Diabetes in adolescence

Cameron, Fergus; Amin, Rakesh; Beaufort, Carine de; Codner, Ethel; Acerini, Carlo L.

doi:10.1111/pedi.12169

Cited by 64 publications

(39 citation statements)

References 114 publications

(179 reference statements)

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“…This finding may be explained in part by omitting insulin inattentively, or in order to lose weight (particularly in females), and poor adherence to diabetes treatment which is common in adolescents with erratic meals and risk-taking behavior (14,15). We found an exponential rise of hospital admission rates for ketoacidosis with increasing HbA1c similar to previous reports from North America (6, 7).…”

Section: Discussionsupporting

confidence: 79%

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Karges

Rosenbauer

Holterhus

et al. 2015

European Journal of Endocrinology

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Objective: To investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes. Design: In total, 31 330 patients with type 1 diabetes (median age 12.7 years) from the Diabetes Patienten Verlaufsdokumentation (DPV) Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included. Methods: Admission rates for DKA (pH !7.3 or bicarbonate !15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis. Results: The mean admission rate for DKA was 4.81/100 patient-years (95% CI, 4.51-5.14). The highest DKA rates were observed in patients with HbA1c R9.0% (15.83 (14.44-17.36)), age 15-20 years (6.21 (5.61-6.88)) and diabetes duration of 2-4.9 years (5.60 (5.00-6.27)). DKA rate was higher in girls than in boys (5.35 (4.88-5.86) vs 4.34 (3.95-4.77), PZ0.002), and more frequent in migrants than in non-migrants (5.65 (4.92-6.49) vs 4.57 (4.23-4.93), PZ0.008). The mean admission rate for severe hypoglycemia was 1.45/100 patient-years (1.30-1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72-2.65) vs 1.28 (1.12-1.47), P!0.001), and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63-20.03) vs patients without preceding hypoglycemia 0.42 (0.35-0.52), P!0.001). Differences remained significant after multivariable adjustment. Conclusions: The identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.

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Section: Discussionsupporting

confidence: 79%

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Karges

Rosenbauer

Holterhus

et al. 2015

European Journal of Endocrinology

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“…Age was an important predictor of good diabetes self-management in our study. Both the scores and HbA1c levels were progressively worse in older children [13]. Furthermore, diabetes duration was longer in our study population than in previous studies (6.2 × 4.9 [4] × 2.9 years [5]), which may be associated to a worse metabolic control due to a progressive beta-cell failure.…”

Section: Discussionmentioning

confidence: 56%

Translation and validation of diabetes self-management profile (DSMP) into Brazilian Portuguese language: first instrument to assess type 1 diabetes self-management in a pediatric population

Passone

Esteves

Savoldelli

et al. 2017

Diabetol Metab Syndr

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ObjectiveTo translate and validate the instrument Diabetes Self-Management Profile (DSMP)—Conventional and Flexible Regimens into Brazilian Portuguese language in order to evaluate the quality of diabetes self-management in children and adolescents with type 1 diabetes and their caregivers.MethodsDSMP was submitted to forward and back translation method and validated in a group of type 1 diabetes youths between 6 and 18 years (n = 102), and their families. Analysis of DSMP internal consistency, intra and interobserver reliability and concurrent correlation with HbA1c were done.ResultsDSMP total scores demonstrated adequate internal consistency (Cronbach’s α = 0.79), 3-month test–retest reliability (ρ = 0.53; p < 0.001), inter-interviewer agreement (ρ = 0.55; p < 0.001). DSMP total score was significantly correlated to HbA1c (ρ = −0.54, p < 0.001).ConclusionDSMP-translated version is a reliable and valid tool to assess diabetes self-management.

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“…Many adolescents find it difficult to follow the recommendations of frequent usage of the CGM, which could result in elevated HbA1c. 19 TIR is a common endpoint in several studies to evaluate the precision and effectiveness of emerging automated insulin delivery technologies and glucose monitoring. 4 Previously, HbA1c has been the main outcome measure for evaluating the efficacy of a new treatment tool.…”

Section: Discussionmentioning

confidence: 99%

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study

et al. 2019

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Background Approximately 90% of children and adolescents with type 1 diabetes in Sweden use continuous glucose monitoring (CGM), either as real‐time CGM or intermittently scanned CGM to monitor their glucose levels. Time in target range (TIT) is an easily understandable metric for assessing glycemic control. Objective The aim of this study was to examine the relation between TIT and hemoglobin A1c (HbA1c). Subjects and Methods Subjects were recruited from three diabetes care centers in Sweden. Glucose data were collected for 133 children and adolescents with type 1 diabetes through CGM using Diasend. Subjects with registration time over 80% were included in the analysis. HbA1c was collected from SWEDIABKIDS, the Swedish pediatric diabetes quality registry. TIT was defined as 3.9 to 7.8 mmol/L (70‐140 mg/dL) and time in range (TIR) as 3.9 to 10 mmol/L (70‐180 mg/dL). Results During the period of 60 days, 105 subjects provided complete data for analysis. Mean age was 12.2 (±3.3) years, mean HbA1c was 53.9 (±8.2) mmol/mol or 7.1% (±0.7%). Mean sensor glucose value was 8.6 (±1.3) mmol/L, mean coefficient of variation was 42.2% (±7.2%), mean TIT was 40.9% (±SD 12.2%), and mean TIR was 60.8% (±13.1%). There was a significant nonlinear relation between TIT during 60 days and HbA1c, R2 = 0.69. Conclusion This study suggests a nonlinear relation between time spent in glucose target range and HbA1c. The finding implies that time spent in TIT could be a useful metric in addition to HbA1c to assess glycemic control.

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Diabetes in adolescence

Cited by 64 publications

References 114 publications

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31 330 young patients with type 1 diabetes

Translation and validation of diabetes self-management profile (DSMP) into Brazilian Portuguese language: first instrument to assess type 1 diabetes self-management in a pediatric population

Translating glycated hemoglobin A1c into time spent in glucose target range: A multicenter study

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