Ahmed M. Hegab, Susana E. Hasaballah, Montaser M. Mohamed
Aims. Assessment of the glycemic outcomes of increasing and splitting mealtime insulin doses for mixed fat and protein meals in pediatric patients with type 1 diabetes mellitus (T1DM) using multiple daily injection regimen and comparing the effects of regular insulin and fast-acting insulin on glycemic outcomes following those meals. Methods. This single-center, randomized, cross-over trial included 43 children and adolescents with T1DM randomly assigned to receive three interventional insulin doses for lunch meals over 3 consecutive days; Intervention A (100% insulin-to-carbohydrate ratio (ICR) dose given as premeal insulin lispro with an additional insulin sensitivity factor-calculated correction dose after 3 hr), Intervention B (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal insulin lispro after 30 min), and Intervention C (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal regular insulin after 30 min). The test meal consisted of two slices of pizza (weight: 150 g, carbohydrates: 40 g, fat: 15 g, protein: 20 g, and calories: 380 kcal). Postprandial blood glucose levels were monitored for 6 hr. Results. There were no significant differences in postprandial blood glucose excursions following the three interventions. However, Intervention C had a significantly lower late (3–6 hr) blood glucose area under the curve ( ). Postprandial hypoglycemia developed in 12 participants (27.9%) following Interventions A and B and in 17 participants (39.5%) following Intervention C ( ). Conclusions. Using regular insulin as a postmeal portion of increased and split insulin doses provided better late postprandial glycemic outcomes following mixed fat and protein meals. However, the amount of additional insulin used needs optimization to reduce the frequency of postprandial hypoglycemia. This trial is registered with NCT04783376.
{"title":"Splitting Mealtime Insulin Doses for Mixed Fat and Protein Meals in Children and Adolescents with Type 1 Diabetes Using Multiple Daily Injection Regimen: A Randomized Cross-Over Trial","authors":"Ahmed M. Hegab, Susana E. Hasaballah, Montaser M. Mohamed","doi":"10.1155/2023/7467652","DOIUrl":"https://doi.org/10.1155/2023/7467652","url":null,"abstract":"Aims. Assessment of the glycemic outcomes of increasing and splitting mealtime insulin doses for mixed fat and protein meals in pediatric patients with type 1 diabetes mellitus (T1DM) using multiple daily injection regimen and comparing the effects of regular insulin and fast-acting insulin on glycemic outcomes following those meals. Methods. This single-center, randomized, cross-over trial included 43 children and adolescents with T1DM randomly assigned to receive three interventional insulin doses for lunch meals over 3 consecutive days; Intervention A (100% insulin-to-carbohydrate ratio (ICR) dose given as premeal insulin lispro with an additional insulin sensitivity factor-calculated correction dose after 3 hr), Intervention B (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal insulin lispro after 30 min), and Intervention C (130% ICR dose split into 60% premeal insulin lispro and 40% postmeal regular insulin after 30 min). The test meal consisted of two slices of pizza (weight: 150 g, carbohydrates: 40 g, fat: 15 g, protein: 20 g, and calories: 380 kcal). Postprandial blood glucose levels were monitored for 6 hr. Results. There were no significant differences in postprandial blood glucose excursions following the three interventions. However, Intervention C had a significantly lower late (3–6 hr) blood glucose area under the curve ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ). Postprandial hypoglycemia developed in 12 participants (27.9%) following Interventions A and B and in 17 participants (39.5%) following Intervention C ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo>=</mo> <mn>0.32</mn> </math> ). Conclusions. Using regular insulin as a postmeal portion of increased and split insulin doses provided better late postprandial glycemic outcomes following mixed fat and protein meals. However, the amount of additional insulin used needs optimization to reduce the frequency of postprandial hypoglycemia. This trial is registered with NCT04783376.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136235028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kellee M. Miller, Colleen Bauza, Lauren G. Kanapka, Mark A. Clements, Daniel J. DeSalvo, Korey Hood, Laurel H. Messer, Jennifer Sherr, Katherine Bergamo, Amy Criego, Emily Freiner, Sarah K. Lyons, Roshanak Monzavi, Wayne Moore, Priya Prahalad, Jill H. Simmons, Mark Sulik, R. Paul Wadwa, Ruth S. Weinstock, Steven M. Willi, Kristen Williams, Lori M. Laffel
Objective. To further evaluate glycemic outcomes during the observational extension phase of the Continuous Glucose Monitoring (CGM) Intervention for Teens and Young Adults randomized clinical trial (RCT). Subjects and Methods. Following a 26-week RCT comparing CGM with blood glucose monitoring (BGM) in 153 adolescents and young adults aged 14 to <25 years old with suboptimally controlled type 1 diabetes, 70 (89%) participants in the BGM group initiated use of CGM (referred to as BGM–CGM cohort), and 70 (95%) participants in the CGM group continued to use of CGM (CGM–CGM cohort) for an additional 26 weeks. Results. In the CGM–CGM cohort, mean hemoglobin A1c (HbA1c) decreased from 8.9% ± 0.9% (74 ± 9.8 mmol/mol) at randomization to 8.3% ± 1.3% (67 ± 14.2 mmol/mol) at 52 weeks ( ); however, significant improvement in time in target range (TIR) 70–180 mg/dL was not observed from prerandomization (38% ± 13%) to 52 weeks (41% ± 18%). Median percent time <70 mg/dL decreased from 3.0% before randomization to 1.1% at 52 weeks ( ). In the BGM–CGM cohort, mean HbA1c decreased from 8.9% ± 1.2% (74 ± 13.1 mmol/mol) before CGM initiation to 8.5% ± 1.3% (69 ± 14.2 mmol/mol) after 26 weeks of CGM use ( ) and mean TIR increased from 34% ± 12% to 38% ± 15% ( ). The median percent time <70 mg/dL decreased from 3.3% before CGM initiation to 1.2% after 26 weeks of CGM use ( ). No participants discontinued CGM use during the extension phase. Conclusions. This further evaluation of CGM supports the findings of the preceding RCT that use of CGM improves glycemic control and reduces hypoglycemia in adolescents and young adults with type 1 diabetes. This trial is registered with NCT03263494.
{"title":"Continuous Glucose Monitoring Provides Durable Glycemic Benefit in Adolescents and Young Adults with Type 1 Diabetes: 12-Month Follow-Up Results","authors":"Kellee M. Miller, Colleen Bauza, Lauren G. Kanapka, Mark A. Clements, Daniel J. DeSalvo, Korey Hood, Laurel H. Messer, Jennifer Sherr, Katherine Bergamo, Amy Criego, Emily Freiner, Sarah K. Lyons, Roshanak Monzavi, Wayne Moore, Priya Prahalad, Jill H. Simmons, Mark Sulik, R. Paul Wadwa, Ruth S. Weinstock, Steven M. Willi, Kristen Williams, Lori M. Laffel","doi":"10.1155/2023/6718115","DOIUrl":"https://doi.org/10.1155/2023/6718115","url":null,"abstract":"Objective. To further evaluate glycemic outcomes during the observational extension phase of the Continuous Glucose Monitoring (CGM) Intervention for Teens and Young Adults randomized clinical trial (RCT). Subjects and Methods. Following a 26-week RCT comparing CGM with blood glucose monitoring (BGM) in 153 adolescents and young adults aged 14 to <25 years old with suboptimally controlled type 1 diabetes, 70 (89%) participants in the BGM group initiated use of CGM (referred to as BGM–CGM cohort), and 70 (95%) participants in the CGM group continued to use of CGM (CGM–CGM cohort) for an additional 26 weeks. Results. In the CGM–CGM cohort, mean hemoglobin A1c (HbA1c) decreased from 8.9% ± 0.9% (74 ± 9.8 mmol/mol) at randomization to 8.3% ± 1.3% (67 ± 14.2 mmol/mol) at 52 weeks ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); however, significant improvement in time in target range (TIR) 70–180 mg/dL was not observed from prerandomization (38% ± 13%) to 52 weeks (41% ± 18%). Median percent time <70 mg/dL decreased from 3.0% before randomization to 1.1% at 52 weeks ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ). In the BGM–CGM cohort, mean HbA1c decreased from 8.9% ± 1.2% (74 ± 13.1 mmol/mol) before CGM initiation to 8.5% ± 1.3% (69 ± 14.2 mmol/mol) after 26 weeks of CGM use ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ) and mean TIR increased from 34% ± 12% to 38% ± 15% ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ). The median percent time <70 mg/dL decreased from 3.3% before CGM initiation to 1.2% after 26 weeks of CGM use ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M5\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ). No participants discontinued CGM use during the extension phase. Conclusions. This further evaluation of CGM supports the findings of the preceding RCT that use of CGM improves glycemic control and reduces hypoglycemia in adolescents and young adults with type 1 diabetes. This trial is registered with NCT03263494.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"27 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134910270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Meryl C. Nath, Blake Frey, Joycelyn Atchison, Jessica A. Schmitt
Background. Racial disparities are well described in glycemic outcomes in youth with Type 1 diabetes mellites (T1D). Hemoglobin A1c (HbA1c) has some limitations in comparing glycemia across patient groups as there are individual variations in mean glucose and HbA1c. Objective. This study aimed to compare glycemic metrics obtained from (Dexcom G6) continuous glucose monitor (CGM) device with HbA1c levels controlling for race, age, duration of diabetes, race, insurance status, and insulin pump use with glycemic control. Subjects and Methods. Data analyzed included 188 patients, majority non-Hispanic White (NHW) (n = 147, 78.2%) and majority privately insured (n = 147, 78.2%). Half of the patients were using insulin pumps, (n = 94, 50.0%) and approximately half were female. Median age was 16.6 (interquartile range: 14.2–18.2) years old with a median age of diabetes diagnosis at 9.3-years old. Results. Significant differences were observed between NHW and non-Hispanic Black (NHB) patients in terms of HbA1c, 90-day mean glucose, and 90-day time >250 mg/dL (>13.9 mmol/L) (7.6% vs. 9.2%, 181 mg/dL vs. 220 mg/dL, and 16.3% vs. 34.7%, respectively, for all comparisons). Multiple linear regression analysis was performed to predict the influence of age, duration of diabetes, race, insurance status, and insulin administration on glycemic outcomes. Regression analysis revealed significant equations for all glycemic outcomes, demonstrating a strong correlation ( , , and , respectively). However, after controlling for these variables, only race and duration of diabetes remained independently associated with glycemic outcomes, suggesting that these factors strongly influence glycemic control independent of age, sex, insurance, and pump use. Conclusion. Even in a subset of youth with T1D using CGM with high rates of insulin pump use, disparities in glycemic outcomes persist. When evaluating glycemic outcomes, race remained a significant cofactor despite controlling for age, duration of diabetes, sex, insurance status, and insulin administration type. These results add to the existing literature, and demonstrate race remains strong predictor of glycemic outcomes.
背景。种族差异在青年1型糖尿病患者(T1D)的血糖结局中得到了很好的描述。血红蛋白糖化血红蛋白(HbA1c)在比较不同患者组的血糖方面有一定的局限性，因为平均葡萄糖和HbA1c存在个体差异。目标。本研究旨在比较从(Dexcom G6)连续血糖监测仪(CGM)获得的血糖指标与控制HbA1c水平的种族、年龄、糖尿病病程、种族、保险状况和胰岛素泵使用与血糖控制。研究对象和方法。数据分析包括188例患者，大多数是非西班牙裔白人(NHW) (n = 147, 78.2%)和大多数私人保险(n = 147, 78.2%)。半数患者使用胰岛素泵(n = 94, 50.0%)，约半数为女性。中位年龄为16.6岁(四分位数间距:14.2-18.2)，糖尿病诊断的中位年龄为9.3岁。结果。NHW和非西班牙裔黑人(NHB)患者在HbA1c、90天平均血糖和90天时间>250 mg/dL (>13.9 mmol/L)方面分别观察到显著差异(7.6% vs. 9.2%， 181 mg/dL vs. 220 mg/dL, 16.3% vs. 34.7%， p <0.001为所有比较)。采用多元线性回归分析预测年龄、糖尿病病程、种族、保险状况和胰岛素给药对血糖结局的影响。回归分析揭示了所有血糖结局的显著方程，显示出强相关性(p <0.0001, p = 0.0001, p <分别为0.0001)。然而，在控制了这些变量后，只有种族和糖尿病病程仍然与血糖结局独立相关，这表明这些因素强烈影响血糖控制，而不受年龄、性别、保险和泵使用的影响。结论。即使在使用CGM且胰岛素泵使用率高的青年T1D患者中，血糖结局的差异仍然存在。在评估血糖结局时，种族仍然是一个重要的辅助因素，尽管控制了年龄、糖尿病病程、性别、保险状况和胰岛素给药类型。这些结果补充了现有文献，并证明种族仍然是血糖结局的有力预测因子。
{"title":"Disparities in Glycemic Outcomes Persist in Youth with Type 1 Diabetes and High-Technology Use","authors":"Meryl C. Nath, Blake Frey, Joycelyn Atchison, Jessica A. Schmitt","doi":"10.1155/2023/6646582","DOIUrl":"https://doi.org/10.1155/2023/6646582","url":null,"abstract":"Background. Racial disparities are well described in glycemic outcomes in youth with Type 1 diabetes mellites (T1D). Hemoglobin A1c (HbA1c) has some limitations in comparing glycemia across patient groups as there are individual variations in mean glucose and HbA1c. Objective. This study aimed to compare glycemic metrics obtained from (Dexcom G6) continuous glucose monitor (CGM) device with HbA1c levels controlling for race, age, duration of diabetes, race, insurance status, and insulin pump use with glycemic control. Subjects and Methods. Data analyzed included 188 patients, majority non-Hispanic White (NHW) (n = 147, 78.2%) and majority privately insured (n = 147, 78.2%). Half of the patients were using insulin pumps, (n = 94, 50.0%) and approximately half were female. Median age was 16.6 (interquartile range: 14.2–18.2) years old with a median age of diabetes diagnosis at 9.3-years old. Results. Significant differences were observed between NHW and non-Hispanic Black (NHB) patients in terms of HbA1c, 90-day mean glucose, and 90-day time >250 mg/dL (>13.9 mmol/L) (7.6% vs. 9.2%, 181 mg/dL vs. 220 mg/dL, and 16.3% vs. 34.7%, respectively, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> for all comparisons). Multiple linear regression analysis was performed to predict the influence of age, duration of diabetes, race, insurance status, and insulin administration on glycemic outcomes. Regression analysis revealed significant equations for all glycemic outcomes, demonstrating a strong correlation ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo><</mo> <mn>0.0001</mn> </math> , <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo>=</mo> <mn>0.0001</mn> </math> , and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mi>p</mi> <mo><</mo> <mn>0.0001</mn> </math> , respectively). However, after controlling for these variables, only race and duration of diabetes remained independently associated with glycemic outcomes, suggesting that these factors strongly influence glycemic control independent of age, sex, insurance, and pump use. Conclusion. Even in a subset of youth with T1D using CGM with high rates of insulin pump use, disparities in glycemic outcomes persist. When evaluating glycemic outcomes, race remained a significant cofactor despite controlling for age, duration of diabetes, sex, insurance status, and insulin administration type. These results add to the existing literature, and demonstrate race remains strong predictor of glycemic outcomes.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"58 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135218915","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aim. The trajectories of the hypoglycemia awareness status (HAS) have not yet been studied in children and adolescents with Type 1 diabetes (T1D). Methods. This 2-year follow-up study included children and adolescents with T1D aged 6‒20 years old and using flash glucose monitoring. The HAS of each participant was determined by the Gold score and assessed at three time points, along with clinical data. The trajectories based on HAS progression over time were identified, and a logistic regression analysis was performed to compare their characteristics. Results. Among the 255 participants, we identified four HAS trajectories (T1–T4). T1: normal awareness of hypoglycemia (NAH) maintained over time (n = 82, 29%); T2: NAH recovered during follow-up (n = 40, 18%); T3: impaired awareness of hypoglycemia (IAH) developed during follow-up (n = 28, 12.4%); T4: IAH maintained over time (n = 59, 21%). Sixteen participants (7%) displayed no identifiable trajectory. Participants belonging to the T3 group were younger. Following a specific trajectory defined the risk of developing future severe hypoglycemia. Conclusions. HAS changed in a significant proportion of pediatric people with T1D over time. Participants with a trajectory toward IAH were younger. Frequent HAS assessments may help to improve hypoglycemia risk management, especially in young children with T1D.
{"title":"Hypoglycemia Awareness Trajectories in Young People with Type 1 Diabetes Using Flash Glucose Monitoring","authors":"Anissa Messaaoui, Sylvie Tenoutasse, Lucia Hajselova, Laurent Crenier","doi":"10.1155/2023/4882902","DOIUrl":"https://doi.org/10.1155/2023/4882902","url":null,"abstract":"Aim. The trajectories of the hypoglycemia awareness status (HAS) have not yet been studied in children and adolescents with Type 1 diabetes (T1D). Methods. This 2-year follow-up study included children and adolescents with T1D aged 6‒20 years old and using flash glucose monitoring. The HAS of each participant was determined by the Gold score and assessed at three time points, along with clinical data. The trajectories based on HAS progression over time were identified, and a logistic regression analysis was performed to compare their characteristics. Results. Among the 255 participants, we identified four HAS trajectories (T1–T4). T1: normal awareness of hypoglycemia (NAH) maintained over time (n = 82, 29%); T2: NAH recovered during follow-up (n = 40, 18%); T3: impaired awareness of hypoglycemia (IAH) developed during follow-up (n = 28, 12.4%); T4: IAH maintained over time (n = 59, 21%). Sixteen participants (7%) displayed no identifiable trajectory. Participants belonging to the T3 group were younger. Following a specific trajectory defined the risk of developing future severe hypoglycemia. Conclusions. HAS changed in a significant proportion of pediatric people with T1D over time. Participants with a trajectory toward IAH were younger. Frequent HAS assessments may help to improve hypoglycemia risk management, especially in young children with T1D.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"23 8","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135366936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maite E. Del Valle Rolón, Elizabeth A. Brown, Risa M. Wolf
Objective. The use of hybrid closed-loop insulin delivery systems, specifically the t:slim X2 insulin pump with Control IQ (CIQ), has demonstrated improvement in glycemic control in clinical trials and real-world settings. We sought to describe changes in glycemic control with use of CIQ in minority and nonminority youth. Research Design and Methods. This was a retrospective study of youth with type 1 diabetes (T1D) using CIQ over a 12-month period. Medical record data, pump data, and hemoglobin A1c (HbA1c) were collected from the visit prior to starting CIQ and at each clinic visit up to 12 months after starting CIQ. Continuous glucose monitor (CGM) data and HbA1c trajectory over time were compared to baseline and between minority and nonminority youth. Results. The study included 136 patients of whom 21 were minority youth (non-Hispanic Black and Hispanic), 50% were male, with median age of 13.3y, and median diabetes duration of 4.9y. After starting CIQ, baseline median HbA1c for the nonminority group decreased from 7.8% to 7.1% ( ), baseline median HbA1c for minority youth decreased from 9.8% to 7.8% ( ), and the percentage of patients meeting target HbA1c <7% increased from 26% to 45%. Both nonminority and minority youth had a significant increase in time in range and decrease of average CGM glucose ( ). Conclusions. HbA1c levels decreased in both minority and nonminority youth within 12 months of starting CIQ, and more patients reached the HbA1c target of less than 7%. Disparities in HbA1c between minority and nonminority youth remained and additional studies are warranted to improve this.
{"title":"Real-World Glycemic Improvements with Hybrid Closed Loop Pumps in Youth with Type 1 Diabetes","authors":"Maite E. Del Valle Rolón, Elizabeth A. Brown, Risa M. Wolf","doi":"10.1155/2023/6621706","DOIUrl":"https://doi.org/10.1155/2023/6621706","url":null,"abstract":"Objective. The use of hybrid closed-loop insulin delivery systems, specifically the t:slim X2 insulin pump with Control IQ (CIQ), has demonstrated improvement in glycemic control in clinical trials and real-world settings. We sought to describe changes in glycemic control with use of CIQ in minority and nonminority youth. Research Design and Methods. This was a retrospective study of youth with type 1 diabetes (T1D) using CIQ over a 12-month period. Medical record data, pump data, and hemoglobin A1c (HbA1c) were collected from the visit prior to starting CIQ and at each clinic visit up to 12 months after starting CIQ. Continuous glucose monitor (CGM) data and HbA1c trajectory over time were compared to baseline and between minority and nonminority youth. Results. The study included 136 patients of whom 21 were minority youth (non-Hispanic Black and Hispanic), 50% were male, with median age of 13.3y, and median diabetes duration of 4.9y. After starting CIQ, baseline median HbA1c for the nonminority group decreased from 7.8% to 7.1% ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ), baseline median HbA1c for minority youth decreased from 9.8% to 7.8% ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo>=</mo> <mn>0.03</mn> </math> ), and the percentage of patients meeting target HbA1c <7% increased from 26% to 45%. Both nonminority and minority youth had a significant increase in time in range and decrease of average CGM glucose ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo><</mo> <mn>0.05</mn> </math> ). Conclusions. HbA1c levels decreased in both minority and nonminority youth within 12 months of starting CIQ, and more patients reached the HbA1c target of less than 7%. Disparities in HbA1c between minority and nonminority youth remained and additional studies are warranted to improve this.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134974983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maria Dora Horvath, Orsolya Papp-Zipernovszky, Zsanett Tesch, Norbert Buzas
This study aimed to explore the attitudes of teachers toward type 1 diabetes (T1D) and its management. Teachers working in kindergartens and schools (N = 30) participated in audio-recorded, semi-structured interviews (three focus groups and 20 individual interviews) that were transcribed and analyzed using thematic analysis. We used the theory of the three components of attitude as a framework for the analysis. The three components of attitude emerged during the analysis: knowledge, positive and negative emotions, approaches, and opinions toward diabetes and its management and behavior. The main theme of knowledge included knowledge about diabetes in general and its management. Besides medical treatment, alternative treatment possibilities were mentioned by the participants. The affective component revealed empathy, integrating, and segregating approaches toward children living with diabetes. The behavior component revealed how teachers contribute to the care and integration of children with diabetes in schools. They support children with diabetes by the virtue of their profession. For example, they teach them health awareness and support their integration through peer education and sensitization. The findings indicated that, in addition to diabetes management tasks, teachers could help children with T1D by tutoring them and their peers about health awareness and T1D acceptance.
{"title":"Exploring Teachers’ Attitudes toward the Management of Type 1 Diabetes: A Qualitative Study","authors":"Maria Dora Horvath, Orsolya Papp-Zipernovszky, Zsanett Tesch, Norbert Buzas","doi":"10.1155/2023/6607310","DOIUrl":"https://doi.org/10.1155/2023/6607310","url":null,"abstract":"This study aimed to explore the attitudes of teachers toward type 1 diabetes (T1D) and its management. Teachers working in kindergartens and schools (N = 30) participated in audio-recorded, semi-structured interviews (three focus groups and 20 individual interviews) that were transcribed and analyzed using thematic analysis. We used the theory of the three components of attitude as a framework for the analysis. The three components of attitude emerged during the analysis: knowledge, positive and negative emotions, approaches, and opinions toward diabetes and its management and behavior. The main theme of knowledge included knowledge about diabetes in general and its management. Besides medical treatment, alternative treatment possibilities were mentioned by the participants. The affective component revealed empathy, integrating, and segregating approaches toward children living with diabetes. The behavior component revealed how teachers contribute to the care and integration of children with diabetes in schools. They support children with diabetes by the virtue of their profession. For example, they teach them health awareness and support their integration through peer education and sensitization. The findings indicated that, in addition to diabetes management tasks, teachers could help children with T1D by tutoring them and their peers about health awareness and T1D acceptance.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"103 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135344510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Louise Norman Jespersen, Tue Helms Andersen, Dan Grabowski
Background. Quality of life (QoL) is extensively used as an outcome in the studies of children with diabetes. The interest in measuring QoL in relation to clinical treatment and interventions has led to an increase in the development and use of QoL measures. The vast number of available instruments can be a barrier for establishing evidence and can be overwhelming for clinicians and researchers who are interested in measuring QoL of children with diabetes. Aim. As a first step for reaching consensus, we aimed to provide a comprehensive overview of the application of QoL instruments used in children (2–18 years old) with diabetes. Method. A literature search for studies published from inception to January 2022 was conducted in the databases MEDLINE (Ovid), Embase (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), and ERIC (EBSCO). The search strategy combined the key concepts of “quality of life”, “diabetes”, and “children or adolescents”. Studies were found eligible if (1) the population was below 19 years of age; (2) had diabetes mellitus; and (3) a quantitative measure of QoL was used. Results. 3,775 unique articles were retrieved in the literature search and, across 503 articles included for synthesis, 67 QoL instruments were identified. The instruments were classified by i.a. population age, continent, use of pre–post measure, self-report or proxy, and type of diabetes. Conclusion. The extensive number of QoL instruments that are used for children with diabetes constitutes a substantial barrier for establishing evidence in relation to QoL in this research area.
背景。生活质量(Quality of life, QoL)在儿童糖尿病研究中被广泛用作一种预后指标。对与临床治疗和干预措施相关的生活质量测量的兴趣导致了生活质量测量的发展和使用的增加。大量可用的仪器可能成为建立证据的障碍，并且对于对测量糖尿病儿童生活质量感兴趣的临床医生和研究人员来说可能是压倒性的。的目标。作为达成共识的第一步，我们旨在全面概述生活质量仪器在2-18岁糖尿病儿童中的应用。方法。在MEDLINE (Ovid)、Embase (Ovid)、PsycInfo (EBSCO)、CINAHL (EBSCO)和ERIC (EBSCO)数据库中检索从成立到2022年1月发表的研究。搜索策略结合了“生活质量”、“糖尿病”和“儿童或青少年”等关键概念。符合以下条件的研究符合条件:(1)研究对象年龄在19岁以下;(2)有糖尿病;(3)定量测量生活质量。结果:在文献检索中检索到3,775篇独特的文章，在纳入合成的503篇文章中，鉴定出67种QoL仪器。这些工具按人口年龄、大洲、使用前后测量、自我报告或代理以及糖尿病类型进行分类。结论。用于糖尿病儿童生活质量的大量仪器构成了在该研究领域建立与生活质量有关的证据的实质性障碍。
{"title":"Comprehensive Overview of Quality of Life Instruments Used in Studies of Children with Diabetes: A Systematic Mapping Review","authors":"Louise Norman Jespersen, Tue Helms Andersen, Dan Grabowski","doi":"10.1155/2023/8885973","DOIUrl":"https://doi.org/10.1155/2023/8885973","url":null,"abstract":"Background. Quality of life (QoL) is extensively used as an outcome in the studies of children with diabetes. The interest in measuring QoL in relation to clinical treatment and interventions has led to an increase in the development and use of QoL measures. The vast number of available instruments can be a barrier for establishing evidence and can be overwhelming for clinicians and researchers who are interested in measuring QoL of children with diabetes. Aim. As a first step for reaching consensus, we aimed to provide a comprehensive overview of the application of QoL instruments used in children (2–18 years old) with diabetes. Method. A literature search for studies published from inception to January 2022 was conducted in the databases MEDLINE (Ovid), Embase (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), and ERIC (EBSCO). The search strategy combined the key concepts of “quality of life”, “diabetes”, and “children or adolescents”. Studies were found eligible if (1) the population was below 19 years of age; (2) had diabetes mellitus; and (3) a quantitative measure of QoL was used. Results. 3,775 unique articles were retrieved in the literature search and, across 503 articles included for synthesis, 67 QoL instruments were identified. The instruments were classified by i.a. population age, continent, use of pre–post measure, self-report or proxy, and type of diabetes. Conclusion. The extensive number of QoL instruments that are used for children with diabetes constitutes a substantial barrier for establishing evidence in relation to QoL in this research area.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135814404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Joseph M. W. S. Leung, Naseem Y. Al-Yahyawi, Heywood S. Choi, Laura L. Stewart, Jeffrey N. Bone, Tricia S. Tang, Shazhan Amed
Background. Youths with type 1 diabetes transitioning from pediatric to adult care are known to experience significant glycemic excursions and medical complications. Diabetes distress and transition readiness are two potentially related constructs involved in this transition process, but the relationship between them has not been extensively studied. Hypothesis. Lower diabetes distress is associated with increased transition readiness among youths with type 1 diabetes transitioning to adult care. Subjects. One hundred one adolescents and emerging adults with type 1 diabetes transitioning to adult care complete data in 63 study participants. Methods. In this cross-sectional study, we collected diabetes distress scale scores (via T1-DDS) and transition readiness scores (via Am I ON TRAC) at the last pediatric diabetes visit. We fitted regression models to estimate the relationship between T1-DDS scores and ON TRAC scores. Results. The total mean T1-DDS score was associated with ON TRAC knowledge score (β = −2.73, 95% CI −4.41,−1.06, ), behavior score (β = −2.61, 95% CI −4.39,−0.84, ), and transition readiness indicator (β = −0.18, −0.34,−0.01, ). Multiple T1-DDS subscales were associated with ON TRAC knowledge score: powerlessness, management distress, negative social perceptions, eating distress, physician distress, and family/friend distress. Multiple T1-DDS subscales were also associated with ON TRAC behavior score: management distress, negative social perceptions, eating distress, and family/friend distress. Conclusions. Diabetes distress and transition readiness have an inversely proportional relationship in youths with type 1 diabetes transitioning to adult care. Targeting diabetes distress may also improve transition readiness (and vice versa) in this population.
背景。青少年1型糖尿病从儿科过渡到成人护理是已知的经历显著的血糖偏差和医疗并发症。糖尿病痛苦和转变准备是参与这一转变过程的两个潜在相关构念，但它们之间的关系尚未得到广泛研究。假设。较低的糖尿病痛苦与1型糖尿病青少年向成人护理过渡的准备程度增加有关。科目。在63名研究参与者中，有101名1型糖尿病青少年和初出期成人过渡到成人护理。方法。在这项横断面研究中，我们在最后一次儿科糖尿病就诊时收集了糖尿病困扰量表评分(通过T1-DDS)和过渡准备评分(通过Am I ON TRAC)。我们拟合回归模型来估计T1-DDS评分与ON TRAC评分之间的关系。结果。总平均T1-DDS评分与ON TRAC知识评分(β = - 2.73, 95% CI - 4.41， - 1.06, p = 0.002)、行为评分(β = - 2.61, 95% CI - 4.39， - 0.84, p = 0.005)和过渡准备指标(β = - 0.18， - 0.34， - 0.01, p = 0.03)相关。多个T1-DDS子量表与ON TRAC知识得分相关:无力感、管理困扰、负面社会认知、饮食困扰、医生困扰和家人/朋友困扰。多个T1-DDS子量表也与ON TRAC行为评分相关:管理困扰、负面社会认知、饮食困扰和家人/朋友困扰。结论。1型糖尿病青少年向成人护理过渡时，糖尿病困扰和过渡准备呈反比关系。针对糖尿病困扰也可能提高这一人群的转变准备(反之亦然)。
{"title":"Diabetes Distress and Transition Readiness in Youths with Type 1 Diabetes Transitioning from Pediatric to Adult Care","authors":"Joseph M. W. S. Leung, Naseem Y. Al-Yahyawi, Heywood S. Choi, Laura L. Stewart, Jeffrey N. Bone, Tricia S. Tang, Shazhan Amed","doi":"10.1155/2023/5580180","DOIUrl":"https://doi.org/10.1155/2023/5580180","url":null,"abstract":"Background. Youths with type 1 diabetes transitioning from pediatric to adult care are known to experience significant glycemic excursions and medical complications. Diabetes distress and transition readiness are two potentially related constructs involved in this transition process, but the relationship between them has not been extensively studied. Hypothesis. Lower diabetes distress is associated with increased transition readiness among youths with type 1 diabetes transitioning to adult care. Subjects. One hundred one adolescents and emerging adults with type 1 diabetes transitioning to adult care complete data in 63 study participants. Methods. In this cross-sectional study, we collected diabetes distress scale scores (via T1-DDS) and transition readiness scores (via Am I ON TRAC) at the last pediatric diabetes visit. We fitted regression models to estimate the relationship between T1-DDS scores and ON TRAC scores. Results. The total mean T1-DDS score was associated with ON TRAC knowledge score (β = −2.73, 95% CI −4.41,−1.06, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.002</mn> </math> ), behavior score (β = −2.61, 95% CI −4.39,−0.84, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo>=</mo> <mn>0.005</mn> </math> ), and transition readiness indicator (β = −0.18, −0.34,−0.01, <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo>=</mo> <mn>0.03</mn> </math> ). Multiple T1-DDS subscales were associated with ON TRAC knowledge score: powerlessness, management distress, negative social perceptions, eating distress, physician distress, and family/friend distress. Multiple T1-DDS subscales were also associated with ON TRAC behavior score: management distress, negative social perceptions, eating distress, and family/friend distress. Conclusions. Diabetes distress and transition readiness have an inversely proportional relationship in youths with type 1 diabetes transitioning to adult care. Targeting diabetes distress may also improve transition readiness (and vice versa) in this population.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"79 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135769914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Olivier G. Pollé, Antoine Delfosse, Nicolas Michoux, Frank Peeters, Gaetan Duchêne, Jacques Louis, Brieuc Van Nieuwenhuyse, Philippe Clapuyt, Philippe A. Lysy
Context. Type 1 diabetes (T1D) is a heterogeneous disease affecting the islets and the exocrine pancreas. How the topographical distribution of the involved tissue lesions correlates with the patient phenotype and pancreas functions is uncertain. Objective. To perform a longitudinal characterization of the pancreas in patients with new-onset T1D and investigate the correlations between magnetic resonance imaging (MRI) parameters and pancreatic functions during the first year postdiagnosis. Methods. Thirty-one pediatric patients with new-onset T1D and 29 retrospective age-, body mass index-, and sex-matched controls were included in the study. Following hypotheses were investigated: (H1) the value of pancreas volume (PV) parameters in T1D and in controls, (H2) the association between MRI parameters and markers of pancreatic functions, (H3) the ability of MRI parameters to predict glucose homeostasis, (H4) the longitudinal evolution of MRI parameters and glucose homeostasis, per-organ (whole pancreas) and per-subregion (head, body, and tail). Results. Patients with new-onset T1D demonstrated a significant decrease of PV at diagnosis compared to controls (−45%), with prepubertal patients having increased pancreas atrophy (+25%) (H1). PV parameters were correlated with C-peptide, and trypsinogen (PVTail and PVHead, respectively). Biparametric regression models including MRI parameters predicted pancreas functions during the first year postdiagnosis (H3). Longitudinal evolution of PV parameters at 1 year postdiagnosis was correlated with PV at diagnosis (R = −0.72) but not with markers of glucose homeostasis (H4). Conclusion. Our study shows that longitudinal analysis of pancreases of children with T1D using multiparametric MRI improve the understanding of T1D heterogeneity both in the context of its onset and its evolution.
{"title":"Pancreas Imaging of Children with Type 1 Diabetes Reveals New Patterns and Correlations with Pancreatic Functions","authors":"Olivier G. Pollé, Antoine Delfosse, Nicolas Michoux, Frank Peeters, Gaetan Duchêne, Jacques Louis, Brieuc Van Nieuwenhuyse, Philippe Clapuyt, Philippe A. Lysy","doi":"10.1155/2023/3295812","DOIUrl":"https://doi.org/10.1155/2023/3295812","url":null,"abstract":"Context. Type 1 diabetes (T1D) is a heterogeneous disease affecting the islets and the exocrine pancreas. How the topographical distribution of the involved tissue lesions correlates with the patient phenotype and pancreas functions is uncertain. Objective. To perform a longitudinal characterization of the pancreas in patients with new-onset T1D and investigate the correlations between magnetic resonance imaging (MRI) parameters and pancreatic functions during the first year postdiagnosis. Methods. Thirty-one pediatric patients with new-onset T1D and 29 retrospective age-, body mass index-, and sex-matched controls were included in the study. Following hypotheses were investigated: (H1) the value of pancreas volume (PV) parameters in T1D and in controls, (H2) the association between MRI parameters and markers of pancreatic functions, (H3) the ability of MRI parameters to predict glucose homeostasis, (H4) the longitudinal evolution of MRI parameters and glucose homeostasis, per-organ (whole pancreas) and per-subregion (head, body, and tail). Results. Patients with new-onset T1D demonstrated a significant decrease of PV at diagnosis compared to controls (−45%), with prepubertal patients having increased pancreas atrophy (+25%) (H1). PV parameters were correlated with C-peptide, and trypsinogen (PVTail and PVHead, respectively). Biparametric regression models including MRI parameters predicted pancreas functions during the first year postdiagnosis (H3). Longitudinal evolution of PV parameters at 1 year postdiagnosis was correlated with PV at diagnosis (R = −0.72) but not with markers of glucose homeostasis (H4). Conclusion. Our study shows that longitudinal analysis of pancreases of children with T1D using multiparametric MRI improve the understanding of T1D heterogeneity both in the context of its onset and its evolution.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136016857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lise E. Nigrovic, Nathan Kuppermann, Simona Ghetti, Jeff E. Schunk, Michael J. Stoner, Arleta Rewers, Julie K. McManemy, Kimberly S. Quayle, Jennifer L. Trainor, Leah Tzimenatos, Jonathan E. Bennett, Maria Y. Kwok, Sage R. Myers, Kathleen M. Brown, T. Charles Casper, Cody S. Olsen, Nicole S. Glaser, Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group
Background. Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of childhood diabetes. However, the influence of demographic factors on presentation are not well-defined. Methods. We included children from 12 centers who were <18 years with DKA (glucose > 300 mg/dL, serum pH < 7.25, or serum bicarbonate <15 mEq/L) enrolled in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) Trial. Data were also collected for children who presented to the centers during the enrollment period but were not enrolled due to disease or treatment-related reasons. We compared demographic, clinical, and biochemical findings among children with newly and previously diagnosed diabetes and children in different age groups. Results. Of the 1,679 DKA episodes in 1,553 children, 799 (47.5%) episodes occurred in children with newly diagnosed diabetes and 396 (23.6%) were severe (pH < 7.1). Newly diagnosed children <6 years of age were not more likely to have severe DKA in terms of pH, but had more severe hypocarbia and higher blood urea nitrogen levels, factors previously associated with the risk of cerebral injury. Lower socioeconomic status (SES) (based on family income and maternal education level) were associated with more severe DKA in new onset children, and recurrent DKA in the previously diagnosed children. Conclusions. Greater efforts are needed to identify the children with diabetes early and to prevent recurrent DKA, particularly among children in low-SES groups. Young children with DKA may need more intensive monitoring due to higher risk of cerebral injury.
{"title":"Emergency Department Presentations of Diabetic Ketoacidosis in a Large Cohort of Children","authors":"Lise E. Nigrovic, Nathan Kuppermann, Simona Ghetti, Jeff E. Schunk, Michael J. Stoner, Arleta Rewers, Julie K. McManemy, Kimberly S. Quayle, Jennifer L. Trainor, Leah Tzimenatos, Jonathan E. Bennett, Maria Y. Kwok, Sage R. Myers, Kathleen M. Brown, T. Charles Casper, Cody S. Olsen, Nicole S. Glaser, Pediatric Emergency Care Applied Research Network (PECARN) DKA FLUID Study Group","doi":"10.1155/2023/6693226","DOIUrl":"https://doi.org/10.1155/2023/6693226","url":null,"abstract":"Background. Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of childhood diabetes. However, the influence of demographic factors on presentation are not well-defined. Methods. We included children from 12 centers who were <18 years with DKA (glucose > 300 mg/dL, serum pH < 7.25, or serum bicarbonate <15 mEq/L) enrolled in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) Trial. Data were also collected for children who presented to the centers during the enrollment period but were not enrolled due to disease or treatment-related reasons. We compared demographic, clinical, and biochemical findings among children with newly and previously diagnosed diabetes and children in different age groups. Results. Of the 1,679 DKA episodes in 1,553 children, 799 (47.5%) episodes occurred in children with newly diagnosed diabetes and 396 (23.6%) were severe (pH < 7.1). Newly diagnosed children <6 years of age were not more likely to have severe DKA in terms of pH, but had more severe hypocarbia and higher blood urea nitrogen levels, factors previously associated with the risk of cerebral injury. Lower socioeconomic status (SES) (based on family income and maternal education level) were associated with more severe DKA in new onset children, and recurrent DKA in the previously diagnosed children. Conclusions. Greater efforts are needed to identify the children with diabetes early and to prevent recurrent DKA, particularly among children in low-SES groups. Young children with DKA may need more intensive monitoring due to higher risk of cerebral injury.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"20 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136306653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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