Predictors of glucose control in children and adolescents with type 1 diabetes mellitus

Urbach, Stacey; LaFranchi, Stephen; Lambert, Lori; Lapidus, Jodi; Daneman, Denis; Becker, Thomas M.

doi:10.1111/j.1399-543x.2005.00104.x

Cited by 82 publications

(90 citation statements)

References 15 publications

(28 reference statements)

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“…Increased BMI is reported to be a side effect of intensive insulin treatment, explained by fear of hypoglycaemia that leads to overeating [37]. A high number of clinical visits in adolescents was associated with higher HbA 1c , as has been described by others [8,9]. The result probably reflects the practice of following patients with poor control more closely.…”

Section: Discussionmentioning

confidence: 84%

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: 84%

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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“…However, this may limit our ability to identify factors that are only of significance in the smaller ethnic groups. No data on family composition or cohesiveness, which likely mediate some of the effects of ethnicity and deprivation on metabolic control, were collected [13,19,47]. Since hypoglycaemia was a rare event the confidence intervals are broad and rates can be affected by recall bias.…”

Section: Discussionmentioning

confidence: 99%

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

et al. 2008

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Aims/hypothesis This study was performed to evaluate the influence of ethnicity and socioeconomic status (SES) on metabolic control in a population-based cohort of children with type 1 diabetes mellitus, and to evaluate whether any relationship between ethnicity and HbA 1c is mediated by SES. Methods We performed a retrospective review of all patients under age 16 years with type 1 diabetes (n=555) from 1995 to 2005 in the greater Auckland region, New Zealand. Diabetes care variables and HbA 1c values were collected prospectively, during clinic visits. Results The mean population HbA 1c was 8.3±1.3%. Maori and Pacific patients had poorer metabolic control than their European counterparts (9.1% and 9.3% vs 8.1%, p<0.001) and higher rates of moderate to severe hypoglycaemia (31.1 and 24.8 vs 14.9 events/100 patient-years, p=0.03). In multiple linear regression analysis, both ethnicity and SES were independently associated with HbA 1c (p<0.001). Other factors associated with higher HbA 1c level were longer duration of diabetes, higher insulin dose, lower BMI z score and less frequent blood glucose monitoring (p<0.001).Conclusions/interpretation Both ethnicity and SES independently influenced metabolic control in a large, unselected population of children with type 1 diabetes. Irrespective of SES, Maori and Pacific youth with type 1 diabetes were at greater risk of both moderate to severe hypoglycaemia and long-term complications associated with poor metabolic control.

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“…There may be no minimum glycemic threshold for the reduction of longterm complications; long-term risk continues to decrease with HbA 1c (A1C) Ͻ8% accompanied by a lessgradual increase in the risk of hypoglycemia (5). Successful management of type 1 diabetes has been shown to reduce the frequency and severity of these long-term consequences; however, although intensive therapy may improve glycemic control, few families are able to maintain metabolic control within the recommended guidelines (1)(2)(3)(4)(5)(6), and control appears to decrease during the adolescent years (7)(8)(9)(10)(11)(12). To reduce potential longterm health effects, Cefalu (13) argues for lowering the pediatric glycemic goal Ͻ8% but recognizes that until we can improve diabetes management during adolescence, such a goal is meaningless.…”

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confidence: 99%

Assessing Regimen Adherence of Adolescents With Type 1 Diabetes

et al. 2006

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OBJECTIVE -The purpose of this study is to evaluate two updated measures of diabetes regimen adherence. The Diabetes Self-Management Profile (DSMP) is a widely used, structured interview. Limitations include a substantial interviewer and respondent time burden and the need for well-trained interviewers to use appropriate prompts and score the open-ended responses. The Diabetes Behavior Rating Scale (DBRS) is a self-administered, fixed-choice survey.RESEARCH DESIGN AND METHODS -Both measures were administered to 146 youth with type 1 diabetes (aged 11-18 years) and their parents. Items were added to the DBRS to allow for both flexible and conventional regimens, and the DSMP was modified to use standardized wording across items, accommodate flexible regimens, and permit administration by nonmedical interviewers.RESULTS -Both measures had good evidence of internal consistency (for the DSMP: parent 0.75 and youth 0.70; for the DBRS: parent 0.84 and youth 0.84). Scores on the DSMP and the DBRS were significantly related (r ϭ 0.72 for parents and 0.74 for youth). There was moderate agreement between parent and youth (DSMP, r ϭ 0.51; DBRS, r ϭ 0.48). The measures were correlated with HbA 1c for both parent (DSMP, r ϭ Ϫ0.35; DBRS, r ϭ Ϫ0.35) and youth (DSMP, r ϭ Ϫ0.36; DBRS, r ϭ Ϫ0.34) reports.CONCLUSIONS -Both measures exhibit good psychometric properties and good criterion validity but varied in terms of respondent and interviewer burden, issues that should be considered in selecting assessment procedures. Diabetes Care 29:2263-2267, 2006L ong-term complications of insulindependent diabetes (type 1 diabetes) include higher morbidity and mortality from retinopathy, nephropathy, neuropathy, and cardiovascular disease (1-4). There may be no minimum glycemic threshold for the reduction of longterm complications; long-term risk continues to decrease with HbA 1c (A1C) Ͻ8% accompanied by a lessgradual increase in the risk of hypoglycemia (5). Successful management of type 1 diabetes has been shown to reduce the frequency and severity of these long-term consequences; however, although intensive therapy may improve glycemic control, few families are able to maintain metabolic control within the recommended guidelines (1-6), and control appears to decrease during the adolescent years (7-12). To reduce potential longterm health effects, Cefalu (13) argues for lowering the pediatric glycemic goal Ͻ8% but recognizes that until we can improve diabetes management during adolescence, such a goal is meaningless.Diabetes self-management includes a variety of skills that must be performed daily: monitoring blood glucose, administering insulin, regulating diet and physical activity, and calculating appropriate care based on the results of these activities (14,15). In addition, the process requires adaptation to changing adolescent physiology and shifting parent and youth responsibilities while recognizing that the goals of diabetes management may be changing at the same time (15). Reliable and valid measures of adherence are essential fo...

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Predictors of glucose control in children and adolescents with type 1 diabetes mellitus

Cited by 82 publications

References 15 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

Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes

Assessing Regimen Adherence of Adolescents With Type 1 Diabetes

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