Person: Laffel, Lori
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Laffel
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Lori
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Laffel, Lori
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Publication A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System for the Management of Adults With Diabetes(Endocrine Society, 2017) Aleppo, Grazia; Laffel, Lori; Ahmann, Andrew J.; Hirsch, Irl B.; Kruger, Davida F.; Peters, Anne; Weinstock, Ruth S.; Harris, Dennis R.After reviewing previously published methods, we developed a practical approach to adjusting insulin doses based on insulin sensitivity for adult patients with diabetes using rtCGM trend arrow data.Publication A Practical Approach to Using Trend Arrows on the Dexcom G5 CGM System to Manage Children and Adolescents With Diabetes(Endocrine Society, 2017) Laffel, Lori; Aleppo, Grazia; Buckingham, Bruce A.; Forlenza, Gregory P.; Rasbach, Lisa E.; Tsalikian, Eva; Weinzimer, Stuart A.; Harris, Dennis R.After assessing previously published methods, we developed a practical approach to adjusting insulin doses using rtCGM trend arrows in pediatric patients with diabetes.Publication Improving dietary quality in youth with type 1 diabetes: randomized clinical trial of a family-based behavioral intervention(BioMed Central, 2015) Nansel, Tonja R; Laffel, Lori; Haynie, Denise L; Mehta, Sanjeev N; Lipsky, Leah M; Volkening, Lisa K; Butler, Deborah; Higgins, Laurie A; Liu, AiyiBackground: Diets of children with type 1 diabetes are low in fruits, vegetables, and whole grains, and high in foods of minimal nutritional value, increasing risk for future adverse health outcomes. This 18-month randomized clinical trial tested the effect of a family-based behavioral intervention integrating motivational interviewing, active learning, and applied problem-solving on the primary outcomes of dietary intake and glycemic control among youth with type 1 diabetes. Methods: A parallel-group study with equal randomization was conducted at an outpatient, free-standing, multidisciplinary tertiary diabetes center in the United States. Eligible youth were those age 8–16 years with type 1 diabetes diagnosis ≥1 year and hemoglobin A1c (HbA1c) ≥6.5% and ≤10.0%. Participants were 136 parent-youth dyads (treatment n = 66, control n = 70). The intervention consisted of 9 in-clinic sessions delivered to the child and parent; control condition comprised equivalent assessments and number of contacts without dietary advice. Dietary intake was assessed using 3-day diet records at 6 time points across the 18-month study. Dietary outcomes included the Healthy Eating Index-2005 (HEI2005; index measuring conformance to the 2005 United States Dietary Guidelines for Americans) and Whole Plant Food Density (WPFD; number of cup or ounce equivalents per 1000 kcal of whole grains, whole fruit, vegetables, legumes, nuts, and seeds consumed). HbA1c was obtained every 3 months. Overall comparison of outcome variables between intervention and usual care groups was conducted using permutation tests. Results: There was a positive intervention effect across the study duration for HEI2005 (p = .015) and WPFD (p = .004). At 18 months, HEI2005 was 7.2 greater (mean ± SE 64.6 ± 2.0 versus 57.4 ± 1.6), and WPFD was 0.5 greater (2.2 ± 0.1 versus 1.7 ± 0.1) in the intervention group versus control. There was no difference between groups in HbA1c across the study duration. Conclusions: This behavioral nutrition intervention improved dietary quality among youth with type 1 diabetes, but did not impact glycemic control. Findings indicate the potential utility of incorporating such strategies into clinical care, and suggest that improvement in diet quality can be achieved in families living with this burdensome disease. Trial registration Clinicaltrials.gov registration number: NCT00999375 Electronic supplementary material The online version of this article (doi:10.1186/s12966-015-0214-4) contains supplementary material, which is available to authorized users.Publication Type 1 Diabetes Through the Life Span: A Position Statement of the American Diabetes Association(American Diabetes Association, 2014-06-12) Chiang, Jane L.; Kirkman, M. Sue; Laffel, Lori; Peters, Anne L.Type 1 diabetes is characterized by an immune-mediated depletion of β-cells that results in lifelong dependence on exogenous insulin. While both type 1 and type 2 diabetes result in hyperglycemia, the pathophysiology and etiology of the diseases are distinct and require us to consider each type of diabetes independently. As such, this position statement summarizes available data specific to the comprehensive care of individuals with type 1 diabetes. The goal is to enhance our ability to recognize and manage type 1 diabetes, to prevent its associated complications, and to eventually cure and prevent this disease.Publication Impact of Type 1 Diabetes Mellitus on the Family is Reduced with the Medical Home, Care Coordination, and Family-Centered Care(Elsevier BV, 2012) Katz, Michelle; Laffel, Lori; Perrin, James; Kuhlthau, KarenObjectives: To examine whether the medical home, care coordination, or family-centered care was associated with less impact of type 1 diabetes (T1D) on families’ work, finances, time, and school attendance. Study design: Using the 2005–2006 National Survey of Children with Special Health Care Needs, we compared impacts among children with T1D (n=583), with other special health care needs (n=39,944), and without special health care needs (n=4,945). We modeled the associations of the medical home, care coordination and family-centered care with family impacts in T1D. Results: In families of children with T1D, 75% reported a major impact versus 45% of families of children with special health care needs (p<0.0001) and 17% of families of children without special health care needs (p<0.0001). In families of children with T1D, 35% reported restricting work, 38% reported financial impact, 41% reported medical expenses >$1000/year, 24% reported spending ≥11 hours/week caring or coordination care and 20% reported ≥11 school absences/year. The medical home, care coordination and family-centered care were associated with less work and financial impacts. Conclusions: In childhood T1D, most families experience major impacts. Better systems of health care delivery may help families reduce some of these impacts.Publication Diabetes Care for Emerging Adults: Recommendations for Transition From Pediatric to Adult Diabetes Care Systems(American Diabetes Association, 2011) Peters, Anne; Laffel, LoriPublication Depressive symptoms and glycemic control in adolescents with type 1 diabetes(American Diabetes Association, 2009) McGrady, Meghan E.; Laffel, Lori; Drotar, Dennis; Repaske, David; Hood, Korey K.OBJECTIVE—To determine whether the association between depressive symptoms and glycemic control is mediated by blood glucose monitoring (BGM). RESEARCH DESIGN AND METHODS—A total of 276 adolescents with type 1 diabetes (mean age ± SD, 15.6 ± 1.4 years) completed a measure of depressive symptoms. Sociodemographic and family characteristics were obtained from caregivers. BGM frequency and glycemic control were obtained at a clinic visit. RESULTS—Separate regression analyses revealed that depressive symptoms were associated with lower BGM frequency (B = −0.03; P = 0.04) and higher A1C (B = 0.03; P = 0.05) and that lower BGM frequency was associated with higher A1C (B = −0.39; P < 0.001). With depressive symptoms and BGM frequency included together, only BGM frequency was associated with A1C and depressive symptoms became nonsignificant (B = 0.02; P = 0.19). The Sobel test was significant (Z = 1.96; P < 0.05) and showed that 38% of the depression-A1C link can be explained by BGM. CONCLUSIONS—BGM is a mediator between depressive symptoms and glycemic control in adolescents with type 1 diabetes.