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Landau Z.,lfson Medical Center | Landau Z.,Maccabi National Juvenile Diabetes Center | Landau Z.,Tel Aviv University | Landau Z.,Pediatric Endocrine and Diabetes Unit | And 6 more authors.
Journal of Pediatric Endocrinology and Metabolism | Year: 2013

Background: Type 1 diabetes (T1D) management requires year-round adherence to treatment regimen. Holidays may present a challenge towards achieving good metabolic control. Objectives: Our aim was to investigate the effect of holidays on diabetes management of schoolchildren with T1D. Methods: Observational, case-crossover study of 45 schoolchildren, age range 7-19 years, mean 13.2 =3.4 years, followed in a pediatric diabetes clinic. Subjects were stratified by age [ < 12 years (n =21), > 12 years (n =24)] and treatment modality [insulin pump (n =29) or multiple daily injections (n =16)]. Data were downloaded from glucometers and insulin pumps during five non-weekend holidays and five subsequent school days. Results: The mean number of blood glucose (BG) readings was significantly lower (4.4 ± 1.9 vs. 4.8 ± 1.9, p < 0.01) and mean BG marginally higher (11.4 ± 2.7 vs. 10.7 ± 3.1 mmol/L, p =0.1) during holidays than during school days in the entire cohort. Children were significantly more adherent to diabetes management than adolescents as expressed by lower mean glycated hemoglobin level (7.7 ± 0.8% vs. 8.6 ± 1.4%, p < 0.05), more BG readings per day (p < 0.001) and lower mean BG on holidays (p < 0.05) and on schooldays (p < 0.01). In pump users, no difference in the mean number of boluses per day and mean insulin units per kilogram per day was observed between holidays and school days. Conclusions: The management of school-aged children with T1D during holidays was worse than during school days; these finding were more pronounced in adolescents. The diabetes team should be aware of suboptimal therapy during holidays and should consider intervention programs in attempts to educate patients accordingly.

Rachmiel M.,Mellitus | Rachmiel M.,Tel Aviv University | Landau Z.,Tel Aviv University | Landau Z.,Pediatric Endocrine and Diabetes Unit | And 18 more authors.
Acta Diabetologica | Year: 2015

Aims: The aim of the study was (a) to compare annual glycemic control in pediatric patients with type 1 diabetes mellitus (T1DM) who used a healthcare-funded continuous glucose monitoring system (RT-CGMS) to that of those who performed self-monitoring blood glucose (SMBG) only, in a real-life setting, and (b) to define parameters associated with compliance and glycemic control. Methods: A total of 149 youth with T1DM (52.3 % females), mean age 11.8 ± 3.6 years, and 83 in the CGMS group were followed prospectively for 12 months. Glycemic control parameters and compliance to RT-CGMS were assessed periodically. Results: Glycemic parameters did not differ significantly between the groups during follow-up periods. The time spent with RT-CGMS decreased and only 38 % used it for more than 75 % of the time during the 12 months (consistent users). Mean HbA1c decreased by 0.27 % in consistent users and increased by 0.21 % among intermittent users (used RT-CGMS less than 75 % of time), p = 0.013. Consistent users were younger 10. 6 ± 4.2 vs. 12.5 ± 3.6, p = 0.07, and had higher frequency of SMBG at baseline, 10.6 ± 4.9 vs. 6.3 ± 2.8, p = 0.011. Conclusions: The adoption of RT-CGMS was low, even in a healthcare system that funds its use. Caregivers should consider patient characteristics when recommending RT-CGMS use. © 2014, Springer-Verlag Italia.

Landau Z.,Maccabi National Juvenile Diabetes Center | Landau Z.,Tel Aviv University | Landau Z.,Pediatric Endocrine and Diabetes Unit | Mazor-Aronovitch K.,Maccabi National Juvenile Diabetes Center | And 9 more authors.
Pediatric Diabetes | Year: 2012

Objective: To determine whether the use of an Internet-based blood glucose monitoring system could improve glycemic control in adolescents with type 1 diabetes mellitus (T1DM). Methods: In a randomized, controlled clinical trial, a total of 70 adolescent subjects with T1DM were recruited. Subjects randomized to the intervention group (n = 36) were instructed to submit their blood glucose levels weekly by Internet to the Diabetes Care Team during a period of 6 months. Subjects randomized to the control group (n = 34) did not submit results but were under routine follow-up. Results: At baseline, patients were 15.1 ± 2.6 years of age with mean HbA1c of 8.3 ± 1.3%. At the 6-month follow-up period, no by-group differences in change from baseline to end of treatment HbA1c levels were detected. In the intervention group, 12/36 did not submit blood glucose levels and were classified as non-compliant. In a secondary exploratory analysis in which non-compliant patients were omitted, HbA1c values in the compliant intervention group declined from 8.5 ± 1.7% at baseline to 8.2 ± 1.2% at 6 months, while in the control group HbA1c values increased from 8.2 ± 1.1 to 8.4 ± 1.1%, this difference did not reach statistical significance. Conclusions: An Internet-based blood glucose monitoring system was not associated with improved glycemic control in adolescents with T1DM. Identification of a sub-group of compliant subjects who may improve metabolic control by using this tool is needed. © 2011 John Wiley & Sons A/S.

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