Biomedical subjects

Timothy W Jones

Publications and source records attributed to Timothy W Jones.

21 records · Page 2Linked to original sources

PubMed2004

The impact of a decade of changing treatment on rates of severe hypoglycemia in a population-based cohort of children with type 1 diabetes.

OBJECTIVE: To determine the impact of changes to treatment on the incidence of severe hypoglycemia and its risk factors in a large population-based cohort of children with type 1 diabetes. RESEARCH DESIGN AND METHODS: The cohort consisted of 1,335 children (age at entry 9.5 +/- 4.3 years [mean +/- SD], range 0-18), yielding 6,928 patient-years of data. The mean follow-up period was 4.7 +/- 3.1 years (range 0-10.7). Prospective assessment of severe hypoglycemia (an event leading to loss of consciousness or seizure) and associated clinical factors and outcomes was made between 1992 and 2002. Patients were reviewed every 3 months. Data were analyzed using the negative binomial regression model. RESULTS: A total of 944 severe events were recorded. The incidence of severe hypoglycemia increased significantly by 29% per year for the first 5 years but appeared to plateau over the last 5 years. The overall average HbA1c significantly decreased (by 0.2% per year) over the whole follow-up period. An increased risk of severe hypoglycemia was associated with lower HbA1c, younger age, higher insulin dose, male sex, and lower parental socioeconomic status. Of insulin therapies, only pump treatment was associated with reduced rates of severe hypoglycemia. CONCLUSIONS: Severe hypoglycemia remains a major problem for children and adolescents with type 1 diabetes. Recent approaches to therapy may be allowing a degree of improved control without the expected increased risk of severe hypoglycemia but further monitoring will be important.

Adolescent↗

PubMed2003

Hypoglycemia in children with type 1 diabetes: current issues and controversies.

Hypoglycemia is a common complication of insulin therapy, particularly in the young. For children and adolescents with diabetes, the risk of hypoglycemia may not only prevent optimal glycemic control but can also add significantly to the psychosocial burden of the disease. Recently, surveys employing prospective monitoring techniques have allowed more precise information to be gained about rates of hypoglycemia, its clinical associations, and the impact of new therapies and technologies. A number of reports have estimated rates of hypoglycemic comas and convulsions to be approximately 20 events per 100 patient years in children on current conventional therapy. There is evidence that the introduction of new analog short- and longer-acting insulins and the more widespread use of continuous subcutaneous infusion therapies may allow improvements in glycemic control to occur without the usual increased rate of severe hypoglycemic episodes. The use of glucose sensor technology has brought into focus the widespread occurrence of asymptomatic hypoglycemia. Asymptomatic hypoglycemia has long been recognized, particularly at night, when the combination of excessive insulin action and suppressed counter-regulatory hormone responses put children at special risk of hypoglycemia. Hypoglycemia unawareness is common in the young and is associated with an increased risk of severe hypoglycemia. Whether episodes of severe hypoglycemia have long-term consequences is controversial. Early studies suggesting that the developing brain is sensitive to permanent neurological damage as a result of hypoglycemia have not been confirmed in more recent reports. Many studies have not found convincing evidence of neurological sequelae of the hypoglycemic events that are an inevitable complication of insulin therapy. The question, however, remains under active investigation. Continued prospective monitoring of hypoglycemia rates and consequences has become an essential component of diabetes management.

Adolescent↗

PubMed2002

Exercise training and glycemic control in adolescents with poorly controlled type 1 diabetes mellitus.

This study sought to establish whether the glycemic control achieved in exercise-trained adolescents with type 1 diabetes mellitus (DM) is dependent on the quality of glycemic control prior to the initiation of exercise training. Adolescents with type 1 DM were randomly assigned to groups with either lower or higher than 9% glycosylated hemoglobin (HbA1c), and submitted to 12 weeks of supervised training followed by 12 weeks of unsupervised training (n = 12 per group). Supervised training caused a 17% rise in the patients' aerobic capacity which during the ensuing period of unsupervised training decreased to pre-training levels, thus suggesting a poor compliance with unsupervised training. The average levels of HbA1c in poorly and well controlled diabetic patients were not affected by training, a finding indicating that irrespective of the quality of glycemia prior to exercise training, glycemic control in adolescents with type 1 DM does not improve in response to exercise training alone.

Adolescent↗