Exploratory analysis of the relationships among different methods of assessing adherence and glycemic control in youth with type 1 diabetes mellitus

Objectives: The present study examined four methods of assessing diabetes adherence (self-report, diary measure, electronic monitoring, and provider rating) within a population of youth with Type I Diabetes Mellitus (T1DM). Methods: Comparisons were conducted among the four methods of assessing diabetes adherence. Associations among the seven different measures of blood glucose monitoring (BGM) and HbA1c were examined. An exploratory stepwise regression analysis was conducted to determine the best predictors of glycemic control (i.e., Hemoglobin A1c; HbA1c) while controlling for relevant demographic variables. Results: The adherence measures appeared to be interrelated. The relationships between many of the BGM measures and HbA1c demonstrated a medium effect size. The Self Care Inventory (SCI) adjusted global score was the strongest predictor of HbA1c, even after taking the demographic variables into account. Conclusions: The SCI is a robust, easy-to-use, and cost-efficient measure of adherence that has a strong relationship to HbA1c. Demographic variables are important to examine within the context of different methods of assessing adherence. The research methodology utilized to assess both general diabetes adherence and more specific behavioral measurements of BGM should be clearly documented in future studies to ensure accurate interpretation of results. (PsycINFO Database Record (c) 2011 APA, all rights reserved

Effectiveness of Groups for Adolescents With Type 1 Diabetes Mellitus and Their Parents

Peer- and family-based group therapies have been used as separate interventions to improve adjustment and self-management among youth with Type 1 diabetes mellitus. This study replicates a treatment protocol that combined these two types of diabetes management groups, while also using a wait-list control design methodology within an outpatient mental health clinic setting. General psychosocial and diabetes-related variables were assessed at baseline, immediately posttreatment, and 4 months posttreatment. Youths’ medical information, including metabolic control values, was extracted from medical charts for the 6 months prior to baseline and 6 months after treatment ended. At 4 months posttreatment, parents and youth reported increased parent responsibility, and parents reported improved youth diabetes-specific quality of life. Although there were no statistically significant changes in hemoglobin A1c values and health care utilization frequency from 6 months prior to and 6 months posttreatment, other psychosocial changes (i.e., increases in parent responsibility and diabetes-specific quality of life) were documented. Therefore, this treatment was found to be a promising intervention for use in an outpatient clinical setting to aid in improving the psychosocial functioning of youth with Type 1 diabetes mellitus

Use of an Observational Coding System with Families of Adolescents: Psychometric Properties among Pediatric and Healthy Populations

Objective: To examine reliability and validity data for the Family Interaction Macro-coding System (FIMS) with adolescents with spina bifida (SB), adolescents with type 1 diabetes mellitus (T1DM), and healthy adolescents and their families.Methods: Sixty-eight families of children with SB, 58 families of adolescents with T1DM, and 68 families in a healthy comparison group completed family interaction tasks and self-report questionnaires. Trained coders rated family interactions using the FIMS.Results: Acceptable interrater and scale reliabilities were obtained for FIMS items and subscales. Observed FIMS parental acceptance, parental behavioral control, parental psychological control, family cohesion, and family conflict scores demonstrated convergent validity with conceptually similar self-report measures.Conclusions: Preliminary evidence supports the use of the FIMS with families of youths with SB and T1DM and healthy youths. Future research on overall family functioning may be enhanced by use of the FIMS

Beneficial Effects of Flexible Insulin Therapy in Children and Adolescents with Type 1 Diabetes Mellitus

The purpose of this study was to determine the feasibility of a flexible multiple daily insulin (FMDI) regimen in routine pediatric diabetes care by comparing HbA1c, body mass index (BMI), and episodes of severe hypoglycemia (SH) before and after initiation of FMDI therapy. Data from 44 patients (2-16 years old), on a conventional insulin (CI) regimen, were collected during quarterly diabetes clinic visits. These patients were transitioned from CI to FMDI regimen: pre-meal lispro (bolus) and once or twice daily Humulin Ultralente with or without bedtime Humulin NPH as the basal insulin. There was a significant improvement in HbA1c in prepubertal (9.3%+/-1.3% vs. 8.0%+/-1.1%, p\u3c0.002) and pubertal subjects (9.2%+/-1.0% vs. 8.2%+/-0.9%, p\u3c0.001). Pubertal subgroup demonstrated an increase in BMI (21.3+/-3.1 vs. 22.7+/-3.2 kg/m2, p\u3c0.0001) after one year. The rate of SH was decreased in both prepubertal ( p\u3c0.01) and pubertal ( p\u3c0.05) groups of patients on FMDI therapy. The use of FMDI in a general pediatric diabetic population is a feasible therapeutic option for maintenance and possible improvement of glycemic control. It may effectively decrease the HbA1c, and reduce hypoglycemic episodes, without producing an abnormal increase in BMI

Cardiovascular Magnetic Resonance Imaging-Based Computational Fluid Dynamics/Fluid-Structure Interaction Pilot Study to Detect Early Vascular Changes in Pediatric Patients with Type 1 Diabetes

We hypothesized that pediatric patients with type 1 diabetes have cardiac magnetic resonance (CMR) detectable differences in thoracic aortic wall properties and hemodynamics leading to significant local differences in indices of wall shear stress, when compared with age-matched control subjects without diabetes. Pediatric patients with type 1 diabetes were recruited from Children’s Hospital of Wisconsin and compared with controls. All underwent morning CMR scanning, 4-limb blood pressure, brachial artery reactivity testing, and venipuncture. Patient-specific computational fluid dynamics modeling with fluid–structure interaction, based on CMR data, determined regional time-averaged wall shear stress (TAWSS) and oscillatory shear index (OSI). Twenty type 1 diabetic subjects, median age 15.8 years (11.6–18.4) and 8 controls 15.4 years (10.3–18.2) were similar except for higher glucose, hemoglobin A1c, and triglycerides for type 1 diabetic subjects. Lower flow-mediated dilation was seen for those with type 1 diabetes (6.5) versus controls (7.8), p = 0.036. For type 1 diabetic subjects, the aorta had more regions with high TAWSS when compared to controls. OSI maps appeared similar. Flow-mediated dilation positively correlated with age at diabetes diagnosis (r = 0.468, p = 0.038) and hemoglobin A1c (r = 0.472, p = 0.036), but did not correlate with aortic distensibility, TAWSS, or OSI. TAWSS did not correlate with any clinical parameter for either group. CMR shows regional differences in aortic wall properties for young diabetic patients. Some local differences in wall shear stress indices were also observed, but a longitudinal study is now warranted

At-Risk and Recent-Onset Type 1 Diabetic Subjects Have Increased Apoptosis in the CD4+CD25+(high) T-Cell Fraction

BACKGROUND: In experimental models, Type 1 diabetes T1D can be prevented by adoptive transfer of CD4+CD25+ FoxP3+ suppressor or regulatory T cells. Recent studies have found a suppression defect of CD4+CD25+(high) T cells in human disease. In this study we measure apoptosis of CD4+CD25+(high) T cells to see if it could contribute to reduced suppressive activity of these cells. METHODS AND FINDINGS: T-cell apoptosis was evaluated in children and adolescent 35 females/40 males subjects comprising recent-onset and long-standing T1D subjects and their first-degree relatives, who are at variable risk to develop T1D. YOPRO1/7AAD and intracellular staining of the active form of caspase 3 were used to evaluate apoptosis. Isolated CD4+CD25+(high) and CD4+CD25− T cells were co-cultured in a suppression assay to assess the function of the former cells. We found that recent-onset T1D subjects show increased apoptosis of CD4+CD25+(high) T cells when compared to both control and long-standing T1D subjects p<0.0001 for both groups. Subjects at high risk for developing T1D 2–3Ab+ve show a similar trend p<0.02 and p<0.01, respectively. On the contrary, in long-standing T1D and T2D subjects, CD4+CD25+(high) T cell apoptosis is at the same level as in control subjects p = NS. Simultaneous intracellular staining of the active form of caspase 3 and FoxP3 confirmed recent-onset FoxP3+ve CD4+CD25+(high) T cells committed to apoptosis at a higher percentage 15.3±2.2 compared to FoxP3+ve CD4+CD25+(high) T cells in control subjects 6.1±1.7 p<0.002. Compared to control subjects, both recent-onset T1D and high at-risk subjects had significantly decreased function of CD4+CD25+(high) T cells p = 0.0007 and p = 0.007, respectively. CONCLUSIONS: There is a higher level of ongoing apoptosis in CD4+CD25+(high) T cells in recent-onset T1D subjects and in subjects at high risk for the disease. This high level of CD4+CD25+(high) T-cell apoptosis could be a contributing factor to markedly decreased suppressive potential of these cells in recent-onset T1D subjects

Apoptosis of CD4+CD25high T Cells in Type 1 Diabetes May Be Partially Mediated by IL-2 Deprivation

from T1D subjects. in T1D may be caught up in a relatively deficient cytokine milieu. function in subjects predisposed to T1D

Increasing incidence of pediatric type 1 diabetes mellitus in Southeastern Wisconsin: relationship with body weight at diagnosis.

IntroductionSeveral studies have confirmed the increasing rate of type 1 diabetes mellitus (T1DM) in children and the link with increasing BMI at diagnosis termed the 'accelerator hypothesis'. Our objective was to assess whether changing incidence of type 1 diabetes in a group of children and adolescent from the Midwest United States was associated with changes in BMI.MethodsData from 1618 (52.1% M/47.9% F) newly-diagnosed children and adolescents (ResultsAn overall, 10-year cumulative incidence of 27.92 per 100,000 (19.12 to 41.72/100,000) was observed, with an average yearly cumulative incidence of 2.39%. The increase was largest in the younger age groups, 0-4, 5-9, and 10-14 having an average yearly increase of 2.4, 2.3, and 3.0%, respectively, corresponding to a relative 10-year increase of 25.3, 33.8, and 38.0%, respectively. Age at diagnosis was inversely correlated with BMI SDS (pConclusionsAnnual incidence of T1DM increased two-fold at CHW over the 10-year study period. The majority of the increase was observed in the youngest age groups, which also appeared to be the heaviest. This research adds to the growing literature supporting the hypothesis that excess weight gain during childhood may be a risk factor for early manifestation of T1DM