Pediatric Diabetes[JOURNAL]
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200 papers
Continuous Glucose Monitoring Provides Durable Glycemic Benefit in Adolescents and Young Adults with Type 1 Diabetes: 12-Month Follow-Up Results.
Miller KM, Bauza C, Kanapka LG … +20 more , Clements MA, DeSalvo DJ, Hood K, Messer LH, Sherr J, Bergamo K, Criego A, Freiner E, Lyons SK, Monzavi R, Moore W, Prahalad P, Simmons JH, Sulik M, Wadwa RP, Weinstock RS, Willi SM, Williams K, Laffel LM, CITY Study Group
Pediatr Diabetes · 2023 · PMID 40303270 · Full text
OBJECTIVE: To further evaluate glycemic outcomes during the observational extension phase of the Continuous Glucose Monitoring (CGM) Intervention for Teens and Young Adults randomized clinical trial (RCT). . Following a...
OBJECTIVE: To further evaluate glycemic outcomes during the observational extension phase of the Continuous Glucose Monitoring (CGM) Intervention for Teens and Young Adults randomized clinical trial (RCT). . Following a 26-week RCT comparing CGM with blood glucose monitoring (BGM) in 153 adolescents and young adults aged 14 to <25 years old with suboptimally controlled type 1 diabetes, 70 (89%) participants in the BGM group initiated use of CGM (referred to as BGM-CGM cohort), and 70 (95%) participants in the CGM group continued to use of CGM (CGM-CGM cohort) for an additional 26 weeks. RESULTS: In the CGM-CGM cohort, mean hemoglobin A1c (HbA1c) decreased from 8.9% ± 0.9% (74 ± 9.8 mmol/mol) at randomization to 8.3% ± 1.3% (67 ± 14.2 mmol/mol) at 52 weeks ( < 0.001); however, significant improvement in time in target range (TIR) 70-180 mg/dL was not observed from prerandomization (38% ± 13%) to 52 weeks (41% ± 18%). Median percent time <70 mg/dL decreased from 3.0% before randomization to 1.1% at 52 weeks ( < 0.001). In the BGM-CGM cohort, mean HbA1c decreased from 8.9% ± 1.2% (74 ± 13.1 mmol/mol) before CGM initiation to 8.5% ± 1.3% (69 ± 14.2 mmol/mol) after 26 weeks of CGM use ( < 0.001) and mean TIR increased from 34% ± 12% to 38% ± 15% (=0.01). The median percent time <70 mg/dL decreased from 3.3% before CGM initiation to 1.2% after 26 weeks of CGM use ( < 0.001). No participants discontinued CGM use during the extension phase. CONCLUSIONS: This further evaluation of CGM supports the findings of the preceding RCT that use of CGM improves glycemic control and reduces hypoglycemia in adolescents and young adults with type 1 diabetes. This trial is registered with NCT03263494.
Disparities in Glycemic Outcomes Persist in Youth with Type 1 Diabetes and High-Technology Use.
Nath MC, Frey B, Atchison J … +1 more , Schmitt JA
Pediatr Diabetes · 2023 · PMID 40303248 · Full text
BACKGROUND: Racial disparities are well described in glycemic outcomes in youth with Type 1 diabetes mellites (T1D). Hemoglobin A1c (HbA1c) has some limitations in comparing glycemia across patient groups as there are in...
BACKGROUND: Racial disparities are well described in glycemic outcomes in youth with Type 1 diabetes mellites (T1D). Hemoglobin A1c (HbA1c) has some limitations in comparing glycemia across patient groups as there are individual variations in mean glucose and HbA1c. OBJECTIVE: This study aimed to compare glycemic metrics obtained from (Dexcom G6) continuous glucose monitor (CGM) device with HbA1c levels controlling for race, age, duration of diabetes, race, insurance status, and insulin pump use with glycemic control. . Data analyzed included 188 patients, majority non-Hispanic White (NHW) ( = 147, 78.2%) and majority privately insured ( = 147, 78.2%). Half of the patients were using insulin pumps, ( = 94, 50.0%) and approximately half were female. Median age was 16.6 (interquartile range: 14.2-18.2) years old with a median age of diabetes diagnosis at 9.3-years old. RESULTS: Significant differences were observed between NHW and non-Hispanic Black (NHB) patients in terms of HbA1c, 90-day mean glucose, and 90-day time >250 mg/dL (>13.9 mmol/L) (7.6% vs. 9.2%, 181 mg/dL vs. 220 mg/dL, and 16.3% vs. 34.7%, respectively, < 0.001 for all comparisons). Multiple linear regression analysis was performed to predict the influence of age, duration of diabetes, race, insurance status, and insulin administration on glycemic outcomes. Regression analysis revealed significant equations for all glycemic outcomes, demonstrating a strong correlation ( < 0.0001, =0.0001, and < 0.0001, respectively). However, after controlling for these variables, only race and duration of diabetes remained independently associated with glycemic outcomes, suggesting that these factors strongly influence glycemic control independent of age, sex, insurance, and pump use. CONCLUSION: Even in a subset of youth with T1D using CGM with high rates of insulin pump use, disparities in glycemic outcomes persist. When evaluating glycemic outcomes, race remained a significant cofactor despite controlling for age, duration of diabetes, sex, insurance status, and insulin administration type. These results add to the existing literature, and demonstrate race remains strong predictor of glycemic outcomes.
Hypoglycemia Awareness Trajectories in Young People with Type 1 Diabetes Using Flash Glucose Monitoring.
Messaaoui A, Tenoutasse S, Hajselova L … +1 more , Crenier L
Pediatr Diabetes · 2023 · PMID 40303242 · Full text
AIM: The trajectories of the hypoglycemia awareness status (HAS) have not yet been studied in children and adolescents with Type 1 diabetes (T1D). METHODS: This 2-year follow-up study included children and adolescents wi...
AIM: The trajectories of the hypoglycemia awareness status (HAS) have not yet been studied in children and adolescents with Type 1 diabetes (T1D). METHODS: This 2-year follow-up study included children and adolescents with T1D aged 6‒20 years old and using flash glucose monitoring. The HAS of each participant was determined by the Gold score and assessed at three time points, along with clinical data. The trajectories based on HAS progression over time were identified, and a logistic regression analysis was performed to compare their characteristics. RESULTS: Among the 255 participants, we identified four HAS trajectories (T1-T4). T1: normal awareness of hypoglycemia (NAH) maintained over time ( = 82, 29%); T2: NAH recovered during follow-up ( = 40, 18%); T3: impaired awareness of hypoglycemia (IAH) developed during follow-up ( = 28, 12.4%); T4: IAH maintained over time ( = 59, 21%). Sixteen participants (7%) displayed no identifiable trajectory. Participants belonging to the T3 group were younger. Following a specific trajectory defined the risk of developing future severe hypoglycemia. CONCLUSIONS: HAS changed in a significant proportion of pediatric people with T1D over time. Participants with a trajectory toward IAH were younger. Frequent HAS assessments may help to improve hypoglycemia risk management, especially in young children with T1D.
Real-World Glycemic Improvements with Hybrid Closed Loop Pumps in Youth with Type 1 Diabetes.
Del Valle Rolón ME, Brown EA, Wolf RM
Pediatr Diabetes · 2023 · PMID 40303258 · Full text
OBJECTIVE: The use of hybrid closed-loop insulin delivery systems, specifically the t:slim X2 insulin pump with Control IQ (CIQ), has demonstrated improvement in glycemic control in clinical trials and real-world setting...
OBJECTIVE: The use of hybrid closed-loop insulin delivery systems, specifically the t:slim X2 insulin pump with Control IQ (CIQ), has demonstrated improvement in glycemic control in clinical trials and real-world settings. We sought to describe changes in glycemic control with use of CIQ in minority and nonminority youth. . This was a retrospective study of youth with type 1 diabetes (T1D) using CIQ over a 12-month period. Medical record data, pump data, and hemoglobin A1c (HbA1c) were collected from the visit prior to starting CIQ and at each clinic visit up to 12 months after starting CIQ. Continuous glucose monitor (CGM) data and HbA1c trajectory over time were compared to baseline and between minority and nonminority youth. RESULTS: The study included 136 patients of whom 21 were minority youth (non-Hispanic Black and Hispanic), 50% were male, with median age of 13.3, and median diabetes duration of 4.9. After starting CIQ, baseline median HbA1c for the nonminority group decreased from 7.8% to 7.1% ( < 0.001), baseline median HbA1c for minority youth decreased from 9.8% to 7.8% (=0.03), and the percentage of patients meeting target HbA1c <7% increased from 26% to 45%. Both nonminority and minority youth had a significant increase in time in range and decrease of average CGM glucose ( < 0.05). CONCLUSIONS: HbA1c levels decreased in both minority and nonminority youth within 12 months of starting CIQ, and more patients reached the HbA1c target of less than 7%. Disparities in HbA1c between minority and nonminority youth remained and additional studies are warranted to improve this.
Exploring Teachers' Attitudes toward the Management of Type 1 Diabetes: A Qualitative Study.
Horvath MD, Papp-Zipernovszky O, Tesch Z … +1 more , Buzas N
Pediatr Diabetes · 2023 · PMID 40303262 · Full text
This study aimed to explore the attitudes of teachers toward type 1 diabetes (T1D) and its management. Teachers working in kindergartens and schools ( = 30) participated in audio-recorded, semi-structured interviews (thr...
This study aimed to explore the attitudes of teachers toward type 1 diabetes (T1D) and its management. Teachers working in kindergartens and schools ( = 30) participated in audio-recorded, semi-structured interviews (three focus groups and 20 individual interviews) that were transcribed and analyzed using thematic analysis. We used the theory of the three components of attitude as a framework for the analysis. The three components of attitude emerged during the analysis: knowledge, positive and negative emotions, approaches, and opinions toward diabetes and its management and behavior. The main theme of knowledge included knowledge about diabetes in general and its management. Besides medical treatment, alternative treatment possibilities were mentioned by the participants. The affective component revealed empathy, integrating, and segregating approaches toward children living with diabetes. The behavior component revealed how teachers contribute to the care and integration of children with diabetes in schools. They support children with diabetes by the virtue of their profession. For example, they teach them health awareness and support their integration through peer education and sensitization. The findings indicated that, in addition to diabetes management tasks, teachers could help children with T1D by tutoring them and their peers about health awareness and T1D acceptance.
Diabetes Distress and Transition Readiness in Youths with Type 1 Diabetes Transitioning from Pediatric to Adult Care.
Leung JMWS, Al-Yahyawi NY, Choi HS … +4 more , Stewart LL, Bone JN, Tang TS, Amed S
Pediatr Diabetes · 2023 · PMID 40303261 · Full text
BACKGROUND: Youths with type 1 diabetes transitioning from pediatric to adult care are known to experience significant glycemic excursions and medical complications. Diabetes distress and transition readiness are two pot...
BACKGROUND: Youths with type 1 diabetes transitioning from pediatric to adult care are known to experience significant glycemic excursions and medical complications. Diabetes distress and transition readiness are two potentially related constructs involved in this transition process, but the relationship between them has not been extensively studied. . Lower diabetes distress is associated with increased transition readiness among youths with type 1 diabetes transitioning to adult care. SUBJECTS: One hundred one adolescents and emerging adults with type 1 diabetes transitioning to adult care complete data in 63 study participants. METHODS: In this cross-sectional study, we collected diabetes distress scale scores (via T1-DDS) and transition readiness scores (via Am I ON TRAC) at the last pediatric diabetes visit. We fitted regression models to estimate the relationship between T1-DDS scores and ON TRAC scores. RESULTS: The total mean T1-DDS score was associated with ON TRAC knowledge score ( = -2.73, 95% CI -4.41,-1.06, =0.002), behavior score ( = -2.61, 95% CI -4.39,-0.84, =0.005), and transition readiness indicator ( = -0.18, -0.34,-0.01, =0.03). Multiple T1-DDS subscales were associated with ON TRAC knowledge score: powerlessness, management distress, negative social perceptions, eating distress, physician distress, and family/friend distress. Multiple T1-DDS subscales were also associated with ON TRAC behavior score: management distress, negative social perceptions, eating distress, and family/friend distress. CONCLUSIONS: Diabetes distress and transition readiness have an inversely proportional relationship in youths with type 1 diabetes transitioning to adult care. Targeting diabetes distress may also improve transition readiness (and vice versa) in this population.
Comprehensive Overview of Quality of Life Instruments Used in Studies of Children with Diabetes: A Systematic Mapping Review.
Jespersen LN, Andersen TH, Grabowski D
Pediatr Diabetes · 2023 · PMID 40303260 · Full text
BACKGROUND: Quality of life (QoL) is extensively used as an outcome in the studies of children with diabetes. The interest in measuring QoL in relation to clinical treatment and interventions has led to an increase in th...
BACKGROUND: Quality of life (QoL) is extensively used as an outcome in the studies of children with diabetes. The interest in measuring QoL in relation to clinical treatment and interventions has led to an increase in the development and use of QoL measures. The vast number of available instruments can be a barrier for establishing evidence and can be overwhelming for clinicians and researchers who are interested in measuring QoL of children with diabetes. AIM: As a first step for reaching consensus, we aimed to provide a comprehensive overview of the application of QoL instruments used in children (2-18 years old) with diabetes. METHOD: A literature search for studies published from inception to January 2022 was conducted in the databases MEDLINE (Ovid), Embase (Ovid), PsycInfo (EBSCO), CINAHL (EBSCO), and ERIC (EBSCO). The search strategy combined the key concepts of "quality of life", "diabetes", and "children or adolescents". Studies were found eligible if (1) the population was below 19 years of age; (2) had diabetes mellitus; and (3) a quantitative measure of QoL was used. RESULTS: 3,775 unique articles were retrieved in the literature search and, across 503 articles included for synthesis, 67 QoL instruments were identified. The instruments were classified by i.a. population age, continent, use of pre-post measure, self-report or proxy, and type of diabetes. CONCLUSION: The extensive number of QoL instruments that are used for children with diabetes constitutes a substantial barrier for establishing evidence in relation to QoL in this research area.
Pancreas Imaging of Children with Type 1 Diabetes Reveals New Patterns and Correlations with Pancreatic Functions.
Pollé OG, Delfosse A, Michoux N … +6 more , Peeters F, Duchêne G, Louis J, Van Nieuwenhuyse B, Clapuyt P, Lysy PA
Pediatr Diabetes · 2023 · PMID 40303255 · Full text
OBJECTIVE: To perform a longitudinal characterization of the pancreas in patients with new-onset T1D and investigate the correlations between magnetic resonance imaging (MRI) parameters and pancreatic functions during th...
OBJECTIVE: To perform a longitudinal characterization of the pancreas in patients with new-onset T1D and investigate the correlations between magnetic resonance imaging (MRI) parameters and pancreatic functions during the first year postdiagnosis. METHODS: Thirty-one pediatric patients with new-onset T1D and 29 retrospective age-, body mass index-, and sex-matched controls were included in the study. Following hypotheses were investigated: (H1) the value of pancreas volume (PV) parameters in T1D and in controls, (H2) the association between MRI parameters and markers of pancreatic functions, (H3) the ability of MRI parameters to predict glucose homeostasis, (H4) the longitudinal evolution of MRI parameters and glucose homeostasis, -organ (whole pancreas) and -subregion (head, body, and tail). RESULTS: Patients with new-onset T1D demonstrated a significant decrease of PV at diagnosis compared to controls (-45%), with prepubertal patients having increased pancreas atrophy (+25%) (H1). PV parameters were correlated with C-peptide, and trypsinogen (PV and PV, respectively). Biparametric regression models including MRI parameters predicted pancreas functions during the first year postdiagnosis (H3). Longitudinal evolution of PV parameters at 1 year postdiagnosis was correlated with PV at diagnosis ( = -0.72) but not with markers of glucose homeostasis (H4). CONCLUSION: Our study shows that longitudinal analysis of pancreases of children with T1D using multiparametric MRI improve the understanding of T1D heterogeneity both in the context of its onset and its evolution.
Emergency Department Presentations of Diabetic Ketoacidosis in a Large Cohort of Children.
Nigrovic LE, Kuppermann N, Ghetti S … +15 more , Schunk JE, Stoner MJ, Rewers A, McManemy JK, Quayle KS, Trainor JL, Tzimenatos L, Bennett JE, Kwok MY, Myers SR, Brown KM, Casper TC, Olsen CS, Glaser NS, PECARN DKA FLUID Study Group
Pediatr Diabetes · 2023 · PMID 40303236 · Full text
BACKGROUND: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of childhood diabetes. However, the influence of demographic factors on presentation are not well-defined. METHODS: We included child...
BACKGROUND: Diabetic ketoacidosis (DKA) is a potentially life-threatening complication of childhood diabetes. However, the influence of demographic factors on presentation are not well-defined. METHODS: We included children from 12 centers who were <18 years with DKA (glucose > 300 mg/dL, serum pH < 7.25, or serum bicarbonate <15 mEq/L) enrolled in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) Trial. Data were also collected for children who presented to the centers during the enrollment period but were not enrolled due to disease or treatment-related reasons. We compared demographic, clinical, and biochemical findings among children with newly and previously diagnosed diabetes and children in different age groups. RESULTS: Of the 1,679 DKA episodes in 1,553 children, 799 (47.5%) episodes occurred in children with newly diagnosed diabetes and 396 (23.6%) were severe (pH < 7.1). Newly diagnosed children <6 years of age were not more likely to have severe DKA in terms of pH, but had more severe hypocarbia and higher blood urea nitrogen levels, factors previously associated with the risk of cerebral injury. Lower socioeconomic status (SES) (based on family income and maternal education level) were associated with more severe DKA in new onset children, and recurrent DKA in the previously diagnosed children. CONCLUSIONS: Greater efforts are needed to identify the children with diabetes early and to prevent recurrent DKA, particularly among children in low-SES groups. Young children with DKA may need more intensive monitoring due to higher risk of cerebral injury.
Adolescent- and Young Adult-Reported Outcomes and Use of Continuous Glucose Monitoring Features: A Report from the CITY Trial.
Messer LH, Bauza C, Miller KM … +6 more , Clements MA, DeSalvo DJ, Sherr J, Weinstock RS, Hood K, Laffel LM
Pediatr Diabetes · 2023 · PMID 40303243 · Full text
OBJECTIVE: To evaluate patterns of continuous glucose monitor (CGM) use and perceptions of quality of life in adolescents/young adults with type 1 diabetes (T1D) after using CGM for up to 52 weeks in the CGM Intervention...
OBJECTIVE: To evaluate patterns of continuous glucose monitor (CGM) use and perceptions of quality of life in adolescents/young adults with type 1 diabetes (T1D) after using CGM for up to 52 weeks in the CGM Intervention in Teens and Young (CITY) Adults randomized clinical trial (RCT). . Participants with T1D were initially randomized 1 : 1 to use of CGM or blood glucose meter (BGM) for 26 weeks. Following the RCT, participants in the BGM group initiated CGM (BGM-CGM cohort) and participants in the CGM group continued CGM (CGM-CGM cohort) for another 26 weeks. Problem Areas in Diabetes Survey-Pediatric Version (PAID-peds), Glucose Monitoring Satisfaction Survey (GMSS), Hypoglycemia Confidence Scale (HCS), Diabetes Technology Attitudes (DTA), Pittsburgh Sleep Quality Index (PSQI), Benefits of CGM, and Burdens of CGM were completed at baseline, 26 and 52 weeks. RESULTS: In both cohorts, >70% of participants were wearing CGM > 5 days/week at 52 weeks; 5% discontinued CGM. The majority used the mobile app to receive glucose data. Adolescents (14 to <19 years) were more likely to use SHARE features than young adults (80% versus 41%). CGM-CGM participants had significantly higher scores on GMSS, DTA, and HCS at 52 weeks compared with baseline, and reported higher benefit and lower burden perceptions than at baseline. Similar results were observed for the BGM-CGM cohort. CONCLUSIONS: Improvements in self-reported measures were observed in adolescents and young adults using CGM. As CGM use is also associated with better glycemic control, utilizing CGM may contribute to improving both medical outcomes and emotional health.
Implementation of After-Hours Nurse Line in an Academic Pediatric Endocrinology Practice.
Choudhary A, Adhikari S, White PC
Pediatr Diabetes · 2023 · PMID 40303279 · Full text
BACKGROUND: After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published exper...
BACKGROUND: After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published experience with this approach in the pediatric diabetes population. METHODS: An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. RESULTS: The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race. CONCLUSIONS: The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization.
Subsequent Device Usage and Caregiver Attitudes to Do-It-Yourself Real-Time Continuous Glucose Monitoring (DIY-rtCGM) among Children with Type 1 Diabetes 3 Months after Participation in a Randomized Controlled Trial.
Zhou Y, Elbalshy MM, Styles SE … +5 more , Crocket H, Jefferies C, Wiltshire E, de Bock MI, Wheeler BJ
Pediatr Diabetes · 2023 · PMID 40303268 · Full text
AIM: To assess children's subsequent device usage and caregiver attitudes to do-it-yourself real-time continuous glucose monitoring (DIY-rtCGM) at least 3 months after completing a randomized controlled trial (RCT). METH...
AIM: To assess children's subsequent device usage and caregiver attitudes to do-it-yourself real-time continuous glucose monitoring (DIY-rtCGM) at least 3 months after completing a randomized controlled trial (RCT). METHODS: A brief online questionnaire or telephone call was used to collect the subsequent device usage and caregivers' attitudes from a total of 55 families at least 3 months after their completion of an RCT investigating DIY-rtCGM adapted from their preexisting intermittently scanned glucose sensors plus education on using DIY-rtCGM system. To be eligible for the RCT, children had to be aged 2-13 years, have type 1 diabetes ≥6 months, and be rtCGM naïve. Data collected investigated current CGM use post-RCT and attitudes/user experiences to DIY-rtCGM in the months since RCT study support ended. RESULTS: Overall, responses from 81.8% (45/55) of caregivers were received. Mean age of children was 9.0 ± 2.7 years, and 31 (68.9%) children used insulin pumps. After 3 months, 44.4% (20/45) of responding caregivers reported ongoing DIY-rtCGM use, and of these, only 13 used DIY-rtCGM as the primary glucose monitoring method 100% of time. Of the 25 (55.6%) families who ceased DIY-rtCGM, 40% (10/25) had transitioned to commercial rtCGM. More than half of families (60%, 12/20) who continued DIY-rtCGM use had a very or extremely positive attitude toward the technology and 75% (15/20) of these families planned to continue DIY-rtCGM use. However, signal loss and sensor inaccuracy remained the major reasons among all responders both for decreased DIY-rtCGM wear time and eventual cessation. Burden of use primarily related to technical errors that could not be solved, and alarms, both of which were reported to contribute to discontinuation. CONCLUSIONS: This study highlights that, among families voluntarily using DIY-rtCGM at least 3 months following support from a trial, more than half have ceased using DIY-rtCGM, with 40% of those discontinuing switching to commercial rtCGM. While overall perceptions of DIY-rtCGM remain largely positive, burdens of use are high and contribute to discontinuation.
Vascular and Myocardial Structure and Function in Adolescents with Type 1 Diabetes: The CARDEA Study.
Harnois-Leblanc S, McNealis V, Friedrich MG … +9 more , Bigras JL, Van Hulst A, Nuyt AM, Barnett TA, Benedetti A, Mathieu MÈ, Drapeau V, Sylvestre MP, Henderson M
Pediatr Diabetes · 2023 · PMID 40303256 · Full text
INTRODUCTION: Despite heightened risk of cardiovascular disease (CVD) among individuals with type 1 diabetes, few studies in this population have investigated the development of CVD using early markers in adolescence. We...
INTRODUCTION: Despite heightened risk of cardiovascular disease (CVD) among individuals with type 1 diabetes, few studies in this population have investigated the development of CVD using early markers in adolescence. We compared risk factors (blood pressure (BP) and dyslipidemia) and early markers of CVD between adolescents with and without type 1 diabetes and explored effect modification by sex. METHODS: Cross-sectional study using data from the CARdiovascular Disease risk in pEdiatric type 1 diAbetes (CARDEA) study. We recruited 100 adolescents with type 1 diabetes at the Sainte-Justine University Hospital Center and 97 adolescents without diabetes (14-18 years). We measured arterial stiffness by carotid-femoral pulse wave velocity, endothelial function by brachial artery flow-mediated dilation test, as well as left ventricular (LV) mass, papillary mass, and wall thickness by cardiac MRI. We used multivariable linear regression models to assess the impact of type 1 diabetes on each outcome adjusting for age, sex, ethnicity, adiposity, and familial income. RESULTS: Adolescents with type 1 diabetes had 0.21 standard deviations (SD) (95% CI: 0.04; 0.38) higher diastolic blood pressure -score (zDBP), 0.21 mmol/L (95% CI: 0.02; 0.40) higher low-density lipoprotein cholesterol (LDL-c) levels, and 17% (95% CI: 4; 29) higher triglyceride levels and lower endothelial function based on acceleration (-77.4 cm/s, 95% CI: -133.1; -21.6) compared with adolescents without diabetes. Girls with type 1 diabetes had higher systolic blood pressure -score (zSBP), and boys with type 1 diabetes had lower LV mass and wall thickness compared to healthy peers. CONCLUSIONS: In addition to higher BP and abnormal lipid profiles, adolescents with type 1 diabetes present endothelial dysfunction and alterations in cardiac structure (in boys) compared to adolescents without diabetes, suggesting that CVD prevention should be incorporated into type 1 diabetes management early in the disease.
Risk Factors for Hyperosmolar Hyperglycemic State in Pediatric Type 2 Diabetes.
Everett EM, Copeland T, Wisk LE … +1 more , Chao LC
Pediatr Diabetes · 2023 · PMID 37614411 · Full text
BACKGROUND: There is a paucity of data on the risk factors for the hyperosmolar hyperglycemic state (HHS) compared with diabetic ketoacidosis (DKA) in pediatric type 2 diabetes (T2D). METHODS: We used the national Kids'...
BACKGROUND: There is a paucity of data on the risk factors for the hyperosmolar hyperglycemic state (HHS) compared with diabetic ketoacidosis (DKA) in pediatric type 2 diabetes (T2D). METHODS: We used the national Kids' Inpatient Database to identify pediatric admissions for DKA and HHS among those with T2D in the years 2006, 2009, 2012, and 2019. Admissions were identified using ICD codes. Those aged <9yo were excluded. We used descriptive statistics to summarize baseline characteristics and Chi-squared test and logistic regression to evaluate factors associated with admission for HHS compared with DKA in unadjusted and adjusted models. RESULTS: We found 8,961 admissions for hyperglycemic emergencies in youth with T2D, of which 6% were due to HHS and 94% were for DKA. These admissions occurred mostly in youth 17-20 years old (64%) who were non-White (Black 31%, Hispanic 20%), with public insurance (49%) and from the lowest income quartile (42%). In adjusted models, there were increased odds for HHS compared to DKA in males (OR 1.77, 95% CI 1.42-2.21) and those of Black race compared to those of White race (OR 1.81, 95% CI 1.34-2.44). Admissions for HHS had 11.3-fold higher odds for major or extreme severity of illness and 5.0-fold higher odds for mortality. CONCLUSION: While DKA represents the most admissions for hyperglycemic emergencies among pediatric T2D, those admitted for HHS had higher severity of illness and mortality. Male gender and Black race were associated with HHS admission compared to DKA. Additional studies are needed to understand the drivers of these risk factors.
Situational Awareness and Proactive Engagement Predict Higher Time in Range in Adolescents and Young Adults Using Hybrid Closed-Loop.
Messer LH, Cook PF, Voida S … +6 more , Fiesler C, Fivekiller E, Agrawal C, Xu T, Forlenza GP, Sankaranarayanan S
Pediatr Diabetes · 2023 · PMID 37614410 · Full text
BACKGROUND: Adolescents and young adults with type 1 diabetes have high HbA1c levels and often struggle with self-management behaviors and attention to diabetes care. Hybrid closed-loop systems (HCL) like the t:slim X2 w...
BACKGROUND: Adolescents and young adults with type 1 diabetes have high HbA1c levels and often struggle with self-management behaviors and attention to diabetes care. Hybrid closed-loop systems (HCL) like the t:slim X2 with Control-IQ technology (Control-IQ) can help improve glycemic control. The purpose of this study is to assess adolescents' situational awareness of their glucose control and engagement with the Control-IQ system to determine significant factors in daily glycemic control. METHODS: Adolescents (15-25 years) using Control-IQ participated in a 2-week prospective study, gathering detailed information about Control-IQ system engagements (boluses, alerts, and so on) and asking the participants' age and gender about their awareness of glucose levels 2-3 times/day without checking. Mixed models assessed which behaviors and awareness items correlated with time in range (TIR, 70-180 mg/dl, 3.9-10.0 mmol/L). RESULTS: Eighteen adolescents/young adults (mean age 18 ± 1.86 years and 86% White non-Hispanic) completed the study. Situational awareness of glucose levels did not correlate with time since the last glucose check ( = 0.8). In multivariable modeling, lower TIR was predicted on days when adolescents underestimated their glucose levels ( = -0.22), received more CGM alerts ( = -0.31), and had more pump engagements ( = -0.27). A higher TIR was predicted when adolescents responded to CGM alerts ( = 0.20) and entered carbohydrates into the bolus calculator ( = 0.49). CONCLUSION: Situational awareness is an independent predictor of TIR and may provide insight into patterns of attention and focus that could positively influence glycemic outcomes in adolescents. Proactive engagements predict better TIR, whereas reactive engagement predicted lower TIR. Future interventions could be designed to train users to develop awareness and expertise in effective diabetes self-management.
Dietary Intake and Body Mass Index Influence the Risk of Islet Autoimmunity in Genetically At-Risk Children: A Mediation Analysis Using the TEDDY Cohort.
Aronsson CA, Tamura R, Vehik K … +13 more , Uusitalo U, Yang J, Haller MJ, Toppari J, Hagopian W, McIndoe RA, Rewers MJ, Ziegler AG, Akolkar B, Krischer JP, Norris JM, Virtanen SM, Larsson HE
Pediatr Diabetes · 2023 · PMID 37614409 · Full text
BACKGROUND/OBJECTIVE: Growth and obesity have been associated with increased risk of islet autoimmunity (IA) and progression to type 1 diabetes. We aimed to estimate the effect of energy-yielding macronutrient intake on...
BACKGROUND/OBJECTIVE: Growth and obesity have been associated with increased risk of islet autoimmunity (IA) and progression to type 1 diabetes. We aimed to estimate the effect of energy-yielding macronutrient intake on the development of IA through BMI. RESEARCH DESIGN AND METHODS: Genetically at-risk children ( = 5,084) in Finland, Germany, Sweden, and the USA, who were autoantibody negative at 2 years of age, were followed to the age of 8 years, with anthropometric measurements and 3-day food records collected biannually. Of these, 495 (9.7%) children developed IA. Mediation analysis for time-varying covariates (BMI -score) and exposure (energy intake) was conducted. Cox proportional hazard method was used in sensitivity analysis. RESULTS: We found an indirect effect of total energy intake (estimates: indirect effect 0.13 [0.05, 0.21]) and energy from protein (estimates: indirect effect 0.06 [0.02, 0.11]), fat (estimates: indirect effect 0.03 [0.01, 0.05]), and carbohydrates (estimates: indirect effect 0.02 [0.00, 0.04]) (kcal/day) on the development of IA. A direct effect was found for protein, expressed both as kcal/day (estimates: direct effect 1.09 [0.35, 1.56]) and energy percentage (estimates: direct effect 72.8 [3.0, 98.0]) and the development of GAD autoantibodies (GADA). In the sensitivity analysis, energy from protein (kcal/day) was associated with increased risk for GADA, hazard ratio 1.24 (95% CI: 1.09, 1.53), 0.042. CONCLUSIONS: This study confirms that higher total energy intake is associated with higher BMI, which leads to higher risk of the development of IA. A diet with larger proportion of energy from protein has a direct effect on the development of GADA.
Formative Development of a Weight Management Intervention for Adolescents with Type 1 Diabetes Mellitus and Obesity.
Warnick J, Darling KE, Topor LS … +1 more , Jelalian E
Pediatr Diabetes · 2023 · PMID 37614408 · Full text
The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes...
The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes. Unfortunately, youth with T1D are often excluded from and/or not referred to standard behavioral lifestyle interventions. This is often attributed to the complexities of managing T1D and an effort not to overburden persons who have T1D. Furthermore, standard behavioral weight management intervention recommendations can be perceived as contradicting T1D disease management (e.g., removing sugar-sweetened beverages from diet, energy balance with exercise, and caloric restriction). A weight management intervention specifically designed for youth with T1D is needed to provide treatment to youth with comorbid T1D and overweight/obesity. The current study interviewed adolescents with T1D and overweight/obesity ( = 12), their caregivers ( = 12), and pediatric endocrinologists ( = 9) to understand (a) whether they would be interested in a weight management intervention adapted for youth with T1D and (b) specific adaptations they would want and need. Five central themes emerged following applied thematic analysis: (1) program content, (2) programmatic messaging, (3) program structure, (4) social support, and (5) eating disorder risk. Results provide detailed recommendations for the adaptation of a behavioral weight management intervention for youth with T1D.
Sedentary Behavior and Physical Activity Associated with Psychosocial Outcomes in Adolescents with Type 1 Diabetes.
Tilden DR, Noser AE, Jaser SS
Pediatr Diabetes · 2023 · PMID 37614407 · Full text
BACKGROUND: Adolescents with type 1 diabetes (T1D) are particularly vulnerable to poor psychosocial outcomes-high rates of diabetes distress and poor quality of life are common among this cohort. Previous work in the gen...
BACKGROUND: Adolescents with type 1 diabetes (T1D) are particularly vulnerable to poor psychosocial outcomes-high rates of diabetes distress and poor quality of life are common among this cohort. Previous work in the general population demonstrated positive associations between quality of life and increases in moderate-to-vigorous physical activity (MVPA), as well as decreased sedentary behavior. While survey-based assessments of young adults with T1D observed similar trends, these studies were limited by their use of subjective assessments of MVPA and sedentary behavior. The use of direct activity monitoring is needed to establish the association between psychosocial outcomes and MVPA and sedentary behavior among adolescents with T1D. OBJECTIVE: To explore the association between objectively measured MVPA and sedentary behavior on psychosocial outcomes among adolescents with T1D. SUBJECTS AND METHODS: The current study is a secondary analysis of baseline data collected for a pilot trial of sleep-promoting intervention for adolescents with T1D. Participants ( = 29, with a mean age of 15.9 ± 1.3 years) completed baseline surveys and wore an actigraph for a week following the baseline visit. We examined minutes per week of MVPA and proportion of awake time spent sedentary in relation to adolescents' diabetes distress, depressive symptoms, and diabetes-related quality of life. RESULTS: Participants engaged in a mean of 19.6 ± 22.4 minutes of MVPA per day and spent 68.6 ± 9.9% of their awake time sedentary. MVPA was associated with lower diabetes distress in unadjusted (-3.6; 95% CI: -6.4 to -0.8) and adjusted (-2.6; 95% CI: -5.0--0.3) analyses. Sedentary time was associated with higher diabetes distress in adjusted (6.3; 95% CI: 1.3-11.2) but not unadjusted (6.0; 95% CI: -5.6-12.6) analyses. In secondary analyses, we did not observe significant associations between quality of life or depressive symptoms with either MVPA or sedentary behavior. DISCUSSION: Our findings extend previous survey-based work demonstrating an association between decreased diabetes distress with greater weekly MVPA and lower sedentary time. The current study highlights the multifaceted benefits of physical activity in this population and provides preliminary evidence for developing interventions to reduce sedentary time as an alternative method to improve psychosocial outcomes in this at-risk population.
A Comparison of Depressive Symptom Presentation in Adolescent Type 1 Diabetes and Pediatric Primary Care Samples.
Bahreman N, Dietrich MS, Jaser S … +2 more , Akard Foster T, Mulvaney S
Pediatr Diabetes · 2023 · PMID 40303264 · Full text
BACKGROUND: Depression is a common comorbidity in adolescents with type 1 diabetes (T1D). It is unclear if patterns of responses from questionnaires used to screen for depressive symptoms are influenced by the burden of...
BACKGROUND: Depression is a common comorbidity in adolescents with type 1 diabetes (T1D). It is unclear if patterns of responses from questionnaires used to screen for depressive symptoms are influenced by the burden of living with T1D and/or the consequences of hyperglycemia. Based on this gap in the adolescent research, we sought to identify potential differences in depression screening response patterns between adolescents with and without T1D and relate response patterns with glycemic outcomes. METHODS: Using a retrospective case-control design, we analyzed electronic health records for age, sex, and race-matched adolescents 13-18 years of age from a pediatric diabetes clinic ( = 477) and a pediatric primary care clinic ( = 477) in the United States. Adolescents in both settings were screened for depressive symptoms during the same time period using the Patient Health Questionnaire-9 (PHQ-9). RESULTS: Participant demographics for matched characteristics were: 53.5% male, 71.7% White, median age 13.0 (interquartile range = 13.0, 14.0). After controlling for type of insurance, adolescents with T1D were more likely to have higher total PHQ-9 scores (odds ratio (OR) = 1.51, 95% CI = 1.17, 1.98, = 0.002) and higher somatic subscores (OR = 1.57, 95% CI = 1.20, 2.05, = 0.001) compared to the primary care sample. The pattern of item endorsement greater than "not at all" indicated that adolescents with T1D were more likely to have higher values for somatic items such as "trouble falling asleep" and "feeling tired" than those in the primary care sample. Item-total correlations and Cronbach's indicated that all items were contributing to the overall score in the same manner in each group. CONCLUSIONS: Symptom endorsement for sleep and fatigue were higher for adolescents with T1D and without T1D. Study results support the need for further examination of the origins of somatic symptoms in T1D and for an additional examination of the specificity of depression screening instruments used in routine pediatric diabetes care.
Ongoing Increase in Incidence of Diabetes in Austrian Children and Adolescents (1989-2021): Results from a Nationwide Registry.
Nagl K, Waldhör T, Hofer SE … +4 more , Blauensteiner N, Fritsch M, Fröhlich-Reiterer E, Rami-Merhar B
Pediatr Diabetes · 2023 · PMID 40303272 · Full text
INTRODUCTION: Since there is no uniform global diabetes trend in childhood and adolescence, regional epidemiological surveys of diabetes incidences are important. In Austria, the incidences of type 1 diabetes (T1D), type...
INTRODUCTION: Since there is no uniform global diabetes trend in childhood and adolescence, regional epidemiological surveys of diabetes incidences are important. In Austria, the incidences of type 1 diabetes (T1D), type 2 diabetes (T2D), and other forms of diabetes have been recorded for decades. METHODS: To analyze recent developments of diabetes incidence within the decades long-standing Austrian nationwide prospective population-based incidence study for diabetes in children aged <15 years. We estimated time trends of age-standardized rates from 1989 to 2021 for T1D and T2D by joinpoint analysis. Annual percent changes (APCs) were calculated. Case ascertainment was 97%. RESULTS: We observed an unusual increase of T1D incidence in the year 2021, reaching a peak of 28.7/100,000/PY (person years). From 2011 to 2020, there had been a constant plateau phase in the total cohort (APC 0.78, 95% CI [-0.99, 2.58], = 0.379), which had followed a steep increase of T1D incidence (APC 4.6, 95% CI [3.94, 5.19], < 0.001) from 1989 to 2011. Age-specific differences in T1D incidence development were observed. For the first time, we observed a statistically significant constant increase in T2D during the observation period (APC 3.47, 95% CI [0.76, 6.26], = 0.014). Other forms of diabetes are two times more common than T2D in this age group. CONCLUSION: The incidence of T1D in Austrian children <15 years is still increasing and showed a peak in 2021. For the first time, a significant increase in pediatric T2D was observed in Austria.
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