101
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Shalitin S, Chase HP. Diabetes technology and therapy in the pediatric age group. Diabetes Technol Ther 2015; 17 Suppl 1:S96-S108. [PMID: 25679436 DOI: 10.1089/dia.2015.1512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shlomit Shalitin
- 1 Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
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102
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Miller VA, Jawad AF. Relationship of youth involvement in diabetes-related decisions to treatment adherence. J Clin Psychol Med Settings 2015; 21:183-9. [PMID: 24659299 DOI: 10.1007/s10880-014-9388-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
The aim of this study was to examine the relationship of youth's involvement in diabetes-related decisions to adherence. Children and adolescents (8-19 years) and their parents (N = 89) completed the Decision Making Involvement Scale and the Self Care Inventory, a self-report measure of adherence. After controlling for youth age, the degree to which youth expressed an opinion and information to parents was associated with better parent- and youth-reported adherence. The degree to which parents expressed an opinion and information to youth was associated with worse parent-reported adherence. Joint decision-making behaviors (e.g., negotiation; provision of options) also were associated with better youth-reported adherence. Encouraging youth to express opinions and share illness-related information with parents during illness management discussions may improve adherence. Additional research is needed to identify mechanisms of effect and determine associations between decision making involvement and health behaviors and outcomes over time.
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103
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Amed S, Nuernberger K, Reimer K, Krueger H, Aydede SK, Ayers D, Collet JP. Care delivery in youth with type 2 diabetes - are we meeting clinical practice guidelines? Pediatr Diabetes 2014; 15:477-83. [PMID: 24888460 DOI: 10.1111/pedi.12147] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 02/14/2014] [Accepted: 03/26/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Studies indicate high rates of treatment failure and early onset diabetes-related complications in youth-onset type 2 diabetes (T2D). We aim to describe the quality of care provided to children and youth with T2D. METHODS This prospective cohort study used administrative datasets to describe individuals aged 10-24 yr diagnosed with T2D at <20 yr of age (488 individuals; 2111 person-years). The primary outcome was being 'at goal' for adherence to Canadian clinical practice guidelines (CPGs). This was defined as having either optimal [three diabetes-related physician visits/year, three hemoglobin A1C (A1C) tests/year, and all recommended screening tests for complications (i.e., retinopathy, nephropathy)] or good (two diabetes-related physician visits/year, two A1C tests/year, and at least two screening tests) adherence to CPGs. Descriptive statistics and logistic regression modeling were used. RESULTS Sixty eight percentage person-years had poor adherence to CPGs (<2 physician visits and A1c tests/year and no screening tests). Only 29% and 25% were at goal for adherence in the 15-19 and 20-24 yr age groups, respectively. There was a 52% decreased odds of being at goal for adherence 4 yr after diagnosis of T2D (p < 0.001). For every year increase in age at diagnosis, there was a 5% decreased odds of being at goal (p = 0.04). CONCLUSIONS Youth with T2D are not receiving high quality care, and older youth and young adults are particularly at risk. Future research is needed to understand the effectiveness of care in the context of poor adherence as well as patient, physician, and health system factors that might improve adherence.
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Affiliation(s)
- Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; BC Children's Hospital, Vancouver, BC, Canada
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104
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Modi AC, Wu YP, Rausch JR, Peugh JL, Glauser TA. Antiepileptic drug nonadherence predicts pediatric epilepsy seizure outcomes. Neurology 2014; 83:2085-90. [PMID: 25355825 DOI: 10.1212/wnl.0000000000001023] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE The aim of the study was to determine sociodemographic, biological epilepsy-specific, and adherence predictors of long-term pediatric seizure outcomes. METHODS This study is a prospective, longitudinal, observational study of antiepileptic drug (AED) adherence and seizure outcomes in children with newly diagnosed epilepsy. Patients were recruited from April 2006 to March 2009 and followed for 2 years. Objective, electronic monitors were used to assess AED adherence. Medical chart reviews assessed medical variables and seizure outcomes. RESULTS Participants (n = 109) were 7.3 ± 2.9 years of age, and 62% male. Four adherence trajectory groups were identified: severe early nonadherence (n = 10), variable nonadherence (n = 16), moderate nonadherence (n = 40), and high adherence (n = 43). Two seizure probability trajectory groups were identified: high seizure (n = 28) and low seizure probability (n = 81). Participants with recognizable syndromes were less likely to be a member of the high seizure probability group (b = -2.372; odds ratio [OR] = 0.093; 95% confidence interval [CI]OR = 0.015, 0.595); those with the presence of epileptiform discharges on EEG were more likely to be in the high seizure probability group (b = 1.649; OR = 5.203; 95% CIOR = 1.422, 19.037). Adherence trajectory group status was a significant predictor of seizure trajectory group status (partial max-rescaled R(2) = 0.13). CONCLUSIONS Adherence trajectories and 2 biological epilepsy-specific variables explain a similar proportion of the variability in longitudinal seizure outcomes. The relationship between AED nonadherence and seizure outcomes is not linear. Early adherence interventions could change the course of seizure outcomes, particularly if variability in adherence was minimized postdiagnosis.
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Affiliation(s)
- Avani C Modi
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH.
| | - Yelena P Wu
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Joseph R Rausch
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
| | - James L Peugh
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
| | - Tracy A Glauser
- From the Division of Behavioral Medicine and Clinical Psychology, Center for Treatment Adherence and Self-Management (A.C.M., Y.P.W.); Division of Behavioral Medicine and Clinical Psychology (J.R.R., J.L.P.); and Division of Neurology (T.A.G.), Cincinnati Children's Hospital Medical Center; and Department of Pediatrics (A.C.M., J.R.R., J.L.P., T.A.G.), University of Cincinnati College of Medicine, Cincinnati, OH
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105
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Patton SR, DeLurgio SA, Fridlington A, Cohoon C, Turpin AL, Clements MA. Frequency of mealtime insulin bolus predicts glycated hemoglobin in youths with type 1 diabetes. Diabetes Technol Ther 2014; 16:519-23. [PMID: 24773597 PMCID: PMC4172563 DOI: 10.1089/dia.2013.0356] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Within pediatric diabetes management, two electronic measures of adherence exist: frequency of daily blood glucose monitoring (BGM) and the BOLUS score, a measure of frequency of mealtime insulin bolusing. Past research has demonstrated that the BOLUS score is superior to daily BGM in predicting youths' glycated hemoglobin (HbA1c) in a cross-sectional study. We present data comparing the two adherence measures in predicting HbA1c using a prospective, longitudinal design. SUBJECTS AND METHODS Blood glucose meter data and insulin pump records were collected from a clinical database of 175 youths with type 1 diabetes (mean age, 11.7 ± 3.6 years at baseline). Youths' HbA1c levels occurring at the download time and at 3, 6, 9, and 12 months post-downloads were also collected. We calculated youths' mean BGM and BOLUS score using a standardized protocol. RESULTS Intraclass correlations (ICCs) revealed significant absolute equivalence between youths' predicted HbA1c values using BOLUS and BGM scores and future actual HbA1c values up to 12 months post-download. However, the ICCs of BOLUS scores with future HbA1c values were consistently higher than those of the BGM scores. Also, the predictions of the BOLUS scores were significantly more accurate (P ≤ 0.002) than those of the BGM scores based on the root mean squared error of predictions. CONCLUSIONS In a prospective, longitudinal design, youths' BOLUS scores were superior to youths' daily BGM in predicting future values of HbA1c. Calculating a BOLUS score versus BGM can help researchers and clinicians achieve a better prediction of youths' HbA1c.
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Affiliation(s)
- Susana R. Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Stephen A. DeLurgio
- Health Outcomes Research Department, Children's Mercy Hospital, Kansas City, Missouri
| | - Amanda Fridlington
- Division of Endocrinology, Children's Mercy Hospital, Kansas City, Missouri
| | - Cyndy Cohoon
- Division of Endocrinology, Children's Mercy Hospital, Kansas City, Missouri
| | - Angela L. Turpin
- Division of Endocrinology, Children's Mercy Hospital, Kansas City, Missouri
| | - Mark A. Clements
- Division of Endocrinology, Children's Mercy Hospital, Kansas City, Missouri
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106
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Hawkes CP, McDarby V, Cody D. Fear of hypoglycemia in parents of children with type 1 diabetes. J Paediatr Child Health 2014; 50:639-42. [PMID: 24953343 DOI: 10.1111/jpc.12621] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2014] [Indexed: 11/26/2022]
Abstract
AIM The aim of this study is to determine if parental hypoglycaemia fear is associated with worse glycaemic control and increased resource utilisation and to identify risk factors for increased hypoglycaemia fear. METHODS Parents of children with diabetes completed a modified Hypoglycaemia Fear Survey. Demographic data, phone contacts and mean glycosylated haemoglobin A1c (HbA1c) were also recorded over a 1 year study period. RESULTS A total of 106 parents participated. Mean patient age was 11.1 years, and duration of diabetes was 4.8 years. Fifty-two per cent were male, and 48% were on insulin pump therapy. Fear of hypoglycaemia was highest among parents of 6- to 11-year-olds. Parents of children with HbA1c less than 7.5% had less hypoglycaemia fear. Previous seizures and increased frequency of phone calls to the diabetes team were not associated with increased fear. CONCLUSION Fear of hypoglycaemia is associated with worse glycaemic control. It is highest among parents of 6- to 11-year-olds but is not affected by previous severe hypoglycaemia or associated with increased contact with the diabetes team.
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107
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Koster ES, Philbert D, Winters NA, Bouvy ML. Medication adherence in adolescents in current practice: community pharmacy staff's opinions. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2014; 23:221-4. [PMID: 25047137 DOI: 10.1111/ijpp.12137] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 06/25/2014] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore pharmacy staff's perspectives regarding medication use behaviour in adolescent patients. METHODS Structured face-to-face interviews were conducted with 170 community pharmacy staff members. KEY FINDINGS Medication-related problems in adolescents had been experienced by 80 respondents; non-adherence was frequently mentioned (n = 73). An important reason for medication-related problems in adolescents not being recognised was that prescriptions are often collected by the parents (with or without the teenager). Solutions suggested by the interviewees to improve adolescents' medication use behaviour included (improving) counselling with emphasis on necessity/benefits of medication (n = 130) and more direct contact with adolescents instead of parent(s) (n = 77). Use of digital media for educational purposes or reminder services was suggested to support medication use (n = 67). CONCLUSIONS Almost half of pharmacy staff experienced problems related to medication use in adolescents. Pharmacy staff see a primary role for counselling on the benefits of therapy but foresee difficulties in obtaining direct contact with adolescents. Use of new media could be useful.
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Affiliation(s)
- Ellen S Koster
- Utrecht Pharmacy Practice Network for Education and Research, Utrecht Institute of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands
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108
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Affiliation(s)
| | - Mary S Burr
- University of Maryland School of Nursing, Baltimore, MD
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109
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Berg CA, Hughes AE, King PS, Korbel C, Fortenberry KT, Donaldson D, Foster C, Swinyard M, Wiebe DJ. Self-Control as a Mediator of the Link Between Intelligence and HbA1c During Adolescence. CHILDRENS HEALTH CARE 2014. [DOI: 10.1080/02739615.2013.837819] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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110
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Shalitin S, Chase HP. Diabetes technology and therapy in the pediatric age group. Diabetes Technol Ther 2014; 16 Suppl 1:S100-9. [PMID: 24479590 DOI: 10.1089/dia.2014.1512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Shlomit Shalitin
- 1 Jesse Z and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel , Petah Tikva, Israel
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111
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Wu YP, Rausch J, Rohan JM, Hood KK, Pendley JS, Delamater A, Drotar D. Autonomy support and responsibility-sharing predict blood glucose monitoring frequency among youth with diabetes. Health Psychol 2014; 33:1224-31. [PMID: 24467252 DOI: 10.1037/hea0000034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Adolescence poses a number of special challenges for youth and their families managing the Type 1 diabetes medical regimen. Little is known on how family and youth factors and management of the regimen change over the course of early adolescence and predict adherence to the regimen during this developmental period. METHODS Youth with Type 1 diabetes (n = 239) and their maternal caregivers completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency (BGMF) at 4 timepoints over a 3-year period. RESULTS Autonomy support and BGMF significantly decreased over time and responsibility for the diabetes regimen shifted from the caregiver toward youth over time. Significant changes in perceived family conflict over time differed depending on the reporter. Baseline BGMF, changes in caregiver autonomy support, and changes in responsibility for the regimen significantly predicted changes in BGMF over time. CONCLUSIONS This study documents changes in autonomy support, youth responsibility for the diabetes regimen, and BGMF during the transition into early adolescence. Higher levels of caregiver autonomy support preserve BGMF during a developmental period in which BGMF typically deteriorates.
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Affiliation(s)
- Yelena P Wu
- Center for Treatment Adherence and Self-Management
| | - Joseph Rausch
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Jennifer M Rohan
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center
| | - Korey K Hood
- Madison Clinic for Pediatric Diabetes, Division of Endocrinology, Department of Pediatrics, University of California
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112
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Chung WW, Chua SS, Lai PSM, Chan SP. Effects of a pharmaceutical care model on medication adherence and glycemic control of people with type 2 diabetes. Patient Prefer Adherence 2014; 8:1185-94. [PMID: 25214772 PMCID: PMC4159395 DOI: 10.2147/ppa.s66619] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Diabetes mellitus is a lifelong chronic condition that requires self-management. Lifestyle modification and adherence to antidiabetes medications are the major determinants of therapeutic success in the management of diabetes. PURPOSE To assess the effects of a pharmaceutical care (PC) model on medication adherence and glycemic levels of people with type 2 diabetes mellitus. PATIENTS AND METHODS A total of 241 people with type 2 diabetes were recruited from a major teaching hospital in Malaysia and allocated at random to the control (n=121) or intervention (n=120) groups. Participants in the intervention group received PC from an experienced pharmacist, whereas those in the control group were provided the standard pharmacy service. Medication adherence was assessed using the Malaysian Medication Adherence Scale, and glycemic levels (glycated hemoglobin values and fasting blood glucose [FBG]) of participants were obtained at baseline and after 4, 8, and 12 months. RESULTS At baseline, there were no significant differences in demographic data, medication adherence, and glycemic levels between participants in the control and intervention groups. However, statistically significant differences in FBG and glycated hemoglobin values were observed between the control and intervention groups at months 4, 8, and 12 after the provision of PC (median FBG, 9.0 versus 7.2 mmol/L [P<0.001]; median glycated hemoglobin level, 9.1% versus 8.0% [P<0.001] at 12 months). Medication adherence was also significantly associated with the provision of PC, with a higher proportion in the intervention group than in the control group achieving it (75.0% versus 58.7%; P=0.007). CONCLUSION The provision of PC has positive effects on medication adherence as well as the glycemic control of people with type 2 diabetes. Therefore, the PC model used in this study should be duplicated in other health care settings for the benefit of more patients with type 2 diabetes.
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Affiliation(s)
- Wen Wei Chung
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Pharmacy Department, University Malaya Medical Centre, Kuala Lumpur, Malaysia
| | - Siew Siang Chua
- Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pauline Siew Mei Lai
- Department of Primary Care Medicine, University Malaya Primary Care Research Group, Kuala Lumpur, Malaysia
| | - Siew Pheng Chan
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Correspondence: Siew Siang Chua, Department of Pharmacy, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia, Tel +60 3 7967 6688, Fax +60 3 7967 4964, Email
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113
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Rohan JM, Rausch JR, Pendley JS, Delamater AM, Dolan L, Reeves G, Drotar D. Identification and prediction of group-based glycemic control trajectories during the transition to adolescence. Health Psychol 2013; 33:1143-52. [PMID: 24274797 DOI: 10.1037/hea0000025] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To identify trajectories of glycemic control over a period of 3 years in a pediatric sample of youth diagnosed with Type 1 diabetes transitioning to adolescence. A second aim was to examine a set of modifiable individual and family level baseline predictors of glycemic control group membership. METHODS This multisite, prospective study included 239 children and adolescents (ages 9-11 years at baseline) diagnosed with Type 1 diabetes and their caregivers. Glycemic control was based on hemoglobin A1c (HbA1c) collected at 6-month intervals over a period of 3 years. Predictors of glycemic control membership included baseline global executive functioning, diabetes self-management, diabetes-specific family conflict, blood glucose monitoring frequency, and relevant individual and family level covariates. RESULTS Group-based trajectory analyses were used to describe patterns of glycemic control from baseline to 36 months and 3 trajectories were identified: low risk (42.9%), elevated risk (44.6%), and high risk (12.1%) subgroups. Baseline maternal-reported family conflict, blood glucose monitoring frequency, and gender were significant predictors of glycemic control group membership. Higher levels of baseline family conflict, lower frequency of blood glucose monitoring, and female gender were associated with elevated and high-risk group membership. CONCLUSIONS These findings underscore the importance of examining trajectories of HbA1c across time. These results suggest that problematic trajectories of glycemic control are evident during the transition to adolescence. Furthermore, there are modifiable individual and family level characteristics that predict group membership and hence could be targeted in interventions to ensure adequate glycemic control is maintained over time and that risks for diabetes-related complications are reduced.
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Affiliation(s)
- Jennifer M Rohan
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | - Joseph R Rausch
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
| | | | | | - Lawrence Dolan
- Department of Endocrinology, Cincinnati Children's Hospital Medical Center
| | - Grafton Reeves
- Division of Pediatric Endocrinology, Alfred I. DuPont Hospital for Children
| | - Dennis Drotar
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center
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114
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Early adolescent predictors of health in emerging adulthood: a comment on Helgeson et al. Ann Behav Med 2013; 47:255-6. [PMID: 24254461 DOI: 10.1007/s12160-013-9564-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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115
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Hilliard ME, Rohan JM, Rausch JR, Delamater A, Pendley JS, Drotar D. Patterns and predictors of paternal involvement in early adolescents' type 1 diabetes management over 3 years. J Pediatr Psychol 2013; 39:74-83. [PMID: 24013966 DOI: 10.1093/jpepsy/jst067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To document trajectories of paternal involvement in diabetes management and examine bidirectional associations with diabetes outcomes across early adolescence. METHODS 3-year prospective assessment of paternal involvement, diabetes self-management, and glycemic control among 136 youth (age 9-12 at baseline) and their mothers and fathers. RESULTS Unconditional growth curves demonstrated decreasing amount (maternal report: F(1,128) = 14.79; paternal report: F(1,111) = 12.95, ps < 0.01) and level of contribution (maternal report: F(1,131) = 23.6, p < .01) of paternal involvement. Controlling for covariates, lower youth self-management predicted an increasing slope in fathers' self-reported amount of involvement (b = -0.15 to -0.22, p < .05), and higher levels of fathers' self-reported level of contribution predicted a decreasing slope in youths' self-reported self-management (b = -0.01, p < .05). CONCLUSIONS Like mothers, fathers' involvement declines modestly during early adolescence. Different aspects of paternal involvement influence or are influenced by youths' self-management. Communication about ways to enhance fathers' involvement before this transition may help prevent or reduce declining diabetes management and control common in adolescence.
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Affiliation(s)
- Marisa E Hilliard
- PhD, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Street, Suite 940, Houston, TX 77030, USA.
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116
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Amed S, Nuernberger K, McCrea P, Reimer K, Krueger H, Aydede SK, Ayers D, Collet JP. Adherence to clinical practice guidelines in the management of children, youth, and young adults with type 1 diabetes--a prospective population cohort study. J Pediatr 2013; 163:543-8. [PMID: 23523280 DOI: 10.1016/j.jpeds.2013.01.070] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 12/21/2012] [Accepted: 02/11/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To describe adherence to clinical practice guidelines for the treatment of childhood type 1 diabetes and identify associated patient and system level factors. STUDY DESIGN This prospective cohort study used population-based administrative data to describe individuals aged 1-24 years who had been diagnosed with type 1 diabetes at <20 years of age (1472 unique individuals and 5883 person-years over a 7-year period) living in British Columbia, Canada. The outcome measure was proportion 'at goal,' which was defined as having optimal adherence (3 diabetes-related physician visits/year, 3 hemoglobin A1c (HbA1c) tests/year, 1 glucagon prescription dispensed/year, and appropriate screening for diabetes-related comorbidity [ie, hypothyroidism] and complications [ie, retinopathy and nephropathy]), or good adherence to guidelines (2 diabetes-related physician visits/year, 2 HbA1c tests/year, and appropriate screening for diabetes-related comorbidity and complications). Statistical methods included descriptive statistics and logistic regression modeling. RESULTS Fifty-four percent person-years had poor adherence to guidelines (<2 diabetes-related physician visits and HbA1c tests/year) and 7.4% had optimal adherence. The proportion of person-years at goal was higher in females vs males (41.0% vs 37.6%; P = .007). Individuals 4-years post-diagnosis of diabetes were 78% less likely to be at goal compared with the year of diagnosis (P < .0001). CONCLUSIONS The treatment of pediatric type 1 diabetes likely does not meet national and international standards. Future studies should explore facilitators and barriers to adherence to guidelines among health care providers, patients, and families, and whether adherence to guidelines is associated with glycemic control.
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Affiliation(s)
- Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada.
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117
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Borus JS, Blood E, Volkening LK, Laffel L, Shrier LA. Momentary assessment of social context and glucose monitoring adherence in adolescents with type 1 diabetes. J Adolesc Health 2013; 52:578-83. [PMID: 23298986 PMCID: PMC4079549 DOI: 10.1016/j.jadohealth.2012.10.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2012] [Revised: 09/29/2012] [Accepted: 10/05/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To investigate the associations between momentary social context and glucose monitoring adherence in adolescents with type 1diabetes (T1D). METHODS For 14 days, patients (14-18 years old, T1D duration >1 year) of a pediatric diabetes clinic carried handheld computers that prompted them to report their location, companionship, and attitudes toward companions at the times they usually checked their glucose, and again 30 minutes later to report whether they checked their glucose and, if not, why. Associations between social context factors and checking glucose (adherence) were analyzed using logistic generalized estimating equations and adjusted for age, sex, duration of T1D, and pump use. RESULTS Thirty-six participants (mean age 16.6 ± 1.5 years, mean duration of T1D 8.7 ± 4.4 years) completed 971 context and 1,210 adherence reports, resulting in 805 paired reports. Median signal response rate was 63%. The odds of checking glucose was higher when participants expressed very strong desire to blend in (adjusted odds ratio [AOR] = 2.30, 95% confidence interval 1.07-4.94, p = .03). Strong desire to impress others was associated with decreased likelihood of checking glucose (AOR = .52, 95% confidence interval .28-.97, p = .04.) Location, solitude, type of companion, and attitudes toward companions were not significantly associated with checking glucose. CONCLUSIONS Desire to blend in may support glucose monitoring adherence and desire to impress others may impede this behavior in adolescents with T1D. Other dimensions of social context were not linked to checking glucose in this study.
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Affiliation(s)
- Joshua S. Borus
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA
| | - Emily Blood
- Clinical Research Center, Boston Children's Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
| | | | - Lori Laffel
- Department of Pediatrics, Harvard Medical School, Boston, MA,Genetics & Epidemiology Section, Joslin Diabetes Center, Boston, MA,Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA
| | - Lydia A. Shrier
- Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, MA,Department of Pediatrics, Harvard Medical School, Boston, MA
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118
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Wu YP, Hilliard ME, Rausch J, Dolan LM, Hood KK. Family involvement with the diabetes regimen in young people: the role of adolescent depressive symptoms. Diabet Med 2013; 30:596-602. [PMID: 23320523 PMCID: PMC4465388 DOI: 10.1111/dme.12117] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/10/2013] [Indexed: 02/03/2023]
Abstract
AIMS In young people with Type 1 diabetes, depressive symptoms and shared responsibility for management of diabetes impact upon diabetes management and control. However, the simultaneous effects of both depressive symptoms and parental involvement on diabetes self-care and glycaemic control have not been examined. Thus, the aim of the current study was to examine the relationships between parental involvement and adolescent depressive symptoms in predicting blood glucose monitoring and glycaemic control. METHODS One hundred and fifty young people with Type 1 diabetes (mean age 15.3 years) and their parents completed responsibility sharing and depressive symptom assessments, meter assessment of blood glucose monitoring and HbA(1c) at baseline and then 6, 12 and 18 months. RESULTS Parental involvement affected HbA1c through blood glucose monitoring only at low levels of adolescent depressive symptoms (score ≤ 6), which made up only 20% of the sample. In the presence of more depressive symptoms, parental involvement no longer was related to HbA1c through blood glucose monitoring. This was the relationship in the majority of the sample (80%). CONCLUSIONS While most young people in this sample are not showing evidence of high levels of depressive symptoms, even modest levels of distress interfere with parental involvement in diabetes management. By addressing adolescent depressive symptoms, interventions promoting parental involvement in these families may be more effective.
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Affiliation(s)
- Y P Wu
- Center for Adherence Promotion and Self-Management, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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119
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McGrady ME, Hood KK. Cognitive–behavioral therapy for adolescents with Type 1 diabetes and subclinical depressive symptoms. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.13.11] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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120
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Patton SR, Clements MA, Fridlington A, Cohoon C, Turpin AL, Delurgio SA. Frequency of mealtime insulin bolus as a proxy measure of adherence for children and youths with type 1 diabetes mellitus. Diabetes Technol Ther 2013; 15:124-8. [PMID: 23317372 PMCID: PMC3558673 DOI: 10.1089/dia.2012.0229] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Electronic measures of adherence can be superior to patient report. In type 1 diabetes, frequency of blood glucose monitoring (BGM), as measured by patients' home blood glucose meters, has already been identified as a valid proxy of adherence. We present methodology to calculate adherence using insulin pump records and evaluate the reliability and validity of this methodology. SUBJECTS AND METHODS Blood glucose meter data, insulin pump records, and corresponding hemoglobin A1c (HbA1c) levels were randomly gathered from clinical and research databases for 100 children and youths (referred to hereafter as youths) with type 1 diabetes (mean±SD age, 12.7±4.6 years). Youths' mean frequency of daily BGM was calculated. Additionally, we calculated a mean mealtime insulin bolus score (BOLUS): youths received 1 point each for a bolus between 0600 and 1000 h, 1100 and 1500 h, and 1600 and 2200 h (maximum of 1 point/meal or 3 points/day). RESULTS Simple correlations between youths' HbA1c level, age, frequency of BGM, and insulin BOLUS scores were all significant. Partial correlations and multiple regression analyses revealed that insulin BOLUS scores better explain variations in HbA1c levels than the electronically recorded frequency of daily blood glucose measures. CONCLUSIONS Our procedures for calculating insulin BOLUS scores using insulin pump records demonstrate better concurrent validity with youths' HbA1c levels than that of the frequency of BGM with youths' HbA1c levels. Our analyses have shown that insulin bolus scoring was superior to the frequency of BGM in predicting youths' HbA1c levels.
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Affiliation(s)
- Susana R Patton
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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121
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Ahmad NS, Ramli A, Islahudin F, Paraidathathu T. Medication adherence in patients with type 2 diabetes mellitus treated at primary health clinics in Malaysia. Patient Prefer Adherence 2013; 7:525-30. [PMID: 23814461 PMCID: PMC3693921 DOI: 10.2147/ppa.s44698] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Diabetes mellitus is a growing global health problem that affects patients of all ages. Even though diabetes mellitus is recognized as a major chronic illness, adherence to antidiabetic medicines has often been found to be unsatisfactory. This study was conducted to assess adherence to medications and to identify factors that are associated with nonadherence in type 2 diabetes mellitus (T2DM) patients at Primary Health Clinics of the Ministry of Health in Malaysia. MATERIALS AND METHODS The cross-sectional survey was carried out among T2DM patients to assess adherence to medication in primary health clinics. Adherence was measured by using the Medication Compliance Questionnaire that consists of a total of seven questions. Other data, such as patient demographics, treatment, outcome, and comorbidities were also collected from patient medical records. RESULTS A total of 557 patients were recruited in the study. Approximately 53% of patients in the study population were nonadherent. Logistic regression analysis was performed to predict the factors associated with nonadherence. Variables associated with nonadherence were age, odds ratio 0.967 (95% confidence interval [CI]: 0.948-0.986); medication knowledge, odds ratio 0.965 (95% CI: 0.946-0.984); and comorbidities, odds ratio 1.781 (95% CI: 1.064-2.981). CONCLUSION Adherence to medication in T2DM patients in the primary health clinics was found to be poor. This is a cause of concern, because nonadherence could lead to a worsening of disease. Improving medication knowledge by paying particular attention to different age groups and patients with comorbidities could help improve adherence.
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Affiliation(s)
- Nur Sufiza Ahmad
- Pharmaceutical Services Division, Ministry of Health, Petaling Jaya, Malaysia
| | - Azuana Ramli
- Pharmaceutical Services Division, Ministry of Health, Petaling Jaya, Malaysia
| | - Farida Islahudin
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Thomas Paraidathathu
- Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
- Correspondence: Thomas Paraidathathu, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abdul Aziz 50300, Kuala Lumpur, Malaysia Tel +603 9289 7484 Fax +603 2698 3271 Email
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