scholarly journals Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

BMJ Open ◽  
2017 ◽  
Vol 7 (12) ◽  
pp. e018094 ◽  
Author(s):  
Carine Sousa Andrade ◽  
Guilherme Sousa Ribeiro ◽  
Carlos Antonio Souza Teles Santos ◽  
Raimundo Celestino Silva Neves ◽  
Edson Duarte Moreira
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Hba1c Level ◽  
Glycated Haemoglobin ◽  
Poor Adherence ◽  
Adherence To Diet ◽  
The Mean ◽  
Lower Education ◽  
Hba1c Levels

ObjectiveLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%–90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil.Design, setting and participantsA cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews.Main outcome measuresHbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c.ResultsOf 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively).ConclusionPoor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.

Ketoacidosis in new-onset type 1 diabetes: did the severity increase during the COVID-19 pandemic?

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Teresa A. Botelho ◽  
Joana M. N. Santos ◽  
Crisbety M. S. Pinho ◽  
Ana Isabel B. R. Martins ◽  
Adriana I. S. Formiga ◽  
...  
Keyword(s):  
Weight Loss ◽  
Type 1 Diabetes ◽  
Relative Risk ◽  
Glycated Haemoglobin ◽  
Treatment Delay ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Mean Differences ◽  
New Onset

Abstract Objectives Since the beginning of the COVID-19 pandemic, there has been a consistent decrease in the number of admissions to the emergency department, leading to a delay in the diagnosis of several pathologies. The time from onset of symptoms to the diagnosis of Type 1 diabetes is highly variable. This treatment delay can lead to the appearance of ketoacidosis. Methods Retrospective study of inaugural Type 1 diabetes cases, from March 2016 to March 2021. The pandemic group was considered between March 2020 to March 2021, and the remaining period was considered as pre-pandemic. Clinical variables were analysed: duration of symptoms, weight loss and value of ketonemia and glycated haemoglobin on admission. The mean differences were considered statistically significant at p<0.05. Results 103 inaugural episodes of Type 1 diabetes were registered. The pandemic group had a lower mean age when compared to pre-pandemic group, and 51.7% of the episodes had ketoacidosis with a higher relative risk of ketoacidosis and severe ketoacidosis, when compared the pandemic with pre-pandemic group, there was a longer symptom evolution time (34 vs. 20 days), greater weight loss occurred (9.5% vs. 6.3%), the pH and HCO3 − values were lower (7.30 vs. 7.36 and 16.43 vs. 20.71 mmol/L respectively) and ketonemia was higher (5.9 vs. 2.3 mmol/L). Conclusions The COVID-19 pandemic caused a delay in the diagnosis of Type 1 diabetes, greater length of disease, greater weight loss, higher ketonemia and lower pH and HCO3 −. There was greater ketoacidosis relative risk in pandemic group when compared to pre-pandemic group.

scholarly journals Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multi-ethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIAL Study

2020 ◽  
Author(s):  
Hood Thabit ◽  
Joshi Navis Prabhu ◽  
Womba Mubita ◽  
Catherine Fullwood ◽  
Shazli Azmi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Young People ◽  
Control Period ◽  
Glucose Monitoring ◽  
Random Order ◽  
Mean Difference ◽  
Time In Range ◽  
Hba1c Levels

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

scholarly journals Effectiveness of quality improvement strategies for type 1 diabetes in children and adolescents: a systematic review protocol

2021 ◽  
Vol 4 ◽  
pp. 87
Author(s):  
Paul M Ryan ◽  
Michael Zahradnik ◽  
Kristin J Konnyu ◽  
Tamara Rader ◽  
Michael Halasy ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Quality Improvement ◽  
Glycaemic Control ◽  
Quality Assessment ◽  
Children And Adolescents ◽  
Care Delivery ◽  
Data Extraction ◽  
Meta Analysis ◽  
Glycated Haemoglobin

Introduction: Optimal glycaemic control is often a challenge in children and adolescents with type 1 diabetes (T1D). Implementation of patient, clinician or organisation-targeted quality improvement (QI) strategies has been proven to be beneficial in terms of improving glycaemic outcomes in adults living with diabetes. This review aims to assess the effectiveness of such QI interventions in improving glycaemic control, care delivery, and screening rates in children and adolescents with T1D. Methods and analysis: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases will be searched for relevant studies up to January 2021. Trial registries, ClinicalTrials.gov and ICTRP, will also be explored for any ongoing trials of relevance. We will include trials which examine QI strategies as defined by a modified version of the Cochrane Effective Practice and Organisation of Care 2015 Taxonomy in children (<18 years) with a diagnosis of T1D. The primary outcome to be assessed is glycated haemoglobin (HbA1c), although a range of secondary outcomes relating to clinical management, adverse events, healthcare engagement, screening rates and psychosocial parameters will also be assessed. Our primary intention is to generate a best-evidence narrative to summarise and synthesise the resulting studies. If a group of studies are deemed to be highly similar, then a meta-analysis using a random effects model will be considered. Cochrane Risk of Bias 1.0 tool will be applied for quality assessment. All screening, data extraction and quality assessment will be performed by two independent researchers. Dissemination: The results of this review will be disseminated through peer-reviewed publication in order to inform invested partners (e.g., Paediatric Endocrinologists) on the potential of QI strategies to improve glycaemic management and other related health outcomes in children with T1D, thereby guiding best practices in the outpatient management of the disorder. PROSPERO registration number: CRD42021233974 (28/02/2021).

scholarly journals An analysis of the relationships between peer support and diabetes outcomes in adolescents with type 1 diabetes

2016 ◽  
Vol 23 (10) ◽  
pp. 1356-1366 ◽  
Author(s):  
Emily Doe
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Health Outcomes ◽  
Peer Support ◽  
Self Care ◽  
Glycated Haemoglobin ◽  
Diabetes Outcomes ◽  
Specific Support

This study explores the relationships between the various subtypes of global and diabetes-specific peer support and health outcomes in adolescents with type 1 diabetes. Global peer support significantly predicted self-care and glycated haemoglobin, although no associations were identified for diabetes-specific support overall, nor its factors. When comparing participants with above or below average glycaemic control, significantly greater diabetes-specific support was reported in those with poorer control. It is suggested that this may be related to feelings of nagging, in which diabetes-specific support is perceived as harassment.

scholarly journals Coping strategies in Type 1 and Type 2 diabetes patients using insulin: the relationship with emotional well-being and glycaemic control

2015 ◽  
Vol 18 (4) ◽  
pp. 41-47
Author(s):  
Oleg G. Motovilin ◽  
Shishkova Y. Andreevna ◽  
Elena V. Surkova
Keyword(s):  
Type 2 Diabetes ◽  
Glycaemic Control ◽  
Coping Strategies ◽  
Depression Scale ◽  
Well Being ◽  
Glycated Haemoglobin ◽  
Epidemiologic Studies ◽  
Hba1c Levels

Background. Over the long disease course of diabetes mellitus (DM), with its demands in terms of everyday self-management of the disease, individual psychological characteristics may be associated with both emotional well-being (WB) and glycaemic control. The former includes various types of coping strategies (CSs) of the patients, which comprise the common ways for patients to overcome difficult situations.Aim. To study the relationships between CS and both glycaemic control and emotional WB in patients with Type 1 diabetes (T1D) and Type 2 diabetes (T2D) treated with insulin.Materials and methods. The study included 84 patients with T1D and 56 patients with insulin-treated T2D [age, 22.5 ± 3.3 and 61.0 ± 8.9 years; men/women, 29/55 and 11/45; duration of DM, 11.9 ± 5.36 and 11.6 ± 6.2 years and glycated haemoglobin (HbA1c), 9.1% ± 2.2% and 9.0% ± 1.4%, respectively]. The HbA1c levels were determined in all patients. The Strategic Approach to Coping Scale constructed by S. Hobfoll was used to study CS, and emotional WB was assessed based on the severity of anxiety and depression. Further, we used the State-Trait Anxiety Inventory developed by C.D. Spielberger and adapted by Y.L. Khanin and the Center for Epidemiologic Studies Depression Scale. Only Russian validated versions of the questionnaires were used in the study.Results. In both groups of patients, ‘Assertive (Persistent) Actions’ was positively associated with emotional WB. In patients with T2D, WB increases when using ‘Cautious Action’ and ‘Social Joining’. The deterioration of emotional WB was associated with ‘Aggressive Actions’ in both groups of patients. In patients with T1D, negative WB was also associated with ‘Avoidance’, while in patients with T2D, negative WB was associated with ‘Instinctive Actions’. In patients with T1D, ‘Instinctive Action’ was associated with higher HbA1c levels. In patients with T2D, ‘Cautious Action’, ‘Avoidance’ and ‘Antisocial Action’ were associated with lower HbA1c levels.Conclusion. In patients with T1D and T2D, CSs are associated with both emotional WB and glycaemic control. Emotional WB and lower HbA1c levels are associated with ‘Assertive Action’, ‘Cautious Action’, ‘Avoidance’ and ‘Asocial Action’. Negative WB and higher HbA1c levels are associated with ‘Aggressive Action’ and ‘Instinctive Action’.

Comparison of HbA1c results obtained by Quo-Test device and Vitros 5,1 FS analyzer in children with type 1 diabetes.

2016 ◽  
Vol 52 (2) ◽  
pp. 95-100
Author(s):  
Patrycja Szybowska ◽  
Małgorzata Wilusz ◽  
Iwona Rogatko ◽  
Krystyna Sztefko
Keyword(s):  
Type 1 Diabetes ◽  
Hba1c Level ◽  
Point Of Care ◽  
Paediatric Population ◽  
Glycated Haemoglobin ◽  
Economic Problem ◽  
Diabetes Diagnosis ◽  
Test Device ◽  
Hba1c Concentration

Introduction: The increase in the prevalence of diabetes, considered as the disease of civilization, is a health and economic problem also in paediatric population. One of the main parameter for monitoring glycaemia is glycated haemoglobin (HbA1c). Determination of HbA1c concentration in blood can be performed on both biochemical analyzers and small devices used at the point of care testing (POCT). Validity of HbA1c results obtained in POCT system is continuously verified. Aim: Comparison of HbA1c results obtained by using Quo-Test device (EKF Diagnostics) and Vitros 5,1 FS analyzer (Diasorin). Materials and methods: The study included 98 children (48 boys, 50 girls) with type 1 diabetes. Diagnosis was done based on the criteria of Polish Diabetes Association (PTD). Venous K2EDTA blood was collected and the HbA1c level was determined on the Quo-Test device (method based on reaction with the boronic acid derivative) and Vitros 5,1 FS analyzer (turbidimetric method). Statistical analysis was performed using Statistica10 (StatSoft). Results: Statistically significantly higher HbA1c concentrations were noticed in the results obtained on Quo-Test compared to Vitros 5,1 FS for all the measurements of HbA1c (p=0.001) and for HbA1c <6.5% (p=0.001), for results HbA1c ≥6.5% obtained concentrations were significantly lower (p=0.014). Analysis of Passing-Bablock regression showed no difference between the methods for HbA1c <6.5%. For HbA1c ≥6.5%, as well as for all HbA1c results, regression coefficients did not confirm the comparability of the two methods. Mean bias ± 95% limits of agreement (LOA) was 0.14% [(-0.32) – 0.61]). The Bland-Altman index was equal to 5.15%. Conclusion: The Quo-Test device can be used only for monitoring HbA1c level in children with type 1 diabetes as long as it will not be used interchangeably with Vitros 5,1 FS.

HbA1c levels in children with type 1 diabetes and correlation to diabetic retinopathy

2018 ◽  
Vol 31 (4) ◽  
pp. 369-374 ◽  
Author(s):  
Rebecka Andreasson ◽  
Charlotte Ekelund ◽  
Mona Landin-Olsson ◽  
Charlotta Nilsson
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Retinopathy ◽  
Glycosylated Hemoglobin ◽  
Acute Onset ◽  
Diabetes Diagnosis ◽  
Adequate Treatment ◽  
The Mean ◽  
Hba1c Levels

AbstractBackground:Type 1 diabetes mellitus (T1D) is a metabolic disease causing hyperglycemia due to β-cell destruction. Despite adequate treatment, complications such as diabetic retinopathy (DR) are common. The first aim was to investigate if acute onset of type 1 diabetes differed between those who had developed retinopathy and who had not after 15 years from diagnosis. The second aim was to investigate if mean glycosylated hemoglobin (HbA1c) levels affect the time to development of DR.Methods:The medical records of all children and adolescents diagnosed with type 1 diabetes during 1993–2001 in our area in Sweden were studied retrospectively and the mean HbA1ceach year until the development of retinopathy was investigated. In total 72 patients were included and the follow-up time was between 15 and 23 years. Gender, p-glucose, age and HbA1cat diagnosis were analyzed for possible correlations to years to retinopathy.Results:HbA1cwas significantly higher among those who had developed DR after 15 years from diagnosis, 98±9.2 (n=25) vs. 86±9.2 (n=46; p=0.025). A negative correlation was found between age at diagnosis and years to DR (rs=−0.376; p=0.026). Mean HbA1clevels at years 6–10 after diabetes diagnosis correlated significantly (rs=−0.354, p=0.037) to years until retinopathy. Mean HbA1clevels at years 1–15 after diabetes diagnosis were significantly higher at years 2–3 and years 5–8 for those who had developed retinopathy after 15 years from diagnosis.Conclusions:Higher HbA1clevels shortened the time to development of retinopathy. It is therefore important to keep HbA1cas close to normal as possible.

scholarly journals Use of factory calibrated real-time continuous glucose monitoring improves time in target and HbA1c in a multiethnic cohort of adolescents and young adults with type 1 diabetes: the MILLENNIALS Study

2020 ◽  
Author(s):  
Hood Thabit ◽  
Joshi Navis Prabhu ◽  
Womba Mubita ◽  
Catherine Fullwood ◽  
Shazli Azmi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Young People ◽  
Control Period ◽  
Glucose Monitoring ◽  
Random Order ◽  
Mean Difference ◽  
Time In Range ◽  
Hba1c Levels

<b>Objective: </b>International type 1 diabetes registries have shown that HbA1c levels are highest in young people with type 1 diabetes, however improving their glycaemic control remains a challenge. We propose that use of factory-calibrated Dexcom G6 CGM system would improve glycaemic control in this cohort. <p><b>Research Design and Methods: </b>We conducted a randomized crossover trial in young people with type 1 diabetes (16 – 24 years old), comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded CGM was worn by each participant for 10 days at the start, week-4 and week-7 of the control period. HbA1c measurements were drawn after enrolment, before and after each treatment period. The primary outcome was time in range 70–180mg/dl.</p> <p><b>Results: </b>Time in range was significantly higher during CGM compared to control [35.7±13.5% vs. 24.6±9.3%, mean difference 11.1% (95% CI 7.0 to 15.2, p<0.001)]. CGM use reduced mean sensor glucose [219.7±37.6mg/dl vs. 251.9±36.3mg/dl, mean difference -32.2mg/dl (95% CI -44.5 to -20.0, p<0.001)] and time above range [61.7±15.1% vs. 73.6±10.4%, mean difference 11.9% (95% CI -16.4 to -7.4, p<0.001)]. HbA1c level was reduced by 0.76% (95% CI -1.1 to -0.4) [-8.5mmol/mol (95% CI -12.4 to -4.6, p<0.001)]. Times spent below range (<70mg/dl and <54mg/dl) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.</p> <p><b>Conclusion: </b>CGM use in young people with type 1 diabetes improves time in target and HbA1c levels compared to SMBG.<b> </b></p>

scholarly journals Family Support and Its Association with Glycemic Control in Adolescents with Type 1 Diabetes Mellitus in Riyadh, Saudi Arabia

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Adwa M. AlHaidar ◽  
Norah A. AlShehri ◽  
Munira A. AlHussaini
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Saudi Arabia ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Hba1c Level ◽  
The Family ◽  
The Mean ◽  
Critical Situations

The prevalence of type 1 diabetes mellitus (T1DM) among children in Saudi Arabia is increasing with unfavorable outcomes. Therefore, in addition to pharmacotherapy, other measures should be studied regarding psychological aspects mainly among adolescents. The family, which acts as the primary caregiver at this age, may play a major role in disease management. Thus, this study is aimed at assessing the perception of adolescents about the behaviors of their families initially and at investigating the correlation between these behaviors and glycemic control. Up to our knowledge, there was no study in Saudi Arabia that addressed this issue previously. This cross-sectional observational study assessed adolescents aged 10–19 years diagnosed with T1DM on insulin and receiving follow-up care at the King Saud University Medical City in Riyadh, Saudi Arabia. Data were collected via telephone interview and the verified “Modified Diabetes Social Support Questionnaire-Family version”. Glycemic control was then assessed using the most recent hemoglobin A1c (HbA1c) level recorded in their electronic files. Fifty-six adolescents participated in this study with an equal sex distribution (each n=28). Almost all participants were Saudis, and the majority were living in Riyadh (n=41). The mean age was 16.1±2.41 years with a mean of 6.1±4.14 years history of diabetes. The mean HbA1c level was 9.6±2.12%. Participants perceived all behaviors as supportive with “support in critical situations” being the highest (77.3%) and the only factor significantly related to HbA1c (p=0.017). Age was significantly related to all factors (p>0.05). Family plays a major role in the management of diabetes. Their supportive behaviors are perceived by their family members diagnosed with T1DM, but there has been no optimal association with disease control. However, the involvement of the family can aid in decreasing possible complications of the disease by intervening in critical situations.

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