Tag Archive for: glycemic control

vials and needles

Study examines severity of COVID-19 on kids with Type 1 diabetes

vials and needles

A new study published in the Journal of Diabetes, found that although nearly 80% of youth with Type 1 diabetes and COVID-19 infection are managed at home, youth from racial and ethnic minority groups – those with higher hemoglobin A1c values – and those with public insurance are at increased risk for hospitalization.

In a new study published in the Journal of Diabetes, researchers found that although nearly 80% of youth with Type 1 diabetes (T1D) and COVID-19 infection are managed at home, youth from racial and ethnic minority groups – those with higher hemoglobin A1c values – and those with public insurance are at increased risk for hospitalization. Most hospitalizations among these youth were related to diabetic ketoacidosis (DKA) (72%) and 86% of youth hospitalized had an A1c value over 9%. The increased risk for DKA among racial and ethnic minority groups and publicly insured youth in this study is indicative of disparities in T1D outcomes and aligns with other research findings both before and during the pandemic.

Adults with certain underlying medical conditions, like diabetes, are at an increased risk for severe illness from COVID-19. Though there are limited data on youth with T1D who have been infected with COVID-19, viral infections can make it harder to control blood glucose levels. If not properly managed, infections may lead to DKA, a serious life-threatening condition where the body converts fat instead of sugar into energy, causing ketones to build up in the blood and acid levels to rise.

“There is still more to learn about COVID-19 and how it affects children with diabetes and other underlying medical conditions,” said Brynn Marks, M.D., MS-HPEd, pediatric endocrinologist at Children’s National Hospital and one of the study’s co-authors. “We are hopeful that this latest data will emphasize the importance of optimizing glycemic control and give physicians and families more information about the virus and T1D so that severe illness and hospitalizations can possibly be prevented.”

In April 2020, the T1D Exchange Quality Improvement Collaborative, along with endocrinology clinics across the U.S., formed a COVID-19 clinical registry to better understand symptoms and outcomes of patients with T1D who also tested positive for SARS-CoV-2 infection. More than 46 centers nationwide, including Children’s National Hospital, submitted data to this novel registry of 266 youth under the age of 19 with previously established T1D and laboratory confirmed COVID-19.

The study found that nearly 80% of youth with T1D and known COVID-19 infection were cared for at home without any adverse outcomes. It is also important to note that COVID-19 was incidentally discovered in 16% of hospitalized youth admitted for reasons unrelated to COVID-19 or T1D (e.g. urological procedures, psychiatric admissions). However, the data revealed a disproportionate rate of hospitalizations and DKA among racial and ethnic minority groups, children who were publicly insured and those with higher A1c. Out of the 266 patients, 72% of the 61 patients were hospitalized due to DKA. An overwhelming majority (82%) of hospitalized patients had an A1c value greater than 9%. More than 40% of non-Hispanic Black youth in the study were hospitalized as compared to 14% of non-Hispanic white youth. Researchers also noted that those patients with public insurance were less likely to use insulin pumps and continuous glucose monitors, emphasizing the continued need to improve more access to diabetes technologies.

“Diabetes technology has advanced rapidly in the last decade and access to insulin pumps and continuous glucose monitors is improving, however these technological advances are perpetuating pre-existing disparities in T1D care and outcomes,” Dr. Marks said. “The data is clear and there is a pressing need to act to promote optimal care for all people with T1D.”

Recently, Dr. Marks and the Children’s National Diabetes team became official members of the Type 1 Diabetes Exchange Collaborative. The team looks forward to using the opportunity to improve diabetes care both here at Children’s National and across the country.

 

nurse checking boy's blood sugar levels

Improving glycemic control in diabetic children

nurse checking boy's blood sugar levels

A 10-week pilot study at Children’s National Health System integrated weekly caregiver coaching, personalized glucose monitoring and incentives into standard treatment for 25 pediatric patients with type 1 diabetes, lowering A1c by .5%

The life of a type 1 diabetes patient – taking daily insulin shots or wearing an insulin pump, monitoring blood sugar, prioritizing healthful food choices and fitting in daily exercise – can be challenging at age 5 or 15, especially as holidays, field trips and sleepovers can disrupt diabetes care routines, creating challenges with compliance. This is why endocrinologists from Children’s National Health System experimented with using health coaches over a 10-week period to help families navigate care for children with type 1 diabetes.

By assembling a team of diabetes educators, dietitians, social workers, psychologists and health care providers, Fran Cogen, M.D., C.D.E., director of diabetes care at Children’s National, helped pediatric patients with type 1 diabetes manage their glycemic status, or blood-sugar control.

On Saturday, June 8, 2019, Dr. Cogen will share results of the pilot program as poster 1260-P, entitled “A Clinical Care Improvement Pilot Program: Individualized Health Coaching and Use of Incentives for Youth with Type 1 Diabetes and their Caregivers,” at the American Diabetes Association’s 79th Scientific Sessions, which takes place June 7-11 at the Moscone Center in San Francisco.

Dr. Cogen’s study was offered at no cost to caregivers of 179 patients at Children’s National seeking treatment for type 1 diabetes. The pilot program included two components: 1) Weekly phone calls or emails from a health coach to a caregiver with personalized insulin adjustments, based on patient blood sugars submitted through continuous glucose monitoring apps; and 2) Incentives for patients to participate in the program and reach health targets.

Twenty-five participants, ages 4-18, with a mean age of 11.6 and A1c ranges between 8.6 – 10% joined the study. The average A1c was 9.4% at the beginning of the program and dropped by an average of .5% at the end of the trial. Twenty of the 25 participants, 80%, improved A1c levels by .5%. Seventeen participants, 68%, improved A1c levels by more than .5%, while seven participants, 28%, improved A1c levels by more than 1%.

“Chronic disease is like a marathon,” says Dr. Cogen. “You need to have constant reinforcement and coaching to get people to do their best. Sometimes what drives people is to have people on the other end say, ‘Keep it up, you’re doing a good job, keep sending us information so that we can make changes to improve your child’s blood sugar management,’ which gives these new apps and continuous glucose monitoring devices a human touch.”

Instead of waiting three months between appointments to talk about ways a family can make changes to support a child’s insulin control and function, caregivers received feedback from coaches each week. Health coaches benefitted, too: They reported feeling greater empathy for patients, while becoming more engaged in personalizing care plans.

Families who participated received a gift card to a local grocery store, supporting a child’s dietary goals. Children who participated were also entered into an iPad raffle. Improvements in A1c levels generated extra raffle tickets per child, which motivated participants, especially teens.

“These incentives are helpful in order to get kids engaged in their health and in an immediate way,” says Dr. Cogen. “Teenagers aren’t always interested in long-term health outcomes, but they are interested in what’s happening right now. Fluctuating blood sugars can cause depression and problems with learning, while increasing risk for future complications, including eye problems, kidney problems and circulation problems. As health care providers, we know the choices children make today can influence their future health outcomes, which is why we designed this study.”

Moving forward, Dr. Cogen and the endocrinologists at Children’s National would like to study the impact of using this model over several months, especially for high-risk patients, while  asynchronously targeting information to drive behavior change – accommodating the needs of families, while delivering dose-specific recommendations from health care providers.

Dr. Cogen adds, “We’re moving away from office-centric research models and creating interventions where they matter: at home and with families in real time.”

Read more about the study at Healio.com and dLife.

Additional study authors, all of whom work within the division of diabetes and endocrinology at Children’s National, include Lauren Clary, Ph.D., Sue-Ann Airborne, C.D.E., Andrew Dauber, M.D., Meredith Dillon, R.D., L.D.N., C.D.E., Beakel Eshete, B.S.N., R.N., C.D.E., Shaina Hatchell, B.S.N., R.N., Shari Jones, R.N., C.D.E., and Priya Vaidyanathan, M.D.