Role of Social Factors in Glycemic Control Among African American Children and Adolescents with Type 1 Diabetes.

OBJECTIVE: With the rising incidence of Type 1 diabetes (T1DM), it is important to recognize deficiencies in care and areas of improvement to provide better access to resources and education for T1DM patients. The objective of this study was to recognize social factors and compliance barriers affecting glycated hemoglobin (A1c) level in T1D patients among the minority population. METHODS: A total of 84 T1DM patients, ages 3 to 21 years, 49% males, 87% African American participated in the study. Study questionnaires assessing patient knowledge and other variables were distributed and patient charts were reviewed retrospectively to obtain relevant clinical data. T-tests, one-way ANOVA and spearman correlation were used for analysis. RESULTS: Mean A1c in our study was 10.5% and mean knowledge score was 10.1 out of 14. There was no significant correlation (r = 0.12, p = 0.26) between A1c and patients' knowledge scores. Patients with more frequent blood sugar (BS) monitoring (3-4 times/day) had 2 points lower A1c (9.6 vs 11.6 %, 95% CI 0.2-3.7, p = 0.03) than those with 2 or less times/day. No significant difference in A1c between 3-4 checks/day vs >4 checks/day BS checks. Most patients reported 'forgetfulness' (19%) followed by 'too time consuming' (17.9%) as barriers to daily BS monitoring. There was no significant difference in A1c between pen or pump users (10.5 vs 10.2 %, p = 0.55). Surprisingly, those with home supervision had higher A1c than those without (10.7 vs 9.6 %, p = 0.04) while there was no significant difference between those with or without nurse supervision at school (10.6 vs 9.8 %, p = 0.33). Those reporting happy mood interestingly had higher A1c than those with sad/depressed mood (10.7 vs 9.4 %, p = 0.04). On multiple linear regression analysis, frequency of BS checks, home supervision and mood were the most significant predictors of A1c and altogether explained 20% of the variability in A1c. CONCLUSION: Frequent BS monitoring is associated with lower A1c. Supervision at home and school did not improve A1c, but it was self-reported information. Mood did not affect A1c contrary to that reported in other studies.

Study of glucose profiles with continuous glucose monitoring in adolescents with poorly controlled type 2 diabetes mellitus.

AIM: To evaluate glycemic excursions in adolescents with poorly controlled type 2 diabetes mellitus (DM2). METHODS: Seventeen adolescents (12 F/5 M) underwent glucose monitoring for 3 days using a continuous glucose monitoring system (CGMS). Glucose measurements were divided into periods of euglycemia, hyperglycemia, and hypoglycemia. The percentage of each period, average glucose concentration per 24 h, day and night, the number of excursions, and area under the curve (AUC) of glucose >150 mg/dl and <70 mg/dl were calculated. RESULTS: On average, patients remained in euglycemia for 28.5%, hyperglycemia for 70%, and hypoglycemia 1.3% of the total day. Hyperglycemic excursions were more frequent during the day. Hypoglycemic events were more frequent during the night. 24-h average glucose, duration of glucose >150 mg/dl, and AUC >150 mg/dl correlate with HbA1c and fructosamine to varying degrees. CONCLUSION: Continuous glucose monitoring provide valuable information on glucose excursions in adolescents with poorly controlled DM2 and may be helpful in improving metabolic control of poorly controlled adolescents with DM2.