Hemoglobin A1c (A1c) is widely regarded as the gold standard for evaluating glycemic control in youth with type 1 diabetes.1 However, A1c represents average glucose levels over the past 6-12 weeks and may not adequately represent the degree of blood glucose (BG) excursions experienced, particularly hypoglycemic episodes.2,3 Greater frequency of BG excursions, even excursions lasting brief periods of time, is related to increased risk for development of diabetesrelated complications. 4 Thus, standardized evaluation of the risk for BG excursions and BG variability may be a critical component in fine-tuning diabetes treatment regimens.In response to the need for more sensitive measures to assess BG variability, Kovatchev and colleagues created the average daily risk range (ADRR).5 ADRR is calculated using ≥14 days of BG values with a minimum of 3 checks/day and is designed to be equally sensitive to hyperglycemic and hypoglycemic episodes. ADRR has been found to be a valid and reliable measure of glycemic variability in adults and has been shown to prospectively predict both hypoglycemia and hyperglycemia within 4 months of ADRR determination. 5 In adult samples, ADRR has been positively and statistically significantly associated with A1c and other indices of glycemic variability, including mean amplitude of glycemic excursions and standard deviations of mean BG levels. 6 ADRR may also be a valuable tool in evaluating BG variability and classifying risk of hypoglycemic and hyperglycemic episodes in young children with type 1 diabetes. Minimizing glycemic variability in young children with type 1 diabetes can be challenging due to greater insulin sensitivity and less insulin resistance than pubertal children, susceptibility to hypoglycemia, highly variable and unpredictable eating and activity schedules, and difficulty communicating symptoms of glycemic excursions to caregivers. Abstract Objective: The objective was to examine the utility of the average daily risk range (ADRR) in young children with type 1 diabetes. Methods: Self-monitored blood glucose (BG) data and A1c values were collected from 134 children (ages 2-6). Other measures of BG variability and diabetes care were calculated using self-monitored BG data. ADRR, A1c, and other glycemic indices were compared to assess their distinctiveness and utility as measures of BG variability and glycemic control. Results: Of young children's ADRR values, 72% were in the "high-risk" range using adult guidelines. ADRR and A1c were highly correlated with indicators of hyperglycemia but only weakly correlated with measures of hypoglycemia. ADRR was moderately correlated with minimum BG value in the past 30 days but not percentage of BG values below 70 mg/dL. A1c was not correlated with either measure of hypoglycemia. Conclusions: ADRR values confirm the high degree of BG variability present in young children with type 1 diabetes, particularly as compared with adults. New ADRR risk guidelines are needed for pediatric patients. ADRR and A1c are adequate indicators of hyper...

ObjectiveInvestigate relationships among neonatal intensive care unit (NICU) parent demographics, reported stress and social support.DesignCross-sectional observation.SettingTertiary referral NICU in Mid-Atlantic USA.PatientsParents (n=300) in the Giving Parents Support trial at enrolment.MeasuresPsychometric scales measured general stress, parental stress, NICU stress and social support. Demographic variables included education level, health insurance type, race, relationship status, age and gender. Length of stay was used to control for illness severity. Associations and potential modifying effects were evaluated using linear regression.ResultsHaving less than a college degree (b=−2.52, SE=0.91) and female parent gender (b=−3.42, SE=1.47) were associated with lower parental stress scores. Older age in years was associated with higher parental stress scores (b=0.21, SE=0.07) but lower NICU stress scores (b=−0.01, SE=0.01). Greater social support scores were associated with lower scores of general (b=−2.76, SE=0.39) and parental stress (b=−1.71, SE=0.47). Less than a college degree (b=−0.26, SE=0.11), Medicaid insurance (b=−0.43, SE=0.11) and black race (b=−0.56, SE=0.12) were associated with decreased social support scores. Level of social support modified the relationship between education and parental stress, with higher social support decreasing education-based differences in parental stress scores (p=0.049).ConclusionSociodemographic risk factors may not infer stress or risk in the anticipated direction. Practice and future research should focus on identifying and supporting NICU families at high risk for stress and low support.Trial registration numberNCT02643472.