CGM data. In the study, pediatric patients were assigned to this bionic pancreas system or a control group. The control group continued to manage insulin with their prestudy insulin delivery methods. Mean HbA1c decreased from 8.1% to 7.5% in the bionic pancreas group after 13 weeks with increased time spent at goal blood glucose levels and decreased time spent hyperglycemic. Hemoglobin A1c remained unchanged in the control group. Hypoglycemic time was low in both groups at baseline and at 13 weeks with no statistically significant difference over time. Of note, two patients in the bionic pancreas group required prescription of insulin glargine to manage prolonged hyperglycemia; however, none of the study participants experienced DKA. This study is incredibly promising for the future of diabetes management. Dual-hormone pump systems utilize insulin and glucagon to control blood glucose levels and are being studied in adult patients with diabetes (Zhou & Isaacs, 2022). These pumps are likely the next step in optimizing glycemic control. Initial studies indicate a reduction in glycemic variability and rates of Conclusion Management of T1DM is complex, and treatment requires individualization and continual adjustments, especially in children. Insulin is the mainstay of therapy, and tight glycemic control typical requires carbohydrate counting and subsequent dose calculations prior to administration. Pediatric healthcare providers must be adequately trained to dose insulin, detect complications, and screen for psychosocial barriers that limit Abela, A. G., & Fava, S. (2021). Why is the Incidence of type 1 diabetes increasing? Current Diabetes Reviews , 17 (8), e030521193110. https://doi.org/10.2174/157339981766621050 3133747 • Abraham, M. B., de Bock, M., Smith, G. J., Dart, J., Fairchild, J. M., King, B. R., Ambler, G. R., Cameron, F. J., McAuley, S. A., Keech, A. C., Jenkins, A., Davis, E. A., O’Neal, D. N., Jones, T. W., & Australian Juvenile Diabetes Research Fund Closed-Loop Research group (2021). Effect of a hybrid closed-loop system on glycemic and psychosocial outcomes in children and adolescents with type 1 diabetes: A randomized clinical trial. JAMA pediatrics , 175 (12), 1227-1235. https://doi.org/10.1001/jamapediatrics.2021.3965 • Addala, A., Hanes, S., Naranjo, D., Maahs, D. M., & Hood, K. K. (2021). Provider implicit bias impacts pediatric type 1 diabetes technology recommendations in the United States: Findings from The Gatekeeper Study. Journal of Diabetes Science and Technology , 15 (5), 1027-1033. https://doi.org/10.1177/19322968211006476 • Al-Gadi, I., Menon, S., Lyons, S. K., & DeSalvo, D. J. (2021). Beyond A1C: A practical approach to interpreting and optimizing continuous glucose data in youth. Diabetes Spectrum: a Publication of the American Diabetes Association , 34 (2), 139-148. https://doi. org/10.2337/ds20-0095 • American Diabetes Association Professional Practice Committee (2022a). 2. Classification and diagnosis of diabetes: Standards of medical care in diabetes, 2022. Diabetes Care , 45 (Suppl 1), S17-S38. https://doi.org/10.2337/dc22-S002 • American Diabetes Association Professional Practice Committee, Draznin, B., Aroda, V. R., Bakris, G., Benson, G., Brown, F. M., Freeman, R., Green, J., Huang, E., Isaacs, D., Kahan, S., Leon, J., Lyons, S. K., Peters, A. L., Prahalad, P., Reusch, J., & Young-Hyman, D. (2022b). 6. Glycemic targets: Standards of medical care in diabetes, 2022. Diabetes Care , 45 (Suppl 1), S83-S96. https://doi.org/10.2337/dc22-S006 • American Diabetes Association Professional Practice Committee, Draznin, B., Aroda, V. R., Bakris, G., Benson, G., Brown, F. M., Freeman, R., Green, J., Huang, E., Isaacs, D., Kahan, S., Leon, J., Lyons, S. K., Peters, A. L., Prahalad, P., Reusch, J., & Young-Hyman, D. (2022c). 7. Diabetes technology: Standards of medical care in diabetes, 2022. Diabetes Care , 45 (Suppl 1), S97–S112. https://doi.org/10.2337/dc22-S007 • American Diabetes Association Professional Practice Committee, Draznin, B., Aroda, V. R., Bakris, G., Benson, G., Brown, F. M., Freeman, R., Green, J., Huang, E., Isaacs, D., Kahan, S., Leon, J., Lyons, S. K., Peters, A. L., Prahalad, P., Reusch, J., & Young-Hyman, D. (2022d). 9. Pharmacologic approaches to glycemic treatment: Standards of medical care in diabetes, 2022. Diabetes Care , 45 (Suppl 1), S125-S143. https://doi.org/10.2337/dc22-S009 • References • American Diabetes Association Professional Practice Committee, Draznin, B., Aroda, V. R., Bakris, G., Benson, G., Brown, F. M., Freeman, R., Green, J., Huang, E., Isaacs, D., Kahan, S., Leon, J., Lyons, S. K., Peters, A. L., Prahalad, P., Reusch, J., & Young-Hyman, D. (2022e). 14. Children and adolescents: Standards of medical care in diabetes, 2022. Diabetes Care , 45 (Suppl 1), S208-S231. https://doi.org/10.2337/dc22-S014 • Antvorskov, J. C., Morgen, C. S., Buschard, K., Jess, T., Allin, K. H., & Josefsen, K. (2020). Antibiotic treatment during early childhood and risk of type 1 diabetes in children: A national birth cohort study. Pediatric siabetes , 21 (8), 1457-1464. https://doi.org/10.1111/ pedi.13111 • Berget, C., Messer, L. H., & Forlenza, G. P. (2019, August). A clinical overview of insulin pump therapy for the management of diabetes: Past, present, and future of intensive therapy. Diabetes Spectr. , 32 (3), 194-204. doi: 10.2337/ds18-0091. PMID: 31462873; PMCID: PMC6695255 • Bombaci, B., Passanisi, S., Alibrandi, A., D’Arrigo, G., Patroniti, S., Averna, S., Salzano, G., & Lombardo, F. (2022, August 18). One-year real-world study on comparison among different continuous subcutaneous insulin infusion devices for the management of pediatric patients with type 1 diabetes: The supremacy of hybrid closed-loop systems. Int J Environ Res Public Health . , 19 (16), 10293. doi: 10.3390/ijerph191610293. PMID: 36011925; PMCID: PMC9408433 • Brodar, K. E., Davis, E. M., Lynn, C., Starr-Glass, L., Lui, J., Sanchez, J., & Delamater, A. M. (2021). Comprehensive psychosocial screening in a pediatric diabetes clinic. Pediatric Diabetes , 22 (4), 656-666. https://doi.org/10.1111/pedi.13193 • Buchberger, B., Huppertz, H., Krabbe, L., Lux, B., Mattivi, J. T., & Siafarikas, A. (2016). Symptoms of depression and anxiety in youth with type 1 diabetes: A systematic review and meta-analysis. Psychoneuroendocrinology , 70 , 70-84. https://doi.org/10.1016/j. psyneuen.2016.04.019 • Centers for Disease Control and Prevention (CDC). (2022a). National diabetes statistics report, 2022: Estimates of diabetes and its burden in the United States. https://www.cdc. gov/diabetes/data/statistics-report/index.html • Centers for Disease Control and Prevention (CDC). (2022b). Recommended child and adolescent immunization schedule for ages 18 years or younger . https://www.cdc.gov/ vaccines/schedules/index.html
hypoglycemia. There are also pumps under research that secrete both insulin and pramlintide (Haidar et al., 2020). Pramlintide, an analog of amylin, is approved in adults for treatment of diabetes. Amylin is a hormone secreted with insulin from pancreatic β cells in patients without diabetes. It functions by prolonging gastric emptying time, reducing postprandial glucagon secretion and centrally suppressing appetite. These mechanisms collectively work to reduce postprandial blood glucose levels. An initial study is promising, but larger trials will need to be performed to ensure optimal safety and efficacy. Eventually, the goal of T1DM care is to eliminate the need for human intervention in glucose management (Zhou & Isaacs, 2022). An ideal artificial pancreas would automatically adjust both basal and prandial insulin requirements without meal input by the user. This would require improved technology and faster-acting insulin to mimic in vivo release. As algorithms are optimized, the idea of a fully functioning artificial pancreas is becoming closer to reality. adherence. Multidisciplinary care is essential in the patient’s education and lifelong glycemic control. As technology advances, diabetes care is becoming more automated with less user intervention. Healthcare providers must stay up to date with these practice changes to ensure patients can access the best care for their diabetes. . • Chin, A., Zonfrillo, M. R., Heinly, A., Ford, S. R., Quintos, J. B., & Topor, L. S. (2022). Screening and counseling for nicotine use in youth with diabetes. Pediatric Diabetes , 23 (1), 157-164. https://doi.org/10.1111/pedi.13287 • Clausen, T. D., Bergholt, T., Bouaziz, O., Arpi, M., Eriksson, F., Rasmussen, S., Keiding, N., & Løkkegaard, E. C. (2016). Broad-spectrum antibiotic treatment and subsequent childhood type 1 diabetes: A nationwide Danish cohort study. PloS one , 11 (8), e0161654. https://doi. org/10.1371/journal.pone.0161654 • Erbas, I. M., Abaci, A., Anik, A., Simsek, E., Tuhan, H. U., Kocyigit, C., Yıldız, M., Dundar, B. N., Bober, E., & Catli, G. (2020). Comparison of the effectiveness of simple carbohydrates on hypoglycemic episodes in children and adolescents with type 1 diabetes mellitus: A randomized study in a diabetes camp. Pediatric Diabetes , 21 (7), 1249-1255. https://doi. org/10.1111/pedi.13077 • Erdal, B., Caferoglu, Z., & Hatipoglu, N. (2021). The comparison of two mealtime insulin dosing algorithms for high and low glycaemic index meals in adolescents with type 1 diabetes. Diabetic Medicine: A Journal of the British Diabetic Association , 38 (3), e14444. https://doi.org/10.1111/dme.14444 • Foster, N. C., Beck, R. W., Miller, K. M., Clements, M. A., Rickels, M. R., DiMeglio, L. A., Maahs, D. M., Tamborlane, W. V., Bergenstal, R., Smith, E., Olson, B. A., & Garg, S. K. (2019). State of type 1 diabetes management and outcomes from the T1D Exchange in 2016–2018. Diabetes Technology & Therapeutics , 21 (2), 66-72. https://doi.org/10.1089/ dia.2018.0384 • Frid, A. H., Kreugel, G., Grassi, G., Halimi, S., Hicks, D., Hirsch, L. J., Smith, M. J., Wellhoener, R., Bode, B. W., Hirsch, I. B., Kalra, S., Ji, L., & Strauss, K. W. (2016). New insulin delivery recommendations. Mayo Clinic Proceedings , 91 (9), 1231-1255. https://doi. org/10.1016/j.mayocp.2016.06.010 • Haidar, A., Tsoukas, M. A., Bernier-Twardy, S., Yale, J. F., Rutkowski, J., Bossy, A., Pytka, E., El Fathi, A., Strauss, N., & Legault, L. (2020). A novel dual-hormone insulin-and-pramlintide artificial pancreas for type 1 diabetes: A randomized controlled crossover trial. Diabetes Care , 43 (3), 597-606. https://doi.org/10.2337/dc19-1922 • Hill, R. M., Gallagher, K., Eshtehardi, S. S., Uysal, S., & Hilliard, M. E. (2021). Suicide risk in youth and young adults with type 1 diabetes: A review of the literature and clinical recommendations for prevention. Current Diabetes Reports , 21 (12), 51. https://doi. org/10.1007/s11892-021-01427-y • Inverso, H., Moore, H. R., Lupini, F., Wang, C. H., Streisand, R., Shomaker, L. B., & Mackey, E. R. (2022). Mindfulness-based interventions: focus on pediatric type 1 and type 2 diabetes. Current Diabetes Reports , 22 (10), 493-500. https://doi.org/10.1007/s11892-022- 01492-x • Karges, B., Schwandt, A., Heidtmann, B., Kordonouri, O., Binder, E., Schierloh, U., Boettcher, C., Kapellen, T., Rosenbauer, J., & Holl, R. W. (2017). Association of insulin pump therapy vs insulin injection therapy with severe hypoglycemia, ketoacidosis, and glycemic control among children, adolescents, and young adults with type 1 diabetes. JAMA , 318 (14), 1358- 1366. https://doi.org/10.1001/jama.2017.13994 • Kumbhare, S. V., Patangia, D., Patil, R. H., Shouche, Y. S., & Patil, N. P. (2019). Factors influencing the gut microbiome in children: From infancy to childhood. Journal of Biosciences , 44 (2), 49. • Laffel, L. M., Kanapka, L. G., Beck, R. W., Bergamo, K., Clements, M. A., Criego, A., DeSalvo, D. J., Goland, R., Hood, K., Liljenquist, D., Messer, L. H., Monzavi, R., Mouse, T. J., Prahalad, P., Sherr, J., Simmons, J. H., Wadwa, R. P., Weinstock, R. S., Willi, S. M., Miller, K. M., … CDE10. (2020). Effect of continuous glucose monitoring on glycemic control in adolescents and young adults with type 1 diabetes: A randomized clinical trial. JAMA , 323 (23), 2388-2396. https://doi.org/10.1001/jama.2020.6940 • Lapolla, A., Amaro, F., Bruttomesso, D., Di Bartolo, P., Grassi, G., Maffeis, C., Purrello, F., & Tumini, S. (2020). Diabetic ketoacidosis: A consensus statement of the Italian Association of Medical Diabetologists (AMD), Italian Society of Diabetology (SID), Italian Society of Endocrinology and Pediatric Diabetoloy (SIEDP). Nutrition, Metabolism, and Cardiovascular Diseases: NMCD , 30 (10), 1633-1644. https://doi.org/10.1016/j.numecd.2020.06.006 • Lee, D., Choi, S., Chang, J., Park, Y. J., Kim, J. H., & Park, S. M. (2022). Association of antibiotics exposure within the first 2 years after birth with subsequent childhood type 1 diabetes. Endocrine , 77 (1), 21-29. https://doi.org/10.1007/s12020-022-03042-7 • Lexicomp. (2022). Insulin products. Lexi-comp . https://online.lexi.com • Maahs, D. M., & Shalitin, S. (2020). Diabetes technology and therapy in the pediatric age group. Diabetes Technology & Therapeutics , 22 (S1), S89-S108. https://doi.org/10.1089/ dia.2020.2507 • Messer, L. H., Buckingham, B. A., Cogen, F., Daniels, M., Forlenza, G., Jafri, R. Z., Mauras, N., Muir, A., Wadwa, R. P., White, P. C., Russell, S. J., Damiano, E. R., El-Khatib, F. H., Ruedy, K. J., Balliro, C. A., Li, Z., Marak, M. C., Calhoun, P., & Beck, R. W. (2022). Positive impact of the bionic pancreas on diabetes control in youth 6-17 years old with type 1 diabetes: A multicenter randomized trial. Diabetes Technology & Therapeutics , 24 (10), 712-725. https:// doi.org/10.1089/dia.2022.0201.pub
Page 110
Book Code: AUS3024
EliteLearning.com/Nursing
Powered by FlippingBook