A randomized controlled trial of telephone calls to young patients with poorly controlled type 1 diabetes

OBJECTIVE: To determine if scheduled telephone calls from a pediatric diabetes educator to children who have type 1 diabetes improve hemoglobin A1c (HbA1c) level, hospital admissions, diabetes knowledge, compliance, and psychological well-being. RESEARCH DESIGN AND METHODS: A randomized controlled trial of 123 young subjects (mean age 11.9 yr, 69 male) with type 1 diabetes (mean duration 3.65 yr). For 7 months, the intervention group held bimonthly 15-30 min scheduled supportive telephone discussions. The primary outcome was change in the HbA1c level. Admission rates and changes in diabetes knowledge, psychological parameters, compliance, and patient perception were measured. RESULTS: There was no significant difference between the treatment and control groups either before or after the intervention. The mean HbA1c level in the control group increased from 8.32 to 8.82% and in the intervention group from 8.15 to 8.85% (p = 0.24). Both groups showed an increase in admissions of 0.2 per yr (p = 0.57). There was no improvement in diabetes knowledge (p = 0.34), compliance, or psychological function. The intervention group viewed their contact with the clinic as more helpful (p = 0.003). Analysis of family function did not reveal subgroups with statistically significant differences. A mean of 13 calls was made to each subject at a cost of 36 Australian dollars per child per month. CONCLUSIONS: Scheduled bimonthly phone support does not improve the HbA1c level, admission rates, diabetes knowledge, psychological function, or self-management but is perceived by patients as helpful. Further study into the effects of more frequent but shorter periods of support for patients experiencing specific difficulties is needed.     

Neurocognitive functioning in preschool‐age children with type 1 diabetes mellitus

Patiño‐Fernández AM, Delamater AM, Applegate EB, Brady E, Eidson M, Nemery R, Gonzalez‐Mendoza L, Richton S. Neurocognitive functioning in preschool‐age children with type 1 diabetes mellitus. Neurocognitive functioning may be compromised in children with type 1 diabetes mellitus (T1DM). The factor most consistently implicated in the long‐term neurocognitive functioning of children with T1DM is age of onset. The pediatric literature suggests that glycemic extremes may have an effect on the neurocognitive functioning of children, but findings are mixed. The purpose of this study was to compare the neurocognitive functioning of young children with T1DM diagnosed before 6 yr of age and healthy children (i.e., without chronic illness). Additionally, in the children with T1DM, we examined the relationship between their neurocognitive functioning and glycemic control. Sixty‐eight (36 with T1DM and 32 without chronic illness) preschool‐age children (M age = 4.4 yr ) were recruited and administered a battery of instruments to measure cognitive, language, and fine motor skills. Children with T1DM performed similar to the healthy controls and both groups' skills fell in the average range. Among children with diabetes, poor glycemic control [higher hemoglobin A1c (HbA1c)] was related to lower general cognitive abilities (r = ?0.44,p < 0.04), slower fine motor speed (r = ?0.64,p < 0.02), and lower receptive language scores (r = ?0.39,p < 0.04). Such findings indicate that young children with T1DM already demonstrate some negative neurocognitive effects in association with chronic hyperglycemia.     

儿童1型糖尿病的诊治与展望

儿童糖尿病主要为儿童1型糖尿病(T1DM),根据我国大中城市的大样本纵向调查,其年发病率增幅约为世界平均增幅的3倍,5岁以下儿童增幅较高,提示我国儿童T1DM低龄化趋势。T1DM的病因机制复杂,遗传易感和环境因素促发是其发病的主要原因。年幼起病、长病程、血糖控制欠佳除导致糖尿病慢性并发症高发外,还影响患儿精神运动发育。药物治疗、血糖监测、健康教育、运动和营养管理是儿童T1DM良好血糖控制的根本举措。人工胰腺、干细胞胰岛分化与移植、免疫干预未来有可能从根本上改善未来T1DM的治疗和预后。     

Changes in management and outcomes for children and adolescents with type 1 diabetes over the last 50 years

Over the 50 years from 1964 to 2014, outcomes for children with type 1diabetes have improved significantly, because of both technological advancements and changes in management philosophy. For the child with type 1 diabetes in 2014, intensive management with multiple daily injections or insulin pump therapy and the support of a specialist multidisciplinary team is now standard care. The main treatment goal is no longer the avoidance of hypoglycaemia, but the minimisation of hyperglycaemia and glucose variability, thereby reducing the risk of microvascular complications. However, the inherent burden of care and diligence required by patients and families, if they are to maintain optimal diabetes control, have not changed and may even have increased. While the long sought‐after cure for diabetes remains elusive, artificial pancreas or closed‐loop systems hold the most promise for improving the burden of care in the near term for children and adolescents with type 1 diabetes.     

Children diagnosed with type 1 diabetes: a randomized controlled trial comparing hospital versus home-based care

Aim: To compare two different regimens for children diagnosed with type 1 diabetes: hospital‐based care or hospital‐based home care (HBHC), referring to specialist care in a home‐based setting. Method: The trial took place in Sweden with a randomized controlled design and included 60 children, aged 3–15 years. After 2–3 days with hospital‐based care, children were randomized to either continued hospital‐based care or to HBHC for 6 days. The primary outcome was the child’s metabolic control after 2 years. Secondary outcomes were set to evaluate the family and child situation as well as the healthcare services. This article presents data 6 months after diagnosis. Results: Results showed equivalence between groups in terms of metabolic control, insulin dose, parents’ employment and working hours as well as parents’ and significant others’ absence from work related to the child’s diabetes. Parents in the HBHC were more satisfied with the received health care and showed less subsequent healthcare resource use. The level of risk for the family’s psychosocial distress assessed at diagnosis was associated with the subsequent use of resources, but not with metabolic control. Conclusion: HBHC was found to be an equally safe and effective way of providing care as hospital‐based care at the onset of type 1 diabetes for children who are medically stable.