The coronavirus disease-2019 (COVID-19) pandemic had widespread impacts on the lives of parents and children. We determined how the pandemic affected Type 1 diabetes patients at a large urban ...pediatric teaching hospital.
We compared patient characteristics, glycemic control, PHQ-9 depression screen, in person and virtual outpatient encounters, hospitalizations and continuous glucose monitor (CGM) utilization in approximately 1600 patients in 1 year periods preceding and following the local imposition of COVID-related restrictions on 3/15/2020 ("2019" and "2020" groups, respectively).
In a generalized linear model, increasing age, non-commercial insurance, Black and Hispanic race/ethnicity, and non-utilization of CGMs were all associated with higher hemoglobin A1c (HbA1c), but there was no difference between the 2019 and 2020 groups. The time in range in CGM users was lower with non-commercial insurance and in Black and Hispanic patients; it improved slightly from 2019 to 2020. CGM utilization by patients with non-commercial insurance (93% of such patients were in government programs, 7% uninsured or "other") increased markedly. In 2020, patients with commercial insurance (i.e., private-pay or provided by an employer) had fewer office visits, but insurance status did not influence utilization of the virtual visit platform. There was no change in hospitalization frequency from 2019 to 2020 in either commercially or non-commercially insured patients, but patients with non-commercial insurance were hospitalized at markedly higher frequencies in both years. PHQ-9 scores were unchanged.
Hospitalization frequency, glycemic control and depression screening were unchanged in our large urban pediatric teaching hospital during the COVID pandemic. Increased utilization of CGM and rapid adoption of telemedicine may have ameliorated the impact of the pandemic on disease management.
Background: Optimal management of childhood diabetes benefits from access to a 24-hour support line. If staffed by on-call physicians, repeated interruptions to sleep can lead to physician burn out. ...Utilization, and outcomes of an after-hours nurse call service in a pediatric endocrinology practice have not been previously reported.
Methods: Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include our institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers.
Results: After we instituted our after-hours nurse triage service (September 2019), the call burden to the on-call physicians decreased by 70%. Patients who called the after-hours line before coming to the emergency room were less sick (higher pH and lower glucose) and were more likely to be discharged home. We cannot infer causality from our data. Nevertheless, given that <10% of patients called first, encouraging earlier and more consistent utilization of the nurse line seems like a low-cost intervention that might reduce hospital admissions for diabetic ketoacidosis. After-hours service was utilized well by our patients of all races and insurance statuses. We noted that language was a barrier in utilization which is an opportunity for improvement.
Disclosure
A.Choudhary: None.
Background: The SEARCH for Diabetes in Youth Registry reported the prevalence of diabetic retinopathy in children with Type 1 and Type 2 diabetes as 5.6% and 9.1% respectively. The American Diabetes ...Association recommends annual retinopathy screening in children ≥ 11 years of age or at onset of puberty whichever is earlier, 3-5 years after diagnosis of Type 1 diabetes. The screening is recommended annually immediately after diagnosis of Type 2 diabetes. In our academic endocrinology practice, we have 2000 established patients with Type 1 diabetes and 900 patients with Type 2 diabetes. Our non-commercially insured population is around 40%. Methods: NIDEK Navis- EX retinal scanner was installed in June 2020 in the clinic for the Medicaid population to improve screening since this group had suboptimal retinal screening. The scan was performed by the medical assistants at check-in during the diabetes clinic visit based on eligibility. The images were transferred to the ophthalmology colleagues for a reading. Once the read was completed, the results were sent back to the patient's electronic medical records. Results: The retinal scan screening was at 37.4% for all insurance groups prior to the implementation of the scanner. After the installation of the scanner, the screening rates increased to 48.7%, 64.8%, and 64.8% at the end of years 1, 2, and 3 respectively in the non-commercially insured group. Among the 349 patients screened in our clinic during the 1st year, 7 had non-proliferative diabetic retinopathy. Conclusions: We improved the retinopathy screening rates in the non-commercially insured population at our center. We are working with our institution, so we can perform retinal scans in our clinic for all our patients without a huge financial burden for our families.
Recent structural and biochemical studies have identified a novel control mechanism of gene expression mediated through the secondary channel of RNA Polymerase (RNAP) during transcription initiation. ...Specifically, the small nucleotide ppGpp, along with DksA, a RNAP secondary channel interacting factor, modifies the kinetics of transcription initiation, resulting in, among other events, down-regulation of ribosomal RNA synthesis and up-regulation of several amino acid biosynthetic and transport genes during nutritional stress. Until now, this mode of regulation of RNAP was primarily associated with ppGpp. Here, we identify TraR, a DksA homolog that mimics ppGpp/DksA effects on RNAP. First, expression of TraR compensates for dksA transcriptional repression and activation activities in vivo. Second, mutagenesis of a conserved amino acid of TraR known to be critical for DksA function abolishes its activity, implying both structural and functional similarity to DksA. Third, unlike DksA, TraR does not require ppGpp for repression of the rrnB P1 promoter in vivo and in vitro or activation of amino acid biosynthesis/transport genes in vivo. Implications for DksA/ppGpp mechanism and roles of TraR in horizontal gene transfer and virulence are discussed.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Background. After-hours triage of pediatric patients by trained nurses improves consistency of triage decisions, access, and quality of care, and decreases burden on physicians on-call. There is a ...lack of published experience with this approach in the pediatric diabetes population. Methods. An after-hours call service was established in September 2019 in our large urban pediatric teaching hospital. Barton Schmitt guidelines, which are widely accepted as the standard for telephone triage care, were modified to include institution specific diabetes management protocols. We analyzed demographics, reasons for call, clinical presentation to the emergency room, and clinical disposition of the callers. Results. The after-hours call service handled 70% of calls without physician involvement. There were no patients triaged to home care who subsequently required an emergency room visit or hospitalization. Patients who called the after-hours nurse line prior to coming to the emergency room were less sick and were discharged more often from the emergency room. Spanish-speaking parents utilized the service less than English speakers. There were no disparities in utilization based on the insurance status or race. Conclusions. The after-hours service accurately triaged calls and reduced physician burden. Patients of all races and insurance statuses utilized the after-hours service equally well. Language was a barrier in the utilization.
Triple A syndrome, formerly known as Allgrove syndrome (AS), is characterized by achalasia, alacrima and adrenal insufficiency. Here we report an adolescent male with adrenal insufficiency who ...developed severe malnutrition secondary to a delayed diagnosis of achalasia. The severe malnutrition in our patient led to superior mesenteric artery (SMA) obstruction syndrome. Severe malnutrition to the point of SMA syndrome has not been previously described in the literature in Triple A syndrome.
Diabetic Ketoacidosis (DKA) has high morbidity and mortality and can be prevented. It is extremely important to give clear guidance to patients and families on how to manage diabetes during ...intercurrent illnesses to avoid complications of ketoacidosis, dehydration,uncontrolled or symptomatic hyperglycemia and hypoglycemia. This descriptive review of clinical cases and management guidelines for sick days in children and adolescents with diabetes is provided as a resource for physicians who may take calls from parents of sick children with diabetes or manage these children in a clinic, emergency room or hospital setting.
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