scholarly journals The impact of blood glucose and HbA1cgoals on glycaemic control in children and adolescents with Type 1 diabetes

2013 ◽  
Vol 30 (3) ◽  
pp. 333-337 ◽  
Author(s):  
M. Boot ◽  
L. K. Volkening ◽  
D. A. Butler ◽  
L. M. B. Laffel
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Children And Adolescents ◽  
The Impact

scholarly journals The impact of “faster aspart” on blood glucose control in children and adolescents with type 1 diabetes treated using a sensor-augmented insulin pump

2021 ◽  
Author(s):  
Jesús González de Buitrago Amigo ◽  
Ana González García ◽  
Paula Díaz Fernández ◽  
Mercedes Fernández Llamas ◽  
María Luz Tejado Bravo ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Children And Adolescents ◽  
Glucose Control ◽  
Insulin Pump ◽  
Blood Glucose Control ◽  
The Impact

Accuracy of Blood Glucose Meters for Self-Monitoring Affects Glucose Control and Hypoglycemia Rate in Children and Adolescents with Type 1 Diabetes

2015 ◽  
Vol 17 (4) ◽  
pp. 275-282 ◽  
Author(s):  
Claudia Boettcher ◽  
Axel Dost ◽  
Stefan A. Wudy ◽  
Marion Flechtner-Mors ◽  
Martin Borkenstein ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Children And Adolescents ◽  
Glucose Control ◽  
Self Monitoring

scholarly journals Hybrid Closed-Loop System Achieves Optimal Perioperative Glycemia in a Boy With Type 1 Diabetes: A Case Report

2021 ◽  
Vol 9 ◽  
Author(s):  
Jesus Dominguez-Riscart ◽  
Nuria Buero-Fernandez ◽  
Ana Garcia-Zarzuela ◽  
Fernando A. Marmolejo-Franco ◽  
Ana C. Perez-Guerrero ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Insulin Infusion ◽  
Closed Loop ◽  
Total Duration ◽  
Blood Glucose Monitoring ◽  
Medical Team ◽  
The Family ◽  
The Impact

The goal in type 1 diabetes (T1D) therapy is to maintain optimal glycemic control under any circumstance. Diabetes technology is in continuous development to achieve this goal. The most advanced Food and Drug Administration- and European Medicines Agency-approved devices are hybrid closed-loop (HCL) systems, which deliver insulin subcutaneously in response to glucose levels according to an automated algorithm. T1D is frequently encountered in the perioperative period. The latest international guidelines for the management of children with diabetes undergoing surgery include specific adjustments to the patient's insulin therapy, hourly blood glucose monitoring, and intravenous (IV) insulin infusion. However, these guidelines were published while the HCL systems were still marginal. We present a case of a 9-year-old boy with long-standing T1D, under HCL system therapy for the last 9 months, and needing surgery for an appendectomy. We agreed with the family, the surgical team, and the anesthesiologists to continue HCL insulin infusion, without further adjustments, hourly blood glucose checks or IV insulin, while monitoring closely. The HCL system was able to keep glycemia within range for the total duration of the overnight fast, the surgery, and the initial recovery, without any external intervention or correction bolus. This is, to the best of our knowledge, the first reported pediatric case to undergo major surgery using a HCL system, and the results were absolutely satisfactory for the patient, his family, and the medical team. We believe that technology is ripe enough to advocate for a “take your pump to surgery” message, minimizing the impact and our interventions. The medical team may discuss this possibility with the family and patients.

The added and interpretative value of CGM-derived parameters in type 1 diabetes depends on the level of glycaemic control.

2020 ◽  
Author(s):  
Helleputte Simon ◽  
De Backer Tine ◽  
Calders Patrick ◽  
Pauwels Bart ◽  
Shadid Samyah ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Glycaemic Control ◽  
Coefficient Of Variation ◽  
Subgroup Analyses ◽  
Time In Range ◽  
Mean Blood Glucose ◽  
Level 2

OBJECTIVE: In type 1 diabetes mellitus (T1DM) management, CGM-derived parameters can provide additional insights, with the concept of time in range (TIR) and other parameters reflecting glycaemic control and variability (GV) being put forward. This study aimed to examine the added and interpretative value of the CGM-derived indices TIR and coefficient of variation (CV%) in T1DM patients stratified according to their level of glycaemic control by means of HbA1c. METHODS: T1DM patients with a minimum disease duration of 10 years and without known macrovascular disease were enrolled. Patients were equipped with a blinded CGM device (Dexcom G4) for seven days. TIR (70–180 mg/dl), time in hypoglycaemia (total: <70 mg/dl; level 2: <54 mg/dl) and hyperglycaemia (total: >180 mg/dl; level 2: >250 mg/dl) were determined, and CV% (=standard deviation(SD)/mean blood glucose(MBG)) was used as parameter for GV. Pearson and Spearman correlations, and regression analysis was used to examine associations. RESULTS: 95 patients (age: 45±10 years; HbAc1: 7.7±0.8%) were included (MBG: 159±31 mg/dl; TIR 55.8±14.9%; CV%: 43.5±7.8%) and labeled as having good (HbA1c ≤7%; n=20), moderate (7–8%; n=44) or poor (>8%; n=31) glycaemic control. HbA1c was significantly associated with MBG (rs=0.48, p<0.001) and time spent in hyperglycaemia (total: rs=0.52; level 2: r=0.46; p<0.001), but not with time in hypoglycaemia and CV%, even after analysis in HbA1c subgroups. Similarly, TIR was negatively associated with HbA1c (r=−0.53; p<0.001), MBG (rs=−0.81; p<0.001) and time in hyperglycaemia (total: rs=−0.90; level 2: rs=−0.84; p<0.001), but not with time in hypoglycaemia. Subgroup analyses, however, showed that TIR did associate with shorter time in level 2 hypoglycaemia in those patients with good (rs=−0.60; p=0.007) and moderate (rs=−0.25; p=0.047) glycaemic control. In contrast, CV% was strongly positively associated with time in hypoglycaemia (total: rs=0.78; level 2: rs=0.76; p<0.001), but not with TIR or time in hyperglycaemia in the entire cohort, although subgroup analyses showed that TIR was negatively associated with CV% in patients with good glycaemic control (r=−0.81, p<0.001) and positively in patients with poor glycaemic control (r=0.47; p<0.01). CONCLUSION: This study demonstrates that CGM-derived metrics TIR and CV% relate with clinically important situations, TIR being strongly dependent on hyperglycaemia and CV% being reflective of hypoglycaemic risk. However, the interpretation and applicability of TIR and CV%, and their relationship, depends on the level of glycaemic control of the individual patient, with CV% generally adding less clinically relevant information in those with poor control. This illustrates the need for further research and evaluation of composite measures of glycaemic control in T1DM. Abbreviations: T1DM = Type 1 diabetes mellitus; CGM = Continuous glucose monitoring; TIR = Time in range; TAR = Time above range; TBR = Time below range; GV = Glycaemic variability; CV% = Coefficient of variation; MBG = Mean blood glucose.

scholarly journals Accurate Carbohydrate Counting Is an Important Determinant of Postprandial Glycemia in Children and Adolescents With Type 1 Diabetes on Insulin Pump Therapy

2016 ◽  
Vol 11 (4) ◽  
pp. 753-758 ◽  
Author(s):  
Asma Deeb ◽  
Ahlam Al Hajeri ◽  
Iman Alhmoudi ◽  
Nico Nagelkerke
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Insulin Pump ◽  
Postprandial Glucose ◽  
Meal Size ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Postprandial Glycemia ◽  
The Impact

Background: Carbohydrate (CHO) counting is a key nutritional intervention utilized in the management of diabetes to optimize postprandial glycemia. The aim of the study was to examine the impact of accuracy of CHO counting on the postprandial glucose in children and adolescents with type 1 diabetes on insulin pump therapy. Methods: Children/adolescents with type 1 diabetes who were on insulin pump therapy for a minimum of 6 months are enrolled in the study. Patients were instructed to record details of meals consumed, estimated CHO count per meal, and 2-hour postprandial glucose readings over 3-5 days. Meals’ CHO contents were recounted by an experienced clinical dietician, and those within 20% of the dietician’s counting were considered accurate. Results: A total of 30 patients (21 females) were enrolled. Age range (median) was 8-18 (SD 13) years. Data of 247 meals were analyzed. A total of 165 (67%) meals’ CHO contents were accurately counted. Of those, 90 meals (55%) had in-target postprandial glucose ( P < .000). There was an inverse relationship between inaccurate CHO estimates and postprandial glucose. Of the 63 underestimated meals, 55 had above-target glucose, while 12 of the 19 overestimated meals were followed by low glucose. There was no association between accuracy and meal size (Spearman’s rho = .019). Conclusion: Accuracy of CHO counting is an important determining factor of postprandial glycemia. However, other factors should be considered when advising on prandial insulin calculation. Underestimation and overestimation of CHO result in postprandial hyperglycemia and hypoglycemia, respectively. Accuracy does not correlate with meal size.

Comparison of breath gases, including acetone, with blood glucose and blood ketones in children and adolescents with type 1 diabetes

2014 ◽  
Vol 8 (4) ◽  
pp. 046010 ◽  
Author(s):  
Tom P J Blaikie ◽  
Julie A Edge ◽  
Gus Hancock ◽  
Daniel Lunn ◽  
Clare Megson ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Blood Glucose ◽  
Children And Adolescents
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