Hypoglycaemic treatment adherence and the association with psychological, self-management and glycaemic characteristics in adults with type 1 diabetes

Glycemic Variability and Disordered Eating Among Adolescents and Young Adults with Type 1 Diabetes: The Role of Disinhibited Eating

Background and Aims: Disordered eating behaviors (DEB) are common among individuals with type 1 diabetes (T1D). Glycemic variability, potentially harmful in T1D, may reveal distinct characteristics between those with higher versus lower variability, particularly concerning DEB. Our aim was to evaluate the prevalence of DEB and associated risk factors among adolescents and young adults with T1D and to investigate unique factors associated with DEB across different levels of glycemic variability. Methods: An observational, cross-sectional study was conducted with 147 individuals with T1D, aged 13-21 years. Data were collected from medical charts, personal technological devices for assessing glycemic variability, and self-reported questionnaires, including assessments of DEB. Results: DEB were found in 62 (42.1%) individuals, and 41.5% achieved the glycemic variability (% coefficient of variation) target ≤36%. Among individuals with low glycemic variability, DEB were positively associated with diabetes distress (odds ratio [OR]: 1.14 [95% confidence interval or CI: 1.05-1.22], P < 0.001), longer diabetes duration (OR: 1.34 [95% CI: 1.05-1.70], P = 0.016) and lower socioeconomic-status (OR: 0.53 [95% CI: 0.31-0.90], P = 0.019). Among those with high glycemic variability, body mass index Z score (OR: 3.82 [95% CI: 1.48-9.85], P = 0.005), HbA1c (OR: 4.12 [95% CI: 1.33-12.80], P = 0.014), disinhibited eating (OR: 1.57 [95% CI: 1.14-2.15], P = 0.005), and tendency to lower socioeconomic status (OR: 0.75 [95% CI: 0.56-1.01], P = 0.065). Discussion: DEB are prevalent among adolescents and young adults with T1D and are associated with various risk factors. Factors associated with DEB vary across different levels of glycemic variability. Both low and high glycemic variability are associated with specific risk factors for DEB. One notable risk factor is diabetes-specific disinhibited eating among individuals with high glycemic variability, in contrast to those with low glycemic variability. Given these different risk factors, it may be prudent to adjust intervention programs to reduce DEB among T1D adolescents according to their glycemic variability levels.

Effect of perceived stress, concern about hypoglycaemia and level of knowledge of management of the disease on glycaemic control in type 1 diabetes mellitus

AIMS AND OBJECTIVES

To evaluate perceived stress, concern about hypoglycaemia and the level of knowledge of management of the disease in patients with type 1 diabetes mellitus and their relationship with glycaemic control, gender and age.

BACKGROUND

Perceived stress and concern about hypoglycaemia are significant obstacles to achieving adequate glycaemic control in patients with type 1 diabetes mellitus, and notably influence management of the disease itself.

MATERIAL AND METHODS

A cross-sectional study was carried out in 193 adult patients with type 1 diabetes mellitus. Study quality was scored using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Glycaemic control was evaluated by number and type of hypoglycaemic event and glycosylated haemoglobin. Questionnaires about hypoglycaemia concern (HFS II), perceived stress (PSS), unrecognised hypoglycaemia (Clarke Test) and level of knowledge of the disease were completed.

RESULTS

Perceived stress was significantly associated with glycosylated haemoglobin (p < 0.001) and concern about hypoglycaemia (p < 0.037). With respect to level of knowledge, we observed that an advanced level was associated with lower glycosylated haemoglobin (p < 0.001), number (p < 0.001) and type (p < 0.001) of hypoglycaemic episode, and less perceived stress (p = 0.006). In addition, age was negatively correlated with perceived stress (p < 0.030) and positively correlated with the number of unrecognised hypoglycaemic episodes (p < 0.002), which was associated, in turn, with a higher number of daily glycaemia tests (p < 0.037) and concern about hypoglycaemia (p < 0.006).

CONCLUSION

In type 1 diabetes mellitus, perceived stress can negatively influence glycaemic control and concern about hypoglycaemia, and level of knowledge about the condition has a bearing on glycosylated haemoglobin levels, perceived stress and number and type of hypoglycaemic events. In addition, higher age is associated with more frequent unrecognised hypoglycaemic events.

RELEVANCE TO CLINICAL PRACTICE

It is essential to identify and address the psychological needs of patients with type 1 diabetes mellitus with the aim of achieving an adequate management of the disease itself and generating a change in future intervention strategies.

Psychometric properties of a questionnaire to measure adherence to treatment in patients with type 1 diabetes mellitus

Aim

To validate the psychometric properties of a questionnaire to measure adherence to treatment among people with type 1 diabetes mellitus and to evaluate its relationship with metabolic control.

Design

A cross‐sectional study of 167 adult people with type 1 diabetes mellitus recruited from the Endocrinology Service of University Hospital Doctor Peset (Spain).

Methods

The validity of the content, construct and reliability of the instrument were evaluated and the results correlated with levels of glycosylated haemoglobin.

Results

The questionnaire was composed of 25 items and 5 dimensions, with a score of 25–150 points and an internal consistency of 0.92, according to Cronbach's coefficient α. The content of validity ratio and the construct (exploratory functional analysis, Kaiser–Meyer–Olkin index and Barlett's spherical test) were adequate. We observed a significant correlation between glycosylated haemoglobin levels and treatment adherence.

Conclusion

The questionnaire to measure adherence to treatment in type 1 diabetes mellitus is consistent, reliable and valid, showing an excellent association with degree of metabolic control.