Pediatric Diabetes[JOURNAL]
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200 papers
Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry.
Evin F, Tittel SR, Piccini B … +7 more , Cardona-Hernandez R, Mul D, Sheanon N, von dem Berge T, Neuman V, Tauschmann M, Gökşen D
Pediatr Diabetes · 2023 · PMID 40303252 · Full text
BACKGROUND AND AIMS: The optimal basal and bolus insulin distribution in type 1 diabetes (T1D) is still controversial. Herein, we aimed to determine the variability of basal to total daily insulin dose according to treat...
BACKGROUND AND AIMS: The optimal basal and bolus insulin distribution in type 1 diabetes (T1D) is still controversial. Herein, we aimed to determine the variability of basal to total daily insulin dose according to treatment modality and diabetes technologies from the Better Control in Pediatric and Adolescent Diabetes: () . The study cohort was generated by using the SWEET database. Patients with T1D for at least 2 years, aged between 2.5 and 18 years, with at least one clinic visit between June 2010 and June 2021, were included in the study. Four groups were composed according to treatment modality as follows: multiple daily injections (MDI) without continuous glucose monitoring (CGM); MDI with CGM; subcutaneous insulin infusion (CSII) without CGM; and CSII with CGM. Data of the participants were analyzed and compared for each treatment modality separately. RESULTS: A total of 38,956 children and adolescents were included in the study. Of the study sample, 48.6% were female, the median (range) age was 15.2 (11.9-17.2) years, and the median diabetes duration was 6.0 (3.8-9.0) years. The distribution of treatment modality was as follows: MDI without CGM, 32.9%; MDI with CGM, 18.0%; CSII without CGM, 11.7%; and CSII with CGM, 37.3%. In unadjusted data, regardless of treatment modality, all the analyses revealed a significant association between basal dose to total daily insulin dose (BD/TDD) with male gender, younger age group, and lower HbA1c, which were all related to a decreased ratio of BD/TDD (all < 0.05). There was no association between BD/TDD and different diabetes technologies after the age, gender, and diabetes duration were adjusted. CONCLUSIONS: Herein, we showed that there was an association between lower proportions of basal to total insulin and lower hemoglobin A1c in a large cross-sectional cohort of children who had T1D. There was also an association between lower BD/TDD and younger age. There was no significant difference between BD/TDD ratios under different diabetes technologies (CGM and/or CSII).
Impact of SARS-CoV-2 Infection on Disease Trajectory in Youth with T1D: An EHR-Based Cohort Study from the RECOVER Program.
Prahalad P, Lorman V, Wu Q … +16 more , Razzaghi H, Chen Y, Pajor N, Case A, Bose-Brill S, Block J, Patel PB, Rao S, Mejias A, Forrest CB, Bailey LC, Jhaveri R, Thacker D, Christakis DA, Lee GM, Consortium OBOTR
Pediatr Diabetes · 2023 · PMID 40303244 · Full text
BACKGROUND: Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is associated with worsening diabetes trajectory. It is unknown whether PASC in children with type 1 diabete...
BACKGROUND: Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is associated with worsening diabetes trajectory. It is unknown whether PASC in children with type 1 diabetes (T1D) manifests as worsening diabetes trajectory. OBJECTIVE: To explore the association between SARS-CoV-2 infection (COVID-19) and T1D-related healthcare utilization (for diabetic ketoacidosis (DKA) or severe hypoglycemia (SH)) or hemoglobin (Hb) A1c trajectory. Methods: We included children <21 years with T1D and ≥1 HbA1c prior to cohort entry, which was defined as COVID-19 (positive diagnostic test or diagnosis code for COVID-19, multisystem inflammatory syndrome in children, or PASC) or a randomly selected negative test for those who were negative throughout the study period (Broad Cohort). A subset with ≥1 HbA1c value from 28 to 275 days after cohort entry (Narrow Cohort) was included in the trajectory analysis. Propensity score-based matched cohort design followed by weighted Cox regression was used to evaluate the association of COVID-19 with healthcare utilization ≥28 days after cohort entry. Generalized estimating equation (GEE) models were used to measure change in HbA1c in the Narrow Cohort. RESULTS: From March 01, 2020 to June 22, 2022, 2,404 and 1,221 youth met entry criteria for the Broad and Narrow Cohorts, respectively. The hazard ratio for utilization was (HR 1.45 (95% CI: 0.97, 2.16)). In the Narrow Cohort, the rate of change (slope) of HbA1c increased 91-180 days after cohort entry for those with COVID-19 (0.138 vs. -0.002, = 0.172). Beyond 180 days, greater declines in HbA1c were observed in the positive cohort (-0.104 vs. 0.008 per month, = 0.024). CONCLUSION: While a trend toward worse outcomes following COVID-19 in T1D patients was observed, these findings were not statistically significant. Continued clinical monitoring of youth with T1D following COVID-19 is warranted.
Metabolomics and Lipidomics Studies in Pediatric Type 1 Diabetes: Biomarker Discovery for the Early Diagnosis and Prognosis.
Liu Y, Dong G, Huang K … +6 more , Hong Y, Chen X, Zhu M, Hao X, Ni Y, Fu J
Pediatr Diabetes · 2023 · PMID 40303249 · Full text
AIM: Type 1 diabetes (T1D) is an autoimmune disease with heterogeneous risk factors. Metabolic perturbations in the pathogenesis of the disease are remarkable to illuminate the interaction between genetic and environment...
AIM: Type 1 diabetes (T1D) is an autoimmune disease with heterogeneous risk factors. Metabolic perturbations in the pathogenesis of the disease are remarkable to illuminate the interaction between genetic and environmental factors and how islet immunity and overt diabetes develop. This review aimed to integrate the metabolic changes of T1D to identify potential biomarkers for predicting disease progression based on recent metabolomics and lipidomics studies with parallel methodologies. METHODS: A total of 18 metabolomics and lipidomics studies of childhood T1D during the last 15 years were reviewed. The metabolic fingerprints consisting of 41 lipids and/or metabolite classes of subjects with islet autoantibodies, progressors of T1D, and T1D children were mapped in four-time dimensions based on a tentative effect-score rule. RESULTS: From birth, high-risk T1D subjects had decreased unsaturated triacylglycerols, unsaturated phosphatidylcholines (PCs), sphingomyelins (SMs), amino acids, and metabolites in the tricarboxylic acid (TCA) cycle. On the contrary, lysophosphatidylcholines (LPCs) and monosaccharides increased. And LPCs and branched-chain amino acids (BCAAs) were elevated before the appearance of islet autoantibodies but were lowered after seroconversion. Choline-related lipids (including PCs, SMs, and LPCs), BCAAs, and metabolites involved in the TCA cycle were identified as consensus biomarkers potentially predicting the development of islet autoimmunity and T1D. Decreased LPCs and amino acids indicated poor glycemic control of T1D, while elevated lysophosphatidylethanolamines and saturated PCs implied good glycemic control. Further pathway analysis revealed that biosynthesis of aminoacyl-tRNA, BCAAs, and alanine, aspartate, and glutamate metabolism were significantly enriched. Moreover, established cohort studies and predictive statistical models of pediatric T1D were also summarized. CONCLUSION: The metabolic profile of high-risk T1D subjects and patients demonstrated significant changes compared with healthy controls. This integrated analysis provides a comprehensive overview of metabolic features and potential biomarkers in the pathogenesis and progression of T1D.
Integrating Physical Activity Strategies to Lower Hyperglycaemia in Structured Education Programmes for Children and Young People with Type 1 Diabetes Improves Glycaemic Control without Augmenting the Risk of Hypoglycaemia.
Pemberton JS, Gupta A, Lau GM … +3 more , Dickinson I, Iyer PV, Uday S
Pediatr Diabetes · 2023 · PMID 40303277 · Full text
OBJECTIVES: Investigate the effect of using short bursts of moderate-intensity activity between meals to lower hyperglycaemia on glucose metrics. . Children and young people with type 1 diabetes (CYPD) attending continuo...
OBJECTIVES: Investigate the effect of using short bursts of moderate-intensity activity between meals to lower hyperglycaemia on glucose metrics. . Children and young people with type 1 diabetes (CYPD) attending continuous glucose monitoring education were taught to use moderate-intensity activity to lower high glucose levels (to <10.0 mmol/L using 10-15 minlowers ∼2.0 mmol/L) between meals. Retrospective cross-sectional data analysis of CYPD at a single tertiary centre between 2019 and 2022. Data were collected on demographics and glucose metrics (HbA1c, time in range (TIR, 3.9-10.0 mmol/L), time above range (TAR, >10.0 mmol/L), time below range (TBR, <3.9 mmol/L)). Minutes of activity usually performed to lower a glucose level of 14.0 mmol/L trending steady at 6 months grouped the CYPD into low (<5 min), mild (5-10 min), or moderate (11-20 min) activity groups. RESULTS: 125 ( = 53, 40% male) CYPD with a mean (standard deviations) age of 12.3 (±3.7) years and diabetes duration of 7.0 ± 3.7 years were included. HbA1c improved from 58.5 (±8.6) mmol/mol at baseline to 54.9 (±7.2) mmol/mol at 6 months ( < 0.001). Low, mild, and moderate activity was reported by 30% ( = 37), 34% ( = 43), and 36% ( = 45), respectively. At 6 months, HbA1c (52.0 vs. 54.3 vs. 59.4 mmol/mol, < 0.001), TIR (68.0% vs. 59.71 vs. 51.1%, < 0.001) and TAR (29.9% vs. 38.3% vs. 45.3%, < 0.001) were significantly different across the moderate, mild, and low activity groups, respectively. No association was found for TBR (2.16% vs. 2.32% vs. 2.58%, = 0.408) across groups. CONCLUSION: Increasing the use of moderate-intensity activity to lower hyperglycaemia between meals is associated with improved glucose control without increasing hypoglycaemia for CYPD.
Longitudinal Height Growth in Children and Adolescents with Type-1 Diabetes Mellitus Compared to Controls in Pune, India.
Areekal SA, Khadilkar A, Goel P … +1 more , Cole TJ
Pediatr Diabetes · 2023 · PMID 40303265 · Full text
BACKGROUND: Height growth is affected by longterm childhood morbidity. OBJECTIVES: To compare the growth curves of Indian children diagnosed with Type-1 diabetes mellitus (T1DM) and a control group of children without di...
BACKGROUND: Height growth is affected by longterm childhood morbidity. OBJECTIVES: To compare the growth curves of Indian children diagnosed with Type-1 diabetes mellitus (T1DM) and a control group of children without diabetes, and to see how parental height and disease severity affect the growth pattern. . The data came from: (i) the Sweetlings T1DM (STDM) study with 460 subjects aged 4-19 years, previously diagnosed with T1DM and followed for 2-6 (median 3) years, with repeat measurements of height and glycated hemoglobin (HbA1c), and (ii) the Pune School-Children Growth (PSCG) study with 1,470 subjects aged 4-19 years, and height measured annually for median 6 years. Height growth was modeled using SuperImposition by Translation and Rotation (SITAR), a mixed effects model which fits a cubic spline mean curve and summarizes individual growth in terms of differences in mean size, and pubertal timing and intensity. RESULTS: SITAR explained 99% of the variance in height, the mean curves by sex showing that compared to controls, the children with diabetes were shorter (by 4/5 cm for boys/girls), with a later (by 1/6 months) and less intense (-5%/-10%) pubertal growth spurt. Adjusted for mean height, timing and intensity, the diabetic and control mean curves were very similar in shape. SITAR modeling showed that mean HbA1c peaked at 10.5% at age 15 years, 1.0% higher than earlier in childhood. Individual growth patterns were highly significantly related to parental height, age at diabetes diagnosis, diabetes duration, and mean HbA1c. Mean height was 3.4 cm more per + 1 SD midparental height, and in girls, 2 cm less per + 1 SD HbA1c. CONCLUSION: The results show that the physiological response to T1DM is to grow more slowly, and to delay and extend the pubertal growth spurt. The effects are dose-related, with more severe disease associated with greater growth faltering.
Longitudinal Estimated Glomerular Filtration Rate Trajectories in Children with Type 1 Diabetes.
Favel K, Mammen C, Panagiotopoulos C
Pediatr Diabetes · 2023 · PMID 40303235 · Full text
Although children with type 1 diabetes (T1D) are at risk for developing diabetic kidney disease (DKD), clinical practice guidelines do not uniformly recommend routine serum creatinine (SCr) monitoring, and data describin...
Although children with type 1 diabetes (T1D) are at risk for developing diabetic kidney disease (DKD), clinical practice guidelines do not uniformly recommend routine serum creatinine (SCr) monitoring, and data describing changes in renal function from diagnosis are lacking. As part of a quality improvement initiative, the Diabetes Clinic at British Columbia Children's Hospital in Vancouver, Canada, implemented routine serum SCr monitoring. This study describes estimated glomerular filtration rate (eGFR) trajectories and prevalence of decreased eGFR, hypertension, and albuminuria and their relationship to patterns of nephrology referral in a cohort of children aged ≤18 years ( = 307) with T1D recruited between December 2016 and February 2019. Annualized eGFR (ml/min/1.73 m per year) was calculated using the CKiD U25 formula and categorized as declining (<-3), stable (-3 to +3), and inclining (>+3). eGFR was categorized as normal (≥90), mildly decreased (60 to <90), and chronic kidney disease (CKD, <60). In this cohort, 54% were male; the median age at diagnosis and duration of T1D was 6.2 years and 6.9 years, respectively. Over a median follow-up of 2.3 years, declining, stable, and inclining trajectories were observed in 33%, 32%, and 35%, respectively. During their follow-up, 32% had mildly decreased eGFR, elevated blood pressures (≥90 percentile), and/or abnormal urine albumin-creatinine ratios (≥2 mg/mmol), with <10% referred for nephrology assessment. Twenty-three percent of subjects had an eGFR <90; this subgroup was more highly represented in the declining trajectory group (vs. stable and inclining). Logistic regression analysis found female sex and higher baseline eGFR to be associated with a declining eGFR trajectory. In conclusion, these data challenge the commonly held paradigm that renal function remains stable in childhood T1D and supports systematic monitoring of renal function in children with T1D, as well as collaboration across disciplines, particularly endocrinology and nephrology, to provide evidence-based individualized care.
Psychosocial Outcomes with the Omnipod® 5 Automated Insulin Delivery System in Children and Adolescents with Type 1 Diabetes and Their Caregivers.
Hood KK, Polonsky WH, MacLeish SA … +15 more , Levy CJ, Forlenza GP, Criego AB, Buckingham BA, Bode BW, Hansen DW, Sherr JL, Brown SA, DeSalvo DJ, Mehta SN, Laffel LM, Bhargava A, Huyett LM, Vienneau TE, Ly TT
Pediatr Diabetes · 2023 · PMID 40303234 · Full text
OBJECTIVE: While automated insulin delivery (AID) systems aim to improve glycemic outcomes, the opportunity to improve psychosocial outcomes is also of critical importance for children and adolescents with type 1 diabete...
OBJECTIVE: While automated insulin delivery (AID) systems aim to improve glycemic outcomes, the opportunity to improve psychosocial outcomes is also of critical importance for children and adolescents with type 1 diabetes and their caregivers. We evaluated psychosocial outcomes in these groups during a clinical trial of a tubeless AID system, the Omnipod® 5 Automated Insulin Delivery System. METHODS: This single-arm, multicenter, prospective study enrolled 83 children (6.0-11.9 years) and 42 adolescents (12.0-17.9 years) with type 1 diabetes to use a tubeless AID system for 3 months. Participants and their caregivers completed age- and role-appropriate validated questionnaires to assess changes in psychosocial outcomes-diabetes distress (PAID), hypoglycemia confidence (HCS), well-being (WHO-5), sleep quality (PSQI), insulin delivery satisfaction (IDSS), and system usability (SUS)-before and after 3 months of AID system use. Associations between participant characteristics and glycemic outcomes with psychosocial measures were evaluated using linear regression analyses. RESULTS: Improvements were found for children, adolescents, and/or their caregivers for diabetes-related distress, insulin delivery satisfaction, and system usability (all < 0.05). Caregivers of children saw additional benefits of improved general well-being, confidence in managing hypoglycemia, and sleep quality (all < 0.05). Regression analyses showed that improvements in psychosocial outcomes were generally independent of baseline characteristics and changes in glycemic outcomes. CONCLUSIONS: The tubeless AID system was associated with significant improvements in a number of psychosocial outcomes for children, adolescents, and their caregivers. : This trial is registered with NCT04196140.
The Danish Version of the Problem Areas in Diabetes-Teen (PAID-T) Scale: Translation and Linguistic Validation.
Rahbæk MØ, Jensen SD, Hansen KK … +3 more , Sandbæk A, Lund S, Andersen A
Pediatr Diabetes · 2023 · PMID 40303269 · Full text
INTRODUCTION: Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the versio...
INTRODUCTION: Diabetes distress is often seen in adolescents with Type 1 diabetes (T1D). Problem Areas in Diabetes (PAID) is the most frequently used scale to assess diabetes distress in clinical settings, but the version for teenagers has not been translated into Danish and validated before now. OBJECTIVE: This study describes the translation into Danish of the PAID-T scale, which was developed to measure emotional distress in teenagers with diabetes. MATERIALS AND METHODS: The study was conducted in two phases. First, the PAID-T was translated into Danish based on the guidelines from the International Society for Pharmacoeconomics and Outcome Research and a forwardbackward translation procedure. Second, cognitive interviews were conducted, and the Danish version of the PAID-T was modified to ensure linguistic equivalence with the original scale in English. RESULTS: The Danish version of the PAID-T questionnaire was found to be understandable and relevant for adolescents with T1D. No questions were found to be irrelevant. However, the cognitive interviews showed that the issue of balancing alcohol intake and blood sugar levels was not covered by PAID-T, although this was found relevant in the Danish target group. CONCLUSION: This study described the translation and linguistic validation of the PAID-T scale into Danish. After modifications based on the feedback from the cognitive interviews, the Danish version was found to be linguistically equivalent to the original English version.
Diabetes-Related Quality of Life Assessment in Children following Total Pancreatectomy with Islet Autotransplantation.
Redel JM, Hornung L, Elder D … +4 more , Nathan JD, Corathers S, Rich KL, Abu-El-Haija M
Pediatr Diabetes · 2023 · PMID 40303247 · Full text
Total pancreatectomy with islet autotransplantation (TPIAT) can improve pain and reduce functional impairment associated with acute recurrent or chronic pancreatitis. However, long-term glucose monitoring and insulin the...
Total pancreatectomy with islet autotransplantation (TPIAT) can improve pain and reduce functional impairment associated with acute recurrent or chronic pancreatitis. However, long-term glucose monitoring and insulin therapy are often required, which can adversely affect the quality of life. We sought to evaluate diabetes-related quality of life (DR-QOL) in youth who underwent TPIAT and compare it to the youth with new-onset type 1 diabetes (T1D). The Pediatric Quality of Life Inventory™ 3.2 Diabetes Module (PedsQL™ DM) was used to assess DR-QOL in 46 youth (<20 years old) who underwent TPIAT. The PedsQL™ DM scores were analyzed for statistically significant changes and minimally important clinical differences (MCID) over time post-TPIAT. Scores at 12 months ( = 29) and 24 months ( = 16) were then compared to PedsQL™ DM scores from a historical cohort of demographically similar (age and sex) youth with a 12 months ( = 52) and 24 months ( = 58) after diagnosis of T1D. The diabetes symptoms summary score (mean 65 to 57 and =0.03) and the total score (mean 74 to 68 and < 0.05) decreased (worsened) during the first 24 months post-TPIAT and met the MCID threshold, suggesting the decrease in these scores was clinically significant. Post-TPIAT PedsQL™ DM scores were not significantly different than youth new diagnosis of T1D after 24 months (all > 0.2). In youth who underwent TPIAT, DR-QOL worsened over the first two years, mostly attributable to the diabetes symptoms score. Compared to children with T1D, post-TPIAT DR-QOL was similar two years after diabetes onset.
Similar Perceptions on Continuous Glucose Monitor Use amongst Youth with Type 1 and Type 2 Diabetes.
Phu A, Lin T, Manfredo JA … +2 more , Brown EA, Wolf RM
Pediatr Diabetes · 2023 · PMID 40303266 · Full text
METHODS: Youth with T1D and T2D (currently on insulin therapy) without current CGM participated in a prospective CGM study and were given a series of questionnaires when starting CGM intervention. BenCGM and BurCGM quest...
METHODS: Youth with T1D and T2D (currently on insulin therapy) without current CGM participated in a prospective CGM study and were given a series of questionnaires when starting CGM intervention. BenCGM and BurCGM questionnaires assessed the participant's perspectives on continuous glucose monitor use, while DDS surveys assessed participants' QoL associated with diabetes. Survey results were compared between T1D and T2D groups, and multivariable analysis was used to assess differences in perceptions of continuous glucose monitor use in youth with diabetes. RESULTS: Participants with T1D ( = 26, 65.4% male, 42.3% non-Hispanic black, median age 14.2 years, median HbA1c 10.3%) and T2D ( = 41, 39% male, 80.5% non-Hispanic black, median age 16.2 years, median HbA1c 10.3%) scored similarly on the BenCGM, BurCGM, and DDS surveys. In a pooled analysis of both T1D and T2D, there was no difference in survey results by race/ethnicity, but female youth had an increased odd of diabetes-related distress, specifically regimen-related distress. CONCLUSIONS: Youth with T1D and T2D on insulin therapy report similar perspectives on continuous glucose monitor use and QoL measures. Insulin use in both T1D and T2D may carry a similar burden of management, and CGM may help improve quality of life. Trial registration: This trial is registered with NCT04721145, NCT04721158.
Sleep Quality and Quantity in Caregivers of Children with Type 1 Diabetes Using Closed-Loop Insulin Delivery or a Sensor-Augmented Pump.
Madrid-Valero JJ, Ware J, Allen JM … +13 more , Boughton CK, Hartnell S, Wilinska ME, Thankamony A, de Beaufort C, Schierloh U, Campbell FM, Sibayan J, Bocchino LE, Kollman C, Hovorka R, Gregory AM, Consortium K
Pediatr Diabetes · 2023 · PMID 40303271 · Full text
INTRODUCTION: Parents of children living with type 1 diabetes (T1D) often report short and/or poor quality sleep. The development of closed-loop systems promises to transform the management of T1D. This study compared sl...
INTRODUCTION: Parents of children living with type 1 diabetes (T1D) often report short and/or poor quality sleep. The development of closed-loop systems promises to transform the management of T1D. This study compared sleep quality and quantity in caregivers of children using a closed-loop system (CL) or sensor-augmented pump (SAP) therapy. METHOD: Data from sleep diaries, accelerometers, and questionnaires were provided by forty parents (classified as caregiver 1 (main analyses) or 2 (supplementary analyses) based on their contribution towards treatment management) of 21 very young children aged 1 to 7 years living with T1D (mean age: 4.7 (SD = 1.7)). Assessments were made at a single post-randomisation time point when the child was completing either the 16-week CL arm ( = 10) or the 16-week SAP arm ( = 11) of the main study. RESULTS: Overall, there was a mixed pattern of results and group differences were not statistically significant at the < 0.05 level. However, when we consider the direction of results and results from caregiver 1, sleep diary data showed that parents of the CL (as compared to the SAP) group reported a shorter sleep duration but better sleep quality, fewer awakenings, and less wake after sleep onset (WASO). Actiwatch data showed that caregiver 1 of the CL (as compared to the SAP) group had a shorter sleep latency; greater sleep efficiency; and less wake after sleep onset. Results from the Pittsburgh Sleep Quality Index also showed better sleep quality for caregiver 1 of the CL group as compared to the SAP group. CONCLUSIONS: Results from this study suggest that sleep quality and quantity in parents of children using CL were not significantly different to those using SAP. Considering effect sizes and the direction of the non-significant results, CL treatment could be associated with better sleep quality in the primary caregiver. However, further research is needed to confirm these findings. This trial is registered with NCT05158816.
Psychological Care for Children and Adolescents with Diabetes and Patient Outcomes: Results from the International Pediatric Registry SWEET.
Chobot A, Eckert AJ, Biester T … +10 more , Corathers S, Covinhas A, de Beaufort C, Imane Z, Kim J, Malatynska A, Moravej H, Pokhrel S, Skinner T, Study Group S
Pediatr Diabetes · 2023 · PMID 40303253 · Full text
BACKGROUND: Easy accessibility of psychosocial care is recommended for children and adolescents with type 1 diabetes (T1D) and their families. OBJECTIVE: The study aimed to evaluate the availability of psychological care...
BACKGROUND: Easy accessibility of psychosocial care is recommended for children and adolescents with type 1 diabetes (T1D) and their families. OBJECTIVE: The study aimed to evaluate the availability of psychological care and its associations with glycemic control in centers from the multinational SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) registry. SUBJECTS: Centers participating in SWEET ( = 112) were invited to complete a structured online survey, designed for the study, regarding their psychology service. METHODS: Linear/logistic regression models adjusted for several confounders were used to determine the patient's HbA1c (mmol/mol) and odds ratios (ORs) for diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) related to survey responses. RESULTS: 76 (68%) centers with relevant data in the SWEET database responded to the survey. Psychological services were provided in 89% of the centers. The availability of psychological service in centers was associated with a slightly lower HbA1c of the patients (72 (62-82) vs. 67 (57-78) mmol/mol, = 0.004) and significantly lower odds for DKA (1.8 (1.1-2.9), = 0.027). CONCLUSIONS: Most centers from the SWEET registry offered some form of structured psychological care, consistent with the recommendations of easy access to psychosocial care for children and adolescents with T1D and their families. The main benefit of this psychological care appears to be in the incidence of DKA between centers. The study data also continues to emphasize the importance of treatment targets in shaping the outcomes of pediatric diabetes care. These findings should inform health-service planners and the diabetes community of the importance of mental healthcare in multidisciplinary diabetes teams.
Disparities in Responsibility Sharing and Gender Differences in Diabetes Care: Changes in Occupational Life of Parents of Children with Type 1 Diabetes.
Karakus KE, Sakarya S, Saßmann H … +14 more , Yıldırım R, Özalkak Ş, Özbek MN, Yıldırım N, Delibağ G, Eklioğlu BS, Haliloğlu B, Aydın M, Kırmızıbekmez H, Gökçe T, Can E, Eviz E, Yesiltepe-Mutlu G, Hatun Ş
Pediatr Diabetes · 2023 · PMID 40303254 · Full text
AIMS: To evaluate responsibility sharing between parents of children with type 1 diabetes and change in their occupational status one year after the diagnosis. METHODS: In this cross-sectional multicenter study, parents...
AIMS: To evaluate responsibility sharing between parents of children with type 1 diabetes and change in their occupational status one year after the diagnosis. METHODS: In this cross-sectional multicenter study, parents of children under the age of 18 with a diagnosis of type 1 diabetes answered a questionnaire assessing diabetes-related responsibility sharing between parents, and occupational changes due to child's diabetes. Changes in the occupational status with associated factors and distribution of diabetes-related responsibilities between parents were analyzed. RESULTS: Among parents of 882 children (mean (SD) age at diagnosis was 7 (3.8) years, female 52.5%), unemployment increased significantly in mothers (59.0% vs. 67.1%; < 0.001), but not in fathers (10.4% vs. 10.7%; > 0.05) within 1 year after their child's diagnosis. Working mother's occupational withdrawal was associated with the child's age at diagnosis (OR = 0.92, [95% CI 0.86-0.99]; =0.02) and mother's education (compared to a university degree or above, high school graduate (OR = 2.93, [95% CI 1.59-5.4]; < 0.001) and not graduated high school (OR = 8.4, [95% CI 3.56-19.83]; < 0.001)). According to the mothers, none of the responsibilities in diabetes care were shared equally between parents, while fathers reported most responsibilities were shared equally. Compared to mothers who preserved their occupation after the diagnosis, mothers who quit their occupation had significantly higher responsibility scores (2.04 vs. 1.55; =0.04), especially in diabetes care at school ( < 0.01). CONCLUSIONS: The difference in parents' perceptions of their involvement in their child's diabetes is remarkable. Gender differences in the child's diabetes care extend to the occupational life of parents unequally.
Impact of the COVID-19 Pandemic on Children and Adolescents with New-Onset Type 1 Diabetes.
Kamrath C, Eckert AJ, Holl RW … +1 more , Rosenbauer J
Pediatr Diabetes · 2023 · PMID 40303240 · Full text
BACKGROUND: The COVID-19 pandemic has an impact on the incidence of type 1 diabetes and frequency of diabetic ketoacidosis. However, the exact relationships are unclear. It is also not known whether this is a short-term...
BACKGROUND: The COVID-19 pandemic has an impact on the incidence of type 1 diabetes and frequency of diabetic ketoacidosis. However, the exact relationships are unclear. It is also not known whether this is a short-term phenomenon or whether the effects have long-term relevance. Furthermore, it is not known whether these changes during the pandemic are due to direct effects of SARS-CoV-2 or to changes in the patient's environment during the pandemic. METHODS: We conducted an extensive literature search on PubMed. For the estimation of relative risks of new-onset type 1 diabetes, we applied a Poisson regression model and for the comparison of incidences and we included the logarithm of person-years. Furthermore, we performed a meta-analysis using the logarithm of the relative risk for new-onset type 1 diabetes as effect size. RESULTS: Pooling the relative risk estimates in a random-effects meta-analysis revealed that the type 1 diabetes incidence rate increased by 20% (relative risk 1.200 (95% CI 1.125, 1.281)), and that the risk of new-onset type 1 diabetes after a SARS-CoV-2 infection increased by 62% (relative risk 1.622 (95% CI 1.347, 1.953)) compared with the prepandemic period. CONCLUSION: There is considerable evidence that there is an increase in type 1 diabetes in children during the COVID-19 pandemic. Many studies suggesting a direct effect of SARS-CoV-2 have methodological weaknesses. As no evidence of an increase in presymptomatic cases with isolated islet autoimmunity was found, this could also suggest an accelerated transition from presymptomatic patients to clinically overt type 1 diabetes. Furthermore, there was a marked exacerbation of the preexisting increase in the prevalence of diabetic ketoacidosis at diagnosis of type 1 diabetes during the pandemic. Both the increased incidence of paediatric type 1 diabetes and the higher prevalence of diabetic ketoacidosis at diagnosis led to a massive rise in the number of children with diabetic ketoacidosis during the pandemic.
Impact of Sleep and Activity on Glycemic Control and Quality of Life in Haitian Children and Youth with Type 1 Diabetes.
Babinski M, Duperval R, Altenor K … +1 more , von Oettingen J
Pediatr Diabetes · 2023 · PMID 40303250 · Full text
BACKGROUND: Sleep and physical activity affect overall health. In youth with type 1 diabetes (T1DM), they may improve glycemic control. Data from low-income countries are lacking. OBJECTIVE: To describe sleep and activit...
BACKGROUND: Sleep and physical activity affect overall health. In youth with type 1 diabetes (T1DM), they may improve glycemic control. Data from low-income countries are lacking. OBJECTIVE: To describe sleep and activity in Haitian children and youth with T1DM, and examine their impact on glycemic control, health-related quality of life (HRQL), and life satisfaction (LS). METHODS: This cross-sectional study in Haiti included people with T1DM aged 8-25 years. Wristbands (Mi Band 3) tracked activity (step count and activity time) and sleep (sleep duration, light sleep, and deep sleep). The Diabetes Quality of Life in Youth (DQOLY) questionnaire was used to evaluate HRQL and LS. Point-of-care (POC) hemoglobin A1c values were recorded. Linear regression was used to assess the relationship between sleep, activity, HbA1c, HRQL, and LS. RESULTS: We included 66 participants (59% female, mean age 17.8 ± 4.8 years, mean diabetes duration 3.7 ± 3.4 years, and mean BMI -score -0.86 ± 1.1). Mean HRQL was 63/100, and mean LS was 65/100. Mean HbA1c was 11.3%. Maximum HbA1c measure was 14% on the POC machine, and 23 participants (35%) had HbA1c recorded as 14%. Mean daily step count was 7,508 ± 3,087, and mean sleep duration was 7 h31 ± 1 h17. When excluding participants with HbA1c ≥ 14%, shorter sleep duration was significantly associated with higher HbA1c ( = 0.024). Sleep duration and step count were not associated with HRQL or LS. CONCLUSIONS: Children and youth with T1DM in Haiti have poor glycemic control and low HRQL and LS. Their sleep and activity habits are similar to peers. While activity did not affect HbA1c, HRQL, or LS, shorter sleep duration was associated with higher HbA1c in participants with HbA1c < 14%. Prospective studies with larger sample sizes are needed to validate our findings.
Effect on Glycemic Control of an Early Intensive Dietary Structured Education Program for Newly Diagnosed Children with Type 1 Diabetes in Jordan.
Alassaf A, Gharaibeh L, Ibrahim S … +2 more , Alkhalaileh S, Odeh R
Pediatr Diabetes · 2023 · PMID 40303263 · Full text
METHODS: This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was com...
METHODS: This is a retrospective medical chart review study at Jordan University Hospital. The glycemic control of children who were diagnosed with T1D and included in the SEP between June 2017 and December 2019, was compared with those who were exposed to the conventional diabetes education, between January 2014 and December 2016. Various factors were assessed for the possible effects on the SEP outcomes. RESULTS: The average age at diagnosis for the 112 persons with diabetes (PwD) included in the dietary SEP was 8.30 ± 3.87 years. Glycated hemoglobin was lower in children in the SEP group at 6 months ( value = 0.001) and 12 months (=0.032) but not at 24 months (=0.290). SEP had better effect on patients older than 5 years. The possible predictors of glycemic control for the SEP group at 12 months included the mother's educational level and the number of hospital admissions due to DKA and hyperglycemia during the first year after diagnosis. CONCLUSION: Our dietary SEP was associated with better glycemic control than conventional diabetes education, at 6 and 12 months after diagnosis. It had a positive effect, mainly in PwD patients who are older than 5 years and had higher maternal educational level.
Predictive Value of 1-Hour Glucose Elevations during Oral Glucose Tolerance Testing for Cystic Fibrosis-Related Diabetes.
Lorenz AN, Pyle L, Ha J … +5 more , Sherman A, Cree-Green M, Sagel SD, Nadeau KJ, Chan CL
Pediatr Diabetes · 2023 · PMID 40303238 · Full text
BACKGROUND: In cystic fibrosis-related diabetes (CFRD) screening, oral glucose tolerance test (OGTT) thresholds for detecting prediabetes and diabetes are defined by the 2-hour glucose (2 hG). Intermediate OGTT glucoses,...
BACKGROUND: In cystic fibrosis-related diabetes (CFRD) screening, oral glucose tolerance test (OGTT) thresholds for detecting prediabetes and diabetes are defined by the 2-hour glucose (2 hG). Intermediate OGTT glucoses, between 0 and 2 hours, that are ≥200 mg/dL are deemed "indeterminate," although lower 1-hour glucose (1 hG) thresholds identify those at increased risk of type 2 diabetes in other populations, and may also better predict clinical decline in CF. Studies of 1 hG thresholds <200 mg/dL in people with CF are limited. METHODS: A single center, retrospective chart review was performed of patients with 1 hG available on OGTTs collected between 2010 and 2019. In patients with ≥2 OGTTs, Kaplan-Meier analysis estimated likelihood of progression to CFRD based on a high vs. low 1 hG. In patients with ≥1 OGTT, mixed-effects models tested whether baseline 1 hG and 2 hG predicted growth and lung function trajectories. RESULTS: A total of 243 individuals with CF were identified with at least 1 OGTT including a 1 hG, and = 177 had ≥2 OGTTs. Baseline age (mean ± SD) was 12.4 ± 2.6 years with 3.2 ± 1.4 years of follow-up. Twenty-eight developed CFRD. All who developed CFRD had a 1 hG ≥ 155 mg/dL prior to 2 hG > 140 mg/dL. The average 1 hG was 267 mg/dL when 2 hG ≥ 200 mg/dL. In a subset with baseline 2 hG < 140 mg/dL, 1 hG ≥ 140 mg/dL conferred an increased 5 years risk of CFRD (=0.036). Baseline 2 hG predicted decline in FEV1%predicted, but 1 hG did not. CONCLUSIONS: In youth with CF, 1 hG ≥ 140 mg/dl is an early indicator of CFRD risk. However, 2 hG, rather than 1 hG, predicted lung function decline.
Examining the Relationship between Nighttime Glucose Values in Youth with Type 1 Diabetes and Parent Fear of Nighttime Hypoglycemia.
Monzon AD, McDonough R, Cushing CC … +2 more , Clements M, Patton SR
Pediatr Diabetes · 2023 · PMID 40303274 · Full text
OBJECTIVE: Youth with type 1 diabetes mellitus (T1D) are at risk for experiencing nighttime hypoglycemia, and many parents report significant anxiety at night regarding glucose management. Limited data exist examining co...
OBJECTIVE: Youth with type 1 diabetes mellitus (T1D) are at risk for experiencing nighttime hypoglycemia, and many parents report significant anxiety at night regarding glucose management. Limited data exist examining continuous nighttime glucose levels as a predictor of parent fear of nighttime hypoglycemia. The present study aimed to examine the relationship between parent fear of nighttime hypoglycemia and nighttime blood glucose levels as measured by continuous glucose monitors (CGMs). METHODS: A sample of 136 parents/caregivers of youth with T1D completed a one-time survey and youth provided 14 days of CGM data. We conducted regression models with mean nighttime glucose value, glycemic variability, and the percent of nighttime glucose values in the hypoglycemic, target, and hyperglycemic range as the independent variable and parents' fear of nighttime hypoglycemia as the dependent variable. RESULTS: Overnight hypoglycemia measured via CGM did not predict parents' fear of nighttime hypoglycemia; however, average youth nighttime glucose levels and nighttime glycemic variability were significant predictors of parents' fear of nighttime hypoglycemia. CONCLUSIONS: The results of the present study indicate that parents of youth with T1D may report higher fear of hypoglycemia if they observe increased fluctuations in their child's nighttime glucose levels, regardless of how often their child's glucose levels are in the hypoglycemic range. The results suggest that clinicians may consider screening for parent fear of nighttime hypoglycemia in families of youth who present with large variability in their glucose values overnight.
Control-IQ Technology Positively Impacts Patient Reported Outcome Measures and Glycemic Control in Youth with Type 1 Diabetes in a Real-World Setting.
Zuijdwijk C, Courtney J, Mitsakakis N … +7 more , Hayawi L, Sutherland S, Newhook D, Ahmet A, Goldbloom EB, Khatchadourian K, Lawrence S
Pediatr Diabetes · 2023 · PMID 40303267 · Full text
OBJECTIVE: To determine the impact of the t:slim X2 insulin pump with Control-IQ technology on the quality of life and glycemic control in youth with type 1 diabetes (T1D) and their parents in a real-world setting. . We...
OBJECTIVE: To determine the impact of the t:slim X2 insulin pump with Control-IQ technology on the quality of life and glycemic control in youth with type 1 diabetes (T1D) and their parents in a real-world setting. . We conducted a single-center, prospective study on pediatric patients (6-18 years old) with T1D using a Tandem t:slim X2 pump and initiating Control-IQ technology as part of routine care. Youth (≥8 years) and parents completed validated patient-reported outcome measures (PROMs) at baseline and the end of the study (16 weeks). Glycemic control measures were recorded at baseline and every 4 weeks until the end of the study. RESULTS: Fifty-nine youth participated; the median (IQR) age was 13.8 (11.1, 15.7) years, and T1D duration was 6.3 (3.1, 8.4) years. INSPIRE scores (evaluating expectations (baseline) and impact (post) of Control-IQ technology) were favorable, unchanged at the end of the study for youth, and lower for parents ( = 0.04). Other PROM scores improved by the end of the study with mean (95% CI) differences for youth and parents, respectively, as follows: Diabetes Impact and Device Satisfaction (DIDS) Scale Diabetes Impact -1.08 (-1.51, -0.64) ( < 0.001) and -1.41 (-1.96, -0.87) ( < 0.001); DIDS Scale Device Satisfaction +0.43 (0.11, 0.74) ( = 0.01) and +0.58 (0.31, 0.85) ( < 0.001); Hypoglycemia Fear Survey -4.41 (-7.65, -1.17) ( = 0.01) and -7.64 (-11.66, -3.62) ( < 0.001); and WHO-5 Well-Being Index +5.10 (-1.40, 11.6) ( = 0.12) and +9.60 (3.40, 15.8) ( = 0.003). The mean time in range increased from 52.6% at baseline to 62.6% ( < 0.001) at 4 weeks, sustained to 16 weeks. CONCLUSIONS: Initiation of Control-IQ technology in a real-world setting significantly reduced the impact of diabetes on daily life while simultaneously improving glycemic control. . This trial is registered with ClinicalTrials.gov Identifier NCT04838561 (https://www.clinicaltrials.gov/ct2/show/NCT04838561?term=Control-IQ&cond=Type+1+Diabetes&cntry=CA&draw=2&rank=1).
Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c.
Beck JK, Allen RA, Jeter KM … +6 more , Fisher RS, Dattilo TM, Traino KA, Anderson M, Cutler J, Sparling DP
Pediatr Diabetes · 2023 · PMID 40303275 · Full text
Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benef...
Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benefits of rtCGM use in a high-risk, under-resourced cohort of adolescents and young adults (AYA) with type 1 diabetes (T1D) who had no prior access to rtCGM. The effects of rtCGM use on hemoglobin A1c (A1c) and the frequency of health care events (i.e., diabetes-related emergency room (ER) visits, hospitalizations, emergency medical services (EMS), and after-hour emergency calls) were evaluated regarding payor costs in 33 AYA with ≥70% rtCGM use. Secondary aims included the evaluation of a phone-based pattern management intervention. The frequency of health care events decreased at 12 and 24 weeks for all participants, and there was no significant difference by treatment group. We estimated that the use of rtCGM in this cohort results in a projected annualized cost-savings of $195,943 to $294,864 or 43-65% per year based on Medicare or list pricing for rtCGM, respectively. Results also revealed improvements in A1c at 12 weeks for all study participants, but this was not maintained at 24 weeks for the phone-based pattern management intervention group. Our findings suggest that rtCGM may be an effective tool for reducing diabetes-related events and underscores the importance of access. Future studies are needed to further examine tailored interventions and support to optimize rtCGM use and glycemic health in high-risk AYA.
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