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- Adolfsson, Peter, 1963, et al.
(author)
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Continuous subcutaneous insulin infusion: Special needs for children.
- 2017
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In: Pediatric diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 18:4, s. 255-261
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Journal article (peer-reviewed)abstract
- Continuous subcutaneous insulin infusion (CSII) is a very common therapy for children with type 1 diabetes. Due to physiological differences they have other requirements for their insulin pump than adults. The main difference is the need for very low basal rates. Even though most available insulin pumps reach a high accuracy at usual basal rates, accuracy decreases for lower rates. In addition, the lowest delivered amount at 1 time is limiting the fine tuning of the basal rate as well as the option for temporary basal rates. Alarms in case of occlusions depend on accumulation of a certain amount of insulin in the catheter, and therefore the time until such an alarm is triggered is much longer with lower basal rates. Accordingly, the risk for hyperglycemia developing into diabetic ketoacidosis increases. The availability of bolus advisors facilitates the calculation of meal and correction boluses for children and their parents. However, there are some differences between the calculators, and the settings that the calculation is based on are very important. Better connectivity, for example with a system for continuous glucose monitoring, might help to further increase safety in the use of CSII in children. When selecting an insulin pump for a child, the features and characteristics of available pumps should be properly compared to ensure an effective and safe therapy.
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| 2. |
- Anderson, B. J., et al.
(author)
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Factors associated with diabetes-specific health-related quality of life in youth with type 1 diabetes: The global teens study
- 2017
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In: Diabetes Care. - : American Diabetes Association. - 0149-5992 .- 1935-5548. ; 40:8, s. 1002-1009
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Journal article (peer-reviewed)abstract
- OBJECTIVE Our objective was to characterize diabetes-specific health-related quality of life (D-HRQOL) in a global sample of youth and young adults with type 1 diabetes (T1D) and to identify the main factors associated with quality of life. RESEARCH DESIGN AND METHODS The TEENs study was an international, cross-sectional study of youth, 8-25 years of age, with T1D. Participants (N= 5,887)were seen in clinical sites in 20 countries across 5 continents enrolled for 3 predetermined age groups: 8-12, 13-18, and 19-25 years of age. To assess D-HRQOL, participants completed the PedsQL DiabetesModule 3.0 and were interviewed about family-related factors. Specifics about treatment regimen and self-management behaviors were collected from medical records. RESULTS Across all age groups, females reported significantly lower D-HRQOL than didmales. The 19-25-year age group reported the lowest D-HRQOL. Multivariate linear regression analyses revealed that D-HRQOL was significantly related to HbA1c; the lower the HbA1c, the better the D-HRQOL. Three diabetes-management behaviors were significantly related to better D-HRQOL: advanced methods used to measure food intake;more frequent daily blood glucose monitoring; and more days per week that youth had 30 min of physical activity. CONCLUSIONS In all three age groups, the lower the HbA1c, the better the D-HRQOL, underscoring the strong association between better D-HRQOL and optimal glycemic control in a global sample of youth and young adults. Three diabetes-management behaviors were also related to optimal glycemic control, which represent potentially modifiable factors for clinical interventions to improve D-HRQOL as well as glycemic control.
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| 3. |
- Charalampopoulos, Dimitrios, et al.
(author)
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Exploring Variation in Glycemic Control Across and Within Eight High-Income Countries: A Cross-sectional Analysis of 64,666 Children and Adolescents With Type 1 Diabetes
- 2018
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In: Diabetes Care. - : AMER DIABETES ASSOC. - 0149-5992 .- 1935-5548. ; 41:6, s. 1180-1187
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Journal article (peer-reviewed)abstract
- OBJECTIVE International studies on childhood type 1 diabetes (T1D) have focused on whole-country mean HbA(1c) levels, thereby concealing potential variations within countries. We aimed to explore the variations in HbA(1c) across and within eight high-income countries to best inform international benchmarking and policy recommendations. RESEARCH DESIGN AND METHODS Data were collected between 2013 and 2014 from 64,666 children with T1D who were amp;lt; 18 years of age across 528 centers in Germany, Austria, England, Wales, U.S., Sweden, Denmark, and Norway. We used fixed-and random-effects models adjusted for age, sex, diabetes duration, and minority status to describe differences between center means and to calculate the proportion of total variation in HbA(1c) levels that is attributable to between-center differences (intraclass correlation [ICC]). We also explored the association between within-center variation and childrens glycemic control. RESULTS Sweden had the lowest mean HbA(1c) (59mmol/mol [7.6%]) and together with Norway and Denmark showed the lowest between-center variations (ICC amp;lt;= 4%). Germany and Austria had the next lowest mean HbA(1c) (61-62 mmol/mol [7.7-7.8%]) but showed the largest center variations (ICC similar to 15%). Centers in England, Wales, and the U.S. showed low-to-moderate variation around high mean values. In pooled analysis, differences between counties remained significant after adjustment for children characteristics and center effects (P value amp;lt; 0.001). Across all countries, children attending centers with more variable glycemic results had higher HbA(1c) levels (5.6mmol/mol [0.5%] per 5mmol/mol [0.5%] increase in center SD of HbA(1c) values of all children attending a specific center). CONCLUSIONS A tsimilar average levels of HbA(1c), countries display different levels of center variation. The distribution of glycemic achievement within countries should be considered in developing informed policies that drive quality improvement.
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| 5. |
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| 6. |
- Enander, Rebecka, et al.
(author)
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Beta cell function after intensive subcutaneous insulin therapy or intravenous insulin infusion at onset of type 1 diabetes in children without ketoacidosis.
- 2018
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In: Pediatric diabetes. - : Hindawi Limited. - 1399-5448 .- 1399-543X. ; 19:6, s. 1079-1085
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Journal article (peer-reviewed)abstract
- Our aim was to see if IV insulin therapy at diagnosis preserves beta-cell function better than multiple subcutaneous (SC) injections.Fifty-four children 9.9 ± 3.5years (range 2.8-14.9) without ketoacidosis were included in a 2years, randomized multicenter study with insulin SC or 48 to 72hours IV initially. Thirty-three (61%) were boys, 22 (41%) were pubertal. Forty-eight subjects completed 12 months follow-up and 43 completed 24 months. At 1, 6, 12, and 24 months, hemoglobin A1c (HbA1c), C-peptide and insulin/kg/24 h were measured. At 24 months, a mixed-meal tolerance test (MMTT) was performed.HbA1c at diagnosis was 10.7%, (93mmol/mol) for IV, 10.7%, (94mmol/mol) for SC. During the first 2 full days of insulin therapy, mean plasma glucose was 8.2 mmol/L for IV, 9.5 for SC (P =.025). Mean insulin dose was 1.5 U/kg/d for IV vs 1.0 for SC (P =.001). Sixteen (7 in IV, 9 in SC group) started with insulin pumps during the follow-up. At 24 months, we saw no significant differences: HbA1c (7.5%, 58mmol/mol, for IV, 7.2%, 55mmol/mol, for SC; ns), insulin doses (0.79 vs 0.88U/kg/d; ns), fasting C-peptide (0.08 vs 0.12nmol/L; ns), maximal MMTT response (0.19 vs 0.25nmol/L; ns) and AUC (18.26 vs 23.9 nmol/L*min; ns). Peak C-peptide >0.2 nmol/L in the combined IV and SC groups correlated significantly with HbA1c and C-peptide at onset in a multiple regression.Residual beta cell function at 2years seems to be independent from initial insulin regimens but related to HbA1c and C-peptide at onset.
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| 8. |
- Haby, Karin, 1960, et al.
(author)
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Lifestyle intervention in pregnant women with BMI ≥30
- 2018
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In: NEON, The Network in Epidemiology and Nutrition. From evidence to practice. April 18-19 2018.
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Conference paper (other academic/artistic)abstract
- Background Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes. Methods The intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790). Results In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG <7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (-0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population. Conclusion Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.
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| 9. |
- Haby, Karin, 1960, et al.
(author)
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Mighty Mums - a Lifestyle intervention at primary care level reduces gestational weiht gain in women with obesity
- 2018
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In: BMC Obesity. - : Springer Science and Business Media LLC. - 2052-9538. ; 5:16
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Journal article (peer-reviewed)abstract
- Background Obesity (BMI ≥30) during pregnancy is becoming an increasing public health issue and is associated with adverse maternal and perinatal outcomes. Excessive gestational weight gain (GWG) further increases the risks of adverse outcomes. However, lifestyle intervention can help pregnant women with obesity to limit their GWG. This study evaluated whether an antenatal lifestyle intervention programme for pregnant women with obesity, with emphasis on nutrition and physical activity, could influence GWG and maternal and perinatal outcomes. Methods The intervention was performed in a city in Sweden 2011–2013. The study population was women with BMI ≥30 in early pregnancy who received standard antenatal care and were followed until postpartum check-up. The intervention group (n = 459) was provided with additional support for a healthier lifestyle, including motivational talks with the midwife, food advice, prescriptions of physical activity, walking poles, pedometers, and dietician consultation. The control group was recruited from the same (n = 105) and from a nearby antenatal organisation (n = 790). Results In the per-protocol population, the intervention group had significantly lower GWG compared with the control group (8.9 ± 6.0 kg vs 11.2 ± 6.9 kg; p = 0.031). The women managed to achieve GWG <7 kg to a greater extent (37.1% vs. 23.0%; p = 0.036) and also had a significantly lower weight retention at the postpartum check-up (-0.3 ± 6.0 kg vs. 1.6 ± 6.5 kg; p = 0.019) compared to the first visit. The most commonly used components of the intervention, apart from the extra midwife time, were support from the dietician and retrieval of pedometers. Overall compliance with study procedures, actual numbers of visits with logbook activity, and dietician contact correlated significantly with GWG. There was no statistically significant difference in GWG (10.3 ± 6.1 kg vs. 11.2 ± 6.9 kg) between the intervention and control groups in the intention-to-treat population. Conclusion Pregnant women with obesity who follow a lifestyle intervention programme in primary health care can limit their weight gain during pregnancy and show less weight retention after pregnancy. This modest intervention can easily be implemented in a primary care setting.
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| 10. |
- Haby, K., et al.
(author)
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Mighty Mums - An antenatal health care intervention can reduce gestational weight gain in women with obesity
- 2015
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In: Midwifery. - : Elsevier BV. - 0266-6138. ; 31:7, s. 685-692
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Journal article (peer-reviewed)abstract
- Background: overweight and obesity are growing public health problems and around 13% of women assigned to antenatal health care (ARC) in Sweden have obesity (Body Mass Index, BMI >= 30). The risk of complications during pregnancy and childbirth increase with increasing BMI. Excessive gestational weight gain (GWG) among obese women further increases the risks of adverse pregnancy outcomes. In this pilot-study from ARC in Gothenburg, a co-ordinated project with standardised care, given by midwives and supported by dietitian and aiming at reducing weight gain in obese pregnant women, is evaluated. Objective: to evaluate the effects of a behavioural intervention programme for women with BMI 30, with emphasis on nutrition and physical activity, with regards to GWG and effect on weight at the post partum check-up. Methods: in the pilot study, the intervention group consisted of the first 50 enrolled obese pregnant women in a large life style project within the AHC in Gothenburg. The control group consisted of 50 obese pregnant women in the same city. The intervention included 60 minutes extra time with the midwife and also offered food discussion group, walking poles and pedometers. The intervention group was prescribed physical activity and could choose from food advice with different content. If needed, the woman was offered referral to the dietitian for a personal meeting. A network was formed with the surrounding community. Outcome measures were GWG, weight change at the postnatal check-up compared with when signing in to antenatal health care, and change in BMI during the same period. Findings: women in the intervention group had a significantly lower GWG (8.6 +/- 49 kg versus 12.5 +/- 5.1 kg; p=0.001) and a significantly lower weight at the postnatal check up versus the first contact with ARC (-0.2 +/- 5.7 kg versus +2.0 +/- 4.5 kg; p=0.032), as well as a decrease in BMI (-0.04 +/- 2.1 versus +0.77 +/- 2.0; p=0.037). More women in the intervention than in the control group managed GWG < 7 kg [18 (36%) versus 8(16%), p=0.039]. Conclusion: obese pregnant women adhering to a standardised life style project in primary care using restricted resources can limit their weight gain during pregnancy, and show less weight retention after pregnancy compared to controls. (C) 2015 Elsevier Ltd. All rights reserved.
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