A typology of coping with Type 1 diabetes in emerging adulthood: associations with demographic, psychological, and clinical parameters

Comparing youth with and without type 1 diabetes on perceived parenting and peer functioning: a propensity weighting approach

The premise of this study was to gain more insight into whether type 1 diabetes (T1D) can impact how youth perceive parents and peers. To address limitations of previous observational studies comparing youth with T1D to control youth, propensity weighting was used to mimic a randomized controlled trial. A total of 558 youth with T1D and 426 control youth (14-26y) completed questionnaires on parental responsiveness, psychological control, overprotection, friend support, extreme peer orientation, and a host of background and psychological functioning variables. The groups were statistically weighted to become as comparable as possible except for disease status. The analysis plan and hypotheses were preregistered on the open science framework. Youth with T1D perceived their mothers to be more overprotective, perceived fewer friend support, and were less extremely oriented toward peers than control youth. There were no group differences for paternal overprotection and paternal and maternal responsiveness and psychological control. Mothers of youth with T1D seem at risk to practice overprotective parenting and clinicians could play an important role in making mothers aware of this risk. However, the absence of group differences for the maladaptive parenting dimension of psychological control and adaptive dimension of responsiveness are reassuring and testify to the resilient nature of youth with T1D and their families. Additionally, there is accumulating evidence that T1D could interfere with engaging in supportive friendships.

Behavior Change in Chronic Health: Reviewing What We Know, What Is Happening, and What Is Next for Hearing Loss

Untreated age-related sensorineural hearing loss is challenged by low adoption and adherence to hearing aids for treatment. Hearing care has evolved from traditional clinic-controlled treatment to online consumer-centered hearing care, supported by the increasingly person-centered design of hearing aid technology. Greater evidence and a more nuanced understanding of the personal need for adoption versus adherence to the use of consumer hearing care devices are required. Research considering consumer hearing aid acceptance behavior rests on behavior modification theories to guide clinical approaches to increasing hearing aid adoption and adherence. However, in the context of complex chronic health management, there may be a gap in how these theories effectively align with the needs of consumers. Similarly, market data indicates evolving consumer behavior patterns have implications for hearing care theory and implementation, particularly in terms of sustained behavior change. This essay proposes that evidence, including theory and application, be strengthened by revising basic theoretical premises of personal experience with complex chronic health, in addition to considering recent changes in commercial contexts.

Needs of young adults with type 1 diabetes during life transitions - An Australian-Danish experience

OBJECTIVE

To explore the similarities and differences in the needs of young adults with T1D during life transitions.

METHODS

Data obtained for this paper was based on three qualitative studies carried out in Denmark and Australia. In total, 33 Individual interviews and two focus groups (n = 46) were conducted. Data was analysed using thematic analysis.

RESULTS

The most pertinent themes related to the importance of support from peers with diabetes and healthcare professionals to help young adults adjust to independent living. The main difference experienced by Australian and Danish young adults related to the willingness and barriers in clinical attendance during this transitional period.

CONCLUSIONS

Clinical care for young adults with diabetes can be better adapted to support this population as they transition through significant milestones by engagement on the young adults' terms and encouraging young adults to seek out peer support. It is vital that clinical care is tailored to support them in order to ensure the best transition into adulthood with diabetes.

PRACTICE IMPLICATIONS

Clinicians need to adopt a person-centred approach when engaging with young adults with diabetes. Considerations need to be made around external factors related to life events in young adulthood that may influence diabetes care.

Diabetes Care Provider Perceptions Regarding Emerging Adults' Diabetes Self-Management Influences and Patient-Provider Visit Interactions Within a Safety-Net Hospital

The increasing number of emerging adults with diabetes (EAWD) being cared for in adult health care settings requires a better understanding of the needs of EAWD and their interactions with adult health care providers (HCPs). This article describes findings from interviews with endocrinologists and diabetes nurses from a safety-net health care system to investigate HCPs' perspectives regarding influences on EAWD self-management and HCP interactions with EAWD. HCPs frequently perceived lower EAWD engagement in diabetes management, which was complicated by barriers such as the emotional burden of diabetes, busy lives and multiple responsibilities, and limited access to resources; however, HCPs valued the role of information and communication at visits in tailoring care for EAWD. Measures to tailor care should address the psychosocial burden related to the life stage goals and priorities of EAWD, identification of resources for EAWD and HCPs, and further elucidation of effective self-management guidance and communication strategies to support EAWD in safety-net settings.

Caring for caregivers: the impact of the COVID-19 pandemic on those responsible for children and adolescents with type 1 diabetes

This study aimed to assess the psychological impact of the COVID-19 pandemic on guardians of children and adolescents with type 1 diabetes. An online survey was performed to assess the prevalence of pandemic-related emotional burden, mental health disorders and diabetes-specific emotional burden related to diabetes care during the COVID-19 pandemic. Caregivers of children and adolescents with diabetes under the age of 18 and caregivers of youth without diabetes for the non-diabetes group were invited to participate. For the primary outcome, mental health disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20), while pandemic-related emotional burden and diabetes-specific emotional burden related to diabetes care were evaluated in different domains with specific questions. For analyses, a hierarchical testing strategy was performed. A total of 764 participants were included in the study. Regarding the pandemic period, caregivers of youth with type 1 diabetes endorsed significantly more pandemic-related emotional burden for both themselves (OR 1.67; 95% CI, 1.10 to 2.53) and for their child (OR 2.28; 95% CI, 1.54 to 3.38) when compared to the non-diabetes group. The emotional burden evaluation on different age ranges showed that the two groups were similar when the dependent youth was younger than 6 years. Moreover, a positive screening for mental health disorders during social distancing was higher in the diabetes group compared to the non-diabetes group (OR 2.43; 95% CI, 1.70 to 3.47), particularly in those aged under 12 years old. There was no difference between groups in mental health disorders among caregivers of adolescents older than 12 years. Our results allow to conclude that concern, burden and mental health disorders can be present in caregivers of youth with diabetes, and behavioral changes during the COVID-19 pandemic may enhance this situation.

Typologies of coping in young adults in the context of the COVID-19 pandemic

The COVID-19 pandemic has created major upheavals in the lives of people worldwide. The virus has mostly affected elderly populations, but there may be corollary effects on young adults' psychosocial adjustment due to educational, economic, and occupational disruptions. Using latent class analysis, we examined unique typologies of coping in response to the pandemic among young adults. We used an expanded set of indicators including traditional measures of problem- and emotion-focused coping as well as measures of resilience and coping flexibility. We also examined whether class membership could be predicted by demographics, stress appraisal, and psychosocial characteristics including catastrophic thinking and impulsivity. The sample of 1,391 young adults (ages 18-35) was recruited via Amazon's Mechanical Turk (MTurk) and snowball methods from late-April to early-May 2020. Six classes were identified: (1) Resilient Flexible Problem-Focused Copers, (2) Resilient Inflexible Problem-Focused Copers, (3) Non-Resilient Flexible Problem-Focused Venters, (4) Non-Resilient Flexible Problem-Focused Copers, (5) Non-Resilient Flexible Non-Copers, and (6) Non-Resilient Inflexible Non-Copers. Using Class 1 as the reference class, we found perceived centrality and uncontrollability of the pandemic as well as catastrophic thinking and impulsivity were significant predictors of class membership. The mean levels of stress appraisal and psychosocial characteristics varied significantly between the classes, reinforcing the structural validity of these classes. The findings suggest the importance of training young adults to develop resilience and flexibility as well as specific coping skills that can help offset the psychological effects of dramatic lifestyle changes that may result from pandemics or other health crises in the future.

Personality, Coping and Developmental Conditions in Female Adolescents and Young Adults with Type 1 Diabetes: Influence on Metabolic Control and Quality of Life

OBJECTIVE

To assess personality factors, coping, developmental conditions and quality of life in female adolescents and young adults with type 1 diabetes (T1D) and high vs.low HbA1c.

METHODS

Patients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included. HIGH-A1c was defined as HbA1c > 7.5%, LOW-A1c as HbA1c ≤ 7.5% and compared to a sample of 56 age-matched female healthy controls. Self-rating questionnaires were used to assess psychosocial factors: Children's Depression Inventory (CDI); Junior Temperament and Character Inventory (J-TCI); Eating Disorders Inventory-2 (EDI-2); KIDCOPE; Subjective Family Image Test (SFIT) and Inventory of Life Quality in Children and Adolescents(ILC).

RESULTS

T1D patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum BMI, higher depression score, and higher frequency of diabetic ketoacidosis in the last year. They showed significantly higher levels of fatigue, lower levels of taking responsibility, lower ability to set goals and lower self-acceptance, as well as higher levels of ineffectiveness, lower levels of emotional attachment within the family, in particular with the fathers, and used negative coping strategies more often compared to patients with LOW-A1c. Furthermore, they reported significantly higher burden of illness and lower quality of life.

CONCLUSIONS

Disadvantageous personality and coping styles as well as developmental conditions should be addressed in the treatment of female adolescents with T1D with management problems.

Process of Diabetes Management in Young Adults with Type 1 Diabetes

This study investigated diabetes management processes among young adults with type 1 diabetes applying the grounded theory method. A total of 15 young adults, with an average age of 29 years, with type 1 diabetes were selected through theoretical sampling between November 2016 and October 2018. Data collected through in-depth interviews were analyzed using the constant comparative method. The core category of this study was defined as “living in a standardized frame.” Participants managed diabetes through the trial-and-error process in addition to selective restriction or selective minimization. They restricted their diet, physical activity, social interactions, and range of thoughts, often following passive and avoidant strategies. Consequently, nurses are in a critical position to assist diabetic individuals via support programs and take the lead in mitigating social prejudice.

The 3i Conceptual Framework for Recognizing Patient Perspectives of Type 1 Diabetes During Emerging Adulthood

IMPORTANCE

Early emerging adulthood, the developmental life stage roughly spanning between the ages of 18 and 24 years, can be a challenging time for individuals living with type 1 diabetes, being associated with an increased risk of acute complications, loss to follow-up, and the emergence of long-term diabetes complications. Few evidence-based interventions exist, and practice guidelines instead emphasize the importance of delivering individualized, developmentally appropriate care.

OBJECTIVE

To inform the provision of tailored care and education by illuminating the individual lived experiences of emerging adults with type 1 diabetes.

DESIGN, SETTING, AND PARTICIPANTS

This qualitative study used in-depth interviews conducted with 33 emerging adults living with type 1 diabetes between October 14, 2016, and May 16, 2017. Participants were recruited from 2 urban Young Adult Diabetes Clinics in the city of Toronto, Ontario, Canada, using a convenience sampling approach. Narrative analysis of participants' accounts was conducted inductively to define story typology.

MAIN OUTCOMES AND MEASURES

Participant accounts of type 1 diabetes during childhood, adolescence, and emerging adulthood.

RESULTS

Interviews were conducted with 33 participants aged 18 to 24 years (mean [SD] age at interview, 20.6 [1.7] years); 17 (51%) were women. Duration of diabetes ranged from 3 to 20 years (mean [SD] duration, 12.0 [4.8] years). Narrative analysis identified 3 distinct story types, or lenses, termed ingrained (n = 14), intrusive (n = 12), and inconspicuous (n = 7). Ingrained narratives portrayed an active integration of diabetes self-management into daily life. Intrusive narratives were characterized by stories of struggles for acceptance and striving for control. Inconspicuous narratives were differentiated by descriptions of a willingness to ignore diabetes and its attendant daily tasks with the goals of preserving normalcy and limiting distress. Mean levels of hemoglobin A1c were higher in participants conveying an intrusive lens narrative (mean [SD], 9.3% [1.6%]) than those conveying an ingrained lens (mean [SD], 7.4% [0.7%]) (difference between intrusive and ingrained, 1.9%; 95% CI, 0.8%-2.9%; P = .007) or an inconspicuous lens (mean [SD], 8.6% [1.5%]).

CONCLUSIONS AND RELEVANCE

Although every person is unique, there are commonalities in how emerging adults perceive and depict their experiences living with type 1 diabetes. Among the emerging adults interviewed in the present study, the 3i conceptual framework of ingrained, intrusive, and inconspicuous lenses encapsulated these commonalities. Recognition of the different psychosocial contexts surrounding type 1 diabetes during emerging adulthood may help health care professionals individualize their care accordingly.

Parental depression and diabetes-specific distress after the onset of type 1 diabetes in children

OBJECTIVE

To examine trajectories of two types of type 1 diabetes (T1D) specific distress (i.e., daily T1D management and worries about the future and long-term complications) and the moderating role of parental depression in parents of children newly diagnosed with T1D.

METHOD

A total of 126 families of 5- to 9-year-olds with new-onset T1D enrolled in the study. One-hundred twenty-five families completed study measures at baseline, 102 at 6-month follow-up, and 89 at 12-month follow-up. Parents completed measures of depression and T1D-specific distress concerning daily T1D management and worries about the future and long-term complications at baseline and at 6- and 12-month follow-ups. We used multilevel modeling to examine 12-month trajectories of daily and long-term T1D-specific distress and to examine if parental depression modified these trajectories.

RESULTS

Results showed a significant reduction in daily T1D-specific distress from baseline to 6-month follow-up and maintenance of daily T1D-specific distress from 6- to 12-month follow-up. The significant interaction of baseline parental depression and time indicated that parents with depressive symptoms had a smaller reduction in daily T1D-specific distress from baseline to 6-month follow-up compared to parents without depressive symptoms. Findings for long-term T1D-specific distress indicated that parents with depressive symptoms reported higher distress across all assessment points, with peak long-term T1D-specific distress for parents with depressive symptoms occurring at 6-month follow-up.

CONCLUSION

Many parents experienced significant T1D-specific distress for a period of time following their child's initial diagnosis and this distress appears to be exacerbated by parental depressive symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Illness Identity in Adolescents and Emerging Adults With Type 1 Diabetes: Introducing the Illness Identity Questionnaire

OBJECTIVE

The current study examined the utility of a new self-report questionnaire, the Illness Identity Questionnaire (IIQ), which assesses the concept of illness identity, or the degree to which type 1 diabetes is integrated into one's identity. Four illness identity dimensions (engulfment, rejection, acceptance, and enrichment) were validated in adolescents and emerging adults with type 1 diabetes. Associations with psychological and diabetes-specific functioning were assessed.

RESEARCH DESIGN AND METHODS

A sample of 575 adolescents and emerging adults (14-25 years of age) with type 1 diabetes completed questionnaires on illness identity, psychological functioning, diabetes-related problems, and treatment adherence. Physicians were contacted to collect HbA1c values from patients' medical records. Confirmatory factor analysis (CFA) was conducted to validate the IIQ. Path analysis with structural equation modeling was used to examine associations between illness identity and psychological and diabetes-specific functioning.

RESULTS

CFA indicated that the IIQ has a clear factor structure, meaningfully differentiating four illness identity dimensions. Rejection was related to worse treatment adherence and higher HbA1c values. Engulfment was related to less adaptive psychological functioning and more diabetes-related problems. Acceptance was related to more adaptive psychological functioning, fewer diabetes-related problems, and better treatment adherence. Enrichment was related to more adaptive psychological functioning.

CONCLUSIONS

The present findings underscore the importance of the concept of illness identity. A valid and reliable measure, the IIQ, is introduced to measure four illness identity dimensions in individuals with type 1 diabetes. These four illness identity dimensions were uniquely related to psychological and diabetes-specific functioning.

Socioeconomic status and glycemic control in adult patients with type 2 diabetes: a mediation analysis

OBJECTIVE

The purpose of this study is to examine the contribution of health behaviors (self-management and coping), quality of care, and individual characteristics (depressive symptoms, self-efficacy, illness representations) as mediators in the relationship between socioeconomic status (SES) and glycemic control.

METHODS

A sample of 295 adult patients with type 2 diabetes was recruited at the end of a diabetes education course. Glycemic control was evaluated through glycosylated hemoglobin (HbA1c). Living in poverty and education level were used as indicators of SES.

RESULTS

Bootstrapping analysis showed that the significant effects of poverty and education level on HbA1c were mediated by avoidance coping and depressive symptoms. The representation that diabetes is unpredictable significantly mediated the relationship between living in poverty and HbA1c, while healthy diet mediated the relationship between education level and HbA1c.

CONCLUSIONS

To improve glycemic control among patients with low SES, professionals should regularly screen for depression, offering treatment when needed, and pay attention to patients' illness representations and coping strategies for handling stress related to their chronic disease. They should also support patients in improving their self-management skills for a healthy diet.

Change and stability in depressive symptoms in young adults with type 1 diabetes

This study examined inter-individual differences in depressive symptom development in young adults with type 1 diabetes. Individuals with persistent depressive symptoms were at risk for suboptimal development in terms of illness perceptions, illness functioning, and self-esteem. Individuals reporting no/minimal depressive symptoms over time were characterized by the most optimal development.

Adolescent and young adult medicine is a special and specific area of medical practice

Adolescent and young adult medicine is a concept that has gained traction in the last decade or so. The medical literature has come primarily from oncology. Advances in neuroscience that document continuing brain development into the third decade, and research that shows risk behaviours associated with adolescence both remain and may increase in the third decade, have been two of the drivers in the conversation around linking these two age groups together as a medical practice group. A third driver of importance is transition care in chronic illness, where older adolescents and young adults continue to have difficulties making effective linkages with adult care. The case for specific training in adolescent and young adult medicine, including the developmental concepts behind it, the benefits of the delineation and the particular challenges in the Australian health-care system, are discussed. On balance, there is a strong case for managing the health issues of adolescents and young adults together. This scenario does not fit easily with the age demarcations that are in place in acute care facilities. However, this is less the case in community services and can work in focused private practice. Such a situation suggests that both paediatric and adult physicians might be interested in adolescent and young adult medicine training and practice.

Exploring the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care. A systematic review with meta-analysis

OBJECTIVE

Depression and anxiety are common in diabetes and are associated with lower diabetes self-care adherence. How this occurs is unclear. Our systematic review explored the relationship between cognitive illness representations and poor emotional health and their combined association with diabetes self-care.

METHODS

Medline, Psycinfo, EMBASE, and CINAHL were searched from inception to June 2013. Data on associations between cognitive illness representations, poor emotional health, and diabetes self-care were extracted. Random effects meta-analysis was used to test the relationship between cognitive illness representations and poor emotional health. Their combined effect on diabetes self-care was narratively evaluated.

RESULTS

Nine cross-sectional studies were included. Increased timeline cyclical, consequences, and seriousness beliefs were associated with poorer emotional health symptoms. Lower perceived personal control was associated with increased depression and anxiety, but not mixed anxiety and depressive symptoms. Remaining cognitive illness representation domains had mixed statistically significant and non-significant relationships across emotional states or were measured only once. Effect sizes ranged from small to large (r=±0.20 to 0.51). Two studies explored the combined effects of cognitions and emotions on diabetes self-care. Both showed that cognitive illness representations have an independent effect on diabetes self-care, but only one study found that depression has an independent effect also.

CONCLUSIONS

Associations between cognitive illness representations and poor emotional health were in the expected direction - negative diabetes perceptions were associated with poorer emotional health. Few studies examined the relative effects of cognitions and emotions on diabetes self-care. Longitudinal studies are needed to clarify directional pathways.

Diabetes-specific variables associated with quality of life changes in young diabetic people: the type 1 diabetes Registry of Turin (Italy)

BACKGROUND AND AIMS

Type 1 diabetes (T1DM) affects young people during the most active years of their life. Our aim was to assess quality of life (QoL) and associated variables in a large cohort of adults with childhood-onset and adult-onset T1DM.

METHODS

A cohort of adult patients (18 years and older) from the T1DM Registry of Turin, Italy, was recruited. Clinical characteristics and Diabetes QoL (DQOL) questionnaire were assessed by standardized procedures.

RESULTS

310 adults completed the questionnaire. Age and diabetes duration at assessment (mean ± SD) were 32.8 ± 7.3 years and 17.3 ± 6.3 years, respectively. DQOL and its subscores were in the lower quartiles of their distributions, indicating a good level of QoL. However, scores were significantly higher in females than in males, particularly for the subscale of diabetes-related worries. In multivariate analysis, lower QoL was independently associated with female sex (β = 1.07, 95% CI 1.03-1.11, p = 0.003), higher age at onset (β = 1.03, 1.00-1.05, p = 0.009), lower schooling (β = 1.05, 1.00-1.09, p = 0.02), higher fasting plasma glucose (β = 1.03, 1.01-1.05, p = 0.008), daily SMBG >4 (β = 1.06, 1.01-1.10, p = 0.01), severe hypoglycemia over the last year (β = 1.06, 1.01-1.11, p = 0.02), lower numbers of diabetologic visits (β = 1.07, 1.01-1.13, p = 0.02) and hypertension (β = 1.06, 1.02-1.10, p = 0.005). Autonomic neuropathy was associated with diabetes impact. Female sex (β = 4.36, 2.43-7.83) and daily SMBG >4 (β = 3.77, 1.72-8.30) were independently associated with worst level and CSII with better level (β = 0.22, 0.07-0.68) of diabetes-related worries.

CONCLUSIONS

The impact of T1DM on QoL may depend on demographic, metabolic control-related variables, presence of complications and insulin delivery modality.

Psychometric evaluation of a coping questionnaire in two independent samples of people with diabetes

The study examines internal item/scale structure and concurrent validity of a newly developed 48-item questionnaire [General Coping Questionnaire (GCQ)] that measures 10 aspects of coping with chronic illness (self-trust, problem-reducing actions, change of values, social trust, minimization, fatalism, resignation, protest, isolation and intrusion). The tests were performed in two independent samples of persons with diabetes mellitus. The first sample consisted of 119 subjects with type I diabetes and the second sample of 184 subjects with type II diabetes. Concurrent validity was examined by comparisons with measures of health-related quality of life (SF-36), a measure of metabolic control (HbA1c) and incidence of diabetic complications. The item/scale structure was found to be similar and very good in both samples. The 10 dimensions correlated as expected with the measure of mental health, although the 'negative' dimensions of the GCQ correlated higher compared with the 'positive' dimensions. Weaker relations with metabolic control were also found in one of the samples. These tests provide further evidence that GCQ is a well-structured, relevant and reliable instrument for assessing coping reactions in chronic somatic conditions.

Goal disturbance and coping in children with type I diabetes mellitus: relationships with health-related quality of life and A1C

OBJECTIVE

Our first objective was to compare the health-related quality of life (HRQoL) of children with type 1 diabetes mellitus (8-12 years) with that of a healthy reference group, and to compare glycated hemoglobin (A1C) values of these children to recommended guidelines. Our second objective was to examine how goal disturbance and coping behaviour were related to HRQoL and A1C.

METHOD

Forty-three children, 8-12 years of age, completed a set of questionnaires that assessed generic and diabetes-specific HRQoL, goal disturbance and coping behaviour. Demographic and clinical characteristics were extracted from medical records.

RESULTS

Children with type 1 diabetes reported lower psychosocial HRQoL than healthy references (d=-0.48), especially on emotional functioning (d=-0.58). Goal disturbance was associated with lower generic HRQoL. Furthermore, the coping strategies avoidance, emotional reaction and wishful thinking were negatively associated with lower generic and disease-specific HRQoL (r ranged from -0.33 to -0.65), whereas acceptance was positively associated with disease-specific HRQoL (r=0.36). The average A1C was with 8.1% significantly above the recommended guidelines of 7.5%. Moreover, the coping strategies avoidance (r=0.31) and emotional reaction (r=0.32) were positively associated with higher blood glucose levels.

CONCLUSIONS

The psychosocial HRQoL of children with type 1 diabetes was affected, which was directly associated with the inability to reach personal goals (goal disturbance). An accepting coping strategy might solve these HRQoL problems and additionally improve A1C values.