bluuebunny/crossref_metadata_2025_split huggingface dataset:
Type 1 Diabetes Transition Program at a Children’s Hospital—Lessons Learned and Future Directions
Authors: CORNWELL HOLLY , YIGIT SEVKET , PURUSHOTHAMAN RADHIKA 
Published: June 2018

Background: Transitioning a child with type 1 diabetes (T1DM) poses many challenges. Structured programs decrease loss to follow-up and hospitalization rates. We created a transition program, modeled after the Sweet transition program (Queensland, Australia) and monitored the outcomes.
Methods: The program was implemented in April 2015. Steps included: Assessing T1DM knowledge at age 12, education based on need/age, providing an adult provider list, sending providers a clinical summary and maintaining a referral registry. The program was revised in October 2016, now included follow-up by a coordinator and a patient survey evaluating the program.
Results: There was increased attendance to education sessions. Transition to adult care within 6 months also improved. No one was lost to follow-up. We received useful feedback from patients about the program.
Lessons learned:
1. The ADA guidelines need to be customized based on available resources.
2. Starting at age 12 helps improve transition.
3. A transition registry and coordinator are important.
Future directions:
1. Provide subjective assessments for patients to gauge their T1DM knowledge.
2. Collaborate with adult providers via combined clinic.
Table 1: Comparison of Program OutcomesApril 2015-16October 2016-17Total No. of Type 1 Patients910875High School and Beyond Education22 (8%)71 (30%)Transfer of Care Education 16 (8%)44 (29%)Referred Patients Seen within 6 months59%80%Referred Patients Seen &gt;6 months17%20%Referred Patients Lost to Follow Up24%0%

Disclosure
H. Cornwell: None. S. Yigit: None. R. Purushothaman: None.
Analysis of the Social Network and Physical Activity Performed as Perceived by Young Patients with Type 1 Diabetes
Authors: FRANCIA PIERGIORGIO , PICCINI BARBARA , SANTOSUOSSO UGO , IANNONE GIULIA , CAPIRCHIO LAURA , VITTORI ALESSANDRO , GULISANO MASSIMO , TONI SONIA 
Published: June 2018

In addition to the knowledge of the daily physical activity performed (PAP), the analysis of the social network perceived directly by the same young patients with type 1 diabetes mellitus (T1DM) could provide useful information to manage their diabetes. The aim of this study was to evaluate the presence of a relationship between the patients’ social networks, the PAP and the metabolic control maintained in young subjects with T1DM. Interviews were conducted in 16 subjects with T1DM (males/females: 7/9), mean age 15,5±3,8 years, duration of diabetes 6,6±4,9 years, mean HbA1c (at baseline) 7,3±1,7% (year before) 7.3±1.6%, body mass index (BMI) 21,6±2,9 kg/m2 and in 12 age and BMI matched healthy control subjects. Participants were asked to fill in an egocentric social network map, which was divided into 5 areas: family, school, health care, leisure and sport activities, other. It was assigned a value ranging from 0 (none) to 5 (maximum) to define importance and frequency of the relationships reported. The PAP was evaluated by the Physical Activity Questionnaire for Children (PAQ-C) and Adolescents (PAQ-A). While the analysis of the PAP and of the glycemic control maintained did not show any correlation with the other parameters, the analysis of the network showed that the frequency reported on the area of leisure and sport activities was significantly lower in the patient group in comparison to controls (4,2±1,8 vs. 3,1±1,0; p&lt;0,05). From the analysis of the two groups, the young patients investigated reported to attend significantly fewer sports clubs (3.3±0.8 vs. 4.2±0.8, p&lt;0.01) and have less contact with teammates (2.8±1.5 vs. 4.2±1.3; p&lt;0.05). However, they mainly attend hospital (2.0±1.1 vs. 0.6±0.7; p &lt;0.001) and friendly societies (1.5±1.1 vs. 0.1±0.4; p&lt;0.001). The results of this pilot study showed that the analysis of patients’ social networks could contribute to improving knowledge and therefore providing additional information useful for better management of these patients.

Disclosure
P. Francia: None. B. Piccini: None. U. Santosuosso: None. G. Iannone: None. L. Capirchio: None. A. Vittori: None. M. Gulisano: None. S. Toni: None.
A Paradoxical Relationship between Physical Activity and HbA1c in Pediatric T1D Patients
Authors: WATSON DAVID A. , BARNES TIMOTHY L. , GANDRUD LAURA M. 
Published: June 2018

Regular physical activity (PA) has been found to contribute to lower HbA1c in T1D pediatric populations, but this relationship is not conclusive.
In a recent study, we examined associations between PA and HbA1c over 6 months in 1T1D pediatric patients. PA was measured with Fitbit monitors and summarized as average weekly steps and hours of moderate to vigorous PA (MVPA). Linear regression was used to analyze associations and adjust for variables including baseline HbA1c.
Counter to expectations, PA across patients was positively associated with HbA1c. An increase of 10K average steps/week was associated with a 0.115 mmol/mol increase in HbA1c (P=0.017). In addition, an increase of 1 hour of average weekly MVPA was associated with a 0.088 mmol/mol increase in HbA1c (P=0.038). However, within patients, weekly PA levels were negatively associated with weekly BG levels in 75% of patients.
This reversal of trend between within and between patient measures is an interesting example of what is called Simpson’s paradox in statistics. The Figure illustrates how these relationships coexist: weekly data show a negative trend for 3 patients (dashed lines); however, averaged data show a positive trend (solid line).
Although across patients, higher PA tended to be associated with higher HbA1c, the within patient association suggests an encouraging effect in which PA among pediatric patients may actually help to lower HbA1c levels.

Disclosure
D.A. Watson: None. T.L. Barnes: None. L.M. Gandrud: Consultant; Self; UnitedHealth Group.
Sustained CGM Use in Low Income Youth following Insurance Coverage
Authors: PRAHALAD PRIYA , BUCKINGHAM BRUCE , WILSON DARRELL , MAAHS DAVID M. 
Published: June 2018

California Children’s Services (CCS) is a supplemental state medical insurance for low income children with chronic medical conditions. Until June 2016, continuous glucose monitors (CGM) were rarely covered by CCS for children with type 1 diabetes (T1D). Current CCS criteria for CGM includes: checking blood sugar 4 times/day and concerns that interfere with T1D management (such as fear of hypoglycemia). Ongoing approval requires CGM use for 5/7 days/week.
We evaluated 6 months of CGM use by the first 41 children approved by CCS attending our clinics (age= 11.1 ± 4.7 years [range 3-21 years], T1D duration=4.8 ± 3.7 years, 59% male, 66% on pumps, 63% ethnic minorities and 15% non-English speakers). Most patients used the Dexcom receiver (73%). Thirty-three (81%) remained on CGM for ≥6 months. Of the 8 who stopped, 2 were due to lapses in insurance coverage. The other 6 stopped due to personal preference (5 within 3 months). All who stopped CGM use were English speakers. Among those who continued CGM with complete data (n=29, 71%), the mean percentage time worn at 6 months was 97±8% based on review of the CGM download. HbA1c remained stable over 6 months of CGM use (8.2±1.2%). Blinded CGM use was not available prior to initiation of personal CGM, so we cannot assess if hypoglycemia decreased. However, many of these children with CCS started CGM due to hypoglycemia and/or fear of hypoglycemia. Time in hypoglycemia as low at 6 months (4.3±4.8%). The number of fingersticks remained stable with 6.3/d at initiation and 5.6/d at 6 months.
Our clinic data from the first 41 CCS patients approved for CGM demonstrates sustained CGM use for 6 months, even among non-English speakers. In this initial chart review, the incidence of hypoglycemia is low while on CGM. These data on sustained usability of CGM support CCS coverage of CGM. Given FDA approval of CGM use for insulin dosing decisions, expansion of CCS coverage of CGM should be considered to improve bolus adherence. Further studies are needed to promote improved clinical use and outcomes with CGM in this population.

Disclosure
P. Prahalad: None. B. Buckingham: Advisory Panel; Self; Novo Nordisk Inc., ConvaTec Inc.. Research Support; Self; Medtronic, Insulet Corporation, Dexcom, Inc., Tandem Diabetes Care, Inc.. Consultant; Self; Tandem Diabetes Care, Inc., Becton, Dickinson and Company. D. Wilson: Research Support; Self; T1D Exchange, Medtronic MiniMed, Inc., Dexcom, Inc., National Institute of Diabetes and Digestive and Kidney Diseases, Insulet Corporation. Advisory Panel; Self; Tolerion. D.M. Maahs: Advisory Panel; Self; Insulet Corporation. Consultant; Self; Abbott. Research Support; Self; Medtronic, Bigfoot Biomedical, Dexcom, Inc., Insulet Corporation, Roche Diabetes Care Health and Digital Solutions.
Inhibition of Nox-1 Activity Attenuates Diabetic Ketoacidosis-Induced Blood Brain Barrier Permeability and Edema Formation
Authors: MARTINEZ-REVOLLAR GABRIELA 
Published: June 2018

Diabetic ketoacidosis (DKA) is a condition characterized by hyperglycemia and high ketone bodies production conducting to acidosis. DKA is highly prevalent in pediatric patients. Approximately 0.5%-1% of these children develop cerebral edema, with a mortality rate of 20-90%. Our research examined the effects of DKA in Blood Brain Barrier (BBB) permeability using Ins2Akita mice as a T1D model. Using magnetic resonance (MR)-based detection of the contrast agent gadolinium diethylenetriaminepenta-acetic acid (Gd-DTPA) we observed BBB permeability and fluid accumulation in the brain, during DKA episodes from day 1 to 5. Our data indicated that increased BBB permeability was present in the thalamus, partial cortex and basal forebrai. Furthermore, the analysis of the morphological and functional changes of BBB under DKA conditions both in vitro and in vivo in vitro showed alterations in TJ proteins, manifested as a slight alteration in ZO-1 and Claudin-5 expression which could represent the ground for BBB leakage. We have further identified that DKA promotes the high production of ROS due to Nox-1 activation, leading to actin reorganization, the subsequent TJ disorganization and increased BBB permeability. The inhibition of Nox-1 activity via Nox-1 inhibitor ML-17 improved the BBB integrity and reduced leakage. Collectively, these studies will provide new information related to novel therapeutic strategies to prevent or reverse vascular hyperpermeability in DKA.

Disclosure
G. Martinez-Revollar: None.
Fetal Brain Activity in Pregnancy of Women with Type 1 Diabetes Mellitus
Authors: FEHLERT ELLEN , SCHLEGER FRANZISKA , LINDER KATARZYNA , HENI MARTIN , HAERING HANS-ULRICH , PREISSL HUBERT , FRITSCHE ANDREAS 
Published: June 2018

We previously found gestational diabetes mellitus (GDM) to be associated with prolonged fetal auditory evoked brain responses (fAER) in fetal magnetoencephalography (fMEG). We asked whether maternal type 1 diabetes mellitus (T1D) may alter fetal brain activity.
Pregnant women with well-controlled T1D (n=4, A1c &lt;6.5%) were measured with fMEG before and 60 min. after a defined meal. Latencies of fAER were analyzed. We obtained two control groups of women with GDM (n=8) and normal glucose tolerance (NGT, n=8) out of 151 pregnant women with fAER measurements during a 75g OGTT. The groups were carefully matched by gestational age and pre-pregnancy maternal BMI.
ANOVA showed a main effect of group on the change in latency between baseline and postprandial state (F(2)=4.14, p=.034). In accordance with our previous results, in post-hoc tests the change of latency was smaller in the GDM than the NGT group (p=.032). No difference was found in the change of latency between T1D and NGT or GDM. The number of fetuses showing faster fAER postprandially is higher in T1D and NGT than in GDM. For details see Table.
To our knowledge, this is the first study investigating fAER in maternal T1D. In contrast to GDM, our preliminary results indicate that well-controlled maternal T1D does not impair fetal postprandial brain activity. These findings may indicate that fAER are associated with metabolic features mainly present in maternal insulin resistance.Latency of fetal auditory evoked responses in ms (mean±SD)GroupnBaseline (0 min)Postprandial (60 min)ChangeNumber of fetuses with speeding up of fAERNGT8277 (±103)204 (±89)- 72 (±81)7/8 (88%)T1D4257 (±57)262 (±151)+ 6 (±119)3/4 (75%)GDM8222 (±82)288 (±74)+ 65 (±100)3/8 (38%)

Disclosure
E. Fehlert: None. F. Schleger: None. K. Linder: None. M. Heni: Research Support; Self; Boehringer Ingelheim GmbH. Speaker's Bureau; Self; Boehringer Ingelheim GmbH, Merck Sharp & Dohme Corp., Novo Nordisk Inc.. H. Haering: None. H. Preissl: None. A. Fritsche: Advisory Panel; Self; Sanofi-Aventis Deutschland GmbH, Novo Nordisk A/S, Eli Lilly and Company, Boehringer Ingelheim GmbH.
Plasma Triglyceride Concentrations during Pregnancy Are Associated with Fetal Hyperinsulinemia, Insulin Resistance, and Birth Weight Independent of Maternal Hyperglycemia and Insulin Resistance
Authors: CHEN KUAN YU , LI HUNG-YUAN 
Published: June 2018

Objective: Intra-uterine environment has a great influence on fetal glucose metabolism and growth. Unlike gestational diabetes, the effect of maternal lipid metabolism on fetal glucose metabolism remains unknown. In this study, we evaluate the relationship between maternal plasma triglyceride concentrations during pregnancy, cord blood c-peptide, fetal insulin resistance index and birth weight.
Research Design and Methods: 663 pregnant women who delivered singleton at National Taiwan University Hospital from 2013 to 2017 were enrolled in this cohort study. We measured plasma lipid profile at each trimester, cord blood c-peptide concentrations and birth weight. Fetal insulin resistance was measured by homeostatic model assessment 2-insulin resistance index (HOMA2-IR).
Results: Maternal plasma triglyceride, total cholesterol, high-density lipoprotein cholesterol and low-density lipoprotein cholesterol increased significantly during pregnancy (all p&lt;0.05). Maternal plasma triglyceride at the visit for oral glucose tolerance tests (OGTT) was associated with cord blood c-peptide (adjusted p&lt;0.05) and fetal HOMA2-IR (adjusted p&lt;0.05), adjusted for family history of diabetes, history of gestational diabetes, pre-pregnancy body mass index (BMI), gestational age, gestational weight gain, maternal hemoglobin A1c, maternal HOMA2-IR and cord blood glucose. Maternal plasma triglyceride at delivery was significantly associated with birth weight (adjusted p&lt;0.05), adjusted for family history of diabetes, history of gestational diabetes, pre-pregnancy BMI, gestational age, gestational weight gain and maternal hemoglobin A1c. Similar associations were also found in women without gestational diabetes.
Conclusions Maternal plasma triglyceride concentrations during pregnancy are associated with fetal hyperinsulinemia, insulin resistance and birth weight.

Disclosure
K. Chen: None. H. Li: None.
Sleep Disordered Breathing—An Unrecognized Contributor to Abnormal Glycemic Profiles in Pregnancy
Authors: FARABI SARAH S. , BARBOUR LINDA A. , HERNANDEZ TERI L. 
Published: June 2018

Sleep disordered breathing (SDB), particularly obstructive sleep apnea (OSA), is poorly understood in pregnancy, yet may insidiously worsen metabolic function. We hypothesized that worse SDB in part accounts for higher 24 hour patterns of glycemia in late pregnancy complicated by obesity without gestational diabetes. At 33±1 weeks, 18 pregnant women without OSA symptoms (29.4±1.2 years [mean±SEM], BMI 34.3±0.6 kg/m2) were provided a eucaloric diet (50% carb, 35% fat) for 72 hour while wearing a continuous glucose monitor (CGM). SDB severity was measured in-home with a WatchPAT200 wrist-worn device and quantified by the apnea hypopnea index (AHI; apneas and hypopneas/hour) and oxygen desaturation index (ODI; O2 desaturations ≥4%/hour). Surprisingly, (12/18) women had an AHI≥5 (mild OSA). Total sleep time was 370.3±12.4 min (∼6 hours), sleep efficiency was impressively low (80.1±1.5%), and AHI and ODI were at least mild at 11.6±2 and 5.2±1.3, respectively. Importantly, AHI was correlated with 24 hour glucose area-under-the-curve (AUC) (r=0.50, p=0.03) and mean 24 hour glucose (r=0.55, p=0.02). ODI was correlated with both 24 hour AUC (r=0.54, p=0.02, Figure 1a) and mean 24 hour glucose (r=0.58, p=0.01, Figure 1b). Poor sleep and undiagnosed mild OSA are common in late pregnancy complicated by obesity, and may contribute to higher patterns of glycemia. SDB may be a treatable risk factor potentially improving maternal and fetal outcomes.

Disclosure
S.S. Farabi: None. L.A. Barbour: None. T.L. Hernandez: None.
Adaptability of Closed-Loop during Labor, Delivery, and Postpartum—A Secondary Analysis of Data From Two Randomized Crossover Trials in Type 1 Diabetes Pregnancy
Authors: YAMAMOTO JENNIFER M. , STEWART ZOE A. , WILINSKA MALGORZATA E. , HARTNELL SARA , HOVORKA ROMAN , MURPHY HELEN R. 
Published: June 2018

Our aim was to evaluate the efficacy of closed-loop insulin delivery for maintaining glucose control in women with type 1 diabetes during labor, delivery and the immediate postpartum period. We report on data collected from two randomized crossover trials examining closed-loop in pregnancy. This is an observational study of women who chose to continue closed-loop during labor, delivery and 48-hour postpartum period. Of the 32 women in these trials, 27 (84.4%) continued closed-loop during this time. Women who used closed-loop during labor and delivery spent 82.0% (IQR 49.3, 93.0) of time in the target range, with a mean glucose level of 124.2±25.4 mg/dl. Closed-loop performed well throughout all modes of delivery (Table 1). In the 48-hour postpartum period, the mean glucose was 130±25.0 mg/dl. During this time women spent 83.3% (IQR 75.2, 94.6) time-in-target range. There was no difference in mean glucose in mothers of infants with neonatal hypoglycemia vs. those without (mean maternal glucose of 124.2±28.8 and 122.4±19.8 mg/dL respectively; p=0.84). This study demonstrates that closed-loop insulin delivery is safe and effective in labor, delivery and the immediate postpartum period. Future research is needed to compare the biomedical efficacy of closed-loop with intensive insulin therapy and intrapartum sliding scale approaches.Table 1: Glucose control during labor and delivery by mode of deliveryVaginal Delivery n=4Emergency Caesarean Section n=12Elective Caesarian Section n=11Mean glucose (mg/dl)113.1±2.7126.1±27.0126.2±28.7Median time-in-target in %84.3 (74.7, 88.8)84.4 (48.5, 93.7)76.5 (48.2, 93.0Median time below target in %0 (0, 3.4)0.8 (0, 2.0)0 (0, 2.2)Median time above target in %15.7 (11.2, 22.0)11.4 (6.3, 50.4)16.5 (7.1, 51.8)Median number of hypoglycemic events0 (0, 1.0)0 (0, 1.0)0 (0, 1.0)Number of women with a hypoglycemic event133

Disclosure
J.M. Yamamoto: None. Z.A. Stewart: None. M.E. Wilinska: None. S. Hartnell: Speaker's Bureau; Self; Medtronic, Roche Pharma. R. Hovorka: Speaker's Bureau; Self; Novo Nordisk A/S. Advisory Panel; Self; Novo Nordisk A/S. Speaker's Bureau; Self; Eli Lilly and Company, AstraZeneca. Other Relationship; Self; B. Braun Medical Inc.. Research Support; Self; Medtronic. Other Relationship; Self; Medtronic. Research Support; Self; Abbott, JDRF, Diabetes UK, National Institute of Diabetes and Digestive and Kidney Diseases. H.R. Murphy: Advisory Panel; Self; Medtronic MiniMed, Inc.. Research Support; Self; Abbott.
How Important Is Early Diagnosis and Intense Insulin Therapy in In Vitro Fertilization Pregnancies Complicated by Gestational Diabetes Mellitus?
Authors: THOMAKOS PETROS , KEPAPTSOGLOU OLGA , TROUVA ANASTASIA , BARETTO CAROL , TROUVAS DIMITRIS , TARAOUNE IBRAHIM , KORANTZIS ASTERIS , ZOUPAS CHRISTOS 
Published: June 2018

GDM is increased in IVF pregnancies. There is limited literature on GDM screening and management of IVF pregnancies. The aim was to investigate the impact of GDM management on the outcome of IVF pregnancies. The study was conducted with 102 singleton IVF (a), 102 GDM spontaneous conceptions (b) vs. 102 normal pregnancies (c). The group characteristics: [age: 38.2±4 vs. 34.1±3 vs. 37.4±5 years, p&lt;0.001 (a vs. b), NS (a vs. c), &lt;0.001 (b vs. c); BMI: 25.8±5 vs. 23±4 vs. 22.7±4 kg/m2, p&lt;0.001 (a vs. b), &lt;0.001 (a vs. c), NS (b vs. c); HbA1c: 5.2±0.5 vs. 5.2±0.7 vs. 4.7±0.3%, p=NS (a vs. b), &lt;0.001 (a vs. c), &lt;0.001 (b vs. c); FBG: 84.1±8.4 vs. 84.2±7.1 vs. 78.2±5.2 mg/dl, p=NS (a vs. b), &lt;0.001 (a vs. c), &lt;0.001 (b vs. c); 1-hour postprandial BG: 103.6±11 vs. 106.5±10 mg/dl, p=NS (a vs. b); week of diagnosis GDM: 21.8±5.2 vs. 23.8±6.2, p=0.03 (a vs. b); week of starting insulin: 22.8±5 vs. 24.8±5, p=0.03 (a vs. b)].The obstetric and neonatal history are: Maternal weight gain: 10.4±4 vs. 11.9±3 vs. 10.5±2kg, p=0.035 (a vs. b), p=NS (a vs. c), p=0.03 (b vs. c); week. of delivery: 36.9±2 vs. 37.4±0.7 vs. 38.1±0.8, p=0.04 (a vs. b), p&lt;0.001 (a vs. c), p&lt;0.001 (b vs. c); neonatal birth wt.: 2857±517 vs. 2891±341 vs. 3117±347g, p=NS (a vs. b), p&lt;0.001 (a vs. c), p&lt;0.001 (b vs. c); preeclampsia rate: 4.9 vs. 3.9 vs. 1.9%; Respiratory Distress Syndrome: 14.7 vs. 12 vs. 5.8%; Neonatal hypoglycemia: 17.6 vs. 14.7 vs. 3.9%, NICU admits: 14.7 vs. 15.6 vs. 5.8%, C-Section: 86.3 vs. 56.9 vs. 41.1%. Associations between characteristics and adverse outcomes were tested among the IVF group. 1-hour Postprandial BG, but not FBG nor HbA1c, was associated with maternal-fetal complications (r=0.504, p&lt;0.001). Maternal hypoglycemia did not affect fetal outcome. Age and BMI were not correlated with the week of GDM diagnosis. The data emphasizes the importance of strict postprandial metabolic control reached by intense early insulin therapy limiting the incidence of adverse pregnancy outcomes. IVF pregnancies must be screened for GDM much earlier than 24-28 weeks.

Disclosure
P. Thomakos: None. O. Kepaptsoglou: None. A. Trouva: None. C. Baretto: None. D. Trouvas: None. I. Taraoune: None. A. Korantzis: None. C. Zoupas: None.