Evaluation of a combined blood glucose monitoring and gaming system (Didget®) for motivation in children, adolescents, and young adults with type 1 diabetes.

The purpose of this study was to assess the performance and acceptability of a blood glucose meter coupled with a gaming system for children, adolescents, and young adults with type 1 diabetes. During an in-clinic visit, duplicate blood samples were tested by subjects (N = 147; aged 5-24 yr) and health care providers (HCPs) to evaluate the accuracy and precision of the Didget® system. Subjects' meter results were compared against Yellow Springs Instruments (YSI) reference results and HCP results using least squares regression and error grid analyses. Precision was measured by average within-subject and within-HCP coefficient of variation (CV). During the home-use component of this study, subjects (n = 58) tested their blood glucose at least two to three times daily for 3-5 d to evaluate routine use of the system. Subjects' meter results showed significant correlations with both YSI (r(2) = 0.94; p < 0.001 for regression slope) and HCP results (r(2) = 0.96; p < 0.001). Average within-subject and within-HCP CVs were 5.9 and 7.2%, respectively. Overall satisfaction was assessed by subjects, their parents or guardians, and HCP surveys. Subject satisfaction with the Didget® system was good to excellent; most subjects found the system easy to use, motivating, and helpful for building good blood glucose monitoring habits. Most HCPs agreed that the system fulfilled a need in diabetes management. In conclusion, the Didget® system was precise and clinically accurate in the hands of children, adolescents, and young adults with type 1 diabetes.

Relationship of highly sensitive C-reactive protein and lipid levels in adolescents with type 1 diabetes mellitus.

BACKGROUND: Atherosclerosis appears to begin in youth with type 1 diabetes mellitus (T1DM). Highly sensitive C-reactive protein (hsCRP) is an independent marker of cardiovascular disease (CVD) risk in adults, but its relation to dyslipidemia and other CVD risk factors in adolescents with T1DM is unknown. OBJECTIVE: To study the association between lipids and hsCRP in youth with T1DM. DESIGN: Cross-sectional cohort. METHODS: hsCRP and fasting lipids were measured in 74 patients with T1DM, mean age 16.2 +/- 2.62 yr, mean duration of diabetes 7.3 +/- 4.0 yr, and mean hemoglobin A1c (HbA1c) 8.5 +/- 1.3%. According to the American Heart Association/Centers for Disease Control recommendations, hsCRP values were divided into three groups: group 1: <1.0 mg/L, low CVD risk; group 2: 1.0-3.0 mg/L, average CVD risk; and group 3: >3 mg/L, high CVD risk. Univariate linear regression between hsCRP and lipid and clinical parameters was used, with adjustment for age. RESULTS: hsCRP was significantly associated with triglycerides (Tg), apoB, systolic blood pressure (SBP), and diastolic blood pressure (DBP). Subjects in the high CVD risk group had no further worsening of lipids or BP, except for a higher Tg level. ApoB, SBP, and DBP were elevated in females with hsCRP > or =1 compared with the low-risk group, and high-density lipoprotein was decreased. In males, this difference was only significant for SBP. CONCLUSIONS: Elevation of hsCRP to a level > or =1.0 mg/L appears to be associated with elevated lipid levels in adolescents with T1DM, particularly in females. hsCRP is a marker in youth that clusters with dyslipidemia and may indicate an increased CVD risk in youth with T1DM.

Feasibility of a hospital-based, family-centered intervention to reduce weight gain in overweight children and adolescents.

OBJECTIVE: To evaluate the effects of a hospital-based, family-centered lifestyle program (Kids N Fitness) on weight and health in overweight 7-17-year-old children. DESIGN: The Kids N Fitness program consisting of up to twelve 90-min sessions was conducted in an outpatient setting. The program comprised interactive nutrition and exercise sessions with behavior modification. Subjects completed a logbook and child's health questionnaire. Measures and surveys were taken before, during, and after the program. PARTICIPANTS: Two hundred and sixty-four overweight children (137 female, 73% Hispanic), mean age 11.5+/-2.1 years, with body mass index (BMI)=85th percentile, no physical limitations, and attendance of >or=50% of sessions. A subgroup of 115 children was observed for up to 6 months prior to program. INTERVENTION RESULTS: Weight and BMI velocity, and BMI, and BMI z-score were lower during the program than during the pre-program observation period. Compared, subjects in the 12-week program had significantly reduced gains in weight and greater losses in body mass index, than in 8 weeks. Improvements in emotional well-being and behavior correlated positively with weight loss (p=0.005). CONCLUSIONS: Positive health outcomes suggest that family-centered programs, stressing healthy eating strategies, participation in team-oriented physical activities, and behavior modification, are effective in improving weight dynamics and psychological functioning.

A pilot trial in pediatrics with the sensor-augmented pump: combining real-time continuous glucose monitoring with the insulin pump.

Real-time continuous glucose monitoring and the insulin pump have been combined into the Sensor-Augmented Pump system (Medtronic MiniMed, Northridge, CA). This short-term pilot trial demonstrated that pediatric subjects with type I diabetes improved mean hemoglobin A1c (A1c) and glucose levels and reduced hypoglycemia and hyperglycemia using the Sensor-Augmented Pump system.

Nocturnal hypoglycemia detected with the Continuous Glucose Monitoring System in pediatric patients with type 1 diabetes.

OBJECTIVE: To use the Continuous Glucose Monitoring System (CGMS, MiniMed, Sylmar, Calif) to determine if bedtime blood glucose levels were associated with the occurrence of nocturnal hypoglycemia. STUDY DESIGN: Patients (n = 47, 18 boys, mean age 11.8 +/- 4.6 years) with type 1 diabetes used CGMS for 167 nights. Data were analyzed for glucose 100 mg/dL and 150 mg/dL. RESULTS: A glucose value of 100 mg/dL, P = NS), and no bedtime glucose value between 110 and 300 mg/dL decreased the incidence of nocturnal hypoglycemia to

Case management: an evaluation at Childrens Hospital Los Angeles.

This prospective, quantitative, and qualitative evaluation of the case management program at CHLA clearly demonstrated the value of professional service coordination of care for children with complex, special health needs. Most specifically, the program documented improvement in three discrete areas of evaluation: 1. Financial, with decreased unnecessary expenditures and increased revenue. 2. Patient satisfaction, documented with validated questionnaires. 3. Clinical process improvement, using quantifiable clinical outcomes. At the very least, case management is an extremely valuable service in the present managed health care environment, and may in fact be indispensable.

Characteristics of glycemic control in young children with type 1 diabetes.

BACKGROUND: The Diabetes Control and Complications Trial (DCCT) demonstrated that the rate-limiting step to the intensification of diabetes management in adolescents and adults was hypoglycemia. Young children were presumed to be at even greater risk for hypoglycemia with severe consequences, particularly if they had HbA1c levels < 8%. SUBJECTS: A retrospective chart review was performed on 148 patients with type 1 diabetes on insulin injection therapy who were < 8 yr of age (mean age 5.7 +/- 1.5, mean diabetes duration 3.0 +/- 1.4 yr) followed quarterly from July 1999 to June 2001. METHODS: The subjects were divided into two groups based on their mean HbA1c values (< 8 vs. > or = 8%) averaged over the 2-yr time period. The following variables were analyzed comparing the two groups: age, duration of diabetes, insulin dose, severe hypoglycemic episodes, episodes of diabetic ketoacidosis (DKA), percentage of glucose levels above, within, and below the target range, and number of diabetes home-management competencies obtained. RESULTS: Patients with HbA1c < 8% spent more time within target range (40.0 vs. 29.5%, p = 0.0001) and less time above their target range (36.9 vs. 51.2%, p = 0.0003). There was no difference in the percentage of glucose levels below target (23.2 vs. 19.4%, p = NS), percentage of severe hypoglycemic episodes (3 vs. 7 episodes per 100 patient-yr, p = NS), or episodes of DKA (1 vs. 3 episodes per 100 patient-yr, p = NS) between the two groups. SUBJECTS with lower HbA1c levels had acquired more home-management competencies (4.0 vs. 3.5, p = 0.01). CONCLUSIONS: If families are competent in fundamental diabetes management, young children can achieve HbA1c levels < 8.0% without increasing the risk of hypoglycemia.