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

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.

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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

BMC Health Services Research ◽

10.1186/s12913-019-4690-0 ◽

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.

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T1D and T2D Youth in the Pediatric Diabetes Consortium (PDC) Registries—Comparing Clinical Characteristics and Glycemic Control

Diabetes ◽

10.2337/db18-1340-p ◽

2018 ◽

Vol 67 (Supplement 1) ◽

pp. 1340-P ◽

Cited By ~ 1

Author(s):

WILLIAM V. TAMBORLANE ◽

PEIYAO CHENG ◽

ROBIN L. GAL ◽

CRAIG KOLLMAN ◽

MICHELLE A. VAN NAME ◽

...

Keyword(s):

Glycemic Control ◽

Clinical Characteristics ◽

Pediatric Diabetes

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Abstract P147: Glycemic Control and Weight in a Pediatric Diabetes Clinic Over Time: Gender Differences in Children With Type 1 Diabetes Between the Ages of 9-17 Years

Circulation ◽

10.1161/circ.135.suppl_1.p147 ◽

2017 ◽

Vol 135 (suppl_1) ◽

Author(s):

Alexandra Bodan

Keyword(s):

Gender Differences ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Mixed Model ◽

Linear Mixed Model ◽

Critical Time ◽

Cvd Risk ◽

Pediatric Diabetes ◽

Increased Risk

Research shows women with type 1 diabetes (T1D) face a disproportionately increased risk for development of cardiovascular disease (CVD) compared to men. We posit, adolescence may be a critical time period for CVD risk development. Our study examined the effects on gender differences in Hemoglobin A1c (HbA1c) and Body Mass Index z-score (BMIz) across puberty in children with T1D in a large pediatric diabetes specialty clinic. A total of 733 T1D children (M=355, F=378) aged 9-17 with a total of 21,534 visits from the Barbara Davis Center were suitable for this retrospective cohort study. To exam HbA1c and BMIz overtime by gender we used a linear mixed model with SAS version 9.4. HbA1c increased with age in both genders (p<0.0001), but there was a greater increase in girls across adolescence (sex by age interaction, p<0.0007). BMIz increased with age in girls only (sex by age interaction, p<0.0001). Teenagers had worse glycemic control than younger children, and girls had worse glycemic control with greater obesity rates than boys. This gender difference in glycemic control and obesity during puberty may explain the increased CVD risk seen in women with T1D compared to men.

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Glycemic Control in Children With Type 1 Diabetes in Wales: Influence of the pediatric diabetes specialist nurse

Diabetes Care ◽

10.2337/dc09-2304 ◽

2010 ◽

Vol 33 (8) ◽

pp. 1724-1726 ◽

Cited By ~ 15

Author(s):

M. O'Hagan ◽

J. N. Harvey ◽

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Specialist Nurse ◽

Diabetes Specialist ◽

Pediatric Diabetes

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Initial Presentation of Type 2 Diabetes in Adolescents Predicts Durability of Successful Treatment with Metformin Monotherapy: Insights from the Pediatric Diabetes Consortium T2D Registry

Hormone Research in Paediatrics ◽

10.1159/000481687 ◽

2017 ◽

Vol 89 (1) ◽

pp. 47-55 ◽

Cited By ~ 11

Author(s):

Fida Bacha ◽

Peiyao Cheng ◽

Robin L. Gal ◽

Craig Kollman ◽

William V. Tamborlane ◽

...

Keyword(s):

Type 2 Diabetes ◽

Glycemic Control ◽

Multivariable Analysis ◽

Diabetes Duration ◽

Adequate Control ◽

Pediatric Diabetes ◽

Metformin Monotherapy ◽

Metformin Group ◽

Group 2

Background/Aims: Many adolescents with type 2 diabetes (T2D) have rapid deterioration of glycemic control on metformin monotherapy within 2 years of diagnosis. Methods: Enrollment data from the Pediatric Diabetes Consortium T2D Registry were used to categorize 276 youth with a T2D duration ≥2 years into two groups: (1) participants with HbA1c <7.5% on metformin monotherapy (group 1, n = 75) and (2) participants treated with insulin ± metformin (group 2, n = 201). The characteristics of the groups were compared. Results: At enrollment, groups 1 and 2 did not differ in age (16.2 vs. 16.8 years) or BMI percentile (99 vs. 98%); group 2 had higher HbA1c (9.9% [85 mmol/mol] vs. 5.9% [41 mmol/mol], p < 0.001). Lower HbA1c and metformin monotherapy at diagnosis were associated with a greater likelihood of adequate control with metformin alone (p < 0.001). In multivariable analysis, HbA1c at diagnosis (p = 0.001) and diabetes duration (p = 0.009) were associated with adequate control on metformin. The HbA1c trajectory after diagnosis was worse in group 2. Conclusion: Durable metabolic control of T2D with metformin monotherapy is most likely in youth presenting with lower HbA1c and with shorter diabetes duration, independent of age, race-ethnicity, and BMI. Elevated HbA1c levels in those on insulin therapy highlight the importance of early diagnosis and a better understanding of glycemic control barriers.

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Original article. Trends and characteristics of childhood diabetes in a tertiary care center in Thailand

Asian Biomedicine ◽

10.5372/1905-7415.0806.348 ◽

2014 ◽

Vol 8 (6) ◽

pp. 707-715 ◽

Cited By ~ 5

Author(s):

Sirawut Trepatchayakorn ◽

Vichit Supornsilchai ◽

Suttipong Wacharasindhu ◽

Suphab Aroonparkmongkol ◽

Taninee Sahakitrungruang

Keyword(s):

Glycemic Control ◽

Care Center ◽

Correct Diagnosis ◽

Tertiary Care ◽

Significant Proportion ◽

Current Treatment ◽

Acid Decarboxylase ◽

Diabetes Clinic ◽

Pediatric Diabetes ◽

Number Of Patients

Abstract Background: Reports on characteristics of pediatric diabetes in children from Southeast Asian countries are limited. Objectives: To describe the clinical characteristics, prevalence, glycemic control, and current treatment regimens of diabetes in Thai children. Materials and Methods: Data from 132 patients seen at our pediatric diabetes clinic at Chulalongkorn University during 2001−2013 were retrospectively reviewed. Results: We found an increasing number of patients newly-diagnosed with type 1- (T1DM) or type 2- diabetes mellitus (T2DM). The overall proportion of T1DM was 69.7%, T2DM 23.4%, and other types 6.9%. Children with T1DM were younger at diagnosis, had higher initial glucose and glycated hemoglobin A1c (HbA1c), a lower body mass index z-score, lower C-peptide and insulin levels, and were more likely to have classic diabetes symptoms and ketoacidosis, compared with children with T2DM. Mixed diabetes phenotypes were found in about 12%−14% of these children. Glutamic acid decarboxylase and islet antigen-2 autoantibodies were found in 70% and 54% of T1DM patients, respectively, and not in T2DM patients. HbA1c in T1DM was 9.6 ± 2.2% total hemoglobin, and in T2DM was 7.9 ± 2.6%. There were no differences in HbA1c levels between different insulin regimens in the T1DM group. Conclusion: The number of children with T1DM or T2DM has been increasing and there are overlapping phenotypes in a significant proportion of these children. Correct diagnosis requires clinical evaluation and monitoring of the clinical course. Further research is needed to determine the risk factors for the poor glycemic control found in children with T1DM.

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