Team Based Pediatric Type 1 Diabetes Care in the US: Current Practices and Sustainability Concerns.

Introduction: Multidisciplinary care can improve glycemic outcomes in individuals with type 1 diabetes (T1D). Yet, prior studies suggest limited utilization of team-based care and either no reimbursement or inadequate reimbursement for diabetes and nutritional education, mental health and social support as well as remote services. We sought to evaluate multidisciplinary care services offered by pediatric diabetes centers to understand whether current practices are sustainable.

Parent Engagement in School Health Decisions for Type 1 Diabetes: Barriers to and Facilitators of Collaboration and Implications for Intervention Design.

Objective: Parent engagement is a frequently cited barrier to school health interventions. Little is known about what influences parent involvement in school health decisions for children with chronic conditions such as type 1 diabetes. We aimed to explore parent perspectives on the factors they believe affect their engagement in school-based type 1 diabetes management to identify potential targets for intervention design and implementation.

Measuring Outcomes for Community Partner Engagement: The Case of the High-Fidelity Wraparound Program for Pediatric Type 1 Diabetes.

Objective: The purpose of this article is to describe the processes for convening and engaging an advisory board to guide the conduct of a research study of the Type 1 Diabetes Wraparound Program (T1DWP) and associated outcomes.

Research Design And Methods: We recruited a diverse advisory board ( = 21) consisting of youth with type 1 diabetes, parents/advocates, and health system partners. The board met monthly over 2 years to discuss all phases of the T1DWP study.

The association between hepatic steatosis, vitamin D status, and insulin resistance in adolescents with obesity.

Introduction: Epidemiological studies suggest an inverse relationship between circulating 25-hydroxy-vitamin D [25(OH)D] levels and insulin resistance (IR), yet interventional studies have yielded inconsistent findings. This study examined the relationship between changes in vitamin D status and markers of IR in adolescents, with a focus on the modifying effect of liver fat.

Methods: A post-hoc analysis was performed using data from 44 adolescents participating in a 6-month observational study evaluating biomarkers of hepatosteatosis.

The Disposition Index in Autoantibody-Positive Individuals at Risk for Type 1 Diabetes.

Unlabelled: Since little is known about the disposition index (DI) in autoantibody-positive individuals, we have assessed whether DI has a similar association between insulin secretion and sensitivity to the association observed in other populations. In TrialNet Pathway to Prevention (TNPTP; n = 6,620) and Diabetes Prevention Trial-Type 1 (DPT-1; n = 704) study participants, two secretion-sensitivity pairs, each representing a DI, were analyzed cross-sectionally at baseline: area under the curve (AUC) C-peptide/AUC glucose (AUC ratio) and Matsuda index (MI) from TNPTP oral glucose tolerance tests (oral DI), first-phase insulin response (FPIR), and 1 / fasting insulin (1/FI) from DPT-1 from intravenous glucose tolerance tests (DI). Participants were followed for progression to type 1 diabetes (T1D).

School-Partnered Collaborative Care (SPACE) for Pediatric Type 1 Diabetes: Development and Usability Study of a Virtual Intervention With Multisystem Community Partners.

Background: School-partnered interventions may improve health outcomes for children with type 1 diabetes, though there is limited evidence to support their effectiveness and sustainability. Family, school, or health system factors may interfere with intervention usability and implementation.

Objective: To identify and address potential implementation barriers during intervention development, we combined methods in user-centered design and implementation science to adapt an evidence-based psychosocial intervention, the collaborative care model, to a virtual school-partnered collaborative care (SPACE) model for type 1 diabetes between schools and diabetes medical teams.

Relationship between liver and cardiometabolic health in type 1 diabetes.

Introduction: Type 1 diabetes (T1D) is a chronic condition marked by insulin deficiency and hyperglycemia, with an increasing global incidence, particularly among children. Despite improvements in diabetes management, individuals with T1D continue to experience higher rates of cardiovascular disease (CVD), the leading cause of mortality in this population. Traditional CVD risk factors such as dyslipidemia and poor glycemic control are insufficient to fully explain the elevated risk in T1D, prompting further investigation into additional factors.

Consensus Guidance for Monitoring Individuals With Islet Autoantibody-Positive Pre-Stage 3 Type 1 Diabetes.

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programs are being increasingly emphasized. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb+) children and adults who are at risk for (confirmed single IAb+) or living with (multiple IAb+) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in nonspecialized settings.

Consensus guidance for monitoring individuals with islet autoantibody-positive pre-stage 3 type 1 diabetes.

Given the proven benefits of screening to reduce diabetic ketoacidosis (DKA) likelihood at the time of stage 3 type 1 diabetes diagnosis, and emerging availability of therapy to delay disease progression, type 1 diabetes screening programmes are being increasingly emphasised. Once broadly implemented, screening initiatives will identify significant numbers of islet autoantibody-positive (IAb) children and adults who are at risk of (confirmed single IAb) or living with (multiple IAb) early-stage (stage 1 and stage 2) type 1 diabetes. These individuals will need monitoring for disease progression; much of this care will happen in non-specialised settings.

Pediatric Endocrine Society Statement on Considerations for Use of Teplizumab (Tzield™) in Clinical Practice.

Teplizumab (TzieldTM, Provention Bio), a monoclonal antibody directed at T-cell marker CD3, is the first medication approved by the FDA to delay progression from stage 2 to stage 3 type 1 diabetes. To date, the overwhelming majority of pediatric endocrinologists do not have experience using immunotherapeutics and seek guidance on the use of teplizumab in clinical practice. To address this need, the Pediatric Endocrine Society (PES) Diabetes Special Interest Group (Diabetes SIG) and Drug and Therapeutics Committee assembled a task force to review clinical trial data and solicit expert recommendations on the approach to teplizumab infusions.

Peer interactions and health among youth with diabetes: An ecological momentary assessment.

Objective: We examined the links of supportive and conflictual peer interactions to mood and self-care via ecological momentary assessment.

Method: Adolescents with Type 1 diabetes ( = 167, 49% female) recruited between 2018 and 2021 were prompted 8 times a day for 8 days to complete brief surveys that measured perceived social interactions, affect, and self-care.

Results: Cross-sectional analyses revealed between- and within-person (WP) links of peer support to positive mood and conflict to negative mood.

Child Opportunity Index and clinical characteristics at diabetes diagnosis in youth: type 1 diabetes versus type 2 diabetes.

Introduction: Among youth with type 1 diabetes (T1D), longitudinal poor glycemic control is associated with adverse socioeconomic conditions at the neighborhood level. Child Opportunity Index (COI), which encompasses measures of education, health, environment, social, and economic factors, is associated with obesity in youth but has not been evaluated in youth with new-onset T1D or type 2 diabetes (T2D). We hypothesized that lower COI would be associated with adverse clinical outcomes at diabetes diagnosis, and due to differing risk factors and pathophysiology, that youth with new-onset T2D would have lower COI than youth with T1D.

Access to Specialty Care for Commercially Insured Youths With Type 1 and Type 2 Diabetes.

Importance: Youths with type 2 diabetes are at higher risk for complications compared with peers with type 1 diabetes, though few studies have evaluated differences in access to specialty care.

Objective: To compare claims with diabetes specialists for youths with type 1 vs type 2 diabetes and the association between specialist claims with multidisciplinary and acute care utilization.

Design, Setting, And Participants: This cross-sectional study used Optum Clinformatics Data Mart commercial claims.

School Nurse Confidence with Diabetes Devices in Relation to Diabetes Knowledge and Prior Training: A Study of Convergent Validity.

Objective: The Diabetes Device Confidence Scale (DDCS) is a new scale designed to evaluate school nurse confidence with diabetes devices. We hypothesized that DDCS score would be associated with related constructs of school nurse diabetes knowledge, experience, and training.

Research Design And Methods: In a cross-sectional study, we co-administered the DDCS and Diabetes Knowledge Test 2 (DKT2) questionnaires to school nurses in Pennsylvania.

Comparisons of school-day glycemia in different settings for children with type 1 diabetes using continuous glucose monitoring.

Objective: Using continuous glucose monitoring (CGM), we examined patterns in glycemia during school hours for children with type 1 diabetes, exploring differences between school and non-school time.

Methods: We conducted a retrospective analysis of CGM metrics in children 7-12 years (n=217, diabetes duration 3.5±2.

School-based diabetes care: A national survey of U.S. pediatric diabetes providers.

Objectives: To understand the practices, attitudes, and beliefs of type 1 diabetes (T1D) providers towards school-based diabetes care (SBDC), including counseling families and communicating with schools, and explore the barriers and facilitators which affect their support of SBDC.

Research Design And Methods: We conducted a national survey of pediatric T1D providers about their perceived support of SBDC, including family counseling and school communication. We used descriptive statistics to analyze results and explored differences by practice size (<500, 500-999, and ≥1000 patients) and environment (academic vs non-academic).

HOMA-IR and the Matsuda Index as predictors of progression to type 1 diabetes in autoantibody-positive relatives.

Aim/hypothesis: We assessed whether HOMA-IR and the Matsuda Index are associated with transitions through stages of type 1 diabetes.

Methods: Autoantibody (AAb)-positive relatives of individuals with type 1 diabetes (n=6256) from the TrialNet Pathway to Prevention were studied. Associations of indicators of insulin resistance (HOMA-IR) and insulin sensitivity (Matsuda Index) with BMI percentile (BMIp) and age were assessed with adjustments for measures of insulin secretion, Index60 and insulinogenic index (IGI).

Support and Conflict Among Youth With Type 1 Diabetes: A Focus on Friends.

Objective: The goal of the study was to examine the relations of general and diabetes-specific friend support and conflict to psychological and diabetes health among youth with type 1 diabetes. We examined gender as a moderator of these relations, and friend responsiveness and information-sharing as potential mediators.

Methods: Youth with type 1 diabetes (n = 167; M age 15.

Hydroxychloroquine in Stage 1 Type 1 Diabetes.

Objective: Innate immune responses may be involved in the earliest phases of type 1 diabetes (T1D).

Research Design And Methods: To test whether blocking innate immaune cells modulated progression of the disease, we randomly assigned 273 individuals with stage 1 T1D to treatment with hydroxychloroquine (n = 183; 5 mg/kg per day to a maximum of 400 mg) or placebo (n = 90) and assessed whether hydroxychloroquine treatment delayed or prevented progression to stage 2 T1D (i.e.