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            Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence

Gregory, John Welbourn; Cameron, Fergus; Joshi, Kriti; Eiswirth, Mirjam Elisabeth; Garrett, Christopher; Garvey, Katharine C.; Agarwal, Shivani; Codner, Ethel

doi:10.1111/pedi.13408

Cited by 45 publications

(55 citation statements)

References 271 publications

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“…It is reasonable to assume that the disease places a particular burden on this group of patients because the life-changing onset of the disease coincides with other changes during this stage of life. Emerging adulthood is a dynamic and changeable period with unique developmental, social, and emotional challenges [ 2 ] that requires specialised diabetes care and education [ 12 ]. The complexity of the disease experience is individually different, as are the individual resources and problems related to living with diabetes.…”

Section: Discussionmentioning

confidence: 99%

“…Diabetes distress in emerging adults is still an understudied phenomenon, even though it is common and occurs more frequently in this age- group and is suspected to contribute to adverse outcomes [ 2 ], such as higher haemoglobin A1c (HbA1c) levels [ 8 – 10 ], higher glycaemic variability [ 11 ], impaired quality of life [ 9 ], more severe depressive symptoms [ 8 ], and worse physical and mental health [ 8 , 9 ]. Since diabetes distress, depressive symptoms and HbA1c levels are interrelated, it seems appropriate to examine these factors simultaneously [ 6 , 8 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS)

Stahl‐Pehe

Bächle²,

Bódis³

et al. 2023

Diabetol Metab Syndr

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Background Diabetes distress is increasingly considered one of the most important psychosocial issues in the care of people with type 1 diabetes (T1D). We analyse whether diabetes distress and depression screening results of emerging adults are associated with the age at T1D onset. Methods Data were taken from two cohort studies conducted at the German Diabetes Center, Düsseldorf, Germany. The 18–30-year-old participants had an age at onset either before the age of 5 years (childhood-onset long-term T1D study group, N = 749) or during adulthood (adult-onset short-term T1D study group from the German Diabetes Study (GDS), N = 163). Diabetes distress and depression screening were analysed by means of the 20-item Problem Areas in Diabetes (PAID-20) scale and the nine-item depression module from the Patient Health Questionnaire (PHQ-9). The average causal effect of age at onset was estimated by a doubly robust causal inference method. Results The PAID-20 total scores were increased in the adult-onset study group [potential outcome mean (POM) 32.1 (95% confidence interval 28.0; 36.1) points] compared to the childhood-onset study group [POM 21.0 (19.6; 22.4) points, difference 11.1 (6.9; 15.3) points, p<0.001] adjusted for age, sex and haemoglobin A1c (HbA1c) levels. Moreover, more participants in the adult-onset group [POM 34.5 (24.9; 44.2) %] than in the childhood-onset group [POM 16.3 (13.3; 19.2) %] screened positive for diabetes distress [adjusted difference 18.3 (8.3; 28.2) %, p<0.001]. The PHQ-9 total score [difference 0.3 (-1.1; 1.7) points, p=0.660] and the proportion of participants with a positive screening result for depression [difference 0.0 (-12.7; 12.8) %, p=0.994] did not differ between the groups in the adjusted analyses. Conclusions Emerging adults with short-term type 1 diabetes screened positive for diabetes distress more often than adults with type 1 diabetes onset during early childhood when age, sex and HbA1c values were considered confounding factors. Accounting for age at onset or the duration of diabetes may help explain the heterogeneity in the data when psychological factors are examined.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS)

Stahl‐Pehe

Bächle²,

Bódis³

et al. 2023

Diabetol Metab Syndr

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“…Type 1 diabetes mellitus (T1DM) is one of the most common endocrine and metabolic conditions in childhood and is often characterized by poor glycemic control [ 1 ]. Integral to the management of T1DM, dietary therapy aims to provide healthy eating principles, improve diabetes outcomes, and reduce cardiovascular risk [ 2 ]. A Mediterranean diet in conjunction with carbohydrate counting is frequently used in the clinical management of T1DM [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Integral to the management of T1DM, dietary therapy aims to provide healthy eating principles, improve diabetes outcomes, and reduce cardiovascular risk [ 2 ]. A Mediterranean diet in conjunction with carbohydrate counting is frequently used in the clinical management of T1DM [ 2 ]. Notwithstanding the pharmaceutical, technological, and nutritional advancements in the past decades, glycemic parameters remain suboptimal, with an average HbA1c of 9.3% between the ages of 15 and 18 years [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

“…Carbohydrates are the primary macronutrient that affects the postprandial glycemic response. The international guidelines published by the International Society of Pediatric and Adolescent Diabetes include 40–50% of total energy consumption from carbohydrates, and achievement of optimal postprandial glycemic control with appropriately matched insulin to carbohydrate ratios and insulin delivery [ 2 ]. The evidence in the literature is currently insufficient to support the use of low-carbohydrate diets (LCD) as an adjunctive treatment for T1DM.…”

Section: Introductionmentioning

confidence: 99%

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The Impact of a Low-Carbohydrate Diet on Micronutrient Intake and Status in Adolescents with Type 1 Diabetes

et al. 2023

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Objective: The aim of this study was to evaluate the macronutrient and micronutrient intake and status in youth with type 1 diabetes mellitus (T1DM) following the consumption of a low-carbohydrate diet (LCD). Research Methods and Procedures: In a prospective intervention clinical trial, adolescents with T1DM using a continuous glucose monitoring device were enrolled. Following a cooking workshop, each participant received a personalized diet regime based on LCD (50–80 g carbohydrate/day). A Food Frequency Questionnaire was administered, and laboratory tests were taken before and 6 months following the intervention. Twenty participants were enrolled. Results: The median age was 17 years (15; 19), and the median diabetes duration was 10 years (8; 12). During the six-months intervention, carbohydrate intake decreased from 266 g (204; 316) to 87 g (68; 95) (p = 0.004). Energy intake, the energy percent from ultra-processed food, and fiber intake decreased (p = 0.001, p = 0.024, and p < 0.0001, respectively). These changes were accompanied by declines in BMI z-score (p = 0.019) and waist-circumference percentile (p = 0.007). Improvement was observed in the median HbA1c from 8.1% (7.5; 9.4) to 7.7% (6.9; 8.2) (p = 0.021). Significant declines below the DRI were shown in median intake levels of iron, calcium, vitamin B1, and folate. Conclusions: The LCD lowered ultra-processed food consumption, BMI z-scores and the indices of central obesity. However, LCDs require close nutritional monitoring due to the possibility of nutrient deficiencies.

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Mediterranean diet adherence and glycemic control in children and adolescents with type 1 diabetes

Rebollo-Román,

Tabernero-Urbieta,

Villaécija

et al. 2023

Eur J Pediatr

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Purpose: To effectively manage type 1 diabetes (T1D) insulin is essential, with dosages based on lifestyle. Mediterranean diet has demonstrated its advantages in preventing and enhancing the management of chronic diseases. Nevertheless, the evidence supporting this association in younger patients with type 1 diabetes remains limited. Our objective was to investigate the potential mediation of sensor activity on the relationship between adherence to the Mediterranean diet and glycemic control in children and adolescents.Methods: 150 children and adolescents (mean age = 13.09, SD = 3.54; 44% female) with type 1 diabetes were recruited. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire.Glycemic control and the duration of sensor activity were evaluated based on data from ash glucose monitoring.Results: The data con rmed our hypothesis by revealing a signi cant relationship between adherence to the Mediterranean diet and glycemic control. This relationship was mediated by the duration of sensor activity.Conclusions: Our results highlight the importance of incorporating Mediterranean diet recommendations to achieve better glycemic control. Furthermore, our ndings support the increased utilization of glycemic control devices, as they contribute to improve glycemic control and mediate on the positive relationship between adherence of Mediterranean diet and adequate glycemic control. WHAT IS KNOWN -WHAT IS NEWWhat is known Mediterranean diet and glycemic control have proven bene ts in improving cardiovascular health in general population. Scarce evidence exists of these bene ts among children and adolescents with T1D. What is newAdherence to Mediterranean diet and greater adherence to glucose monitoring in children and adolescents with T1D are related to better glycemic control. These variables can be enhanced by psychoeducational interventions, which highlights the importance of focusing in these aspects.

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ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence

Cited by 45 publications

References 271 publications

Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS)

Comparison of diabetes distress and depression screening results of emerging adults with type 1 diabetes onset at different ages: findings from the German early-onset T1D study and the German Diabetes Study (GDS)

The Impact of a Low-Carbohydrate Diet on Micronutrient Intake and Status in Adolescents with Type 1 Diabetes

Mediterranean diet adherence and glycemic control in children and adolescents with type 1 diabetes

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