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Demirtaş A, Aykanat Girgin B, Güven A, Kırmızıbekmez H. Psychometric Properties of the Turkish Version of the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes. J Clin Res Pediatr Endocrinol 2022; 14:324-333. [PMID: 35633640 PMCID: PMC9422910 DOI: 10.4274/jcrpe.galenos.2022.2022-2-10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/23/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Resilience in diabetes refers to the capacity overcome diabetes-related challenges to achieve favorable psychosocial and health outcomes. Despite the known benefits of resilience in adolescents with type 1 diabetes mellitus (T1DM), there tends to be more emphasis on risk factors in research and practice. This study evaluated the psychometric properties of the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes (DSTAR-Teen) in Turkey. Methods This descriptive, methodological study was conducted between October 2020 and May 2021. The Turkish DSTAR-Teen was administered to 120 adolescents with T1DM, and the data were evaluated using Cronbach’s alpha coefficients, factor analyses, test-retest correlation, and item-total score correlations. Results The Turkish DSTAR-Teen has 12 items in two factors that explained 50.64% of the total variance. Confirmatory factor analysis revealed goodness-of-fit and comparative fit indices of 0.92 and 0.95, respectively. The total Cronbach’s alpha value of the scale was 0.85. Item-total score correlations ranged from 0.49 to 0.74 (p<0.001). Conclusion Our analyses showed that the Turkish DSTAR-Teen is a valid and reliable instrument in Turkish adolescents with T1DM. The Turkish DSTAR-Teen can be used to evaluate strengths and resilience associated with diabetes management in adolescents with T1DM in Turkey.
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Affiliation(s)
- Aslı Demirtaş
- Zeynep Kamil Maternity and Children Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Burcu Aykanat Girgin
- University of Health Sciences Turkey, Hamidiye Faculty of Nursing, Department of Pediatric Nursing, İstanbul, Turkey
| | - Ayla Güven
- Zeynep Kamil Maternity and Children Diseases Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
| | - Heves Kırmızıbekmez
- İstanbul Ümraniye Training and Research Hospital, Clinic of Pediatric Endocrinology, İstanbul, Turkey
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2
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Parent-Child Conflict Moderates the Relationship Between Executive Functioning and Child Disruptive Behaviors in Youth with T1D. J Clin Psychol Med Settings 2022; 29:357-364. [PMID: 34985630 PMCID: PMC9893479 DOI: 10.1007/s10880-021-09838-5] [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: 12/15/2021] [Indexed: 02/04/2023]
Abstract
Executive function (EF) skills, parent-child conflict, and high blood glucose (BG) may impact child externalizing behaviors. We examined these child and parent factors in families of 5-9 year olds with recent-onset type 1 diabetes (T1D). Parents (N = 125) reported child EF, child externalizing behaviors, and conflict regarding T1D-specific tasks. We used self-monitoring BG uploads to calculate the percentage of time children had high BG (> 180 mg/dl). We entered data into a moderated path analysis using MPlus8. The path analysis revealed a positive direct effect for parent-reported child EF and child externalizing behavior (p < .01). Further, T1D-specific conflict moderated the positive association between parent-reported child EF and child externalizing behaviors (p < .05). Early screening of child EF, externalizing behavior, and family conflict may be particularly important in the recent-onset period of T1D. The introduction of T1D-related conflict after diagnosis may impact child externalizing behavior and limited child EF skills that pre-date diagnosis.
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3
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Goethals ER, Lemiere J, Snoek FJ, Casteels K, Luyckx K, de Wit M. Executive function mediates the link between externalizing behavior and HbA1c in children and adolescents with type 1 diabetes: A cross-national investigation. Pediatr Diabetes 2021; 22:503-510. [PMID: 33314616 DOI: 10.1111/pedi.13172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/14/2020] [Accepted: 11/11/2020] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Externalizing behavior (i.e., conduct problems, hyperactivity) and executive function (EF) problems in children and adolescents with type 1 diabetes (T1D) have been associated with worse diabetes-related and psychosocial outcomes but have not been examined in relationship to each other. We aimed to examine whether externalizing behavior is associated with HbA1c and whether this relationship is mediated by EF problems, specifically metacognition (i.e., ability to initiate, plan, organize and monitor behavior) and behavioral regulation (i.e., impulse control, regulation of emotion and behavior). RESEARCH DESIGN AND METHODS Cohorts of Belgian and Dutch parents of children and adolescents (6-18 years) with T1D filled out questionnaires on externalizing behavior (Strengths and Difficulties Questionnaire; SDQ) and EF (Behavior Rating Inventory of Executive Function; BRIEF) composite scales. Treating physicians collected HbA1c values. Mediation analyses were performed separately for the BRIEF composite Metacognition and Behavior Regulation scales, correcting for age, sex and diabetes duration. RESULTS The 335 parents of children and adolescents with T1D (mean age 12.3 ± 2.8 SD; mean HbA1c 7.6% ± 1.1 SD [60 mmol/mol ± 12.0 SD]; mean diabetes duration 5.3 ± 3.6 SD; 49.6% female) participated. Analyses showed that the association between externalizing behavior and HbA1c is mediated by metacognition (ab path Point estimate = 0.05 BCa CI 95% 0.02-0.08), and not behavioral regulation. CONCLUSIONS Results uncovered the influence externalizing behavior may have on EF problems in the metacognition domain, which in turn seem to influence HbA1c. Clinicians should be mindful of these EF problems when working with children and adolescents displaying externalizing behavior, and not only target behavioral but also cognitive processes.
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Affiliation(s)
- Eveline R Goethals
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Harvard Medical School, Joslin Diabetes Center, Boston, Massachusetts, USA
| | - Jurgen Lemiere
- Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Frank J Snoek
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | | | - Koen Luyckx
- School Psychology and Development in Context, Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,Unit for Professional Training and Service in the Behavioural Sciences, University of the Free State, Bloemfontein, South Africa
| | - Maartje de Wit
- Medical Psychology, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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4
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Abstract
PURPOSE OF REVIEW To synthesize findings from studies of neurocognitive complications in children with type 1 diabetes (T1D) and highlight potential risk and protective factors. RECENT FINDINGS Emerging evidence suggests that hyperglycemia and time in range may be more important for brain development than episodes of hypoglycemia. Further, diabetic ketoacidosis (DKA) at the time of T1D diagnosis appears to be a particular risk factor for neurocognitive complications, particularly deficits in executive function skills and memory, with differences in cerebral white matter microstructure seen via advanced magnetic resonance imaging methods, and lower scores on measures of attention and memory observed among children who were diagnosed in DKA. Other factors that may influence neurocognitive development include child sleep, caregiver distress, and diabetes device use, presumably due to improved glycemic control. We highlight neurocognitive risk and protective factors for children with T1D and priorities for future research in this high-risk population.
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Affiliation(s)
- Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37203, USA.
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37203, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Science, Vanderbilt University Medical Center, Nashville, TN, USA
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Ding K, Reynolds CM, Driscoll KA, Janicke DM. The Relationship Between Executive Functioning, Type 1 Diabetes Self-Management Behaviors, and Glycemic Control in Adolescents and Young Adults. Curr Diab Rep 2021; 21:10. [PMID: 33616838 DOI: 10.1007/s11892-021-01379-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/13/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE OF REVIEW Understanding barriers to self-management behaviors and glycemic stability may inform specific needs for behavior change in adolescents and young adults with type 1 diabetes (T1D). The current review aims to systematically synthesize the literature on the relationships between executive functioning, self-management, and A1C in adolescents and young adults with T1D. Fifteen studies were retained in the current review. Study quality assessment for the majority of the studies were "Fair" or "Good." RECENT FINDINGS This review highlights several advances in research design, including use of longitudinal designs, data from multiple informants, and use of objective measures. Adolescents and young adults reported that more executive functioning weaknesses were related to decreased self-management behaviors and higher A1C. The current review demonstrated that self-perceived executive functioning weaknesses negatively impact self-management behaviors and A1C. Future research is needed to determine the utility of objective measures in assessing the relationships between executive functioning, T1D self-management, and A1C.
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Affiliation(s)
- Ke Ding
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida, 32610, USA.
| | - Cheyenne M Reynolds
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida, 32610, USA
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida, 32610, USA
| | - David M Janicke
- Department of Clinical and Health Psychology, University of Florida, P.O. Box 100165, Gainesville, Florida, 32610, USA
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Sanjari M, Peyrovi H, Mehrdad N. The Process of Managing the Children with Type 1 Diabetes in the Family: A Grounded Theory Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:25-33. [PMID: 33954095 PMCID: PMC8074732 DOI: 10.4103/ijnmr.ijnmr_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/04/2022]
Abstract
Background: Diabetes is a disease that affects all family members. Parents of children with type 1 diabetes are always concerned about all aspects of children's life. The aim of this study was to elucidate the process of managing children with diabetes in the family. Materials and Methods: This is a qualitative grounded theory of a doctoral dissertation, which was done on 2016. The 18 participants were selected through purposive and theoretical sampling until data saturation. The main participants in this study included parents, siblings, and children with type 1 diabetes. The data was gathered by semi-structured interviews as well as field notes and memos. Data analysis was done concurrently with data collection in four levels, including data analysis for concept and contex, bringing the process into the analysis, and integration of categories according to Corbin and Struss (2008). Core category appeared at the end of integrated categories. Results: “The family with diabetes in the child's diabetes orbit” as a core category contains the process of managing children with diabetes within the family, which included three main subcategories, including “entering into the diabetes orbit”, “movement into the diabetes orbit”, and “living into the diabetes orbit”. Conclusions: The family through the concept of “The family with diabetes in the child's diabetes orbit “as a main concern of families with diabetes suffering diabetes attempt to select and practicing appropriate strategies and manage diabetes and children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Department of Critical Care Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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7
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Zaremba N, Watson A, Kan C, Broadley M, Partridge H, Figuereido C, Hopkins D, Treasure J, Ismail K, Harrison A, Stadler M. Multidisciplinary healthcare teams' challenges and strategies in supporting people with type 1 diabetes to recover from disordered eating. Diabet Med 2020; 37:1992-2000. [PMID: 31833586 DOI: 10.1111/dme.14207] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2019] [Indexed: 11/30/2022]
Abstract
AIM To examine the challenges healthcare teams face when treating people with type 1 diabetes and disordered eating and the strategies these teams have developed to facilitate effective treatment. METHODS Four semi-structured focus groups were conducted including two tertiary diabetes specialist teams and three tertiary eating disorders specialist teams between July and December 2018. Thematic analysis of the transcripts followed a six-phase process. RESULTS Twenty-nine experienced healthcare professionals (16 diabetes and 13 eating disorder specialists, 16±12 years' professional experience) were interviewed. The challenges identified in treating people with type 1 diabetes and disordered eating included subthemes the 'challenges specific to the healthcare professional' (feeling not competent enough and perceived emotional burden), 'challenges pertaining to patient factors' (e.g. difficulties with engaging in therapy) and 'challenges created by the healthcare system' (time pressure and staff shortage). Healthcare professionals expressed the need for a consensus on diagnosis and the definition of disordered eating in type 1 diabetes, as well as the need for training and educational resources specific to type 1 diabetes and disordered eating. Healthcare professionals gave practical examples of strategies of communication for better patient engagement and felt that multidisciplinary working in joint clinics with the other specialty were facilitators for recovery from disordered eating. CONCLUSIONS Healthcare professionals require multidisciplinary team support when treating people with type 1 diabetes and to improve their own competencies. The development of effective screening and assessment tools, educational resources and training for healthcare professionals, and developing multidisciplinary treatment pathways will be key to improving outcomes for their service users with type 1 diabetes and disordered eating.
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Affiliation(s)
- N Zaremba
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
| | - A Watson
- Division of Medicine, University College London, London, UK
| | - C Kan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - H Partridge
- Diabetes Centre, Royal Bournemouth and Christchurch Hospital, Bournemouth, UK
| | - C Figuereido
- Dorset Eating Disorders Service, Royal Bournemouth and Christchurch Hospital, Bournemouth, UK
| | - D Hopkins
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
| | - J Treasure
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - K Ismail
- Institute of Diabetes Endocrinology and Obesity, King's Health Partners, London, UK
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, King's College London, London, UK
| | - A Harrison
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- University College London, Institute of Education, London, UK
| | - M Stadler
- Diabetes Research Group, Weston Education Centre, King's College London, London, UK
- Department of Psychological Medicine, Diabetes Psychology and Psychiatry Research Group, Weston Education Centre, King's College London, London, UK
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8
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Suchy Y, Butner J, Wiebe DJ, Campbell M, Turner SL, Berg CA. Executive Cognitive Functions and Behavioral Control Differentially Predict HbA1c in Type 1 Diabetes across Emerging Adulthood. J Int Neuropsychol Soc 2020; 26:353-363. [PMID: 31822304 PMCID: PMC7124994 DOI: 10.1017/s1355617719001310] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To examine the contributions of two aspects of executive functioning (executive cognitive functions and behavioral control) to changes in diabetes management across emerging adulthood. METHODS Two hundred and forty-seven high school seniors with type 1 diabetes were assessed at baseline and followed up for 3 years. The baseline assessment battery included performance-based measures of executive cognitive functions, behavioral control, IQ estimate (IQ-est), and psychomotor speed; self-report of adherence to diabetes regimen; and glycated hemoglobin (HbA1c) assay kits as a reflection of glycemic control. RESULTS Linear and quadratic growth curve models were used to simultaneously examine baseline performance on four cognitive variables (executive cognitive functions, behavioral control, IQ, and psychomotor speed) as predictors of indices of diabetes management (HbA1c and adherence) across four time points. Additionally, general linear regressions examined relative contributions of each cognitive variable at individual time points. The results showed that higher behavioral control at baseline was related to lower (better) HbA1c levels across all four time points. In contrast, executive cognitive functions at baseline were related to HbA1c trajectories, accounting for increasingly more HbA1c variance over time with increasing transition to independence. IQ-est was not related to HbA1c levels or changes over time, but accounted instead for HbA1c variance at baseline (while teens were still living at home), above and beyond all other variables. Cognition was unrelated to adherence. CONCLUSIONS Different aspects of cognition play a different role in diabetes management at different time points during emerging adulthood years.
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Affiliation(s)
- Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Jonathan Butner
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Deborah J Wiebe
- Department of Psychology, University of California, Merced, USA
| | | | - Sara L Turner
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
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9
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Miller AL, Lo SL, Bauer KW, Fredericks EM. Developmentally informed behaviour change techniques to enhance self-regulation in a health promotion context: a conceptual review. Health Psychol Rev 2020; 14:116-131. [PMID: 31957556 PMCID: PMC7254982 DOI: 10.1080/17437199.2020.1718530] [Citation(s) in RCA: 12] [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] [Received: 11/30/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
Self-regulation (SR), or the ability to manage thoughts, emotions, and behaviours in order to achieve a desired goal, is seen as underlying positive health behaviours. In adults, behaviour change techniques (BCTs) are recommended to promote SR across health domains; although establishing healthy habits early in life is important, studies of SR and health in children are rare. This conceptual review provides guidance on developmental considerations for applying BCTs to enhance SR capacity in children and youth with the goal of fostering positive behavioural health trajectories early in the lifespan. Key considerations include the nature of developmental changes in SR and interaction among SR processes; temporal associations between SR and health behaviours; and relevance of health goals for children and youth. Building on a meta-review of BCT's used to promote SR in adults and youth, this conceptual review highlights key SR milestones to consider in behaviour change-focused interventions from early childhood through adolescence and provides an overview of social-ecologic influences on SR development and associations between SR and health behaviours across these age periods. Implications for and examples of using developmentally-informed BCTs in interventions to enhance SR in children and youth are noted and suggestions for future research are discussed.
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Affiliation(s)
- Alison L Miller
- Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Sharon L Lo
- Department of Health Behaviour and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan School of Medicine, Ann Arbor, MI, USA
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10
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Hamburger ER, Lyttle M, Compas BE, Jaser SS. Performance-based and questionnaire measures of executive function in adolescents with type 1 diabetes. J Behav Med 2019; 42:1041-1049. [PMID: 30879224 PMCID: PMC6746613 DOI: 10.1007/s10865-019-00027-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Accepted: 03/09/2019] [Indexed: 12/16/2022]
Abstract
The purpose of the current study was to examine executive function (EF) in adolescents with type 1 diabetes using both performance-based and questionnaire measures in relation to diabetes indicators. Adolescents age 13-17 completed performance-based measures of EF and measures of adherence. Adolescents' parents reported on adolescents' EF and adherence. HbA1c and frequency of blood glucose monitoring (glucometer data) were obtained from adolescents' medical records. None of the performance-based measures of EF were significantly associated with adherence or with HbA1c. Parent-reported problems with EF were associated with poorer adherence, and adolescents who scored in the impaired range of the Behavioral Regulation Index of EF had significantly poorer adherence (both parent-reported adherence and frequency of blood glucose monitoring) and higher HbA1c than those in the normal range. Our findings suggest that parent-reported measures of EF may be more strongly linked to diabetes indicators than performance-based measures.
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Affiliation(s)
- Emily R Hamburger
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37232, USA
| | - Morgan Lyttle
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37232, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37232, USA.
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11
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Vaid E, Lansing AH, Stanger C. Problems With Self-Regulation, Family Conflict, and Glycemic Control in Adolescents Experiencing Challenges With Managing Type 1 Diabetes. J Pediatr Psychol 2019; 43:525-533. [PMID: 29077875 DOI: 10.1093/jpepsy/jsx134] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/13/2017] [Indexed: 01/12/2023] Open
Abstract
Objective This study explored the associations between problems with self-regulation and glycemic control (HbA1c) in teens experiencing challenges with managing type 1 diabetes by examining greater diabetes-related family conflict and poorer adherence as serial mediators of the link between greater problems with self-regulation and higher HbA1c. Methods Teens experiencing challenges with managing type 1 diabetes (n = 93, HbA1c ≥8%, 96% White, 57% male) completed an HbA1c test, and their parents completed assessments including measures of adherence and family conflict related to diabetes management during an intake for a larger Web-based intervention study or fMRI study. Teen problems with self-regulation were indexed the Child Behavior Checklist using the dysregulation profile. Results Bivariate correlations found significant associations between greater problems with self-regulation, greater family conflict about diabetes management, poorer adherence, and higher HbA1c. However, only greater family conflict, and not adherence, significantly explained the association between greater self-regulation problems and higher HbA1c. Conclusions These findings suggest that among teens experiencing challenges with managing type 1 diabetes, interventions that decrease family conflict may be critical to promoting optimal glycemic control in those teens with greater problems with self-regulation.
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Affiliation(s)
- Esha Vaid
- Center for Technology and Behavioral Health at Dartmouth.,Dartmouth Geisel School of Medicine
| | - Amy Hughes Lansing
- Center for Technology and Behavioral Health at Dartmouth.,Dartmouth Geisel School of Medicine
| | - Catherine Stanger
- Center for Technology and Behavioral Health at Dartmouth.,Dartmouth Geisel School of Medicine
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12
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Syarif H, Waluyo A, Afiyanti Y, Mansyur M. Executive function in breast cancer survivors and the influencing factors. ENFERMERIA CLINICA 2019. [DOI: 10.1016/j.enfcli.2019.04.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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13
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Pierce JS, Wasserman R, Enlow P, Aroian K, Lee J, Wysocki T. Benefit finding among parents of young children with type 1 diabetes. Pediatr Diabetes 2019; 20:652-660. [PMID: 31006941 PMCID: PMC7416424 DOI: 10.1111/pedi.12860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 02/15/2019] [Accepted: 04/16/2019] [Indexed: 12/30/2022] Open
Abstract
Benefit finding, perceived positive effects of adversity, has been associated with psychological well-being in people with chronic illnesses and with better adherence for adolescents with type 1 diabetes (T1D). Our qualitative research with parents of young children (< 6 years old) with T1D indicated that benefit finding (BF) is a common parental coping mechanism, but no tools exist to measure BF in parents. We determined psychometric properties of the Diabetes Benefit Finding Scale for Parents (DBFS-P), a 16-item questionnaire adapted from the validated adolescent version. Parents of young children with T1D (n = 172) were participants in a randomized trial of an online intervention. We examined the DBFS-P factor structure through principal component analysis (PCA); internal consistency through Cronbach's alpha; convergent validity via bivariate correlations between the DBFS-P and measures of parental depression, anxiety, T1D self-efficacy, and hypoglycemia fear; and discriminant validity via bivariate correlations between the DBFS-P and measures of parental somatization and child behavior problems. PCA revealed one factor (56.47% variance) with Cronbach's α = 0.95. Convergent validity of the DBFS-P was supported by significant correlations with parental depression (r = -0.35, P < 0.001), anxiety (r = -0.20, P = 0.008), T1D self-efficacy (r = 0.36, P < 0.001), and hypoglycemia fear (r = 0.27, P < 0.001). Non-significant correlations with parental somatization (r = -0.06, P = 0.42) and child behavior problems (r = -0.12, P = 0.14) support its discriminant validity. The DBFS-P demonstrated good psychometric properties as a tool for assessing BF among caregivers.
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Affiliation(s)
- Jessica S. Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida
| | - Rachel Wasserman
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida
| | - Paul Enlow
- Center for Healthcare Delivery Science, Nemours Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Karen Aroian
- College of Nursing, University of Central Florida, Orlando, Florida
| | - Joyce Lee
- Division of Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, Michigan
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Specialty Care, Jacksonville, Florida
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14
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Lansing AH, Stoianova M, Stanger C. Adolescent Emotional Control Moderates Benefits of a Multicomponent Intervention to Improve Type 1 Diabetes Adherence: A Pilot Randomized Controlled Trial. J Pediatr Psychol 2019; 44:126-136. [PMID: 30247640 PMCID: PMC6319445 DOI: 10.1093/jpepsy/jsy071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 08/15/2018] [Accepted: 08/15/2018] [Indexed: 11/13/2022] Open
Abstract
Objective We previously tested via randomized controlled trial a novel intervention for adolescents with type 1 diabetes and above-target glycemic control that combined web-delivered incentives for self-monitoring of blood glucose (SMBG) and brief web counseling with working memory training and parental contingency contracting training. Results showed improved SMBG and decreased glycosylated hemoglobin (HbA1c) at 6- and 12-month follow-ups. However, it has not been elucidated if improvements in SMBG mediated the immediate benefits of this treatment on HbA1c nor if this intensive intervention uniquely benefited a subgroup of adolescents with higher problems in emotional control. Methods Adolescents with type 1 diabetes and above-target glycemic control (n = 61) were randomized to receive the 6-month intervention (n = 30) or usual care (n = 31). Adolescents completed the Behavior Rating Inventory of Executive Function-Self-Report, problems with emotional control subscale at baseline, and provided meter downloads to assess frequency of SMBG and completed an HbA1c blood draw at baseline and 6 months later. Results At 6-month follow-up, improvements in SMBG mediated the effects of receiving the treatment on having lower average HbA1c. Further, problems in emotional control moderated the benefits of the intervention on improvements in SMBG and in turn HbA1c. Only adolescents with above average problems in emotional control evidenced improvements in SMBG in response to treatment, which then explained lower HbA1c levels at 6-month follow-up. Conclusions This multicomponent, web-delivered intervention provided unique benefits for improving SMBG and lowering HbA1c in teens with higher problems in emotional control.
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Affiliation(s)
| | - Maria Stoianova
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth
| | - Catherine Stanger
- Center for Technology and Behavioral Health, Geisel School of Medicine at Dartmouth
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Joiner KL, Holland ML, Grey M. Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry. J Nurs Scholarsh 2018; 50:676-686. [PMID: 30246919 DOI: 10.1111/jnu.12428] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose was to test associations among stressful life events, frequency of missed insulin doses, and glycemic control in young adults with type 1 diabetes (T1D). DESIGN The study was a cross-sectional descriptive secondary analysis. METHODS Data from 2,921 participants (ages 18-26 years) in the U.S. T1D Exchange Clinic Registry were analyzed. Report of a stressful life event was defined as one or more positive responses on a 17-item stressful life events index and defined as a dichotomous variable (yes or no). Frequency of missed insulin doses was measured using a single self-report item and collapsed into two levels (fewer than three times a week, three or more times a week). The glycosylated hemoglobin (A1c) level recorded at the time of enrollment was used to assess glycemic control. FINDINGS Nearly half (48.6%) of the participants reported having a stressful life event during the previous year. The most frequently reported stressful life events were problems at work or school (16.1%), serious arguments with family members or a close friend (15.2%), and financial problems in the family (13.8%). Compared to the participants not reporting stressful life events, those who reported stressful life events were more likely to be older, female, with a higher educational attainment level, and not working or unemployed. Those who reported a stressful life event were more likely than those who did not to say they typically missed insulin doses at least three times a week and less likely to say they typically missed insulin doses fewer than three times a week (p < .001 adjusted for age, sex, race or ethnicity, educational attainment level, duration of T1D diagnosis, and insulin delivery method). Mean A1c level was higher for the group who reported having a stressful life event in the past 12 months compared to the group who did not (8.7 ± 1.8% vs. 8.2 ± 1.6%; adjusted p < .001). The results of a mediation analysis suggest that the measure of frequency of missed insulin doses may be a mediator of the relationship between recent stressful life events and glycemic control (Sobel test: ab = .841, 95% confidence interval = 0.064-1.618). CONCLUSIONS These findings suggest that, for young adults with T1D, the experience of stressful life events may increase their risk for poorer glycemic control, possibly by disrupting adherence with insulin doses. CLINICAL RELEVANCE Further exploration of these relationships may allow for the potential for identifying those at risk and assisting them with more positive approaches to managing stressful events.
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Affiliation(s)
- Kevin L Joiner
- Rho, Research Fellow, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Margaret L Holland
- Associate Research Scientist in Nursing, Yale University School of Nursing, Orange, CT, USA
| | - Margaret Grey
- Delta Mu , Annie Goodrich Professor of Nursing, Yale University School of Nursing, Orange, CT, USA
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16
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Broadley MM, White MJ, Andrew B. Executive function is associated with diabetes-specific disordered eating in young adults with type 1 diabetes. J Psychosom Res 2018; 111:1-12. [PMID: 29935740 DOI: 10.1016/j.jpsychores.2018.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 03/28/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Disordered eating behavior in young adults with type 1 diabetes is overrepresented and associated with significant negative health consequences. Thus, determining the key correlates of these behaviors is essential. The aim of the present study was to determine the association between executive function and disordered eating in young adults with type 1 diabetes, relative to a control group without diabetes. METHODS 74 young adults with type 1 diabetes and 201 demographically similar control participants completed an online survey containing the Eating Disorders Examination Questionnaire (EDE-Q), Diabetes Eating Problems Survey- Revised (DEPS-R), Behavior Rating Inventory of Executive Function- Adult version, Depression Anxiety and Stress Scales, and 3 subscales of the Family Environment Scale (independence, control, and cohesion). RESULTS Hierarchical multiple regressions showed that lower executive function was associated with significantly greater disordered eating (as measured by the DEPS-R) over and above psychological and family functioning in the type 1 diabetes group (ΔR2 = 0.056, β = 0.366, p = .031). The same relationship was not found when disordered eating was measured by the EDE-Q in either the diabetes group (ΔR2 = 0.049, β = 0.342, p = .054), or the control group (ΔR2 = 0.010, β = 0.136, p = .100). CONCLUSIONS Executive function may play a greater role in the development and/or maintenance of disordered eating in groups with type 1 diabetes relative to those without. This relationship may contribute to the over-representation of eating problems in this clinical group, and may represent a target for prevention or intervention.
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Affiliation(s)
- Melanie M Broadley
- Queensland University of Technology, School of Psychology and Counselling, 170 Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia.
| | - Melanie J White
- Queensland University of Technology, School of Psychology and Counselling, 170 Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
| | - Brooke Andrew
- Queensland University of Technology, School of Psychology and Counselling, 170 Victoria Park Rd, Kelvin Grove, QLD 4059, Australia; Institute of Health and Biomedical Innovation, 60 Musk Avenue, Kelvin Grove, QLD 4059, Australia
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Vitvarová T, Neumann D, Šimáková R, Kremláček J. Neurophysiological Evidence for a Compensatory Activity during a Simple Oddball Task in Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res 2018; 2018:8105407. [PMID: 30116745 PMCID: PMC6079416 DOI: 10.1155/2018/8105407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Revised: 06/11/2018] [Accepted: 06/20/2018] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The poor metabolic control in type 1 diabetes mellitus (T1D) has a negative impact on the developing brain. Hyperglycemia and glycemic fluctuations disrupt mainly executive functions. To assess a hypothesized deficit of the executive functions, we evaluated visual processing and reaction time in an oddball task. METHODS Oddball visual event-related potentials (ERPs), reaction time, and pattern-reversal visual evoked potentials (VEPs) were examined in a cohort of twenty-two 12- to 18-year-old T1D patients without diabetic retinopathy at normal glycemia and in nineteen 10- to 21-year-old healthy controls. RESULTS The P100 peak time of the VEPs was significantly prolonged in T1D patients compared with the control group (p < 0.017). In contrast to the deteriorated sensory response, the area under the curve of the P3b component of the ERPs was significantly larger (p = 0.035) in patients, while reaction time in the same task did not differ between groups (p = 0.713). CONCLUSIONS The deterioration on a sensory level, enhanced activity during cognitive processing, and balanced behavioral response support the view that neuroplasticity counterbalances the neural impairment by enhanced cognitive processing to achieve normal behavioral performance in T1D adolescents.
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Affiliation(s)
- Tereza Vitvarová
- Department of Pediatrics, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - David Neumann
- Department of Pediatrics, University Hospital Hradec Kralove, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
| | - Radka Šimáková
- Philosophy Faculty, Palacky University Olomouc, Olomouc, Czech Republic
| | - Jan Kremláček
- Department of Pathological Physiology, Faculty of Medicine in Hradec Kralove, Charles University, Hradec Kralove, Czech Republic
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Hilliard ME, Iturralde E, Weissberg-Benchell J, Hood KK. The Diabetes Strengths and Resilience Measure for Adolescents With Type 1 Diabetes (DSTAR-Teen): Validation of a New, Brief Self-Report Measure. J Pediatr Psychol 2018; 42:995-1005. [PMID: 28549160 DOI: 10.1093/jpepsy/jsx086] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 05/09/2017] [Indexed: 01/09/2023] Open
Abstract
Objective Despite the challenges of managing type 1 diabetes, many adolescents achieve optimal outcomes. A validated measure of diabetes-specific strengths is needed to measure adaptive behaviors and attitudes associated with overcoming challenges and achieving "resilient" outcomes. Methods Baseline data from 260 adolescents (age 14-18 years, M = 15.7 ± 1.1, 60% female, 33% Non-Caucasian, M A1c = 9.1 ± 1.9%) and caregivers in a behavioral intervention trial were analyzed to evaluate psychometric properties of the 12-item self-report Diabetes Strengths and Resilience measure for adolescents (DSTAR-Teen). Reliability and validity were examined in relation to measures of related constructs, regimen adherence, and glycemic outcomes, and confirmatory factor analysis was conducted. Results Reliability was good (internal consistency: α = .89; item-total correlations: r range = .55-.78). Significant correlations demonstrated construct and criterion validity. A two-factor structure reflecting intrapersonal and interpersonal processes fit the data better than a one-factor solution. Conclusions The DSTAR-Teen has strong psychometric properties, captures adaptive aspects of adolescents' diabetes management (i.e., "strengths"), and is related to clinical outcomes.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine
| | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine
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19
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Goethals ER, de Wit M, Van Broeck N, Lemiere J, Van Liefferinge D, Böhler S, De Wulf M, Dello E, Laridaen J, Van Hecke L, Van Impe S, Casteels K, Luyckx K. Child and parental executive functioning in type 1 diabetes: Their unique and interactive role toward treatment adherence and glycemic control. Pediatr Diabetes 2018; 19:520-526. [PMID: 28758314 DOI: 10.1111/pedi.12552] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/30/2017] [Accepted: 05/31/2017] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE Managing type 1 diabetes (T1D) requires the ability to make complex and critical decisions regarding treatment, to execute complex tasks accurately, and to make adjustments when problems arise. This requires effective neuropsychological competences of patients and their families, especially in the domain of executive functioning (EF): the ability to self-monitor, plan, solve problems, and set priorities. Previous research focused mainly on child EF, neglecting the impact of parental EF. This study included both mothers and fathers and examined associations between child and parental EF and treatment adherence to T1D in a broad age range of patients. METHODS Parents of 270 patients (6-18 years) with T1D (mean age 12.7 years; 52.6% female) were included. Mothers (N = 232) and fathers (N = 168) completed questionnaires on child and parental EF and on treatment adherence. Analyses examined the associations linking child and parental EF to treatment adherence and glycemic control (and potential moderation effects in these associations) using hierarchical linear regression. RESULTS Child EF problems were negatively associated with treatment adherence. As an indication of moderation, this effect was stronger in older children. Better treatment adherence and glycemic control were reported when both child and parent showed less EF problems. Effects were more pronounced in mothers than in fathers. CONCLUSIONS This study demonstrated a significant interplay between child and parental EF in the association with treatment adherence and glycemic control. Researchers and clinicians should remain attentive toward the role of neuropsychological concepts such as EF. Implementation in clinical practice seems meaningful.
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Affiliation(s)
- Eveline R Goethals
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | - Maartje de Wit
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Nady Van Broeck
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
| | - Jurgen Lemiere
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
| | | | - Susanne Böhler
- Department of Pediatrics, University Hospital Brussels, Brussels, Belgium
| | - Marian De Wulf
- Department of Pediatrics, Antwerp University Hospital, Edegem, Belgium
| | - Elke Dello
- Department of Pediatrics, Hospital Maas & Kempen, Bree, Belgium
| | - Jolien Laridaen
- Department of Pediatrics, University Hospital Ghent, Ghent, Belgium
| | - Lynn Van Hecke
- Department of Pediatrics, Delta Hospital Roeselare, Roeselare, Belgium
| | - Shana Van Impe
- Department of Pediatrics, Queen Paola Children's Hospital ZNA, Antwerp, Belgium
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, University of Leuven, Leuven, Belgium
| | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium
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20
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Pierce JS, Jordan SS, Arnau RC. Development and Validation of the Pediatric Diabetes Routines Questionnaire for Adolescents. J Clin Psychol Med Settings 2018; 26:47-58. [DOI: 10.1007/s10880-018-9563-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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21
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Wiebe DJ, Berg CA, Mello D, Kelly CS. Self- and Social-Regulation in Type 1 Diabetes Management During Late Adolescence and Emerging Adulthood. Curr Diab Rep 2018; 18:23. [PMID: 29564640 DOI: 10.1007/s11892-018-0995-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW This paper aims to examine how self-regulation (i.e., cognition, emotion) and social-regulation (i.e., parents, friends, romantic partners) are interrelated risk and protective factors for type 1 diabetes management during late adolescence and emerging adulthood. RECENT FINDINGS Problems in cognitive (e.g., executive function) and emotional (e.g., depressive symptoms) self-regulation are associated with poorer management, both at the between- and within-person levels. Better management occurs when parents are supportive and when individuals actively regulate the involvement of others (e.g., seek help, minimize interference). Friends both help and hinder self-regulation, while research on romantic partners is limited. Facets of self- and social-regulation are important risk and protective factors for diabetes management during emerging adulthood. At this time when relationships are changing, the social context of diabetes may need to be regulated to support diabetes management. Interventions targeting those with self-regulation problems and facilitating self- and social-regulation in daily life may be useful.
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Affiliation(s)
- Deborah J Wiebe
- Psychological Sciences and the Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Road, Merced, CA, 95343, USA.
| | - Cynthia A Berg
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT, 84112, USA
| | - Daniel Mello
- Psychological Sciences and the Health Sciences Research Institute, University of California, Merced, 5200 N. Lake Road, Merced, CA, 95343, USA
| | - Caitlin S Kelly
- Department of Psychology, University of Utah, 380 South 1530 East, Salt Lake City, UT, 84112, USA
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Perez KM, Patel NJ, Lord JH, Savin KL, Monzon AD, Whittemore R, Jaser SS. Executive Function in Adolescents With Type 1 Diabetes: Relationship to Adherence, Glycemic Control, and Psychosocial Outcomes. J Pediatr Psychol 2018; 42:636-646. [PMID: 28008003 DOI: 10.1093/jpepsy/jsw093] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/11/2016] [Indexed: 12/24/2022] Open
Abstract
Objective Impairments in executive function (EF) skills have been observed in youth with type 1 diabetes (T1D), and these skills are critical for following the complex treatment regimen. This study examines parent reports of EF in relation to measures of adherence, glycemic control (A1c), and psychosocial outcomes (depression and quality of life) in adolescents with T1D. A total of 120 adolescents (aged 13-17 years, 52.5% female, 87.5% White) with T1D and their parents completed questionnaires. Glucometers were downloaded and A1c was obtained during clinical visits at the time of enrollment. The prevalence of clinically significant elevated scores on specific EF skills ranged from 11 to 18.6%. In multivariate analyses, parent-reported EF deficits were associated with poorer adherence and lower quality of life, explaining 13 and 12% of the variance, respectively. Adolescents with T1D exhibit specific EF deficits that may negatively impact their quality of life and their ability to engage in self-management activities.
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Murdock KW, LeRoy AS, Lacourt TE, Duke DC, Heijnen CJ, Fagundes CP. Executive functioning and diabetes: The role of anxious arousal and inflammation. Psychoneuroendocrinology 2016; 71:102-9. [PMID: 27261922 PMCID: PMC5662196 DOI: 10.1016/j.psyneuen.2016.05.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Revised: 05/02/2016] [Accepted: 05/03/2016] [Indexed: 12/19/2022]
Abstract
Individuals who perform poorly on measures of the executive function of inhibition have higher anxious arousal in comparison to those with better performance. High anxious arousal is associated with a pro-inflammatory response. Chronically high anxious arousal and inflammation increase one's risk of developing type 2 diabetes. We sought to evaluate anxious arousal and inflammation as underlying mechanisms linking inhibition with diabetes incidence. Participants (N=835) completed measures of cognitive abilities, a self-report measure of anxious arousal, and donated blood to assess interleukin-6 (IL-6) and glycated hemoglobin (HbA1c). Individuals with low inhibition were more likely to have diabetes than those with high inhibition due to the serial pathway from high anxious arousal to IL-6. Findings remained when entering other indicators of cognitive abilities as covariates, suggesting that inhibition is a unique cognitive ability associated with diabetes incidence. On the basis of our results, we propose several avenues to explore for improved prevention and treatment efforts for type 2 diabetes.
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Affiliation(s)
- Kyle W. Murdock
- Department of Psychology, Rice University, Bioscience Research Collaborative Room 773, 6500 Main Street, Houston, Texas 77005
| | - Angie S. LeRoy
- Department of Psychology, Rice University, Bioscience Research Collaborative Room 773, 6500 Main Street, Houston, Texas 77005,Department of Psychology, University of Houston, 3695 Cullen Boulevard Room 126 Houston, Texas 77204
| | - Tamara E. Lacourt
- Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030
| | - Danny C. Duke
- Division of Psychology, Institute on Development and Disability, Oregon Health and Science University, 707 SW Gaines Street, Portland, Oregon 97239
| | - Cobi J. Heijnen
- Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030
| | - Christopher P. Fagundes
- Department of Psychology, Rice University, Bioscience Research Collaborative Room 773, 6500 Main Street, Houston, Texas 77005,Department of Symptoms Research, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1450, Houston, Texas 77030,Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, Texas 77030
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