ISPAD Clinical Practice Consensus Guidelines, Compendium. Assessment and monitoring of glycemic control in children and adolescents with diabetes

Barbara Davis Center, University of Colorado Denver, Aurora, CO 80045-6511, USA.
Pediatric Diabetes (Impact Factor: 2.13). 09/2009; 10 Suppl 12(6):71-81. DOI: 10.1111/j.1399-5448.2009.00582.x
Source: PubMed

ABSTRACT In addition to the IFCC Working Group, an IFFC/ ADA/EASD/IDF Working Group was formed, now with representation from Juvenile Diabetes Research Foundation International. This group has been focused on implementing an international study to document what the clinical world has always thought to be true but never proven: that the A1c assay does indeed reflect an average BG over many months. If the direct relationship can be documented, then the reporting of the assay would include an ’estimated average blood glucose’, or 'A1c-derived average glucose (ADAG)’, and the units would be in mmol/L (or mg/dL) (93, 94). IFFC/ADA/EASD/IDF has issued a Consensus statement (91), with which the Guideline editors agree, stating (i) A1c test results should be standardized worldwide, including the reference system and results reporting; (ii) the new IFCC reference system for A1c represents the only valid anchor to implement standardization of the measurement; (iii) A1c results are to be reported worldwide in derived National Glycohemoglobin Standardization Program (NGSP) units (%) using the NGSP-IFCC master equation and IFCC units (mmol/mol) (Note: this transaction will most likely occur over several years.); (iv) if the ongoing ’average plasma glucose study’ fulfills it's a priori specified criteria, an ADAG value calculated from the A1c result will also be reported as an interpretation of the A1c results; and (v) glycemic goals appearing in clinical guidelines should be expressed in IFCC units, derived NGSP units, and ADAG.

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Available from: Peter Swift, Mar 11, 2014
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    • "The Diabetes Control and Complications Trial (DCCT) and the follow-up Epidemiology of Diabetes Intervention and Complications Study (EDIC) confirmed that intensive insulin treatment could improve glycemic control, reducing or delaying the long-term complications of T1DM, with a persistent benefit [1] [2] [3]. Since these results were published, intensive insulin therapy has been widely applied in clinical practice, almost becoming the standard of care [4] [5] [6]. However, in contrast to the DCCT and EDIC findings, Holl et al. [7] found that the use of intensive therapy did not improve glucose control in clinical practice in 17 European countries. "
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    ABSTRACT: Aims. To determine whether multiple daily injections (MDIs) or continuous subcutaneous insulin infusion (CSII) contributes to better glucose control in children with different type 1 diabetes duration. Methods. Subjects were grouped according to early (≤1 year after disease onset; 1A) or late (1-3 years after onset; 2A) MDIs/CSII treatment initiation. Corresponding control groups (1B, 2B) received insulin injections twice daily. Results. HbA1c levels were consistently lower in group 1A than in group 1B (6 months (T2): 7.37% versus 8.21%; 12 months (T3): 7.61% versus 8.41%; 24/36 months (T4/T5): 7.61% versus 8.72%; all P < 0.05), but were lower in group 2A than in group 2B only at T2 (8.36% versus 9.19%; P = 0.04). Levels were lower in group 1A than in group 2A when disease duration was matched (7.61% versus 8.49%; P < 0.05). Logistic regression revealed no correlation between HbA1c level and MDIs/CSII therapy. HbA1c levels were only negatively related to insulin dosage. Conclusions. Blood glucose control was better in patients receiving MDIs/CSII than in those receiving conventional treatment. Early MDIs/CSII initiation resulted in prolonged maintenance of low HbA1c levels compared with late initiation. MDIs/CSII therapy should be combined with comprehensive management.
    International Journal of Endocrinology 08/2014; 2014:526591. DOI:10.1155/2014/526591 · 1.52 Impact Factor
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    • "The overall purpose of a diabetes regimen is to establish and maintain good metabolic control in order to minimize the risk of long-term complications (Rewers et al., 2009). Only 35% of Swedish children with type 1 diabetes meet the target level for HbA1c (a long-term measure of blood glucose levels) (Hanberger et al., 2008), which increases the risk of complications later in life for a large group of children. "
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    ABSTRACT: The purpose of this study was to analyze how Swedish pediatric diabetes teams perceived and discussed fathers' involvement in the care of their child with type 1 diabetes. It also aimed to discuss how the teams' attitudes towards the fathers' involvement developed during the data collection process. The Constructivist Grounded Theory design was used and data were collected during three repeated focus group discussions with three Swedish pediatric diabetes teams. The core category of the teams' perception of fathers' involvement emerged as: If dad attends, we are happy - if mom doesn't, we become concerned. Initially the teams balanced their perception of fathers' involvement on the mother's role as the primary caregiver. In connection with the teams' directed attention on fathers, in the focus group discussions, the teams' awareness of the importance of fathers increased. As a consequence, the team members began to encourage fathers' engagement in their child's care. We conclude that by increasing the teams' awareness of fathers as a health resource, an active health promotion perspective could be implemented in pediatric diabetes care.
    Nursing and Health Sciences 11/2012; 15(2). DOI:10.1111/nhs.12011 · 0.85 Impact Factor
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    • "International Journal of Pediatrics severe neuroglycopenia generally occur only when blood glucose levels are extremely low (<2.5 mM) or prolonged and can result in acute confusion, disorientation, and clumsiness [6], a situation that is very undesirable from a health and safety perspective. Symptoms of hyperglycemia, on the other hand, may include fatigue, dehydration and blurred vision or may go completely unnoticed by the individual [7]. What is particularly challenging in recognizing hypo-and hyperglycemia in active adolescents with T1DM is that many of the symptoms are also associated with vigorous exercise (increased heart rate, sweating, shakiness, fatigue, dehydration , etc.), thus making increased glucose monitoring critical [3]. "
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    ABSTRACT: Background. Acute hypo- and hyperglycemia causes cognitive and psychomotor impairment in individuals with type 1 diabetes mellitus (T1DM) that may affect sports performance. Objective. To quantify the effect of concurrent and antecedent blood glucose concentrations on sports skills and cognitive performance in youth with T1DM attending a sports camp. Design/Methods. 28 youth (ages 6-17 years) attending a sports camp carried out multiple skill-based tests (tennis, basketball, or soccer skills) with glucose monitoring over 4 days. Glucose levels at the time of testing were categorized as (a) hypoglycemic (<3.6 mM); (b) within an acceptable glycemic range (3.6-13.9 mM); or (c) hyperglycemic (>13.9 mM). Results. Overall, sports performance skill was approximately 20% lower when glucose concentrations were hypoglycemic compared to either acceptable or hyperglycemic at the time of skill testing (P < .05). During Stroop testing, "reading" and "color recognition" also degraded during hypoglycemia, while "interference" scores improved (P < .05). Nocturnal hypoglycemia was present in 66% of subjects, lasting an average of 84 minutes, but this did not affect sports skill performance the following day. Conclusions. Mild hypoglycemia markedly reduces sports skill performance and cognition in young athletes with T1DM.
    International Journal of Pediatrics 08/2010; 2010. DOI:10.1155/2010/216167
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