Objective: To test whether the addition of an insulin pump or continuous glucose monitor (CGM) related to reduced glycated hemoglobin A1c (HbA1c) in large cohort of children, 5-9 years old, and within 1 year of their type 1 diabetes (T1D) diagnosis. Research Design and Methods: The study uses data from families of children with recent-onset T1D and who were between 5 and 9 years old. Study analyses used children's HbA1c values at baseline and at the 6-month follow-up. Parents reported on family demographics and children's T1D device use in their daily management (e.g., insulin pump or CGM). Children's mean T1D duration was 4.70-3.28 months at baseline, so the 6-month assessment point was *12 months postdiagnosis. Results: One hundred-eleven families participated. At baseline, child mean age was 7.51-1.37 years, and mean child HbA1c was 7.65%-1.40%. In addition, 17% of children used an insulin pump, and 17.1% of children used CGM. Six months later, 35.1% of children had started an insulin pump and 25.2% had started CGM. Repeated measures analyses of variance results showed a smaller overall HbA1c between baseline and 6 months for children using an insulin pump versus children not on a pump. For CGM, results showed that children starting a CGM during this window had a significantly lower HbA1c level than children who had not started on CGM. Conclusions: The study results suggest that early initiation of either an insulin pump or CGM in children newly diagnosed with T1D may help to improve child HbA1c levels within the first 12 months of diabetes.
To describe sociodemographic and clinical characteristics of youth and young adults with type 1 diabetes who endorsed suicidal ideations as part of routine depression screening and the results of their suicide risk assessments. RESEARCH DESIGN AND METHODSThe Patient Health Questionnaire-9 was used to assess depressive symptoms and suicide/death ideation in 550 youth and young adults with type 1 diabetes ages 10-24 years. Only individuals who endorsed suicidal/death ideations (n 5 49) completed a standardized suicide risk assessment protocol and safety planning. RESULTSNine percent of individuals endorsed suicidal/death ideation and of those, 83.4% reported clinically elevated depressive symptoms; 16% made a previous suicide attempt. No youth (n 5 39) or young adults (n 5 11) disclosed current plans or preparations for suicide, but five who expressed suicidal ideation acknowledged the lethality of insulin for an attempt. Three previously used insulin to attempt suicide. The overwhelming majority of individuals were classified as being low risk for future suicide attempt/completion. None were hospitalized as a part of the suicide risk assessment, and no suicide completions have occurred. CONCLUSIONSThe findings of this study provide initial insight into the behaviors and cognitions of youth and young adults with type 1 diabetes who experience suicidal and death ideations. Comprehensive suicide risk assessment and safety planning are feasible during routine type 1 diabetes clinic appointments.
During fall 2022, a resurgence of invasive group A Streptococcus (iGAS) infection in children and adolescents was observed in two of CDC's Emerging Infections Program (EIP)* surveillance sites: Colorado (Denver metropolitan area) and Minnesota (entire state). This increase followed historic declines in invasive bacterial diseases during 2020, concurrent with mitigation strategies implemented during the COVID-19 pandemic † (1). Whereas reports of iGAS increased among all age groups, including adults, the increase among children and adolescents was notable, occurred earlier than seasonal increases during previous years, and accompanied a resurgence in hospitalizations for respiratory viral illnesses such as respiratory syncytial virus (RSV) and influenza. Viral infections, such as influenza and varicella, have been identified as risk factors for iGAS infection in children, adolescents, and adults (2) and can be reduced by vaccination.Surveillance for iGAS is conducted by 10 U.S. sites as part of EIP's Active Bacterial Core surveillance (ABCs). § An analysis of cases among Colorado and Minnesota EIP site residents aged <18 years who met criteria for iGAS ¶ was conducted using ABCs data from the Colorado and Minnesota surveillance sites. Case counts, age distribution, and clinical characteristics of patients with iGAS infection were compared over three periods:
Objective: To determine autism spectrum disorder (ASD) prevalence within our pediatric type 1 diabetes (T1D) clinic population and determine clinical characteristics and technology used by individuals with both ASD and T1D compared to matched controls with T1D alone and compared to our overall pediatric T1D clinic.Methods: Medical chart review showed 30 individuals with both ASD and type 1 diabetes (ASD + T1D). Controls (n = 90) were matched for age, sex, race/ethnicity, and T1D duration. ASD + T1D was compared to both matched controls and the pediatric T1D clinical population.Results: ASD prevalence in the pediatric T1D population was 1.16% (CI 0.96-1.26).Compared to the T1D clinic, ASD + T1D had more males (93% vs 52%; P < 0.0001), lower hemoglobin A1c (HbA1c) (8.2% vs 8.9%; 66 vs 74 mmol/mol; P = 0.006), and lower insulin pump (CSII) use (37% vs 56%; P < 0.0001). No differences were found between ASD + T1D and matched controls in HbA1c or blood glucose checks per day. The ASD + T1D group was less likely to use CSII than matched controls (37% vs 61%; P = 0.03). HbA1c did not change after CSII initiation in ASD + T1D, but increased for matched controls.Conclusions: Prevalence of ASD in the pediatric T1D population is comparable to the general population in Colorado. Individuals with ASD may experience barriers limiting CSII use, but achieve equivalent glycemic control compared to those without ASD.CSII may be more effective in maintaining lower HbA1c over time in those with ASD than in those without ASD. K E Y W O R D S autistic disorder, diabetes mellitus, disease management, pediatrics, type 1 Type 1 diabetes (T1D) is one of the most common chronic diseases of childhood, 1,2 requiring complex management and multiple daily interventions to administer insulin and monitor blood sugars. Psychological comorbidities, such as depression have been extensively studied in T1D. However, existing research on T1D and developmental disorders, specifically autism spectrum disorder (ASD), is extremely sparse. Impairments in social behavior and reciprocal social interactions are hallmark features of ASD. 3 Individuals with ASD show delayed language development, deficits in social-emotional reciprocity, eye
Parents' use of authoritarian-like strategies may negatively impact glycemic control over the course of six-month in children with new-onset T1D.
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