Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA1c

ABSTRACT Objective To review the dietary intake of children and adolescents with type 1 diabetes Mellitus and its association with the glycemic profile. Methods Longitudinal observational study. Dietary intake was measured using a three-day dietary record and the glycemic profile with a continuous glucose monitoring (range between 70 and 180mg/dL) and serum glycated hemoglobin levels (ideal <7.5%). Anthropometric data, insulin therapy, and carbohydrate counting were collected. Results The sample included 34 individuals with type 1 diabetes Mellitus aged 13.6±2.1 years. The majority of the population was eutrophic (76.4%). The entire sample used the basal-bolus insulin regimen, with mean insulin dose of 1.0±0.2U/kg/day; for 44.1% of the sample the carbohydrate counting method was used. Macronutrients intake was adequate in only 8.8% of the individuals, the highest frequency of inadequacy was related to carbohydrates (p=0.07). Inadequate glycemic control with hyperglycemia episodes and high mean glycated hemoglobin (9.7%) was observed in all individuals (61.3±18.5%). Carbohydrate counting was responsible for maintaining the percentage of time that the patient had interstitial blood glucose values within the range >40% (p<0.001) and maintaining the percentage of time in hyperglycemia <50% (p<0.001). Conclusion The majority of individuals were eutrophic, but presented inadequate dietary intake and glycemic control. The method of counting carbohydrates positively influenced the glycemic profile.

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Use of telemedicine improves glycemic control and quality of life in type 1 diabetes children on insulin pump therapy

Diabetes Mellitus ◽

10.14341/dm8677 ◽

2018 ◽

Vol 20 (6) ◽

pp. 420-426 ◽

Cited By ~ 1

Author(s):

Dmitry N. Laptev ◽

Valentina A. Peterkova

Keyword(s):

Quality Of Life ◽

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Insulin Pump ◽

Insulin Pump Therapy

Rationale: Healthcare access plays a significant role in the improvement and maintaining of glycemic control and quality of life in type 1 diabetes mellitus (T1DM) patients on continuous subcutaneous insulin infusion (CSII). Aims: The aim of the study was to evaluate the feasibility of remote support in children and adolescents with type 1 diabetes mellitus (T1DM) and its effect on glycemic control and quality of life. Materials and methods: In 40 children and adolescents (132,7 years, 18/22 m/f) on CSII with inadequately controlled T1DM (HbA1c7,5%) we evaluated the effectiveness of telemedical support (TS), as compared with conventional support (CS). Parameters of glycemic control (HbA1c, average glycemia, SD, etc.) and quality of a life were obtained on follow-up visits. Patients and their parents in ТМ group twice a month sent their insulin pump data using to CSII center and diabetologists sent back their advice via e-mail, phone or Skype. The primary end point was the change from the baseline HbA1c level and the proportion of patients achieving HbA1c of less than 7.5%. Results: At 24 weeks, the baseline mean HbA1c (8.7% in the two study groups) had decreased to 7.7% in the TS group, as compared with 8.4% in the CS group (P0,05). The proportion of patients who reached the HbA1c target (7,5%) was greater in the TS group (50%) than in the CS group (20%, p0,05). A number of quality of life indicators for both parents and children with T1DM at the end of the study compared to baseline significantly increased in the TS group compared with the TC group (p0.05). During the study period rate of severe hypoglycemia and DKA in TS group (0 and 10 cases per 100 person-years) did not differ significantly from that in CS group (0 and 20 cases per 100 person-years, P0,05). Conclusion: In children with inadequately controlled T1DM, telemedical support proved to be feasible and resulted in significant improvement in glucose control (HbA1c, glucose variability) and quality of life without the increase in the incidence of DKA and severe glycemia.

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Factors related to glycemic control in children and adolescents with type 1 diabetes mellitus in Isfahan, Iran

Journal of Diabetes & Metabolic Disorders ◽

10.1007/s40200-021-00854-8 ◽

2021 ◽

Author(s):

Mahin Hashemipour ◽

Silva Hovsepian ◽

Nafiseh Mozafarian ◽

Zohreh Motaghi ◽

Elahe Izadikhah ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents

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Impact of type 1 diabetes mellitus, glucose levels, and glycemic control on sleep in children and adolescents: a case–control study

SLEEP ◽

10.1093/sleep/zsz226 ◽

2019 ◽

Author(s):

Grace C Macaulay ◽

Barbara C Galland ◽

Sara E Boucher ◽

Esko J Wiltshire ◽

Jillian J Haszard ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Sleep Onset ◽

Sleep Time ◽

Glucose Levels ◽

Control Subjects

Abstract Study Objectives To assess differences in habitual sleep patterns and sleep states between children and adolescents with type 1 diabetes mellitus (T1DM) and control subjects, and to explore the relationships between sleep, glucose levels, and glycemic control. Methods Participants included 82 children (5–18 years); 41 with T1DM (cases), and 41 healthy control subjects group matched for age and sex. Sleep was measured by 7-day actigraphy and single-night home-based polysomnography (PSG) recordings. Hemoglobin A1c (HbA1c) and 7 days of continuous glucose monitoring (CGM) data were collected in cases. Regression analyses were used to model all within- and between-group comparisons adjusted for age, sex, and BMI z-scores. Results There were no significant differences in sleep duration, efficiency, or awakenings as measured by actigraphy and PSG between cases and controls, nor sleep states measured by PSG. However, cases had significantly later sleep onset and offset than controls (both p < 0.05), partially moderated by age. Cases with suboptimal glycemic control (HbA1c ≥ 58 mmol/mol [≥7.5%]) had significantly shorter actigraphy-derived total sleep time (TST) (mean difference = −40 minutes; 95% confidence interval = −77, −3), with similar differences in TST measured by PSG. Cases with mean CGM glucose levels ≥10 mmol/L (≥180 mg/dL) on PSG night had significantly more stage N3 (%) sleep and less stage REM (%) sleep (both p < 0.05). Conclusions Short- and long-term suboptimal glycemic control in T1DM children appears to be associated with sleep alterations. Pediatric diabetes care teams should be aware of potential interrelationships between sleep and T1DM, including management and glycemic control.

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Status and trends in the use of insulin analogs, insulin delivery systems and their association with glycemic control: comparison of the two consecutive recent cohorts of Japanese children and adolescents with type 1 diabetes mellitus

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2018-0329 ◽

2019 ◽

Vol 32 (1) ◽

pp. 1-9 ◽

Cited By ~ 4

Author(s):

Yukiyo Yamamoto ◽

Toru Kikuchi ◽

Tatsuhiko Urakami ◽

Motohide Goto ◽

Kohji Tsubouchi ◽

...

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Type 1 Diabetes Mellitus ◽

Children And Adolescents ◽

Insulin Analogs ◽

Japanese Children ◽

Registration Data ◽

Basal Bolus

AbstractBackgroundTreatment for type 1 diabetes mellitus (T1DM) has greatly changed by the general use of insulin analogs and continuous subcutaneous insulin infusion (CSII). To investigate whether these advances have been translated into continued improvement in glycemic control in Japanese children and adolescents, we analyzed the registration data of the two consecutive recent cohorts of Japanese childhood-onset T1DM patients.MethodsThe registration data including hemoglobin A1c(HbA1c), hypoglycemia and insulin regimen were compared between the two cohorts (862 patients in the 2008 cohort and 1090 in the 2013 cohort).ResultsThe proportion of subjects with multiple daily insulin injection therapy (MDI) and CSII significantly increased (p<0.0001) from 67.4% and 9.7% to 71.8% and 23.4%, respectively. In the 2013 cohort, almost all patients were treated with basal-bolus treatment using insulin analogs. The use of CSII increased in all age groups, especially in the age group 0–5 years. The rates of overall, moderate and severe hypoglycemia significantly declined from 10.24, 10.18 and 0.056 events/100 persons/period in the 2008 cohort to 0.66, 0.62 and 0.033 in the 2013 cohort (p<0.0001, <0.0001, 0.04), respectively. Contrarily, there were no significant changes in HbA1cvalues between the two cohorts.ConclusionsThe popularization of the basal-bolus treatment using insulin analogs hascontributed to a significant decrease in hypoglycemia. In contrast, the intensive insulin treatment may not be enough for the satisfactory improvement of glycemic control in Japanese children and adolescents with T1DM. Considerable points remain, such as diabetic education and support to motivate patients.

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