Journal
JOURNAL OF PEDIATRICS
Volume 150, Issue 3, Pages 279-285Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.jpeds.2006.12.009
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Funding
- NIDDK NIH HHS [T32 DK063702, 5T32DK063702, R01 DK046887, R01DK046887] Funding Source: Medline
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Objective To evaluate temporal trends in pediatric type 1 diabetes (T1DM) management and resultant effects on outcomes. Study design Two pediatric T1DM cohorts were followed prospectively for 2 years and compared; Cohort 1 (N = 299) was enrolled in 1997 and Cohort 2 (N = 152) was enrolled in 2002. In both cohorts, eligible participants were identified and sequentially approached at regularly scheduled clinic visits until the target number of participants was reached. Main outcome measures were hemoglobin A1c (A1c), body mass index Z score and incidence rate (IR; per 100 patient-years) of hypoglycemia, hospitalizations, and emergency room (ER) visits. Results At baseline, Cohort 2 monitored blood glucose more frequently than Cohort 1 (>= 4 times/day: 72% vs 39%, P < .001) and was prescribed more intensive therapy than Cohort 4 (>= 3 injections/day or pump: 85% vs 65%, P <.001). A1c was lower in Cohort 2 than Cohort 1 at baseline (8.4% vs 8.7%, P = .03) and study's end (8.7% vs 9.0%, P = .04). The cohorts did not differ in Z-BMI (0.83 vs 0.79, P = .57) or IR of hospitalizations (11.2 vs 12.9, P = .38). Cohort 2 had lower IR of total severe hypoglycemic events (29.4 vs 55.4, P < .001) and ER visits (22.0 vs 29.3, P = .02). Conclusions T1DM management intensified during 5 years between cohorts and was accompanied by improved A1c and stable Z-BMI. Along with improved control, IR of severe hypoglycemia and ER visits decreased by almost 50% and 25%. respectively.
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