Nighttime is the worst time: Parental fear of hypoglycemia in young children with type 1 diabetes

BACKGROUND: Fear of hypoglycemia is common in parents of young children with type 1 diabetes (T1D), but little is known about the specific fears that parents most often experience. Hypoglycemia fear has been associated with poorer glycemic control in older children, though not yet studied in a large cohort of very young children. MATERIALS AND METHODS: Parents of 549 children <7 years (mean 5.2 ± 1.2 years [19% <3 years]) with a mean diabetes duration of 2.4 ± 1.0 years (range 1-6 years) and mean HbA1c 8.2% ± 1.1% (66 ± 12 mmol/mol) registered in the T1D Exchange completed the worry scale of the Hypoglycemia Fear Survey modified for parents (HFS-P). RESULTS: Mean parental fear of hypoglycemia worry score was 36.1 ± 23.1 (possible range 0-100), with most frequent worries related to the child having a low while asleep and the child not recognizing a low. The mean worry score was not associated with the child's age, glycemic control, or recent severe hypoglycemic event. Parental worries about lows while sleeping were significantly higher in pump users than non-users (61% vs. 45%; P < .001), and tended to be higher in CGM users than non-users (62% vs 51%; P = .02). CONCLUSIONS: The greatest worries of parents of young children with T1D were related to hypoglycemia during sleep and other times/circumstances during which it would be difficult to detect hypoglycemia. Using advanced diabetes technologies may be an effort to temper fears about hypoglycemia during sleep, though the directionality of this relationship is undetermined. Additional studies can clarify this association and leverage use of diabetes technologies to improve glycemic control

A multinational prospective observational real-world cohort study

Funding Information: The authors thank the ISPAD executive committee and ISPAD JENIOUS members for their support. An abstract with partial study data was presented in June 2021 at the Virtual Advanced Technologies and Treatment for Diabetes (ATTD) conference. There was no commercial sponsor for this study. This study was partially funded by the ISPAD JDRF Fellowship Grant. KD was supported by the Slovenian National Research Agency (grant nos. J3–6798, V3–1505, and P3–0343). Funding Information: ISPAD, Grant/Award Number: ISPAD JDRF Fellowship Grant; Slovenian National Research Agency, Grant/Award Numbers: J36798, V31505, P30343 Funding information Funding Information: KD received honoraria for participation on the speakerʼs bureau of Pfizer, Novo Nordisk, and Eli Lilly. JG received speakerʼs honoraria from Eli Lilly and Sanofi, and clinical trials investigatorʼs payment from Novo Nordisk. RM received advisory board honoraria from Abbott and Novo Nordisk. JP received speakerʼs honoraria from Medtronic. JS serves as a consultant to Cecelia Health, Lexicon, Lilly, Insulet, Medtronic, and Sanofi, is a member of the advisory board for Bigfoot Biomedical, Cecelia Health, Insulet, Medtronic, and the T1D Fund and Vertex, and has had research support from the NIH, JDRF, and the Helmsley Charitable Trust. Her institution has had research support from Medtronic and Insulet. AC received speakerʼs honoraria from Medtronic, Eli Lilly, and Novo Nordisk. TB received speakerʼs honoraria from DexCom, Medtronic, Novo Nordisk, Roche, Sanofi, and Ypsomed, and advisory board honoraria from Ascensia, AstraZeneca, DexCom, Medtronic, and Sanofi.publishersversionpublishe

Continuous glucose monitoring use and glucose variability in very young children with type 1 diabetes ( VibRate ): A multinational prospective observational real‐world cohort study

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“I’m essentially his pancreas”: Parent perceptions of diabetes burden and opportunities to reduce burden in the care of children <8 years old with type 1 diabetes

Background: Across all age groups, management of type 1 diabetes (T1D) places substantial responsibility and emotional burden upon families. This study explored parent perceptions of the burdens of caring for very young children with T1D. Methods: Semi-structured qualitative interviews were conducted with parents (85% mothers) of 79 children with T1D, aged 1 to <8 years old, from four diverse pediatric diabetes clinical centers. Interviews were transcribed, coded, and analyzed using hybrid thematic analysis to derive central themes. Results: Youth (77% White) had T1D for ≥6 months: age (M ± SD) 5.2 ± 1.5 years, diabetes duration 2.4 ± 1.3 years, and A1c 63 ± 10 mmol/mol (7.9 ± 0.9%); 66% used an insulin pump and 61% used CGM. Three major themes emerged related to diabetes burdens: (a) the emotional burden of diabetes on themselves and their children, (b) the burden of finding, training, and trusting effective secondary caregivers to manage the child's diabetes, and (c) suggestions for how more comprehensive, personalized diabetes education from healthcare providers for parents and secondary caregivers could help reduce parent burden and worry. Conclusions: In families with very young children with T1D, parental perceptions of the burden of managing diabetes are common and could be mitigated by tailored education programs that increase parent knowledge, bolster parents' confidence in themselves, and increase trust in their secondary caregivers to manage diabetes. Reduced parental burden and increased caregiver knowledge may positively impact child's glycemic control, as well as improve parent and child quality of life

Time spent outside of target glucose range for young children with type 1 diabetes: a continuous glucose monitor study

Aim To assess the associations between demographic and clinical characteristics and sensor glucose metrics in young children with type 1 diabetes, using masked, continuous glucose monitoring data from children aged 2 to < 8 years. Research design and methods The analysis included 143 children across 14 sites in the USA, enrolled in a separate clinical trial. Eligibility criteria were: age 2 to <8 years; type 1 diabetes duration ≥3 months; no continuous glucose monitoring use for past 30 days; and HbA1c concentration 53 to <86 mmol/mol (7.0 to <10.0%). All participants wore masked continuous glucose monitors up to 14 days. Results On average, participants spent the majority (13 h) of the day in hyperglycaemia (>10.0 mmol/l) and a median of ~1 h/day in hypoglycaemia (<3.9 mmol/l). Participants with minority race/ethnicity and higher parent education levels spent more time in target range, 3.9–10.0 mmol/l, and less time in hyperglycaemia. More time in hypoglycaemia was associated with minority race/ethnicity and younger age at diagnosis. Continuous glucose monitoring metrics were similar in pump and injection users. Conclusions Given that both hypo- and hyperglycaemia negatively impact neurocognitive development, strategies to increase time in target glucose range for young children are needed

Large expert-curated database for benchmarking document similarity detection in biomedical literature search

Document recommendation systems for locating relevant literature have mostly relied on methods developed a decade ago. This is largely due to the lack of a large offline gold-standard benchmark of relevant documents that cover a variety of research fields such that newly developed literature search techniques can be compared, improved and translated into practice. To overcome this bottleneck, we have established the RElevant LIterature SearcH consortium consisting of more than 1500 scientists from 84 countries, who have collectively annotated the relevance of over 180 000 PubMed-listed articles with regard to their respective seed (input) article/s. The majority of annotations were contributed by highly experienced, original authors of the seed articles. The collected data cover 76% of all unique PubMed Medical Subject Headings descriptors. No systematic biases were observed across different experience levels, research fields or time spent on annotations. More importantly, annotations of the same document pairs contributed by different scientists were highly concordant. We further show that the three representative baseline methods used to generate recommended articles for evaluation (Okapi Best Matching 25, Term Frequency-Inverse Document Frequency and PubMed Related Articles) had similar overall performances. Additionally, we found that these methods each tend to produce distinct collections of recommended articles, suggesting that a hybrid method may be required to completely capture all relevant articles. The established database server located at https://relishdb.ict.griffith.edu.au is freely available for the downloading of annotation data and the blind testing of new methods. We expect that this benchmark will be useful for stimulating the development of new powerful techniques for title and title/abstract-based search engines for relevant articles in biomedical research.Peer reviewe

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals &lt;1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Incretin effect determines glucose trajectory and insulin sensitivity in youths with obesity

: In youth with obesity, the gut hormone potentiation of insulin secretion - the incretin effect - is blunted. We explored the longitudinal impact of the incretin effect during pubertal transition on beta cell function and insulin sensitivity. Youths with obesity and 2-h glucose≥120mg/dL underwent a 3-h OGTT and an isoglycemic intravenous glucose infusion to quantify the incretin effect. After 2 years, 30/39 participants had a repeated OGTT and were stratified into three tertiles according to the baseline incretin effect. Thirty participants completed the baseline and follow-up tests. The high-incretin effect group demonstrated a longitudinal increase in beta cell function (DIMM) (p=0.034), with greater insulin sensitivity at follow-up (p=0.034) and stable insulin secretion (φtotal) (p=0.077). A lower incretin effect at baseline was associated with a higher 1-h and 2-h glucose at follow-up (r = -0.558, p=0.001 and r = -0.533, p=0.004). The high-incretin effect group displayed a greater increase of GLP-17-36 than the moderate- and low-incretin group at baseline (p=0.008 and p=0.029), while such a difference did not persist after 2 years. Glucagon suppression was reduced at follow-up in those with low-baseline incretin respect to the high-incretin group (p=0.049)