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Ketoacidosis children rct

Nathan Kuppermann, Simona Ghetti, Jeff E Schunk, Michael J Stoner, Arleta Rewers, Julie K McManemy, Sage R Myers, Lise E Nigrovic, Aris Garro, Kathleen M Brown, Kimberly S Quayle, Jennifer L Trainor, Leah Tzimenatos, Jonathan E Bennett, Andrew D DePiero, Maria Y Kwok, Clinton S Perry, Cody S Olsen, T Charles Casper, J Michael Dean, Nicole S Glaser
BACKGROUND: Diabetic ketoacidosis in children may cause brain injuries ranging from mild to severe. Whether intravenous fluids contribute to these injuries has been debated for decades. METHODS: We conducted a 13-center, randomized, controlled trial that examined the effects of the rate of administration and the sodium chloride content of intravenous fluids on neurologic outcomes in children with diabetic ketoacidosis. Children were randomly assigned to one of four treatment groups in a 2-by-2 factorial design (0...
June 14, 2018: New England Journal of Medicine
Belinda S Lennerz, Anna Barton, Richard K Bernstein, R David Dikeman, Carrie Diulus, Sarah Hallberg, Erinn T Rhodes, Cara B Ebbeling, Eric C Westman, William S Yancy, David S Ludwig
OBJECTIVES: To evaluate glycemic control among children and adults with type 1 diabetes mellitus (T1DM) who consume a very low-carbohydrate diet (VLCD). METHODS: We conducted an online survey of an international social media group for people with T1DM who follow a VLCD. Respondents included adults and parents of children with T1DM. We assessed current hemoglobin A1c (HbA1c) (primary measure), change in HbA1c after the self-reported beginning of the VLCD, total daily insulin dose, and adverse events...
May 7, 2018: Pediatrics
N Dhochak, M Jayashree, S Singhi
PURPOSE: To compare one vs. two bag system with respect to blood glucose variability (BGV), time for resolution of acidosis and incidence of hypoglycemia, hypokalemia, and cerebral edema in children with diabetic ketoacidosis (DKA). MATERIAL AND METHODS: In an open labelled randomized controlled trial, thirty consecutive patients ≤12years with DKA were randomized to either one (n=15) or two bag (n=15) system of intravenous fluid delivery. The two bags had similar electrolyte but differing dextrose concentration (none vs...
February 2018: Journal of Critical Care
Jemma J A Anderson, Jennifer J Couper, Lynne C Giles, Catherine E Leggett, Roger Gent, Brian Coppin, Alexia S Peña
Context: Children with type 1 diabetes have vascular dysfunction preceding atherosclerosis. Early interventions are needed to reduce cardiovascular disease. Objective: To evaluate the effect of metformin on vascular function in children with type 1 diabetes. Design: Twelve-month double-blind, randomized, placebo-controlled trial. Setting: Tertiary pediatric diabetes clinic. Participants: Ninety children (8 to 18 years of age), >50th percentile body mass index (BMI), with type 1 diabetes...
December 1, 2017: Journal of Clinical Endocrinology and Metabolism
Reem A Al Khalifah, Abdulrahman Alnhdi, Hassan Alghar, Mohammad Alanazi, Ivan D Florez
We aimed to assess the effectiveness of adding metformin to insulin in type 1 diabetes mellitus (T1DM) children for improving metabolic outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) conducted on children age 6 to 19 years who are diagnosed with T1DM, and examined the effect of adding Metformin to standard insulin therapy. We performed literature searches on Ovid Midline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from the date of inception of the database to February 15, 2016...
November 2017: Pediatric Diabetes
Katherine Bakes, Jason S Haukoos, Sara J Deakyne, Emily Hopkins, Josh Easter, Kim McFann, Alison Brent, Arleta Rewers
BACKGROUND: The optimal rate of fluid administration in pediatric diabetic ketoacidosis (DKA) is unknown. OBJECTIVE: Our aim was to determine whether the volume of fluid administration in children with DKA influences the rate of metabolic normalization. METHODS: We performed a randomized controlled trial conducted in a tertiary pediatric emergency department from December 2007 until June 2010. The primary outcome was time to metabolic normalization; secondary outcomes were time to bicarbonate normalization, pH normalization, overall length of hospital treatment, and adverse outcomes...
April 2016: Journal of Emergency Medicine
Carlos A Andrade-Castellanos, Luis Enrique Colunga-Lozano, Netzahualpilli Delgado-Figueroa, Daniel A Gonzalez-Padilla
BACKGROUND: Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of uncontrolled diabetes that mainly occurs in individuals with autoimmune type 1 diabetes, but it is not uncommon in some people with type 2 diabetes. The treatment of DKA is traditionally accomplished by the administration of intravenous infusion of regular insulin that is initiated in the emergency department and continued in an intensive care unit or a high-dependency unit environment. It is unclear whether people with DKA should be treated with other treatment modalities such as subcutaneous rapid-acting insulin analogues...
January 21, 2016: Cochrane Database of Systematic Reviews
Juan Pablo Ferreira, Matias Penazzi, Macarena Taborda, Santiago Funes, Mauricio Villareal
BACKGROUND: Treatment of diabetic ketoacidosis (DKA) requires hourly controls of blood glucose, which define changes in the intravenous glucose and insulin administration. Every change requires preparing a new solution, wasting time and allowing errors. The two bag system (same electrolytes composition, but one with and the other without glucose) allows immediate changes in glucose administration rate, just by changing the solutions drip. OBJECTIVE: To compare the time needed to reach stabilization of patients with DKA using two different hydration systems: the traditional one (1 glucose/electrolyte solution) vs...
2015: Revista de la Facultad de Ciencias Médicas
Nandu Thalange, Larry Deeb, Violeta Iotova, Tomoyuki Kawamura, Georgeanna Klingensmith, Areti Philotheou, Janet Silverstein, Stefano Tumini, Ann-Marie Ocampo Francisco, Ona Kinduryte, Thomas Danne
Insulin degludec (IDeg) once-daily was compared with insulin detemir (IDet) once- or twice-daily, with prandial insulin aspart in a treat-to-target, randomized controlled trial in children 1-17 yr with type 1 diabetes, for 26 wk (n = 350), followed by a 26-wk extension (n = 280). Participants were randomized to receive either IDeg once daily at the same time each day or IDet given once or twice daily according to local labeling. Aspart was titrated according to a sliding scale or in accordance with an insulin:carbohydrate ratio and a plasma glucose correction factor...
May 2015: Pediatric Diabetes
Birgit Fullerton, Klaus Jeitler, Mirjam Seitz, Karl Horvath, Andrea Berghold, Andrea Siebenhofer
BACKGROUND: Clinical guidelines differ regarding their recommended blood glucose targets for patients with type 1 diabetes and recent studies on patients with type 2 diabetes suggest that aiming at very low targets can increase the risk of mortality. OBJECTIVES: To assess the effects of intensive versus conventional glycaemic targets in patients with type 1 diabetes in terms of long-term complications and determine whether very low, near normoglycaemic values are of additional benefit...
February 14, 2014: Cochrane Database of Systematic Reviews
Nicole S Glaser, Simona Ghetti, T Charles Casper, J Michael Dean, Nathan Kuppermann
Treatment protocols for pediatric diabetic ketoacidosis (DKA) vary considerably among centers in the USA and worldwide. The optimal protocol for intravenous (IV) fluid administration is an area of particular controversy, mainly in regard to possible associations between rates of IV fluid infusion and the development of cerebral edema (CE), the most common and the most feared complication of DKA in children. Theoretical concerns about associations between osmotic fluid shifts and CE have prompted recommendations for conservative fluid infusion during DKA...
September 2013: Pediatric Diabetes
Kevin Kaiserman, Henry Rodriguez, Amanda Stephenson, Linda Wolka, Jessie L Fahrbach
OBJECTIVE: To provide a comprehensive review of insulin lispro administered by continuous subcutaneous insulin infusion (CSII) in children and adolescents. METHODS: We performed PubMed literature searches to identify clinical studies of insulin lispro administered via CSII within pediatric and adolescent populations. RESULTS: Twenty-six studies involving 2521 pediatric patients with type 1 diabetes mellitus met inclusion criteria. Of these, 10 were randomized controlled trials (RCTs), 6 of which compared insulin lispro CSII with multiple daily injection (MDI) therapy...
May 2012: Endocrine Practice
Josephine Ho, Carol Huang, Alberto Nettel-Aguirre, Danièle Pacaud
BACKGROUND: Children with type 1 diabetes (DM1) often use three daily (TID) injections with intermediate acting insulin at breakfast and bedtime, and rapid acting insulin at breakfast and dinner. Substituting the evening intermediate acting insulin with a long acting insulin analogue (LAIA) at dinner in a twice daily (BID) injection regimen may be as effective as a TID regimen. The objective of this pilot study was to compare HbA1c in children with DM1 using a BID regimen with a LAIA at dinner (intervention) to those using a standard TID regimen (control) over 6 months...
November 8, 2011: International Journal of Pediatric Endocrinology
Horng Ruey Chua, Antoine Schneider, Rinaldo Bellomo
OBJECTIVE: This study was designed to examine the efficacy and risk of bicarbonate administration in the emergent treatment of severe acidemia in diabetic ketoacidosis (DKA). METHODS: PUBMED database was used to identify potentially relevant articles in the pediatric and adult DKA populations. DKA intervention studies on bicarbonate administration versus no bicarbonate in the emergent therapy, acid-base studies, studies on risk association with cerebral edema, and related case reports, were selected for review...
July 6, 2011: Annals of Intensive Care
Richard M Bergenstal, William V Tamborlane, Andrew Ahmann, John B Buse, George Dailey, Stephen N Davis, Carol Joyce, Tim Peoples, Bruce A Perkins, John B Welsh, Steven M Willi, Michael A Wood
BACKGROUND: Recently developed technologies for the treatment of type 1 diabetes mellitus include a variety of pumps and pumps with glucose sensors. METHODS: In this 1-year, multicenter, randomized, controlled trial, we compared the efficacy of sensor-augmented pump therapy (pump therapy) with that of a regimen of multiple daily insulin injections (injection therapy) in 485 patients (329 adults and 156 children) with inadequately controlled type 1 diabetes. Patients received recombinant insulin analogues and were supervised by expert clinical teams...
July 22, 2010: New England Journal of Medicine
Ewa Pańkowska, Marlena Błazik, Piotr Dziechciarz, Agnieszka Szypowska, Hania Szajewska
OBJECTIVE: To investigate potential effects of continuous subcutaneous insulin infusion (CSII) compared with multiple daily injections (MDI) on glycemic control in children with type 1 diabetes mellitus (T1DM). STUDY DESIGN: Meta-analysis and systematic review of randomized control studies (RCTs). The electronic databases MEDLINE, Cochrane Library, and EMBASE were searched through October 2007. RESULTS: Six RCTs involving 165 participants with T1DM met our predefined inclusion criteria...
February 2009: Pediatric Diabetes
Johnny Ludvigsson, Ulf Samuelsson
OBJECTIVE: There is a common opinion that CSII is superior to MDI. CSII offers the most physiological insulin substitution. METHOD: Review of recent publications (Cochrane criteria), on modern multiple daily injections (MDI) based on insulin analogues, modern self-control and education. RESULTS: There is a lack of randomised controlled studies comparing CSII with modern MDI in children and adolescents. In some studies CSII seems to give a slight decrease of HbA1c, a slightly better quality of life, perhaps less hypoglycemia...
December 2007: Pediatric Endocrinology Reviews: PER
Lynda K Fisher
Continuous subcutaneous insulin infusion (CSII) was first introduced as a mode of treatment for persons with type 1 diabetes mellitus (T1DM) in the late 1970s. Since that time, there have been many reports and reviews of this modality of treatment in adults and adolescents with diabetes and several reports of the use of this technology in the treatment of children with T1DM. Conflicting data have accumulated on the consistency of improvement in hemoglobin A1c (HbA1c) and in the frequency of complications, most significantly that of hypoglycemia...
August 2006: Pediatric Diabetes
Larry A Fox, Lisa M Buckloh, Shiela D Smith, Tim Wysocki, Nelly Mauras
OBJECTIVE: This study assesses the effects of insulin pump therapy on diabetes control and family life in children 1-6 years old with type 1 diabetes. RESEARCH DESIGN AND METHODS: Twenty-six children with type 1 diabetes for >/=6 months were randomly assigned to current therapy (two or three shots per day using NPH insulin and rapid-acting analog) or continuous subcutaneous insulin infusion (CSII) for 6 months. After 6 months, current therapy subjects were offered CSII...
June 2005: Diabetes Care
C E de Beaufort, C M Houtzagers, G J Bruining, R S Aarsen, N C den Boer, W F Grose, R van Strik, J J de Visser
The effect of continuous subcutaneous insulin infusion (CSII), begun at diagnosis, on blood glucose control and endogenous insulin production was studied in a group of consecutively referred newly diagnosed diabetic children. In a random order, 15 children started CSII (age 9.5 +/- 4.2 (+/- SD) years) and 15 conventional injection therapy (age 7.0 +/- 3.6 years). For 2 years HbA1 and urinary C-peptide were measured monthly, C-peptide responses to glucagon 6-monthly, and insulin antibodies every 3 months. None of the patients requested change of therapy during the study period, but at 28 months 1 adolescent girl changed to injection therapy from CSII...
December 1989: Diabetic Medicine: a Journal of the British Diabetic Association
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