Changes in Treatment Adherence and Glycemic Control During the Transition to Adolescence in Type 1 Diabetes

Rausch, Joseph R.; Hood, Korey K.; Delamater, Alan M.; Pendley, Jennifer Shroff; Rohan, Jennifer; Reeves, Grafton; Dolan, Lawrence M.; Drotar, Dennis

doi:10.2337/dc11-2163

Cited by 150 publications

(135 citation statements)

References 20 publications

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“…First, the relationship between nonadherence to AEDs and seizure outcomes is not linear, as it is with other chronic conditions (e.g., diabetes, hypertension, HIV). [17][18][19] However, these data suggest that patients in the moderate and variable nonadherence groups could benefit from adherence promotion interventions early in the epilepsy course that are geared to the family's specific adherence barriers, which were not examined in this study. Several empirically supported adherence interventions (e.g., multimodal interventions involving education, organization strategies, and problem-solving) have been developed for pediatric chronic conditions.…”

Section: Discussionmentioning

confidence: 71%

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Modi

Rausch

et al. 2014

Neurology

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Objective: The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes.Methods: This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes.Results: Participants (n 5 109) were 7.3 6 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n 5 10), variable nonadherence (n 5 16), moderate nonadherence (n 5 40), and high adherence (n 5 43). Two seizure probability trajectory groups were identified: high seizure (n 5 28) and low seizure probability (n 5 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b 5 22.372; odds ratio [OR] 5 0.093; 95% confidence interval [CI] OR 5 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b 5 1.649; OR 5 5.203; 95% CI OR 5 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial maxrescaled R 2 5 0.13). Despite the introduction of multiple new efficacious antiepileptic drugs (AEDs), 20% to 35% of children with newly diagnosed epilepsy continue to have seizures. 1-3 Several biologically based factors have been examined to understand this disease course, including underlying brain disorders and structural abnormalities, seizure type/etiology, and genetics. Conclusions:4,5 However, these biological factors, which are nonmodifiable, do not fully explain the variability in seizure outcomes. In contrast, behavioral factors, such as AED nonadherence, are modifiable and may affect long-term seizure outcome. While discrete trajectories of AED nonadherence in children with newly diagnosed epilepsy have been identified, 6 similar trajectories of long-term seizure outcomes have not been examined. Our prior work also indicates that children who are nonadherent to their AEDs within the first 6 months of therapy are 3.24 times more likely to have seizures 4 years after diagnosis. 7 In adults, AED nonadherence increases short-term risk of seizures. 8,9 However, what remains unknown is the relationship between long-term nonadherence and seizure outcome in both adults and children. We conducted a prospective, longitudinal, observational study to

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Section: Discussionmentioning

confidence: 71%

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Modi

Rausch

et al. 2014

Neurology

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“…3 This measure has been found to correlate negatively with youths' hemoglobin A1c (HbA1c) level, suggesting that more frequent BGM is related to lower HbA1c levels. [5][6][7] It is presumed that more frequent BGM may allow a youth to more readily identify and correct high blood glucose levels, which leads to better control. This is a reasonable assumption because it is unlikely that youths would check their blood glucose frequently if they did not use these data as part of their self-care.…”

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confidence: 99%

Frequency of Mealtime Insulin Bolus as a Proxy Measure of Adherence for Children and Youths with Type 1 Diabetes Mellitus

Patton

Clements²,

Fridlington³

et al. 2013

Diabetes Technology & Therapeutics

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Background: Electronic measures of adherence can be superior to patient report. In type 1 diabetes, frequency of blood glucose monitoring (BGM), as measured by patients' home blood glucose meters, has already been identified as a valid proxy of adherence. We present methodology to calculate adherence using insulin pump records and evaluate the reliability and validity of this methodology. Subjects and Methods: Blood glucose meter data, insulin pump records, and corresponding hemoglobin A1c (HbA1c) levels were randomly gathered from clinical and research databases for 100 children and youths (referred to hereafter as youths) with type 1 diabetes (mean -SD age, 12.7 -4.6 years). Youths' mean frequency of daily BGM was calculated. Additionally, we calculated a mean mealtime insulin bolus score (BOLUS): youths received 1 point each for a bolus between 0600 and 1000 h, 1100 and 1500 h, and 1600 and 2200 h (maximum of 1 point/meal or 3 points/day). Results: Simple correlations between youths' HbA1c level, age, frequency of BGM, and insulin BOLUS scores were all significant. Partial correlations and multiple regression analyses revealed that insulin BOLUS scores better explain variations in HbA1c levels than the electronically recorded frequency of daily blood glucose measures. Conclusions: Our procedures for calculating insulin BOLUS scores using insulin pump records demonstrate better concurrent validity with youths' HbA1c levels than that of the frequency of BGM with youths' HbA1c levels. Our analyses have shown that insulin bolus scoring was superior to the frequency of BGM in predicting youths' HbA1c levels.

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“…The low treatment adherence fits well with previous studies in adolescents with severe obesity (13,14,15). Treatment adherence is a well-known problem in many chronic diseases such as obesity, especially in adolescents, and treatment outcome depends largely on adherence (60,68,69). Adolescent patients often present greater challenges given the unique developmental, psychosocial and lifestyle issues implicit in adolescence (60,70).…”

Section: Introductionmentioning

confidence: 99%

Should bariatric surgery be performed in adolescents?

Beamish

Reinehr

2017

European Journal of Endocrinology

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Adolescent obesity has markedly increased worldwide in both its extent and prevalence in recent decades and obesity prevention strategies are failing. As a result, effective treatment strategies are urgently needed. As behavioral and pharmacological treatment approaches have only moderate effects in severe obesity, bariatric surgery has begun to emerge as a treatment option. In this debate article, we offer arguments opposing and supporting bariatric surgery in the treatment of severe obesity in adolescents. Bariatric surgery has superior therapeutic outcomes with respect to weight loss and resolution of comorbid diseases over other existing treatments. However, long-term outcomes after bariatric surgery in adolescents are only just beginning to emerge. Furthermore, the procedures are generally considered irreversible, apart from gastric banding. Most importantly, not all adolescents seem to benefit greatly from bariatric surgery and we are not yet able to reliably identify those who stand to gain the greatest benefit. The authors agree that adolescent bariatric surgery should be offered exclusively within formal adolescent obesity programs, delivered by specialist multidisciplinary child/adolescent obesity teams, and within specialist centers, in order to optimize outcomes and minimize potential detrimental effects. Patients and their family/carers must be educated regarding the benefits and risks, potential side effects, expected changes in eating behavior and the lifelong requirement for regular medical follow-up after surgery. Before embarking upon a surgical treatment pathway in adolescents with severe obesity, it may also be beneficial to ensure compliance to treatment is demonstrated, in order to minimize the risk of nutritional deficiencies and associated potential complications.

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Changes in Treatment Adherence and Glycemic Control During the Transition to Adolescence in Type 1 Diabetes

Cited by 150 publications

References 20 publications

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes

Frequency of Mealtime Insulin Bolus as a Proxy Measure of Adherence for Children and Youths with Type 1 Diabetes Mellitus

Should bariatric surgery be performed in adolescents?

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