Browsing by Author "Agarwal, Shivani"

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    Changes in Device Uptake and Glycemic Control Among Pregnant Women With Type 1 Diabetes: Data From the T1D Exchange
    (Sage, 2021) Levy, Carol J.; Foster, Nicole C.; DuBose, Stephanie N.; Agarwal, Shivani; Lyons, Sarah K.; Peters, Anne L.; Uwaifo, Gabriel I.; DiMeglio, Linda A.; Sherr, Jennifer L.; Polsky, Sarit; Pediatrics, School of Medicine
    Objectives: To examine changes in device use and glycemic outcomes for pregnant women from the T1D Exchange Clinic Registry between the years 2010-2013 and 2016-2018. Methods: Participant-reported device use and glycemic outcomes were compared for women aged 16-40 years who were pregnant at the time of survey completion, comparing 2010-2013 (cohort 1) and 2016-2018 (cohort 2). Hemoglobin A1c results within 30 days prior to survey completion were obtained from medical records. Results: There were 208 pregnant women out of 5,236 eligible participants completing the questionnaire in cohort 1 and 47 pregnant women out of 2,818 eligible participants completing the questionaire in cohort 2. Continuous glucose monitor (CGM) use while pregnant trended upward among cohort 2 (70% vs 37%, P = .02), while reported continuous subcutaneous insulin infusion (CSII) use while pregnant declined (76% vs 64%, P = .04). HbA1c levels trended downward (6.8% cohort 1 vs 6.5% cohort 2, P = .07). Conclusions: Self-reported CGM use while pregnant increased over the studied intervals whereas CSII use decreased. Additional evaluation of device use and the potential benefits for T1D pregnancies is needed.
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    Incident Diabetes Complications among Women with type 1 diabetes based on Parity
    (Taylor & Francis, 2020) Polsky, Sarit; Foster, Nicole C.; DuBose, Stephanie N.; Agarwal, Shivani; Lyons, Sarah; Peters, Anne L.; Uwaifo, Gabriel I.; DiMeglio, Linda A.; Sherr, Jennifer L.; Levy, Carol J.; Pediatrics, School of Medicine
    Objectives To assess risk factors and incidence of diabetes complications in women with type 1 diabetes (T1D) based on parity. Research design/methods Data were collected from women (16–40 years old) in the T1D Exchange completing pregnancy/childbirth questionnaires during 2011–2013 and 2016–2018. Incidence of risk factors and diabetes complications were compared between women with a first pregnancy at/within 1-year of enrollment (n = 28) and never pregnant women by year 5 (n = 469). Results There was a trend for lower HbA1c (adjusted p = .14) and higher rates of overweight/obesity, triglyceride/HDL > 2, log (triglyercide/HDL), and hypertension among parous women compared with nulliparous women. There were no significant differences in rates of advanced nephropathy, albuminuria or cardiovascular disease. Conclusions Four-5 years after delivery, parous women with T1D tended to have lower HbA1c levels despite higher body mass indices and more frequent adverse lipid profiles and hypertension compared with nulliparous women. Further studies based on these trends are warranted.
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    Interventions to address global inequity in diabetes: international progress
    (Elsevier, 2023) Walker, Ashby F.; Graham, Sian; Maple-Brown, Louise; Egede, Leonard E.; Campbell, Jennifer A.; Walker, Rebekah J.; Wade, Alisha N.; Mbanya, Jean Claude; Long, Judith A.; Yajnik, Chittaranjan; Thomas, Nihal; Ebekozien, Osagie; Odugbesan, Oriyomi; DiMeglio, Linda A.; Agarwal, Shivani; Pediatrics, School of Medicine
    Diabetes is a serious chronic disease with high associated burden and disproportionate costs to communities based on socioeconomic, gender, racial, and ethnic status. Addressing the complex challenges of global inequity in diabetes will require intentional efforts to focus on broader social contexts and systems that supersede individual-level interventions. We codify and highlight best practice approaches to achieve equity in diabetes care and outcomes on a global scale. We outline action plans to target diabetes equity on the basis of the recommendations established by The Lancet Commission on Diabetes, organising interventions by their effect on changing the ecosystem, building capacity, or improving the clinical practice environment. We present international examples of how to address diabetes inequity in the real world to show that approaches addressing the individual within a larger social context, in addition to addressing structural inequity, hold the greatest promise for creating sustainable and equitable change that curbs the global diabetes crisis.