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Article: Remote glucose monitoring is feasible for patients and providers using a commercially available population health platform.

Crossen, Stephanie S / Romero, Crystal C / Lewis, Carrie / Glaser, Nicole S

2023 Volume 14, Page(s) 1063290

Abstract: Objective: Remote patient monitoring (RPM) holds potential to enable more individualized and effective care for patients with type 1 diabetes (T1D), but requires population analytics to focus limited clinical resources on patients most in need. We ... ...

Abstract	Objective: Remote patient monitoring (RPM) holds potential to enable more individualized and effective care for patients with type 1 diabetes (T1D), but requires population analytics to focus limited clinical resources on patients most in need. We explored the feasibility of RPM from patient and provider standpoints using a commercially available data analytic platform ( Study design: Patients aged 1-20 years with established T1D (≥12 months) and CGM use (≥3 months) were recruited to participate. Participants' CGM devices were connected to the Results: Remote data-sharing was successful for 36 of 39 participants (92%). Between 33%-66% of participants merited outreach each month, and clinician outreach required a median of 10 minutes per event. RPM was reported to be helpful by 94% of participants. RPM was associated with a GMI change of -0.25% ( Conclusions: This study demonstrates the feasibility of RPM for patients with T1D using a commercially available population health platform, and suggests that RPM with clinician-initiated outreach may be particularly beneficial for patients with suboptimal glycemic control at entry. However, larger randomized studies are needed to fully explore the glycemic impact of RPM. Clinical trial registration: https://clinicaltrials.gov/ct2/show/NCT04696640, identifier NCT04696640.
MeSH term(s)	Adolescent ; Humans ; Blood Glucose ; Blood Glucose Self-Monitoring ; Diabetes Mellitus, Type 1/drug therapy ; Glycemic Control ; Surveys and Questionnaires
Chemical Substances	Blood Glucose
Language	English
Publishing date	2023-02-02
Publishing country	Switzerland
Document type	Clinical Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ZDB-ID	2592084-4
ISSN	1664-2392
ISSN	1664-2392
DOI	10.3389/fendo.2023.1063290
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Article ; Online: Fluid Infusion Rates for Pediatric Diabetic Ketoacidosis.

Kuppermann, Nathan / Glaser, Nicole S

The New England journal of medicine

2018 Volume 379, Issue 12, Page(s) 1183–1184

MeSH term(s)	Child ; Diabetic Ketoacidosis ; Fluid Therapy ; Humans ; Insulin
Chemical Substances	Insulin
Language	English
Publishing date	2018-09-19
Publishing country	United States
Document type	Letter ; Comment
ZDB-ID	207154-x
ISSN	1533-4406 ; 0028-4793
ISSN (online)	1533-4406
ISSN	0028-4793
DOI	10.1056/NEJMc1810064
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Article ; Online: Patient Perspectives on Use of Video Telemedicine for Type 1 Diabetes Care in the United States during the COVID-19 Pandemic.

Crossen, Stephanie S / Romero, Crystal C / Loomba, Lindsey A / Glaser, Nicole S

Endocrines

2021 Volume 2, Issue 4, Page(s) 449–456

Abstract: The COVID-19 pandemic has resulted in widespread adoption of telemedicine for management of chronic conditions such as type 1 diabetes (T1D), but few data have been collected about the patient experience and perceived quality of care during this time. We ...

Abstract	The COVID-19 pandemic has resulted in widespread adoption of telemedicine for management of chronic conditions such as type 1 diabetes (T1D), but few data have been collected about the patient experience and perceived quality of care during this time. We surveyed members of the T1D Exchange patient registry and online community regarding their experiences with and opinions about telemedicine care during the pandemic. Among 2235 survey respondents, 65% had utilized telemedicine. The most common reasons for adopting telemedicine were providers not offering in-person care (66%), concerns about the health risks of in-person care (59%), providers offering (52%) or insurance covering (19%) telemedicine for the first time, and local or state orders to stay home (33%). Among telemedicine users, 62% felt video care was as effective as or more effective than in-person care, and 82% hoped to use telemedicine in the future. The most-cited reason for non-use of telemedicine was that providers were not offering it (49%). Our findings highlight the role of telemedicine in maintaining access to T1D care during the COVID-19 pandemic. Respondents' satisfaction with telemedicine and interest in its continued use signifies the need for ongoing access to this care modality and for the development of telemedicine best practices within T1D care.
Language	English
Publishing date	2021-11-01
Publishing country	Switzerland
Document type	Journal Article
ISSN	2673-396X
ISSN (online)	2673-396X
DOI	10.3390/endocrines2040040
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Article ; Online: Diabetic ketoacidosis.

Dhatariya, Ketan K / Glaser, Nicole S / Codner, Ethel / Umpierrez, Guillermo E

Nature reviews. Disease primers

2020 Volume 6, Issue 1, Page(s) 40

Abstract: Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of ... ...

Abstract	Diabetic ketoacidosis (DKA) is the most common acute hyperglycaemic emergency in people with diabetes mellitus. A diagnosis of DKA is confirmed when all of the three criteria are present - 'D', either elevated blood glucose levels or a family history of diabetes mellitus; 'K', the presence of high urinary or blood ketoacids; and 'A', a high anion gap metabolic acidosis. Early diagnosis and management are paramount to improve patient outcomes. The mainstays of treatment include restoration of circulating volume, insulin therapy, electrolyte replacement and treatment of any underlying precipitating event. Without optimal treatment, DKA remains a condition with appreciable, although largely preventable, morbidity and mortality. In this Primer, we discuss the epidemiology, pathogenesis, risk factors and diagnosis of DKA and provide practical recommendations for the management of DKA in adults and children.
MeSH term(s)	Acidosis/etiology ; Acidosis/therapy ; Diabetes Mellitus, Type 1/complications ; Diabetes Mellitus, Type 1/epidemiology ; Diabetes Mellitus, Type 2/complications ; Diabetes Mellitus, Type 2/epidemiology ; Diabetic Ketoacidosis/diagnosis ; Diabetic Ketoacidosis/etiology ; Diabetic Ketoacidosis/therapy ; Disease Management ; Fluid Therapy/methods ; Humans ; Hypoglycemic Agents/therapeutic use ; Insulin/therapeutic use ; Risk Factors
Chemical Substances	Hypoglycemic Agents ; Insulin
Language	English
Publishing date	2020-05-14
Publishing country	England
Document type	Journal Article ; Review
ISSN	2056-676X
ISSN (online)	2056-676X
DOI	10.1038/s41572-020-0165-1
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Article ; Online: Parental marital relationship satisfaction predicts glycemic outcomes in children with type 1 diabetes.

Loomba, Lindsey A / Hughes Lansing, Amy / Cortez, Justine N / Welch, Kearnan / Solowiejczyk, Joe N / Ghetti, Simona / Styne, Dennis M / Glaser, Nicole S

Journal of pediatric endocrinology & metabolism : JPEM

2022 Volume 35, Issue 10, Page(s) 1293–1297

Abstract: Objectives: Glycemic outcomes in children with type 1 diabetes (T1D) vary widely, despite uniform care. We hypothesized that glycemic outcomes in children with T1D are affected by the marital relationship satisfaction of the child's parents.: Methods!# ...

Abstract	Objectives: Glycemic outcomes in children with type 1 diabetes (T1D) vary widely, despite uniform care. We hypothesized that glycemic outcomes in children with T1D are affected by the marital relationship satisfaction of the child's parents. Methods: We evaluated a prospective sample of 51 families with a child with newly diagnosed T1D, including 36 married parent families. We assessed indicators of marital relationship satisfaction and used multiple regression models to determine whether marital relationship satisfaction at diagnosis was associated with mean HbA Results: Marital status and parental relationship satisfaction at the time of the child's T1D diagnosis were associated with HbA Conclusions: The quality of the primary diabetes caregiver's relationship with a spouse predicts glycemic outcomes for children with T1D. Interventions to improve spousal relationships and caregiver support could improve glycemic control in children with T1D.
MeSH term(s)	Blood Glucose ; Child ; Diabetes Mellitus, Type 1 ; Humans ; Marriage ; Parents ; Personal Satisfaction ; Prospective Studies
Chemical Substances	Blood Glucose
Language	English
Publishing date	2022-09-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1231070-0
ISSN	2191-0251 ; 0334-018X
ISSN (online)	2191-0251
ISSN	0334-018X
DOI	10.1515/jpem-2022-0392
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Article: Parental marital relationship satisfaction is associated with glycemic outcomes in children with type 1 diabetes.

Loomba, Lindsey A / Lansing, Amy Hughes / Cortez, Justine N / Welch, Kearnan / Solowiejczyk, Joe N / Ghetti, Simona / Styne, Dennis M / Glaser, Nicole S

Journal of diabetes and metabolic disorders

2022 Volume 21, Issue 2, Page(s) 1479–1489

Abstract: Objectives: We hypothesized that glycemic outcomes in children with type 1 diabetes are linked to marital satisfaction of primary caregivers above and beyond parent neuroticism and child effortful control.: Methods: We evaluated a cross-sectional ... ...

Abstract	Objectives: We hypothesized that glycemic outcomes in children with type 1 diabetes are linked to marital satisfaction of primary caregivers above and beyond parent neuroticism and child effortful control. Methods: We evaluated a cross-sectional sample of 73 married parent families with a child (ages 7-18 years) with type 1 diabetes of at least 2 years duration. We assessed marital relationship satisfaction, parent neuroticism, and child effortful control through the use of validated questionnaires. We used univariate comparisons and multivariable models to determine whether marital relationship satisfaction was associated with hemoglobin A1c [HbA1c] and whether this association persisted after adjusting for demographic factors and parent neuroticism/child effortful control. Results: In univariate analyses, HbA1c was associated with marital relationship satisfaction of the primary caregiver. In multivariable models adjusting for demographic factors, marital satisfaction remained associated with HbA1c, whereas none of the other factors tested (including family income and race/ethnicity) retained significance. In univariate analyses, child effortful control was also associated with HbA1c. When child effortful control was added to the multivariable model, marital satisfaction remained associated with HbA1c with similar coefficient and confidence intervals describing the relationship between marital satisfaction and hemoglobin A1c. Conclusions: Higher levels of marital satisfaction of the primary diabetes caregiver are associated with glycemic outcomes for children with type 1 diabetes. Interventions to improve spousal relationships may have downstream benefits that could include promoting more optimal child HbA1c levels.
Language	English
Publishing date	2022-07-29
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2680289-2
ISSN	2251-6581
ISSN	2251-6581
DOI	10.1007/s40200-022-01084-2
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Article ; Online: Enroller Experience and Parental Familiarity of Disease Influence Participation in a Pediatric Trial.

Schunk, Jeff E / Jacobsen, Kammy K / Stephens, Dilon / Watson, Amy / Olsen, Cody S / Casper, T Charles / Glaser, Nicole S / Kuppermann, Nathan

The western journal of emergency medicine

2021 Volume 22, Issue 5, Page(s) 1176–1182

Abstract: Introduction: Acquiring parental consent is critical to pediatric clinical research, especially in interventional trials. In this study we investigated demographic, clinical, and environmental factors associated with likelihood of parental permission ... ...

Abstract	Introduction: Acquiring parental consent is critical to pediatric clinical research, especially in interventional trials. In this study we investigated demographic, clinical, and environmental factors associated with likelihood of parental permission for enrollment in a study of therapies for diabetic ketoacidosis (DKA) in children. Methods: We analyzed data from patients and parents who were approached for enrollment in the Pediatric Emergency Care Applied Research Network (PECARN) Fluid Therapies Under Investigation in DKA (FLUID) trial at one major participating center. We determined the influence of various factors on patient enrollment, including gender, age, distance from home to hospital, insurance status, known vs new onset of diabetes, glycemic control (hemoglobin A1c), DKA severity, gender of the enroller, experience of the enroller, and time of enrollment. Patients whose parents consented to participate were compared to those who declined participation using bivariable and multivariable analyses controlling for the enroller. Results: A total of 250 patient/parent dyads were approached; 177 (71%) agreed to participate, and 73 (29%) declined. Parents of patients with previous episodes of DKA agreed to enroll more frequently than those with a first DKA episode (94.3% for patients with 1-2 previous DKA episodes, 92.3% for > 2 previous episodes, vs 64.9% for new onset diabetes and 63.2% previously diagnosed but no previous DKA). Participation was also more likely with more experienced enrollers (odds ratio [95% confidence interval] of participation for an enroller with more than two years' experience vs less than two years: 2.46 [1.53, 3.97]). After adjusting for demographic and clinical factors, significant associations between participation and both DKA history and enroller experience remained. Patient age, gender, distance of home from hospital, glycemic control, insurance status, and measures of DKA severity were not associated with likelihood of participation. Conclusion: Familiarity with the disease process (previously diagnosed diabetes and previous experience with DKA) and experience of the enroller favorably influenced the likelihood of parental permission for enrollment in a study of DKA in children.
MeSH term(s)	Adolescent ; Biomedical Research ; Child ; Clinical Trials as Topic ; Diabetes Mellitus, Type 1/complications ; Diabetic Ketoacidosis/epidemiology ; Diabetic Ketoacidosis/etiology ; Diabetic Ketoacidosis/therapy ; Female ; Fluid Therapy ; Humans ; Male ; Parental Consent/psychology ; Parents/psychology ; Surveys and Questionnaires
Language	English
Publishing date	2021-09-02
Publishing country	United States
Document type	Journal Article
ZDB-ID	2375700-0
ISSN	1936-9018 ; 1936-9018
ISSN (online)	1936-9018
ISSN	1936-9018
DOI	10.5811/westjem.2021.4.54647
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Article ; Online: Relationships among biochemical measures in children with diabetic ketoacidosis.

Glaser, Nicole S / Stoner, Michael J / Kwok, Maria Y / Quayle, Kimberly S / Brown, Kathleen M / Schunk, Jeff E / Trainor, Jennifer L / McManemy, Julie K / Tzimenatos, Leah / Rewers, Arleta / Nigrovic, Lise E / Bennett, Jonathan E / Myers, Sage R / Smith, McKenna / Casper, T Charles / Kuppermann, Nathan

Journal of pediatric endocrinology & metabolism : JPEM

2023 Volume 36, Issue 3, Page(s) 313–318

Abstract: Objectives: Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures ... ...

Abstract	Objectives: Investigating empirical relationships among laboratory measures in children with diabetic ketoacidosis (DKA) can provide insights into physiological alterations occurring during DKA. We determined whether alterations in laboratory measures during DKA conform to theoretical predictions. Methods: We used Pearson correlation statistics and linear regression to investigate correlations between blood glucose, electrolytes, pH and PCO Results: pH and bicarbonate levels were strongly correlated (r=0.64), however, pH and PCO Conclusions: Elevated glucose levels at DKA presentation largely reflect alterations in glomerular filtration rate. pH and PCO
MeSH term(s)	Humans ; Child ; Diabetic Ketoacidosis ; Blood Glucose ; Glucose ; Glomerular Filtration Rate ; Diabetes Mellitus
Chemical Substances	Blood Glucose ; Glucose (IY9XDZ35W2)
Language	English
Publishing date	2023-01-16
Publishing country	Germany
Document type	Journal Article
ZDB-ID	1231070-0
ISSN	2191-0251 ; 0334-018X
ISSN (online)	2191-0251
ISSN	0334-018X
DOI	10.1515/jpem-2022-0570
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Article ; Online: Clinical and Laboratory Predictors of Dehydration Severity in Children With Diabetic Ketoacidosis.

Trainor, Jennifer L / Glaser, Nicole S / Tzimenatos, Leah / Stoner, Michael J / Brown, Kathleen M / McManemy, Julie K / Schunk, Jeffrey E / Quayle, Kimberly S / Nigrovic, Lise E / Rewers, Arleta / Myers, Sage R / Bennett, Jonathan E / Kwok, Maria Y / Olsen, Cody S / Casper, T Charles / Ghetti, Simona / Kuppermann, Nathan

Annals of emergency medicine

2023 Volume 82, Issue 2, Page(s) 167–178

Abstract: Study objective: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives ... ...

Abstract	Study objective: Our primary objective was to characterize the degree of dehydration in children with diabetic ketoacidosis (DKA) and identify physical examination and biochemical factors associated with dehydration severity. Secondary objectives included describing relationships between dehydration severity and other clinical outcomes. Methods: In this cohort study, we analyzed data from 753 children with 811 episodes of DKA in the Pediatric Emergency Care Applied Research Network Fluid Therapies Under Investigation Study, a randomized clinical trial of fluid resuscitation protocols for children with DKA. We used multivariable regression analyses to identify physical examination and biochemical factors associated with dehydration severity, and we described associations between dehydration severity and DKA outcomes. Results: Mean dehydration was 5.7% (SD 3.6%). Mild (0 to <5%), moderate (5 to <10%), and severe (≥10%) dehydration were observed in 47% (N=379), 42% (N=343), and 11% (N=89) of episodes, respectively. In multivariable analyses, more severe dehydration was associated with new onset of diabetes, higher blood urea nitrogen, lower pH, higher anion gap, and diastolic hypertension. However, there was substantial overlap in these variables between dehydration groups. The mean length of hospital stay was longer for patients with moderate and severe dehydration, both in new onset and established diabetes. Conclusion: Most children with DKA have mild-to-moderate dehydration. Although biochemical measures were more closely associated with the severity of dehydration than clinical assessments, neither were sufficiently predictive to inform rehydration practice.
MeSH term(s)	Child ; Humans ; Diabetic Ketoacidosis/complications ; Diabetic Ketoacidosis/diagnosis ; Dehydration/diagnosis ; Dehydration/etiology ; Cohort Studies ; Fluid Therapy/methods ; Hypertension/complications ; Retrospective Studies ; Diabetes Mellitus
Language	English
Publishing date	2023-04-05
Publishing country	United States
Document type	Randomized Controlled Trial ; Journal Article ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	603080-4
ISSN	1097-6760 ; 0196-0644
ISSN (online)	1097-6760
ISSN	0196-0644
DOI	10.1016/j.annemergmed.2023.01.001
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Article ; Online: Pyuria in Children with Diabetic Ketoacidosis.

Glaser, Nicole S / Myers, Sage R / Nigrovic, Lise E / Stoner, Michael J / Tzimenatos, Leah / Brown, Kathleen M / Casper, T Charles / Olsen, Cody S / Kuppermann, Nathan

The Journal of pediatrics

2022 Volume 252, Page(s) 204–207.e2

Abstract: Acute kidney injury occurs frequently during pediatric diabetic ketoacidosis (DKA). We reviewed urinalyses from 561 children with DKA; pyuria was detected in 19% overall and in 40% of children with more comprehensive urine testing (≥3 urinalyses) during ... ...

Abstract	Acute kidney injury occurs frequently during pediatric diabetic ketoacidosis (DKA). We reviewed urinalyses from 561 children with DKA; pyuria was detected in 19% overall and in 40% of children with more comprehensive urine testing (≥3 urinalyses) during DKA.
MeSH term(s)	Child ; Humans ; Diabetic Ketoacidosis/complications ; Pyuria/etiology ; Diabetes Mellitus, Type 1 ; Acute Kidney Injury/etiology
Language	English
Publishing date	2022-09-06
Publishing country	United States
Document type	Review ; Case Reports ; Research Support, N.I.H., Extramural ; Research Support, U.S. Gov't, P.H.S.
ZDB-ID	3102-1
ISSN	1097-6833 ; 0022-3476
ISSN (online)	1097-6833
ISSN	0022-3476
DOI	10.1016/j.jpeds.2022.08.054
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