundred and eight-one youth with type 1 diabetes completed the AADQ, DAAS, and measures of mindfulness, cognitive fusion, and health-related quality of life. HbA1c was extracted from medical records. Confirmatory factor analysis (CFA) was used to cull items and evaluate the factor structures of the AADQ and DAAS. Bivariate correlations were conducted between all measures to explore content validity. RESULTS CFAs supported a one-factor structure of the AADQ (for youth and parent report) and a second-order DAAS solution with a total score indicated by avoidance, values impairment, and avoidance subscales. All scales and subscales displayed strong internal consistency (α = .86-.95). The AADQ and DAAS evidence good content validity based on associations with other measures. CONCLUSIONS The AADQ and DAAS are reliable, valid measures of diabetes-specific psychological flexibility.
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Affiliation(s)
- Kristoffer S Berlin
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Mary E Keenan
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | - Kimberly L Klages
- Department of Psychology, The University of Memphis, Memphis, Tennessee, USA
| | | | - Tiffany M Rybak
- Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ramin Alemzadeh
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Pediatrics, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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4
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Banks GG, Berlin KS, Keenan ME, Cook J, Klages KL, Rybak TM, Ankney R, Semenkovich K, Cohen R, Thurston I, Diaz-Thomas A, Alemzadeh R, Eddington A. How Peer Conflict Profiles and Socio-Demographic Factors Influence Type 1 Diabetes Adaptation. J Pediatr Psychol 2020; 45:663-672. [PMID: 32483599 DOI: 10.1093/jpepsy/jsaa036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 04/21/2020] [Accepted: 04/23/2020] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE This study aimed to (a) validate the factor structure for a measure of peer conflict in youth with type 1 diabetes (T1D); (b) determine empirical patterns of peer conflict in terms of context (friend vs. nonfriend) and content (diabetes-specific vs. general) within a broader context of socio-demographic factors; and (c) examine how these patterns and socio-demographic factors relate to adolescents' T1D adherence, quality of life, and glycemic control (HbA1c). METHODS Youth with T1D (N = 178), ages 12-18, reported demographic variables, illness duration, adherence, quality of life, and peer conflict. HbA1c was extracted from medical records. Confirmatory factor analysis validated a factor structure for the Diabetes Peer Conflict Scale (DPCS) and latent profile analysis (LPA) determined profiles of peer conflict. RESULTS A four-factor structure emerged for the DPCS: general friend conflict, general nonfriend conflict, T1D friend conflict, and T1D nonfriend conflict. Using these factors as indicators in LPA, four profiles were confirmed: (a) Low Overall Conflict (LOC) and (b) Moderate Overall Conflict (MOC), (c) a Nonfriend Conflict (NFC), and (d) a Friend Conflict (FC) profile. Differences were not identified between diabetes specific versus general conflict. Socio-demographic variables did not predict class membership. The LOC profile reported the highest quality of life and best glycemic control, whereas the FC profile reported the lowest adherence behaviors. Conclusions: Peer conflict uniquely contributes to diabetes adaptation above and beyond socio-demographic and illness factors.
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Affiliation(s)
| | | | | | - Jessica Cook
- Department of Psychology, The University of Memphis
| | - Kimberly L Klages
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | - Tiffany M Rybak
- Department of Psychology, Cincinnati Children's Hospital Medical Center
| | | | | | - Robert Cohen
- Department of Psychology, The University of Memphis
| | - Idia Thurston
- Department of Psychology & Brain Science, Texas A&M University
| | - Alicia Diaz-Thomas
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| | - Ramin Alemzadeh
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
| | - Angelica Eddington
- Department of Pediatrics-Endocrinology, The University of Tennessee Health Science Center
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5
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Semenkovich K, Berlin KS, Ankney RL, Klages KL, Keenan ME, Rybak TM, Banks GG, Alemzadeh R, Eddington A. Predictors of diabetic ketoacidosis hospitalizations and hemoglobin A1c among youth with Type 1 diabetes. Health Psychol 2019; 38:577-585. [PMID: 30973748 DOI: 10.1037/hea0000719] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Diabetic ketoacidosis (DKA) and elevated hemoglobin A1c (HbA1c) in youth with Type 1 diabetes (T1D) can result in significant morbidity and mortality. Elucidating the risk factors for poor glycemic control and DKA hospitalizations is crucial for the refinement and development of prevention and treatment efforts. METHOD Based on a conceptual framework, this study used path analysis to evaluate individual and family characteristics, psychosocial responses, and individual and family responses that prospectively predict the number of DKA hospitalizations and HbA1c approximately 1 year after assessment, accounting for sociodemographics. A total of 174 youth 12-18 years old with T1D (M = 14.68, SD = 1.77) and their caregivers completed measures assessing demographics, internalizing symptoms, diabetes stress, diabetes-related family conflict, and adherence. Medical records were reviewed to obtain the number of episodes of DKA and the HbA1c at 1-year follow-up. RESULTS Thirty-one participants had at least 1 episode of DKA based on chart review. Greater duration of diabetes, higher baseline HbA1c, lower income, identifying as non-Hispanic White, and higher youth report of internalizing symptoms were significant predictors of DKA at follow-up (p < .05). Identifying as Black-African American, a younger age, and higher baseline HbA1c significantly predicted higher HbA1c at follow-up (p < .05). CONCLUSIONS Future studies should assess the utility and accuracy of using screeners for internalizing symptoms in pediatric endocrinology clinics to identify youth at risk for DKA hospitalizations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Siller AF, Shimony A, Shinawi M, Amarillo I, Dehner LP, Semenkovich K, Arbeláez AM. Inherited Deletion of 1q, Hyperparathyroidism and Signs of Y-chromosomal Influence in a Patient with Turner Syndrome. J Clin Res Pediatr Endocrinol 2019; 11:88-93. [PMID: 29739732 PMCID: PMC6398186 DOI: 10.4274/jcrpe.galenos.2018.2018.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
We report a detailed phenotypic, cytogenetic and molecular characterization of a patient prenatally diagnosed with Turner syndrome (TS). In addition to having typical TS clinical characteristics including webbed neck, high arched palate and coarctation of the aorta, the patient had features less frequently seen in TS. These included recurrent parathyroid adenomas, growth along the 75th-90th centiles on the TS height curve despite minimal treatment with growth hormone, behavioral problems and evidence of gonadal dysgenesis with testicular-like structures, such as seminiferous tubules lined by Sertoli cells and a contiguous nodule of Leydig cells. While fluorescence in situ hybridization (FISH) failed to detect Y-chromosome material in gonadal tissue or blood samples, chromosomal microarray analysis (CMA) confirmed X monosomy and a 4.69 Mb copy number loss on 1q31.2q31.3 (bp 192,715,814 to 197,401,180). This region contains the CDC73 gene which has been associated with hyperparathyroidism-jaw tumor syndrome, features of which include recurrent, functional parathyroid adenomas and behavioral issues. This case illustrates how atypical features in a TS patient, such as robust growth and recurrent parathyroid adenomas, may suggest an underlying molecular etiology that should be explored by additional genetic diagnostic modalities. It is therefore appropriate in such cases to conduct further genetic testing, such as CMA and FISH, to explore other diagnostic possibilities and possibly prevent further complications.
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Affiliation(s)
- Alejandro F. Siller
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Alex Shimony
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Marwan Shinawi
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Ina Amarillo
- Washington University Faculty of Medicine, Department of Pathology and Immunology, Washington, USA
| | - Louis P. Dehner
- Washington University Faculty of Medicine, Department of Pathology and Immunology, Washington, USA
| | - Katherine Semenkovich
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA
| | - Ana María Arbeláez
- Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA,* Address for Correspondence: Washington University Faculty of Medicine, Department of Pediatrics, Washington, USA Phone: +3144546051 E-mail:
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7
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Siller AF, Lugar H, Rutlin J, Koller JM, Semenkovich K, White NH, Arbelaez AM, Shimony J, Hershey T. Severity of clinical presentation in youth with type 1 diabetes is associated with differences in brain structure. Pediatr Diabetes 2017; 18:686-695. [PMID: 27488913 PMCID: PMC5290262 DOI: 10.1111/pedi.12420] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [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: 03/23/2016] [Revised: 06/30/2016] [Accepted: 07/01/2016] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE Differences in cognition and brain structure have been found in youth with type 1 diabetes compared with controls, even after relatively short disease duration. To determine whether severity of clinical presentation contributes to these differences, we obtained structural magnetic resonance imaging (MRI) scans in youth ages 7-17 who were either newly diagnosed with type 1 diabetes (<3.5 months from diagnosis, n = 46) or a sibling without diabetes (n = 28). RESEARCH DESIGN AND METHODS Severity of presentation was measured by the presence of diabetic ketoacidosis (DKA) and degree of hyperglycemia exposure [hemoglobin A1c (HbA1c)] at diagnosis. MRI were obtained using T1-weighted, T2-weighted, and diffusion-weighted sequences. RESULTS Within the group with type 1 diabetes, 12 subjects presented in DKA and 34 did not. After controlling for age, sex, and multiple comparisons, the type 1 diabetes group had lower volume in the left temporal-parietal-occipital cortex compared with controls. Within the type 1 diabetes group, DKA at presentation was associated with lower radial, axial, and mean diffusivity (MD) throughout major white matter tracts and higher HbA1c was associated with lower hippocampal, thalamic, and cerebellar white matter volumes, lower right posterior parietal cortical thickness, and greater right occipital cortical thickness. CONCLUSION These data suggest that severity of clinical presentation is an important factor in predicting brain structural differences in youth with type 1 diabetes approximately 3 months after diagnosis.
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Affiliation(s)
| | | | | | | | | | - Neil H. White
- Department of Pediatrics,Department of Medicine,St. Louis Children’s Hospital
| | | | | | - Tamara Hershey
- Department of Psychiatry,Department of Radiology,Department of Neurology
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8
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Lee JJ, Khoury N, Shackleford AM, Nelson S, Herrera H, Antenor-Dorsey JA, Semenkovich K, Shimony JS, Powers WJ, Cryer PE, Arbeláez AM. Dissociation Between Hormonal Counterregulatory Responses and Cerebral Glucose Metabolism During Hypoglycemia. Diabetes 2017; 66:2964-2972. [PMID: 28970283 PMCID: PMC5697948 DOI: 10.2337/db17-0574] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 05/15/2017] [Accepted: 09/23/2017] [Indexed: 11/13/2022]
Abstract
Hypoglycemia is the most common complication of diabetes, causing morbidity and death. Recurrent hypoglycemia alters the cascade of physiological and behavioral responses that maintain euglycemia. The extent to which these responses are normally triggered by decreased whole-brain cerebral glucose metabolism (CMRglc) has not been resolved by previous studies. We measured plasma counterregulatory hormonal responses and whole-brain CMRglc (along with blood-to-brain glucose transport rates and brain glucose concentrations) with 1-[11C]-d-glucose positron emission tomography during hyperinsulinemic glucose clamps at nominal plasma glucose concentrations of 90, 75, 60, and 45 mg/dL (5.0, 4.2, 3.3, and 2.5 mmol/L) in 18 healthy young adults. Clear evidence of hypoglycemic physiological counterregulation was first demonstrated between 75 mg/dL (4.2 mmol/L) and 60 mg/dL (3.3 mmol/L) with increases in both plasma epinephrine (P = 0.01) and glucagon (P = 0.01). In contrast, there was no statistically significant change in CMRglc (P = 1.0) between 75 mg/dL (4.2 mmol/L) and 60 mg/dL (3.3 mmol/L), whereas CMRglc significantly decreased (P = 0.02) between 60 mg/dL (3.3 mmol/L) and 45 mg/dL (2.5 mmol/L). Therefore, the increased epinephrine and glucagon secretion with declining plasma glucose concentrations is not in response to a decrease in whole-brain CMRglc.
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Affiliation(s)
- John J Lee
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Nadia Khoury
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Angela M Shackleford
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Suzanne Nelson
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Hector Herrera
- Division of Biostatistics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Jo Ann Antenor-Dorsey
- Department of Psychiatry, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Katherine Semenkovich
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Joshua S Shimony
- Mallinckrodt Institute of Radiology, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - William J Powers
- Department of Neurology, University of North Carolina, Chapel Hill, NC
| | - Philip E Cryer
- Department of Medicine, Washington University School of Medicine in St. Louis, St. Louis, MO
| | - Ana María Arbeláez
- Department of Pediatrics, Washington University School of Medicine in St. Louis, St. Louis, MO
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9
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Semenkovich K, Bischoff A, Doty T, Nelson S, Siller AF, Hershey T, Arbeláez AM. Clinical presentation and memory function in youth with type 1 diabetes. Pediatr Diabetes 2016; 17:492-499. [PMID: 26377697 PMCID: PMC4803626 DOI: 10.1111/pedi.12314] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [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: 05/19/2015] [Revised: 08/14/2015] [Accepted: 08/19/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE While cerebral edema and diabetic ketoacidosis (DKA) in type 1 diabetes (T1DM) have well-described acute effects on cognition, little is known about the impact of clinical presentation on longer term cognitive outcomes. We hypothesized that clinical factors (degree of hyperglycemia exposure and DKA) at the time of diagnosis would relate to cognition within 3.5 months later in children with T1DM. METHODS Cognitive testing was performed on children 7-17 years old with T1DM (n = 66) within 3.5 months of diagnosis and siblings without T1DM (n = 33). Overall intelligence, processing speed, and memory (including a sensitive long-delay spatial memory test; spatial delayed response or SDR) were assessed. Medical records were reviewed for hemoglobin A1c (HbA1c), DKA status, and other clinical factors at diagnosis. RESULTS Within the group with T1DM, 17 children presented in DKA and 49 did not. After adjusting for age, gender, and socioeconomic status, the subgroup with T1DM and DKA at diagnosis performed worse on the long-delay SDR task compared to sibling controls (p = 0.006). In addition, within the group with T1DM, higher HbA1c at diagnosis was associated with worse performance on the long-delay SDR task (p = 0.027). Performance on the other cognitive tasks was not different across groups or subgroups. CONCLUSIONS DKA and degree of hyperglycemia exposure at diagnosis have implications for long-delay spatial memory function within 3.5 months of diagnosis. These findings suggest that early detection of T1DM, which decreases risk for prolonged exposure to hyperglycemia and DKA, may avoid negative effects on memory function.
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Affiliation(s)
| | - Allison Bischoff
- Department of Psychiatry, Washington University, St Louis, MO 63110
| | - Tasha Doty
- Department of Psychiatry, Washington University, St Louis, MO 63110
| | - Suzanne Nelson
- Department of Pediatrics, Washington University, St Louis, MO 63110
| | | | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA. .,Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA.
| | - Ana Maria Arbeláez
- Department of Pediatrics, Washington University, St Louis, MO 63110,St. Louis Children’s Hospital, St Louis, MO 63110
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10
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Cade WT, Khoury N, Nelson S, Shackleford A, Semenkovich K, Krauss MJ, Arbeláez AM. Hypoglycemia during moderate intensity exercise reduces counterregulatory responses to subsequent hypoglycemia. Physiol Rep 2016; 4:4/17/e12848. [PMID: 27597762 PMCID: PMC5027337 DOI: 10.14814/phy2.12848] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2016] [Accepted: 06/09/2016] [Indexed: 11/24/2022] Open
Abstract
Hypoglycemia, which occurs commonly during and following exercise in people with diabetes, is thought to be due to attenuated counterregulation in the setting of therapeutic insulin excess. To better understand the pathophysiology of counterregulation, we aimed to determine if dextrose administration to maintain euglycemia during moderate intensity exercise alters the attenuation of counterregulatory responses to subsequent hypoglycemia in healthy adults. Counterregulatory responses to hypoglycemia were assessed in 18 healthy adults after bed rest and following exercise with (n = 9) and without (n = 9) dextrose infusion. Responses were measured during a stepped euglycemic‐hypoglycemic clamp 24 h after either bed rest or two 90‐min bouts of exercise at 70% peak oxygen uptake. Hypoglycemia occurred during the second bout of exercise without dextrose infusion. Plasma glucagon and epinephrine responses to stepped hypoglycemia after antecedent exercise without dextrose infusion were significantly lower at the 45 mg/dL glycemic level compared to after bed rest. However, no attenuation of the counterregulatory responses to hypoglycemia was evident after antecedent exercise when dextrose was infused. This study suggests that the attenuation of the counterregulatory responses during hypoglycemia after exercise is likely due to the hypoglycemia that occurs during moderate prolonged exercise and not solely due to exercise or its intensity.
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Affiliation(s)
- W Todd Cade
- Program in Physical Therapy, Washington University School of Medicine, Saint Louis, Missouri
| | - Nadia Khoury
- Department of Medicine, Washington University School of Medicine, Saint Louis, Missouri
| | - Suzanne Nelson
- Division of Biostatistics, Washington University School of Medicine, Saint Louis, Missouri
| | - Angela Shackleford
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
| | - Katherine Semenkovich
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
| | - Melissa J Krauss
- Division of Biostatistics, Washington University School of Medicine, Saint Louis, Missouri
| | - Ana María Arbeláez
- Department of Pediatrics, Washington University School of Medicine, Saint Louis, Missouri
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11
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Semenkovich K, Patel PP, Pollock AB, Beach KA, Nelson S, Masterson JJ, Hershey T, Arbeláez AM. Academic abilities and glycaemic control in children and young people with Type 1 diabetes mellitus. Diabet Med 2016; 33:668-73. [PMID: 26173465 PMCID: PMC4713372 DOI: 10.1111/dme.12854] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/07/2015] [Indexed: 12/11/2022]
Abstract
AIMS To determine if children and young people aged < 23 years with Type 1 diabetes differ in academic ability from age-matched control subjects without Type 1 diabetes and whether academic scores are related to glycaemic control. METHODS Using a cross-sectional study design, we administered cognitive and academic tests (Woodcock-Johnson III Spatial Relations, General Information, Letter-Word Recognition, Calculation and Spelling tests) to young people with Type 1 diabetes (n=61) and control subjects (n=26) aged 9-22 years. The groups did not differ in age or gender. Participants with Type 1 diabetes had a disease duration of 5-17.7 years. History of glycaemic control (HbA1c , diabetic ketoacidosis and severe hypoglycaemic episodes) was obtained via medical records and interviews. RESULTS The participants with Type 1 diabetes had a lower mean estimated verbal intelligence (IQ) level compared with those in the control group (P=0.04). Greater exposure to hyperglycaemia over time was associated with lower spelling abilities within the group with Type 1 diabetes (P=0.048), even after controlling for age, gender, socio-economic status, blood glucose level at time of testing and verbal IQ (P=0.01). History of severe hypoglycaemia or ketoacidosis was not associated with differences in academic abilities. CONCLUSIONS In children and young people, Type 1 diabetes was associated with a lower verbal IQ. Moreover, increased exposure to hyperglycaemia was associated with lower spelling performance. These results imply that hyperglycaemia can affect cognitive function and/or learning processes that may affect academic achievement.
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Affiliation(s)
- K Semenkovich
- Departments of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - P P Patel
- Departments of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - A B Pollock
- Department of Occupational Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - K A Beach
- Departments of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - S Nelson
- Department of Biostatistics, Washington University School of Medicine, St. Louis, MO, USA
| | - J J Masterson
- Department of Communication Sciences and Disorders, Missouri State University, Springfield, MO, USA
| | - T Hershey
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
- Department of Neurology, Washington University School of Medicine, St. Louis, MO, USA
- Department of Radiology, Washington University School of Medicine, St. Louis, MO, USA
| | - A M Arbeláez
- Departments of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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12
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Abstract
Clinically significant depression is present in one of every four people with type 2 diabetes mellitus (T2DM). Depression increases the risk of the development of T2DM and the subsequent risks of hyperglycemia, insulin resistance, and micro- and macrovascular complications. Conversely, a diagnosis of T2DM increases the risk of incident depression and can contribute to a more severe course of depression. This linkage reflects a shared etiology consisting of complex bidirectional interactions among multiple variables, a process that may include autonomic and neurohormonal dysregulation, weight gain, inflammation, and hippocampal structural alterations. Two recent meta-analyses of randomized controlled depression treatment trials in patients with T2DM concluded that psychotherapy and antidepressant medication (ADM) were each moderately effective for depression and that cognitive behavior therapy (CBT) had beneficial effects on glycemic control. However, the number of studies (and patients exposed to randomized treatment) included in these analyses is extremely small and limits the certainty of conclusions that can be drawn from the data. Ultimately, there is no escaping the paucity of the evidence base and the need for additional controlled trials that specifically address depression management in T2DM. Future trials should determine both the effects of treatment and the change in depression during treatment on measures of mood, glycemic control, and medical outcome.
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Affiliation(s)
- Katherine Semenkovich
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
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13
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Khoury N, Semenkovich K, Arbeláez AM. Coeliac disease presenting as severe hypoglycaemia in youth with type 1 diabetes. Diabet Med 2014; 31:e33-6. [PMID: 24805141 DOI: 10.1111/dme.12488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/20/2014] [Accepted: 04/28/2014] [Indexed: 12/19/2022]
Abstract
BACKGROUND Coeliac disease is an autoimmune disorder classically characterized by gastrointestinal symptoms and poor growth. The disease can be difficult to recognize in patients with Type 1 diabetes mellitus. Some clinicians find treatment of the disease in asymptomatic individuals controversial. CASE REPORTS Two adolescent female patients with Type 1 diabetes experienced recurrent hypoglycaemic seizures. Neither patient reported gastrointestinal symptoms or poor growth. After diagnosis and treatment of coeliac disease, hypoglycaemia resolved. CONCLUSION These cases illustrate how frequent unexplained severe hypoglycaemia can be an atypical presentation of coeliac disease in youth with Type 1 diabetes. Furthermore, they emphasize the importance of screening and treatment of coeliac disease in asymptomatic patients with Type 1 diabetes. Although controversial, management of coeliac disease in these asymptomatic patients can prevent the vicious cycle of recurrent hypoglycaemia and decrease risk for morbidity and death.
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Affiliation(s)
- N Khoury
- Department of Metabolism and Endocrinology, Washington University School of Medicine
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Semenkovich K, Chockalingam R, Scherrer JF, Panagopoulos VN, Lustman PJ, Ray JM, Freedland KE, Svrakic DM. Prescription Opioid Analgesics Increase Risk of Major Depression: New Evidence, Plausible Neurobiological Mechanisms and Management to Achieve Depression Prophylaxis. Mo Med 2014; 111:148-154. [PMID: 30323529 PMCID: PMC6179498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
More than 200 million prescriptions are written annually for opioid analgesics despite limited evidence of their long-term efficacy. These medications currently are prescribed to 10% - 15% of Americans with use of long-acting opioids projected to double in the next three to four years. Despite this widespread use, little is known about the risks of opioids, particularly with chronic use. New data from our research group published in the Journal of General Internal Medicine provides clear evidence that prescription opioid used for non-cancer, non-HIV pain increases significantly the risk of development of major depressive disorder in opioid naïve individuals with no recent history of depression and substance used disorders. The risk of depression increased as the dose and/or the duration of opioid use increased. The purpose of the present paper is to elucidate the details of this study, to examine potential neurobiological mechanisms responsible for the depressogenic effect of opioid analgesics, and to discuss management options that emphasize depression prophylaxis.
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Affiliation(s)
- Katherine Semenkovich
- Katherine Semenkovich, BA, is in the Department of Pediatrics at Washington University School of Medicine
| | - Ravikumar Chockalingam
- Ravikumar Chockalingam, MD, Department of Psychiatry at Washington University School of Medicine
| | - Jeffrey F Scherrer
- Jeffrey F. Scherrer, PhD, is in Research Service, John Cochran Hospital, St. Louis VA Medical Center
| | - Vassilis N Panagopoulos
- Vassilis N. Panagopoulos, MD, Bell Street Clinic Opioid Treatment Program and at the at the Washington University School of Medicine and the Veterans Administration Medical Center in St. Louis
| | - Patrick J Lustman
- Patrick J. Lustman, PhD, Bell Street Clinic Opioid Treatment Program and at the at the Washington University School of Medicine and the Veterans Administration Medical Center in St. Louis
| | - John M Ray
- John M. Ray, MA, is in Mental Health Service, St. Louis VA Medical Center
| | - Kenneth E Freedland
- Kenneth E. Freedland, PhD, Department of Psychiatry at Washington University School of Medicine
| | - Dragan M Svrakic
- Dragan M. Svrakic, MD, PhD, Bell Street Clinic Opioid Treatment Program and at the at the Washington University School of Medicine and the Veterans Administration Medical Center in St. Louis
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15
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Arbelaez AM, Semenkovich K, Hershey T. Glycemic extremes in youth with T1DM: the structural and functional integrity of the developing brain. Pediatr Diabetes 2013; 14:541-53. [PMID: 24119040 PMCID: PMC3857606 DOI: 10.1111/pedi.12088] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 08/14/2013] [Accepted: 09/04/2013] [Indexed: 12/13/2022] Open
Abstract
The adult brain accounts for a disproportionally large percentage of the body’s total energy consumption (1). However, during brain development,energy demand is even higher, reaching the adult rate by age 2 and increasing to nearly twice the adult rate by age 10, followed by gradual reduction toward adult levels in the next decade (1,2). The dramatic changes in brain metabolism occurring over the first two decades of life coincide with the initial proliferation and then pruning of synapses to adult levels.The brain derives its energy almost exclusively from glucose and is largely driven by neuronal signaling, biosynthesis, and neuroprotection (3–6).Glucose homeostasis in the body is tightly regulated by a series of hormones and physiologic responses. As a result, hypoglycemia and hyperglycemia are rare occurrences in normal individuals, but they occur commonly inpatients with type 1 diabetes mellitus (T1DM) due to a dysfunction of peripheral glucose-insulin-glucagon responses and non-physiologic doses of exogenous insulin, which imperfectly mimic normal physiology. These extremes can occur more frequently in children and adolescents with T1DM due to the inadequacies of insulin replacement therapy, events leading to the diagnosis [prolonged untreated hyperglycemia and diabetic ketoacidosis (DKA)], and to behavioral factors interfering with optimal treatment. When faced with fluctuations in glucose supply the metabolism of the body and brain change dramatically, largely to conserve resources and, at a cost to other organs, to preserve brain function (7). However,if the normal physiological mechanisms that prevent these severe glucose fluctuations and maintain homeostasis are impaired, neuronal function and potentially viability can be affected (8–11).
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Affiliation(s)
- Ana Maria Arbelaez
- Department of Pediatrics, Washington University School of Medicine St. Louis, Missouri, United States, 63110
| | - Katherine Semenkovich
- Department of Pediatrics, Washington University School of Medicine St. Louis, Missouri, United States, 63110
| | - Tamara Hershey
- Department of Psychiatry, Washington University School of Medicine St. Louis, Missouri, United States, 63110,Department of Neurology, Washington University School of Medicine St. Louis, Missouri, United States, 63110,Department of Radiology, Washington University School of Medicine St. Louis, Missouri, United States, 63110
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