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Defeudis G, Massari MC, Terrana G, Coppola L, Napoli N, Migliaccio S. Gluten-Free Diet and Metabolic Syndrome: Could Be a Not Benevolent Encounter? Nutrients 2023; 15:nu15030627. [PMID: 36771334 PMCID: PMC9921299 DOI: 10.3390/nu15030627] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/19/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023] Open
Abstract
Celiac disease is a rising disorder and is becoming frequently diagnosed in recent years. To date, the only available treatment is the gluten-free diet (GFD). The role of gluten on components of metabolic syndrome and on related inflammatory response is still unclear due to controversial results. In recent years, scientific focus on this topic has been growing up, in particular regarding the role of the GFD on glycometabolic parameters and diabetes. In addition, studies on the remaining components showed discordant results, which was likely due to heterogeneous and large celiac disease populations and to the lack of prospective studies. Furthermore, knowledge about the role of the GFD on inflammatory cytokines and the relationship among vitamin D and celiac disease, metabolic syndrome (MS) and GFD is needed. In this narrative review, we provided evidence regarding the role of the GFD on glycometabolic parameters, cholesterol, triglycerides, waist circumference, blood pressure and inflammatory cascade, also evaluating the role of vitamin D, trying to summarize whether this nutritional pattern may be a value-added for subjects with dysmetabolic conditions. Finally, due to the limited findings and very low-certainty evidence, predominantly based on observational studies, the real effects of a GFD on different components of MS, however, are unclear; nevertheless, an improvement in HDL levels has been reported, although data on glycemic levels are discordant.
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Affiliation(s)
- Giuseppe Defeudis
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, 00135 Rome, Italy
- Correspondence: or (G.D.); (S.M.)
| | - Maria Chiara Massari
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Giovanni Terrana
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Lucia Coppola
- Department of Experimental Medicine, Sapienza University of Rome, 00185 Rome, Italy
| | - Nicola Napoli
- Unit of Endocrinology and Diabetes, Department of Medicine, University Campus Bio-Medico of Rome, 00128 Rome, Italy
| | - Silvia Migliaccio
- Department of Movement, Human and Health Sciences, University Foro Italico of Rome, 00135 Rome, Italy
- Correspondence: or (G.D.); (S.M.)
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Does a Gluten-Free Diet Affect BMI and Glycosylated Hemoglobin in Children and Adolescents with Type 1 Diabetes and Asymptomatic Celiac Disease? A Meta-Analysis and Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9081247. [PMID: 36010137 PMCID: PMC9406674 DOI: 10.3390/children9081247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 07/30/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022]
Abstract
Background: Children diagnosed with type 1 diabetes mellitus (T1DM) are more prone to having celiac disease (CD) than the normal population. Moreover, patients with this dual diagnosis who are also on a diabetic and gluten-free diet (GFD) risk faltering growth and uncontrolled blood glucose levels. This review aims to assess the efficacy and effectiveness of managing patients with T1DM screened for CD with GFD to prevent complications associated with these chronic pathologies in childhood and adulthood. Materials and Methods: We abided by the PRISMA guidelines in this meta-analysis and used multiple databases and search engines. We included case−control studies. The primary outcomes were changes in the standard deviation score, body mass index (SDS BMI), and glycosylated hemoglobin (HA1C) after being on a GFD for at least twelve months. Results: The pooled data from the six studies included showed that there was neither a statistically significant difference in the mean SDS BMI (−0.28 (95% CI −0.75, 0.42)) (p = 0.24) nor in the mean of HA1C (mean −0.07 (95% CI −0.44, 0.30)) (p = 0.36) for the same group. HDL cholesterol improved significantly in patients on a strict GFD (p < 0.01). Conclusions: In children with T1DM and asymptomatic CD, being on a GFD had no significant effect on BMI or HA1C. However, it can have a protective effect on the other complications found in both chronic pathologies.
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Abdullah W, Akram N, Ibrahim B. Factors contribute to elevated blood pressure values in children with type 1 diabetes mellitus: A review. MEDICAL JOURNAL OF BABYLON 2022. [DOI: 10.4103/mjbl.mjbl_58_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Zhao X, Huang H, Zheng S. Effectiveness of Internet and Phone-Based Interventions on Diabetes Management of Children and Adolescents With Type 1 Diabetes: A Systematic Review. Worldviews Evid Based Nurs 2021; 18:217-225. [PMID: 34018327 DOI: 10.1111/wvn.12511] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2020] [Indexed: 12/14/2022]
Abstract
AIMS To synthesize evidence about the impact of Internet and phone-based diabetes education and management on metabolic control, self-management behavior changes, and psychological effects among children and adolescents with type 1 diabetes mellitus (T1DM). BACKGROUND Internet and mobile technologies were commonly used to improve diabetes management among children and adolescents with type 1 diabetes mellitus. The effectiveness of new technology-based diabetes education and management has previously not been synthesized. METHODS PubMed, EBSCO, Cochrane Library, Web of Science, Joanna Briggs Institute Library, and the Chinese databases CNKI and Wanfang were searched from 1989 to March 2020. Two reviewers independently selected randomized controlled trials (RCTs), in English and Chinese, which compared an intervention group of new technology-based diabetes education and management with a control group of usual care. The primary outcomes were metabolic control, such as glycated hemoglobin (HbA1c), and secondary outcomes consisted of behavior changes and psychological effects, such as self-efficacy and quality of life. RESULTS A total of 23 RCTs with 1,824 participants met the inclusion criteria. The meta-analysis showed that phone calls could significantly reduce HbA1c (MD = -.17; 95% CI [-.33, -.01]; I2 = 0%) in children and adolescents with T1DM. New technology-based diabetes education and management could significantly improve self-efficacy (SMD = 0.37; 95% CI [.07, .67]; I2 = 0%). No benefits on behavior changes and quality of life were identified. LINKING EVIDENCE TO ACTION New technology-based diabetes education has potential benefits for children and adolescents with T1DM, such as improving metabolic control through phone calls and increasing their self-efficacy of diabetes management. Well-designed RCTs with larger sample sizes and longer intervention duration should be conducted, especially in developing countries.
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Affiliation(s)
- Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Houqiang Huang
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Silin Zheng
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
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Saxby N, Beggs S, Kariyawasam N, Battersby M, Lawn S. Do guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review. Chronic Illn 2020; 16:239-252. [PMID: 30244592 DOI: 10.1177/1742395318799844] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis. METHODS Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE 'Guideline Quality Checklist', and mapping of the supporting evidence. RESULTS Fifteen guidelines were identified: asthma (n=7) and type 1 diabetes mellitus (n=7), CF (n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration (n=15), chronic condition self-management education (n= 17), clinicians' skills (n= 4); personalized action plans (n=3), problem-solving (n=2); and the assessment of children's chronic condition self-management needs (n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool (n=2), and adolescence (n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines' recommendations was poor; only 14 out of 57 journals listed as evidence were concordant. DISCUSSION Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.
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Affiliation(s)
- Nicole Saxby
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia.,Tasmanian Cystic Fibrosis Service, Tasmanian Health Service, Hobart, Tasmania
| | - Sean Beggs
- Tasmanian Cystic Fibrosis Service, Tasmanian Health Service, Hobart, Tasmania
| | - Nadish Kariyawasam
- eHealth Services Research Group, University of Tasmania, Hobart, Tasmania
| | - Malcolm Battersby
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
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Butalia S, McGuire KA, Dyjur D, Mercer J, Pacaud D. Youth with diabetes and their parents' perspectives on transition care from pediatric to adult diabetes care services: A qualitative study. Health Sci Rep 2020; 3:e181. [PMID: 32782975 PMCID: PMC7410016 DOI: 10.1002/hsr2.181] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/28/2020] [Accepted: 07/09/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND AIMS When youth with diabetes transition from pediatric to adult diabetes care, they are at high risk for loss to follow up and worsening glucose control. We aimed to gain insight on how to improve the transition of youth with type 1 diabetes from pediatric to adult diabetes care from the patients' and parents' perspective. METHODS We conducted focus groups in youth with type 1 diabetes in transition from pediatric to adult diabetes care and their parents, in Calgary, Alberta, between June and August 2014. Eligibility criteria included: (a) type 1 diabetes; (b) aged 15 to 25 years; (c) have or had received care at the pediatric hospital; and, (d) either pre or post-transfer; or, (e) parents of recently transferred youth. Purposive sampling was used, and the theoretical framework used was the Integrated Behaviour Model. Participants were asked about positive, negative, or challenging experiences related to diabetes and transition, solutions to challenges, and tools and strategies to improve and better support transition. Thematic analysis was conducted after focus groups were recorded and transcribed. RESULTS Three focus groups were conducted: pre-transfer youth with diabetes (4 females and 3 males; median age 17.5 years, IQR 1.3 years); post-transfer young adults with diabetes (2 females and 2 males; median age 23.5 years, IQR 1.2 years); and parents of recently transferred young adults with diabetes (n = 3). Main themes were: (a) communication technology; (b) the need for more transition and diabetes education and preparation during transition; and, (c) the importance and need for social and peer support. CONCLUSION This study describes specific areas that may improve diabetes transfer and transition from pediatric to adult diabetes care. This information can help inform clinical care delivery for transition and the development of programs, strategies, and interventions to improve transition care.
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Affiliation(s)
- Sonia Butalia
- Division of Endocrinology and Metabolism, Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- O'Brien Institute for Public Health, Cumming School of Medicine, CalgaryUniversity of CalgaryCalgaryAlbertaCanada
- Libin Cardiovascular Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - K. Ashlee McGuire
- Provincial Primary Health CareAlberta Health ServicesCalgaryAlbertaCanada
- Department of Family Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - David Dyjur
- Diabetes Centre CalgaryAlberta Health ServicesCalgaryAlbertaCanada
| | - Julia Mercer
- Alberta Children's Hospital, Diabetes ClinicAlberta Health ServicesCalgaryAlbertaCanada
| | - Daniele Pacaud
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Alberta Children's Hospital Research Institute, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
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Risk factors for reamputations in patients amputated after revascularization for critical limb-threatening ischemia. J Vasc Surg 2020; 73:258-266.e1. [PMID: 32360684 DOI: 10.1016/j.jvs.2020.03.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 03/18/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Despite vascular intervention, patients with critical limb-threatening ischemia (CLTI) have a high risk of amputation. Furthermore, this group has a high risk for stump complications and reamputation. The primary aim of this study was to identify risk factors predicting reamputation after a major lower limb amputation in patients revascularized because of CLTI. The secondary aim was to investigate mortality after major lower limb amputation. METHODS There were 288 patients who underwent a major ipsilateral amputation after revascularization because of CLTI in Stockholm, Sweden, during 2007 to 2013. The main outcome was ipsilateral reamputation. RESULTS Of 288 patients, 50 patients had a reamputation and 222 died during the 11-year follow-up. Patients with ischemic pain as an indication for primary amputation had nearly four times higher risk for a reamputation compared with those with a nonhealing ulcer (subdistribution hazard ratio, 3.55; confidence interval, 1.55-8.17). Higher age was associated with an increased risk for death in the multivariable analysis (hazard ratio, 1.03; confidence interval, 1.02-1.04). CONCLUSIONS Patients with ischemic pain as an indication for amputation have an elevated risk of reamputation. Ischemic pain may be indicative of a more extensive and proximal ischemia compared with patients with foot tissue loss. An extended evaluation of the preoperative circulation before amputation may facilitate the choice of amputation level and could lead to a reduction of reamputations.
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Lawson ML, Shephard AL, Feenstra B, Boland L, Sourial N, Stacey D. Decision coaching using a patient decision aid for youth and parents considering insulin delivery methods for type 1 diabetes: a pre/post study. BMC Pediatr 2020; 20:1. [PMID: 31900152 PMCID: PMC6941252 DOI: 10.1186/s12887-019-1898-4] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 12/22/2019] [Indexed: 11/20/2022] Open
Abstract
Background Choice of insulin delivery for type 1 diabetes can be difficult for many parents and children. We evaluated decision coaching using a patient decision aid for helping youth with type 1 diabetes and parents decide about insulin delivery method. Methods A pre/post design. Youth and parent(s) attending a pediatric diabetes clinic in a tertiary care centre were referred to the intervention by their pediatric endocrinologist or diabetes physician between September 2013 and May 2015. A decision coach guided youth and their parents in completing a patient decision aid that was pre-populated with evidence on insulin delivery options. Primary outcomes were youth and parent scores on the low literary version of the validated Decisional Conflict Scale (DCS). Results Forty-five youth (mean age = 12.5 ± 2.9 years) and 66 parents (45.8 ± 5.6 years) participated. From pre- to post-intervention, youth and parent decisional conflict decreased significantly (youth mean DCS score was 32.0 vs 6.6, p < 0.0001; parent 37.6 vs 3.5, p < 0.0001). Youth’s and parents’ mean decisional conflict scores were also significantly improved for DCS subscales (informed, values clarity, support, and certainty). 92% of youth and 94% of parents were satisfied with the decision coaching and patient decision aid. Coaching sessions averaged 55 min. Parents (90%) reported that the session was the right length of time; some youth (16%) reported that it was too long. Conclusion Decision coaching with a patient decision aid reduced decisional conflict for youth and parents facing a decision about insulin delivery method.
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Affiliation(s)
- Margaret L Lawson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario, K1H 8L1, Canada.
| | - Allyson L Shephard
- Children's Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Bryan Feenstra
- University of Ottawa, School of Nursing, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
| | - Laura Boland
- University of Ottawa, Population Health, 25 University Private, Ottawa, ON, K1N 7K4, Canada
| | - Nadia Sourial
- Children's Hospital of Eastern Ontario (CHEO), 401 Smyth Road, Ottawa, ON, K1H 8L1, Canada
| | - Dawn Stacey
- University of Ottawa, School of Nursing, 451 Smyth Rd, Ottawa, ON, K1H 8M5, Canada
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Shulman R, Slater M, Khan S, Jones C, Walker JD, Jacklin K, Green ME, Frymire E, Shah BR. Prevalence, incidence and outcomes of diabetes in Ontario First Nations children: a longitudinal population-based cohort study. CMAJ Open 2020; 8:E48-E55. [PMID: 31992559 PMCID: PMC6996034 DOI: 10.9778/cmajo.20190226] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND First Nations people are known to have a higher risk of childhood-onset type 2 diabetes, yet population-level data about diabetes in First Nations children are unavailable. In a partnership between Chiefs of Ontario and academic researchers, we describe the epidemiologic features and outcomes of diabetes in First Nations children in Ontario. METHODS We created annual cohorts from 1995/96 to 2014/15 using data from the Registered Persons Database linked with the federal Indian Register. We used the Ontario Diabetes Database to identify children with all types of diabetes and calculated the prevalence and incidence for First Nations children and other children in Ontario. We describe glycemic control in First Nations children and other children in 2014. RESULTS In 2014/15, there were 254 First Nations children and 10 144 other children with diagnosed diabetes in Ontario. From 1995/96 to 2014/15, the prevalence increased from 0.17 to 0.57 per 100 children, and the annual incidence increased from 37 to 94 per 100 000 per year among First Nations children. In 2014/15, the prevalence of diabetes was 0.62/100 among First Nations girls and 0.36/100 among other girls. The mean glycosylated hemoglobin level among First Nations children was 9.1% (standard deviation 2.7%) and for other children, 8.5% (standard deviation 2.1%). INTERPRETATION First Nations children have substantially higher rates of diabetes than non-Aboriginal children in Ontario; this is likely driven by an increased incidence of type 2 diabetes and increased risk for diabetes among First Nations girls. There is an urgent need for strategies to address modifiable factors associated with the risk of diabetes, improve access to culturally sensitive diabetes care and improve outcomes for First Nations children.
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Affiliation(s)
- Rayzel Shulman
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont.
| | - Morgan Slater
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Shahriar Khan
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Carmen Jones
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Jennifer D Walker
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Kristen Jacklin
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Michael E Green
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Eliot Frymire
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
| | - Baiju R Shah
- The Hospital for Sick Children (Shulman); ICES (Shulman, Slater, Khan, Walker, Green, Frymire, Shah); Departments of Pediatrics (Shulman, Green) and Medicine (Shah), University of Toronto, Toronto, Ont.; Department of Family Medicine (Slater), Queen's University, Kingston, Ont.; Chiefs of Ontario (Jones), Toronto, Ont.; School of Rural and Northern Health (Walker), Laurentian University, Sudbury, Ont.; Memory Keepers Medical Discover Team (Jacklin), Department of Family Medicine and Biobehavioral Health, University of Minnesota Medical School, Duluth, Minn.; Health Services and Policy Research Institute (Khan, Green, Frymire), Queen's University, Kingston, Ont.; Division of Endocrinology (Shah), Sunnybrook Health Sciences Centre, Toronto, Ont
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Francia P, Sorelli M, Piccini B, Iannone G, Capirchio L, Toni S, Gulisano M, Bocchi L. Glycemic Control Maintained over Time and Joint Stiffness in Young Type 1 Patients: What Is the Mathematical Relationship? J Diabetes Sci Technol 2019; 13:728-733. [PMID: 30255709 PMCID: PMC6610591 DOI: 10.1177/1932296818802840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND It is widely known that diabetes can induce stiffness and adversely affect joint mobility even in young patients with type 1 diabetes mellitus (T1D). The aim of this study was to identify a mathematical model of diabetes mellitus long-term effects on young T1D patients. METHODS Ankle joint mobility (AJM) was evaluated using an inclinometer in 48 patients and 146 healthy, sex- BMI-, and age-matched controls. Assuming time invariance and linear superposition of the effects of hyperglycemia, the influence of T1D on AJM was formalized as an impulse response putting into relationship past supernormal HbA1c concentrations with the ankle total range of motion. The proposed model was identified by means of a nonlinear evolutionary optimization algorithm. RESULTS AJM was significantly reduced in young T1D patients (P < .001). AJM in both plantar and dorsiflexion was significantly lower in subjects with diabetes than in controls (P < .001). The identified impulse response indicates that impaired metabolic control requires 3 months to bring out its maximum effect on the reduction of AJM, while the following long-lasting decay phase with the expected AJM recovery times, normally depends on the slow turnover of collagen. HbA1c concentration levels above 7.2% are sufficient to produce a reduction of ankle ROM. CONCLUSIONS In young patients with T1D the lack of glycemic control over time affects AJM. HbA1c levels can serve as a relevant prognostic factor for assessing the progression of LJM in subjects with diabetes.
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Affiliation(s)
- Piergiorgio Francia
- Department of Clinical and Experimental
Medicine, University of Florence, Florence, Italy
- Piergiorgio Francia, BSc, Department of
Clinical and Experimental Medicine, University of Florence, 50121 Florence,
Italy.
| | - Michele Sorelli
- Department of Information Engineering,
University of Florence, Florence, Italy
| | | | - Giulia Iannone
- ANIMO, National Association of Movement
Sciences, Florence, Italy
| | | | - Sonia Toni
- Diabetes Unit, Meyer Children’s
Hospital, Florence, Italy
| | - Massimo Gulisano
- Department of Clinical and Experimental
Medicine, University of Florence, Florence, Italy
| | - Leonardo Bocchi
- Department of Information Engineering,
University of Florence, Florence, Italy
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Paruk IM, Naidoo VG, Pirie FJ, Maharaj S, Nkwanyana NM, Dinnematin HL, Ganie Y, Ramdial PK, Motala AA. Prevalence and characteristics of celiac disease in South African patients with type 1 diabetes mellitus: Results from the Durban Diabetes and Celiac Disease Study. J Gastroenterol Hepatol 2019; 34:673-678. [PMID: 30600564 DOI: 10.1111/jgh.14596] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/20/2018] [Accepted: 12/25/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND AIM The aim of this study was to assess the prevalence and characteristics of celiac disease (CD) in all patients with type 1 diabetes mellitus attending a tertiary adult diabetes clinic in Durban, South Africa. METHODS This was a cross-sectional observational study that screened 202 patients; of these, 56.4% were African (Black), 31.7% Asian Indian, 4.5% White, and 7.4% mixed race. Demographic data, symptoms, and anthropometry were documented. Blood tests included anti-tissue transglutaminase antibody (tTG), anti-endomysial antibody (EMA), and anti-gliadin antibody (AGA). Endoscopy and duodenal biopsy were performed in patients with celiac antibodies. Diagnosis of CD was based on the modified Marsh classification. RESULTS Mean age and mean duration of diabetes were 26.4 ± 11.4 and 10.7 ± 9.1 years, respectively. Celiac antibodies were found in 65 (32.2%) patients: EMA 7.4%, tTG immunoglobulin A (IgA) 8.4%, tTG immunoglobulin G 1.9%, AGA IgA 18.3%, and AGA immunoglobulin G 21.8%. Histological evidence of CD was found in 5.9% (n = 12/202): 2.5% were classed as definite CD (Marsh 3) and 3.4% as potential CD (Marsh 1). None of the patients with CD were symptomatic. The sensitivity of AGA IgA, EMA, and tTG IgA antibodies for detecting histologically proven CD was 66.7%, 50.0%, and 41.7%, respectively. CONCLUSION The prevalence of CD was similar to reports from western countries. No ethnic specific differences were noted. CD was silent in all patients in this study. The sensitivity of EMA and tTG antibodies was poor and merits further evaluation as screening tools for CD in South African patients with type 1 diabetes mellitus.
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Affiliation(s)
- Imran M Paruk
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Vasudevan G Naidoo
- Department of Gastroenterology and Hepatology, University of KwaZulu-Natal, Durban, South Africa
| | - Fraser J Pirie
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | - Sureka Maharaj
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
| | | | - Hilary L Dinnematin
- Department of Haematology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Yasmeen Ganie
- Department of Paediatrics, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Pratistadevi K Ramdial
- Department of Anatomical Pathology, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
| | - Ayesha A Motala
- Department of Diabetes and Endocrinology, University of KwaZulu-Natal, Durban, South Africa
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12
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Flood K, Nour M, Holt T, Cattell V, Krochak C, Inman M. Implementation and Evaluation of a Diabetic Ketoacidosis Order Set in Pediatric Type 1 Diabetes at a Tertiary Care Hospital: A Quality-Improvement Initiative. Can J Diabetes 2019; 43:297-303. [PMID: 30777707 DOI: 10.1016/j.jcjd.2018.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 12/11/2018] [Accepted: 12/19/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Despite published clinical practice guidelines in pediatrics for the use of a standardized diabetic ketoacidosis (DKA) protocol, our centre lacked an accepted, evidence-informed protocol for pediatric DKA management. Our primary aim was to attain broad clinical uptake of a DKA order set. Secondary aims included improved standard-of-care DKA management principles regarding fluid, potassium and dextrose administration. METHODS A pediatric multidisciplinary collaborative was created to examine evidence for the development and implementation of a DKA order set. A modified plan-do-study-act cycle guided by end-user feedback and early clinical outcomes allowed progressive order-set modifications and hospitalwide implementation. RESULTS We achieved 83% uptake of the order set for patients presenting to our tertiary centre and 67% uptake for patients transferred from peripheral centres. Following the implementation of the DKA order set, we observed improvements in DKA management, which included more appropriate intravenous (IV) replacement fluid rates (30% vs. 55.1%; p=0.03); earlier administration of potassium to IV fluids (66% vs. 93.1%; p=0.006); more appropriate potassium chloride dosing to IV fluid (40% vs. 79.3%; p=0.0007) and earlier addition of IV dextrose (67.4% vs. 93.1%; p=0.009). CONCLUSIONS Implementation of a DKA order set in a tertiary hospital required identification of key stakeholders, formation of a multidisciplinary team and the development of an evaluation process. There was an observed increase in physician order-set uptake and DKA management practice improvements. Future goals involve expanding the implementation and evaluation process to provincial regional and remote centres and analyzing the impact on resource utilization.
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Affiliation(s)
- Kayla Flood
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Munier Nour
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Tanya Holt
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Vicki Cattell
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Carla Krochak
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Mark Inman
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada; Royal University Hospital, Saskatoon, Saskatchewan, Canada.
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13
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Kosowan L, Wicklow B, Queenan J, Yeung R, Amed S, Singer A. Enhancing Health Surveillance: Validation of a Novel Electronic Medical Records-Based Definition of Cases of Pediatric Type 1 and Type 2 Diabetes Mellitus. Can J Diabetes 2019; 43:392-398. [PMID: 30956098 DOI: 10.1016/j.jcjd.2019.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 12/18/2018] [Accepted: 02/13/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To compose and validate an electronic medical records-based case definition for pediatric diabetes in primary care. METHODS Data from the electronic medical records of 221 primary care providers participating in the Manitoba Primary Care Research Network were extracted from April 1, 1998, to March 31, 2015. We assessed agreement among the 3 case definitions of pediatric diabetes and compared the performance of each with the clinical database of the Manitoba Diabetes Education Resource for Children and Adolescents. RESULTS Our reference dataset included 41,055 pediatric patients. Electronic medical records-based case definitions, which included billing records, health conditions lists, prescription records and laboratory results, showed substantially higher sensitivity compared to the administration-based case definition that relied on billing and prescription records (96.9% and 94.9% vs 48.5%). Our study suggests a higher prevalence of pediatric diabetes in Manitoba than was previously reported through administration-based case definitions or in patients whose data were captured in the Manitoba Diabetes Education Resource for Children and Adolescents clinical database. CONCLUSIONS We describe a novel method of calculating the prevalence of pediatric diabetes in a primary care population. This case definition will improve the surveillance of pediatric diabetes and enhance service planning and the development of strategies to support prevention and management.
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Affiliation(s)
- Leanne Kosowan
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - John Queenan
- Centre for Studies in Primary Care, Department of Family Medicine, Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Roseanne Yeung
- Division of Endocrinology & Metabolism, Department of Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Shazhan Amed
- Division of Endocrinology & Diabetes, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Singer
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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14
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Arda Sürücü H, Baran Durmaz G, Turan E. Does Type 1 Diabetic Adolescents' Fear of Stigmatization Predict a Negative Perception Insulin Treatment? Clin Nurs Res 2018; 29:235-242. [PMID: 30472886 DOI: 10.1177/1054773818815258] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The purpose of this study was to investigate stigmatization, sociodemographic/diabetes-related characteristics and parents-related characteristics as predictors of a negative perception of insulin treatment in adolescents with type 1 diabetes in Turkey. The study was carried out using a cross-sectional correlation design. The research sample included 80 adolescents with type 1 diabetes who volunteered to take part. A positive perception of insulin treatment (β = -.38, p < .001), stigmatization (β = -.24, p = .013), informing others about one's type 1 diabetes (β = .24, p = .017) and only using insulin when alone in public places (β = .19, p = .042) were significant predictors of a negative perception of insulin treatment, and these variables explained 35% of the common variance. Diabetes' nurses should take stigmatization into account during their training and plan appropriate measures. Entrepreneurial, randomized, and controlled studies should be conducted to decrease the negative influence of stigmatization on the perception of insulin treatment in individuals with type 1 diabetes.
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Affiliation(s)
| | | | - Engin Turan
- Diyarbakır Gazi Yaşargil Training and Research Hospital, Turkey
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15
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Gurnani M, Pais V, Cordeiro K, Steele S, Chen S, Hamilton JK. One potato, two potato,… assessing carbohydrate counting accuracy in adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19:1302-1308. [PMID: 29999219 DOI: 10.1111/pedi.12717] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/16/2018] [Accepted: 07/01/2018] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/OBJECTIVE Carbohydrate (CHO) counting is a recommended daily practice to help manage blood glucose levels in type 1 diabetes. Evidence suggests that CHO estimates should be within 10 to 15 g of the actual meal for optimal postprandial blood glucose control. The objective of this study was to assess accuracy of CHO counting in adolescents with type 1 diabetes. METHODS Adolescents (aged 12-18 years) with type 1 diabetes who self-identified as regular CHO counters were recruited from the SickKids Diabetes Clinic, Toronto, Canada. Adolescents completed the PedsCarbQuiz (PCQ) and estimated CHO content of test trays (three meals and three snack trays) that were randomly assigned. Analyses were conducted to identify factors associated with accuracy of counting and CHO counting knowledge (PCQ score). RESULTS A total of 140 adolescents (78 females, mean age 14.7, SD = 1.8) participated. The average PCQ score was 81 ± 10%. Forty-two percent of adolescents were accurate in estimating meal trays (ie, within 10 g of the actual CHO content), 44% estimated inaccurately (within 10-20 g), while 14% were significantly inaccurate counters (>20 g variation). PCQ scores were higher in teens who CHO counted accurately than in those with significant inaccuracy (>20 g) (P < 0.05), and a longer duration of diabetes corresponded significantly with a lower PCQ score. No demographics correlated significantly with CHO counting accuracy. CONCLUSIONS Less than half of the teens in our study were accurate CHO counters. These results indicate the need for regular clinical accuracy check and reeducation.
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Affiliation(s)
- Muskaan Gurnani
- Division of Endocrinology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Vanita Pais
- Division of Endocrinology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Kristina Cordeiro
- Division of Endocrinology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Shawna Steele
- Division of Endocrinology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Shiyi Chen
- Clinical Research Services, Biostatistical Design and Analysis Unit, University of Toronto, Toronto, Canada.,Research Institute, University of Toronto, Toronto, Canada
| | - Jill K Hamilton
- Division of Endocrinology, University of Toronto, Toronto, Canada.,The Hospital for Sick Children, University of Toronto, Toronto, Canada.,Research Institute, University of Toronto, Toronto, Canada
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16
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Burry E, Ivers N, Mahmud FH, Shulman R. Interventions using pediatric diabetes registry data for quality improvement: A systematic review. Pediatr Diabetes 2018; 19:1249-1256. [PMID: 29877012 DOI: 10.1111/pedi.12699] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 05/30/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Diabetes registries contain vast amounts of data that can be used for quality improvement (QI) and are foundational elements of learning health systems; infrastructure to share data, create knowledge rapidly and inform decisions to improve health outcomes. QI interventions using adult diabetes registries are associated with improved glycemic control, complication screening rates, and reduced hospitalizations; pediatric data are limited. OBJECTIVE To evaluate the effects of QI strategies that use pediatric diabetes registry data on care processes, organization of care, and patient outcomes. METHODS We searched MEDLINE, EMBASE, Web of Science, Cochrane Central Register of Controlled Trials, Google, Google Scholar, Directory of Open Access Journals, and diabetes registry websites for studies that evaluated the impact of QI interventions on diabetes care processes, care organization, or patient outcomes, using pediatric diabetes registry data. Two reviewers independently assessed eligibility, extracted data and assessed the risk of bias. RESULTS Twelve studies were included. Most interventions targeted health-care providers and evaluated effects on patient outcomes. Five of nine studies that evaluated hemoglobin A1c found improvements of 0.26% to 0.85% (2.8-9.3 mmol/mol) while four found no difference. Many report positive effects on care processes or organization. Study data could not be combined because of variable study design and outcome measures. Included studies represent a minority of existing registries. CONCLUSIONS Pediatric diabetes registries are underused for QI and may facilitate improved care and outcomes. Existing vast amount of pediatric registry data could be used to foster the development of learning health systems and to improve diabetes care and outcomes.
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Affiliation(s)
- Erica Burry
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Noah Ivers
- Department of Family Medicine, Women's College Hospital, University of Toronto, Toronto, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Rayzel Shulman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.,SickKids Research Institute, Toronto, Canada
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17
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Ephraim MS, Rabia J, Musawenkosi N, Felicia SN, Johan L, Andrew O, Anthony MR. A Lanosteryl triterpene from Protorhus longifolia augments insulin signaling in type 1 diabetic rats. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 18:265. [PMID: 30285704 PMCID: PMC6167861 DOI: 10.1186/s12906-018-2337-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 09/25/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND A substantial literature supports antidiabetic properties of the lanosteryl triterpene (methyl-3β-hydroxylanosta-9,24-dien-21-oate, RA-3) isolated from Protorhus longifolia stem bark. However, the molecular mechanism(s) associated with the antihyperglycemic properties of the triterpene remained to be explored. The current study aimed at investigating the molecular mechanism(s) through which RA-3 improves insulin signaling in streptozotocin-induced type 1 diabetic rats. METHODS The type 1 diabetic rats were treated daily with a single oral dose of RA-3 (100 mg/kg) for 28 days. The rats were then sacrificed, and blood, skeletal muscle and pancreases were collected for biochemical, protein expression and histological analysis, respectively. RESULTS Persistently high blood glucose levels in the diabetic control rats significantly increased expression of IRS-1Ser307 while the expression of p-Akt Ser473, p-GSK-3β Ser9, GLUT 4 and GLUT 2 were decreased. However, enhanced muscle insulin sensitivity, which was indicated by a decrease in the expression of IRS-1ser307 with a concomitant increase in the p-AktSer473, p-GSK-3β Ser9, GLUT 4 and GLUT 2 expression were observed in the diabetic rats treated with RA-3. The triterpene-treated animals also showed an improved pancreatic β-cells morphology, along with increased C-peptide levels. An increase in the levels of serum antioxidants such as catalase, superoxide dismutase, and reduced glutathione was noted in the rats treated with the triterpene, while their serum levels of interleukin-6 and malondialdehyde were reduced. CONCLUSIONS It is apparent that RA-3 is able to improve the insulin signaling in type 1 diabetic rats. Its beta (β)-cells protecting mechanism could be attributed to its ability to alleviate inflammation and oxidative stress in the cells.
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Affiliation(s)
- Mabhida Sihle Ephraim
- Department of Biochemistry and Microbiology, University of Zululand, Private Bag X1001, KwaDlangezwa, 3886 South Africa
| | - Johnson Rabia
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, 7505 South Africa
- Division of Medical Physiology, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, 7505 South Africa
| | - Ndlovu Musawenkosi
- Department of Biochemistry and Microbiology, University of Zululand, Private Bag X1001, KwaDlangezwa, 3886 South Africa
| | | | - Louw Johan
- Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council, Tygerberg, 7505 South Africa
| | - Opoku Andrew
- Department of Biochemistry and Microbiology, University of Zululand, Private Bag X1001, KwaDlangezwa, 3886 South Africa
| | - Mosa Rebamang Anthony
- Department of Biochemistry and Microbiology, University of Zululand, Private Bag X1001, KwaDlangezwa, 3886 South Africa
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18
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Jefferies C, Rhodes E, Rachmiel M, Agwu JC, Kapellen T, Abdulla MA, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Management of children and adolescents with diabetes requiring surgery. Pediatr Diabetes 2018; 19 Suppl 27:227-236. [PMID: 30039617 DOI: 10.1111/pedi.12733] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/10/2018] [Indexed: 12/13/2022] Open
Affiliation(s)
- Craig Jefferies
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Erinn Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, Massachusetts
| | - Marianna Rachmiel
- Assaf Haroffeh Medical Center, Zerifin, Sackler School of Medicine, Tel Aviv University, Israel
| | - Juliana C Agwu
- Department of Paediatrics, Sandwell and West Birmingham NHS Trust, Birmingham, UK
| | - Thomas Kapellen
- Department for Women and Child Health, Hospital for Children and Adolescents, University of Leipzig, Leipzig, Germany
| | | | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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19
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Hans FP, Busch HJ. Der Diabetespatient in der Notfallversorgung. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0497-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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20
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Hyperglycemia in Young Adults With Types 1 and 2 Diabetes Seen in the Emergency Department: A Health Records Review. Can J Diabetes 2018; 42:296-301.e5. [DOI: 10.1016/j.jcjd.2017.06.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 06/13/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
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21
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An Update on Hypertension in Children With Type 1 Diabetes. Can J Diabetes 2018; 42:199-204. [DOI: 10.1016/j.jcjd.2018.02.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Accepted: 02/21/2018] [Indexed: 12/21/2022]
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22
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Watt L. "Her Life Rests on Your Shoulders": Doing Worry as Emotion Work in the Care of Children With Diabetes. Glob Qual Nurs Res 2017; 4:2333393617743638. [PMID: 29242810 PMCID: PMC5724634 DOI: 10.1177/2333393617743638] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 10/26/2017] [Accepted: 10/30/2017] [Indexed: 11/17/2022] Open
Abstract
Research on parents' caregiving experiences in the context of diabetes management have consistently shown that parents experience high levels of pediatric parenting stress, anxiety, depression, and general worry. However, how parents understand their worry is largely unexplored and little attention is paid to the work parents are already actively doing to manage their worry. Adopting Arlie Hochschild's concept of "emotion work" and Dorothy Smith's concept of "work," this article examines how parents engage in the emotion work of doing worry. Drawing on the analysis of transcribed data from interviews with seven parents caring for children with diabetes, I show how parents expressed worry as an emotion they experience as well as an embodied way of knowing the presence of potential threats to their child's health. Thus, doing worry is an essential aspect of work done by parents to ensure the safety and well-being of their children with diabetes.
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Affiliation(s)
- Lisa Watt
- McMaster University, Hamilton, Ontario, Canada
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23
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Zahanova S, Tsouka A, Palmert MR, Mahmud FH. The iSCREEN Electronic Diabetes Dashboard: A Tool to Improve Knowledge and Implementation of Pediatric Clinical Practice Guidelines. Can J Diabetes 2017; 41:603-612. [DOI: 10.1016/j.jcjd.2016.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 12/08/2016] [Accepted: 12/23/2016] [Indexed: 01/06/2023]
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24
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Selvakumar D, Al-Sallami HS, de Bock M, Ambler GR, Benitez-Aguirre P, Wiltshire E, Tham E, Simm P, Conwell LS, Carter PJ, Albert BB, Willis J, Wheeler BJ. Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand: A survey of current practice. J Paediatr Child Health 2017; 53:1208-1214. [PMID: 28727196 DOI: 10.1111/jpc.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 12/16/2022]
Abstract
AIM There is no consensus on the optimal insulin treatment for children newly diagnosed with type 1 diabetes mellitus (T1DM). The aims of this study were (i) to describe the insulin regimens used at diagnosis by patient age and geographical region and (ii) to explore differences between and within Australia (AU) and New Zealand (NZ) with regards to other aspects of patient management and education. METHODS An online survey of medical professionals caring for children with T1DM in AU and NZ was undertaken. Questions included clinic demographics, insulin regimen/dosing choices and patient education. RESULTS Of 110 clinicians identified, 100 responded (91%). The majority of those in AU (69%, P < 0.0001) favour multiple daily injections (MDI) for all ages. In NZ, for patients < 10 years old, (twice daily (BD)) BD therapy was favoured (75%, P < 0.0001), with MDI dominant for ages ≥ 10 years (82%, P < 0.0001). Insulin pump therapy was never considered at diagnosis in NZ, but 38% of clinicians in AU considered using pumps at diagnosis in patients <2 years, but rarely in patients aged 2 and over (16%). Differences in clinician choices were also seen in relation to starting insulin dose. CONCLUSION This is the first study to examine current clinical practice with regards to children newly diagnosed with T1DM. Practice varies across Australasia by clinician and region. This lack of consensus is likely driven by ongoing debates in the current paediatric diabetes evidence base as well as by differences in clinician/centre preference, variations in resourcing and their interpretations of the influence of various patient factors.
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Affiliation(s)
| | | | - Martin de Bock
- Department of Paediatric and Child Health, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Elaine Tham
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Peter Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Louise S Conwell
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Endocrinology and Diabetes, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Phillipa J Carter
- Starship Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - Benjamin B Albert
- Starship Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - Jinny Willis
- Don Beaven Medical Research Centre, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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25
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Rosolowsky E, Yaskina M, Couch R. Pediatric Type 1 Diabetes: Patients' and Caregivers' Perceptions of Glycemic Control. Can J Diabetes 2017; 42:302-307.e1. [PMID: 28843470 DOI: 10.1016/j.jcjd.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 06/27/2017] [Accepted: 07/06/2017] [Indexed: 01/03/2023]
Abstract
OBJECTIVES (1) to describe pediatric patients with T1D and their caregivers' perceptions of measures of glycemic control (hemoglobin [A1C] and blood glucose [BG] levels) and (2) to determine the relationship between patients' and caregivers' perceptions of measures of glycemic control with actual A1C levels and adherence to diabetes self-care behaviors. METHODS Patients (8 to 18 years) with T1D and caregivers completed questionnaires that queried their perceptions of (1) what the A1C level assesses, (2) the ideal A1C target, and (3) the ideal BG range. Point-of-care A1C levels were measured for each patient. They also completed the Self-Care Inventory Revised (SCI-R) to assess adherence to diabetes self-care behaviors. RESULTS Among 253 dyads, the frequencies of patients compared to caregivers who could accurately describe what the A1C level assesses, identify the ideal A1C target, and identify the ideal BG range were 20 vs. 66, 31 vs. 56, and 72 vs. 76%, respectively. Patients' accuracy in reporting ideal targets for glycemic control was significantly associated with caregivers' accuracy. There was a trend for lower median A1C levels in patients who were part of a dyad wherein both had accurate perceptions of glycemic control. CONCLUSIONS Patients and caregivers had accurate knowledge of ideal BG range but were less knowledgeable about the meaning of A1C levels and ideal A1C targets. Nevertheless, whether glycemic control was perceived as an A1C measurement or a BG range, A1C levels trended lower for patients when both they and their caregivers had accurate perceptions of glycemic control.
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Affiliation(s)
- Elizabeth Rosolowsky
- Division of Endocrinology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
| | - Maryna Yaskina
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Couch
- Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
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McIntosh B, Khatchadourian K, Amed S. British Columbian Healthcare Providers' Perspectives on Facilitators and Barriers to Adhering to Pediatric Diabetes Treatment Guidelines. Can J Diabetes 2017; 41:224-240. [DOI: 10.1016/j.jcjd.2016.10.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Revised: 09/29/2016] [Accepted: 10/03/2016] [Indexed: 01/09/2023]
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Potthoff S, Presseau J, Sniehotta FF, Johnston M, Elovainio M, Avery L. Planning to be routine: habit as a mediator of the planning-behaviour relationship in healthcare professionals. Implement Sci 2017; 12:24. [PMID: 28222751 PMCID: PMC5319033 DOI: 10.1186/s13012-017-0551-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 02/04/2017] [Indexed: 11/18/2022] Open
Abstract
Background Gaps in the quality of care provided to people with type 2 diabetes are regularly identified. Healthcare professionals often have a strong intention to follow practice guidelines during consultations with people with type 2 diabetes; however, this intention does not always translate into action. Action planning (planning when, where and how to act) and coping planning (planning how to overcome pre-identified barriers) have been hypothesised to help with the enactment of intentions by creating mental cue-response links that promote habit formation. This study aimed to investigate whether habit helps to better understand how action and coping planning relate to clinical behaviour in the context of type 2 diabetes care. Methods The study utilised a prospective correlational design with six nested sub-studies. General practitioners and practice nurses (n = 427 from 99 UK primary care practices) completed measures of action planning, coping planning and habit at baseline and then self-reported their enactment of guideline-recommended advising, prescribing and examining behaviours 12 months later. Bootstrapped mediation analyses were used to test the indirect effect of action and coping planning on healthcare professionals’ clinical behaviour via their relationship with habit. Results Healthcare professionals who reported higher degrees of action or coping planning for performing six guideline recommended behaviours in the context of type 2 diabetes care were more likely to report performing these behaviours in clinical practice. All 12 bootstrapped mediation analyses showed that the positive relationship between planning (action and coping planning) and healthcare professionals’ clinical behaviour operated indirectly through habit. Conclusions These findings suggest that habit mediates the relationship between planning (action and coping planning) and healthcare professional behaviour. Promoting careful action and coping planning may support routinised uptake of guideline-recommended care by healthcare professionals in the primary care setting. Given the competing demands on healthcare professionals, exploring the behavioural processes involved in promoting more routinisation of behaviours where possible and appropriate could free up cognitive capacity for clinical behaviours that rely on more deliberation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-017-0551-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sebastian Potthoff
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK.
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada.,School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Falko F Sniehotta
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, NE2 4AX, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, College of Life Sciences and Medicine, University of Aberdeen, Aberdeen, UK
| | | | - Leah Avery
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, NE2 4HH, UK
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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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Sayed MH, Hegazi MA, Abdulwahed K, Moussa K, El-Deek BS, Gabel H, Ragheb R. Risk factors and predictors of uncontrolled hyperglycemia and diabetic ketoacidosis in children and adolescents with type 1 diabetes mellitus in Jeddah, western Saudi Arabia. J Diabetes 2017; 9:190-199. [PMID: 27043144 DOI: 10.1111/1753-0407.12404] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/24/2016] [Accepted: 03/09/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Little is known about levels of glycemic control and risk factors for uncontrolled hyperglycemia in Saudi children with type 1 diabetes mellitus (T1DM). The aim of the present study was to identify levels of glycemic control, risk factors and predictors of uncontrolled hyperglycemia (HG) and diabetic ketoacidosis (DKA) in children with T1DM. METHODS A retrospective study was performed on Saudi children and adolescents with confirmed T1DM who were followed at the Pediatric Endocrinology Clinic of the Maternity and Children Hospital, Jeddah, from 2000 to 2014. Data collection included all possible factors that may be associated with uncontrolled T1DM. Patients were classified according to American Diabetes Association guidelines for target HbA1c levels per age group. Comparisons were made between well-controlled (WC) patients, HG patients, and DKA patients. Calculation of odds ratios and logistic regression allowed for estimation of the role of each risk factor in uncontrolled T1DM. RESULTS Only 31.2 % of children and adolescents with T1DM were well controlled. Better glycemic control was associated with age < 6 years, urban residence, and T1DM duration <5 years. Glycemic control was not affected by gender, insulin therapy, or comorbidities. The most significant independent predictors of hyperglycemia and DKA were poor compliance with a healthy lifestyle (adjusted hazards ratio [AHR] 28.94; 95 % confidence interval [CI] 8.37-100.04) and an excess intake of sweets (AHR 3.31; 95 % CI 1.54-7.11). CONCLUSION The most significant independent predictor for poor glycemic control (particularly DKA rather than hyperglycemia) in Saudi children and adolescents was poor compliance with a healthy lifestyle with an excessive intake of sweets.
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Affiliation(s)
- Mohamed Hesham Sayed
- Pediatric Department, Faculty of Medicine in Rabigh, King Adbulaziz University, Jeddah, Suadi Arabia
- Pediatric Department, Cairo University, Cairo, Egypt
| | - Moustafa Abdelaal Hegazi
- Pediatric Department, Faculty of Medicine in Rabigh, King Adbulaziz University, Jeddah, Suadi Arabia
- Pediatric Department, Mansoura University Children's Hospital, Mansoura, Egypt
| | | | - Khairya Moussa
- Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia
| | - Basem Salama El-Deek
- Department of Community Medicine and Public Health, King Abdulaziz University, Jeddah, Suadi Arabia
- Department of Community Medicine and Public Health, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Hala Gabel
- Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia
| | - Rana Ragheb
- Pediatric Department, Maternity and Children Hospital, Jeddah, Saudi Arabia
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Tannenbaum C, Clow B, Haworth-Brockman M, Voss P. Sex and gender considerations in Canadian clinical practice guidelines: a systematic review. CMAJ Open 2017; 5:E66-E73. [PMID: 28401121 PMCID: PMC5378537 DOI: 10.9778/cmajo.20160051] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The importance of sex and gender in the diagnosis and management of health conditions is well established, but the extent to which this evidence is integrated into clinical practice guidelines remains unknown. We aimed to determine the proportion of Canadian clinical practice guidelines that integrate evidence on sex and gender considerations. METHODS We searched the Canadian Medical Association's CPG Infobase, PubMed, all provincial/territorial websites and websites of professional organizations for English- and French-language Canadian clinical practice guidelines published between January 2013 and June 2015 on selected conditions identified as priorities by policy-makers and practitioners. Citations and text were searched electronically using keyword terms related to sex and gender. Three investigators independently analyzed and categorized the content of text-positive clinical practice guidelines based on clinical relevance for practitioners. RESULTS Of the 118 clinical practice guidelines that met the inclusion criteria, 79 (66.9%) were text-positive for sex and/or gender keywords; 8 (10%) of the 79 used the keywords only in relation to pregnancy. Of the remaining 71 guidelines, 25 (35%) contained sex-related diagnostic or management recommendations. An additional 5 (7%) contained recommendations for sex-specific laboratory reference values, 29 (41%) referred to differences in epidemiologic features or risk factors only, and 12 (17%) contained nonrelevant mentions of search keywords. Twenty-five (35%) of the text-positive guidelines used the terms "sex" and/or "gender" correctly. INTERPRETATION Recommendations related to sex and gender are inconsistently reported in Canadian clinical practice guidelines. Guidelines such as the Sex and Gender Equity in Research guidelines may help inform the meaningful inclusion of sex and gender evidence in the development of clinical practice guidelines.
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Affiliation(s)
- Cara Tannenbaum
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
| | - Barbara Clow
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
| | - Margaret Haworth-Brockman
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
| | - Patrice Voss
- Faculties of Medicine and Pharmacy (Tannenbaum), Université de Montréal; Centre de Recherche (Tannenbaum), Institut universitaire de Gériatrie de Montréal, Université de Montréal; Institute of Gender and Health (Tannenbaum, Voss), Canadian Institutes of Health Research, Montréal, Que.; Barbara Clow Consulting (Clow); Department of History (Clow), Faculty of Graduate Studies, Dalhousie University, Halifax, NS; Department of Sociology (Haworth-Brockman), Faculty of Arts, University of Winnipeg; Rady Faculty of Health Sciences (Haworth-Brockman), National Collaborating Centre for Infectious Diseases, University of Manitoba, Winnipeg, Man
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Stein RI, Doulla M, Seabrook JA, Yau L, Hamilton N, Salvadori MI, Dworatzek PDN. Impact of the Balanced School Day on Glycemic Control in Children with Type 1 Diabetes. Can J Diabetes 2016; 41:64-68. [PMID: 27727090 DOI: 10.1016/j.jcjd.2016.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 07/14/2016] [Accepted: 07/20/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The balanced school day (BSD) is an alternative elementary school schedule whereby children have 2 20-minute eating periods instead of 1 20-minute lunch, as is found in the traditional schedule (TS). We assessed the glycated hemoglobin (A1C) levels of children with type 1 diabetes in the TS vs. the BSD because 2 eating periods have the potential to impact blood glucose control. METHODS A1C levels representative of the summer months (SumA1C) and A1C levels occurring at least 3 months after the start of the school year (SchA1C) were obtained retrospectively. A parental survey of perceptions of lunch planning, activity levels and diabetes management at school was also completed. RESULTS Our sample included 97 students (TS=42, BSD=55). The mean age ± SD was 10.9±2.6 and 10.1±2.8 years in the TS and BSD, respectively (p=0.12). Sex distribution was not statistically different; 54% were female in TS vs. 36% in BSD; p=0.08. SumA1C was similar in the 2 groups (TS: 8.3±1.1% vs. BSD: 8.0±0.8%; p=0.08). There was a significant within-group increase from SumA1C to SchA1C in the BSD group only (p=0.001), with mean A1C values increasing from 8.0%±0.8% to 8.5%±1.0% in the BSD group compared to no significant increase in the TS group. Parental perceptions of lunch planning, physical activity and diabetes management were similar, regardless of school schedule. CONCLUSIONS Children with type 1 diabetes in the BSD appear to have worse diabetes control during the school year compared to the summer, which is not evident in children in the TS. Additional school supports may assist students in the BSD.
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Affiliation(s)
- Robert I Stein
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Manpreet Doulla
- Department of Pediatrics, Western University, London, Ontario, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Jamie A Seabrook
- School of Food and Nutritional Sciences, Brescia University College, Western University, London, Ontario, Canada; Children's Health Research Institute, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Human Environments Analysis Laboratory, Western University, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Lorraine Yau
- School of Food and Nutritional Sciences, Brescia University College, Western University, London, Ontario, Canada
| | | | | | - Paula D N Dworatzek
- School of Food and Nutritional Sciences, Brescia University College, Western University, London, Ontario, Canada; Schulich Interfaculty Program in Public Health, Western University, London, Ontario, Canada.
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Srivastava A, Chaturvedi S, Dabadghao P, Mathias A, Shukla U, Singh U, Yachha SK. Prevalence of celiac disease in Indian children with type 1 diabetes. Indian J Gastroenterol 2016; 35:372-378. [PMID: 27663711 DOI: 10.1007/s12664-016-0692-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 08/31/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Type 1 diabetes (T1D) patients are at an increased risk of having celiac disease (CD). We evaluated the prevalence and clinical profile of CD in children and adolescents with T1D and reviewed the Indian literature to determine prevalence and reasons for variability. METHODS In this cross-sectional study, subjects with T1D were prospectively evaluated with a demographic and gastrointestinal (GI) questionnaire, human IgA-tissue transglutaminase (IgA-tTGA), and endoscopic duodenal biopsy in serology positive patients. Studies evaluating prevalence of CD in T1D from India were reviewed. RESULTS Fourteen (13.6 %) of the 103 (52 boys, 13 years [2-20]) T1D patients were IgA-tTGA (182 U [47-300]) positive and 3.8 % (4/103) had villous atrophy on histology. Subjects with T1D and CD (n = 4) were younger at onset of T1D (32.5 ± 12.6 vs. 110.5 ± 53.8 months; p < 0.005) and more often had GI symptoms (pain abdomen [2/4 vs. 6/89; p = 0.01], stool frequency of 2-3/day [3/4 vs. 38/89; p = 0.004]) than screen negative T1D (n = 89). Growth and glycemic control were not different between the groups. In the 7 Indian studies involving 915 children and adults, 13.8 % (8 % to 17.8 %) T1D were serology positive. Prevalence of CD was reported as 6.9 % (2.3 % to 11.1 %), but only 3.1 % (2.3 % to 4.2 %) had villous atrophy on histology. CONCLUSIONS Potential CD and CD were present in 13.6 % and 3.8 % children with T1D respectively. T1D with CD have onset of diabetes at younger age and were more often symptomatic than screen negative T1D.
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Affiliation(s)
- Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India.
| | - Saurabh Chaturvedi
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Amrita Mathias
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Umesh Shukla
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Uttam Singh
- Department of Biostatistics, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Raebareli Road, Lucknow, 226 014, India
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Hatun Ş, Demirbilek H, Darcan Ş, Yüksel A, Binay C, Şimşek DG, Kara C, Çetinkaya E, Ünüvar T, Uçaktürk A, Tütüncüler F, Cesur Y, Bundak R, Sağlam H, Şimşek E, Bereket A. Evaluation of therapeutics management patterns and glycemic control of pediatric type 1 diabetes mellitus patients in Turkey: A nationwide cross-sectional study. Diabetes Res Clin Pract 2016; 119:32-40. [PMID: 27423071 DOI: 10.1016/j.diabres.2016.04.059] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 04/04/2016] [Accepted: 04/21/2016] [Indexed: 11/26/2022]
Abstract
AIMS To evaluate the management strategies, glycemic control and complications of pediatric type 1 diabetes mellitus (T1DM) patients in Turkey. METHODS Study included 498 patients with T1DM between the ages 1-18. Data provided from patients' hospital files were recorded on standard case report forms by applicant clinicians within the 3months of data collection period between October 2012 and July 2013. RESULTS Mean age of patients was 11.3±3.8years. Mean duration of DM was determined as 3.7±3.1years. Majority of patients (85.5%) used basal/bolus injection (BBI), and 6.5% used continuous subcutaneous insulin infusion pump. Assessment of glycemic control based on HbA1c levels showed that 29.1% of patients had an HbA1c value <7.5% (58mmol/mol), 16.1% had a value between 7.5% (58mmol/mol) and 8% (64mmol/mol), 19.1% had a value between 8.1% (64mmol/mol) and 9%(75mmol/mol) and 35.7% a value >9%(75mmol/mol). Hypoglycemia was reported in 145 (29.1%) patients and the number of severe hypoglycemic attacks in the last 3months was 1.0±2.4. Taking into consideration the carbohydrate count and insulin correction dose and parents with high socioeconomic status was related to have better glycemic control. The most common comorbidities were Hashimoto's thyroiditis/hypothyroidism (6.2%) followed by celiac disease (3.8%), epilepsy(1.2%), and asthma(1.0%). CONCLUSIONS BBI insulin therapy is widely used among pediatric T1DM patients in Turkey. However, despite improvements in treatment facilities and diabetic care, glycemic control is not at a satisfactory level. Therefore, new and comprehensive initiatives require for pediatric T1DM patients with poor glycemic control. Promoting use of carbohydrate count and insulin correction doses may improve the glycemic control of pediatric T1DM in Turkey.
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Affiliation(s)
- Şükrü Hatun
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey
| | - Hüseyin Demirbilek
- Diyarbakır Children State Hospital, Clinic of Pediatric Endocrinology, 21100 Diyarbakır, Turkey
| | - Şükran Darcan
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey
| | - Ayşegül Yüksel
- Kocaeli University Faculty of Medicine, Department of Pediatric Endocrinology, 41100 Kocaeli, Turkey
| | - Cigdem Binay
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey
| | - Damla Gökşen Şimşek
- Ege University Faculty of Medicine, Department of Pediatric Endocrinology, 35100 İzmir, Turkey
| | - Cengiz Kara
- Ondokuz Mayıs University Faculty of Medicine, Department of Pediatric Endocrinology, 55100 Samsun, Turkey
| | | | - Tolga Ünüvar
- Kanuni Sultan Süleyman Training and Research Hospital, Clinic of Pediatric Endocrinology, 34100 Istanbul, Turkey
| | - Ahmet Uçaktürk
- Maternity and Children's Hospital, Clinic of Pediatric Endocrinology, 33100 Mersin, Turkey
| | - Filiz Tütüncüler
- Trakya University Faculty of Medicine, Department of Pediatric Endocrinology, 22000 Edirne, Turkey
| | - Yaşar Cesur
- Bezmialem University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 Istanbul, Turkey
| | - Ruveyde Bundak
- Istanbul University, Istanbul Faculty of Medicine, Department of Pediatric Endocrinology, 34110 Istanbul, Turkey
| | - Halil Sağlam
- Uludag University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Enver Şimşek
- Osmangazi University Faculty of Medicine, Department of Pediatric Endocrinology, 26100 Eskişehir, Turkey
| | - Abdullah Bereket
- Marmara University Faculty of Medicine, Department of Pediatric Endocrinology, 34100 İstanbul, Turkey
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Shulman R, Miller FA, Stukel TA, Daneman D, Guttmann A. Resources and population served: a description of the Ontario Paediatric Diabetes Network. CMAJ Open 2016; 4:E141-6. [PMID: 27398356 PMCID: PMC4933641 DOI: 10.9778/cmajo.20150006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The Network of Ontario Pediatric Diabetes Programs was established in 2001 to provide access to specialized pediatric diabetes care. Universal funding for pediatric insulin pump therapy has been available in Ontario since 2006. The objective of this study was to describe the distribution of patients, resources and insulin pump use across centres within the network, now called the Ontario Paediatric Diabetes Network. METHODS We conducted a cross-sectional survey in 2012 of the 35 pediatric diabetes centres in Ontario to measure centre characteristics, patient volume and available clinical and social resources. We used health administrative data from the provincial Assistive Devices Program to describe patients aged 18 years or less using insulin pumps by centre as a measure of technology uptake. RESULTS All 35 centres participated, reporting a total of 6676 children with type 1 diabetes and 368 with type 2 diabetes. Most (> 80%) children with type 1 diabetes were followed at tertiary (n = 5) or large community (n = 14) centres. Nursing patient load was similar between centre types, but there was a large range across centres within any type. Overall, percent insulin pump use was 38.1% and varied widely across centres (5.3%-66.7%). Funded 24-hour support for pump users was available at 5 (36%) small community centres, 3 (19%) large community centres and 2 (40%) tertiary centres. INTERPRETATION Our study showed differences in access to specialized and after-hours care for children with diabetes in Ontario. Pump use varied widely across centres. Further research is needed to assess the impact of these observed differences on quality of care and outcomes.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Fiona A Miller
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Therese A Stukel
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Denis Daneman
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
| | - Astrid Guttmann
- Department of Pediatrics (Shulman, Daneman, Guttmann), The Hospital for Sick Children, University of Toronto; Institute of Health Policy, Management and Evaluation (Shulman, Miller, Stukel, Guttmann), University of Toronto; Institute for Clinical Evaluative Sciences (Shulman, Stukel, Guttmann); Toronto Health Economics and Technology Assessment (THETA) Collaborative (Miller), University of Toronto, Toronto, Ont
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Klein-Schwartz W, Stassinos GL, Isbister GK. Treatment of sulfonylurea and insulin overdose. Br J Clin Pharmacol 2016; 81:496-504. [PMID: 26551662 DOI: 10.1111/bcp.12822] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 11/02/2015] [Accepted: 11/03/2015] [Indexed: 11/26/2022] Open
Abstract
The most common toxicity associated with sulfonylureas and insulin is hypoglycaemia. The article reviews existing evidence to better guide hypoglycaemia management. Sulfonylureas and insulin have narrow therapeutic indices. Small doses can cause hypoglycaemia, which may be delayed and persistent. All children and adults with intentional overdoses need to be referred for medical assessment and treatment. Unintentional supratherapeutic ingestions can be initially managed at home but if symptomatic or if there is persistent hypoglycaemia require medical referral. Patients often require intensive care and prolonged observation periods. Blood glucose concentrations should be assessed frequently. Asymptomatic children with unintentional sulfonylurea ingestions should be observed for 12 h, except if this would lead to discharge at night when they should be kept until the morning. Prophylactic intravenous dextrose is not recommended. The goal of therapy is to restore and maintain euglycaemia for the duration of the drug's toxic effect. Enteral feeding is recommended in patients who are alert and able to tolerate oral intake. Once insulin or sulfonylurea-induced hypoglycaemia has developed, it should be initially treated with an intravenous dextrose bolus. Following this the mainstay of therapy for insulin-induced hypoglycaemia is intravenous dextrose infusion to maintain the blood glucose concentration between 5.5 and 11 mmol l(-1) . After sulfonylurea-induced hypoglycaemia is initially corrected with intravenous dextrose, the main treatment is octreotide which is administered to prevent insulin secretion and maintain euglycaemia. The observation period varies depending on drug, product formulation and dose. A general guideline is to observe for 12 h after discontinuation of intravenous dextrose and, if applicable, octreotide.
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Affiliation(s)
- Wendy Klein-Schwartz
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, USA
| | - Gina L Stassinos
- Maryland Poison Center, Department of Pharmacy Practice and Science, University of Maryland School of Pharmacy, USA
| | - Geoffrey K Isbister
- Clinical Toxicology Research Group, University of Newcastle, Newcastle, Australia
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Shulman R, Stukel TA, Miller FA, Newman A, Daneman D, Wasserman JD, Guttmann A. Low socioeconomic status is associated with adverse events in children and teens on insulin pumps under a universal access program: a population-based cohort study. BMJ Open Diabetes Res Care 2016; 4:e000239. [PMID: 27547416 PMCID: PMC4932320 DOI: 10.1136/bmjdrc-2016-000239] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 05/24/2016] [Accepted: 05/31/2016] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To describe adverse events in pediatric insulin pump users since universal funding in Ontario and to explore the role of socioeconomic status and 24-hour support. RESEARCH DESIGN AND METHODS Population-based cohort study of youth (<19 years) with type 1 diabetes (n=3193) under a universal access program in Ontario, Canada, from 2006 to 2013. We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. The relationship between patient and center-level characteristics and time to first diabetic ketoacidosis (DKA) admission or death was tested using a Cox proportional hazards model and the rate of diabetes-related emergency department visits and hospitalizations with a Poisson model, both using generalized estimating equations. RESULTS The rate of DKA was 5.28/100 person-years and mortality 0.033/100 person-years. Compared with the least deprived quintile, the risk of DKA or death for those in the most deprived quintile was significantly higher (HR 1.58, 95% CI 1.05 to 2.38) as was the rate of diabetes-related acute care use (RR 1.60, 95% CI 1.27 to 2.00). 24-hour support was not associated with these outcomes. Higher glycated hemoglobin, prior DKA, older age, and higher nursing patient load were associated with a higher risk of DKA or death. CONCLUSIONS The safety profile of pump therapy in the context of universal funding is similar to other jurisdictions and unrelated to 24-hour support. Several factors including higher deprivation were associated with an increased risk of adverse events and could be used to inform the design of interventions aimed at preventing poor outcomes in high-risk individuals.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Therese A Stukel
- 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, Toronto, Ontario, Canada
| | - Alice Newman
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
| | - Jonathan D Wasserman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
- Sickkids Research Institute
- 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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Assor E, Marcon MA, Hamilton N, Fry M, Cooper T, Mahmud FH. Design of a dietary intervention to assess the impact of a gluten-free diet in a population with type 1 Diabetes and Celiac Disease. BMC Gastroenterol 2015; 15:181. [PMID: 26692164 PMCID: PMC4687374 DOI: 10.1186/s12876-015-0413-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 12/14/2015] [Indexed: 12/25/2022] Open
Abstract
Background Celiac Disease occurs at a 5–10 fold greater prevalence in patients with type-1 diabetes (T1D), despite this increased risk, there is limited objective evidence regarding the impact of a Gluten-Free Diet (GFD) in the large proportion of asymptomatic (30–70 %) patients with both autoimmune diseases. Given the requirements and intricacies inherent to each condition, we describe the rationale and design a dietary curriculum specifically addressing the educational requirements for children and adults with CD and diabetes as part of the CD-DIET Study. Methods and design The CD-DIET Study (Celiac Disease and Diabetes - Dietary Intervention and Evaluation Trial) is a multicenter randomized controlled trial aimed at evaluating the safety and efficacy of a GFD in patients with asymptomatic celiac disease and T1D on key diabetes and patient-centered outcomes. Discussion Key dietary components of the trial include a description and evaluation of food consumption patterns including glycemic index and glycemic load, novel assessments of gluten quantification, and objective and subjective measures of GFD adherence. This dietary curriculum will establish rigorous guidelines to assess adherence and facilitate evaluation of a GFD on metabolic control, bone health and patient quality of life in patients with CD and diabetes. Trial registration Number NCT01566110. Date of Registration: March, 2012.
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Affiliation(s)
- Esther Assor
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
| | - Natasha Hamilton
- Division of Endocrinology Paediatrics, London Health Sciences Centre, London, ON, Canada.
| | - Marilyn Fry
- Division of Endocrinology, Markham Stouffville Hospital, Toronto, ON, Canada.
| | - Tammy Cooper
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Farid H Mahmud
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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Amin A, Lau L, Crawford S, Edwards A, Pacaud D. Prospective assessment of hypoglycemia symptoms in children and adults with type 1 diabetes. Can J Diabetes 2015; 39 Suppl 4:26-31. [PMID: 26541488 DOI: 10.1016/j.jcjd.2015.09.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 10/22/2022]
Abstract
PURPOSE To compare the characteristics of symptoms of hypoglycemia in children and in adults with type 1 diabetes. METHODS Adults with diabetes and parents of children with diabetes who were participants were asked to call a phone system to report episodes of hypoglycemia (presence of symptoms and a blood glucose <4.0 mmol/L). For each episode, blood glucose reading and a scoring of 28 symptoms on a 7-point scale (1 = not present, 7 = very intense) were collected. RESULTS Sixty six children (49.2% males, mean age = 12.1±2.4 years, mean age at diagnosis = 7.5±2.9 years) and 53 adults (41.2% males, mean age 38.7±14.5 years, mean age at diagnosis = 17.5±12.9 years) with type 1 diabetes participated. The most common symptoms in adults were hunger, sweating, trembling and weakness. The most common symptoms in children were weakness, trembling and hunger. The 2 most discriminating variables between children and adults were sleepiness and tiredness, which were more common in children (p<0.01). In a comparative factor analysis, 3 factors emerged: factor 1, autonomic and neuroglycopenic; factor 2, behavioural; and factor 3, general malaise. Factors 2 and 3 were significantly more common or intense in children than in adults; MANOVA: F(1, 113) = 6.72, p<0.05 and F(1, 113) = 4.64, p<0.05, respectively. CONCLUSIONS Symptoms relating to behaviour and general malaise are more common in children than in adults with type 1 diabetes. The results of this study may assist providers in educating caregivers of children and patients with diabetes how to better recognize episodes of hypoglycemia.
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Affiliation(s)
- Aditi Amin
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Lau
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alun Edwards
- Section of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danièle Pacaud
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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DeMelo EN, McDonald C, Saibil F, Marcon MA, Mahmud FH. Celiac Disease and Type 1 Diabetes in Adults: Is This a High-Risk Group for Screening? Can J Diabetes 2015; 39:513-9. [PMID: 26293006 DOI: 10.1016/j.jcjd.2015.06.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 05/26/2015] [Accepted: 06/16/2015] [Indexed: 12/27/2022]
Abstract
The association between celiac disease (CD), an autoimmune condition involving intestinal inflammation related to gluten ingestion, and type 1 diabetes has long been recognized. CD prevalence rates 4 to 6 times greater in adults with type 1 diabetes than in the general population. Much of the existing literature focuses on important implications related to the impact of a gluten-free diet on short-term outcomes in metabolic control and quality of life. Canadian Diabetes Association guidelines recommend targeted CD screening in patients with type 1 diabetes who have classic symptoms, such as abdominal pain, bloating, diarrhea, unexplained weight loss or labile metabolic control; however, a significant proportion (40% to 60%) of patients may have mild or absent symptoms. Recent evidence suggests that adult patients with both conditions are at higher risk for diabetes microvascular comorbidities, increased mortality and impaired bone health if the CD is untreated. The purpose of this review is to describe the association between CD and type 1 diabetes and to summarize recent literature that evaluates risks in patients with both conditions.
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Affiliation(s)
- Emilia N DeMelo
- Division of Endocrinology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte McDonald
- Department of Medicine, Division of Endocrinology and Metabolism, St. Joseph's Health Care, University of Western Ontario, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.
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40
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Mahmud FH, De Melo EN, Noordin K, Assor E, Sahota K, Davies-Shaw J, Cutz E, Somers G, Lawson M, Mack DR, Gallego P, McDonald C, Beaton MD, Bax K, Saibil F, Gilbert J, Kirsch S, Perkins BA, Cino M, Szentgyorgyi E, Koltin D, Parikh A, Mukerji G, Advani A, Lou O, Marcon MA. The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) protocol: a randomised controlled study to evaluate treatment of asymptomatic coeliac disease in type 1 diabetes. BMJ Open 2015; 5:e008097. [PMID: 25968008 PMCID: PMC4431067 DOI: 10.1136/bmjopen-2015-008097] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Coeliac disease (CD) is an autoimmune condition characterised by gluten-induced intestinal inflammation, and observed at a 5-10 fold greater prevalence in type 1 diabetes. While universal screening for CD in patients with diabetes is frequently advocated, objective data is limited as to benefits on diabetes control, bone health or quality of life related to the adoption of a gluten-free diet (GFD) in the large proportion of patients with diabetes with asymptomatic CD. The Celiac Disease and Diabetes-Dietary Intervention and Evaluation Trial (CD-DIET) study is a multicenter, randomised controlled trial to evaluate the efficacy and safety of a GFD in patients with type 1 diabetes with asymptomatic CD. METHODS AND ANALYSIS Children and adults (8-45 years) with type 1 diabetes will be screened for asymptomatic CD. Eligible patients with biopsy-proven CD will be randomly assigned in a 1:1 ratio to treatment with a GFD for 1 year, or continue with a gluten-containing diet. The primary outcome will evaluate the impact of the GFD on change in glycated haemoglobin. Secondary outcomes will evaluate changes in bone mineral density, blood glucose variability and health-related quality of life between GFD-treated and the regular diet group over a 1-year period. The study was initiated in 2012 and has subsequently expanded to multiple paediatric and adult centres in Ontario, Canada. ETHICS AND DISSEMINATION The findings from this study will provide high-quality evidence as to the impact of GFD treatment on glycaemic control and complications in asymptomatic children and adults with CD and type 1 diabetes. TRIAL REGISTRATION NUMBER NCT01566110.
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Affiliation(s)
- Farid H Mahmud
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Emilia N De Melo
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Karima Noordin
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Esther Assor
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Kamaljeet Sahota
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Jolie Davies-Shaw
- Department of Pediatrics, Division of Endocrinology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Ernest Cutz
- Department of Pathology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Gino Somers
- Department of Pathology, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Margaret Lawson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - David R Mack
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Patricia Gallego
- Division of Endocrinology Paediatrics, London Health Sciences Centre, London, Ontario, Canada
| | - Charlotte McDonald
- Division of Endocrinology and Metabolism, St. Joseph Health Care, London Health Sciences Centre, London, Ontario, Canada
| | - Melanie D Beaton
- Division of Gastroenterology, London Health Sciences Centre, London, Ontario, Canada
| | - Kevin Bax
- Pediatric Gastroenterology, Department of Pediatrics, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | - Fred Saibil
- Division of Gastroenterology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Jeremy Gilbert
- Division of Endocrinology and Metabolism, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Susan Kirsch
- Division of Endocrinology, Markham Stouffville Hospital, Toronto, Ontario, Canada
| | - Bruce A Perkins
- Division of Endocrinology and Metabolism, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Maria Cino
- Division of Gastroenterology, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Eva Szentgyorgyi
- Department of Pathology, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Dror Koltin
- Division of Endocrinology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Amish Parikh
- Division of Endocrinology, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Geetha Mukerji
- Division of Endocrinology, Women's College Hospital, Toronto, Ontario, Canada
| | - Andrew Advani
- Division of Endocrinology, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Olivia Lou
- Juvenile Diabetes Research Foundation—Canadian Clinical Trials Network (JDRF-CCTN), Toronto, Ontario, Canada
| | - Margaret A Marcon
- Division of Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Abstract
An intensified diabetes management approach (including increased education, monitoring, and contact with diabetes team) should be used for adolescents and also for younger children if glycaemic control is not achieved by insulin therapy. Treatment options may include increased frequency of injections (e.g. the patients on 2 bolus may require 3 or 4 bolus injections), change in the type of basal and/or bolus insulin depending on multiple times monitoring for adolescents and for younger children, and change to continuous subcutaneous insulin infusion pump therapy. Results of epidemiology of diabetes interventions and complications (EDIC) Research Group, where the Diabetes Control and Complications Trial patients were further followed up almost for a period of 7 years or more showed that intensive therapy significantly reduced and maintained glycated hemoglobin with relative risk reduction of microvascular complications in the intensive therapy group. In addition, intensive treatment reduced the risk of any cardiovascular disease (CVD) event by 42% and the risk of nonfatal myocardial infarction, stroke, or death from CVD by 57%. The reduction of microvascular and macrovascular events in the intensively-treated group persisted due to the "legacy effect" or "metabolic memory" of early intensive glycemic control. The main advantage of intensive insulin therapy is that it reduces the rate of diabetes complications, in the long run. Furthermore, it offers flexibility as the doses can be adjusted according to the activity and food consumed. The main disadvantage of intensive insulin therapy is the risk of hypoglycemia especially in type 1 diabetes mellitus and weight gain.
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Affiliation(s)
- Banshi Saboo
- Consultant Diabetologist and Endocrine and Metabolic Physician at Diabetes Care and Hormone Clinic, Ahmedabad, Gujarat, India
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Lawrence SE, Cummings EA, Pacaud D, Lynk A, Metzger DL. Managing type 1 diabetes in school: Recommendations for policy and practice. Paediatr Child Health 2015; 20:35-44. [PMID: 25722642 DOI: 10.1093/pch/20.1.35] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Diabetes requiring insulin is increasingly common and likely to impact students in most, if not all, schools. Diabetes and its complications have major personal, social and economic impact, and improved diabetes control reduces the risk of both short- and long-term complications. Evidence shows that more intensive management of diabetes - through frequent blood glucose monitoring, insulin administration with injections and/or insulin pumps, and careful attention to diet and exercise - leads to better control. Since children spend 30 to 35 hours per week at school, effectively managing their diabetes while there is integral to their short- and long-term health. The Canadian Paediatric Society and the Canadian Pediatric Endocrine Group recommend that minimum standards for supervision and care be established across Canada to support children and youth with type 1 diabetes in schools. These recommendations are derived from evidence-based clinical practice guidelines, with input from diabetes care providers from across Canada, and are consistent with the Canadian Diabetes Association's Guidelines for the Care of Students Living with Diabetes at School.
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Feenstra B, Lawson ML, Harrison D, Boland L, Stacey D. Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study. BMC Med Inform Decis Mak 2015; 15:5. [PMID: 25889602 PMCID: PMC4326318 DOI: 10.1186/s12911-014-0126-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections). METHODS Pre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children's hospital. Parent-child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention. RESULTS Of 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent-child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making. CONCLUSION Decision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.
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Affiliation(s)
- Bryan Feenstra
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Laura Boland
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
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Rhodes ET, Gong C, Edge JA, Wolfsdorf JI, Hanas R. ISPAD Clinical Practice Consensus Guidelines 2014. Management of children and adolescents with diabetes requiring surgery. Pediatr Diabetes 2014; 15 Suppl 20:224-31. [PMID: 25182316 DOI: 10.1111/pedi.12172] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Accepted: 06/09/2014] [Indexed: 11/25/2022] Open
Affiliation(s)
- Erinn T Rhodes
- Division of Endocrinology, Boston Children's Hospital, Boston, MA, USA; Department of Pediatrics, Harvard Medical School, Boston, MA, USA
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Aylward NM, Shah N, Sellers EA. The Ketogenic Diet for the Treatment of Myoclonic Astatic Epilepsy in a Child with Type 1 Diabetes Mellitus. Can J Diabetes 2014; 38:223-4. [DOI: 10.1016/j.jcjd.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Revised: 04/30/2014] [Accepted: 05/02/2014] [Indexed: 10/25/2022]
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Samaan MC, Valencia M, Cheung C, Wilk B, Lau K, Thabane L. Design, implementation, and evaluation of a pediatric and adolescent type 2 diabetes management program at a tertiary pediatric center. J Multidiscip Healthc 2014; 7:321-31. [PMID: 25114539 PMCID: PMC4124128 DOI: 10.2147/jmdh.s63842] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Global rates of type 2 diabetes in children and adolescents have increased significantly over the past three decades. Type 2 diabetes is a relatively new disease in this age group, and there is a dearth of information about how to structure treatment programs to manage its comorbidities and complications. In this paper, we describe the design and implementation of a personalized multidisciplinary, family-centered, pediatric and adolescent type 2 diabetes program at a tertiary pediatric center in Hamilton, Ontario, Canada. We report the process of designing and implementing such a program, and show that this multidisciplinary program led to improvement in glycated hemoglobin (n=17, 8% at baseline versus 6.4% at 1 year, 95% confidence interval (0.1–0.28), P-value <0.0001) and stabilized body mass index, with lowered C-peptide and no change in fitness or metabolic biomarkers of lipid metabolism and liver function. As type 2 diabetes becomes more prevalent in youth, the need for programs that successfully address the complex nature of this disease is central to its management and to mitigate its long-term adverse outcomes.
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Affiliation(s)
- M Constantine Samaan
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Endocrinology, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada
| | - Marlie Valencia
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Connie Cheung
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Boguslaw Wilk
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Children's Exercise and Nutrition Center, McMaster University, Hamilton, ON, Canada
| | - Keith Lau
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Division of Pediatric Nephrology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Lehana Thabane
- Department of Pediatrics, McMaster University, Hamilton, ON, Canada ; Population Health Research Institute, McMaster University, Hamilton, ON, Canada ; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada ; Department of Anesthesia, McMaster University, Hamilton, ON, Canada ; Centre for Evaluation of Medicines, Hamilton, ON, Canada
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Amin A, Lau L, Crawford S, Edwards A, Pacaud D. Prospective assessment of hypoglycemia symptoms in children and adults with type 1 diabetes. Can J Diabetes 2014; 38:263-8. [PMID: 25023739 DOI: 10.1016/j.jcjd.2014.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/16/2014] [Accepted: 05/21/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE To compare the characteristics of symptoms of hypoglycemia in children and in adults with type 1 diabetes. METHODS Adults with diabetes and parents of children with diabetes who were participants were asked to call a phone system to report episodes of hypoglycemia (presence of symptoms and a blood glucose <4.0 mmol/L). For each episode, blood glucose reading and a scoring of 28 symptoms on a 7-point scale (1 = not present, 7 = very intense) were collected. RESULTS Sixty six children (49.2% males, mean age = 12.1±2.4 years, mean age at diagnosis = 7.5±2.9 years) and 53 adults (41.2% males, mean age 38.7±14.5 years, mean age at diagnosis = 17.5±12.9 years) with type 1 diabetes participated. The most common symptoms in adults were hunger, sweating, trembling and weakness. The most common symptoms in children were weakness, trembling and hunger. The 2 most discriminating variables between children and adults were sleepiness and tiredness, which were more common in children (p<0.01). In a comparative factor analysis, 3 factors emerged: factor 1, autonomic and neuroglycopenic; factor 2, behavioural; and factor 3, general malaise. Factors 2 and 3 were significantly more common or intense in children than in adults; MANOVA: F(1, 113) = 6.72, p<0.05 and F(1, 113) = 4.64, p<0.05, respectively. CONCLUSIONS Symptoms relating to behaviour and general malaise are more common in children than in adults with type 1 diabetes. The results of this study may assist providers in educating caregivers of children and patients with diabetes how to better recognize episodes of hypoglycemia.
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Affiliation(s)
- Aditi Amin
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Lorraine Lau
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Susan Crawford
- Department of Pediatrics, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Alun Edwards
- Section of Endocrinology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danièle Pacaud
- Section of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada.
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