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Grand Rapids, MI, United States

Cemeroglu A.,Spectrum Health Medical Group | Kleis L.,Spectrum Health Medical Group | 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.,Spectrum Health Medical Group | 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.

Chin M.S.,Grand Rapids Medical Education Partners GRMEP | Betz B.W.,Helen DeVos Childrens Hospital | Halanski M.A.,Grand Rapids Medical Education Partners GRMEP
Journal of Pediatric Orthopaedics | Year: 2011

BACKGROUND: The purpose of this paper was to compare the use of computed tomography (CT) versus magnetic resonance imaging (MRI) to evaluate hip reduction in patients with dysplasia of the hip. METHODS: A retrospective review of postoperative pelvic CT and MRI in patients <13 months of age with hip dysplasia was performed. Scanner time, anesthesia requirement, cost, and radiation dosage were recorded. Hips were classified as dislocated, subluxated, or reduced. Sensitivity and specificity of CT and MRI were calculated. The outcomes of the subluxated hips were followed. RESULTS: Thirty-two CT scans and 33 MRI scans in 39 patients were evaluated. CT scanner time was 2.8 minutes, which was significantly less than the 8.9 minutes required for MRI (P=0.0001). Postoperative anesthesia was only required for 1 CT case. Average cost of CT examination was $788 and $1104 for MRI. Average radiation dose with CT examinations was 1 mSv. Of the postoperative nonsubluxated hips (n=30 for CT and n=37 for MRI), CT demonstrated a sensitivity of 100% and a specificity of 96%, whereas MRI exhibited a sensitivity of 100% and a specificity of 100%. Of the postoperative subluxated hips, 66.7% spontaneously reduced, 22.2% remained subluxated, and 11.1% redislocated. CONCLUSIONS: This is the first study to compare these imaging modalities in the evaluation of hip reduction in DDH. This study affirms MRI as an alternative to CT scan. The sensitivity and specificity of both modalities appears excellent. Similar to other studies, a large percentage of subluxated hips in both groups reduce without additional surgical intervention. LEVEL OF EVIDENCE: Diagnostic level II. © 2011 Lippincott Williams & Wilkins, Inc.

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.,Spectrum Health Medical Group | 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.

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