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Patterns of youths' glycemic control with insulin pump therapy.

Type 1 diabetes mellitus is the most common pediatric endocrine disorder affecting approximately 1 of every 400 to 600 children under the age of 18 (American Diabetes Association [ADA], 2008). Medical goals for youths with type 1 diabetes mellitus include achieving optimal glycemic control, minimizing acute and chronic complications, maximizing psychosocial adjustment to living with diabetes mellitus, and achieving normal growth and development (ADA, 2008). Studies have reported insulin pump therapy is a safe and effective intensive therapy for youths with type 1 diabetes mellitus (Bode, Tamborlane, & Davidson, 2002; Boland, Grey, Oesterle, Fredrickson, & Tamborlane, 1999; Doyle et al., 2004; Maniatis, Klingensmith, Slover, Mowry, & Chase, 2001 ; Plotnick, Clark, Brancati, & Erlinger, 2003; Weintrob et al., 2003).

Clinicians identify a target glycosylated hemoglobin ([HbA.sub.1c]) value when planning the youth's treatment regimen. Benefits of using insulin pump therapy include improved glycemic control, fewer episodes of hypoglycemia, and potentially lower risks of long-term complications associated with high glycemic levels (Maniatis et al., 2001). Youth have reported insulin pump therapy provides greater flexibility with meal time and more consistent glycemic levels (Cogen, Streisand, & Sarin, 2002; Davies & Baum, 1988; Weintrob et al., 2003). Knowing that insulin pump therapy can improve [HbA.sub.1c], the investigators wanted more information about how the youth's [HbA.sub.1c] values change over time. The purpose of this study was to examine youths' [HbA.sub.1c] values during the first 12 months of insulin pump therapy for patterns.

Background Literature

The Diabetes Control and Complications Trial Research Group (1993) emphasized that intensive insulin therapy was needed to maximize glycemic control in individuals with type 1 diabetes mellitus. Youths diagnosed with type 1 diabetes mellitus begin intensive treatment of multiple daily insulin injections and checking blood glucose levels at least six times during the day and night. During the last decade, many youths with their parents and health care providers have made the decision to switch from multiple daily insulin injections to pump therapy. The ADA has identified a target glycosylated hemoglobin ([HbA.sub.1c]) goal for children ages 6 to 12 years old as less than 8.0% and for teens 13 to 19 years old as less than 7.5% (ADA, 2008). Glycemic control can reduce potential retinopathy and other microvascular complications associated with type 1 diabetes mellitus.

Multiple factors affect a youth's achievement and management of glycemic control (Ginsburg et al., 2005; Glasgow, Toobert, & Gillette, 2001; Grey, Boland, Davidson, Li, Tamborlane, 2000; Guthrie, Bartsocas, Jarosz-Chabot, & Konstantinova, 2003; Insabella, Grey, Knafl, & Tamborlane, 2007; Lewin et al., 2006; Pendley et al., 2002; Silverstein et al., 2005; Valenzuela et al., 2006). Examples include the youth's age, gender, pubertal changes, and exercise activities, which are linked to the body's insulin need. The youth's problem-solving and coping skills influence mastery of self care. Emotional responses of depression and altered perception of quality of life can negatively affect following treatment plans. Youths may experience stress from conflict with parents related to implementing or not implementing the prescribed treatment tasks.

The insulin pump mimics physiologic insulin release by delivering a small continuous amount of insulin throughout 24 hours that correlates with the body's physiological insulin needs (Cogen et al., 2002; Lee, Ira, & Magbual, 2004). Additional units of insulin are administered through a bolus mechanism on the pump at meal times and for planned carbohydrates to be eaten. Insulin pump therapy allows a youth greater flexibility regarding when to eat (Cogen et al., 2002; Davies & Baum, 1988).

Insulin pump therapy has been reported to be a safe and effective method to improve youths' glycemic control (Bode et al., 2002; Doyle et al., 2004; Maniatis et al., 2001; Plotnick et al., 2003). Adolescents (n = 50) who used insulin pump for an average of 3.5 years demonstrated a significant decline in mean [HbA.sub.1c] from 9.6% to 8.3 % (Bode et al., 2002). After four months of insulin pump therapy, youths (n = 32) demonstrated a significant decrease in mean [HbA.sub.1c] from 8.1% to 7.2% (Doyle et al., 2004). When insulin pump therapy was used for 6 to 35 months, youths (n = 56) had a significant decline in mean [HbA.sub.1c] value, and 66% of these youths achieved [HbA.sub.1c] less than 8.1% (Maniatis et al., 2001). in contrast to these cited studies, 95 youths (9 to 15 years old) demonstrated an initial significant decrease in mean [HbA.sub.1c] to 7.7%, but by 12 months, the mean [HbA.sub.1c] had increased to 8.3% (Plotnick et al., 2003). A chart review of youths (n 236) who used insulin pump therapy for at least six months reported only 38% achieved the [HbA.sub.1c] goal, and 146 youths had [HbA.sub.1c] values greater than 8.6 % (McVean, Eickhoff, & MacDonald, 2007).

All but one study reported their sample mean [HbA.sub.1c]. A sample's mean [HbA.sub.1c] greater than 8.0 % implies there were youths who did not meet the target glycemic control. McVean and colleagues (2007) reported frequency of youths who did not achieve glycemic target using the insulin pump.

Health care providers for youths with type 1 diabetes mellitus establish a target [HbA.sub.1c] goal as part of the treatment plan. However, predictability of lowering the youth's blood glucose levels and [HbA.sub.1c] with insulin pump therapy is uncertain. Health care providers adjust insulin doses according to the [HbA.sub.1c] and wait to evaluate effectiveness of the adjustment at the next clinic appointment. The time between clinic appointments is usually three or more months. There were no descriptions of the youths' [HbA.sub.1c] patterns with insulin pump therapy found. This study was conducted to answer the research question, "How do youths' [HbA.sub.1c] values change during the first 12 months of insulin pump therapy?"

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Methods

Design, Setting, and Sample

A repeated-measures design guided data collection of youths' [HbA.sub.1c] values after initiation of insulin pump therapy at the Midwestern university outpatient pediatric endocrinology clinic. The five data collection points corresponded to the scheduled clinical appointments at one month before insulin pump therapy and post-initiation at 1, 4, 8, and 12 months. The inclusion criteria for the study were that the youth a) was 9 to 18 years old, b) had type 1 diabetes mellitus, c) had used multiple daily insulin injections, and d) the child or adolescent with their parent(s) had decided to begin insulin pump therapy. There were no exclusion criteria. Youths and parents received the clinic's standard teaching for use of the insulin pump and frequency of blood glucose monitoring. Clinic appointments or telephone contacts were the same for youths in the study and those who chose not to participate.

After receiving Institutional Review Board approval, 59 youths and parents were given an explanation of the study. Eighteen youths chose not to participate in this research. Two youths were assented, but the insulin pump therapy was not started. Another youth had insulin pump therapy for four months and then stopped. The research team was not told the reasons for not starting or stopping pump therapy. One ]8-year-old youth was lost when she enrolled in college and changed health care provider.

Measurement

The [HbA.sub.1c] value measures the individual's average blood glucose level for the previous three months (Park Nicollet, 2008). For each increase in whole percentage points of [HbA.sub.1c] value there is an equivalent increase of 30 mg/dl in blood glucose. For example, the [HbA.sub.1c] value of 7.5% correlates to a blood glucose level of 165 mg/dl (see Table 1). Certified laboratories reported all the [HbA.sub.1c] values at this clinic. Research team members obtained the [HbA.sub.1c] values from the laboratory reports or the health care provider's appointment summary in the youth's medical record. Upon enrollment in the study, each youth completed a demographic questionnaire indicating age, gender, and race.

Data Analysis

Thirty youths had four or more [HbA.sub.1c] values during the first 12 months of insulin pump therapy. Seven youths who had three or fewer reported [HbA.sub.1c] were dropped from the study. This study focused on the change of individual's [HbA.sub.1c], and thus, no mean scores were calculated.

The research team began data inspection by plotting each youth's [HbA.sub.1c] values for the five data collection times. Researchers divided the youths into groups of "achieving" or "did not achieve" the glycemic target. Finally, investigators examined each group to determine whether there was any pattern in the [HbA.sub.1c] values over time.

At the time of data collection, the clinic used 7.6% as the target [HbA.sub.1c] for youth regardless the age or gender. This value was lower than the current ADA recommendation for school age children (8.0%) but similar to the recommendation for adolescents (7.5%).

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Findings

Thirty youths in this study were 18 females (9 to 18 years old) and 12 males (9 to 18 years old). There were 15 school-age children and 15 adolescents. Nineteen youths (10 females and 9 males) achieved target glycemic goal, and 11 youths (8 females and 3 males) did not achieve the target value. All participants were Caucasian. Table 2 illustrates the age and gender distribution per group.

Youths Who Achieved Glycemic Control

For youths who achieved glycemic goal, three different patterns were identified. Group 1 represents the pattern of achieving and sustaining the target of less than 7.6% during the 12 months. Group 2 pattern illustrates achieving less than 7.6% but not sustaining the target value over 12 months. Group 3 pattern shows [HbA.sub.1c] approached the 7.6% target but did not consistently maintain the target. The [HbA.sub.1c] values are illustrated in Figures 1 through 3.

Group 1 had 5 school-age children and 3 adolescents. These 8 youths achieved the 7.6% [HbA.sub.1c] target with one month of insulin pump therapy and sustained the value over 12 months. Before insulin pump therapy, 4 youths had [HbA.sub.1c] values below the target goal. The values of 2 adolescent males increased during the 12 months but remained below the target goal. The values of 1 pre-adolescent female gradually increased over time but remained below the target. The other five youths had decrease in their [HbA.sub.1c] values over time. If the ADA adolescent recommended target [HbA.sub.1c] less than 7.5 % was applied to this group, all youths--even the school-age youths--achieved and maintained the glycemic control.

Group 2 had 5 school-age children and 4 adolescents who achieved the target goal but had one or more [HbA.sub.1c] above the goal. The increase in [HbA.sub.1c] value was either at 8 or 12 months after beginning pump therapy. Three youths had [HbA.sub.1c] values below the target goal before starting insulin pump therapy. One 13-year-old male and one 12-year-old female had their increase at 8 months but a decrease to the target by 12 months. An 11-year-old female had a 4.6% value at baseline, then two values below the 7.6% target goal and two above. The remaining 6 youths' had an increase above the target goal at 12 months. All adolescents had one [HbA.sub.1c] value between 7.8% to 8.2%. The values of the school-age children did not rise above ADA's target value of less than 8.0%, but there were increases of 0.8% to 1.2% from the previous reading.

Two youths in Group 3 had minimal change, but their [HbA.sub.1c] fluctuated between each data collection time. At baseline, the school-age girl's value met the target but was above 7.6% the next time and changed from 0.7 to 0.8% between readings. The school-age female met the ADA glycemic target, but the adolescent female did not achieve 7.5% (ADA target value) throughout the 12 months.

Youths Who Did Not Achieve Glycemic Control

Two different patterns were identified in the youths who did not achieve target goal. Group 4 pattern showed values with minimal change and were above 8.0% during the 12 months. Group 5 [HbA.sub.1c] pattern was no consistent trend but an increase or decrease between data collection points. All [HbA.sub.1c] values were above the clinic's target goal. [HbA.sub.1c] values are in Figures 4 and 5, respectively.

Four adolescents did not reach the desired goal of 7.6% and had little change during the 12 months. None of the adolescents had glycemic control before starting insulin pump therapy. At 12 months, the [HbA.sub.1c] values were 1.1% to 1.3% above the clinic's target goal.

[FIGURE 5 OMITTED]

Four school-age children and 3 adolescents in Group 5 had no consistent pattern. At baseline, 2 school-age children and one adolescent had [HbA.sub.1c] values at the target goal. Four school-age children had one [HbA.sub.1c] value less than 7.6% during the 12 months. One school-age female's value started at the target goal, then 2 values above the 8.0%, and the last [HbA.sub.1c] returned to the target. Two school-age females had a decrease in [HbA.sub.1c] with one month of pump therapy, but their last values were above 8.0%. One adolescent female's values gradually increased over time. Another adolescent female had a 2.0% decline over 12 months but ended at 8.4% value at 12 months. One adolescent male had a lower [HbA.sub.1c] value with one month with pump therapy, but other [HbA.sub.1c] values were greater than 11.0%. One school-age male's [HbA.sub.1c] values increased, decreased, and then increased greater than 8.0%. No adolescents met the clinic or ADA target glycemic goal. The school-age children had one or more values below 8.0%, but at 12 months, their [Hb.sub.A1c] values were above 8.0%.

In summary, three different patterns of [HbA.sub.1c] values were identified for youths who demonstrated glycemic (Groups 1, 2, and 3). There were two different patterns of [HbA.sub.1c] values for youths who did not achieve target glycemic control (Groups 4 and 5).

Discussion

The Diabetes Control and Complications Trial Research Group (1993) emphasized that intensive treatment to improve glycemic control included either multiple daily insulin injections or continuous subcutaneous insulin infusion by pump and frequent blood glucose testing. Treatment regimens for youths with type 1 diabetes mellitus are developed to achieve optimal glycemic control and reduce microvascular and neuropathic complications associated with elevated blood glucose levels (ADA, 2008). In the past decade, many youths and their parents have decided to use insulin pump therapy. Many clinicians believe insulin pump therapy can assist youths to achieve glycemic control. This study had more than 60% of the youths achieving the target glycemic control goal with 12 months of insulin pump therapy. This is opposite of the reported 62% of youths using insulin pump therapy for at least 6 months who did not achieve glycemic control (McVean et al., 2007).

Three different patterns of [HbA.sub.1c] were identified for youths achieving glycemic control. One could conclude these youths were following the prescribed treatment regimen. However, the g youths (Group 2) who had one or more [HbA.sub.1c] values above the target probably had something that affected their glycemic control. One factor may have been a lapse in implementing the prescribed treatment tasks. The 0.7% to 1.6% increase may have been related to the youths' eating excessive carbohydrates or skipping insulin bolus for meals or snacks. Burdick and colleagues (2004) reported that downloaded insulin pump data revealed missed meal and snack insulin boluses. Chase and colleagues (2006) reported youths ignored alarms as reminders for insulin bolus with food. Other explanations for increased [HbA.sub.1c] values could be youths were experiencing stress or parents reduced their involvement in treatment management (Delamater et al., 2001; Ginsburg et al., 2005; Pendley et al., 2002; Valenzuela et al., 2006). Only 2 of the 9 had regained their glycemic control from the previous time. One can suspect that the clinicians discussed the importance of doing blood glucose checks and administering insulin, and the youths returned to implementing the prescribed plans. Parents have suggested that reviewing the treatment plans at every clinic appointment is necessary for youths and their parents (Ginsburg et al., 2005; Lewin et al., 2006; Pendley et al., 2002). These parents also suggested discussion regarding implementing treatment plans needs to avoid blame, shame, or embarrassment comments but focus on reinforcing positive efforts.

Eleven youths (37%) did not achieve glycemic control. These youths need to be identified because they are at greater risk for developing complications. Four adolescents (Group 4) and 3 adolescents (Group 5) did not demonstrate glycemic control before insulin pump therapy or with pump therapy. One possible explanation may be associated with puberty changes and the body's use of insulin. Effective problem-solving skills connecting the blood glucose levels with insulin may also not be used by these adolescents. These adolescents could have been experiencing psychological stress from conflicts with their parents. Health care providers need to develop avenues of open communication without judgments to foster a caring attitude and develop working relationships with the youth and their parents (Ginsburg et al., 2005; Lewin et al., 2005; Pendley et al., 2002).

The school-age children in Group 5 were probably inconsistent in implementing the treatment regimen of insulin boluses with food and completing frequent blood glucose levels. Two children started with glycemic control, but the insulin pump did not potentiate glycemic control. One factor may have been that the parents expected their children to be responsible for the care. More parental involvement in treatment tasks fosters improved glycemic control (Holmes et al., 2006; La Greca, Follansbee, & Skyler, 1990; McVean et al., 2007). Silverstein and Malone (2000) suggest to maximize benefits from pump therapy; the family needs to be committed to following the treatment regimen, willing to change in family lifestyles, and able to work together to meet the demands of the treatment protocol.

Limitations of this study included a small sample size from one Midwestern clinic. No additional data, such as age when diabetes mellitus was diagnosed or length of time living with type 1 diabetes mellitus, to use as factors to determine differences among groups. In addition, there were no data regarding how the youths and parents viewed the new technology in relation to the diabetes mellitus treatment plan.

In summary, these findings are the first documentation of youths' [HbA.sub.1c] patterns with insulin pump therapy for 12 months. The patterns of [HbA.sub.1c] provide evidence of the effectiveness of implementing the new technology (insulin pump therapy) and treatment regimen. However, the uncontrolled glycemic levels and what has changed since the last clinic appointment need to be addressed through discussion with the youth and parent(s). The youths and parents need assistance to determine factors that create barriers to glycemic control. Health care providers must offer repetitive education and support problem-solving skills to maximize optimal glycemic control. Studies are needed to determine which factors predict better glycemic control. Health care providers need to examine their clinic contacts with youth and parents to implement either reinforcement or additional teaching to reduce the barriers of consistent implementation of treatment plans.

References

American Diabetes Association (ADA). (2008). Standards of medical care in diabetes--2008. Diabetes Care, 31(Suppl. 1), 512-554.

Bode, B.W., Tamborlane, W.V., & Davidson, P.C. (2002). Insulin pump therapy in the 21st century. Postgraduate Medicine, 111(5), 69-77.

Boland, E.A., Grey, M., Oesterle, A., Fredrickson, L., & Tamborlane, W.V. (1999). Continuous subcutaneous insulin infusion. Diabetes Care, 22, 1779-1784.

Burdick, J., Chase, H.P., Slover, R.H., Knievel, K., Scrimgeour, L., Maniatis, A.K., et al. (2004). Missed insulin meal boluses and elevated hemoglobin A1c levels in children receiving insulin pump therapy. Pediatrics, 113, 221-224.

Chase, H.P., Homer, B., McFann, K., Yetzer, H., Gaston, J., Banion, C., et al. (2006). The use of insulin pumps with meal bolus alarms in children with type 1 diabetes to improve glycemic control. Diabetes Care, 29(5), 1012-1015.

Cogen, F.R., Streisand, R., & Sarin, S. (2002). Selecting children and adolescents for insulin pump therapy: Medical and behavioral considerations. Diabetes Spectrum, 15(2), 72-75.

Davies, A.G., & Baum, J.D. (1988). A decade of insulin infusion pumps. Archives of Disease in Childhood, 63(3), 329-332.

Delamater, A.M., Jacobson, A.M., Anderson, B., Cox, D., Fisher, L., Lustman, P. et al. (2001). Psychosocial therapies in diabetes: Report of the Psychosocial Therapies Working Group. Diabetes Care, 24(7), 1286-1292.

Diabetes Control and Complications Trial Research Group. (1993). The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. New England Journal of Medicine, 329(14), 977-986.

Doyle, E.A., Weinzimer, S.A., Steffen, A.T., Ahem, J.H., Vincent, M., & Tamborlane, W.V. (2004). A randomized, prospective trial comparing the efficacy of continuous subcutaneous insulin infusion with multiple daily injections using insulin glargine. Diabetes Care, 27(7), 1554-1558.

Ginsburg, K.R., Howe, C.J., Jawad, A.F., Buzby, M., Ayala, J.M., Tuttle, A. et al. (2005). Parents' perception of factors that affect successful diabetes management of their children. Pediatrics, 116(5), 1095-1104.

Glasgow, R.E., Toobert, D., & Gillette, C.D. (2001). Psychosocial barriers to diabetes self-management and quality of life. Diabetes Spectrum, 14(1), 33-41.

Grey, M., Boland, E.A., Davidson, M., Li, J., & Tamborlane W. (2000). Coping skills training for youth with diabetes mellitus has long-lasting effects on metabolic control and quality of life. Journal of Pediatrics, 137(1), 107-113.

Guthrie, D.W., Bartsocas, C., Jarosz-Chabot, P., & Konstantinova, M. (2003). Psychosocial issues for children and adolescents with diabetes: Overview and recommendations. Diabetes Spectrum, 16(1), 7-12.

Holmes, C.S., Chen, R., Streisand, R., Marschall, D.E., Souter, S., Swift, E.E. et al. (2006). Predictors of youth diabetes care behaviors and metabolic control: A structural equation modeling approach. Journal of Pediatric Psychology, 31(8), 770-784.

Insabella, G., Grey, M., Knafl, G., & Tamborlane (2007). The transition to young adulthood in youth with type 1 diabetes on intensive treatment. Pediatric Diabetes, 8(4), 228-234.

La Greca, A.M, Follansbee, D., & Skyler, J.S. (1990). Developmental and behavioral aspects of diabetes management in youngsters. Children's Health Care, 19(3), 132-139.

Lee, S.W., Im, R., & Magbual, R. (2004). Current perspectives on the use of continuous subcutaneous insulin infusion in the acute care setting and overview of therapy. Critical Care Nursing Quarterly, 27(2), 172-184.

Lewin, A.B., Heidgerken, A.D., Geffken, G.R., Williams, L.B., Storch, E.A., Gelfand, K.M., et al. (2006). The relation between family factors and metabolic control: The role of diabetes adherence. Journal of Pediatric Psychology, 31(2), 174-183.

Lewin, A.B., Storch, E.A., Geffken, G.R., Heidgerken, A.D., Williams, L.B., & Silverstein, J.H. (2005). Further examination of a structured adherence interview of diabetes for children, adolescents, and parents. Children's Health Care, 34(2), 149-164.

Maniatis, A.K., Klingensmith, G.J., Slover, R.H., Mowry, C.J., & Chase, H.P. (2001). Continuous subcutaneous insulin infusion therapy for children and adolescents: An option for routine diabetes care. Pediatrics, 107(2), 351-356.

McVean, J.J., Eickhoff, J.C., & MacDonald, M.J. (2007). Factors correlating with improved Alc in children using continuous subcutaneous insulin infusion. Diabetes Care, 30(10), 2499-2500.

Park Nicollet. (n.d.). A1c test. Retrieved May 23, 2008, from http://www.parknicollet.com/Diabetes/selfCare/alc.cfm

Pendley, J.S., Kasmen, L.J., Miller, D.L., Donze, J., Swenson, C., & Reeves, G. (2002). Peer and family support in children and adolescents with type 1 diabetes. Journal of Pediatric Psychology, 27(5), 429-438.

Plotnick, L.P., Clark, L.M., Brancati, EL., & Erlinger, T. (2003). Safety and effectiveness of insulin pump therapy in children and adolescents with type 1 diabetes. Diabetes Care, 26(4), 1142-1146.

Silverstein, J., Klingensmith, G., Copeland, K., Plotnick, L., Kaufman ,F., Laffel, L., et al. (2005). Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association. Diabetes Care, 28(1), 186-212.

Silverstein, J.H., & Malone, J.I. (2000). Strict glycemic control is necessary but not practical in most children with type 1 diabetes. Journal of Clinical Endocrinology and Metabolism, 85(2), 518-522.

Valenzuela, J.M., Patino, A.M., McCullough, J., Ring, C., Sanchez, J., Eidson, M. et al. (2006). Insulin pump therapy and health-related quality of life in children and adolescents with type 1 diabetes. Journal of Pediatric Psychology, 31(6), 650-660.

Weintrob, N., Benzaquen, H., Galatzer, A., Shalitin, S., Lazar, L., Fayman, G., et al. (2003). Comparison of continuous subcutaneous insulin infusion and multiple daily injection regimens in children with type 1 diabetes: A randomized open crossover trial. Pediatrics, 112(3 Pt 1), 559-564.

Acknowledgment: Funding for this study was provided by Novo Nordisk Pharmaceuticals, Inc.

Audrey Nelson, PhD, RN, is an Associate Professor, University of Nebraska Medical Center College of Nursing, Omaha, NE.

Jennifer A. Genthe, MSN, APRN, is a Pediatric Nurse Practitioner, Pediatrics EC., Lincoln, NE.

Kristin M. (Bertrang) Gall, MSN, RN, is a Community Health Nurse Ill, Nebraska Health and Human Services System, Lincoln, NE

Earline Edwards, MSN, APRN, CPNP, CE, is a Pediatric Nurse Practitioner, Pediatric Endocrinology and Diabetology, University of Nebraska Medical Center, Omaha, NE.
Table 1.Conversion of Hemoglobin A1c
([HbA.sub.1C]) to Blood Glucose Level

                       Average Blood
[HbA.sub.1C] Value    Glucose (mg/dl)

 5.0%                        90
 6.0%                       120
 7.0%                       150
 7.5%                       165
 8.0%                       180
 9.0%                       210
10.0%                       240
11.0%                       270
12.0%                       300

Source: Park Nicollet, n.d.

Table 2.
Demographic of Youths

Youths Who Achieved Glycemic
Controls

       Age Started
 ID   on Pump (Year)   Gender

         Group 1

  1         11             F
  2         12             M
  7         10             M
 15         12             F
 29         14             M
 31         14             M
 40         11             M
 57         18             F

         Group 2

  3         13             M
  5         14             F
 19         14             F
 21         10             M
 22         11             M
 36         18             M
 43         11             F
 45         11             F
 54         12             F

         Group 3

 10         11             F
 38         14             F

Youths Who Did Not Achieve
Glycemic Control

       Age Started
 ID   on Pump (Year)   Gender

         Group 4

  6         13             F
 17         17             F
 18         14             F
 23         13             M

         Group 5

  4         17             F
  9         11             F
 20         10             F
 26         15             M
 30         13             F
 46         9              F
 59         9              M
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Author:Nelson, Audrey; Genthe, Jennifer A.; Gall, Kristin M.; Edwards, Earline
Publication:Pediatric Nursing
Article Type:Report
Geographic Code:1USA
Date:Jul 1, 2009
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