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Liberman A, Shenker MN, Bello R, Yackobovitch-Gavan M, Shachar-Lavie I, Wójcik M, Starmach A, Starzyk JB, Kostopoulou E, Chrysis D, Phillip M. Fear of hyperglycemia in parents of children with type 1 diabetes mellitus - a multi-center multi-national study. Diabet Med 2023:e15114. [PMID: 37052607 DOI: 10.1111/dme.15114] [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: 10/01/2022] [Revised: 04/03/2023] [Accepted: 04/12/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Study aims: (1) developing and validating a novel questionnaire for measuring fear of hyperglycemia among parents of children with type 1 diabetes (T1D) - the Hyperglycemia Fear Survey - Parent version (FoHyper-P); (2) investigating correlations between parental fear of hyperglycemia and objective measures of glycemic control. RESEARCH DESIGN AND METHODS A multi-center, multi-national study of 152 parents of children with T1D was conducted in three large diabetes clinics from Israel, Poland, and Greece. Inclusion criteria were parents of children aged 6-16 years, at least 6 months from diagnosis, at least 3 months of CGM use and parental involvement in care. Parents filled the FoHyper-P and the Hypoglycemia Fear Survey - Parent Version (HFS-P). Patient data were obtained via electronic medical records and informative questionnaires. Bonferroni correction was performed to counteract multiple comparisons. RESULTS Significant strong-moderate correlations were found between FoHyper-P and HFS-P including total questionnaires scoring (r=0.747, PBonf. <0.001), worries subscales (r=0.735, PBonf <0.001), and behavior subscales (r=0.532, PBonf <0.001). Using linear regression models we found a positive association between the worry subscale and HbA1C. Weak correlations (P<0.05, not significant after Bonferroni correction) were found between time in range, time above range and parental fear of hyperglycemia as well as between worry subscales and a higher HbA1C in the past year, percent of hyperglycemia and lower TIR. CONCLUSIONS The FoHyper-P is a novel, validated tool for assessing parental fear of hyperglycemia. Integrating it into clinical practice addresses an underestimated aspect of parental diabetes management, enabling better care for children with T1D.
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Affiliation(s)
- Alon Liberman
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Michal Nevo Shenker
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Rachel Bello
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Michal Yackobovitch-Gavan
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
- Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Shachar-Lavie
- Psychological Medicine, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
| | - Małgorzata Wójcik
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Children's University Hospital, Kraków, Poland
| | - Anna Starmach
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Children's University Hospital, Kraków, Poland
| | - Jerzy B Starzyk
- Department of Pediatric and Adolescent Endocrinology, Jagiellonian University Medical College, Children's University Hospital, Kraków, Poland
| | - Eirini Kostopoulou
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University General Hospital of Patras, Rio, Greece
| | - Dionisios Chrysis
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, University General Hospital of Patras, Rio, Greece
| | - Moshe Phillip
- Jesse Z. and Sara Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikvah, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Nimri R, Dassau E, Segall T, Muller I, Bratina N, Kordonouri O, Bello R, Biester T, Dovc K, Tenenbaum A, Brener A, Šimunović M, Sakka SD, Nevo Shenker M, Passone CG, Rutigliano I, Tinti D, Bonura C, Caiulo S, Ruszala A, Piccini B, Giri D, Stein R, Rabbone I, Bruzzi P, Omladič JŠ, Steele C, Beccuti G, Yackobovitch-Gavan M, Battelino T, Danne T, Atlas E, Phillip M. Adjusting insulin doses in patients with type 1 diabetes who use insulin pump and continuous glucose monitoring: Variations among countries and physicians. Diabetes Obes Metab 2018; 20:2458-2466. [PMID: 29885025 DOI: 10.1111/dom.13408] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [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: 03/31/2018] [Revised: 05/27/2018] [Accepted: 06/05/2018] [Indexed: 12/14/2022]
Abstract
AIMS To evaluate physicians' adjustments of insulin pump settings based on continuous glucose monitoring (CGM) for patients with type 1 diabetes and to compare these to automated insulin dose adjustments. METHODS A total of 26 physicians from 16 centres in Europe, Israel and South America participated in the study. All were asked to adjust insulin dosing based on insulin pump, CGM and glucometer downloads of 15 patients (mean age 16.2 ± 4.3 years, six female, mean glycated haemoglobin 8.3 ± 0.9% [66.8 ± 7.3 mmol/mol]) gathered over a 3-week period. Recommendations were compared for the relative changes in the basal, carbohydrate to insulin ratio (CR) and correction factor (CF) plans among physicians and among centres and also between the physicians and an automated algorithm, the Advisor Pro (DreaMed Diabetes Ltd, Petah Tikva, Israel). Study endpoints were the percentage of comparison points for which there was full agreement on the trend of insulin dose adjustments (same trend), partial agreement (increase/decrease vs no change) and full disagreement (opposite trend). RESULTS The percentages for full agreement between physicians on the trend of insulin adjustments of the basal, CR and CF plans were 41 ± 9%, 45 ± 11% and 45.5 ± 13%, and for complete disagreement they were 12 ± 7%, 9.5 ± 7% and 10 ± 8%, respectively. Significantly similar results were found between the physicians and the automated algorithm. The algorithm magnitude of insulin dose change was at least equal to or less than that proposed by the physicians. CONCLUSIONS Physicians provide different insulin dose recommendations based on the same datasets. The automated advice of the Advisor Pro did not differ significantly from the advice given by the physicians in the direction or magnitude of the insulin dosing.
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Affiliation(s)
- Revital Nimri
- 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
| | - Eyal Dassau
- Harvard John A. Paulson School of Engineering and Applied Sciences, Harvard University, Cambridge, Massachusetts
| | | | - Ido Muller
- DreaMed Diabetes Ltd, Petah Tikva, Israel
| | - Natasa Bratina
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Rachel Bello
- 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
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Klemen Dovc
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Ariel Tenenbaum
- 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
| | - Avivit Brener
- 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
| | - Marko Šimunović
- Department of Pediatrics, University Hospital Centre Split, Split, Croatia
| | - Sophia D Sakka
- Department of Endocrinology and Diabetes, Evelina London Children's Hospital, London, UK
| | - Michal Nevo Shenker
- 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
| | | | - Irene Rutigliano
- Pediatrics IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo, Italy
| | - Davide Tinti
- Centre of Pediatric Diabetes, Department of Pediatrics, University of Turin, Turin, Italy
| | - Clara Bonura
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Silvana Caiulo
- San Raffaele Hospital, Vita-Salute San Raffaele University, Milan, Italy
| | - Anna Ruszala
- Department of Pediatric and Adolescent Endocrinology, Institute of Pediatrics, Jagiellonian University Medical College, Krakow, Poland
| | - Barbara Piccini
- Diabetology Unit, Meyer Children's Hospital, Florence, Italy
| | - Dinesh Giri
- Department of Paediatric Endocrinology and Diabetes, Bristol Royal Hospital for Children, Bristol, UK
| | - Ronnie Stein
- Paediatric Endocrinology and Diabetes Unit, Dana-Dwek Children's Hospital, Sourasky Medical Centre, Tel Aviv, Israel
| | - Ivana Rabbone
- Centre of Pediatric Diabetes, Department of Pediatrics, University of Turin, Turin, Italy
| | - Patrizia Bruzzi
- Departments of Medical and Surgical Sciences of Mothers, Children and Adults, Azienda Ospedaliero-Univeristaria of Modena Policlinico, Paediatric Unit, Modena, Italy
| | - Jasna Šuput Omladič
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
| | - Caroline Steele
- Paediatric Endocrinology and Diabetes, Leeds Children's Hospital, Leeds, UK
| | - Guglielmo Beccuti
- Division of Endocrinology, Diabetes and Metabolism, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michal Yackobovitch-Gavan
- 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
| | - Tadej Battelino
- Department of Pediatric Endocrinology, Diabetes and Metabolism, University Medical Centre-University Children's Hospital, Ljubljana, Slovenia
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, Auf der Bult, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Eran Atlas
- DreaMed Diabetes Ltd, Petah Tikva, Israel
| | - Moshe Phillip
- 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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