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Pinhas-Hamiel O.,Maccabi Juvenile Diabetes Center | Pinhas-Hamiel O.,Pediatric Endocrine and Diabetes Unit | Pinhas-Hamiel O.,Tel Aviv University | Hamiel U.,Tel Aviv University | And 6 more authors.
PLoS ONE | Year: 2014

Results: Crude percentiles of HbA1c as a function of age and gender, and the modeled curves produced using quantile regression showed good concordance. The curves show a decline in HbA1c levels from age 2 to 4 years at each percentile. Thereafter, there is a gradual increase during the prepubertal years with a peak at ages 12 to 14 years. HbA1c levels subsequently decline to the lowest values in the third decade. Curves of females and males followed closely, with females having HbA1c levels about 0.1% (1.1 mmol/mol) higher in the 25th 50th and 75th percentiles.Conclusion: We constructed age-specific distribution curves for HbA1c levels for patients with T1DM. These percentiles may be used to demonstrate the individual patient's measurements longitudinally compared with age-matched patients.Purpose: To illustrate the distribution of Hemoglobin A1c (HbA1c) levels according to age and gender among children, adolescents and youth with type 1 diabetes (T1DM).Methods: Consecutive HbA1c measurements of 349 patients, aged 2 to 30 years with T1DM were obtained from 1995 through 2010. Measurement from patients diagnosed with celiac disease (n =20), eating disorders (n= 41) and hemoglobinopathy (n=1) were excluded. The study sample comprised 4815 measurements of HbA1c from 287 patients. Regression percentiles of HbA1c were calculated as a function of age and gender by the quantile regression method using the SAS procedure QUANTREG. © 2014 Pinhas-Hamiel et al. Source


Levy-Shraga Y.,Pediatric Endocrine and Diabetes Unit | Levy-Shraga Y.,Tel Aviv University | Lerner-Geva L.,Tel Aviv University | Lerner-Geva L.,Gertner Institute | And 10 more authors.
Diabetic Medicine | Year: 2012

Aims To identify clinical characteristics and co-morbidity rates of children diagnosed with Type 1 diabetes mellitus at younger than 6years of age. Methods Data were obtained from a retrospective chart review of 103 patients diagnosed with Type 1 diabetes at younger than 6years (study group) and 220 patients at older than 6years (comparison group). Measures of glycaemic control and occurrence of co-morbidities (coeliac disease, autoimmune thyroid disease, hypertension, nephropathy and retinopathy) were compared. Results The mean follow-up period was more than 8years. For the study group, mean HbA1c levels ranged from 64mmol/mol to 66mmol/mol (8.0-8.2%) until age 10years, and then rose to 73mmol/mol (8.8%). The HbA1c levels were higher in the study than in the comparison group for comparable ages (P=0.003). After adjustment for duration of diabetes this difference was not significant. The overall rate of severe hypoglycaemic events was greater in the study group than in the comparison group (P=0.03). Kaplan-Meier diagnosis rates of celiac disease, 10years after Type 1 diabetes diagnosis, were 14.4% and 4.2% in the study and comparison groups, respectively (P log-rank=0.03). There were no differences in rates of autoimmune thyroid disease, hypertension, nephropathy or retinopathy. Conclusions Children diagnosed with Type 1 diabetes before the age of 6years were in greater risk of developing celiac disease, compared with children diagnosed after the age of 6years. For children diagnosed with Type 1 diabetes aged under 6years, good metabolic control was achievable until age 10years, after which it deteriorated. Higher HbA1c levels observed in children diagnosed before the age of 6years were associated with longer duration of disease. © 2012 The Authors. Diabetic Medicine © 2012 Diabetes UK. Source


Pinhas-Hamiel O.,Maccabi Juvenile Diabetes Center | Pinhas-Hamiel O.,Tel Aviv University | Graph-Barel C.,Maccabi Juvenile Diabetes Center | Boyko V.,Raman Research Institute | And 5 more authors.
Diabetes Technology and Therapeutics | Year: 2010

Aim: This study evaluated the feasibility of insulin pump treatment in adolescent girls with type 1 diabetes mellitus (T1DM) and eating disorders (ED). Methods: Sixty-three girls >10 years old were included in the study. Forty-eight were treated with pump (no-ED-pump group); 15 had ED, of whom eight were treated with pump (ED-pump group), and seven were treated with multiple daily injections (MDI) (ED-MDI group). Results: Girls in the ED-pump group had higher hemoglobin A1c (HbA1c) compared to those in the no-ED-pump group both before and after pump initiation (P=0.007). In the ED-pump group, levels 0-6 months after pump initiation were slightly but not significantly lower compared to baseline reference values (8.48% vs. 8.84%, respectively; P=0.42). In the no-ED-pump group there was a significant decrease in HbA1c level 0-6 months after pump initiation (8.03% vs. 7.67%, respectively; P=0.004). Thereafter HbA1c levels were not different from baseline reference on both groups. The rate of hypoglycemic episodes was similar in the ED pump and no-ED-pump groups (0.9 vs. 1.0 episodes per 100 patient-years, respectively). Prior to diagnosis of ED, mean HbA1c levels in the ED-pump group and the ED-MDI group were similar: 9.24±1.25% versus 8.47±1.30% (P=0.51). In the time intervals after the diagnosis of ED, mean HbA1c level of all measurements in the eight girls in the ED-pump group was significantly lower compared with the seven patients in the ED-MDI group: 9.07±1.33% versus 10.40±2.01% (P=0.04). Conclusions: Treatment with an insulin pump was feasible in girls with T1DM and ED and resulted in significantly lower HbA1c levels compared to the ED-MDI group. © Copyright 2010, Mary Ann Liebert, Inc. Source


Pinhas-Hamiel O.,Maccabi Juvenile Diabetes Center | Pinhas-Hamiel O.,Tel Aviv University | Tzadok M.,Maccabi Juvenile Diabetes Center | Tzadok M.,Gertner Institute | And 7 more authors.
Diabetes Technology and Therapeutics | Year: 2010

Objective: This study was done to identify factors influencing long-term metabolic control in youth with type 1 diabetes mellitus (T1DM) treated with an insulin pump. Research Design and Methods: Data were obtained from retrospective chart review of 113 patients (52 males) with T1DM treated with an insulin pump for up to 7 years. Their mean±SD age at diagnosis of T1DM was 9.7±5.1 years, and that at pump therapy initiation was 13.8±6.1 years. Linear trends and changes in hemoglobin A1c (HbA1c) levels following pump insertion were evaluated according to gender, metabolic control prior to initiation of pump therapy, time from diagnosis of diabetes until pump therapy, age at initiation, and the duration of pump treatment. Results: Mean HbA1c levels of patients with good baseline metabolic control (HbA1c level ≤7.5%) were significantly lower during the whole follow-up period (7.2±0.9%) compared to the moderate (baseline HbA1c level 7.5% to ≤9%) and poor (baseline HbA1c level >9%) control groups (8.1±0.9% and 8.2±1.1%, respectively; P<0.001). However, with time a significant trend for increasing HbA1c level was demonstrated in the group with good metabolic control (P value for trend=0.004). HbA1c levels of patients with poor baseline metabolic control decreased significantly immediately after pump initiation (9.4±1.6% vs. 8.0±1.2%, P=0.0001) and thereafter remained stable (P value for trend=0.54). In the multivariable analyses, baseline HbA1c level ≤7.5%, duration of ≤1 year between diagnosis of diabetes and pump initiation, and younger age at pump initiation were independently associated with lower HbA1c levels during long-term follow-up. Conclusions: Long-term response to pump treatment was dependent on baseline metabolic control. Early pump treatment had a significant long-term impact on metabolic control. © 2010, Mary Ann Liebert, Inc. Source


Levy-Shraga Y.,Pediatric Endocrine and Diabetes Unit | Levy-Shraga Y.,Tel Aviv University | Lerner-Geva L.,Tel Aviv University | Lerner-Geva L.,Gertner Institute | And 10 more authors.
Experimental and Clinical Endocrinology and Diabetes | Year: 2013

Objective: The incidence of type 1 diabetes mellitus (T1DM) in young children has increased considerably over recent years. The purpose was to examine the effectiveness and safety of continuous subcutaneous insulin infusion (CSII) therapy in preschool children with T1DM. Methods: A retrospective chart review of 113 children diagnosed with T1DM while younger than age 6 years. Mean age at diagnosis was 3.5±1.5 years and mean duration of follow 9.7±7.0 years. Patients were divided into 3 groups. Group1 initiated CSII therapy before the age of 6 years (n=26), Group 2 was treated with multiple daily injections (MDI) throughout follow-up (n=34), and Group 3 initiated CSII after age 6 (n=53). Metabolic control was assessed by HbA1C levels and safety by rates of severe hypoglycemia and diabetic ketoacidosis (DKA) events. Results: In Group 1, the highest mean HbA1C value (8.5%) was observed 1-2 years prior to CSII initiation. During the 5 year period following CSII initiation, mean HbA1C levels ranged between 7.4 and 8.0%. Throughout the entire follow-up period, mean HbA1C levels were lower for Group 1 than Group 2 (p=0.05). In Group 3, mean HbA1C level decreased from 8.7% pre-CSII to 8.3% post-CSII (p<0.001). Nevertheless HbA1C levels remained higher than for those who started pump therapy before age 6 (p=0.02). Conclusions:Our study demonstrated better metabolic control in pre-school children treated with CSII compared to those treated with MDI. This benefit sustained for 5 years after CSII initiation and was not accompanied by increased risk of severe hypoglycemia or DKA events. © J. A. Barth Verlag in Georg Thieme Verlag KG Stuttgart · New York. Source

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