Using the geographically and socioeconomjcally varied collaborative Lipid Research Clinics Prevalence Study data, this report focuses upon relationships between dietary intake and plasma lipids and lipoproteins in 1234 white children, 661 boys and 573 girls, aged 6-19 years who were sampled in a random recall (Visit 2) from large populations in six Lipid Research Clinics. Using multiple regression analysis, we found that in 6-to 12-year-old boys the dietary polyunsaturated-to-saturated fat ratio was inversely associated with plasma total and low density lipoprotein cholesterol and dietary cholesterol was positively associated with plasma high density lipoprotein cholesterol. In 13-to 19-year-old boys, high density lipoprotein cholesterol and the ratio of high density lipoprotein cholesterol to total cholesterol were inversely related to sucrose intake. In 6-to 12-year-old girls, plasma triglycerides were positively related to dietary sucrose. Using analysis of covariance in children having the lowest, middle, and top decile nutrient intakes, we found that higher carbohydrate intakes were associated with lower plasma total cholesterol in boys. The highest polyunsaturated fat intake (in 6-to 12-year-old girls) was associated with the lowest plasma cholesterol and very low density lipoprotein cholesterol. The highest cholesterol intake (in 6-to 12-year-old boys) was associated with the highest high density lipoprotein cholesterol levels. In girls, the highest sucrose intakes were associated with the highest plasma triglyceride levels. We conclude that the weak, but statistically significant, associations that we observed were meaningful relative to etiologies of nutrient-lipoprotein interrelationships, and should be useful in forming new hypotheses for focused metabolic ward studies. (Arteriosclerosis

An observation study was conducted at Boston Children’s Hospital on patients with type 1 diabetes mellitus (T1DM) who elected to treat their diabetes with the FDA approved Medtronic 670G hybrid closed loop insulin pump. 83 pediatric and young adults were trained and started on the Medtronic 670G in automode between 5/30/17-9/7/18 (Age range 6-25 years). Average follow up time for the patient population was 8 months (range 3-18 months). 19% (16/83) of T1DM patients discontinued use of automode hybrid closed loop technology completely, often due to technical difficulties with the sensor or difficulties staying in automode. Calibration requirements, problems with sensor durability or adhesion, skin irritation and forced exits from automode were common areas of difficulty. 81% (67/83) continued to use automode although a wide range of percent time in automode was observed (10-90%). A subset of 58 patients who continued to use automode technology and who had available hemoglobin a1c data obtained within 6 months before and within 6 months after starting automode were analyzed . A mean decrease in hemoglobin A1c of 0.27% (95% confidence interval is -0.5, -0.03) was seen after an average of 97 days using automode closed loop technology (P=0.025). In conclusion, our data supports the observation that closed loop insulin delivery in subjects that are successful in using the technology improves glucose control (reduces HbA1c). Additional work is needed to understand barriers to successful implementation of technology.

Background: Recent data demonstrating a lack of improvement in average hemoglobin A1c levels despite the increased use of insulin pumps and continuous glucose monitors (CGMs) suggest that patients are not using these technologies optimally. Suboptimal provider understanding of these devices may be a contributing factor. Methods: We sought to assess fellows' knowledge, attitudes, and practices regarding insulin pumps and CGMs using a mixed-methods survey. We polled 42 pediatric endocrinology fellows and 69 attending physicians in pediatric endocrinology using items on a five-point Likert scale. Results: Perceived fellow knowledge of insulin pumps and CGMs was only 3.6-1.0 and 3.6-0.9, respectively. Despite consensus about the need for pediatric endocrinologists to understand these technologies, only 14.7% of fellows reported the presence of a formal curriculum about these technologies at their institutions. Potential gaps identified in fellows' knowledge include general use and troubleshooting, advanced insulin pump features, infusion sets and dermatological complications, systematic approach to data, interpretation and application of CGM data, and keeping pace with technological advances. Conclusions: Our data suggest suboptimal fellow knowledge and understanding of insulin pumps and CGMs in pediatric type 1 diabetes management, which is likely attributable to inadequate education in fellowship training programs. The development of formal educational curricula targeting areas of weakness identified in this survey may improve clinician knowledge of these technologies and ultimately impact patient education and care.

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