Grand Rapids Medical Education Partners GRMEP

Grand Rapids, MI, United States

Grand Rapids Medical Education Partners GRMEP

Grand Rapids, MI, United States
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Cemeroglu A.P.,s Hospital | Thomas J.P.,Spectrum Health | Zande L.T.V.,Spectrum Health | Nguyen N.T.,Spectrum Health | And 3 more authors.
Endocrine Practice | Year: 2013

Objective: Guidelines for insulin dosing, including the insulin to carbohydrate ratio (I/C), insulin sensitivity factor (ISF), and basal/bolus ratio guidelines, have been well established for adults with type 1 diabetes mellitus (T1DM). However, clinical experience suggests that these guidelines are not appropriate for children. The purpose of this study was to determine the continuous subcutaneous insulin infusion (CSII) settings in children with T1DM at different ages and stages of puberty.Methods: A total of 154 patients data between the ages of 3 and 21 years with well-controlled T1DM according to American Diabetes Association guidelines were reviewed. Only patients on CSII who were not in the honeymoon period were included.Results: Patients were divided into 8 groups according to age, gender, and/or pubertal stage. Insulin requirements increased with puberty in both sexes (0.69, 0.97, and 0.90 U/kg/day in children <7 years of age, midpubertal girls, and late-pubertal boys, respectively). Basal insulin requirement was lowest in the youngest group (34%; P<.01). The youngest group had the lowest I/C prediction factor (PF) (mean, 315.7 ± 79.4; P<.01 with all groups), and the ISF-PF was higher than that of the oldest group (mean, 2,588.3 ± 1,101.8; P<.01).Conclusion: CSII dose calculations vary with age and pubertal status in children with T1DM. These differences must be considered when calculating CSII dosing, especially for younger children. © 2013 AACE.


Cemeroglu A.,Helen DeVos Childrens Hospital | Kleis L.,Helen DeVos Childrens Hospital | Wood A.,Spectrum Health | Parkes C.,Spectrum Health | And 2 more authors.
Endocrine Practice | Year: 2013

Objective: Rapid-acting insulins, including insulin aspart (NovoLog) and lispro (Humalog), do not seem to effectively control postprandial glycemic excursions in children with type 1 diabetes mellitus (T1DM). The objective of this study was to determine if insulin glulisine (Apidra), another rapid-acting insulin analog, would be superior in controlling postprandial hyperglycemia in children with T1DM.Methods: Thirteen prepubertal children ages 4 to 11 years completed this study. Inclusion criteria included T1DM ≥6 months, glycosylated hemoglobin (HbA1C) 6.9 to 10%, blood glucose (BG) levels in adequate control for 1 week prior to study start, multiple daily injections (MDI) with insulin glargine or determir once daily and aspart or lispro premeal. If fasting BG was 70 to 180 mg/dL, subjects received insulin glulisine alternating with aspart prior to a prescribed breakfast with a fixed amount of carbohydrate (45, 60, or 75 g) for 20 days. Postprandial BG values were obtained at 2 and 4 hours.Results: Mean baseline BG values for insulin glulisine (136.4 ± 15.7 mg/dL; mean ± SD) and aspart (133.4 ± 14.7 mg/dL) were similar (P = .34). Mean increase in 2-hour postprandial BG was higher in glulisine (+113.5 ± 65.2 mg/dL) than aspart (+98.6 ± 66.9 mg/dL), (P = .01). BG remained higher at 4 hours (glulisine: 141.9 ± 36.5 mg/dL, aspart: 129.0 ± 37.0 mg/dL) (P = .04). Although statistically insignificant, more hypoglycemic events occurred at 2-and 4-hours postprandial with insulin aspart.Conclusion: Insulin aspart appears to be more effective than insulin glulisine in controlling 2-and 4-hour postprandial BG excursions in prepubertal children with T1DM. © 2013 AACE.


Cemeroglu A.P.,Helen DeVos Childrens Hospital | Cemeroglu A.P.,Michigan State University | Can A.,Michigan State University | Davis A.T.,Grand Rapids Medical Education Partners GRMEP | And 7 more authors.
Endocrine Practice | Year: 2015

Objective: To assess the prevalence of fear of needles and its effect on glycemic control in children with type 1 diabetes mellitus (T1DM) on multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII). Methods: Patients aged 6 to 17 years with T1DM on MDI or CSII (n = 150) were enrolled. All caregivers and patients aged ≥11 years completed a "Diabetes Fear of Injecting and Self-testing Questionnaire" (D-FISQ). Needle phobia was defined as a score ≥6 for fear of self-testing (FST), fear of injections (FI), and fear of infusion-site changes (FISC). Results: Positive FST scores were noted in 10.0% and positive FI or FISC scores in 32.7% (caregivers' responses). Patients aged 6 to 10 years on CSII had greater fear (FISC) than those on MDI (FI) (P = .010). FST was inversely related to the number of daily blood sugar checks (P = .003). Patients with positive scores for FI/FISC or FST had significantly higher glycated hemoglobin (HbA1c) levels than those without. An inverse association was noted between positive FI/FISC scores and age of the patient (P = .029). Based on patient responses, FST severity was directly related to the age of the patient (P = .013). Conclusion: Needle phobia is common in children with T1DM. Although FI/FISC are more common in younger children, especially in those on CSII, FST is more often encountered in older patients. Patients with a more intense fear of needles have higher HbA1c levels and less frequent blood sugar monitoring. Identifying these patients may help improve glycemic control. Copyright © 2015 AACE.


Cemeroglu A.P.,Michigan State University | Timmer S.,Michigan State University | Turfe Z.,Michigan State University | Davis A.T.,Grand Rapids Medical Education Partners GRMEP | And 6 more authors.
Journal of Pediatric Endocrinology and Metabolism | Year: 2016

Background: Assessing the degree of involvement of caregivers for children with type 1 diabetes mellitus (T1DM) in their diabetes care, differences in the degree of involvement based on the method of insulin administration (multiple daily injections: MDI/continuous subcutaneous insulin infusion: CSII), and its effect on glycemic control. Methods: This was a cross-sectional study with T1DM patients, ages 6-13 years using a six question survey derived from the Diabetes Family Responsibility Questionnaire (DFRQ). All caregivers (n=140) and participants between ages 11 and 13 (n=60) completed the survey. Results: Significant differences between MDI and CSII caregiver responses were found for responsibility for giving insulin boluses, as well as for rotation of infusion/injection sites (p<0.001 and p=0.03, respectively). A sub-analysis of caregiver responses for caregiver versus child responsibility for giving infusion boluses (excluding shared responsibility) showed that 36% of children in the CSII group had primary responsibility for giving insulin boluses, compared to 17% in the MDI group (p<0.001). The median agreement for all questions combined between participants and caregivers for ages 11-13 (n=60 pairs) was "poor" (κ=0.18). No significant effect of parental involvement on last 2-year average HbA1C was found for CSII or MDI groups (p>0.20). Conclusions: Caregiver reported diabetes care responsibility (mostly parent, mostly child, shared between parent and child) varies for certain aspects of diabetes related care for children ages 6-13, depending upon the mode of insulin administration. Based on the reported degree of parental collaboration, HbA1C did not differ significantly. However, long-term effects are yet to be determined in longitudinal studies. © 2016 by De Gruyter.


Chin M.S.,Grand Rapids Medical Education Partners GRMEP | Shoemaker A.,Grand Rapids Medical Education Partners GRMEP | Reinhart D.M.,Helen DeVos Childrens Hospital | Betz B.W.,Helen DeVos Childrens Hospital | And 2 more authors.
Journal of Pediatric Orthopaedics | Year: 2011

Background: To date no comparison between 1.5 Tesla (T) and 3 T magnetic resonance imaging (MRI) scans have been performed in assessing hip reduction in patients with hip dysplasia. This study compares the use of these scans in assessing hip reduction. Methods: A retrospective review of 1.5 T and 3 T postreduction pelvic MRIs in developmental dysplasia of the hip patients for scanner time, anesthesia requirement, and subjective image quality scores were performed. Intrareader and interreader agreement of state of hip reduction was assessed. A scoring system was used to objectively compare MRI sequences between the 1.5 T and 3 T scans. Results: Of the 37 MRI scans, scanner time and anesthetic requirement was not significantly different between 1.5 T and 3 T scans (P>0.05). The 3 T scans showed slightly better image quality than 1.5 T scans (5.7 vs. 4.7), but not significant (P=0.08). With regards to state of hip reduction, intrareader Cronbach α was 0.89 with 1.5 T and 0.98 with 3 T, whereas interreader agreement was 0.79 with 1.5 T and 0.95 with 3 T, revealing greater consistency with 3 T. Mean anatomic score comparison of hip anatomic markers show no overall statistical difference between fast hip protocol sequences (f=1.113, sig=0.346) or magnet strength (f=3.817, sig=0.053). Only the coronal T2W fast spin echo demonstrated a statistically higher score on the 3 T versus the 1.5 T (19.3±9.3 vs. 12.2±6.7) scanner. Conclusions: Our study affirms that adequate images are obtainable with fast hip MRI without additional anesthesia. Good agreement was reached on image quality and hip state of reduction between readers for 1.5 T and 3 T scans, with more consistency with 3 T. Level of evidence: Diagnostic Level II. © 2011 by Lippincott Williams & Wilkins.


Cemeroglu A.P.,Helen DeVos Childrens Hospital | Cemeroglu A.P.,Michigan State University | Can A.,Michigan State University | Davis A.T.,Grand Rapids Medical Education Partners GRMEP | And 6 more authors.
Endocrine Practice | Year: 2014

Objective: Children who are given unsupervised responsibility for their diabetes care prior to developmental and/or emotional readiness may have poorer glycemic control. The purpose of this study was to assess the age-related expectations of children and caregivers for independence in diabetes care-related tasks.Methods: A total of 150 participants with type 1 diabetes mellitus (T1DM) receiving multiple daily injections (MDI) or continuous subcutaneous insulin infusion (CSII) were enrolled in this study. All caregivers and participants older than 10 years of age completed questionnaires evaluating the expected age of independence for different diabetes care-related tasks.Results: The participants expected independence with no direct supervision in most diabetes care-related tasks at a younger age than their caregivers (P<.05). The difference was more prominent for those on CSII compared to MDI (P<.01). There was a positive correlation between the age when caregivers expect independence for most of the diabetes-related tasks and the age at diagnosis, regardless of the use of MDI or CSII (P<.01).Conclusion: Children with T1DM expect to assume independence at a younger age than their caregivers do. The younger the children are at diagnosis, the younger they are expected by their caregivers to be independent, especially those on CSII. © 2014 AACE.

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