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Trief PM, Foster NC, Chaytor N, Hilliard ME, Kittelsrud JM, Jaser SS, Majidi S, Corathers SD, Bzdick S, Adkins DW, Weinstock RS. Longitudinal Changes in Depression Symptoms and Glycemia in Adults With Type 1 Diabetes. Diabetes Care 2019; 42:1194-1201. [PMID: 31221694 DOI: 10.2337/dc18-2441] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 11/27/2018] [Accepted: 04/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed longitudinal change in depression symptoms over ≥4 years in adults with type 1 diabetes and examined the association between change in depression symptom status and glycemia. RESEARCH DESIGN AND METHODS Adults in the T1D Exchange registry with HbA1c and Patient Health Questionnaire (PHQ-8) at 1 year (baseline) and 5 years post-enrollment (follow-up; n = 2,744, mean age, 42 years; 57% female, 92% white; mean HbA1c, 7.6% [58 mmol/mol]) were included. Depression status was defined as Persistent Elevated Depression Symptoms (EDS) (EDS at baseline and follow-up), Resolved EDS (EDS at baseline, no EDS at follow-up), New Onset EDS (no EDS at baseline, EDS at follow-up), and Not Depressed (no EDS at baseline or follow-up). RESULTS Overall, 131 (5%) had Persistent EDS, 122 (4%) had Resolved EDS, 168 (6%) had New Onset EDS, and 2,323 (85%) were Not Depressed. Of those with EDS (PHQ ≥ 10) at baseline, 53% had EDS at follow-up; of those not depressed at baseline, 7% had EDS at follow-up. An increase in PHQ-8 was associated with an increase in HbA1c (P < 0.001). Although HbA1c increased in all groups, the increase was less in the Resolved EDS and Not Depressed groups (P = 0.001). Persistent EDS and New Onset EDS groups were more likely to experience diabetic ketoacidosis (DKA) (P < 0.001). CONCLUSIONS T1D Exchange registry data provide evidence for relationships over time between persistently, and newly developing EDSs and worsening glycemic control, and suggest relationships between depression symptoms and the occurrence of severe hypoglycemia and DKA. Successful treatment of depression symptoms may lead to better long-term diabetes outcomes.
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Affiliation(s)
- Paula M Trief
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Naomi Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Sarah D Corathers
- Cinncinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Suzan Bzdick
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY
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Feuerstein-Simon C, Bzdick S, Padmanabhuni A, Bains P, Roe C, Weinstock RS. Use of a Smartphone Application to Reduce Hypoglycemia in Type 1 Diabetes: A Pilot Study. J Diabetes Sci Technol 2018; 12:1192-1199. [PMID: 29291641 PMCID: PMC6232731 DOI: 10.1177/1932296817749859] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Hypoglycemia and hypoglycemia unawareness are common in long-standing type 1 diabetes (T1D). This pilot study examined the real-world use of a smartphone application (app), which receives meter readings and logs hypoglycemic symptoms, causes, and treatments to reduce hypoglycemia. METHODS Adults with T1D and recent hypoglycemia synchronized their glucose meter to their smartphone and used the Joslin HypoMap™ app powered by Glooko to track hypoglycemic events. At baseline, and after 6 and 12 weeks of using the app, a blinded continuous glucose monitor (CGM; Dexcom G4) was used for 2 weeks and surveys administered. RESULTS Participants (n = 22) at baseline had mean (SD) age 43 (14) years, duration of diabetes 26 (13) years, A1c 8.0% (0.87) and 21/22 had reduced hypoglycemia awareness per Clarke Hypoglycemia Unawareness survey scores; 13 (59%) were "CGM completers" (CGM data available at baseline and follow-up). Most noncompletion related to time required/difficulties using the mobile app. After 6 weeks, 8/13 completers (62% of CGM completers, 36% of total participants) had reduced daytime minutes with glucose <54 mg/dL (mean ↓331 minutes) and 10/13 (77% of CGM completers; 45% of total participants) had reduced time ≤ 70 mg/dL (mean ↓449 minutes). This was not sustained at 12 weeks, at which time half of the completers had less time ("improved"). Five participants reported improved hypoglycemia awareness; 9 stated the app helped them better recognize hypoglycemia. CONCLUSIONS Use of this phone app has the potential to help reduce daytime hypoglycemia in a subset of T1D adults with reduce hypoglycemia awareness; larger studies are needed.
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Affiliation(s)
| | - Suzan Bzdick
- SUNY Upstate Medical University,
Syracuse, NY, USA
| | | | | | - Cheryl Roe
- SUNY Upstate Medical University,
Syracuse, NY, USA
| | - Ruth S. Weinstock
- SUNY Upstate Medical University,
Syracuse, NY, USA
- Ruth S. Weinstock, MD, PhD, SUNY Upstate
Medical University, 750 E Adams St (CWB 353), Syracuse, NY 13210, USA.
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B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, 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Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Bergenstal RM, Gal RL, Connor CG, Gubitosi-Klug R, Kruger D, Olson BA, Willi SM, Aleppo G, Weinstock RS, Wood J, Rickels M, DiMeglio LA, Bethin KE, Marcovina S, Tassopoulos A, Lee S, Massaro E, Bzdick S, Ichihara B, Markmann E, McGuigan P, Woerner S, Ecker M, Beck RW. Racial Differences in the Relationship of Glucose Concentrations and Hemoglobin A1c Levels. Ann Intern Med 2017; 167:95-102. [PMID: 28605777 DOI: 10.7326/m16-2596] [Citation(s) in RCA: 204] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Debate exists as to whether the higher hemoglobin A1c (HbA1c) levels observed in black persons than in white persons are due to worse glycemic control or racial differences in the glycation of hemoglobin. OBJECTIVE To determine whether a racial difference exists in the relationship of mean glucose and HbA1c. DESIGN Prospective, 12-week observational study. SETTING 10 diabetes centers in the United States. PARTICIPANTS 104 black persons and 104 white persons aged 8 years or older who had had type 1 diabetes for at least 2 years and had an HbA1c level of 6.0% to 12.0%. MEASUREMENTS Mean glucose concentration, measured by using continuous glucose monitoring and compared by race with HbA1c, glycated albumin, and fructosamine values. RESULTS The mean HbA1c level was 9.1% in black persons and 8.3% in white persons. For a given HbA1c level, the mean glucose concentration was significantly lower in black persons than in white persons (P = 0.013), which was reflected in mean HbA1c values in black persons being 0.4 percentage points (95% CI, 0.2 to 0.6 percentage points) higher than those in white persons for a given mean glucose concentration. In contrast, no significant racial differences were found in the relationship of glycated albumin and fructosamine levels with the mean glucose concentration (P > 0.20 for both comparisons). LIMITATION There were too few participants with HbA1c levels less than 6.5% to generalize the results to such individuals. CONCLUSION On average, HbA1c levels overestimate the mean glucose concentration in black persons compared with white persons, possibly owing to racial differences in the glycation of hemoglobin. However, because race only partially explains the observed HbA1c differences between black persons and white persons, future research should focus on identifying and modifying barriers impeding improved glycemic control in black persons with diabetes. PRIMARY FUNDING SOURCE Helmsley Charitable Trust.
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Affiliation(s)
- Richard M Bergenstal
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Robin L Gal
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Crystal G Connor
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Rose Gubitosi-Klug
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Davida Kruger
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Beth A Olson
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Steven M Willi
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Grazia Aleppo
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Ruth S Weinstock
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Jamie Wood
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Michael Rickels
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Linda A DiMeglio
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Kathleen E Bethin
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Santica Marcovina
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Andreana Tassopoulos
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Sooji Lee
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Elaine Massaro
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Suzan Bzdick
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Brian Ichihara
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Eileen Markmann
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Paul McGuigan
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Stephanie Woerner
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Michelle Ecker
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
| | - Roy W Beck
- From International Diabetes Center Park Nicollet, Minneapolis, Minnesota; Jaeb Center for Health Research, Tampa, Florida; University Hospitals of Cleveland, Cleveland, Ohio; Henry Ford Health System, Detroit, Michigan; Children's Hospital of Philadelphia and Perelman School of Medicine and Rodebaugh Diabetes Center, University of Pennsylvania, Philadelphia, Pennsylvania; Northwestern University, Chicago, Illinois; SUNY Upstate Medical University, Syracuse, New York; Children's Hospital of Los Angeles, Los Angeles, California; Indiana University School of Medicine, Indianapolis, Indiana; SUNY Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York; and Northwest Lipid Metabolism and Diabetes Research Laboratories, Seattle, Washington
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5
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Chaytor NS, Riddlesworth TD, Bzdick S, Odegard PS, Gray SL, Lock JP, DuBose SN, Beck RW. The relationship between neuropsychological assessment, numeracy, and functional status in older adults with type 1 diabetes. Neuropsychol Rehabil 2015; 27:507-521. [PMID: 26605669 DOI: 10.1080/09602011.2015.1116448] [Citation(s) in RCA: 11] [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] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
While data are accumulating on the association between neuropsychological performance and real-world endpoints, less is known about the association with medical self-management skills. The self-management of type 1 diabetes (T1D) is often complex, and mismanagement can result in hypoglycaemia and hyperglycaemia and associated morbidity and mortality. The T1D Exchange conducted a case-control study evaluating factors associated with severe hypoglycaemia in older adults (≥ 60 years old) with longstanding T1D (≥ 20 years). A battery of neuropsychological and functional assessments was administered, including measures of diabetes-specific self-management skill (diabetes numeracy) and instrumental activities of daily living (IADL). After adjusting for confounding variables, diabetes numeracy was related to memory and complex speeded attention; while IADL were associated with simple processing speed, executive functioning, complex speeded attention and dominant hand dexterity. The severity of overall cognitive deficit was uniquely associated with both diabetes numeracy and IADL, when controlling for age, education, frailty and depression. This study demonstrates that the cognitive deficits in older adults with T1D have functional implications for both diabetes management and IADL. Further research is needed to determine specific interventions to maximise diabetes self-management in older adults with declining cognition.
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Affiliation(s)
- Naomi S Chaytor
- a Elson S. Floyd College of Medicine , Washington State University , Spokane , WA , USA
| | | | - Suzan Bzdick
- c Joslin Diabetes Center, Department of Endocrinology, Diabetes, and Metabolism , State University of New York- Upstate Medical University , Syracuse , NY , USA
| | - Peggy S Odegard
- d School of Pharmacy , University of Washington , Seattle , WA , USA
| | - Shelly L Gray
- d School of Pharmacy , University of Washington , Seattle , WA , USA
| | - John-Paul Lock
- e Department of Medicine, Division of Diabetes, Diabetes Center of Excellence , University of Massachusetts School of Medicine , Worcester , MA , USA
| | | | - Roy W Beck
- b Jaeb Center for Health Research , Tampa , FL , USA
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6
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Walders-Abramson N, Anderson B, Larkin ME, Chang N, Venditti E, Bzdick S, Tryggestad JB, Tan K, Geffner ME, Hirst K. Benefits and barriers to participating in longitudinal research of youth-onset type 2 diabetes: Results from the TODAY retention survey. Clin Trials 2015; 13:240-3. [PMID: 26531295 DOI: 10.1177/1740774515613949] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND/AIMS Conducting longitudinal research related to chronic illness in adolescents is inherently challenging due to developmental changes and psychosocial stressors. Participants in the Treatment Options for type 2 Diabetes in Adolescents and Youth clinical trial were socioeconomically disadvantaged as well. This study assessed attitudes and beliefs about retention in Treatment Options for type 2 Diabetes in Adolescents and Youth to shed light on the factors that potentially promote and detract from the likelihood of sustained participation. METHODS After an average 7.3 years of follow-up (range 4.9-9.5), Treatment Options for type 2 Diabetes in Adolescents and Youth participants completed a survey examining their perceptions of the benefits and barriers to sustained involvement in the protocol. RESULTS The most common reasons for staying in Treatment Options for type 2 Diabetes in Adolescents and Youth included having a strong relationship with the medical team, getting study-provided diabetes care, access to free diabetes medicine and supplies, and being part of a large study to learn more about how to care for youth-onset type 2 diabetes. The most commonly endorsed challenges included scheduling conflicts, possibly disappointing others, difficulties getting to study visits, and the occurrence of other medical issues. CONCLUSIONS Similar to other published reports, a supportive relationship with study staff was commonly endorsed as a benefit of engagement in the longitudinal study, suggesting that rapport, staff consistency, and relationship quality are important components of optimal retention. Moreover, our findings suggest the value of trying to remove logistical barriers, such as transportation and scheduling challenges, in order to promote long-term participation in research. Further research is recommended to evaluate factors that contribute to attrition versus retention in an a priori manner within longitudinal studies, especially protocols involving cohorts that are more vulnerable to attrition due to developmental transitions and/or socioeconomic challenges. Additional efforts to optimize quantitative and qualitative measurement of barriers would also help to expand our understanding of how to optimally retain participants in longitudinal protocols.
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Affiliation(s)
- Natalie Walders-Abramson
- Department of Pediatrics, University of Colorado Denver and Children's Hospital Colorado, Aurora, CO, USA
| | - Barbara Anderson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Mary E Larkin
- Massachusetts General Hospital Diabetes Center, Harvard Medical School, Boston, MA, USA
| | - Nancy Chang
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Elizabeth Venditti
- Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Suzan Bzdick
- SUNY Upstate Medical University, Syracuse, NY, USA
| | - Jeanie B Tryggestad
- Department of Pediatrics, Section of Pediatric Diabetes and Endocrinology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kenny Tan
- The George Washington University Biostatistics Center, Rockville, MD, USA
| | - Mitchell E Geffner
- The Saban Research Institute of Children's Hospital Los Angeles, Keck School of Medicine of USC, Los Angeles, CA, USA
| | - Kathryn Hirst
- The George Washington University Biostatistics Center, Rockville, MD, USA
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7
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DuBose SN, Hermann JM, Tamborlane WV, Beck RW, Dost A, DiMeglio LA, Schwab KO, Holl RW, Hofer SE, Maahs DM, Lipman T, Calvano T, Kucheruk O, Minnock P, Nguyen C, Klingensmith G, Banion C, Barker J, Cain C, Chase P, Hoops S, Kelsy M, Klingensmith G, Maahs D, Mowry C, Nadeau K, Raymond J, Rewers M, Rewers A, Slover R, Steck A, Wadwa P, Walravens P, Zeitler P, Haro H, Manseau K, Weinstock R, Izquierdo R, Sheikh U, Conboy P, Bulger J, Bzdick S, Goland R, Gandica R, Weiner L, Cook S, Greenberg E, Kohm K, Pollack S, Lee J, Gregg B, Tan M, Burgh K, Eason A, Garg S, Michels A, Myers L, DiMeglio L, Hannon T, Orr D, Cruz C, Woerner S, Wolfsdorf J, Quinn M, Tawa O, Ahmann A, Castle J, Joarder F, Bogan C, Cady N, Cox J, Pitts A, Fitch R, White B, Wollam B, Bode B, Lindmark K, Hosey R, Bethin K, Quattrin T, Ecker M, Wood J, Chao L, Cheung C, Fisher L, Jeandron D, Kaufman F, Kim M, Miyazaki B, Monzavi R, Patel P, Pitukcheewanont P, Sandstrom A, Cohen M, Ichihara B, Lipton M, Cemeroglu A, Appiagyei-Dankah Y, Daniel M, Postellon D, Racine M, Wood M, Kleis L, Hirsch I, DeSantis A, Dugdale D, Failor RA, Gilliam L, Greenbaum C, Janci M, Odegard P, Trence D, Wisse B, Batts E, Dove A, Hefty D, Khakpour D, Klein J, Kuhns K, McCulloch-Olson M, Peterson C, Ramey M, Marie MS, Thomson P, Webber C, Liljenquist D, Sulik M, Vance C, Coughenour T, Brown C, Halford J, Prudent A, Rigby S, Robison B, Starkman H, Berry T, Cerame B, Chin D, Ebner-Lyon L, Guevarra F, Sabanosh K, Silverman L, Wagner C, Fox M, Buckingham B, Shah A, Caswell K, Harris B, Bergenstal R, Criego A, Damberg G, Matfin G, Powers M, Tridgell D, Burt C, Olson B, Thomas L, Mehta S, Katz M, Laffel L, Hathway J, Phillips R, Cengiz E, Tamborlane W, Cappiello D, Steffen A, Zgorski M, Peters A, Ruelas V, Benjamin R, Adkins D, Cuffee J, Spruill A, Bergenstal R, Criego A, Damberg G, Matfin G, Powers M, Tridgell D, Burt C, Olson B, Thomas L, Aleppo-Kacmarek G, Derby T, Massaro E, Webb K, Burt Solorzano C, DeBoer M, Madison H, McGill J, Buechler L, Clifton MJ, Hurst S, Kissel S, Recklein C, Tsalikian E, Tansey M, Cabbage J, Coffey J, Salamati S, Clements M, Raman S, Turpin A, Bedard J, Cohoon C, Elrod A, Fridlington A, Hester L, Kruger D, Schatz D, Clare-Salzler M, Cusi K, Digman C, Fudge B, Haller M, Meehan C, Rohrs H, Silverstein J, Wagh S, Cintron M, Sheehan E, Thomas J, Daniels M, Clark S, Flannery T, Forghani N, Naidu A, Reh C, Scoggin P, Trinh L, Ayala N, Quintana R, Speer H, Zipf W, Seiple D, Kittelsrud J, Gupta A, Peterson V, Stoker A, Gottschalk M, Hashiguchi M, Smith K, Rodriguez H, Bobik C, Henson D, Simmons J, Potter A, Black M, Brendle F, Gubitosi-Klug R, Kaminski B, Bergant S, Campbell W, Tasi C, Copeland K, Beck J, Less J, Schanuel J, Tolbert J, Adi S, Gerard-Gonzalez A, Gitelman S, Chettout N, Torok C, Pihoker C, Yi-Frazier J, Kearns S, Libman I, Bills V, Diaz A, Duke J, Nathan B, Moran A, Bellin M, Beasley S, Kogler A, Leschyshyn J, Schmid K, Street A, Nelson B, Frost C, Reifeis E, Haymond M, Bacha F, Caldas-Vasquez M, Klinepeter S, Redondo M, Berlanga R, Falk T, Garnes E, Gonzalez J, Martinez C, Pontifes M, Yulatic R, Arnold K, Evans T, Sellers S, Raman V, Foster C, Murray M, Raman V, Brown T, Slater H, Wheeler K, Harlan D, Lee M, Lock JP, Hartigan C, Hubacz L, Buse J, Calikoglu A, Largay J, Young L, Brown H, Duncan V, Duclos M, Tricome J, Brandenburg V, Blehm J, Hallanger-Johnson J, Hanson D, Miller C, Weiss J, Hoffman R, Chaudhari M, Repaske D, Gilson E, Haines J, Rudolph J, McClave C, Biersdorf D, Tello A, Blehm J, Amundson D, Ward R, Rickels M, Dalton-Bakes C, Markman E, Peleckis A, Rosenfeld N, Dolan L, Corathers S, Kichler J, Baugh H, Standiford D, Hassing J, Jones J, Willis S, Willis S, Wysham C, Davis L, Blackman S, Abel KL, Clark L, Jonas A, Kagan E, Sosenko J, Blashke C, Matheson D, Edelen R, Repas T, Baldwin D, Borgwardt T, Conroy C, DeGrote K, Marchiando R, Wasson M, Fox L, Mauras N, Damaso L, Englert K, Hamaty M, Kennedy L, Schweiger M, Konstantinopoulos P, Mawhorter C, Orasko A, Rose D, Deeb L, Rohrbacher K, Schroeder L, Roark A, Ali O, Kramer J, Whitson-Jones D, Potter A, Black M, Brendle F, Gassner H, Kollipara S, Bills V, Duke J, Harwood K, Prasad V, Brault J. Obesity in Youth with Type 1 Diabetes in Germany, Austria, and the United States. J Pediatr 2015; 167:627-32.e1-4. [PMID: 26164381 DOI: 10.1016/j.jpeds.2015.05.046] [Citation(s) in RCA: 122] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 04/28/2015] [Accepted: 05/22/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the current extent of the obesity problem in 2 large pediatric clinical registries in the US and Europe and to examine the hypotheses that increased body mass index (BMI) z-scores (BMIz) are associated with greater hemoglobin A1c (HbA1c) and increased frequency of severe hypoglycemia in youth with type 1 diabetes (T1D). STUDY DESIGN International (World Health Organization) and national (Centers for Disease Control and Prevention/German Health Interview and Examination Survey for Children and Adolescents) BMI references were used to calculate BMIz in participants (age 2-<18 years and ≥ 1 year duration of T1D) enrolled in the T1D Exchange (n = 11,435) and the Diabetes Prospective Follow-up (n = 21,501). Associations between BMIz and HbA1c and severe hypoglycemia were assessed. RESULTS Participants in both registries had median BMI values that were greater than international and their respective national reference values. BMIz was significantly greater in the T1D Exchange vs the Diabetes Prospective Follow-up (P < .001). After stratification by age-group, no differences in BMI between registries existed for children 2-5 years, but differences were confirmed for 6- to 9-, 10- to 13-, and 14- to 17-year age groups (all P < .001). Greater BMIz were significantly related to greater HbA1c levels and more frequent occurrence of severe hypoglycemia across the registries, although these associations may not be clinically relevant. CONCLUSIONS Excessive weight is a common problem in children with T1D in Germany and Austria and, especially, in the US. Our data suggest that obesity contributes to the challenges in achieving optimal glycemic control in children and adolescents with T1D.
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Affiliation(s)
| | - Julia M Hermann
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | | | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | - Axel Dost
- Department of Pediatrics, University Children's Hospital Jena, Jena, Germany
| | | | | | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - David M Maahs
- Barbara Davis Center for Childhood Diabetes, Aurora, CO
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