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CARBOHYDRATE COUNTING IMPLEMENTATION ON PEDIATRIC TYPE 1 DIABETES MELLITUS: SYSTEMATIC REVIEW & META-ANALYSIS
- Lowilius Wiyono (Indonesia)
Abstract
Background and Aims
Type 1 diabetes mellitus – the one most commonly found amongst children – is not currently curable, but can be managed properly to maintain a patient’s quality of life. One of its treatments includes carbohydrate counting. This systematic review and meta-analysis aimed to evaluate the efficacy of HbA1c reduction with carbohydrate counting in children with type 1 diabetes mellitus.
Methods
Seven studies were assessed, with the primary outcome being glycemic control (HbA1c changes). We searched the following electronic databases: ProQuest, PubMed, Scopus, and ScienceDirect. The quality of studies included was assessed using RoB for RCTs and JBI Critical Appraisal Checklist for observational and cross-sectional studies. Quantitative analyses were made and extrapolated into a forest plot.
Results
A total of 1693 articles were identified, and four reviewers independently screened titles and abstracts. Of the 36 articles screened, 34 articles were found to be eligible, and 32 were excluded because outcomes and study designs were not suitable. Nine articles were included in the final analysis. Meta-analysis showed that there was a reduction in HbA1c in the carbohydrate counting group as compared to the control group. The meta-analysis has shown the cumulative effect on the mean difference of -0.55 (95% CI: -0.81;-0.28, p-value <0.0001). While all studies exhibit similar results with mean difference reduction favoring the interventional group, the heterogeneity analysis showed the I2 value of 88%, implying the high heterogeneity of the meta-analysis.
Conclusions
The meta-analysis showed evidence favouring the use of carbohydrate counting in the management of DMT1.
EUTHYROID SICK SYNDROME AND ITS ASSOCIATION WITH METABOLIC AND KIDNEY COMPLICATIONS IN CHILDREN WITH TYPE 1 DIABETES MELLITUS ONSET.
- Pierluigi Marzuillo (Italy)
Abstract
Background and Aims
Euthyroid sick syndrome (ESS) refers to changes in thyroid tests during critical illness and is associated to negative outcomes. We evaluated i) the association of ESS with severity indexes of type 1 diabetes mellitus (T1DM) onset such as diabetic ketoacidosis (DKA), renal tubular damage (RTD), acute kidney injury (AKI), and acute tubular necrosis (ATN); ii) the influence of ESS on timing to recover AKI.
Methods
This is a prospective observational study. AKI was defined according to the KDIGO criteria. RTD was defined by abnormal urinary beta-2-microglobulin and/or neutrophil gelatinase-associated lipocalin and/or tubular reabsorption of phosphate<85% and/or fractional excretion of Na(FENa)>2%. ATN was defined by RTD+AKI. 161children were followed-up after 14days from T1DM onset. The patients who did not recover from AKI/RTD were followed-up 30 and 60days later. The thyroid hormones were measured at T1DM onset and after 6-12months. ESS was defined when FT3 and/or FT4 were decreased and TSH levels were normal or decreased.
Results
ESS was found in 60/161patients(37.3%) and was more prevalent among patients with DKA, AKI, RTD and ATN compared with patients without these conditions. FT3 was inversely correlated with serum triglycerides and creatinine, and urinary calcium/creatinine ratio and NGAL. DKA and ATN were significantly associated to ESS at adjusted analysis. Patients with euthyroidism showed an earlier recovery from AKI than those with ESS (p=0.02). ESS spontaneously disappeared in all patients.
Conclusions
ESS prevalence was higher in patients showing complications of severe T1DM onset. Patients with ESS showed a slower recovery from AKI compared to those without ESS.
THE USE OF AUDIO-VISUAL MODALITY PRIOR TO ENDOCRINE STIMULATION TESTS IS EFFECTIVE IN REDUCING CHILDREN'S FEAR OF THE PROCEDURE
- Bella Gustus (Israel)
Abstract
Background and Aims
Medical procedures that use needles are a common source of anxiety for children. Intravenous catheterization for blood sampling, as performed during endocrine stimulation tests, is one such procedure. The use of audio-visual modalities relieves anxiety among children during painful procedures.
To evaluate the benefit of an audio-visual modality (AVM) as an explanatory tool for pre-procedural instruction to children prior to endocrine stimulation tests.
Methods
This case-control study is based on a prospective follow-up of clinic practices. From January 2018, all the children who underwent endocrine stimulation tests at Shamir (Assaf-Harofe) Medical Center, or their parents, were asked to fill satisfaction questionnaires, as part of clinical practice. As of January 2020, all the children received similar pre-test explanations by a cartoon (AVM group) instead of orally by a nurse (control group). The outcome parameters compared between the groups included satisfaction from the explanation according to 10 questions on a 1-5 scale (1 indicated the greatest satisfaction), and response on a 6-point pain scale.
Results
The AVM group included 105 patients, 46% males, mean age 8.61±3.75 years. The control group included 73 patients, 39% males, mean age 9.42±3.29 years. Patients from the AVM compared with the control group reported a lower level of fear after explanation (1.90 vs. 2.36 p=0.002), rated the explanations as more detailed and clearer (1.19 vs. 1.40 p=0.006), and felt they had received all the required explanations (1.12 vs.1.33 p=0.004).
Conclusions
Using AVM prior to endocrine stimulation tests may improve children's experience from the procedure.