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":null,"pages":null},"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":null,"pages":null},"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}
Background. The COVID-19 pandemic has an impact on the incidence of type 1 diabetes and frequency of diabetic ketoacidosis. However, the exact relationships are unclear. It is also not known whether this is a short-term phenomenon or whether the effects have long-term relevance. Furthermore, it is not known whether these changes during the pandemic are due to direct effects of SARS-CoV-2 or to changes in the patient’s environment during the pandemic. Methods. We conducted an extensive literature search on PubMed. For the estimation of relative risks of new-onset type 1 diabetes, we applied a Poisson regression model and for the comparison of incidences and we included the logarithm of person-years. Furthermore, we performed a meta-analysis using the logarithm of the relative risk for new-onset type 1 diabetes as effect size. Results. Pooling the relative risk estimates in a random-effects meta-analysis revealed that the type 1 diabetes incidence rate increased by 20% (relative risk 1.200 (95% CI 1.125, 1.281)), and that the risk of new-onset type 1 diabetes after a SARS-CoV-2 infection increased by 62% (relative risk 1.622 (95% CI 1.347, 1.953)) compared with the prepandemic period. Conclusion. There is considerable evidence that there is an increase in type 1 diabetes in children during the COVID-19 pandemic. Many studies suggesting a direct effect of SARS-CoV-2 have methodological weaknesses. As no evidence of an increase in presymptomatic cases with isolated islet autoimmunity was found, this could also suggest an accelerated transition from presymptomatic patients to clinically overt type 1 diabetes. Furthermore, there was a marked exacerbation of the preexisting increase in the prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes during the pandemic. Both the increased incidence of paediatric type 1 diabetes and the higher prevalence of diabetic ketoacidosis at diagnosis led to a massive rise in the number of children with diabetic ketoacidosis during the pandemic.
背景。2019冠状病毒病大流行对1型糖尿病发病率和糖尿病酮症酸中毒发病频率有影响。然而，确切的关系尚不清楚。目前还不清楚这是一种短期现象还是其影响具有长期相关性。此外，尚不清楚大流行期间的这些变化是由于SARS-CoV-2的直接影响还是由于大流行期间患者环境的变化。方法。我们在PubMed上进行了广泛的文献检索。为了估计新发1型糖尿病的相对风险，我们采用了泊松回归模型和发病率的比较，并纳入了人年的对数。此外，我们使用新发1型糖尿病相对风险的对数作为效应量进行了荟萃分析。结果。随机效应荟萃分析中汇总的相对风险估计显示，与大流行前相比，1型糖尿病发病率增加了20%(相对风险为1.200 (95% CI 1.125, 1.281))， SARS-CoV-2感染后新发1型糖尿病的风险增加了62%(相对风险为1.622 (95% CI 1.347, 1.953))。结论。有大量证据表明，在2019冠状病毒病大流行期间，儿童1型糖尿病患者有所增加。许多表明SARS-CoV-2直接影响的研究在方法上存在弱点。由于没有证据表明症状前孤立胰岛自身免疫病例增加，这也可能表明从症状前患者到临床显性1型糖尿病的加速转变。此外，在大流行期间，在诊断为1型糖尿病时，先前存在的糖尿病酮症酸中毒患病率的增加明显加剧。儿童1型糖尿病发病率的增加和诊断时糖尿病酮症酸中毒的较高患病率导致大流行期间糖尿病酮症酸中毒儿童人数的大量增加。
{"title":"Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes","authors":"C. Kamrath, A. Eckert, R. Holl, J. Rosenbauer","doi":"10.1155/2023/7660985","DOIUrl":"https://doi.org/10.1155/2023/7660985","url":null,"abstract":"Background. The COVID-19 pandemic has an impact on the incidence of type 1 diabetes and frequency of diabetic ketoacidosis. However, the exact relationships are unclear. It is also not known whether this is a short-term phenomenon or whether the effects have long-term relevance. Furthermore, it is not known whether these changes during the pandemic are due to direct effects of SARS-CoV-2 or to changes in the patient’s environment during the pandemic. Methods. We conducted an extensive literature search on PubMed. For the estimation of relative risks of new-onset type 1 diabetes, we applied a Poisson regression model and for the comparison of incidences and we included the logarithm of person-years. Furthermore, we performed a meta-analysis using the logarithm of the relative risk for new-onset type 1 diabetes as effect size. Results. Pooling the relative risk estimates in a random-effects meta-analysis revealed that the type 1 diabetes incidence rate increased by 20% (relative risk 1.200 (95% CI 1.125, 1.281)), and that the risk of new-onset type 1 diabetes after a SARS-CoV-2 infection increased by 62% (relative risk 1.622 (95% CI 1.347, 1.953)) compared with the prepandemic period. Conclusion. There is considerable evidence that there is an increase in type 1 diabetes in children during the COVID-19 pandemic. Many studies suggesting a direct effect of SARS-CoV-2 have methodological weaknesses. As no evidence of an increase in presymptomatic cases with isolated islet autoimmunity was found, this could also suggest an accelerated transition from presymptomatic patients to clinically overt type 1 diabetes. Furthermore, there was a marked exacerbation of the preexisting increase in the prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes during the pandemic. Both the increased incidence of paediatric type 1 diabetes and the higher prevalence of diabetic ketoacidosis at diagnosis led to a massive rise in the number of children with diabetic ketoacidosis during the pandemic.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-05-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48737633","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}
Ryan P. Brady, Elizabeth T. Jensen, Joseph Rigdon, Nancy A. Crimmins, Daniel Mallon, Lawrence M. Dolan, Giuseppina Imperatore, Anna R. Kahkoska, Amy K. Mottl, Ann Honor, David J. Pettitt, Lina Merjaneh, Dana Dabelea, Amy S. Shah
Aims. Celiac disease (CD) in adults with type 1 diabetes has been associated with increased cardiovascular risk and the earlier occurrence of diabetes-associated complications. In the Search for Diabetes in Youth study, we aimed to assess the frequency of CD and the potential for undiagnosed CD among youth with childhood onset type 1 diabetes. In addition, we assessed the burden of cardiovascular risk factors and diabetes-associated complications in youth with type 1 diabetes by CD status and IgA tissue transglutaminase autoantibody (tTGA) levels. Methods. 2,444 youths with type 1 diabetes completed a CD questionnaire and underwent tTGA testing. Integrating the celiac disease questionnaire and tTGA results for this cross-sectional analysis, participants were categorized as follows: (1) reported CD; (2) seropositive for CD (no reported CD and seropositive tTGA); and (3) type 1 diabetes only (comparison group: no reported CD and seronegative tTGA). Subanalyses were performed on those with no reported CD and tTGA ≥10x ULN, designated potentially undiagnosed CD. Cardiovascular risk factors and diabetes-associated complications were evaluated by CD status and tTGA levels utilizing a Poisson model to estimate relative risk. Results. Reported CD in youths with type 1 diabetes was 7%. Seropositivity for tTGA with no reported CD was present in 4%, and 1.2% had potentially undiagnosed CD. Youths with potentially undiagnosed CD had a 2.69x higher risk of diabetic retinopathy than comparison group. In addition, CD with tTGA <0.05 (controlled CD) was associated with lower HbA1c. Conclusions. Undiagnosed CD is likely present in youths with type 1 diabetes and potentially undiagnosed CD is associated with a higher risk of diabetic retinopathy. These findings indicate the importance of routine screening for CD in type 1 diabetes in youths.
{"title":"The Frequency of Undiagnosed Celiac Disease in Youth with Type 1 Diabetes and Its Association with Diabetic Retinopathy: The SEARCH for Diabetes in Youth Study","authors":"Ryan P. Brady, Elizabeth T. Jensen, Joseph Rigdon, Nancy A. Crimmins, Daniel Mallon, Lawrence M. Dolan, Giuseppina Imperatore, Anna R. Kahkoska, Amy K. Mottl, Ann Honor, David J. Pettitt, Lina Merjaneh, Dana Dabelea, Amy S. Shah","doi":"10.1155/2023/9038795","DOIUrl":"https://doi.org/10.1155/2023/9038795","url":null,"abstract":"Aims. Celiac disease (CD) in adults with type 1 diabetes has been associated with increased cardiovascular risk and the earlier occurrence of diabetes-associated complications. In the Search for Diabetes in Youth study, we aimed to assess the frequency of CD and the potential for undiagnosed CD among youth with childhood onset type 1 diabetes. In addition, we assessed the burden of cardiovascular risk factors and diabetes-associated complications in youth with type 1 diabetes by CD status and IgA tissue transglutaminase autoantibody (tTGA) levels. Methods. 2,444 youths with type 1 diabetes completed a CD questionnaire and underwent tTGA testing. Integrating the celiac disease questionnaire and tTGA results for this cross-sectional analysis, participants were categorized as follows: (1) reported CD; (2) seropositive for CD (no reported CD and seropositive tTGA); and (3) type 1 diabetes only (comparison group: no reported CD and seronegative tTGA). Subanalyses were performed on those with no reported CD and tTGA ≥10x ULN, designated potentially undiagnosed CD. Cardiovascular risk factors and diabetes-associated complications were evaluated by CD status and tTGA levels utilizing a Poisson model to estimate relative risk. Results. Reported CD in youths with type 1 diabetes was 7%. Seropositivity for tTGA with no reported CD was present in 4%, and 1.2% had potentially undiagnosed CD. Youths with potentially undiagnosed CD had a 2.69x higher risk of diabetic retinopathy than comparison group. In addition, CD with tTGA <0.05 (controlled CD) was associated with lower HbA1c. Conclusions. Undiagnosed CD is likely present in youths with type 1 diabetes and potentially undiagnosed CD is associated with a higher risk of diabetic retinopathy. These findings indicate the importance of routine screening for CD in type 1 diabetes in youths.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135831652","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}
M. Babinski, R. Duperval, Ketly Altenor, J. V. von Oettingen
Background. Sleep and physical activity affect overall health. In youth with type 1 diabetes (T1DM), they may improve glycemic control. Data from low-income countries are lacking. Objective. To describe sleep and activity in Haitian children and youth with T1DM, and examine their impact on glycemic control, health-related quality of life (HRQL), and life satisfaction (LS). Methods. This cross-sectional study in Haiti included people with T1DM aged 8–25 years. Wristbands (Mi Band 3) tracked activity (step count and activity time) and sleep (sleep duration, light sleep, and deep sleep). The Diabetes Quality of Life in Youth (DQOLY) questionnaire was used to evaluate HRQL and LS. Point-of-care (POC) hemoglobin A1c values were recorded. Linear regression was used to assess the relationship between sleep, activity, HbA1c, HRQL, and LS. Results. We included 66 participants (59% female, mean age 17.8 ± 4.8 years, mean diabetes duration 3.7 ± 3.4 years, and mean BMI Z-score −0.86 ± 1.1). Mean HRQL was 63/100, and mean LS was 65/100. Mean HbA1c was 11.3%. Maximum HbA1c measure was 14% on the POC machine, and 23 participants (35%) had HbA1c recorded as 14%. Mean daily step count was 7,508 ± 3,087, and mean sleep duration was 7 h31 ± 1 h17. When excluding participants with HbA1c ≥ 14%, shorter sleep duration was significantly associated with higher HbA1c ( p = 0.024 ). Sleep duration and step count were not associated with HRQL or LS. Conclusions. Children and youth with T1DM in Haiti have poor glycemic control and low HRQL and LS. Their sleep and activity habits are similar to peers. While activity did not affect HbA1c, HRQL, or LS, shorter sleep duration was associated with higher HbA1c in participants with HbA1c < 14%. Prospective studies with larger sample sizes are needed to validate our findings.
{"title":"Impact of Sleep and Activity on Glycemic Control and Quality of Life in Haitian Children and Youth with Type 1 Diabetes","authors":"M. Babinski, R. Duperval, Ketly Altenor, J. V. von Oettingen","doi":"10.1155/2023/4289288","DOIUrl":"https://doi.org/10.1155/2023/4289288","url":null,"abstract":"Background. Sleep and physical activity affect overall health. In youth with type 1 diabetes (T1DM), they may improve glycemic control. Data from low-income countries are lacking. Objective. To describe sleep and activity in Haitian children and youth with T1DM, and examine their impact on glycemic control, health-related quality of life (HRQL), and life satisfaction (LS). Methods. This cross-sectional study in Haiti included people with T1DM aged 8–25 years. Wristbands (Mi Band 3) tracked activity (step count and activity time) and sleep (sleep duration, light sleep, and deep sleep). The Diabetes Quality of Life in Youth (DQOLY) questionnaire was used to evaluate HRQL and LS. Point-of-care (POC) hemoglobin A1c values were recorded. Linear regression was used to assess the relationship between sleep, activity, HbA1c, HRQL, and LS. Results. We included 66 participants (59% female, mean age 17.8 ± 4.8 years, mean diabetes duration 3.7 ± 3.4 years, and mean BMI Z-score −0.86 ± 1.1). Mean HRQL was 63/100, and mean LS was 65/100. Mean HbA1c was 11.3%. Maximum HbA1c measure was 14% on the POC machine, and 23 participants (35%) had HbA1c recorded as 14%. Mean daily step count was 7,508 ± 3,087, and mean sleep duration was 7 h31 ± 1 h17. When excluding participants with HbA1c ≥ 14%, shorter sleep duration was significantly associated with higher HbA1c (\u0000 \u0000 p\u0000 =\u0000 0.024\u0000 \u0000 ). Sleep duration and step count were not associated with HRQL or LS. Conclusions. Children and youth with T1DM in Haiti have poor glycemic control and low HRQL and LS. Their sleep and activity habits are similar to peers. While activity did not affect HbA1c, HRQL, or LS, shorter sleep duration was associated with higher HbA1c in participants with HbA1c < 14%. Prospective studies with larger sample sizes are needed to validate our findings.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44287506","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}
Abeer Alassaf, L. Gharaibeh, S. Ibrahim, Shatha Alkhalaileh, R. Odeh
Background and Aim. Early diabetes education for persons with type 1 diabetes (T1D) is important to achieve early glycemic control. We had developed a dietary structured education program (SEP) to provide patients with the required skills for optimal diabetes management. Our aim was to study the effect of our program and factors that might affect its outcomes. Methods. This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was compared with those who were exposed to the conventional diabetes education, between January 2014 and December 2016. Various factors were assessed for the possible effects on the SEP outcomes. Results. The average age at diagnosis for the 112 persons with diabetes (PwD) included in the dietary SEP was 8.30 ± 3.87 years. Glycated hemoglobin was lower in children in the SEP group at 6 months ( P value = 0.001) and 12 months ( P = 0.032 ) but not at 24 months ( P = 0.290 ). SEP had better effect on patients older than 5 years. The possible predictors of glycemic control for the SEP group at 12 months included the mother’s educational level and the number of hospital admissions due to DKA and hyperglycemia during the first year after diagnosis. Conclusion. Our dietary SEP was associated with better glycemic control than conventional diabetes education, at 6 and 12 months after diagnosis. It had a positive effect, mainly in PwD patients who are older than 5 years and had higher maternal educational level.
{"title":"Effect on Glycemic Control of an Early Intensive Dietary Structured Education Program for Newly Diagnosed Children with Type 1 Diabetes in Jordan","authors":"Abeer Alassaf, L. Gharaibeh, S. Ibrahim, Shatha Alkhalaileh, R. Odeh","doi":"10.1155/2023/7258136","DOIUrl":"https://doi.org/10.1155/2023/7258136","url":null,"abstract":"Background and Aim. Early diabetes education for persons with type 1 diabetes (T1D) is important to achieve early glycemic control. We had developed a dietary structured education program (SEP) to provide patients with the required skills for optimal diabetes management. Our aim was to study the effect of our program and factors that might affect its outcomes. Methods. This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was compared with those who were exposed to the conventional diabetes education, between January 2014 and December 2016. Various factors were assessed for the possible effects on the SEP outcomes. Results. The average age at diagnosis for the 112 persons with diabetes (PwD) included in the dietary SEP was 8.30 ± 3.87 years. Glycated hemoglobin was lower in children in the SEP group at 6 months (\u0000 \u0000 P\u0000 \u0000 value = 0.001) and 12 months (\u0000 \u0000 P\u0000 =\u0000 0.032\u0000 \u0000 ) but not at 24 months (\u0000 \u0000 P\u0000 =\u0000 0.290\u0000 \u0000 ). SEP had better effect on patients older than 5 years. The possible predictors of glycemic control for the SEP group at 12 months included the mother’s educational level and the number of hospital admissions due to DKA and hyperglycemia during the first year after diagnosis. Conclusion. Our dietary SEP was associated with better glycemic control than conventional diabetes education, at 6 and 12 months after diagnosis. It had a positive effect, mainly in PwD patients who are older than 5 years and had higher maternal educational level.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47641163","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}
Andrea N. Lorenz, L. Pyle, Joon Ha, A. Sherman, M. Cree‐Green, S. Sagel, K. Nadeau, Christine L. Chan
Background. In cystic fibrosis-related diabetes (CFRD) screening, oral glucose tolerance test (OGTT) thresholds for detecting prediabetes and diabetes are defined by the 2-hour glucose (2 hG). Intermediate OGTT glucoses, between 0 and 2 hours, that are ≥200 mg/dL are deemed “indeterminate,” although lower 1-hour glucose (1 hG) thresholds identify those at increased risk of type 2 diabetes in other populations, and may also better predict clinical decline in CF. Studies of 1 hG thresholds <200 mg/dL in people with CF are limited. Methods. A single center, retrospective chart review was performed of patients with 1 hG available on OGTTs collected between 2010 and 2019. In patients with ≥2 OGTTs, Kaplan–Meier analysis estimated likelihood of progression to CFRD based on a high vs. low 1 hG. In patients with ≥1 OGTT, mixed-effects models tested whether baseline 1 hG and 2 hG predicted growth and lung function trajectories. Results. A total of 243 individuals with CF were identified with at least 1 OGTT including a 1 hG, and n = 177 had ≥2 OGTTs. Baseline age (mean ± SD) was 12.4 ± 2.6 years with 3.2 ± 1.4 years of follow-up. Twenty-eight developed CFRD. All who developed CFRD had a 1 hG ≥ 155 mg/dL prior to 2 hG > 140 mg/dL. The average 1 hG was 267 mg/dL when 2 hG ≥ 200 mg/dL. In a subset with baseline 2 hG < 140 mg/dL, 1 hG ≥ 140 mg/dL conferred an increased 5 years risk of CFRD ( p = 0.036 ). Baseline 2 hG predicted decline in FEV1%predicted, but 1 hG did not. Conclusions. In youth with CF, 1 hG ≥ 140 mg/dl is an early indicator of CFRD risk. However, 2 hG, rather than 1 hG, predicted lung function decline.
{"title":"Predictive Value of 1-Hour Glucose Elevations during Oral Glucose Tolerance Testing for Cystic Fibrosis-Related Diabetes","authors":"Andrea N. Lorenz, L. Pyle, Joon Ha, A. Sherman, M. Cree‐Green, S. Sagel, K. Nadeau, Christine L. Chan","doi":"10.1155/2023/4395556","DOIUrl":"https://doi.org/10.1155/2023/4395556","url":null,"abstract":"Background. In cystic fibrosis-related diabetes (CFRD) screening, oral glucose tolerance test (OGTT) thresholds for detecting prediabetes and diabetes are defined by the 2-hour glucose (2 hG). Intermediate OGTT glucoses, between 0 and 2 hours, that are ≥200 mg/dL are deemed “indeterminate,” although lower 1-hour glucose (1 hG) thresholds identify those at increased risk of type 2 diabetes in other populations, and may also better predict clinical decline in CF. Studies of 1 hG thresholds <200 mg/dL in people with CF are limited. Methods. A single center, retrospective chart review was performed of patients with 1 hG available on OGTTs collected between 2010 and 2019. In patients with ≥2 OGTTs, Kaplan–Meier analysis estimated likelihood of progression to CFRD based on a high vs. low 1 hG. In patients with ≥1 OGTT, mixed-effects models tested whether baseline 1 hG and 2 hG predicted growth and lung function trajectories. Results. A total of 243 individuals with CF were identified with at least 1 OGTT including a 1 hG, and n = 177 had ≥2 OGTTs. Baseline age (mean ± SD) was 12.4 ± 2.6 years with 3.2 ± 1.4 years of follow-up. Twenty-eight developed CFRD. All who developed CFRD had a 1 hG ≥ 155 mg/dL prior to 2 hG > 140 mg/dL. The average 1 hG was 267 mg/dL when 2 hG ≥ 200 mg/dL. In a subset with baseline 2 hG < 140 mg/dL, 1 hG ≥ 140 mg/dL conferred an increased 5 years risk of CFRD (\u0000 \u0000 p\u0000 =\u0000 0.036\u0000 \u0000 ). Baseline 2 hG predicted decline in FEV1%predicted, but 1 hG did not. Conclusions. In youth with CF, 1 hG ≥ 140 mg/dl is an early indicator of CFRD risk. However, 2 hG, rather than 1 hG, predicted lung function decline.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49036957","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}
Alexandra D. Monzon, Ryan J. McDonough, Christopher C. Cushing, M. Clements, S. Patton
Objective. Youth with type 1 diabetes mellitus (T1D) are at risk for experiencing nighttime hypoglycemia, and many parents report significant anxiety at night regarding glucose management. Limited data exist examining continuous nighttime glucose levels as a predictor of parent fear of nighttime hypoglycemia. The present study aimed to examine the relationship between parent fear of nighttime hypoglycemia and nighttime blood glucose levels as measured by continuous glucose monitors (CGMs). Methods. A sample of 136 parents/caregivers of youth with T1D completed a one-time survey and youth provided 14 days of CGM data. We conducted regression models with mean nighttime glucose value, glycemic variability, and the percent of nighttime glucose values in the hypoglycemic, target, and hyperglycemic range as the independent variable and parents’ fear of nighttime hypoglycemia as the dependent variable. Results. Overnight hypoglycemia measured via CGM did not predict parents’ fear of nighttime hypoglycemia; however, average youth nighttime glucose levels and nighttime glycemic variability were significant predictors of parents’ fear of nighttime hypoglycemia. Conclusions. The results of the present study indicate that parents of youth with T1D may report higher fear of hypoglycemia if they observe increased fluctuations in their child’s nighttime glucose levels, regardless of how often their child’s glucose levels are in the hypoglycemic range. The results suggest that clinicians may consider screening for parent fear of nighttime hypoglycemia in families of youth who present with large variability in their glucose values overnight.
{"title":"Examining the Relationship between Nighttime Glucose Values in Youth with Type 1 Diabetes and Parent Fear of Nighttime Hypoglycemia","authors":"Alexandra D. Monzon, Ryan J. McDonough, Christopher C. Cushing, M. Clements, S. Patton","doi":"10.1155/2023/9953662","DOIUrl":"https://doi.org/10.1155/2023/9953662","url":null,"abstract":"Objective. Youth with type 1 diabetes mellitus (T1D) are at risk for experiencing nighttime hypoglycemia, and many parents report significant anxiety at night regarding glucose management. Limited data exist examining continuous nighttime glucose levels as a predictor of parent fear of nighttime hypoglycemia. The present study aimed to examine the relationship between parent fear of nighttime hypoglycemia and nighttime blood glucose levels as measured by continuous glucose monitors (CGMs). Methods. A sample of 136 parents/caregivers of youth with T1D completed a one-time survey and youth provided 14 days of CGM data. We conducted regression models with mean nighttime glucose value, glycemic variability, and the percent of nighttime glucose values in the hypoglycemic, target, and hyperglycemic range as the independent variable and parents’ fear of nighttime hypoglycemia as the dependent variable. Results. Overnight hypoglycemia measured via CGM did not predict parents’ fear of nighttime hypoglycemia; however, average youth nighttime glucose levels and nighttime glycemic variability were significant predictors of parents’ fear of nighttime hypoglycemia. Conclusions. The results of the present study indicate that parents of youth with T1D may report higher fear of hypoglycemia if they observe increased fluctuations in their child’s nighttime glucose levels, regardless of how often their child’s glucose levels are in the hypoglycemic range. The results suggest that clinicians may consider screening for parent fear of nighttime hypoglycemia in families of youth who present with large variability in their glucose values overnight.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"64806368","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}
Caroline Zuijdwijk, Jennilea Courtney, Nicholas Mitsakakis, Lamia Hayawi, Stephanie Sutherland, Dennis Newhook, Alexandra Ahmet, Ellen B. Goldbloom, Karine Khatchadourian, Sarah Lawrence
Objective. To determine the impact of the t:slim X2 insulin pump with Control-IQ technology on the quality of life and glycemic control in youth with type 1 diabetes (T1D) and their parents in a real-world setting. Research Design and Methods. We conducted a single-center, prospective study on pediatric patients (6–18 years old) with T1D using a Tandem t:slim X2 pump and initiating Control-IQ technology as part of routine care. Youth (≥8 years) and parents completed validated patient-reported outcome measures (PROMs) at baseline and the end of the study (16 weeks). Glycemic control measures were recorded at baseline and every 4 weeks until the end of the study. Results. Fifty-nine youth participated; the median (IQR) age was 13.8 (11.1, 15.7) years, and T1D duration was 6.3 (3.1, 8.4) years. INSPIRE scores (evaluating expectations (baseline) and impact (post) of Control-IQ technology) were favorable, unchanged at the end of the study for youth, and lower for parents ( ). Other PROM scores improved by the end of the study with mean (95% CI) differences for youth and parents, respectively, as follows: Diabetes Impact and Device Satisfaction (DIDS) Scale Diabetes Impact −1.08 (−1.51, −0.64) ( ) and −1.41 (−1.96, −0.87) ( ); DIDS Scale Device Satisfaction +0.43 (0.11, 0.74) ( ) and +0.58 (0.31, 0.85) ( ); Hypoglycemia Fear Survey −4.41 (−7.65, −1.17) ( ) and −7.64 (−11.66, −3.62) ( ); and WHO-5 Well-Being Index +5.10 (−1.40, 11.6) ( ) and +9.60 (3.40, 15.8) ( ). The mean time in range increased from 52.6% at baseline to 62.6% ( ) at 4 weeks, sustained to 16 weeks. Conclusions. Initiation of Control-IQ technology in a real-world setting significantly reduced the impact of diabetes on daily life while simultaneously improving glycemic control. Trial Registration. This trial is registered with ClinicalTrials.gov Identifier NCT04838561 (https://www.clinicaltrials.gov/ct2/show/NCT04838561?term=Control-IQ&cond=Type+1+Diabetes&cntry=CA&dr
{"title":"Control-IQ Technology Positively Impacts Patient Reported Outcome Measures and Glycemic Control in Youth with Type 1 Diabetes in a Real-World Setting","authors":"Caroline Zuijdwijk, Jennilea Courtney, Nicholas Mitsakakis, Lamia Hayawi, Stephanie Sutherland, Dennis Newhook, Alexandra Ahmet, Ellen B. Goldbloom, Karine Khatchadourian, Sarah Lawrence","doi":"10.1155/2023/5106107","DOIUrl":"https://doi.org/10.1155/2023/5106107","url":null,"abstract":"Objective. To determine the impact of the t:slim X2 insulin pump with Control-IQ technology on the quality of life and glycemic control in youth with type 1 diabetes (T1D) and their parents in a real-world setting. Research Design and Methods. We conducted a single-center, prospective study on pediatric patients (6–18 years old) with T1D using a Tandem t:slim X2 pump and initiating Control-IQ technology as part of routine care. Youth (≥8 years) and parents completed validated patient-reported outcome measures (PROMs) at baseline and the end of the study (16 weeks). Glycemic control measures were recorded at baseline and every 4 weeks until the end of the study. Results. Fifty-nine youth participated; the median (IQR) age was 13.8 (11.1, 15.7) years, and T1D duration was 6.3 (3.1, 8.4) years. INSPIRE scores (evaluating expectations (baseline) and impact (post) of Control-IQ technology) were favorable, unchanged at the end of the study for youth, and lower for parents ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.04</mn> </math> ). Other PROM scores improved by the end of the study with mean (95% CI) differences for youth and parents, respectively, as follows: Diabetes Impact and Device Satisfaction (DIDS) Scale Diabetes Impact −1.08 (−1.51, −0.64) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ) and −1.41 (−1.96, −0.87) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); DIDS Scale Device Satisfaction +0.43 (0.11, 0.74) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ) and +0.58 (0.31, 0.85) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M5\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); Hypoglycemia Fear Survey −4.41 (−7.65, −1.17) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M6\"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ) and −7.64 (−11.66, −3.62) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M7\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); and WHO-5 Well-Being Index +5.10 (−1.40, 11.6) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M8\"> <mi>p</mi> <mo>=</mo> <mn>0.12</mn> </math> ) and +9.60 (3.40, 15.8) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M9\"> <mi>p</mi> <mo>=</mo> <mn>0.003</mn> </math> ). The mean time in range increased from 52.6% at baseline to 62.6% ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M10\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ) at 4 weeks, sustained to 16 weeks. Conclusions. Initiation of Control-IQ technology in a real-world setting significantly reduced the impact of diabetes on daily life while simultaneously improving glycemic control. Trial Registration. This trial is registered with ClinicalTrials.gov Identifier NCT04838561 (https://www.clinicaltrials.gov/ct2/show/NCT04838561?term=Control-IQ&cond=Type+1+Diabetes&cntry=CA&dr","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134953098","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}
Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benefits of rtCGM use in a high-risk, under-resourced cohort of adolescents and young adults (AYA) with type 1 diabetes (T1D) who had no prior access to rtCGM. The effects of rtCGM use on hemoglobin A1c (A1c) and the frequency of health care events (i.e., diabetes-related emergency room (ER) visits, hospitalizations, emergency medical services (EMS), and after-hour emergency calls) were evaluated regarding payor costs in 33 AYA with ≥70% rtCGM use. Secondary aims included the evaluation of a phone-based pattern management intervention. The frequency of health care events decreased at 12 and 24 weeks for all participants, and there was no significant difference by treatment group. We estimated that the use of rtCGM in this cohort results in a projected annualized cost-savings of $195,943 to $294,864 or 43–65% per year based on Medicare or list pricing for rtCGM, respectively. Results also revealed improvements in A1c at 12 weeks for all study participants, but this was not maintained at 24 weeks for the phone-based pattern management intervention group. Our findings suggest that rtCGM may be an effective tool for reducing diabetes-related events and underscores the importance of access. Future studies are needed to further examine tailored interventions and support to optimize rtCGM use and glycemic health in high-risk AYA.
{"title":"Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c","authors":"","doi":"10.1155/2023/5253515","DOIUrl":"https://doi.org/10.1155/2023/5253515","url":null,"abstract":"Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benefits of rtCGM use in a high-risk, under-resourced cohort of adolescents and young adults (AYA) with type 1 diabetes (T1D) who had no prior access to rtCGM. The effects of rtCGM use on hemoglobin A1c (A1c) and the frequency of health care events (i.e., diabetes-related emergency room (ER) visits, hospitalizations, emergency medical services (EMS), and after-hour emergency calls) were evaluated regarding payor costs in 33 AYA with ≥70% rtCGM use. Secondary aims included the evaluation of a phone-based pattern management intervention. The frequency of health care events decreased at 12 and 24 weeks for all participants, and there was no significant difference by treatment group. We estimated that the use of rtCGM in this cohort results in a projected annualized cost-savings of $195,943 to $294,864 or 43–65% per year based on Medicare or list pricing for rtCGM, respectively. Results also revealed improvements in A1c at 12 weeks for all study participants, but this was not maintained at 24 weeks for the phone-based pattern management intervention group. Our findings suggest that rtCGM may be an effective tool for reducing diabetes-related events and underscores the importance of access. Future studies are needed to further examine tailored interventions and support to optimize rtCGM use and glycemic health in high-risk AYA.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":null,"pages":null},"PeriodicalIF":3.4,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49157684","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：