Pediatric Diabetes最新文献

{"title":"Adolescent- and Young Adult-Reported Outcomes and Use of Continuous Glucose Monitoring Features: A Report from the CITY Trial","authors":"Laurel H. Messer, Colleen Bauza, Kellee M. Miller, Mark A. Clements, Daniel J. DeSalvo, Jennifer Sherr, Ruth S. Weinstock, Korey Hood, Lori M. Laffel","doi":"10.1155/2023/6906023","DOIUrl":"https://doi.org/10.1155/2023/6906023","url":null,"abstract":"Objective. To evaluate patterns of continuous glucose monitor (CGM) use and perceptions of quality of life in adolescents/young adults with type 1 diabetes (T1D) after using CGM for up to 52 weeks in the CGM Intervention in Teens and Young (CITY) Adults randomized clinical trial (RCT). Subjects and Methods. Participants with T1D were initially randomized 1 : 1 to use of CGM or blood glucose meter (BGM) for 26 weeks. Following the RCT, participants in the BGM group initiated CGM (BGM–CGM cohort) and participants in the CGM group continued CGM (CGM–CGM cohort) for another 26 weeks. Problem Areas in Diabetes Survey-Pediatric Version (PAID-peds), Glucose Monitoring Satisfaction Survey (GMSS), Hypoglycemia Confidence Scale (HCS), Diabetes Technology Attitudes (DTA), Pittsburgh Sleep Quality Index (PSQI), Benefits of CGM, and Burdens of CGM were completed at baseline, 26 and 52 weeks. Results. In both cohorts, >70% of participants were wearing CGM > 5 days/week at 52 weeks; 5% discontinued CGM. The majority used the mobile app to receive glucose data. Adolescents (14 to <19 years) were more likely to use SHARE features than young adults (80% versus 41%). CGM–CGM participants had significantly higher scores on GMSS, DTA, and HCS at 52 weeks compared with baseline, and reported higher benefit and lower burden perceptions than at baseline. Similar results were observed for the BGM–CGM cohort. Conclusions. Improvements in self-reported measures were observed in adolescents and young adults using CGM. As CGM use is also associated with better glycemic control, utilizing CGM may contribute to improving both medical outcomes and emotional health.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"239 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135394725","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Household Food Insecurity and Cognition in Youth and Young Adults with Youth-Onset Diabetes","authors":"Andrea D. Brown, Angela D. Liese, Allison L. B. Shapiro, Edward A. Frongillo, Greta Wilkening, Julius Fridriksson, Anwar T. Merchant, Leora Henkin, Elizabeth T. Jensen, Beth A. Reboussin, Amy S. Shah, Santica Marcovina, Lawrence M. Dolan, Dana Dabelea, Catherine Pihoker, Jason A. Mendoza","doi":"10.1155/2023/6382663","DOIUrl":"https://doi.org/10.1155/2023/6382663","url":null,"abstract":"Objective. We evaluated the association of household food insecurity (FI) with cognition in youth and young adults with type 1 diabetes (T1D) or type 2 diabetes (T2D). Design. In this cross-sectional study, age-adjusted scores for composite fluid cognition, and sub-domain scores for receptive language and inhibitory control and attention, were stratified by diabetes type using linear regression, with FI in the past year as the predictor, controlling for covariates. Tests for processing speed, inhibitory control/attention, working memory, episodic memory, and cognitive flexibility were administered to measure the composite fluid cognition score. The NIHT-CB Picture Vocabulary Test was used to assess the crystallized cognition score, and rapid identification of congruent versus noncongruent items was used to assess inhibitory control and attention score. Setting. The SEARCH for Diabetes in Youth study is representative of five U.S. states. Participants. Included 1,574 youth and young adults with T1D or T2D, mean age of 21 years, mean diabetes duration of 11 years, 51% were non-Hispanic white, and 47% had higher HbA1c levels (>9% HbA1c). Results. Approximately 18% of the 1,240 participants with T1D and 31% of the 334 with T2D experienced FI. The food-insecure group with T1D had a lower composite fluid cognition score (β = −2.5, 95% confidence interval (CI) = −4.8, −0.1) and a lower crystallized cognition score (β = −3.4, CI = −5.6, −1.3) than food-secure peers. Findings were attenuated to non-significance after adjustment for demographics. Among T2D participants, no associations were observed. In participants with T1D, effect modification by glycemic levels was found in the association between FI and composite fluid cognition score but adjustment for socioeconomic characteristics attenuated the interaction ( p = 0.0531 ). Conclusions. Food-insecure youth and young adults with T1D or T2D did not have different cognition compared to those who were food-secure after adjustment for confounders. Longitudinal research is needed to further understand relations amongst these factors.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"34 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134910904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Implementation of After-Hours Nurse Line in an Academic Pediatric Endocrinology Practice","authors":"Abha Choudhary, Soumya Adhikari, Perrin C. White","doi":"10.1155/2023/2550101","DOIUrl":"https://doi.org/10.1155/2023/2550101","url":null,"abstract":"Background. After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a lack of published experience with this approach in the pediatric diabetes population. Methods. An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. Results. The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race. Conclusions. The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135938710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"DNA Methylation Near DLGAP2 May Mediate the Relationship between Family History of Type 1 Diabetes and Type 1 Diabetes Risk","authors":"Randi K. Johnson, Amanda J. Ireton, Patrick M. Carry, Lauren A. Vanderlinden, Fran Dong, Alex Romero, David R. Johnson, Debashis Ghosh, Fan Yang, Brigitte Frohnert, Ivana V. Yang, Katerina Kechris, Marian Rewers, Jill M. Norris","doi":"10.1155/2023/5367637","DOIUrl":"https://doi.org/10.1155/2023/5367637","url":null,"abstract":"Given the differential risk of type 1 diabetes (T1D) in offspring of affected fathers versus affected mothers and our observation that T1D cases have differential DNA methylation near the imprinted DLGAP2 gene compared to controls, we examined whether methylation near DLGAP2 mediates the association between T1D family history and T1D risk. In a nested case–control study of 87 T1D cases and 87 controls from the Diabetes Autoimmunity Study in the Young, we conducted causal mediation analyses at 12 DLGAP2 region CpGs to decompose the effect of family history on T1D risk into indirect and direct effects. These effects were estimated from two regression models adjusted for the human leukocyte antigen DR3/4 genotype: a linear regression of family history on methylation (mediator model) and a logistic regression of family history and methylation on T1D (outcome model). For 8 of the 12 CpGs, we identified a significant interaction between T1D family history and methylation on T1D risk. Accounting for this interaction, we found that the increased risk of T1D for children with affected mothers compared to those with no family history was mediated through differences in methylation at two CpGs (cg27351978, cg00565786) in the DLGAP2 region, as demonstrated by a significant pure natural indirect effect (odds ratio (OR) = 1.98, 95% confidence interval (CI): 1.06–3.71) and nonsignificant total natural direct effect (OR = 1.65, 95% CI: 0.16–16.62) (for cg00565786). In contrast, the increased risk of T1D for children with an affected father or sibling was not explained by DNA methylation changes at these CpGs. Results were similar for cg27351978 and robust in sensitivity analyses. Lastly, we found that DNA methylation in the DLGAP2 region was associated ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>P</mi> <mo><</mo> <mn>0.05</mn> </math> ) with gene expression of nearby protein-coding genes DLGAP2, ARHGEF10, ZNF596, and ERICH1. Results indicate that the maternal protective effect conferred through exposure to T1D in utero may operate through changes to DNA methylation that have functional downstream consequences.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"24 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135938706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Subsequent Device Usage and Caregiver Attitudes to Do-It-Yourself Real-Time Continuous Glucose Monitoring (DIY-rtCGM) among Children with Type 1 Diabetes 3 Months after Participation in a Randomized Controlled Trial","authors":"Yongwen Zhou, Mona M. Elbalshy, Sara E. Styles, H. Crocket, C. Jefferies, E. Wiltshire, M. D. de Bock, B. Wheeler","doi":"10.1155/2023/3435944","DOIUrl":"https://doi.org/10.1155/2023/3435944","url":null,"abstract":"Aim. To assess children’s subsequent device usage and caregiver attitudes to do-it-yourself real-time continuous glucose monitoring (DIY-rtCGM) at least 3 months after completing a randomized controlled trial (RCT). Methods. A brief online questionnaire or telephone call was used to collect the subsequent device usage and caregivers’ attitudes from a total of 55 families at least 3 months after their completion of an RCT investigating DIY-rtCGM adapted from their preexisting intermittently scanned glucose sensors plus education on using DIY-rtCGM system. To be eligible for the RCT, children had to be aged 2–13 years, have type 1 diabetes ≥6 months, and be rtCGM naïve. Data collected investigated current CGM use post-RCT and attitudes/user experiences to DIY-rtCGM in the months since RCT study support ended. Results. Overall, responses from 81.8% (45/55) of caregivers were received. Mean age of children was 9.0 ± 2.7 years, and 31 (68.9%) children used insulin pumps. After 3 months, 44.4% (20/45) of responding caregivers reported ongoing DIY-rtCGM use, and of these, only 13 used DIY-rtCGM as the primary glucose monitoring method 100% of time. Of the 25 (55.6%) families who ceased DIY-rtCGM, 40% (10/25) had transitioned to commercial rtCGM. More than half of families (60%, 12/20) who continued DIY-rtCGM use had a very or extremely positive attitude toward the technology and 75% (15/20) of these families planned to continue DIY-rtCGM use. However, signal loss and sensor inaccuracy remained the major reasons among all responders both for decreased DIY-rtCGM wear time and eventual cessation. Burden of use primarily related to technical errors that could not be solved, and alarms, both of which were reported to contribute to discontinuation. Conclusions. This study highlights that, among families voluntarily using DIY-rtCGM at least 3 months following support from a trial, more than half have ceased using DIY-rtCGM, with 40% of those discontinuing switching to commercial rtCGM. While overall perceptions of DIY-rtCGM remain largely positive, burdens of use are high and contribute to discontinuation.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46254733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Vascular and Myocardial Structure and Function in Adolescents with Type 1 Diabetes: The CARDEA Study","authors":"Soren Harnois-Leblanc, Vanessa McNealis, M. Friedrich, J. Bigras, A. Van Hulst, A. Nuyt, T. Barnett, A. Benedetti, M. Mathieu, V. Drapeau, M. Sylvestre, M. Henderson","doi":"10.1155/2023/8662038","DOIUrl":"https://doi.org/10.1155/2023/8662038","url":null,"abstract":"Introduction. Despite heightened risk of cardiovascular disease (CVD) among individuals with type 1 diabetes, few studies in this population have investigated the development of CVD using early markers in adolescence. We compared risk factors (blood pressure (BP) and dyslipidemia) and early markers of CVD between adolescents with and without type 1 diabetes and explored effect modification by sex. Methods. Cross-sectional study using data from the CARdiovascular Disease risk in pEdiatric type 1 diAbetes (CARDEA) study. We recruited 100 adolescents with type 1 diabetes at the Sainte-Justine University Hospital Center and 97 adolescents without diabetes (14–18 years). We measured arterial stiffness by carotid-femoral pulse wave velocity, endothelial function by brachial artery flow-mediated dilation test, as well as left ventricular (LV) mass, papillary mass, and wall thickness by cardiac MRI. We used multivariable linear regression models to assess the impact of type 1 diabetes on each outcome adjusting for age, sex, ethnicity, adiposity, and familial income. Results. Adolescents with type 1 diabetes had 0.21 standard deviations (SD) (95% CI: 0.04; 0.38) higher diastolic blood pressure z-score (zDBP), 0.21 mmol/L (95% CI: 0.02; 0.40) higher low-density lipoprotein cholesterol (LDL-c) levels, and 17% (95% CI: 4; 29) higher triglyceride levels and lower endothelial function based on acceleration (−77.4 cm/s2, 95% CI: −133.1; −21.6) compared with adolescents without diabetes. Girls with type 1 diabetes had higher systolic blood pressure z-score (zSBP), and boys with type 1 diabetes had lower LV mass and wall thickness compared to healthy peers. Conclusions. In addition to higher BP and abnormal lipid profiles, adolescents with type 1 diabetes present endothelial dysfunction and alterations in cardiac structure (in boys) compared to adolescents without diabetes, suggesting that CVD prevention should be incorporated into type 1 diabetes management early in the disease.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"1 1","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42010349","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Comparison of Depressive Symptom Presentation in Adolescent Type 1 Diabetes and Pediatric Primary Care Samples","authors":"Nasreen Bahreman, M. Dietrich, S. Jaser, Terrah Akard Foster, Shelagh A. Mulvaney","doi":"10.1155/2023/5597133","DOIUrl":"https://doi.org/10.1155/2023/5597133","url":null,"abstract":"Background. Depression is a common comorbidity in adolescents with type 1 diabetes (T1D). It is unclear if patterns of responses from questionnaires used to screen for depressive symptoms are influenced by the burden of living with T1D and/or the consequences of hyperglycemia. Based on this gap in the adolescent research, we sought to identify potential differences in depression screening response patterns between adolescents with and without T1D and relate response patterns with glycemic outcomes. Methods. Using a retrospective case–control design, we analyzed electronic health records for age, sex, and race-matched adolescents 13–18 years of age from a pediatric diabetes clinic (n = 477) and a pediatric primary care clinic (n = 477) in the United States. Adolescents in both settings were screened for depressive symptoms during the same time period using the Patient Health Questionnaire-9 (PHQ-9). Results. Participant demographics for matched characteristics were: 53.5% male, 71.7% White, median age 13.0 (interquartile range = 13.0, 14.0). After controlling for type of insurance, adolescents with T1D were more likely to have higher total PHQ-9 scores (odds ratio (OR) = 1.51, 95% CI = 1.17, 1.98, \u0000 \u0000 p\u0000 =\u0000 0.002\u0000 \u0000 ) and higher somatic subscores (OR = 1.57, 95% CI = 1.20, 2.05, \u0000 \u0000 p\u0000 =\u0000 0.001\u0000 \u0000 ) compared to the primary care sample. The pattern of item endorsement greater than “not at all” indicated that adolescents with T1D were more likely to have higher values for somatic items such as “trouble falling asleep” and “feeling tired” than those in the primary care sample. Item-total correlations and Cronbach’s α indicated that all items were contributing to the overall score in the same manner in each group. Conclusions. Symptom endorsement for sleep and fatigue were higher for adolescents with T1D and without T1D. Study results support the need for further examination of the origins of somatic symptoms in T1D and for an additional examination of the specificity of depression screening instruments used in routine pediatric diabetes care.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44684507","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ongoing Increase in Incidence of Diabetes in Austrian Children and Adolescents (1989–2021): Results from a Nationwide Registry","authors":"K. Nagl, T. Waldhör, S. Hofer, Nicole Blauensteiner, M. Fritsch, E. Fröhlich-Reiterer, B. Rami-Merhar","doi":"10.1155/2023/4616903","DOIUrl":"https://doi.org/10.1155/2023/4616903","url":null,"abstract":"Introduction. Since there is no uniform global diabetes trend in childhood and adolescence, regional epidemiological surveys of diabetes incidences are important. In Austria, the incidences of type 1 diabetes (T1D), type 2 diabetes (T2D), and other forms of diabetes have been recorded for decades. Methods. To analyze recent developments of diabetes incidence within the decades long-standing Austrian nationwide prospective population-based incidence study for diabetes in children aged <15 years. We estimated time trends of age-standardized rates from 1989 to 2021 for T1D and T2D by joinpoint analysis. Annual percent changes (APCs) were calculated. Case ascertainment was 97%. Results. We observed an unusual increase of T1D incidence in the year 2021, reaching a peak of 28.7/100,000/PY (person years). From 2011 to 2020, there had been a constant plateau phase in the total cohort (APC 0.78, 95% CI [−0.99, 2.58], \u0000 \u0000 p\u0000 =\u0000 0.379\u0000 \u0000 ), which had followed a steep increase of T1D incidence (APC 4.6, 95% CI [3.94, 5.19], \u0000 \u0000 p\u0000 <\u0000 0.001\u0000 \u0000 ) from 1989 to 2011. Age-specific differences in T1D incidence development were observed. For the first time, we observed a statistically significant constant increase in T2D during the observation period (APC 3.47, 95% CI [0.76, 6.26], \u0000 \u0000 p\u0000 =\u0000 0.014\u0000 \u0000 ). Other forms of diabetes are two times more common than T2D in this age group. Conclusion. The incidence of T1D in Austrian children <15 years is still increasing and showed a peak in 2021. For the first time, a significant increase in pediatric T2D was observed in Austria.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43982821","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Basal and Bolus Insulin Distribution According to Treatment Modality: Data from SWEET Diabetes Registry","authors":"Ferda Evin, S. Tittel, B. Piccini, R. Cardona-Hernández, D. Mul, Nicole Sheanon, T. von dem Berge, Vit Neuman, M. Tauschmann, D. Gökşen","doi":"10.1155/2023/8837506","DOIUrl":"https://doi.org/10.1155/2023/8837506","url":null,"abstract":"Background and Aims. The optimal basal and bolus insulin distribution in type 1 diabetes (T1D) is still controversial. Herein, we aimed to determine the variability of basal to total daily insulin dose according to treatment modality and diabetes technologies from the Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference (SWEET) registry. Methods. The study cohort was generated by using the SWEET database. Patients with T1D for at least 2 years, aged between 2.5 and 18 years, with at least one clinic visit between June 2010 and June 2021, were included in the study. Four groups were composed according to treatment modality as follows: multiple daily injections (MDI) without continuous glucose monitoring (CGM); MDI with CGM; subcutaneous insulin infusion (CSII) without CGM; and CSII with CGM. Data of the participants were analyzed and compared for each treatment modality separately. Results. A total of 38,956 children and adolescents were included in the study. Of the study sample, 48.6% were female, the median (range) age was 15.2 (11.9–17.2) years, and the median diabetes duration was 6.0 (3.8–9.0) years. The distribution of treatment modality was as follows: MDI without CGM, 32.9%; MDI with CGM, 18.0%; CSII without CGM, 11.7%; and CSII with CGM, 37.3%. In unadjusted data, regardless of treatment modality, all the analyses revealed a significant association between basal dose to total daily insulin dose (BD/TDD) with male gender, younger age group, and lower HbA1c, which were all related to a decreased ratio of BD/TDD (all \u0000 \u0000 p\u0000 <\u0000 0.05\u0000 \u0000 ). There was no association between BD/TDD and different diabetes technologies after the age, gender, and diabetes duration were adjusted. Conclusions. Herein, we showed that there was an association between lower proportions of basal to total insulin and lower hemoglobin A1c in a large cross-sectional cohort of children who had T1D. There was also an association between lower BD/TDD and younger age. There was no significant difference between BD/TDD ratios under different diabetes technologies (CGM and/or CSII).","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45940857","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of SARS-CoV-2 Infection on Disease Trajectory in Youth with T1D: An EHR-Based Cohort Study from the RECOVER Program","authors":"P. Prahalad, V. Lorman, Qiong Wu, H. Razzaghi, Yong Chen, N. Pajor, A. Case, S. Bose-Brill, J. Block, Payal B. Patel, Suchitra Rao, A. Mejias, Christopher B. Forrest, L. C. Bailey, R. Jhaveri, D. Thacker, D. Christakis, Grace M. Lee, on behalf of the Simons Vip consortium","doi":"10.1155/2023/8798997","DOIUrl":"https://doi.org/10.1155/2023/8798997","url":null,"abstract":"Background. Postacute sequelae of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PASC) is associated with worsening diabetes trajectory. It is unknown whether PASC in children with type 1 diabetes (T1D) manifests as worsening diabetes trajectory. Objective. To explore the association between SARS-CoV-2 infection (COVID-19) and T1D-related healthcare utilization (for diabetic ketoacidosis (DKA) or severe hypoglycemia (SH)) or hemoglobin (Hb) A1c trajectory. Methods: We included children <21 years with T1D and ≥1 HbA1c prior to cohort entry, which was defined as COVID-19 (positive diagnostic test or diagnosis code for COVID-19, multisystem inflammatory syndrome in children, or PASC) or a randomly selected negative test for those who were negative throughout the study period (Broad Cohort). A subset with ≥1 HbA1c value from 28 to 275 days after cohort entry (Narrow Cohort) was included in the trajectory analysis. Propensity score-based matched cohort design followed by weighted Cox regression was used to evaluate the association of COVID-19 with healthcare utilization ≥28 days after cohort entry. Generalized estimating equation (GEE) models were used to measure change in HbA1c in the Narrow Cohort. Results. From March 01, 2020 to June 22, 2022, 2,404 and 1,221 youth met entry criteria for the Broad and Narrow Cohorts, respectively. The hazard ratio for utilization was (HR 1.45 (95% CI: 0.97, 2.16)). In the Narrow Cohort, the rate of change (slope) of HbA1c increased 91–180 days after cohort entry for those with COVID-19 (0.138 vs. −0.002, \u0000 \u0000 p\u0000 =\u0000 0.172\u0000 \u0000 ). Beyond 180 days, greater declines in HbA1c were observed in the positive cohort (−0.104 vs. 0.008 per month, \u0000 \u0000 p\u0000 =\u0000 0.024\u0000 \u0000 ). Conclusion. While a trend toward worse outcomes following COVID-19 in T1D patients was observed, these findings were not statistically significant. Continued clinical monitoring of youth with T1D following COVID-19 is warranted.","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47121936","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}