Unique Challenges for Pediatric Patients With Diabetes

Halvorson, Mary; Yasuda, Patrice; Carpenter, Sue; Kaiserman, Kevin

doi:10.2337/diaspect.18.3.167

Cited by 28 publications

(22 citation statements)

References 26 publications

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“…2A). Similar betweentreatment reductions in HbA1c were also observed in children 1-5 yr of age [−0.36 %-points (3.9 mmol/mol) for IDeg 1-5 and −0.16%-points (1.7 mmol/mol) for IDet [1][2][3][4][5] ,], children 6-11 yr of age [−0.35%points (3.8 mmol/mol) for IDeg 6-11, −0.33%-points (3.6 mmol/mol) for IDet [6][7][8][9][10][11] ] and adolescents 11-17 yr of age [−0.10%-points (1.1 mmol/mol) for IDeg [11][12][13][14][15][16][17] and −0.14%-points (1.5 mmol/mol) for IDet [11][12][13][14][15][16][17] ], respectively, at 52 wk. At 52 wk, there was a statistically significant difference in laboratory-analyzed FPG, which decreased from baseline in the IDeg group, but increased in the IDet group.…”

Section: Glycemic Controlmentioning

confidence: 99%

“…Management of T1D in children and adolescents presents particular challenges. Factors that increase the complexity of treating children include hormonal changes during normal growth and development (e.g., rapid growth, pubertal insulin resistance, psychosocial and cognitive development), family dynamics (including socioeconomic status, cultural considerations and parent/caregiver viewpoints) and the provision and quality of care and support outside the home, for example at school/college (6). In recognition of this, the American Diabetes Association and the International Society for Pediatric and Adolescent Diabetes (ISPAD) have published specific guidance for children (7,8).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Insulin degludec in combination with bolus insulin aspart is safe and effective in children and adolescents with type 1 diabetes

Thalange

Deeb²,

Iotova

et al. 2015

Pediatr Diabetes

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Insulin degludec (IDeg) once-daily was compared with insulin detemir (IDet) once- or twice-daily, with prandial insulin aspart in a treat-to-target, randomized controlled trial in children 1–17 yr with type 1 diabetes, for 26 wk (n = 350), followed by a 26-wk extension (n = 280). Participants were randomized to receive either IDeg once daily at the same time each day or IDet given once or twice daily according to local labeling. Aspart was titrated according to a sliding scale or in accordance with an insulin:carbohydrate ratio and a plasma glucose correction factor. Randomization was age-stratified: 85 subjects 1–5 yr. (IDeg: 43), 138 6–11 yr (IDeg: 70) and 127 12–17 yr (IDeg: 61) were included. Baseline characteristics were generally similar between groups overall and within each stratification. Non-inferiority of IDeg vs. IDet was confirmed for HbA1c at 26 wk; estimated treatment difference (ETD) 0.15% [−0.03; 0.32]95%CI. At 52 wk, HbA1c was 7.9% (IDeg) vs. 7.8% (IDet), NS; change in mean FPG was −1.29 mmol/L (IDeg) vs. +1.10 mmol/L (IDet) (ETD −1.62 mmol/L [−2.84; −0.41]95%CI, p = 0.0090) and mean basal insulin dose was 0.38 U/kg (IDeg) vs. 0.55 U/kg (IDet). The majority of IDet treated patients (64%) required twice-daily administration to achieve glycemic targets. Hypoglycemia rates did not differ significantly between IDeg and IDet, but confirmed and severe hypoglycemia rates were numerically higher with IDeg (57.7 vs. 54.1 patient-years of exposure (PYE) [NS] and 0.51 vs. 0.33, PYE [NS], respectively) although nocturnal hypoglycemia rates were numerically lower (6.0 vs. 7.6 PYE, NS). Rates of hyperglycemia with ketosis were significantly lower for IDeg vs. IDet [0.7 vs. 1.1 PYE, treatment ratio 0.41 (0.22; 0.78)95%CI, p = 0.0066]. Both treatments were well tolerated with comparable rates of adverse events. IDeg achieved equivalent long-term glycemic control, as measured by HbA1c with a significant FPG reduction at a 30% lower basal insulin dose when compared with IDet. Rates of hypoglycemia did not differ significantly between the two treatment groups; however, hyperglycemia with ketosis was significantly reduced in those treated with IDeg.

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Section: Glycemic Controlmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insulin degludec in combination with bolus insulin aspart is safe and effective in children and adolescents with type 1 diabetes

Thalange

Deeb²,

Iotova

et al. 2015

Pediatr Diabetes

View full text Add to dashboard Cite

show abstract

“…Gulabani, John and Isaac (2008) indicated that increasing patient knowledge regarding disease and its complications has significant benefits with regard to patient compliance to treatment and to decreasing complications associated with the disease. Adolescents with diabetes have been overlooked despite the unique challenges their care presents (Halvorson, Yasuda, Carpenter, and Kaiserman, 2005). The complex regimen like monitoring of blood glucose, insulin injections and dietary restraint becomes overwhelming and timeconsuming for them (Wysocki, Lochrie, Antal, and Buckloth, 2011).…”

Section: Introductionmentioning

confidence: 99%

Patient’s Knowledge Assessment on Diabetes and SelfCare Practices Among Older Adolescents with Type 1 Diabetes Mellitus in Malawi

Phiri

Msiska

Kululanga

et al. 2017

ESJ

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Adolescents with Type 1 Diabetes Mellitus (T1DM) face risks of long-term health complications due to difficulties in achieving and maintaining target glycemic control. The study aimed at assessing knowledge on diabetes and self-care practices among older adolescents with type 1 diabetes to identify significant knowledge gaps. Gathering information from adolescents on how much they know about the condition and their self-care practices would help identify significant knowledge and self-care gaps. A quantitative descriptive cross-sectional study design was used. Convenience sampling was employed to recruit 46 adolescents with TIDM from two tertiary hospitals in Malawi. Data were collected using interviewer administered questionnaire from January to March, 2014, and analyzed using SPSS version 20. The study results revealed inadequate knowledge amongst the adolescents on issues pertinent to self-cares. 58% (42/72) had inadequate knowledge on managing hyperglycemia, 61% (28/46) were inappropriately doing the self-monitoring of blood glucose resulting in high admission rate with 44% being admitted 3-4 times and 11% more than 7 times in a year. Linear regression showed a significant association between age and number of admissions (P=0.022) hence as age increases, so does the number of admissions. 78% (36/46) were not adequately counseled on diet plan. Excessive thirst and frequent urination were the most mentioned signs of Type 1 Diabetes Mellitus 24% (45/191). Ulcers on the feet were the most mentioned complication 33% (42/127.

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“…First, the diagnostic presentation is often more severe in younger children than in older children, in that a high proportion of young children present as critically ill at the time of diagnosis (Quinn, Fleischman, Rosner, Nigrin, & Wolfsdorf, 2006). Disease management is also complicated by developmental and physiological factors unique to this age group; caregivers’ efforts to achieve optimal T1D management are complicated by young children’s rapid growth, erratic eating and changing insulin demands, limited communication of hypoglycemic/hyperglycemic symptoms, and efforts to gain mastery and control in the environment (Halverson, Yasuda, Carpernter, & Kaiserman, 2005; Kushion, Salisbury, Seitz, & Wilson, 1991). Thus, there is a need to identify possible effects of the demands of treatment management on mothers of young children with T1D in order to support them and promote the best adjustment to the illness.…”

mentioning

confidence: 99%

Coping and Psychosocial Adjustment in Mothers of Young Children With Type 1 Diabetes

Grey

2009

Children's Health Care

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This study examined symptoms of anxiety and depression in mothers of young children with type 1 diabetes (T1D) in relation to mothers’ fears of hypoglycemia, perceptions of coping, and children’s metabolic control. Sixty-seven mothers of children less than 8 years of age diagnosed with T1D completed self-report measures, and children’s metabolic control was measured with glycosolated hemoglobin (HbA1c). Twenty-one percent of mothers reported clinically significant levels of symptoms of anxiety, and twenty-four percent reported clinically significant levels of depression. Lower income level and finding it more upsetting to cope with diabetes-related stress accounted for higher symptoms of anxiety and depression in mothers. Mothers’ symptoms were not related to children’s metabolic control. Recommendations are made for screening mothers and providing supportive interventions to alleviate their distress.

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Unique Challenges for Pediatric Patients With Diabetes

Cited by 28 publications

References 26 publications

Insulin degludec in combination with bolus insulin aspart is safe and effective in children and adolescents with type 1 diabetes

Insulin degludec in combination with bolus insulin aspart is safe and effective in children and adolescents with type 1 diabetes

Patient’s Knowledge Assessment on Diabetes and SelfCare Practices Among Older Adolescents with Type 1 Diabetes Mellitus in Malawi

Coping and Psychosocial Adjustment in Mothers of Young Children With Type 1 Diabetes

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