101
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Younes ZMH, Abuali AM, Tabba S, Farooqi MH, Hassoun AAK. Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates. Pediatr Diabetes 2021; 22:683-691. [PMID: 33745208 DOI: 10.1111/pedi.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/11/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care. To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates. All adolescents aged 13 to 18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study. RESEARCH DESIGN AND METHODS Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires. RESULTS The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared with males (p<0.05). Females showed significantly greater levels of distress as compared with males. Although adolescents with HbA1c≥7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another. CONCLUSIONS Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population.
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Affiliation(s)
| | - Alaa M Abuali
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
| | - Shadi Tabba
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
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102
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Brodar KE, Davis EM, Lynn C, Starr-Glass L, Lui JHL, Sanchez J, Delamater AM. Comprehensive psychosocial screening in a pediatric diabetes clinic. Pediatr Diabetes 2021; 22:656-666. [PMID: 33604976 DOI: 10.1111/pedi.13193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center. RESEARCH DESIGN AND METHODS Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c). RESULTS Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eighty-three percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented. CONCLUSIONS Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.
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Affiliation(s)
- Kaitlyn E Brodar
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Eileen M Davis
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Courtney Lynn
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lolly Starr-Glass
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joyce H L Lui
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Janine Sanchez
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alan M Delamater
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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The Synergistic Effects of a Complementary Physiotherapeutic Scheme in the Psychological and Nutritional Treatment in a Teenage Girl with Type 1 Diabetes Mellitus, Anxiety Disorder and Anorexia Nervosa. CHILDREN-BASEL 2021; 8:children8060443. [PMID: 34070247 PMCID: PMC8225211 DOI: 10.3390/children8060443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/21/2021] [Accepted: 05/23/2021] [Indexed: 01/09/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is a chronic disease that can affect the physical and mental health of children and adolescents, often leading to anxiety disorders with chronic activation of the hypothalamic axis (HPA). Moreover, a great proportion of adolescents with T1DM also demonstrate anorexia nervosa (AN), due to the increased preoccupation with food and the need to have an acceptable body image. Herein is described the first case study of an adolescent patient diagnosed with T1DM, anxiety disorder (AD), and AN. A 14-year-old girl with T1DM since the age of 12 years presented weight loss at age 13 years and 3 months and low body mass index (BMI), which did not improve despite dietary recommendations and adequate disease control. Additionally, she presented menstrual disorders at the age of 12 years and 11 months (menstrual age 12 years and 1 month). A psychological evaluation of the teenager was conducted using a semi-structured interview that assessed perceived stress, health status, quality of life, and depression. AD and AN were diagnosed and the patient initiated an intervention focusing on psychological health and nutrition and which incorporated physiotherapeutic relaxation sessions and breathing exercises. After 3 months of treatment, the patient’s BMI was increased, and a normal menstrual cycle was apparent. These results have since remained consistent. Stress leads to the appearance of AN and menstrual disorders. Therefore, physiotherapeutic programs could reduce stress and effectively ameliorate AN and AD.
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105
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Disordered Eating Behaviors Among Italian Adolescents with Type 1 Diabetes: Exploring Relationships with Parents' Eating Disorder Symptoms, Externalizing and Internalizing Behaviors, and Body Image Problems. J Clin Psychol Med Settings 2021; 27:727-745. [PMID: 31587133 DOI: 10.1007/s10880-019-09665-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The purpose of this study is to examine associations of disordered eating behaviors (DEBs) with body image problems, parents' eating disorder symptoms, and emotional and behavioral problems among adolescents with type 1 diabetes (T1D). 200 adolescents (M age = 15.24 ± 1.45 years) with T1D completed a self-report measure of DEBs and body ideal internalization, and their parents completed self-report measures of parents' eating problems and child's psychological symptoms. Seventy-three (36.5%) adolescents were DEPS-r-positive (scores ≥ 20), with higher rates among girls (χ2 = 9.034, p = .003). Adolescents with T1D and DEBs reported lower SES, worse metabolic control, higher zBMI (p < .001), more eating disorder symptoms, more body image problems, and more emotional and behavioral problems than adolescents with T1D but no DEBs (all p < .05). Parents of adolescents with DEBs showed higher levels of bulimia (p = .028) than parents of adolescents without DEBs. In both genders, pressure to conform to societal norms about body image (p < .01) and externalization symptoms (p < .05) emerged as significant predictors of DEBs. Findings suggest that adolescents with T1D and DEBs showed an alarming psychological condition, with higher level of body image and more emotional and behavioral problems.
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106
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The Role of Trust in the Care of Young Children with Type 1 Diabetes. CHILDREN-BASEL 2021; 8:children8050383. [PMID: 34066217 PMCID: PMC8151212 DOI: 10.3390/children8050383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 04/28/2021] [Accepted: 05/10/2021] [Indexed: 01/21/2023]
Abstract
Using the theoretical framework of Guido Möllering conceptualising trust as a mental process composed of three elements—expectation, interpretation and suspension—we examined the role of trust in relation to young children’s (age ≤ 7 years) psychosocial needs when diagnosed with type 1 diabetes. Based on qualitative interviews with health care professionals (HPCs) from paediatric diabetes clinics in all regions of Denmark, we identified four main themes: trust through meaningful interaction, trust as a key factor at the time of diagnosis, trust in a long-term perspective and caregivers as the bridge to trust. We conclude that trust between young children and HCPs is central to children’s psychosocial experience, as well as a primary need, when children are diagnosed with type 1 diabetes. Trusting relationships counteract children’s experience of fear, anxiety and needle phobia and reinforce HCPs’ experience of providing good psychosocial as well as medical care. The present study offers insights into how trust can positively affect young children’s experience of diagnosis. This study also points out some key barriers to and facilitators of creating trusting relationships. This research is a first step towards a greater understanding that can inform collective future guidelines on the psychosocial care of young children.
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Validation Study and Outcomes of the Diabetes Quality of Life in Youth Instrument in Haitian Youth With Type 1 Diabetes Residing in Haiti. Can J Diabetes 2021; 46:32-39. [PMID: 34144909 DOI: 10.1016/j.jcjd.2021.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 04/26/2021] [Accepted: 04/30/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Health-related quality of life (HRQL) in type 1 diabetes is a critical health outcome but has not been studied in many low-income countries. In this study we evaluated the validity of 2 HRQL instruments, measured the HRQL and explored the association between HRQL and glycemic control. METHODS This was a cross-sectional study of Haitian youth with diabetes between 0 and 25 years of age and living in Haiti. We administered the 51-item Diabetes Quality of Life in Youth (DQOLY) questionnaire and the EuroQol Visual Analogue Scale (EQ-VAS). Psychometric analyses evaluated internal consistency and construct validity of the DQOLY and its 21-item short form, the DQOLY-SF. Linear regression was used to identify predictors of HRQL and glycated hemoglobin (A1C). RESULTS In 85 youth (59% female; mean age, 17.5 years; mean diabetes duration, 3.7 years; mean A1C, 11.3%), DQOLY and DQOLY-SF had adequate internal consistency with Cronbach's alpha values of 0.86 and 0.84, respectively. Confirmatory factor analysis revealed adequate validity for the DQOLY-SF and DQOLY Satisfaction subscale. HRQL, as measured using the DQOLY-SF, was 62±16 (mean ± standard deviation) out of 100. Mean EQ-VAS score was 78±24 out of 100. Older age (p=0.004), female sex (p=0.02) and lower socioeconomic status (SES) (p=0.03) were risk factors for lower DQOLY score, and older age (p=0.02) and marginally female sex (p=0.06) for lower DQOLY-SF score. No predictors of EQ-VAS were identified. HRQL measures were not associated with glycemic control. CONCLUSIONS The DQOLY-SF and DQOLY Satisfaction subscale are valid measures of HRQL in Haitian youth with diabetes. HRQL is low and was worse in older, female and low-SES youth, but was not associated with glycemic control.
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108
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Tittel SR, Dunstheimer D, Hilgard D, Knauth B, Fröhlich-Reiterer E, Galler A, Wurm M, Holl RW. Coeliac disease is associated with depression in children and young adults with type 1 diabetes: results from a multicentre diabetes registry. Acta Diabetol 2021; 58:623-631. [PMID: 33483854 PMCID: PMC8076130 DOI: 10.1007/s00592-020-01649-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/28/2020] [Indexed: 02/06/2023]
Abstract
AIMS To analyse the association between coeliac disease (CD) and depression in children, adolescents, and young adults with type 1 diabetes (T1D). METHODS We included 79,067 T1D patients aged 6-20 years, with at least six months of diabetes duration, and treatment data between 1995 and 2019 were documented in the diabetes patient follow-up registry. We categorized patients into four groups: T1D only (n = 73,699), T1 + CD (n = 3379), T1D + depression (n = 1877), or T1D + CD + depression (n = 112). RESULTS CD and depression were significantly associated (adjusted OR: 1.25 [1.03-1.53]). Females were more frequent in both the depression and the CD group compared with the T1D only group. Insulin pumps were used more frequently in T1D + CD and T1D + depression compared with T1D only (both p < .001). HbA1c was higher in T1D + depression (9.0% [8.9-9.0]), T1D + CD + depression (8.9% [8.6-9.2]), both compared with T1D only (8.2% [8.2-8.2], all p < .001). We found comorbid autism, attention deficit hyperactivity disorder, anxiety, schizophrenia, and eating disorders more frequently in the T1D + CD + depression group compared with T1D only (all p < .001). CONCLUSIONS CD and depression are associated in young T1D patients. The double load of T1D and CD may lead to an increased risk for depression. Depression was associated with additional psychological and neurological comorbidities. Aside from imperative CD screening after T1D diagnosis and regular intervals, depression screening might be helpful in routine care, especially in patients with diagnosed CD.
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Affiliation(s)
- Sascha René Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | - Désirée Dunstheimer
- Paediatrics and Adolescent Medicine, Medical Faculty University of Augsburg, Augsburg, Germany
| | | | - Burkhild Knauth
- Department of Pediatrics and Adolescent Medicine, CJD Berchtesgaden, Berchtesgaden, Germany
| | - Elke Fröhlich-Reiterer
- Division of General Pediatrics, Department of Paediatrics and Adolescent Medicine, Medical University Graz, Graz, Austria
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael Wurm
- Clinic St. Hedwig, University Children’s Hospital Regensburg (KUNO Clinics), University of Regensburg, Regensburg, Germany
| | - Reinhard Walter Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Albert-Einstein-Allee 41, 89081 Ulm, Germany
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany
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109
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Addala A, Chan RY, Vargas J, Weigensberg MJ. Global Well-Being Is Associated With A1C and Frequency of Self-Monitoring of Blood Glucose in Predominately Latinx Youth and Young Adults With Type 1 Diabetes. Diabetes Spectr 2021; 34:202-208. [PMID: 34149262 PMCID: PMC8178714 DOI: 10.2337/ds20-0041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA
| | - Randall Y. Chan
- Department of Pediatrics, Keck School of Medicine of the University of Southern California and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| | - Jaclyn Vargas
- Department of Pediatrics, Keck School of Medicine of the University of Southern California and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
| | - Marc J. Weigensberg
- Department of Pediatrics, Keck School of Medicine of the University of Southern California and the Los Angeles County + University of Southern California Medical Center, Los Angeles, CA
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110
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Goethals ER, Lemiere J, Snoek FJ, Casteels K, Luyckx K, de Wit M. Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross-national investigation. Pediatr Diabetes 2021; 22:503-510. [PMID: 33314616 DOI: 10.1111/pedi.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes-related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior). RESEARCH DESIGN AND METHODS Cohorts of Belgian and Dutch parents of children and adolescents (6-18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration. RESULTS The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02-0.08), and not behavioral regulation. CONCLUSIONS Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes.
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Affiliation(s)
- Eveline R Goethals
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Jurgen Lemiere
- Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Frank J Snoek
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Koen Luyckx
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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111
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Galler A, Tittel SR, Baumeister H, Reinauer C, Brosig B, Becker M, Haberland H, Hilgard D, Jivan M, Mirza J, Schwab J, Holl RW. Worse glycemic control, higher rates of diabetic ketoacidosis, and more hospitalizations in children, adolescents, and young adults with type 1 diabetes and anxiety disorders. Pediatr Diabetes 2021; 22:519-528. [PMID: 33470512 DOI: 10.1111/pedi.13177] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/27/2020] [Accepted: 11/30/2020] [Indexed: 01/13/2023] Open
Abstract
The aim of the study was to explore the metabolic characteristics and outcome parameters in youth with type 1 diabetes and anxiety disorders. HbA1c levels, rates of severe hypoglycemia, diabetic ketoacidosis (DKA), and hospital admission in children, adolescents, and young adults with type 1 diabetes and an anxiety disorder from 431 diabetes-care-centers participating in the nationwide German/Austrian/Swiss/Luxembourgian diabetes survey DPV were analyzed and compared with youth without anxiety disorders. Children, adolescents, and young adults with type 1 diabetes and anxiety disorders (n = 1325) had significantly higher HbA1c (8.5% vs. 8.2%), higher rates of DKA (4.2 vs. 2.5 per 100 patient-years), and higher hospital admission rates (63.6 vs. 40.0 per 100 patient-years) than youth without anxiety disorders (all p < 0.001). Rates of severe hypoglycemia did not differ. Individuals with anxiety disorders other than needle phobia (n = 771) had higher rates of DKA compared to those without anxiety disorders (4.2 vs. 2.5 per 100 patient-years, p = 0.003) whereas the rate of DKA in individuals with needle phobia (n = 555) was not significantly different compared to those without anxiety disorders. Children, adolescents, and young adults with anxiety disorders other than needle phobia had higher hospitalization rates (73.7 vs. 51.4 per 100 patient-years) and more inpatient days (13.2 vs. 10.1 days) compared to those with needle phobia (all p < 0.001). Children, adolescents, and young adults with type 1 diabetes and anxiety disorders had worse glycemic control, higher rates of DKA, and more hospitalizations compared to those without anxiety disorders. Because of the considerable consequences, clinicians should screen for comorbid anxiety disorders in youth with type 1 diabetes.
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Affiliation(s)
- Angela Galler
- Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sascha R Tittel
- Institute for Epidemiology und Medical Biometry, ZIBMT, Universität Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
| | - Harald Baumeister
- Institut für Psychologie und Pädagogik, Klinische Psychologie und Psychotherapie, Universität Ulm, Ulm, Germany
| | - Christina Reinauer
- Zentrum für Kinder- und Jugendmedizin, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - Burkhard Brosig
- Zentrum für Kinderheilkunde und Jugendmedizin, Familien-und Kinderpsychosomatik, Universitätsklinikum Gießen, Gießen, Germany
| | - Marianne Becker
- Paediatric Clinic, Paediatric Endocrinology and Diabetology (DECCP), Centre Hospitalier de Luxembourg, Luxembourg
| | - Holger Haberland
- Klinik für Kinder- und Jugendmedizin, Paediatric Diabetology, Sana-Kliniken Lichtenberg, Berlin, Germany
| | - Dörte Hilgard
- Kinder- und Jugendarztpraxis Dr. Dörte Hilgard, Witten, Germany
| | - Marcelus Jivan
- CJD Berchtesgaden, Christliches Jugenddorfwerk Deutschland e.V, Germany
| | - Joaquina Mirza
- Kinderkrankenhaus Amsterdamer Straße, Klinik für Kinder- und Jugendmedizin, Paediatric Diabetology, Kliniken Köln, Köln, Germany
| | - Julia Schwab
- Diabetes-Klinik Bad Mergentheim GmbH & Co. KG, Bad Mergentheim, Germany
| | - Reinhard W Holl
- Institute for Epidemiology und Medical Biometry, ZIBMT, Universität Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
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112
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Hannonen R, Vuorimaa H, Rantanen K, Alho I, Luukkaala T, Heikkilä A, Lappalainen R. Finnish diabetes-related quality of life questionnaire for children and adolescents: Reliability and validity. Acta Paediatr 2021; 110:1516-1525. [PMID: 33289955 DOI: 10.1111/apa.15707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/01/2020] [Accepted: 12/04/2020] [Indexed: 01/09/2023]
Abstract
AIM To study the psychometric properties, reliability and validity of the FinDiab quality-of-life questionnaire (FDQL), a strength-oriented quality-of-life (QOL) questionnaire for children and adolescents with type 1 diabetes (T1D). METHODS Participants were 215 youths with T1D (aged 10-17 years). They completed FDQL and comparison questionnaires (KINDL-R and SDQ). Demographic and disease measures were collected from the participants' medical records. The questionnaire's psychometric properties were investigated. Construct validity was studied through principal component analysis using Promax rotation, reliability with alphas, and criterion and convergent validity with correlations between sum scale, subscales, demographic and disease factors, and comparison measures. RESULTS FDQL demonstrated an adequate range of measurement and feasibility. The four-factor solution was found to be optimal, resulting in the subscales of flexibility with diabetes, well-being, social relations and health behaviour. The sum scale correlated significantly with glycaemic control and the psychosocial and QOL comparison measures. Construct, criterion and convergent validity of the subscales was also good. Children under 14 years of age reported better QOL than older adolescents. CONCLUSION FDQL is a practical QOL assessment method focusing on strengths. The questionnaire has good validity and reliability and is easy to use as a clinical tool.
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Affiliation(s)
- Riitta Hannonen
- Department of Psychology Kymenlaakso Social and Health Care Kotka Finland
| | - Hanna Vuorimaa
- Department of Pediatrics Päijät‐Häme Central Hospital Lahti Finland
| | - Kati Rantanen
- Faculty of Social Sciences, Psychology, Tampere University Department of Pediatrics Tampere University Hospital Tampere Finland
| | - Iina Alho
- Department of Psychology, University of Jyväskylä Department of Pediatrics Central Finland Health Care District Jyväskylä Finland
| | - Tiina Luukkaala
- Faculty of Social Sciences, Tampere University Research, Development and Innovation Centre Tampere University Hospital Tampere Finland
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113
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Bakır E, Çavuşoğlu H, Mengen E. Effects of the Information-Motivation-Behavioral Skills Model on Metabolic Control of Adolescents with Type 1 Diabetes in Turkey: Randomized Controlled Study. J Pediatr Nurs 2021; 58:e19-e27. [PMID: 33371976 DOI: 10.1016/j.pedn.2020.11.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/27/2020] [Accepted: 11/29/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the effects of information-motivation-behavioral skills model interventions given by nurses during home visits on the knowledge levels, personal and social motivation levels, behavioral skills, and HbA1C levels of adolescents with poor glycemic control. DESIGN AND METHODS The present study was designed as randomized controlled trial. 50 adolescents with type 1 diabetes were equally divided into study and control groups. Socio-Demographic Form, Diabetes Information Evaluation Form, The Child Attitude Toward Illness Scale, The Multidimensional Scale of Perceived Social Support, and Diabetes Management Self-Efficacy Scale were utilized in data collection. The scales were administered at the beginning of the study and six months later. HbA1c levels of adolescents were evaluated in the third and sixth months. Multiple home visits and phone calls were made to each participant in the intervention group. Interventions to improve the information-motivation-behavioral skills model-based knowledge, personal and social motivation, and behavioral skills were applied during the home visits. RESULTS As a result of information-motivation-behavioral skills model-based interventions, knowledge levels (p<0.001), personal motivation levels (p = 0.001), social motivation levels (p = 0.004), and behavioral skills (p<0.001) of the study group improved. Additionally, HbA1c levels decreased significantly in the third (p<0.001) and sixth months (p<0.001). CONCLUSION Information-Motivation-Behavioral Skills Model-based intervention effectively improved glycemic control among adolescents with type 1 diabetes. PRACTICE IMPLICATIONS Nurses should develop strategies to increase personal motivation, social motivation, and behavioral skills to training programs planned for adolescents with type 1 diabetes.
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Affiliation(s)
- Elif Bakır
- Pediatric Nursing Department, Hacettepe University, Turkey.
| | - Hicran Çavuşoğlu
- Head of Pediatric Nursing Department, Hacettepe University, Turkey.
| | - Eda Mengen
- Department of Pediatric Endocrinology, Turkey.
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Abstract
Studies suggest that the relationship between psychosocial well-being and type 1 diabetes (T1D) is bidirectional, with T1D typically having a negative influence on psychological functioning, which in turn negatively affects the course of T1D. Here, we investigate the potential role of the capacity for mentalizing, or reflective functioning, in children and their mothers in diabetes control. We tested differences in mentalizing as assessed by the Reflective Functioning Scale in two groups of mother-son dyads with good (GDC) versus poor (PDC) diabetes control. Fifty-five boys (8-12 years old) and their mothers were recruited from the Juvenile Diabetes Foundation in Santiago, Chile. The mothers were interviewed with the Parental Development Interview and the children with the Child Attachment Interview, and both were scored for reflective functioning by using the Reflective Functioning Scale. Self-report measures of stress and diabetes outcomes were completed by the mothers and children, and levels of glycated hemoglobin (HbA1c) were assessed as an index of diabetes control. The results showed that both maternal and child reflective functioning were higher in the GDC than the PDC group and were negatively correlated with HbA1c in the total sample. Our findings suggest an important role for mentalizing in diabetes outcomes, but further prospective research is needed.
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115
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Lohiya NN, Kajale NA, Lohiya NN, Khadilkar VV, Gondhalekar K, Khadilkar A. Diabetes distress in Indian children with type 1 diabetes mellitus and their mothers. J Pediatr Endocrinol Metab 2021; 34:209-216. [PMID: 33180040 DOI: 10.1515/jpem-2020-0339] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/26/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Children and their mothers, who are usually the primary caregivers, are likely to be distressed due to type 1 diabetes (T1DM). OBJECTIVES (1) To assess diabetes-specific distress (DD) perceived by children and adolescents with T1DM and their mothers and association of distress between children and mothers. (2) To study the association of diabetes distress with glycemic control and disease duration. SUBJECTS Children and adolescents with T1DM over eight years and their mothers. METHODS Clinical data were recorded. DD was assessed by Problem Associated in Diabetes-Pediatric (PAID-Peds) (range 0-80) and Problem Associated in Diabetes-Parents Revised (PAID-PR) (range 0-72) questionnaires (higher scores indicate higher distress); administered to children and mothers, respectively. Sub-dimensions in questionnaires included diabetes-related emotional problems, and treatment-, food-, and social support-related problems. Correlation analysis (Spearman's) was performed, and a paired t-test was used to compare PAID-Peds and PAID-PR (SPSS 25). RESULTS Mean PAID-Peds and PAID-PR scores in 67 children and mothers were 24.4 ± 18.1 and 31.9 ± 21.5, respectively (p=0.009), and a significant correlation was noted between their scores (R=0.45, p=0.001). PAID-Peds score was positively associated with HbA1c (R=0.25, p=0.04). Diabetes-related emotional problems of mothers and children (R=0.38, p=0.003), treatment problems (R=0.5, p=0.001), and food problems (R=0.24, p=0.05) correlated positively. Subdimension scores were significantly different in children and mothers except in the social support domain. CONCLUSION DD was higher in mothers than children; higher distress in children was associated with poor metabolic control. Evaluation of DD needs to be performed in children with T1DM.
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Affiliation(s)
- Nirali N Lohiya
- Developmental and Behavioural Pediatrics, Dr. D. Y. Patil Medical College Hospital and Research Centre, Pune, Maharashtra, India
| | - Neha A Kajale
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Nikhil N Lohiya
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Vaman V Khadilkar
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Ketan Gondhalekar
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
| | - Anuradha Khadilkar
- Growth and Pediatric Endocrine, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
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116
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Mulvaney SA, Vaala SE, Carroll RB, Williams LK, Lybarger CK, Schmidt DC, Dietrich MS, Laffel LM, Hood KK. A mobile app identifies momentary psychosocial and contextual factors related to mealtime self-management in adolescents with type 1 diabetes. J Am Med Inform Assoc 2021; 26:1627-1631. [PMID: 31529065 DOI: 10.1093/jamia/ocz147] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 05/31/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023] Open
Abstract
Effective diabetes problem solving requires identification of risk factors for inadequate mealtime self-management. Ecological momentary assessment was used to enhance identification of factors hypothesized to impact self-management. Adolescents with type 1 diabetes participated in a feasibility trial for a mobile app called MyDay. Meals, mealtime insulin, self-monitored blood glucose, and psychosocial and contextual data were obtained for 30 days. Using 1472 assessments, mixed-effects between-subjects analyses showed that social context, location, and mealtime were associated with missed self-monitored blood glucose. Stress, energy, mood, and fatigue were associated with missed insulin. Within-subjects analyses indicated that all factors were associated with both self-management tasks. Intraclass correlations showed within-subjects accounted for the majority of variance. The ecological momentary assessment method provided specific targets for improving self-management problem solving, phenotyping, or integration within just-in-time adaptive interventions.
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Affiliation(s)
- Shelagh A Mulvaney
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.,Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah E Vaala
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Rachel B Carroll
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Laura K Williams
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA
| | - Cindy K Lybarger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Douglas C Schmidt
- Electrical Engineering and Computer Science Department, School of Engineering, Vanderbilt University, Nashville, Tennessee, USA
| | - Mary S Dietrich
- School of Nursing, Vanderbilt University, Nashville, Tennessee, USA.,Department of Biostatistics, Vanderbilt University, Nashville, Tennessee, USA
| | - Lori M Laffel
- Joslin Diabetes Center, Harvard University, Boston, Massachusetts, USA
| | - Korey K Hood
- Department of Pediatrics, Stanford University Medical Center, Palo Alto, California, USA
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117
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Monaghan M, Mara CA, Kichler JC, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Stone JY, Hood KK, Mulvaney SA. Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes. Can J Diabetes 2021; 45:411-416. [PMID: 33722492 DOI: 10.1016/j.jcjd.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. METHODS The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. RESULTS Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. CONCLUSIONS Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Research, Children's National Hospital, Washington, District of Columbia, United States.
| | - Constance A Mara
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Alana Rawlinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Laura M Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, United States
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jenine Y Stone
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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Pulungan AB, Fadiana G, Annisa D. Type 1 diabetes mellitus in children: experience in Indonesia. Clin Pediatr Endocrinol 2021; 30:11-18. [PMID: 33446947 PMCID: PMC7783121 DOI: 10.1297/cpe.30.11] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 09/18/2020] [Indexed: 01/11/2023] Open
Abstract
The prevalence of type 1 diabetes mellitus (T1DM) in children in Indonesia is increasing
although the real number is unknown due to high rate of misdiagnosis. Public and
healthcare awareness on T1DM in children is still low, reflected by the high number of
children diagnosed with diabetic ketoacidosis (DKA). The Indonesian Pediatric Society
(IPS) had published a guideline on T1DM management, which consists of insulin injection,
daily monitoring of blood glucose, nutrition, physical activity, and education. Aside from
low awareness, current challenges on T1DM management in Indonesia are funding by the
national health insurance, fasting during Ramadan, and inequities on DM care. The
involvement of society, healthcare workers, stakeholders, and the government is of
importance to ensure optimal management for children with diabetes.
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Affiliation(s)
- Aman B Pulungan
- Child Health Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Ghaisani Fadiana
- Child Health Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
| | - Diadra Annisa
- Child Health Department, Faculty of Medicine Universitas Indonesia, Cipto Mangunkusumo General Hospital, Jakarta, Indonesia
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119
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Totka JP, Snethen JA, Cox ED. Youth and Parent Health-Related Quality of Life and Association With Glycemic Outcomes in Preadolescents and Adolescents With Type 1 Diabetes. J Pediatr Health Care 2021; 35:64-73. [PMID: 32928601 DOI: 10.1016/j.pedhc.2020.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 07/25/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023]
Abstract
INTRODUCTION We explored differences in Health-Related Quality of Life (HRQOL) and the youth's glycosylated hemoglobin (A1c) of preadolescent and adolescent youths with type 1 diabetes (T1D) by individual (age, sex, race) and family (socioeconomic status) factors, and associations between youths' HRQOL, their parents' HRQOL, and youth's A1c. METHOD Correlational secondary analysis of baseline data from a randomized controlled trial testing a developmental intervention for youths with T1D and their parents from two diabetes clinics. RESULTS Better adolescent HRQOL was associated with better glycemic control. Better preadolescent HRQOL was associated with better parent HRQOL. Non-White adolescents had worse HRQOL than White adolescents; whereas Non-White preadolescents had worse glycemic control than White preadolescents. DISCUSSION Addressing HRQOL may promote better glycemic control in adolescents with T1D. For preadolescents with T1D, parent HRQOL support may impact preadolescent HRQOL and improve glycemic control moving into adolescence. Further study is warranted for non-White youths with T1D HRQOL and A1c outcomes.
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120
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Troncone A, Chianese A, Cascella C, Zanfardino A, Iafusco D. Psychological Outcomes in Children and Early Adolescents With Type 1 Diabetes Following Pediatric Diabetes Summer Camp: A 3-Month Follow-Up Study. Front Pediatr 2021; 9:650201. [PMID: 33777869 PMCID: PMC7987815 DOI: 10.3389/fped.2021.650201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/05/2021] [Indexed: 01/09/2023] Open
Abstract
Objective: The aim of this study was to assess general psychosocial adjustment to diabetes and perceived disease management among patients with type 1 diabetes (T1D) and their parents before and after patients' participation in a diabetes summer camp. Methods: In this follow-up study, 20 children and adolescents with T1D (eight boys; mean age = 11.01 ± 0.94 years; mean diabetes duration = 3.02 ± 2.27) attending a southern Italian diabetic center, along with their parents, were assessed prior to and 3 months after the youths participated in a 1 week camp-based intervention involving didactic and interactive child-centered education and recreational activities. Patients and their parents completed measures assessing patients' quality of life and strategies employed by patients to cope with pain. Patients also completed measures evaluating their diabetes psychosocial adjustment, diabetes self-efficacy management, and illness perception; also, their parents completed measures of caregivers' perceived diabetes burden and treatment satisfaction. Youths' glycated hemoglobin (HbA1c) and standardized body mass index (z-BMI) values were also assessed. Within-subjects repeated-measures analyses of variance evaluated pre- and post-camp changes. Results: Camp attendance showed no beneficial effects on glycemic control, as indicated by HbA1c values both before (7.02%) and after (7.28%) camp being lower than 7.5%. HbA1c values were found to have increased after camp (pre-camp = 7.02%, post-camp = 7.28%; p = 0.010), but since they still fell within an acceptable range, they did not reveal clinically relevant changes in glycemic control. No substantial significant improvement in psychosocial measures was observed in children or parents (all p > 0.05). According to the parents' evaluation, social support-seeking as a patient pain-coping strategy was slightly increased (p = 0.044) after attending the camp. Conclusions: This study does not provide empirical evidence of benefits of participating in a diabetes camp for either patients or their parents. These findings suggest that healthcare providers rethink such camps as an experience for youths with T1D that actively involves parents and that includes both youth- and parent-focused psychological interventions.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "L. Vanvitelli", Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dario Iafusco
- Department of the Woman, Child and General and Specialized Surgery, University of Campania "L. Vanvitelli", Naples, Italy
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121
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de Beaufort C, Pit-ten Cate IM, Schierloh U, Cohen N, Boughton CK, Tauschmann M, Allen JM, Nagl K, Fritsch M, Yong J, Metcalfe E, Schaeffer D, Fichelle M, Thiele AG, Abt D, Faninger K, Mader JK, Slegtenhorst S, Ashcroft N, Wilinska ME, Sibayan J, Kollman C, Hofer SE, Fröhlich-Reiterer E, Kapellen TM, Acerini CL, Campbell F, Rami-Merhar B, Hovorka R. Psychological Well-Being of Parents of Very Young Children With Type 1 Diabetes - Baseline Assessment. Front Endocrinol (Lausanne) 2021; 12:721028. [PMID: 34456876 PMCID: PMC8397439 DOI: 10.3389/fendo.2021.721028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 07/26/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Type 1 diabetes in young children is a heavy parental burden. As part of pilot phase of the KIDSAP01 study, we conducted a baseline assessment in parents to study the association between hypoglycemia fear, parental well-being and child behavior. METHODS All parents were invited to fill in baseline questionnaires: hypoglycemia fear survey (HFS), WHO-5, Epworth Sleepiness Scale and Strength and Difficulties Questionnaire (SDQ). RESULTS 24 children (median age: 5-year, range 1-7 years, 63% male, mean diabetes duration: 3 ± 1.7 years) participated. 23/24 parents filled out the questionnaires. We found a higher score for the hypoglycemia fear behavior 33.9 ± 5.6 compared to hypoglycemia worry 34.6 ± 12.2. Median WHO-5 score was 16 (8 - 22) with poor well-being in two parents. Median daytime sleepiness score was high in five parents (>10). For six children a high total behavioral difficulty score (>16) was reported. Pro social behavior score was lower than normal in six children (<6). Parental well-being was negatively associated with HFS total (r = - 0.50, p <.05) and subscale scores (r = - 0.44, p <.05 for HFS-Worry and HFS-Behavior), child behavior (r = - 0.45, p = .05) and positively with child age and diabetes duration (r = 0.58, p <.01, r = 0.6, p <.01). HFS, parental well-being nor daytime sleepiness are associated with the HbA1c. CONCLUSION Regular screening of parental well-being, hypoglycemia fear and child behavior should be part of routine care to target early intervention.
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Affiliation(s)
- Carine de Beaufort
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
- Department of Pediatrics, University Clinic Brussels, Brussels, Belgium
- *Correspondence: Carine de Beaufort,
| | - Ineke M. Pit-ten Cate
- Luxembourg Center for Educational Assessment, University of Luxembourg, Esch sur Alzette, Luxembourg
| | - Ulrike Schierloh
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
| | - Nathan Cohen
- Jaeb Center for Health Research, Tampa, FL, United States
| | - Charlotte K. Boughton
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Martin Tauschmann
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Janet M. Allen
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Katrin Nagl
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Maria Fritsch
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - James Yong
- Department of Paediatric Diabetes, Leeds Children´s Hospital, Leeds, United Kingdom
| | - Emily Metcalfe
- Department of Paediatric Diabetes, Leeds Children´s Hospital, Leeds, United Kingdom
| | - Dominique Schaeffer
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
| | - Muriel Fichelle
- Diabetes & Endocrine Care Clinique Pediatrique (DECCP)-Pediatric Clinic, Pediatric Clinic/Centre Hospitalier de Luxembourg DECCP, Luxembourg, Luxembourg
| | - Alena G. Thiele
- Division of Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Daniela Abt
- Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria
| | - Kerstin Faninger
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Julia K. Mader
- Department of Internal Medicine, Division of Endocrinology and Diabetology, Medical University of Graz, Graz, Austria
| | - Sonja Slegtenhorst
- Department of Nutrition & Dietetics, Cambridge University Hospitals National Health Service (NHS) Foundation Trust, Cambridge, United Kingdom
| | - Nicole Ashcroft
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
| | - Malgorzata E. Wilinska
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Judy Sibayan
- Jaeb Center for Health Research, Tampa, FL, United States
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, FL, United States
| | - Sabine E. Hofer
- Department of Pediatrics 1, Medical University of Innsbruck, Innsbruck, Austria
| | - Elke Fröhlich-Reiterer
- Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
| | - Thomas M. Kapellen
- Division of Paediatric Diabetology, University of Leipzig, Leipzig, Germany
| | - Carlo L. Acerini
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
| | - Fiona Campbell
- Department of Paediatric Diabetes, Leeds Children´s Hospital, Leeds, United Kingdom
| | - Birgit Rami-Merhar
- Department of Pediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Roman Hovorka
- Wellcome Trust-Medical Research Council (MRC) Institute of Metabolic Science, University of Cambridge, Cambridge, United Kingdom
- Department of Pediatrics, University of Cambridge, Cambridge, United Kingdom
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Troncone A, Chianese A, Zanfardino A, Cascella C, Piscopo A, Borriello A, Rollato S, Casaburo F, Testa V, Iafusco D. Disordered eating behaviors in youths with type 1 diabetes during COVID-19 lockdown: an exploratory study. J Eat Disord 2020; 8:76. [PMID: 33292623 PMCID: PMC7708884 DOI: 10.1186/s40337-020-00353-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 11/20/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Recent research indicates that patients with type 1 diabetes (T1D) are at higher risk for disordered eating behaviors (DEBs) than their peers without diabetes. The present study aimed to explore the prevalence of DEBs in a sample of Italian children and adolescents with T1D and in matched-pair healthy controls during the COVID-19 lockdown. METHODS In a cross-sectional study, 138 children and adolescents with T1D (aged 8.01-19.11 years, 65 boys) attending a Southern Italian diabetic service and 276 age- and gender-matched healthy peers voluntarily completed an online survey about eating behaviors (ChEAT and EAT-26), anthropometric characteristics, and clinical characteristics. RESULTS 8.69% (N = 12) of participants with T1D and 13.4% (N = 37) of controls had ChEAT/EAT-26 scores indicating presence of DEBs, with no differences between patients-whether children (total ChEAT score F(1, 157) = .104, p = .748) or adolescents (total EAT-26 score F(1, 255) = .135, p = .731)-and healthy peers. zBMI values were lower than those measured in the latest diabetes visit (p < .0001), while HbA1c values remained unchanged (p = .110). In both groups, adolescents had lower Oral Control scores than children (T1D: F(1, 138) = 20.411, p < .0001, η2 = .132, controls: F(1, 276) = 18.271, p < .0001, η2 = .063); additionally, gender (female) and age were found to be significant predictors of several ChEAT/EAT-26 scores. CONCLUSIONS This exploratory study suggested that children and adolescents with T1D did not experience more DEB symptoms during the COVID-19 lockdown compared to healthy controls. Results revealed DEBs as more of a female adolescent developmental issue rather than a result of the challenges of living with a chronic illness under quarantine measures. Possible effects of parental pressure on their children's eating behaviors in the context of home confinement and of using a non-diabetes-specific measure to assess DEBs are discussed.
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Affiliation(s)
- Alda Troncone
- University of Campania "Luigi Vanvitelli", Caserta, Italy.
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy.
| | - Antonietta Chianese
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Crescenzo Cascella
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Alessia Piscopo
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Anna Borriello
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Serena Rollato
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Francesca Casaburo
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Veronica Testa
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
| | - Dario Iafusco
- University of Campania "Luigi Vanvitelli", Caserta, Italy
- Department of the Woman, of the Child and of the General and Specialized Surgery, Napoli, Italy
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Zaharieva DP, Addala A, Simmons KM, Maahs DM. Weight Management in Youth with Type 1 Diabetes and Obesity: Challenges and Possible Solutions. Curr Obes Rep 2020; 9:412-423. [PMID: 33108635 PMCID: PMC8087153 DOI: 10.1007/s13679-020-00411-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW This review highlights challenges associated with weight management in children and adolescents with type 1 diabetes (T1D). Our purpose is to propose potential solutions to improve weight outcomes in youth with T1D. RECENT FINDINGS A common barrier to weight management in T1D is reluctance to engage in exercise for fear of hypoglycemia. Healthcare practitioners generally provide limited guidance for insulin dosing and carbohydrate modifications to maintain stable glycemia during exercise. Adherence to dietary guidelines is associated with improved glycemia; however, youth struggle to meet recommendations. When psychosocial factors are addressed in combination with glucose trends, this often leads to successful T1D management. Newer medications also hold promise to potentially aid in glycemia and weight management, but further research is necessary. Properly addressing physical activity, nutrition, pharmacotherapy, and psychosocial factors while emphasizing weight management may reduce the likelihood of obesity development and its perpetuation in this population.
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Affiliation(s)
- Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
| | - Kimber M Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford, CA, USA
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Hilliard ME, Minard CG, Marrero DG, de Wit M, Thompson D, DuBose SN, Verdejo A, Monzavi R, Wadwa RP, Jaser SS, Anderson BJ. Assessing Health-Related Quality of Life in Children and Adolescents with Diabetes: Development and Psychometrics of the Type 1 Diabetes and Life (T1DAL) Measures. J Pediatr Psychol 2020; 45:328-339. [PMID: 31665389 DOI: 10.1093/jpepsy/jsz083] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To develop and validate new measures of diabetes-specific health-related quality of life (HRQOL) for people with type 1 diabetes (T1D) that are brief, developmentally appropriate, and usable in clinical research and care. Here we report on the phases of developing and validating the self-report Type 1 Diabetes and Life (T1DAL) measures for children (age 8-11) and adolescents (age 12-17). METHODS Measure development included qualitative interviews with youth and parents (n = 16 dyads) followed by piloting draft measures and conducting cognitive debriefing with youth (n = 9) to refine the measures. To evaluate the psychometric properties, children (n = 194) and adolescents (n = 257) at three T1D Exchange Clinic Network sites completed the age-appropriate T1DAL measure and previously validated questionnaires measuring related constructs. Using psychometric data, the investigators reduced the length of each T1DAL measure to 21 and 23 items, respectively, and conducted a final round of cognitive debriefing with six children and adolescents. RESULTS The T1DAL measures for children and adolescents demonstrated good internal consistency (α = 0.84 and 0.89, respectively) and test-retest reliability (r = 0.78 and 0.80, respectively). Significant correlations between the T1DAL scores and measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, and diabetes strengths demonstrated construct validity. Correlations with measures of self-management (child and adolescent) and glycemic control (adolescent only) demonstrated criterion validity. Factor analyses indicated four developmentally specific subscales per measure. Participants reported satisfaction with the measures. CONCLUSIONS The new T1DAL measures for children and adolescents with T1D are reliable, valid, and suitable for use in care settings and clinical research.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | | | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine
| | | | | | - Roshanak Monzavi
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
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Abstract
PURPOSE OF REVIEW Eating disorders represent one of the most common psychiatric disorders in adolescents with type 1 diabetes mellitus (T1DM), with a prevalence twice as high as in individuals without diabetes. The increased risk for acute and long-term medical complications and a three-fold mortality rate with this dual condition makes it extremely important to screen adolescents for eating disorders as soon as possible. RECENT FINDINGS A number of 13 surveys in the last two years focussed on prevalence rates of disordered eating and associations with sociodemographic, eating disorder-specific and diabetes-related factors in this population. Variations in study design, sample size, age range, sex, instruments to assess eating disorders and outcome make comparisons difficult. Healthcare professionals report challenges in detecting and treating adolescents with this dual condition because of a lack of validated screening tools, guidelines, and integration across specialist care. Studies on psychological treatments for the comorbidity of eating disorders and T1DM are scarce, especially for adolescents. SUMMARY The development and evaluation of psychological treatments for adolescents with eating disorders and T1DM are urgently needed.
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Sullivant SA, Bradley-Ewing A, Williams DD, McDonough R, Aguinaldo LD, Wharff EA, Horowitz LM, Goggin K. Prevalence of positive suicide risk screens among adolescents with type 1 diabetes (T1D). J Psychosom Res 2020; 138:110247. [PMID: 32971436 DOI: 10.1016/j.jpsychores.2020.110247] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/09/2020] [Accepted: 09/11/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Shayla A Sullivant
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Andrea Bradley-Ewing
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - David D Williams
- Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Ryan McDonough
- Division of Pediatric Endocrinology & Diabetes, Children's Mercy Kansas City, Kansas City, MO, USA.
| | - Laika D Aguinaldo
- Department of Psychiatry, University of California, San Diego, San Diego, CA, USA.
| | - Elizabeth A Wharff
- Department of Psychiatry, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Lisa M Horowitz
- Office of the Clinical Director, National Institute of Mental Health, Bethesda, MD, USA.
| | - Kathy Goggin
- Division of Health Services and Outcomes Research, Children's Mercy Kansas City, University of Missouri - Kansas City, Schools of Medicine and Pharmacy, Kansas City, MO, USA.
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Sarteau AC, Crandell J, Seid M, Kichler JC, Maahs DM, Wang J, Mayer-Davis E. Characterization of youth goal setting in the self-management of type 1 diabetes and associations with HbA1c: The Flexible Lifestyle Empowering Change trial. Pediatr Diabetes 2020; 21:1343-1352. [PMID: 32741045 PMCID: PMC7855488 DOI: 10.1111/pedi.13099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/05/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Youth with type 1 diabetes (T1D) commonly do not meet HbA1c targets. Youth-directed goal setting as a strategy to improve HbA1c has not been well characterized and associations between specific goal focus areas and glycemic control remain unexplored. OBJECTIVE To inform future trials, this analysis characterized intended focus areas of youth self-directed goals and examined associations with change in HbA1c over a 18 months. METHODS We inductively coded counseling session data from youth in the Flexible Lifestyle Empowering Change Intervention (n = 122, 13-16 years, T1D duration >1 year, HbA1c 8-13%) to categorize intended goal focus areas and examine associations between frequency of goal focus areas selected by youth and change in HbA1c between first and last study visit. RESULTS We identified 13 focus areas that categorized youth goal intentions. Each session where youth goal setting concurrently incorporated blood glucose monitoring (BGM), continuous glucose monitoring (CGM), and insulin dosing was associated with a 0.4% (95% CI: -0.77, -0.01; P = .03) lower HbA1c at the end of intervention participation. No association was observed between HbA1c and frequency of sessions where goal intentions focused on BG only (without addressing insulin or CGM) (β: 0.07; 95% CI: -0.07, 0.21; P = .33) nor insulin dosing only (without addressing BGM or CGM) (β: 0.00; 95% CI: -0.11, 0.10; P = .95). CONCLUSIONS Findings exemplify how guiding youth goal development and combining multiple behaviors proximally related to glycemic control into goal setting may benefit HbA1c among youth with T1D. More research characterizing optimal goal setting practices in youth with T1D is needed.
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Affiliation(s)
| | - Jamie Crandell
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Seid
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - Jessica C Kichler
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California,Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, California
| | - Jessica Wang
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina,School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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Eriksen TM, Gaulke A, Thingholm PR, Svensson J, Skipper N. Association of type 1 diabetes and school wellbeing: a population-based cohort study of 436,439 Danish schoolchildren. Diabetologia 2020; 63:2339-2348. [PMID: 32815027 DOI: 10.1007/s00125-020-05251-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/04/2020] [Indexed: 01/09/2023]
Abstract
AIMS/HYPOTHESIS We aimed to examine the association of type 1 diabetes with school wellbeing among Danish children. METHODS This is a population-based cohort study involving 436,439 Danish children, of which 1499 had a confirmed diagnosis of type 1 diabetes. The children were enrolled in grade levels 4 to 9 (middle school) in Danish public schools in the years 2014-2017. Questionnaire outcomes from the yearly National Wellbeing Survey related to self-efficacy, perceived competences, peer and teacher support, bullying and somatic symptoms were analysed. Ordered logistic regression was used to compare outcomes of children with and without type 1 diabetes, and to compare subgroups of children with type 1 diabetes by different levels of HbA1c and diabetes duration. Primary outcomes were answers to seven pre-specified questionnaire items (scale, 1 to 5). RESULTS A total of 817,679 questionnaires were initiated, of which n = 2681 were from children with type 1 diabetes. Compared with the background population, children with type 1 diabetes expressed more peer support; adjusted OR 1.17 (95% CI 1.08, 1.27). Children with diabetes also reported more often having a headache; adjusted OR 1.09 (95% CI 1.00, 1.19). Overall, children with poor glycaemic control (HbA1c >70 mmol/mol) had worse outcomes on the wellbeing measures compared with the background population. Even after adjusting for socioeconomic status, they still reported significantly worse perceived competences, less teacher support and more somatic symptoms (stomach ache and headache). CONCLUSIONS/INTERPRETATION In Denmark, children with type 1 diabetes generally feel well supported in school but have more headaches than other children. Poor glycaemic control is associated with worse psychological school-related wellbeing. Graphical abstract.
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Affiliation(s)
- Tine M Eriksen
- VIVE-The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Amanda Gaulke
- Department of Economics, Kansas State University, Manhattan, KS, USA
| | - Peter R Thingholm
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | | | - Niels Skipper
- Department of Economics and Business Economics, Centre for Integrated Register-based Research, CIRRAU, Aarhus University, Fuglesangs Allé 4, 8210, Aarhus V., Denmark.
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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DeCosta P, Grabowski D, Skinner TC. The psychosocial experience and needs of children newly diagnosed with type 1 diabetes from their own perspective: a systematic and narrative review. Diabet Med 2020; 37:1640-1652. [PMID: 32619028 DOI: 10.1111/dme.14354] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/25/2020] [Indexed: 01/09/2023]
Abstract
AIM To understand the psychosocial experience of children and identify their primary support needs following a type 1 diabetes diagnosis. METHODS A systematic review and narrative synthesis of the literature in this area was conducted. RESULTS A total of 32 studies were included in the review. At diagnosis, the majority of children experienced high distress, including grief, anxiety, anger, irritation and injection anxiety. The intensity of this reaction decreased rapidly over the following weeks. At diagnosis, rates of depressive symptoms, anxiety, stress disorders and suicidal ideation were elevated. The initial reaction tended to peak shortly after diagnosis and declined over the following year. Thereafter, symptoms of depression and anxiety appeared to increase once again, corresponding with the children's experience of diabetes management and implications as being more difficult and upsetting. Injection anxiety, distress and depressive symptoms persisted for a smaller group of children. CONCLUSION The initial high prevalence of depressive symptoms following diagnosis is transitional and should be regarded as a normal adaptive response. To facilitate this adaptive process, specific child-centred support should be prioritized as an integrated part of early diabetes care. Our findings point to five inter-related support needs following a type 1 diabetes diagnosis: (1) children need time to adjust to the diagnosis; (2) children need supportive relationships; (3) children need an opportunity for meaningful participation and appropriate protection; (4) children need to engage and explore; and (5) children need to feel supported, but not different.
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Affiliation(s)
- P DeCosta
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Diabetes Management Research, Gentofte, Copenhagen, Denmark
| | - D Grabowski
- Steno Diabetes Centre Copenhagen, Diabetes Management Research, Gentofte, Copenhagen, Denmark
| | - T C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Diabetes Management Research, Gentofte, Copenhagen, Denmark
- Department of Rural Health, La Trobe University, Bendigo, Vic., Australia
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Troncone A, Cascella C, Chianese A, Zanfardino A, Piscopo A, Borriello A, Casaburo F, Del Giudice EM, Iafusco D. Body Image Problems and Disordered Eating Behaviors in Italian Adolescents With and Without Type 1 Diabetes: An Examination With a Gender-Specific Body Image Measure. Front Psychol 2020; 11:556520. [PMID: 33071880 PMCID: PMC7538612 DOI: 10.3389/fpsyg.2020.556520] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 09/02/2020] [Indexed: 01/09/2023] Open
Abstract
Objective To examine body image problems and their associations with disordered eating behavior in adolescents with type 1 diabetes and well-matched healthy peers. Methods Using a cross-sectional design, 183 adolescents with type 1 diabetes (13.02–18.05 years) were recruited from diabetes centers in southern Italy and compared to healthy peers matched for age and gender. Participants completed self-report measures of disordered eating behaviors (DEPS-r and EDI-3RF) and a gender-specific body image problem questionnaire (SATAQ-4R). Socio-demographic and clinical data (zBMI, HbA1c, and disease duration) were also collected. Hierarchical multiple linear regression analyses were computed to determine the relative importance of diabetes variables and body image problems on participants’ disordered eating behaviors after controlling for demographic variables. Results Adolescents with type 1 diabetes showed diabetes-specific eating problems in 37.7% of cases and had more eating problem symptoms (assessed as drive for thinness and bulimia) than healthy peers. Male adolescents with type 1 diabetes did not display more body image problems (p > 0.05); females with type 1 diabetes compared to females in the control group were found to be more pressured by family (p = 0.025) but less by media (p = 0.022) to improve their appearance and attain a thin body. zBMI and body image problems contributed to a significant increase in disordered eating behavior risk both in male and female adolescents with diabetes and in healthy peers (zBMI 0.213 < β < 0.426, p < 0.05; body image 0.243 < β < 0.572, p < 0.05). None of the variables analyzed were found to significantly predict male bulimic symptoms (all β < 0.296, p > 0.05). Conclusion Since in adolescence type 1 diabetes and insulin therapy may increase the risk of weight gain and promote focus and attention on the body and thus contribute to the development of body image problems and disordered eating behaviors, continuity of medical, nutritional, and psychological care is needed.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Angela Zanfardino
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Alessia Piscopo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Anna Borriello
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Francesca Casaburo
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Emanuele Miraglia Del Giudice
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
| | - Dario Iafusco
- Department of Woman, Child and General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Napoli, Italy
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Chronic illness and transition from paediatric to adult care: a systematic review of illness specific clinical guidelines for transition in chronic illnesses that require specialist to specialist transfer. JOURNAL OF TRANSITION MEDICINE 2020. [DOI: 10.1515/jtm-2020-0001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AbstractIntroductionA quarter of a century has passed since the importance of transition from paediatric to adult care for chronically ill adolescents was highlighted by the American Society of Adolescent Health and Medicine. Despite discussions, the development of generic guidelines and some cohorting of age groups in paediatric speciality care, adolescents continue, unacceptably, to fall through the care gaps with negative clinical outcomes. Government bodies and international organisations have developed clinical practice guidelines (CPGs) for specific chronic physical illness although it remains unclear as to what extent these discuss transition from paediatric to adult care. This study systematically reviewed scientific and grey literature to determine how effectively transition has been incorporated into chronic illness specific CPGs.MethodsFive bibliographical databases; Medline, Embase, PsycINFO, CINAHL and Web of Science plus an extensive grey literature search from the internet were used to identify published guidelines between 2008 and 2018 using key words adolescents, transition, guidelines, together with the names of over 20 chronic physical illnesses which require specialist to specialist care after transitioning from paediatric care. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. In addition a measure of trustworthiness for CPGs was included. Guidelines were benchmarked against a published set of Australian transition principles embodying the comprehensive recommendations from National Institute for health and Care Excellence (NICE) transition guidelines discussing key transition aspects on: a systematic and formal transition process; early preparation; transition coordinators, good communication and collaboration between health professionals; individualised transition plan, enhancing self-management and active follow up after transition.ResultsInitially, 1055 articles were identified from the literature searches. Eight hundred and sixty eight articles were selected for title and abstract review. One hundred and seventy eight articles were included for full text review. Ultimately, 25 trustworthy CPGs were identified and included across 14 chronic physical illnesses. Five articles exclusively discussed illness specific transition recommendations and two included all the seven key transition principles. Three provided a minimal discussion of transition to adult care due to lack of high level evidence. Follow up and evaluation was the least addressed principle with recommendations in only seven CPGs.ConclusionsA limited number of chronic physical illnesses have illness specific CPGs that address transition from paediatric to adult care. The CPGs’ content emphasises the need for empirical data in order to develop quality transition recommendations for adolescents with chronic physical illness to ensure long term engagement and retention within health services.
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Sikorová L, Valiašková T. Psychometric properties of the Czech version of the tool - screening for early eating disorder signs (SEEDS-CZ). CENTRAL EUROPEAN JOURNAL OF NURSING AND MIDWIFERY 2020. [DOI: 10.15452/cejnm.2020.11.0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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Galler A, Hilgard D, Bollow E, Hermann T, Kretschmer N, Maier B, Mönkemöller K, Schiel R, Holl RW. Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control. Pediatr Diabetes 2020; 21:1050-1058. [PMID: 32506592 DOI: 10.1111/pedi.13065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/13/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. METHODS Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. RESULTS Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). CONCLUSIONS In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.
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Affiliation(s)
- Angela Galler
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | | | - Esther Bollow
- Institute for Epidemiology und Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
| | - Thomas Hermann
- Fachklinik Prinzregent Luitpold Scheidegg, Rehaklinik für Kinder und Jugendliche, Pädiatrische Diabetologie, Scheidegg, Germany
| | - Nicole Kretschmer
- AKK-Altonaer Kinderkrankenhaus gGmbH, Subsidiary of Universitätsklinikum Hamburg-Eppendorf (UKE), Paediatric Diabetology and Endocrinology and Child and Adolescent Psychiatry and Psychosomatics, Hamburg, Germany
| | - Berthold Maier
- Diabetes-Klinik Bad Mergentheim GmbH & Co. KG Bad Mergentheim, Kinder- und Jugend-Diabetologie, Bad Mergentheim, Germany
| | - Kirsten Mönkemöller
- Kliniken Köln, Kinderkrankenhaus Amsterdamer Straße, Klinik für Kinder- und Jugendmedizin, Pädiatrische Diabetologie, Köln, Germany
| | - Ralf Schiel
- MEDIGREIF Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Heringsdorf, Germany
| | - Reinhard W Holl
- Institute for Epidemiology und Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
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135
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Predieri B, Bruzzi P, Bigi E, Boncompagni A, Bocchi F, Cenciarelli V, Madeo SF, Poluzzi S, Pugliese M, Toffoli C, Lucaccioni L, Iughetti L. Health-related quality of life and metabolic control in immigrant and Italian children and adolescents with type 1 diabetes and in their parents. Pediatr Diabetes 2020; 21:1031-1042. [PMID: 32418308 DOI: 10.1111/pedi.13042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/23/2020] [Accepted: 05/08/2020] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To determine if the diabetes-specific health-related quality of life (D-HRQOL) of young people with type 1 diabetes (T1D) and their parents is influenced by migrant status. SUBJECTS AND METHODS One hundred and twenty-five patients (12.4 ± 3.55 years, males 53.6%) with T1D and their parents (102 mothers, 37 fathers) were enrolled and categorized into: group A (both foreign parents) and group B (both native Italian parents). The Pediatric Quality of Life Inventory™ 3.0 Diabetes Module (PedsQL™ 3.0 DM) was used to evaluate the D-HRQOL. Data on diabetic ketoacidosis (DKA) at T1D onset, insulin therapy, and glycosylate hemoglobin (HbA1c) were also collected. RESULTS Group A (n = 40), compared to group B (n = 85), had higher frequency of DKA at T1D onset (P < .001) and a lower use of sensor augmented insulin pump (P = .015). HbA1c values were higher in group A than in group B (P < .001). Patients' "Diabetes symptoms" (P = .004), "Treatment barriers" (P = .001), and "Worry" (P = .009) scales scores were lower in group A than in group B. Mothers of group A had lower scores in "Diabetes symptoms" (P = .030), "Treatment barriers" (P < .001), "Treatment adherence" (P = .018), "Communication" (P = .009) scales, and total score (P = .011) compared to the group B ones. High PedsQL™ 3.0 DM was significantly associated with being Italian, being prepubertal, and having lower HbA1c mean levels. CONCLUSIONS Being a migrant confers disadvantages in terms of D-HRQOL and metabolic control in children and adolescents with T1D. Specific educational interventions should be considered in the clinical care of patients with migration background, to improve D-HRQOL and health status.
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Affiliation(s)
- Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy.,Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Patrizia Bruzzi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Elena Bigi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Alessandra Boncompagni
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Federica Bocchi
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Cenciarelli
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Simona F Madeo
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Silvia Poluzzi
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Marisa Pugliese
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Carlotta Toffoli
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy
| | - Lorenzo Iughetti
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, Pediatric Unit - University of Modena and Reggio Emilia, Modena, Italy.,Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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136
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Jethwani P, Saboo B, Jethwani L, Kesavadev J, Kalra S, Sahay R, Agarwal S, Hasnani D. Management of children and adolescents having type 1 diabetes during COVID-19 pandemic in India: challenges and solutions. Int J Diabetes Dev Ctries 2020; 40:335-339. [PMID: 32952333 PMCID: PMC7490475 DOI: 10.1007/s13410-020-00865-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 08/19/2020] [Indexed: 01/09/2023] Open
Abstract
Purpose Type 1 diabetes (T1D) requires a holistic approach and continuous care. The current COVID-19 pandemic has made the health care professionals realise its challenges even more ardently than in the normal times. In a country like India with its huge population burden and a significant number of people having T1D, the risk of COVID-19 in people having T1DM is considerably high. Methods In this article, we are sharing our practical experiences of problems faced by children and adolescents having T1DM during the past 2 months of lockdown. Results We have classified the challenges into 3 broad categories based on diabetes self-management, healthcare system and psychosocial aspects. We have tried to provide precise, comprehensive and region specific solutions to these challenges. Solutions briefly include maintaining the supply chain of essentials like insulin, syringes and glucose meter strips to psychological support, financial aid and support for hospitalization in case of COVID-19 itself or diabetes complications including diabetic ketoacidosis. Conclusions Children and adolescents having T1DM require special care and attention during this period of COVID-19 pandemic because of various challenges as discussed. Our proposed solutions may help them overcome these problems and help them in better diabetes management during such emergency situations.
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Affiliation(s)
| | - B. Saboo
- Diacare-Diabetes Care & Hormone Clinic, Ahmedabad, India
| | - L. Jethwani
- Jethwani Hospital, 5-Junction Plot, Rajkot-1, India
| | - J. Kesavadev
- Jothydev’s Diabetes Research Center, Thiruvananthapuram, India
| | - S. Kalra
- Department of Endocrinology, Bharati Hospital, Karnal, India
| | - R. Sahay
- Department of Endocrinology, Osmania Medical College, Hyderabad, India
| | - S. Agarwal
- Department of Medicine, Ruby Hall Clinic, Pune, India
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137
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Bhatt P, Dave M, Amponsah JK, Jain A, Yagnik P, Asare-Afriyie B, Donda K, Sharma M, Parmar N, Patel A, Bhatt N, Lunsford AJ, Dapaah-Siakwan F. Etiologies, trends, and predictors of 30-day pediatric readmissions after hospitalizations for diabetic ketoacidosis in the United States. Pediatr Diabetes 2020; 21:969-978. [PMID: 32469429 DOI: 10.1111/pedi.13059] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To determine the causes, predictors, and trends of 30-day readmissions following hospitalizations for pediatric diabetic ketoacidosis (DKA) in the United States (US) from 2010 to 2014. RESEARCH DESIGN AND METHODS We used International Classification of Diseases, ninth revision, Clinical Modification codes to identify children with DKA aged 2 to 18 years from the National Readmission Database in the US. Patients who had readmission within 30 days after an index admission for DKA were included in the study. We combined similar diagnoses into clinically important categories to determine the cause of readmission. The primary outcome was all-cause 30-day (AC30) readmissions. Categorical and continuous variables were analyzed using chi-square or student's t-test or Wilcoxon rank sum tests respectively. We performed multivariable logistic regression to identify predictors of 30-day readmission. RESULTS From 2010 through 2014, a weighted total of 87 815 index DKA-related pediatric hospitalizations were identified of which, 4055 patients (4.6%) had AC30 readmissions and this remained unchanged during the study period. Of all the readmissions, 69% were attributed to DKA. In multivariable regression analysis, the odds of AC30 readmission and 30-day readmission attributed to DKA alone were increased for females, adolescents, patients with depression and psychosis, and discharge against medical advice, while private insurance, the highest income quartile, and admission at teaching hospitals were associated with lower odds of AC30 readmission and 30-day readmission attributed to DKA only. CONCLUSION We identified several factors associated with readmission after hospitalization for DKA. Addressing these factors such as depression may help lower readmissions after an admission for DKA.
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Affiliation(s)
- Parth Bhatt
- Department of Pediatrics, United Hospital Center, Bridgeport, West Virginia
| | - Mihir Dave
- Department of Internal Medicine, University of Nevada, Reno, Nevada
| | - Jason K Amponsah
- Department of Public Health, Emory School of Public Health, Atlanta, Georgia
| | - Apurva Jain
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas
| | - Priyank Yagnik
- Department of Pediatrics, University of Kansas School of Medicine, Wichita, Kansas
| | - Barbara Asare-Afriyie
- Department of Public Health, Tulane School of Public Health and Tropical Medicine, New Orleans, Louisiana
| | - Keyur Donda
- Department of Pediatrics, University South Florida, Tampa, Florida
| | - Mayank Sharma
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Narendrasinh Parmar
- Department of Pediatrics, Brookdale University Hospital Medical Center, Brooklyn, New York
| | - Achint Patel
- Department of Internal Medicine, University of Nevada, Reno, Nevada
| | - Neel Bhatt
- Department of Pediatrics, University of Washington, Seattle, Washington
| | - Alison J Lunsford
- Department of Pediatrics, Texas Tech University Health Sciences Center, Amarillo, Texas
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138
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Ayar D, Gürkan KP, Bektas M, Böber E, Abaci A. Psychometric properties of a Turkish version of the Collaborative Parent Involvement Scale for youths with type 1 diabetes. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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139
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Svensson J, Sildorf SM, Bøjstrup J, Kreiner S, Skrivarhaug T, Hanberger L, Petersson C, Åkesson K, Frøisland DH, Chaplin J. The DISABKIDS generic and diabetes-specific modules are valid but not directly comparable between Denmark, Sweden, and Norway. Pediatr Diabetes 2020; 21:900-908. [PMID: 32333631 DOI: 10.1111/pedi.13036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 03/31/2020] [Accepted: 04/06/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/OBJECTIVES Government guidance promote benchmarking comparing quality of care including both clinical values and patient reported outcome measures in young persons with type 1 diabetes. The aim was to test if the Nordic DISABKIDS health-related quality of life (HrQoL) modules were construct valid and measurement comparable within the three Nordic countries. METHODS Data from three DISABKIDS validation studies in Sweden, Denmark, and Norway were compared using Rasch and the graphical log-linear Rasch modeling. Monte Carlo methods were used to estimate reliability coefficient and target was defined as the point with the lowest SE of the mean. Self-report data were available from 99 Danish (8-18 years), 103 Norwegian (7-19 years), and 131 Swedish (8-18 years) young people. RESULTS For the DISABKIDS higher scores on most subscales were noted in the Norwegian population. The Swedish sample had a significantly higher score on the "Diabetes treatment" subscale and scores closer to optimal target than the other countries. For each country, construct validity and sensitivity were acceptable when accounting for differential item function (DIF) and local dependency (LD). Less LD and DIF were found if only Denmark and Norway were included. The combined model was reliable; however, some differences were noted in the scale translations relating to the stem and response alternatives, which could explain the discrepancies. CONCLUSION The Nordic versions of the DISABKIDS questionnaires measures valid and reliable HrQoL both within and between countries when adjusted for DIF and LD. Adjusting the Likert scales to the same respond categories may improve comparability.
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Affiliation(s)
- Jannet Svensson
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | | | - Julie Bøjstrup
- Pediatric Department, Herlev University Hospital, Herlev, Denmark
| | - Svend Kreiner
- Section of Biostatistics, Department of Public Health, Faculty of Health and Medical Sciences , University of Copenhagen, Copenhagen, Denmark
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, The Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lena Hanberger
- Division of Nursing Science, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Christina Petersson
- Department of Nursing Sciences, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Karin Åkesson
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.,Department of Pediatrics, Ryhov County Hospital, Jønkøping, Sweden
| | | | - John Chaplin
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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140
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Raile K, Boss K, Braune K, Heinrich-Rohr M. Versorgung von Kindern und Jugendlichen mit Typ-1-Diabetes: Lösungen für technische und psychosoziale Herausforderungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:856-863. [DOI: 10.1007/s00103-020-03162-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungDiabetes mellitus Typ 1 ist die häufigste endokrinologische Erkrankung bei Kindern und Jugendlichen unter 15 Jahren. Eine Heilungsperspektive bezüglich der Autoimmunreaktion gegen die insulinbildenden Betazellen ist weiterhin nicht in Sicht. Dennoch konnte durch technische Innovationsschübe bei Glukosesensoren, Insulinpumpen und Steuerungsalgorithmen innerhalb der letzten Jahre die Stoffwechselkontrolle optimiert werden. Diese Entwicklungen führen zusammen mit individuellen Diabetesschulungen und psychosozialer Unterstützung zu einer deutlichen Verbesserung der Versorgung.In diesem Übersichtsartikel wird die aktuelle Versorgungssituation von Kindern und Jugendlichen mit Typ-1-Diabetes sowie ihren Eltern dargestellt. In Deutschland ist die multidisziplinäre, spezialisierte Versorgung durch Teams aus Kinder- und Jugenddiabetolog*innen, Diabetesberater*innen, Sozialarbeiter*innen und Kinder- und Jugendpsychotherapeut*innen seit vielen Jahren etabliert und führt zu einer im internationalen Vergleich sehr guten Versorgungsqualität. Fokussiert werden die Diabetesschulung mit dem Schwerpunkt, das Selbstmanagement optimal zu unterstützen, die psychosoziale Begleitung und Intervention sowie die Inklusion in Schulen und Kindertagesstätten. Wir gehen außerdem auf neue soziale Entwicklungen der Diabetes-Online-Community ein. Ein aktuelles Beispiel ist die patientenbetriebene Bewegung „Do-It-Yourself Artificial Pancreas System“ (DIY-APS), die als Open-Source-Projekt mittlerweile Innovationsgeber auch für Medizinproduktehersteller ist. Zum Schluss beleuchten wir die damit verbundenen Chancen, aber auch die Verschiebung der klassischen Arzt-Patienten-Rollen.
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141
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Abstract
PURPOSE OF REVIEW This manuscript describes how person-reported outcomes (PROs) can be utilized in care for young people with diabetes in the context of motivation. RECENT FINDINGS The use of person-reported outcome measures (PROMS) in clinical care is feasible and acceptable, and helps focus the clinical encounter on life domains important to the person with diabetes. Results with regard to impact on self-management and glycemic outcomes are limited. Motivation is an important factor for self-management. Based on self-determination theory, autonomy-supportive, person-centered, and collaborative communication by diabetes care providers is associated with better outcomes. PROMs can facilitate this conversation. Understanding of youth motivation for maintaining or improving self-management behaviors requires a person-centered approach. PROMs can be used to facilitate an autonomy-supportive and person-centered conversation in clinical care. Training diabetes care providers in autonomy-supportive, person-centered conversation skills to discuss PROs might help to tap into youth's motivation, but further research is needed.
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Affiliation(s)
- Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
| | - Judith Versloot
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ian Zenlea
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Eveline R Goethals
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
- KU Leuven, Leuven, Belgium
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142
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Anarte MT, Carreira M, Leiva Gea A, Varela E, Mateo-Anarte M, López Siguero JP, Leiva Gea I. Diabetes Summer Camp in children and adolescents with type 1 diabetes: Effects on well-being and quality of life. ENDOCRINOL DIAB NUTR 2020; 67:326-332. [DOI: 10.1016/j.endinu.2019.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 07/26/2019] [Accepted: 08/16/2019] [Indexed: 01/09/2023]
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143
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Saßmann H, Dehn-Hindenberg A, Jördening M, Huhn F, Landgraf R, Lange K. Gestörtes Essverhalten und psychosoziale Versorgungssituation
junger Menschen mit Typ 1 Diabetes. Psychother Psychosom Med Psychol 2020; 70:449-456. [DOI: 10.1055/a-1142-6705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Zusammenfassung
Einleitung Gestörtes Essverhalten oder klinisch relevante
Essstörungen in Verbindung mit Typ 1 Diabetes haben schwerwiegende
Folgen für die Qualität der Stoffwechseleinstellung und die
langfristige gesundheitliche Prognose Betroffener. Eine frühzeitige
Diagnose und qualifizierte therapeutische Interventionen können bereits
bei gestörtem Essverhalten dazu beitragen, vorzeitige
mikrovaskuläre Schädigungen zu vermeiden. In dieser Studie
wurden für eine Gruppe junger Menschen mit Typ 1 Diabetes, die an einem
4-tägigen Camp teilnahmen, die Prävalenz essgestörten
Verhaltens und die spezifische psychosoziale Versorgungssituation
untersucht.
Material und Methoden Während eines bundesweit ausgeschriebenen
Diabetescamps für junge Menschen (16–29 Jahre) beantworteten die
Teilnehmenden Fragen zu ihrer aktuellen Diabetesbehandlung, zu
diabetesspezifischen Belastungen (PAID-5) sowie zur psychosozialen Versorgung im
Rahmen der ambulanten Langzeittherapie. Symptome gestörten Essverhaltens
wurden mit einem diabetesspezifischen Screeningfragebogen, dem Diabetes Eating
Problem Survey-Revised (DEPS-R), erhoben. Eine lineare multiple Regression wurde
berechnet, um Prädiktoren gestörten Essverhaltens zu
identifizieren.
Ergebnisse An der Umfrage beteiligten sich 308 junge Menschen mit Typ 1
Diabetes (Alter 21,4±3,4 Jahre; 73% weiblich; Diabetesdauer
10,2±5,9 Jahre; 74% in internistischer Behandlung). Bei
28,2% der Befragten ergaben sich Hinweise auf ein gestörtes
Essverhalten (17% der Männer, 32% der Frauen).
Teilnehmende mit einem auffälligen Summenwert im DEPS-R wurden nur zu
7% entsprechend psychologisch betreut. Das HbA1c, der BMI, die
diabetesspezifischen Belastungen, das Alter, die Diabetesdauer sowie das
Geschlecht erwiesen sich als signifikante Prädiktoren für das
Ausmaß gestörten Essverhaltens.
Diskussion Unter den Teilnehmenden eines Diabetescamps für junge
Menschen zeigten sich bei über einem Viertel Hinweise auf ein
gestörtes Essverhalten. Insgesamt waren davon junge Frauen
häufiger betroffen, weitere relevante Risikofaktoren waren ein
erhöhter BMI, ein höheres HbA1c und stärkere
diabetesspezifische Belastungen. Nur ein sehr geringer Anteil der jungen
Menschen mit Typ 1 Diabetes und gestörtem Essverhalten erhielt
psychologische Unterstützung.
Schlussfolgerung In der ambulanten diabetologischen Versorgung sollten
diabetesspezifische Screeninginstrumente und/oder gezielte
Screeningfragen insbesondere bei jungen Frauen regelmäßig
eingesetzt und die Ergebnisse mit den Betroffenen im Hinblick auf eine
weiterführende Behandlung besprochen werden.
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Affiliation(s)
- Heike Saßmann
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | | | - Mia Jördening
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Friederike Huhn
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
| | - Rüdiger Landgraf
- Bevollmächtigter des Vorstands, Deutsche Diabetes Stiftung,
München
| | - Karin Lange
- Forschungs- und Lehreinheit Medizinische Psychologie, Medizinische
Hochschule Hannover
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van Duinkerken E, Snoek FJ, de Wit M. The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Diabet Med 2020; 37:555-563. [PMID: 31850538 PMCID: PMC7154747 DOI: 10.1111/dme.14216] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 01/09/2023]
Abstract
Across the lifespan, type 1 diabetes mellitus has a profound (neuro)psychological impact. In young people, type 1 diabetes can interfere with psychosocial development and hamper school performance. In adulthood, it can interfere with work life, relationships and parenting. A substantial minority of adults with type 1 diabetes experience coping difficulties and high diabetes-related distress. In youth and adulthood, type 1 diabetes is related to mild cognitive decrements as well as affective disorders, such as depression and anxiety. There is limited literature available that explores the interaction between cognitive and psychological comorbidity and underlying mechanisms. The aims of the present narrative review were to summarize the current state of the literature regarding both cognitive and psychological comorbidities in type 1 diabetes across the lifespan, and to explore potential links between the two domains of interest to make suggestions for future research and clinical practice.
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Affiliation(s)
- E. van Duinkerken
- Epilepsy CentreInstituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroRJBrazil
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
- Amsterdam Diabetes Centre/Department of Internal MedicineAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| | - F. J. Snoek
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| | - M. de Wit
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
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145
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Morrissey EC, Casey B, Dinneen SF, Lowry M, Byrne M. Diabetes Distress in Adolescents and Young Adults Living With Type 1 Diabetes. Can J Diabetes 2020; 44:537-540. [PMID: 32507646 DOI: 10.1016/j.jcjd.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/05/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Galway, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland.
| | - Blathin Casey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, Ireland; Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
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146
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Abstract
The term 'diabetes distress' first entered the psychosocial research vernacular in 1995, and refers to 'the negative emotional or affective experience resulting from the challenge of living with the demands of diabetes'. At first the proponents of the concept were hesitant in advocating that diabetes distress was a major barrier to individuals' self-care and management of diabetes. Since then, a burgeoning body of evidence, now including several systematic reviews of intervention studies, suggests that diabetes distress, in both type 1 and type 2 diabetes, across ages and in all countries and cultures where it has been studied, is common and can be a barrier to optimal emotional well-being, self-care and management of diabetes. As a consequence, monitoring diabetes distress as part of routine clinical care is part of many national guidelines. The present narrative review summarizes this research and related literature, to postulate the aetiology of diabetes distress, and thus how it may be prevented. The current evidence base for the management of diabetes distress is summarized, and the next steps in the prevention and management of diabetes distress identified.
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Affiliation(s)
- T C Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - L Joensen
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - T Parkin
- School of Health Professions, University of Plymouth, Plymouth, UK
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147
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Mann EA, Binder AT, Young HN, Moreno MA, Cox ED. Factors associated with health psychology use in pediatric type 1 diabetes. Diabetes Res Clin Pract 2020; 161:108071. [PMID: 32057961 PMCID: PMC7078029 DOI: 10.1016/j.diabres.2020.108071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 11/14/2019] [Accepted: 02/10/2020] [Indexed: 01/09/2023]
Abstract
AIMS Identify the prevalence of health psychology use in children with type 1 diabetes (T1D) and evaluate how individual and contextual characteristics are associated with use. METHODS Children ages 8-16 years with T1D and their parents were recruited from two tertiary diabetes clinics. Cross-sectional data included parent and adolescent surveys and hemoglobin A1c. Parents self-reported the child's use of health psychology in the last year along with individual factors (e.g., predisposing factors including demographics, enabling factors including health insurance type, evaluated need including mental health diagnoses and perceived need including self-management barriers). Association of health psychology use with individual (e.g., demographics, enabling factors, evaluated and perceived need) and contextual (e.g., clinical site) characteristics was evaluated using logistic regression. RESULTS Of 363 eligible participants, 267 (74%) participated. Health psychology use was reported by only 8.2% (n = 22) of participants and was significantly associated with evaluated need factor of mental health diagnosis (OR 5.8; p < 0.001) and perceived need factor of parent-reported self-management barriers. Use was not associated with other individual or contextual factors. CONCLUSIONS Though infrequent, health psychology use was positively associated with mental health diagnoses and self-management barriers.
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Affiliation(s)
- Elizabeth A Mann
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA.
| | - Alex T Binder
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Henry N Young
- Department of Clinical and Administrative Pharmacy, University of Georgia, Athens, GA, USA
| | - Megan A Moreno
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
| | - Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA; Department of Population Health Sciences, University of Wisconsin-Madison, School of Medicine and Public Health, Madison, WI, USA
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148
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Corathers SD, DeSalvo DJ. Therapeutic Inertia in Pediatric Diabetes: Challenges to and Strategies for Overcoming Acceptance of the Status Quo. Diabetes Spectr 2020; 33:22-30. [PMID: 32116450 PMCID: PMC7026749 DOI: 10.2337/ds19-0017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Despite significant advances in therapies for pediatric type 1 diabetes, achievement of glycemic targets remains elusive, and management remains burdensome for patients and their families. This article identifies common challenges in diabetes management at the patient-provider and health care system levels and proposes practical approaches to overcoming therapeutic inertia to enhance health outcomes for youth with type 1 diabetes.
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Affiliation(s)
- Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH
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149
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Predieri B, Leo F, Candia F, Lucaccioni L, Madeo SF, Pugliese M, Vivaccia V, Bruzzi P, Iughetti L. Glycemic Control Improvement in Italian Children and Adolescents With Type 1 Diabetes Followed Through Telemedicine During Lockdown Due to the COVID-19 Pandemic. Front Endocrinol (Lausanne) 2020; 11:595735. [PMID: 33424771 PMCID: PMC7793913 DOI: 10.3389/fendo.2020.595735] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Accepted: 11/11/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND/OBJECTIVE To minimize the wide spread of coronavirus disease (COVID-19) pandemic, Italy was placed in an almost complete lockdown state that forced people to "stay at home". Aim of this study was to evaluate the effects of lockdown on glycemic control in children and adolescents with type 1 diabetes (T1D) followed through telemedicine. SUBJECTS/METHODS This observational study involved patients with T1D using the real-time continuous glucose monitoring (CGM) Dexcom G6®. Ambulatory glucose profile data from the 3-months before schools closure (November 26, 2019-February 23, 2020; T0) and from the 3-months of consecutive lockdown (February 24-May 18, 2020; T1) were compared. RESULTS Sixty-two children and adolescents (11.1 ± 4.37 years, 50% males) with T1D (median time disease 3.67 years) were enrolled in the study. Insulin total daily dose was unchanged, while time spent on physical activities was decreased (p<0.0001). Despite the lack of statistical significance, median value of the glucose management indicator decreased from 7.4% to 7.25%. Glucose standard deviation (p<0.0001) and coefficient of variation (p=0.001) improved across the study. Median time in range increased from 60.5% to 63.5% (p=0.008), time above range decreased from 37.3% to 34.1% (p=0.048), and time below range decreased from 1.85% to 1.45% (p=0.001). CONCLUSIONS Overall, in our children and adolescents with T1D glycemic control improved during lockdown. Despite patients were confined to their homes and limited to exercise, our data suggest that the use of real-time CGM, the continuous parental management, and the telemedicine can display beneficial effects on T1D care.
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Affiliation(s)
- Barbara Predieri
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- *Correspondence: Barbara Predieri,
| | - Francesco Leo
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Francesco Candia
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Laura Lucaccioni
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Simona F. Madeo
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Marisa Pugliese
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Valentina Vivaccia
- Department of Metabolic Diseases and Clinical Nutrition, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Patrizia Bruzzi
- Pediatric Unit, Department of Pediatrics, Azienda Ospedaliero-Universitaria Policlinic, Modena, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
- Post-Graduate School of Pediatrics, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
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150
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Whittemore R, Coleman J, Delvy R, Zincavage R, Ambrosoli JA, Shi L, Kato B, Marceau L. An eHealth Program for Parents of Adolescents With T1DM Improves Parenting Stress: A Randomized Control Trial. DIABETES EDUCATOR 2019; 46:62-72. [PMID: 31808376 DOI: 10.1177/0145721719890372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the short-term effects of the Type 1 Teamwork program for parents of adolescents with type 1 diabetes mellitus (T1DM) on the primary outcome of psychosocial stress. METHODS The study was a randomized wait-list control trial evaluating an eHealth program to reduce parenting stress around T1DM management during adolescence through interactive sessions on the safe transfer of responsibility, positive communication, and stress management. The primary outcome was psychosocial stress (parenting stress specific to child illness and general stress). Secondary outcomes included depressive and anxiety symptoms, parent support for adolescent autonomy, family conflict, and adolescent metabolic control (A1C). Data were collected at baseline, 3 months, and 6 months online. Mixed-model analyses were conducted, using intent-to-treat procedures. RESULTS Parents (n = 162) had a mean age of 45.6 (±5.3) years, were 98% female, 91% white, 91% married/partnered, 51% of high income, and geographically dispersed around the United States. Parents reported that adolescents had a mean A1C of 7.9% (±1.2%) and T1DM duration of 5.08 (±3.62) years. At 6 months, parents in the Type 1 Teamwork group demonstrated less parenting stress compared with the control group. There were no differences between groups on general stress or secondary outcomes. Attrition at 6 months was 32% in the treatment group and 11% in the control group. CONCLUSIONS An eHealth program for parents of adolescents with T1DM improves parenting stress in a sample of parents from across the United States.
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Affiliation(s)
| | | | | | | | | | - Ling Shi
- HealthCore, Inc, Watertown, Massachusetts
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