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Titmuss A, Korula S, Wicklow B, Nadeau KJ. Youth-onset Type 2 Diabetes: An Overview of Pathophysiology, Prognosis, Prevention and Management. Curr Diab Rep 2024; 24:183-195. [PMID: 38958831 PMCID: PMC11269415 DOI: 10.1007/s11892-024-01546-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2024] [Indexed: 07/04/2024]
Abstract
PURPOSE OF REVIEW This review explores the emerging evidence regarding pathogenesis, future trajectories, treatment options, and phenotypes of youth-onset type 2 diabetes (T2D). RECENT FINDINGS Youth-onset T2D is increasing in incidence and prevalence worldwide, disproportionately affecting First Nations communities, socioeconomically disadvantaged youth, and people of colour. Youth-onset T2D differs in pathogenesis to later-onset T2D and progresses more rapidly. It is associated with more complications, and these occur earlier. While there are limited licensed treatment options available, the available medications also appear to have a poorer response in youth with T2D. Multiple interacting factors likely contribute to this rising prevalence, as well as the increased severity of the condition, including structural inequities, increasing obesity and sedentary lifestyles, and intergenerational transmission from in-utero exposure to maternal hyperglycemia and obesity. Youth-onset T2D is also associated with stigma and poorer mental health, and these impact clinical management. There is an urgent need to develop effective interventions to prevent youth-onset T2D and enhance engagement of affected youth. It is also critical to better understand the differing phenotypes of youth-onset T2D, to effectively target treatments, and to address intergenerational transmission in high-risk populations.
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Affiliation(s)
- Angela Titmuss
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, PO Box 41096, Darwin, Northern Territory, Australia.
- Department of Paediatrics, Division of Women, Child and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia.
| | - Sophy Korula
- Paediatric Endocrinology and Metabolism Division, Paediatric Unit-1, Christian Medical College Hospital, Vellore, India
- Department of Paediatrics, Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Brandy Wicklow
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Canada
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Kristen J Nadeau
- Children's Hospital Colorado, Aurora, Colorado, USA
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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2
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van der Laan SEI, Berkelbach van der Sprenkel EE, Lenters VC, Finkenauer C, van der Ent CK, Nijhof SL. Defining and Measuring Resilience in Children with a Chronic Disease: a Scoping Review. ADVERSITY AND RESILIENCE SCIENCE 2023; 4:105-123. [PMID: 37139096 PMCID: PMC10088629 DOI: 10.1007/s42844-023-00092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 05/05/2023]
Abstract
More than 25% of all children grow up with a chronic disease. They are at higher risk for developmental and psychosocial problems. However, children who function resiliently manage to adapt positively to these challenges. We aim to systematically review how resilience is defined and measured in children with a chronic disease. A search of PubMed, Cochrane, Embase, and PsycINFO was performed on December 9, 2022, using resilience, disease, and child/adolescent as search terms. Two reviewers independently screened articles for inclusion according to predefined criteria. Extraction domains included study characteristics, definition, and instruments assessing resilience outcomes, and resilience factors. Fifty-five out of 8766 articles were identified as relevant. In general, resilience was characterized as positive adaptation to adversity. The included studies assessed resilience by the outcomes of positive adaptation, or by resilience factors, or both. We categorized the assessed resilience outcomes into three groups: personal traits, psychosocial functioning, and disease-related outcomes. Moreover, myriad of resilience factors were measured, which were grouped into internal resilience factors (cognitive, social, and emotional competence factors), disease-related factors, and external factors (caregiver factors, social factors, and contextual factors). Our scoping review provides insight into the definitions and instruments used to measure resilience in children with a chronic disease. More knowledge is needed on which resilience factors are related to positive adaptation in specific illness-related challenges, which underlying mechanisms are responsible for this positive adaptation, and how these underlying mechanisms interact with one another. Supplementary Information The online version contains supplementary material available at 10.1007/s42844-023-00092-2.
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Affiliation(s)
- Sabine E. I. van der Laan
- Department of Pediatric Pulmonology,Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | | | - Virissa C. Lenters
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Catrin Finkenauer
- Department of Interdisciplinary Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Cornelis K. van der Ent
- Department of Pediatric Pulmonology,Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Sanne L. Nijhof
- Department of Pediatrics, Wilhelmina Children’s Hospital, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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3
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Wu Y, Zhang YY, Zhang YT, Zhang HJ, Long TX, Zhang Q, Huang J, Li MZ. Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis. World J Pediatr 2023; 19:323-339. [PMID: 36534296 PMCID: PMC9761642 DOI: 10.1007/s12519-022-00666-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND This study aimed to analyze the efficacy of resilience-promoting interventions among adolescents and youth aged 10-24 years with any type of diabetes. METHODS A systematic literature search was performed using the PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO databases from inception to May 25, 2022. The Cochrane risk of bias tool (version 2) was used to assess the quality of the included studies. A meta-analysis was performed to calculate the pooled effects of resilience-promoting interventions. RESULTS Nineteen articles were included covering an overall sample of 2048 adolescents with diabetes. When analyzing the effectiveness of resilience-promoting interventions, hemoglobin A1c (HbA1c) at six months [mean difference = - 0.47, 95% confidence interval (CI) = - 0.83 to - 0.12, P = 0.009] after the intervention was improved. However, long-term (≥ 12 months) improvement in HbA1c was not significant. In addition, comparing the control group, there were significant differences in the effect size for stress [standardized mean difference (SMD) = - 0.87, 95% CI = - 1.25 to -0.48, P < 0.05], self-efficacy (SMD = 0.50, 95% CI = 0.02-0.98, P = 0.04) and quality of life (SMD = 0.27, 95% CI = 0.03-0.51, P = 0.03). CONCLUSIONS Resilience-promoting intervention is a promising way for adolescent diabetes management to improve HbA1c, stress, self-efficacy, and quality of life. Incorporating resilience-promoting components into diabetes education and re-enforcing these contents every six months are recommended for implementation in clinical practice.
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Affiliation(s)
- Yi Wu
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Yi-Yun Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ya-Ting Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | | | - Tian-Xue Long
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Qi Zhang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Jing Huang
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China
- School of Nursing, Peking University, Beijing, China
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China
| | - Ming-Zi Li
- Peking University Health Science Center, 38 Huayuan Road, Haidian District, Beijing, 100191, China.
- School of Nursing, Peking University, Beijing, China.
- Peking University Health Science Centre for Evidence-Based Nursing, A Joanna Briggs Institute Affiliated Group, Beijing, China.
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Vlcek C, Greenberg D, Yardley JE, Klaprat N, MacIntosh A, Greenberg M, Brandt J, Gregoire N, Dostie S, Boutin D, Pow C, Archibald M, McGavock J. "How we do it": A qualitative study of strategies for adopting an exercise routine while living with type 1 diabetes. Front Endocrinol (Lausanne) 2023; 13:1063859. [PMID: 36686448 PMCID: PMC9849595 DOI: 10.3389/fendo.2022.1063859] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Introduction For people living with type 1 diabetes (T1D) the challenge of increasing daily physical activity (PA) is compounded by the increased risks of hypoglycemia and glucose variability. Little information exists on the lived experience of overcoming these barriers and adopting and maintaining an active lifestyle while living with T1D. Research Design and Methods We conducted a patient-led qualitative study consisting of semi-structured interviews or focus groups with 22 individuals at least 16 years old living with T1D. We used existing patient co-researcher networks and snowball sampling to obtain a sample of individuals who reported being regularly physically active and had been diagnosed with T1D for at least one year. We used an interpretive description analysis to generate themes and strategies associated with maintaining an active lifestyle while living with T1D. We involved patient co-researchers in study design, data collection, and interpretation. Results 14 self-identified women and 8 self-identified men (ages 19-62, median age 32 years) completed the study, led by either a researcher, or a patient co-researcher and research assistant regarding their strategies for maintaining an active lifestyle. We identified five themes that facilitate regular sustained PA: (1) Structure and organization are important to adopt safe PA in daily life "I can't do spontaneous exercise. I actually need a couple hours of warning minimum"; (2) Trial and error to learn how their body responds to PA and food "Once you put the time and effort into learning, you will have greater success"; (3) Psychosocial aspects of PA "…because it's not just your body, it's your soul, it's your mind that exercise is for"; (4) Diabetes technology and (5) Education and peer support. Strategies to overcome barriers included (1) Technology; (2) Integrating psychosocial facilitators; (3) Insulin and carbohydrate adjustments; and (4) Planning for exercise. Conclusions Living an active lifestyle with T1D is facilitated by dedicated structure and organization of routines, accepting the need for trial and error to understand the personalized glycemic responses to PA and careful use of food to prevent hypoglycemia. These themes could inform clinical practice guidelines or future trials that include PA interventions.
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Affiliation(s)
- Cristine Vlcek
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
| | | | - Jane E. Yardley
- Diabetes Action Canada, Toronto, ON, Canada
- Augustana Faculty, University of Alberta, Camrose, AB, Canada
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
- Alberta Diabetes Institute, Edmonton, AB, Canada
- Women and Children’s Health Research Institute, Edmonton, AB, Canada
| | - Nika Klaprat
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
| | - Andrea MacIntosh
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
| | | | | | | | | | | | - Conrad Pow
- Diabetes Action Canada, Toronto, ON, Canada
| | - Mandy Archibald
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
- College of Nursing, University of Manitoba, Winnipeg, MB, Canada
| | - Jonathan McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, MB, Canada
- Diabetes Action Canada, Toronto, ON, Canada
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Children’s Hospital Research Institute of Manitoba, Winnipeg, MB, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, Winnipeg, MB, Canada
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Adolfsson P, Taplin CE, Zaharieva DP, Pemberton J, Davis EA, Riddell MC, McGavock J, Moser O, Szadkowska A, Lopez P, Santiprabhob J, Frattolin E, Griffiths G, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Exercise in children and adolescents with diabetes. Pediatr Diabetes 2022; 23:1341-1372. [PMID: 36537529 PMCID: PMC10107219 DOI: 10.1111/pedi.13452] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/07/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Peter Adolfsson
- Department of Pediatrics, Kungsbacka Hospital, Kungsbacka, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Craig E Taplin
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, School of Medicine, Stanford University, Stanford, California, USA
| | - John Pemberton
- Department of Endocrinology and Diabetes, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Elizabeth A Davis
- Department of Endocrinology and Diabetes, Perth Children's Hospital, Nedlands, Western Australia, Australia.,Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia.,Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Michael C Riddell
- Muscle Health Research Centre, York University, Toronto, Ontario, Canada
| | - Jonathan McGavock
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada.,Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Action Canada SPOR Network, Toronto, Ontario, Canada
| | - Othmar Moser
- Division Exercise Physiology and Metabolism, Department of Sport Science, University of Bayreuth, Bayreuth, Germany.,Interdisciplinary Metabolic Medicine Trials Unit, Division of Endocrinology and Diabetology, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Agnieszka Szadkowska
- Department of Pediatrics, Diabetology, Endocrinology & Nephrology, Medical University of Lodz, Lodz, Poland
| | - Prudence Lopez
- Department of Paediatrics, John Hunter Children's Hospital, Newcastle, New South Wales, Australia.,University of Newcastle, Newcastle, New South Wales, Australia
| | - Jeerunda Santiprabhob
- Siriraj Diabetes Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.,Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | | | | | - Linda A DiMeglio
- Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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Sellers EAC, McLeod L, Prior HJ, Dragan R, Wicklow BA, Ruth C. Mental health comorbidity is common in children with type 2 diabetes. Pediatr Diabetes 2022; 23:991-998. [PMID: 35838140 DOI: 10.1111/pedi.13389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the prevalence of mental health comorbidity in children with type 2 diabetes compared to a matched population without diabetes and children with type 1 diabetes. RESEARCH DESIGN AND METHODS Population-based cohorts of 528 youth (7-18 years of age) with prevalent type 2 diabetes, 1519 matched children without diabetes and 778 youth with type 1 diabetes were identified from a clinical registry and linked to provincial health care records to assess the prevalence of mental health comorbidity using ICD-9CM, ICD-10CA and ATC codes. RESULTS The majority of children with type 2 diabetes were of First Nations heritage. Compared to their matched peers, children with type 2 diabetes where more likely to have a mood or anxiety disorder before and after diagnosis [RR 2.38 (1.63, 3.48) p < 0.001 and 1.70 (1.39, 2.08) p < 0.001 respectively], to attempt/complete suicide [RR 3.18 (1.30, 7.81) p = 0.012 and 2.18 (1.32, 3.60) p = 0.0002 respectively] and be prescribed an antipsychotic [RR 2.33 (1.23, 4.39) p = 0.009 and 1.76 (1.23, 2.52) p = 0.002 respectively]. Following adjustment for age and sex, children with type 2 diabetes, compared to children with type 1 diabetes where more likely to have a mood or anxiety disorder and be prescribed an antipsychotic after diagnosis [RR 1.43 (1.07, 1.91) p = 0.015; RR 2.41 (1.44, 4.06) p = 0.0009 respectively]. CONCLUSIONS Children with type 2 diabetes have high rates of comorbid mental illness. Programs to provide care, support, and education must address the mental health comorbidity in the context of the demographic, socioeconomic, and psycho-cultural characteristics of the population.
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Affiliation(s)
- Elizabeth A C Sellers
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorraine McLeod
- First Nations Health & Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy A Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Department of Pediatrics, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Child Health, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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Shah AS, Zeitler PS, Wong J, Pena AS, Wicklow B, Arslanian S, Chang N, Fu J, Dabadghao P, Pinhas-Hamiel O, Urakami T, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:872-902. [PMID: 36161685 DOI: 10.1111/pedi.13409] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.
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Affiliation(s)
- Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Philip S Zeitler
- Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Central Clinical School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alexia S Pena
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Brandy Wicklow
- Division of Endocrinology, Winnipeg Children's Hospital and University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Junfen Fu
- Division of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sackler School of Medicine, Tel-Aviv, Israel
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
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8
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Weaver E, Freeman N, Mack S, Titmuss A, Dowler J, Corpus S, Hyatt T, Ellis E, Sanderson C, Connors C, Moore E, Silver B, Azzopardi P, Maple-Brown L, Kirkham R. "I Don't Really Know What Diabetes Is": A Qualitative Study Exploring the Experiences of Aboriginal and Torres Strait Islander Young People Aged 10 to 25 Years Living With Type 2 Diabetes in Northern and Central Australia. Can J Diabetes 2022; 46:S1499-2671(22)00095-8. [PMID: 35963668 DOI: 10.1016/j.jcjd.2022.04.010] [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: 12/15/2021] [Revised: 03/14/2022] [Accepted: 04/26/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Our aim in this study was to gain an understanding of the experiences of Aboriginal and Torres Strait Islander young people aged 10 to 25 years with type 2 diabetes (T2D) living in Northern and Central Australia. METHODS In this qualitative study we explored participants' experiences of T2D using a social constructionist epistemology and a phenomenologic methodology. Twenty-seven young people participated in semistructured in-depth interviews from 4 primary health-care sites. RESULTS Three major constructs emerged. Young people experienced a normalisation-shame paradox in response to their diagnosis (partly related to that "everyone has diabetes," as well as the fear that friends "might judge [me]"), had suboptimal levels of understanding of T2D ("I don't really know what diabetes is. I just need somebody to explain to me a bit more") and experienced multiple barriers inhibiting their T2D management. These included complex lives ("I have a rheumatic heart disease […] then they told me that I have diabetes…I have two things") and the availability of support ("[I] talk to my mum…I talk to my aunty too…I don't talk to anyone else"). Successful management requires support from health professionals and family and includes strengthening social networks and educational opportunities. CONCLUSIONS Our findings reinforce the need for alternative support systems tailored to the specific needs of young Aboriginal and Torres Strait Islander people with T2D. Enhanced models of care must be codesigned with young people and their communities and include a focus on shifting norms and expectations about youth T2D to reduce diabetes stigma and broaden social support and consider the delivery of health information in youth-friendly environments.
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Affiliation(s)
- Emma Weaver
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
| | - Natasha Freeman
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Shiree Mack
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angela Titmuss
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Department of Paediatrics, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - James Dowler
- Department of Paediatrics, Alice Springs Hospital, Northern Territory, Australia
| | - Sumaria Corpus
- Danila Dilba Health Services, Darwin, Northern Territory, Australia; Endocrine Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Teresa Hyatt
- Population and Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elna Ellis
- Department of Medicine, Alice Springs Hospital, Alice Springs, Northern Territory, Australia
| | - Cheryl Sanderson
- Danila Dilba Health Services, Darwin, Northern Territory, Australia; Aboriginal Medical Service Alliance Northern Territory, Alice Springs, Northern Territory, Australia
| | - Christine Connors
- Population and Primary Health Care, Top End Health Service, Northern Territory Department of Health, Darwin, Northern Territory, Australia
| | - Elizabeth Moore
- Aboriginal Medical Service Alliance Northern Territory, Alice Springs, Northern Territory, Australia
| | - Bronwyn Silver
- Central Australian Aboriginal Congress, Alice Springs, Northern Territory, Australia
| | - Peter Azzopardi
- Burnet Institute, Melbourne, Victoria, Australia; Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Louise Maple-Brown
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia; Endocrine Department, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Renae Kirkham
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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9
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Carino M, Quill Z, Gabbs M, Sellers E, Hamilton J, Pinto T, Jetha M, Ho J, Alecio OG, Dart A, Wicklow B. The impact of the COVID-19 pandemic on adolescents and young adults living with type 2 diabetes. Can J Diabetes 2022; 46:404-410. [PMID: 35484051 PMCID: PMC8801385 DOI: 10.1016/j.jcjd.2022.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 12/16/2021] [Accepted: 01/04/2022] [Indexed: 11/30/2022]
Abstract
Objectives The aim of this study was to assess the impacts of the COVID-19 pandemic on adolescents and young adults living with type 2 diabetes (T2D) involved in the national Improving Renal Complications in Adolescents with T2D through REsearch (iCARE) study. Methods The Environmental influences on Child Health Outcomes (ECHO) COVID-19 Questionnaire developed by the National Institutes of Health ECHO COVID-19 Task Force was administered to participants (n=85) from the iCARE study between June 2020 and October 2020. Children 12 years old (via parent report) and adolescents and young adults ≥13 years old (via self-report) participated. The questionnaire assessed the impact of the pandemic on health-care appointments, lifestyle, internet use, social connections and mental health. Results Participants were 17.0±3.1 (range, 12 to 27) years of age and predominantly female (61.3%). During the pandemic, 69.4% were able to attend their health-care appointments by telephone or virtual platforms, 31.7% ate more, 45.1% slept more and 29.3% spent less time on physical activities. There was an increase in internet use for both educational (42.0%) and noneducational purposes (54.9%). Participants felt less socially connected (64.6%). Participants also felt sometimes (59.2%), often (19.7%) and very often (6.7%) satisfied with their lives. Discussion Our study revealed that the COVID-19 pandemic has had various impacts on the daily lives of adolescents and young adults living with T2D. Future research should include longitudinal studies of the health burden of the COVID-19 pandemic on this population, with a more in-depth evaluation of mental health outcomes and clinical outcomes.
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Affiliation(s)
- Marylin Carino
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Zoe Quill
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Gabbs
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Sellers
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jill Hamilton
- Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Teresa Pinto
- Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mary Jetha
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Josephine Ho
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - Allison Dart
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada; Department of Pediatrics and Child Health, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.
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Gabbs MH, Dart AB, Woo MR, Pinto T, Wicklow BA. Poor sleep, increased stress, and metabolic co-morbidity in adolescents and youth with type 2 diabetes. Can J Diabetes 2021; 46:142-149. [DOI: 10.1016/j.jcjd.2021.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 04/15/2021] [Accepted: 07/29/2021] [Indexed: 10/20/2022]
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Slaght JL, Wicklow BA, Dart AB, Sellers EAC, Gabbs M, Carino M, McGavock JM. Physical activity and cardiometabolic health in adolescents with type 2 diabetes: a cross-sectional study. BMJ Open Diabetes Res Care 2021; 9:9/1/e002134. [PMID: 33990367 PMCID: PMC8127979 DOI: 10.1136/bmjdrc-2021-002134] [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: 01/12/2021] [Revised: 04/14/2021] [Accepted: 04/25/2021] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Youth living with type 2 diabetes display increased risk of cardiovascular disease (CVD). It is unclear if regular physical activity (PA) modifies this risk. RESEARCH DESIGN AND METHODS We compared CVD risk factors in a cross-sectional study of 164 youth with type 2 diabetes stratified according to weekly vigorous-intensity PA. Outcomes were hemoglobin A1c (HbA1c), ambulatory blood pressure (BP; ambulatory 24-hour readings), plasma lipoproteins, and albuminuria. The main exposure, vigorous-intensity PA, was quantified with the Adolescent Physical Activity Recall Questionnaire. RESULTS Youth were 15±3 years, and 78% lived rurally and 68% were female, with a mean body mass index (BMI) Z-score of 2.4±1.1 and a mean HbA1c of 9.6% ±2.6%. Youth who participated in regular vigorous-intensity PA (40%; n=67) achieved nearly twice the dose of PA than peers who did not (62 vs 34 metabolic equivalent score-hour/week, p=0.001). After adjusting for duration of diabetes, BMI Z-score, sex, and smoking, youth who engaged in vigorous-intensity PA displayed lower HbA1c (9.1% vs 9.9%, p=0.052), diastolic BP (70 mm Hg vs 73 mm Hg, p=0.002), diastolic load (20% vs 26%, p=0.023), and mean arterial pressure (87.3 mm Hg vs 90.3 mm Hg, p<0.01), compared with youth who did not. Compared with youth who did not participate in regular vigorous-intensity PA, those who did also displayed lower odds of albuminuria after adjusting for duration of diabetes, sex, smoking, rural residence, and BMI Z-score (adjusted OR: 0.40, 95% CI 0.19 to 0.84). CONCLUSIONS Among youth with type 2 diabetes, participation in vigorous-intensity PA is associated with lower CVD risk.
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Affiliation(s)
- Jana L Slaght
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Alexandra Wicklow
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Pediatric Endocrinology and Metabolism, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allison B Dart
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth A C Sellers
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Pediatric Endocrinology and Metabolism, Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Melissa Gabbs
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Marylin Carino
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan M McGavock
- Pediatrics and Child Health, University of Manitoba Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Theme, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
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Tanikawa Y, Kimachi M, Ishikawa M, Hisada T, Fukuhara S, Yamamoto Y. Association between work schedules and motivation for lifestyle change in workers with overweight or obesity: a cross-sectional study in Japan. BMJ Open 2020; 10:e033000. [PMID: 32354776 PMCID: PMC7213847 DOI: 10.1136/bmjopen-2019-033000] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE To investigate the association between work schedules and motivation for behavioural change of lifestyle, based on the transtheoretical model (TTM) in workers with overweight or obesity. DESIGN A cross-sectional observational study. SETTING A healthcare examination centre in Japan. PARTICIPANTS Between April 2014 and March 2016, we recruited 9243 participants who underwent healthcare examination and met the inclusion criteria, namely, age 20-65 years, body mass index (BMI) ≥25 kg/m2 and full-time workers. EXPOSURE Night and shift (night/shift) workers were compared with daytime workers in terms of motivation for behavioural change. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was action and maintenance stages of change (SOC) for lifestyle in TTM. In a subgroup analysis, we investigated interactions between characteristics, including age, sex, BMI, current smoking, alcohol habits, hours of sleep and working hours. RESULTS Overall, 1390 participants (15.0%) were night/shift workers; night/shift workers were younger (median age (IQR): 46 (40-54) vs 43 (37-52) years) and the proportion of men was lesser (75.4 vs 60.9%) compared with daytime workers. The numbers of daytime and night/shift workers in the action and maintenance SOC were 2113 (26.9%) and 309 (22.2%), respectively. Compared with daytime workers, night/shift workers were less likely to demonstrate action and maintenance SOC (adjusted OR (AOR): 0.85, 95% CI: 0.74 to 0.98). In a subgroup analysis that included only those with long working hours (≥10 hours/day), results revealed a strong inverse association between night/shift work and action and maintenance SOC (AOR: 0.65, 95% CI: 0.48 to 0.86). A significant interaction was observed between long working hours and night/shift work (P for interaction=0.04). CONCLUSIONS In workers with overweight or obesity, a night/shift work schedule was associated with a lower motivation for behavioural change in lifestyle, and the association was strengthened in those with long working hours.
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Affiliation(s)
- Yukihiro Tanikawa
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Miho Kimachi
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Minoru Ishikawa
- Health Examination Centre, Urasoe General Hospital, Urasoe, Japan
| | | | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Centre for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan
- Shirakawa STAR for General Medicine, Fukushima Medical University, Fukushima, Japan
| | - Yosuke Yamamoto
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Guillemette L, Dart A, Wicklow B, Dolinsky VW, Cheung D, Jassal DS, Sellers EAC, Gelinas J, Eves ND, Balshaw R, Agarwal P, Duhamel TA, Gordon JW, McGavock JM. Cardiac structure and function in youth with type 2 diabetes in the iCARE cohort study: Cross-sectional associations with prenatal exposure to diabetes and metabolomic profiles. Pediatr Diabetes 2020; 21:233-242. [PMID: 31802590 DOI: 10.1111/pedi.12954] [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: 08/19/2019] [Revised: 11/25/2019] [Accepted: 12/02/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE This study aimed to determine the degree of left ventricular (LV) dysfunction and its determinants in adolescents with type 2 diabetes (T2D). We hypothesized that adolescents with T2D would display impaired LV diastolic function and that these cardiovascular complications would be exacerbated in youth exposed to maternal diabetes in utero. METHODS Left ventricular structure and function, carotid artery intima media thickness and strain, and serum metabolomic profiles were compared between adolescents with T2D (n = 121) and controls (n = 34). Sub-group analyses examined the role of exposure to maternal diabetes as a determinant of LV or carotid artery structure and function among adolescents with T2D. RESULTS Adolescents with T2D were 15.1 ± 2.5 years old, (65% female, 99% Indigenous), had lived with diabetes for 2.7 ± 2.2 years, had suboptimal glycemic control (HbA1c = 9.4 ± 2.6%) and 58% (n = 69) were exposed to diabetes in utero. Compared to controls, adolescents with T2D displayed lower LV diastolic filling (early diastole/atrial filling rate ratio [E/A] = 1.9 ± 0.6 vs 2.2 ± 0.6, P = 0.012), lower LV relaxation and carotid strain (0.12 ± 0.05 vs 0.17 ± 0.05, P = .03) and elevated levels of leucine, isoleucine and valine. Among adolescents with T2D, exposure to diabetes in utero was not associated with differences in LV diastolic filling, LV relaxation, carotid strain or branched chain amino acids. CONCLUSIONS Adolescents with T2D display LV diastolic dysfunction, carotid artery stiffness, and elevated levels of select branch chain amino acids; differences were not associated with exposure to maternal diabetes in utero.
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Affiliation(s)
- Laetitia Guillemette
- Department of Pediatrics and Child Health, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada
| | - Vernon W Dolinsky
- Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada.,Department of Pharmacology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - David Cheung
- St. Boniface Cardiovascular Research Centre, Winnipeg, Manitoba, Canada.,Division of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Davinder S Jassal
- St. Boniface Cardiovascular Research Centre, Winnipeg, Manitoba, Canada.,Division of Cardiology, St. Boniface Hospital, Winnipeg, Manitoba, Canada
| | - Elizabeth A C Sellers
- Department of Pediatrics and Child Health, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada
| | - Jinelle Gelinas
- School of Health and Exercise Sciences, Faculty of health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Neil D Eves
- School of Health and Exercise Sciences, Faculty of health and Social Development, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Robert Balshaw
- Biostatistical Consulting Unit, George and Fay Yee Centre for Health Care Innovation, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Prasoon Agarwal
- Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada.,Department of Pharmacology, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Todd A Duhamel
- Faculty of Kinesiology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Joseph W Gordon
- Faculty of Nursing, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jonathan M McGavock
- Department of Pediatrics and Child Health, Max Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada.,Diabetes Research Envisioned and Accomplished in Manitoba Research Theme, Winnipeg, Manitoba, Canada.,Faculty of Kinesiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Kaar JL, Schmiege SJ, Drews K, Higgins J, Walders-Abramson N, Isganaitis E, Willi SM, Marcus MD, Zeitler PS, Kelsey MM. Evaluation of the longitudinal change in health behavior profiles across treatment groups in the TODAY clinical trial. Pediatr Diabetes 2020; 21:224-232. [PMID: 31886931 PMCID: PMC7597379 DOI: 10.1111/pedi.12976] [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] [Received: 04/10/2019] [Revised: 08/28/2019] [Accepted: 09/18/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Individual health behaviors (ie, eating habits and sedentary lifestyle) are associated with type 2 diabetes (T2D). Health behavior profiles specific to adolescents with T2D have not been described. OBJECTIVE To identify health behavior profiles in adolescents with T2D and examine how these profiles change over time. METHODS Diet (via food frequency questionnaire) and activity behaviors (via 3-day physical activity recall) examined at baseline, 6 months, and 24 months from participants in the the Treatment Options for T2D in Adolescents and Youth (TODAY) study were used for this analysis. Latent profile analysis identified profiles of health behaviors within three time points, and latent transition probabilities were estimated to examine the change from baseline to 6 months (n = 450) and baseline to 24 months (n = 415). Multinomial logistic regressions were used to examine if the assigned TODAY treatment group (Metformin [Met], Met + Rosiglitazone [Rosi], or Met + Lifestyle) predicted change in health behavior profiles. RESULTS Three profiles emerged: "most sedentary," "healthy eaters," and "active and eat most." At 6 months, 50% of males and 29% of females in the Met + Lifestyle treatment group improved in their health behavior profile. Among males only, the Met + Lifestyle treatment group were more likely to improve their profiles from baseline to 6 months (P = .01). CONCLUSIONS Three health behavior profiles emerged and shifted over time. A high quality, lifestyle intervention had little effect on improving health behavior profiles. Optimizing outcomes in youth with T2D might require more robust and multifaceted interventions beyond family-level lifestyle, including more extensive psychosocial intervention, novel medication regimen, or bariatric surgery.
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Affiliation(s)
- Jill L Kaar
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Sarah J Schmiege
- Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Kimberly Drews
- The Biostatistics Center, George Washington University, Washington DC
| | - Janine Higgins
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Natalie Walders-Abramson
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Elvira Isganaitis
- Harvard Medical School, Boston, Massachusetts
- Joslin Diabetes Center, Boston, Massachusetts
| | - Steven M Willi
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Marsha D Marcus
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Philip S Zeitler
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
| | - Megan M Kelsey
- Department of Pediatrics, Division of Endocrinology, University of Colorado School of Medicine, Aurora, Colorado
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15
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Shen Y, Wang T, Gao M, Wang F, Zhu X, Zhang X, Li D, Gan Y, Zhang Y, Gao Y, Sun X. Association of glucose control and stages of change for multiple self-management behaviors in patients with diabetes: A latent profile analysis. PATIENT EDUCATION AND COUNSELING 2020; 103:214-219. [PMID: 31447198 DOI: 10.1016/j.pec.2019.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 07/05/2019] [Accepted: 08/16/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine whether the joint use of the transtheoretical model and latent profile analysis could help us better understand the shared characteristics of patients with diabetes and explore the association of patients' latent classes and glucose control. METHODS Five hundred twenty-three (523) patients with diabetes were included in the study. The questionnaire evaluated patients' stages of change for medication-taking, diet control, exercise, and glucose-monitoring. Latent profile analysis was performed based on the four indicators. RESULTS Patients were classified into four latent groups and defined as follows: good medication-taking/good lifestyle (GM/GL, 41.7%), poor medication-taking/poor lifestyle (PM/PL, 27.7%), good medication-taking/poor lifestyle (GM/PL, 21.6%), and poor medication-taking/good lifestyle (PM/GL, 9.0%). Patients in the PM/PL group were generally younger and better educated while those in the GM/GL group exhibited the opposite pattern. Compared with patients in the PM/PL group, those in the PM/GL and GM/GL groups had significantly lower HbA1c values (PM/GL: standardized β = -0.694, P = 0.007; GM/GL: standardized β = -0.499, P = 0.003). CONCLUSION With the help of the transtheoretical model and latent profile analysis, future study could cluster homogeneous patients before the initiation of intervention and provide tailored instructions to different types of patients accordingly. PRACTICE IMPLICATIONS A combination of the transtheoretical model and latent profile analysis could shed some light into future diabetic interventions.
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Affiliation(s)
- Ying Shen
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Taotao Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Min Gao
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Fengbin Wang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China; Department of Health and Education, Beijing Municipal Commission of Health and Family Planning, Beijing, China
| | - Xiaorou Zhu
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Xing Zhang
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China
| | - Dongmei Li
- Daxing District Center for Disease Control and Prevention, Beijng, China
| | - Yadi Gan
- Daxing District Center for Disease Control and Prevention, Beijng, China
| | - Yong Zhang
- Daxing District Center for Disease Control and Prevention, Beijng, China
| | - Yanqing Gao
- Daxing District Center for Disease Control and Prevention, Beijng, China.
| | - Xinying Sun
- Department of Social Medicine and Health Education, School of Public Health, Peking University, Beijing, China.
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Eva JJ, Kassab YW, Neoh CF, Ming LC, Wong YY, Abdul Hameed M, Hong YH, Sarker MMR. Self-Care and Self-Management Among Adolescent T2DM Patients: A Review. Front Endocrinol (Lausanne) 2018; 9:489. [PMID: 30459707 PMCID: PMC6232899 DOI: 10.3389/fendo.2018.00489] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Accepted: 08/06/2018] [Indexed: 01/30/2023] Open
Abstract
Uncontrolled hyperglycaemia can lead to macro- and microvascular complications. Adolescents with T2DM develop similar complications as in adults, including cardiovascular disease, stroke, myocardial infarction, renal insufficiency, and chronic renal failure. Although regular medical follow-up is essential to avoid long-term complications, patients with diabetes mellitus need to perform holistic self-care activities such as opting for a healthy diet, physical activity, self-monitoring, and proper medication. To the best of our knowledge, only a limited number of studies have focused on self-care activities and self-management, including self-care practices, supportive networks, and self-care education programs in adolescent with T2DM. Some of the studies focused on the appreciation of self-care in adolescents with T2DM. This review aimed to analyse self-care and self-management among adolescents with T2DM, and discuss the impact of self-care and self-management on glycaemic control. The difficulties faced by adolescents in self-managing their disease are also highlighted. Such information is essential for healthcare providers in promoting self-care practices among adolescents with T2DM. A thorough search of the literature was performed using three databases: Medline, Google Scholar, and Scopus. The articles focused on self-care and self-management of adolescents patients with T2DM aged between 12 and 19 years old were included. Findings from this review reveal that healthy food adaptation, adequate physical activity, proper medication practices, and regular glucose monitoring are the most common self-care practices. Parental involvement and clinician encouragement also contribute toward the practice of self-care and self-management among the adolescents with T2DM. In conclusion, independent self-management regimens and supportive networks for appropriate administration are vital factors to enhance clinical outcomes of adolescents with T2DM.
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Affiliation(s)
- Jafrin Jahan Eva
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
| | - Yaman Walid Kassab
- Faculty of Pharmacy, Cyberjaya University College of Medical Sciences, Cyberjaya, Malaysia
| | - Chin Fen Neoh
- Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Malaysia
- Collaborative Drug Discovery Research Group, Pharmaceutical and Life Sciences Community of Research, Universiti Teknologi MARA, Shah Alam, Malaysia
| | - Long Chiau Ming
- School of Pharmacy, KPJ Healthcare University College, Negeri Sembilan, Malaysia
- Pharmacy, School of Medicine, University of Tasmania, Hobart, TAS, Australia
| | - Yuet Yen Wong
- Faculty of Pharmacy, Universiti Teknologi MARA, Bertam, Malaysia
| | | | - Yet Hoi Hong
- Department of Physiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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