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Balgobin S, Basak S, Teoh CW, Noone D. Hypertension in diabetes. Pediatr Nephrol 2024; 39:1739-1758. [PMID: 37831122 DOI: 10.1007/s00467-023-06163-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 09/01/2023] [Accepted: 09/01/2023] [Indexed: 10/14/2023]
Abstract
Diabetes mellitus, a disease that affects hundreds of millions of people worldwide, is increasing in prevalence in all age groups, including children and adolescents. Much of the morbidity and mortality associated with diabetes is closely related to hypertension, often coincident with diabetes. Comorbid hypertension and diabetes often worsen the outcomes of each other, likely rooted in some overlapping pathogenic mechanisms. In this educational review, we will discuss the shared pathophysiology of diabetes and hypertension, particularly in regard to inflammation and oxidative stress, the sympathetic nervous system, vascular remodeling, and the renin-angiotensin-aldosterone system (RAAS). We will also review current hypertension diagnosis and management guidelines from many international jurisdictions for both adult and paediatric populations in the setting of diabetes. Many of these guidelines highlight the use and utility of RAAS blockers in this clinical scenario; however, on review of the evidence for their use, several meta-analyses and systematic reviews fail to demonstrate superiority of RAAS blockers over other anti-hypertensive medications. Finally, we discuss several new anti-hypertensive medications, review their mechanisms of action, and highlight some of the evidence for their use in the setting of hypertension and diabetes.
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Affiliation(s)
- Steve Balgobin
- Division of Paediatric Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Sanjukta Basak
- Pediatric Endocrinologist, BC Children's Hospital, Vancouver, BC, Canada
- Division of Endocrinology & Metabolism, Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Chia Wei Teoh
- Division of Paediatric Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Damien Noone
- Division of Paediatric Nephrology, The Hospital for Sick Children, 555 University Avenue, Toronto, M5G 1X8, Canada.
- Department of Paediatrics, University of Toronto, Toronto, Canada.
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Wu X, Wang R, Chen J, Feng G, Wang X, Bai RN, Liang X, Cao B, Gong C, Li W, Sang Y, Wang X, Wu D. Influence of disease course and comprehensive management on blood glucose level in children and adolescents with type 2 diabetes mellitus. J Diabetes Investig 2024. [PMID: 38563225 DOI: 10.1111/jdi.14194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/03/2024] [Accepted: 03/12/2024] [Indexed: 04/04/2024] Open
Abstract
AIMS/INTRODUCTION The aim of the present study was to evaluate the status of glycemic control, and assess the effects of the disease course and comprehensive management measures on the blood glucose level in children and adolescents with type 2 diabetes mellitus. MATERIALS AND METHODS The study collected the clinical data of type 2 diabetes patients in Beijing Children's Hospital from January 2015 to September 2020. Patients were grouped based on the disease course to compare their glycated hemoglobin (HbA1c) level, islet β-cell function, insulin resistance and comprehensive management measures. RESULTS Of the 170 participants, the median disease course was 2.0 years (interquartile range [IQR] 1.0-4.0 years). The baseline HbA1c was 11.2% (IQR 9.2-12.4%). According to the grouping by the disease course, the median HbA1c was the lowest (5.7% [IQR 5.3-6.1%]) in the half-year course group and the highest in the 4-year course group (9.0 [IQR 6.8%-11.3%]). Compared with the group with a disease duration <2 years, patients in the >4 years group had a lower proportion of patients with HbA1c <7% (29.2% vs 66.2%), a lower homeostasis model assessment of β-cell function, and a lower proportion with a controlled diet, moderate-intensity exercise, regular follow up and no drug treatment. We deemed HbA1c as the dependent variable, and found that disease duration, homeostasis model assessment of β-cell function at follow up, continuous moderate-intensity exercise, regular review and treatment regimen were significant influencing factors for glycemic control. CONCLUSIONS Children and adolescents with type 2 diabetes and a prolonged disease course showed poor glycemic control and decreased islet β-cell function. A good lifestyle, especially moderate-intensity exercise, can help such cases better control their blood glucose level.
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Affiliation(s)
- Xiaozhi Wu
- Department of Pediatrics, Beijing Haidian Hospital, Beijing, China
| | - Rui Wang
- Department of Infection Management, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Jiahui Chen
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Guoshuang Feng
- Department of Big Data Center, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Xinyu Wang
- Department of Big Data Center, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Robin N Bai
- Department of Microbiology and Molecular Cell Biology, Eastern Virginia Medical School, Norfolk, Virginia, USA
| | - Xuejun Liang
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Binyan Cao
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Chunxiu Gong
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Wenjing Li
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Yanmei Sang
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Xumei Wang
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
| | - Di Wu
- Department of Endocrinology, Genetics and Metabolism, Beijing Children's Hospital, Capital Medical University, National Children's Medical Center, Beijing, China
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Kostopoulou E. The Interplay Between COVID-19 and Pediatric Endocrine Disorders. What have we Learned After More than Three Years of the Pandemic? Horm Metab Res 2024; 56:181-192. [PMID: 37673081 DOI: 10.1055/a-2152-4590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
As an increased body of COVID-19 related research is now available, it becomes apparent that the effects of COVID-19 extend beyond that of the respiratory system. Among others, the endocrine system is particularly vulnerable to perturbation from the COVID-19 infection. The present scoping review summarizes the bidirectional relationship between COVID-19 and endocrine system in children and adolescents, by describing both the possible susceptibility of children and adolescents without endocrinopathies to endocrine disorders following COVID-19 infection, but also the potential susceptibility to COVID-19 infection and severe infection, or the aggravation of endocrine dysfunction in patients with pre-existing endocrine diseases. Data suggest increased obesity and diabetes rates, as well as increased severity and frequency of diabetic ketoacidosis following COVID-19 infection. Conversely, patients with diabetes and obesity may experience a more severe course of COVID-19 infection. However, in the majority of cases, children and adolescents with well-managed and regulated endocrine disorders do not appear to be at increased risk of infection or severe infection from COVID-19. Thus, adhering to the appropriate "sick day management rules", maintaining adequate supply of medications and supplies, keeping close contact with the therapeutic team and seeking medical help without delay when needed, are the main recommendations for a safe outcome. Additional lessons learnt during the pandemic include the risk for mental health diseases caused by children's disrupted routine due to COVID-19 related protective measures and the importance of adopting alternative communication options, such as telehealth visits, in order to ensure uninterrupted endocrine care.
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Affiliation(s)
- Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University of Patras School of Medicine, Patras, Greece
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Schlarb P, Büttner JM, Tittel SR, Mönkemöller K, Müller-Godeffroy E, Boettcher C, Galler A, Berger G, Brosig B, Holl RW. Family structures and parents' occupational models: its impact on children's diabetes. Acta Diabetol 2024; 61:235-244. [PMID: 37847378 PMCID: PMC10866793 DOI: 10.1007/s00592-023-02187-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 09/15/2023] [Indexed: 10/18/2023]
Abstract
AIMS This study examines how family-related factors influence the management of children and adolescents with type 1 diabetes (T1DM). We investigate the relationship between family patterns, parental work schedules and metabolic control. MATERIALS AND METHODS We analysed data from a nationwide diabetes survey (DPV) focusing on HbA1c, severe hypoglycaemia, diabetic ketoacidosis, hospital admissions and inpatient treatment duration. We used linear regression and negative binomial regression models. Our study includes 15,340 children under the age of 18 with data on family structure and parental division of labour. RESULTS Children from two-parent households have better HbA1c outcomes than children from single-parent, blended or no-parent households (p < .0001). Higher HbA1C levels are associated with children living with an unemployed father, as opposed to those with full-time working parents or with a full-time working father and a part-time working mother (p < .001). CONCLUSIONS These findings emphasise the importance of carefully considering family structure and working time models in the management of paediatric T1DM. Our results highlight risk factors within the family environment and emphasise the need for family-focused counselling of high-risk patients or severe cases in clinical practice.
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Affiliation(s)
- Pauline Schlarb
- Centre of Child and Adolescent Medicine, Division of Family- and Child-Psychosomatics, Justus Liebig University, Klinikstrasse 36, 35392, Giessen, Germany
| | - Janina M Büttner
- Centre of Child and Adolescent Medicine, Division of Family- and Child-Psychosomatics, Justus Liebig University, Klinikstrasse 36, 35392, Giessen, Germany
| | - Sascha R Tittel
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Albert Einstein Alle 41, 89075, Ulm, Germany
- German Centre for Diabetes Research (DZD), Ingolstädter Landstrasse, 185764, Munich-Neuherberg, Germany
| | - Kirsten Mönkemöller
- Department of Pediatric and Adolescent Medicine, Kliniken Der Stadt Köln gGmbH, Amsterdamer Strasse 59, 50735, Cologne, Germany
| | - Esther Müller-Godeffroy
- Department of Pediatric and Adolescent Medicine, University of Luebeck, Ratzeburger Allee 160, 23538, Luebeck, Germany
| | - Claudia Boettcher
- Pediatric Endocrinology and Diabetology, University of Berne, University Children's Hospital, Freiburgstrasse 15, 3010, Berne, Switzerland
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Sozialpädiatrisches Zentrum, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Gabriele Berger
- Department of Paediatrics and Adolescent Medicine, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf, Karl-Aschenbrenner-Gasse 3, 1210, Vienna, Austria
| | - Burkhard Brosig
- Centre of Child and Adolescent Medicine, Division of Family- and Child-Psychosomatics, Justus Liebig University, Klinikstrasse 36, 35392, Giessen, Germany.
| | - Reinhard W Holl
- ZIBMT, Institute of Epidemiology and Medical Biometry, University of Ulm, Albert Einstein Alle 41, 89075, Ulm, Germany
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Julceus EF, Frongillo EA, Mendoza JA, Sauder KA, Malik FS, Jensen ET, Dolan LM, Bellatorre A, Dabelea D, Reboussin BA, Reynolds K, Pihoker C, Liese AD. Self-Reported Food Security in Adolescents with Type 1 Diabetes: Association with Hemoglobin A 1c and Mental Health Symptoms Independent of Household Food Security. J Nutr 2024; 154:543-553. [PMID: 38072157 PMCID: PMC10900134 DOI: 10.1016/j.tjnut.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/17/2023] [Accepted: 12/06/2023] [Indexed: 12/28/2023] Open
Abstract
BACKGROUND Typically, child exposure to food insecurity is assessed by caregiver reports of household food security. Child report has the potential for greater accuracy because it pertains only to the child whose experiences may differ from caregiver reports. OBJECTIVE We assessed if adolescent-reported food insecurity was associated with levels of hemoglobin A1c (HbA1c), acute diabetes-related complications, depressive symptoms, and disordered eating behaviors in adolescents with type 1 diabetes, independently from household food security. METHODS In a cross-sectional analysis of the multicenter SEARCH for Diabetes in Youth Cohort Study (phase 4, 2016-2019) including 601 adolescents aged 10-17 y with type 1 diabetes and their caregivers, household food security, and adolescent-reported food security were assessed using the 18-item Household Food Security Survey Module and the 6-item Child Food Security Assessment questionnaire. Age-stratified (10-13 and 14-17) regression models were performed to estimate independent associations, adjusting for sociodemographics, clinical factors, and household food security. RESULTS Food insecurity was reported by 13.1% (n = 79) of adolescents and 15.6% (n = 94) of caregivers. Among adolescent-caregiver dyads, 82.5% (n = 496) of reports were concordant and 17.5% (n = 105) discordant, Cohen's κ= 0.3. Adolescent-reported food insecurity was not independently associated with HbA1c, diabetic ketoacidosis, and severe hypoglycemia, including in age-stratified analyses. Adolescent-reported food insecurity was independently associated with elevated odds of depressive symptoms [odds ratio (OR): 3.6; 95% confidence interval (CI): 1.3, 10.3] and disordered eating behaviors (OR: 2.5, 95% CI: 1.4, 4.6) compared with adolescents reporting food security; these associations remained in both age groups for disordered eating behaviors and in the older group for depressive symptoms. CONCLUSIONS Adolescents with type 1 diabetes may experience food insecurity differently than caregivers. Adolescent-reported food insecurity was independently associated with depressive symptoms and disordered eating behaviors and thus may be an important attribute to assess in addition to household food security in adolescents with type 1 diabetes.
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Affiliation(s)
- Emmanuel F Julceus
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States
| | - Jason A Mendoza
- Fred Hutch Cancer Center, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Katherine A Sauder
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Elizabeth T Jensen
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Lawrence M Dolan
- Department of Pediatrics, Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD Center), Colorado School of Public Health, Aurora, CO, United States
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, United States
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, United States
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, and Seattle Children's Research Institute, Seattle, WA, United States
| | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, United States.
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Almeida AC, Tavares F, Pereira MG. Metabolic control and quality of life in type 1 diabetes: Do adherence, family support, and school support matter? Nurs Health Sci 2023; 25:456-465. [PMID: 37640532 DOI: 10.1111/nhs.13042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 07/21/2023] [Accepted: 07/25/2023] [Indexed: 08/31/2023]
Abstract
This study analyzed the relationship between clinical and demographic variables, family support, school support, and adherence on adolescents' metabolic control and quality of life (QoL) based on Adaptation to Chronic Disease in Childhood's model. The sample included 100 adolescents and 100 parents. Adolescents were assessed on adherence, family support, school support, and QoL. Parents were assessed on family functioning and parental coping. A path analysis was performed to assess the adequacy of the theoretical model to the sample. Daily glycemic monitoring was associated with better metabolic control and diabetes hospitalizations with worse metabolic control. The final model showed adherence, family support, school support, and family functioning having an indirect effect on the relationship between adolescence stage, number of daily glycemic monitorings, number of hospitalizations, and metabolic control/QoL. Adherence had an indirect effect on the relationship between glycemic monitoring and family and school support, suggesting that adolescents need both types of support to perform diabetes self-care tasks. QoL showed a direct effect on metabolic control revealing the importance of QoL in the design of interventions to promote metabolic control in adolescents.
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Affiliation(s)
- Ana C Almeida
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
| | | | - M Graça Pereira
- Psychology Research Centre (CIPsi), School of Psychology, University of Minho, Braga, Portugal
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Oza C, Khadilkar A, Mondkar S, Amutha A, Uppal S, De H, Ghosh A, Khadilkar V, Mohan V. A Cross-Sectional Multicentre Study to Validate Insulin Sensitivity Index Cut-Offs for Detection of Metabolic Syndrome in Indian Adolescents with Type-1 Diabetes. Indian J Endocrinol Metab 2023; 27:301-306. [PMID: 37867981 PMCID: PMC10586563 DOI: 10.4103/ijem.ijem_411_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 01/21/2023] [Accepted: 02/03/2023] [Indexed: 10/24/2023] Open
Abstract
Background A previous study compared insulin sensitivity indices for the detection of double diabetes (DD) in Indian adolescents with type-1 diabetes (T1D) and derived a cut-off to predict future risk for the development of metabolic syndrome (MS) in adolescents with T1D. We conducted the current study with the aim to validate these cut-offs for detecting DD among Indian subjects with T1D from various geographical locations. Methods This multicentric cross-sectional study included 161 Indian adolescents with T1D. Demographic, anthropometric, clinical, and biochemical data were collected using standard protocols. Insulin sensitivity (IS) was calculated using various equations developed to determine insulin sensitivity in subjects with T1D. Metabolic syndrome was diagnosed using International Diabetes Federation (IDF) Consensus Definition 2017. Results We report 4.3% prevalence of MS in Indian adolescents with T1D with an additional 29.8% of study participants at risk of development of MS. Low High density lipoprotein (HDL) (23.6%) was the commonest abnormal component of the MS definition. Insulin sensitivity calculated by an equation derived by the SEARCH group was the most appropriate index to identify MS and metabolic risk in Indian adolescents with T1D. The proposed cut-off of 5.48 had high specificity, positive predictive value, and negative predictive value in identifying the risk of the development of DD. Conclusions Insulin sensitivity calculated by the equation proposed by the SEARCH group together with cut-offs derived in earlier study may be used effectively to identify risk of development of MS/DD in Indian adolescents with T1D from various geographical locations.
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Affiliation(s)
- Chirantap Oza
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | - Shruti Mondkar
- Department of Growth and Pediatric Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anandakumar Amutha
- Department of Growth and Pediatric Endocrinology, Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
| | - Saurabh Uppal
- Department of Growth and Pediatric Endocrinology, ENDO-KIDZ Growth Diabetes and Hormone Clinic for Children, Jalandhar, Punjab, India
| | - Hriday De
- Department of Pediatrics, Institute of Child Health, Kolkata, West Bengal, India
| | - Apurba Ghosh
- Department of Pediatrics, Institute of Child Health, Kolkata, West Bengal, India
| | - Vaman Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
- Senior Paediatric Endocrinologist, Jehangir Hospital, Pune, Maharashtra, India
| | - Viswanathan Mohan
- Department of Growth and Pediatric Endocrinology, Madras Diabetes Research Foundation and Dr. Mohan’s Diabetes Specialities Centre, Chennai, Tamil Nadu, India
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Diaz-Thomas AM, Golden SH, Dabelea DM, Grimberg A, Magge SN, Safer JD, Shumer DE, Stanford FC. Endocrine Health and Health Care Disparities in the Pediatric and Sexual and Gender Minority Populations: An Endocrine Society Scientific Statement. J Clin Endocrinol Metab 2023; 108:1533-1584. [PMID: 37191578 PMCID: PMC10653187 DOI: 10.1210/clinem/dgad124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Indexed: 05/17/2023]
Abstract
Endocrine care of pediatric and adult patients continues to be plagued by health and health care disparities that are perpetuated by the basic structures of our health systems and research modalities, as well as policies that impact access to care and social determinants of health. This scientific statement expands the Society's 2012 statement by focusing on endocrine disease disparities in the pediatric population and sexual and gender minority populations. These include pediatric and adult lesbian, gay, bisexual, transgender, queer, intersex, and asexual (LGBTQIA) persons. The writing group focused on highly prevalent conditions-growth disorders, puberty, metabolic bone disease, type 1 (T1D) and type 2 (T2D) diabetes mellitus, prediabetes, and obesity. Several important findings emerged. Compared with females and non-White children, non-Hispanic White males are more likely to come to medical attention for short stature. Racially and ethnically diverse populations and males are underrepresented in studies of pubertal development and attainment of peak bone mass, with current norms based on European populations. Like adults, racial and ethnic minority youth suffer a higher burden of disease from obesity, T1D and T2D, and have less access to diabetes treatment technologies and bariatric surgery. LGBTQIA youth and adults also face discrimination and multiple barriers to endocrine care due to pathologizing sexual orientation and gender identity, lack of culturally competent care providers, and policies. Multilevel interventions to address these disparities are required. Inclusion of racial, ethnic, and LGBTQIA populations in longitudinal life course studies is needed to assess growth, puberty, and attainment of peak bone mass. Growth and development charts may need to be adapted to non-European populations. In addition, extension of these studies will be required to understand the clinical and physiologic consequences of interventions to address abnormal development in these populations. Health policies should be recrafted to remove barriers in care for children with obesity and/or diabetes and for LGBTQIA children and adults to facilitate comprehensive access to care, therapeutics, and technological advances. Public health interventions encompassing collection of accurate demographic and social needs data, including the intersection of social determinants of health with health outcomes, and enactment of population health level interventions will be essential tools.
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Affiliation(s)
- Alicia M Diaz-Thomas
- Department of Pediatrics, Division of Endocrinology, University of Tennessee Health Science Center, Memphis, TN 38163, USA
| | - Sherita Hill Golden
- Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Dana M Dabelea
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO 80045, USA
| | - Adda Grimberg
- Department of Pediatrics, Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sheela N Magge
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetes, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Joshua D Safer
- Department of Medicine, Division of Endocrinology, Diabetes, and Bone Disease, Icahn School of Medicine at Mount Sinai, New York, NY 10001, USA
| | - Daniel E Shumer
- Department of Pediatric Endocrinology, C.S. Mott Children's Hospital, University of Michigan School of Medicine, Ann Arbor, MI 48109, USA
| | - Fatima Cody Stanford
- Massachusetts General Hospital, Department of Medicine-Division of Endocrinology-Neuroendocrine, Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA 02114, USA
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Manfredo J, Lin T, Gupta R, Abiola K, West M, Busin K, Tracey J, Brown EA, Magge SN, Wolf RM. Short-term use of CGM in youth onset type 2 diabetes is associated with behavioral modifications. Front Endocrinol (Lausanne) 2023; 14:1182260. [PMID: 37313442 PMCID: PMC10258317 DOI: 10.3389/fendo.2023.1182260] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/10/2023] [Indexed: 06/15/2023] Open
Abstract
Background Continuous glucose monitoring (CGM) is beneficial to glycemic control in youth with type 1 diabetes (T1D) and adults with type 2 diabetes (T2D); however, studies in youth with T2D are limited. Objective Determine if 10-day trial CGM use in youth with T2D improves glycemic control and behavioral modifications. Methods Youth with T2D > 3 months, on insulin, with no prior CGM use were enrolled. Staff placed CGM and provided education. Participants received 5-day and 10-day follow-up phone calls to review CGM data, behavioral modifications, and adjust insulin doses as needed. We compared 5-day to 10-day TIR, and baseline to 3-6 month HbA1c via paired t-test. Results Participants (n=41) had median age of 16.2 y, were 61% female, 81% NH Black, median diabetes duration of 0.8 y, and baseline HbA1c of 10.3%. A majority had household income<$50,000 (81%) and parental education level of HS or less (73%). Average 5-day TIR 49% was similar to 10-day TIR 51% (p=0.62). There was no change in HbA1c after 3-6 months (10.2% v 10.3%, p=0.89). Nineteen participants completed full 10-day CGM use; of those, 84% wanted a CGM long-term. Adolescents reported behavioral changes including increased blood sugar checks, increased insulin administration and overall improved diabetes management. Conclusion Although 10-day CGM use did not impact short-term or long-term glycemic control in youth with T2D, most participants reported behavioral changes and wanted to continue using CGM. Future studies with longer use of CGM may clarify the potential impact of CGM in youth with T2D.
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Antani M, Oza C, Khadilkar V, Gondhalekar K, Khadilkar A. Utility of apolipoprotein ratio in predicting metabolic risk and microvascular complications in Indian children and young adults with type 1 diabetes mellitus. J Pediatr Endocrinol Metab 2023:jpem-2022-0403. [PMID: 37141397 DOI: 10.1515/jpem-2022-0403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 04/17/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVES To assess the relationship of apolipoproteins with glycemic control and insulin resistance (IR) in Indian children and youth with type-1 diabetes (T1D) and to assess its utility in predicting metabolic risk (MR) and microvascular complications in these subjects. METHODS This cross-sectional study included 152 participants aged 6-23 years with T1D. Demographic, anthropometric, clinical, biochemical and body composition data were obtained using standard protocols. IR was calculated using estimated glucose disposal rate (eGDR) and metabolic syndrome (MS) was diagnosed using the international diabetes federation consensus definition 2017. RESULTS Apolipoprotein ratio in subjects with T1D had negative and positive correlation with eGDR and HbA1c respectively. Positive correlation of Apolipoproten B and apolipoprotein ratio with urinary albumin creatinine ratio is noted. The ratio had area under curve of 0.766 and 0.737 to predict MR and microvascular complications respectively. The ratio cut-off of 0.536 yielded 77.1 % sensitivity and 61 % specificity to predict MR. On adding the apolipoprotein ratio as a predictor to the regression model developed to predict MR, the R2 and accuracy improved. CONCLUSIONS The apolipoprotein ratio had significant correlation with IR, microalbuminuria and glycaemic control. The ratio also predicts risk of development of microvascular complications and maybe used to predict MR in subjects with T1D.
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Affiliation(s)
- Misha Antani
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Vaman Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
- Senior Paediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | | | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Khadilkar AV, Oza C, Mondkar SA, Khadilkar V, Kanungo A, Sethi BK, Kumar KMP, Tandon N, Rao PV, Kumar S, Bandgar TR, Raghupathy P. Nutritional Status of Underprivileged Indian Children and Youth with Type-1 Diabetes - A Multicentre Study. Indian J Endocrinol Metab 2023; 27:216-222. [PMID: 37583405 PMCID: PMC10424112 DOI: 10.4103/ijem.ijem_224_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 08/17/2023] Open
Abstract
Background India has the highest number of prevalent type-1 diabetes (T1D) cases in the under-20-year age population. Data on the anthropometry of underprivileged Indian children with T1D are scarce. In economically disadvantaged countries like India, poor growth in patients with T1D is a major concern due to limited accessibility and affordability. Besides, due to the double burden of malnutrition, the prevalence of obesity is increasing mirroring the global trends, which may lead to the development of insulin resistance. Objectives This study aims to assess the prevalence of malnutrition in Indian children and youth with T1D and to identify the determinants of short stature. Methods A registry-based cross-sectional analysis of data collected from various centres across India enrolled in the Changing Diabetes in Children (CDiC) programme. Results We observed that 6.4% were undernourished (3.4% severe undernutrition) and 17.7% (overweight 13.2%) had combined overweight/obesity. 21.2% of participants had short stature (adjusted for mid-parental height) with 7.4% cases of familial short stature. Longer duration of illness and insulin requirement were significant positive predictors of short stature while glycaemic control, insulin regimen and mid-parental height did not have a significant relationship with short stature. Participants on basal-bolus regimen had significantly higher insulin requirements and better glycaemic control than the ones on mixed-split regimen. Conclusion We report that around one-fifth of children and youth with T1D were overweight/obese and around a fourth were stunted, especially those with longer duration of diabetes and higher insulin requirements. Close monitoring of anthropometric parameters is necessary for all children with T1D to optimize growth and nutrition.
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Affiliation(s)
- Anuradha V. Khadilkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, Odisha, India
| | - Chirantap Oza
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India
| | - Shruti A. Mondkar
- Department of Growth and Endocrinology, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, Odisha, India
| | - Vaman Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, Odisha, India
- Department of Paediatric Endocrinology, Senior Paediatric Endocrinologist, Jehangir Hospital, Pune, Maharashtra, Odisha, India
| | - Alok Kanungo
- Department of Pediatric Endocrinology, Kanungo Institute of Diabetes Specialties, 1120, Dumduma, Bhubhaneswar, Odisha, India
| | - Bipin K. Sethi
- Department of Endocrinology – Tapadia Diagnostics, Hyderabad, Telangana, India
| | - KM Prasanna Kumar
- Department of Endocrinology, Centre for Diabetes and Endocrine Care, Bengaluru, Karnataka, India
| | - Nikhil Tandon
- Department of Endocrinology, All India Institute of Medical Sciences, Delhi, India
| | - P V Rao
- Diabetes Research Society, Hyderabad, Telangana, India
| | - Surendra Kumar
- Department of Endocrinology, Patna Medical College, Patna, Bihar, India
| | - Tushar R. Bandgar
- Department of Endocrinology, Seth G S Medical College and KEM Hospital, Parel, Mumbai, Maharashtra, India
| | - Palany Raghupathy
- Department of Pediatric Endocrinology, Paediatric and Adolescent Endocrinology Division, Indira Gandhi Institute of Child Health, Bengaluru, Karnataka, India
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Kirkendall ES, Brady PW, Corathers SD, Ruddy RM, Fox C, Nelson H, Wetterneck TB, Rodgers I, Walsh KE. Safer Type 1 Diabetes Care at Home: SEIPS-based Process Mapping with Parents and Clinicians. Pediatr Qual Saf 2023; 8:e649. [PMID: 38571735 PMCID: PMC10990404 DOI: 10.1097/pq9.0000000000000649] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 04/02/2023] [Indexed: 04/05/2024] Open
Abstract
Introduction The limited data indicate that pediatric medical errors in the outpatient setting, including at home, are common. This study is the first step of our Ambulatory Pediatric Patient Safety Learning Lab to address medication errors and treatment delays among children with T1D in the outpatient setting. We aimed to identify failures and potential solutions associated with medication errors and treatment delays among outpatient children with T1D. Methods A transdisciplinary team of parents, safety researchers, and clinicians used Systems Engineering Initiative for Patient Safety (SEIPS) based process mapping of data we collected through in-home medication review, observation of administration, chart reviews, parent surveys, and failure modes and effects analysis (FMEA). Results Eight (57%) of the 14 children who had home visits experienced 18 errors (31 per 100 medications). Four errors in two children resulted in harm, and 13 had the potential for harm. Two injuries occurred when parents failed to treat severe hypoglycemia and lethargy, and two were due to repeated failures to administer insulin at home properly. In SEIPS-based process maps, high-risk errors occurred during communication between the clinic and home or in management at home. Two FMEAs identified interventions to better communicate with families and support home care, especially during evolving illness. Conclusion Using SEIPS-based process maps informed by multimodal methods to identify medication errors and treatment delays, we found errors were common. Better support for managing acute illness at home and improved communication between the clinic and home are potentially high-yield interventions.
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Affiliation(s)
- Eric S. Kirkendall
- From the Center for Healthcare Innovation, Wake Forest University School of Medicine, Winston-Salem, N.C
- Center for Biomedical Informatics, Wake Forest University School of Medicine, Winston-Salem, N.C
- Department of Pediatrics, Wake Forest University School of Medicine, Winston-Salem, N.C
| | - Patrick W. Brady
- Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Sarah D. Corathers
- James M. Anderson Center of Health Systems Excellence, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Richard M. Ruddy
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Catherine Fox
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Hailee Nelson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Tosha B. Wetterneck
- Department of Medicine, Division of General Internal Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Isabelle Rodgers
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
| | - Kathleen E. Walsh
- Division of General Pediatrics, Harvard Medical School, Boston, Mass
- Department of Pediatrics, Boston Children’s Hospital, Boston, Mass
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Stanley JR, Clarke ABM, Shulman R, Mahmud FH. Mediating Effects of Technology-Based Therapy on the Relationship Between Socioeconomic Status and Glycemic Management in Pediatric Type 1 Diabetes. Diabetes Technol Ther 2023; 25:186-193. [PMID: 36409503 DOI: 10.1089/dia.2022.0388] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Socioeconomic disparities exist related to accessibility and uptake of diabetes technologies that impact glycemic management. The aims of this study were to describe diabetes technology use (continuous subcutaneous insulin infusion [CSII] and continuous glucose monitoring [CGM]) in children with type 1 diabetes (T1D) and assess the mediating effects of each technology on the relationship between socioeconomic status (SES) and glycemic management. Methods: Single-center retrospective cross-sectional study of children aged 0-18 years (n = 813) with T1D and valid postal codes between 2018 and 2020. Extracted data were linked to validated census-based material deprivation (MD) quintiles. Exposures included MD and technology use (CSII, CGM), whereas the primary outcome was glycemic management (HbA1c). Results: Of 813 patients included, 379 (46.6%) and 246 (30.3%) individuals used CGM and CSII, respectively. Real-time CGM (rtCGM) and CSII were associated with both MD and HbA1c, but intermittently scanned CGM (isCGM) was not. There was a difference in HbA1c of +1.17% between patients from the most (Q5) and least deprived (Q1) MD quintile (P < 0.0001), and significant mediating effects for rtCGM and CSII use, but not isCGM. rtCGM use and CSII use accounted for 0.14% (P < 0.0001) and 0.25% (P < 0.0001) of the difference in HbA1c between patients from Q1 and Q5 quintiles (indirect effects), representing 12.0% and 23.1% of this difference, respectively. Conclusions: CSII and rtCGM use partially mediated the significant discrepancies observed with SES and glycemic management, highlighting potential benefits of broader access to these technologies to improve diabetes outcomes and help mitigate the negative impact of deprivation on diabetes management.
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Affiliation(s)
- Joshua R Stanley
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Antoine B M Clarke
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
| | - Rayzel Shulman
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada
- Department of Pediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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14
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Maahs DM, Prahalad P, Schweiger DŠ, Shalitin S. Diabetes Technology and Therapy in the Pediatric Age Group. Diabetes Technol Ther 2023; 25:S118-S145. [PMID: 36802194 DOI: 10.1089/dia.2023.2508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Affiliation(s)
- David M Maahs
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
- Department of Health Research and Policy (Epidemiology), Stanford University, Stanford, CA, USA
| | - Priya Prahalad
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford University, Stanford, CA, USA
| | - Darja Šmigoc Schweiger
- University Medical Center-University Children's Hospital Ljubljana, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Shlomit Shalitin
- Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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15
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Oza C, Khadilkar A, Mondkar SA, Gondhalekar K, Khadilkar V. Longitudinal trends in lipid profile in indian children and youth with type-1 diabetes: a 5-year follow up from a single centre. Endocrine 2023; 79:313-322. [PMID: 36414859 DOI: 10.1007/s12020-022-03259-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 11/08/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION High prevalence of dyslipidaemia in children and adolescents with type-1 diabetes (T1D) places them at increased risk of developing atherosclerosis leading to mortality caused by cardiovascular disease(CVD). Thus, screening for fasting blood lipids when diabetes is stabilized in children aged 11 years and above is routinely recommended with follow-up every 5 years. OBJECTIVES (1) To characterize the lipid profile of children and adolescents with respect to diabetes duration. (2) To describe longitudinal changes in lipid profile over a 5-year period in patients with T1D. METHODS This longitudinal 5-year follow-up study included 112 patients with T1D aged 3-18 years. Demographic data, anthropometry and laboratory measurements were performed using standard protocols at baseline and endline. P value < 0.05 was considered significant. RESULTS The prevalence of dyslipidaemia in our study was 49.5% with abnormal LDL as the most frequently deranged parameter. Duration of illness played a major role in deterioration of lipid profile mediated by triglyceride and VLDL. Duration of illness and fibre intake in diet significantly predicted the change in lipid profile which were driven by triglycerides and VLDL. Glycemic control, insulin sensitivity and serum TSH also significantly altered components of lipid profile with no impact on overall dyslipidaemia. A total of 6.5% subjects had LDL concentrations >130 mg/dl and the same proportion had non-HDL cholesterol concentrations >145 mg/dl at baseline while at endline, 11.9% subjects had LDL concentrations >130 mg/dl and 15.6% subjects had non-HDL cholesterol concentrations >145 mg/dl. 28.6% subjects with LDL > 130 mg/dl and non-HDL cholesterol >145 mg/dl at baseline had persistently elevated concentrations while 10.3% and 14.4% additional subjects developed elevated LDL and non-HDL cholesterol concentrations respectively during the study period. CONCLUSIONS The deterioration of lipid profile in T1D, due to increase in disease duration was chiefly mediated by increase in serum triglyceride and VLDL concentrations which may be prevented by improving glycaemic control, insulin sensitivity and fibre intake in diet.
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Affiliation(s)
- Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Senior Paediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, India.
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
| | - Shruti A Mondkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | | | - Vaman Khadilkar
- Senior Paediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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16
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Antani M, Pargaonkar Y, Oza C, Mondkar SA, Khadilkar V, Gondhalekar K, Khadilkar A. Triple burden of malnutrition and role of anaemia in the development of complications associated with type 1 diabetes in Indian children and youth. J Pediatr Endocrinol Metab 2022; 35:1464-1473. [PMID: 36284507 DOI: 10.1515/jpem-2022-0327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Accepted: 10/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The double burden of malnutrition accompanied by micronutrient deficiency is referred to as the triple burden of malnutrition (TBM). Very few studies have highlighted the TBM in children with type-1 diabetes. We conducted this study with the objective of estimating the TBM in Indian children and youth with type-1 diabetes (T1D) and to study role of anaemia in the development of complications associated with T1D. METHODS This cross-sectional observational study included 394 subjects with T1D. Demographic data, anthropometry, blood pressure, biochemical measurements, dual energy X-ray absorptiometry (DXA) and peripheral quantitative computed tomography were performed using standard protocols. Estimated glucose disposal rate (eGDR) and estimated glomerular filtration rate (eGFR) were calculated for all subjects. RESULTS We report a 16, 5.8, and 16.2% prevalence of anaemia, underweight and overweight/obese suggesting TBM with microcytic hypochromic anaemia as the most common morphological form. Haemoglobin concentrations showed positive correlation with systolic and diastolic blood pressure. The presence of anaemia was a significant predictor of eGDR and macrovascular complications in T1D which could not be attributed to glycemic control. Bone health of anaemic T1D subjects was poor than subjects without anaemia on DXA scan after adjusting for confounders. No systematic pattern between Hb concentrations and eGFR or ACR was found. CONCLUSIONS TBM in Indian children and youth with T1D is a significant health problem and anaemia is an important predictor in the development of macrovascular complications and poor bone health associated with T1D. However, its role in development of microvascular complications remains to be explored.
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Affiliation(s)
- Misha Antani
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Yash Pargaonkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Shruti A Mondkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Vaman Khadilkar
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.,India Senior Paediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Pune, India
| | | | - Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India.,Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
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Snyder LL, Foland-Ross LC, Cato A, Reiss AL, Shah C, Hossain J, Elmufti H, Nelly Mauras. Impact of dysglycemia and obesity on the brain in adolescents with and without type 2 diabetes: A pilot study. Pediatr Diabetes 2022; 23:1674-1686. [PMID: 36131363 DOI: 10.1111/pedi.13420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/04/2022] [Accepted: 09/17/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE Both diabetes and obesity can affect the brain, yet their impact is not well characterized in children with type 2 (T2) diabetes and obesity. This pilot study aims to explore differences in brain function and cognition in adolescents with T2 diabetes and obesity and nondiabetic controls with obesity and lean controls. RESEARCH DESIGN AND METHODS Participants were 12-17 years old (5 T2 diabetes with obesity [mean HgbA1C 10.9%], 6 nondiabetic controls with obesity and 10 lean controls). Functional MRI (FMRI) during hyperglycemic/euglycemic clamps was performed in the T2 diabetes group. RESULTS When children with obesity, with and without diabetes, were grouped (mean BMI 98.8%), cognitive scores were lower than lean controls (BMI 58.4%) on verbal, full scale, and performance IQ, visual-spatial and executive function tests. Lower scores correlated with adiposity and insulin resistance but not HgbA1C. No significant brain activation differences during task based and resting state FMRI were noted between children with obesity (with or without diabetes) and lean controls, but a notable effect size for the visual-spatial working memory task and resting state was observed. CONCLUSIONS In conclusion, our pilot study suggests that obesity, insulin resistance, and dysglycemia may contribute to relatively poorer cognitive function in adolescents with T2 diabetes and obesity. Further studies with larger sample size are needed to assess if cognitive decline in children with obesity, with and without T2 diabetes, can be prevented or reversed.
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Affiliation(s)
- Lydia L Snyder
- Nemours Children's Health, Pediatric Endocrinology, Jacksonville, Florida, USA
| | - Lara C Foland-Ross
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California, USA
| | - Allison Cato
- Nemours Children's Health, Pediatric Neuropsychology, Jacksonville, Florida, USA
| | - Allan L Reiss
- Center for Interdisciplinary Brain Sciences Research, Stanford University, Stanford, California, USA
| | - Chetan Shah
- Nemours Children's Health, Pediatric Neuroradiology, Jacksonville, Florida, USA
| | - Jobayer Hossain
- Nemours Children's Health, Nemours Biomedical Research, Biostatistics Core, Wilmington, Delaware, USA
| | - Hussein Elmufti
- Nemours Children's Health, Pediatric Endocrinology, Jacksonville, Florida, USA
| | - Nelly Mauras
- Nemours Children's Health, Pediatric Endocrinology, Jacksonville, Florida, USA
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Reid LA, Mendoza JA, Merchant AT, Geraci M, Reboussin BA, Malik FS, Ellyson AM, Dabelea D, Merjaneh L, Marcovina SM, Lustigova E, Lawrence JM, Liese AD. Household food insecurity is associated with diabetic ketoacidosis but not severe hypoglycemia or glycemic control in youth and young adults with youth-onset type 2 diabetes. Pediatr Diabetes 2022; 23:982-990. [PMID: 35752872 PMCID: PMC9588511 DOI: 10.1111/pedi.13386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Revised: 05/24/2022] [Accepted: 06/13/2022] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE To examine the association between household food insecurity (HFI), glycemic control, severe hypoglycemia and diabetic ketoacidosis (DKA) among youth and young adults (YYA) with youth-onset type 2 diabetes. RESEARCH DESIGN AND METHODS This cross-sectional study included 395 YYA with type 2 diabetes from the SEARCH for Diabetes in Youth Study (2015-2019). HFI was reported by young adult participants or parents of minor participants via the US Household Food Security Survey Module. Glycemic control was assessed by HbA1c and analyzed as a continuous and categorical variable (optimal: <7.0%, suboptimal: ≥7.0%-9.0%, poor: >9.0%). Acute complications included self-reported severe hypoglycemia or DKA in the last 12 months. Adjusted logistic and linear regression were used for binary and continuous outcomes, respectively. RESULTS Approximately 31% reported HFI in the past 12 months. Mean HbA1c among those with HFI was 9.2% compared to 9.5% without HFI. Of those with HFI, 56% had an HbA1c >9.0% compared to 55% without HFI. Adjusted models showed no associations between HFI and glycemic control. Of those with HFI, 14.4% reported experiencing DKA and 4.7% reported severe hypoglycemia. YYA with HFI had 3.08 times (95% CI: 1.18-8.06) the odds of experiencing DKA as those without HFI. There was no association between HFI and severe hypoglycemia. CONCLUSIONS HFI was associated with markedly increased odds of DKA but not with glycemic control or severe hypoglycemia. Future research among YYA with type 2 diabetes should evaluate longitudinally whether alleviating HFI reduces DKA.
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Affiliation(s)
- Lauren A. Reid
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Jason A. Mendoza
- Center for Child Health, Behavior and DevelopmentSeattle Children's Research InstituteSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA,Fred Hutchinson Cancer Research CenterSeattleWashingtonUSA
| | - Anwar T. Merchant
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - Marco Geraci
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA,School of EconomicsSapienza University of RomeRomeItaly
| | - Beth A. Reboussin
- Department of Biostatistics and Data SciencesWake Forest School of MedicineWinston SalemNorth CarolinaUSA
| | - Faisal S. Malik
- Center for Child Health, Behavior and DevelopmentSeattle Children's Research InstituteSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Alice M. Ellyson
- Center for Child Health, Behavior and DevelopmentSeattle Children's Research InstituteSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Dana Dabelea
- Department of EpidemiologyUniversity of Colorado School of MedicineAuroraColoradoUSA
| | - Lina Merjaneh
- Center for Child Health, Behavior and DevelopmentSeattle Children's Research InstituteSeattleWashingtonUSA,Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | | | - Eva Lustigova
- Department of PediatricsUniversity of WashingtonSeattleWashingtonUSA
| | - Jean M. Lawrence
- Division of Epidemiologic Research, Department of Research & EvaluationKaiser Permanente Southern CaliforniaPasadenaCaliforniaUSA
| | - Angela D. Liese
- Department of Epidemiology and BiostatisticsUniversity of South CarolinaColumbiaSouth CarolinaUSA
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Schmidt M, Lu J, Luo W, Cheng L, Lee M, Huang R, Weng Y, Kichler JC, Corathers SD, Jacobsen LM, Albanese-O′Neill A, Smith L, Westen S, Gutierrez-Colina AM, Heckaman L, Wetter SE, Driscoll KA, Modi A. Learning experience design of an mHealth self-management intervention for adolescents with type 1 diabetes. Educ Technol Res Dev 2022; 70:2171-2209. [PMID: 36278247 PMCID: PMC9580427 DOI: 10.1007/s11423-022-10160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. This approach applied design thinking methods within a Successive Approximation Model design process. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions.
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Affiliation(s)
- Matthew Schmidt
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Jie Lu
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Wenjing Luo
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Li Cheng
- Worcester Polytechnic Institute, Worcester, USA
| | - Minyoung Lee
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Rui Huang
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Yueqi Weng
- College of Education, Purdue University, West Lafayette, USA
| | | | - Sarah D. Corathers
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | | | | | - Laura Smith
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | | | - Leah Heckaman
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sara E. Wetter
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Kimberly A. Driscoll
- University of Florida Diabetes Institute, Gainesville, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Avani Modi
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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20
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Tilden DR, French B, Shoemaker AH, Corathers S, Jaser SS. Prolonged lapses between pediatric and adult care are associated with rise in HbA1c and inpatient days among patients with type 1 diabetes. Diabetes Res Clin Pract 2022; 192:110113. [PMID: 36208847 PMCID: PMC9867942 DOI: 10.1016/j.diabres.2022.110113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
AIM To quantify the association between the duration of the pediatric-to-adult care transfer with glycemic control among patients with type 1 diabetes (T1D). METHODS This retrospective cohort study included patients with T1D who completed transfer between pediatric and adult diabetes clinics at a single academic medical center between 2004 and 2020. The primary exposure was time from the last pediatric to first adult diabetes care encounter. The primary outcome was the average HbA1c in the first year after entry into adult care. RESULTS A total of 449 patients (mean age at transfer 19.8yrs, 51.7 % male) were included for analysis. Transfer required a median of nearly 5 months (196 days; IQR:93-251) and in adjusted and unadjusted models was strongly associated with increased HbA1c within 1 year of transfer (0.19 %, 2 mmol/mol; 95 %CI:0.04 %-0.33 %) for each 6 months of latency. In secondary analyses, transfer latency also exhibited a significant association with days spent hospitalized (IRR 1.23 per 6 months; 95 %CI:1.08-1.33). CONCLUSIONS Our findings isolate and quantify the impact of prolonged lapses in care associated with the pediatric-to-adult care transfer. These findings underscore the need for providers and healthcare systems to improve this care transition in order to improve outcomes for this vulnerable patient population.
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Affiliation(s)
- Daniel R Tilden
- Division of Endocrinology, Diabetes, and Clinical Pharmacology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ashley H Shoemaker
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
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21
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Valenzuela JM, Dimentstein K, Yee S, Pan B, Snyder MC, Wolf RM. Psychosocial Impact of the COVID-19 Pandemic in Racially/Ethnically Diverse Youth With Diabetes. J Pediatr Psychol 2022; 48:17-28. [PMID: 36137256 PMCID: PMC9673468 DOI: 10.1093/jpepsy/jsac070] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE This study examined caregiver perceived impact of the Coronavirus Disease 2019 (COVID-19) pandemic on a diverse sample of U.S. youth with diabetes and their families. METHODS Caregivers of youth with diabetes completed an electronic survey in English or Spanish at two sites. Participants provided demographic and disease characteristics and completed the COVID-19 Exposure and Family Impact Scales (CEFIS). Glycemic health was assessed via Hemoglobin A1c (HbA1c) from medical chart review. Analysis of variance and analyses of covariance were utilized to examine racial/ethnic differences in glycemic health and in COVID-19 Exposure, Impact, and Distress scales. Hierarchical linear regression was conducted to predict HbA1c. Thematic analysis was conducted on open-ended responses regarding the effects of COVID-19 on youth and families' overall and diabetes-related well-being. RESULTS Caregivers (n = 114) of youth with diabetes (M = 12.6 ± 3.5 years) completed study measures. Mean HbA1c for Non-Hispanic White youth was lowest and significantly different from Hispanic and Non-Hispanic Black youth. Exposure to COVID-19 stressors differed by race/ethnicity (p < .05) with Hispanic caregivers reporting greatest exposure. CEFIS scales did not predict HbA1c after controlling for demographic/disease variables. Caregivers described child/family changes during COVID (e.g., more time together, health-related hypervigilance), as well as differences in diabetes management during COVID-19. CONCLUSIONS Findings indicate differences in COVID-19 exposure but did not demonstrate other racial/ethnic disparities in COVID-19 impact or distress. Household income was the most important predictor of glycemic health. Addressing structural inequalities experienced by youth with diabetes and their families is critical. Recommendations to support families with diabetes are made.
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Affiliation(s)
- Jessica M Valenzuela
- All correspondence concerning this article should be addressed to
Jessica M. Valenzuela, PhD, College of Psychology, Department of Clinical & School
Psychology, Nova Southeastern University, 3301 College Avenue, Fort Lauderdale, FL 33314,
USA. E-mail:
| | - Karen Dimentstein
- College of Psychology, Department of Clinical & School Psychology, Nova
Southeastern University, USA
| | - Shanique Yee
- College of Psychology, Department of Clinical & School Psychology, Nova
Southeastern University, USA
| | - Bernard Pan
- Division of Pediatric Endocrinology, Johns Hopkins School of
Medicine, USA
| | - Meg C Snyder
- Division of Pediatric Endocrinology, Johns Hopkins School of
Medicine, USA,Department of Behavioral Psychology, Kennedy Krieger
Institute, USA
| | - Risa M Wolf
- Division of Pediatric Endocrinology, Johns Hopkins School of
Medicine, USA
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22
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Alassaf A, Gharaibeh L, Odeh R, Ibrahim S, Ajlouni K. Predictors of glycemic control in children and adolescents with type 1 diabetes at 12 months after diagnosis. Pediatr Diabetes 2022; 23:729-735. [PMID: 35393709 DOI: 10.1111/pedi.13342] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/03/2022] [Accepted: 04/05/2022] [Indexed: 11/28/2022] Open
Abstract
Identifying risk factors for suboptimal glycemic control during the first year after diagnosis with type 1 diabetes (T1D) may provide early appropriate and individualized management. Our aim was to study possible predictors of early glycemic control during the first year after diagnosis with T1D in children and adolescents in Jordan. This is a retrospective study conducted through a review of medical records at Jordan University Hospital and the National Centre for Diabetes, Endocrinology and Genetics. Children and adolescents diagnosed with T1D at age younger than 16 years and with diabetes duration of at least 2 years were included. Demographic, clinical and socioeconomic factors were collected, in addition to glycosylated hemoglobin (HbA1c) values during the first year after diagnosis. Average age at diagnosis of the 337 patients who were enrolled in the study was 7.7 ± 3.8 years. HbA1c at diagnosis was 10.9 ± 1.9% (95.64 ± 20.76 mmol/mol). Factors such as the involvement of children's mothers in deciding insulin doses, higher mother's educational level and higher family monthly income were associated with better early glycemic control. HbA1c at 6 months after diagnosis, parental marital status and compliance to counting carbohydrates were significant predictors of glycemic control at 12 months after diagnosis. Many clinical and socioeconomic factors were associated with early glycemic control at 12 months after diagnosis. Modifiable risk factors must be addressed as early as possible to decrease future complications. Children with nonmodifiable risk factors should be identified early for closer observation and providing individualized diabetes care plan.
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Affiliation(s)
- Abeer Alassaf
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Lobna Gharaibeh
- Pharmacological and Diagnostic Research Center, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Rasha Odeh
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Sarah Ibrahim
- Department of Pediatrics, University of Jordan, Amman, Jordan
| | - Kamel Ajlouni
- The National Center (Institute) for Diabetes, Endocrinology and Genetics (NCDEG), University of Jordan, Amman, Jordan
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23
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Addison J, Razzaghi H, Bailey C, Dickinson K, Corathers SD, Hartley DM, Utidjian L, Carle AC, Rhodes ET, Alonso GT, Haller MJ, Gannon AW, Indyk JA, Arbeláez AM, Shenkman E, Forrest CB, Eckrich D, Magnusen B, Davies SD, Walsh KE. Testing an Automated Approach to Identify Variation in Outcomes among Children with Type 1 Diabetes across Multiple Sites. Pediatr Qual Saf 2022; 7:e602. [PMID: 38584961 PMCID: PMC10997286 DOI: 10.1097/pq9.0000000000000602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/21/2022] [Indexed: 11/26/2022] Open
Abstract
Introduction Efficient methods to obtain and benchmark national data are needed to improve comparative quality assessment for children with type 1 diabetes (T1D). PCORnet is a network of clinical data research networks whose infrastructure includes standardization to a Common Data Model (CDM) incorporating electronic health record (EHR)-derived data across multiple clinical institutions. The study aimed to determine the feasibility of the automated use of EHR data to assess comparative quality for T1D. Methods In two PCORnet networks, PEDSnet and OneFlorida, the study assessed measures of glycemic control, diabetic ketoacidosis admissions, and clinic visits in 2016-2018 among youth 0-20 years of age. The study team developed measure EHR-based specifications, identified institution-specific rates using data stored in the CDM, and assessed agreement with manual chart review. Results Among 9,740 youth with T1D across 12 institutions, one quarter (26%) had two or more measures of A1c greater than 9% annually (min 5%, max 47%). The median A1c was 8.5% (min site 7.9, max site 10.2). Overall, 4% were hospitalized for diabetic ketoacidosis (min 2%, max 8%). The predictive value of the PCORnet CDM was >75% for all measures and >90% for three measures. Conclusions Using EHR-derived data to assess comparative quality for T1D is a valid, efficient, and reliable data collection tool for measuring T1D care and outcomes. Wide variations across institutions were observed, and even the best-performing institutions often failed to achieve the American Diabetes Association HbA1C goals (<7.5%).
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Affiliation(s)
- Jessica Addison
- From the Division of Adolescent and Young Adult Medicine, Boston Children’s Hospital, Boston, Mass
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pa
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pa
| | - Charles Bailey
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pa
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pa
| | - Kimberley Dickinson
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pa
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pa
| | - Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - David M. Hartley
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | - Levon Utidjian
- Applied Clinical Research Center, Children’s Hospital of Philadelphia, Philadelphia, Pa
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Pa
| | - Adam C. Carle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children’s Hospital, Cincinnati, Ohio
- Department of Psychology, College of Arts and Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Erinn T. Rhodes
- Division of Endocrinology, Boston Children’s Hospital, Boston, Mass
- Department of Pediatrics, Harvard Medical School, Boston, Mass
| | - G. Todd Alonso
- University of Colorado Anschutz Medical Campus, Barbara Davis Center, Aurora, Colo
| | | | | | - Justin A. Indyk
- Section of Endocrinology, Nationwide Children’s Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
| | - Ana Maria Arbeláez
- Washington University in St. Louis, St. Louis, Mo
- St. Louis Children’s Hospital, St. Louis, Mo
| | - Elizabeth Shenkman
- University of Florida, College of Medicine, Department of Health Outcomes and Biomedical Informatics, Gainesville, Fla
| | | | | | | | - Sara Deakyne Davies
- University of Colorado Anschutz Medical Campus, Barbara Davis Center, Aurora, Colo
| | - Kathleen E. Walsh
- Department of Pediatrics, Harvard Medical School, Boston, Mass
- Division of General Pediatrics, Boston Children’s Hospital, Boston, Mass
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24
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Redondo MJ, Gignoux CR, Dabelea D, Hagopian WA, Onengut-Gumuscu S, Oram RA, Rich SS. Type 1 diabetes in diverse ancestries and the use of genetic risk scores. Lancet Diabetes Endocrinol 2022; 10:597-608. [PMID: 35724677 PMCID: PMC10024251 DOI: 10.1016/s2213-8587(22)00159-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/16/2022] [Accepted: 05/06/2022] [Indexed: 02/06/2023]
Abstract
Over 75 genetic loci within and outside of the HLA region influence type 1 diabetes risk. Genetic risk scores (GRS), which facilitate the integration of complex genetic information, have been developed in type 1 diabetes and incorporated into models and algorithms for classification, prognosis, and prediction of disease and response to preventive and therapeutic interventions. However, the development and validation of GRS across different ancestries is still emerging, as is knowledge on type 1 diabetes genetics in populations of diverse genetic ancestries. In this Review, we provide a summary of the current evidence on the evolutionary genetic variation in type 1 diabetes and the racial and ethnic differences in type 1 diabetes epidemiology, clinical characteristics, and preclinical course. We also discuss the influence of genetics on type 1 diabetes with differences across ancestries and the development and validation of GRS in various populations.
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Affiliation(s)
- Maria J Redondo
- Division of Diabetes and Endocrinology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
| | - Christopher R Gignoux
- Department of Medicine and Colorado Center for Personalized Medicine, Anschutz Medical Campus, University of Colorado, Aurora, CO, USA
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - William A Hagopian
- Division of Diabetes Programs, Pacific Northwest Research Institute, Seattle, WA, USA
| | - Suna Onengut-Gumuscu
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Richard A Oram
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, University of Exeter, Exeter, UK; The Academic Kidney Unit, Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Stephen S Rich
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
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25
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Abstract
The incidence of type 1 diabetes mellitus (T1DM) in children has been increasing worldwide. However, there is not much information about the situation of pediatric T1DM in China. In the past 60 years, the clinical management and research of pediatric T1DM in China have made tremendous progress. We introduced the history of pediatric diabetes in China. In addition to review the current situation of research in pediatric diabetes, we summarized the progress in the treatment and management of pediatric T1DM in China. Finally, we pointed out some shortcomings, which need to be improved in the future.
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Affiliation(s)
- Yan Liang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ling Hou
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Wu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Feng Ye
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cai Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xiaoping Luo
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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26
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Fantahun B, Leulseged TW. Glycemic control among children with type 1 diabetes mellitus and its determinants in a resource-limited setting. J Pediatr Endocrinol Metab 2022; 35:813-817. [PMID: 35538692 DOI: 10.1515/jpem-2022-0144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/22/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Glycemic control is an important parameter that can predict long-term complications of diabetes mellitus. It can be affected by many factors. Hence, identifying those factors for improving disease outcomes is essential. The purpose of this study was to assess glycemic control in children who were treated with a conventional insulin regimen and to identify its associated factors. METHODS A retrospective cohort study was conducted among children with type one diabetes mellitus (T1DM) who had follow-up from November 2015 to November 2020 at the pediatric endocrinology clinic of St. Paul's Hospital Millennium Medical College in Addis Ababa, Ethiopia. Glycemic control was assessed by measuring glycosylated hemoglobin (HbA1C) and children who had HbA1C within three to six months of the data collection were recruited. RESULTS A total of 106 children with TIDM who were on conventional insulin therapy were included in this study. Their median age at diagnosis was nine years, 47.2% were females, and 57.5% were from urban areas. The average HbA1c of the children was 9.7%. The majority (85.2%) of the children had poor glycemic control (>7.5%). Younger age, longer disease duration, and urban residence were found to be significant predictors of good glycemic control. CONCLUSIONS A significant majority of children with T1DM had poor glycemic control. This calls for the need to create access to intensive diabetes care by health authorities and stakeholders to prevent the long-term complications of T1DM.
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Affiliation(s)
- Bereket Fantahun
- Department of Pediatrics, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
| | - Tigist W Leulseged
- Department of Pediatrics, Saint Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia
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27
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Lavik AR, Ebekozien O, Noor N, Alonso GT, Polsky S, Blackman SM, Chen J, Corathers SD, Demeterco-Berggren C, Gallagher MP, Greenfield M, Garrity A, Rompicherla S, Rapaport R, Yayah Jones NH. Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at 7 US Centers: Highest Burden on non-Hispanic Black Patients. J Clin Endocrinol Metab 2022; 107:1948-1955. [PMID: 35380700 PMCID: PMC8992309 DOI: 10.1210/clinem/dgac158] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT The impact of the COVID-19 pandemic on individuals with type 1 diabetes remains poorly defined. OBJECTIVE We examined United States trends in diabetic ketoacidosis (DKA) among individuals with type 1 diabetes (T1D) during the COVID-19 pandemic at 7 large US medical centers and factors associated with these trends. METHODS We compared DKA events among children and adults with T1D during COVID-19 surge 1 (March-May 2020) and COVID-19 surge 2 (August-October 2020) to the same periods in 2019. Analysis was performed using descriptive statistics and chi-square tests. RESULTS We found no difference in the absolute number of T1D patients experiencing DKA in 2019 vs 2020. However, a higher proportion of non-Hispanic Black (NHB) individuals experienced DKA in 2019 than non-Hispanic White (NHW) individuals (44.6% vs 16.0%; P < .001), and this disparity persisted during the COVID-19 pandemic (48.6% vs 18.6%; P < .001). DKA was less common among patients on continuous glucose monitor (CGM) or insulin pump in 2020 compared to 2019 (CGM: 13.2% vs 15.0%, P < .001; insulin pump: 8.0% vs 10.6%, P < .001). In contrast to annual DKA totals, a higher proportion of patients had DKA during COVID-19 surges 1 and 2 compared to the same months in 2019 (surge 1: 7.1% vs 5.4%, P < .001; surge 2: 6.6% vs 5.7%, P = .001). CONCLUSION DKA frequency increased among T1D patients during COVID-19 surges with highest frequency among NHB patients. DKA was less common among patients using CGM or insulin pumps. These findings highlight the urgent need for improved strategies to prevent DKA among patients with T1D-not only under pandemic conditions, but under all conditions-especially among populations most affected by health inequities.
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Affiliation(s)
- Andrew R Lavik
- Correspondence: Andrew R. Lavik, MD, PhD, Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | | | - Nudrat Noor
- T1D Exchange, Boston, Massachusetts 02111, USA
| | - G Todd Alonso
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Sarit Polsky
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Scott M Blackman
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Justin Chen
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Sarah D Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
| | | | - Mary Pat Gallagher
- Hassenfeld Children’s Hospital at NYU Langone, New York, New York 10016, USA
| | | | - Ashley Garrity
- Division of Pediatric Endocrinology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | | | - Nana-Hawa Yayah Jones
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
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28
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Hu TY, Price J, Pierce JS, Gannon AW. The association between pediatric mental health disorders and type 1 diabetes-related outcomes. Pediatr Diabetes 2022; 23:507-515. [PMID: 35249249 DOI: 10.1111/pedi.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Transition from pediatric to adult healthcare systems is a difficult process for young adults with Type 1 Diabetes (T1D) and most patients experience a deterioration in disease control. Mental health (MH) disorders are common in individuals with T1D and are believed to play a role in disease control and transition of care. We evaluated the association between the presence of pediatric MH disorder and measures of success in diabetes care in young adults who recently transitioned to adult care. RESEARCH DESIGN AND METHODS Retrospective cohort study of young adults in a large adult endocrinology system who transitioned from a pediatric hospital system after 2009. MH disorders were diagnosed by clinical pediatric psychologists during routine care at the pediatric hospital. Measurements of Hemoglobin A1c, diabetes-related emergencies, clinic attendance and intervals in transition were assessed and compared between the pediatric and adult hospital systems. RESULTS 237 young adults were identified and 100 (42%) of these were diagnosed with a MH disorder during pediatric care. Presence of a MH disorder was associated with higher Hemoglobin A1c levels prior to transition and increased rates of diabetes-related hospitalizations during the transition interval. Patients with a MH disorder were less likely to establish a pattern of consistent follow up after transition (p = 0.021). CONCLUSIONS MH disorders are common and predict greater challenges with diabetes management and less effective transition into the adult endocrinology system. Early recognition of MH disorders may allow for allocation of more proactive and intensive support for affected patients.
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Affiliation(s)
- Tina Y Hu
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julia Price
- Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware, USA
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida, USA.,Department of Pediatrics, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Anthony W Gannon
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Irwin A, Igudesman D, Crandell J, Kichler JC, Kahkoska AR, Burger K, Zaharieva DP, Addala A, Mayer-Davis EJ. Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change (FLEX) intervention trial. Pediatr Diabetes 2022; 23:516-526. [PMID: 35297136 PMCID: PMC9268578 DOI: 10.1111/pedi.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the relationship between mindfulness and glycemia among adolescents with type 1 diabetes (T1D) with suboptimal glycemia, and evaluate the potential mediation by ingestive behaviors, including disordered eating, and impulsivity. RESEARCH DESIGN AND METHODS We used linear mixed models for hemoglobin A1c (HbA1c) and linear regression for continuous glucose monitoring (CGM) to study the relationship of mindfulness [Child and Adolescent Mindfulness Measure (CAMM)] and glycemia in adolescents with T1D from the 18-month Flexible Lifestyles Empowering Change (FLEX) trial. We tested for mediation of the mindfulness-glycemia relationship by ingestive behaviors, including disordered eating (Diabetes Eating Problem Survey-Revised), restrained eating, and emotional eating (Dutch Eating Behavior Questionnaire); and impulsivity (total, attentional, and motor, Barrett Impulsiveness Scale). RESULTS At baseline, participants (n = 152) had a mean age of 14.9 ± 1.1 years and HbA1c of 9.4 ± 1.2% [79 ± 13 mmol/mol]. The majority of adolescents were non-Hispanic white (83.6%), 50.7% were female, and 73.0% used insulin pumps. From adjusted mixed models, a 5-point increase in mindfulness scores was associated with a -0.19% (95%CI -0.29, -0.08, p = 0.0006) reduction in HbA1c. We did not find statistically significant associations between mindfulness and CGM metrics. Mediation of the relationship between mindfulness and HbA1c by ingestive behaviors and impulsivity was not found to be statistically significant. CONCLUSIONS Among adolescents with T1D and suboptimal glycemia, increased mindfulness was associated with lower HbA1c levels. Future studies may consider mindfulness-based interventions as a component of treatment for improving glycemia among adolescents with T1D, though more data are needed to assess feasibility and efficacy.
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Affiliation(s)
- Ashley Irwin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Jamie Crandell
- Department of Biostatistics and School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | | | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Dessi P. Zaharieva
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA 94305
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA 94305
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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30
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Keenan ME, Berlin KS, Cook JL, Choquette AE, Ankney RL, Klages KL, Semenkovich KA, Rybak TM, Banks GG, Alemzadeh R, Eddington AR. Brief assessment of diabetes-specific psychological flexibility in racially and income diverse youth with type 1 diabetes. Pediatr Diabetes 2022; 23:370-379. [PMID: 35094464 DOI: 10.1111/pedi.13321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 01/11/2022] [Accepted: 01/22/2022] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Diabetes-specific psychological flexibility (the ability to engage in valued behaviors, be open to internal experiences, with present-moment awareness, while living with diabetes) is associated with HbA1c and health-related quality of life in youth with type 1 diabetes (T1D). Having brief diabetes-specific psychological flexibility assessments that perform equivalently across diverse individuals is important for research and clinical work addressing health disparities. The present study aimed to create 9-and 3-item short forms (DAASito-9 and -3) of the Diabetes Acceptance and Action Scale (DAAS-22), and evaluate their validity, reliability, and measurement invariance (MI). RESEARCH DESIGN AND METHODS Youth with T1D (n = 179, Mage = 14.64, 50% female, 56% Black/African American) completed self-report measures at an endocrinology clinic visit. HbA1c was extracted from medical records. One-half of the sample was used to develop the DAASitos with the highest reliability, McDonald's 𝜔 ≥ 0.75, and convergent validity (r ≥ 0.90 to DASS-22). Confirmatory factor analyses evaluated structural validity. MI was assessed across demographic (race, gender, grade, household income) and disease characteristic (illness duration, HbA1c) groups. Correlations with measures of psychological flexibility assessed additional convergent validity, and latent mean differences across groups were evaluated after confirming MI. RESULTS MI was supported. The DAASito-9 and -3 were correlated in expected directions with other psychological flexibility measures, HbA1c, and health-related quality of life. CONCLUSIONS The psychometric properties of the DAASito-9 and -3 support their use in research and clinical care of diverse youth with T1D. Significant differences in psychological flexibility across race, income, and glycemic health warrant further research and clinical intervention.
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Affiliation(s)
- Mary E Keenan
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Kristoffer S Berlin
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Jessica L Cook
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Adora E Choquette
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA
| | - Rachel L Ankney
- Psychology Department, Oklahoma State University, Stillwater, OK, USA
| | - Kimberly L Klages
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - Tiffany M Rybak
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Gabrielle G Banks
- Department of Psychology, University of Memphis, Memphis, Tennessee, USA.,Department of Pediatrics, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Ramin Alemzadeh
- Division of Pediatric Endocrinology & Diabetes, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Angelica R Eddington
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences, Washington DC, USA.,Endocrinology & Diabetes Clinic, Children's National Hospital, Washington DC, USA
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31
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Nwosu BU. The Theory of Hyperlipidemic Memory of Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 13:819544. [PMID: 35432186 PMCID: PMC9009047 DOI: 10.3389/fendo.2022.819544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 03/09/2022] [Indexed: 11/13/2022] Open
Abstract
A literature search was conducted to identify publications addressing the early phases of lipid phenotypes in children and adults with either type 1 diabetes or type 2 diabetes. Medline, EMBASE, and Ovid were searched using the following search terms: clinical remission, partial remission, partial clinical remission, honeymoon phase, C-peptide, type 1 or 2 diabetes, children, pediatric type 1 or 2 diabetes, and paediatrics type 1 or 2 diabetes, adults, adult type 1 or type 2 diabetes. Partial clinical remission (PR) of type 1 diabetes (T1D) is characterized by continued endogenous production of insulin and C-peptide following the diagnosis and the introduction of exogenous insulin therapy. PR is associated with improved glycemic control and reduced prevalence of diabetes complications. The theory of hyperglycemic memory was proposed to explain this concept of improved glycemic outcomes in remitters (those who experienced PR) versus non-remitters (those who did not experience PR). However, this theory is incomplete as it does not explain the dichotomy in early lipid phenotypes in T1D based on PR status, which is an understudied area in diabetology and lipidology. To fill this knowledge gap, we propose the Theory of Hyperlipidemic Memory of T1D. This theory is premised on our 5-year research on early post-diagnostic dichotomy in lipid phenotypes between remitters and non-remitters across the lifespan. It provides a more rigorous explanation for the differences in lifelong atherosclerotic cardiovascular disease (ASCVD) risk between remitters and non-remitters. We conducted 4 clinical studies in pediatric and adult subjects with diabetes mellitus to characterize the particulars of the hyperlipidemic memory. In the first investigation, we explored the impact of the presence or absence of PR on lipid parameters in children and adolescents with T1D. In the second, we investigated whether pubertal maturation influenced our findings in T1D; and whether these findings could be replicated in healthy, non-diabetic children and adolescents. In the third, we leveraged our findings from T1D and controls to investigate the mechanisms of early lipid changes in T2D by comparing the earliest lipid phenotype of subjects with type 2 diabetes (T2D) to those of remitters, non-remitters, and controls. In the fourth, we investigated the impact of PR on the earliest lipid phenotypes in adults with T1D and compared these early lipid data to those of T2D subjects and controls. This body of work across the lifespan in children, adolescents, and adults supports the Theory of Hyperlipidemic Memory. This new theory clarifies why PR largely determines the risks for early-phase dyslipidemia, mid-term microvascular disease risk, and long-term ASCVD risk in subjects with T1D.
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Affiliation(s)
- Benjamin Udoka Nwosu
- Division of Endocrinology, Department of Pediatrics, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, United States
- Division of Endocrinology, Department of Pediatrics, University of Massachusetts Medical School, Worcester, MA, United States
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32
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Butler AM, Hilliard ME, Fegan-Bohm K, Minard C, Anderson BJ. Peer-support intervention for African American and Latino parents to improve the glycemic control trajectory among school-aged children with type 1 diabetes: A pilot and feasibility protocol. Contemp Clin Trials 2022; 116:106739. [PMID: 35341991 DOI: 10.1016/j.cct.2022.106739] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 03/20/2022] [Accepted: 03/21/2022] [Indexed: 11/03/2022]
Abstract
Background Type 1 diabetes (T1D) is a common, chronic pediatric health condition with complicated management demands. African American and Latino children with T1D have troubling disparities in glycemic outcomes and acute complications. While there are empirically supported behavioral interventions to support disease management in youth with T1D, there are few that specifically aim to reduce health disparities in this population. While collaborative parent involvement with the child with T1D management tasks is important to promote optimal glycemic outcomes during childhood, our formative research identified multiple individual, family, and broader system factors that impede or facilitate collaborative parental involvement among African American and Latino parents of children with T1D. Methods This paper describes the development, design, and study protocol for the Type 1 Diabetes Empowerment And Management (TEAM) pilot trial. The TEAM intervention is a novel, group-based behavioral intervention designed to enhance collaborative involvement in T1D management for African American and Latino parents of children aged 5-10. This randomized pilot trial's primary aim is to evaluate the TEAM intervention's feasibility and acceptability. The secondary aim is to examine preliminary intervention outcomes (i.e., children's HbA1c, treatment adherence, collaborative parent involvement in T1D management, parent/child quality of life, and parent's diabetes-related distress, depressive symptoms, and self-efficacy) compared to usual T1D care. Discussion The trial will provide preliminary information about whether optimizing appropriate parent involvement during the school-age years may increase T1D treatment adherence and stabilize or improve glycemic control in African American and Latino school-aged children.
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Affiliation(s)
- Ashley M Butler
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA.
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA
| | - Kelly Fegan-Bohm
- Texas Department of State Health Services, 1100 West 49(th) Street, Austin, TX 78756, USA
| | - Charles Minard
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA
| | - Barbara J Anderson
- Baylor College of Medicine and Texas Children's Hospital, One Baylor Plaza, Houston, TX 77030, USA
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33
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Oza C, Khadilkar V, Karguppikar M, Ladkat D, Gondhalekar K, Shah N, Khadilkar A. Prevalence of metabolic syndrome and predictors of metabolic risk in Indian children, adolescents and youth with type 1 diabetes mellitus. Endocrine 2022; 75:794-803. [PMID: 34741238 DOI: 10.1007/s12020-021-02924-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 10/20/2021] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Children with type 1 diabetes (T1D) are at the same risk of developing metabolic syndrome (MS) as the general population. Several environmental factors such as lifestyle, exogenous insulin therapy (over-insulinization) and genetic/familial factors are thought to underlie the phenotype of 'double diabetes' (co-existence of MS components in patients with T1D). OBJECTIVES To determine the prevalence of overweight/obesity and MS and to identify its predictors in Indian children, adolescents and young adults with T1D. METHODS This cross-sectional study included 355 children and youth aged 6-23 years with T1D. Demographic data were obtained from patients using questionnaires. Anthropometry, blood pressure, sexual maturity rating, biochemical measurements and body composition measurements were performed using standard protocols. Insulin resistance (IR) was calculated using estimated glucose disposal rate (eGDR) and MS was diagnosed using the international diabetes federation (IDF) consensus definition 2017. RESULTS The prevalence of overweight/obesity and MS in our study was 15.5% and 4.5%, respectively. Abnormal HDL-cholesterol was the most common component of MS (55.6%) among children with T1D. Age, gender, body mass index (BMI) and eGDR were identified as significant predictors of the likelihood of MS. CONCLUSIONS We found a similar prevalence of MS in children with T1D as compared to other healthy children, which emphasises the need for monitoring of eGDR to determine IR in these children.
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Affiliation(s)
- Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Vaman Khadilkar
- Senior Pediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Mumbai, India
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
| | | | - Dipali Ladkat
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | | | - Nikhil Shah
- Hirabai Cowasji Jehangir Medical Research Institute, Pune, India
| | - Anuradha Khadilkar
- Senior Pediatric Endocrinologist, Jehangir Hospital, Pune and Bombay Hospital, Mumbai, India.
- Department of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India.
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Nimri R, Oron T, Muller I, Kraljevic I, Alonso MM, Keskinen P, Milicic T, Oren A, Christoforidis A, den Brinker M, Bozzetto L, Bolla AM, Krcma M, Rabini RA, Tabba S, Smith L, Vazeou A, Maltoni G, Giani E, Atlas E, Phillip M. Adjustment of Insulin Pump Settings in Type 1 Diabetes Management: Advisor Pro Device Compared to Physicians' Recommendations. J Diabetes Sci Technol 2022; 16:364-372. [PMID: 33100030 PMCID: PMC8861776 DOI: 10.1177/1932296820965561] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
AIMS To compare insulin dose adjustments made by physicians to those made by an artificial intelligence-based decision support system, the Advisor Pro, in people with type 1 diabetes (T1D) using an insulin pump and self-monitoring blood glucose (SMBG). METHODS This was a multinational, non-interventional study surveying 17 physicians from 11 countries. Each physician was asked to provide insulin dose adjustments for the settings of the pump including basal rate, carbohydrate-to-insulin ratios (CRs), and correction factors (CFs) for 15 data sets of pumps and SMBG of people with T1D (mean age 18.4 ± 4.8 years; eight females; mean glycated hemoglobin 8.2% ± 1.4% [66 ± 11mmol/mol]). The recommendations were compared among the physicians and between the physicians and the Advisor Pro. The study endpoint was the percentage of comparison points for which there was an agreement on the direction of insulin dose adjustments. RESULTS The percentage (mean ± SD) of agreement among the physicians on the direction of insulin pump dose adjustments was 51.8% ± 9.2%, 54.2% ± 6.4%, and 49.8% ± 11.6% for the basal, CR, and CF, respectively. The automated recommendations of the Advisor Pro on the direction of insulin dose adjustments were comparable )49.5% ± 6.4%, 55.3% ± 8.7%, and 47.6% ± 14.4% for the basal rate, CR, and CF, respectively( and noninferior to those provided by physicians. The mean absolute difference in magnitude of change between physicians was 17.1% ± 13.1%, 14.6% ± 8.4%, and 23.9% ± 18.6% for the basal, CR, and CF, respectively, and comparable to the Advisor Pro 11.7% ± 9.7%, 10.1% ± 4.5%, and 25.5% ± 19.5%, respectively, significant for basal and CR. CONCLUSIONS Considerable differences in the recommendations for changes in insulin dosing were observed among physicians. Since automated recommendations by the Advisor Pro were similar to those given by physicians, it could be considered a useful tool to manage T1D.
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Affiliation(s)
- Revital Nimri
- The Jesse Z and Sara Lea Shafer
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes,
Schneider Children’s Medical Center of Israel, Petah, Tikva, Israel
- Revital Nimri, MD, The Jesse Z and Sara Lea
Shafer Institute for Endocrinology and Diabetes, National Center for Childhood
Diabetes, Schneider Children’s Medical Center of Israel, 14 Kaplan St. Petah
Tikva, 49202, Israel.
| | - Tal Oron
- The Jesse Z and Sara Lea Shafer
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes,
Schneider Children’s Medical Center of Israel, Petah, Tikva, Israel
| | - Ido Muller
- DreaMed Diabetes Ltd, Petah Tiqva,
Israel
| | - Ivana Kraljevic
- Department of Endocrinology and
Diabetes, UHC Zagreb, School of Medicine, University of Zagreb, Zagreb,
Croatia
| | - Montserrat Martín Alonso
- Department of Pediatrics, Children’s
Endocrinology Unit, University Hospital of Salamanca, Spain
| | - Paivi Keskinen
- Department of Pediatrics, University
Hospital of Tampere, Finland
| | - Tanja Milicic
- Clinic for Endocrinology, Diabetes and
Metabolic Diseases, Clinical Center of Serbia, Faculty of Medicine University of
Belgrade, Serbia
| | - Asaf Oren
- Pediatric Endocrinology and Diabetes
Unit, Dana-Dwek Children’s Hospital, Tel Aviv Sourasky Medical Center, Israel
- Sackler School of Medicine, Tel Aviv
University, Israel
| | - Athanasios Christoforidis
- Pediatric Department, Aristotle
University of Thessaloniki, Hippokratio General Hospital, Thessaloniki, Greece
| | - Marieke den Brinker
- Department of Pediatrics, Division of
Pediatric Endocrinology and Diabetology, Antwerp University Hospital and University
of Antwerp, Belgium
| | - Lutgarda Bozzetto
- Department of Clinical Medicine and
Surgery, University of Naples “Federico II”, Italy
| | | | - Michal Krcma
- Department of Internal Medicine,
Diabetes and Endocrinology Unit, University Hospital Pilsen, Faculty of Medicine in
Pilsen, Charles University, Czech Republic
| | - Rosa Anna Rabini
- Department of Diabetology, Hospital
Mazzoni, Ascoli Piceno, Italy
| | - Shadi Tabba
- Children’s Hospital of the King’s
Daughters, Eastern Virginia Medical School, Norfolk, VA, USA
| | - Lizl Smith
- Department of Internal Medicine,
Division of Endocrinology, University of Pretoria, South Africa
| | - Andriani Vazeou
- A’ Department of Pediatrics, Diabetes
Center, P&A Kyriakou, Athens, Greece
| | - Giulio Maltoni
- Department of Pediatrics, University
Hospital of Bologna Sant’Orsola-Malpighi Polyclinic, Italy
| | - Elisa Giani
- Department of Biomedical Sciences,
Humanitas Clinical and Research Center-IRCCS and Humanitas University, Milan,
Italy
| | - Eran Atlas
- DreaMed Diabetes Ltd, Petah Tiqva,
Israel
| | - Moshe Phillip
- The Jesse Z and Sara Lea Shafer
Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes,
Schneider Children’s Medical Center of Israel, Petah, Tikva, Israel
- Sackler School of Medicine, Tel Aviv
University, Israel
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Modarelli R, Sarah S, Ramaker ME, Bolobiongo M, Benjamin R, Balikcioglu PG. Pediatric Diabetes on the Rise: Trends in Incident Diabetes during the COVID-19 Pandemic. J Endocr Soc 2022; 6:bvac024. [PMID: 35265783 PMCID: PMC8900286 DOI: 10.1210/jendso/bvac024] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 11/19/2022] Open
Abstract
Abstract
Context
The effects of the COVID-19 pandemic on the incident cases of pediatric Type 1 (T1D) and Type 2 diabetes (T2D) are not clear.
Objective
To identify trends in incidence and presentation of pediatric new-onset T1D and T2D during the COVID-19 pandemic.
Methods
A retrospective chart review was conducted. Demographics, anthropometrics, and initial labs from patients ages 0-21 who presented with new-onset diabetes to a pediatric tertiary care center were recorded.
Results
During the pandemic incident cases of pediatric T1D increased from 31 in each of the prior two years to 46; an increase of 48%. Incident cases of pediatric T2D increased by 231% from 2019 to 2020. The number of incident cases of pediatric T2D increased significantly more than the number of incident cases of pediatric T1D (p-value = 0.009). Patients with T2D were more likely to present in DKA, though this was not statistically significant (p-value=0.093). Severe DKA was higher compared to moderate DKA (p-value = 0.036) in incident cases of pediatric T2D. During the pandemic, for the first time, incident cases of T2D accounted for more than half of the all newly diagnosed pediatric diabetes cases (53%).
Conclusions
There were more incident pediatric T1D and T2D cases as well as an increase in DKA severity in T2D at presentation during the COVID-19 pandemic. More importantly, incident T2D cases were higher than the incident T1D during the pandemic. This clearly suggests a disruption and change in the pediatric diabetes trends with profound individual and community health consequences.
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Affiliation(s)
- Rachel Modarelli
- Department of Pediatrics, Duke University Medical Center, Durham, NC, United States
| | - Salma Sarah
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, United States
| | - Megan E Ramaker
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
| | - Mboli Bolobiongo
- Duke School of Medicine, Master of Biomedical Sciences, Durham, NC, United States
| | - Robert Benjamin
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, United States
| | - Pinar Gumus Balikcioglu
- Division of Pediatric Endocrinology and Diabetes, Duke University Medical Center, Durham, NC, United States
- Duke Molecular Physiology Institute, Duke University Medical Center, Durham, NC, United States
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Palmer T, Jennings HM, Shannon G, Salustri F, Grewal G, Chelagat W, Sarker M, Pelletier N, Haghparast-Bidgoli H, Skordis J. Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh. Pediatr Diabetes 2022; 23:19-32. [PMID: 34713540 DOI: 10.1111/pedi.13277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 08/23/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components. RESEARCH DESIGN AND METHODS The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically. RESULTS The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care. CONCLUSION Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.
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Affiliation(s)
- Tom Palmer
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
| | | | | | | | - Mithun Sarker
- Diabetic Association of Bangladesh, Dhaka, Bangladesh
| | - Nicole Pelletier
- Institute for Global Health, University College London, London, UK
| | | | - Jolene Skordis
- Institute for Global Health, University College London, London, UK
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Malik FS, Sauder KA, Isom S, Reboussin BA, Dabelea D, Lawrence JM, Roberts A, Mayer-Davis EJ, Marcovina S, Dolan L, Igudesman D, Pihoker C, Lawrence JM, Hung P, Koebnick C, Li X, Lustigova E, Reynolds K, Pettitt DJ, Mayer-Davis EJ, Mottl A, Thomas J, Jackson M, Knight L, Liese AD, Turley C, Bowlby D, Amrhein J, Apperson E, Nelson B, Dabelea D, Bellatorre A, Crume T, Hamman RF, Sauder KA, Shapiro A, Testaverde L, Klingensmith GJ, Maahs D, Rewers MJ, Wadwa P, Daniels S, Kahn MG, Wilkening G, Bloch CA, Powell J, Love-Osborne K, Hu DC, Dolan LM, Shah AS, Standiford DA, Urbina EM, Pihoker C, Hirsch I, Kim G, Malik FA, Merjaneh L, Roberts A, Taplin C, Yi-Frazier J, Beauregard N, Franklin C, Gangan C, Kearns S, Klingsheim M, Loots B, Pascual M, Greenbaum C, Imperatore G, Saydah SH, Linder B, Marcovina SM, Chait A, Clouet-Foraison N, Harting J, Strylewicz G, D'Agostino R, Jensen ET, Wagenknecht LE, Bell RA, Casanova R, Divers J, Goldstein MT, Henkin L, Isom S, Lenoir K, Pierce J, Reboussin B, Rigdon J, South AM, Stafford J, Suerken C, Wells B, Williams C. Trends in Glycemic Control Among Youth and Young Adults With Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2022; 45:285-294. [PMID: 34995346 PMCID: PMC8914430 DOI: 10.2337/dc21-0507] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/15/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe temporal trends and correlates of glycemic control in youth and young adults (YYA) with youth-onset diabetes. RESEARCH DESIGN AND METHODS The study included 6,369 participants with type 1 or type 2 diabetes from the SEARCH for Diabetes in Youth study. Participant visit data were categorized into time periods of 2002-2007, 2008-2013, and 2014-2019, diabetes durations of 1-4, 5-9, and ≥10 years, and age groups of 1-9, 10-14, 15-19, 20-24, and ≥25 years. Participants contributed one randomly selected data point to each duration and age group per time period. Multivariable regression models were used to test differences in hemoglobin A1c (HbA1c) over time by diabetes type. Models were adjusted for site, age, sex, race/ethnicity, household income, health insurance status, insulin regimen, and diabetes duration, overall and stratified for each diabetes duration and age group. RESULTS Adjusted mean HbA1c for the 2014-2019 cohort of YYA with type 1 diabetes was 8.8 ± 0.04%. YYA with type 1 diabetes in the 10-14-, 15-19-, and 20-24-year-old age groups from the 2014-2019 cohort had worse glycemic control than the 2002-2007 cohort. Race/ethnicity, household income, and treatment regimen predicted differences in glycemic control in participants with type 1 diabetes from the 2014-2019 cohort. Adjusted mean HbA1c was 8.6 ± 0.12% for 2014-2019 YYA with type 2 diabetes. Participants aged ≥25 years with type 2 diabetes had worse glycemic control relative to the 2008-2013 cohort. Only treatment regimen was associated with differences in glycemic control in participants with type 2 diabetes. CONCLUSIONS Despite advances in diabetes technologies, medications, and dissemination of more aggressive glycemic targets, many current YYA are less likely to achieve desired glycemic control relative to earlier cohorts.
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Affiliation(s)
- Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA
| | - Katherine A Sauder
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Scott Isom
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Beth A Reboussin
- Department of Biostatistical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora, CO
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Alissa Roberts
- Department of Pediatrics, University of Washington, Seattle, WA
| | | | | | - Lawrence Dolan
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Daria Igudesman
- Departments of Nutrition and Medicine, University of North Carolina, Chapel Hill, NC
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Skipper N, Thingholm PR, Borch L, Gaulke A, Eriksen TLM, Søndergaard C, Svensson J. Center differences in diabetes treatment outcomes among children with type 1 diabetes: A nationwide study of 3866 Danish children. Pediatr Diabetes 2022; 23:73-83. [PMID: 34766429 DOI: 10.1111/pedi.13284] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Accepted: 10/14/2021] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Mean differences in HbA1c across centers are well established, but less well understood. The aim was to assess whether differences in patient case-mix can explain the variation in mean HbA1c between pediatric diabetes centers in Denmark. The association between HbA1c , frequency of blood glucose monitoring (BGM), treatment modality, and center visits was investigated. RESEARCH DESIGN AND METHODS This longitudinal nationwide study included 3866 Danish children with type 1 diabetes from 2013 to 2017 (n = 12,708 child-year observations) from 16 different pediatric diabetes centers. Mean HbA1c , proportion of children reaching HbA1c treatment target (HbA1c ≤ 58 mmol/mol [7.5%]) were compared across centers using linear regression models. This was done with and without adjustment for socioeconomic characteristics (patient case-mix). RESULTS The mean difference in HbA1c during follow-up was 11.6 mmol/mol (95% CI 7.9, 15.3) (1.1% [95% CI 0.7, 1.4]) when comparing the centers with the lowest versus highest mean HbA1c . The difference was attenuated and remained significant after adjustment for the patient case-mix (difference: 10.5 mmol/mol [95% CI 6.8, 14.2] (1.0% [95% CI 0.6, 1.3])). Overall, 6.8% of the differences in mean HbA1c across centers were explained by differences in the patient case-mix. Across centers, more frequent BGM was associated with lower HbA1c . The proportion of insulin pump users and number of visits was not associated with HbA1c . CONCLUSION In a setting of universal health care, large differences in HbA1c across centers were found, and could not be explained by patient background, number of visits or use of technology. Only BGM was associated with center HbA1c .
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Affiliation(s)
- Niels Skipper
- Department of Economics and Business Economics and CIRRAU - Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Peter R Thingholm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Luise Borch
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Gødstrup, Denmark
| | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, Kansas, USA
| | - Tine L M Eriksen
- VIVE - The Danish Center for Social Science Research, Aarhus, Denmark
| | - Charlotte Søndergaard
- Department of Pediatrics and Adolescent Medicine, Gødstrup Hospital, Gødstrup, Denmark
| | - Jannet Svensson
- Pediatrics and Adolescent Department, Copenhagen University Hospital, Herlev, Denmark
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van den Boom L, Kostev K. Patterns of insulin therapy and insulin daily doses in children and adolescents with type 1 diabetes in Germany. Diabetes Obes Metab 2022; 24:296-301. [PMID: 34676653 DOI: 10.1111/dom.14581] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 10/05/2021] [Accepted: 10/16/2021] [Indexed: 12/01/2022]
Abstract
AIM To describe the different insulin therapy patterns and insulin daily doses in children and adolescents (aged 1-17 years) with type 1 diabetes. METHODS This cross-sectional study based on the longitudinal prescription (LRx) database (IQVIA) included children and adolescents who received at least two insulin prescriptions of the same drug from 1 January 2016 to 31 December 2019. The study outcomes included the proportion of patients with insulin pumps and multiple daily injection therapy, human insulin and insulin analogue use, as well as insulin daily doses. A multivariable linear regression model was used to study the association between age, sex, insulin drugs, and daily dose. RESULTS A total of 22 512 children and adolescents (mean age: 13.5 years, 47.1% female) were included. The proportion of patients using insulin pump therapy decreased with age, from 72.6% (females) and 73.0% (males) in the age group of younger than 6 years to 30.8% (females) and 26.1% (males) in adolescents. Insulin aspart was the most common short-acting insulin, with the proportion of users increasing from 56% in the age group of younger than 6 years to 69%-70% in the 13-17 years age group. The daily dose of insulin pump therapy was 10 units lower than multiple daily injection (MDI) (P < .001). CONCLUSION We found a marked age dependency for pump use, with a strong increase observed in the youngest age group. Insulin aspart was the most frequently used analogue insulin. A higher total daily insulin dose was shown in patients on MDI versus insulin pump, along with a significant age dependency.
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Abstract
Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care team. The increasing prevalence of T1D in the adolescent age group and deteriorating glycaemic control from childhood to adolescence and youth, as well as the secular trend of worsening glycaemic control in youth and young adults with T1D, are a matter of real concern. Lack of monitoring, insufficient self-control, psychosocial factors, lack of family support and parental supervision, inadequate adherence to treatment, pubertal increase in insulin resistance and incompetent transition from paediatric to adult care are likely causes of deteriorating glycaemic control in youth. Efforts to improve insulin sensitivity by using pharmacological agents such as metformin are insufficient in resolving this problem. Interventions such as structured intervention, motivational interviews, development of youth friendly services and organization of diabetes camps for peer support can improve adherence in these individuals. Innovative technologies such as continuous subcutaneous insulin infusion and continuous glucose monitoring, comprehensive multidisciplinary teams with effective communication, parental support and supervision with planned transition from paediatric to adult care will not only reduce the risk of micro- and macrovascular complications in young adults with T1D but will also cause significant improvement in their quality of life.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
- Correspondence: Anuradha Khadilkar Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, 411001, IndiaTel +91 206057004 Email
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
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Momani AM, Callery P, Lin YL, Abduelkader RH, Al Akash HY. "It [Diabetes] is From God and I Need to Take Care of Myself": Type 1 Diabetes Self-Management Among Adolescents and Their Parents in Jordan. Curr Diabetes Rev 2022; 18:e140222201109. [PMID: 35156585 DOI: 10.2174/1573399818666220214114908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 1 diabetes is the most common endocrine condition among adolescents. Diabetes self-management can be challenging during adolescence. OBJECTIVE The objective of this study is to understand how adolescents and their parents manage type 1 diabetes in Jordan. METHODS Constructivist grounded theory methodology principles were used to achieve the study aim. A total of 48 participants were recruited using purposive and theoretical sampling techniques, including adolescents and their parents. Data were collected (October 2016 - April 2017) using 38 semi-structured, audio-recorded interviews (one-to-one or joint interviews based on participants' preferences). Data were collected and analyzed concurrently using different levels of coding, constant comparative analysis, and memo writing. This study was approved by relevant ethics committees from the University of Manchester and Jordan University Hospital. RESULTS The theme of living with diabetes is presented and discussed in this article. Culture emerged as the central theme; two aspects of culture are presented in this article: collectivism and cultural beliefs. CONCLUSION This study identified that diabetes self-management could be influenced by the culture in which Jordanian adolescents live in as well as being shaped by their religious beliefs. These findings are potentially transferable to other Arab and non-Arab countries that share similar cultural aspects and religious beliefs.
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Affiliation(s)
| | - Peter Callery
- School of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work at the University of Manchester, Manchester, UK
| | - Yin-Ling Lin
- School of Biology, Medicine and Health, Division of Dentistry at the University of Manchester, Manchester, UK
| | | | - Hekmat Y Al Akash
- School of Nursing at the Applied Science Private University, Amman, Jordan
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Momani AM, Callery P, Lin YL, Abduelkader RH, Khalil H. "I Like People to Treat Me Normally": Barriers to Type 1 Diabetes Self-Management Among Adolescents. Clin Diabetes 2022; 40:196-203. [PMID: 35669300 PMCID: PMC9160554 DOI: 10.2337/cd20-0116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adolescents with type 1 diabetes face barriers that can have a negative influence on self-management behaviors. This study was an analysis of semi-structured interviews with adolescents, parents, and health care providers to better understand these barriers among adolescents in Jordan. Adolescents with type 1 diabetes reported individual-level barriers including feeling labeled, pitied, and stigmatized for having type 1 diabetes. They also discussed the system-level barrier of an education system that does not adapt to meet their needs. Individual- and system-level barriers are interrelated and could influence adolescents' decisions regarding whether to disclose their condition to others.
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Affiliation(s)
- Aaliyah M. Momani
- Applied Science Private University, Amman, Jordan
- School of Biology, Medicine and Health, University of Manchester, Manchester, U.K
- Corresponding author: Aaliyah M. Momani,
| | - Peter Callery
- School of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Yin-Ling Lin
- School of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | | | - Heba Khalil
- Faculty of Health Sciences, Higher Colleges of Technology, Fujairah, United Arab Emirates
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Gill A, Gothard MD, Briggs Early K. Glycemic outcomes among rural patients in the type 1 diabetes T1D Exchange registry, January 2016-March 2018: a cross-sectional cohort study. BMJ Open Diabetes Res Care 2022; 10:10/1/e002564. [PMID: 35042753 PMCID: PMC8768930 DOI: 10.1136/bmjdrc-2021-002564] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 12/06/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Does rural status influence glycemic outcomes among participants in the type 1 diabetes T1D Exchange clinic registry? RESEARCH DESIGN AND METHODS Data from the T1D Exchange clinic registry between January 2016 and March 2018 were identified by rural-urban status and stratified by age and hemoglobin A1c (HbA1c). Multivariable regression modeling was performed to isolate HbA1c differences. A full model including all significant (p<0.05 via two-sided testing) differential factors was determined with an additional indicator for rural status, and adjusted for duration of diabetes, use of continuous glucose monitoring device, age, race/ethnicity, and private insurance status. The model was reduced using backwards elimination stepwise procedures until only significant factors remained. RESULTS Mean HbA1c levels for all rural participants were significantly higher (8.71%; 72 mmol/mol) compared with the urban group (8.48%; 69 mmol/mol), p<0.001. For youth under 13 years of age, rural participants had a higher mean HbA1c (8.65%; 71 mmol/mol) compared with urban (8.45% 69 mmol/mol), p=0.022. Rural youth (13-<18 years) had a higher mean HbA1c (9.39%; 79 mmol/mol) than urban youth (9.14%; 76 mmol/mol), p<0.001. Rural young adults (18-<26 years) had a higher mean HbA1c (9.07%; 76 mmol/mol) than urban young adults (8.88%; 74 mmol/mol), p=0.042. Rural adults (≥26 years; n=589) were the only group that did not have a higher mean HbA1c (7.76%, 61.3 mmol) than urban adults (n=4770; 7.72%, 60.9 mmol/mol), p=0.503. Rural locale was highly significant (beta=0.175, p<0.001) despite controlling for potentially confounding differences between rural and urban groups. CONCLUSIONS Among this T1D Exchange cohort, there is a pattern of higher mean HbA1c being associated with rural status, even after adjustment for characteristic differences, most strikingly among those under 26 years of age. This disparity and contributing factors need to be more thoroughly studied to provide effective solutions.
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Affiliation(s)
- Arashpreet Gill
- College of Osteopathic Medicine, Pacific Northwest University, Yakima, Washington, USA
| | | | - Kathaleen Briggs Early
- College of Osteopathic Medicine, Department of Biomedical Sciences, Pacific Northwest University, Yakima, Washington, USA
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Dennig MJ, Sommer G, Zingg T, Flück CE, Boettcher C. Stable Metabolic Control but Increased Demand for Professional Support in Children with Type 1 Diabetes in the Past Ten Years in Bern/Switzerland: A Quality Control Study. J Diabetes Res 2022; 2022:3170558. [PMID: 36034586 PMCID: PMC9402297 DOI: 10.1155/2022/3170558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 07/17/2022] [Accepted: 08/01/2022] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Lower HbA1c targets and increasingly complex diabetes management with substantially increasing costs dominate today's type 1 diabetes therapy in children and adolescents. OBJECTIVE To evaluate metabolic control in children and adolescents with type 1 diabetes and assess associated factors, evaluate determinants for frequency of healthcare contacts, and compare actual with historical data. METHOD This cross-sectional observational study collected data on 178 children and adolescents with type 1 diabetes treated at the University Children's Hospital in Bern. RESULTS Mean HbA1c was 7.9% (63 mmol/mol), 33.1% (59/178) of children reached the target of HbA1c < 7.5% (<59 mmol/mol), and 18.0% (32/178) had an HbA1c value < 7.0% (<53 mmol/mol). Compared to historical data, stable HbA1c levels appeared with a doubled proportion of individuals using insulin pumps. Metabolic control was worse with a longer duration of diabetes and younger age at diagnosis but better when parents came from a Western European country. Age at the consultation, use of diabetes technology and native language influenced the number of healthcare contacts. Younger patients, patients using CSII, and patients without an official Swiss language as mother tongue had more consultations with a healthcare professional than older and native language individuals. CONCLUSION The metabolic targets in childhood and adolescent type 1 diabetes are still unmet despite a shift towards more technology. Our study documents a higher demand for support and supervision in specific patient groups. An investment to increase healthcare contacts could help combat the increase in total diabetes cost and significantly improve metabolic control.
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Affiliation(s)
- Michelle J. Dennig
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Grit Sommer
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
- Department of BioMedical Research, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Tanja Zingg
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
| | - Christa E. Flück
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
- Department of BioMedical Research, Bern University Hospital and University of Bern, Bern, Switzerland
| | - Claudia Boettcher
- Department of Paediatric Endocrinology, Diabetology & Metabolism, University Children's Hospital, Inselspital, Bern, Switzerland
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Shapira A, Harrington KR, Goethals ER, Volkening LK, Laffel LM. Health-related quality of life in youth with type 1 diabetes: Associations with multiple comorbidities and mental health conditions. Diabet Med 2021; 38:e14617. [PMID: 34060668 PMCID: PMC8429188 DOI: 10.1111/dme.14617] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/28/2021] [Indexed: 01/09/2023]
Abstract
AIM This cross-sectional study examined the associations of comorbid conditions on health-related quality of life (HRQOL) in 601 youth with type 1 diabetes. We evaluated associations between number of comorbid conditions (0, 1, ≥2) and particular comorbid conditions and youth HRQOL by self-report and parent proxy-report. RESEARCH DESIGN AND METHODS Youth with type 1 diabetes, aged 5-18 years, and their parents completed the PedsQL 4.0 Generic Core Scales self-report and parent proxy-report, respectively; they also reported youths' comorbid medical and mental health conditions. Separate linear regression models tested the relationship between number of comorbid conditions and specific comorbid conditions with youth-reported and parent proxy-reported HRQOL. RESULTS Youth with ≥2 comorbid conditions had significantly lower HRQOL by both self- and parent proxy-reports compared with youth with 0 or 1 comorbid condition (youth self-report: 0: 85 ± 12, 1: 85 ± 13, 2+: 78 ± 16, p = <0.0001; parent proxy-report: 0: 83 ± 12, 1: 81 ± 13, 2+: 74 ± 15, p = <0.0001). Amongst the comorbid conditions, only a mental health comorbidity was associated with lower HRQOL. For youth and parent proxy-reports, both the number of comorbidities (≥2) and the presence of a mental health comorbidity were significantly associated with lower HRQOL. CONCLUSIONS Health-related quality of life seems to be preserved in youth with type 1 diabetes unless confronted by multiple comorbidities as reported by youth and their parents. Our findings highlight the importance of tracking the presence of multiple comorbid conditions, possibly by reviewing problem and medication lists in the medical record, as well as screening for and addressing mental health conditions in routine diabetes care.
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Affiliation(s)
- Amit Shapira
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Kara R. Harrington
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Eveline R. Goethals
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
- Vanderbilt University Medical Center, Nashville, TN
- KU Leuven, Leuven, Belgium
| | - Lisa K. Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lori M. Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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Liese AD, Reboussin BA, Kahkoska AR, Frongillo EA, Malik FS, Imperatore G, Saydah S, Bellatorre A, Lawrence JM, Dabelea D, Mendoza JA. Inequalities in Glycemic Control in Youth with Type 1 Diabetes Over Time: Intersectionality Between Socioeconomic Position and Race and Ethnicity. Ann Behav Med 2021; 56:461-471. [PMID: 34570884 DOI: 10.1093/abm/kaab086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Racial/ethnic health inequities have been well-documented among youth and young adults with type 1 diabetes (T1D), yet little is known about how socioeconomic position (SEP) intersects with the risk marker of race/ethnicity to predict inequities in longitudinal glycemic control. PURPOSE To identify patterns of SEP, race/ethnicity, and clinical characteristics that differentiate hemoglobin A1c (HbA1c) trajectories among youth and young adults after T1D diagnosis. METHODS The SEARCH for Diabetes in Youth cohort includes youth with diabetes diagnosed from 2002 to 2006 and 2008 who were followed through 2015. We analyzed data from 1,313 youth and young adults with T1D with ≥3 HbA1c measures. Classification tree analysis identified patterns of baseline demographic, SEP, and clinical characteristic that best predicted HbA1c trajectories over an average of 8.3 years using group-based trajectory modeling. RESULTS Two HbA1c trajectories were identified: Trajectory 1 (77%) with lower baseline HbA1c and mild increases (from mean 7.4% to 8.4%) and Trajectory 2 (23%) with higher baseline HbA1c and major increases (from 8.5% to 11.2%). Race/ethnicity intersected with different SEP characteristics among non-Hispanic white (NHW) than in non-whites. Public health insurance predicted high-risk Trajectory 2 membership in non-whites, whereas parental education, household structure, diagnosis age and glucose checking frequency predicted membership for NHW youth and young adults. Two characteristics, race/ethnicity and parental education alone identified 80% of the Trajectory 2 members. CONCLUSIONS Race/ethnicity intersects with multiple SEP and clinical characteristics among youth and young adults with T1D, which is associated with particularly high risk of poor long-term glycemic control.
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Affiliation(s)
- Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Beth A Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Anna R Kahkoska
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA, USA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Sharon Saydah
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, GA, USA
| | - Anna Bellatorre
- Department of Epidemiology and LEAD Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jean M Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA
| | - Dana Dabelea
- Department of Epidemiology and LEAD Center, Colorado School of Public Health, Aurora, CO, USA
| | - Jason A Mendoza
- Fred Hutchinson Cancer Research Center, University of Washington, and Seattle Children's Research Institute, Seattle, WA, USA
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Chalew S, Delamater AM, Washington S, Bhat J, Franz D, Gomez R, Felipe D, Tieh P, Finger L. Can Innovative Technologies Overcome HbA1c Disparity for African-American Youth with Type 1 Diabetes? J Diabetes Sci Technol 2021; 15:1069-1075. [PMID: 34137288 PMCID: PMC8442203 DOI: 10.1177/19322968211021386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Achieving normal or near-normal glycemic control as reflected by HbA1c levels in patients with type 1 diabetes (T1D) is important for preventing the development and progression of chronic complications. Despite delineation and dissemination of HbA1c management targets and advances in insulin pharmacology, insulin delivery systems, and glucose monitoring, the majority of children with T1D do not achieve HbA1c goals. In particular, African Americans are more likely not to reach HbA1c goals and have persistently higher HbA1c than Non-Hispanic Whites. Availability of pumps and other technology has not eliminated the disparity in HbA1c. Multiple factors play a role in the persisting racial disparity in HbA1c outcome. The carefully designed application and deployment of new technology to help the patient/family and facilitate the supportive role of the diabetes management team may be able to overcome racial disparity in glycemic outcome and improve patient quality of life.
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Affiliation(s)
- Stuart Chalew
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
- Stuart Chalew, MD, Department of
Pediatrics, Endocrinology and Diabetes, School of Medicine, Louisiana
State University Health Sciences Center, Children’s Hospital of New
Orleans, 200 Henry Clay Avenue, New Orleans, LA 70118, USA.
| | - Alan M. Delamater
- Department of Pediatrics,
University of Miami Miller School of Medicine, Miami, FL, USA
| | - Sonja Washington
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Jayalakshmi Bhat
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Diane Franz
- Department of Psychology, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
| | - Ricardo Gomez
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Dania Felipe
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Peter Tieh
- Department of Pediatrics,
Division of Pediatric Endocrinology and Diabetes, School of Medicine,
Louisiana State University Health Sciences Center, Children’s Hospital of
New Orleans, New Orleans, LA, USA
| | - Laurie Finger
- Endocrinology and Diabetes, The
Children’s Hospital of New Orleans, New Orleans, LA, USA
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48
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Kahkoska AR, Dabelea D. Diabetes in Youth: A Global Perspective. Endocrinol Metab Clin North Am 2021; 50:491-512. [PMID: 34399958 PMCID: PMC8374087 DOI: 10.1016/j.ecl.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Diabetes is a common disease among pediatric populations in the United States and worldwide. The incidence of type 1 and type 2 diabetes is increasing, with disproportional increases in racial/ethnic subpopulations. As the prevalence of obesity continue to increase, type 2 diabetes now represents a major form of pediatric diabetes. The management of diabetes in youth centers on maintaining glycemic control to prevent acute and chronic complications. This article summarizes the epidemiology, etiology, management, and complications of type 1 and type 2 diabetes in youth, as well as future directions and opportunities.
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Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall 2205A, Chapel Hill, NC 27599, USA.
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 East 17th Avenue, Box B119, Room W3110, Aurora, CO 80045, USA
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49
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Wasserman RM, Schwartz DD, Anderson BJ. The Diabetes-Specific Risk-Taking Inventory: Piloting a New Measure for Adolescents With Type 1 Diabetes. Diabetes Spectr 2021; 34:292-300. [PMID: 34511856 PMCID: PMC8387607 DOI: 10.2337/ds20-0084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE We sought to develop and pilot a new measure, the Diabetes-Specific Risk-Taking Inventory (DSRI), to assess unhealthy risk-taking behaviors among adolescents with type 1 diabetes. METHODS Thirteen diabetes health care providers, 30 adolescents with type 1 diabetes (aged 15-19 years, 60% female, mean A1C 8.7% [72 mmol/mol], and 33% on insulin pumps), and the adolescents' caregivers rated the perceived riskiness of each item on the DSRI. Adolescents completed the DSRI, for which they reported how often they engaged in 34 behaviors that could place them at risk for acute complications of type 1 diabetes or out-of-range blood glucose levels. Adolescents also completed the risk-taking subscale from the Risk-Taking and Self-Harm Inventory for Adolescents, and parents completed the parent-proxy Diabetes Management Questionnaire. Mean A1C during the previous year was obtained via medical chart review. RESULTS Results indicated good content validity and feasibility for using the DSRI in a research context, as 100% of adolescents who consented to the study completed the measure. The DSRI was positively correlated with general risk-taking and negatively correlated with diabetes management, indicating preliminary evidence of convergent validity. The DSRI also correlated with A1C. CONCLUSION This pilot study extends our previous work in developing a conceptual model for illness-specific risk-taking. The DSRI is a promising new measure to assess illness-specific risk-taking, including unhealthy risk-taking behaviors, for adolescents with type 1 diabetes.
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Affiliation(s)
- Rachel M. Wasserman
- Center for Healthcare Delivery Science, Nemours Children’s Hospital, Orlando, FL
- Corresponding author: Rachel M. Wasserman,
| | - David D. Schwartz
- Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
| | - Barbara J. Anderson
- Department of Pediatrics, Baylor College of Medicine/Texas Children’s Hospital, Houston, TX
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50
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Walker AF, Cuttriss N, Haller MJ, Hood KK, Gurka MJ, Filipp SL, Anez-Zabala C, Yabut K, Roque X, Wong JJ, Baer L, Figg L, Bernier A, Westen S, Lewit E, Sheehan E, Basina M, Lal R, Maizel J, Maahs DM. Democratizing type 1 diabetes specialty care in the primary care setting to reduce health disparities: project extension for community healthcare outcomes (ECHO) T1D. BMJ Open Diabetes Res Care 2021; 9:9/1/e002262. [PMID: 34244218 PMCID: PMC8268922 DOI: 10.1136/bmjdrc-2021-002262] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 06/05/2021] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Project ECHO (Extension for Community Healthcare Outcomes) is a tele-education outreach model that seeks to democratize specialty knowledge to reduce disparities and improve health outcomes. Limited utilization of endocrinologists forces many primary care providers (PCPs) to care for patients with type 1 diabetes (T1D) without specialty support. Accordingly, an ECHO T1D program was developed and piloted in Florida and California. Our goal was to demonstrate the feasibility of an ECHO program focused on T1D and improve PCPs' abilities to manage patients with T1D. RESEARCH DESIGN AND METHODS Health centers (ie, spokes) were recruited into the ECHO T1D pilot through an innovative approach, focusing on Federally Qualified Health Centers and through identification of high-need catchment areas using the Neighborhood Deprivation Index and provider geocoding. Participating spokes received weekly tele-education provided by the University of Florida and Stanford University hub specialty team through virtual ECHO clinics, real-time support with complex T1D medical decision-making, access to a diabetes support coach, and access to an online repository of diabetes care resources. Participating PCPs completed pre/post-tests assessing diabetes knowledge and confidence and an exit survey gleaning feedback about overall ECHO T1D program experiences. RESULTS In Florida, 12 spoke sites enrolled with 67 clinics serving >1000 patients with T1D. In California, 11 spoke sites enrolled with 37 clinics serving >900 patients with T1D. During the 6-month intervention, 27 tele-education clinics were offered and n=70 PCPs (22 from Florida, 48 from California) from participating spoke sites completed pre/post-test surveys assessing diabetes care knowledge and confidence in diabetes care. There was statistically significant improvement in diabetes knowledge (p≤0.01) as well as in diabetes confidence (p≤0.01). CONCLUSIONS The ECHO T1D pilot demonstrated proof of concept for a T1D-specific ECHO program and represents a viable model to reach medically underserved communities which do not use specialists.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA
| | - Nicolas Cuttriss
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Michael J Haller
- University of Florida Diabetes Institute, Gainesville, FL, USA
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Korey K Hood
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | - Stephanie L Filipp
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida, USA
| | | | - Katarina Yabut
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Xanadu Roque
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Jessie J Wong
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Linda Baer
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Lauren Figg
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
| | - Angelina Bernier
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Eugene Lewit
- Department of Health Research and Policy, Stanford, Palo Alto, California, USA
| | - Eleni Sheehan
- Department of Pediatrics, University of Florida, Gainesville, Florida, USA
| | - Marina Basina
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Rayhan Lal
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
- Department of Medicine, Division of Endocrinology, Gerontology & Metabolism, Stanford University, Palo Alto, California, USA
| | - Jennifer Maizel
- College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - David M Maahs
- Department of Pediatrics and Division of Pediatric Endocrinology and Diabetes, Stanford University, Palo Alto, California, USA
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