Yaru Liu, G. Dong, K. Huang, Ye Hong, Xuefeng Chen, Mingqiang Zhu, Xiaoqiang Hao, Y. Ni, Junfen Fu
Aim. Type 1 diabetes (T1D) is an autoimmune disease with heterogeneous risk factors. Metabolic perturbations in the pathogenesis of the disease are remarkable to illuminate the interaction between genetic and environmental factors and how islet immunity and overt diabetes develop. This review aimed to integrate the metabolic changes of T1D to identify potential biomarkers for predicting disease progression based on recent metabolomics and lipidomics studies with parallel methodologies. Methods. A total of 18 metabolomics and lipidomics studies of childhood T1D during the last 15 years were reviewed. The metabolic fingerprints consisting of 41 lipids and/or metabolite classes of subjects with islet autoantibodies, progressors of T1D, and T1D children were mapped in four-time dimensions based on a tentative effect-score rule. Results. From birth, high-risk T1D subjects had decreased unsaturated triacylglycerols, unsaturated phosphatidylcholines (PCs), sphingomyelins (SMs), amino acids, and metabolites in the tricarboxylic acid (TCA) cycle. On the contrary, lysophosphatidylcholines (LPCs) and monosaccharides increased. And LPCs and branched-chain amino acids (BCAAs) were elevated before the appearance of islet autoantibodies but were lowered after seroconversion. Choline-related lipids (including PCs, SMs, and LPCs), BCAAs, and metabolites involved in the TCA cycle were identified as consensus biomarkers potentially predicting the development of islet autoimmunity and T1D. Decreased LPCs and amino acids indicated poor glycemic control of T1D, while elevated lysophosphatidylethanolamines and saturated PCs implied good glycemic control. Further pathway analysis revealed that biosynthesis of aminoacyl-tRNA, BCAAs, and alanine, aspartate, and glutamate metabolism were significantly enriched. Moreover, established cohort studies and predictive statistical models of pediatric T1D were also summarized. Conclusion. The metabolic profile of high-risk T1D subjects and patients demonstrated significant changes compared with healthy controls. This integrated analysis provides a comprehensive overview of metabolic features and potential biomarkers in the pathogenesis and progression of T1D.
{"title":"Metabolomics and Lipidomics Studies in Pediatric Type 1 Diabetes: Biomarker Discovery for the Early Diagnosis and Prognosis","authors":"Yaru Liu, G. Dong, K. Huang, Ye Hong, Xuefeng Chen, Mingqiang Zhu, Xiaoqiang Hao, Y. Ni, Junfen Fu","doi":"10.1155/2023/6003102","DOIUrl":"https://doi.org/10.1155/2023/6003102","url":null,"abstract":"Aim. Type 1 diabetes (T1D) is an autoimmune disease with heterogeneous risk factors. Metabolic perturbations in the pathogenesis of the disease are remarkable to illuminate the interaction between genetic and environmental factors and how islet immunity and overt diabetes develop. This review aimed to integrate the metabolic changes of T1D to identify potential biomarkers for predicting disease progression based on recent metabolomics and lipidomics studies with parallel methodologies. Methods. A total of 18 metabolomics and lipidomics studies of childhood T1D during the last 15 years were reviewed. The metabolic fingerprints consisting of 41 lipids and/or metabolite classes of subjects with islet autoantibodies, progressors of T1D, and T1D children were mapped in four-time dimensions based on a tentative effect-score rule. Results. From birth, high-risk T1D subjects had decreased unsaturated triacylglycerols, unsaturated phosphatidylcholines (PCs), sphingomyelins (SMs), amino acids, and metabolites in the tricarboxylic acid (TCA) cycle. On the contrary, lysophosphatidylcholines (LPCs) and monosaccharides increased. And LPCs and branched-chain amino acids (BCAAs) were elevated before the appearance of islet autoantibodies but were lowered after seroconversion. Choline-related lipids (including PCs, SMs, and LPCs), BCAAs, and metabolites involved in the TCA cycle were identified as consensus biomarkers potentially predicting the development of islet autoimmunity and T1D. Decreased LPCs and amino acids indicated poor glycemic control of T1D, while elevated lysophosphatidylethanolamines and saturated PCs implied good glycemic control. Further pathway analysis revealed that biosynthesis of aminoacyl-tRNA, BCAAs, and alanine, aspartate, and glutamate metabolism were significantly enriched. Moreover, established cohort studies and predictive statistical models of pediatric T1D were also summarized. Conclusion. The metabolic profile of high-risk T1D subjects and patients demonstrated significant changes compared with healthy controls. This integrated analysis provides a comprehensive overview of metabolic features and potential biomarkers in the pathogenesis and progression of T1D.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45536134","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}
J. Pemberton, Ankita Gupta, G. M. Lau, India Dickinson, Pranav Iyer, S. Uday
Objectives. Investigate the effect of using short bursts of moderate-intensity activity between meals to lower hyperglycaemia on glucose metrics. Design and Methods. Children and young people with type 1 diabetes (CYPD) attending continuous glucose monitoring education were taught to use moderate-intensity activity to lower high glucose levels (to <10.0 mmol/L using 10–15 minlowers ∼2.0 mmol/L) between meals. Retrospective cross-sectional data analysis of CYPD at a single tertiary centre between 2019 and 2022. Data were collected on demographics and glucose metrics (HbA1c, time in range (TIR, 3.9–10.0 mmol/L), time above range (TAR, >10.0 mmol/L), time below range (TBR, <3.9 mmol/L)). Minutes of activity usually performed to lower a glucose level of 14.0 mmol/L trending steady at 6 months grouped the CYPD into low (<5 min), mild (5–10 min), or moderate (11–20 min) activity groups. Results. 125 (n = 53, 40% male) CYPD with a mean (standard deviations) age of 12.3 (±3.7) years and diabetes duration of 7.0 ± 3.7 years were included. HbA1c improved from 58.5 (±8.6) mmol/mol at baseline to 54.9 (±7.2) mmol/mol at 6 months ( p < 0.001 ). Low, mild, and moderate activity was reported by 30% (n = 37), 34% (n = 43), and 36% (n = 45), respectively. At 6 months, HbA1c (52.0 vs. 54.3 vs. 59.4 mmol/mol, p < 0.001 ), TIR (68.0% vs. 59.71 vs. 51.1%, p < 0.001 ) and TAR (29.9% vs. 38.3% vs. 45.3%, p < 0.001 ) were significantly different across the moderate, mild, and low activity groups, respectively. No association was found for TBR (2.16% vs. 2.32% vs. 2.58%, p = 0.408 ) across groups. Conclusion. Increasing the use of moderate-intensity activity to lower hyperglycaemia between meals is associated with improved glucose control without increasing hypoglycaemia for CYPD.
{"title":"Integrating Physical Activity Strategies to Lower Hyperglycaemia in Structured Education Programmes for Children and Young People with Type 1 Diabetes Improves Glycaemic Control without Augmenting the Risk of Hypoglycaemia","authors":"J. Pemberton, Ankita Gupta, G. M. Lau, India Dickinson, Pranav Iyer, S. Uday","doi":"10.1155/2023/2519368","DOIUrl":"https://doi.org/10.1155/2023/2519368","url":null,"abstract":"Objectives. Investigate the effect of using short bursts of moderate-intensity activity between meals to lower hyperglycaemia on glucose metrics. Design and Methods. Children and young people with type 1 diabetes (CYPD) attending continuous glucose monitoring education were taught to use moderate-intensity activity to lower high glucose levels (to <10.0 mmol/L using 10–15 minlowers ∼2.0 mmol/L) between meals. Retrospective cross-sectional data analysis of CYPD at a single tertiary centre between 2019 and 2022. Data were collected on demographics and glucose metrics (HbA1c, time in range (TIR, 3.9–10.0 mmol/L), time above range (TAR, >10.0 mmol/L), time below range (TBR, <3.9 mmol/L)). Minutes of activity usually performed to lower a glucose level of 14.0 mmol/L trending steady at 6 months grouped the CYPD into low (<5 min), mild (5–10 min), or moderate (11–20 min) activity groups. Results. 125 (n = 53, 40% male) CYPD with a mean (standard deviations) age of 12.3 (±3.7) years and diabetes duration of 7.0 ± 3.7 years were included. HbA1c improved from 58.5 (±8.6) mmol/mol at baseline to 54.9 (±7.2) mmol/mol at 6 months (\u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ). Low, mild, and moderate activity was reported by 30% (n = 37), 34% (n = 43), and 36% (n = 45), respectively. At 6 months, HbA1c (52.0 vs. 54.3 vs. 59.4 mmol/mol, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ), TIR (68.0% vs. 59.71 vs. 51.1%, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ) and TAR (29.9% vs. 38.3% vs. 45.3%, \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ) were significantly different across the moderate, mild, and low activity groups, respectively. No association was found for TBR (2.16% vs. 2.32% vs. 2.58%, \u0000 \u0000 p\u0000 =\u0000 0.408\u0000 \u0000 ) across groups. Conclusion. Increasing the use of moderate-intensity activity to lower hyperglycaemia between meals is associated with improved glucose control without increasing hypoglycaemia for CYPD.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48765460","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}
Sandra Aravind Areekal, A. Khadilkar, P. Goel, T. Cole
Background. Height growth is affected by longterm childhood morbidity. Objectives. To compare the growth curves of Indian children diagnosed with Type-1 diabetes mellitus (T1DM) and a control group of children without diabetes, and to see how parental height and disease severity affect the growth pattern. Subjects and Methods. The data came from: (i) the Sweetlings T1DM (STDM) study with 460 subjects aged 4–19 years, previously diagnosed with T1DM and followed for 2–6 (median 3) years, with repeat measurements of height and glycated hemoglobin (HbA1c), and (ii) the Pune School-Children Growth (PSCG) study with 1,470 subjects aged 4–19 years, and height measured annually for median 6 years. Height growth was modeled using SuperImposition by Translation and Rotation (SITAR), a mixed effects model which fits a cubic spline mean curve and summarizes individual growth in terms of differences in mean size, and pubertal timing and intensity. Results. SITAR explained 99% of the variance in height, the mean curves by sex showing that compared to controls, the children with diabetes were shorter (by 4/5 cm for boys/girls), with a later (by 1/6 months) and less intense (−5%/−10%) pubertal growth spurt. Adjusted for mean height, timing and intensity, the diabetic and control mean curves were very similar in shape. SITAR modeling showed that mean HbA1c peaked at 10.5% at age 15 years, 1.0% higher than earlier in childhood. Individual growth patterns were highly significantly related to parental height, age at diabetes diagnosis, diabetes duration, and mean HbA1c. Mean height was 3.4 cm more per + 1 SD midparental height, and in girls, 2 cm less per + 1 SD HbA1c. Conclusion. The results show that the physiological response to T1DM is to grow more slowly, and to delay and extend the pubertal growth spurt. The effects are dose-related, with more severe disease associated with greater growth faltering.
背景。身高增长受儿童长期发病率的影响。目标。比较诊断为1型糖尿病(T1DM)的印度儿童和对照组无糖尿病儿童的生长曲线，并了解父母身高和疾病严重程度如何影响生长模式。研究对象和方法。数据来自:(i) Sweetlings T1DM (STDM)研究，460名年龄在4-19岁的受试者，先前诊断为T1DM，随访2-6年(中位数为3年)，重复测量身高和糖化血红蛋白(HbA1c); (ii)普纳学龄儿童生长(PSCG)研究，1470名年龄在4-19岁的受试者，每年测量身高，中位数为6年。身高生长采用平移旋转叠加模型(superstacking by Translation and Rotation, SITAR)，这是一种混合效应模型，拟合三次样条平均曲线，总结了个体生长在平均尺寸、青春期时间和强度方面的差异。结果。SITAR解释了99%的身高差异，按性别划分的平均曲线显示，与对照组相比，糖尿病儿童更矮(男孩/女孩低4/5厘米)，青春期生长突增时间更晚(1/6个月)，强度更低(- 5%/ - 10%)。调整平均身高、时间和强度后，糖尿病患者和对照组的平均曲线在形状上非常相似。SITAR模型显示，平均HbA1c在15岁时达到10.5%的峰值，比儿童早期高1.0%。个体生长模式与父母身高、糖尿病诊断年龄、糖尿病病程和平均HbA1c高度显著相关。平均身高每增加1 SD增加3.4 cm，女孩每增加1 SD HbA1c减少2 cm。结论。结果表明，T1DM的生理反应是生长缓慢，青春期生长突增期延迟和延长。其影响与剂量有关，疾病越严重，生长速度越慢。
{"title":"Longitudinal Height Growth in Children and Adolescents with Type-1 Diabetes Mellitus Compared to Controls in Pune, India","authors":"Sandra Aravind Areekal, A. Khadilkar, P. Goel, T. Cole","doi":"10.1155/2023/8813031","DOIUrl":"https://doi.org/10.1155/2023/8813031","url":null,"abstract":"Background. Height growth is affected by longterm childhood morbidity. Objectives. To compare the growth curves of Indian children diagnosed with Type-1 diabetes mellitus (T1DM) and a control group of children without diabetes, and to see how parental height and disease severity affect the growth pattern. Subjects and Methods. The data came from: (i) the Sweetlings T1DM (STDM) study with 460 subjects aged 4–19 years, previously diagnosed with T1DM and followed for 2–6 (median 3) years, with repeat measurements of height and glycated hemoglobin (HbA1c), and (ii) the Pune School-Children Growth (PSCG) study with 1,470 subjects aged 4–19 years, and height measured annually for median 6 years. Height growth was modeled using SuperImposition by Translation and Rotation (SITAR), a mixed effects model which fits a cubic spline mean curve and summarizes individual growth in terms of differences in mean size, and pubertal timing and intensity. Results. SITAR explained 99% of the variance in height, the mean curves by sex showing that compared to controls, the children with diabetes were shorter (by 4/5 cm for boys/girls), with a later (by 1/6 months) and less intense (−5%/−10%) pubertal growth spurt. Adjusted for mean height, timing and intensity, the diabetic and control mean curves were very similar in shape. SITAR modeling showed that mean HbA1c peaked at 10.5% at age 15 years, 1.0% higher than earlier in childhood. Individual growth patterns were highly significantly related to parental height, age at diabetes diagnosis, diabetes duration, and mean HbA1c. Mean height was 3.4 cm more per + 1 SD midparental height, and in girls, 2 cm less per + 1 SD HbA1c. Conclusion. The results show that the physiological response to T1DM is to grow more slowly, and to delay and extend the pubertal growth spurt. The effects are dose-related, with more severe disease associated with greater growth faltering.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43955690","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}
Although children with type 1 diabetes (T1D) are at risk for developing diabetic kidney disease (DKD), clinical practice guidelines do not uniformly recommend routine serum creatinine (SCr) monitoring, and data describing changes in renal function from diagnosis are lacking. As part of a quality improvement initiative, the Diabetes Clinic at British Columbia Children’s Hospital in Vancouver, Canada, implemented routine serum SCr monitoring. This study describes estimated glomerular filtration rate (eGFR) trajectories and prevalence of decreased eGFR, hypertension, and albuminuria and their relationship to patterns of nephrology referral in a cohort of children aged ≤18 years (n = 307) with T1D recruited between December 2016 and February 2019. Annualized eGFR (ml/min/1.73 m2 per year) was calculated using the CKiD U25 formula and categorized as declining (<−3), stable (−3 to +3), and inclining (>+3). eGFR was categorized as normal (≥90), mildly decreased (60 to <90), and chronic kidney disease (CKD, <60). In this cohort, 54% were male; the median age at diagnosis and duration of T1D was 6.2 years and 6.9 years, respectively. Over a median follow-up of 2.3 years, declining, stable, and inclining trajectories were observed in 33%, 32%, and 35%, respectively. During their follow-up, 32% had mildly decreased eGFR, elevated blood pressures (≥90th percentile), and/or abnormal urine albumin-creatinine ratios (≥2 mg/mmol), with <10% referred for nephrology assessment. Twenty-three percent of subjects had an eGFR <90; this subgroup was more highly represented in the declining trajectory group (vs. stable and inclining). Logistic regression analysis found female sex and higher baseline eGFR to be associated with a declining eGFR trajectory. In conclusion, these data challenge the commonly held paradigm that renal function remains stable in childhood T1D and supports systematic monitoring of renal function in children with T1D, as well as collaboration across disciplines, particularly endocrinology and nephrology, to provide evidence-based individualized care.
{"title":"Longitudinal Estimated Glomerular Filtration Rate Trajectories in Children with Type 1 Diabetes","authors":"K. Favel, C. Mammen, C. Panagiotopoulos","doi":"10.1155/2023/6648920","DOIUrl":"https://doi.org/10.1155/2023/6648920","url":null,"abstract":"Although children with type 1 diabetes (T1D) are at risk for developing diabetic kidney disease (DKD), clinical practice guidelines do not uniformly recommend routine serum creatinine (SCr) monitoring, and data describing changes in renal function from diagnosis are lacking. As part of a quality improvement initiative, the Diabetes Clinic at British Columbia Children’s Hospital in Vancouver, Canada, implemented routine serum SCr monitoring. This study describes estimated glomerular filtration rate (eGFR) trajectories and prevalence of decreased eGFR, hypertension, and albuminuria and their relationship to patterns of nephrology referral in a cohort of children aged ≤18 years (n = 307) with T1D recruited between December 2016 and February 2019. Annualized eGFR (ml/min/1.73 m2 per year) was calculated using the CKiD U25 formula and categorized as declining (<−3), stable (−3 to +3), and inclining (>+3). eGFR was categorized as normal (≥90), mildly decreased (60 to <90), and chronic kidney disease (CKD, <60). In this cohort, 54% were male; the median age at diagnosis and duration of T1D was 6.2 years and 6.9 years, respectively. Over a median follow-up of 2.3 years, declining, stable, and inclining trajectories were observed in 33%, 32%, and 35%, respectively. During their follow-up, 32% had mildly decreased eGFR, elevated blood pressures (≥90th percentile), and/or abnormal urine albumin-creatinine ratios (≥2 mg/mmol), with <10% referred for nephrology assessment. Twenty-three percent of subjects had an eGFR <90; this subgroup was more highly represented in the declining trajectory group (vs. stable and inclining). Logistic regression analysis found female sex and higher baseline eGFR to be associated with a declining eGFR trajectory. In conclusion, these data challenge the commonly held paradigm that renal function remains stable in childhood T1D and supports systematic monitoring of renal function in children with T1D, as well as collaboration across disciplines, particularly endocrinology and nephrology, to provide evidence-based individualized care.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47294412","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}
K. Hood, W. Polonsky, S. Macleish, C. Levy, G. Forlenza, A. Criego, B. Buckingham, B. Bode, David W. Hansen, J. Sherr, Sue A Brown, D. DeSalvo, S. Mehta, L. Laffel, A. Bhargava, Lauren M. Huyett, T. Vienneau, T. Ly
Objective. While automated insulin delivery (AID) systems aim to improve glycemic outcomes, the opportunity to improve psychosocial outcomes is also of critical importance for children and adolescents with type 1 diabetes and their caregivers. We evaluated psychosocial outcomes in these groups during a clinical trial of a tubeless AID system, the Omnipod® 5 Automated Insulin Delivery System. Methods. This single-arm, multicenter, prospective study enrolled 83 children (6.0–11.9 years) and 42 adolescents (12.0–17.9 years) with type 1 diabetes to use a tubeless AID system for 3 months. Participants and their caregivers completed age- and role-appropriate validated questionnaires to assess changes in psychosocial outcomes—diabetes distress (PAID), hypoglycemia confidence (HCS), well-being (WHO-5), sleep quality (PSQI), insulin delivery satisfaction (IDSS), and system usability (SUS)—before and after 3 months of AID system use. Associations between participant characteristics and glycemic outcomes with psychosocial measures were evaluated using linear regression analyses. Results. Improvements were found for children, adolescents, and/or their caregivers for diabetes-related distress, insulin delivery satisfaction, and system usability (all P < 0.05 ). Caregivers of children saw additional benefits of improved general well-being, confidence in managing hypoglycemia, and sleep quality (all P < 0.05 ). Regression analyses showed that improvements in psychosocial outcomes were generally independent of baseline characteristics and changes in glycemic outcomes. Conclusions. The tubeless AID system was associated with significant improvements in a number of psychosocial outcomes for children, adolescents, and their caregivers. Trial registration: This trial is registered with NCT04196140.
{"title":"Psychosocial Outcomes with the Omnipod® 5 Automated Insulin Delivery System in Children and Adolescents with Type 1 Diabetes and Their Caregivers","authors":"K. Hood, W. Polonsky, S. Macleish, C. Levy, G. Forlenza, A. Criego, B. Buckingham, B. Bode, David W. Hansen, J. Sherr, Sue A Brown, D. DeSalvo, S. Mehta, L. Laffel, A. Bhargava, Lauren M. Huyett, T. Vienneau, T. Ly","doi":"10.1155/2023/8867625","DOIUrl":"https://doi.org/10.1155/2023/8867625","url":null,"abstract":"Objective. While automated insulin delivery (AID) systems aim to improve glycemic outcomes, the opportunity to improve psychosocial outcomes is also of critical importance for children and adolescents with type 1 diabetes and their caregivers. We evaluated psychosocial outcomes in these groups during a clinical trial of a tubeless AID system, the Omnipod® 5 Automated Insulin Delivery System. Methods. This single-arm, multicenter, prospective study enrolled 83 children (6.0–11.9 years) and 42 adolescents (12.0–17.9 years) with type 1 diabetes to use a tubeless AID system for 3 months. Participants and their caregivers completed age- and role-appropriate validated questionnaires to assess changes in psychosocial outcomes—diabetes distress (PAID), hypoglycemia confidence (HCS), well-being (WHO-5), sleep quality (PSQI), insulin delivery satisfaction (IDSS), and system usability (SUS)—before and after 3 months of AID system use. Associations between participant characteristics and glycemic outcomes with psychosocial measures were evaluated using linear regression analyses. Results. Improvements were found for children, adolescents, and/or their caregivers for diabetes-related distress, insulin delivery satisfaction, and system usability (all \u0000 \u0000 P\u0000 <\u0000 0.05\u0000 \u0000 ). Caregivers of children saw additional benefits of improved general well-being, confidence in managing hypoglycemia, and sleep quality (all \u0000 \u0000 P\u0000 <\u0000 0.05\u0000 \u0000 ). Regression analyses showed that improvements in psychosocial outcomes were generally independent of baseline characteristics and changes in glycemic outcomes. Conclusions. The tubeless AID system was associated with significant improvements in a number of psychosocial outcomes for children, adolescents, and their caregivers. Trial registration: This trial is registered with NCT04196140.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43060825","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}
Marie Ørts Rahbæk, S. D. Jensen, Karina Kudahl Hansen, A. Sandbæk, Sten Lund, Anette Andersen
Introduction. Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the version for teenagers has not been translated into Danish and validated before now. Objective. This study describes the translation into Danish of the PAID-T scale, which was developed to measure emotional distress in teenagers with diabetes. Materials and Methods. The study was conducted in two phases. First, the PAID-T was translated into Danish based on the guidelines from the International Society for Pharmacoeconomics and Outcome Research and a forwardbackward translation procedure. Second, cognitive interviews were conducted, and the Danish version of the PAID-T was modified to ensure linguistic equivalence with the original scale in English. Results. The Danish version of the PAID-T questionnaire was found to be understandable and relevant for adolescents with T1D. No questions were found to be irrelevant. However, the cognitive interviews showed that the issue of balancing alcohol intake and blood sugar levels was not covered by PAID-T, although this was found relevant in the Danish target group. Conclusion. This study described the translation and linguistic validation of the PAID-T scale into Danish. After modifications based on the feedback from the cognitive interviews, the Danish version was found to be linguistically equivalent to the original English version.
{"title":"The Danish Version of the Problem Areas in Diabetes-Teen (PAID-T) Scale: Translation and Linguistic Validation","authors":"Marie Ørts Rahbæk, S. D. Jensen, Karina Kudahl Hansen, A. Sandbæk, Sten Lund, Anette Andersen","doi":"10.1155/2023/4655563","DOIUrl":"https://doi.org/10.1155/2023/4655563","url":null,"abstract":"Introduction. Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the version for teenagers has not been translated into Danish and validated before now. Objective. This study describes the translation into Danish of the PAID-T scale, which was developed to measure emotional distress in teenagers with diabetes. Materials and Methods. The study was conducted in two phases. First, the PAID-T was translated into Danish based on the guidelines from the International Society for Pharmacoeconomics and Outcome Research and a forwardbackward translation procedure. Second, cognitive interviews were conducted, and the Danish version of the PAID-T was modified to ensure linguistic equivalence with the original scale in English. Results. The Danish version of the PAID-T questionnaire was found to be understandable and relevant for adolescents with T1D. No questions were found to be irrelevant. However, the cognitive interviews showed that the issue of balancing alcohol intake and blood sugar levels was not covered by PAID-T, although this was found relevant in the Danish target group. Conclusion. This study described the translation and linguistic validation of the PAID-T scale into Danish. After modifications based on the feedback from the cognitive interviews, the Danish version was found to be linguistically equivalent to the original English version.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45248758","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}
Jacob M. Redel, Lindsey Hornung, Deborah Elder, Jaimie D. Nathan, Sarah Corathers, Kristin L. Rich, Maisam Abu-El-Haija
Total pancreatectomy with islet autotransplantation (TPIAT) can improve pain and reduce functional impairment associated with acute recurrent or chronic pancreatitis. However, long-term glucose monitoring and insulin therapy are often required, which can adversely affect the quality of life. We sought to evaluate diabetes-related quality of life (DR-QOL) in youth who underwent TPIAT and compare it to the youth with new-onset type 1 diabetes (T1D). The Pediatric Quality of Life Inventory™ 3.2 Diabetes Module (PedsQL™ DM) was used to assess DR-QOL in 46 youth (<20 years old) who underwent TPIAT. The PedsQL™ DM scores were analyzed for statistically significant changes and minimally important clinical differences (MCID) over time post-TPIAT. Scores at 12 months (n = 29) and 24 months (n = 16) were then compared to PedsQL™ DM scores from a historical cohort of demographically similar (age and sex) youth with a 12 months (n = 52) and 24 months (n = 58) after diagnosis of T1D. The diabetes symptoms summary score (mean 65 to 57 and ) and the total score (mean 74 to 68 and ) decreased (worsened) during the first 24 months post-TPIAT and met the MCID threshold, suggesting the decrease in these scores was clinically significant. Post-TPIAT PedsQL™ DM scores were not significantly different than youth new diagnosis of T1D after 24 months (all ). In youth who underwent TPIAT, DR-QOL worsened over the first two years, mostly attributable to the diabetes symptoms score. Compared to children with T1D, post-TPIAT DR-QOL was similar two years after diabetes onset.
{"title":"Diabetes-Related Quality of Life Assessment in Children following Total Pancreatectomy with Islet Autotransplantation","authors":"Jacob M. Redel, Lindsey Hornung, Deborah Elder, Jaimie D. Nathan, Sarah Corathers, Kristin L. Rich, Maisam Abu-El-Haija","doi":"10.1155/2023/2851620","DOIUrl":"https://doi.org/10.1155/2023/2851620","url":null,"abstract":"Total pancreatectomy with islet autotransplantation (TPIAT) can improve pain and reduce functional impairment associated with acute recurrent or chronic pancreatitis. However, long-term glucose monitoring and insulin therapy are often required, which can adversely affect the quality of life. We sought to evaluate diabetes-related quality of life (DR-QOL) in youth who underwent TPIAT and compare it to the youth with new-onset type 1 diabetes (T1D). The Pediatric Quality of Life Inventory™ 3.2 Diabetes Module (PedsQL™ DM) was used to assess DR-QOL in 46 youth (<20 years old) who underwent TPIAT. The PedsQL™ DM scores were analyzed for statistically significant changes and minimally important clinical differences (MCID) over time post-TPIAT. Scores at 12 months (n = 29) and 24 months (n = 16) were then compared to PedsQL™ DM scores from a historical cohort of demographically similar (age and sex) youth with a 12 months (n = 52) and 24 months (n = 58) after diagnosis of T1D. The diabetes symptoms summary score (mean 65 to 57 and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.03</mn> </math> ) and the total score (mean 74 to 68 and <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo><</mo> <mn>0.05</mn> </math> ) decreased (worsened) during the first 24 months post-TPIAT and met the MCID threshold, suggesting the decrease in these scores was clinically significant. Post-TPIAT PedsQL™ DM scores were not significantly different than youth new diagnosis of T1D after 24 months (all <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo>></mo> <mn>0.2</mn> </math> ). In youth who underwent TPIAT, DR-QOL worsened over the first two years, mostly attributable to the diabetes symptoms score. Compared to children with T1D, post-TPIAT DR-QOL was similar two years after diabetes onset.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"57 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136248315","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}
Alexander Phu, Tyger Lin, Jacquelyn Manfredo, Elizabeth A. Brown, R. Wolf
Background and Objective. Continuous glucose monitoring (CGM) is shown to improve quality of life (QoL) in youth with type 1 diabetes (T1D), yet there is limited data on CGM in youth with type 2 diabetes (T2D). The objective was to compare perceptions of CGM and QoL between patients with T1D and T2D. Methods. Youth with T1D and T2D (currently on insulin therapy) without current CGM participated in a prospective CGM study and were given a series of questionnaires when starting CGM intervention. BenCGM and BurCGM questionnaires assessed the participant’s perspectives on continuous glucose monitor use, while DDS surveys assessed participants’ QoL associated with diabetes. Survey results were compared between T1D and T2D groups, and multivariable analysis was used to assess differences in perceptions of continuous glucose monitor use in youth with diabetes. Results. Participants with T1D (n = 26, 65.4% male, 42.3% non-Hispanic black, median age 14.2 years, median HbA1c 10.3%) and T2D (n = 41, 39% male, 80.5% non-Hispanic black, median age 16.2 years, median HbA1c 10.3%) scored similarly on the BenCGM, BurCGM, and DDS surveys. In a pooled analysis of both T1D and T2D, there was no difference in survey results by race/ethnicity, but female youth had an increased odd of diabetes-related distress, specifically regimen-related distress. Conclusions. Youth with T1D and T2D on insulin therapy report similar perspectives on continuous glucose monitor use and QoL measures. Insulin use in both T1D and T2D may carry a similar burden of management, and CGM may help improve quality of life. Trial registration: This trial is registered with NCT04721145, NCT04721158.
{"title":"Similar Perceptions on Continuous Glucose Monitor Use amongst Youth with Type 1 and Type 2 Diabetes","authors":"Alexander Phu, Tyger Lin, Jacquelyn Manfredo, Elizabeth A. Brown, R. Wolf","doi":"10.1155/2023/1979635","DOIUrl":"https://doi.org/10.1155/2023/1979635","url":null,"abstract":"Background and Objective. Continuous glucose monitoring (CGM) is shown to improve quality of life (QoL) in youth with type 1 diabetes (T1D), yet there is limited data on CGM in youth with type 2 diabetes (T2D). The objective was to compare perceptions of CGM and QoL between patients with T1D and T2D. Methods. Youth with T1D and T2D (currently on insulin therapy) without current CGM participated in a prospective CGM study and were given a series of questionnaires when starting CGM intervention. BenCGM and BurCGM questionnaires assessed the participant’s perspectives on continuous glucose monitor use, while DDS surveys assessed participants’ QoL associated with diabetes. Survey results were compared between T1D and T2D groups, and multivariable analysis was used to assess differences in perceptions of continuous glucose monitor use in youth with diabetes. Results. Participants with T1D (n = 26, 65.4% male, 42.3% non-Hispanic black, median age 14.2 years, median HbA1c 10.3%) and T2D (n = 41, 39% male, 80.5% non-Hispanic black, median age 16.2 years, median HbA1c 10.3%) scored similarly on the BenCGM, BurCGM, and DDS surveys. In a pooled analysis of both T1D and T2D, there was no difference in survey results by race/ethnicity, but female youth had an increased odd of diabetes-related distress, specifically regimen-related distress. Conclusions. Youth with T1D and T2D on insulin therapy report similar perspectives on continuous glucose monitor use and QoL measures. Insulin use in both T1D and T2D may carry a similar burden of management, and CGM may help improve quality of life. Trial registration: This trial is registered with NCT04721145, NCT04721158.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43321511","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}
Juan J. Madrid-Valero, J. Ware, Janet M. Allen, C. Boughton, S. Hartnell, M. Wilinska, A. Thankamony, C. de Beaufort, U. Schierloh, F. Campbell, J. Sibayan, L. Bocchino, C. Kollman, R. Hovorka, A. Gregory, KidsAP Consortium
Introduction. Parents of children living with type 1 diabetes (T1D) often report short and/or poor quality sleep. The development of closed-loop systems promises to transform the management of T1D. This study compared sleep quality and quantity in caregivers of children using a closed-loop system (CL) or sensor-augmented pump (SAP) therapy. Method. Data from sleep diaries, accelerometers, and questionnaires were provided by forty parents (classified as caregiver 1 (main analyses) or 2 (supplementary analyses) based on their contribution towards treatment management) of 21 very young children aged 1 to 7 years living with T1D (mean age: 4.7 (SD = 1.7)). Assessments were made at a single post-randomisation time point when the child was completing either the 16-week CL arm (n = 10) or the 16-week SAP arm (n = 11) of the main study. Results. Overall, there was a mixed pattern of results and group differences were not statistically significant at the p < 0.05 level. However, when we consider the direction of results and results from caregiver 1, sleep diary data showed that parents of the CL (as compared to the SAP) group reported a shorter sleep duration but better sleep quality, fewer awakenings, and less wake after sleep onset (WASO). Actiwatch data showed that caregiver 1 of the CL (as compared to the SAP) group had a shorter sleep latency; greater sleep efficiency; and less wake after sleep onset. Results from the Pittsburgh Sleep Quality Index also showed better sleep quality for caregiver 1 of the CL group as compared to the SAP group. Conclusions. Results from this study suggest that sleep quality and quantity in parents of children using CL were not significantly different to those using SAP. Considering effect sizes and the direction of the non-significant results, CL treatment could be associated with better sleep quality in the primary caregiver. However, further research is needed to confirm these findings. This trial is registered with NCT05158816.
{"title":"Sleep Quality and Quantity in Caregivers of Children with Type 1 Diabetes Using Closed-Loop Insulin Delivery or a Sensor-Augmented Pump","authors":"Juan J. Madrid-Valero, J. Ware, Janet M. Allen, C. Boughton, S. Hartnell, M. Wilinska, A. Thankamony, C. de Beaufort, U. Schierloh, F. Campbell, J. Sibayan, L. Bocchino, C. Kollman, R. Hovorka, A. Gregory, KidsAP Consortium","doi":"10.1155/2023/7937007","DOIUrl":"https://doi.org/10.1155/2023/7937007","url":null,"abstract":"Introduction. Parents of children living with type 1 diabetes (T1D) often report short and/or poor quality sleep. The development of closed-loop systems promises to transform the management of T1D. This study compared sleep quality and quantity in caregivers of children using a closed-loop system (CL) or sensor-augmented pump (SAP) therapy. Method. Data from sleep diaries, accelerometers, and questionnaires were provided by forty parents (classified as caregiver 1 (main analyses) or 2 (supplementary analyses) based on their contribution towards treatment management) of 21 very young children aged 1 to 7 years living with T1D (mean age: 4.7 (SD = 1.7)). Assessments were made at a single post-randomisation time point when the child was completing either the 16-week CL arm (n = 10) or the 16-week SAP arm (n = 11) of the main study. Results. Overall, there was a mixed pattern of results and group differences were not statistically significant at the \u0000 \u0000 p\u0000 <\u0000 0.05\u0000 \u0000 level. However, when we consider the direction of results and results from caregiver 1, sleep diary data showed that parents of the CL (as compared to the SAP) group reported a shorter sleep duration but better sleep quality, fewer awakenings, and less wake after sleep onset (WASO). Actiwatch data showed that caregiver 1 of the CL (as compared to the SAP) group had a shorter sleep latency; greater sleep efficiency; and less wake after sleep onset. Results from the Pittsburgh Sleep Quality Index also showed better sleep quality for caregiver 1 of the CL group as compared to the SAP group. Conclusions. Results from this study suggest that sleep quality and quantity in parents of children using CL were not significantly different to those using SAP. Considering effect sizes and the direction of the non-significant results, CL treatment could be associated with better sleep quality in the primary caregiver. However, further research is needed to confirm these findings. This trial is registered with NCT05158816.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46061983","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}
A. Chobot, A. Eckert, T. Biester, Sarah D. Corathers, Ana Covinhas, C. de Beaufort, Z. Imane, Jaehyun Kim, Anna Malatyńska, H. Moravej, Santosh Pokhrel, T. Skinner, Sweet Study Group
Background. Easy accessibility of psychosocial care is recommended for children and adolescents with type 1 diabetes (T1D) and their families. Objective. The study aimed to evaluate the availability of psychological care and its associations with glycemic control in centers from the multinational SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) registry. Subjects. Centers participating in SWEET (n = 112) were invited to complete a structured online survey, designed for the study, regarding their psychology service. Methods. Linear/logistic regression models adjusted for several confounders were used to determine the patient’s HbA1c (mmol/mol) and odds ratios (ORs) for diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) related to survey responses. Results. 76 (68%) centers with relevant data in the SWEET database responded to the survey. Psychological services were provided in 89% of the centers. The availability of psychological service in centers was associated with a slightly lower HbA1c of the patients (72 (62–82) vs. 67 (57–78) mmol/mol, p = 0.004 ) and significantly lower odds for DKA (1.8 (1.1–2.9), p = 0.027 ). Conclusions. Most centers from the SWEET registry offered some form of structured psychological care, consistent with the recommendations of easy access to psychosocial care for children and adolescents with T1D and their families. The main benefit of this psychological care appears to be in the incidence of DKA between centers. The study data also continues to emphasize the importance of treatment targets in shaping the outcomes of pediatric diabetes care. These findings should inform health-service planners and the diabetes community of the importance of mental healthcare in multidisciplinary diabetes teams.
{"title":"Psychological Care for Children and Adolescents with Diabetes and Patient Outcomes: Results from the International Pediatric Registry SWEET","authors":"A. Chobot, A. Eckert, T. Biester, Sarah D. Corathers, Ana Covinhas, C. de Beaufort, Z. Imane, Jaehyun Kim, Anna Malatyńska, H. Moravej, Santosh Pokhrel, T. Skinner, Sweet Study Group","doi":"10.1155/2023/8578231","DOIUrl":"https://doi.org/10.1155/2023/8578231","url":null,"abstract":"Background. Easy accessibility of psychosocial care is recommended for children and adolescents with type 1 diabetes (T1D) and their families. Objective. The study aimed to evaluate the availability of psychological care and its associations with glycemic control in centers from the multinational SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) registry. Subjects. Centers participating in SWEET (n = 112) were invited to complete a structured online survey, designed for the study, regarding their psychology service. Methods. Linear/logistic regression models adjusted for several confounders were used to determine the patient’s HbA1c (mmol/mol) and odds ratios (ORs) for diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) related to survey responses. Results. 76 (68%) centers with relevant data in the SWEET database responded to the survey. Psychological services were provided in 89% of the centers. The availability of psychological service in centers was associated with a slightly lower HbA1c of the patients (72 (62–82) vs. 67 (57–78) mmol/mol, \u0000 \u0000 p\u0000 =\u0000 0.004\u0000 \u0000 ) and significantly lower odds for DKA (1.8 (1.1–2.9), \u0000 \u0000 p\u0000 =\u0000 0.027\u0000 \u0000 ). Conclusions. Most centers from the SWEET registry offered some form of structured psychological care, consistent with the recommendations of easy access to psychosocial care for children and adolescents with T1D and their families. The main benefit of this psychological care appears to be in the incidence of DKA between centers. The study data also continues to emphasize the importance of treatment targets in shaping the outcomes of pediatric diabetes care. These findings should inform health-service planners and the diabetes community of the importance of mental healthcare in multidisciplinary diabetes teams.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"1 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-06-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64800826","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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