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Indianapolis, IN, United States

Nabhan Z.M.,Section of Pediatric Endocrinology and Diabetology | Ryder K.W.,Indiana University | Fuqua J.S.,Section of Pediatric Endocrinology and Diabetology | Nebesio T.D.,Section of Pediatric Endocrinology and Diabetology
Diabetes Technology and Therapeutics | Year: 2012

Background: The hemoglobin A1c (HbA1c) assay is considered the gold standard for assessing glycemic control in children and adolescents with type 1 diabetes mellitus (T1DM). In recent years, point-of-care (POC) testing has been more commonly used in the outpatient clinic. However, despite its popularity, little is known about the accuracy of the POC methods in children. Patients and Methods: In this case series, we describe seven children - six with T1DM and one with type 2 diabetes mellitus - who had major discrepancies between measured POC HbA1c via A1cNow+® (Bayer Healthcare Metrika, Sunnyvale, CA) and self-monitored blood glucose records. Results: In six subjects, the discrepancy was explained by the presence of the hemoglobin S trait, and an additional subject had the hemoglobin C trait. Conclusions: This report demonstrates that as with all laboratory tests, the HbA1c test is subject to limitations, particularly in children with hemoglobin variants. Increased awareness regarding these limitations among healthcare professionals is paramount, especially with the increased use of the HbA1c POC method in the medical community. Failure to recognize these limitations can lead to unnecessary medical, financial, and social interventions that could have profound impact on the patient-doctor relationship. © Copyright 2012, Mary Ann Liebert, Inc. Source

Carroll A.E.,Indiana University | Carroll A.E.,Regenstrief Institute for Health Care | Dimeglio L.A.,Section of Pediatric Endocrinology and Diabetology | Stein S.,Section of Pediatric Endocrinology and Diabetology | And 2 more authors.
Diabetes Technology and Therapeutics | Year: 2011

Background: Adolescents are developmentally in a period of transition-from children cared for by their parents to young adults capable of self-care, independent judgment, and self-directed problem solving. We wished to develop a behavioral contract for adolescent diabetes management that addresses some negotiable points of conflict within the parent-child relationship regarding self-monitoring and then assess its effectiveness in a pilot study as part of a novel cell phone-based glucose monitoring system. Methods: In the first phase of this study we used semistructured interview techniques to determine the major sources of diabetes-related conflict in the adolescent-parent relationship, to identify factors that could facilitate or inhibit control, and to determine reasonable goals and expectations. These data were then used to inform development of a behavioral contract that addressed the negotiable sources of conflict between parents and their adolescent. The second phase of this research was a 3-month pilot study to measure how a novel cell phone glucose monitoring system would support the contract and have an effect on glucose management, family conflict, and quality of life. Results: Interviews were conducted with 10 adolescent-caregiver pairs. The major theme of contention was nagging about diabetes management. Two additional themes emerged as points of negotiation for the behavioral contract: glucose testing and contact with the diabetes clinical team. Ten adolescent-parent pairs participated in the pilot test of the system and contract. There was a significant improvement in the Diabetes Self-Management Profile from 55.2 to 61.1 (P<0.01). A significant reduction in hemoglobin A1c also occurred, from 8.1% at the start of the trial to 7.6% at 3 months (P<0.04). Conclusions: This study confirms previous findings that mobile technologies do offer significant potential in improving the care of adolescents with type 1 diabetes. Moreover, behavioral contracts may be an important adjunct to reduce nagging and improve outcomes with behavioral changes. © Copyright 2011, Mary Ann Liebert, Inc. Source

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