Glycemic control in youth with diabetes: The SEARCH for diabetes in Youth Study

Biomedical Informatics, Arizona State University, Phoenix, AZ, USA.
The Journal of pediatrics (Impact Factor: 3.79). 07/2009; 155(5):668-72.e1-3. DOI: 10.1016/j.jpeds.2009.05.025
Source: PubMed


To assess correlates of glycemic control in a diverse population of children and youth with diabetes.
This was a cross-sectional analysis of data from a 6-center US study of diabetes in youth, including 3947 individuals with type 1 diabetes (T1D) and 552 with type 2 diabetes (T2D), using hemoglobin A(1c) (HbA(1c)) levels to assess glycemic control.
HbA(1c) levels reflecting poor glycemic control (HbA(1c) >or= 9.5%) were found in 17% of youth with T1D and in 27% of those with T2D. African-American, American Indian, Hispanic, and Asian/Pacific Islander youth with T1D were significantly more likely to have higher HbA(1c) levels compared with non-Hispanic white youth (with respective rates for poor glycemic control of 36%, 52%, 27%, and 26% vs 12%). Similarly poor control in these 4 racial/ethnic groups was found in youth with T2D. Longer duration of diabetes was significantly associated with poorer glycemic control in youth with T1D and T2D.
The high percentage of US youth with HbA(1c) levels above the target value and with poor glycemic control indicates an urgent need for effective treatment strategies to improve metabolic status in youth with diabetes.

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    • "Young adults, during the period known as emerging adulthood (18–25 years) (Arnett, 2000), have unique needs and face different challenges in comparison with other age groups (Balfe et al., 2013; Garvey & Wolpert, 2011). The implications of living with type 1 diabetes for young adults and the service providers working with them are reflected in growing evidence demonstrating poor physiological (Petitti et al., 2009; The National Health Service Information Centre, 2011), psychological (Hislop, Fegan, Schlaeppi, Duck, & Yeap, 2008; Johnson, Elliott, Scott, Heller, & Eiser, 2014), and behavioural (Goebel-Fabbri et al., 2008; Morris et al., 1997; Sparud-Lundin, € Ohrn, Danielson, & Forsander, 2008) outcomes. Therefore, researchers and service providers have called for a new treatment paradigm to inform service delivery for young adults with type 1 diabetes (Balfe et al., 2013; Dovey-Pearce, Hurrell, May, Walker, & Doherty, 2005; Garvey & Wolpert, 2011). "
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    ABSTRACT: Young adulthood is a time of significant challenges and risks for people with type 1 diabetes. Poor outpatient clinic attendance is common among young adults with type 1 diabetes. The aim of this qualitative study was to develop a theory explaining attendance at a hospital-based diabetes clinic. Using a grounded theory methodology, data were collected through semi-structured qualitative interviews. Twenty-nine people (21 young adults with type 1 diabetes and eight service providers) from one hospital-based diabetes clinic were interviewed. Interviews were audio-recorded, transcribed, and analysed according to grounded theory methodology. Relationships between young adults and service providers is the core category of this theory. Collaborative relationships between young adults and service providers increased the perceived value of attendance and reduced the vulnerability of young adults to the barriers within the existing service, such as meeting unfamiliar service providers. Relationships between young adults and service providers were developed following opportunities for contact (e.g., structured education programme or crisis of diabetes), and facilitated engagement with the service and further attendance. Barriers to clinic attendance included young adults' negative perceptions of their diabetes self-management and a lack of value associated with attending. The diabetes clinic was described as an important and valued resource by young adults and service providers. Collaborative relationships between young adults and service providers enhanced service provision in this study. According to the results of this study, clinic attendance may be improved by increasing opportunities for relationship development between service providers and young adults. Statement of contribution What is already known on this subject? Attendance by young adults at hospital-based diabetes clinics is important to support self-management. Young adults with type 1 diabetes are at risk of clinic non-attendance. What does this study add? This study presents an explanatory theory of clinic attendance among young adults with type 1 diabetes. According to this theory: Barriers within existing models of service delivery prevent collaboration and may contribute to non-attendance. Relationships between service users and providers can establish or maintain regular clinic attendance by fostering the engagement of young adults with diabetes clinics. © 2015 The British Psychological Society.
    British Journal of Health Psychology 06/2015; 20(4). DOI:10.1111/bjhp.12145 · 2.70 Impact Factor
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    • "Insulin remains the lifesaving treatment for type 1 diabetes and is also required by many patients with type 2 diabetes. However, despite the recent advances in diabetes management , including the new long-and rapid-acting insulin analogs and insulin intensification strategies such as basal/bolus or insulin pump therapy, at least 50% of the type 1 diabetes patients in pediatric age exhibits poor glycemic control and fails to reach or maintain target glycosylated hemoglobin (HbA1c) values, putting them at increased risk for vascular complications [3]. Observational studies have clearly linked the quality of glycemic control (expressed as HbA1c) with the frequency of daily selfmonitored blood glucose (SMBG) tests in insulin-treated patients [4]. "
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    ABSTRACT: Type 1 diabetes care may be very costly not only in terms of money but also in terms of psychological and therapeutic acceptance and compliance. Recently, a lot of new technologies have been introduced in the care of patients with type 1 diabetes that should allow them to achieve an improvement in glycemic control, quality of life and above all prevent long-term complications. Combining continuous glucose monitoring (CGM) and continuous subcutaneous insulin infusion (CSII) provides a more useful tool for patients with type 1 diabetes, the sensor-augmented pump (SAP). The aim of the present review is to explore SAP efficacy and safety in young patients with type 1 diabetes. SAP demonstrated increased efficacy in lowering glycated hemoglobin when compared either to multiple daily injections or CSII alone. Its efficacy is positively associated with CGM use, baseline HbA1c and patients' age. According to currently available evidence, SAP seems sufficiently safe, effective and beneficial in improving glycemic control in pediatric patients with type 1 diabetes. Moreover, encouraging results using semi-closed loop systems are emerging, paving the way towards a fully-automated artificial pancreas. As pediatric diabetologists we have the duty to offer our patients the best therapeutic option currently available, supported by evidence, to help them gain the best results with the fewest adverse effects (hypoglycemia and/or diabetic ketoacidosis), better if chomping a little piece of dark chocolate. Copyright © 2015. Published by Elsevier Ltd.
    Pharmacological Research 03/2015; 98. DOI:10.1016/j.phrs.2015.03.001 · 4.41 Impact Factor
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    • "Parental education did not have an effect on glycemic control or CVD risk prolife. Our questionnaire, as in the SEARCH study [17], did not identify the parent associated with each education level, which is a limitation in our study as analyses could not be done to determine effect based on paternal or maternal education level. Previous studies have shown an effect based on paternal, but not maternal education level [15,16] and not distinguishing between these two may have contributed to the lack of associations in this study. "
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    ABSTRACT: Background Adult studies have shown a correlation between low socioeconomic status and Type 1 Diabetes complications, but studies have not been done in children to examine the effect of socioeconomic status on risk for future complications. This study investigates the relationship between insurance status and parental education and both glycemic control and cardiovascular disease (CVD) risk factors in youth with type 1 diabetes. Methods A cross-sectional study of 295 youth with established type 1 diabetes who underwent examination with fasting blood draw and reported insurance status and parental education. Results Youth with type 1 diabetes and public insurance had higher hemoglobin A1c (HbA1c), body mass index, hs-CRP, and blood pressure (p < 0.05) than those with private insurance. Insulin regimen varied between insurance groups, and differences in HbA1c and CVD risk factors, except for diastolic blood pressure (DBP), were no longer evident after controlling for insulin regimen. Parental education was not associated with HbA1c or CVD risk factors. Conclusions Youth with type 1 diabetes and public insurance have worse glycemic control and elevated CVD risk factors compared to those with private insurance, but this was no longer seen when insulin regimen was controlled for. Further research is needed to look at differences between those with public insurance and private insurance that contribute to differences in type 1 diabetes outcomes, and to identify modifiable risk factors in pediatric patients in order to focus earlier interventions to decrease and prevent future diabetes complications.
    Journal of Diabetes and Metabolic Disorders 05/2014; 13(1):59. DOI:10.1186/2251-6581-13-59
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