1
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Klada E, Alikari V, Toska A, Saridi M, Albani E, Lavdaniti M, Zyga S, Fradelos EC. Greek School Nurses' Confidence With Diabetes Devices. Cureus 2024; 16:e65920. [PMID: 39221386 PMCID: PMC11365008 DOI: 10.7759/cureus.65920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2024] [Indexed: 09/04/2024] Open
Abstract
Aim School nurses often use diabetes mellitus devices as part of the care provided to students with Type 1 Diabetes Mellitus. The aim of this study was to explore the psychometric properties of the Greek version of the Diabetes Devices Confidence Scale (DDCS). Methods In this cross-sectional, descriptive study, 143 school nurses completed the DDCS. This is a self-administered questionnaire exploring the nurses' confidence in the use of diabetes devices. The scale was translated and culturally adapted according to the WHO guidelines. The Intraclass Correlation Coefficient and Cronbach's Alpha Index were used to explore the reliability and internal consistency, respectively. The construct validity was tested via exploratory and confirmatory factor analysis (EFA, CFA). Data were analyzed via Statistical Package for the Social Sciences (SPSS), version 22.0 (IBM Corp., Armonk, NY, USA). Results Significant correlations were observed between the two administrations (p<0.001) indicating the good reliability of the scale (ICC = 0525, p<0.001) while Cronbach's Alpha was 0.966 suggesting excellent internal consistency. The EFA resulted in a unidimensional solution explaining 53.7% of the total variance. The CFA showed that the model presents good fit to the data. Conclusions The DDCS is a reliable and valid tool to test the nurses' confidence in diabetes devices.
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Affiliation(s)
- Evangelia Klada
- School of Social Sciences, Hellenic Open University, Patras, GRC
| | | | | | - Maria Saridi
- General Department of Lamia, University of Thessaly, Corinth, GRC
| | - Eleni Albani
- Department of Nursing, University of Patras, Patra, GRC
| | - Maria Lavdaniti
- Department of Nursing, International Hellenic University, Thessaloniki, GRC
| | - Sofia Zyga
- Department of Nursing, Faculty of Health Sciences, University of Peloponnese, Tripolis, GRC
| | - Evangelos C Fradelos
- Laboratory of Clinical Nursing/Department of Nursing, University of Thesssaly, Larissa, GRC
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2
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Ben Abdesselem I, Kebaili R, Derbel K, Ben Said H, Boughammoura L, Rouatbi S, Bouguila J. Effect of diabetes self-management education on health-related quality of life of Tunisian children with type1 diabetes mellitus and their parents: A randomized controlled trial. LA TUNISIE MEDICALE 2024; 102:205-211. [PMID: 38746959 PMCID: PMC11387992 DOI: 10.62438/tunismed.v102i4.4846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 06/14/2024]
Abstract
AIM To assess the effect of diabetes self-management education (DSME) on health related quality of life (HRQoL) of Tunisian children/adolescents with type 1 diabetes mellitus and their parents. METHODS This monocentral study used a randomized controlled trial design, during five-month intervention and five-month follow-up and including 110 patients (54 in the DSME intervention group and 56 in the Individual Education by Pediatrician (IEP) control group) and their parents. Pediatric Generic Core Quality-of-Life Inventory 4.0-Scale (PedsQL4.0) evaluated HRQoL. RESULTS At baseline, both groups had similar clinical features and PedsQL4.0 scores (p>0.05). In DSME, clinical outcomes were significantly improved from baseline to follow-up (p<0.001), while in the IEP group, which received no intervention, these outcomes remained unchanged. During follow-up, DSME showed higher PedsQL4.0 scores in parents' proxy-report and children/adolescents self-report (p<0.001). According to parents' proxy-report, PedsQL4.0 scores were significantly higher during follow-up compared to baseline in DSME (p<0.001) while they remained the same in IEP (p>0.05). DSME had higher percentage of change in the PedsQL4.0 scores than IEP (p<0.01). The median change varied from -5.01% to 0% vs 5.41% to 36.36% in IEP and DSME, respectively. CONCLUSION Encouraging healthcare professionals to incorporate these interventions could enhance the HRQoL of diabetic children and bolster their self-esteem.
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Affiliation(s)
- Imen Ben Abdesselem
- Department of Physiology, Hospital Farhat Hached, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research laboratory "Heart failure" (LR12SP09), University of Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Raoudha Kebaili
- Department of Pediatrics, Hospital Farhat Hached, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Khansa Derbel
- Department of Physiology, Hospital Farhat Hached, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Hichem Ben Said
- Department of Pediatrics, Hospital Farhat Hached, Sousse, Tunisia
| | - Lamia Boughammoura
- Research laboratory "Heart failure" (LR12SP09), University of Sousse, Sousse, Tunisia
- Department of Pediatrics, Hospital Farhat Hached, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Sonia Rouatbi
- Department of Physiology, Hospital Farhat Hached, Sousse, Tunisia
- Laboratory of Physiology, Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
- Research laboratory "Heart failure" (LR12SP09), University of Sousse, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
| | - Jihene Bouguila
- Research laboratory "Heart failure" (LR12SP09), University of Sousse, Sousse, Tunisia
- Department of Pediatrics, Hospital Farhat Hached, Sousse, Tunisia
- Faculty of Medicine of Sousse, University of Sousse, Sousse, Tunisia
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3
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Buzás N, Horváth MD, Tesch Z, Hallgató E. How online peer support affects management efficacy and mitigates difficulties of parents caring for children with type 1 diabetes. Prim Care Diabetes 2023; 17:607-611. [PMID: 37730520 DOI: 10.1016/j.pcd.2023.09.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 08/31/2023] [Accepted: 09/14/2023] [Indexed: 09/22/2023]
Abstract
The proper management of pediatric type 1 diabetes depends substantially on the parents of affected children. Parental psychological traits specifically related to diabetes caregiving influence the quality of their care and management of the disease in their children. Parents often use Facebook groups as sources of peer support and information about diabetes care. The present study aimed to examine the influence of devices used in diabetes management, ascertain the impact of Facebook peer-support groups on parental perceptions of problems and probe parental self-efficacy. 318 parents of children with type 1 diabetes completed an online questionnaire on demographics, diabetes-related data, and diabetes care-related psychological characteristics. Data analysis revealed three variables that determined competence in diabetes management: the utility of information and suggestions offered in the Facebook groups on diabetes; the form of insulin administration and membership in Facebook groups. Our results underpin that peer-support groups on social media platforms can serve as sources of the necessary information, support, and feedback on diabetes management competence for parents of children living with type 1 diabetes, they may thus facilitate parental diabetes management capabilities.
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Affiliation(s)
- Norbert Buzás
- Department of Health Economics, Faculty of Medicine, University of Szeged, Kossuth L. sgt. 35., H-6724 Szeged, Hungary.
| | - Mária Dóra Horváth
- Department of Health Economics, Faculty of Medicine, University of Szeged, Kossuth L. sgt. 35., H-6724 Szeged, Hungary; Department of Cognitive- and Neuropsychology, Faculty of Arts, University of Szeged, Egyetem u. 2., H-6722 Szeged, Hungary
| | - Zsanett Tesch
- Department of Health Economics, Faculty of Medicine, University of Szeged, Kossuth L. sgt. 35., H-6724 Szeged, Hungary
| | - Emese Hallgató
- Department of Cognitive- and Neuropsychology, Faculty of Arts, University of Szeged, Egyetem u. 2., H-6722 Szeged, Hungary
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4
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Edelman S, Cheatham WW, Norton A, Close KL. Patient Perspectives on the Benefits and Challenges of Diabetes and Digital Technology. Clin Diabetes 2023; 42:243-256. [PMID: 38666210 PMCID: PMC11040029 DOI: 10.2337/cd23-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/28/2024]
Abstract
Diabetes technology continues to evolve, advancing with our understanding of human biology and improving our ability to treat people with diabetes. Diabetes devices are broadly classified into the following categories: glucose sensors, insulin delivery devices, and digital health care technology (i.e., software and mobile applications). When supported by education and individually tailored, technology can play a key role in optimizing outcomes. Digital devices assist in diabetes management by tracking meals, exercise, sleep, and glycemic measurements in real time, all of which can guide physicians and other clinicians in their decision-making. Here, as people with diabetes and patient advocates, as well as diabetes specialists, primary care providers, and diabetes care and education specialists, we present our perspectives on the advances, benefits, and challenges of diabetes technology in primary care practices.
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Affiliation(s)
- Steve Edelman
- University of California San Diego, Veterans Affairs Medical Center, San Diego, CA
- Taking Control of Your Diabetes, Solana Beach, CA
| | | | - Anna Norton
- National Minority Quality Forum, Washington, DC
| | - Kelly L. Close
- Close Concerns, Inc., and the diaTribe Foundation, San Francisco, CA
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5
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Alfaleh A, Alkattan A, Alzaher A, Alhabib D, Alshatri A, Alnamshan A, Almalki O, Almutairi L, Khairat M, Sagor K, Alabdulkareem K, Ibrahim M. Quality of life among schoolchildren with type 1 diabetes mellitus and the satisfaction of their guardians towards school health care in Saudi Arabia. Diabetes Res Clin Pract 2023; 204:110901. [PMID: 37699476 DOI: 10.1016/j.diabres.2023.110901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 08/11/2023] [Accepted: 09/06/2023] [Indexed: 09/14/2023]
Abstract
AIMS This study aimed to assess the quality of life of schoolchildren with type 1 diabetes mellitus (T1DM) and determine their guardians' satisfaction of diabetes health care in Saudi Arabian schools. METHODS A cross-section multicenter study was conducted from February to July 2022 among Schoolchildren with T1DM in Saudi Arabia. The study included T1DM school children aged 6-18 years. The patients' health-related quality of life (HRQoL) data were collected and determined using a modified version of the PedsQL 3.0 Diabetes Module. RESULTS The grand total median PedQL-DM score among the included participants (N = 283) was 64.7, while items related to diabetes symptoms and diabetes management were 61.1 and 68.7, respectively. Schoolchildren who have lower HbA1c levels and take care of regular monitoring of their blood glucose showed significantly better quality of life concerning diabetes symptoms. A significant number of guardians claimed they were not satisfied with the current status of diabetes management at schools. CONCLUSIONS The overall HRQoL among schoolchildren with T1DM was average and acceptable to some extent. The PedsQL-DM median score was higher among those who received health care during school time. The guardians' satisfaction of diabetes health care was low, emphasizing the role of health clinics in schools.
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Affiliation(s)
- Amjad Alfaleh
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Abdullah Alkattan
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia.
| | - Abrar Alzaher
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Dina Alhabib
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Amani Alshatri
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Amani Alnamshan
- Research Department, Assistant Agency for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Ohood Almalki
- Department of Research, Assisting Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia
| | - Laila Almutairi
- Research Department, Assistant Agency for Preventive Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Mansour Khairat
- Department of Telemedicine, General Directorate of Medical Consultations, Ministry of Health, Riyadh, Saudi Arabia
| | - Khlood Sagor
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia
| | - Khaled Alabdulkareem
- Department of Research, Assisting Deputyship for Primary Health Care, Ministry of Health, Riyadh, Saudi Arabia; Department of Family Medicine, College of Medicine, Al-Imam Mohammad Bin Saud Islamic University, Riyadh, Saudi Arabia
| | - Mona Ibrahim
- Research and Planning Unit, General Directorate of School Health, Ministry of Health, Riyadh, Saudi Arabia; Department of Community, Environmental and Occupational Medicine, Faculty of Medicine, Zagazig University, Zagazig, Egypt
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6
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Stern A, Duran B, Streisand R, Wang CH, Tully C, Clary L, Gallagher K, Cogen F, Karaviti L, Monaghan M, Hilliard ME. Parent Perspectives of School/Daycare Experiences in Young Children Newly Diagnosed With Diabetes. J Pediatr Psychol 2023; 48:490-501. [PMID: 36888882 PMCID: PMC10199729 DOI: 10.1093/jpepsy/jsad011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 03/10/2023] Open
Abstract
OBJECTIVE A central part of family adjustment to a new diagnosis of type 1 diabetes (T1D) is integrating T1D management into the child's school/daycare. This may be particularly challenging for young children who rely on adults for their diabetes management. This study aimed to describe parent experiences with school/daycare during the first 1.5 years following a young child's T1D diagnosis. METHODS As part of a randomized controlled trial of a behavioral intervention, 157 parents of young children with new-onset (<2 months) T1D reported on their child's school/daycare experience at baseline and at 9- and 15-month post-randomization. We used a mixed-methods design to describe and contextualize parents' experiences with school/daycare. Qualitative data were collected via open-ended responses, and quantitative data were collected from a demographic/medical from. RESULTS While most children were enrolled in school/daycare at all time points, over 50% of parents endorsed that T1D affected their child's enrollment, rejection, or removal from school/daycare at 9 or 15 months. We generated five themes related to parents' school/daycare experiences: Child factors, Parent factors, School/Daycare factors, Cooperation between Parents and Staff, and Socio-historical factors. Parents of younger children and those with lower subjective socioeconomic status were significantly more likely to endorse challenges with school/daycare enrollment. CONCLUSIONS School/daycare settings present challenges for parents of young children with T1D. Changes may need to occur across contexts to support early childhood education, including advocacy resources for parents to navigate school policies, increased training for school staff, and healthcare team outreach initiatives to parents and schools.
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Affiliation(s)
- Alexa Stern
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Brenda Duran
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Randi Streisand
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Christine H Wang
- Clinical and Translational Research, Children’s National Hospital, USA
| | - Carrie Tully
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Lauren Clary
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Katherine Gallagher
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Fran Cogen
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Lefkothea Karaviti
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
| | - Maureen Monaghan
- Clinical and Translational Research, Children’s National Hospital, USA
- Department of Psychiatry, George Washington University School of Medicine, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Texas Children’s Hospital and Baylor College of Medicine, USA
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7
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Eysenbach G, Lin YK, Chhabra M, Henschke A, Brown E, Pedley L, Pedley E, Hannan K, Brown K, Wright K, Phillips C, Tricoli A, Nolan CJ, Suominen H, Desborough J. Toward Diabetes Device Development That Is Mindful to the Needs of Young People Living With Type 1 Diabetes: A Data- and Theory-Driven Qualitative Study. JMIR Diabetes 2023; 8:e43377. [PMID: 36696176 PMCID: PMC9947809 DOI: 10.2196/43377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 12/01/2022] [Accepted: 12/01/2022] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND An important strategy to understand young people's needs regarding technologies for type 1 diabetes mellitus (T1DM) management is to examine their day-to-day experiences with these technologies. OBJECTIVE This study aimed to examine young people's and their caregivers' experiences with diabetes technologies in an exploratory way and relate the findings to the existing technology acceptance and technology design theories. On the basis of this procedure, we aimed to develop device characteristics that meet young people's needs. METHODS Overall, 16 in-person and web-based face-to-face interviews were conducted with 7 female and 9 male young people with T1DM (aged between 12 and 17 years) and their parents between December 2019 and July 2020. The participants were recruited through a pediatric diabetes clinic based at Canberra Hospital. Data-driven thematic analysis was performed before theory-driven analysis to incorporate empirical data results into the unified theory of acceptance and use of technology (UTAUT) and value-sensitive design (VSD). We used the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist for reporting our research procedure and findings. In this paper, we summarize the key device characteristics that meet young people's needs. RESULTS Summarized interview themes from the data-driven analysis included aspects of self-management, device use, technological characteristics, and feelings associated with device types. In the subsequent theory-driven analysis, the interview themes aligned with all UTAUT and VSD factors except for one (privacy). Privacy concerns or related aspects were not reported throughout the interviews, and none of the participants made any mention of data privacy. Discussions around ideal device characteristics focused on reliability, flexibility, and automated closed loop systems that enable young people with T1DM to lead an independent life and alleviate parental anxiety. However, in line with a previous systematic review by Brew-Sam et al, the analysis showed that reality deviated from these expectations, with inaccuracy problems reported in continuous glucose monitoring devices and technical failures occurring in both continuous glucose monitoring devices and insulin pumps. CONCLUSIONS Our research highlights the benefits of the transdisciplinary use of exploratory and theory-informed methods for designing improved technologies. Technologies for diabetes self-management require continual advancement to meet the needs and expectations of young people with T1DM and their caregivers. The UTAUT and VSD approaches were found useful as a combined foundation for structuring the findings of our study.
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Affiliation(s)
| | | | - Madhur Chhabra
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Adam Henschke
- Philosophy Section, Faculty of Behavioural, Management, and Social Sciences, University of Twente, Enschede, Netherlands
| | - Ellen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Lachlan Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Elizabeth Pedley
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Kristal Hannan
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Karen Brown
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Kristine Wright
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia.,The Centenary Hospital for Women and Children, Canberra Health Services, Canberra, Australia
| | - Christine Phillips
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Antonio Tricoli
- Nanotechnology Research Laboratory, Faculty of Engineering, The University of Sydney, Sydney, Australia.,Nanotechnology Research Laboratory, Research School of Chemistry, College of Science, The Australian National University, Canberra, Australia
| | - Christopher J Nolan
- School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia.,The John Curtin School of Medical Research, College of Health and Medicine, The Australian National University, Canberra, Australia.,Department of Endocrinology and Diabetes, Canberra Health Services, Canberra, Australia
| | - Hanna Suominen
- School of Computing, College of Engineering, Computing and Cybernetics, The Australian National University, Canberra, Australia.,Department of Computing, University of Turku, Turku, Finland
| | - Jane Desborough
- National Centre for Epidemiology and Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
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8
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Kim YK, Munir KM, Davis SN. Type 1 diabetes: key drug targets and how they could influence future therapeutics. Expert Opin Ther Targets 2023; 27:31-40. [PMID: 36744390 DOI: 10.1080/14728222.2023.2177150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite significant strides made in the management of T1DM, standard management is still insulin analog therapy. Some non-insulin therapies traditionally reserved for the treatment of T2DM have been explored in caring for patients with T1DM, and pancreas transplant is an option for few. However, T1DM remains a challenging disease to manage, encouraging development of novel pharmacologic agents. AREAS COVERED We retrieved PubMed, Cochrane Library, Scopus, Google Scholar, and ClinicalTrials.gov records to identify studies and articles focused on new pharmacologic advances to treat T1DM. EXPERT OPINION Recent research has focused on new targets of pharmacologic treatment of T1DM. Beta-cell preservation through immunomodulation or inhibiting inflammation hopes to delay or halt the progression of the disease. Beta cell regeneration through islet cell transplant or modification in transcription pathways aim to reverse the disease effects. Multiple other new targets such as glucagon antagonism and glucokinase activation are also in development as a potential adjunctive therapy. These new therapeutic targets offer the hope of reducing the daily burden of diabetes management with eventual insulin discontinuation for many individuals with T1DM.
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Affiliation(s)
- Yoon Kook Kim
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Center for Diabetes and Endocrinology, 800 Linden Ave, 8th Floor, 21201, Baltimore, MD, USA
| | - Kashif M Munir
- Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Center for Diabetes and Endocrinology, 800 Linden Ave, 8th Floor, 21201, Baltimore, MD, USA
| | - Stephen N Davis
- Department of Medicine, University of Maryland School of Medicine, 22 South Greene Street, 21201, Baltimore, MD, USA
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de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, Delamater AM, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes 2022; 23:1373-1389. [PMID: 36464988 PMCID: PMC10107478 DOI: 10.1111/pedi.13428] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, Netherlands
| | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda A DiMeglio
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,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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10
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Nguyen KT, Xu NY, Buckingham BA, Chattaraj S, Cohen O, Heinemann L, Pickup J, Svensson J, Vigersky RA, Wong JC, Ziegler R. Improving the Patient Experience With Longer Wear Infusion Sets Symposium Report. J Diabetes Sci Technol 2022; 16:775-782. [PMID: 35227075 PMCID: PMC9294583 DOI: 10.1177/19322968221078884] [Citation(s) in RCA: 3] [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] [Indexed: 12/26/2022]
Abstract
Continuous subcutaneous insulin infusion (CSII) therapy is becoming increasingly popular. CSII provides convenient insulin delivery, precise dosing, easy adjustments for physical activity, stress, or illness, and integration with continuous glucose monitors in hybrid or other closed-loop systems. However, even as insulin pump hardware and software have advanced, technology for insulin infusion sets (IISs) has stayed relatively stagnant over time and is often referred to as the "Achilles heel" of CSII. To discuss barriers to insulin pump therapy and present information about advancements in, and results from clinical trials of extended wear IISs, Diabetes Technology Society virtually hosted the "Improving the Patient Experience with Longer Wear Infusion Sets Symposium" on December 1, 2021. The symposium featured experts in the field of IISs, including representatives from Steno Diabetes Center Copenhagen, University of California San Francisco, Stanford University, Medtronic Diabetes, and Science Consulting in Diabetes. The webinar's seven speakers covered (1) advancements in insulin pump therapy, (2) efficacy of longer wear infusion sets, and (3) innovations to reduce plastics and insulin waste.
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Affiliation(s)
- Kevin T. Nguyen
- Diabetes Technology Society, Burlingame, CA,
USA
- Kevin T. Nguyen, BA, Diabetes Technology Society,
845 Malcolm Road Suite 5, Burlingame, CA 94010, USA.
| | - Nicole Y. Xu
- Diabetes Technology Society, Burlingame, CA,
USA
| | | | | | - Ohad Cohen
- Medtronic Diabetes EMEA, Tolochenaz,
Switzerland
| | | | - John Pickup
- Faculty of Life Sciences & Medicine,
King’s College London, London, UK
| | | | | | - Jenise C. Wong
- University of California, San Francisco, San
Francisco, CA, USA
| | - Ralph Ziegler
- Diabetes Clinic for Children and Adolescents,
Muenster, Germany
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11
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Alkhaled L, O’Riordan M, MacLeish S, Hazen R, Wood JR. Psychological Characteristics and Goals of Caregivers Choosing Continuous Glucose Monitoring for Children With Type 1 Diabetes. Diabetes Spectr 2022; 35:111-117. [PMID: 35308154 PMCID: PMC8914595 DOI: 10.2337/ds21-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Continuous glucose monitoring (CGM) can improve glycemic outcomes in pediatric type 1 diabetes management. However, its impact on the psychosocial functioning of caregivers is less well described. The objectives of this pilot study were to explore caregiver reasons for adding CGM to their child's type 1 diabetes management, parental psychosocial function before initiating CGM, and the relationship between the two. METHODS Thirty-two families with a child with type 1 diabetes from Rainbow Babies and Children's Hospital diabetes clinics who were initiating CGM were recruited over 3 months. Before CGM initiation, the caregivers completed the Fear of Hypoglycemia Scale, State-Trait Anxiety Inventory, Problem Areas in Diabetes Scale, and a questionnaire assessing their primary reason for starting CGM. Participant characteristics and questionnaire results were summarized with descriptive statistics. Participants were grouped by reason for starting CGM, and results were compared among groups using ANOVA and reporting the global F test. RESULTS Fifty percent of respondents indicated that they were starting CGM to optimize glycemic control. The majority of parents (71.8%) expressed worry about helplessness during a hypoglycemic episode. There were no statistically significant differences in patient characteristics or questionnaire results between groups. Forty-three percent of participating families started using CGM during the study's 8-month follow-up period. The main reason (64%) for not starting CGM was not having the chance to start the process of obtaining a CGM system. There were no statistically significant differences between children who did and did not start CGM. CONCLUSION Caregivers have different reasons for starting CGM for their child with type 1 diabetes. Further studies are needed to understand whether these reasons are related to differences in psychosocial functioning. Despite interest in starting CGM, there remain barriers to implementation.
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Affiliation(s)
- Lina Alkhaled
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
- Corresponding author: Lina Alkhaled,
| | | | - Sarah MacLeish
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
| | - Rebecca Hazen
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
| | - Jamie R. Wood
- Rainbow Babies and Children’s Hospital, University Hospitals Cleveland Medical Center, Cleveland, OH
- Case Western Reserve University, Cleveland, OH
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12
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Oral Health Status of Children Living with Type 1 Diabetes Mellitus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19010545. [PMID: 35010805 PMCID: PMC8744624 DOI: 10.3390/ijerph19010545] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 12/30/2021] [Accepted: 01/01/2022] [Indexed: 02/04/2023]
Abstract
Background: Diabetes is a well-known predisposing factor for oral diseases, so prevention in an early age is mandatory. Objective: To provide oral screening for children living with type 1 diabetes. We aimed to investigate the oral and general health indexes of T1DM children and compare these data to healthy siblings and controls. Methods: In this cross-sectional study, 120 DM patients and 78 siblings, thereafter 80 DM children and 95 controls, took part. A detailed questionnaire, panoramic radiographs, and lateral cephalograms were obtained in every orthodontic consultation. We used Pearson’s chi-square test for statistical analysis and compared the data of the study and control groups. Results: The oral health values of DM children were significantly better (DMF-T 0.83–1.3) than the national average (3.8–4.5). A total of 75% (n = 60) of the children needed orthodontic treatment for orthodontic or skeletal anomalies. The prevalence of skeletal anomalies was significantly (p < 0.05) higher among patients with diabetes mellitus (DM) than in the control group. The frequency of coeliac disease was significantly elevated compared to any literature data (1–3.5%) in the study (15%) and in the control sibling group (13%). Conclusions: Co-morbidities such as CD should get more attention as a prognostic factor for a future higher incidence of diabetes. T1DM children can be motivated and health-conscious patients with excellent oral hygiene and dental status. Orthodontic treatment can help eliminate the oral complications of DM. Special diabetes ambulances may help provide oral care for patients with DM.
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13
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Pemberton JS, Kershaw M, Dias R, Idkowiak J, Mohamed Z, Saraff V, Barrett TG, Krone R, Uday S. DYNAMIC: Dynamic glucose management strategies delivered through a structured education program improves time in range in a socioeconomically deprived cohort of children and young people with type 1 diabetes with a history of hypoglycemia. Pediatr Diabetes 2021; 22:249-260. [PMID: 33205572 DOI: 10.1111/pedi.13155] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/28/2020] [Accepted: 11/11/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES Create and evaluate the effectiveness of a structured education program in children and young people (CYP) with type 1 diabetes using continuous glucose monitoring (CGM). DESIGN AND METHODS Step 1: CGM devices were evaluated for predetermined criteria using a composite score. Step 2: The education program was developed following review of international structured education guidance, dynamic glucose management (DynamicGM) literature, award-winning diabetes educators' websites, and CGM user feedback. Step 3: Program effectiveness was assessed at six months by change in time below range (TBR) (<3.9mmol/L), time in range (TIR) (3.9-10.0mmol/L), time above range level 2 (TAR2) (>13.9mmol/L), severe hypoglycemia and HbA1c using a paired T-test. A DynamicGM score was developed to assess proactive glucose management. Factors predicting TBR and TIR were assessed using regression analysis. RESULTS Dexcom G6 was chosen for integrated CGM (iCGM) status and highest composite score (29/30). Progressive DynamicGM strategies were taught through five sessions delivered over two months. Fifty CYP (23 male) with a mean (±SD) age and diabetes duration of 10.2 (±4.8) and 5.2 (±3.7) years respectively, who completed the education program were prospectively evaluated. Evaluation at six months showed a significant reduction in TBR (10.4% to 2.1%, p<.001), TAR2 (14.1% to 7.3%, p<.001), HbA1c [7.4 to 7.1% (57.7 to 53.8 mmol/mol), p<.001] and severe hypoglycemic episodes (10 to 1, p<.05); TIR increased (47.4% to 57.0%, p<.001). Number of Dexcom followers (p<.05) predicted reduction in TBR and DynamicGM score (p<.001) predicted increased TIR. CONCLUSION Teaching DynamicGM strategies successfully improves TIR and reduces hypoglycemia.
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Affiliation(s)
- John S Pemberton
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Melanie Kershaw
- Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Renuka Dias
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Jan Idkowiak
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Zainab Mohamed
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Vrinda Saraff
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Timothy G Barrett
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Cancer and Genomic Sciences, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Ruth Krone
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Suma Uday
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK.,Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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14
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Xu Y, Xu L, Zhao W, Li Q, Li M, Lu W, Zeng H, Yan J, Yang D, Wu W, Weng J, Pan J, Liu F. Effectiveness of a WeChat Combined Continuous Flash Glucose Monitoring System on Glycemic Control in Juvenile Type 1 Diabetes Mellitus Management: Randomized Controlled Trial. Diabetes Metab Syndr Obes 2021; 14:1085-1094. [PMID: 33727842 PMCID: PMC7955684 DOI: 10.2147/dmso.s299070] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 02/23/2021] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Smartphones have received increasing attention and achieved positive outcomes in diabetes intervention. The widespread use of WeChat in China provides an opportunity for self-management practices in patients with diabetes. Nevertheless, how to combine the strengths of the WeChat platform with traditional medical strategy remains to be explored. This study aimed to evaluate the efficacy of a novel flash glucose monitoring device combined with the WeChat platform in juvenile type 1 diabetes management. PATIENTS AND METHODS A total of 60 juvenile patients with type 1 diabetes were randomly assigned into three groups: a blood glucose self-monitoring group (group A), a flash glucose monitoring (group B), and a flash glucose monitoring combined WeChat-interactive management group (group C). The intergroup differences in demographics, biochemical indicators, and questionnaire scores of the Diabetes Monitoring and Treatment Satisfaction Questionnaire and Diabetes Specific Quality of Life assessment were compared at the baseline and after 6 months. RESULTS After the 6-month intervention, groups B and C showed significantly lower glycated hemoglobin A1c (HbA1c) levels compared to those observed at baseline (both P <0.05), with the largest decrease observed in group C (group B vs group C, P =0.04). Hypoglycemic episodes per month decreased from baseline in groups B and C (both P <0.05) and were more significant in group C (P <0.001). In addition, the DMTSQ scores increased in the 6th month in all groups (all P <0.05), and the largest rise in scores was found in group C, followed by groups B and A. The DQOL scores in groups B and C decreased significantly from the baseline (both P <0.05), with no change in group A. CONCLUSION Flash glucose monitoring combined with the WeChat-interactive system may help achieve sustained glycemic control and higher satisfaction in patients with juvenile type 1 diabetes. TRIAL REGISTRATION This study was registered at chictr.org.cn, number ChiCTR1900025495. Registered 29 August 2019.
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Affiliation(s)
- Yuejie Xu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Lei Xu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Weijing Zhao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Qing Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Ming Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Wei Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Hui Zeng
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
| | - Jinhua Yan
- Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Daizhi Yang
- Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Wei Wu
- Department of Pediatrics, Tongji Hospital, Wuhan Tongji Medical University, Wuhan, Hubei, 430030, People’s Republic of China
| | - Jianping Weng
- Department of Endocrinology and Metabolic Disease, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510630, People’s Republic of China
| | - Jiemin Pan
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
- Correspondence: Jiemin Pan; Fang Liu Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, 600 Yishan Road, Xuhui District, Shanghai, 200233, People’s Republic of ChinaTel +86-18930173803 Email ;
| | - Fang Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai Clinical Center for Diabetes, Shanghai Key Clinical Center for Metabolic Disease, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai, 200233, People’s Republic of China
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15
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Swaney EE, McCombe J, Coggan B, Donath S, O'Connell MA, Cameron FJ. Has subsidized continuous glucose monitoring improved outcomes in pediatric diabetes? Pediatr Diabetes 2020; 21:1292-1300. [PMID: 32829528 DOI: 10.1111/pedi.13106] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/13/2020] [Accepted: 08/17/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION In 2017, the Australian Federal Government fully subsidized continuous glucose monitoring (CGM) devices for patients under 21 years of age with T1D with the aim of reducing rates of severe hypoglycaemia (SH) and improving metabolic control. The aim of this study was to reports on metabolic outcomes in youth from a single tertiary centre. METHODS The study design was observational. Data were obtained on youth who commenced CGM between May 2017 and December 2019. RESULTS Three hundred and forty one youth who commenced CGM and had clinical outcome data for a minimum of 4 months. 301, 261, 216, 172, and 125 had outcome data out to 8, 12, 16, 20, and 24 months, respectively. Cessation occurred between 27.9% and 32.8% of patients 12 to 24 months after CGM commencement. HbA1c did not change in patients who continued to use CGM. In the 12 months prior to starting CGM the rate of severe hypoglycaemia events were 5.0 per 100 patient years. The rates of severe hypoglycaemia in those continuing to use CGM at 4, 8, 12, 16, 20, and 24 months, were 5.2, 5.1, 1.6, 6.1, 2.4, and 0 per 100 patient years, respectively. DISCUSSION Our experience of patients either ceasing or underusing CGM is less than reported in other cohorts but is nonetheless still high. There may have been a reduction in rates of severe hypoglycaemia over the 24 months follow up period; however, the absolute numbers of events were so low as to preclude meaningful statistical analysis.
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Affiliation(s)
- Ella Ek Swaney
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Julia McCombe
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Brenda Coggan
- The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Susan Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Michele A O'Connell
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Fergus J Cameron
- Diabetes Research, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,The Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia.,The Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia
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16
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Insulin Pump Therapy Improves Quality of Life of Young Patients With Type 1 Diabetes Enrolled in a Government-Funded Insulin Pump Program: A Qualitative Study. Can J Diabetes 2020; 45:395-402. [PMID: 33109446 DOI: 10.1016/j.jcjd.2020.08.101] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 08/17/2020] [Accepted: 08/17/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The Nova Scotia Insulin Pump Program (NSIPP) subsidizes the cost of insulin pump therapy for young patients (≤25 years) with type 1 diabetes. The first NSIPP evaluation focused on clinical outcomes rather than quality of life. Existing research on insulin pumps and quality of life is mostly survey based, with limited first-voice experiences. In this qualitative study, we examined patient and parent perspectives on how insulin pumps affect quality of life in the context of a government-funded program. METHODS In this investigation, we used a phenomenological approach, guided by a conceptual model. In-depth semistructured telephone interviews (median, 37 minutes) were completed with NSIPP enrollees and/or their parents. Saturation was reached after 23 interviews. Verbatim transcripts were coded independently by 2 researchers. Coding discrepancies were discussed and resolved using concept mapping to clarify relationships between codes and to identify main themes. RESULTS There were 2 main themes: 1) NSIPP financial support was necessary for those without private insurance and 2) control over life and diabetes with subthemes of social experiences and worry. Participants expressed this theme differently depending on their stage of life. For example, some children experienced shame and even hid their pump, whereas teens were more self-confident with the discreetness of pumps and young adults wore their pump with pride. CONCLUSIONS Insulin pump therapy, subsidized through the NSIPP, led to improved quality of life, which was experienced differently depending on stage of life.
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17
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Wong JJ, Barley RC, Hanes S, Tanenbaum ML, Lanning M, Naranjo D, Hood KK. Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use. Diabetes Technol Ther 2020; 22:674-680. [PMID: 31971451 DOI: 10.1089/dia.2019.0492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Despite the demonstrated benefits of diabetes device use, uptake of insulin pumps and continuous glucose monitors (CGMs) remains quite low. The current study aimed to identify profiles of parents of youth with type 1 diabetes based on their attitudes toward diabetes-specific technology and barriers to diabetes technology uptake. Methods: Online survey data were collected from 471 parents in the T1D Exchange Clinic Network (child's age = 12.0 ± 3.2 years; diabetes duration = 7.0 ± 2.9 years; A1c = 8.4% ± 1.3; 75% using insulin pump; 27% using CGM). Results: K-means cluster analyses revealed five parent profiles: Embracers (50.7%), Burdened (15.7%), Hopeful but Hassled (14.2%), Distrusting (12.7%), and Data Minimalists (6.6%). ANOVAs and chi-square tests identified differences between groups based on diabetes distress, worry over hypoglycemia, device use, and demographic characteristics. Conclusions: Providers encouraging device uptake may benefit from tailoring their approaches based on these distinct groups and their corresponding concerns and needs.
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Affiliation(s)
- Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Regan C Barley
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Monica Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
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18
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Haslund-Thomsen H, Hasselbalch LA, Laugesen B. Parental Experiences of Continuous Glucose Monitoring in Danish Children with Type 1 Diabetes Mellitus. J Pediatr Nurs 2020; 53:e149-e155. [PMID: 32245681 DOI: 10.1016/j.pedn.2020.03.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/17/2020] [Accepted: 03/17/2020] [Indexed: 12/27/2022]
Abstract
PURPOSE To explore parents 'experience of having a child aged 4-9 years with type 1 diabetes mellitus (T1DM) using continuous glucose monitor (CGM). DESIGN AND METHODS The study was a qualitative study. Twelve families were recruited for individual or dyadic interviews through purposeful and convenience sampling procedures. RESULTS Thematic analysis generated three main themes: 1) Living in the context of the unpredictability of diabetes 2) Establishing a sense of control and security with the CGM 3) Learning to use and trust the CGM and educating other caregivers. CONCLUSIONS Living in the context of the unpredictability of T1DM causes a loss of stability and control as T1DM pervades family life and transforms everyday routines. CGM use seems to increase opportunities for other family activities, as it provides parents with a sense of control and moderates the pervasiveness of T1DM. Yet the parents have to learn how to trust and use the CGM and take on the burdensome task of training and trusting other caregivers. PRACTICE IMPLICATIONS The CGM is used as an integral part of T1DM care in everyday life. Therefore, it should be accessible to families. Health-care professionals should be aware of how to assist parents with how to use and trust the CGM. Furthermore, parents may need help and support in educating other caregivers on how to use the CGM. This could be done through teaching sessions, written materials and recorded demonstrations of CGM use.
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Affiliation(s)
- Helle Haslund-Thomsen
- Clinical Nursing research Unit, Aalborg University Hospital, Aalborg, Denmark; Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark; Pediatric Department, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark.
| | - Line Aagaard Hasselbalch
- Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark; Pediatric Department, Clinic for Anesthesiology, Child Diseases, Circulation and Women, Aalborg University Hospital, Aalborg, Denmark
| | - Britt Laugesen
- Clinical Nursing research Unit, Aalborg University Hospital, Aalborg, Denmark; Danish Centre of Clinical Guidelines, Department of Clinical Medicine, Aalborg University, Denmark
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19
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Sakane N, Murata T, Tone A, Kato K, Kimura M, Kawashima S, Sawaki H, Hirota Y, Okada A, Kuroda A, Matsuhisa M, Watanabe T, Suganuma A, Nirengi S, Toyoda M. Development and Validation of the Continuous Subcutaneous Insulin Infusion-Related Quality-of-Life (CSII-QOL) Scale. Diabetes Technol Ther 2020; 22:216-221. [PMID: 31638420 DOI: 10.1089/dia.2019.0216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Continuous subcutaneous insulin infusion (CSII) is associated with improved glycemic control, a reduced incidence of hypoglycemia, and improved quality of life (QOL). To date, however, there has been no QOL scale specific to CSII. The objective of this study was to develop and validate a scale to measure CSII-QOL for people with type 1 diabetes (T1D). Methods: A total of 50 people with T1D aged ≥15 years who used CSII (28% males; age, 47.6 ± 17.0 years; duration of diabetes, 14.7 ± 9.7 years; duration of CSII use, 6.1 ± 3.3 years; HbA1c, 7.4% ± 0.8%) took part in the CSII-QOL study. Twenty-eight potential CSII-QOL items were developed in a combined approach consisting of semistructured patient interviews, expert input, and a literature search. The resulting CSII-QOL was tested for factor analysis, validity, reliability, and influencing factors. Results: The final 25-item questionnaire had a 3-domain structure ("convenience," "social restriction," and "psychological problems"), high internal consistency (Cronbach's alpha = 0.870), and substantial test-retest reliability (intraclass correlation coefficient = 0.65). The CSII-QOL score was correlated negatively with the Problem Areas in Diabetes score. Conclusion: The CSII-QOL is the first CSII-related QOL scale for people with T1D. This short, validated, and reliable instrument might potentially be useful in future clinical studies and routine clinical patient care. Further validation is required to confirm these issues because of the small and potentially biased sample (UMIN-CTR: UMIN000031595).
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Affiliation(s)
- Naoki Sakane
- Division of Preventive Medicine, Clinical Research Institute and National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Takashi Murata
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Atsuhito Tone
- Diabetes Center, Okayama University Hospital, Okayama, Japan
| | - Ken Kato
- Diabetes Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Moritsugu Kimura
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
| | | | - Hideaki Sawaki
- Sawaki Internal Medicine and Diabetes Clinic, Osaka, Japan
| | - Yushi Hirota
- Division of Diabetes and Endocrinology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Hyogo, Japan
| | - Akira Okada
- Department of Internal Medicine, Okada Clinic, Fukuoka, Japan
| | - Akio Kuroda
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Munehide Matsuhisa
- Diabetes Therapeutics and Research Center, Institute of Advanced Medical Sciences, Tokushima University, Tokushima, Japan
| | - Tomokazu Watanabe
- Diabetes Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Akiko Suganuma
- Division of Preventive Medicine, Clinical Research Institute and National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shinsuke Nirengi
- Division of Preventive Medicine, Clinical Research Institute and National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masao Toyoda
- Division of Nephrology, Endocrinology and Metabolism, Department of Internal Medicine, Tokai University School of Medicine, Kanagawa, Japan
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20
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Rosner B, Roman-Urrestarazu A. Health-related quality of life in paediatric patients with Type 1 diabetes mellitus using insulin infusion systems. A systematic review and meta-analysis. PLoS One 2019; 14:e0217655. [PMID: 31237873 PMCID: PMC6592525 DOI: 10.1371/journal.pone.0217655] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022] Open
Abstract
Background In 2017, more than 1.1 million children were living with type 1 diabetes mellitus (T1DM) globally. The goal in paediatric diabetes therapy is reaching optimal glycaemic control as early as possible in order to avoid complications and early mortality without compromising the quality of life (QoL) of children. Several different insulin regimens are available for T1DM patients to reach this goal. Aims This review set out to analyse whether continuous subcutaneous insulin infusion (CSII) regimens are superior to multiple daily injection (MDI) therapy in T1DM youth regarding QoL. Additionally, it assessed glycaemic control and adverse events as secondary outcomes and discussed potential future public health implications and justifications for using CSII as a first-line therapy in diabetic youth. Methods A systematic review and random effects meta-analysis was performed on studies investigating the association between QoL and diabetes treatment regimen. Differences in adverse event rates between groups were analysed using a Mann-Whitney U test. Lastly, differences in glycaemic control were assessed using a random effects meta-analysis. Results QoL and glycaemic control was significantly better in CSII subjects at baseline and follow-up. No significant differences in adverse events were found between study groups. No significant changes over time could be shown for either QoL or glycaemic control. Conclusion CSII proved to provide similar or slightly better outcomes in all analysed fields. This is consistent with previous research. However, to make credible recommendations, better-designed studies are needed to investigate the impact of CSII in children.
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Affiliation(s)
- Bastian Rosner
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, United Kingdom
| | - Andres Roman-Urrestarazu
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, United Kingdom.,Faculty of Health, Medicine and Life Sciences, Department of International Health, University of Maastricht, Maastricht, Netherlands
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21
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Vergier J, Samper M, Dalla-Vale F, Ventura V, Baucher F, Joubert F, Pons C, De Oliveira M, Salet R, Faure-Galon N, Adiceam P, Baechler-Sadoul E, Epstein S, Simonin G, Reynaud R. Evaluation of flash glucose monitoring after long-term use: A pediatric survey. Prim Care Diabetes 2019; 13:63-70. [PMID: 30268507 DOI: 10.1016/j.pcd.2018.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 07/14/2018] [Accepted: 08/01/2018] [Indexed: 12/11/2022]
Abstract
AIMS To understand the opinions of children with type 1 diabetes about their everyday use of flash glucose monitoring. (FGM). METHODS Children with type 1 diabetes using the FreeStyle Libre® FGM system and/or their parents were surveyed in several French medical centers between December 2016 and June 2017, regardless of their treatment regimen and metabolic control. RESULTS Of the 347 patients recruited, 79.5% had been using the sensor for more than three months (average usage time: 285 days). The main reported motivations for initiating this type of monitoring were to avoid finger prick pain (for 85.9% of patients) and to allow parents to check nocturnal glucose levels (60.8%). Two-thirds of respondents experienced difficulties, mainly the sensor falling off (47.6%), measurement discrepancies (25.1%) and cutaneous reactions (22.2%); 89.5% changed their habits: 70.6% took more scans, 37.2% corrected their hyperglycemia more promptly, and 37.5% used trends to adjust their insulin dosage. About one-third of the study group (35.1%) experienced lower HbA1c levels, and two thirds (67.1%) were satisfied with the device. CONCLUSIONS Our results show that FGM is a widely accepted option for self-monitoring diabetes, but that specific training is required to improve its use for insulin dosage adjustment and metabolic results.
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Affiliation(s)
- Julia Vergier
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France.
| | - Martine Samper
- Pediatric Val Pré Vert Rehabilitation and Recuperative Care Facilities, 929 route de Gardanne, 13105 Mimet, France
| | - Fabienne Dalla-Vale
- Montpellier University Hospital, Department of Pediatrics, Arnaud De Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295 Montpellier, France; Saint-Pierre Institute, Department of Pediatrics, 371 Avenue de l'évêché de Maguelone, 34250 Palavas-les-Flots, France
| | - Valérie Ventura
- Saint-Pierre Institute, Department of Pediatrics, 371 Avenue de l'évêché de Maguelone, 34250 Palavas-les-Flots, France
| | - Franciane Baucher
- Saint-Pierre Institute, Department of Pediatrics, 371 Avenue de l'évêché de Maguelone, 34250 Palavas-les-Flots, France
| | - Florence Joubert
- Avignon Hospital, Department of Pediatrics, 305 Rue Raoul Follereau, 84902 Avignon, France
| | - Charlotte Pons
- Avignon Hospital, Department of Pediatrics, 305 Rue Raoul Follereau, 84902 Avignon, France
| | - Murielle De Oliveira
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - Randa Salet
- Nîmes University Hospital, Department of Pediatrics, Place du Pr. Robert Debré, 30029 Nîmes, France
| | - Noémie Faure-Galon
- Aix-en-Provence Pertuis Hospital, Department of Pediatrics, Avenue des Tamaris, Aix-en Provence, France
| | - Paola Adiceam
- Aix-en-Provence Pertuis Hospital, Department of Pediatrics, Avenue des Tamaris, Aix-en Provence, France; Marseille Saint Joseph Hospital, Department of Pediatrics, 26 boulevard de Louvain, 13008 Marseille, France
| | | | - Sophie Epstein
- Aubagne Hospital, Department of Pediatrics, 179 Av des Sœurs Gastine, 13677 Aubagne, France
| | - Gilbert Simonin
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - Rachel Reynaud
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France; Aix Marseille Univ, INSERM, MMG (Marseille Medical Genetics) Marseille, France
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22
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Mueller-Godeffroy E, Vonthein R, Ludwig-Seibold C, Heidtmann B, Boettcher C, Kramer M, Hessler N, Hilgard D, Lilienthal E, Ziegler A, Wagner VM. Psychosocial benefits of insulin pump therapy in children with diabetes type 1 and their families: The pumpkin multicenter randomized controlled trial. Pediatr Diabetes 2018; 19:1471-1480. [PMID: 30302877 DOI: 10.1111/pedi.12777] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/28/2018] [Accepted: 09/04/2018] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) is on the rise among pediatric patients with type 1 diabetes mellitus. Metabolic effects alone cannot explain this rising popularity. From the patient's perspective, the main benefits of CSII may be found in subjective psychosocial health outcomes (patient-reported outcomes [PRO]). SUBJECTS AND METHODS In a multicenter open randomized controlled trial, children and adolescents aged 6 to16 years currently treated with multiple daily injections (MDI) were randomized 1:1, stratified by center, to either starting with CSII immediately after the baseline interview or to continuing MDI while waiting 6 months for transmission to CSII. The primary outcomes were patient-reported diabetes-specific health-related quality of life (DHRQOL) and diabetes burden of the main caregiver. Secondary outcomes were caregiver stress, fear of hypoglycemia, satisfaction with treatment, and HbA1c. RESULTS Two-hundred and eleven patients were randomized between February 2011 and October 2014, and 186 caregivers and 170 patients were analyzed using the intention-to-treat principle for primary outcomes. Children 8 to 11 years in the CSII group reported improved DHRQOL at follow-up compared to MDI (median difference [MD] 9.5, 95% confidence interval [CI] 3.6-16.7, P = 0.004). There were no treatment differences in the adolescent age-group 12 to 16 years (MD 2.7; 95% CI -3.2-9.5; P = 0.353). The main caregivers of the CSII group reported a significant decline of overall diabetes burden at follow-up compared to the MDI group (MD 0; 95% CI -1-0; P = 0.029). Secondary PROs also were in favor of CSII. CONCLUSIONS CSII has substantial psychosocial benefits. PROs demonstrate these benefits. Registered as NCT01338922 at clinicaltrials.gov.
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Affiliation(s)
| | - Reinhard Vonthein
- Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Center for Clinical Trials, University of Luebeck, Luebeck, Germany
| | | | - Bettina Heidtmann
- Catholic Children's Hospital, Wilhelmstift gGmbH, Department of Endocrinology and Diabetology, Hamburg, Germany
| | - Claudia Boettcher
- Division of Pediatric Endocrinology and Diabeteology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Frankfurt, Germany
| | - Miriam Kramer
- Division of Pediatric Endocrinology and Diabeteology, Center of Child and Adolescent Medicine, Justus Liebig University Giessen, Frankfurt, Germany
| | - Nicole Hessler
- Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Doerte Hilgard
- Department of Pediatrics, Gemeinschaftskrankenhaus Herdecke gGmbH, Herdecke, Germany.,Pediatric and Adolescent Medical Practice, Witten, Germany
| | - Eggert Lilienthal
- Department of Pediatrics, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Andreas Ziegler
- Institute of Medical Biometry and Statistics, University of Luebeck, University Medical Center Schleswig-Holstein, Luebeck, Germany.,Center for Clinical Trials, University of Luebeck, Luebeck, Germany.,School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal, Pietermaritzburg, South Africa
| | - Verena M Wagner
- Department of Pediatric and Adolescent Medicine, University of Luebeck, Luebeck, Germany.,Pediatric and Adolescent Medical Practice, 18055 Rostock, Germany
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23
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Holtz BE, Mitchell KM, Hershey DD, Cotten SR, Holmstrom AJ, Richman J, Dunneback JK, Wood MA. Using an mHealth App to Transition Care of Type 1 Diabetes from Parents to Teens: Protocol for a Pilot Study. JMIR Res Protoc 2018; 7:e10803. [PMID: 30377142 PMCID: PMC6234347 DOI: 10.2196/10803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Revised: 07/20/2018] [Accepted: 08/14/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) afflicts approximately 154,000 people under the age of 20 in the United States. Most people with T1DM are diagnosed at a young age, and parents have to take on the responsibility of T1DM management. Eventually, the child must begin to transition to self-management. Adolescents often struggle to take on responsibility for all the necessary tasks to successfully self-manage their T1DM. In fact, approximately three-quarters of adolescents are not achieving American Diabetes Association-recommended glycated hemoglobin (HbA1c) targets. This lack of adherence can lead to negative health outcomes. OBJECTIVE The goals of this interdisciplinary proposal are as follows: (1) to develop a unique and theory-driven technology using a mobile phone app to promote self-management behaviors for adolescents aged 10-15 years with T1DM and their parents and (2) to explore the feasibility and impact of the self-management mobile app. METHODS This study has two phases: app development and pilot testing. In the app development phase, the app will be conceptualized and a prototype will be tested. In Phase 2, the mobile app will undergo pilot testing to determine its feasibility and impact on diabetes self-management. RESULTS The pilot test was launched in September 2017. Data collection for the final pilot test is underway, and results are forthcoming. CONCLUSIONS Adolescents with T1DM and their parents can have a difficult time managing the transition of diabetes care. It is hoped that this app can help. The focus groups and prototype testing have indicated promising outcomes of app use. TRIAL REGISTRATION ClinicalTrials.gov NCT03436628; https://clinicaltrials.gov/ct2/show/NCT03436628 (Archived by WebCite at http://www.webcitation.org/72tHXTE2Z). INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/10803.
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Affiliation(s)
- Bree E Holtz
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Katharine M Mitchell
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI, United States
| | - Denise D Hershey
- College of Nursing, Michigan State University, East Lansing, MI, United States
| | - Shelia R Cotten
- Department of Media and Information, Michigan State University, East Lansing, MI, United States
| | - Amanda J Holmstrom
- Department of Communication, Michigan State University, East Lansing, MI, United States
| | - Joshua Richman
- Department of Surgery, University of Alabama-Birmingham, Birmingham, AL, United States
| | - Julie K Dunneback
- Department of Pediatric Endocrinology, Sparrow Health System, Lansing, MI, United States
| | - Michael A Wood
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, United States
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24
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Forlenza GP, Messer LH, Berget C, Wadwa RP, Driscoll KA. Biopsychosocial Factors Associated With Satisfaction and Sustained Use of Artificial Pancreas Technology and Its Components: a Call to the Technology Field. Curr Diab Rep 2018; 18:114. [PMID: 30259309 PMCID: PMC6535227 DOI: 10.1007/s11892-018-1078-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Summarize biopsychosocial factors associated with using continuous glucose monitors (CGMs), insulin pumps, and artificial pancreas (AP) systems and provide a "call to the field" about their importance to technology uptake and maintained use. RECENT FINDINGS Insulin pumps and CGMs are becoming standard of care for individuals with type 1 diabetes (T1D). AP systems combining a CGM, insulin pump, and automated dosing algorithm are available for commercial use. Despite improved glycemic control with AP system use, numerous barriers exist which may limit their benefit. Studies on components of AP systems (pumps, CGMs) are limited and demonstrate mixed results of their impact on fear of hypoglycemia, adherence, quality of life, depression and anxiety, and diabetes distress. Studies examining biopsychological factors associated specifically with sustained use of AP systems are also sparse. Biological, psychological and social impacts of AP systems have been understudied and the information they provide has not been capitalized upon.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Laurel H. Messer
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Cari Berget
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - R. Paul Wadwa
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
| | - Kimberly A. Driscoll
- Barbara Davis Center, University of Colorado Denver, 1775 Aurora CT MS A140, Aurora, CO 80045, USA
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25
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Garza KP, Jedraszko A, Weil LEG, Naranjo D, Barnard KD, Laffel LMB, Hood KK, Weissberg-Benchell J. Automated Insulin Delivery Systems: Hopes and Expectations of Family Members. Diabetes Technol Ther 2018; 20:222-228. [PMID: 29565721 PMCID: PMC6422006 DOI: 10.1089/dia.2017.0301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study examines the hopes and expectations that children, adolescents, and adults with type 1 diabetes and their families have for new automated insulin delivery systems. The study also aims to examine how the automated insulin delivery system may impact family functioning and individual members' psychosocial adjustment. METHODS Forty-eight semistructured focus groups (n = 195) and 89 individual interviews were conducted with children, adolescents, and adults with type 1 diabetes and parents and partners. Coders reviewed results in key themes most likely to contain references to the family system. Clusters were analyzed using thematic analysis to identify participants' salient hopes and expectations of how new technology may impact family relationships and individual psychosocial functioning. RESULTS Three main themes emerged for participants' hopes and expectations for implementation of the automated insulin delivery system. First, there is an expectation that this diabetes technology will alleviate diabetes-specific worry and burden for the people with diabetes and other family members. Second, there is also hope that this system may reduce day-to-day stress and, third, improve family relationships. CONCLUSIONS The unique perspective of a broad age group provides insight into how individuals and families creatively address the multiple tasks required in daily diabetes management. Study findings elucidate the very high hopes and expectations held by those managing type 1 diabetes and the impact this new technology may have on family relationships. Awareness of these hopes and expectations is important for developers and clinicians in addressing potential challenges to uptake and to ensure that expectations are set appropriately.
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Affiliation(s)
- Kimberly P Garza
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Aneta Jedraszko
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Lindsey E G Weil
- 2 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Diana Naranjo
- 3 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
| | | | - Lori M B Laffel
- 5 Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Korey K Hood
- 3 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
- 6 Department of Pediatrics, Stanford University School of Medicine , Stanford, California
| | - Jill Weissberg-Benchell
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
- 2 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
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26
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McGill DE, Volkening LK, Pober DM, Muir AB, Young-Hyman DL, Laffel LM. Depressive Symptoms at Critical Times in Youth With Type 1 Diabetes: Following Type 1 Diabetes Diagnosis and Insulin Pump Initiation. J Adolesc Health 2018; 62:219-225. [PMID: 29212599 PMCID: PMC5803334 DOI: 10.1016/j.jadohealth.2017.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Depressive symptoms occur at various times during the life cycle in persons with type 1 diabetes. We investigated depressive symptoms prospectively in youth with new-onset type 1 diabetes and in those beginning pump therapy. METHODS Youth with type 1 diabetes (N = 96), ages 10-17 years, completed the Children's Depression Inventory (CDI) at baseline and at 1, 6, and 12 months after diabetes onset or pump start; scores ≥13 indicated clinical elevation. The change in depressive symptoms and the association between CDI score and hemoglobin A1c (HbA1c) level were assessed over 1 year. RESULTS The new-onset group (n = 54) had an HbA1c level of 11.4% ± 2.5%. The pump group (n = 42) had a diabetes duration of 4.1 ± 3.4 years and an HbA1c level of 8.3% ± 1.3%. The baseline median CDI was 5.0 in both groups and remained low over time (ranging from 2.0 to 3.5). Most youth (new onset 72%, pump 81%) scored <13 at all times. Those with a CDI score of ≥13 in month 1 had 9-fold (95% confidence interval: 3-28) and 11-fold (95% confidence interval: 3-38) higher risks of CDI score of ≥13 at 6 and 12 months, respectively, than those with a CDI score of <13. New-onset youth with a CDI score of ≥13 in month 1 had a higher HbA1c level at 6 months (8.3% ± 1.7%) than new-onset youth with a CDI score of <13 (7.2% ± 1.6%, p = .04). CONCLUSIONS CDI scores over 1 year were similar in the new-onset and pump groups. Youth with elevated CDI in the first month after diagnosis or pump start were significantly more likely to have a CDI score of ≥13 at 6 or 12 months, supporting recommendations to screen for depressive symptoms because of persistence over time. Those with new-onset diabetes and depressive symptoms in the first month had higher HbA1c at 6 months; confirmatory research is needed.
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Affiliation(s)
- Dayna E. McGill
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lisa K. Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - David M. Pober
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Andrew B. Muir
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA
| | | | - Lori M. Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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27
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Mitsuishi S, Nishimura R, Harashima SI, Kawamura T, Tsujino D, Koide K, Nishimura A, Utsunomiya K, Inagaki N, Atsumi Y. The Effect of Novel Glucose Monitoring System (Flash Glucose Monitoring) on Mental Well-being and Treatment Satisfaction in Japanese People with Diabetes. Adv Ther 2018; 35:72-80. [PMID: 29273859 DOI: 10.1007/s12325-017-0649-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION FreeStyle Libre (Abbot Diabetes Care Ltd) has been launched as a novel glucose monitoring system called flash glucose monitoring (FGM) in Europe. Several reports are becoming available on its usefulness and safety. To date, however, reports from Asian countries have not been made available. In this study, we evaluated its usefulness in Japanese people with diabetes in terms of its mental well-being and patient satisfaction outcomes. METHODS Individuals with type 1 and 2 diabetes treated with insulin were enrolled, and they performed self-monitoring of blood glucose. All participants were subjected to FGM for 14 days and compared for changes in mental well-being using the WHO-Five Well-Being Index (WHO-5) (1998 version) as well as in patient satisfaction using the Diabetes Treatment Satisfaction Questionnaire (DTSQ) before and after implementation of FGM. RESULTS The study included a total of 80 subjects (type 1/2 diabetes, 57/23). The WHO-5 scores were significantly improved from 15.5 ± 4.1 at baseline to 17.2 ± 4.5 after implementation of FGM (P < 0.001); the DTSQ scores also were significantly improved from 24.8 ± 6.0 to 26.7 ± 5.2 (P = 0.001). In type 1 diabetes, both the WHO-5 and DTSQ scores were significantly improved from baseline (P = 0.001, P = 0.001), while neither the WHO-5 scores nor the DTSQ scores were improved in type 2 diabetes. CONCLUSIONS The study results suggest that FGM has the potential to improve mental well-being and treatment satisfaction among individuals with type 1 diabetes.
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Affiliation(s)
- Sumie Mitsuishi
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Rimei Nishimura
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan.
| | - Shin-Ichi Harashima
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tomoyuki Kawamura
- Department of Pediatrics, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Daisuke Tsujino
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Keiko Koide
- Diabetes Center, Eiju General Hospital, Tokyo, Japan
| | - Akiko Nishimura
- Department of Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazunori Utsunomiya
- Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Tokyo, Japan
| | - Nobuya Inagaki
- Department of Diabetes, Endocrinology and Nutrition, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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28
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Al Khalifah RA, Alnhdi A, Alghar H, Alanazi M, Florez ID. The effect of adding metformin to insulin therapy for type 1 diabetes mellitus children: A systematic review and meta-analysis. Pediatr Diabetes 2017; 18:664-673. [PMID: 28145083 DOI: 10.1111/pedi.12493] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 11/29/2016] [Accepted: 11/29/2016] [Indexed: 12/12/2022] Open
Abstract
We aimed to assess the effectiveness of adding metformin to insulin in type 1 diabetes mellitus (T1DM) children for improving metabolic outcomes. We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) conducted on children age 6 to 19 years who are diagnosed with T1DM, and examined the effect of adding Metformin to standard insulin therapy. We performed literature searches on Ovid Midline, Ovid Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) from the date of inception of the database to February 15, 2016. Two reviewers screened titles and abstracts independently, assessed full text eligibility, and extracted information from eligible trials. The primary outcome is glycated hemoglobin (HbA1c), and the secondary outcomes are health-related quality of life, body mass index (BMI), lipid profile, total insulin daily dose, hypoglycaemia, and diabetes ketoacidosis. We screened 736 studies, and included 6 RCTs with 325 patients. All RCTs were of low risk of bias, and included adolescents (mean age 15 years). The meta-analysis showed that the addition of Metformin resulted in decreased total insulin daily dose (TIDD) (unit/kg/d) (mean difference [MD] = -0.15, 95%CI, -0.24, -0.06), and reduced BMI kg/m2 (MD -1.46, 95%CI -2.54, 0.38), and BMI z-score (MD= - 0.11, 95%CI -0.21, -0.01), and similar HbA1c (%) (MD= - 0.05, 95%CI, -0.19, 0.29). The overall evidence quality was high to moderate. Current evidence does not support use of Metformin in T1DM adolescents to improve HbA1c. However, Metformin may provide modest reduction in TIDD and BMI.
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Affiliation(s)
- Reem A Al Khalifah
- Department of Pediatrics, Division of Pediatric Endocrinology, King Saud University, Riyadh, Saudi Arabia
| | | | - Hassan Alghar
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alanazi
- Department of Pediatrics, King Saud University, Riyadh, Saudi Arabia
| | - Ivan D Florez
- Department of Pediatrics, Universidad de Antioquia, Medellin, Colombia.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Canada
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29
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Oser TK, Oser SM, McGinley EL, Stuckey HL. A Novel Approach to Identifying Barriers and Facilitators in Raising a Child With Type 1 Diabetes: Qualitative Analysis of Caregiver Blogs. JMIR Diabetes 2017; 2:e27. [PMID: 30291073 PMCID: PMC6238834 DOI: 10.2196/diabetes.8966] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 10/04/2017] [Accepted: 10/04/2017] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND With rising incidence of type 1 diabetes (T1D) diagnoses among children and the high levels of distress experienced by the caregivers of these children, caregiver support is becoming increasingly important. Historically, relatively few support resources have existed. Increasing use of the Internet, and blogs in particular, has seen a growth of peer support between caregivers of children with T1D. However, little is known about the type and quality of information shared on T1D caregiver blogs. At the same time, the information on such blogs offers a new window into what challenges and successes caregivers experience in helping to manage their children's T1D. OBJECTIVE The purpose of this study was to (1) analyze blogs of caregivers to children with T1D to better understand the challenges and successes they face in raising a child with T1D, and (2) assess the blogs for the presence of unsafe or inaccurate clinical information or advice. METHODS An inductive thematic qualitative study was conducted of three blogs authored by caregivers of children living with T1D, which included 140 unique blog posts and 663 associated comments. Two physician investigators evaluated the blogs for presence of clinical or medical misinformation. RESULTS Five major themes emerged: (1) the impact of the child's diagnosis, (2) the burden of intense self-management experienced in caring for a child with T1D, (3) caregivers' use of technology to ease their fear of hypoglycemia and impacts that device alarms associated with this technology have on caregiver burden, (4) caregivers' perceptions of frequently missed or delayed diagnosis of T1D and the frustration this causes, and (5) the resilience that caregivers develop despite the burdens they experience. Misinformation was exceedingly rare and benign when it did occur. CONCLUSIONS Blog analysis represents a novel approach to understand the T1D caregiver's experience. This qualitative study found many challenges that caregivers face in raising a child with T1D. Despite the many barriers caregivers face in managing their children's T1D, they find support through advocacy efforts and peer-to-peer blogging. Blogs provide a unique avenue for support, with only rare and benign findings of medical misinformation, and may be a resource that diabetes care providers can consider offering to families for support.
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Affiliation(s)
- Tamara K Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Sean M Oser
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Erin L McGinley
- Department of Family and Community Medicine, Penn State College of Medicine, Hershey, PA, United States
| | - Heather L Stuckey
- Departments of Internal Medicine, Humanities, and Public Health Sciences, Penn State College of Medicine, Hershey, PA, United States
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Troncone A, Cascella C, Zanfardino A, Chianese A, Confetto S, Giglio M, Villano P, Perrone L, Iafusco D. Psychological outcomes of injection port therapy in children and adolescents with type 1 diabetes and their primary caregivers. Acta Diabetol 2017; 54:975-978. [PMID: 28597351 DOI: 10.1007/s00592-017-1014-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Accepted: 06/01/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy.
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Regional Centre of Paediatric Diabetology "G.Stoppoloni", Via Luigi De Crecchio, 2, Naples, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Santino Confetto
- Department of the Woman, of the Child and of the General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Regional Centre of Paediatric Diabetology "G.Stoppoloni", Via Luigi De Crecchio, 2, Naples, Italy
| | - Milena Giglio
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico 31, Caserta, Italy
| | - Pasquale Villano
- Department of the Woman, of the Child and of the General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Regional Centre of Paediatric Diabetology "G.Stoppoloni", Via Luigi De Crecchio, 2, Naples, Italy
| | - Laura Perrone
- Department of the Woman, of the Child and of the General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Regional Centre of Paediatric Diabetology "G.Stoppoloni", Via Luigi De Crecchio, 2, Naples, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialistic Surgery, University of Campania "Luigi Vanvitelli", Regional Centre of Paediatric Diabetology "G.Stoppoloni", Via Luigi De Crecchio, 2, Naples, Italy
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Bode BW, Kaufman FR, Vint N. An Expert Opinion on Advanced Insulin Pump Use in Youth with Type 1 Diabetes. Diabetes Technol Ther 2017; 19:145-154. [PMID: 28135116 DOI: 10.1089/dia.2016.0354] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Among children and adolescents with type 1 diabetes mellitus, the use of insulin pump therapy has increased since its introduction in the early 1980s. Optimal management of type 1 diabetes mellitus depends on sufficient understanding by patients, their families, and healthcare providers on how to use pump technology. The goal for the use of insulin pump therapy should be to advance proficiency over time from the basics taught at the initiation of pump therapy to utilizing advanced settings to obtain optimal glycemic control. However, this goal is often not met, and appropriate understanding of the full features of pump technology can be lacking. The objective of this review is to provide an expert perspective on the advanced features and use of insulin pump therapy, including practical guidelines for the successful use of insulin pump technology, and other considerations specific to patients and healthcare providers.
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Affiliation(s)
- Bruce W Bode
- 1 Atlanta Diabetes Associates , Atlanta, Georgia
| | - Francine R Kaufman
- 2 The Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles , Los Angeles, California
- 3 Medtronic , Northridge, California
| | - Nan Vint
- 4 Lilly USA, LLC, Lilly Corporate Center , US Medical Affairs, Indianapolis, Indiana
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Hussain T, Akle M, Nagelkerke N, Deeb A. Comparative study on treatment satisfaction and health perception in children and adolescents with type 1 diabetes mellitus on multiple daily injection of insulin, insulin pump and sensor-augmented pump therapy. SAGE Open Med 2017; 5:2050312117694938. [PMID: 28321303 PMCID: PMC5347412 DOI: 10.1177/2050312117694938] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/25/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Diabetes management imposes considerable demands on patients. Treatment method used has an impact on treatment satisfaction. We aim to examine the relationship between treatment satisfaction and health perception with the method used for treatment of type 1 diabetes mellitus in children and adolescents. SUBJECTS AND METHOD We have interviewed patients with type 1 diabetes mellitus using questionnaires to assess treatment satisfaction and health perception. Patients were divided into three groups based on treatment used: multiple daily injection, insulin pump and sensor-augmented pump therapy. Comparison of scores was done between the groups. RESULTS A total of 72 patients were enrolled (36 males). Mean age (standard deviation) was 11.4 (4.4) years and duration of diabetes of 4.9 (3.5) years. Mean (standard deviation) HbA1c was 8.1 (1.2). Median (range) duration of sensor use was 17.7 (3-30) days/month. Mean scale for treatment satisfaction and health perception questions was 25.3, 29.7 and 31.7 and 60, 79.7 and 81 for the multiple daily injection, pump and sensor-augmented pump, respectively (p = 0.00). Significant difference was seen between the multiple daily injection and both other groups. Sensor-augmented pump group scored higher than the pump group. However, the difference was not statistically significant. Duration of sensor use showed no correlation with treatment satisfaction. CONCLUSION The method used for diabetes treatment has an impact on patients' satisfaction and health perception in children and adolescents with type 1 diabetes mellitus. Insulin pump users have a higher treatment satisfaction and better health perception than those on multiple daily injection. Augmenting pump therapy with sensor use adds value to treatment satisfaction without correlation with the duration of the sensors use.
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Affiliation(s)
- Tara Hussain
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Mariette Akle
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Nico Nagelkerke
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
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Nefs G, Pouwer F, Holt RIG, Skovlund S, Hermanns N, Nicolucci A, Peyrot M. Correlates and outcomes of worries about hypoglycemia in family members of adults with diabetes: The second Diabetes Attitudes, Wishes and Needs (DAWN2) study. J Psychosom Res 2016; 89:69-77. [PMID: 27663113 DOI: 10.1016/j.jpsychores.2016.07.017] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 07/28/2016] [Accepted: 07/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We examined (a) the demographic and clinical correlates of worries about hypoglycemia in adult family members of adults with diabetes, and (b) the association of these worries with measures of diabetes support. METHODS The second multinational Diabetes Attitudes, Wishes and Needs (DAWN2) study cross-sectionally surveyed 2057 family members from 17 countries. Participants completed questions about demographics, diabetes, and psychosocial functioning, including worry about overall and nocturnal hypoglycemia. Analyses included hierarchical ordinal and linear regression. RESULTS Eighty-five percent of family members (n=1661) were at least occasionally very worried about the risk of hypoglycemic events overall. Correlates of worries about hypoglycemia included female gender, higher age and lower education in the family member, younger age of the person with diabetes and this person being a parent or another adult (versus spouse or partner), insulin or non-insulin injectable treatment, severe or non-severe hypoglycemia in the past 12months, and family member recognition of hypoglycemia. Elevated worries about hypoglycemia had a significant independent association with increased odds of diabetes-related family arguments and family member frustration in providing helpful support (OR range 1.60-3.72). High levels of worries about hypoglycemia were associated with increased odds of attending diabetes-related health-care visits. Worries about hypoglycemia were not associated with family member involvement in diabetes care. Similar results were found for worries about nocturnal events. CONCLUSION Worries about hypoglycemia were common in family members and were associated with suboptimal diabetes support. This issue therefore deserves increased clinician attention.
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Affiliation(s)
- Giesje Nefs
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands.
| | - François Pouwer
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Richard I G Holt
- Human Development and Health Academic Unit, Faculty of Medicine, University of Southampton, Southampton, UK; University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Søren Skovlund
- Global Health Economics and Outcomes Research, Novo Nordisk, Denmark
| | - Norbert Hermanns
- Research Institute of the Diabetes Academy Mergentheim (FIDAM) Diabetes Centre Mergentheim, Germany; University of Bamberg, Germany
| | - Antonio Nicolucci
- Center for Outcomes Research and Clinical Epidemiology, Pescara, Italy
| | - Mark Peyrot
- Department of Sociology, Loyola University Maryland, Baltimore, MD, USA
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Kubiak T, Mann CG, Barnard KC, Heinemann L. Psychosocial Aspects of Continuous Glucose Monitoring: Connecting to the Patients' Experience. J Diabetes Sci Technol 2016; 10:859-63. [PMID: 27234808 PMCID: PMC4928243 DOI: 10.1177/1932296816651450] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Continuous glucose monitoring (CGM) systems provide people with diabetes with valuable real-time information on glucose trajectories and trends, thus offering opportunities for improving diabetes self-management. Ample evidence from clinical trials underscores CGM effectiveness for biomedical outcomes including HbA1C and hypoglycemia. However, interindividual variability in CGM uptake seems to be substantial: Neither do all individuals with diabetes adopt CGM readily in their diabetes self-management, nor do all of them benefit from CGM. In this article, we focus on CGM effects on quality of life and the potential role of psychosocial patient characteristics for determining the uptake and outcomes of CGM. After providing a brief overview on existing evidence on psychosocial factors in CGM use, gaps in existing research are identified and directions for future research are proposed that could answer key research questions and offer guidance for clinical diabetes care.
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Affiliation(s)
- Thomas Kubiak
- Health Psychology, Johannes Gutenberg University Mainz, Germany
| | - Caroline G Mann
- Health Psychology, Johannes Gutenberg University Mainz, Germany
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Ghazanfar H, Rizvi SW, Khurram A, Orooj F, Qaiser I. Impact of insulin pump on quality of life of diabetic patients. Indian J Endocrinol Metab 2016; 20:506-11. [PMID: 27366717 PMCID: PMC4911840 DOI: 10.4103/2230-8210.183472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM Diabetes is an emerging health problem, both in developing and developed countries and has an enormous economic and social impact. The objective of our study was to find the impact of insulin pump on the quality of life of patients with type 2 diabetes (T2D) and compare it to the quality of life of patients with T2D using an insulin pen. SUBJECTS AND METHODS This is a case-control study which was conducted among patients with T2D presenting between November 2014 and November 2015. A total of 83 patients with T2D, using insulin pump were enrolled in the study as cases and 322 patients with T2D not using insulin pump but using insulin pens were enrolled as controls. Short form-36 quality of life questionnaire was used for data collection. RESULTS Mean age of patients using insulin pump was 52.49 ± 9.28 while the mean age of patients not using insulin pump was 54.72 ± 16.87. Mean score of all domains in the questionnaire was found to be higher in patients using insulin pump as compared to patients not using insulin pumps (P < 0.05). In 81.1% of the patients, the insulin pump decreased the frequency of hypoglycemic episodes. CONCLUSION Insulin pump has significantly improved the quality of life of patients in terms of better self-esteem, decreased stress, and better mood. It has resulted in improved physical health, meal time flexibility, and ease of travel. It allows patient to have more active participation in social and recreational activities improving their personal and family life.
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Affiliation(s)
| | - Syed Wajih Rizvi
- R Endocrinology Clinic and Endocrine Department of Robert Wood Johnson Hospital, New Jersey, United States of America
| | - Aliya Khurram
- R Endocrinology Clinic, New Jersey, United States of America
| | - Fizza Orooj
- R Endocrinology Clinic, New Jersey, United States of America
| | - Iman Qaiser
- R Endocrinology Clinic, New Jersey, United States of America
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Shulman R, Miller FA, Daneman D, Guttmann A. Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes. Health Policy 2015; 120:64-71. [PMID: 26563632 DOI: 10.1016/j.healthpol.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada.
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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Leung JS, Perlman K, Rumantir M, Freedman SB. Emergency department ondansetron use in children with type 1 diabetes mellitus and vomiting. J Pediatr 2015; 166:432-8. [PMID: 25454931 DOI: 10.1016/j.jpeds.2014.10.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Revised: 08/25/2014] [Accepted: 10/03/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the hypothesis that ondansetron administration to children with type 1 diabetes mellitus (T1DM) presenting for emergency department (ED) care with intercurrent illness and vomiting improves clinical outcomes by reducing hospitalization rates (primary), length of ED stay, intravenous fluid (IVF) administration, and revisits (secondary outcomes). STUDY DESIGN We conducted a single-center, 10-year retrospective cohort study of 345 ED encounters of children aged 6 months-8 years with T1DM and vomiting. We compared outcomes among children receiving and not receiving ondansetron. To avoid selection bias related to ondansetron administration, we also investigated outcomes by conducting comparisons by ondansetron usage periods (ie, low [2002-2004] vs high [2009-2011]). RESULTS Ondansetron usage increased from 0% to 67% of ED encounters between 2002 and 2011. Admission rates were similar among those administered [54% (58/107)] and not administered ondansetron [55% (131/238)]. Length of stay was longer in children receiving ondansetron (409 vs 315 minutes; P = .03). IVF administration (77% vs 77%) and revisits (5.6% vs 5.9%) were similar. Ondansetron administration was not associated with reduced admission in logistic regression modeling. Admission rate (62%; 56/91 vs 49%; 57/111) (-13%, 95% CI -23%, 3%), length of stay (395 vs 327 minutes [IQR 164 501]; P < .001), and IVF administration decreased (84% [77/91] to 70% [78/111]; P = .02] when comparing low and high ondansetron usage periods. CONCLUSIONS Ondansetron administration was not independently associated with lower admission rates. Over time, along with increasing ondansetron use, there have been reductions in admissions, length of stay, and IVF administration in children with T1DM.
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Affiliation(s)
- James S Leung
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Kusiel Perlman
- Division of Pediatric Endocrinology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Maggie Rumantir
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
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Mitragotri S, Burke PA, Langer R. Overcoming the challenges in administering biopharmaceuticals: formulation and delivery strategies. Nat Rev Drug Discov 2014; 13:655-72. [PMID: 25103255 PMCID: PMC4455970 DOI: 10.1038/nrd4363] [Citation(s) in RCA: 1081] [Impact Index Per Article: 108.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The formulation and delivery of biopharmaceutical drugs, such as monoclonal antibodies and recombinant proteins, poses substantial challenges owing to their large size and susceptibility to degradation. In this Review we highlight recent advances in formulation and delivery strategies--such as the use of microsphere-based controlled-release technologies, protein modification methods that make use of polyethylene glycol and other polymers, and genetic manipulation of biopharmaceutical drugs--and discuss their advantages and limitations. We also highlight current and emerging delivery routes that provide an alternative to injection, including transdermal, oral and pulmonary delivery routes. In addition, the potential of targeted and intracellular protein delivery is discussed.
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Affiliation(s)
- Samir Mitragotri
- Department of Chemical Engineering, Center for Bioengineering, University of California, Santa Barbara, California 92106, USA
| | - Paul A Burke
- Burke Bioventures LLC, 277 Broadway, Cambridge, Massachusetts 02139, USA
| | - Robert Langer
- Department of Chemical Engineering, Koch Institute for Integrative Cancer Research, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139, USA
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Tauschmann M, Hovorka R. Insulin pump therapy in youth with type 1 diabetes: toward closed-loop systems. Expert Opin Drug Deliv 2014; 11:943-55. [PMID: 24749563 DOI: 10.1517/17425247.2014.910192] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Insulin pump technology has advanced considerably over the past three decades, leading to more favorable metabolic control and less hypoglycemic events when compared with multiple daily injection therapy. The use of insulin pumps is increasing, particularly in children and adolescents with type 1 diabetes. AREAS COVERED This review outlines recent developments in insulin pump therapy from a pediatric perspective. 'Smart' pumps, sensor-augmented pump therapy and threshold-suspend feature of insulin pumps are reviewed in terms of efficacy, safety and psychosocial impact. The current status of closed-loop systems focusing on clinical outcomes is highlighted. EXPERT OPINION Closed-loop insulin delivery is gradually progressing from bench to the clinical practice. Longer and larger studies in home settings are needed to expand on short- to medium-term outpatient evaluations. Predictive low glucose management and overnight closed-loop delivery may be the next applications to be implemented in daily routine. Further challenges include improvements of control algorithms, sensor accuracy, duration of insulin action, integration and size of devices and connectivity and usability. Gradual improvements and increasing sophistication of closed-loop components lie on the path toward unsupervised hands-off fully closed-loop system.
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Affiliation(s)
- Martin Tauschmann
- University of Cambridge, Wellcome Trust-MRC Institute of Metabolic Science , Cambridge , UK
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Luyckx K, Rassart J, Weets I. Illness self-concept in Type 1 diabetes: A cross-sectional view on clinical, demographic, and psychosocial correlates. PSYCHOL HEALTH MED 2014; 20:77-86. [DOI: 10.1080/13548506.2014.902482] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Rassart J, Luyckx K, Moons P, Weets I. Personality and self-esteem in emerging adults with Type 1 diabetes. J Psychosom Res 2014; 76:139-45. [PMID: 24439690 DOI: 10.1016/j.jpsychores.2013.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 11/21/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The present study examined (1) mean-level differences in self-esteem and Big Five personality traits between individuals with and without diabetes; and (2) demographic, clinical, and psychological correlates of patients' self-esteem and Big Five. RESEARCH DESIGN AND METHODS A total of 478 emerging adults with Type 1 diabetes (18-35 years old) were selected from the Belgian Diabetes Registry and completed questionnaires on personality, self-esteem, and diabetes-related distress. The control group consisted of 341 healthy participants who were matched (1:1) on sex and age with the patient group. RESULTS First, mean-level differences between patients and controls differed according to patients' sex and illness duration. Women with diabetes reported lower self-esteem and were less extraverted and emotionally stable as compared to female controls. In contrast, men with diabetes reported higher self-esteem and were more agreeable but less emotionally stable as compared to male controls. Furthermore, whereas both patients with shorter and longer illness duration were less extraverted and emotionally stable as compared to controls, only patients with longer illness duration reported heightened agreeableness. Second, self-esteem and Big Five were found to relate to patients' sex and (to a lesser extent) age and illness duration. Finally, patients reporting elevated diabetes-related distress reported lower self-esteem, and were less agreeable and emotionally stable as compared to patients not reporting such distress. CONCLUSIONS Patients' personality and self-esteem might be important targets for future prevention and intervention efforts. The present findings can assist healthcare professionals in identifying those patients who might benefit the most from such programs.
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Affiliation(s)
| | | | - Philip Moons
- KU Leuven, Leuven, Belgium; University Hospitals of Leuven, Leuven, Belgium; The Heart Centre, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ilse Weets
- Free University Brussels, Brussels, Belgium
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Christie D. Current recommendations and considerations for psychosocial and psychoeducational support of adolescents with Type 1 diabetes. ACTA ACUST UNITED AC 2013. [DOI: 10.2217/dmt.12.90] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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