Communication frequency between visits is associated with improved glycemic control in pediatric diabetes

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Rohini Verma ◽  
Chrystal G. Thomas ◽  
Margaret West ◽  
Laura Prichett ◽  
Christine Glancey ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Insulin Dose ◽  
Retrospective Chart Review ◽  
Diabetes Clinic ◽  
Pediatric Diabetes ◽  
Communication Frequency ◽  
Diabetes Center ◽  
Electronic Messaging ◽  
Clinic Visits

AbstractObjectivesChildren with diabetes are advised to see their diabetes team every 3 months, with interim communication to address insulin dose adjustments. Despite increasing digital accessibility, there is limited data on whether provider–patient communication frequency is associated with glycemic control in pediatric diabetes. We assessed patterns of communication between diabetes clinic visits and whether communication frequency via electronic messaging (EM) and telephone was associated with glycemic control in pediatric diabetes.MethodsRetrospective chart review of 267 children with type 1 (T1DM) and type 2 diabetes (T2DM) over a 1-year period (July 2018–June 2019) at an urban academic pediatric diabetes center. Association between frequency of communication (via EM and telephone) and HbA1c was analyzed using regression analysis.ResultsOf 267 participants, 224 (84%) had T1DM, 43 (16%) had T2DM, mean age 11.6 years (SD 4), mean duration of diabetes 3.5 years (SD 3.4), and mean HbA1c 73.8 ± 23 mmol/mol (8.9 ± 2.2%). Most participants (82%) communicated with their diabetes team at least once per year, with a mean number of overall communications of 10.3 ± 13.6 times. Communications were via EM (48%), phone (40%), or both (53%). Participants with more frequent communication had lower HbA1c values (p=0.007), even when controlling for age, sex, provider, and number of clinic visits per year. We determined that a threshold of three communications per year was associated with a lower HbA1c (p=0.006).ConclusionsMore frequent communication with the diabetes team between visits is associated with improved glycemic control. Initiatives to contact diabetes patients between clinic visits may impact their overall glycemic control.

scholarly journals Influence of the Type of Basal Insulin and Other Variables on Clinical Outcomes in Children with Newly Diagnosed Type 1 Diabetes

2014 ◽  
Vol 2014 ◽  
pp. 1-6
Author(s):  
Ruth M. Garrison ◽  
Jeremy L. Johnson ◽  
Michelle E. Condren ◽  
Kevin C. Farmer ◽  
David H. Jelley
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Basal Insulin ◽  
Retrospective Chart Review ◽  
Severe Hypoglycemia ◽  
First Year ◽  
Newly Diagnosed ◽  
Diabetes Clinic ◽  
Pediatric Diabetes

Background. Basal insulin detemir and glargine each have characteristics that may make them a superior choice in children and adolescents with type 1 diabetes, but there is a paucity of data on glycemic results in this population. Objective. Examination of variables associated with achievement of HbA1c goal in children and adolescents with newly diagnosed type 1 diabetes. Methods. The primary outcome, factors associated with achievement of HbA1c goal, was examined in a retrospective chart review. Variables, including type of basal insulin, were collected during the first year of diagnosis of patients in a pediatric diabetes clinic. Secondary outcomes included change in HbA1c, severe hypoglycemic events, and episodes of DKA. Results. 94 patients were included in the study. HbA1c at diagnosis was found to be a significant predictor of achievement of goal at 3 months (P=0.002) and of change in HbA1c at 3 and 12 months (P<0.001 for each). Severe hypoglycemia and episodes of DKA were uncommon. Conclusions. Choice of basal insulin was not found to be a predictor of achieving HbA1c goal or of change in HbA1c over the course of the first year of diagnosis with type 1 diabetes.

1322-P: Communication Frequency between Visits Is Associated with Improved Glycemic Control in Pediatric Diabetes

Diabetes ◽  
2020 ◽  
Vol 69 (Supplement 1) ◽  
pp. 1322-P
Author(s):  
KIMBER-LEE ABEL ◽  
ROHINI VERMA ◽  
CHRYSTAL G. THOMAS ◽  
MARGARET WEST ◽  
CHRISTINE GLANCEY ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Pediatric Diabetes ◽  
Communication Frequency

scholarly journals Testing an audit and feedback-based intervention to improve glycemic control after transfer to adult diabetes care: protocol for a quasi-experimental pre-post design with a control group

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Rayzel Shulman ◽  
Ian Zenlea ◽  
Baiju R. Shah ◽  
Cheril Clarson ◽  
Jennifer Harrington ◽  
...  
Keyword(s):  
Young Adults ◽  
Glycemic Control ◽  
Diabetes Care ◽  
Audit And Feedback ◽  
System Level ◽  
Pediatric Diabetes ◽  
Patient Reported ◽  
Quasi Experimental ◽  
Adult Diabetes

Abstract Background When young adults transfer from pediatric to adult diabetes care they are at risk for deterioration of glycemic control, putting them at an increased risk of developing both acute and chronic complications. Despite increased awareness of these risks, there are gaps in care delivery during this vulnerable time and variability in the implementation of recommended transition practice. Audit and feedback (AF) interventions have a positive but variable effect on implementation of best practices. An expert group identified specific suggestions for optimizing the effectiveness of AF interventions. We aim to test an AF-based intervention incorporating these specific suggestions to improve transition practices and glycemic control in the first year after transfer from pediatric to adult diabetes care. Methods This is a pragmatic quasi-experimental study; a series of three cohort studies (pre-implementation, early-implementation, and post-implementation) to compare the baseline adjusted hemoglobin A1c (HbA1c) in the 12 months after the final pediatric visit in five pediatric diabetes centres within the Ontario Pediatric Diabetes Network in Ontario, Canada. The intervention includes three components: 1) centre-level feedback reports compiling data from chart abstraction, linked provincial administrative datasets, and patient-reported experience measures; 2) webinars for facilitated conversations/coaching about the feedback; and 3) online repository of curated transition resources for providers. The primary outcome will be analyzed using a multivariable linear regression model. We will conduct a qualitative process evaluation to understand intervention fidelity and to provide insight into the mechanisms of action of our results. Discussion There is a need to develop an innovative system-level approach to improve outcomes and the quality of care for young adults with type 1 diabetes during the vulnerable time when they transfer to adult care. Our research team, a collaboration of health services, implementation science, and quality improvement researchers, are designing, implementing, and evaluating an AF-based intervention using recommendations about how to optimize effectiveness. This knowledge will be generalizable to other care networks that aim to deliver uniformly high-quality care in diverse care settings. Trial registration ClinicalTrials.gov NCT03781973. Registered 13 December 2018. Date of enrolment of the first participant to the trial: June 1, 2019.

Level of Internet use among Greek adolescents with type 1 diabetes

2017 ◽  
Vol 31 (1) ◽  
Author(s):  
Katerina Daniilidou ◽  
Panagiota Triantafyllou ◽  
Maria Resta ◽  
Meropi Dimitriadou ◽  
Athanasios Christoforidis
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Internet Use ◽  
Insulin Pump ◽  
Addictive Behavior ◽  
The Internet ◽  
Control Group ◽  
Healthy Children ◽  
Diabetes Clinic

Abstract Background Compulsive Internet use has emerged as a contemporary addictive behavior. Our aim was to investigate the reasons for Greek adolescents with type 1 diabetes mellitus (T1DM) and their families to use the Internet and additionally to investigate the level of Internet use and its associations to demographic, socio-economic parameters and glycemic control. Methods Patients with T1DM, aged >12 years and their parents were recruited during their regular visits to the Pediatric Diabetes Clinic. A similar group of healthy children, age- and sex-matched served as a control group. All participants were asked to fill out the Greek translated version of the Internet Addiction Test (IAT). Caregivers of patients with T1DM were asked to complete a second questionnaire consisting of questions regarding demographic and socio-economic data of the family and data concerning disease management. Results Thirty-five patients with T1DM (mean decimal age of 14.95 ± 1.90 years) and 35 controls participated in the study. Nine patients were on an insulin pump whereas the rest were on multiple daily injections. The mean total score of the patients’ IAT questionnaires was significantly lower compared to the controls (26.26 ± 12.67 vs. 39.91 ± 18.55, p = 0.003). Controls were characterized as exhibiting moderate addictive behavior at a significantly higher percentage than patients (31.43% vs. 2.86%, p = 0.002). All patients on insulin pumps demonstrated normal Internet use. Mild addictive behavior was associated with a lower parental educational level. Finally, level of Internet use (IAT score) was positively associated to glycemic control (HbA1c value) with a correlation that was approaching significance (r = 0.315, p = 0.065). Conclusions Adolescents with T1DM and especially those on an insulin pump exhibit normal Internet use compared to their healthy peers. Time consumed on Internet correlates reversibly with glycemic control.

Serum leptin concentrations in children with type 1 diabetes mellitus: Relationship to body mass index, insulin dose, and glycemic control

Metabolism ◽  
2002 ◽  
Vol 51 (3) ◽  
pp. 292-296 ◽  
Author(s):  
Ashraf T. Soliman ◽  
Magdi Omar ◽  
Hala M. Assem ◽  
Ibrahim S. Nasr ◽  
Mohamed M. Rizk ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Body Mass Index ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Type 1 Diabetes Mellitus ◽  
Body Mass ◽  
Insulin Dose ◽  
Serum Leptin

scholarly journals Liraglutide as additional treatment for type 1 diabetes

2011 ◽  
Vol 165 (1) ◽  
pp. 77-84 ◽  
Author(s):  
Ajay Varanasi ◽  
Natalie Bellini ◽  
Deepti Rawal ◽  
Mehul Vora ◽  
Antoine Makdissi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Glucose Monitoring ◽  
Glycemic Variability ◽  
Additional Treatment ◽  
The Body ◽  
The Mean ◽  
Bolus Insulin

ObjectiveTo determine whether the addition of liraglutide to insulin to treat patients with type 1 diabetes leads to an improvement in glycemic control and diminish glycemic variability.Subjects and methodsIn this study, 14 patients with well-controlled type 1 diabetes on continuous glucose monitoring and intensive insulin therapy were treated with liraglutide for 1 week. Of the 14 patients, eight continued therapy for 24 weeks.ResultsIn all the 14 patients, mean fasting and mean weekly glucose concentrations significantly decreased after 1 week from 130±10 to 110±8 mg/dl (P<0.01) and from 137.5±20 to 115±12 mg/dl (P<0.01) respectively. Glycemic excursions significantly improved at 1 week. The mean s.d. of glucose concentrations decreased from 56±10 to 26±6 mg/dl (P<0.01) and the coefficient of variation decreased from 39.6±10 to 22.6±7 (P<0.01). There was a concomitant fall in the basal insulin from 24.5±6 to 16.5±6 units (P<0.01) and bolus insulin from 22.5±4 to 15.5±4 units (P<0.01).In patients who continued therapy with liraglutide for 24 weeks, mean fasting, mean weekly glucose concentrations, glycemic excursions, and basal and bolus insulin dose also significantly decreased (P<0.01). HbA1c decreased significantly at 24 weeks from 6.5 to 6.1% (P=0.02), as did the body weight by 4.5±1.5 kg (P=0.02).ConclusionLiraglutide treatment provides an additional strategy for improving glycemic control in type 1 diabetes. It also leads to weight loss.

Contrasting Challenges of Insulin Pump Therapy in a Toddler and Adolescent With Type 1 Diabetes

2005 ◽  
Vol 31 (4) ◽  
pp. 584-590 ◽  
Author(s):  
Elizabeth A. Doyle ◽  
Amy T. Steffen ◽  
William V. Tamborlane
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Diabetes Clinic ◽  
Physically Active ◽  
Parental Assistance ◽  
Life Improvement

Purpose To describe the challenges and outcomes of continuous subcutaneous insulin infusion (CSII) pump therapy in a toddler and adolescent with type 1 diabetes. Insight into patient-family aspects motivating pump use is provided. Methods Two cases treated at the Pediatric Diabetes Clinic at Yale University. Results Upon parental request, CSII was initiated to improve glycemic control in a 4-year-old boy (case 1) with unpredictable food intake. During 68 months of CSII therapy, hemoglobin A1C levels averaged 6.3% ± 0.6%. Severe hypoglycemic episodes ceased 36 months ago, and occasional postprandial hyperglycemia during early school years was corrected with school nurses’ reminders about premeal insulin bolus doses. Currently 9.5 years old, he independently manages all his insulin injections with parental assistance only to change the catheter site. Case 2 is a girl who was nearly 12 years of age when diagnosed with type 1 diabetes. Initially managed with daily injections, hypoglycemic episodes were interfering with her physically active lifestyle. At age 13 years, she elected CSII therapy, and glycemic control improved. Temporarily erratic in the immediate period pre- and postmenarche, metabolic control has since stabilized. At 15 years old, she successfully manages her diabetes independently. Conclusions To optimize glycemic control, CSII can be initiated and used effectively, both in children of all ages and in adolescents with type 1 diabetes. CSII may be ideal therapy for toddlers, with no apparent lower age boundary for initiating CSII; however, the parenting challenges and requirements for supportive education differ between toddlers and adolescents. When disease and pump management are appropriately individualized, CSII therapy can help children with diabetes achieve and sustain glycemic control. Lifestyle flexibility, quality-of-life improvement, and independence can thus begin early in childhood and be maintained throughout young adulthood.

scholarly journals A Modular Safety System for an Insulin Dose Recommender: A Feasibility Study

2019 ◽  
Vol 14 (1) ◽  
pp. 87-96 ◽  
Author(s):  
Chengyuan Liu ◽  
Parizad Avari ◽  
Yenny Leal ◽  
Marzena Wos ◽  
Kumuthine Sivasithamparam ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Insulin Dose ◽  
Safety System ◽  
Target Range ◽  
Percentage Time ◽  
Viable Solution ◽  
System Functioning ◽  
Safety Constraint

Background: Delivering insulin in type 1 diabetes is a challenging, and potentially risky, activity; hence the importance of including safety measures as part of any insulin dosing or recommender system. This work presents and clinically evaluates a modular safety system that is part of an intelligent insulin dose recommender platform developed within the EU-funded PEPPER project. Methods: The proposed safety system is composed of four modules which use a novel glucose forecasting algorithm. These modules are predictive glucose alerts and alarms; a predictive low-glucose basal insulin suspension module; an advanced rescue carbohydrate recommender for resolving hypoglycemia; and a personalized safety constraint applied to insulin recommendations. The technical feasibility of the proposed safety system was evaluated in a pilot study including eight adult subjects with type 1 diabetes on multiple daily injections over a duration of six weeks. Glycemic control and safety system functioning were compared between the two-weeks run-in period and the end point at eight weeks. A standard insulin bolus calculator was employed to recommend insulin doses. Results: Overall, glycemic control improved over the evaluated period. In particular, percentage time in the hypoglycemia range (<3.0 mmol/l) significantly decreased from 0.82% (0.05-4.79) at run-in to 0.33% (0.00-0.93) at endpoint ( P = .02). This was associated with a significant increase in percentage time in target range (3.9-10.0 mmol/l) from 52.8% (38.3-61.5) to 61.3% (47.5-71.7) ( P = .03). There was also a reduction in number of carbohydrate recommendations. Conclusion: A safety system for an insulin dose recommender has been proven to be a viable solution to reduce the number of adverse events associated to glucose control in type 1 diabetes.

The relationship between first-trimester haemoglobin a1c and pregnancy loss in women with type 1 diabetes mellitus

2012 ◽  
Vol 19 (3) ◽  
pp. 229-236
Author(s):  
Alin Albai ◽  
Viorel Șerban ◽  
Romulus Timar ◽  
Adrian Vlad ◽  
Bogdan Timar ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Pregnancy Loss ◽  
First Trimester ◽  
Adverse Outcomes ◽  
Control Group ◽  
Haemoglobin A1c ◽  
Diabetes Clinic ◽  
Increasing Risk ◽  
The Relationship

Abstract Background and aims: A precarious glycemic control in the first 10 weeks ofpregnancy, the period defining organogenesis, increases the risk of pregnancy loss.The aim of this study was to estimate the relationship between pregnancy loss andHbA1c values in early pregnancy in type 1 diabetic women.Material and method: The present study included all pregnancies in type 1 diabetic women followed atDiabetes Clinic, Emergency County Clinical Hospital, Timişoara, from 1990-2011.Results: The risk of pregnancy loss was significantly increased compared with thebackground control group. In our study the relative risk of pregancy loss increasedwhen HbA1c exceeded 6.5%. We found a consistent increasing risk with stepwiseincreasing levels of HbA1c. Conclusions: A better glycemic control in this periodand throughout the pregnancy could reduce the risk of severe adverse outcomes intype 1 diabetic pregnancies.

High-dose Vitamin D Supplementation on type 1 Diabetes Mellitus Patients: is there an Improvement in Glycemic Control?

2021 ◽  
Vol 17 ◽  
Author(s):  
Franciane Trindade Cunha de Melo ◽  
Karem Mileo Felício ◽  
Natércia Neves Marques de Queiroz ◽  
Hana Andrade de Rider Brito ◽  
João Felício Abrahão Neto ◽  
...  
Keyword(s):  
Glycemic Control ◽  
Insulin Dose ◽  
Vitamin D Supplementation ◽  
High Dose ◽  
General Improvement ◽  
High Doses ◽  
Dose Variation ◽  
High Dose Vitamin ◽  
Group 1

Background: Some authors evaluated the effect of VD on hyperglycemia in T1DM, but the results remain controversial. This study aims to analyze the effects of high-dose VD supplementation on T1DM patients’ glycemic levels, maintaining stable doses of insulin. Methods: Prospective, 12-week clinical trial including 67 T1DM patients, who were supplemented with high doses of cholecalciferol according to participants' VD value. Patients with VD levels below 30 ng/mL received 10,000 IU/day; those with levels between 30-60 ng/mL received 4,000 IU/day. Patients who had not achieved 25(OH)D levels > 30 ng/ml or presented insulin dose variation during the study were not analyzed. Results: Only 46 out of 67 patients accomplished the criteria at the end of the study. There was no general improvement in the glycemic control evaluated by HbA1c (9.4 ± 2.4 vs 9.4 ± 2.6, p=NS) after VD supplementation. However, a posthoc analysis, based on HbA1c variation, identified patients who had HbA1c reduced at least 0.6% (group 1, N = 13 (28%)). In addition, a correlation between 25(OH)D levels with HbA1c and total insulin dose at the end of the study was observed (r = -0.3, p<0.05; r=-0.4, p<0.05, respectively) and a regression model demonstrated that 25(OH)D was independent of BMI, duration of T1DM and final total insulin dose, being capable of determining 9.2% of HbA1c final levels (Unstandardized B coefficient = −0.033 (CI 95%: −0.064 to −0.002), r² = 0.1, p <0.05). Conclusion: Our data suggests that VD is not widely recommended for glycemic control. Nevertheless, specific patients might benefit from this approach.

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