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Jan Olof Hornquist - One of the best experts on this subject based on the ideXlab platform.

Reinhard W Holl - One of the best experts on this subject based on the ideXlab platform.

  • both the frequency of hba1c testing and the frequency of self monitoring of blood glucose predict Metabolic Control a multicentre analysis of 15 199 adult type 1 diabetes patients from germany and austria
    Diabetes-metabolism Research and Reviews, 2017
    Co-Authors: Anke Schwandt, F Best, Torben Biester, Arthur Grunerbel, Florian Kopp, D Krakow, Markus Laimer, Christian Wagner, Reinhard W Holl
    Abstract:

    BACKGROUND The objective of this study was to examine the association between Metabolic Control and frequency of haemoglobin A1c (HbA1c ) measurements and of self-monitoring of blood glucose, as well as the interaction of both. METHODS Data of 15 199 adult type 1 diabetes patients registered in a standardized electronic health record (DPV) were included. To model the association between Metabolic Control and frequency of HbA1c testing or of self-monitoring of blood glucose, multiple hierarchic regression models with adjustment for confounders were fitted. Tukey-Kramer test was used to adjust P values for multiple comparisons. Vuong test was used to compare non-nested models. RESULTS The baseline variables of the study population were median age 19.9 [Q1; Q3: 18.4; 32.2] years and diabetes duration 10.4 [6.8; 15.7] years. Haemoglobin A1c was 60.4 [51.5; 72.5] mmol/mol. Frequency of HbA1c testing was 8.0 [5.0; 9.0] within 2 years, and daily self-monitoring of blood glucose frequency was 5.0 [4.0; 6.0]. After adjustment, a U-shaped association between Metabolic Control and frequency of HbA1c testing was observed with lowest HbA1c levels in the 3-monthly HbA1c testing group. There was an inverse relationship between self-monitoring of blood glucose and HbA1c with lower HbA1c associated with highest frequency of testing (>6 daily measurements). Quarterly HbA1c testing and frequent self-monitoring of blood glucose were associated with best Metabolic Control. The adjusted Vuong Z statistic suggests that Metabolic Control might be better explained by HbA1c testing compared to self-monitoring of blood glucose (P < .0001). CONCLUSION This research reveals the importance of quarterly clinical HbA1c monitoring together with frequent self-monitoring of blood glucose in diabetes management to reach and maintain target HbA1c .

  • international comparison of smoking and Metabolic Control in patients with type 1 diabetes
    Diabetes Care, 2016
    Co-Authors: Sabine E Hofer, Reinhard W Holl, Kellee M Miller, Julia M Hermann, Daniel J Desalvo, Michaela Riedl, Irl B Hirsch, Wolfram Karges, Roy W Beck, David M Maahs
    Abstract:

    Smoking may influence Metabolic Control and increase the risk of vascular complications in type 1 diabetes (T1D) (1,2). Antismoking public health policy may influence smoking habits in the population with diabetes; therefore, different behaviors between Europe and the U.S. may be expected (3,4). The T1D Exchange Registry (T1DX) in the U.S. and the Prospective Diabetes Follow-up Registry (DPV) in Germany and Austria are two large consortia of diabetes centers, which used their data sets to describe the prevalence of smoking habits in adults with T1D and analyzed the relationship between smoking status and Metabolic outcomes. Our analyses include 20,405 patients with T1D aged ≥18 years and with T1D duration ≥1 year (10,579 participants from 65 T1DX centers and 9,826 participants from 297 DPV centers). Smoking status was defined by smoking at least one cigarette per day, former smokers reported smoking in the past, and nonsmokers never smoked. Smoking data were self-reported in …

  • improved Metabolic Control in children and adolescents with type 1 diabetes a trend analysis using prospective multicenter data from germany and austria
    Diabetes Care, 2012
    Co-Authors: Joachim Rosenbauer, Axel Dost, Beate Karges, Andreas Hungele, A Stahl, Christina Bachle, E M Gerstl, Christian Kastendieck, Sabine E Hofer, Reinhard W Holl
    Abstract:

    OBJECTIVE To investigate the temporal trend of Metabolic Control and potential predictors in German and Austrian children and adolescents with type 1 diabetes. RESEARCH DESIGN AND METHODS This study is based on a large, multicenter database for prospective longitudinal documentation of diabetes care in Germany and Austria. Data from 30,708 patients documented in 305 diabetes centers between 1995 and 2009 were analyzed. Generalized linear mixed regression models were used to adjust trend analysis for relevant confounders. RESULTS Unadjusted mean HbA 1c decreased from 8.7 ± 1.8% in 1995 to 8.1 ± 1.5% in 2009. In multiple regression analysis, treatment year, age, sex, diabetes duration, migration background, BMI-SDS, and daily insulin dose were significant predictors of Metabolic Control ( P 1c decreased significantly by 0.038% per year (95% CI 0.032–0.043%), average odds ratio (OR) per year for HbA 1c >7.5% (>9.0%) was 0.969 (95% CI 0.961–0.977) (0.948, 95% CI 0.941–0.956). Intensified insulin regimen was associated with lower frequency of poor Metabolic Control (HbA 1c >9%; P = 0.005) but not with average HbA 1c ( P = 0.797). Rate of severe hypoglycemia and hypoglycemic coma decreased significantly (relative risk [RR] per year 0.948, 95% CI 0.918–0.979; RR 0.917, 95% CI 0.885–0.950) over the study period. Diabetic ketoacidosis rate showed no significant variation over time. CONCLUSIONS This study showed a significant improvement in Metabolic Control in children and adolescents with type 1 diabetes during the past decade and a simultaneous decrease in hypoglycemic events. The improvement was not completely explained by changes in the mode of insulin treatment. Other factors such as improved patient education may have accounted for the observed trend.

  • insulin injection regimens and Metabolic Control in an international survey of adolescents with type 1 diabetes over 3 years results from the hvidore study group
    European Journal of Pediatrics, 2003
    Co-Authors: Reinhard W Holl, Francesco Chiarelli, P G F Swift, Henrik B Mortensen, Helle Lynggaard, Phillip Hougaard, Henkjan Aanstoot, Denis Daneman, Thomas Danne, Harry Dorchy
    Abstract:

    The optimal insulin regimen for paediatric patients with type 1 diabetes remains controversial. Therefore this multicentre study was performed in adolescents over a 3-year period to assess Metabolic Control, severe hypoglycaemia, and weight gain in relation to insulin injection regimens. Out of 2873 children and adolescents in an international survey in 1995, 872 adolescents (433 boys, 439 girls, mean age in 1995 11.3±2.2 years) were restudied in 1998, relating insulin regimens to HbA1c measured in a central laboratory. In addition, the daily dose of insulin, changes in body mass index (BMI), and events of severe hypoglycaemia were evaluated. Over 3 years, the use of multiple injection regimens increased from 42% to 71%: 251 patients remained on twice daily insulin, 365 remained on multiple injections and 256 shifted from twice daily insulin to multiple injections. In all three subgroups an increase in insulin dose, a deterioration of Metabolic Control, and an increase in BMI were observed. Metabolic Control deteriorated less than expected over 3 years during adolescence (HbA1c 1995: 8.7±1.6%; 1998 observed: 8.9±1.6%, HbA1c expected for 1998: 9.0%). BMI increased more than expected, the increase was greatest in patients switching from twice daily to multiple injections, and higher in females compared to males. Conclusion: in this international study, Metabolic Control was unsatisfactory in many adolescents with type 1 diabetes irrespective of the insulin regimen. No improvement in Metabolic Control was observed in this cross-sectional survey, over 3 years in any of the subgroups. Even the group switching from twice to multiple injections did not improve blood glucose Control and the increase in body mass index was most pronounced in this group. Conclusive evidence, however, should be based on prospectively planned, randomised therapeutic trials in paediatric patients.

Francesco Chiarelli - One of the best experts on this subject based on the ideXlab platform.

  • target setting in intensive insulin management is associated with Metabolic Control the hvidoere childhood diabetes study group centre differences study 2005
    Pediatric Diabetes, 2009
    Co-Authors: P G F Swift, Fergus J Cameron, Francesco Chiarelli, Timothy Skinner, C De Beaufort, Jan Aman, Hj Aanstoot, Luis Castano, D Daneman, Thomas Danne
    Abstract:

    Swift PGF, Skinner TC, de Beaufort CE, Cameron FJ, Aman J, Aanstoot H-J, Castano L, Chiarelli F, Daneman D, Danne T, Dorchy H, Hoey H, Kaprio EA, Kaufman F, Kocova M, Mortensen HB, Njolstad PR, Phillip M, Robertson KJ, Schoenle EJ, Urakami T, Vanelli M, Ackermann RW, Skovlund SE for the Hvidoere Study Group on Childhood Diabetes. Target setting in intensive insulin management is associated with Metabolic Control: the Hvidoere Childhood Diabetes Study Group Centre Differences Study 2005. Objective: To evaluate glycaemic targets set by diabetes teams, their perception by adolescents and parents, and their influence on Metabolic Control. Methods: Clinical data and questionnaires were completed by adolescents, parents/carers and diabetes teams in 21 international centres. HbA1c was measured centrally. Results: A total of 2062 adolescents completed questionnaires (age 14.4 ± 2.3 yr; diabetes duration 6.1 ± 3.5 yr). Mean HbA 1c = 8.2 ± 1.4% with significant differences between centres (F = 12.3; p 17.4;p < 0.001). A lower target HbA1c and greater consistency between members of teams within centres were associated with lower centre HbA1c (F = 16.0; df = 15; p < 0.001). Conclusions: Clear and consistent setting of glycaemic targets by diabetes teams is strongly associated with HbA1c outcome in adolescents. Target setting appears to play a significant role in explaining the differences in Metabolic outcomes between centres.

  • insulin injection regimens and Metabolic Control in an international survey of adolescents with type 1 diabetes over 3 years results from the hvidore study group
    European Journal of Pediatrics, 2003
    Co-Authors: Reinhard W Holl, Francesco Chiarelli, P G F Swift, Henrik B Mortensen, Helle Lynggaard, Phillip Hougaard, Henkjan Aanstoot, Denis Daneman, Thomas Danne, Harry Dorchy
    Abstract:

    The optimal insulin regimen for paediatric patients with type 1 diabetes remains controversial. Therefore this multicentre study was performed in adolescents over a 3-year period to assess Metabolic Control, severe hypoglycaemia, and weight gain in relation to insulin injection regimens. Out of 2873 children and adolescents in an international survey in 1995, 872 adolescents (433 boys, 439 girls, mean age in 1995 11.3±2.2 years) were restudied in 1998, relating insulin regimens to HbA1c measured in a central laboratory. In addition, the daily dose of insulin, changes in body mass index (BMI), and events of severe hypoglycaemia were evaluated. Over 3 years, the use of multiple injection regimens increased from 42% to 71%: 251 patients remained on twice daily insulin, 365 remained on multiple injections and 256 shifted from twice daily insulin to multiple injections. In all three subgroups an increase in insulin dose, a deterioration of Metabolic Control, and an increase in BMI were observed. Metabolic Control deteriorated less than expected over 3 years during adolescence (HbA1c 1995: 8.7±1.6%; 1998 observed: 8.9±1.6%, HbA1c expected for 1998: 9.0%). BMI increased more than expected, the increase was greatest in patients switching from twice daily to multiple injections, and higher in females compared to males. Conclusion: in this international study, Metabolic Control was unsatisfactory in many adolescents with type 1 diabetes irrespective of the insulin regimen. No improvement in Metabolic Control was observed in this cross-sectional survey, over 3 years in any of the subgroups. Even the group switching from twice to multiple injections did not improve blood glucose Control and the increase in body mass index was most pronounced in this group. Conclusive evidence, however, should be based on prospectively planned, randomised therapeutic trials in paediatric patients.

  • the effect of subclinical hypothyroidism on Metabolic Control in children and adolescents with type 1 diabetes mellitus
    Diabetic Medicine, 2002
    Co-Authors: Angelika Mohn, S Di Michele, R Di Luzio, Stefano Tumini, Francesco Chiarelli
    Abstract:

    Aims Associated autoimmune phenomena might influence Metabolic Control in children and adolescents with Type 1 diabetes mellitus. A retrospective case Control study was performed in order to explore the effect of subclinical hypothyroidism on Metabolic Control in Type 1 diabetes mellitus. Patients and methods For this purpose each patient with Type 1 diabetes and subclinical hypothyroidism (cases) was matched for age, duration of disease and, if possible, for sex, with two to three diabetic patients without hypothyroidism (Controls). Parameters of Metabolic Control such as HbA1c, total insulin requirement and frequency of symptomatic hypoglycaemia were retrieved for 12, 6 and 3 months before and after diagnosis of hypothyroidism. Results Thirteen patients (two male/11 female) patients were diagnosed with subclinical hypothyroidism and were matched with 31 Controls (nine male/22 female). There was no difference (mean and range) in terms of age (11.9 years (4.4–18.1) vs. 11.7 years (3.5–18.1), P = 0.9) and duration of disease (5.1 years (1.2–10.5) vs. 4.38 years (0.9–10.8), P = 0.6) between the two groups. There was no difference in HbA1c and total insulin requirement between the two groups at any time point of assessment (anovaP = 0.8 and P = 0.1, respectively). Patients with hypothyroidism had significantly more symptomatic hypoglycaemic episodes during the 12 months before diagnosis (anovaP = 0.05), increasing progressively during this time period and reaching a peak at time 0 (5.5 ± 0.4 vs. 1.6 ± 0.1 episodes/month, P = 0.01). No difference could be detected within 6 months of starting substitution therapy (2.4 ± 0.2 vs. 1.6 ± 0.1 episodes/week, P = 0.8). Conclusions These data suggest that subclinical hypothyroidism is associated with an increased risk of symptomatic hypoglycaemia. The prompt introduction of substitution therapy is recommended as it reduces its frequency.

Perolof Andersson - One of the best experts on this subject based on the ideXlab platform.

Sukran Darcan - One of the best experts on this subject based on the ideXlab platform.

  • effects of carbohydrate counting method on Metabolic Control in children with type 1 diabetes mellitus
    Journal of Clinical Research in Pediatric Endocrinology, 2014
    Co-Authors: Damla Goksen, Samim Ozen, Yasemin Atik Altinok, Gunay Demir, Sukran Darcan
    Abstract:

    Ob­jec­ti­ve: Medical nutritional therapy is important for glycemic Control in children and adolescents with type 1 diabetes mellitus (T1DM). Carbohydrate (carb) counting, which is a more flexible nutritional method, has become popular in recent years. This study aimed to investigate the effects of carb counting on Metabolic Control, body measurements and serum lipid levels in children and adolescents with T1DM. Methods: T1DM patients aged 7-18 years and receiving flexible insulin therapy were divided into carb counting (n=52) and Control (n=32) groups and were followed for 2 years in this randomized, Controlled study. Demographic characteristics, body measurements, insulin requirements, hemoglobin A1c (HbA1c) and serum lipid levels at baseline and at follow-up were evaluated. Results: There were no statistically significant differences between the groups in mean HbA1c values in the year preceding the study or in age, gender, duration of diabetes, puberty stage, total daily insulin dose, body mass index (BMI) standard deviation score (SDS) and serum lipid values. While there were no differences in BMI SDS, daily insulin requirement, total cholesterol, low-density lipoprotein and triglyceride values between the two groups (p>0.05) during the follow-up, annual mean HbA1c levels of the 2nd year were significantly lower in the carb counting group (p=0.010). The mean values of high-density lipoprotein were also significantly higher in the first and 2nd years in the carb counting group (p=0.02 and p=0.043, respectively). Conclusion: Carb counting may provide good Metabolic Control in children and adolescents with T1DM without causing any increase in weight or in insulin requirements.

  • the effects of pilates on Metabolic Control and physical performance in adolescents with type 1 diabetes mellitus
    Journal of Diabetes and Its Complications, 2012
    Co-Authors: Mert Tunar, Samim Ozen, Damla Goksen, Gulgun Asar, Cem Seref Bediz, Sukran Darcan
    Abstract:

    Abstract Physical activity is a substantial method in the management of children and adolescents with Type 1 diabetes mellitus but it is not considered as a treatment for diabetes. The aim of this study was to investigate the effects of Pilates exercises on Metabolic Control and physical performance in patients with type 1 diabetes mellitus. Thirty one sedentary patients with type 1 diabetes mellitus, ranging in age from 12 to 17 (experimental group, n =17 and Control group, n =14) were submitted to 12 weeks of Pilates training. Participants underwent tests to determine the physical performance and Metabolic Control before and after 12 weeks of Pilates session. At the end of study, there were significant alterations in physical performance of the study group. Peak power, mean power, vertical jump and flexibility of study group increased. There were no alterations for this parameters in the Control group. There was no significant difference for glycated hemoglobin (HbA1c) in both groups. Conclusions: Physical performance increased via Pilates exercises in the patients with type 1 DM. However there were no changes in Metabolic Control. In the present study, the positive effects of exercise on Metabolic Control could not be shown in patients with Type 1 DM.