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Article ; Online: Salivary cortisol in late preterm infants.

Zwimpfer, Lucy / Elder, Dawn / Lewis, John G / Stanley, James / Wiltshire, Esko

Acta paediatrica (Oslo, Norway : 1992)

2021 Volume 111, Issue 1, Page(s) 101–103

MeSH term(s)	Humans ; Hydrocortisone ; Hypothalamo-Hypophyseal System ; Infant ; Infant, Newborn ; Infant, Premature ; Pituitary-Adrenal System ; Saliva
Chemical Substances	Hydrocortisone (WI4X0X7BPJ)
Language	English
Publishing date	2021-08-31
Publishing country	Norway
Document type	Journal Article
ZDB-ID	203487-6
ISSN	1651-2227 ; 0365-1436 ; 0803-5253
ISSN (online)	1651-2227
ISSN	0365-1436 ; 0803-5253
DOI	10.1111/apa.16086
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Article ; Online: Prevalence and incidence of type 1 diabetes in children aged 0-14 years old in New Zealand in 2021.

Wu, Rachel / Burnside, Mercedes / Davies, Hannah / Jefferies, Craig / Wheeler, Benjamin / Paul, Ryan / Wiltshire, Esko / de Bock, Martin / Williman, Jonathan

Journal of paediatrics and child health

2023 Volume 59, Issue 3, Page(s) 519–525

Abstract: Aim: National prevalence and incidence data are important for understanding population trends and allocating health-care resources. We aimed to provide a current national snapshot of prevalence and annual incidence rates for children aged 0-14 with type ...

Abstract	Aim: National prevalence and incidence data are important for understanding population trends and allocating health-care resources. We aimed to provide a current national snapshot of prevalence and annual incidence rates for children aged 0-14 with type 1 diabetes (T1D) in Aotearoa New Zealand and to identify differences associated with demographic variables. Methods: Paediatric diabetes centres across Aotearoa were invited to record anonymised demographic and diabetes data on children under their services between 1 October 2020 and 30 September 2021. National prevalence and incidence were calculated using usually resident population counts from the 2018 census. The effect of ethnicity on prevalence and incidence was assessed using Poisson regression. Results: There were 1209 children aged 0-14 with T1D in October 2021. The national prevalence was 131/100 000 (95% confidence interval (CI) 124-139). European children had twice the prevalence as those of Māori or Pacific ethnicity (P < 0.001). There was no effect by gender (P = 0.3) and prevalence predictably increased with age. The annualised incidence of T1D was 23/100 000 (95% CI 20-26). European children were 2.6 times as likely as Māori children to be diagnosed with T1D in that year (incidence rate ratio = 2.6, 95% CI 1.7-4.2). Regional differences in prevalence and incidence were noted, potentially due to the ethnicity differences across regions. Unadjusted prevalence and incidence decreased with lower socio-economic status, likely due to an over-representation of non-Europeans living in the most deprived areas. Conclusions: T1D affects an ethnically diverse population in Aotearoa and important regional differences exist that may impact workforce planning.
MeSH term(s)	Humans ; Child ; Infant, Newborn ; Infant ; Child, Preschool ; Adolescent ; Diabetes Mellitus, Type 1/epidemiology ; Incidence ; New Zealand/epidemiology ; Prevalence ; Ethnicity
Language	English
Publishing date	2023-01-28
Publishing country	Australia
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1024476-1
ISSN	1440-1754 ; 1034-4810
ISSN (online)	1440-1754
ISSN	1034-4810
DOI	10.1111/jpc.16342
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Article ; Online: Effects of 12-Week Freestyle Libre 2.0 in Children with Type 1 Diabetes and Elevated HbA1c: A Multicenter Randomized Controlled Trial.

Jefferies, Craig A / Boucsein, Alisa / Styles, Sara E / Chamberlain, Bronte / Michaels, Venus R / Crockett, Hamish R / De Lange, Michel / Lala, Anita / Cunningham, Vicki / Wiltshire, Esko J / Serlachius, Anna S / Wheeler, Benjamin J

Diabetes technology & therapeutics

2023 Volume 25, Issue 12, Page(s) 827–835

Abstract: Objective: ...

Abstract	Objective:
MeSH term(s)	Humans ; Child ; Diabetes Mellitus, Type 1/drug therapy ; Glycated Hemoglobin ; Blood Glucose ; Blood Glucose Self-Monitoring ; Australia ; Hypoglycemic Agents/therapeutic use
Chemical Substances	Glycated Hemoglobin ; Blood Glucose ; Hypoglycemic Agents
Language	English
Publishing date	2023-10-20
Publishing country	United States
Document type	Randomized Controlled Trial ; Multicenter Study ; Journal Article
ZDB-ID	1452816-2
ISSN	1557-8593 ; 1520-9156
ISSN (online)	1557-8593
ISSN	1520-9156
DOI	10.1089/dia.2023.0292
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Article ; Online: Perceptions and Experiences of Using Intermittently Scanned Continuous Glucose Monitoring among Youth Ages 13–20 Years with Type 1 Diabetes and Above Recommended HbA1c

Sara E. Styles / Hamish R. Crocket / Esko J. Wiltshire / Martin I. de Bock / Benjamin J. Wheeler

Medical Sciences Forum, Vol 18, Iss 1, p

A Qualitative Study

2023 Volume 28

Abstract: The experiences of youth with high-risk glycaemic control using intermittently scanned continuous glucose monitoring (isCGM) systems are not well known. In the context of a randomised controlled trial investigating a 6-month isCGM intervention, this sub- ... ...

Abstract	The experiences of youth with high-risk glycaemic control using intermittently scanned continuous glucose monitoring (isCGM) systems are not well known. In the context of a randomised controlled trial investigating a 6-month isCGM intervention, this sub-study aimed to explore the experiences of youth using isCGM for 6 months. Semi-structured interviews were conducted with 14 youth aged 14–20 years who had Type 1 diabetes for ≥12 months and a glycated haemoglobin (HbA1c) of ≥75 mmol/mol (≥9%) pre-isCGM intervention. Interviews were recorded, transcribed and coded using Nvivo. A thematic analytic approach was used to identify key themes overall and by comparing participants who at 6 months had: (1) experienced a ≥10 mmol/L (0.9%) reduction in HbA1c and (2) sustained scanning frequency ≥3/day to those who did not. All participants expressed a strong preference for isCGM over self-monitoring blood glucose. Overall, isCGM contributed to perceived reduced diabetes burden without a requirement for more support in diabetes management. Increased engagement with self-management, including successful changes in dosage of basal or bolus insulin and increased frequency of administration of insulin, were behaviours reported by those experiencing the greatest improvement in HbA1c (>10 mmol/L [>0.9%], n = 6). They noted feeling more energetic, thus, making it easier to maintain self-management behaviours. Most youths reported best practices, such as following prompts to rescan in 10 min and timely sensor replacement; however, most did not check capillary blood glucose levels in recommended situations. Over 6 months, youth with high-risk diabetes experienced isCGM as a useful short-term tool for overcoming diabetes burden and facilitating self-management.
Keywords	continuous glucose monitoring ; glycaemic control ; qualitative research ; adolescents ; young adults ; type 1 diabetes mellitus ; Medicine ; R
Subject code	360
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
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Article ; Online: Advanced ECG analysis of cardiac function in children and adolescents with type 1 diabetes-a pilot study.

Marsters, Brooke / Shi, Bhija / Wheeler, Benjamin J / Boucher, Sara / Macaulay, Grace / Galland, Barbara / Elder, Dawn / Larsen, Peter / Wiltshire, Esko

Acta diabetologica

2021 Volume 58, Issue 8, Page(s) 1119–1122

Language	English
Publishing date	2021-03-27
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1097676-0
ISSN	1432-5233 ; 0940-5429
ISSN (online)	1432-5233
ISSN	0940-5429
DOI	10.1007/s00592-021-01704-y
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Article ; Online: Early identification of cardiac autonomic neuropathy using complexity analysis in children with type 1 diabetes.

Kane, Penny / Larsen, Peter / Wiltshire, Esko

Journal of paediatrics and child health

2019 Volume 56, Issue 5, Page(s) 786–790

Abstract: Aim: In children and adolescents, there are significant limitations to detecting cardiac autonomic neuropathy (CAN), an important contributor to morbidity and mortality in adults with type 1 diabetes (T1D). The analysis of heart rate variability (HRV) ... ...

Abstract	Aim: In children and adolescents, there are significant limitations to detecting cardiac autonomic neuropathy (CAN), an important contributor to morbidity and mortality in adults with type 1 diabetes (T1D). The analysis of heart rate variability (HRV) is one method available to detect CAN. Some evidence shows traditional linear HRV measures detect abnormalities in youth with T1D. In this study, we aimed to assess whether non-linear complexity analysis of HRV would assist identification of CAN in youth with T1D and to assess contributory factors. Methods: We studied 19 youth with T1D and 17 healthy controls. Each had an electrocardiogram recorded continuously for 10 min, at a sampling frequency of 1000 Hz. Using Labview software and an algorithm for complexity analysis, along with standard time-domain and spectral analysis, recordings of the electrocardiogram were analysed to detect differences in HRV between groups. Results: Youth with T1D had significantly higher sample entropy than controls (P = 0.015) suggesting increased complexity in HRV, but similar detrended fluctuation analysis (P = 0.68). Youth with T1D also had increased % high frequency power (P = 0.017) and reduced mid-frequency power (P = 0.019) on spectral analysis. There were no differences in heart rate or blood pressure responses to standing, or time-domain analysis of HRV. Within the T1D group, sample entropy correlated strongly with triglycerides (r = 0.76, P = 0.001) and detrended fluctuation analysis correlated strongly with serum potassium (r = -0.86, P < 0.001). Conclusions: Complexity analysis of HRV, particularly using sample entropy, may aid detection of CAN in youth with T1D.
MeSH term(s)	Adolescent ; Adult ; Child ; Diabetes Mellitus, Type 1/complications ; Electrocardiography ; Heart ; Heart Rate ; Humans ; Systems Analysis
Language	English
Publishing date	2019-12-28
Publishing country	Australia
Document type	Journal Article
ZDB-ID	1024476-1
ISSN	1440-1754 ; 1034-4810
ISSN (online)	1440-1754
ISSN	1034-4810
DOI	10.1111/jpc.14745
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Article ; Online: Newborn bloodspot screening: setting the Australian national policy agenda.

Wiltshire, Esko / Cameron, Fergus

The Medical journal of Australia

2014 Volume 201, Issue 2, Page(s) 91–92

MeSH term(s)	Health Policy ; Humans ; Neonatal Screening/standards
Language	English
Publishing date	2014-05-13
Publishing country	Australia
Document type	Letter ; Comment
ZDB-ID	186082-3
ISSN	1326-5377 ; 0025-729X
ISSN (online)	1326-5377
ISSN	0025-729X
DOI	10.5694/mja14.00402
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Article ; Online: High dose folic acid is a potential treatment for pulmonary hypertension, including when associated with COVID-19 pneumonia.

Wiltshire, Esko / Peña, Alexia Sophie / MacKenzie, Karen / Shaw, Geoffrey / Couper, Jennifer

Medical hypotheses

2020 Volume 143, Page(s) 110142

Abstract: Background: Pulmonary hypertension is a significant complication for some patients with COVID-19 pneumonia, especially those requiring intensive care. Tachyphylaxis to the current therapy, inhaled nitric oxide (iNO), is also common. In vitro, folic acid ...

Abstract	Background: Pulmonary hypertension is a significant complication for some patients with COVID-19 pneumonia, especially those requiring intensive care. Tachyphylaxis to the current therapy, inhaled nitric oxide (iNO), is also common. In vitro, folic acid directly increases nitric oxide (NO) production and extends its duration of action; effects which could be of benefit in reversing pulmonary hypertension and severe hypoxaemia. Our work has shown that, in the systemic circulation, folic acid in high dose rapidly improves nitric oxide mediated vasodilation, by activating endothelial nitric oxide synthase (eNOS). Hypothesis: A similar effect of high dose folic acid on pulmonary endothelial function would be expected from the same mechanism and would lead to improvement in pulmonary perfusion. We therefore hypothesise that folic acid, 5 mg or greater, is a useful therapeutic option for pulmonary hypertension and/or refractory severe hypoxaemia, in patients with severe COVID-19 associated pneumonia in whom NO therapy is considered, with a very low risk of adverse effects.
MeSH term(s)	Administration, Inhalation ; Animals ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/complications ; Endothelium, Vascular/drug effects ; Endothelium, Vascular/physiology ; Enzyme Activation/drug effects ; Folic Acid/administration & dosage ; Folic Acid/pharmacology ; Folic Acid/therapeutic use ; Humans ; Hypertension, Pulmonary/complications ; Hypertension, Pulmonary/drug therapy ; Hypoxia/drug therapy ; Hypoxia/etiology ; Mice ; Nitric Oxide/administration & dosage ; Nitric Oxide/metabolism ; Nitric Oxide/therapeutic use ; Nitric Oxide Synthase Type III/drug effects ; Pandemics ; Pneumonia, Viral/complications ; SARS-CoV-2 ; Tachyphylaxis
Chemical Substances	Nitric Oxide (31C4KY9ESH) ; Folic Acid (935E97BOY8) ; NOS3 protein, human (EC 1.14.13.39) ; Nitric Oxide Synthase Type III (EC 1.14.13.39)
Keywords	covid19
Language	English
Publishing date	2020-07-26
Publishing country	United States
Document type	Journal Article
ZDB-ID	193145-3
ISSN	1532-2777 ; 0306-9877
ISSN (online)	1532-2777
ISSN	0306-9877
DOI	10.1016/j.mehy.2020.110142
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Article ; Online: Youth and non-European ethnicity are associated with increased loss of publicly funded insulin pump access in New Zealand people with type 1 diabetes.

Hennessy, Lorelei D / De Lange, Michel / Wiltshire, Esko J / Jefferies, Craig / Wheeler, Benjamin J

Diabetic medicine : a journal of the British Diabetic Association

2020 Volume 38, Issue 1, Page(s) e14450

Abstract: Aims: Continuous subcutaneous insulin infusion (CSII) has been publicly funded in New Zealand for people living with type 1 diabetes since 2012. The aim of the current study was to investigate the loss of access, once obtained, to public-funded CSII. ... ...

Abstract	Aims: Continuous subcutaneous insulin infusion (CSII) has been publicly funded in New Zealand for people living with type 1 diabetes since 2012. The aim of the current study was to investigate the loss of access, once obtained, to public-funded CSII. The frequency and socio-demographics of access, and loss, to CSII spanning the period 2012 to 2018 were examined. Methods: Nationally held data collections including the New Zealand Virtual Diabetes Register were used to calculate the overall and subgroup proportions using and ceasing CSII. A logistic regression model was used to estimate odds ratios for pump use for the predictor variables (sex, age group, ethnicity and deprivation index) and to calculate odds ratios for pump cessation for the same demographic factors. Results: Once CSII access is obtained, approximately 4% per year cease CSII in a subsequent year. This cessation of publicly funded CSII was not distributed equally among the population, showing over-representation in youth (aged 10-29 years) and non-Europeans, in particular Māori and Pasifika. Compounding this, it remains less likely for people with diabetes to initially access publicly funded CSII in New Zealand if they are non-European and more socio-economically deprived. Conclusions: In New Zealand, Māori and Pasifika, as well as youth, are over-represented in the cessation of CSII in comparison with Europeans and all other age groups. These groups are also less likely to gain initial access to public funding. Efforts to understand and reduce these disparities are needed, including review of current public funding access criteria.
MeSH term(s)	Adolescent ; Adult ; Age Distribution ; Aged ; Child ; Child, Preschool ; Diabetes Mellitus, Type 1/drug therapy ; Diabetes Mellitus, Type 1/ethnology ; Ethnicity ; Female ; Health Services Accessibility ; Humans ; Infant ; Infant, Newborn ; Insulin Infusion Systems ; Male ; Medical Assistance ; Middle Aged ; Native Hawaiian or Other Pacific Islander ; New Zealand/epidemiology ; Sociodemographic Factors ; Young Adult
Language	English
Publishing date	2020-11-17
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	605769-x
ISSN	1464-5491 ; 0742-3071 ; 1466-5468
ISSN (online)	1464-5491
ISSN	0742-3071 ; 1466-5468
DOI	10.1111/dme.14450
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Article ; Online: Inequity in access to continuous glucose monitoring and health outcomes in paediatric diabetes, a case for national continuous glucose monitoring funding

Mercedes J. Burnside / Jonathan A. Williman / Hannah M. Davies / Craig A. Jefferies / Ryan G. Paul / Benjamin J. Wheeler / Esko J. Wiltshire / Yvonne C. Anderson / Martin I. de Bock

The Lancet Regional Health. Western Pacific, Vol 31, Iss , Pp 100644- (2023)

A cross-sectional population study of children with type 1 diabetes in New ZealandResearch in context

1480

Abstract: Summary: Background: Continuous glucose monitoring (CGM) improves glycaemia for people affected by type 1 diabetes (T1D), but is not funded in Aotearoa/New Zealand. This study explores the impact of non-funded CGM on equity of access and associated ... ...

Abstract	Summary: Background: Continuous glucose monitoring (CGM) improves glycaemia for people affected by type 1 diabetes (T1D), but is not funded in Aotearoa/New Zealand. This study explores the impact of non-funded CGM on equity of access and associated glycaemic outcomes. Methods: Cross-sectional population-based study collected socio-demographic (age, gender, prioritised ethnicity, socioeconomic status) and clinical data from all regional diabetes centres in New Zealand with children <15 years with T1D as of 1st October 2021. De-identified data were obtained from existing databases or chart review. Outcomes compared socio-demographic characteristics between those using all forms of CGM and self-monitoring of blood glucose (SMBG), and association with HbA1c. Findings: 1209 eligible children were evaluated: 70.2% European, 18.1% Māori, 7.1% Pacific, 4.6% Asian, with even distribution across socioeconomic quintiles. Median HbA1c was 64 mmol/mol (8.0%), 40.2% utilised intermittently scanned (is)CGM, and 27.2% real-time (rt)CGM. CGM utilisation was lowest with Pacific ethnicity (38% lower than Māori) and the most deprived socioeconomic quintiles (quintile 5 vs. 1 adjusted RR 0.69; 95% CI, 0.57 to 0.84). CGM use was associated with regional diabetes centre (P < 0.001). The impact of CGM use on HbA1c differed by ethnicity: Māori children had the greatest difference in HbA1c between SMBG and rtCGM (adjusted difference −15.3 mmol/mol; 95% CI, −21.5 to −9.1), with less pronounced differences seen with other ethnicities. Interpretation: Inequities in CGM use exist based on prioritised ethnicity and socioeconomic status. Importantly, CGM was independently associated with lower HbA1c, suggesting that lack of CGM funding contributes to health disparity in children with T1D. Funding: Australasian Paediatric Endocrine Group (APEG), Canterbury Medical Research Foundation, Starship Foundation.
Keywords	Continuous glucose monitoring ; Type 1 diabetes ; Paediatrics ; Equity ; Disparity ; Diabetes technology ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-02-01T00:00:00Z
Publisher	Elsevier
Document type	Article ; Online
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