1
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Higgins H, Gupta N. Characterizing social and policy determinants of hospital length of stay among paediatric inpatients with diabetes using linked population-based data. Int J Popul Data Sci 2022; 6:1678. [PMID: 34970634 PMCID: PMC8678978 DOI: 10.23889/ijpds.v6i1.1678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background Evidence is limited on the non-medical factors influencing hospital length of stay (LOS) among paediatric inpatients with diabetes, notably potential social and policy correlates. This study aimed to characterize the associations of socioeconomic status and health policy environment with diabetes-attributable LOS to help inform accountability monitoring of a provincial comprehensive diabetes strategy aiming to minimize time in hospital among this high-risk population. Data and methods This retrospective population-based study drew on multiple linked administrative and geospatial databases among all children aged 18 and under with a diabetes-related hospitalization in the province of New Brunswick, Canada, during the four-year period following implementation of an insulin pump funding program. Multiple linear regression was used to assess the role of access to the public insulin pump resourcing scheme and relative neighbourhood deprivation as predictors of days spent in acute care, controlling for age, sex, and place of residence. Results Among the paediatric inpatient population (N = 386), 21% had accessed social resources made available through the insulin pump funding policy and 42% resided in the most materially deprived neighbourhoods. Diabetes-related hospital stays averaged 3.87 days. Paediatric inpatients having accessed resources through the social insurance policy spent significantly fewer days in hospital (1.34 days less [95% CI: 0.63–2.05]) than those who had not, all else being equal. Observed differences in LOS by neighbourhood socioeconomic deprivation were not found to be statistically significant in the multivariate analysis. Conclusion Findings from this context of universal medical coverage suggested that public policy for supplemental financing of assistive technologies among children with diabetes may be associated with reduced burden to the hospital system. The causes of socioenvironmental disparities in LOS require further investigation to inform interventions to mitigate preventable patient-level variations in hospital-based health outcomes.
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Affiliation(s)
- Heather Higgins
- University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
| | - Neeru Gupta
- University of New Brunswick, PO Box 4400, Fredericton, New Brunswick E3B 5A3, Canada
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2
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Yamamoto Y, Kikuchi T, Urakami T, Goto M, Tsubouchi K, Sasaki G, Mizuno H, Abe Y, Kitsuda K, Amemiya S, Sugihara S. Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2019; 32:1-9. [PMID: 30517078 DOI: 10.1515/jpem-2018-0329] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 11/08/2018] [Indexed: 11/15/2022]
Abstract
Background Treatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients. Methods The registration data including hemoglobin A1c (HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort). Results The proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0-5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA1c values between the two cohorts. Conclusions The popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.
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Affiliation(s)
- Yukiyo Yamamoto
- Director of Medical Education, Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Japan, 1-1, Iseigaoka, Yahatanishi-ku, Kitakyushu City 807-8555, Japan.,The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Toru Kikuchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Tatsuhiko Urakami
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Motohide Goto
- Department of Pediatrics, University of Occupational and Environmental Health Japan, Kitakyushu, Japan
| | - Kohji Tsubouchi
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Chuno Kosei Hospital, Gifu, Japan
| | - Goro Sasaki
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Tokyo Dental College Ichikawa General Hospital, Chiba, Japan
| | - Haruo Mizuno
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Departments of Pediatrics and Neonatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yuki Abe
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Niigata City General Hospital, Niigata, Japan
| | - Kazuteru Kitsuda
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Kitasato University, Kanagawa, Japan
| | - Shin Amemiya
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Faculty of Medicine, Saitama Medical University, Saitama, Japan
| | - Shigetaka Sugihara
- The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Kyoto, Japan.,Department of Pediatrics, Tokyo Women's Medical University Medical Center East, Tokyo, Japan
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3
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Hoshina S, Andersen GS, Jørgensen ME, Ridderstråle M, Vistisen D, Andersen HU. Treatment Modality-Dependent Risk of Diabetic Ketoacidosis in Patients with Type 1 Diabetes: Danish Adult Diabetes Database Study. Diabetes Technol Ther 2018; 20:229-234. [PMID: 29437465 DOI: 10.1089/dia.2017.0231] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND AIMS The aim of this study was to evaluate the incidence rates of diabetic ketoacidosis (DKA) according to treatment modality in patients with type 1 diabetes (T1D) in Denmark, either multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). MATERIALS AND METHODS A total of 20,902 T1D registered in the Danish Adult Diabetes Database were followed for an average of 5.4 years. Poisson regression analyses with risk time as offset were used to compare differences in rates of DKA between CSII and MDI. Model was adjusted for age, sex, diabetes duration, previous DKA events, and hemoglobin A1c (HbA1c). A modifying effect of number of CSII patients on the DKA rates was tested. RESULTS During 113,731 person-years, 3100 DKA events were registered (53 among CSII). CSII patients were younger (42.3 vs. 47.9 years), a larger proportion was female (59% vs. 43%), had a shorter diabetes duration (19 vs. 21 years), and a lower HbA1c (61.9 vs. 66.6 mmol/mol). There was no significant difference in the incidence rate of DKA between CSII and MDI (rate ratio: 1.30, 95% confidence interval: 0.97-1.76). However, in clinics with at least 250 CSII patients, rates of DKA events were lower among CSII users, while the opposite was true for the smaller clinics (P = 0.016). CONCLUSIONS Delivery of CSII in large diabetes clinics with sufficient support and patient education may ensure that CSII treatment does not lead to an increased risk of DKA.
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Affiliation(s)
- Sari Hoshina
- 1 Department of Diabetes Center, Tokyo Women's Medical University School of Medicine , Tokyo, Japan
- 2 Steno Diabetes Center Copenhagen , Gentofte, Denmark
| | | | - Marit E Jørgensen
- 2 Steno Diabetes Center Copenhagen , Gentofte, Denmark
- 3 National Institute of Public Health, University of Southern Denmark, Odense M, Denmark
| | - Martin Ridderstråle
- 2 Steno Diabetes Center Copenhagen , Gentofte, Denmark
- 4 Novo Nordisk A/S , Clinical Pharmacology, Søborg, Denmark
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4
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Rabbone I, Minuto N, Bonfanti R, Marigliano M, Cerutti F, Cherubini V, d'Annunzio G, Frongia AP, Iafusco D, Ignaccolo G, Lombardo F, Schiaffini R, Toni S, Tumini S, Zucchini S, Pistorio A, Scaramuzza AE. Insulin pump failures in Italian children with Type 1 diabetes: retrospective 1-year cohort study. Diabet Med 2017; 34:621-624. [PMID: 27885706 DOI: 10.1111/dme.13294] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/21/2016] [Indexed: 11/27/2022]
Abstract
AIMS Insulin pump failure and/or malfunction requiring replacement have not been thoroughly investigated. This study evaluated pump replacement in children and adolescents with Type 1 diabetes using insulin pump therapy. METHODS Data were collected for all participants younger than 19 years, starting insulin pump therapy before 31 December 2013. For each child, age, disease duration, date of insulin pump therapy initiation, insulin pump model, failure/malfunction/replacement yes/no and reason were considered for the year 2013. RESULTS Data were returned by 40 of 43 paediatric centres belonging to the Diabetes Study Group of the Italian Society of Paediatric Endocrinology and Diabetology. In total, 1574 of 11 311 (13.9%) children and adolescents with Type 1 diabetes were using an insulin pump: 29.2% Animas VIBE™ , 9.4% Medtronic MiniMed 715/515™ , 34.3% Medtronic MiniMed VEO™ , 24.3% Accu-Check Spirit Combo™ and 2.8% other models. In 2013, 0.165 insulin pump replacements per patient-year (11.8% due to pump failure/malfunction and 4.7% due to accidental damage) were recorded. Animas VIBE™ (22.1%) and Medtronic MiniMed VEO™ (17.7%) were the most replaced. CONCLUSIONS In a large cohort of Italian children and adolescents with Type 1 diabetes, insulin pump failure/malfunction and consequent replacement are aligned with rates previously reported and higher in more sophisticated pump models.
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Affiliation(s)
- I Rabbone
- Department of Paediatrics, University of Turin, Turin, Italy
| | - N Minuto
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - R Bonfanti
- Department of Paediatrics, Scientific Institute Hospital San Raffaele, Vita-Salute University, Milan, Italy
| | - M Marigliano
- Regional Center for Paediatric Diabetes, University of Verona, Verona, Italy
| | - F Cerutti
- Department of Paediatrics, University of Turin, Turin, Italy
| | - V Cherubini
- Regional Center for Diabetes in Children and Adolescents, AOU Salesi Hospital, Ancona, Italy
| | - G d'Annunzio
- Department of Paediatrics, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - A P Frongia
- Unit of Paediatric Diabetes, Brotzu Hospital, Cagliari, Italy
| | - D Iafusco
- Regional Center for Paediatric Diabetes Second University of Naples, Naples, Italy
| | - G Ignaccolo
- Department of Paediatrics, University of Turin, Turin, Italy
| | - F Lombardo
- Department of Paediatric Sciences, University of Messina, Messina, Italy
| | - R Schiaffini
- Endocrinology and Diabetes Unit, University Department of Paediatric Medicine, Bambino Gesù Children's Hospital, Rome, Italy
| | - S Toni
- Juvenile Diabetes Center, Anna Meyer Children's Hospital, Florence, Italy
| | - S Tumini
- Center of Paediatric Diabetology, University of Chieti, Chieti, Italy
| | - S Zucchini
- Department of Paediatrics, S. Orsola-Malpighi Hospital, Bologna, Italy
| | - A Pistorio
- Epidemiology and Biostatistics Unit, Istituto Giannina Gaslini, Genoa, Italy
| | - A E Scaramuzza
- Department of Paediatrics, Azienda Ospedaliera, University of Milan, Milan, Italy
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5
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Shulman R, Stukel TA, Miller FA, Newman A, Daneman D, Guttmann A. Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada. Pediatr Diabetes 2017; 18:33-44. [PMID: 26748950 DOI: 10.1111/pedi.12353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe insulin pump use by youth since introduction of universal funding in Ontario, Canada and to explore the relationship between pump use and pediatric diabetes center characteristics and the relationship between discontinuation and center and patient characteristics. RESEARCH DESIGN AND METHODS Observational, population-based cohort study of youth with type 1 diabetes (<19 yr) who received pump funding from 2006 to 2013 (n = 3700). We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. We tested the relationship between center-level pump uptake and center characteristics (center type, physician model, and availability of 24-h support) using an adjusted negative binomial model; we studied center- and patient-level factors (socioeconomic status and baseline glycemic control) associated with discontinuation using a Cox proportional hazards model with generalized estimating equations. RESULTS Pump users were more likely to be in the highest income quintile than non-pump users (29.6 vs. 19.1%, p < 0.0001). In 2012, mean percent pump use was 38.0% with variability across centers. There was no association between uptake and center characteristics. Discontinuation was low (0.42/100 person-yr) and was associated with being followed at a small community center [hazard ratio (HR): 2.24 (1.05-4.76)] and being more deprived [HR: 2.36 (1.14-1.48)]. Older age was associated with a lower rate of discontinuation [HR: 0.31 (0.14-0.66)]. CONCLUSIONS Rates of pump use have increased since 2006 and discontinuation is rare. Large variation in uptake across centers was not explained by the factors we examined but may reflect variation in patient populations or practice patterns, and should be further explored.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
| | - Alice Newman
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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6
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Szypowska A, Schwandt A, Svensson J, Shalitin S, Cardona-Hernandez R, Forsander G, Sundberg F, De Beaufort C, Maahs D, Maffeis C, O'Riordan SMP, Krisane ID, Scharf M, Castro S, Konstantinova M, Obermannova B, Casteels K, Gökşen D, Galhardo J, Kanaka-Gantenbein C, Rami-Merhar B, Madacsy L. Insulin pump therapy in children with type 1 diabetes: analysis of data from the SWEET registry. Pediatr Diabetes 2016; 17 Suppl 23:38-45. [PMID: 27417128 DOI: 10.1111/pedi.12416] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/06/2016] [Accepted: 06/09/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Intensified insulin delivery using multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) is recommended in children with type 1 diabetes (T1D) to achieve good metabolic control. OBJECTIVE To examine the frequency of pump usage in T1D children treated in SWEET (Better control in Paediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) centers and to compare metabolic control between patients treated with CSII vs MDI. METHODS This study included 16 570 T1D children participating in the SWEET prospective, multicenter, standardized diabetes patient registry. Datasets were aggregated over the most recent year of treatment for each patient. Data were collected until March 2016. To assess the organization of pump therapy a survey was carried out. RESULTS Overall, 44.4% of T1D children were treated with CSII. The proportion of patients with pump usage varied between centers and decreased with increasing age compared with children treated with MDI. In a logistic regression analysis adjusting for age, gender and diabetes duration, the use of pump was associated with both: center size [odd ratio 1.51 (1.47-1.55), P < .0001) and the diabetes-related expenditure per capita [odd ratio 1.55 (1.49-1.61), P < .0001]. Linear regression analysis, adjusted for age, gender, and diabetes duration showed that both HbA1c and daily insulin dose (U/kg/d) remained decreased in children treated with CSII compared to MDI (P < .0001). CONCLUSIONS Insulin pump therapy is offered by most Sweet centers. The differences between centers affect the frequency of use of modern technology. Despite the heterogeneity of centers, T1D children achieve relatively good metabolic control, especially those treated with insulin pumps and those of younger age.
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Affiliation(s)
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Jannet Svensson
- Pediatric Department, Copenhagen University Hospital, Herlev, Denmark
| | - Shlomit Shalitin
- The Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Gun Forsander
- Institute for Clinical Sciences, Sahlgrenska Achademy, University of Gothenburg, Gothenburg, Sweden.,The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Frida Sundberg
- The Queen Silvia Childrens Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carine De Beaufort
- DCCP-Clinique pédiatrique de Luxembourg, Luxembourg, Luxembourg.,Department of Pediatric Endocrinology, UZBrussels, Brussels, Belgium
| | - David Maahs
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver Aurora, Colorado, USA
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit & Regional Center for Pediatric Diabetes, University Hospital, University of Verona, Verona, Italy
| | - Stephen M P O'Riordan
- Paediatrics Diabetes & Endocrine Unit, Department of Paediatrics & Child Health, Cork University Hospital, University College Cork, Cork, Ireland
| | - Iveta Dzivite Krisane
- Children's University Hospital Children's Endocrinology Centre, Riga Stradins University, Riga, Latvia
| | - Mauro Scharf
- Pediatric Endocrinology, Hospital Nossa Senhora Das Graças, Brazil
| | - Sofia Castro
- Child and Young Department, APDP-Diabetes, Lisbon, Portugal
| | - Maia Konstantinova
- Medical University-Clinic of Endocrinology, Diabetes and Genetics, Sofia University Pediatric Hospital, Sofia, Bulgaria
| | - Barbora Obermannova
- Department of Pediatrics, University Hospital Motol and 2nd Faculty of Medicine, Charles University in Prague, Prague, Czech Republic
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Belgium
| | - Damla Gökşen
- Faculty of Medicine Pediatric Endocrinology and Diabetes, Ege University, İzmir, Turkey
| | - Júlia Galhardo
- Unit of Pediatric Endocrinology and Diabetes, Hospital Dona Estefânia, Lisbon, Portugal
| | - Christina Kanaka-Gantenbein
- Diabetes Center, Division of Endocrinology, Diabetes and Metabolism First Department of Pediatrics, Medical School National and Kapodistrian University of Athens-Greece "Aghia Sophia" Children's Hospital, Athens, Greece
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine of Medical University of Vienna, Vienna, Austria
| | - Laszlo Madacsy
- First Department of Pediatrics, Semmelweis University, Budapest, Hungary
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7
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Bonfanti R, Lepore G, Bozzetto L, Corsi A, Di Blasi V, Girelli A, Grassi G, Iafusco D, Rabbone I, Schiaffini R, Laviola L, Bruttomesso D. Survey on the use of insulin pumps in Italy: comparison between pediatric and adult age groups (IMITA study). Acta Diabetol 2016; 53:403-12. [PMID: 26429560 DOI: 10.1007/s00592-015-0810-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
Abstract
AIMS The aim of the study was to evaluate and compare continuous subcutaneous insulin infusion (CSII) use in pediatric and adult age groups. METHODS Data were collected with a questionnaire sent by e-mail to CSII-experienced Diabetes Centers. The questionnaire assessed: (1) number of CSII-treated patients; (2) patient demographic data and characteristics; (3) structure and organization of Diabetes Centers providing CSII therapy; (4) pump characteristics (conventional pump, sensor-augmented pump); and (5) CSII dropouts. RESULTS A total of 217 out of 1093 Italian centers participated: 51 pediatric (23.5 %) and 166 (76.5 %) adult centers (AP). Compared to a survey performed in 2005, there was a significant increase in the number of pediatric units when compared to adult units (112 vs 37 %, respectively, p < 0.05). Pediatric age is characterized by a greater concern for quality of life and injections, and a higher dropout rate (10.6 vs 8.9 %) mainly related to pump wearability and site reactions. A complete diabetes-care team is associated with a superior use of technology (fewer dropouts, increased CGM and advanced bolus use) which is, however, still used in a small percentage of patients. CONCLUSIONS In Italy, the number of CSII-treated pediatric patients (PP) is growing more significantly when compared to adults. Only 60 % of all patients are using advanced functions and 20 % are using CGMs continuously. This confirms the great interest in diabetes technology that is growing in pediatric diabetologists. However, much improvement is warranted in the organization and specialized training of pediatric, adult and transitional facilities.
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Affiliation(s)
- R Bonfanti
- Pediatric Department and Diabetes Research Institute (OSR-DRI), IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - G Lepore
- Unit of Endocrine Disease and Diabetology, A.O Papa Giovanni XXIII, Bergamo, Italy
| | - L Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - A Corsi
- Unit of Diabetology and Endocrinology, P.O. Metropolitano, ASL 3, Genoa, Italy
| | - V Di Blasi
- Department of Endocrinology and Diabetology, ASL Salerno, Salerno, Italy
| | - A Girelli
- Unit of Diabetology, A.O. Spedali Civili, Brescia, Italy
| | - G Grassi
- Division of Endocrinology, Diabetology and Metabolism, A.O Città della Salute e della Scienza, Turin, Italy
| | - D Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - I Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - R Schiaffini
- Unit of Endocrinology and Diabetes, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Aldo Moro, Bari, Italy
| | - D Bruttomesso
- Department of Medicine, DIMED, Metabolic Diseases, University of Padua, Padua, Italy
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8
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Picard S, Hanaire H, Baillot-Rudoni S, Gilbert-Bonnemaison E, Not D, Reznik Y, Guerci B. Evaluation of the Adherence to Continuous Glucose Monitoring in the Management of Type 1 Diabetes Patients on Sensor-Augmented Pump Therapy: The SENLOCOR Study. Diabetes Technol Ther 2016; 18:127-35. [PMID: 26950530 DOI: 10.1089/dia.2015.0240] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) and sensor-augmented pump (SAP) therapy improve glucose control provided good adherence. In France, not only diabetologists, nurses, and dieticians but also nurses employed by homecare providers (HCPNs) are together involved in the initiation and/or follow-up of continuous subcutaneous insulin injection (CSII) and SAP training. The SENLOCOR Study is an observational study designed to assess SAP adherence over 6 months (primary objective). Secondary objectives included the impact of SAP on metabolic control and patients' satisfaction. MATERIALS AND METHODS CGM initiation (M0) was performed within 3 months after CSII. CGM adherence, defined by sensor wear >70% of the time, glycated hemoglobin (HbA1c) levels, and satisfaction questionnaires were collected at inclusion and at 3 (M3) and 6 (M6) months. RESULTS The analysis population was 234 patients, including 27 children. Of the physicians, 88.0% were involved in SAP education for the whole cohort (median time, 45 min), whereas HCPNs were involved in CGM training for 190 patients (81.2%) (median time: at M0, 156 min; at M3, 20 min). Good adherence was obtained in 86.1% (M0-M3) and 68.9% (M3-M6) of the patients. The HbA1c level decreased from 8.16 ± 1.35% (M0) to 7.67 ± 1.01% (M6) in 189 patients (change, -0.48%; 95% confidence interval, -0.64, -0.33). The percentage of patients who experienced severe hypoglycemia decreased from 20.7% (M0) to 13.6% (M3) and 13.3% (M6). Satisfaction scores were high. CONCLUSIONS In patients with type 1 diabetes, a 6-month training on SAP involving a multidisciplinary team, and especially HCPNs, improved metabolic control with a high level of adherence and satisfaction.
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Affiliation(s)
- Sylvie Picard
- 1 Point Médical , Rond-Point de la Nation, Dijon, France
| | - Hélène Hanaire
- 2 Endocrinology-Diabetes Care Unit, Toulouse University Hospital , Toulouse, France
| | | | | | - Didier Not
- 5 Center of Clinical Research , Lyon, France
| | - Yves Reznik
- 6 Endocrinology-Diabetes Care Unit, Caen University Hospital , Caen, France
| | - Bruno Guerci
- 7 Endocrinology-Diabetes Care Unit, University of Lorraine , Vandoeuvre Lès Nancy, France
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9
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Pozzilli P, Battelino T, Danne T, Hovorka R, Jarosz‐Chobot P, Renard E. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics. Diabetes Metab Res Rev 2016; 32:21-39. [PMID: 25865292 PMCID: PMC5033023 DOI: 10.1002/dmrr.2653] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 01/01/2023]
Abstract
The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients' health-related quality of life; reviews relevant pharmacoeconomic data; and discusses recent advances in pump technology, including the development of closed-loop 'artificial pancreas' systems. © 2015 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Paolo Pozzilli
- Area of Endocrinology and DiabetesUniversity Campus Bio‐MedicoRomeItaly
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Children's Hospital LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Thomas Danne
- Diabetes Centre for Children and AdolescentsAUF DER BULT, Kinder‐ und JugendkrankenhausHannoverGermany
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Przemyslawa Jarosz‐Chobot
- Department of Pediatrics, Endocrinology and Diabetes School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition and CIC INSERM 1411Montpellier University HospitalMontpellierFrance
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Shulman R, Miller FA, Daneman D, Guttmann A. Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes. Health Policy 2015; 120:64-71. [PMID: 26563632 DOI: 10.1016/j.healthpol.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada.
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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11
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Muratalina A, Smith-Palmer J, Nurbekova A, Abduakhassova G, Zhubandykova L, Roze S, Karamalis M, Shamshatova G, Demessinov A, D'Agostino ND, Lynch P, Yedigarova L, Klots M, Valentine W, Welsh J, Kaufman F. Project Baiterek: A Patient Access Program to Improve Clinical Outcomes and Quality of Life in Children with Type 1 Diabetes in Kazakhstan. Value Health Reg Issues 2015; 7:74-79. [PMID: 29698155 DOI: 10.1016/j.vhri.2015.09.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 09/01/2015] [Accepted: 09/04/2015] [Indexed: 10/22/2022]
Abstract
Diabetes is a key driver in the rise of noncommunicable diseases globally. It causes expensive and burdensome short- and long-term complications, with both an economic and social impact. In many countries, however, access to care and disease management in type 1 diabetes is suboptimal, increasing the risk for complications. In 2011, Project Baiterek was initiated as a collaborative effort between the Kazakhstan Ministry of Health, industry (Medtronic Plc), local physicians, and the Diabetes Association of the Republic of Kazakhstan to enhance patient access to continuous subcutaneous insulin infusion (CSII) therapy. It was the first countrywide project to provide equity and universal access to insulin pump therapy among children with type 1 diabetes, increasing pump use from zero to two-thirds of this population in less than 3 years. The project also involved instigating longitudinal data collection, and long-term clinical outcomes continue to be monitored. Here, we provide an overview of the clinical, quality-of-life, and economic outcomes to date associated with providing CSII therapy to children with type 1 diabetes in Kazakhstan. Initial clinical data show that CSII therapy improved clinical outcomes and quality of life for patients entered into the program and that CSII therapy was cost-effective relative to multiple daily injection therapy. The positive outcomes of Project Baiterek provide a template for similar patient access programs in other settings, and its framework could be adapted to initiatives to change health care infrastructures and standards of care for other noncommunicable diseases.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Motty Klots
- Medtronic International Trading Sarl, Tolochenaz, Switzerland
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12
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Marks A, Wilson V, Crisp J. The management of type 1 diabetes in Australian primary schools. ACTA ACUST UNITED AC 2014; 37:168-82. [PMID: 25007139 DOI: 10.3109/01460862.2014.932860] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
AIM The aim of this study was to explore the management of type 1 diabetes in Australian primary schools: kindergarten-Year 2, from the parent's perspective. The study questions were: What diabetes treatment is being delivered? Who is providing the treatment? Where is the treatment given? METHODS A cross sectional, descriptive approach was used to collect data from parents (66) of children with type 1 diabetes attending an Australian primary school (kindergarten-Year 2). An online self-administered questionnaire was designed in Survey Monkey and was available via a dedicated Facebook page. Data were analysed using statistical analysis (SPSSv21). RESULTS Blood glucose testing was occurring for all children, with 49% of children self testing. 77% of children were receiving an insulin bolus or injection at school. 34% was provided by the child and 53% of insulin was given via pump. Teachers, parents and teacher's aides also provided insulin at school. There was a statistically significant association between the number of children receiving insulin at school and the insulin delivery device, χ(2 )= 16.75, df = 1, p ≤ 0.000). Children using insulin pump therapy were more likely (97%) to receive insulin at school than children who used injections (55%). Children who were able to self-administer insulin were more likely to receive insulin (93%) at school than children who were unable to self-administer insulin (65%) (χ(2 )= 7.38, df = 1, p = 0.007) 81% of children received diabetes treatment in the classroom, with the remainder in the school administration office. CONCLUSION Insulin administration across Australian primary schools was inconsistent. Not all children were receiving the recommended insulin treatment. Insulin pump therapy appears to increase access to this treatment at school.
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Affiliation(s)
- Anne Marks
- Faculty of Health, University of Technology Sydney , Australia
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13
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Cherubini V, Gesuita R, Bonfanti R, Franzese A, Frongia AP, Iafusco D, Iannilli A, Lombardo F, Rabbone I, Sabbion A, Salvatoni A, Scaramuzza A, Schiaffini R, Sulli N, Toni S, Tumini S, Mosca A, Carle F. Health-related quality of life and treatment preferences in adolescents with type 1 diabetes. The VIPKIDS study. Acta Diabetol 2014; 51:43-51. [PMID: 23508374 DOI: 10.1007/s00592-013-0466-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2012] [Accepted: 03/04/2013] [Indexed: 10/27/2022]
Abstract
A multi-centre, observational, cross-sectional study was carried out to determine whether the health-related quality of life (HRQOL) of adolescents with type 1 diabetes is affected by different insulin treatment systems, and which features of HRQOL are impacted by the respective insulin treatment. The study regarded 577 adolescents, aged 10-17 years, with type 1 diabetes treated with continuous subcutaneous insulin infusion (CSII) (n = 306) or multiple daily injections (MDI) (n = 271). The Insulin Delivery System Rating Questionnaire was validated in Italian and was self-completed by the subjects during a routine visit to the centres. Subjects were compared following the domains of the questionnaire. Good HRQOL was seen in subjects treated with either MDI or CSII. Significant differences were not found in the domains for general diabetes, including diabetes worries, social burden and psychological well-being. Multiple quantile regression analysis showed that CSII confers significant advantages in terms of HRQOL with improvements in treatment satisfaction, perceived clinical efficacy and reduction in treatment interference with daily activities. This favourable impact was more evident in subjects reporting lower HRQOL scores, suggesting that CSII may be especially useful for individuals perceiving a poor HRQOL. Analysis of the domains indicated that CSII was associated with a higher HRQOL than MDI. Life-course HRQOL evaluation using a standardised questionnaire can ensure better chronic disease management. This is particularly important when providing individualised care for adolescents, as they become increasingly responsible for managing their diabetes.
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Affiliation(s)
- V Cherubini
- Division of Pediatric Diabetes, Maternal-Infant Department, AOU OO RR Ancona, "G. Salesi" Hospital, Via Corridoni, 11, 60123, Ancona, Italy,
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Taylor MJ, Gregory R, Mitchell H, Alblihed M, Alsabih A, Tomlins P, Sahota TS. Insulin pump users would not rule out using an implantable artificial pancreas. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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15
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Tubiana-Rufi N. Les technologies au service de l’enfant atteint de diabète de type 1. Arch Pediatr 2013; 20 Suppl 4:S127-30. [DOI: 10.1016/s0929-693x(13)71426-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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16
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Rendell S, Kosoko-Lasaki O, Penny G, Cook CT, Sharma A, Austin WP, Rendell M. Improved quality of life in unselected insulin pump-treated children with type 1 diabetes in Eastern Nebraska. J Diabetes Sci Technol 2013; 7:579-81. [PMID: 23567015 PMCID: PMC3737659 DOI: 10.1177/193229681300700235] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | | | - Greg Penny
- Children’s Hospital Medical Center, Omaha, Nebraska
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Penfornis A, Personeni E, Tiv M, Monnier C, Meillet L, Combes J, Mouret C, Picard S. Quality of care of patients with type 1 diabetes: population-based results in a French region. DIABETES & METABOLISM 2012; 38:436-43. [PMID: 22749623 DOI: 10.1016/j.diabet.2012.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2011] [Revised: 04/22/2012] [Accepted: 04/23/2012] [Indexed: 10/28/2022]
Abstract
AIM Although the incidence of type 1 diabetes (T1D) has been increasing, little is known of its quality of care. Thus, our survey was designed to retrospectively evaluate this issue in French patients. METHODS Patients with T1D living in northeastern France were identified thanks to the healthcare system (CPAM) database, and the resulting list reviewed by local diabetes specialists. All of the listed patients and their primary physicians were asked to fill in a questionnaire including clinical data, laboratory results and follow-up habits. The 'optimized results' included CPAM-based results plus any specialized care provided during hospitalizations in diabetes and non-diabetes units, according to questionnaire data. RESULTS A total of 227 individuals, for whom CPAM data were available, were identified as having T1D. From these patients, 174 questionnaires were answered, and optimized results (having both CPAM data and a completely filled-in questionnaire) were available for 149 patients. Of the 169 patients who responded, 71.3% reported at least a yearly visit with a diabetologist. This number reached 77.9% when optimized results were considered. Patients who received specialized care were younger, underwent HbA(1c) tests more often and were more frequently on optimal treatment; however, there was no difference in HbA(1c) values or in the prevalence of complications. Eye examinations and kidney tests had been performed at least once over the 2-year period in more than 87% of the patients, whereas around 30%, 21% and 23% had an eye exam, creatinine test and urinary albumin excretion measurement, respectively, only once over the same time period. CONCLUSION This is the first large-scale study of the quality of care in patients with T1DM in France, and it could serve as a preliminary survey for a national study. Although the follow-up was better than previously reported, there is still considerable room for improvement.
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Affiliation(s)
- A Penfornis
- Department of Endocrinology-Metabolism and Diabetology-Nutrition, Jean-Minjoz Hospital, EA 3920, University of Franche-Comté, 25030 Besançon cedex, France.
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Hasselmann C, Bonnemaison E, Faure N, Mercat I, Bouillo Pépin-Donat M, Magontier N, Chantepie A, Labarthe F. Bénéfices de l’insulinothérapie par pompe chez les enfants diabétiques de type 1. Arch Pediatr 2012; 19:593-8. [DOI: 10.1016/j.arcped.2012.03.051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2011] [Revised: 02/05/2012] [Accepted: 03/14/2012] [Indexed: 12/27/2022]
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Shulman R, Palmert MR, Daneman D. Insulin pump therapy in youths with Type 1 diabetes: uptake and outcomes in the ‘real world’. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/dmt.12.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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