Glucose Control In Adolescents Research Articles

The influencing factors of blood glucose control in adolescents with diabetes: A systematic review

The influencing factors of blood glucose control in adolescents with diabetes: A systematic review

COVID-19 pandemic lockdown in young people with type 1 diabetes: Positive results of an unprecedented challenge for patients through telemedicine and change in use of continuous glucose monitoring

There has been little data published related to glucose control in adolescents and young adults with type 1 diabetes (T1D) during lockdown, but rarely focusing on telemedicine’s role. During this unpreceded period, glucose control and self-monitoring improved in our young patients, with better results associated with telemedicine.

Are We Ready to Treat Our Diabetes Patients Using Social Media? Yes, We Are.

The aim of the study was to evaluate Facebook group as possible communication tool to improve glucose control in adolescents and young people with type 1 diabetes (T1D). This retrospective and cross-sectional study included 728 T1D patients (age 11-25) on continuous subcutaneous insulin infusion (CSII) or multiple daily injections (MDI) treated at the center for insulin pump and glucose sensor in Skopje from January 2012 to December 2017. Data were collected through the electronic medical record system and cross-sectional analysis (telephone, social media (Facebook and Viber) or email). Patients were analyzed in two groups: (a) non-Internet group, with 398 patients treated using standard medical protocol with regular clinic visits; (b) Internet group, with 330 patients who, besides standard medical protocol, were active members of a national closed Facebook group on diabetes. Both the non-Internet and Internet groups had regular visits every 2-3 months. Patients from the Internet group were members of the closed Facebook group "Diabetes Macedonia" and had an opportunity to interact with questions, answers, and comments on diabetes care. An additional analysis was performed of the Internet group on combined use of Facebook and Viber. Average HbA1c levels were compared in both groups. Each patient from the Facebook group had 1.5 ± 3.5 posts per day. Hba1c was significantly lower in patients from the Internet group (7.1 ± 3.2%; 54 ± 35 mmol/mol) compared to patients from the non-Internet group (7.6 ± 2.8%; 60 ± 31 mmol/mol). Social media like Facebook and Viber can be additional communication tool in adolescents and young people with T1D and can significantly lower HbA1c compared to patients without social media use. CSII patients are more likely to use both social media (Facebook and Viber) compared with MDI patients (Facebook only).

The Effect of Self-Care on Glycated Hemoglobin and Fasting Blood Sugar Levels on Adolescents with Diabetes

Background: Type 1 diabetes is a chronic condition that causesmanyproblems for adolescents and their families. Given the increasing prevalence of diabetes and the numerous complications of the disease that require long-term treatment and the need for daily blood glucose control, lifestyle modification and knowledge acquisition regarding self-care behaviors are essential throughout life. Objectives: Considering the increasing prevalence of diabetes, this study evaluated the effect of self-care education on glycosylated Hemoglobin (HbA1c) level and blood glucose control in adolescents with diabetes in Ilam, Iran. Methods: A randomized clinical trial was conducted on patients with type 1 diabetes in Ilam. Patients were assigned randomly to experimental (n = 21) and control (n = 24) groups. A total of seven self-care group training sessions were arranged by the researcher; each session lasted 90 minutes and each group included five people. Patient fasting blood sugar (FBS) and HbA1c levels were measured before and three months after the intervention and analyzed using the SPSS 16.0 software, including descriptive statistics and chi-square, Mann-Whitney, independent t, and paired t-tests. Results: The findings of this study showed that there was no significant difference between the control and experimental groups regarding FBS and HbA1c findings before the intervention. However, compared to the levels before the intervention, the difference was significant in the experimental group yet insignificant in the control group. Conclusions: Thesefindings suggest that nurses should provide patients with this type of training to improve the health of patients with type1 diabetes. © 2018, Journal of Comprehensive Pediatrics.

A single exercise session increases insulin sensitivity in normal weight and overweight/obese adolescents.

We measured the effect of an aerobic exercise session on postprandial glucose control in adolescents with habitually low-physical activity. The goal was to determine if the acute or residual response of exercise was altered in people who are overweight/obese (OW/Ob). Eleven normal weight, body mass index (NW, BMI = 48 ± 13 percentile) and 12 OW/Ob (BMI = 91 ± 5 percentile) participants completed 3 trials. In the no exercise (No Ex) trial, participants rested quietly before and after consuming a test meal. In the other 2 trials, a 45-minute aerobic exercise session was performed either 17-hour (Prior Day Ex) or 40 minutes (Same Day Ex) before the test meal. On all trials, the OW/Ob group had higher fasting glucose (~6%) and insulin (~66%), and lower insulin sensitivity (~9%) than the NW group. The Same Day Ex and Prior Day Ex trials resulted in reduced area under the curve for glucose (6% on both trials, P < .01) and insulin (15% and 13%, respectively, P < .03), and increased insulin sensitivity (8% and 6%, respectively, P < .01). The magnitudes of those effects did not differ between the NW and OW/Ob groups. Plasma fatty acids declined and carbohydrate oxidation increased after the meal, but did not differ among trials or groups. The results demonstrate that moderate intensity aerobic exercise increases insulin sensitivity in NW and OW/Ob adolescents and that the beneficial effects of exercise last up to 17 hours. The acute impact of exercise on metabolic health in adolescents is not impaired in overweight/obese participants.

Self-Control, Daily Negative Affect, and Blood Glucose Control in Adolescents With Type 1 Diabetes.

For adolescents with Type 1 diabetes, maintaining optimal daily blood glucose control is a complex self-regulatory process that likely requires self-control. This study examined whether higher self-control was associated with lower daily negative affect about diabetes and, in turn, better daily blood glucose control, that is, lower mean daily blood glucose (MBG) and smaller standard deviations of daily blood glucose (SDBG), through 2 paths: (1) self-control maintaining lower mean level of negative affect and (2) self-control buffering the association of the number of daily diabetes problems with daily negative affect. Adolescents (M age = 12.87 years) with Type 1 diabetes (n = 180) completed an initial survey containing a self-report measure of self-control. Nightly electronic diaries were completed for 14 days during which adolescents reported daily problems with and negative affect about diabetes and used a study-provided blood glucose meter. Hypotheses were examined through multilevel modeling. Lower mean levels of daily negative affect partially mediated the relation between higher adolescent self-control and lower MBG. Adolescent self-control also buffered the association of the number of daily problems with daily negative affect, and smaller fluctuations in daily negative affect were associated with lower SDBG. Adolescent self-control is associated with daily affect regulatory processes that may influence MBG. However, fluctuations in daily negative affect about diabetes may represent a unique within-subject daily process associated with SDBG. These findings suggest that studies examining daily disease processes and interventions targeting daily affect regulation may be important to improving health in adolescents with Type 1 diabetes. (PsycINFO Database Record

Diabulimia: how eating disorders can affect adolescents with diabetes.

Adherence to self-management and medication regimens is required to achieve optimal blood glucose control in adolescents with type 1 diabetes mellitus. Non-adherence places adolescents at serious risk of short and long-term health complications. Adherence difficulties may be exacerbated by concurrent eating disorders. Diabulimia is a term used to describe the deliberate administration of insufficient insulin to maintain glycaemic control for the purpose of causing weight loss. This article explores the concept of diabulimia and the compounding complications of an eating disorder on maintaining self-management regimens in adolescents with diabetes.

Closed-loop basal insulin delivery over 36 hours in adolescents with type 1 diabetes: randomized clinical trial.

OBJECTIVEWe evaluated the safety and efficacy of closed-loop basal insulin delivery during sleep and after regular meals and unannounced periods of exercise.RESEARCH DESIGN AND METHODSTwelve adolescents with type 1 diabetes (five males; mean age 15.0 [SD 1.4] years; HbA1c 7.9 [0.7]%; BMI 21.4 [2.6] kg/m2) were studied at a clinical research facility on two occasions and received, in random order, either closed-loop basal insulin delivery or conventional pump therapy for 36 h. During closed-loop insulin delivery, pump basal rates were adjusted every 15 min according to a model predictive control algorithm informed by subcutaneous sensor glucose levels. During control visits, subjects’ standard infusion rates were applied. Prandial insulin boluses were given before main meals (50–80 g carbohydrates) but not before snacks (15–30 g carbohydrates). Subjects undertook moderate-intensity exercise, not announced to the algorithm, on a stationary bicycle at a 140 bpm heart rate in the morning (40 min) and afternoon (20 min). Primary outcome was time when plasma glucose was in the target range (71–180 mg/dL).RESULTSClosed-loop basal insulin delivery increased percentage time when glucose was in the target range (median 84% [interquartile range 78–88%] vs. 49% [26–79%], P = 0.02) and reduced mean plasma glucose levels (128 [19] vs. 165 [55] mg/dL, P = 0.02). Plasma glucose levels were in the target range 100% of the time on 17 of 24 nights during closed-loop insulin delivery. Hypoglycemia occurred on 10 occasions during control visits and 9 occasions during closed-loop delivery (5 episodes were exercise related, and 4 occurred within 2.5 h of prandial bolus).CONCLUSIONSDay-and-night closed-loop basal insulin delivery can improve glucose control in adolescents. However, unannounced moderate-intensity exercise and excessive prandial boluses pose challenges to hypoglycemia-free closed-loop basal insulin delivery.

The use of an automated, portable glucose control system for overnight glucose control in adolescents and young adults with type 1 diabetes.

OBJECTIVEA key milestone in progress towards providing an efficacious and safe closed-loop artificial pancreas system for outpatient use is the development of fully automated, portable devices with fault detection capabilities to ensure patient safety. The ability to remotely monitor the operation of the closed-loop system would facilitate future physician-supervised home studies.RESEARCH DESIGN AND METHODSThis study was designed to investigate the efficacy and safety of a fully automated, portable, closed-loop system. The Medtronic Portable Glucose Control System (PGCS) consists of two subcutaneous glucose sensors, a control algorithm based on proportional-integral-derivative with insulin feedback operating from a BlackBerry Storm smartphone platform, Bluetooth radiofrequency translator, and an off-the-shelf Medtronic Paradigm Veo insulin pump. Participants with type 1 diabetes using insulin pump therapy underwent two consecutive nights of in-clinic, overnight, closed-loop control after a baseline open-loop assessment.RESULTSEight participants attended for 16 overnight studies. The PGCS maintained mean overnight plasma glucose levels of 6.4 ± 1.7 mmol/L (115 ± 31 mg/dL). The proportion of time with venous plasma glucose <3.9, between 3.9 and 8 (70 and 144 mg/dL), and >8 mmol/L was 7, 78, and 15%, respectively. The proportion of time the sensor glucose values were maintained between 3.9 and 8 mmol/L was greater for closed-loop than open-loop (84.5 vs. 46.7%; P < 0.0001), and time spent <3.3 mmol/L was also reduced (0.9 vs. 3%; P < 0.0001).CONCLUSIONSThese results suggest that the PGCS, an automated closed-loop device, is safe and effective in achieving overnight glucose control in patients with type 1 diabetes.

Postprandial improvement in insulin sensitivity after a single exercise session in adolescents with low aerobic fitness and physical activity

The purpose of this study was to determine the acute and residual impact of a single exercise bout on meal glucose control in adolescents with habitually low physical activity. Twelve adolescents (seven females/five males, 14 ± 2 yr) completed three trials. One trial [No Exercise (No Ex)] was completed after refraining from vigorous activity for ≥ 3 d. On the other two trials, a 45-min aerobic exercise bout at 75% peak heart rate was performed either 17-h Prior Day Exercise (Prior Day Ex) trial or 1-h Same Day Exercise (Same Day Ex) trial before consuming the test meal (2803 kJ, 45/40/15% energy as carbohydrate/fat/protein, respectively). Compared to No Ex, insulin sensitivity (SI) (minimal model analysis) was increased by 45% (p < 0.03) and 78% (p < 0.01) on the Prior Day Ex and Same Day Ex trials, respectively. This improvement in glucose control was supported by corresponding reductions in the net area under the curve for glucose, insulin, and c-peptide, although there was no change in postprandial suppression of fatty acids. These results show that SI is improved with a single bout of moderate intensity exercise in adolescents with habitually low physical activity and that the residual beneficial effect of exercise lasts at least 17 h. This finding highlights the plasticity of exercise responses in youth and the importance of daily exercise for metabolic health.

Predicting Poor Glucose Control in Adolescents with Type 1 Diabetes

Management of type 1 diabetes during adolescence is challenging. Investigators at a tertiary care, multidisciplinary diabetes clinic identified patterns of control and predictors of deterioration in control in 150 adolescents (age range, 13–18 years) with type 1 diabetes and at least one parent. Half of the adolescents were female, 86% were white, most had two parents, and mean duration of diabetes was 6 years. Outcome measures (HbA1c and frequency of blood glucose monitoring) were assessed four …

Clarifying responsibility for self‐management of diabetes in adolescents using insulin pumps – a qualitative study

To gain insight into and generate theoretical knowledge about the processes involved when insulin pump-treated adolescents take or miss taking their bolus doses. Insulin pump treatment is considered the most physiological way to imitate the healthy body's insulin profile in adolescents with diabetes. Despite insulin pump treatment, it is hard to maintain near-normal glucose control in adolescents; one reason for this is missed bolus doses with meals. In this qualitative interview study, the grounded theory method was chosen as a model for the collection and analysis of data. Twelve adolescents (five boys and seven girls, mean age: 14·4 years, range: 12-19 years) from different Swedish paediatric diabetes clinics, four parents and one paediatric diabetes nurse were interviewed during 2008 and 2009. Two adolescents and two parents were re-interviewed after approximately 10 months. Data from clinical visits and diabetes camps were used to verify emerging categories. Responsibility in the context of taking or missing bolus doses emerged as the core category. It is elaborated and explained through three subcategories: distribution of responsibility, transfer of responsibility and clarification of responsibility. The findings describe the need to clarify the responsibility for diabetes self-management in continuous negotiations between adolescents and parents to avoid missed doses. Negotiations to clarify the responsibility for diabetes self-management must be a continuous process between adolescents and parents. Diabetes care teams can facilitate and encourage these negotiations.

Physical activity and sedentary behavior in adolescents with type 1 diabetes

The purpose of this study was to describe the associations between levels of physical activity measured by accelerometry and changes in fitness, body composition, lipids, and glucose control (i.e., glycosolated hemoglobin [A1C]) in a sample of 16 adolescents with type 1 diabetes participating in a personalized exercise program. More sedentary activity was associated with lower fitness and fat free mass and increased total cholesterol, low-density lipoprotein (LDL-c), and triglycerides (p < .05). Greater amounts of moderate to vigorous activity were associated with higher fitness and fat free mass, and decreased total cholesterol, LDL-c, triglycerides, and A1C (p < .05). Findings support the beneficial effects of increased moderate activity and decreased sedentary behavior to reduce cardiovascular risks and improve glucose control in adolescents with type 1 diabetes.