Type 1 Diabetes Not Controlled in Teens

Glucose control remained inadequate in a cohort of teens with type 1 diabetes, and many of these young patients already had microvascular complications, a British observational study found.
Among a group of 96 adolescents treated at multidisciplinary young adult clinics, the mean glycosylated hemoglobin (HbA1c) level was 10%, and only 9.4% had levels below the recommended 7.5%, according to Christine Eiser, PhD, of the University of Sheffield, and colleagues.
And in a subgroup who had been diagnosed with type 1 diabetes more than 7 years earlier, 46.9% showed signs of nonproliferative retinopathy, the researchers reported online in Diabetic Medicine.
A retrospective study done a decade ago found that in a group of teens and young adults, glycemic control was suboptimal, clinic visits were sporadic, and complications were common.
The U.K.'s National Institute for Health and Care Excellence has noted that young patients with type 1 diabetes have special concerns that need to be addressed, including mental health problems.
Despite this attention, and advances in treatment, technology, and delivery systems, young patients in the U.K. appeared to be faring worse than those elsewhere in Europe.
To see if that pattern of inadequate disease control persisted, Eiser's group conducted a study between November 2010 and August 2011 that included 60% female participants whose mean age was 18 years.
Depression and anxiety were measured on the Hospital Anxiety and Depression Scale, with a cutoff point of 8 or higher suggesting a clinical diagnosis, and eating disorders were assessed on the Diabetes Eating Problem Survey, with cutoff scores of 2.5 or higher.
Most participants were white and living with their parents, and three-quarters were still in school.
They had been diagnosed an average of 8 years earlier.
A total of 76% were receiving multiple injections each day, 12.5% were on twice-daily insulin, and 11.5% were using insulin pumps.
Mean HbA1c level was higher among girls and young women, at 10.4%, than among their male counterparts, whose mean level was 9.5%.
Levels were lower for those using insulin pumps (9.2%) than for those having multiple daily injections (9.9%) or taking insulin twice daily (11.2%).
Failure to keep clinic appointments was higher, at 13.7%, in those who had been treated at the center for more than 2 years than for those treated for less than a year (10.5%).
Referrals to a clinical psychologist had been made for 21.9%, and 17.9% had kept at least one appointment.
Overall, 26.6% of patients had symptoms of anxiety and 10.9% showed symptoms of depression, while 35.1% had eating disorders.
Girls had higher scores for disordered eating than boys, with average scores of 1.4 compared with 0.6.
Those who scored above the cutoff for depression had higher HbA1c levels, at 11.7%, than those scoring lower, whose mean level was 9.8% (P=0.007).
Among those who had been diagnosed more than 7 years earlier, 94.2% had had an eye exam within the previous year, 92.3% had been screened for nephropathy, and 90.4% were evaluated for hypertension.
Those levels of screening represented an improvement over rates reported in the earlier study, the researchers noted.
A total of 14.6% had an elevated albumin-to-creatinine ratio, 4.2% had microalbuminuria, and 12.8% were hypertensive.
"We have made changes to delivery of care in our clinic to meet current recommendations for transition from pediatrics, multidisciplinary clinics, and psychological support. This has been successful to the extent that some 17.9% of young people accessed psychological support," they observed.
Nonetheless, levels of HbA1c remain too high and complications are frequent.
"Improved technologies offer the potential for better control only when the considerable burden shouldered by young people in assuming responsibility for their self-care and achieving optimal glycemic control is also addressed," they concluded

Ingredients to Make Any Diabetic Menu Delicious

Preparing a diabetic menu does not have to be boring! This article is the second part to 8 Easy Tips for Creating a Diabetic Menu. Ah, now where was I? I remember, flavor. No, not just flavor, spark and decadence!

Mayonnaise and Sour Cream Sauces

Just the way tartar sauce adds a lot of flavor and balance to a boring fish dish, mayonnaise and sour cream sauces add that extra bit of zip to almost any dish. Or it can be as simple as adding horseradish to sour cream for steak and fish, or adding chopped capers and shallot to create a Royal Caper sauce, using a remoulade sauce (see recipe) on anything and everything from a cheese sandwich to that turkey loaf I mentioned. Too bland?  Want something hotter? Add curry or chopped hot peppers to either mayonnaise or sour cream for spicy taste. Only your imagination and creativity is the limit.

Mustard

I can’t talk about adding flavor to a recipe without mentioning mustards. A small amount of mustard adds spark to chicken and to pork and to beef. It gives it another layer on the palate. Please don’t limit yourself to yellow mustard. Don’t get me wrong, I like old fashioned yellow mustard on a ham sandwich, but there are too many varieties available in the market to limit yourself to just one variety. Try a whole grain mustard. It has a very different taste and texture.

Vinegars

There are no two ways about it. If you are diabetic, salad is a big part of your diet. There are a few commercial dressings on the market that are low in carbohydrates. Ken’s Steakhouse is one I use a lot. But nothing could be easier than making your own vinaigrette dressing.

I am sure you have done this with red wine vinegar, maybe with white wine vinegar, or apple cider vinegar. I suggest that you look in the same aisle for Champagne vinegar, tarragon vinegar, raspberry vinegar (great for a salad that contains berries) and balsamic vinegar. Vinegars vary in cost.

I suggest that you buy the best one you can afford. You will use less of it and it will give you the most distinctive flavor. One of my personal favorites is ARISTON Balsamic vinegar. It comes from Greece and is thick and slightly sweet. I also use it in marinades like the pork roast I shared with you last week.

Herbs

The debate rages on about dry versus fresh. Just how many years were those dry herbs in the jar on the shelf of the “stupidmarket”? If you are concerned about the age (staleness?), go to a store that sells bulk herbs. Chances are that they are fresher there than ones the shelf. I can’t swear that it is true, but it’s a good guess. I grow a few herbs in the garden. I use them fresh all summer.

But who is kidding who, I live in Maine. Summer is very short. I will cut the herbs down at the end of the season and hang them to dry in my cellar. With tarragon, I get such a good yield that what I can’t give away fresh, I dry. Even then I might not get to it. I have had some dry for over a year.

Let me tell you that the flavor is still great. Dry is softer than fresh. The same is true for oregano and thyme. Parsley, basil and dill are available fresh all year. Use them! They store pretty well in a glass of water in the refrigerator. Used at the last minute add a real freshness to you dish. And the green color ain’t bad to look at either. The thing is to use them. I grew up in a household that used salt (far too much), pepper, garlic and onion. That was all! I never knew better. I never starved.

Versatility

It is so easy to eat a varied and fun diet even though I am type 2 diabetic. By using, citrus, compound butters, soup cubes, mayonnaises, mustards, vinegars, and herbs, I dine very well indeed. No, scratch that. I dine DECADENTLY!