The relationship of glycemic control, insulin dose, and race with hypoglycemia in youth with type 1 diabetes

Chalew, Stuart A.; Kamps, Jodi L.; Jurgen, Brittney; Gómez, Ricardo; Hempe, James M.

doi:10.1016/j.jdiacomp.2019.107519

Cited by 7 publications

(5 citation statements)

References 19 publications

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“…In addition to the modifiable factors, non-modifiable factors that influenced the use of CSII were also found in this review, these include racial and ethnic characteristics or people who are socially vulnerable [ 67 ]. Similar results were described in a retrospective study, in which black children and adolescents had higher levels of HbA1c and Caucasians more episodes of hypoglycemia [ 138 ]. Although some of these factors are not modifiable, it is important that health professionals know how to identify them and how to incorporate these characteristics in the design of educational approaches.…”

Section: Discussionsupporting

confidence: 87%

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

et al. 2022

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Background Among the treatments for type 1 diabetes mellitus (T1DM), Continuous Subcutaneous Insulin Infusion (CSII) is a device that infuses insulin through the subcutaneous tissue in an uninterrupted manner and that comes closest to the physiological secretion of insulin. The use of CSII can provide the family with greater security and children and adolescents have more autonomy in relation to the treatment of T1DM. There is a lack of reviews that systematically gather the mounting evidence about the use of CSII in children and adolescents with T1DM. Therefore, the aim of this review was to group and describe primary and secondary studies on the use of CSII in children and adolescents with T1DM. Methods A systematic mapping review was performed based on searches in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, using a combination of descriptors and keywords. The screening of the studies was carried out with the aid of the Rayyan software and reading in full was conducted independently by two reviewers. The data extraction of the studies was performed using an extraction tool adapted and validated by researchers specialized in diabetes. The data were analyzed according to the content analysis technique. The map from geocoding of the studies was produced using the ArcGis 10.5 software. Results A total of 113 studies were included in the review, including primary studies, literature reviews and gray literature publications. The content analysis of the results of the studies allowed for the identification of four categories: 1) metabolic control; 2) support networks; 3) benefits of using CSII; and 4) challenges of using CSII, each category having its respective subcategories. The review also made it possible to conduct a rigorous mapping of the literature on the use of CSII considering the location of development and the design of the studies. Conclusions The use of CSII should be indicated by health professionals able to prepare children, adolescents, and their families for the treatment of T1DM, and, despite being a technological device, it may not be suitable for the entire pediatric population.

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Section: Discussionsupporting

confidence: 87%

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

et al. 2022

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“…Furthermore, East African patients may not have the availability of insulin analogues which are thought to help reduce glycemic variability and risk of hypoglycemia [27]. In clinical situations where insulin management is based on patientgenerated home glucose data, and HbA1c is not available at the time of clinic visit, AH patients did not have the occurrence of hypoglycemia higher than W patients [14].…”

Section: Discussionmentioning

confidence: 99%

“…Te occurrence of hypoglycemia may be particularly troublesome when a treatment to the HbA1c target is the primary management approach [12]. Tis seems to be a paradoxical observation as in the Diabetes Control and Complications Trial (DCCT) and other studies of the occurrence of hypoglycemia where lower HbA1c has been associated with more hypoglycemia [13,14].…”

Section: Introductionmentioning

confidence: 99%

“…In less-resourced areas of the world such as Africa, the use of self-monitored capillary glucose is prohibitively expensive and a point of care clinic HbA1c may be the main and sometimes the only metric for the assessment of glycemic control and for guiding insulin dosing [16]. However, if HbA1c overestimates the MBG of youth with diabetes living in Africa, as it does for African diaspora populations, then treatment to HbA1c target might lead to inadvertent over prescription of insulin and more frequent occurrence of hypoglycemia [14]. Te purpose of this data analysis was to compare the population data for the relationship between HbA1c and MBG derived from a relatively homogenous population of youth in Uganda and Kenya, East Africa, with similar data gathered from the previously cited populations outside of Africa and comprised of large numbers of non-AH patients.…”

Section: Introductionmentioning

confidence: 99%

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Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?

et al. 2023

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Introduction. The relationship of HbA1c versus the mean blood glucose (MBG) is an important guide for diabetes management but may differ between ethnic groups. In Africa, the patient’s glucose information is limited or unavailable and the management is largely guided by HbA1c. We sought to determine if the reference data derived from the non-African populations led to an appropriate estimation of MBG from HbA1c for the East African patients. Methods. We examined the relationship of HbA1c versus MBG obtained by the continuous glucose monitoring in a group of East African youth having type 1 diabetes in Kenya and Uganda (n = 54) compared with the data obtained from A1c-derived average glucose (ADAG) and glucose management indicator (GMI) studies. A self-identified White (European heritage) population of youth (n = 89) with type 1 diabetes, 3–18 years old, living in New Orleans, LA, USA metropolitan area (NOLA), was studied using CGM as an additional reference. Results. The regression equation for the African cohort was MBG (mg/dL) = 32.0 + 16.73 × HbA1c (%), r = 0.55, p < 0.0001 . In general, the use of the non-African references considerably overestimated MBG from HbA1c for the East African population. For example, an HbA1c = 9% (74.9 mmol/mol) corresponded to an MBG = 183 mg/dL (10.1 mmol/L) in the East African group, but 212 mg/dL (11.7 mmol/L) using ADAG, 237 mg/dL (13.1 mmol/L) using GMI and 249 mg/dL (13.8 mmol/L) using NOLA reference. The reported occurrence of serious hypoglycemia among the African patients in the year prior to the study was 21%. A reference table of HbA1c versus MBG from the East African patients was generated. Conclusions. The use of non-African-derived reference data to estimate MBG from HbA1c generally led to the overestimation of MBG in the East African patients. This may put the East African and other African patients at higher risk for hypoglycemia when the management is primarily based on achieving target HbA1c in the absence of the corresponding glucose data.

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“…Além dos fatores modificáveis, também foram encontrados nesta revisão fatores não modificáveis que influenciaram o uso do SICI, a exemplo de características raciais e étnicas ou de pessoas que apresentam vulnerabilidades sociais e culturais. Resultados semelhantes foram descritos em um estudo retrospectivo, no qual crianças e adolescentes negros apresentaram maiores níveis de HbA1c e os brancos mais episódios de hipoglicemias (183). Embora alguns desses fatores não sejam modificáveis, é importante que os profissionais de saúde saibam identificá-los e observem de que maneira interferem nos resultados do DM1 da criança e adolescente.…”

Section: Discussionunclassified

Uso do sistema de infusão contínua de insulina em crianças e adolescentes com diabetes mellitus tipo 1: revisão de mapeamento sistemático

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DeusA Deus primeiramente, que em sua infinita bondade e graça conduz-me diariamente em seus caminhos. Agradeço por me guiar nas tomadas de decisão, suster todas as minhas necessidades, acalmar minhas aflições e, principalmente, abrir as portas que jamais abriria sozinha. Este trabalho jamais seria possível de ser realizado sem Cristo. Mãe À minha mãe querida, que sempre me apoiou e me guiou em todas as minhas decisões com todo seu amor, carinho e sabedoria. Pelos dias incessantes de suas preciosas orações, pelas noites em claro, pelas lágrimas derramadas em busca de fazer da minha vida o melhor que poderia ser. Amo você antes mesmo de você descobrir minha existência. WillieAo meu esposo, que me ressignificou o conhecimento sobre companheirismo e casamento, por seus dias de apoio e incentivo para o término desta pesquisa, por toda a sua paciência nos dias mais atarefados. Agradeço pelo apoio incondicional em minhas decisões e por todo seu conhecimento compartilhado.Profa. Dra. Lucila Castanheira Nascimento À professora querida que me acolheu na pós-graduação e me ensinou os primeiros passos da condução de uma pesquisa. Admiro a forma como ensina e inspira diariamente todos os seus alunos a trabalhar com dedicação e eficiência, proporcionando sempre bons resultados. Obrigada por todo apoio, compreensão e ajuda na construção de um dos meus sonhos! Agradecimentos Aos meus irmãos Camila e Lucas Por todos os risos e companheirismo de uma vida toda. A infância jamais teria sido boa sem a cumplicidade e o amor de vocês. À minha avó Alcinda, tia Márcia e Vó Ondina Por todo o carinho e amor cultivados até hoje. Obrigada pelas mensagens diárias de ânimo! Ao Prof. Dr. Raphael Del Roio Liberatore Júnior Que providenciou todo o suporte necessário para o acompanhamento e realização das consultas de enfermagem e participação no grupo de crianças e adolescentes com Diabetes Mellitus tipo 1. À Rebecca Ortiz La Banca Que plantou a sementinha apaixonante da pesquisa em diabetes, além de inspirar diariamente muitos (as) enfermeiros (as) com seus preciosos ensinamentos práticos para serem transmitidos a crianças e adolescentes com DM1 e seus familiares. À Ana Carolina Andrade Biaggi Leite e Rhyquelle Rhibna Neris Que me ajudaram infinitas vezes durante a pós-graduação sempre incentivando e ensinando a importância de um trabalho científico ser realizado da melhor forma possível. À família Spinelli Calorosos, piadistas e receptivos. É uma honra fazer parte de uma família composta por tantas pessoas queridas. À família Alvarenga Pelo acolhimento, paciência, carinho e atenção. São todos muito especiais para mim. Às minhas tias Maria Rosa e Maria Constança Pelos dias de curso, congressos, passeios culturais e pela riqueza de suas conversas. Às #Luciletes e #Lucilords Por sempre compartilharem experiências, dicas e conselhos acadêmicos e profissionais. Vocês arrasam!! Às minhas colegas de profissão Que diariamente dedicam suas vidas a oferecer cuidado aos que necessitam. Como é bom ser enfermeira! A arte de cuidar é realizada não apenas aos...

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The relationship of glycemic control, insulin dose, and race with hypoglycemia in youth with type 1 diabetes

Cited by 7 publications

References 19 publications

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

Can HbA1c Alone Be Safely Used to Guide Insulin Therapy in African Youth with Type 1 Diabetes?

Uso do sistema de infusão contínua de insulina em crianças e adolescentes com diabetes mellitus tipo 1: revisão de mapeamento sistemático

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