Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes

Rosilio, Myriam; Jb, Cotton; Mc, Wieliczko; Gendrault, B; Jc, Carel; Couvaras, O; N, Ser; Gillet, P; Soskin, Samuel; Garandeau, Patrick; Stuckens, C.; B, Le Luyer; J, Jos; Bony-Trifunovic, H.; Am, Bertrand; Leturcq, F.; Lafuma, A; Pf, Bougnères

doi:10.2337/diacare.21.7.1146

Cited by 194 publications

(170 citation statements)

References 10 publications

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“…The result probably reflects the practice of following patients with poor control more closely. Furthermore, in adolescents HbA 1c increased with increasing diabetes duration, a finding that has been reported earlier [2,6]. This could reflect the decline or end of endogenous insulin production [1,6] or the fact that HbA 1c often deteriorates with age in adolescents [1,3].…”

Section: Discussionmentioning

confidence: 58%

The influence of dietary intake and meal pattern on blood glucose control in children and adolescents using intensive insulin treatment

et al. 2007

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Aims/hypothesis We studied dietary factors and their association with blood glucose control in type 1 diabetic children and adolescents using intensive insulin treatment. Materials and methods A total of 550 children and adolescents with type 1 diabetes mellitus (age 2-19 years) recorded their diet for 4 days in pre-coded food diaries. Of the study group, 34% used insulin pumps, 43% used four or more injections and 16% three injections per day. HbA 1c was related to targets of optimal blood glucose control defined by the International Society for Pediatric and Adolescent Diabetes (ISPAD). Results Adolescents with optimal glucose control (HbA 1c ≤7.5%) had a lower intake of added sugar (7.7 vs 9.1% of energy intake, p=0.004), a higher intake of fibre (19.3 vs 17.0 g/day, p=0.01) and a higher intake of fruits and vegetables (257 vs 227 g/day, p=0.04) than those with suboptimal metabolic control (HbA 1c >7.5%). Multiple regression analysis in adolescents showed that fibre and meal pattern were significantly associated with blood glucose control (effect fibre intake=−0.02, p=0.04, effect having breakfast regularly=−0.89, p=0.009). In children meal pattern was associated with blood glucose control (effect having dinner regularly=−0.66, p=0.02, effect having supper regularly=−0.78, p=0.03). Conclusions/interpretation In diabetic adolescents both intake of fibre and having a regular meal pattern are associated with blood glucose control. Lower intake of added sugar and sugar-sweetened soft drinks and higher intake of fruits and vegetables are observed among those with optimal compared with those with suboptimal blood glucose control. Dietary guidance should be intensified during adolescence to improve dietary intake and blood glucose control.

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Section: Discussionmentioning

confidence: 58%

The influence of dietary intake and meal pattern on blood glucose control in children and adolescents using intensive insulin treatment

et al. 2007

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“…We observed a substantial decrease in the annual incidence of total severe hypoglycemic events between our two cohorts. Interestingly, this decrease occurred despite the fact that the 2002 cohort had diabetes of longer duration, a known risk factor for hypoglycemia (32,33). We speculate that the cause of this declining incidence was multifactorial and likely due to more physiologic insulin replacement with MDI, CSII, and analog use.…”

Section: Discussionmentioning

confidence: 93%

Temporal Trends in the Treatment of Pediatric Type 1 Diabetes and Impact on Acute Outcomes

Svoren

Volkening

Butler

et al. 2007

The Journal of Pediatrics

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Objective-To evaluate temporal trends in pediatric type 1 diabetes (T1DM) management and resultant effects on outcomes.Study design-Two pediatric T1DM cohorts were followed prospectively for 2 years and compared; Cohort 1 (N=299) was enrolled in 1997 and Cohort 2 (N=152) was enrolled in 2002. In both cohorts, eligible participants were identified and sequentially approached at regularly scheduled clinic visits until the target number of participants was reached. Main outcome measures were A1c, z-BMI, and incidence rates (IR, per 100 patient-years) of hypoglycemia, hospitalizations, and emergency room (ER) visits.Results-At baseline, Cohort 2 monitored blood glucose more frequently than Cohort 1 (≥4 times/ day: 72% vs. 39%, p<.001) and was prescribed more intensive therapy than Cohort 1 (≥3 injections/ day or pump: 85% vs. 65%, p<.001). A1c was lower in Cohort 2 than Cohort 1 at baseline (8.4% vs. 8.7%, p=.03) and study's end (8.7% vs. 9.0%, p=.04). The cohorts did not differ in z-BMI (0.83 vs. 0.79, p=.57) or IR of hospitalizations (11.2 vs. 12.9, p=.38). Cohort 2 had lower IR of total severe hypoglycemic events (29.4 vs. 55.4, p<.001) and ER visits (22.0 vs. 29.3, p=.02).Conclusions-T1DM management intensified during the 5 years between cohorts and was accompanied by improved A1c and stable z-BMI. Along with improved control, IRs of severe hypoglycemia and ER visits decreased by almost 50% and 25%, respectively. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Treatment of T1DM in children and adolescents is difficult. The combination of severe insulin deficiency and the physical and psychosocial changes that accompany normal growth and development present unique challenges to pediatric health care professionals (6-9). In the DCCT, the 195 adolescents, ages 13-17 years at entry, had significantly higher A1c values compared to their adult counterparts, and the investigators anticipated that worldwide translation of treatment recommendations for youth would be especially challenging (10). Recent data, however, suggest that clinicians have gained success in implementing DCCT standards in pediatric practice. Advances in technology, such as improved methods of SMBG, modern insulin infusion pumps, and new short-and long-acting insulin analogs, as well as innovative behavioral and educational approaches, have contributed to this success (11-14). Keywords NIH Public AccessMaintenance of near-euglycemia, however, is not the only goal of intensive diabetes management. The prevention of excessive weight gain, previously associated with intensification of diabetes therapy (15...

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“…No presente estudo a média de HBA 1c foi de 8,04% (índice de 1,29), semelhante à descrita na Bélgica 3 , de 6,6% (índice de 1,2) e inferior à descrita em outros estudos, em corte transverso com crianças e adolescentes, realizados na França 5 O presente trabalho permite inferir que o atendimento em nosso centro, apesar de todas as dificuldade inerentes aos pacientes de hospital público e à própria instituição, alcançou resultados favoráveis, no que se refere ao controle glicêmico, em um ano de acompanhamento de crianças e adolescentes com DM1. Achamos importante que estudos prospectivos analisem a incidência de complicações microvasculares do diabetes, considerando não só o nível, mas também a variabilidade do controle glicêmico em pacientes com DM1.…”

Section: Discussionunclassified

Controle glicêmico de pré-púberes e púberes com diabetes mellitus tipo 1 durante um ano de acompanhamento ambulatorial

Gomes¹,

Castro²,

Garfinkel³

et al. 2001

J. Pediatr. (Rio J.)

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Objective: To evaluate glycemic control in patients with type 1 diabetes mellitus followed up during 1998.Patients and Methods: 38 patients, 22 male, aged 10.4 ± 4.1 years, 12 (31.6%) prepubertal, 26 (68.4%) pubertal, with diabetes duration of 3.7 ± 3.4 years and age of diagnosis of 7.2 ± 4.7 years were studied. HbA 1c was done by high performance (L-9100 Merck Hitachi, reference value 2.6 to 6.2%).Results: The HbA 1c was 8.04 ± 2.4% without association with gender and puberty. During the follow-up of the 27 patients who measured HbA 1c at least twice, 8 (29.6%) patients changed their control level group and 19 (70.4%) patients maintained the same level of control. From these, 3 (11.1%) were in bad control and 16 (59.3%) were in good control. In the latter group, 4 patients (25%) had maintained HbA 1c in the reference value, 7 (43.75%) had at least one HbA 1c in this level and 5 (31.25%) had all HbA 1c above. There was no association between the last glycemic control evaluation and the number of HbA 1c determinations.The intraindividual coefficient of variation of HbA 1c in the group that had at least three HbA 1c determinations (n = 19) was 11.2 ± 5.6% (P = 0.0000).Conclusion: In our study, although the majority of the patients presented a satisfactory glycemic control during the period, only 4 patients (14.8%) maintained the normal values of HbA 1c . The variability of HbA 1c must be evaluated when considering the interrelation between the glycemic control and the evolution to diabetic microvascular complications. IntroduçãoNo momento atual, podemos considerar o diabetes mellitus tipo 1 (DM1) como a endocrinopatia mais comum na infância e adolescência em países desenvolvidos e em

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Factors Associated With Glycemic Control: A cross-sectional nationwide study in 2,579 French children with type 1 diabetes

Abstract: Although overall results remain unsatisfactory, 33% of studied French children with type 1 diabetes had HbA1c < 8%, the value obtained in Diabetes Control and Complications Trial adolescents treated intensively. Diabetes management in specialized centers should be encouraged.

Cited by 194 publications

References 10 publications

The influence of dietary intake and meal pattern on blood glucose control in children and adolescents using intensive insulin treatment

The influence of dietary intake and meal pattern on blood glucose control in children and adolescents using intensive insulin treatment

Temporal Trends in the Treatment of Pediatric Type 1 Diabetes and Impact on Acute Outcomes

Controle glicêmico de pré-púberes e púberes com diabetes mellitus tipo 1 durante um ano de acompanhamento ambulatorial

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