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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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52
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Goldberg A. Parents’ representations and glycemic control among adolescents with type 1 diabetes. J Public Health (Oxf) 2018. [DOI: 10.1007/s10389-018-1003-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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53
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Yeowell G, Smith P, Nazir J, Hakimi Z, Siddiqui E, Fatoye F. Real-world persistence and adherence to oral antimuscarinics and mirabegron in patients with overactive bladder (OAB): a systematic literature review. BMJ Open 2018; 8:e021889. [PMID: 30467131 PMCID: PMC6252764 DOI: 10.1136/bmjopen-2018-021889] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 09/12/2018] [Accepted: 09/25/2018] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To evaluate persistence and adherence of oral pharmacotherapy used in the treatment of overactive bladder (OAB) in a real-world setting. MATERIALS AND METHODS Systematic literature searches of six electronic publication databases were performed to identify observational studies of patients with OAB treated with antimuscarinics and/or mirabegron. Studies obtaining persistence and adherence data from sources other than electronic prescription claims were excluded. Reference lists of identified studies and relevant systematic reviews were assessed to identify additional relevant studies. RESULTS The search identified 3897 studies, of which 30 were included. Overall, persistence ranged from 5% to 47%. In studies reporting data for antimuscarinics and mirabegron (n=3), 1-year persistence was 12%-25% and 32%-38%, respectively. Median time to discontinuation was <5 months for antimuscarinics (except one study (6.5 months)) and 5.6-7.4 months for mirabegron. The proportion of patients adherent at 1 year varied between 15% and 44%. In studies reporting adherence for antimuscarinics and mirabegron, adherence was higher with mirabegron (mean medication possession ratio (MPR): 0.59 vs 0.41-0.53; mean proportion of days covered: 0.66 vs 0.55; and median MPR: 0.65 vs 0.19-0.49). Reported determinants of persistence and adherence included female (sex), older age group, use of extended-release formulation and treatment experience. CONCLUSION Most patients with OAB discontinued oral OAB pharmacotherapy and were non-adherent 1 year after treatment initiation. In general, mirabegron was associated with greater persistence and adherence compared with antimuscarinics. Combined with existing clinical trial evidence, this real-world review merits consideration of mirabegron for first-line pharmacological treatment among patients with OAB. PROSPERO REGISTRATION NUMBER CRD42017059894.
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Affiliation(s)
| | - Philip Smith
- Manchester Metropolitan University, Manchester, UK
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54
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Habenicht AE, Gallagher S, O’Keeffe MC, Creaven AM. Making the leap and finding your feet: A qualitative study of disclosure and social support in university students with type 1 diabetes. J Health Psychol 2018; 26:260-269. [DOI: 10.1177/1359105318810875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
University poses unique challenges surrounding disclosure for students living with type 1 diabetes, with implications for social support and self-management. Semi-structured interviews with students and peer interviewers living with type 1 diabetes explored university experiences of disclosure and social support. Thematic analysis identified three major themes: disclosure as a measured process, the need for lived experience for true understanding and personal growth and self-awareness. Findings emphasize the need to scaffold the university transition for individuals with type 1 diabetes as disclosure can elicit effective social support. In addition, the importance of lived experience suggests support from students with type 1 diabetes could considerably impact diabetes management.
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55
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Piona C, Dovc K, Mutlu GY, Grad K, Gregorc P, Battelino T, Bratina N. Non-adjunctive flash glucose monitoring system use during summer-camp in children with type 1 diabetes: The free-summer study. Pediatr Diabetes 2018; 19:1285-1293. [PMID: 30022571 DOI: 10.1111/pedi.12729] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 06/08/2018] [Accepted: 07/02/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A factory-calibrated sensor for intermittently scanned continuous glucose monitoring (isCGM) is accurate and safe in children with type 1 diabetes (T1D). Data on isCGM effectiveness as a replacement for self-monitoring of blood glucose (SMBG) in this population is scarce. OBJECTIVE The aim of this study was to evaluate the non-adjunctive use of isCGM in children with T1D during 2 weeks in a challenging summer-camp setting. METHODS In this two-arm, parallel, randomized, outpatient clinical trial we enrolled 46 children (25 females, mean ± SD: age 11.1 ± 2.6 years, glycated hemoglobin (HbA1c) 7.4% ± 0.7%): 26 in the isCGM group were blinded for the SMBG and insulin dosing was isCGM-based, whereas 20 in the control group were blinded for isCGM and performed SMBG-based insulin dosing. The primary outcome of intention-to-treat analysis was between-group difference in the proportion of time within range 3.9 to 10 mmol/L (TIR). RESULTS There was no significant difference in TIR (3.9-10 mmol/L) between the two groups. In participants with suboptimal metabolic control (HbA1c > 7%) we observed a significant reduction in time spent above 10 mmol/L (P < 0.05) and an improvement in TIR (P = 0.05) in the isCGM group. No severe hypoglycemic events or serious adverse events occurred. Overall mean absolute relative difference (MARD) between isCGM and SMBG was 18.3%, with median absolute relative difference (ARD) of 8%. Consensus error grid analysis demonstrated 82.2% and 95.2% of results in zone A, and zone A + B, respectively. CONCLUSION The non-adjunctive use of isCGM was as safe and effective as SMBG, and reduced time spent in hyperglycemia in a sub-population of children with T1D with suboptimal glycemic control. TRIAL REGISTRATION NCT03182842.
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Affiliation(s)
- Claudia Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Klemen Dovc
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
| | - Gül Y Mutlu
- Department of Pediatrics, Koç University Hospital, İstanbul, Turkey
| | - Klara Grad
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Petra Gregorc
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Tadej Battelino
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia.,Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Nataša Bratina
- Department of Paediatric Endocrinology, Diabetes and Metabolic Diseases, University Children's Hospital, University Medical Centre, Ljubljana, Slovenia
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56
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Rankin D, Harden J, Barnard K, Bath L, Noyes K, Stephen J, Lawton J. Barriers and facilitators to taking on diabetes self-management tasks in pre-adolescent children with type 1 diabetes: a qualitative study. BMC Endocr Disord 2018; 18:71. [PMID: 30316299 PMCID: PMC6186043 DOI: 10.1186/s12902-018-0302-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND When children with type 1 diabetes approach adolescence, they are encouraged to become more involved in diabetes self-management. This study explored the challenges pre-adolescent children encounter when self-managing diabetes and the factors which motivate and enable them to take on new diabetes-related tasks. A key objective was to inform the support offered to pre-adolescent children. METHODS In-depth interviews using age-appropriate questioning with 24 children (aged 9-12 years) with type 1 diabetes. Data were analysed using an inductive, thematic approach. RESULTS Children reported several barriers to taking on self-management tasks. As well as seeking respite from managing diabetes, children described relying on their parents to: perform the complex maths involved in working out carbohydrate content in food; calculate insulin doses if they did not use a bolus advisor; and administer injections or insert a cannula in hard-to-reach locations. Children described being motivated to take on diabetes tasks in order to: minimise the pain experienced when others administered injections; alleviate the burden on their parents; and participate independently in activities with their peers. Several also discussed being motivated to take on diabetes-management responsibilities when they started secondary school. Children described being enabled to take on new responsibilities by using strategies which limited the need to perform complex maths. These included using labels on food packaging to determine carbohydrate contents, or choosing foods with carbohydrate values they could remember. Many children discussed using bolus advisors with pre-programmed ratios and entering carbohydrate on food labels or values provided by their parents to calculate insulin doses. Several also described using mobile phones to seek advice about carbohydrate contents in food. CONCLUSIONS Our findings highlight several barriers which deter children from taking on diabetes self-management tasks, motivators which encourage them to take on new responsibilities, and strategies and technologies which enable them to become more autonomous. To limit the need to perform complex maths, children may benefit from using bolus advisors provided they receive regular review from healthcare professionals to determine and adjust pre-programmed insulin-to-carbohydrate ratios. Education and support should be age-specific to reflect children's changing involvement in self-managing diabetes.
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Affiliation(s)
- David Rankin
- The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Jeni Harden
- The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Katharine Barnard
- BHR Ltd, 42 Kilmiston Drive, Portchester, Fareham, Hants, PO16 8EG and Faculty of Health & Social Science, Bournemouth University, Royal London House, Bournemouth, BH1 3LT UK
| | - Louise Bath
- Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF UK
| | - Kathryn Noyes
- Royal Hospital for Sick Children, Sciennes Road, Edinburgh, EH9 1LF UK
| | - John Stephen
- Child Health Department, Borders General Hospital, Melrose, TD6 9BS UK
| | - Julia Lawton
- The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG UK
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57
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Bergner EM, Whittemore R, Patel NJ, Savin KL, Hamburger ER, Jaser SS. Participants' Experience and Engagement in Check It!: a Positive Psychology Intervention for Adolescents with Type 1 Diabetes. TRANSLATIONAL ISSUES IN PSYCHOLOGICAL SCIENCE 2018; 4:215-227. [PMID: 30505889 DOI: 10.1037/tps0000161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Problems with adherence are common among adolescents with type 1 diabetes (T1D), who must follow a complex treatment regimen. Positive psychology interventions increase adherence and improve health outcomes in adults with chronic conditions; however, they have not been translated to pediatric populations. We evaluated the acceptability and feasibility of Check It!, a positive psychology intervention to improve adherence in adolescents with T1D. Adolescents with T1D and their parents were randomized to a positive psychology intervention (via phone or text message) or an attention control (education) group. Exit interviews and satisfaction surveys were conducted with adolescents (n=63) and parents (n=55) to assess the acceptability and feasibility of Check it! from a representative sample of each group. Chi-square, t-tests, ANOVA and content analysis methods were used to analyze data. Parents and adolescents indicated interest in the intervention, and enrollment numbers support feasibility. In terms of intervention delivery, we identified challenges in implementing the positive psychology reminders to adolescents, particularly in the phone group. Parents in the positive psychology group appreciated the reminders to provide affirmations to their children, and adolescents enjoyed the affirmations and reported using the positive psychology exercises. Regarding acceptability, participants in both groups reported high satisfaction with the intervention overall. Participants reported favorable experiences with Check It!, and findings indicate that text messages are more feasible than phone calls for interventions with adolescents. Overall, a positive psychology intervention delivered with automated text messages is feasible and acceptable to adolescents with T1D and their parents.
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58
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Holtz BE, Murray K, Park T. Serious Games for Children with Chronic Diseases: A Systematic Review. Games Health J 2018; 7:291-301. [PMID: 29957082 DOI: 10.1089/g4h.2018.0024] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVE The purpose of this study was to systematically review the literature to assess if serious games impact health outcomes for children less than 18 years of age with chronic diseases. Additionally, the impact of self-efficacy, adherence, knowledge, use of theory, parent involvement, and study quality was also examined. MATERIALS AND METHODS Searches were conducted in databases EBSCO, PubMed, and Web of Science between June and August 2016. Randomized controlled trials using a serious game as an intervention, for participants under 18 years of age, to improve their chronic disease were included. RESULTS Data were extracted by two independent researchers, including: Title, author, and publication year; chronic disease; game description; number and age of participants; intervention duration; significant findings; parent involvement; theory; and study quality. Any disagreements were tackled and consensus was achieved. Eighteen studies were included in the review. The areas of health addressed included cerebral palsy, asthma, diabetes, developmental coordination disorders, and vision disorders. In these articles, eight health outcome variables were measured, including: lung function, glycemic control, hospital visits, motor proficiency, and visual acuity. Psychosocial variables that were assessed included self-efficacy and knowledge. Two articles included parents in the intervention, and three articles used theory. Six studies had significant health outcome finding, and four studies found a significant change in one psychosocial variable. CONCLUSION This review demonstrates the potential for games to improve health outcomes of young individuals. However, the mixed results suggest that more serious game interventions need to be better designed and rigorously tested to support their impact on improving health outcomes.
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Affiliation(s)
- Bree E Holtz
- 1 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Katharine Murray
- 1 Department of Advertising and Public Relations, Michigan State University , East Lansing, Michigan
| | - Taiwoo Park
- 2 Department of Media and Information, Michigan State University , East Lansing, Michigan
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59
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Hannon TS, Moore CM, Cheng ER, Lynch DO, Yazel-Smith LG, Claxton GE, Carroll AE, Wiehe SE. Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test. J Particip Med 2018; 10:e8. [PMID: 33052121 PMCID: PMC7434065 DOI: 10.2196/jopm.9652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/14/2018] [Accepted: 04/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents’ thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution’s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus.
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Affiliation(s)
- Tamara S Hannon
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney M Moore
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Erika R Cheng
- Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dustin O Lynch
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Lisa G Yazel-Smith
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gina Em Claxton
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Aaron E Carroll
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sarah E Wiehe
- Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
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Garza KP, Jedraszko A, Weil LEG, Naranjo D, Barnard KD, Laffel LMB, Hood KK, Weissberg-Benchell J. Automated Insulin Delivery Systems: Hopes and Expectations of Family Members. Diabetes Technol Ther 2018; 20:222-228. [PMID: 29565721 PMCID: PMC6422006 DOI: 10.1089/dia.2017.0301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study examines the hopes and expectations that children, adolescents, and adults with type 1 diabetes and their families have for new automated insulin delivery systems. The study also aims to examine how the automated insulin delivery system may impact family functioning and individual members' psychosocial adjustment. METHODS Forty-eight semistructured focus groups (n = 195) and 89 individual interviews were conducted with children, adolescents, and adults with type 1 diabetes and parents and partners. Coders reviewed results in key themes most likely to contain references to the family system. Clusters were analyzed using thematic analysis to identify participants' salient hopes and expectations of how new technology may impact family relationships and individual psychosocial functioning. RESULTS Three main themes emerged for participants' hopes and expectations for implementation of the automated insulin delivery system. First, there is an expectation that this diabetes technology will alleviate diabetes-specific worry and burden for the people with diabetes and other family members. Second, there is also hope that this system may reduce day-to-day stress and, third, improve family relationships. CONCLUSIONS The unique perspective of a broad age group provides insight into how individuals and families creatively address the multiple tasks required in daily diabetes management. Study findings elucidate the very high hopes and expectations held by those managing type 1 diabetes and the impact this new technology may have on family relationships. Awareness of these hopes and expectations is important for developers and clinicians in addressing potential challenges to uptake and to ensure that expectations are set appropriately.
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Affiliation(s)
- Kimberly P Garza
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Aneta Jedraszko
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Lindsey E G Weil
- 2 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Diana Naranjo
- 3 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
| | | | - Lori M B Laffel
- 5 Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Korey K Hood
- 3 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
- 6 Department of Pediatrics, Stanford University School of Medicine , Stanford, California
| | - Jill Weissberg-Benchell
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
- 2 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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Tucker C, Wiebe DJ, Main A, Lee AG, White PC. Adolescent Information Management and Parental Knowledge in Non-Latino White and Latino Youth Managing Type 1 Diabetes. J Pediatr Psychol 2018; 43:207-217. [PMID: 29048542 DOI: 10.1093/jpepsy/jsx111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Accepted: 08/09/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives The objective of this study is to examine associations between adolescents' regulation of information about their type 1 diabetes (adolescent disclosure, secrecy), parental knowledge about their adolescent's diabetes management, diabetes outcomes (adherence, HbA1c), and depressive symptoms in Non-Latino White and Latino families. Methods In all, 118 adolescents (56 = Latino, 62 = Non-Latino White) completed surveys of disclosure to and secrecy from parents, parental knowledge of adolescent diabetes management, adherence, and depressive symptoms, and mothers completed measures of maternal knowledge and adolescent adherence. Glycemic control was extracted from medical records. Adolescents also completed structured interviews about parental knowledge about their diabetes-related problems. Results Interviews revealed that adolescent disclosure is the primary method by which parents gain knowledge about adolescent diabetes management problems. Adolescent disclosure to and secrecy from parents were uniquely associated with diabetes management and depressive symptoms independent of parental knowledge across ethnic groups; maternal reports of knowledge about her adolescent's diabetes care activities were associated with diabetes management independent of adolescent disclosure and secrecy. Conclusions Adolescent information management strategies are a primary means by which parents gain knowledge about diabetes, which may facilitate more effective management.
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Affiliation(s)
- Christy Tucker
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Deborah J Wiebe
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Psychological Sciences, University of California, Merced, CA, USA
| | - Alexandra Main
- Psychological Sciences, University of California, Merced, CA, USA
| | - Alyssa G Lee
- Division of Psychology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Perrin C White
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX, USA
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62
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Radcliff Z, Weaver P, Chen R, Streisand R, Holmes C. The Role of Authoritative Parenting in Adolescent Type 1 Diabetes Management. J Pediatr Psychol 2018; 43:185-194. [PMID: 29048478 PMCID: PMC5896594 DOI: 10.1093/jpepsy/jsx107] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Revised: 07/25/2017] [Accepted: 07/26/2017] [Indexed: 01/14/2023] Open
Abstract
Objective Adolescents with Type 1 diabetes are at risk for poorer adherence, lower quality of life (QOL), and poorer glycemic control (HbA1c). Authoritative parenting (AP) along with youth adherence and QOL was hypothesized to relate to better HbA1c. Methods Parent-youth dyads (N = 257) completed baseline measures of adherence and QOL. Youth completed an AP questionnaire, and HbA1c samples were evaluated. Structural equation modeling determined relations among AP, adherence, QOL, and glycemic control. Results AP indirectly linked to better HbA1c (β = -.15, p = .021) through both better adherence and higher QOL. AP also was associated directly with better adherence (β = .26, p = .001), which in turn was linked to better HbA1c (β = -.35, p = .021). In addition, adherence was associated directly with QOL (β = -.56, p = .001). Conclusions Together, better youth adherence and higher QOL are two mechanisms by which more AP indirectly relates to better glycemic control during the early adolescent years.
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63
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Perez KM, Patel NJ, Lord JH, Savin KL, Monzon AD, Whittemore R, Jaser SS. Executive Function in Adolescents With Type 1 Diabetes: Relationship to Adherence, Glycemic Control, and Psychosocial Outcomes. J Pediatr Psychol 2018; 42:636-646. [PMID: 28008003 DOI: 10.1093/jpepsy/jsw093] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/11/2016] [Indexed: 12/24/2022] Open
Abstract
Objective Impairments in executive function (EF) skills have been observed in youth with type 1 diabetes (T1D), and these skills are critical for following the complex treatment regimen. This study examines parent reports of EF in relation to measures of adherence, glycemic control (A1c), and psychosocial outcomes (depression and quality of life) in adolescents with T1D. A total of 120 adolescents (aged 13-17 years, 52.5% female, 87.5% White) with T1D and their parents completed questionnaires. Glucometers were downloaded and A1c was obtained during clinical visits at the time of enrollment. The prevalence of clinically significant elevated scores on specific EF skills ranged from 11 to 18.6%. In multivariate analyses, parent-reported EF deficits were associated with poorer adherence and lower quality of life, explaining 13 and 12% of the variance, respectively. Adolescents with T1D exhibit specific EF deficits that may negatively impact their quality of life and their ability to engage in self-management activities.
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Abstract
The American Diabetes Association (ADA) "Standards of Medical Care in Diabetes" includes ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, a multidisciplinary expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations, please refer to the Standards of Care Introduction Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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65
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Holtz BE, Murray KM, Hershey DD, Richman J, Dunneback JK, Vyas A, Wood MA. The design and development of MyT1DHero: A mobile app for adolescents with type 1 diabetes and their parents. J Telemed Telecare 2017; 25:172-180. [PMID: 29228854 DOI: 10.1177/1357633x17745470] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Type 1 diabetes impacts approximately 1.25 m Americans, many of them young children. As a child grows, there is a transition towards independence and they must learn to manage their diabetes independently. The objective of this study was to design, develop and conduct a prototype test to assess the satisfaction and feasibility of a mobile app for adolescents with type 1 diabetes and their parents to aid in this transition. METHODS Ten parent/adolescent groups used MyT1DHero for four weeks. They were given a pre-test/post-test survey regarding family conflict with three tasks of diabetes management and the general tone of family communication. At post-test they were asked questions regarding their satisfaction and perception of ease of use of the app. They also participated in short interviews regarding the app. Additionally, we used server data to examine actual app usage. RESULTS The parents' perceptions of conflict around the results of the blood sugar tests increased ( t(9) = 2.71, p = .02) as did perceptions of conflict around logging the blood sugar results ( t(9) = 3.67, p = .005). The adolescents perceived increased conflict surrounding the results around logging the blood sugars results ( t(9) = 3.09, p = .01).There was no change in the tone of general family communication. During the prototype testing, we discovered that the app crashed repeatedly and several of the functions were not working properly. In the interview data, three main themes emerged, app-crashing issues, problems with notifications and positive feedback. DISCUSSION Through this process, all of the reported issues were corrected and new features were planned for subsequent versions. A smartphone application has the potential to be a novel intervention for engaging adolescents and their parents in positive communication to support type 1 diabetes management.
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Affiliation(s)
- Bree E Holtz
- 1 Department of Advertising & Public Relations, Michigan State University, MI, USA
| | - Katharine M Murray
- 1 Department of Advertising & Public Relations, Michigan State University, MI, USA
| | | | - Joshua Richman
- 3 Department of Surgery, University of Alabama-Birmingham, MI, USA
| | - Julie K Dunneback
- 4 Department of Paediatric Endocrinology, Sparrow Health System, MI, USA
| | - Arpita Vyas
- 5 Department of Paediatrics, Texas Tech University, MI, USA
| | - Michael A Wood
- 6 Department of Paediatrics, University of Michigan, MI, USA
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66
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Berg CA, Butner J, Wiebe DJ, Lansing AH, Osborn P, King PS, Palmer DL, Butler JM. Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. DEVELOPMENTAL REVIEW 2017; 46:1-26. [DOI: 10.1016/j.dr.2017.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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67
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Martin D, Elie C, Dossier C, Godot C, Gagnayre R, Choleau C, Cahané M, Robert JJ. Diabetes knowledge in adolescents with type 1 diabetes and their parents and glycemic control. Pediatr Diabetes 2017; 18:559-565. [PMID: 27726250 DOI: 10.1111/pedi.12458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/13/2016] [Accepted: 09/09/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate diabetes knowledge and skills (DKS) in adolescents (>10 year) with type 1 diabetes (T1D) and their parents, and its effect on glycemic control. METHODS A ready-to-use program and a standardized questionnaire comprising 50 true-false questions based on this program, were elaborated by a National Committee, to help dispensing education at diagnosis of T1D. The questionnaire was completed by 2933 T1D patients (49% girls, 51% boys; 14.1 ± 2.5 year), 2180 mothers and 798 fathers, in 115 pediatric centers. Associations between DKS score (number of correct answers), glycated hemoglobin (HbA1c) and sociofamilial characteristics were assessed. RESULTS DKS score increased with age, and was higher in girls than in boys and in mothers than in fathers; it correlated strongly between adolescents and their own parents; it was higher when adolescents had previously participated in diabetes camp and when parents had higher academic levels. HbA1c decreased significantly with parents' higher DKS score and academic level, and when both parents lived together. Mean adolescent DKS score was significantly higher in patients with HbA1c below 8% or 8.5% than for patients with HbA1c above these thresholds. CONCLUSION A large survey in T1D children and adolescents and their parents showed associations between DKS and glycemic control, and the major role of sociofamilial factors.
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Affiliation(s)
- Delphine Martin
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants malades, Paris, France.,L'Aide aux Jeunes Diabétiques (AJD), Paris, France
| | - Caroline Elie
- Unité de Recherche clinique/Centre d'Investigation Clinique Paris Descartes Necker Cochin, Hôpital Necker-Enfants malades, Paris, France
| | - Claire Dossier
- Néphrologie pédiatrique, Hôpital Robert Debré, Paris, France
| | - Cécile Godot
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants malades, Paris, France
| | - Rémi Gagnayre
- Laboratoire de Pédagogie de la Santé, Université Paris 13, Bobigny, France
| | | | | | - Jean-Jacques Robert
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants malades, Paris, France.,L'Aide aux Jeunes Diabétiques (AJD), Paris, France.,Sorbonne Paris Cité, Université René Descartes, Paris, France
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68
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Keller M, Attia R, Beltrand J, Djadi-Prat J, Nguyen-Khoa T, Jay JP, Cahané M, Choleau C, Robert JJ. Insulin regimens, diabetes knowledge, quality of life, and HbA1c in children and adolescents with type 1 diabetes. Pediatr Diabetes 2017; 18:340-347. [PMID: 27161814 DOI: 10.1111/pedi.12397] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 04/07/2016] [Accepted: 04/12/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES To further describe the changes in insulin therapy regimens and hemoglobin A1c (HbA1c) in children and adolescents with type 1 diabetes, and their associations with diabetes knowledge and quality of life. RESEARCH DESIGN AND METHODS The study included 4293 children and adolescents (12.9 ± 2.6 yr, diabetes >1 yr) attending AJD (Aide aux Jeunes Diabétiques) summer camps between 2009 and 2014. The distribution of insulin regimens and associations between HbA1c, therapeutic regimens, diabetes knowledge (AJD questionnaire), and Quality of Life (Ingersoll et Marrero, Hvidoere Study Group short version) were assessed. RESULTS The percentage of youth treated with insulin pumps increased up to about 45%, basal bolus stabilized around 40%, and other regimens decreased majorly. HbA1c was higher with premixed insulins only regimens (9.05 ± 2.43%), but there was no difference between pump (8.12 ± 1.09%), basal bolus (8.32 ± 1.33%) and two to three injections (8.18 ± 1.28%). Mean HbA1c decreased by 0.014% per year. The percentage of HbA1c <7.5% increased by 1.5% per year, and the percentages of HbA1c >9% or >10% decreased by 4 and 5.5%, changes being greater with the pump. HbA1c was weakly associated with diabetes knowledge, and strongly with general health perception and perception about diabetes. CONCLUSION The percentage of children and adolescents with the highest risk of complications decreased markedly. The distribution of HbA1c better depicts the glycemic control in a population than the mean or the percentage of patients reaching the target (7.5%). HbA1c was more strongly associated with general health perception than with therapeutic regimens and diabetes knowledge.
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Affiliation(s)
- Marion Keller
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker, Paris, France
| | - Radhouène Attia
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker, Paris, France
| | - Jacques Beltrand
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker, Paris, France.,Université René Descartes, Sorbonne Paris Cité, Paris, France
| | | | - Thao Nguyen-Khoa
- Laboratoire de Biochimie Générale, Hôpital Necker, Paris, France
| | - Jean-Philippe Jay
- Université René Descartes, Sorbonne Paris Cité, Paris, France.,Laboratoire de Biochimie Générale, Hôpital Necker, Paris, France
| | | | | | - Jean-Jacques Robert
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker, Paris, France.,Université René Descartes, Sorbonne Paris Cité, Paris, France.,L'Aide aux Jeunes Diabétiques (AJD), Paris, France
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69
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Anderson BJ, Laffel LM, Domenger C, Danne T, Phillip M, Mazza C, Hanas R, Waldron S, Beck RW, Calvi-Gries F, Mathieu C. Factors Associated With Diabetes-Specific Health-Related Quality of Life in Youth With Type 1 Diabetes: The Global TEENs Study. Diabetes Care 2017; 40:1002-1009. [PMID: 28546221 PMCID: PMC5864137 DOI: 10.2337/dc16-1990] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 04/21/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Our objective was to characterize diabetes-specific health-related quality of life (D-HRQOL) in a global sample of youth and young adults with type 1 diabetes (T1D) and to identify the main factors associated with quality of life. RESEARCH DESIGN AND METHODS The TEENs study was an international, cross-sectional study of youth, 8-25 years of age, with T1D. Participants (N = 5,887) were seen in clinical sites in 20 countries across 5 continents enrolled for 3 predetermined age groups: 8-12, 13-18, and 19-25 years of age. To assess D-HRQOL, participants completed the PedsQL Diabetes Module 3.0 and were interviewed about family-related factors. Specifics about treatment regimen and self-management behaviors were collected from medical records. RESULTS Across all age groups, females reported significantly lower D-HRQOL than did males. The 19-25-year age group reported the lowest D-HRQOL. Multivariate linear regression analyses revealed that D-HRQOL was significantly related to HbA1c; the lower the HbA1c, the better the D-HRQOL. Three diabetes-management behaviors were significantly related to better D-HRQOL: advanced methods used to measure food intake; more frequent daily blood glucose monitoring; and more days per week that youth had ≥30 min of physical activity. CONCLUSIONS In all three age groups, the lower the HbA1c, the better the D-HRQOL, underscoring the strong association between better D-HRQOL and optimal glycemic control in a global sample of youth and young adults. Three diabetes-management behaviors were also related to optimal glycemic control, which represent potentially modifiable factors for clinical interventions to improve D-HRQOL as well as glycemic control.
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Affiliation(s)
| | | | | | - Thomas Danne
- Auf der Bult Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Moshe Phillip
- Institute for Endocrinology and Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Carmen Mazza
- Hospital de Pediatria J.P. Garrahan, Buenos Aires, Argentina
| | - Ragnar Hanas
- Sahlgrenska Academy, Gothenburg, Sweden.,NU Hospital Group, Uddevalla, Sweden
| | - Sheridan Waldron
- National Children & Young People's Diabetes Network, London, U.K
| | - Roy W Beck
- Jaeb Center for Health Research, Tampa, FL
| | | | - Chantal Mathieu
- Clinical and Experimental Endocrinology, UZ Gasthuisberg, University of Leuven, Leuven, Belgium
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70
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Niba LL, Aulinger B, Mbacham WF, Parhofer KG. Predictors of glucose control in children and adolescents with type 1 diabetes: results of a cross-sectional study in Cameroon. BMC Res Notes 2017; 10:207. [PMID: 28606170 PMCID: PMC5469010 DOI: 10.1186/s13104-017-2534-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 06/05/2017] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND In sub-Saharan Africa the prognosis of children with type 1 diabetes is poor. Many are not diagnosed and those diagnosed have a dramatically reduced life expectancy (less than one year). The purpose of this study was to identify the predictors of glucose control in children and adolescents with type 1 diabetes. METHODS This hospital based cross-sectional study involved 76 children/adolescents (35 boys and 41 girls, mean age of 15.1 ± 3.1 years) with type 1 diabetes included in the "Changing Diabetes in Children" (CDiC) program and attending the clinics for children living with type 1 diabetes in the North West Region of Cameroon. Data on glycosylated haemoglobin (HbA1c) was obtained from hospital records of participants. Information on socio-demographic characteristics and diabetes related practices were obtained from participants using a structured questionnaire. Odds ratios (OR) were calculated using logistic regression models to assess the association between determinants and good glyceamic control. RESULTS The study population had a mean HbA1c of 10.3 ± 2.9%. Bivariate analysis indicated that having a mother as the primary caregiver (OR 0.07, 95% CI 0.02-0.2), being on 2 daily insulin injections (OR 0.2, 95% CI 0.1-0.5) and good blood glucose monitoring (BGM) adherence (OR 0.1, 95% CI 0.04-0.3) were significantly (p < 0.001) associated with better HbA1c. Minimal/moderate caregiver involvement in BGM (OR 7.7, 95% CI 2.7-22.0) and insulin injection (OR 14.9, 95% CI 4.8-46.5) were significantly (p < 0.001) associated with poor outcome. Multivariate analysis showed that having a mother as the primary caregiver (OR 0.02, 95% CI 0.002-0.189) was an independent predictor of good glucose control. CONCLUSIONS This study has shown that the mother's involvement in the diabetes management of their children and minimal/moderate caregiver involvement in the task of insulin injection are the most important determinants for good and poor glucose control respectively. It is currently unclear whether the direct involvement of the mother is causal or whether "mother as a primary caregiver" is just an indicator for a setting in which good diabetes treatment is possible.
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Affiliation(s)
- Loveline L. Niba
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Biochemistry, Catholic University of Cameroon (CATUC), P.O. Box 782, Bamenda, Cameroon
| | - Benedikt Aulinger
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
| | - Wilfred F. Mbacham
- Department of Physiology and Biochemistry, Faculty of Medicine, University of Yaoundé I, P.O. Box 8094, Yaoundé, Cameroon
| | - Klaus G. Parhofer
- CIHLMU Center for International Health at Ludwig-Maximilians-Universität, Munich, Germany
- Department of Medicine II-Grosshadern, Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 Munich, Germany
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DeBoer MD, Valdez R, Chernavvsky DR, Grover M, Burt Solorzano C, Herbert K, Patek S. The Impact of Frequency and Tone of Parent-Youth Communication on Type 1 Diabetes Management. Diabetes Ther 2017; 8:625-636. [PMID: 28405895 PMCID: PMC5446384 DOI: 10.1007/s13300-017-0259-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The purpose of this study is to assess the impact of frequency and tone of parent-youth communication on glycemic control as measured by the Family Communication Inventory (FCI). Adolescence provides a unique set of diabetes management challenges, including suboptimal glycemic control. Continued parental involvement in diabetes management is associated with improved HbA1c outcomes; however, diabetes-related conflict within the family can have adverse effects. Although it is clear that communication plays an important role in diabetes outcomes, the specific impact of frequency and tone of such communication is largely understudied. METHODS A total of 110 youths with type 1 diabetes and their parents completed questionnaires assessing diabetes-related adherence, family conflict, and family communication (i.e., frequency and tone) during a routine clinic visit. Routine testing of HbA1c was performed. RESULTS Youth- and parent-reported frequency of communication were unrelated to HbA1c. Instead, greater discrepancies between parents and children on reported frequency of communication (most commonly parents reporting frequent and youth reporting less frequent communication) corresponded with poorer glycemic control and increased family conflict. More positive tone of communication as rated by youth was associated with lower HbA1c. CONCLUSIONS Diabetes-related communication is more complex than conveyed simply by how often children and their parents communicate. Tone of communication and discrepancies in a family's perception of the frequency of communication were better than frequency as predictors of glycemic control. The FCI appears to capture the frequency and tone of diabetes-related communication, though larger-scale studies are warranted to inform future use of this scale.
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Affiliation(s)
- Mark D DeBoer
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA.
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Daniel R Chernavvsky
- Department of Psychiatry and Neurobehavioral Sciences, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
| | - Monica Grover
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | | | - Kirabo Herbert
- Department of Pediatrics, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen Patek
- Department of Systems and Information Engineering, University of Virginia School of Medicine, Charlottesville, VA, 22908, USA
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Jaser SS, Lord JH, Savin K, Gruhn M, Rumburg T. Developing and Testing an Intervention to Reduce Distress in Mothers of Adolescents with Type 1 Diabetes. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2017; 6:19-30. [PMID: 30345210 DOI: 10.1037/cpp0000220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objectives To develop and pilot test a program to meet the needs of mothers of adolescents with type 1 diabetes (T1D) and improve outcomes in adolescents with type 1 diabetes. Methods We conducted focus groups with mothers of adolescents to identify needs and develop a cognitive behavioral intervention aimed at reducing maternal distress, improving parenting practices, and reducing family conflict. This intervention was pilot tested in a randomized trial; mothers were randomized to either the Coping & Communication (N=15) intervention or Usual Care (N=15). Mothers and adolescents completed questionnaires measuring distress, parenting, and family conflict pre- and post-intervention, and HbA1c values were obtained from adolescents' medical records pre- and post-intervention. Results Intervention materials (Communication & Coping) received high scores on health literacy and engagement. There was a significant Time × Group interaction for maternal diabetes distress, family conflict (as reported by both mothers and adolescents) and adolescent quality of life. Mothers and adolescents randomized to the intervention group reported significant improvements on these factors as compared to those randomized to usual care. Conclusions The Communication & Coping program was developed by adapting existing interventions proven to reduce depressive symptoms and improve parenting practices to address the specific needs of mothers of adolescents with T1D. The program shows promise for not only reducing distress in mothers, but also for improving adolescent outcomes, possibly through reductions in family conflict.
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Affiliation(s)
- Sarah S Jaser
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Jadienne H Lord
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Kimberly Savin
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Meredith Gruhn
- Department of Pediatrics, Vanderbilt University, Nashville, USA
| | - Tamara Rumburg
- Department of Pediatrics, Vanderbilt University, Nashville, USA
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Wagner DV, Barry SA, Stoeckel M, Teplitsky L, Harris MA. NICH at Its Best for Diabetes at Its Worst: Texting Teens and Their Caregivers for Better Outcomes. J Diabetes Sci Technol 2017; 11:468-475. [PMID: 28745094 PMCID: PMC5505437 DOI: 10.1177/1932296817695337] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND There is growing evidence for the feasibility of text-based interventions for pediatric patients with type 1 diabetes (T1D). However, less is known regarding whether the use of personalized text messages with high-risk youth and their caregivers is associated with improvements in youth health. This study examines the use of diabetes-specific texts and associated health outcomes for participants of the Novel Interventions in Children's Healthcare (NICH) program. METHODS Text messages sent to youth with T1D and their caregivers during NICH intervention were coded regarding diabetes relevance and adherence-related content. Health outcome data (eg, HbA1c values, hospital admissions) prior to and following NICH program enrollment were collected. RESULTS Fewer than half (43%) of texts sent to patients and their caregivers were identified as being related to diabetes, and over 95% of diabetes-related texts were identified as adherence-related. Participants in the NICH program demonstrated a significant decrease in HbA1c values, t(23) = 2.78, p ≤ .05, and DKA-related hospital visits, t(24) = 2.78, p ≤ .01, during program involvement. Although no relationships were identified between patient-recipient text characteristics and health outcomes, the frequency and type of text messaging with caregivers was significantly associated with changes in health outcomes. CONCLUSIONS This study represents the most extensive evaluation of diabetes-related SMS use and health outcomes for NICH participants to date. Findings demonstrate improvements in patient health during NICH program involvement. Implications include that sending frequent, personalized, and adherence-reinforcing texts to patients' caregivers may result in improved patient health, decreased utilization, and, potentially, associated reductions in health care costs.
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Affiliation(s)
| | - Samantha A. Barry
- University of Massachusetts Medical Center, Diabetes Center of Excellence, Worcester, MA, USA
| | - Maggie Stoeckel
- Seattle Children’s Hospital, University of Washington, Seattle, WA, USA
| | | | - Michael A. Harris
- Oregon Health & Science University, Portland, OR, USA
- Harold Schnitzer Diabetes Health Center, Portland, OR, USA
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Floyd BD, Block JM, Buckingham BB, Ly T, Foster N, Wright R, Mueller CL, Hood KK, Shah AC. Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control. Pediatr Diabetes 2017; 18:204-212. [PMID: 26919322 DOI: 10.1111/pedi.12373] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/19/2016] [Accepted: 01/28/2016] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D. METHODS SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months. SUBJECTS A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria. RESULTS HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance. CONCLUSION SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.
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Affiliation(s)
- Baraka D Floyd
- Department of General Pediatrics, Stanford University School of Medicine, Stanford, CA, USA
| | - Jennifer M Block
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Bruce B Buckingham
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Trang Ly
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Robert Wright
- Department of Psychology, University of California Riverside, Riverside, CA, USA
| | - Claudia L Mueller
- Department of Pediatric Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Korey K Hood
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
| | - Avni C Shah
- Department of Pediatric Endocrinology and Metabolism, Stanford University School of Medicine, Stanford, CA, USA
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Gee BT, Nansel TR, Liu A. Reduction of hypoglycaemic events with a behavioural intervention: a randomized clinical trial for paediatric patients with Type 1 diabetes mellitus. Diabet Med 2017; 34:340-347. [PMID: 25763988 PMCID: PMC4589424 DOI: 10.1111/dme.12744] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/28/2022]
Abstract
AIMS To determine if a low-intensity, clinic-integrated behavioural intervention reduced the incidence of hypoglycaemic events in children with Type 1 diabetes. METHODS A total of 390 families with children with Type 1 diabetes were enrolled in a 2-year, randomized clinical trial of a behavioural intervention. The intervention was designed to improve diabetes management practices by targeting the family's diabetes problem-solving skills. Hypoglycaemic events were categorized in two groups: those treated by oral ingestion and those treated by parenteral therapy. Events were self-reported by participants at each clinic visit, which occurred approximately every 3-4 months. Analyses included two-sample t-tests, the mean cumulative function test, and the Cox proportional hazards model for recurrent events to compare the incidence between groups. RESULTS Across the entire 2-year study period, the incidence of hypoglycaemic events treated by oral ingestion of glucose-rich foods and events requiring parenteral therapy did not significantly differ between study conditions; however, during the second year of participant enrolment, the incidence of events treated by oral ingestion in the intervention group was 13.6 per 100 person-years compared with 27.3 per 100 patient-years in the control group (P = 0.02). The hazard ratio of these events during the second year was 0.49 (95% CI 0.27-0.90; P = 0.02). CONCLUSIONS Our findings suggest the need for a long-term (> 1 year) focus on the implementation of interventions targeting diabetes management in young people. Behavioural interventions targeting problem-solving skills could be considered as practical, non-pharmacological strategies to reduce hypoglycaemia in adolescents with Type 1 diabetes.
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Affiliation(s)
- B T Gee
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - T R Nansel
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - A Liu
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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Prakasam G, Rees C, Lyden M, Parkin CG. Use of a Novel Smartphone-Based Diabetes Management System Improved Feelings of Confidence and Safety and Reduced Hypoglycemia Fear Among Parents/Caregivers of Children/Adolescents With Type 1 Diabetes. J Diabetes Sci Technol 2017; 11:182-183. [PMID: 27207891 PMCID: PMC5375059 DOI: 10.1177/1932296816650901] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Christen Rees
- Roche Diagnostics Corporation, Indianapolis, IN, USA
| | - Maureen Lyden
- BioStat International, Inc, Statistics Department, Tampa, FL, USA
| | - Christopher G. Parkin
- CGParkin Communications, Inc, Boulder City, NV, USA
- Christopher G. Parkin, MS, CGParkin Communications, Inc, 932 Vista Lago Way, Boulder City, NV, Nevada 89005, USA.
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78
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Whittemore R, Liberti LS, Jeon S, Chao A, Minges KE, Murphy K, Grey M. Efficacy and implementation of an Internet psychoeducational program for teens with type 1 diabetes. Pediatr Diabetes 2016; 17:567-575. [PMID: 26611663 PMCID: PMC4882266 DOI: 10.1111/pedi.12338] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2015] [Revised: 10/18/2015] [Accepted: 10/23/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of the study was to evaluate the participation and preliminary efficacy of an Internet psychoeducational program (Teens.Connect) shown to be efficacious under controlled conditions compared with an open-access diabetes website for youth (Planet D) on the primary outcomes of A1C and quality of life (QoL), and secondary outcomes of psychosocial and behavioral factors. RESEARCH DESIGN AND METHODS Teens with type 1 diabetes (n = 124, 11-14 yr) from two clinical sites were randomly prescribed one of the programs and completed baseline, 3-month and 6-month data. A1C was obtained from clinic records. Participation data included number of log ins, posts to the discussion board, and lessons completed (Teens.Connect only). Descriptive and mixed model analyses were used. RESULTS Eighty-five percent (85%) of consented teens registered for their prescribed program. Satisfaction and log ins were similar between groups (satisfaction ranged 3.3-3.5/5; mean log ins = 14/teen). Posts to the discussion forum were higher in Planet D (mean = 28 vs. 19). Participation in the Teens.Connect lessons was low, with only 69% of teens completing any lesson. After 6 months there were no significant differences in A1C, QoL or secondary outcomes between groups. Teens in the Teens.Connect group reported lower perceived stress over time (p < 0.01). CONCLUSIONS Teens do not actively participate in an Internet psychoeducational program when they do not have frequent reminders, which may have contributed to a lack of treatment effect. Teens have many competing demands. Strategic implementation that includes targeted reminders and family support may be necessary to assure participation and improvement in health outcomes.
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Affiliation(s)
| | | | | | - Ariana Chao
- Yale University School of Nursing, Orange, Connecticut
| | | | - Kathryn Murphy
- The Division of Endocrinology & Diabetes at the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Margaret Grey
- Yale University School of Nursing, Orange, Connecticut
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Jönsson L, Lundqvist P, Hallström I. Parents HRQOL, Their Satisfaction with Care, and Children Over the Age of Eight’s Experiences of Family Support Two Years Subsequent to the Child’s Diagnosis with Type 1 Diabetes. Compr Child Adolesc Nurs 2016. [DOI: 10.1080/24694193.2016.1241837] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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80
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Gandhi KK, Baranowski T, Anderson BJ, Bansal N, Redondo MJ. Psychosocial aspects of type 1 diabetes in Latino- and Asian-American youth. Pediatr Res 2016; 80:347-55. [PMID: 27074124 DOI: 10.1038/pr.2016.87] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 02/18/2016] [Indexed: 11/09/2022]
Abstract
Latino and Asian-Americans represent the fastest growing immigrant populations in the United States. We aimed to review the current knowledge on the psychosocial factors that influence type 1 diabetes (T1D) care, education, and outcomes in Latino and Asian-American youth immigrants in the United States, as well as culturally sensitive programs to address health disparities. We conducted a narrative, conceptual review of studies on T1D in Latino and Asian-American youth and relevant studies in type 2 diabetes and adults. Approximately 50% of both Latino and Asian-American youth with T1D are in suboptimal glycemic control. Socioeconomic status, literacy, English proficiency, acculturation, access to health care, family functioning, mental health, and nutrition influence T1D care and outcomes. However, the degree to which these complex, inter-related and dynamic factors affect long-term T1D outcomes is largely unknown. Culturally sensitive programs for Latino or Asian-American youth with T1D are scarce in the United States. Research is needed among Latino and Asian-American youth with T1D so that comprehensive, culturally sensitive diabetes education, and care programs can be developed to decrease disparities in the health burden of these groups.
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Affiliation(s)
- Kajal K Gandhi
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Tom Baranowski
- Children's Nutrition Research Center, Baylor College of Medicine, Houston, Texas
| | - Barbara J Anderson
- Division of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Nidhi Bansal
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Maria J Redondo
- Division of Pediatric Endocrinology and Metabolism, Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
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81
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Robinson EM, Weaver P, Chen R, Streisand R, Holmes CS. A model of parental distress and factors that mediate its link with parental monitoring of youth diabetes care, adherence, and glycemic control. Health Psychol 2016; 35:1373-1382. [PMID: 27513476 DOI: 10.1037/hea0000406] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Parental monitoring of adolescents' diabetes self-care is associated with better adherence and glycemic control (A1c). A number of parent-level factors are associated with higher levels of parental monitoring, including lower levels of parental distress (depressive symptoms, stress, anxiety), as well as higher levels of parental self-efficacy for diabetes management and authoritative parenting. Often studied in isolation, these factors may be best considered simultaneously as they are interrelated and are associated with parental monitoring and youth adherence. METHOD Structural equation modeling with a cross-sectional sample of 257 parent/youth (aged 11-14) dyads: (a) examined a broad model of parental factors (i.e., parental distress, parental diabetes self-efficacy, authoritative parenting), and (b) assessed their relation to parental monitoring, youth adherence, and A1c. Post hoc analyses of variance (ANOVAs) evaluated clinical implications of daily parental monitoring. RESULTS Parental distress was not related directly to parental monitoring. Instead less distress related indirectly to more monitoring via higher parental self-efficacy and more authoritative parenting which, in turn, related to better adherence and A1c. Higher parental self-efficacy also related directly to better youth adherence and then to better A1c. Clinically, more parental monitoring related to more daily blood glucose checks and to better A1c (8.48% vs. 9.17%). CONCLUSIONS A broad model of parent-level factors revealed more parental distress was linked only indirectly to less monitoring via lower parental self-efficacy and less authoritative parenting. Behaviorally, more parental monitoring related to better adherence and to clinically better A1c in adolescents. Further study of parent-level factors that relate to parental distress and monitoring of adherence appears warranted. (PsycINFO Database Record
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Affiliation(s)
| | | | - Rusan Chen
- Center For New Designs In Learning and Scholarship, Georgetown University
| | - Randi Streisand
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Clinical Psychology, Children's National Medical Center
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82
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Thompson D, Cullen KW, Redondo MJ, Anderson B. Use of Relational Agents to Improve Family Communication in Type 1 Diabetes: Methods. JMIR Res Protoc 2016; 5:e151. [PMID: 27468762 PMCID: PMC4981691 DOI: 10.2196/resprot.5817] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Accepted: 05/06/2016] [Indexed: 11/25/2022] Open
Abstract
Background Physiological and environmental risk factors interact to undermine blood glucose control during early adolescence. This has been documented to be associated with family conflict and poor adherence to diabetes management tasks. Family Teamwork is an efficacious program demonstrated to enhance family communication and reduce conflict during this vulnerable period. It was designed to be delivered to families in-person, which limited reach and potential impact. Objective The purpose of this paper is to present the protocol for adapting Family Teamwork for Web-based delivery. Methods Formative research with health care providers, parents, and adolescents will help modify Family Teamwork for Web-based delivery by a relational agent (ie, a computerized character with human-like features and actions). Sessions will be interactive, requiring both parent and adolescent participation, with the relational agent serving as a health coach. After programming, usability testing will be conducted to help ensure the program is easy to use. Video and instructional materials will be developed to facilitate use, and a small pilot study will be conducted to assess feasibility. Families will provide written informed consent prior to participation in any phase of the study. The Institutional Review Board at Baylor College of Medicine reviewed and approved the protocol (H-37245). Results Formative research is underway. No results are available at this time. Conclusions This research has the potential to make an important contribution to diabetes management by using technology to enhance the reach of an efficacious program.
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Affiliation(s)
- Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States.
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83
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Nazareth M, Richards J, Javalkar K, Haberman C, Zhong Y, Rak E, Jain N, Ferris M, van Tilburg MAL. Relating Health Locus of Control to Health Care Use, Adherence, and Transition Readiness Among Youths With Chronic Conditions, North Carolina, 2015. Prev Chronic Dis 2016; 13:E93. [PMID: 27442993 PMCID: PMC4956478 DOI: 10.5888/pcd13.160046] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Health locus of control refers to the belief that health is in one’s control (internal control) or is not in one’s control (external control). Among adults, external locus of control is associated with negative health outcomes, whereas internal locus of control is associated with favorable outcomes. Few studies examined these associations among youths. The objective of our study was to determine how locus of control relates to health care use, medication adherence, missed school, and readiness for transition to adult medical care for youths with chronic conditions. Methods Participants at a camp for youths aged 6 to 17 years with chronic health conditions completed a survey measuring locus of control, readiness for transition to adult care, and medication adherence. Their parents completed a separate part of the survey about health care use and missed school days in the past year. Results A total of 163 youths completed the survey (78.5% white; 52.1% female; mean age, 12.3 y). Internal locus of control (β = 0.196; P = .013) and external Doctor locus of control with doctors controlling disease (β = 0.181; P = .025) were positively associated with transition readiness. External control by chance or with others controlling disease was negatively associated with transition readiness (β = −0.248; P = .002) and positively associated with emergency department visits (β = 0.225; P = .004) and with number of hospital inpatient nights at hospital (β = 0.166; P = .04). Conclusion Adolescents with external control of their health by chance or by other people are at increased risk for negative health outcomes and may fail to develop the self-management skills needed for successful transitioning to adult care. Future studies should examine effects of changes in locus of control on health outcomes among youths.
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Affiliation(s)
- Meaghan Nazareth
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Jordan Richards
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Karina Javalkar
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Cara Haberman
- Wake Forest University, Winston-Salem, North Carolina
| | - Yi Zhong
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Eniko Rak
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Nina Jain
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Maria Ferris
- The University of North Carolina, Chapel Hill, Chapel Hill, North Carolina
| | - Miranda A L van Tilburg
- University of North Carolina, Department of Medicine, Division of Gastroenterology and Hepatology, 130 Mason Farm Rd, CB 7080, Chapel Hill, NC 27599.
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84
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Serkel-Schrama IJP, de Vries J, Nieuwesteeg AM, Pouwer F, Nyklíček I, Speight J, de Bruin EI, Bögels SM, Hartman EE. The Association of Mindful Parenting with Glycemic Control and Quality of Life in Adolescents with Type 1 Diabetes: Results from Diabetes MILES-The Netherlands. Mindfulness (N Y) 2016; 7:1227-1237. [PMID: 27642376 PMCID: PMC5010614 DOI: 10.1007/s12671-016-0565-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The objective of this study was to examine associations between the mindful parenting style of parents of adolescents (aged 12-18) with type 1 diabetes mellitus (T1DM), and the glycaemic control and quality of life (QoL) of the adolescents. Chronic health conditions, such as T1DM, that require demanding treatment regimens, can negatively impact adolescents' quality of life. Therefore, it is important to determine whether mindful parenting may have a positive impact in these adolescents. Age, sex and duration of T1DM were examined as potential moderators. Parents (N = 215) reported on their own mindful parenting style (IM-P-NL) and the adolescents' glycaemic control. Parents and the adolescents with T1DM (N = 129) both reported on adolescents' generic and diabetes-specific QoL (PedsQL™). The results showed that a more mindful parenting style was associated with more optimal hemoglobin A1c (HbA1c) values for boys. For girls, a more mindful parenting style was associated with not having been hospitalized for ketoacidosis. For both boys and girls, a more mindful parenting style was associated with better generic and diabetes-specific proxy-reported QoL. In conclusion, mindful parenting style may be a factor in helping adolescents manage their T1DM. Mindful parenting intervention studies for parents of adolescents with T1DM are needed to examine the effects on adolescents' glycaemic control and their quality of life.
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Affiliation(s)
| | - Jolanda de Vries
- Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Anke M. Nieuwesteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
| | - Frans Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Ivan Nyklíček
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Jane Speight
- School of Psychology, Deakin University, Geelong, VIC Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, Melbourne, VIC Australia
| | - Esther I. de Bruin
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Susan M. Bögels
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
| | - Esther E. Hartman
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
- Department of Developmental Psychology, Tilburg University, Tilburg, The Netherlands
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85
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Smaldone A, Findley S, Bakken S, Matiz LA, Rosenthal SL, Jia H, Matos S, Manwani D, Green NS. Study protocol for a randomized controlled trial to assess the feasibility of an open label intervention to improve hydroxyurea adherence in youth with sickle cell disease. Contemp Clin Trials 2016; 49:134-42. [PMID: 27327779 PMCID: PMC5024731 DOI: 10.1016/j.cct.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/10/2016] [Accepted: 06/16/2016] [Indexed: 12/26/2022]
Abstract
BACKGROUND Community health workers (CHW) are increasingly recognized as a strategy to improve health outcomes for the underserved with chronic diseases but has not been formally explored in adolescents with sickle cell disease (SCD). SCD primarily affects African American, Hispanic and other traditionally underserved populations. Hydroxyurea (HU), an oral, once-daily medication, is the only approved therapeutic drug for sickle cell disease and markedly reduces symptoms, morbidity and mortality and improves quality of life largely by increasing hemoglobin F blood levels. This paper presents the rationale, study design and protocol for an open label randomized controlled trial to improve parent-youth partnerships in self-management and medication adherence to HU in adolescents with SCD. METHODS/DESIGN A CHW intervention augmented by text messaging was designed for adolescents with SCD ages 10-18years and their parents to improve daily HU adherence. Thirty adolescent parent dyads will be randomized with 2:1 intervention group allocation. Intervention dyads will establish a relationship with a culturally aligned CHW to identify barriers to HU use, identify cues to build a habit, and develop a dyad partnership to improve daily HU adherence and achieve their individualized "personal best" hemoglobin F target. Intervention feasibility, acceptability and efficacy will be assessed via a 2-site trial. Outcomes of interest are HU adherence, dyad self-management communication, quality of life, and resource use. DISCUSSION Despite known benefits, poor HU adherence is common. If feasible and acceptable, the proposed intervention may improve health of underserved adolescents with SCD by enhancing long-term HU adherence. TRIAL REGISTRATION NCT02029742.
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Affiliation(s)
- Arlene Smaldone
- Columbia University School of Nursing, New York, NY, United States; College of Dental Medicine, Columbia University Medical Center, New York, NY, United States
| | - Sally Findley
- Mailman School of Public Health, New York, NY, United States
| | - Suzanne Bakken
- Columbia University School of Nursing, New York, NY, United States; Department of Biomedical Informatics, Columbia University Medical Center, New York, NY, United States
| | - L Adriana Matiz
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States; New York Presbyterian Hospital, New York, NY, United States
| | - Susan L Rosenthal
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States; Department of Psychiatry, Columbia University Medical Center, New York, NY, United States
| | - Haomiao Jia
- Columbia University School of Nursing, New York, NY, United States; Mailman School of Public Health, New York, NY, United States
| | - Sergio Matos
- Community Health Worker Network of New York City, United States
| | - Deepa Manwani
- Department of Pediatrics, Albert Einstein Medical School and Montefiore Hospital, NY, NY, United States
| | - Nancy S Green
- Department of Pediatrics, Columbia University Medical Center, New York, NY, United States
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86
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Wagner DV, Barry S, Teplitsky L, Sheffield A, Stoeckel M, Ogden JD, Karkula E, Hartman A, Duke DC, Spiro K, Harris MA. Texting Adolescents in Repeat DKA and Their Caregivers. J Diabetes Sci Technol 2016; 10:831-9. [PMID: 27030051 PMCID: PMC4928235 DOI: 10.1177/1932296816639610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Text message interventions are feasible, preferable, and sometimes effective for youth with diabetes. However, few, if any studies, have examined the personalized use of text messages with youth repeatedly hospitalized for diabetic ketoacidosis (DKA) and their caregivers. This study characterizes the use of personalized text messages in Novel Interventions in Children's Healthcare (NICH). METHODS Approximately 2 months of text messages sent to youth with repeat DKA and their caregivers were logged regarding the following text characteristics: (1) content, (2) intervention type, (3) timing, and (4) recipient characteristics. RESULTS NICH interventionists sent 2.3 and 1.5 texts per day to patients and caregivers, respectively. Approximately 59% of outgoing texts occurred outside of typical business hours, and roughly 68% of texts contained some form of support and/or encouragement. The relation between type of intended intervention and day/time of text was significant, χ(2)(2, N = 5,808) = 266.93, P < .001. Interventionists were more likely to send behavioral intervention text messages outside of business hours, whereas they were more likely to send care coordination and case management text messages during business hours. CONCLUSIONS To our knowledge, this is the first study to specifically categorize and describe the personalized use of text messages with youth repeatedly hospitalized for DKA and their caregivers. Findings indicate that a promising treatment program for these youth frequently used text interventions to deliver praise and encouragement to patients and caregivers alike, often outside of typical business hours, and tailored text content based on patient and caregiver characteristics.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Danny C Duke
- Oregon Health & Science University, Portland, OR, USA Harold Schnitzer Diabetes Health Center, Portland, OR, USA
| | - Kim Spiro
- Oregon Health & Science University, Portland, OR, USA
| | - Michael A Harris
- Oregon Health & Science University, Portland, OR, USA Harold Schnitzer Diabetes Health Center, Portland, OR, USA
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87
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Neylon OM, Skinner TC, O'Connell MA, Cameron FJ. A novel tool to predict youth who will show recommended usage of diabetes technologies. Pediatr Diabetes 2016; 17:174-83. [PMID: 25643603 DOI: 10.1111/pedi.12253] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 12/14/2014] [Accepted: 12/16/2014] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Controversy exists regarding which individuals will benefit most from commencement of diabetes technologies such as continuous subcutaneous insulin infusion (CSII) or continuous glucose monitoring systems (CGMS), such as 'real-time' sensor-augmented pumping (SAP). Because higher usage correlates with haemoglobin A1c (HbA1c) achieved, we aimed to predict future usage of technologies using a questionnaire-based tool. SUBJECTS The tool was distributed to two groups of youth with type 1 diabetes; group A (n = 50; mean age 12 ± 2.5 yr) which subsequently commenced 'real-time' CGMS and group B (n = 47; mean age 13 ± 3 yr) which commenced CSII utilisation. METHODS For the CGMS group, recommended usage was ≥5 days (70%) per week [≥70% = high usage (HU); <70% = low usage (LU)], assessed at 3 months. In the CSII group, HU was quantified as entering ≥5 blood sugars per day to the pump and LU as <5 blood sugars per day, at 6 months from initiation. Binary logistic regression with forward stepwise conditional was used to utilise tool scales and calculate an applied formula. RESULTS Of the CGMS group, using gender, baseline HbA1c, and two subscales of the tool generated a formula which predicted both high and low usage with 92% accuracy. Twelve (24%) showed HU vs. 38 who exhibited LU at 3 months. Of the CSII group, 32 (68%) exhibited HU vs. 15 who exhibited LU at 6 months. Four tool items plus gender predicted HU/LU with 95% accuracy. CONCLUSIONS This pilot study resulted in successful prediction of individuals who will and those who will not go on to show recommended usage of CSII and CGMS.
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Affiliation(s)
- Orla M Neylon
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Parkville, Australia
| | - Timothy C Skinner
- School of Psychological and Clinical Sciences, Charles Darwin University, Darwin, Australia
| | - Michele A O'Connell
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Parkville, Australia
| | - Fergus J Cameron
- Department of Endocrinology, Murdoch Childrens Research Institute and The Royal Children's Hospital, Parkville, Australia
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88
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Gruhn MA, Lord JH, Jaser SS. Collaborative and Overinvolved Parenting Differentially Predict Outcomes in Adolescents With Type 1 Diabetes. Health Psychol 2016; 35:2016-13811-001. [PMID: 26998735 PMCID: PMC5031507 DOI: 10.1037/hea0000349] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The current study examined the impact of collaborative and intrusive parenting on depression and glycemic control in children with Type 1 diabetes (T1D). Research examining the association between parenting and child adjustment in this population has been limited by a reliance primarily on questionnaire data and cross-sectional analyses. To address these gaps, the current study used an observational coding system to measure the effects of parenting on child adjustment over a 1-year period. METHOD Youth (10 to 16 years old) with T1D and their mothers (N = 81) were recruited from an outpatient pediatrics diabetes clinic. Mothers' symptoms of anxiety and depression and children's depressive symptoms were assessed by self- reports; parenting behaviors were assessed via video-recorded observations coded using the Iowa Family Interaction Rating Scales; and adolescents' glycosylated hemoglobin (HbA1c) was obtained from medical records. RESULTS Bivariate correlations and linear regression analyses revealed that higher levels of observed collaborative parenting were related to significantly lower HbA1c 12 months later, and higher levels of observed overinvolved parenting were related to significantly greater child depressive symptoms 12 months later. Further, age and treatment type moderated the relation between overinvolved parenting and child depressive symptoms. CONCLUSIONS Collaborative and overinvolved parenting appears important for adolescents in predicting both psychological and health-related outcomes over time. Parenting behaviors may serve as an important target for future interventions to enhance adjustment in these children. (PsycINFO Database Record
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89
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Helping Adolescents with Type 1 Diabetes "Figure It Out". J Pediatr Nurs 2016; 31:123-31. [PMID: 26586309 DOI: 10.1016/j.pedn.2015.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Revised: 09/11/2015] [Accepted: 10/12/2015] [Indexed: 01/08/2023]
Abstract
UNLABELLED The aim of this study was to gain an understanding of adolescent's experiences living with diabetes and build a theoretical paradigm for future interventions in adolescents with type 1 diabetes mellitus (T1DM). The adolescent's quest for independence, balancing blood sugars, and integrating diabetes led to increased conflict with parents which contributed to difficulty coping. One code in this study, "figuring it out", is the focus of this manuscript. METHODS Grounded theory with 15 in depth interviews were conducted with adolescents ages 11 to 15 with T1DM. RESULTS A theoretical model about the concept of "normalizing" was identified. Normalizing was defined as the ability to integrate diabetes into the background of one's daily life to make diabetes 'part of me'. The fifth phase of normalizing was "Figuring it out" which had 4 sub codes: (1) learning to accept diabetes, (2) believing it's possible to manage their diabetes, (3) showing responsibility, and (4) staying on track, and the normalizing task was "accepting the new normal". CONCLUSIONS Adolescents with T1DM develop the understanding that diabetes is their 'new normal'. The use of motivational interviewing, goal setting, and promotion of self-management may be important interventions in supporting adolescents with T1DM to normalize their life.
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Nieuwesteeg AM, Hartman EE, Aanstoot HJ, van Bakel HJA, Emons WHM, van Mil E, Pouwer F. The relationship between parenting stress and parent-child interaction with health outcomes in the youngest patients with type 1 diabetes (0-7 years). Eur J Pediatr 2016; 175:329-38. [PMID: 26438336 PMCID: PMC4757610 DOI: 10.1007/s00431-015-2631-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2015] [Revised: 08/23/2015] [Accepted: 08/31/2015] [Indexed: 10/30/2022]
Abstract
UNLABELLED To test whether parenting stress and the quality of parent-child interaction were associated with glycemic control and quality of life (QoL) in young children (0-7 years) with type 1 diabetes (T1DM), we videotaped 77 families with a young child with T1DM during mealtime (including glucose monitoring and insulin administration). Parent-child interactions were scored with a specifically designed instrument. Questionnaires assessed general and disease-related parenting stress and (diabetes-specific (DS)) QoL. HbA(1c) (glycemic control) was extracted from the medical records. Both general and disease-related parenting stress were associated with a lower (DS)QoL (r ranged from -0.39 to -0.70, p < 0.05), but not with HbA(1c) levels. Furthermore, with regard to the parent-child interaction, emotional involvement of parents (r = 0.23, p < 0.05) and expressed discomfort of the child (r = 0.23, p < 0.05) were related to suboptimal HbA(1c) levels. There was no clear pattern in the correlations between parent-child interaction and (DS)QoL. CONCLUSION The results support the notion that diabetes does not only affect the child with T1DM: T1DM is a family disease, as parenting factors (like stress and parent-child interactions) are associated with important child outcomes. Therefore, it is important for health-care providers to not only focus on the child with T1DM, but also on the family system.
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Affiliation(s)
- Anke M Nieuwesteeg
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - Esther E Hartman
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | | | - Hedwig J A van Bakel
- Department of TRANZO, Scientific Center for Care and Welfare, Tilburg University, Tilburg, The Netherlands.
| | - Wilco H M Emons
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
- Department of Methodology and Statistics, Tilburg University, PO Box 90153, 5000 LE, Tilburg, The Netherlands.
| | - Edgar van Mil
- Kidz&Ko, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
| | - Frans Pouwer
- Center of Research on Psychology in Somatic diseases (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
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91
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Rechenberg K, Whittemore R, Grey M, Jaser S. Contribution of income to self-management and health outcomes in pediatric type 1 diabetes. Pediatr Diabetes 2016; 17:120-6. [PMID: 25545117 PMCID: PMC4550560 DOI: 10.1111/pedi.12240] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/11/2014] [Accepted: 10/15/2014] [Indexed: 01/05/2023] Open
Abstract
Low income has been established as a risk factor for poorer outcomes in youth with type 1 diabetes; however, the effect of moderate income has not been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and psychosocial outcomes [depression, stress, and quality of life (QOL)] at different income levels in adolescents with type 1 diabetes. Youth (n = 320, mean age = 12.3 + 1.1, 55% female, 64% white, mean A1C = 8.3 ± 1.4) completed established self-management and psychosocial measures. A1C levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40-80K), or low (<$40K). Youth from high-income families had significantly lower A1C (mean = 7.9 ± 1.2) than those from the moderate-income group (8.6 ± 1.7, p < 0.001) or the low-income group (mean A1C = 8.6 ± 1.5, p = 0.003). Youth from the high-income group reported significantly better diabetes problem solving and more self-management goals than those from the moderate- or low-income groups (both p < 0.01). Youth from the high-income group also reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low-income groups (all p < 0.05). Multivariate linear regression models were used to test psychological and behavioral predictors of A1C and QOL. Parents' education status (p < 0.05) and self-management activities (p < 0.01) were significant predictors of hemoglobin A1c, while income (p < 0.01) and self-management activities (p < 0.05) were significant predictors of QOL.
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Affiliation(s)
| | | | - Margaret Grey
- School of Nursing; Yale University; West Haven CT USA
| | - Sarah Jaser
- School of Nursing; Yale University; West Haven CT USA
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92
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Affiliation(s)
- Alon Liberman
- 1 Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
| | - Bruce Buckingham
- 2 Stanford Medical Center , Division of Endocrinology and Diabetes, Stanford, CA
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93
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Walker A, Schatz D, Johnson C, Silverstein J, Lyles S, Rohrs H. Type 1 diabetes through two lenses: comparing adolescent and parental perspectives with photovoice. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2016; 2016:2. [PMID: 26793242 PMCID: PMC4719694 DOI: 10.1186/s13633-016-0020-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 01/12/2016] [Indexed: 12/19/2022]
Abstract
Background Parental support and care-coordination are vital for youth with type 1 diabetes (T1D) in achieving positive health outcomes. Yet, studies are rarely designed to identify factors that influence parent/youth collaboration or how their perspectives about diabetes may vary. Methods Photovoice was used to explore how adolescent and parental perspectives on T1D compare to identify factors that may influence care collaboration. A follow-up study was conducted where parents/caregivers of adolescents with T1D were prompted to take and explain five photos capturing what diabetes meant to them. Selection criteria included having a child 12–19 years with a diagnosis of T1D (≥2 years since onset). Thirty-three parents/caregivers participated (24 mothers, six fathers, two grandmothers, and one grandfather of 19 sons/14 daughters; mean age 15 years [±2.1]; mean disease duration 6 years [±3.3]). Content analysis was used to compare parent/caregiver photos with those captured by adolescents in a previous study with 40 youth participants (20 males/20 females; mean age 15 years [±1.9]; mean disease duration 6 years [±3.9]) through a method of constant comparison. Socioeconomic status was measured by household income and parental education. Glycemic control was captured by HbA1c. Mann-Whitney U testing was used to compare representations across demographic variables (202 youth photos, 153 parental photos). Results Over half of adolescents and parents took at least one photo of: (1) diabetes supplies (2) food (3) coping mechanisms/resilience and (4) disease encroachment. Parents and adolescents similarly framed food-related issues as a major source of frustration in diabetes care. However, narratives about diabetes supplies differed: adolescents framed supplies as a negative aspect of diabetes whereas parents tended to celebrate supplies as improving life. Also, images of disease encroachment differed: adolescents took photos of their bodies to depict how diabetes trespasses on their lives whereas parents took pictures of clocks to denote sleep disruption or exhaustion from constant care demands. Conclusions Food-related issues and varying views on supplies may trigger diabetes-specific conflicts. Contrasting viewpoints about the most cumbersome aspects of diabetes may provide insight into differential paths for interventions aimed at offsetting the burdens of T1D for adolescents and parents.
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Affiliation(s)
- Ashby Walker
- The Department of Health Outcomes and Policy and the Institute for Child Health Policy, University of Florida, PO Box 100177, Gainesville, 32610-0177 FL USA ; The Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610-0296 USA
| | - Desmond Schatz
- The Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610-0296 USA
| | - Cathryn Johnson
- The Department of Sociology, Emory University, 1555 Dickey Drive, Atlanta, GA 30322 USA
| | - Janet Silverstein
- The Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610-0296 USA
| | - Shannon Lyles
- The Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610-0296 USA
| | - Henry Rohrs
- The Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610-0296 USA
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95
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Children With Anorectal Malformations, Hirschsprung Disease, and Their Siblings: Proxy Reports and Self-Reports. J Pediatr Gastroenterol Nutr 2015; 61:630-5. [PMID: 25988556 DOI: 10.1097/mpg.0000000000000855] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the present study was to compare parent proxy reports with that of self-reports of children with anorectal malformations (ARMs) or Hirschsprung disease (HD) and healthy siblings and thereafter was examine whether these comparisons differed between patients and their siblings. METHODS Parents (n = 98) of either children with ARM (n = 44) or HD (n = 54) and a healthy sibling (n = 98) recruited from the 6 Dutch pediatric surgical centers and from the ARM and HD patient societies were included in this cross-sectional multilevel study. Agreement between child self-reports and parent proxy reports was compared through mean differences and through (intraclass) correlations. We conducted multilevel analyses to take dependencies between assessments within families into account. RESULTS All of the children (children with ARM or HD and their siblings) reported more pain and symptoms than their parents reported. We also found that only children with ARM or HD reported less positive emotions than their parents. Furthermore, higher correlations were found between parent proxy reports and patient-self reports than between parent proxy reports and sibling self-reports on cognitive functioning and social interaction. CONCLUSIONS Parents tend to overestimate the physical functioning of both their ill and healthy children, and overestimate the emotional functioning of only their children with ARM or HD. Furthermore, children with ARM or HD and parents agree more on health-related quality of life domains than healthy children and parents.
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96
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Mehta SN, Nansel TR, Volkening LK, Butler DA, Haynie DL, Laffel LMB. Validation of a contemporary adherence measure for children with Type 1 diabetes: the Diabetes Management Questionnaire. Diabet Med 2015; 32:1232-8. [PMID: 26280463 PMCID: PMC4802856 DOI: 10.1111/dme.12682] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 12/16/2022]
Abstract
AIMS To evaluate the psychometric properties of the Diabetes Management Questionnaire, a brief, self-report measure of adherence to contemporary diabetes management for young people with Type 1 diabetes and their caregivers. METHODS A total of 273 parent-child dyads completed parallel versions of the Diabetes Management Questionnaire. Eligible children (aged 8-18 years) had Type 1 diabetes for ≥1 year. A multidisciplinary team designed the Diabetes Management Questionnaire as a brief, self-administered measure of adherence to Type 1 diabetes management over the preceding month; higher scores reflect greater adherence. Psychometrics were evaluated for the entire sample and according to age of the child. RESULTS The children (49% female) had a mean ± sd (range) age 13.3 ± 2.9 (8-18) years and their mean ± sd HbA1c was 71 ± 15 mmol/mol (8.6 ± 1.4%). Internal consistency was good for parents (α = 0.83) and children (α = 0.79). Test-retest reliability was excellent for parents (intraclass correlation coefficient =0.83) and good for children (intraclass correlation coefficient = 0.65). Parent and child scores had moderate agreement (intraclass correlation coefficient = 0.54). Diabetes Management Questionnaire scores were inversely associated with HbA1c (parents: r = -0.41, P < 0.0001; children: r = -0.27, P < 0.0001). Psychometrics were stronger in the children aged ≥13 years compared with those aged < 13 years, but were acceptable in both age groups. Mean ± sd Diabetes Management Questionnaire scores were higher among children who were receiving insulin pump therapy (n = 181) than in children receiving multiple daily injections (n = 92) according to parent (75.9 ± 11.8 vs. 70.5 ± 15.5; P = 0.004) and child report (72.2 ± 12.1 vs. 67.6 ± 13.9; P = 0.006). CONCLUSIONS The Diabetes Management Questionnaire is a brief, valid self-report measure of adherence to contemporary diabetes self-management for people aged 8-18 years who are receiving either multiple daily injections or insulin pump therapy.
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Affiliation(s)
- S N Mehta
- Pediatric, Adolescent and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - T R Nansel
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - L K Volkening
- Pediatric, Adolescent and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - D A Butler
- Pediatric, Adolescent and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
| | - D L Haynie
- Health Behavior Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - L M B Laffel
- Pediatric, Adolescent and Young Adult Section, Genetics and Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
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97
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Mistry B, Van Blyderveen S, Punthakee Z, Grant C. Condition-related predictors of successful transition from paediatric to adult care among adolescents with Type 1 diabetes. Diabet Med 2015; 32:881-5. [PMID: 25764182 DOI: 10.1111/dme.12746] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/29/2022]
Abstract
AIMS To describe patient attendance for adult treatment after completion by young people of a structured Diabetes Transition Clinic and to identify the predictors of non-attendance at adult clinics by young people with Type 1 diabetes transitioning from paediatric care. METHODS Young people with Type 1 diabetes were consecutively enrolled on a Diabetes Transition Clinic programme at a Canadian paediatric teaching hospital, beginning in December 2007. Data from clinical interviews completed by an adolescent medicine specialist and an adult endocrinologist were prospectively collected at the Diabetes Transition Clinic visit in the patient's 18(th) year, before he/she was transferred at age 18 years to the adult clinic and at the first adult clinic visit. RESULTS As of June 2011, 136 young people participating in the Diabetes Transition Clinic programme had been discharged from paediatric care at least 1 year earlier. Of these, 43 participants were lost to follow-up. Loss to follow-up was more frequent among: those who were diagnosed with diabetes before the age of 12 years; those who were taking insulin twice or three times daily rather than by pump or multiple daily injections; those who had higher HbA1c levels; those who had fewer diabetes physician visits in the year preceding the Diabetes Transition Clinic visit; and those who did not ask questions at the Diabetes Transition Clinic visit. CONCLUSIONS Several factors easily ascertained at a clinical encounter before transition can predict the likelihood of attendance in adult care, including age at diagnosis, mode of insulin administration, frequency of physician visits, and questions asked by patients during a transition visit.
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Affiliation(s)
- B Mistry
- McMaster University, Hamilton, Ontario, Canada
| | | | - Z Punthakee
- McMaster University, Hamilton, Ontario, Canada
| | - C Grant
- McMaster University, Hamilton, Ontario, Canada
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98
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Telo GH, Volkening LK, Butler DA, Laffel LM. Salient characteristics of youth with type 1 diabetes initiating continuous glucose monitoring. Diabetes Technol Ther 2015; 17:373-8. [PMID: 25749206 PMCID: PMC4432486 DOI: 10.1089/dia.2014.0290] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Consistent continuous glucose monitoring (CGM) use is a challenge in youth with type 1 diabetes. This study aimed to investigate patient and family behavioral and clinical characteristics associated with interest in implementing CGM. RESEARCH DESIGN AND METHODS In a cross-sectional study, we compared 120 youth interested in starting CGM (the CGM group) with a general sample of 238 youth with type 1 diabetes (the Standard group). Youth and their parents completed validated surveys assessing adherence to diabetes management, diabetes-specific family conflict, parent involvement in diabetes management, and youth quality of life. Demographic and clinical data were obtained from chart review and interview. RESULTS Youth participants had a mean age of 13.0±2.8 years, diabetes duration of 6.3±3.4 years, and hemoglobin A1c (HbA1c) level of 8.2±1.0% (66±11 mmol/mol). Youth in the CGM group performed more frequent blood glucose monitoring, had lower HbA1c levels, and were more likely to be treated by continuous subcutaneous insulin infusion (CSII) and to be living in two-parent homes than youth in the Standard group. Compared with the Standard group, youth interested in wearing a CGM device and their parents reported greater adherence to diabetes management, less diabetes-specific family conflict, and higher youth quality of life. No differences were found between groups with respect to parent involvement in diabetes management by both youth and parent reports. CONCLUSIONS In efforts to enhance CGM uptake, it is important to address factors such as blood glucose monitoring frequency, CSII use, adherence, and diabetes-specific family conflict when considering youth with type 1 diabetes for CGM implementation.
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Affiliation(s)
- Gabriela H. Telo
- Pediatric, Adolescent, & Young Adult and Genetics and Epidemiology Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
- Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
- CAPES Foundation, Ministry of Education, Brasilia, Brazil
| | - Lisa K. Volkening
- Pediatric, Adolescent, & Young Adult and Genetics and Epidemiology Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Deborah A. Butler
- Pediatric, Adolescent, & Young Adult and Genetics and Epidemiology Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Lori M. Laffel
- Pediatric, Adolescent, & Young Adult and Genetics and Epidemiology Sections, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
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Abstract
Diabetes is one of the most common chronic medical disorders in children. The management of diabetes remains a substantial burden on children with diabetes and their families, despite improvements in treatment and rates of morbidity and mortality. Although most children with diabetes have type 1 diabetes, the increasing recognition of type 2 diabetes and genetic forms of diabetes in the paediatric population has important treatment implications. Diabetes therapy focuses strongly on targets for good metabolic control to reduce the risk of long-term complications. A parallel goal is to minimise short-term complications of hypoglycaemia and diabetic ketoacidosis. Technology offers opportunity for improvement in care, but has not yet fully lived up to its potential. New insights into the pathogenesis of diabetes and the development of new therapies have led to clinical trials aimed at the prevention of diabetes.
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Affiliation(s)
- Fergus J Cameron
- Centre for Hormone Research, Department of Endocrinology and Diabetes, The Royal Children's Hospital, Murdoch Children's Research Institute and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Diane K Wherrett
- Division of Endocrinology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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100
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Babler E, Strickland CJ. Normalizing: adolescent experiences living with type 1 diabetes. DIABETES EDUCATOR 2015; 41:351-60. [PMID: 25824416 DOI: 10.1177/0145721715579108] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this research study was to gain a greater understanding of adolescents' experiences living with diabetes and build a theoretical paradigm to inform interventional design. METHODS Classical grounded theory was utilized; 15 in-depth interviews of 11 subjects were conducted with Caucasian adolescents' ages 11 to 15 with type 1 diabetes. Interviews were recorded and transcribed verbatim. Data were analyzed using constant comparative analysis. Codes were linked to create the paradigm. RESULTS A theoretical model was developed about the concept of "normalizing." Normalizing is defined as the ability of the adolescents to integrate diabetes into the background of their daily life by creating routines to make diabetes "part of me." Codes identified in normalizing included: (1) recognizing life is changing, (2) taking action to prevent a crisis, (3) disclosing to engage support, (4) taking on the burden of care, (5) accepting the "new normal," and (6) hoping for a normal future. CONCLUSIONS Normal developmental tasks of adolescence were closely related and contribute to understanding why adolescents struggle with diabetes. These research findings place a different and positive perspective on diabetes management; the focus shifts to supporting wellness and maintaining a normal life rather than on illness. Findings are expected to be of value to health providers working with adolescents with type 1 diabetes, parents, nursing researchers, and adolescents facing the challenge of diabetes management.
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Affiliation(s)
- Elizabeth Babler
- University of Wisconsin-Milwaukee, College of Nursing, Milwaukee, Wisconsin (Dr Babler)
| | - C June Strickland
- University of Washington School of Nursing, Psychosocial & Community Health, Seattle, Washington (Dr Strickland)
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