scholarly journals Parent and Pediatrician Preferences for Type 1 Diabetes Screening in the U.S.

2020 ◽  
Author(s):  
Jessica L. Dunne ◽  
Anne Koralova ◽  
Jessie Sutphin ◽  
Jesse S. Bushman ◽  
Barbara Fontanals-Ciera ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Screening Test ◽  
The United States ◽  
Screening Tests ◽  
Relative Importance ◽  
Mode Of Administration ◽  
Monitoring Programs ◽  
Equal Importance ◽  
Insulin Dependence

<a><b>Objective:</b> The purpose of this study was to use a discrete-choice experiment methodology to understand the relative importance of the attributes of screening tests for type 1 diabetes among parents and pediatricians in the United States.</a> <p><b>Research Design and Methods:</b> Online surveys presented hypothetical Screening Test profiles from which respondents chose their preferred test profile. Survey attributes were based on likely screening test options and included the mode of administration, where and when the test was conducted, the type of education and monitoring available to lower the risk of diabetic ketoacidosis (DKA), and whether a treatment was available that would delay onset of insulin dependence. Data were analyzed using random-parameters logit models.</p> <p><b>Results:</b> Parents placed the highest relative importance on monitoring programs that could reduce the risk of DKA to 1%, followed by treatment to delay onset of insulin dependence by 1 or 2 years, and, finally, avoiding a $50 out-of-pocket cost. Pediatricians placed equal importance on monitoring programs that reduced a patient’s risk of DKA to 1% and on avoiding a $50 out-of-pocket cost for the screening test, followed by the option of a treatment to delay the onset of insulin dependence. The mode of administration and location and timing of the screening were much less important to both parents and pediatricians<i>.</i></p> <p><b>Conclusions:</b> Parents and pediatricians preferred screening tests that were accompanied by education and monitoring plans to reduce the risk of DKA, had available treatment to delay type 1 diabetes, and had lower out-of-pocket costs.</p>

scholarly journals Parent and Pediatrician Preferences for Type 1 Diabetes Screening in the U.S.

2020 ◽  
Author(s):  
Jessica L. Dunne ◽  
Anne Koralova ◽  
Jessie Sutphin ◽  
Jesse S. Bushman ◽  
Barbara Fontanals-Ciera ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Screening Test ◽  
The United States ◽  
Screening Tests ◽  
Relative Importance ◽  
Mode Of Administration ◽  
Monitoring Programs ◽  
Equal Importance ◽  
Insulin Dependence

<a><b>Objective:</b> The purpose of this study was to use a discrete-choice experiment methodology to understand the relative importance of the attributes of screening tests for type 1 diabetes among parents and pediatricians in the United States.</a> <p><b>Research Design and Methods:</b> Online surveys presented hypothetical Screening Test profiles from which respondents chose their preferred test profile. Survey attributes were based on likely screening test options and included the mode of administration, where and when the test was conducted, the type of education and monitoring available to lower the risk of diabetic ketoacidosis (DKA), and whether a treatment was available that would delay onset of insulin dependence. Data were analyzed using random-parameters logit models.</p> <p><b>Results:</b> Parents placed the highest relative importance on monitoring programs that could reduce the risk of DKA to 1%, followed by treatment to delay onset of insulin dependence by 1 or 2 years, and, finally, avoiding a $50 out-of-pocket cost. Pediatricians placed equal importance on monitoring programs that reduced a patient’s risk of DKA to 1% and on avoiding a $50 out-of-pocket cost for the screening test, followed by the option of a treatment to delay the onset of insulin dependence. The mode of administration and location and timing of the screening were much less important to both parents and pediatricians<i>.</i></p> <p><b>Conclusions:</b> Parents and pediatricians preferred screening tests that were accompanied by education and monitoring plans to reduce the risk of DKA, had available treatment to delay type 1 diabetes, and had lower out-of-pocket costs.</p>

scholarly journals Is Hypoglycemia Caused by G6PD Deficiency?

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A388-A389
Author(s):  
Shubham Agarwal ◽  
Zubina Unjom ◽  
Janice L Gilden ◽  
Aditi Singh ◽  
Shayaan Shaik
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Type 1 Diabetes Mellitus ◽  
Hemolytic Anemia ◽  
G6pd Deficiency ◽  
Screening Test ◽  
Screening Tests ◽  
Normal Male ◽  
Oral Glucose

Abstract Background: Individuals with G6PD deficiency are mostly asymptomatic but develop hemolytic anemia with the use of certain medications, chemicals, or food. Hemolytic anemia episodes in patients with G6PD deficiency have been observed to occur following hypoglycemia. Case: An 18-year-old, vigorously exercising African American male was referred to the endocrine clinic for post-prandial hypoglycemia (Blood glucose (BG) of 47 mg/dl) accompanied by palpitations, lightheadedness, dyspnea, diaphoresis, and tremulousness. He admitted to having short symptomatic episodes, almost daily over four years. His mother has sickle cell trait, and due to the need for blood typing, a qualitative direct fluoroscopic screening test was positive for G6PD deficiency. Physical examination revealed a height of 5’2” with a weight of 126 lbs. (BMI: 22.7 kg/m2), blood pressure of 97/55 mmHg, and heart rate of 62/minute. The patient was a normal male with low set ears, and no other abnormalities, except for questionable non-genetic short stature. Fingerstick BG was 62 mg/dl. Lab tests showed a fasting BG of 90 mg with concomitant proinsulin of 8.2 pmol/l (≤ 18.8 pmol/l), fasting insulin of 8.98 mIU/l (≤ 25 mIU/l), 2-hour post-prandial insulin of 33.4 µIU/ml (5.0–55.0 µIU/ml), and a c-peptide 1.24 ng/ml (0.81–3.85 ng/ml). Uric acid, TSH, Free T4, LH, FSH, Prolactin, IGF-1, PTH, free and total testosterone were all normal. Fasting cortisol level was normal with an elevated ACTH of 72 pg/ml (0–47 pg/ml), low 25-hydroxyvitamin D at 18.5 ng/ml (30–100 ng/ml), and a flat oral glucose tolerance test. A continuous glucose monitor revealed average daily glucose of 85 mg/dl with 34% of the time spent &lt; 80 mg/dl. A high carbohydrate diet with frequent meals improved symptoms with normal fingerstick BG. However, due to the concern that hypoglycemia can be related to G6PD deficiency, hemoglobin electrophoresis, and gene testing for G6PD were done to confirm this diagnosis, and they were both normal. In addition, a bone density scan was done, which revealed osteopenia. He was started on vitamin D supplementation. Conclusion: Case reports exist of G6PD deficient hospitalized patients with type 1 diabetes mellitus and DKA in recovery, who have had new onset hemolytic anemia, proposing that relative hypoglycemia can be responsible for this effect. Multiple screening tests have been developed for the detection of G6PD deficiency, which assay the normal function of the enzyme and reduction of NADP to NADPH. However, confirmatory testing needs to be conducted if the screening test is positive. Although this adds to the burden of testing, screening tests can result in false positives and lead to a misdiagnosis, as in our case. References: Messina MF et al. Hemolytic crisis in a non-ketotic and euglycemic child with glucose-6-phosphate dehydrogenase deficiency and onset of type 1 diabetes mellitus. J Pediatr Endocrinol Metab. 2004 Dec;17(12):1671–3

Diagnostic Accuracy of Serologic Screening Tests for Celiac Disease in Asymptomatic Adults and Children with Type 1 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 1579-P
Author(s):  
MICHELLE GOULD ◽  
FARID H. MAHMUD ◽  
ANTOINE B. CLARKE ◽  
ESTHER ASSOR ◽  
AMISH PARIKH ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Celiac Disease ◽  
Diagnostic Accuracy ◽  
Screening Tests ◽  
Adults And Children ◽  
Serologic Screening

Dextrose-Sulfonylurea Challenge as a Screening Test for Monogenic Diabetes in Patients Diagnosed with Type 1 Diabetes

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 310-LB
Author(s):  
AURELIA C.H. WOOD ◽  
MARIA S. REMEDI ◽  
COLIN NICHOLS ◽  
BESS A. MARSHALL
Keyword(s):  
Type 1 Diabetes ◽  
Screening Test ◽  
Monogenic Diabetes

scholarly journals Fluctuations in the incidence of type 1 diabetes in the United States from 2001 to 2015: a longitudinal study

BMC Medicine ◽  
2017 ◽  
Vol 15 (1) ◽  
Author(s):  
Mary A. M. Rogers ◽  
Catherine Kim ◽  
Tanima Banerjee ◽  
Joyce M. Lee
Keyword(s):  
United States ◽  
Type 1 Diabetes ◽  
Longitudinal Study ◽  
The United States

scholarly journals The Future of Clinical Islet Transplantation in the United States

2021 ◽  
Vol 5 (1) ◽  
Author(s):  
Michael F Knoll ◽  
Carmela A Knoll ◽  
Rita Bottino ◽  
Massimo Trucco ◽  
Suzanne Bertera ◽  
...  
Keyword(s):  
Quality Of Life ◽  
United States ◽  
Type 1 Diabetes ◽  
Islet Transplantation ◽  
Drug Administration ◽  
The United States ◽  
Clinical Islet Transplantation ◽  
The World

Clinical islet transplantation was first realized over four decades ago at the University of Minnesota. Autologous islet transplantation is now widely recognized as a treatment to prevent diabetes in patients after pancreas excision and is offered at major transplant centers throughout the United States and the world. Type 1 diabetes represents a much larger demographic in which islet transplantation may benefit patients. Allogeneic islet transplantation can now offer similar outcomes to pancreas transplantation in a subset of patients with labile type 1 diabetes with less risk than whole organ transplantation. It is recognized as a standard of care in nations around the world but not in the United States, despite the important developmental role US scientists and physicians have played. Early reports of islet transplantation focused on insulin independence that proved to diminish over time. However, regardless of insulin status, islet transplantation provides benefits ranging from improved quality of life to reduction in diabetic complications. A National Institutes of Health sponsored multi-center Phase 3 Clinical Trial (CIT-07) demonstrated safety and efficacy, although the Food and Drug Administration chose to consider islets as a biologic that requires licensure, which makes offering the procedure in the clinic very challenging. Until regulations can be brought into communion with international standards, allogeneic islet transplantation in the United States is unlikely to match international levels of success and once promising programs are left to wither on the vine. Food and Drug Administration approval would open the door for third party medical reimbursement and allow many patients the opportunity to enjoy better health and quality of life. Establishment of clinical islet transplantation for type 1 diabetes would lead to optimizations in procedures making it more efficacious and cost effective while offering support for ongoing islet xenotransplantation studies that could bring islet transplantation to even more patients.

scholarly journals Inequities in Diabetic Ketoacidosis Among Patients With Type 1 Diabetes and COVID-19: Data From 52 US Clinical Centers

2020 ◽  
Author(s):  
Osagie Ebekozien ◽  
Shivani Agarwal ◽  
Nudrat Noor ◽  
Anastasia Albanese-O’Neill ◽  
Jenise C Wong ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
The United States ◽  
Cross Sectional Study ◽  
Multivariable Logistic Regression Analysis ◽  
Cross Sectional ◽  
Black Patients ◽  
Hispanic Patients ◽  
White Patients

Abstract Objective We examined whether diabetic ketoacidosis (DKA), a serious complication of type 1 diabetes (T1D) was more prevalent among Non-Hispanic (NH) Black and Hispanic patients with T1D and laboratory-confirmed coronavirus disease 2019 (COVID-19) compared with NH Whites. Method This is a cross-sectional study of patients with T1D and laboratory-confirmed COVID-19 from 52 clinical sites in the United States, data were collected from April to August 2020. We examined the distribution of patient factors and DKA events across NH White, NH Black, and Hispanic race/ethnicity groups. Multivariable logistic regression analysis was performed to examine the odds of DKA among NH Black and Hispanic patients with T1D as compared with NH White patients, adjusting for potential confounders, such as age, sex, insurance, and last glycated hemoglobin A1c (HbA1c) level. Results We included 180 patients with T1D and laboratory-confirmed COVID-19 in the analysis. Forty-four percent (n = 79) were NH White, 31% (n = 55) NH Black, 26% (n = 46) Hispanic. NH Blacks and Hispanics had higher median HbA1c than Whites (%-points [IQR]: 11.7 [4.7], P &lt; 0.001, and 9.7 [3.1] vs 8.3 [2.4], P = 0.01, respectively). We found that more NH Black and Hispanic presented with DKA compared to Whites (55% and 33% vs 13%, P &lt; 0.001 and P = 0.008, respectively). After adjusting for potential confounders, NH Black patients continued to have greater odds of presenting with DKA compared with NH Whites (OR [95% CI]: 3.7 [1.4, 10.6]). Conclusion We found that among T1D patients with COVID-19 infection, NH Black patients were more likely to present in DKA compared with NH White patients. Our findings demonstrate additional risk among NH Black patients with T1D and COVID-19.

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