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Browsing by Author "Maahs, David M."
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Item COVID-19 and Children With Diabetes-Updates, Unknowns, and Next Steps: First, Do No Extrapolation(American Diabetes Association, 2020-09-04) DiMeglio, Linda A.; Albanese-O'Neill, Anastasia; Muñoz, Cynthia E.; Maahs, David M.; Pediatrics, School of MedicineWe are in a place where the only certainty is continued uncertainty about the course of this pandemic. We thank our international pediatric diabetes colleagues and hope their work spurs others to collaborate internationally to gather more evidence. We call on our community to articulate needs and refine recommended actions. As federal diabetes funding is uncertain and many not-for-profit organizations, including the American Diabetes Association and JDRF, announce cuts in funding opportunities and staffing, we must galvanize the pediatric diabetes volunteer community to join our efforts. We must continue to be humble and patient about what we know and advocate strenuously for coordinated, expanded, and responsive public health systems to support youth with both type 1 and type 2 diabetes.Item Effects of Frequency of Sensor-Augmented Pump Use on HbA1c and C-Peptide Levels in the First Year of Type 1 Diabetes(American Diabetes Association, 2016-04) Triolo, Taylor M.; Maahs, David M.; Pyle, Laura; Slover, Robert; Buckingham, Bruce; Cheng, Peiyao; DiMeglio, Linda A.; Bremer, Andrew A.; Weinzimer, Stuart A.; Chase, H. Peter; Pediatrics, School of MedicineItem The Evolution of Hemoglobin A1c Targets for Youth With Type 1 Diabetes: Rationale and Supporting Evidence(American Diabetes Association, 2021) Redondo, Maria J.; Libman, Ingrid; Maahs, David M.; Lyons, Sarah K.; Saraco, Mindy; Reusch, Jane; Rodriguez, Henry; DiMeglio, Linda A.; Pediatrics, School of MedicineThe American Diabetes Association 2020 Standards of Medical Care in Diabetes (Standards of Care) recommends a hemoglobin A1c (A1C) of <7% (53 mmol/mol) for many children with type 1 diabetes (T1D), with an emphasis on target personalization. A higher A1C target of <7.5% may be more suitable for youth who cannot articulate symptoms of hypoglycemia or have hypoglycemia unawareness and for those who do not have access to analog insulins or advanced diabetes technologies or who cannot monitor blood glucose regularly. Even less stringent A1C targets (e.g., <8%) may be warranted for children with a history of severe hypoglycemia, severe morbidities, or short life expectancy. During the "honeymoon" period and in situations where lower mean glycemia is achievable without excessive hypoglycemia or reduced quality of life, an A1C <6.5% may be safe and effective. Here, we provide a historical perspective of A1C targets in pediatrics and highlight evidence demonstrating detrimental effects of hyperglycemia in children and adolescents, including increased likelihood of brain structure and neurocognitive abnormalities, microvascular and macrovascular complications, long-term effects, and increased mortality. We also review data supporting a decrease over time in overall severe hypoglycemia risk for youth with T1D, partly associated with the use of newer insulins and devices, and weakened association between lower A1C and severe hypoglycemia risk. We present common barriers to achieving glycemic targets in pediatric diabetes and discuss some strategies to address them. We aim to raise awareness within the community on Standards of Care updates that impact this crucial goal in pediatric diabetes management.Item ISPAD Clinical Practice Consensus Guidelines 2018: Glycemic control targets and glucose monitoring for children, adolescents, and young adults with diabetes(Wiley, 2018-10) DiMeglio, Linda A.; Acerini, Carlo L.; Codner, Ethel; Craig, Maria E.; Hofer, Sabine E.; Pillay, Kubendran; Maahs, David M.; Pediatrics, School of MedicineItem ISPAD Clinical Practice Consensus Guidelines 2022: Glycemic targets and glucose monitoring for children, adolescents, and young people with diabetes(Wiley, 2023) de Bock, Martin; Codner, Ethel; Craig, Maria E.; Huynh, Tony; Maahs, David M.; Mahmud, Farid H.; Marcovecchio, Loredana; DiMeglio, Linda A.; Pediatrics, School of MedicineItem The obesity epidemic in 32,936 youth with type 1 diabetes (T1D) in the German/Austrian DPV and US T1D Exchange (T1DX) registries(Elsevier, 2015-09) DuBose, Stephanie N.; Hermann, Julia M.; Tamborlane, William V.; Beck, Roy W.; Dost, Axel; DiMeglio, Linda A.; Schwab, Karl Otfried; Holl, Reinhard W.; Hofer, Sabine E.; Maahs, David M.; Department of Pediatrics, IU School of MedicineObjective To examine the current extent of the obesity problem in 2 large pediatric clinical registries in the US and Europe and to examine the hypotheses that increased body mass index (BMI) z-scores (BMIz) are associated with greater hemoglobin A1c (HbA1c) and increased frequency of severe hypoglycemia in youth with type 1 diabetes (T1D). Study design International (World Health Organization) and national (Centers for Disease Control and Prevention/German Health Interview and Examination Survey for Children and Adolescents) BMI references were used to calculate BMIz in participants (age 2-<18 years and ≥1 year duration of T1D) enrolled in the T1D Exchange (n = 11 435) and the Diabetes Prospective Follow-up (n = 21 501). Associations between BMIz and HbA1c and severe hypoglycemia were assessed. Results Participants in both registries had median BMI values that were greater than international and their respective national reference values. BMIz was significantly greater in the T1D Exchange vs the Diabetes Prospective Follow-up (P < .001). After stratification by age-group, no differences in BMI between registries existed for children 2-5 years, but differences were confirmed for 6- to 9-, 10- to 13-, and 14- to 17-year age groups (all P < .001). Greater BMIz were significantly related to greater HbA1c levels and more frequent occurrence of severe hypoglycemia across the registries, although these associations may not be clinically relevant. Conclusions Excessive weight is a common problem in children with T1D in Germany and Austria and, especially, in the US. Our data suggest that obesity contributes to the challenges in achieving optimal glycemic control in children and adolescents with T1D.Item State of Type 1 Diabetes Management and Outcomes from the T1D Exchange in 2016–2018(Liebert, 2019-02) Foster, Nicole C.; Beck, Roy W.; Miller, Kellee M.; Clements, Mark A.; Rickels, Michael R.; DiMeglio, Linda A.; Maahs, David M.; Tamborlane, William V.; Bergenstal, Richard; Smith, Elizabeth; Olson, Beth A.; Garg, Satish K.; Pediatrics, School of MedicineObjective: To provide a snapshot of the profile of adults and youth with type 1 diabetes (T1D) in the United States and assessment of longitudinal changes in T1D management and clinical outcomes in the T1D Exchange registry. Research Design and Methods: Data on diabetes management and outcomes from 22,697 registry participants (age 1–93 years) were collected between 2016 and 2018 and compared with data collected in 2010–2012 for 25,529 registry participants. Results: Mean HbA1c in 2016–2018 increased from 65 mmol/mol at the age of 5 years to 78 mmol/mol between ages 15 and 18, with a decrease to 64 mmol/mol by age 28 and 58–63 mmol/mol beyond age 30. The American Diabetes Association (ADA) HbA1c goal of <58 mmol/mol for youth was achieved by only 17% and the goal of <53 mmol/mol for adults by only 21%. Mean HbA1c levels changed little between 2010–2012 and 2016–2018, except in adolescents who had a higher mean HbA1c in 2016–2018. Insulin pump use increased from 57% in 2010–2012 to 63% in 2016–2018. Continuous glucose monitoring (CGM) increased from 7% in 2010–2012 to 30% in 2016–2018, rising >10-fold in children <12 years old. HbA1c levels were lower in CGM users than nonusers. Severe hypoglycemia was most frequent in participants ≥50 years old and diabetic ketoacidosis was most common in adolescents and young adults. Racial differences were evident in use of pumps and CGM and HbA1c levels. Conclusions: Data from the T1D Exchange registry demonstrate that only a minority of adults and youth with T1D in the United States achieve ADA goals for HbA1c.Item Unintended Consequences of COVID-19: Remember General Pediatrics(Elsevier, 2020) Cherubini, Valentino; Gohil, Anisha; Addala, Ananta; Zanfardino, Angela; Iafusco, Dario; Hannon, Tamara; Maahs, David M.; Pediatrics, School of Medicine