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Skagseth M, Fimland MS, Ivar Lund Nilsen T, Aasdahl L. Physical activity after inpatient occupational rehabilitation: Secondary outcomes of two randomized controlled trials. Scand J Med Sci Sports 2019; 30:339-348. [PMID: 31609021 DOI: 10.1111/sms.13577] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/25/2019] [Accepted: 10/08/2019] [Indexed: 12/30/2022]
Abstract
OBJECTIVES To assess whether inpatient multicomponent occupational rehabilitation, including physical activity (PA), increases the PA level of participants more than an outpatient program without PA, and whether changes in PA are associated with future work outcomes. METHODS A total of 265 participants were included in one of two randomized clinical trials. Participants had been sick listed 2-12 months with a musculo-skeletal, psychological, or general/unspecified diagnosis. We measured PA by questionnaires at the start of the programs and at 3, 6, and 12 months of follow-up. Between-group differences in PA were assessed using linear mixed models. Associations between change in PA and future work outcomes were assessed by logistic and linear regression. RESULTS There was no difference in change in PA between the inpatient and outpatient programs during 12 months of follow-up. We did not find any associations between the amount of PA and future work outcomes. However, intensity of PA was positively associated with return to work (RTW); participants reporting increased vigorous PA had an odds ratio (OR) for RTW of 4.1 (95% confidence interval [CI] 1.1-15.7) whereas participants reporting consistently high intensity of PA had an OR of 3.1 (95% CI 1.0-9.7), compared to participants reporting low-intensity PA. CONCLUSION Inpatient occupational rehabilitation, including PA, did not increase PA-level in the follow-up period more than a less comprehensive program without PA. The amount of PA was not associated with future work outcomes. However, vigorous PA showed a positive association with RTW.
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Affiliation(s)
- Martin Skagseth
- Department of Public Health and Nursing, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway
| | - Marius Steiro Fimland
- Department of Neuromedicine and Movement Science, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.,UnicareHelsefort Rehabilitation Center, Rissa, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,Clinic of Anesthesia and Intensive Care, St.Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Faculty of Medicine, NTNU, Norwegian University of Science and Technology, Trondheim, Norway.,UnicareHelsefort Rehabilitation Center, Rissa, Norway
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O'Hara MC, Hynes L, O'Donnell M, Nery N, Byrne M, Heller SR, Dinneen SF. A systematic review of interventions to improve outcomes for young adults with Type 1 diabetes. Diabet Med 2017; 34:753-769. [PMID: 27761951 PMCID: PMC5484309 DOI: 10.1111/dme.13276] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/18/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Many young adults with Type 1 diabetes experience poor outcomes. The aim of this systematic review was to synthesize the evidence regarding the effectiveness of interventions aimed at improving clinical, behavioural or psychosocial outcomes for young adults with Type 1 diabetes. METHODS Electronic databases were searched. Any intervention studies related to education, support, behaviour change or health service organizational change for young adults aged between 15-30 years with Type 1 diabetes were included. A narrative synthesis of all studies was undertaken due to the large degree of heterogeneity between studies. RESULTS Eighteen studies (of a possible 1700) were selected and categorized: Health Services Delivery (n = 4), Group Education and Peer Support (n = 6), Digital Platforms (n = 4) and Diabetes Devices (n = 4). Study designs included one randomized controlled trial, three retrospective studies, seven feasibility/acceptability studies and eight studies with a pre/post design. Continuity, support, education and tailoring of interventions to young adults were the most common themes across studies. HbA1c was the most frequently measured outcome, but only 5 of 12 studies that measured it showed a significant improvement. CONCLUSION Based on the heterogeneity among the studies, the effectiveness of interventions on clinical, behavioural and psychosocial outcomes among young adults is inconclusive. This review has highlighted a lack of high-quality, well-designed interventions, aimed at improving health outcomes for young adults with Type 1 diabetes.
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Affiliation(s)
- M. C. O'Hara
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
| | - L. Hynes
- School of PsychologyNUI GalwayGalwayIreland
| | | | - N. Nery
- School of MedicineNUI GalwayGalwayIreland
| | - M. Byrne
- School of PsychologyNUI GalwayGalwayIreland
| | - S. R. Heller
- Department of Human MetabolismAcademic Unit of DiabetesEndocrinology and MetabolismUniversity of SheffieldSheffieldUK
| | - S. F. Dinneen
- School of MedicineNUI GalwayGalwayIreland
- Endocrinology and Diabetes CentreGalway University HospitalsGalwayIreland
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3
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Hynes L, Byrne M, Casey D, Dinneen SF, O'Hara MC. ‘It makes a difference, coming here’: A qualitative exploration of clinic attendance among young adults with type 1 diabetes. Br J Health Psychol 2015; 20:842-58. [DOI: 10.1111/bjhp.12145] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/21/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Lisa Hynes
- School of Psychology; National University of Ireland; Galway Ireland
| | - Molly Byrne
- School of Psychology; National University of Ireland; Galway Ireland
| | - Dympna Casey
- School of Nursing and Midwifery; National University of Ireland; Galway Ireland
| | - Sean F. Dinneen
- School of Medicine; National University of Ireland; Galway Ireland
- Endocrinology and Diabetes Centre; Galway University Hospitals; Galway Ireland
| | - Mary Clare O'Hara
- School of Medicine; National University of Ireland; Galway Ireland
- Endocrinology and Diabetes Centre; Galway University Hospitals; Galway Ireland
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4
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Ravert RD, Boren SA, Wiebke E. Transitioning through college with diabetes: themes found in online forums. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:258-267. [PMID: 25693002 DOI: 10.1080/07448481.2015.1015026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Content analysis of Internet-based diabetes forum text was used to examine the experiences encountered by students with diabetes transitioning into and through college. PARTICIPANTS Forum posts (N = 238) regarding attending college with diabetes were collected and analyzed. METHODS Thematic coding was used to identify prominent topics, followed by analysis of theme distribution across college transitional stages. Three students with diabetes were recruited to review results and corroborate findings. RESULTS Twenty thematic categories were identified. Preparation for college involved efforts to move toward autonomous diabetes management. Transitioning in was marked by adjusting to a college lifestyle, then working to manage issues such as busy schedules and alcohol use as continuing students, and turning attention toward future career options and finances while transitioning out. CONCLUSIONS As they move into and through college, students with diabetes negotiate developmental and diabetes-specific tasks within an environment that presents unique logistical, lifestyle, and psychological challenges.
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Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW. An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in educational settings. BMC Pediatr 2014; 14:228. [PMID: 25213220 PMCID: PMC4263204 DOI: 10.1186/1471-2431-14-228] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. METHOD Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3-25 years in educational settings. RESULTS Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. CONCLUSION This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.
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Affiliation(s)
- Deborah Edwards
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jane Noyes
- />School of Social Sciences, Bangor University, Bangor, LL57 2EF UK
| | - Lesley Lowes
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Llinos Haf Spencer
- />School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - John W Gregory
- />Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
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Noyes JP, Lowes L, Whitaker R, Allen D, Carter C, Edwards RT, Rycroft-Malone J, Sharp J, Edwards D, Spencer LH, Sylvestre Y, Yeo ST, Gregory JW. Developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multicentre randomised controlled trial. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jane P Noyes
- Centre for Health-Related Research, Bangor University, Bangor, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cynthia Carter
- Cardiff School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, UK
| | - Rhiannon T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Janice Sharp
- Media Resources Centre, University Hospital of Wales, Cardiff, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Yvonne Sylvestre
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - John W Gregory
- Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
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Fonte D, Apostolidis T, Lagouanelle-Simeoni MC. Compétences psychosociales et éducation thérapeutique du patient diabétique de type 1 : une revue de littérature. SANTE PUBLIQUE 2014. [DOI: 10.3917/spub.146.0763] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Hill S, Gingras J, Gucciardi E. The Lived Experience of Canadian University Students with Type 1 Diabetes Mellitus. Can J Diabetes 2013; 37:237-242. [DOI: 10.1016/j.jcjd.2013.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 03/28/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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Conn VS, Hafdahl AR, Brown SA, Brown LM. Meta-analysis of patient education interventions to increase physical activity among chronically ill adults. PATIENT EDUCATION AND COUNSELING 2008; 70:157-72. [PMID: 18023128 PMCID: PMC2324068 DOI: 10.1016/j.pec.2007.10.004] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2007] [Revised: 09/24/2007] [Accepted: 10/06/2007] [Indexed: 05/25/2023]
Abstract
OBJECTIVE This meta-analysis integrates primary research testing the effect of patient education to increase physical activity (PA) on behavior outcomes among adults with diverse chronic illnesses. METHODS Extensive literature searching strategies located published and unpublished intervention studies that measured PA behavior outcomes. Primary study results were coded. Fixed- and random-effects meta-analytic procedures included moderator analyses. RESULTS Data were synthesized across 22,527 subjects from 213 samples in 163 reports. The overall mean weighted effect size for two-group comparisons was 0.45 (higher mean for treatment than control). This effect size is consistent with a difference of 48 min of PA per week or 945 steps per day. Preliminary moderator analyses suggest interventions were most effective when they targeted only PA behavior, used behavioral strategies (versus cognitive strategies), and encouraged PA self-monitoring. Differences among chronic illnesses were documented. Individual strategies unrelated to PA outcomes included supervised exercise sessions, exercise prescription, fitness testing, goal setting, contracting, problem solving, barriers management, and stimulus/cues. PA outcomes were unrelated to gender, age, ethnicity, or socioeconomic distribution among samples. CONCLUSION These findings suggest that some patient education interventions to increase PA are effective, despite considerable heterogeneity in the magnitude of intervention effect. PRACTICE IMPLICATIONS Moderator analyses are preliminary and provide suggestive evidence for further testing of interventions to inform practice.
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Affiliation(s)
- Vicki S Conn
- S317 School of Nursing, University of Missouri, Columbia, MO 65211, USA.
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Balfe M. Diets and discipline: the narratives of practice of university students with type 1 diabetes. SOCIOLOGY OF HEALTH & ILLNESS 2007; 29:136-53. [PMID: 17286710 DOI: 10.1111/j.1467-9566.2007.00476.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Type 1 diabetes is one of the most common chronic conditions of adolescence and young adulthood. It is characterised by a demanding and complex management regime. Individuals with diabetes must engage in continual self-care actions such as eating healthily and exercising if they are to minimise their risks of developing long-term diabetes' complications. Research has demonstrated, however, that many young adults experience difficulties with exercising and eating healthily. Narrative approaches could provide important insights into the reasons why young people do or do not experience difficulties here. In this article I examine the food consumption and exercise narratives of a particular group of young adults with type 1 diabetes, university students, to see what personal, social and cultural factors influence their practices.
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Affiliation(s)
- Myles Balfe
- Department of Geography, University of Sheffield.
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11
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Affiliation(s)
- Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville 3052, Victoria, Australia.
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Maia FF, Araújo LR. Projeto "Diabetes Weekend": Proposta de Educação em Diabetes Mellitus Tipo 1. ACTA ACUST UNITED AC 2002. [DOI: 10.1590/s0004-27302002000500011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
A educação em diabetes é parte imprescindível do tratamento do paciente, associado ao controle metabólico adequado, atividade física e dieta. O maior nível de conhecimento sobre a doença e suas complicações estão relacionadas a uma melhora da qualidade de vida, com redução do número de crises de hipoglicemia, menor número de internações hospitalares, melhor controle metabólico e maior aceitação da doença. Apresenta-se uma proposta de educação em diabetes na forma de colônia de fim de semana associada a educação via internet, através do projeto educacional Diabetes Weekend. Objetiva-se informar e alertar médicos e educadores da área de saúde da importância da educação em forma de colônia de fim de semana na prevenção de complicações agudas e crônicas do diabetes mellitus tipo 1 e seu impacto sobre a qualidade de vida dos pacientes.
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Abstract
AIMS To determine whether intra-individual measures of diabetes control deteriorated through adolescence and whether HbA1c in late childhood was predictive of HbA1c after adolescence. METHODS Retrospective analysis of sequential 3-6 monthly data including HbA1c, height, weight, and total daily insulin dosage in 118 patients with Type 1 diabetes aged between 8.00 and 17.99 years between 1983 and 1999. RESULTS In females mean body mass index (BMI) increased sharply during adolescence but there was no significant increase in males. The mean total daily dose of insulin/weight (TDDI/W) increased sharply for females through puberty. Males exhibited a constant rate of increase in mean TDDI/W from pre- to post-puberty. There was a constant increase in mean HbA1c for females, with an estimated increase from pre- to post-puberty of 0.92%. In males there was only a slight increase from pre- to peri-puberty and no change subsequently. Comparing pre-puberty (8-9.99 years) and post-puberty (15-17.99 years) in the total group, 47% of patients remained in the same mean HbA1c grouping, 37% had worsened control and 16% had improved control. Analysis of change in the absolute value of mean HbA1c showed that the majority of patients had mean HbA1c values that remained within +/- 1% (54%) or +/- 2% (82%) from pre- to post-puberty. A significant proportion showed significantly worsening control with only a minority showing improved metabolic control from pre- to post-puberty. CONCLUSIONS The likelihood of a significant improvement in HbA1c from late childhood to adolescence is remote, with the majority of patients having either constant or deteriorating metabolic control.
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Affiliation(s)
- P Dabadghao
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Melbourne, Australia
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