RESEARCH ROUNDUP

Pre-diabetes prevalence and associated factors in New Zealand school children

We bring you some of the latest local and international research news impacting on diabetes care.

Pre-diabetes and type 2 diabetes are increasing in children, and early identifi cation of pre-diabetes is vital to stopping it progressing to type 2.

This New Zealand study collected data from a subset of the 685 children who took part in the Children's Bone Study (a cross-sectional study of children aged 8 to 11 years in Auckland). HbAlc was measured, as was weight, height, waist circumference, and body-fat percentage. Information on ethnicity and physical activity was collected through questionnaires.

The study found that pre-diabetes was present in 71 children – 16% of the total group. It was most prevalent in South Asian children, followed by Pacifi c children and then Māori children. It was also associated with high body-fat percentages and low physical activity.

The researchers say, ‘The prevalence of prediabetes in children of South Asian and Pacifi c Island ethnicities suggests the need for appropriate and timely identifi cation and intervention to halt the progression to T2DM.’

Endocrinologist Professor Jeremy Krebs comments that the fi gures shown in this study ‘mirror the diff erence between ethnicities seen in adults and, once again, illustrate the inequities in health in New Zealand.’*

Cardiovascular and Renal Disease Burden in Type 1 Compared With Type 2 Diabetes: A Two-Country Nationwide Observational Study

Type 1 diabetes and type 2 diabetes both increase the risks of cardiovascular and renal (kidney) disease. A Scandinavian study, based in Norway and Sweden, set out to compare the diff erence between those with type 1 and type 2.

They followed 59,331 patients with type 1 and 484,241 patients with type 2 – aged 18 to 84 years old – over a mean period of 2.6 years.

The study found that adult patients with type 1 had an overall greater risk of cardiorenal disease than those with type 2. They also found a greater risk of all-cause death among those with type 1 at middle to older ages and a greater risk of stroke at younger ages. The study found that the total burden and risks were greater among patients with type 1 diabetes compared with those with type 2.

Professor Jeremy Krebs comments, ‘It is a poignant reminder that we still need to aggressively manage cardiac risk factors in people with type 1 diabetes.’*

doi.org/10.2337/dc20-2839

* Diabetes & Obesity Research Review, Issue 144, 2021.

Iwi (tribal) data collection at a primary health care organisation in Aotearoa

A survey of National Hauora Coalition general practice clinics set out to understand whether iwi data was being routinely collected at a primary healthcare organisation level, how it is being collected, and what the results are. The study found that nine of the 33 clinics studied (27%) sought iwi name(s) with a specifi c question on their enrolment form, and that the National Hauora Collective had iwi data for only 13% of its Māori enrolments.

The researchers say, ‘Indigenous peoples’ rights include the right to self-determine one’s identity. For Māori, this includes self-assignment of ethnicity, and traditional identities such as Iwi (tribe).

‘…This is the fi rst study to describe the quantity and quality of Iwi data collection in NZ primary care. Standard procedures for collecting, recording and using Iwi data are being developed by the National Hauora Collective PHO. These could inform national protocols to optimise the quality of Iwi data.’

doi.org/10.1071/HC20037

Effi cacy of telemedicine for persons with type 1 diabetes during Covid-19 lockdown

In March 2020, the Italian government began a Covid-19 lockdown. Outpatient visits were limited and ‘telemedicine’ – using remote technology for virtual appointments with healthcare professionals – was encouraged.

The researchers analysed data from continuous or fl ash glucose monitoring systems shared through diff erent cloud systems during the lockdown by patients with type 1 diabetes. It compared data four weeks before and four weeks after a remote visit to a healthcare professional.

The study found that, during the four weeks following the virtual visit, there was an improvement of glycemic control. It concluded, ‘A structured telephonic visit appears to be an eff ective way to replace or integrate routine visits in particular conditions … The Covid-19 emergency made this type of remote control necessary but once the emergency was over, this type of approach could be off ered as an alternative or integration to the usual visit.

‘… The strategy changes imposed by the Covid-19 emergency could open new avenues in the treatment of sick patients.’

Telehealth in type 1 diabetes

A US review commented that ‘The role of telehealth in the care of people with type 1 diabetes (T1D) has expanded dramatically during the coronavirus pandemic, and is expected to remain a major care delivery modality going forward.’

The researchers found that ‘Telemedicine for routine T1D care has shown equivalence to standard in-person care, with respect to glycemic control, while also increasing access, convenience, and satisfaction. Telehealth use promotes increased engagement of adolescents with T1D.’

Furthermore, ‘Telehealth platforms have successfully been used in the care of microvascular complications and to support mental health related to diabetes … As this care modality scales, it has the potential to increase access to high-quality diabetes care for many people with T1D.

doi: 10.1097/MED.0000000000000600