Maternal Efforts to Prevent Type 1 Diabetes in At-Risk Children

Baughcum, Amy E.; Johnson, Suzanne Bennett; Carmichael, Stacy K.; Lewin, Adam B.; She, Jin‐Xiong; Schatz, Desmond

doi:10.2337/diacare.28.4.916

Cited by 24 publications

(27 citation statements)

References 22 publications

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“…The parents got information about the implications of increased genetic susceptibility to type 1 diabetes at the time of the birth of the child. There are some indications that information about increased susceptibility influences, at least to some extent, the living habits within the family (37) . After knowing about their child's increased risk for type 1 diabetes, 34 % of US parents made some changes in the child's diet with the intention of decreasing the disease risk, although risk factors for type 1 diabetes are not well established.…”

Section: Discussionmentioning

confidence: 99%

Food consumption and nutrient intake in Finnish 1–6-year-old children

Kyttälä

Erkkola

Kronberg-Kippilä

et al. 2010

Public Health Nutr.

111

141

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Objective: To study food consumption and nutrient intake in Finnish children aged 1-6 years and to assess the effect of age and sex on food consumption and nutrient intake. Design: Cross-sectional samples of children participating in the Type 1 Diabetes Prediction and Prevention (DIPP) birth cohort study in Finland. Subjects: The study population comprised healthy children recruited in the nutrition study within the DIPP study in 1998-2003. Three-day food records (2535 in total) from 1-, 2-, 3-, 4-and 6-year-old children were kept between the years 2003 and 2005. Results: The energy-adjusted consumption of fruits and berries, cereal products, infant formulas and meat dishes was higher and the consumption of vegetables, salads, breads, dairy products, fat spreads, drinks, sweets and sugar was lower among 1-year-old children than older age groups (P for all ,0?05). The mean daily energy intake increased with age and was higher among boys than girls in all age groups, except among the 2-year-olds (P for all ,0?05). The diet of the 2-6-year-old children contained too much saturated fat and sucrose, and too little PUFA compared with the current Nordic Nutrition Recommendations. The intakes of most vitamins and minerals met the recommendations. However, the intakes of vitamin D, E and iron fell below the recommended levels. The nutrient density of the diet decreased after the age of 1 year at the time that the children adapted to the regular family diet. Conclusions: In order to improve the diet of young children, it is essential to evaluate the diet of the whole family.

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Section: Discussionmentioning

confidence: 99%

Food consumption and nutrient intake in Finnish 1–6-year-old children

Kyttälä

Erkkola

Kronberg-Kippilä

et al. 2010

Public Health Nutr.

111

141

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“…Disease prevention efforts have been previously reported in highrisk individuals (6,8). Since unknown environmental triggers are thought to play a role in type 1 diabetes onset in genetically at-risk individuals (9), such behavior may undermine the integrity of any trial.…”

Section: )mentioning

confidence: 99%

Participant and Parent Experiences in the Parenteral Insulin Arm of the Diabetes Prevention Trial for Type 1 Diabetes

Johnson¹,

Baughcum²,

Hood

et al. 2007

Diabetes Care

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FOR THE DPT-1 STUDY GROUPOBJECTIVE -To assess participant and parent experiences in the parenteral insulin arm of the Diabetes Prevention Trial for Type 1 Diabetes (DPT-1).RESEARCH DESIGN AND METHODS -Before trial results were publicized, surveys were completed by 82 intervention participants (the intervention group) (who received annual 4-day insulin infusions and daily insulin injections), 81 closely monitored control subjects (the closely monitored group), and 135 parents of children in the trial.RESULTS -Survey results suggest that participant perspective (adult, child, parent, and sex), study procedures, and group assignment have important implications when planning clinical trials. Parents rated the trial more favorably but worried about hypoglycemia and diabetes onset. Children had the least favorable reaction to the study. Parents preferred assignment to the intervention group; child/adult participants preferred assignment to the closely monitored group. The intervention group rated the annual 4-day insulin infusions more negatively than all other study procedures. Intervention group participants/parents reported poorer insulin injection adherence over the course of the study. Intervention group participants, parents, and female subjects expressed an interest in additional psychosocial support during the trial. Random assignment was viewed negatively by both study groups. Close observation for diabetes onset was viewed as the most favorable aspect of the study. Behaviors outside of the study protocol to prevent or delay diabetes onset were common and should be monitored in future prevention studies.CONCLUSIONS -Overall, most participants were positive about the trial, and many expressed optimism about the intervention's potential for success. These results have implications for study design, recruitment, and retention procedures in future prevention trials. Diabetes Care 30:2193-2198, 2007T he Diabetes Prevention Trial for Type 1 Diabetes (DPT-1) tested whether insulin could prevent or delay type 1 diabetes onset in relatives of type 1 diabetic patients. There were two separate arms in the trial. Relatives with Ͼ50% risk of developing diabetes within 5 years were offered randomization to a closely monitored control condition (the closely monitored group) or a parenteral insulin intervention (the intervention group) requiring annual hospitalizations for 4-day intravenous insulin infusions as well as twice-a-day low-dose insulin injections administered at home. Relatives with a 5-year risk of 26 -50% were offered randomization to oral insulin therapy or a placebo (1).The design of prevention trials like the DPT-1 often involve tension between scientific considerations as to what interventions should be tested and practical and ethical concerns about the demands placed on trial participants. This tension is usually resolved based on investigators' experiences conducting similar studies, since there are very little data from trial participants per se. Documenting participant experiences in prevention trials ...

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“…Mothers then take part in phone interviews to determine understanding of infant diabetes risk, 13 the psychologic impact of the news, 14 -16 and prevention efforts. 17 The scant available research literature from PANDA and other screening programs suggests that mothers of infants and children screened for genetic risk may experience some initial anxiety, but that seems to dissipate over time. 14,18,19 There seems to be little evidence of an increase in depressive symptoms associated with genetic testing in this population, although few studies have been conducted.…”

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confidence: 99%

“…Indeed, accurate knowledge of information presented about risk in the context of screening for T1D, as well as other diseases, has an impact on decisionmaking in genetic risk studies 21 and efforts to prevent disease onset. 17 In this study, we aimed to elucidate this complex picture of factors promoting maternal understanding of infant diabetes risk in a sample of mothers whose newborns had been identified as at increased risk for T1D through the PANDA study. We tested the effects of the passage of time, maternal sociodemographic characteristics (ethnic minority status, education), and child characteristics (family history of diabetes) on maternal risk perception accuracy.…”

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confidence: 99%