Socioeconomic factors associated with pediatric diabetic ketoacidosis admissions in Southern West Virginia.

OBJECTIVE: Diabetic Ketoacidosis (DKA) is a well-known complication in children with type 1 diabetes mellitus (T1DM) with a mortality rate estimated at 2%. A previous study identified that T1DM children of non-Caucasian race with Medicaid insurance had increased incidence of DKA admissions. The aim of this study is to identify the socioeconomic factors associated with DKA admissions in West Virginia (WV). DESIGN AND METHODS: Retrospective chart review of patients admitted to the paediatric intensive care unit with DKA in Charleston, WV from January 2007-December 2010. Included subjects were 1-18 years of age and those with type 1 diabetes of >6 months duration. Admission rates were compared with the normal population distribution in WV. The data collection tool included multiple socioeconomic factors and HbA1c. RESULTS: We reviewed a total of 167 patients with an admitting diagnosis of DKA; 57% were female, 43% male. Average age was 13.5 years ± 2.7; 56.4% were covered by Medicaid/Chips (WV state insurance) and 43.6% by commercial payers. 11.9% were African American and 88.1% were Caucasian. The average HbA1c was 10.85 ± 2.36%. Higher risks for DKA included those with HbA1c >14%, African American children (OR 17.4, CI 4-73) and children with Medicaid/Chips insurance (OR 9.3, 95% CI 1.1-76.2). CONCLUSIONS: This study identifies socioeconomic factors associated with children admitted for DKA in WV. Patients at higher risk for DKA include those with elevated HbA1c, African American race and those covered by Medicaid/CHIPS (thereby presumed lower socioeconomic status). Findings can be utilized to identify patients at highest risk for DKA and implementation of prevention strategies.

Benefits of expanding behavioral health screening in a pediatric diabetes clinic to include anxiety and caregiver reports in youth 12 years and younger.

INTRODUCTION: Depression and anxiety among youth with Type 1 diabetes (T1D) are associated with poor diabetes management. Further guidance regarding psychosocial screening measures would benefit pediatric integrated care clinics. The purpose of this exploratory study was to examine whether screening for anxiety, assessing caregiver reports, and screening children 12 years old and younger could identify a larger percentage of youth who may benefit from behavioral health support compared to the standard approach of only screening youth 13 and older for depression. METHOD: Sixty-five youth 8-17 years old with T1D (N = 65; M = 13.2 years; 55.4% females) and their caregivers (75% mothers) completed validated self-report and proxy-report depression and anxiety screeners during routine clinic visits between 2019 and 2021. Twenty-seven youth aged 13-17 also completed a measure of diabetes-related distress. RESULTS: The standard approach of screening youth aged 13-17 for depression via self-report identified 25.6% of participants, whereas screening youth ages 8-17 for depression and anxiety via self- and proxy-reports identified 47.7%. Screening for depression/anxiety identified unique portions of youth independent of diabetes distress. DISCUSSION: Utilizing anxiety and proxy-report measures may identify youth likely to benefit from behavioral health support who are not identified when only a self-report depression measure is used in screening. Research should evaluate whether utilizing multiple measures and screening children under 13 years old improve detection and connection to care for youth experiencing difficulty managing diabetes. Early identification and intervention could subsequently mitigate the negative impacts of social-emotional difficulties on diabetes management. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Effectiveness of continuous glucose monitoring in children, adolescents, and young adults with poorly controlled type 1 diabetes.

OBJECTIVE: The purpose of this study was to determine the effect of continuous glucose monitoring (CGM) on glycemic control in children, adolescents, and young adults ages 7-21 years with poorly controlled diabetes HbA1c 9.0% or more (74 mmol/mol IFCC). MATERIALS AND METHODS: The primary outcome was improvement in HbA1c. The secondary outcome included self-reported hypoglycemia. This 12-week study used a prospective, one-group, pre- and posttest pre-experimental design with a convenience sample. The study used the Medtronic Guardian CGM with Enlite Sensor. RESULTS AND CONCLUSIONS: Thirty-three subjects enrolled in the study. The mean age of the participants was 15.57 years, range was 11-20 years, 47.6% were male, and 52.4% were female. Twenty-one (63.6%) completed the final study visit. There was a clinically and statistically significant reduction of 1.46 (SD = 1.6711) (p = .001) in HbA1c at 12 weeks. Fifteen of the 21 participants (71.4%) had an HbA1c reduction of greater than 0.5%. The CGM monitor was worn a mean of 4.262 days a week. None of the subjects reported significant hypoglycemia while wearing the monitor. CGM was effective in improving glycemic control in this population with poorly controlled diabetes.