Karin Åkesson

The influence of age, gender, insulin dose, BMI, and blood pressure on metabolic control in young patients with type 1 diabetes

To explore the relationship between certain clinical variables and metabolic HbA1c at diagnosis correlated to HbA1c at follow‐up (p < 0.001). There was a clear gender difference regarding HbA1c. Girls had higher values both at diagnosis and at follow‐up (p < 0.001). Girls also had lower BMI and pH at diagnosis than boys (p < 0.001). In contrast, girls with the highest body mass index (BMI) at follow‐up had higher mean HbA1c at follow‐up in 2010 (p < 0.001). Having a mother and/or a father with high BMI implied higher HbA1c at diagnosis (p < 0.003).

Glycated haemoglobin variations in paediatric type 1 diabetes: the impact of season, gender and age.

To study whether monthly variations in type 1 diabetes incidence are related to monthly glycated haemoglobin (HbA1c) levels at diagnosis and if high HbA1c at diagnosis is related to certain clinical variables at diagnosis and during the clinical course of the disease.

Teenagers with poor metabolic control already have a higher risk of microvascular complications as young adults

AIMS To evaluate how HbA1c in adolescents with type 1 diabetes affects microvascular complications in young adults. METHODS All individuals registered in the Swedish paediatric diabetes quality registry (SWEDIABKIDS) 13-18 years of age, and as adults registered in the Swedish National Diabetes Registry (NDR) in both the years 2011 and 2012 were included, in total 4250 individuals. RESULTS Of the individuals with mean HbA1c >78 mmol/mol in SWEDIABKIDS 83.4% had retinopathy, 15.8% had microalbuminuria and 4.9% had macroalbuminuria in NDR. The logistic regression analysis showed that the OR to develop macroalbuminuria as a young adult was significantly higher in the group with mean HbA1c >78 mmol/mol in SWEDIABKIDS (p<0.05). Among the patients with mean HbA1c above 78 mmol/mol in both registries there was a significantly higher proportion that had retinopathy, microalbuminuria (p<0.001) and/or macroalbuminuria (p<0.01) compared to the group with HbA1c below 57 mmol/mol in both registries. Only 6.5% of the persons in this study were over 30 years of age. CONCLUSIONS Paediatric diabetes teams working with teenagers must be aware of the impact of good metabolic control during adolescence, and should intensify the care during this vulnerable period of life to reduce the risk of microvascular complications in young adults.

Islet cell autoantibody levels after the diagnosis of young adult diabetic patients

Aims  The aim was to determine the course of islet cell antibodies [glutamate decarboxylase (GADA), tyrosine phosphatase‐like islet antigen 2 (IA‐2A) and islet cell (ICA)] after the diagnosis of the diabetic patient.

Increased risk of diabetes among relatives of female insulin-treated patients diagnosed at 15-34 years of age

Aims  This study aimed to determine the risk of developing diabetes among relatives of patients diagnosed between 15 and 34 years of age who were treated with insulin. Our second aim was to determine whether there was a difference in risk of diabetes between relatives of male and female patients.

Teenage girls with type 1 diabetes have poorer metabolic control than boys and face more complications in early adulthood

AIMS To compare metabolic control between males and females with type 1 diabetes during adolescence and as young adults, and relate it to microvascular complications. METHODS Data concerning 4000 adolescents with type 1 diabetes registered in the Swedish paediatric diabetes quality registry, and above the age of 18years in the Swedish National Diabetes Registry was used. RESULTS When dividing HbA1c values in three groups; < 7.4% (57mmol/mol), 7.4-9.3% (57-78mmol/mol) and >9.3% (78mmol/mol), there was a higher proportion of females in the highest group during adolescence. In the group with the highest HbA1c values during adolescence and as adults, 51.7% were females, expected value 46.2%; in the group with low HbA1c values in both registries, 34.2% were females, p<0.001. As adults, more females had retinopathy, p<0.05. Females had higher mean HbA1c values at diagnosis, 11.2 vs. 10.9% (99 vs. 96mmol/mol), p<0.03, during adolescence, 8.5 vs. 8.2% (69 vs. 66mmol/mol) p<0.01, but not as young adults. CONCLUSIONS Worse glycaemic control was found in adolescent females, and they had a higher frequency of microvascular complications. Improved paediatric diabetes care is of great importance for increasing the likelihood of lower mortality and morbidity later in life.

Caesarean section per se does not increase the risk of offspring developing type 1 diabetes: a Swedish population-based study

Aims/hypothesisSome studies have revealed a relationship between Caesarean section (CS) and type 1 diabetes, while other studies have not. By using the Swedish paediatric quality register we investigated whether birth by CS is related to the risk of developing type 1 diabetes during childhood.MethodsAll children diagnosed with type 1 diabetes from 2000 to 2012 and included in the register (n = 9,376) were matched with four controls by year, day of birth, sex and county of birth from the Swedish Medical Birth Register.ResultsOverall, 13.5% of deliveries were by CS. By group, 14.7% of children who developed type 1 diabetes were delivered by CS compared with 13.3% of control children (p < 0.001). Mothers with diabetes more often gave birth by CS than mothers without diabetes (78.8% vs 12.7%, p < 0.001). In a logistic regression model adjusting for maternal age, maternal diabetes and BMI in early pregnancy, the OR for CS was 1.0. A child who developed type 1 diabetes and had a mother with type 1 diabetes at the time of delivery had the highest OR to have been born by CS. Children of mothers without diabetes, delivered by CS, had no increased risk of developing type 1 diabetes. Maternal diabetes was the strongest predictor of childhood diabetes (OR 3.4), especially if the mother had type 1 diabetes (OR 7.54).Conclusions/interpretationCS had no influence on the risk of type 1 diabetes during childhood or adolescence. However, maternal diabetes itself strongly increased the risk of offspring developing type 1 diabetes.

Improved diabetes management in Swedish schools : results from two national surveys

Support in diabetes self‐care in school is essential to achieve optimal school performance and metabolic control. Swedish legislation regulating support to children with chronic diseases was strengthened 2009.

Children's experiences about a structured assessment of health‐related quality of life during a patient encounter

BACKGROUND It has been stated that care for children with chronic health conditions tends to focus on condition-specific issues rather than how these children experience their health and everyday life functioning. AIM The aim of this study was to explore childrens experiences about a structured assessment of health-related quality of life applied during a patient encounter. METHODS Prior to the start of the study, a clinical intervention based on the questionnaire DISABKIDS Chronic Generic Measure (DCGM-37) was performed. A qualitative explorative design was chosen, and 25 children between 10-17 years of age were interviewed after the consultation at four different paediatric outpatient clinics. Data were analysed according to qualitative content analysis. RESULTS The results were twofold: children experienced that the assessment was providing them with insights about their health, which motivated them to make lifestyle changes. When outcomes were discussed and requested, the children felt encouraged. CONCLUSIONS The use of an assessment of health-related quality of life may promote insights about health and encourage children with chronic health conditions to discuss their outcomes with healthcare professionals.

Use of the national quality registry to monitor health-related quality of life of children with type 1 diabetes: A pilot study

The management of diabetes is complicated, as treatment affects the everyday life of both children and their families. To enable optimal care for children with type 1 diabetes, it is important to highlight health-related quality of life (HrQoL) as well as medical outcomes to detect psychological problems that otherwise could be missed. The aim was to study HrQoL in children and adolescents with type 1 diabetes dependent on gender, age and co-morbidity and to study the consistency between children’s self-reporting and parents’ proxy reporting. The cross-sectional data were collected using the questionnaire DISABKIDS Chronic Generic Measure and the DISABKIDS diabetes module. Parents in the proxy report perceived their children’s HrQoL to be lower than children themselves. Boys reported their HrQoL to be better than girls. Results show that living with an additional disease has an impact on the HrQoL, which is an important factor to consider in the quality registry. Assessing HrQoL on a routine basis may facilitate detection and discussion of HrQoL-related questions in the national quality registry.