Prevalance and associations of food insecurity in children with diabetes mellitus.

OBJECTIVES: To examine the prevalence of food insecurity in households with a child with insulin-requiring diabetes mellitus (DM), investigate whether food insecurity is associated with poorer DM control, and describe the household characteristics and coping strategies of food-insecure families with a child with DM. STUDY DESIGN: Telephone interviews were conducted with consecutive consenting families over a 16-month period. Food insecurity was assessed through a validated questionnaire; additional questions elicited demographic information and DM management strategies. Charts were reviewed for hemoglobin A1c (HbA1c). Univariate and logistic regression analyses were performed. RESULTS: A total of 183 families were interviewed. Food insecurity was present in 21.9% (95% confidence interval, 15.87%-27.85%), significantly higher than the overall prevalences in Nova Scotia (14.6%) and Canada (9.2%). Food insecurity was associated with higher HbA1c level; however, in multivariate analysis, only child's age and parents' education were independent predictors of HbA1c. Children from food-insecure families had higher rates of hospitalization, for which food security status was the only independent predictor. Common characteristics and coping strategies of food-insecure families were identified. CONCLUSIONS: Food insecurity was more common in families with a child with DM, and the presence of food insecurity was predictive of the child's hospitalization. Risk factors identified in this study should be used to screen for this problem in families with a child with DM.

Pioglitazone as adjunctive therapy in adolescents with type 1 diabetes.

OBJECTIVE: To determine whether the addition of the thiazoladinedione, pioglitazone, to standard therapy improves metabolic control in adolescents with type 1 diabetes (T1D) and clinical evidence of insulin resistance. STUDY DESIGN: Randomized, placebo-controlled 6-month 2-site trial of pioglitazone therapy in 35 adolescents with T1D, high insulin requirements (>0.9 U/kg/d), and suboptimal metabolic control (A1c 7.5%-11%), with the primary outcome of change in A1c. Secondary outcomes include change in insulin dose, body mass index (BMI), lipids, and waist and hip circumference. RESULTS: Metabolic control (A1c) was improved at 6 months in all subjects (P = .02). There was no significant difference between the pioglitazone and placebo treatment groups at 6 months in either change in A1c (-0.4% +/- 0.9% and -0.5% +/- 1.2%, respectively) or insulin dose. BMI SDS increased by 0.3 +/- 0.3 (kg/m(2)) in the pioglitazone group and remained unchanged in the placebo group (P = .01). There was no significant difference in change in any lipid parameters between the pioglitazone and placebo groups at 6 months. CONCLUSIONS: Adjunctive pioglitazone therapy was not effective in improving glycemic control in adolescents with T1D. Pioglitazone was associated with increased BMI.

Population-based study of incidence and risk factors for cerebral edema in pediatric diabetic ketoacidosis.

OBJECTIVES: To determine incidence, outcomes, and risk factors for pediatric cerebral edema with diabetic ketoacidosis (CEDKA) in Canada. STUDY DESIGN: This was a case-control study nested within a population-based active surveillance study of CEDKA in Canada from July 1999 to June 2001. Cases are patients with DKA <16 years of age with cerebral edema. Two unmatched control subjects per case are patients with DKA without cerebral edema. RESULTS: Thirteen cases of CEDKA were identified over the surveillance period for an incidence rate of 0.51%; 23% died and 15% survived with neurologic sequelae. CEDKA was present at initial presentation of DKA in 19% of cases. CEDKA was associated with lower initial bicarbonate ( P = .001), higher initial urea ( P = .001), and higher glucose at presentation ( P = .014). Although there was a trend to association with higher fluid rates and treatment with bicarbonate, these were not independent predictors. CONCLUSIONS: CEDKA remains a significant problem with a high mortality rate. No association was found between the occurrence of CEDKA and treatment factors. The presence of cerebral edema before treatment of DKA and the association with severity of illness suggest that prevention of DKA is the key to avoiding this devastating complication.