Racial Disparities on Glycemic Control and Lipid Profiles in Children with Type 1 Diabetes

Objective We assessed the racial (Black–White) differences in glycemic control, prevalence of abnormal lipid profiles and factors influencing temporal trends in children with type 1 diabetes (T1DM). Methods This retrospective study was done in children with T1DM. The outcome measure was based on glycemic control and all lipid determinations which were stratified according to the published guidelines. Results The study included 181 children; 76.2% Whites and 23.8% Blacks. The mean glycated hemoglobin (A1C) was higher in Blacks than in Whites (p < 0.0001). Blacks had elevated total cholesterol (TC) (p = 0.0013), lower TC/HDL ratio (p < 0.0001) and higher concentration of HDL (<0.0001) when compared to Whites. The longitudinal analyses over a 5 year period showed changes in A1C significantly associated with changes in the lipid profiles. The lipid profiles in Blacks were more altered by the trend in A1C with changes in the TC (p = 0.0079), non-HDL (p < 0.0001) and HDL (p < 0.0001). Conclusions Black children with T1DM have poorer glycemic control. However they retained excellent levels of HDL when compared to Whites.

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Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001934 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001934

Author(s):

Anne M Doherty ◽

Anne Herrmann-Werner ◽

Arann Rowe ◽

Jennie Brown ◽

Scott Weich ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Real Time ◽

Instant Messaging ◽

Controlled Trial ◽

Self Management ◽

Diabetes Distress ◽

The Mean ◽

Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

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Glycated Hemoglobin A1c Levels in Type 1 Diabetes Mellitus and Outcomes After Myocardial Infarction

Circulation ◽

10.1161/circulationaha.118.039223 ◽

2019 ◽

Vol 139 (20) ◽

pp. 2380-2382 ◽

Cited By ~ 1

Author(s):

Thomas Nyström ◽

Ulrik Sartipy ◽

Andrea Contardi ◽

Marcus Lind ◽

Rino Bellocco ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Type 1 Diabetes ◽

Type 1 Diabetes Mellitus ◽

Hemoglobin A1c ◽

Glycated Hemoglobin ◽

Glycated Hemoglobin A1c

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Association of Race and Ethnicity With Glycemic Control and Hemoglobin A1c Levels in Youth With Type 1 Diabetes

JAMA Network Open ◽

10.1001/jamanetworkopen.2018.1851 ◽

2018 ◽

Vol 1 (5) ◽

pp. e181851 ◽

Cited By ~ 12

Author(s):

Anna R. Kahkoska ◽

Christina M. Shay ◽

Jamie Crandell ◽

Dana Dabelea ◽

Giuseppina Imperatore ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Race And Ethnicity ◽

Hemoglobin A1c

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Type 1 Diabetes in the Young: Organization of two National Centers in Israel and Slovenia / Sladkorna Bolezen Tipa 1 Pri Otrocih in Mladostnikih: Organizacija Dela V Dveh Nacionalnih Centrih V Izraelu in Sloveniji

Slovenian Journal of Public Health ◽

10.1515/sjph-2015-0021 ◽

2015 ◽

Vol 54 (2) ◽

pp. 139-145 ◽

Cited By ~ 1

Author(s):

Nataša Bratina ◽

Shlomit Shalitin ◽

Moshe Phillip ◽

Tadej Battelino

Keyword(s):

Type 1 Diabetes ◽

Glycated Hemoglobin ◽

Severe Hypoglycemia ◽

Modern Technology ◽

Steady Increase ◽

Chronic Complications ◽

The Mean ◽

Chronic Autoimmune Disease

Abstract Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.

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Liraglutide as additional treatment for type 1 diabetes

Acta Endocrinologica ◽

10.1530/eje-11-0330 ◽

2011 ◽

Vol 165 (1) ◽

pp. 77-84 ◽

Cited By ~ 94

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.

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Inflammatory Markers Are Increased in Youth with Type 1 Diabetes: The SEARCH Case-Control Study

The Journal of Clinical Endocrinology & Metabolism ◽

10.1210/jc.2009-1993 ◽

2010 ◽

Vol 95 (6) ◽

pp. 2868-2876 ◽

Cited By ~ 66

Author(s):

Janet K. Snell-Bergeon ◽

Nancy A. West ◽

Elizabeth J. Mayer-Davis ◽

Angela D. Liese ◽

Santica M. Marcovina ◽

...

Keyword(s):

Type 1 Diabetes ◽

South Carolina ◽

Glycemic Control ◽

Apolipoprotein B ◽

Inflammatory Markers ◽

Glycated Hemoglobin ◽

Case Control ◽

Good Glycemic Control ◽

Diabetes Status

Abstract Context: Increased inflammation may contribute to type 1 diabetes (T1D) complications. Objective: The objective of the study was to investigate the association of inflammation with obesity, hyperglycemia and dyslipidemia in youth with T1D. Design: This was a cross-sectional study of youth with and without T1D. Setting: The study was conducted in Colorado and South Carolina. Patients: SEARCH Case-Control participants with T1D [n = 553, mean age 15 yr (range 10–22), median duration 2.7 yr] and without diabetes [n = 215, mean age 15 yr (range 10–22)]. Intervention: This was an observational study. Main Outcome Measures: IL-6, high-sensitivity C-reactive protein (hsCRP), fibrinogen, and leptin were measured. Results: Inflammatory markers were evaluated by diabetes status, quartiles of glycated hemoglobin, and obesity using multiple linear regression analyses, adjusted for age, sex, study site, race/ethnicity, T1D duration, body mass index, and pubertal status. Compared with controls, youth with T1D had higher IL-6 and fibrinogen levels at all levels of glycemia and obesity, and hsCRP levels were significantly higher in youth with T1D in the top three quartiles of glycated hemoglobin (≥7.2%) and among normal-weight subjects. Leptin was lower in youth with poor glycemic control. Higher hsCRP and fibrinogen were correlated with higher total and LDL cholesterol, and apolipoprotein B in youth with T1D, whereas higher fibrinogen was correlated with higher LDL and apolipoprotein B in controls. Conclusions: T1D is characterized by excess inflammation, independent of adiposity and glycemic control. Even T1D youth in good glycemic control had higher levels of IL-6 and fibrinogen than controls. Elevated inflammatory markers were associated with an atherogenic lipid profile, which may contribute to accelerated atherosclerosis in youth with T1D.

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MON-671 Embarrassed to Eat: Two Cases of Gustatory Hyperhidrosis

Journal of the Endocrine Society ◽

10.1210/jendso/bvaa046.279 ◽

2020 ◽

Vol 4 (Supplement_1) ◽

Author(s):

Omer H Tarar ◽

Andres J Munoz

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Medical History ◽

Early Identification ◽

Hemoglobin A1c ◽

Past Medical History ◽

History Of ◽

Bolus Insulin ◽

Basal Bolus

Abstract Introduction Diabetic Gustatory Hyperhidrosis is characterized by profuse sweating with eating and may be a manifestation of Diabetic autonomic dysfunction. Most patients have evidence of other microvascular complications including nephropathy, retinopathy, peripheral neuropathy and other signs of autonomic neuropathy. We present 2 cases of gustatory hyperhidrosis associated with longstanding poorly controlled type 1 diabetes. Case 1: 49 year old Male with past medical history of longstanding type 1 diabetes with poor control, complicated with diabetic retinopathy, polyneuropathy, albuminuria presented to endocrine clinic for management of diabetes. His hemoglobin A1c was 10.8%. He was on basal-bolus Insulin at home. However, he admitted to missing most doses of prandial Insulin. On further questioning, he mentioned having episodes of profuse head and neck sweating while eating any type of food. He attributed these episodes to “low blood sugars” without checking and therefore tried to avoid Insulin. However, he continued having these episodes. He was diagnosed with Diabetic gustatory hyperhidrosis and started on topical Aluminum hexahydrate. Case 2: 34 year old Female with past medical history of long-standing DM type 1 complicated with poly- neuropathy, autonomic dysfunction, nephropathy, Retinopathy, chronic kidney disease stage III presented for follow up of her diabetes. Her hemoglobin A1c was 9.8%. She was on basal-bolus Insulin at home and reported good compliance. Given her extensive polyneuropathy, she was questioned about hyperhidrosis. She reported having profuse facial and neck sweating with eating all types of food which led to increased embarrassment while eating in public. She was diagnosed with diabetic gustatory hyperhidrosis and started on topical aluminum hexahydrate, with plans for Botox if symptoms persisted. Discussion Diabetic Gustatory Hyperhidrosis is an under- recognized condition and may be misdiagnosed as hypoglycemia, anxiety, gastroparesis or other conditions. This gustatory sweating is a source of severe distress and embarrassment for patients and can have serious emotional, social and professional implications. Associated symptoms may also be mistaken for hypoglycemia and in turn lead to nonadherence with Insulin and other diabetic medications causing suboptimal glycemic control. Topical anti-perspirants like Aluminum Chloride hexahydrate are often used as first line therapy. Second line treatment options include glycopyrrolate, Oxybutynin and Botulinum toxin. Conclusion Most patients are reluctant to mention these symptoms to health care providers and diligent history taking with specific questions in high risk patients may help in early identification and management of this condition. Early identification and management can also help promote overall confidence, quality of life and better glycemic control.

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Growth and glycemic control in children with type 1 diabetes and asymptomatic celiac disease treated with a gluten -free diet for 1 year

European Journal of Inflammation ◽

10.1177/2058739219855574 ◽

2019 ◽

Vol 17 ◽

pp. 205873921985557

Author(s):

Maria Giulia Berioli ◽

Giulia Mancini ◽

Nicola Principi ◽

Elisa Santi ◽

Martina Ascenzi ◽

...

Keyword(s):

Type 1 Diabetes ◽

Celiac Disease ◽

Glycemic Control ◽

Gluten Free Diet ◽

Gluten Free ◽

Age And Gender ◽

The Mean ◽

And Gender ◽

Nutritional Status Of Children

To compare growth and glycemic control in children with type 1 diabetes and silent celiac disease treated with a gluten-free diet for 1 year with those of similar age and gender with type 1 diabetes but without celiac disease, 16 type 1 diabetes patients with silent celiac disease were enrolled and each celiac disease-positive case was matched for age, sex, and duration of diabetes with two type 1 diabetes controls with negative serologic markers of celiac disease. All 16 children with positive celiac disease serology had histologic features consistent with celiac disease despite the absence of symptoms. The mean growth and metabolic control values were similar between children with type 1 diabetes and celiac disease and those with type 1 diabetes but without celiac disease. This study seems to suggest that the early diagnosis of celiac disease and initiation of a gluten-free diet may prevent further deterioration in the nutritional status of children with type 1 diabetes and celiac disease and may reduce the prospect of celiac disease complications without any impact on type 1 diabetes control.

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