Pediatric Diabetes最新文献

{"title":"Control-IQ Technology Positively Impacts Patient Reported Outcome Measures and Glycemic Control in Youth with Type 1 Diabetes in a Real-World Setting","authors":"Caroline Zuijdwijk, Jennilea Courtney, Nicholas Mitsakakis, Lamia Hayawi, Stephanie Sutherland, Dennis Newhook, Alexandra Ahmet, Ellen B. Goldbloom, Karine Khatchadourian, Sarah Lawrence","doi":"10.1155/2023/5106107","DOIUrl":"https://doi.org/10.1155/2023/5106107","url":null,"abstract":"Objective. To determine the impact of the t:slim X2 insulin pump with Control-IQ technology on the quality of life and glycemic control in youth with type 1 diabetes (T1D) and their parents in a real-world setting. Research Design and Methods. We conducted a single-center, prospective study on pediatric patients (6–18 years old) with T1D using a Tandem t:slim X2 pump and initiating Control-IQ technology as part of routine care. Youth (≥8 years) and parents completed validated patient-reported outcome measures (PROMs) at baseline and the end of the study (16 weeks). Glycemic control measures were recorded at baseline and every 4 weeks until the end of the study. Results. Fifty-nine youth participated; the median (IQR) age was 13.8 (11.1, 15.7) years, and T1D duration was 6.3 (3.1, 8.4) years. INSPIRE scores (evaluating expectations (baseline) and impact (post) of Control-IQ technology) were favorable, unchanged at the end of the study for youth, and lower for parents ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M1\"> <mi>p</mi> <mo>=</mo> <mn>0.04</mn> </math> ). Other PROM scores improved by the end of the study with mean (95% CI) differences for youth and parents, respectively, as follows: Diabetes Impact and Device Satisfaction (DIDS) Scale Diabetes Impact −1.08 (−1.51, −0.64) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M2\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ) and −1.41 (−1.96, −0.87) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M3\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); DIDS Scale Device Satisfaction +0.43 (0.11, 0.74) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M4\"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ) and +0.58 (0.31, 0.85) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M5\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); Hypoglycemia Fear Survey −4.41 (−7.65, −1.17) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M6\"> <mi>p</mi> <mo>=</mo> <mn>0.01</mn> </math> ) and −7.64 (−11.66, −3.62) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M7\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ); and WHO-5 Well-Being Index +5.10 (−1.40, 11.6) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M8\"> <mi>p</mi> <mo>=</mo> <mn>0.12</mn> </math> ) and +9.60 (3.40, 15.8) ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M9\"> <mi>p</mi> <mo>=</mo> <mn>0.003</mn> </math> ). The mean time in range increased from 52.6% at baseline to 62.6% ( <math xmlns=\"http://www.w3.org/1998/Math/MathML\" id=\"M10\"> <mi>p</mi> <mo><</mo> <mn>0.001</mn> </math> ) at 4 weeks, sustained to 16 weeks. Conclusions. Initiation of Control-IQ technology in a real-world setting significantly reduced the impact of diabetes on daily life while simultaneously improving glycemic control. Trial Registration. This trial is registered with ClinicalTrials.gov Identifier NCT04838561 (https://www.clinicaltrials.gov/ct2/show/NCT04838561?term=Control-IQ&cond=Type+1+Diabetes&cntry=CA&dr","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"134953098","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":"Real-Time Continuous Glucose Monitoring Reduced Costly Diabetes-Related Events in Adolescents and Young Adults despite Lack of Short-Term Reduction in Hemoglobin A1c.","authors":"Joni K Beck, Rebecca A Allen, Kathryn M Jeter, Rachel S Fisher, Taylor M Dattilo, Katherine A Traino, Michael Anderson, James Cutler, David P Sparling","doi":"10.1155/2023/5253515","DOIUrl":"10.1155/2023/5253515","url":null,"abstract":"<p><p>Real-time continuous glucose monitoring (rtCGM) can directly improve patient outcomes, including decreased health care system utilization and associated costs. The purpose of this study was to evaluate the clinical benefits of rtCGM use in a high-risk, under-resourced cohort of adolescents and young adults (AYA) with type 1 diabetes (T1D) who had no prior access to rtCGM. The effects of rtCGM use on hemoglobin A1c (A1c) and the frequency of health care events (i.e., diabetes-related emergency room (ER) visits, hospitalizations, emergency medical services (EMS), and after-hour emergency calls) were evaluated regarding payor costs in 33 AYA with ≥70% rtCGM use. Secondary aims included the evaluation of a phone-based pattern management intervention. The frequency of health care events decreased at 12 and 24 weeks for all participants, and there was no significant difference by treatment group. We estimated that the use of rtCGM in this cohort results in a projected annualized cost-savings of $195,943 to $294,864 or 43-65% per year based on Medicare or list pricing for rtCGM, respectively. Results also revealed improvements in A1c at 12 weeks for all study participants, but this was not maintained at 24 weeks for the phone-based pattern management intervention group. Our findings suggest that rtCGM may be an effective tool for reducing diabetes-related events and underscores the importance of access. Future studies are needed to further examine tailored interventions and support to optimize rtCGM use and glycemic health in high-risk AYA.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":"5253515"},"PeriodicalIF":3.9,"publicationDate":"2023-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49157684","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glycated Hemoglobin is a Significant Predictor of Femoral, but Not of Carotid or Popliteal, Intima-Media Thickness in Adolescents with Type 1 Diabetes: A Case-Series Study.","authors":"Hung-Chi Ho, Fu-Sung Lo, Jen-Kuang Lee, Wen-Yu Tsai, Ta-Chen Su","doi":"10.1155/2023/6471597","DOIUrl":"10.1155/2023/6471597","url":null,"abstract":"<p><p>In healthy adults, the association between the glycated hemoglobin A1c (HbA1c) level and intima-media thickness (IMT) is stronger in the femoral artery than that in the carotid artery. However, whether this differential strength of association also applies to adolescents with type 1 diabetes (T1D) is unknown. Therefore, this study aimed to examine whether IMT increases in extracarotid arteries (specifically in the lower extremities) prior to the carotid artery. In total, 286 adolescents with T1D (15.9 ± 4.9 years; 42.0% male participants) were enrolled, and the B-mode ultrasonographic measurement of IMT in the carotid, femoral, and popliteal arteries was performed. Cardiovascular risk factors, including blood pressure (BP), body mass index, lipid levels, and glycemic parameters, were evaluated. To evaluate the site-dependent relationship between IMT and cardiovascular risk factors, a linear mixed-effects model was developed with repeated IMT measurements at various arterial sites as fixed effects and participants as random effects. Glycemic parameters, lipids, uric acid, high-sensitivity C-reactive protein, and advanced glycation end-products were some cardiovascular risk factors that worsened with increasing HbA1c levels. Patients with a higher HbA1c level (>10% vs. ≤10%) had thicker IMT in the femoral artery but not in the carotid or popliteal arteries. Patients with poorer diabetic control exhibited significant changes in certain cardiovascular functions, including central systolic BP, left ventricular (LV) ejection time, LV dp/dt max, stroke volume, and brachial artery compliance. A standard mediation analysis revealed that none of the aforementioned cardiovascular functions mediated the relationship between higher HbA1c level and greater femoral IMT. In adolescents with T1D, cardiovascular risk factors deteriorate with worsening blood glucose control. In the early stages of T1D, femoral IMT may serve as a more sensitive surrogate marker for hyperglycemia-induced subclinical atherosclerosis, an effect that may not be mediated by alterations in cardiovascular functions.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":"6471597"},"PeriodicalIF":3.9,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12017205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47987945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cranial Nerve Affection in Adolescents with Type 1 Diabetes Assessed by Corneal Confocal Microscopy, Smell and Taste Tests.","authors":"Vinni Faber Rasmussen, Dorthe Rasmussen, Mathilde Thrysøe, Páll Karlsson, Mette Madsen, Kurt Kristensen, Jens Randel Nyengaard, Astrid Juhl Terkelsen, Esben Thyssen Vestergaard, Therese Ovesen","doi":"10.1155/2023/2709361","DOIUrl":"10.1155/2023/2709361","url":null,"abstract":"<p><strong>Aim: </strong>To determine whether adolescents with type 1 diabetes (T1D) have morphological changes of the corneal nerve fibers and reduced smell and taste function compared to healthy control subjects as a sign of cranial nerve affection and to evaluate possible associated risk factors for cranial nerve affection.</p><p><strong>Methods: </strong>The study was a part of the T1DANES study including 60 adolescents (15-<19 years) and 23 healthy age-matched controls. First, clinical and biochemical data on the participants were obtained, and the second step involved a test day with neurological examinations including corneal confocal microscopy (CCM), olfactory testing with Sniffin' Sticks, and gustatory assessment with taste-drop test.</p><p><strong>Results: </strong>The adolescents with T1D (mean diabetes duration 9.8 years, mean HbA1c 61 mmol/mol) had lower CCM parameters (corneal nerve fiber density, corneal nerve branch density, corneal nerve fiber length, and corneal nerve fiber fractal dimension) compared to control subjects (all <i>p</i> < 0.05). No differences in total score for smell test (<i>p</i> = 0.66) and taste test (<i>p</i> = 0.47) were found, but adolescents with T1D had reduced ability to taste sweet (<i>p</i> < 0.01). In total, 24% had two or more reduced CCM parameters, 12% had reduced smell test, and 23% had abnormal taste test. Higher waist to height ratio (WHtR) was the only risk factor found for reduced corneal nerve fiber density, and higher BMI-SDS and WHtR were found for impaired taste function. Having abnormal smell test increased the risk for having abnormal taste perception, and vice versa.</p><p><strong>Conclusion: </strong>Up to 29% of adolescents with T1D had abnormal test scores indicating cranial nerve affection. Lower corneal nerve fiber density and reduced ability to taste sweet were found in adolescents with T1D compared to control subjects. Clinical attention to smell and taste function seems important because it requires intervention for advising adolescents with impaired smell and taste function.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":"2709361"},"PeriodicalIF":3.9,"publicationDate":"2023-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016890/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44070380","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of 6 months' Use of Intermittently Scanned Continuous Glucose Monitoring on Habitual Sleep Patterns and Sleep Quality in Adolescents and Young Adults with Type 1 Diabetes and High-Risk HbA1c.","authors":"Shelley Rose, Barbara C Galland, Sara E Styles, Esko J Wiltshire, James Stanley, Martin I de Bock, Paul A Tomlinson, Jenny A Rayns, Benjamin J Wheeler","doi":"10.1155/2023/1842008","DOIUrl":"10.1155/2023/1842008","url":null,"abstract":"<p><strong>Background: </strong>The bidirectional relationship between sleep and blood glucose levels may particularly affect adolescents and young adults (AYA), who are more likely to experience less healthy glycemic outcomes and more disrupted sleep patterns. To date, few data exist describing the impact of intermittently scanned continuous glucose monitoring (isCGM) on habitual sleep patterns and sleep quality in AYA with type 1 diabetes (T1D).</p><p><strong>Objective: </strong>To evaluate the impact of 6-month use of isCGM on habitual sleep and wake timing, sleep duration, frequency, and duration of night-time awakenings, sleep efficiency, and perceived sleep quality in young people with T1D and HbA1c ≥ 75 mmol/mol. <i>Participants.</i> The study recruited 64 participants aged 13-20 years (mean 16.6 ± 2.1), 48% female, diabetes duration 7.5 ± 3.8 years, 41% Māori or Pasifika, and a mean HbA1c 96.0 ± 18.0 mmol/mol [10.9 ± 3.8%]; 33 were allocated to an isCGM plus self-monitoring blood glucose [SMBG] intervention, and 31 were allocated to the SMBG control group.</p><p><strong>Methods: </strong>Participants completed 7-day actigraphy measures and the Pittsburgh Sleep Quality Index questionnaire at the baseline and at 6 months. Regression analyses were used to model between-group comparisons, adjusted for baseline sleep measures.</p><p><strong>Results: </strong>At 6 months, subjective measures for overall sleep quality, latency, duration, efficiency, night-time disturbances, use of sleep medications, and daytime dysfunction were similar between the groups. Regression analyses of actigraphy found no significant differences in objectively measured sleep timing and duration across the week after adjusting for age, the period of the school year, and baseline sleep values.</p><p><strong>Conclusions: </strong>The use of first-generation isCGM in addition to finger-prick testing did not impact objective or subjective sleep measures in AYA with T1D, elevated HbA1c, and highly variable sleep patterns. Research using alternative interventions for improving glycemic outcomes and habitual sleep-wake timing, duration, and perceived sleep quality is warranted in this population group.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":"1842008"},"PeriodicalIF":3.9,"publicationDate":"2023-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016692/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45783314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perceived Knowledge and Confidence for Providing Youth-Specific Type 1 Diabetes Exercise Recommendations amongst Pediatric Diabetes Healthcare Professionals: An International, Cross-Sectional, Online Survey.","authors":"Paula Chinchilla, Klemen Dovc, Katarina Braune, Ananta Addala, Michael C Riddell, Tiago Jeronimo Dos Santos, Dessi P Zaharieva","doi":"10.1155/2023/8462291","DOIUrl":"10.1155/2023/8462291","url":null,"abstract":"<p><strong>Background: </strong>Managing glycemia around exercise is challenging for individuals with type 1 diabetes (T1D) and their healthcare professionals (HCP). We investigated HCP knowledge and confidence around exercise counseling for youth with T1D worldwide.</p><p><strong>Objective: </strong>To assess HCP familiarity with ISPAD Clinical Practice Consensus Guidelines and confidence to deliver recommendations about T1D and exercise.</p><p><strong>Methods: </strong>A new online survey was developed on strategies and competencies about exercise for youth with T1D, comprising of 64 questions, divided into eight different categories, assessing HCPs perceived exercise knowledge, confidence, training, and barriers to exercise counseling.</p><p><strong>Results: </strong>A total of 125 HCPs mean ± SD age 42 ± 8.2 years (74% female, 73% physicians) completed the survey. The ISPAD exercise guidelines were considered familiar to 68/125 (54%) of responders. Overall, 91/125 (73%) felt confident with giving recommendations about exercise with 47/125 (38%) recommending 45-60 mins/day of physical activity, while 16/125 (13%) recommended >60 mins/day. Several topics related to self-management around exercise were covered by most, but not all responders, and differences were observed in exercise content \"confidence\" and/or \"competence\" based on geographic location (<i>p</i> = 0.048). No differences in exercise recommendation dose, confidence, or familiarity with ISPAD guidelines were observed for age, sex, type of HCP, years in practice, or healthcare type.</p><p><strong>Conclusions: </strong>Exercise counseling for youth with T1D remains a challenge in most healthcare settings, globally. In general, the number of physically active minutes per week is under-prescribed for youth with T1D and many HCPs in various settings around the world feel that more professional education is needed to boost confidence around the education of several exercise-related topics.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":" ","pages":"8462291"},"PeriodicalIF":3.9,"publicationDate":"2023-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12016985/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48493872","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Formative Development of a Weight Management Intervention for Adolescents with Type 1 Diabetes Mellitus and Obesity.","authors":"Jennifer Warnick,&nbsp;Katherine E Darling,&nbsp;Lisa Swartz Topor,&nbsp;Elissa Jelalian","doi":"10.1155/2023/9584419","DOIUrl":"10.1155/2023/9584419","url":null,"abstract":"<p><p>The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes. Unfortunately, youth with T1D are often excluded from and/or not referred to standard behavioral lifestyle interventions. This is often attributed to the complexities of managing T1D and an effort not to overburden persons who have T1D. Furthermore, standard behavioral weight management intervention recommendations can be perceived as contradicting T1D disease management (e.g., removing sugar-sweetened beverages from diet, energy balance with exercise, and caloric restriction). A weight management intervention specifically designed for youth with T1D is needed to provide treatment to youth with comorbid T1D and overweight/obesity. The current study interviewed adolescents with T1D and overweight/obesity (<i>n</i> = 12), their caregivers (<i>n</i> = 12), and pediatric endocrinologists (<i>n</i> = 9) to understand (a) whether they would be interested in a weight management intervention adapted for youth with T1D and (b) specific adaptations they would want and need. Five central themes emerged following applied thematic analysis: (1) program content, (2) programmatic messaging, (3) program structure, (4) social support, and (5) eating disorder risk. Results provide detailed recommendations for the adaptation of a behavioral weight management intervention for youth with T1D.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"2023 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445778/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10458643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Dietary Intake and Body Mass Index Influence the Risk of Islet Autoimmunity in Genetically At-Risk Children: A Mediation Analysis Using the TEDDY Cohort.","authors":"Carin Andrén Aronsson, Roy Tamura, Kendra Vehik, Ulla Uusitalo, Jimin Yang, Michael J Haller, Jorma Toppari, William Hagopian, Richard A McIndoe, Marian J Rewers, Anette-G Ziegler, Beena Akolkar, Jeffrey P Krischer, Jill M Norris, Suvi M Virtanen, Helena Elding Larsson","doi":"10.1155/2023/3945064","DOIUrl":"10.1155/2023/3945064","url":null,"abstract":"<p><strong>Background/objective: </strong>Growth and obesity have been associated with increased risk of islet autoimmunity (IA) and progression to type 1 diabetes. We aimed to estimate the effect of energy-yielding macronutrient intake on the development of IA through BMI.</p><p><strong>Research design and methods: </strong>Genetically at-risk children (<i>n</i> = 5,084) in Finland, Germany, Sweden, and the USA, who were autoantibody negative at 2 years of age, were followed to the age of 8 years, with anthropometric measurements and 3-day food records collected biannually. Of these, 495 (9.7%) children developed IA. Mediation analysis for time-varying covariates (BMI <i>z</i>-score) and exposure (energy intake) was conducted. Cox proportional hazard method was used in sensitivity analysis.</p><p><strong>Results: </strong>We found an indirect effect of total energy intake (estimates: indirect effect 0.13 [0.05, 0.21]) and energy from protein (estimates: indirect effect 0.06 [0.02, 0.11]), fat (estimates: indirect effect 0.03 [0.01, 0.05]), and carbohydrates (estimates: indirect effect 0.02 [0.00, 0.04]) (kcal/day) on the development of IA. A direct effect was found for protein, expressed both as kcal/day (estimates: direct effect 1.09 [0.35, 1.56]) and energy percentage (estimates: direct effect 72.8 [3.0, 98.0]) and the development of GAD autoantibodies (GADA). In the sensitivity analysis, energy from protein (kcal/day) was associated with increased risk for GADA, hazard ratio 1.24 (95% CI: 1.09, 1.53), <i>p =</i> 0.042.</p><p><strong>Conclusions: </strong>This study confirms that higher total energy intake is associated with higher BMI, which leads to higher risk of the development of IA. A diet with larger proportion of energy from protein has a direct effect on the development of GADA.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"2023 ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445692/pdf/nihms-1905294.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10158641","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sedentary Behavior and Physical Activity Associated with Psychosocial Outcomes in Adolescents with Type 1 Diabetes.","authors":"Daniel R Tilden, Amy E Noser, Sarah S Jaser","doi":"10.1155/2023/1395466","DOIUrl":"10.1155/2023/1395466","url":null,"abstract":"<p><strong>Background: </strong>Adolescents with type 1 diabetes (T1D) are particularly vulnerable to poor psychosocial outcomes-high rates of diabetes distress and poor quality of life are common among this cohort. Previous work in the general population demonstrated positive associations between quality of life and increases in moderate-to-vigorous physical activity (MVPA), as well as decreased sedentary behavior. While survey-based assessments of young adults with T1D observed similar trends, these studies were limited by their use of subjective assessments of MVPA and sedentary behavior. The use of direct activity monitoring is needed to establish the association between psychosocial outcomes and MVPA and sedentary behavior among adolescents with T1D.</p><p><strong>Objective: </strong>To explore the association between objectively measured MVPA and sedentary behavior on psychosocial outcomes among adolescents with T1D.</p><p><strong>Subjects and methods: </strong>The current study is a secondary analysis of baseline data collected for a pilot trial of sleep-promoting intervention for adolescents with T1D. Participants (<i>n</i> = 29, with a mean age of 15.9 ± 1.3 years) completed baseline surveys and wore an actigraph for a week following the baseline visit. We examined minutes per week of MVPA and proportion of awake time spent sedentary in relation to adolescents' diabetes distress, depressive symptoms, and diabetes-related quality of life.</p><p><strong>Results: </strong>Participants engaged in a mean of 19.6 ± 22.4 minutes of MVPA per day and spent 68.6 ± 9.9% of their awake time sedentary. MVPA was associated with lower diabetes distress in unadjusted (-3.6; 95% CI: -6.4 to -0.8) and adjusted (-2.6; 95% CI: -5.0--0.3) analyses. Sedentary time was associated with higher diabetes distress in adjusted (6.3; 95% CI: 1.3-11.2) but not unadjusted (6.0; 95% CI: -5.6-12.6) analyses. In secondary analyses, we did not observe significant associations between quality of life or depressive symptoms with either MVPA or sedentary behavior.</p><p><strong>Discussion: </strong>Our findings extend previous survey-based work demonstrating an association between decreased diabetes distress with greater weekly MVPA and lower sedentary time. The current study highlights the multifaceted benefits of physical activity in this population and provides preliminary evidence for developing interventions to reduce sedentary time as an alternative method to improve psychosocial outcomes in this at-risk population.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"2023 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445792/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10458644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Hyperosmolar Hyperglycemic State in Pediatric Type 2 Diabetes.","authors":"Estelle M Everett,&nbsp;Timothy Copeland,&nbsp;Lauren E Wisk,&nbsp;Lily C Chao","doi":"10.1155/2023/1318136","DOIUrl":"10.1155/2023/1318136","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of data on the risk factors for the hyperosmolar hyperglycemic state (HHS) compared with diabetic ketoacidosis (DKA) in pediatric type 2 diabetes (T2D).</p><p><strong>Methods: </strong>We used the national Kids' Inpatient Database to identify pediatric admissions for DKA and HHS among those with T2D in the years 2006, 2009, 2012, and 2019. Admissions were identified using ICD codes. Those aged <9yo were excluded. We used descriptive statistics to summarize baseline characteristics and Chi-squared test and logistic regression to evaluate factors associated with admission for HHS compared with DKA in unadjusted and adjusted models.</p><p><strong>Results: </strong>We found 8,961 admissions for hyperglycemic emergencies in youth with T2D, of which 6% were due to HHS and 94% were for DKA. These admissions occurred mostly in youth 17-20 years old (64%) who were non-White (Black 31%, Hispanic 20%), with public insurance (49%) and from the lowest income quartile (42%). In adjusted models, there were increased odds for HHS compared to DKA in males (OR 1.77, 95% CI 1.42-2.21) and those of Black race compared to those of White race (OR 1.81, 95% CI 1.34-2.44). Admissions for HHS had 11.3-fold higher odds for major or extreme severity of illness and 5.0-fold higher odds for mortality.</p><p><strong>Conclusion: </strong>While DKA represents the most admissions for hyperglycemic emergencies among pediatric T2D, those admitted for HHS had higher severity of illness and mortality. Male gender and Black race were associated with HHS admission compared to DKA. Additional studies are needed to understand the drivers of these risk factors.</p>","PeriodicalId":19797,"journal":{"name":"Pediatric Diabetes","volume":"2023 ","pages":""},"PeriodicalIF":3.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10445777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10458645","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}