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Cardiometabolic Profile and Body Composition of Children Exposed or Unexposed to Gestational Diabetes Mellitus in Utero
Abstracts / Can J Diabetes 40 (2016) S2–S20
vs. 33±13%) or 24-hour blood pressure (45 [22 to 74] vs. 42 [24 to 53] vs. 33 [19 to 61] %), respectively. We observed smaller left ventricular (LV) mass (137 [112 to 174] vs. 150 [130 to 183] vs. 168 [140 to 190] g; p=0.02) and impaired LV relaxation (early-to-late tissue relaxation: 1.9 [1.6 to 2.3] vs. 1.8 [1.6 to 2.3] vs. 2.3 [1.8 to 3.0]; p=0.03) in those exposed to T2D and GDM compared to normoglycemia. No differences were observed in LV hypertrophy (posterior wall thickness: 9.88 [8.86 to 10.8] vs. 10.4 [9.8 to 11.0] vs. 10.2 [9.2 to 11.0] mm; p=0.4) and systolic function was reduced only in GDM-exposed adolescents (ejection fraction: 61.3 [57.0 to 64.2] %) compared to those exposed to T2D (64.3 [62.0 to 67.3] %) or normoglycemia (64.3 [62.0 to 65.7]%; p=0.02). Conclusion: Adolescents with T2D exposed in utero to T2D or GDM exhibited smaller LV size and impaired LV relaxation in the absence of hypertrophy or altered systolic function. Thus, these in utero exposures may predispose adolescents with T2D to early cardiomyopathy. 41 Cardiometabolic Profile and Body Composition of Children Exposed or Unexposed to Gestational Diabetes Mellitus in Utero MICHÈLE KEARNEY*,†, CAMILLE DUGAS†, ROXANNE MERCIER, JULIE PERRON†, ANDRÉ TCHERNOF†, ISABELLE MARC, S. JOHN WEISNAGEL, JULIE ROBITAILLE† Quebec, QC Background: Children exposed to gestational diabetes (GDM) are more likely to develop obesity and type 2 diabetes. Concomitant metabolic alterations have not been fully characterized. This ongoing study aims to demonstrate the impact of GDM on the metabolic profile of children exposed (GDM+) or unexposed (GDM−). Methods: To date, 69 GDM+ and 29 GDM− were recruited (mean age 7.2±2.8 years). Fasting blood samples were taken, weight, height and waist circumference were measured and body mass index (BMI) and weight z-scores were calculated. Body composition was measured by dual-energy x-ray absorptiometry (n=31 for GDM+ and n=20 for GDM−). Pearson correlations were used to analyze the association between anthropometric measurements and biochemical markers. Results: Children age, weight z-score and BMI z-score were not different between groups. Fat mass percentage was higher and lean mass percentage was lower among GDM+ (p=0.02 for both). GDM+ tended to have a higher waist circumference (p=0.053) and higher fasting insulinemia (p=0.051) than GDM−. Waist circumference was positively correlated with fasting insulinemia (r=0.34, p=0.01), with the Homeostasis model assessment of insulin resistance index (r=0.34, p=0.01), with plasma triglyceride levels (r=0.41, p=0.001) and with C-reactive protein (CRP) (r=0.43, p=0.001) in GDM+, but not in GDM−. Fat mass percentage was positively correlated with glycated hemoglobin (r=0.55, p=0.003), with triglyceride levels (r=0.50, p=0.01) and with CRP concentrations (r=0.58, p=0.001) in GDM+, while it only tended to be correlated with CRP levels (r=0.44, p=0.09) in GDM−. Conclusions: Exposure to GDM is associated with an altered cardiometabolic profile and increased fat mass. 42 Shared Decision Making (SDM) in Pediatric Type 1 Diabetes: Evaluation of Decision Coaching with a Patient Decision Aid ALLYSON SHEPHARD Ottawa, ON Purpose: To evaluate the effect of decision coaching with a decision aid on decisional conflict and participants’ satisfaction for youth and parents considering a change in insulin delivery method. Methods: Pre-post test design. Social workers in a pediatric type 1 diabetes clinic were trained to provide decision coaching through
S15
an online tutorial and skill-building workshop. Youth and parents considering a change in the youth’s insulin delivery method were referred for decision coaching by their physician. Decision coaches used the Ottawa Family Decision Guide pre-populated for insulin delivery options. Data were collected from family members precoaching (T1) and at 10 to 14 days post-coaching (T2). Primary outcome was decisional conflict measured with the Decisional Conflict Scale (DCS), and compared at T1 and T2 using a paired t-test. Other outcomes: Choice predisposition vs. actual choice (T1 and T2) and satisfaction with coaching questionnaire (T2). Results: Forty-two families participated, each consisting of 1 youth and 1 to 2 parents. Youth (n=42), 52% male, median age 11.5 years (range 6.3 to 17.7). Parents (n=62), 40% male. Coaching sessions averaged 55.2±8.9 minutes. Mean youth DCS decreased from 36.4±19.8 (SD) (T1) to 4.6±10.0 (T2) (p<0.0001). Mean parent DCS decreased from 42.0±24.0 (T1) to 3.8±8.0 (T2) (p<0.0001). Between T1 and T2, choice predisposition changed for parents but not youth. Youth (88.9 to 96.3%) and parents (87.8 to 100%) rated the coaching session as helpful, clear and balanced and would definitely/probably recommend it. Conclusion: Decision coaching with a decision aid reduced decisional conflict for youth and parents facing a preference-sensitive insulin delivery decision with high satisfaction ratings from youth and parents.
43 Corneal Confocal Microscopy Detects Progressive Nerve Fibre Loss over 2 Years in Children with Type 1 Diabetes HEIDI VIRTANEN*, ANDREI S. NASTASE, KENNETH ROMANCHUK, JEAN K. MAH, ALBERTO NETTEL-AGUIRRE, RAYAZ A. MALIK, DANIÈLE PACAUD† Calgary, AB Background: Corneal confocal microscopy (CCM) has emerged as a novel, non-invasive early surrogate marker of diabetic neuropathy in adults; its use in children has not been widely studied. Objectives: To examine abnormalities and changes in CCM parameters over 2 years in children with type 1 diabetes (T1DM). Methods: Sixty-two T1DM children (14.8±2.2 years; 9.2±2.8 years T1DM duration) underwent baseline and 2-year follow-up CCM examination. CCM images were analyzed with an automated program for corneal nerve fibre length (CNFL), density (CNFD), branch density (CNBD) and total branch density (CTBD). CCM parameter changes were compared using paired t-tests with Bonferroni correction (p<0.0125). McNemar’s Test compared frequencies of individuals with abnormal CCM results between baseline and 2 years. Results: Point estimates of mean CNFL, CNFD and CNBD differences indicated lower 2-year measures, while mean CTBD was higher; none were statistically significant. Participants with abnormal CNFL results (cut-offs established from healthy controls) increased from 6 (baseline) to 12 (2 year) (p=0.109). For CNFD it increased from 3 (baseline) to 13 (2 years) (p=0.002). Conclusion: Point estimates indicate CNFL and CNFD worsening over 2 years; with Bonferroni correction these are not statistically significant. The frequency of abnormal CNFL results doubled and CNFD increased 4-fold. This suggests that CCM can detect progressive nerve loss over a relatively short period of time in children with T1DM.
Mean±SD T1DM Baseline T1DM 2yr p-value Difference with 95%CI
CNFL (mm/mm2) 15.24±2.97 14.58±3.36 0.058 0.66 (-0.02 to 1.35)
CNFD (no/mm2) 24.76±5.87 22.77±7.36 0.020 1.98 (0.32 to 3.65)
CNBD (no/mm2) 31.03±14.06 29.63±15.35 0.389 1.40 (-1.83 to 4.64)
CTBD (no/mm2) 50.10±22.86 50.65±22.31 0.825 -0.55 (-5.47 to 4.38)
vs. 33±13%) or 24-hour blood pressure (45 [22 to 74] vs. 42 [24 to 53] vs. 33 [19 to 61] %), respectively. We observed smaller left ventricular (LV) mass (137 [112 to 174] vs. 150 [130 to 183] vs. 168 [140 to 190] g; p=0.02) and impaired LV relaxation (early-to-late tissue relaxation: 1.9 [1.6 to 2.3] vs. 1.8 [1.6 to 2.3] vs. 2.3 [1.8 to 3.0]; p=0.03) in those exposed to T2D and GDM compared to normoglycemia. No differences were observed in LV hypertrophy (posterior wall thickness: 9.88 [8.86 to 10.8] vs. 10.4 [9.8 to 11.0] vs. 10.2 [9.2 to 11.0] mm; p=0.4) and systolic function was reduced only in GDM-exposed adolescents (ejection fraction: 61.3 [57.0 to 64.2] %) compared to those exposed to T2D (64.3 [62.0 to 67.3] %) or normoglycemia (64.3 [62.0 to 65.7]%; p=0.02). Conclusion: Adolescents with T2D exposed in utero to T2D or GDM exhibited smaller LV size and impaired LV relaxation in the absence of hypertrophy or altered systolic function. Thus, these in utero exposures may predispose adolescents with T2D to early cardiomyopathy. 41 Cardiometabolic Profile and Body Composition of Children Exposed or Unexposed to Gestational Diabetes Mellitus in Utero MICHÈLE KEARNEY*,†, CAMILLE DUGAS†, ROXANNE MERCIER, JULIE PERRON†, ANDRÉ TCHERNOF†, ISABELLE MARC, S. JOHN WEISNAGEL, JULIE ROBITAILLE† Quebec, QC Background: Children exposed to gestational diabetes (GDM) are more likely to develop obesity and type 2 diabetes. Concomitant metabolic alterations have not been fully characterized. This ongoing study aims to demonstrate the impact of GDM on the metabolic profile of children exposed (GDM+) or unexposed (GDM−). Methods: To date, 69 GDM+ and 29 GDM− were recruited (mean age 7.2±2.8 years). Fasting blood samples were taken, weight, height and waist circumference were measured and body mass index (BMI) and weight z-scores were calculated. Body composition was measured by dual-energy x-ray absorptiometry (n=31 for GDM+ and n=20 for GDM−). Pearson correlations were used to analyze the association between anthropometric measurements and biochemical markers. Results: Children age, weight z-score and BMI z-score were not different between groups. Fat mass percentage was higher and lean mass percentage was lower among GDM+ (p=0.02 for both). GDM+ tended to have a higher waist circumference (p=0.053) and higher fasting insulinemia (p=0.051) than GDM−. Waist circumference was positively correlated with fasting insulinemia (r=0.34, p=0.01), with the Homeostasis model assessment of insulin resistance index (r=0.34, p=0.01), with plasma triglyceride levels (r=0.41, p=0.001) and with C-reactive protein (CRP) (r=0.43, p=0.001) in GDM+, but not in GDM−. Fat mass percentage was positively correlated with glycated hemoglobin (r=0.55, p=0.003), with triglyceride levels (r=0.50, p=0.01) and with CRP concentrations (r=0.58, p=0.001) in GDM+, while it only tended to be correlated with CRP levels (r=0.44, p=0.09) in GDM−. Conclusions: Exposure to GDM is associated with an altered cardiometabolic profile and increased fat mass. 42 Shared Decision Making (SDM) in Pediatric Type 1 Diabetes: Evaluation of Decision Coaching with a Patient Decision Aid ALLYSON SHEPHARD Ottawa, ON Purpose: To evaluate the effect of decision coaching with a decision aid on decisional conflict and participants’ satisfaction for youth and parents considering a change in insulin delivery method. Methods: Pre-post test design. Social workers in a pediatric type 1 diabetes clinic were trained to provide decision coaching through
S15
an online tutorial and skill-building workshop. Youth and parents considering a change in the youth’s insulin delivery method were referred for decision coaching by their physician. Decision coaches used the Ottawa Family Decision Guide pre-populated for insulin delivery options. Data were collected from family members precoaching (T1) and at 10 to 14 days post-coaching (T2). Primary outcome was decisional conflict measured with the Decisional Conflict Scale (DCS), and compared at T1 and T2 using a paired t-test. Other outcomes: Choice predisposition vs. actual choice (T1 and T2) and satisfaction with coaching questionnaire (T2). Results: Forty-two families participated, each consisting of 1 youth and 1 to 2 parents. Youth (n=42), 52% male, median age 11.5 years (range 6.3 to 17.7). Parents (n=62), 40% male. Coaching sessions averaged 55.2±8.9 minutes. Mean youth DCS decreased from 36.4±19.8 (SD) (T1) to 4.6±10.0 (T2) (p<0.0001). Mean parent DCS decreased from 42.0±24.0 (T1) to 3.8±8.0 (T2) (p<0.0001). Between T1 and T2, choice predisposition changed for parents but not youth. Youth (88.9 to 96.3%) and parents (87.8 to 100%) rated the coaching session as helpful, clear and balanced and would definitely/probably recommend it. Conclusion: Decision coaching with a decision aid reduced decisional conflict for youth and parents facing a preference-sensitive insulin delivery decision with high satisfaction ratings from youth and parents.
43 Corneal Confocal Microscopy Detects Progressive Nerve Fibre Loss over 2 Years in Children with Type 1 Diabetes HEIDI VIRTANEN*, ANDREI S. NASTASE, KENNETH ROMANCHUK, JEAN K. MAH, ALBERTO NETTEL-AGUIRRE, RAYAZ A. MALIK, DANIÈLE PACAUD† Calgary, AB Background: Corneal confocal microscopy (CCM) has emerged as a novel, non-invasive early surrogate marker of diabetic neuropathy in adults; its use in children has not been widely studied. Objectives: To examine abnormalities and changes in CCM parameters over 2 years in children with type 1 diabetes (T1DM). Methods: Sixty-two T1DM children (14.8±2.2 years; 9.2±2.8 years T1DM duration) underwent baseline and 2-year follow-up CCM examination. CCM images were analyzed with an automated program for corneal nerve fibre length (CNFL), density (CNFD), branch density (CNBD) and total branch density (CTBD). CCM parameter changes were compared using paired t-tests with Bonferroni correction (p<0.0125). McNemar’s Test compared frequencies of individuals with abnormal CCM results between baseline and 2 years. Results: Point estimates of mean CNFL, CNFD and CNBD differences indicated lower 2-year measures, while mean CTBD was higher; none were statistically significant. Participants with abnormal CNFL results (cut-offs established from healthy controls) increased from 6 (baseline) to 12 (2 year) (p=0.109). For CNFD it increased from 3 (baseline) to 13 (2 years) (p=0.002). Conclusion: Point estimates indicate CNFL and CNFD worsening over 2 years; with Bonferroni correction these are not statistically significant. The frequency of abnormal CNFL results doubled and CNFD increased 4-fold. This suggests that CCM can detect progressive nerve loss over a relatively short period of time in children with T1DM.
Mean±SD T1DM Baseline T1DM 2yr p-value Difference with 95%CI
CNFL (mm/mm2) 15.24±2.97 14.58±3.36 0.058 0.66 (-0.02 to 1.35)
CNFD (no/mm2) 24.76±5.87 22.77±7.36 0.020 1.98 (0.32 to 3.65)
CNBD (no/mm2) 31.03±14.06 29.63±15.35 0.389 1.40 (-1.83 to 4.64)
CTBD (no/mm2) 50.10±22.86 50.65±22.31 0.825 -0.55 (-5.47 to 4.38)