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Zuniga-Kennedy M, Wang OH, Fonseca LM, Cleveland MJ, Bulger JD, Grinspoon E, Hansen D, Hawks ZW, Jung L, Singh S, Sliwinski M, Verdejo A, Miller KM, Weinstock RS, Germine L, Chaytor N. Nocturnal hypoglycemia is associated with next day cognitive performance in adults with type 1 diabetes: Pilot data from the GluCog study. Clin Neuropsychol 2024; 38:1627-1646. [PMID: 38380810 PMCID: PMC11336034 DOI: 10.1080/13854046.2024.2315749] [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: 06/11/2023] [Accepted: 01/11/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE Individuals with type 1 diabetes (T1D) have increased risk for cognitive dysfunction and high rates of sleep disturbance. Despite associations between glycemia and cognitive performance using cross-sectional and experimental methods few studies have evaluated this relationship in a naturalistic setting, or the impact of nocturnal versus daytime hypoglycemia. Ecological Momentary Assessment (EMA) may provide insight into the dynamic associations between cognition, affective, and physiological states. The current study couples EMA data with continuous glucose monitoring (CGM) to examine the within-person impact of nocturnal glycemia on next day cognitive performance in adults with T1D. Due to high rates of sleep disturbance and emotional distress in people with T1D, the potential impacts of sleep characteristics and negative affect were also evaluated. METHODS This pilot study utilized EMA in 18 adults with T1D to examine the impact of glycemic excursions, measured using CGM, on cognitive performance, measured via mobile cognitive assessment using the TestMyBrain platform. Multilevel modeling was used to test the within-person effects of nocturnal hypoglycemia and hyperglycemia on next day cognition. RESULTS Results indicated that increases in nocturnal hypoglycemia were associated with slower next day processing speed. This association was not significantly attenuated by negative affect, sleepiness, or sleep quality. CONCLUSIONS These results, while preliminary due to small sample size, showcase the power of intensive longitudinal designs using ambulatory cognitive assessment to uncover novel determinants of cognitive fluctuation in real world settings, an approach that may be utilized in other populations. Findings suggest reducing nocturnal hypoglycemia may improve cognition in adults with T1D.
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Affiliation(s)
| | - Olivia H Wang
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Luciana M. Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
- Old Age Research Group (PROTER), Department and Institute of Psychiatry, University of Sao Paulo, Sao Paulo, Brazil
| | | | | | | | - Devon Hansen
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | - Shifali Singh
- McLean Hospital/Harvard Medical School, Belmont, MA, USA
| | | | | | | | | | | | - Naomi Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
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2
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de Klerk E, Deacon E, van Rensburg E. Reviewing identity development in young people living with Type 1 Diabetes Mellitus. J Adolesc 2024. [PMID: 39327821 DOI: 10.1002/jad.12412] [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: 08/07/2023] [Revised: 08/27/2024] [Accepted: 09/13/2024] [Indexed: 09/28/2024]
Abstract
INTRODUCTION Type 1 Diabetes Mellitus (T1DM) is a chronic condition increasing among young people. Identity development occurs during an individual's life and can be significantly influenced by a chronic disease such as T1DM. We have critically reviewed the relevant scientific literature to understand young people's identity development with T1DM. METHODS A critical review design was employed to answer the research question: "What does scientific literature state regarding identity development in young people living with Type 1 Diabetes Mellitus?" Numerous databases were searched to include the most relevant scientific literature to answer the research questions. Boolean operator phrases were ultimately used to search for the literature. The initial screening produced 1319 scientific literature, among which seven articles were analyzed thematically. RESULTS Analysis revealed several significant themes: The identity of young people with T1DM develops differently from those without this chronic condition; young people can either incorporate or contain their T1DM in their identity development, highlighting the complex nature of this process; and numerous external factors significantly influence identity development in young people living with a chronic condition such as T1DM. CONCLUSION The study underscores that identity develops differently in young people living with T1DM than in those without chronic conditions. However, the existing studies and literature exploring the experiences of young people living with T1DM have relied on information from caregivers and health professionals. This reliance on secondary sources underscores the urgent need for more research to obtain data from young people living with T1DM as a primary source. Such a shift in research practices is crucial to gaining a more comprehensive and accurate understanding of their experiences.
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Affiliation(s)
- Elinda de Klerk
- Community Psychosocial Research (COMPRES), School of Psychosocial Health, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
| | - Elmarí Deacon
- Optentia Research Focus Area, Faculty of Humanities, North-West University, Potchefstroom, South Africa
| | - Esmé van Rensburg
- Community Psychosocial Research (COMPRES), School of Psychosocial Health, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
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O'Connell MA, Northam EA, Brown A, Papoutsis J, Schuster T, Skinner T, Jenkins AJ, Ambler GR, Cameron FJ. Does insulin pump therapy offer benefits for behaviour, mood, cognition and HbA1c in children and adolescents with type 1 diabetes? A randomised controlled trial with observational follow-up. Arch Dis Child 2024; 109:806-811. [PMID: 38237958 DOI: 10.1136/archdischild-2023-326007] [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: 06/26/2023] [Accepted: 12/13/2023] [Indexed: 09/27/2024]
Abstract
AIMS Improved behaviour, mood, cognition and HbA1c have been reported with short-term use of continuous subcutaneous insulin infusion (CSII) in youth with type 1 diabetes (T1D). We sought to re-examine these findings in a randomised controlled trial (RCT), with longitudinal follow-up. METHODS RCT of youth aged 7-15 years with T1D, at two tertiary paediatric centres. Participants were randomised to commence CSII or continue multiple daily injections (MDI). Behaviour, mood, cognition and HbA1c were assessed. Primary outcome was difference in parent-reported behaviour (BASC-2) at 4 months. After the 4-month RCT, MDI participants commenced CSII; outcomes were reassessed at +2 years. RESULTS Participating youth (n=101) were randomised to CSII (n=56) or MDI (n=45). Significant differences favouring CSII were found at 4 months in parent-reported behaviour problems (Cohen's d 0.41 (95% CI 0.004 to 0.795); p=0.048) and HbA1c (mean (95% CI) difference: 7 (2.3 to 11.7) mmol/mol (0.6% (0.2 to 1.0%); p=0.001)). Improvements from baseline were documented in mood and cognitive outcomes in both study groups over the 4-month RCT; however, no between-group differences were evident at 4 months. Sixteen of 76 (21%) participants completing assessments at +2 years had discontinued CSII. In n=60 still using CSII, measurements of behaviour, mood and HbA1c were comparable to baseline. CONCLUSIONS Parent-reported behaviour problems and HbA1c, but not mood or neurocognitive outcomes, were clinically significantly lower with CSII, relative to MDI, after 4 months. Observational follow-up indicated no impact of treatment modality at +2 years, relative to baseline levels. Taken together, these data indicate that use of CSII alone does not comprehensively benefit neuropsychological outcomes in childhood T1D.
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Affiliation(s)
- Michele A O'Connell
- Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
| | | | - Amy Brown
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | | | - Tibor Schuster
- Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Timothy Skinner
- La Trobe University, Melbourne, Victoria, Australia
- Australian Centre for Behavioural Research in Diabetes, Deakin University, Geelong, Victoria, Australia
- Institute of Psychology, Copenhagen University, Copenhagen, Denmark
| | - Alicia J Jenkins
- Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
- Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia
- The University of Sydney, Sydney, New South Wales, Australia
| | - Geoffrey R Ambler
- The University of Sydney, Sydney, New South Wales, Australia
- Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Fergus J Cameron
- Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Parkville, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The University of Melbourne, Melbourne, Victoria, Australia
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Gardener L, Bourke-Taylor H, Desha L, Gardener M, Turpin M. Developing Self-Management in Type 1 Diabetes at Secondary Schools: Who Is Responsible? A Qualitative Study. Am J Occup Ther 2024; 78:7805205110. [PMID: 39137007 DOI: 10.5014/ajot.2024.050662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/15/2024] Open
Abstract
IMPORTANCE Occupational therapists have the proven capacity to improve outcomes for young adults who are self-managing Type 1 diabetes (T1D). There is insufficient understanding of adolescents' experiences of developing responsibility for diabetes self-management (DSM). OBJECTIVE To investigate adolescents' perceptions of sharing responsibility for T1D management at school. DESIGN This study had a descriptive qualitative design and used semistructured interviews and thematic analysis. It is the second phase of a mixed-methods study with a sequential explanatory design that investigated mechanisms of responsibility-sharing at school. SETTING Secondary school in Australia. PARTICIPANTS Purposive sample of adolescents (age 15-16 yr) with T1D (N = 11). RESULTS Adolescents approached the complex occupation of school-based DSM primarily in partnership with their parents, with each adolescent having unique responsibilities while sharing others. Health care professionals and teachers reportedly had minimal involvement. Adolescents described owning most DSM tasks, with their perceptions of building independence limiting the sharing of this responsibility. A heightened sense of risk meant that adolescents were likely to communicate with others in cases of errant blood glucose readings. Current processes commonly resulted in reduced school participation. CONCLUSIONS AND RELEVANCE Adolescents valued working responsively and interdependently with their parents to manage T1D at school, which aligns with the occupational therapy model of co-occupation. Effective responsibility-sharing depends on clear, frequent, autonomy-supportive, team-based communications. Our results showed that patterns of communication for determining school-based DSM processes were fragmented and risk focused, with limited adolescent involvement, resulting in strategies that led to students at times being excluded from school activities. Plain-Language Summary: This is the first study to use an occupational lens to examine the way in which adolescents share their responsibility for diabetes care at school. Diabetes self-management in secondary schools occurs more often when adolescents work interdependently with their parents to manage their diabetes. Adolescent involvement in formal school processes and a clearer allocation of team roles and responsibilities would better support health-promoting habits and school participation.
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Affiliation(s)
- Lisa Gardener
- Lisa Gardener, BOccThy, is PhD Candidate, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia;
| | - Helen Bourke-Taylor
- Helen Bourke-Taylor, BAppSc OT, MS, PhD, is Professor, Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Laura Desha
- Laura Desha, BOcc Thy (Hons), PhD, is Adjunct Research Fellow, Department of Occupational Therapy, University of Otago, Wellington, New Zealand
| | - Madeline Gardener
- Madeline Gardener, BOccThy (Hons), MTeach, is Research Assistant, School of Education and Professional Studies, Griffith University, Mt. Gravatt, Queensland, Australia
| | - Merrill Turpin
- Merrill Turpin, BOccThy, GradDipCounsel, PhD, is Senior Lecturer, School of Health and Rehabilitation, The University of Queensland, St. Lucia, Queensland, Australia
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5
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Salihu EY, Ali AM, Hassan JH, Joseph DT, Chewning B. Perspectives on Self-Management and Meditation: A Qualitative Study of Adolescents With Type 1 Diabetes Mellitus and Their Parents. Cureus 2024; 16:e70019. [PMID: 39315319 PMCID: PMC11419737 DOI: 10.7759/cureus.70019] [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: 09/23/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND One in three adolescents with type 1 diabetes mellitus (T1DM) experiences diabetes distress, which predicts poor self-management and glycemic control. Mindfulness-based interventions such as meditation have been associated with reduced psychological distress and health outcomes in different populations. This study explores the psychosocial barriers and facilitators of diabetes self-management and beliefs about meditation practices. METHODS Eight adolescents aged 15-19 who had been diagnosed with T1DM for more than a year were invited to participate in a 40-60-minute semi-structured one-on-one interview. Their parents were also invited to participate in the study. Three of the eight parents invited were able to participate in the study. Participants were asked about perceived psychosocial barriers and facilitators of diabetes self-management and their beliefs about meditation as a tool for addressing some of the psychosocial barriers to self-management. Data were analyzed using NVivo 10 (QSR International, Melbourne, Australia). Conventional content analysis was conducted based on an inductive coding approach. RESULTS Adolescents with T1DM had similar psychosocial challenges with managing T1DM, including high levels of diabetes distress and forgetfulness due to competing demands on their time. They also noted similar facilitators to effective self-management, such as the presence of family and peer support. Acceptance of T1DM diagnosis and personal commitment to self-management were also indicated as common facilitators of self-management. Adolescents with T1DM and parents of adolescents with T1DM believe that meditation can play a positive role in T1DM self-management by reducing diabetes distress and improving mental health and overall well-being. CONCLUSION Results suggest that adolescents with T1DM and parents of adolescents with T1DM believe peer and family support is crucial to diabetes self-management. They also noted that diabetes distress and forgetfulness are primary barriers to self-management. Participants also see a potential for meditation to help manage general stress and diabetes distress, thereby aiding self-management. Further research is needed to explore meditation-based interventions to reduce diabetes distress in adolescents diagnosed with T1DM. The findings from this study can inform the development and implementation of meditation-based interventions that integrate family and peer support to reduce diabetes distress and enhance self-management in adolescents with T1DM.
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Affiliation(s)
- Ejura Y Salihu
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, USA
| | - Asma M Ali
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, USA
| | - Judith H Hassan
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, USA
| | - Deborah T Joseph
- Department of Health Sciences and Social Work, Western Illinois University, Macomb, USA
| | - Betty Chewning
- Department of Social and Administrative Sciences, University of Wisconsin-Madison, Madison, USA
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Whitmore C, Mytkolli L, Mangialardi N, Maghera J, Rudick A, Shephard K, Zazzera S, Saiva A, McQuire T, Senior P, Sherifali D, Selby P. Partnered Recruitment: Engaging Individuals With Lived Experience in the Recruitment of Co-Design Participants. Health Expect 2024; 27:e14131. [PMID: 38965808 PMCID: PMC11224126 DOI: 10.1111/hex.14131] [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: 01/31/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Young adults with type 1 diabetes (T1D) face complex health challenges, including a heightened risk for distress. To counter this distress, there is a need to develop accessible, acceptable comprehensive care solutions that integrate diabetes and mental health care to enhance self-efficacy and counter mental health challenges in this population. OBJECTIVE To describe the engagement of individuals with lived experience of T1D and mental health challenges in the development of a recruitment strategy to support the co-design of an innovative integrated care programme. RESULTS Seven individuals with lived experience formed a Partner Advisory Council (PAC) to recruit young adults (18-29 years old) living with T1D, their friends or family and health researchers and professionals in co-design interviews (n = 19) and co-design events (n = 12). The PAC played a key role in developing a comprehensive recruitment strategy, overcoming traditional barriers and stigmas in the design of an integrated model of care. CONCLUSION Assuming the presence of mental health challenges in young adults living with T1D during recruitment had far-reaching impacts on the development of a whole-person and integrated diabetes and mental health care solution. The efficient recruitment of this sample provided invaluable insights into the nuanced challenges experienced by young adults with T1D, the individual skills developed in response to their mental health challenges and the ways that this understanding can shape future programming to support mental health, quality of life and well-being. The ongoing involvement of the PAC as co-researchers underscores the enduring impact of patient engagement in developing integrated care solutions. PATIENT OR PUBLIC CONTRIBUTION The co-design of the TECC-T1D3 model was enriched by the invaluable contributions of individuals with lived experience. This included the engagement of a diverse PAC in the recruitment of participants in co-design interviews and co-design events. PAC members actively participated in research decision-making with their insights informing a robust recruitment strategy. Beyond recruitment, PAC members continue to serve as co-researchers, shaping ongoing research and actively contributing to the TECC-T1D3 project. Six PAC members are co-authors on this manuscript.
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Affiliation(s)
- Carly Whitmore
- School of NursingMcMaster UniversityHamiltonOntarioCanada
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Natalie Mangialardi
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
- Diabetes Action CanadaTorontoOntarioCanada
| | - Jasmine Maghera
- Diabetes Action CanadaTorontoOntarioCanada
- Department of PharmacologyUniversity of AlbertaEdmontonAlbertaCanada
| | | | | | | | - Anika Saiva
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | | | - Peter Senior
- Faculty of Medicine & DentistryUniversity of Alberta, EdmontonAlbertaCanada
| | - Diana Sherifali
- School of NursingMcMaster UniversityHamiltonOntarioCanada
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
| | - Peter Selby
- INTREPID LabCentre for Addiction and Mental HealthTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
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7
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Yi-Frazier JP, Hilliard ME, O’Donnell MB, Zhou C, Ellisor BM, Garcia Perez S, Duran B, Rojas Y, Malik FS, DeSalvo DJ, Pihoker C, Bradford MC, Scott S, Devaraj S, Rosenberg AR. Promoting Resilience in Stress Management for Adolescents With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Netw Open 2024; 7:e2428287. [PMID: 39158914 PMCID: PMC11333977 DOI: 10.1001/jamanetworkopen.2024.28287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Accepted: 06/21/2024] [Indexed: 08/20/2024] Open
Abstract
Importance Type 1 diabetes (T1D) requires demanding self-management health behaviors, and adolescents with T1D are at risk for poor psychosocial and medical outcomes. Developing resilience skills may help adolescents with T1D and elevated distress navigate common stressors and achieve positive outcomes. Objective To test the efficacy of the Promoting Resilience in Stress Management (PRISM) intervention on levels of hemoglobin A1c (HbA1c), diabetes distress, self-management behaviors, resilience, and quality of life among adolescents. Design, Setting, and Participants This phase 3, parallel, 1:1 randomized clinical trial that followed up 172 participants for 12 months was conducted from January 1, 2020, to November 30, 2022, at each of 2 children's hospitals, in Seattle, Washington, and Houston, Texas. Participants were ages 13 to 18 years with T1D for at least 12 months and elevated diabetes distress. Intervention PRISM, a manualized, skills-based, individual intervention program that teaches stress management, goal setting, reframing, and meaning-making, facilitated by a coach and accompanied by a digital app, was delivered in three 30- to 60-minute sessions approximately 2 weeks apart. Main Outcomes and Measures The 2 primary outcomes, diabetes distress and HbA1c levels, and 3 secondary outcomes, resilience, quality of life, and engagement in self-management behaviors, were assessed at baseline and 6 and 12 months after baseline. Linear mixed-effects regression models were used to evaluate associations between PRISM or usual care (UC) and these outcomes at both time points for the intention-to-treat population. Results Among 172 adolescents (mean [SD] age, 15.7 [1.6] years), 96 were female (56%), and their baseline mean (SD) HbA1c level was 8.7% (2.0%). No differences were evident between PRISM and UC recipients in HbA1c levels (β, -0.21 [95% CI, -0.65 to 0.22]; P = .33) or diabetes distress (β, -2.71 [95% CI, -6.31 to 0.90]; P = .14) or any participant-reported outcome (eg, β, 2.25 [95% CI, -0.30 to 4.80]; P = .08 for self-management behaviors) at 6 months. At 12 months, there was no statistically significant difference between arms in HbA1c levels (β, -0.26 [95% CI, -0.72 to 0.19]; P = .25); however, PRISM recipients reported significantly greater amelioration of diabetes distress (β, -4.59 [95% CI, -8.25 to -0.94]; P = .01) and improvement in self-management behaviors (β, 3.4 [95% CI, 0.9 to 5.9]; P = .01) compared with UC recipients. Conclusions and Relevance The findings in this randomized clinical trial of psychosocial and behavioral improvements associated with PRISM at 12 months illustrate the value of a strengths-based intervention. Integrating resilience skills-building with traditional diabetes care may be a promising approach for improving outcomes among adolescents with T1D and elevated diabetes distress. Trial Registration ClinicalTrials.gov number: NCT03847194.
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Affiliation(s)
- Joyce P. Yi-Frazier
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Marisa E. Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Maeve B. O’Donnell
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Cambia Palliative Care Center of Excellence, University of Washington School of Medicine, Seattle
| | - Chuan Zhou
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of General Pediatrics, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Britney M. Ellisor
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha Garcia Perez
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
| | - Brenda Duran
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Yuliana Rojas
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Faisal S. Malik
- Center for Child Health, Behavior, and Development, Seattle Children’s Research Institute, Seattle, Washington
- Division of Diabetes/Endocrinology, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Daniel J. DeSalvo
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Catherine Pihoker
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Division of Diabetes/Endocrinology, Department of Pediatrics, University of Washington School of Medicine, Seattle
| | - Miranda C. Bradford
- Core for Biostatistics, Epidemiology and Analytics for Research (BEAR), Seattle Children’s Research Institute, Seattle, Washington
| | - Samantha Scott
- Center for Clinical & Translational Research, Seattle Children’s Research Institute, Seattle, Washington
- Department of Psychology, University of Denver, Denver, Colorado
| | - Sridevi Devaraj
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston
| | - Abby R. Rosenberg
- Department of Psychosocial Oncology & Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
- Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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8
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Knauft KM, Jacques-Tiura AJ, Idalski Carcone A, Evans M, Weissberg-Benchell J, Buggs-Saxton C, Boucher-Berry C, Miller JL, Drossos T, Dekelbab B, Ellis DA. The moderating role of diabetes distress on the effect of a randomized eHealth intervention on glycemic control in Black adolescents with type 1 diabetes. J Pediatr Psychol 2024; 49:538-546. [PMID: 38775162 PMCID: PMC11335142 DOI: 10.1093/jpepsy/jsae033] [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: 10/10/2023] [Revised: 04/11/2024] [Accepted: 04/28/2024] [Indexed: 05/31/2024] Open
Abstract
OBJECTIVE Due to systemic inequities, Black adolescents with type 1 diabetes are more likely to have suboptimal glycemic control and high rates of diabetes distress, but tailored interventions for this population are lacking. In primary outcomes of a randomized clinical trial, a family-based eHealth intervention improved glycemic control in Black adolescents with type 1 diabetes and elevated depressive symptoms. The present study is a secondary analysis of these clinical trial data examining the moderating effect of diabetes distress on the efficacy of the intervention. METHODS Using secondary data from a multicenter randomized clinical trial (Clinicaltrials.gov [NCT03168867]), caregiver-adolescent dyads were randomly assigned to either up to three sessions of an eHealth parenting intervention (n = 75) or a standard medical care control group (n = 74). Black adolescents (10 years, 0 months to 14 years, 11 months old) with type 1 diabetes and a caregiver willing to participate were eligible. Adolescents reported their diabetes distress at baseline, and hemoglobin A1c (HbA1c) data were collected at baseline, 6-, 13-, and 18-month follow-up. RESULTS No between-group contrasts emerged in a linear mixed-effects regression (p's > .09). Within-group contrasts emerged such that adolescents assigned to the intervention who reported high diabetes distress had lower HbA1c at the 18-month follow-up relative to baseline (p = .004); the 18-month decrease in HbA1c was -1.03%. CONCLUSIONS Black adolescents with type 1 diabetes and high levels of diabetes distress showed significant decreases in HbA1c following a family-based eHealth intervention, suggesting diabetes distress may be a key moderator of intervention efficacy within this population.
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Affiliation(s)
- Katherine M Knauft
- Department of Psychology, Wayne State University, 5057 Woodward Ave, Detroit, MI 48202, United States
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Angela J Jacques-Tiura
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Colleen Buggs-Saxton
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Claudia Boucher-Berry
- Department of Pediatrics, University of Illinois School of Medicine at Chicago, Chicago, IL, United States
| | - Jennifer L Miller
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
| | - Bassem Dekelbab
- Pediatric Endocrinology, Corewell Health, Royal Oak, MI, United States
| | - Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
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9
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Ehrmann D, Hermanns N, Schmitt A, Klinker L, Haak T, Kulzer B. Perceived glucose levels matter more than CGM-based data in predicting diabetes distress in type 1 or type 2 diabetes: a precision mental health approach using n-of-1 analyses. Diabetologia 2024:10.1007/s00125-024-06239-9. [PMID: 39078490 DOI: 10.1007/s00125-024-06239-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/13/2024] [Indexed: 07/31/2024]
Abstract
AIMS/HYPOTHESIS Diabetes distress is one of the most frequent mental health issues identified in people with type 1 and type 2 diabetes. Little is known about the role of glucose control as a potential contributor to diabetes distress and whether the subjective perception of glucose control or the objective glycaemic parameters are more important for the experience. With the emergence of continuous glucose monitoring (CGM), this is a relevant question as glucose values are now visible in real-time. We employed a precision monitoring approach to analyse the independent associations of perceived and measured glucose control with diabetes distress on a daily basis. By using n-of-1 analyses, we aimed to identify individual contributors to diabetes distress per person and analyse the associations of these individual contributors with mental health at a 3 month follow-up. METHODS In this prospective, observational study, perceived (hypoglycaemia/hyperglycaemia/glucose variability burden) and measured glucose control (time in hypoglycaemia and hyperglycaemia, CV) were assessed daily for 17 days using an ecological momentary assessment (EMA) approach with a special EMA app and CGM, respectively. Mixed-effect regression analysis was performed, with daily diabetes distress as the dependent variable and daily perceived and CGM-measured metrics of glucose control as random factors. Individual regression coefficients of daily distress with perceived and CGM-measured metrics were correlated with levels of psychosocial well-being at a 3 month follow-up. RESULTS Data from 379 participants were analysed (50.9% type 1 diabetes; 49.6% female). Perceived glucose variability (t=14.360; p<0.0001) and perceived hyperglycaemia (t=13.637; p<0.0001) were the strongest predictors of daily diabetes distress, while CGM-based glucose variability was not significantly associated (t=1.070; p=0.285). There was great heterogeneity between individuals in the associations of perceived and measured glucose parameters with diabetes distress. Individuals with a stronger association between perceived glucose control and daily distress had more depressive symptoms (β=0.32), diabetes distress (β=0.39) and hypoglycaemia fear (β=0.34) at follow-up (all p<0.001). Individuals with a stronger association between CGM-measured glucose control and daily distress had higher levels of psychosocial well-being at follow-up (depressive symptoms: β=-0.31; diabetes distress: β=-0.33; hypoglycaemia fear: β=-0.27; all p<0.001) but also higher HbA1c (β=0.12; p<0.05). CONCLUSIONS/INTERPRETATION Overall, subjective perceptions of glucose seem to be more influential on diabetes distress than objective CGM parameters of glycaemic control. N-of-1 analyses showed that CGM-measured and perceived glucose control had differential associations with diabetes distress and psychosocial well-being 3 months later. The results highlight the need to understand the individual drivers of diabetes distress to develop personalised interventions within a precision mental health approach.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany.
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany.
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany.
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany.
| | - Andreas Schmitt
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
| | - Laura Klinker
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
| | - Thomas Haak
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim (FIDAM), Bad Mergentheim, Germany
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
- German Centre for Diabetes Research (DZD), München-Neuherberg, Germany
- Diabetes Clinic, Diabetes Centre Mergentheim (DZM), Bad Mergentheim, Germany
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10
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Ni MH, Yang YS, Huang JY, Lo SC, Huang CN, Kornelius E. The association of depression and sleep disorders in patients with type 1 diabetes in Taiwan. Medicine (Baltimore) 2024; 103:e38969. [PMID: 39029051 PMCID: PMC11398819 DOI: 10.1097/md.0000000000038969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
The association between depression and sleep disorders in patients with type 1 diabetes mellitus (T1DM) in Taiwan is underexplored. We used a nationwide population-based dataset to evaluate the association of T1DM with these conditions in Taiwan from 2001 to 2019. Patients with T1DM were identified as cases, and 2 control groups were used for comparison: patients with type 2 diabetes mellitus (T2DM) and nondiabetic patients. Age, sex, date of diagnosis, and multiple comorbidities were included and matched using propensity score matching between cases and controls. The primary outcome of this study was to identify new occurrences of the first diagnosis of depression or sleep disorders. After matching, this study included 27,029 T1DM cases, 54,058 T2DM controls, and 108,116 nondiabetic controls. Patients with T1DM exhibited a 1.55-fold higher risk of developing depression (hazard ratio [HR] 1.55, 95% confidence intervals [CI] 1.48-1.61) and a 1.41-fold higher risk of experiencing sleep disorders (HR 1.41, 95% CI 1.37-1.46) compared to nondiabetic controls. Similarly, patients with T2DM displayed elevated risks of both depression (HR 1.39, 95% CI 1.34-1.43) and sleep disorders (HR 1.40, 95% CI 1.37-1.44) relative to non-diabetic controls. When comparing the T1DM and T2DM groups, T1DM patients demonstrated a slightly higher risk of depression (HR 1.11, 95% CI 1.07-1.16) but no significant difference in the risk of sleep disorders compared to T2DM patients. These results were consistent regardless of different ages or sexes. This study demonstrates a significant association between diabetes mellitus and the risk of depression and sleep disorders in a large cohort of Taiwanese patients.
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Affiliation(s)
- Meng-Han Ni
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Sun Yang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shih-Chang Lo
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chien-Ning Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Edy Kornelius
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Division of Endocrinology and Metabolism, Chung Shan Medical University Hospital, Taichung, Taiwan
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11
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Formánek T, Chen D, Šumník Z, Mladá K, Hughes J, Burgess S, Wareham NJ, Murray GK, Jones PB, Perry BI. Childhood-onset type 1 diabetes and subsequent adult psychiatric disorders: a nationwide cohort and genome-wide Mendelian randomization study. NATURE. MENTAL HEALTH 2024; 2:1062-1070. [PMID: 39263363 PMCID: PMC11383797 DOI: 10.1038/s44220-024-00280-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 06/05/2024] [Indexed: 09/13/2024]
Abstract
Childhood-onset type 1 diabetes (T1D) is associated with substantial psychiatric morbidity in later life, but it remains unknown whether these associations are due to common underlying biological mechanisms or the impacts of living with the condition and its treatment. Here, using Czech national register data, we identified children with T1D aged ≤14 years between 1994 and 2007 and estimated the risk of psychiatric disorders up to 24 years later. We found that children diagnosed with T1D had an elevated risk of developing substance use, mood, anxiety and personality disorders, and behavioral syndromes. Conversely, we found that children with T1D had a lower risk of developing psychotic disorders. In Mendelian randomization analysis, we found an association with schizophrenia, which, however, did not persist following multiple testing adjustment. The combined observational and Mendelian randomization evidence suggests that T1D diagnosis in childhood predisposes to far-reaching, extensive psychiatric morbidity, which is unlikely to be explicable by common underlying biological mechanisms. The findings of this study highlight that monitoring and addressing the mental health needs of children with T1D is imperative, whereas glucose dysregulation and/or inflammation implicated in schizophrenia pathogenesis warrants future research.
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Affiliation(s)
- Tomáš Formánek
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
| | - Danni Chen
- Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Zdeněk Šumník
- Department of Pediatrics, Motol University Hospital and 2nd Faculty of Medicine, Charles University, Prague, Czechia
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia
- Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czechia
| | - James Hughes
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stephen Burgess
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | | | - Graham K Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Benjamin I Perry
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
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12
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Trojanowski PJ, Pardon A, Reynolds C, O'Donnell HK, Alonso GT, Majidi S, Snell-Bergeon J, Wadwa RP, Driscoll KA. Body mass index moderates the association between diabetes distress and objective self-management behaviours in adolescents with type 1 diabetes and elevated A1Cs. Diabet Med 2024; 41:e15325. [PMID: 38551326 PMCID: PMC11164643 DOI: 10.1111/dme.15325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 04/07/2024]
Abstract
OBJECTIVE To examine the cross-sectional associations between diabetes distress, BMI (zBMI; BMI z-score), objectively measured mean daily blood glucose readings and insulin boluses administered, and A1C in adolescents with type 1 diabetes (T1D) using insulin pumps. METHODS T1D self-management behaviour data were downloaded from adolescents' (N = 79) devices and mean daily frequency of blood glucose readings and insulin boluses were calculated. Diabetes distress was measured (Problem Areas in Diabetes-Teen questionnaire [PAID-T]), A1C collected, and zBMI calculated from height and weight. Three multiple linear regressions were performed with blood glucose readings, insulin boluses, and A1C as the three dependent variables and covariates (age, T1D duration), zBMI, diabetes distress, and the diabetes distress x zBMI interaction as independent variables. RESULTS Participants (55.7% female) were 14.9 ± 1.9 years old with T1D for 6.6 ± 3.4 years. zBMI moderated the relationship between diabetes distress and mean daily insulin boluses administered (b = -0.02, p = 0.02); those with higher zBMI and higher diabetes distress administered fewer daily insulin boluses. zBMI was not a moderator of the association between diabetes distress and blood glucose readings (b = -0.01, p = 0.29) or A1C (b = 0.002, p = 0.81). CONCLUSIONS Using objective behavioural data is useful for identifying how adolescent diabetes distress and zBMI affect daily bolusing behaviour amongst adolescent insulin pump users. Although distinct interventions exist to improve T1D self-management or diabetes distress, none addresses them together while considering zBMI. Decreasing diabetes distress could be especially important for youth with high zBMI.
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Affiliation(s)
- Paige J Trojanowski
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Alicia Pardon
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Cheyenne Reynolds
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Holly K O'Donnell
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - G Todd Alonso
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Shideh Majidi
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Janet Snell-Bergeon
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - R Paul Wadwa
- Department of Pediatrics, Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
- University of Florida Diabetes Institute, Gainesville, Florida, USA
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13
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Renaud-Charest O, Stoljar Gold A, Mok E, Kichler J, Nakhla M, Li P. Suicidal Ideation, Suicide Attempts, and Suicide Deaths in Adolescents and Young Adults With Type 1 Diabetes: A Systematic Review and Meta-analysis. Diabetes Care 2024; 47:1227-1237. [PMID: 38900947 DOI: 10.2337/dc24-0411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 04/13/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND Evidence is lacking on the risk of suicide-related behaviors (suicidal ideation, suicide attempt, suicide death) in youth with type 1 diabetes (T1D). PURPOSE We aimed to 1) determine the prevalence of suicidal ideation, suicide attempts, and suicide deaths in adolescents and young adults (AYA) with T1D aged 10-24 years; 2) compare suicide-related behavior prevalence in youth with and without T1D; and 3) identify factors associated with suicide-related behaviors. DATA SOURCES A systematic search was conducted in MEDLINE, Embase, and PsycInfo up to 3 September 2023. STUDY SELECTION We included observational studies where investigators reported the prevalence of suicide-related behaviors among AYA aged 10-24 years with T1D. DATA EXTRACTION We collected data on study characteristics, data on prevalence of suicide-related behaviors, and data on associated factors. DATA SYNTHESIS We included 31 studies. In AYA with versus without T1D, pooled prevalence of suicidal ideation was 15.4% (95% CI 10.0-21.7; n = 18 studies) vs. 11.5% (0.4-33.3; n = 4), respectively, and suicide attempts 3.5% (1.3-6.7; n = 8) vs. 2.0% (0.0-6.4; n = 5). Prevalence of suicide deaths ranged from 0.04% to 4.4% among youth with T1D. Difficulties with T1D self-management were frequently reported to be associated with higher rates of suicide-related behaviors. However, findings on the association of glycemic levels and suicide-related behaviors were inconsistent. LIMITATIONS There was a considerable level of heterogeneity in meta-analysis of both suicidal ideation and suicide attempts. CONCLUSIONS Suicidal ideation and suicide attempts are prevalent in AYA with T1D. Current evidence does not suggest that these rates are higher among AYA with T1D than rates among those without.
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Affiliation(s)
| | | | - Elise Mok
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Jessica Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Meranda Nakhla
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
| | - Patricia Li
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
- Division of General Pediatrics, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
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14
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Evans M, Ellis DA, Vesco AT, Feldman MA, Weissberg-Benchell J, Carcone AI, Miller J, Boucher-Berry C, Buggs-Saxton C, Degnan B, Dekelbab B, Drossos T. Diabetes distress in urban Black youth with type 1 diabetes and their caregivers: associations with glycemic control, depression, and health behaviors. J Pediatr Psychol 2024; 49:394-404. [PMID: 38216126 DOI: 10.1093/jpepsy/jsad096] [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: 05/24/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms. METHODS Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression. RESULTS DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management. CONCLUSIONS Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.
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Affiliation(s)
- Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Deborah A Ellis
- School of Medicine, Wayne State University, Detroit, MI, United States
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Marissa A Feldman
- Division of Psychology, Johns Hopkins, All Children's Hospital, St Petersburg, FL, United States
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | | | - Jennifer Miller
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Claudia Boucher-Berry
- Division of Pediatric Endocrinology, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Bernard Degnan
- Pediatric Endocrinology, Ascension St John Children's Hospital, Detroit, MI, United States
| | - Bassem Dekelbab
- Pediatric Endocrinology, Beaumont Health Care, Royal Oak, MI, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
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15
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Kortegaard AS, Rokkjær RB, Harboe HMH, Lund S, Andersen A, Bohl M. A group-based intervention for diabetes-related emotional distress among emerging adults with type 1 diabetes: A pilot study. Eur J Intern Med 2024:S0953-6205(24)00241-3. [PMID: 38852025 DOI: 10.1016/j.ejim.2024.06.002] [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: 02/20/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
AIMS To assess diabetes-related emotional distress (DD) in emerging adults with type 1 diabetes (T1D) and assess a group-based intervention's impact. METHODS To investigate DD we used data from the Problem Areas in Diabetes Questionnaire comprising 20 items (PAID-20). Furthermore, changes in the WHO Well-Being Index comprising five items (WHO-5) and glycated haemoglobin (HbA1c) were analysed. The intervention was evaluated using follow-up data from the emerging adults who participated. RESULTS From 2021 to 2023, we screened 180 emerging adults using PAID-20. DD (PAID-20≥30) was prevalent in 25.0 % (95 % CI 18.9; 32.0 %), and associated with the female sex, higher HbA1c and WHO-5 < 50. Continuous subcutaneous insulin infusion at baseline was associated with PAID-20<30. 21 individuals attended a group-based intervention. At one-week follow up PAID-20 was reduced (29.1 ± 15.4 vs. 41.3 ± 12.1 at baseline, p = 0.003), and at nine-twelve months' follow-up HbA1c was reduced (59.3 ± 15.3 mmol/mol vs. 68.0 ± 17.4 mmol/mol at baseline, p = 0.012). CONCLUSIONS This pilot study demonstrated that 25 % of the investigated emerging adults with T1D experienced DD (PAID-20≥30) associated with four clinical factors. We found a reduction in HbA1c and a short-term reduction in PAID-20 following the group-based intervention.
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Affiliation(s)
- Anne-Sofie Kortegaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark.
| | - Rikke B Rokkjær
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Hanne Marie H Harboe
- Department of Public Health, Aarhus University, Bartholins Allé 2, 8000 Aarhus C, Denmark.
| | - Sten Lund
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark.
| | - Anette Andersen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark
| | - Mette Bohl
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Palle Juul-Jensens Boulevard 11, 8200 Aarhus N, Denmark; Department of Clinical Medicine - Medical Diagnostic Centre, Regional Hospital Central Jutland, Heibergs Allé 4, 8800 Viborg, Denmark.
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16
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Passanisi S, Galletta F, Bombaci B, Cherubini V, Tiberi V, Minuto N, Bassi M, Iafusco D, Piscopo A, Mozzillo E, Di Candia F, Rabbone I, Pozzi E, Franceschi R, Cauvin V, Maffeis C, Piona CA, Salzano G. Device-Related Skin Reactions Increase Emotional Burden in Youths With Type 1 Diabetes and Their Parents. J Diabetes Sci Technol 2024:19322968241253285. [PMID: 38804535 DOI: 10.1177/19322968241253285] [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] [Indexed: 05/29/2024]
Abstract
BACKGROUND Skin reactions due to technological devices pose a significant concern in the management of type 1 diabetes (T1D). This multicentric, comparative cross-sectional study aimed to assess the psychological impact of device-related skin issues on youths with T1D and their parents. METHODS Participants with skin reactions were matched in a 1:1 ratio with a control group. Diabetes-related emotional distress was evaluated using the Problem Areas in Diabetes-Teen version (PAID-T) for participants aged 11 to 19 years and the Problem Areas in Diabetes-Parent Revised version (PAID-PR) completed by parents. In addition, glucose control was assessed through glycated hemoglobin (HbA1c) values and continuous glucose monitoring (CGM) metrics. RESULTS A total of 102 children and adolescents were consecutively recruited. Adolescents with skin issues had higher PAID-T scores compared to those without (79.6 ± 21.1 vs 62 ± 16.8; P = .004). Parents of youths with skin reactions also reported higher PAID-PR scores than the control group (34.0 ± 11.0 vs 26.9 ± 12.3; P = .015). No differences were observed in HbA1c levels (6.9 ± 0.8% vs 6.8 ± 0.8%, P = .555) or CGM glucose metrics between the two groups. Remarkably, 25.5% were forced to discontinue insulin pumps and/or glucose sensors (21.5% and 5.9%, respectively). CONCLUSIONS Our study highlighted the increased emotional burden experienced by youths with T1D and their parents due to device-related skin reactions, emphasizing the need for further research and interventions in this crucial aspect of diabetes management.
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Affiliation(s)
- Stefano Passanisi
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Francesca Galletta
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Bruno Bombaci
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
| | - Valentino Cherubini
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero Universitaria delle Marche, "G. Salesi" Hospital, Ancona, Italy
| | - Valentina Tiberi
- Pediatric Endocrinology and Diabetology Unit, Department of Women's and Children's Health, Azienda Ospedaliero Universitaria delle Marche, "G. Salesi" Hospital, Ancona, Italy
| | | | - Marta Bassi
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Dario Iafusco
- Department of Pediatrics, Regional Center of Pediatric Diabetology "G.Stoppoloni," University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Alessia Piscopo
- Department of Pediatrics, Regional Center of Pediatric Diabetology "G.Stoppoloni," University of Campania "Luigi Vanvitelli," Naples, Italy
| | - Enza Mozzillo
- Section of Pediatrics, Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Francesca Di Candia
- Section of Pediatrics, Regional Center of Pediatric Diabetes, Department of Translational Medical Science, Federico II University of Naples, Naples, Italy
| | - Ivana Rabbone
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Erica Pozzi
- Division of Pediatrics, Department of Health Sciences, University of Piemonte Orientale, Novara, Italy
| | - Roberto Franceschi
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trento, Italy
| | - Vittoria Cauvin
- Department of Pediatrics, S. Chiara Hospital of Trento, APSS, Trento, Italy
| | - Claudio Maffeis
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Claudia Anita Piona
- Pediatric Diabetes and Metabolic Disorders Unit, Regional Center for Pediatric Diabetes, University City Hospital, Verona, Italy
| | - Giuseppina Salzano
- Department of Human Pathology in Adult and Developmental Age "Gaetano Barresi," University of Messina, Messina, Italy
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Stojanova A, Harrison MA, Mitsakakis N, Thawer Z, Kirolos N, Stevens L, Paul J, Richardson C, Zuijdwijk C, Goldbloom EB, Lawrence S, Robinson ME, Ahmet A. Implementation of the Mind Youth Questionnaire (MY-Q) for routine health-related quality of life screening of adolescents with type 1 diabetes in a large tertiary care center. J Pediatr Endocrinol Metab 2024; 37:462-466. [PMID: 38630246 DOI: 10.1515/jpem-2023-0461] [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: 10/15/2023] [Accepted: 02/05/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Prevalence of diabetes distress and mental health comorbidities among adolescents with type 1 diabetes (T1D) is high. Despite recommendations for routine psychosocial risk assessment, there is little guidance for their implementation. This study aims to describe the implementation and baseline outcomes of the Mind Youth Questionnaire (MY-Q), a validated psychosocial screening tool for health-related quality of life (QoL) including mood, among adolescents living with T1D. METHODS Adolescents aged 13-18 years completed the MY-Q from October 1, 2019-April 1, 2023. Baseline characteristics, MY-Q results including categories flagged positive (noting possible areas of concern), debrief duration, and frequency of social work or mental health referral were collected and analyzed using descriptive statistics. RESULTS A total of 343 adolescents (mean age 15.3 years; 52 % female) completed a baseline MY-Q. Median overall MY-Q debrief time (IQR) was 10.0 min (6.0, 20.0). About 290 (84.5 %) adolescents had at least one of seven categories flagged, most commonly "Family" (61 %). About 30 % of adolescents had "Mood" flagged, and 2.9 % of adolescents were referred to mental health following debrief. CONCLUSIONS Without the need for additional resources, implementation of the MY-Q in a pediatric tertiary care diabetes clinic successfully identified QoL issues and mental health concerns among adolescents with T1D.
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Affiliation(s)
| | - Mary-Ann Harrison
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
| | - Nicholas Mitsakakis
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
| | - Zoyah Thawer
- Division of Pediatric Endocrinology and Metabolism, 8204 Vancouver Island Health Authority , Victoria, BC, Canada
| | - Nardin Kirolos
- Faculty of Medicine, 12366 University of Toronto , Toronto, ON, Canada
| | - Liz Stevens
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Jolianne Paul
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Christine Richardson
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Ellen B Goldbloom
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Sarah Lawrence
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Marie-Eve Robinson
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
- Division of Pediatric Endocrinology and Metabolism, 27338 Children's Hospital of Eastern Ontario , Ottawa, ON, Canada
| | - Alexandra Ahmet
- Faculty of Medicine, 12365 University of Ottawa , Ottawa, ON, Canada
- 274065 Children's Hospital of Eastern Ontario Research Institute , Ottawa, ON, Canada
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18
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Albright D, Wardell J, Harrison A, Mizokami-Stout K, Hirschfeld E, Garrity A, Thomas I, Lee J. Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes. J Pediatr Psychol 2024; 49:356-364. [PMID: 38647266 PMCID: PMC11098041 DOI: 10.1093/jpepsy/jsae016] [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: 07/22/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults. METHODS In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c). RESULTS Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress. CONCLUSIONS In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.
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Affiliation(s)
- Dana Albright
- Health Services and Informatics Research, Parkview Health, Fort Wayne, IN, United States
| | - Joseph Wardell
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Annalise Harrison
- Health Services and Informatics Research, Parkview Health, Fort Wayne, IN, United States
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Emily Hirschfeld
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Ashley Garrity
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
| | - Inas Thomas
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
| | - Joyce Lee
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
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Kamrath C, Tittel SR, Buchal G, Brämswig S, Preiss E, Göldel JM, Wiegand S, Minden K, Warschburger P, Stahl-Pehe A, Holl RW, Lanzinger S. Psychosocial Burden During the COVID-19 Pandemic in Adolescents With Type 1 Diabetes in Germany and Its Association With Metabolic Control. J Adolesc Health 2024; 74:900-907. [PMID: 38323968 DOI: 10.1016/j.jadohealth.2023.12.004] [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: 03/21/2023] [Revised: 11/30/2023] [Accepted: 12/01/2023] [Indexed: 02/08/2024]
Abstract
PURPOSE To investigate the psychosocial burden during the COVID-19 pandemic in adolescents with type 1 diabetes and its association with metabolic control. METHODS Prospective multicenter observational cohort study based on data from the German Diabetes Prospective Follow-up Registry. Adolescents aged 12-20 years with type 1 diabetes were asked during routine follow-up visits to complete a questionnaire on psychosocial distress and daily use of electronic media during the COVID-19 pandemic from June 2021 to November 2022. Well-being, anxiety, and depression symptoms were assessed using World Health Organization Five Well-Being Index (WHO-5), General Anxiety Disorder scale 7 (GAD-7), and Patient Health Questionnaire-9 questionnaires. The impact of mental health symptoms on metabolic control was analyzed by using multivariable linear regression models adjusted for sex, diabetes duration, treatment, socioeconomic deprivation, and immigrant background. RESULTS Six hundred eighty eight adolescents (45.6% females) from 20 diabetes centers participated. Compared with a prepandemic cohort, WHO-5 scores were lower during the COVID-19 pandemic (estimated mean difference -9.6 [95% confidence interval -11.6; -7.6], p < .001), but GAD-7 scores were not different (estimated mean difference 0.6 [95% confidence interval -0.2; 1.5], p = .14). HbA1c was significantly positively associated with GAD-7 and Patient Health Questionnaire-9 and negatively associated with WHO-5 scores (all p < .001). Daily electronic media use was positively associated with adjusted mental health symptoms (all p < .01). DISCUSSION Although the overall well-being of adolescents with type 1 diabetes was reduced during the later phase of the COVID-19 pandemic, the additional psychological burden was relatively low. However, mental health symptoms were associated with poorer metabolic control and higher use of electronic media.
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Affiliation(s)
- Clemens Kamrath
- Department of General Pediatrics and Neonatology, Division of Pediatric Endocrinology and Diabetology, Center of Child and Adolescent Medicine, Justus Liebig University, Giessen, Germany.
| | - Sascha R Tittel
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
| | | | | | - Eva Preiss
- Divison of Pediatric Diabetology, Darmstädter Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Julia M Göldel
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Susanna Wiegand
- Department of Pediatric Endocrinology and Diabetology, Center for Social-Pediatric Care, Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin und Humboldt- Universität zu Berlin, Berlin, Germany
| | - Kirsten Minden
- German Rheumatism Research Center (DRFZ), Program Area Epidemiology, Berlin, Germany; Department of Pediatric Respiratory Medicine, German Charité University Medicine Berlin, corporate member of Freie Universität Berlin und Humboldt- Universität zu Berlin, Immunology and Critical Care Medicine at Charité University Hospital Berlin, Berlin, Germany
| | - Petra Warschburger
- Department of Psychology, Counseling Psychology, University of Potsdam, Potsdam, Germany
| | - Anna Stahl-Pehe
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute for Biometrics and Epidemiology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Reinhard W Holl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
| | - Stefanie Lanzinger
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; Institute of Epidemiology and Medical Biometry, CAQM, Ulm University, Ulm, Germany
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20
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Luo D, Cai X, Wang H, Wang Y, Xu J. The role of peer social relationships in psychological distress and quality of life among adolescents with type 1 diabetes mellitus: a longitudinal study. BMC Psychiatry 2024; 24:270. [PMID: 38605327 PMCID: PMC11010305 DOI: 10.1186/s12888-024-05692-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes mellitus suffer from diabetes distress and poor health-related quality of life (HRQOL) since living with the condition that differentiates them from their peers. The present study investigated the effects of peer support and stress on diabetes distress and HRQOL and whether positive coping mediated the effects. METHODS We used a prospective study design. A total of 201 adolescents with type 1 diabetes mellitus from 20 cities in 4 provinces were recruited.Participants complete two separate surveys at approximately 18-month intervals. The scales employed at both Time 1 and Time 2 included the Diabetes-Specific Peer Support Measure, Diabetes Stress Questionnaire for Youths, Simplified Coping Style Questionnaire, 5-item Problem Areas in Diabetes Scale, and the Diabetes Quality of Life for Youth scale. RESULTS Baseline peer stress directly predicted diabetes distress and HRQOL at 18 months, even controlling for age, gender, and peer support. However, the direct effect of baseline peer support on 18-month diabetes distress and HRQOL was insignificant. Baseline peer support indirectly affected diabetes distress and HRQOL at 18 months through positive coping, indicating that positive coping plays a mediating role. CONCLUSION The findings suggest that peer social relationships, especially peer stress, and positive coping are promising intervention targets for adolescents facing challenges in psychosocial adaptation.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Jiangsu Province, Nanjing, China.
| | - Xue Cai
- Nursing Department, Zhongda Hospital, Southeast University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yubing Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jingjing Xu
- Department of Nursing, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
- School of Public Health, Nanjing Medical University, Nanjing, China.
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21
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Brown J, Cox L, Mulligan K, Wilson S, Heys M, Livermore P, Gray S, Bogosian A. Gaining consensus on emotional wellbeing themes and preferences for digital intervention type and content to support the mental health of young people with long-term health conditions: A Delphi study. Health Expect 2024; 27:e14025. [PMID: 38591848 PMCID: PMC11003273 DOI: 10.1111/hex.14025] [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: 11/03/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. METHODS Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. RESULTS Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). CONCLUSION There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. IMPLICATIONS The results will be important to consider for a future intervention, although further consultation will be needed for app development. PATIENT OR PUBLIC CONTRIBUTION Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.
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Affiliation(s)
- Jennie Brown
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Lauren Cox
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Kathleen Mulligan
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Stephanie Wilson
- School of Mathematics, Computer Science and EngineeringCity University of LondonLondonUK
| | - Michelle Heys
- East London NHS Foundation TrustLondonUK
- Population, Policy and Practice DepartmentUniversity College LondonLondonUK
| | - Polly Livermore
- Great Ormond Street Institute of Child Health (GOS ICH)LondonUK
| | - Suzy Gray
- Great Ormond Street Institute of Child Health (GOS ICH)LondonUK
| | - Angeliki Bogosian
- School of Health and Psychological SciencesCity University of LondonLondonUK
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22
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Li S, Yang D, Zhou X, Chen L, Liu L, Lin R, Li X, Liu Y, Qiu H, Cao H, Liu J, Cheng Q. Neurological and metabolic related pathophysiologies and treatment of comorbid diabetes with depression. CNS Neurosci Ther 2024; 30:e14497. [PMID: 37927197 PMCID: PMC11017426 DOI: 10.1111/cns.14497] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 09/26/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND The comorbidity between diabetes mellitus and depression was revealed, and diabetes mellitus increased the prevalence of depressive disorder, which ranked 13th in the leading causes of disability-adjusted life-years. Insulin resistance, which is common in diabetes mellitus, has increased the risk of depressive symptoms in both humans and animals. However, the mechanisms behind the comorbidity are multi-factorial and complicated. There is still no causal chain to explain the comorbidity exactly. Moreover, Selective serotonin reuptake inhibitors, insulin and metformin, which are recommended for treating diabetes mellitus-induced depression, were found to be a risk factor in some complications of diabetes. AIMS Given these problems, many researchers made remarkable efforts to analyze diabetes complicating depression from different aspects, including insulin resistance, stress and Hypothalamic-Pituitary-Adrenal axis, neurological system, oxidative stress, and inflammation. Drug therapy, such as Hydrogen Sulfide, Cannabidiol, Ascorbic Acid and Hesperidin, are conducive to alleviating diabetes mellitus and depression. Here, we reviewed the exact pathophysiology underlying the comorbidity between depressive disorder and diabetes mellitus and drug therapy. METHODS The review refers to the available literature in PubMed and Web of Science, searching critical terms related to diabetes mellitus, depression and drug therapy. RESULTS In this review, we found that brain structure and function, neurogenesis, brain-derived neurotrophic factor and glucose and lipid metabolism were involved in the pathophysiology of the comorbidity. Obesity might lead to diabetes mellitus and depression through reduced adiponectin and increased leptin and resistin. In addition, drug therapy displayed in this review could expand the region of potential therapy. CONCLUSIONS The review summarizes the mechanisms underlying the comorbidity. It also overviews drug therapy with anti-diabetic and anti-depressant effects.
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Affiliation(s)
- Sixin Li
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Dong Yang
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Xuhui Zhou
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Lu Chen
- Department of Gastroenterology, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of GastroenterologyBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Lini Liu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Ruoheng Lin
- Department of Psychiatry, National Clinical Research Center for Mental DisordersThe Second Xiangya Hospital of Central South UniversityChangshaHunanChina
| | - Xinyu Li
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Ying Liu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Huiwen Qiu
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Hui Cao
- Department of Psychiatry, The School of Clinical MedicineHunan University of Chinese MedicineChangshaHunanChina
- Department of PsychiatryBrain Hospital of Hunan Province (The Second People's Hospital of Hunan Province)ChangshaHunanChina
| | - Jian Liu
- Center for Medical Research and Innovation, The First Hospital, Hunan University of Chinese MedicineChangshaHunanChina
| | - Quan Cheng
- Department of Neurosurgery, Xiangya HospitalCentral South UniversityChangshaHunanChina
- National Clinical Research Center for Geriatric Disorders, Xiangya HospitalCentral South UniversityChangshaHunanChina
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23
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Wardell J, Albright D, Chang C, Plegue MA, Lee JE, Hirschfeld E, Garrity A, Lee JM, DeJonckheere M. Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic. Sci Diabetes Self Manag Care 2024; 50:116-129. [PMID: 38456252 PMCID: PMC11042759 DOI: 10.1177/26350106241232634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care. METHODS A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C. RESULTS Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity. CONCLUSIONS In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports.
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Affiliation(s)
- Joseph Wardell
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Dana Albright
- Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana
| | - Claire Chang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Melissa A Plegue
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jung Eun Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Joyce M Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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Shapiro JB, Garza KP, Feldman MA, Suhs MC, Ellis J, Terry A, Howard KR, Weissberg-Benchell J. Psychosocial Care for Youth with Type 1 Diabetes: Summary of Reviews to Inform Clinical Practice. Endocrinol Metab Clin North Am 2024; 53:107-122. [PMID: 38272590 DOI: 10.1016/j.ecl.2023.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The intensive demands of diabetes care can be difficult for youth with type 1 diabetes and their families to integrate into daily life. Standards of care in pediatric diabetes highlight the importance of evidence-based psychosocial interventions to optimize self-management behaviors and psychological well-being. The current review summarizes select systematic reviews and meta-analyses on evidence-based behavioral health interventions in pediatric diabetes. Interventions include strategies to strengthen youth psychosocial skills, improve family dynamics and caregiver mental health, enhance health and mental health equity, and address psychosocial factors related to diabetes technology use.
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Affiliation(s)
- Jenna B Shapiro
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Department of Psychiatry & Behavioral Sciences, 446 E Ontario Street, Chicago, IL, USA.
| | | | - Marissa A Feldman
- Johns Hopkins All Children's Hospital, Child Development and Rehabilitation Center, 880 Sixth Street South #170, Saint Petersburg, FL 33701, USA
| | - Madeleine C Suhs
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Julia Ellis
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Amanda Terry
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Department of Psychiatry & Behavioral Sciences, 446 E Ontario Street, Chicago, IL, USA
| | - Kelsey R Howard
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Department of Psychiatry & Behavioral Sciences, 446 E Ontario Street, Chicago, IL, USA
| | - Jill Weissberg-Benchell
- Ann & Robert H. Lurie Children's Hospital of Chicago, Pritzker Department of Psychiatry and Behavioral Health, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA; Northwestern University Feinberg School of Medicine, Department of Psychiatry & Behavioral Sciences, 446 E Ontario Street, Chicago, IL, USA
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Marks BE, Grundman JB, Meighan S, Monaghan M, Streisand R, Perkins A. Hybrid Closed Loop Systems Improve Glycemic Control and Quality of Life in Historically Minoritized Youth with Diabetes. Diabetes Technol Ther 2024; 26:167-175. [PMID: 38444316 PMCID: PMC11071108 DOI: 10.1089/dia.2023.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Background: We assessed changes in glycemic control and person-reported outcome measures (PROMs) with t:slim X2 insulin pump with Control-IQ technology use among historically minoritized youth who are least likely to access hybrid closed loop (HCL) technology. Methods: This single-arm, prospective pilot study enrolled 15 publicly insured, insulin pump-naïve, non-Hispanic Black youth ages 6 to <21 years with type 1 diabetes and hemoglobin A1c (HbA1c) ≥10% in a 6-month study of HCL use. The primary outcome was absolute change in time in range (TIR) (70-180 mg/dL). Secondary outcomes included other continuous glucose monitor metrics, PROMs, and diabetic ketoacidosis (DKA) incidence. Results: For 13 youth (median 14.8 years, 53.3% female, HbA1c 11.7%) who completed the study, baseline TIR of 12.3% (6.3-27.1%) increased 23.7%-points (16.9, 30.5%; P < 0.001) or 5.7 h per day. Percent time >250 mg/dL decreased 33.9%-points (-44.8, -23.1%; P < 0.001) or 8.1 h per day from a baseline of 69.4% (51.6, 84.0%). Median time in HCL was 78.3% (59.7, 87.3%). Youth received 10.1 (9.2, 11.9) boluses per day, 71.7% (63.8, 79.3%) of which were HCL-initiated autoboluses. Diabetes-specific quality of life increased among parents (P < 0.001) and youth (P = 0.004), and diabetes distress decreased in both groups (P < 0.001, P = 0.005). Improvements in glycemia did not correlate with any baseline youth or parent PROMs. DKA was high at baseline (67 episodes/100-person years) and did not increase during the intervention (72 episodes/100-person years, P = 0.78). Conclusion: Improvements in glycemic control and quality of life exceeding pivotal trial findings without increased safety risks among historically minoritized youth emphasize the need for equitable access to HCL systems. ClinicalTrials.gov: clinicaltrials.gov ID (NCT04807374).
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Affiliation(s)
- Brynn E. Marks
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Jody B. Grundman
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Seema Meighan
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Maureen Monaghan
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Randi Streisand
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
| | - Amanda Perkins
- Division of Endocrinology, Children's National Medical Center, Washington, District of Columbia, USA
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ElSayed NA, Aleppo G, Bannuru RR, Beverly EA, Bruemmer D, Collins BS, Darville A, Ekhlaspour L, Hassanein M, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S77-S110. [PMID: 38078584 PMCID: PMC10725816 DOI: 10.2337/dc24-s005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Benioudakis ES, Karlafti E, Kalaitzaki A, Kalpou MA, Georgiou ED, Savopoulos C, Didangelos T. Comparison of the Sensor-Augmented Pump System with the Advanced Hybrid Closed-Loop Delivery System: Quality of Life, Diabetes Distress, and Glycaemic Outcomes in a Real-Life Context. Curr Diabetes Rev 2024; 20:e310523217505. [PMID: 37259938 DOI: 10.2174/1573399820666230531161858] [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: 02/02/2023] [Revised: 05/02/2023] [Accepted: 05/08/2023] [Indexed: 06/02/2023]
Abstract
BACKGROUND Type 1 diabetes mellitus (T1D) is a chronic disease that requires exogenous insulin administration and intensive management to prevent any complications. Recent innovations in T1D management technologies include the Advanced Hybrid Closed-Loop delivery system (AHCL). The pioneer AHCL system provides automated basal and automated bolus corrections when needed. OBJECTIVE This study aimed to compare the Advanced Hybrid Closed-Loop (AHCL) system and the Sensor-Augmented Pump (SAP) with Predictive Low Glucose Management (PLGM) system, in relation to glycaemic outcomes, general and diabetes-related Quality of Life (QoL), and diabetes distress. METHODS General and diabetes-related QoL were assessed with the Diabetes Quality of Life Brief Clinical Inventory (DQOL-BCI) and the World Health Organization Quality of Life-BREF (WHOQOL-BREF), respectively. Diabetes distress was assessed with the Diabetes Distress Scale for Type 1 diabetes (T1-DDS). RESULTS Eighty-nine T1D adults participated in the study, mostly females (65.2%), with a mean age of 39.8 (± 11.5 years). They had on average 23 years of diabetes (± 10.7) and they were on continuous subcutaneous insulin infusion therapy. Significant differences favoring the AHCL over the SAP + PLGM system were demonstrated by lower mean glucose levels, less time above range, lower scores on DQOL-BCI, T1-DDS, and higher scores on WHOQOL-BREF. Finally, the linear regression models revealed the association of time in range in most of the above aspects. CONCLUSION This study highlighted the advantages of the AHCL system over the SAP + PLGM system in the real-world setting in relation to general and diabetes-related QoL, diabetes distress, and glycaemic outcomes.
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Affiliation(s)
- Emmanouil S Benioudakis
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Karlafti
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Argyroula Kalaitzaki
- Department of Social Work, Laboratory of Interdisciplinary Approaches to the Enhancement of Quality of Life, Health Sciences Faculty, Hellenic Mediterranean University, Heraklion, Crete, Greece
| | - Maria-Alexandra Kalpou
- Department of Psychology, National and Kapodistrian University of Athens, Athens, Greece
| | - Evangelos D Georgiou
- Department of Psychology, University of Cyprus Centre for Field Studies, University of Cyprus, Nicosia, Cyprus
| | - Christos Savopoulos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Triantafyllos Didangelos
- Diabetes Center, 1st Propaedeutic Department of Internal Medicine, Medical School, "AHEPA" General University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Soufi A, Mok E, Henderson M, Dasgupta K, Rahme E, Nakhla M. Association of stigma, diabetes distress and self-efficacy with quality of life in adolescents with type 1 diabetes preparing to transition to adult care. Diabet Med 2024; 41:e15159. [PMID: 37269172 DOI: 10.1111/dme.15159] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 04/26/2023] [Accepted: 06/01/2023] [Indexed: 06/04/2023]
Abstract
AIMS In type 1 diabetes (T1D), psychosocial factors may impact quality of life (QOL) and clinical outcomes, but remain understudied, particularly during late adolescence. Our aim was to determine whether stigma, diabetes distress and self-efficacy are associated with QOL in adolescents with T1D as they are preparing to transition to adult care. METHODS We conducted a cross-sectional study of adolescents (ages 16-17 years) with T1D participating in the Group Education Trial to Improve Transition (GET-IT) in Montreal, Canada. Participants completed validated questionnaires on stigma using the Barriers to Diabetes Adherence (BDA) stigma subscale, self-efficacy (Self-Efficacy for Diabetes Self-Management Measure [SEDM], score 1-10), diabetes distress (Diabetes Distress Scale for Adults with type 1 diabetes) and QOL (Pediatric Quality of Life Inventory [PedsQL] 4.0 Generic Core Scale and PedsQL 3.2 Diabetes Module). We examined associations of stigma, diabetes distress and self-efficacy with QOL using multivariate linear regression models adjusted for sex, diabetes duration, socioeconomic status and HbA1c. RESULTS Of 128 adolescents with T1D, 76 (59%) self-reported having the diabetes-related stigma and 29 (22.7%) reported experiencing diabetes distress. Those with stigma had lower diabetes-specific and general QOL scores compared with those without stigma, and stigma and diabetes distress were both associated with lower diabetes-specific QOL and lower general QOL. Self-efficacy was associated with higher diabetes-specific and general QOL. CONCLUSIONS Stigma and diabetes distress are associated with lower QOL, whereas self-efficacy is associated with higher QOL in adolescents with T1D preparing to transfer to adult care.
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Affiliation(s)
- Arij Soufi
- McGill University Faculty of Medicine and Health Sciences, Montreal, Québec, Canada
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Mélanie Henderson
- Department of Pediatrics, Université de Montréal, Montreal, Québec, Canada
- Centre de Recherche CHU Sainte-Justine, Montreal, Québec, Canada
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Meranda Nakhla
- Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montreal, Québec, Canada
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Dover S, Ahmet A, Bluth K, Feldman BM, Goldbloom EB, Goldfield GS, Hamilton S, Imran O, Khalif A, Khatchadourian K, Lawrence S, Leonard A, Liu K, Ouyang Y, Peeters C, Shah J, Spector N, Zuijdwijk C, Robinson ME. Teaching Adolescents With Type 1 Diabetes Self-Compassion (TADS) to Reduce Diabetes Distress: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e53935. [PMID: 38048480 PMCID: PMC10777281 DOI: 10.2196/53935] [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: 10/24/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Adolescents living with type 1 diabetes (T1D) often experience diabetes distress (DD), a construct distinct from depression or anxiety that refers to the negative emotions that arise from living with and managing diabetes. Self-compassion, which involves being open to one's own suffering and treating oneself with the same care one would show to loved ones, is associated with better psychological and clinical outcomes among individuals with T1D. Self-compassion is a skill that can be taught and therefore represents an opportunity for intervention. OBJECTIVE The overall aim of this study is to assess the effectiveness of a web-based mindful self-compassion for teens (MSC-T) intervention on improving DD, anxiety, depression, diabetes-related disordered eating, and suicidal ideation experienced by youth with T1D (aged between 12 and 17 years) compared with a waitlist control group (standard of care). We will also explore (1) if the effect of the MSC-T intervention changes over time, (2) if the MSC-T intervention has a positive impact on measures of glycemic control, and (3) if the effect of the MSC-T intervention differs based on self-reported gender. METHODS We will conduct a single-center, parallel-group randomized controlled trial of 140 adolescents with T1D followed for 12 months. Participants will be randomly allocated (using hidden allocation) in a 1:1 ratio to either the MSC-T intervention or the waitlist control group. Our primary outcome is DD, as measured by the Problem Areas in Diabetes-Teen (PAID-T) version at 3 months. Secondary outcomes, assessed at 3 and 12 months, include anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale), depression (Patient Health Questionnaire-9 [PHQ-9]), diabetes-related disordered eating (Diabetes Eating Problem Survey-Revised [DEPS-R] version), and suicidal ideation (using 1 question from the PHQ-9). RESULTS Study recruitment began in October 2022 and was completed in March 2023, with a total of 141 participants enrolling. Data collection will be ongoing until March 2024. The first results are expected in June 2024. CONCLUSIONS This study will be the first randomized trial to assess the effectiveness of the web-based MSC-T intervention on adolescents with T1D. Given that adolescence is a period where individuals are typically required to assume more responsibility for their diabetes care, providing adolescents with the tools they need to better manage the stress that often accompanies T1D management is paramount. TRIAL REGISTRATION ClinicalTrials.gov NCT05463874; https://clinicaltrials.gov/study/NCT05463874. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53935.
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Affiliation(s)
- Saunya Dover
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Alexandra Ahmet
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Brian M Feldman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gary S Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Hamilton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Omar Imran
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Adam Khalif
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Karine Khatchadourian
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Lawrence
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Leonard
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Kuan Liu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yongdong Ouyang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Corien Peeters
- Development & Rehabilitation, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Noah Spector
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Eve Robinson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
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Garner K, Thabrew H, Lim D, Hofman P, Jefferies C, Serlachius A. Exploring the Usability and Acceptability of a Well-Being App for Adolescents Living With Type 1 Diabetes: Qualitative Study. JMIR Pediatr Parent 2023; 6:e52364. [PMID: 38153804 PMCID: PMC10766165 DOI: 10.2196/52364] [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: 08/31/2023] [Revised: 11/01/2023] [Accepted: 11/03/2023] [Indexed: 12/30/2023] Open
Abstract
Background Adolescents living with either type 1 diabetes (T1D) or type 2 diabetes (T2D) have an increased risk of psychological disorders due to the demands of managing a chronic illness and the challenges of adolescence. Psychological disorders during adolescence increase the risk of suboptimal glycemic outcomes and may lead to serious diabetes-related complications. Research shows that digital health interventions may increase access to psychological support for adolescents and improve physical and mental health outcomes for youth with diabetes. To our knowledge, there are no evidence-based, publicly available mental health apps with a focus on improving the psychological well-being of adolescents with diabetes. Objective This study aimed to explore the acceptability and usability of our evidence-based well-being app for New Zealand adolescents, Whitu: 7 Ways in 7 Days (Whitu), to allow us to further tailor it for youth with diabetes. We interviewed adolescents with T1D and T2D, their parents, and health care professionals to explore their views on the Whitu app and suggestions for tailoring the app for adolescent with diabetes. We also explored the cultural acceptability of the Whitu app for Māori and Pacific adolescents. Methods A total of 34 participants, comprising 13 adolescents aged 12-16 years (11 with T1D and 2 with T2D), 10 parents, and 11 health care professionals, were recruited from a specialist diabetes outpatient clinic and Facebook diabetes groups. Each participant attended one 1-hour focus group on Zoom, in person, or via phone. Researchers gathered general feedback on what makes an effective and engaging app for adolescents with diabetes, as well as specific feedback about Whitu. Transcribed audio recordings of the focus groups were analyzed using directed content analysis. Results Adolescents with T1D, their parents, and health care professionals found Whitu to be acceptable and usable. Adolescents with T1D and their parents signaled a preference for more diabetes-specific content. Health care professionals expressed less awareness and trust of digital health interventions and, as such, recommended that they be used with external support. Due to challenges in recruitment and retention, we were unable to include the views of adolescents with T2D in this qualitative study. Conclusions There appears to be sufficient openness to the use of an app such as Whitu for supporting the well-being of adolescents with T1D, albeit with modifications to make its content more diabetes specific. Based on this qualitative study, we have recently developed a diabetes-specific version of Whitu (called LIFT: Thriving with Diabetes). We are also planning a qualitative study to explore the views of youth with T2D and their perspectives on the new LIFT app, where we are using alternative research approaches to recruit and engage adolescents with T2D and their families.
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Affiliation(s)
- Katie Garner
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Paul Hofman
- Liggins Institute and Department of Pediatrics, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Liggins Institute and Department of Pediatrics, University of Auckland, Auckland, New Zealand
- Starship Child Health, Te Whatu Ora – Health New Zealand, Te Toka Tumai Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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Lupini F, Rubinstein TB, Mackey ER, Sule S. Behavioral health outcomes and social determinants of health in children with diabetes and juvenile arthritis. RESEARCH SQUARE 2023:rs.3.rs-3610878. [PMID: 38076886 PMCID: PMC10705696 DOI: 10.21203/rs.3.rs-3610878/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Objective Children with chronic illnesses, including arthritis, are at increased risk for adverse psychosocial outcomes influenced by social determinants of health (SDOH). Comparing psychosocial outcomes in families affected by juvenile arthritis compared to other chronic illnesses may help identify areas in need of special attention vs areas that may be addressed through adopting other disease examples' care models. We examined child and parent behavioral health outcomes for families with juvenile arthritis compared to diabetes, accounting for SDOH. Methods Secondary data analysis of the National Survey of Children's Health including 365 children (<18yrs) with arthritis and 571 children with diabetes. Psychosocial outcomes were depression, anxiety, ADHD, physical pain, behavioral problems, and treatment for mental health. School outcomes were school engagement, school absence, involvement in clubs/organization, and involvement in organized activities. Parent outcomes were family resilience, emotional support, coping with daily demands of raising a child, job change due to problems with childcare, and parent mental health. SDOH variables were food insecurity, food/cash assistance, unsafe neighborhood, detracting neighborhood elements, parent education, households earning <100% of the federal poverty line. Logistic regression analyses were utilized to examine variation in child and parent outcomes, variation in SDOH, and the role of SDOH. Results Children with arthritis experienced significantly more physical pain, anxiety, depression, ADHD, and behavior problems compared to children with diabetes. Children with arthritis were more likely to see a mental health professional and get treatment for problems with emotions/behaviors. When considering SDOH, children with arthritis were still more likely to experience adverse psychosocial outcomes but were no longer more likely to get treatment. Children with arthritis had increased likelihood of school absence and were less involved in organized activities than children with diabetes. Parents of children with arthritis had poorer mental health than parents of children with diabetes. SDOH were more prevalent in children with arthritis than children with diabetes. Conclusions Increased risk for adverse psychosocial outcomes in youth with arthritis compared to youth with diabetes indicates a need to mirror endocrinology models of care in rheumatology clinics. The role of SDOH highlights the need for regular SDOH screening in clinic.
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Affiliation(s)
| | | | - Eleanor R Mackey
- Children's National Medical Center: Children's National Hospital
| | - Sangeeta Sule
- Children's National Medical Center: Children's National Hospital
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Singh P, Seth A. Transition of Care of Pediatric Patients with Special Needs to Adult Care Settings: Children with Diabetes Mellitus and Other Endocrine Disorders. Indian J Pediatr 2023; 90:1134-1141. [PMID: 37542570 DOI: 10.1007/s12098-023-04780-w] [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: 01/08/2023] [Accepted: 07/12/2023] [Indexed: 08/07/2023]
Abstract
Childhood onset endocrine disorders need long-term medical, psychological and social management. Over time, many illnesses evolve, while others may witness onset of new complications. Thus, the components of the care change as the child grows into adolescence and then adulthood. The transition of children and adolescents with chronic endocrine disorders to adult care continues to be a major challenge. Pediatric and adult healthcare teams should together design a transitional care plan that is developmentally appropriate and responsive to the needs of young adults. The preparation for transition to adult care should begin early in adolescence and involve both the adolescent and his parents. A structured and planned transitional care bridges the gap between pediatric and adult care teams, promote ongoing engagement and build trust with the new healthcare teams. Combined pediatric-adult care transition model for endocrine conditions has yielded high adherence rates and patient satisfaction.
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Affiliation(s)
- Preeti Singh
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India
| | - Anju Seth
- Department of Pediatrics, Lady Hardinge Medical College, New Delhi, India.
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Torbjørnsen A, Jensen AL, Singstad T, Weldingh NM, Holmen H. Patient-reported outcome measures in diabetes outpatient care: a scoping review. BMJ Open Diabetes Res Care 2023; 11:e003628. [PMID: 37963648 PMCID: PMC10649597 DOI: 10.1136/bmjdrc-2023-003628] [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: 07/10/2023] [Accepted: 10/13/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) measures are increasingly used in clinical diabetes care to increase patient involvement and improve healthcare services. The objectives were to identify instruments used to measure PROs in outpatient diabetes clinics and to investigate the use of these PRO measures alongside the experiences of patients and healthcare personnel in a clinical setting. RESEARCH DESIGN AND METHODS A scoping review was conducted according to the framework of Arksey and O'Malley with scoping searches of Cinahl, EMBASE, Medline and Health and Psychosocial Instruments. Studies reporting on adults with diabetes in a clinical setting where the PRO measure response directly affected patient care were eligible for inclusion. RESULTS In total, 35 197 citations were identified, of which 7 reports presenting 4 different PRO measures were included in the review. All four of the included items measured psychosocial aspects of diabetes, and three included elements of the Problem Areas in Diabetes scale. All the patients were satisfied with the use of PRO measures in clinical care, whereas the level of satisfaction among healthcare personnel with PRO measures varied within and among studies. CONCLUSIONS The limited number of eligible studies in this review suggests that research on PRO measures for diabetes outpatient care is scarce. Patients welcome the opportunity to express their concerns through the systematic collection of PRO measures, and some healthcare personnel value the broader insight that PRO measures provide into the impact of diabetes on patients' lives. However, the heterogeneity among services and among patients challenges the implementation of PRO measures. Research is needed to explore how PRO measures in clinical outpatient care affect healthcare personnel workflow. REVIEW REGISTRATION https://doi.org/10.17605/OSF.IO/46AHC.
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Affiliation(s)
- Astrid Torbjørnsen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
| | - Annesofie Lunde Jensen
- Health Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Steno Diabetes Centre Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Tone Singstad
- Department of Endocrinology Outpatient Service, Akershus University Hospital, Lorenskog, Norway
| | | | - Heidi Holmen
- Department of Nursing and Health Promotion, Oslo Metropolitan University, Oslo, Norway
- Intervention Centre, Oslo Universitetssykehus, Oslo, Norway
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Babiker A, Elbarbary NS, Alaqeel B, Al Noaim K, Al Yaarubi S, Al-Abdulrazzaq D, Al-Kandari H, Alkhayyat H, Odeh R, Babiker O, Abu-Libdeh A, Aljohani A, Al Abdul Salam N, Al-Juailla F, Masuadi E, Deeb A, Weissberg-Benchell J, Gregory AM, Hassanein M, Al Alwan I. Lessons Learned From COVID-19 Lockdown: An ASPED/MENA Study on Lifestyle Changes and Quality of Life During Ramadan Fasting in Children and Adolescents Living With Type 1 Diabetes. Clin Med Insights Endocrinol Diabetes 2023; 16:11795514231203907. [PMID: 37867504 PMCID: PMC10588419 DOI: 10.1177/11795514231203907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/10/2023] [Indexed: 10/24/2023] Open
Abstract
Background Lockdown was a unique experience that affected many aspects of life, particularly during the challenge of Ramadan fasting (RF). Studying this can increase understanding of the effects of lifestyle changes on quality of life (QoL) for children with type 1 diabetes (T1D) during RF. Methods A cross-sectional study that assessed the effect of lockdown on lifestyle and QoL on fasting children living with T1D during Ramadan in the Middle East and North Africa region (2020-2021). We compared the child (self) and parent (proxy) reports using PEDQoL v3.0 disease specific questionnaire during lockdown and non-lockdown periods, and assessed correlations with lifestyle changes using regression and gap analyses. Results A total of 998 reports from 499 children with T1D aged 8 to 18 years (study = 276, control = 223), and their parents during RF in lockdown and non-lockdown periods. Fathers were more involved in their children's care during lockdown (P = .019). Patients had better compliance with treatment (P = .002), a reversed sleep pattern (P = .033), increased food intake (P ⩽ .001), and less exercise (P < .001). Children and parents perceived better QoL during lockdown (P ⩽.001) with no differences between their reports in "Diabetes Symptoms", "Treatment Adherence," and "Communication" domains. Self and proxy reports were different in all domains during non-lockdown (P = <.001-.009). In gap analysis, although not statistically significant, the gap was approximated between children's and parents' perceptions in all domains during lockdown. Conclusion COVID-19 lockdown had a positive impact on QoL of children living with T1D during RF, possibly due to lifestyle changes and superior psychosocial family dynamics.
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Affiliation(s)
- Amir Babiker
- King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | | | - Bothainah Alaqeel
- King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Khalid Al Noaim
- Department of Pediatrics, King Faisal University Medical Center, AlAhsa, Saudi Arabia
| | - Saif Al Yaarubi
- College of Medicine & Health Science, Sultan Qaboos University, Muscat, Oman
| | - Dalia Al-Abdulrazzaq
- Department of Pediatrics, Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Hessa Al-Kandari
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
- Department of Pediatrics, Farwaniya Hospital, Ministry of Health, Farwaniya, Kuwait
| | - Haya Alkhayyat
- Pediatric Department, Bahrain Defense Force Royal Medical Services, Riffa, Bahrain
| | - Rasha Odeh
- Department of Pediatrics, School of Medicine, The University of Jordan, Amman, Jordan
| | - Omer Babiker
- Sudan Childhood Diabetes Center, Khartoum, Sudan
| | - Abdulsalam Abu-Libdeh
- Department of Pediatrics, Endocrinology Unit, Makassed Islamic Hospital & Al-Quds Medical School, Jerusalem, Palestine, Israel
| | - Amal Aljohani
- King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
| | - Noof Al Abdul Salam
- College of Medicine & Health Science, Sultan Qaboos University, Muscat, Oman
| | - Fatima Al-Juailla
- Department of Population Health, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Emad Masuadi
- King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
| | - Asma Deeb
- Sheikh Shakhbout Medical City & Khalifa University, Pediatric Endocrinology, Abu Dhabi, UAE
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Alice M. Gregory
- Department of Psychology, Goldsmiths, University of London, London, UK
| | - Mohamed Hassanein
- Department of Endocrinology and Diabetes, Dubai Hospital, Dubai, UAE
| | - Ibrahim Al Alwan
- King Abdullah Specialized Children’s Hospital, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Centre, Riyadh, Saudi Arabia
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Straton E, Inverso H, Moore H, Anifowoshe K, Washington K, Streisand R, Datye K, Jaser SS. Glycemic and Psychosocial Correlates of Continuous Glucose Monitor Use Among Adolescents With Type 1 Diabetes. J Diabetes Sci Technol 2023:19322968231186428. [PMID: 37846485 DOI: 10.1177/19322968231186428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use. METHODS This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (Current Users, Past Users, and Never Users). RESULTS Current Users demonstrated significantly lower HbA1c than Never Users and significantly lower diabetes distress than Past Users. CGM use was not associated with family conflict or quality of life. CONCLUSIONS CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.
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Affiliation(s)
- Emma Straton
- Children's National Hospital, Washington, DC, USA
| | - Hailey Inverso
- Children's National Hospital, Washington, DC, USA
- University of Florida, Gainesville, FL, USA
| | - Hailey Moore
- Children's National Hospital, Washington, DC, USA
| | | | | | - Randi Streisand
- Children's National Hospital, Washington, DC, USA
- School of Medicine, The George Washington University, Washington, DC, USA
| | - Karishma Datye
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
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LeStourgeon L, Bergner E, Datye K, Streisand R, Jaser S. Evaluation of Study Engagement With an mHealth Intervention (THR1VE) to Treat Diabetes Distress in Teens With Type 1 Diabetes: Randomized Clinical Trial. JMIR Pediatr Parent 2023; 6:e47089. [PMID: 37800881 PMCID: PMC10594399 DOI: 10.2196/47089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 06/06/2023] [Accepted: 07/13/2023] [Indexed: 10/07/2023] Open
Abstract
Background Positive psychology interventions demonstrate improvements in diabetes self-management and quality of life among adults with chronic health conditions, but few interventions for adolescents use this approach. Objective This study describes engagement with a positive psychology intervention delivered via automated SMS text messages aimed at treating diabetes distress and improving diabetes outcomes. In addition, demographic and clinical predictors of intervention engagement were examined. Methods Adolescents with type 1 diabetes (ages 13-17 years) who reported at least moderate diabetes distress were randomized to receive either the education or positive affect + education intervention, comprising 8 weeks of automated SMS text messages. Engagement was assessed as the response to the SMS text messages. Adolescents completed satisfaction surveys 3 months post intervention, and a subset of participants from both intervention groups completed exit interviews. Results Adolescents in both groups reported high levels of satisfaction with the study, with 95% (163/172) reporting that they would participate again. Engagement with the SMS text messages was high; on average, adolescents in the positive affect + education group responded to 92.5% of intervention messages, and their caregivers responded to 88.5% of messages. There were no significant differences in rates of engagement related to adolescents' sex, age, device use, or race/ethnicity. Conclusions A positive psychology intervention for adolescents delivered via automated SMS text messages was feasible and acceptable across genders, ages, and racial/ethnic groups, suggesting potential for wider dissemination.
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Affiliation(s)
- Lauren LeStourgeon
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Erin Bergner
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Karishma Datye
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
| | - Randi Streisand
- Department of Pyschology and Behavioral Health, Children's National Hospital, WashingtonDC, United States
- Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, WashingtonDC, United States
| | - Sarah Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, NashvilleTN, United States
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Titoria R, Fung A, Tang TS, Amed S. Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care. Diabet Med 2023; 40:e15172. [PMID: 37428650 DOI: 10.1111/dme.15172] [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: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
AIMS There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers. METHODS CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool. RESULTS Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia. CONCLUSIONS Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.
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Affiliation(s)
- Reena Titoria
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Andrea Fung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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Zeiler M, Wittek T, Graf T, Bozic I, Nitsch M, Waldherr K, Karwautz A, Wagner G, Berger G. Psychosocial impact of the COVID-19 pandemic for adolescents with type-1-diabetes: a qualitative interview study involving adolescents and parents. Behav Med 2023; 49:412-422. [PMID: 35816425 DOI: 10.1080/08964289.2022.2084358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 12/23/2022]
Abstract
This study aims to investigate the psychosocial impact of the COVID-19 pandemic on adolescents with type-1-diabetes (T1D). We conducted 18 semi-structured interviews including adolescents with T1D (n = 10, 50% female, 15-18 years) and their parents (n = 8, 88% mothers). The main topics addressed were experiences during confinement regarding everyday life, lifestyle behaviors, diabetes management and treatment. We applied thematic analysis to identify common patterns of meanings. Being aware of belonging to a potential COVID-19 risk group caused worries especially in parents which resulted in strict adherence to preventive measures. Information from trustworthy sources regarding the actual risk mitigated the concerns. Digital diabetes treatment was well accepted and experienced as highly usable. The pandemic situation either facilitated or hindered the transition from parental control to diabetes self-management. While some patients managed to improve healthy lifestyle behaviors as their everyday lives seemed more predictable, others had difficulties in adapting to changed daily routines resulting in increased sedentary behavior and snacking. The perceived level of stress was directly associated with blood glucose levels. In conclusion, the implementation of psychological interventions (both for adolescents with T1D and their parents) addressing mental health literacy and media literacy seems to be important to promote positive coping skills for dealing with the pandemic situation.
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Affiliation(s)
- Michael Zeiler
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Tanja Wittek
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Theres Graf
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Ina Bozic
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
| | - Martina Nitsch
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Karin Waldherr
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Andreas Karwautz
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gudrun Wagner
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gabriele Berger
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf
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Sińska BI, Rzońca E, Kucharska A, Gałązkowski R, Traczyk I, Rzońca P. Factors Influencing the Control of Diabetes Measured via Glycated Hemoglobin Concentrations in Adults with Type 1 Diabetes. Eur J Investig Health Psychol Educ 2023; 13:2035-2045. [PMID: 37887145 PMCID: PMC10606861 DOI: 10.3390/ejihpe13100144] [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: 07/19/2023] [Revised: 09/04/2023] [Accepted: 09/21/2023] [Indexed: 10/28/2023] Open
Abstract
Numerous complications of type 1 diabetes (T1D) may be prevented through suitable glycemic control. Glycated hemoglobin (HbA1c) may be one of the markers for the early detection of the metabolic imbalance characteristic of the disease. However, optimal control of diabetes is not achieved in a large group of patients. It was demonstrated that numerous factors (sociodemographic, psychological, and clinical) contributed to this condition. The aim of the study was to identify factors influencing the control of diabetes measured via glycated hemoglobin concentrations in people with T1D. Independent factors influencing better diabetes control measured via HbA1c in the study group included higher disease acceptance, higher nutritional adherence, lower BMI, and a lower risk of eating disorders. Describing the determinants will allow for the improvement of the system of care provided to people with T1D and for it to comprise important psychological variables related to self-care and acceptance of the disease.
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Affiliation(s)
- Beata I. Sińska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (I.T.)
| | - Ewa Rzońca
- Department of Obstetrics and Gynecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Alicja Kucharska
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (I.T.)
| | - Robert Gałązkowski
- Department of Emergency Medical Services, Faculty of Health Sciences, Medical University of Warsaw, 00-575 Warsaw, Poland;
| | - Iwona Traczyk
- Department of Human Nutrition, Faculty of Health Sciences, Medical University of Warsaw, 01-445 Warsaw, Poland; (A.K.); (I.T.)
| | - Patryk Rzońca
- Department of Human Anatomy, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland;
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Aguirre Vergara F, Fischer A, Seuring T, de Beaufort C, Fagherazzi G, Aguayo GA. Mixed-methods study protocol to identify expectations of people with type 1 diabetes and their caregivers about voice-based digital health solutions to support the management of diabetes distress: the PsyVoice study. BMJ Open 2023; 13:e068264. [PMID: 37709324 PMCID: PMC10503348 DOI: 10.1136/bmjopen-2022-068264] [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: 09/12/2022] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Type 1 diabetes (T1D) requires continuous management to obtain a good metabolic control and prevent acute complications. This often affects psychological well-being. People with T1D frequently report diabetes distress (DD). Psychological issues can negatively affect metabolic control and well-being. New technologies can improve quality of life, reduce the treatment burden and improve glycaemic control. Voice technology may serve as an innovative and inexpensive remote monitoring device to evaluate psychological well-being. Tailoring digital health interventions according to the ability and interest of their intended 'end-users' increases the acceptability of the intervention itself. PsyVoice explores the perspectives and needs of people with T1D on voice-based digital health interventions to manage DD. METHODS AND ANALYSIS PsyVoice is a mixed-methods study with qualitative and quantitative data sources. For the qualitative part, the researchers will invite 20 people with a T1D or caregivers of children with T1D to participate in in-depth semi-structured interviews. They will be invited as well to answer three questionnaires to assess socio-demographics, diabetes management, e-Health literacy and diabetes distress. Information from questionnaires will be integrated with themes developed in the qualitative analysis of the interviews. People with T1D will be invited to participate in the protocol and give feedback on interview guides, questionnaires, information sheets and informed consent. ETHICS AND DISSEMINATION PsyVoice received ethical approval from Luxembourg's National Research Ethics Committee. Participants will receive information about the purpose, risks and strategies to ensure the confidentiality and anonymity of the study. The results of PsyVoice will guide the selection and development of voice-based technological interventions for managing DD. The outcome will be disseminated to academic and non-academic stakeholders through peer-reviewed open-access journals and a lay public report. TRIAL REGISTRATION NUMBER This study is registered on ClinicalTrials.gov with the number NCT05517772.
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Affiliation(s)
| | - Aurélie Fischer
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Till Seuring
- Department of Living Conditions, Luxembourg Institute of Socio-Economic Research, Esch-sur-Alzette, Luxembourg
| | - Carine de Beaufort
- Diabetes & Endocrine Care, Clinique Pédiatrique, Centre Hospitalier de Luxembourg, Luxembourg, Luxembourg
- Department of Paediatric Endocrinology, UZ-VUB, Jette, Belgium
| | - Guy Fagherazzi
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Gloria A Aguayo
- Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
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Patton SR, Kahhan N, Pierce JS, Benson M, Fox LA, Clements MA. Parental diabetes distress is a stronger predictor of child HbA1c than diabetes device use in school-age children with type 1 diabetes. BMJ Open Diabetes Res Care 2023; 11:e003607. [PMID: 37699721 PMCID: PMC10503346 DOI: 10.1136/bmjdrc-2023-003607] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/29/2023] [Indexed: 09/14/2023] Open
Abstract
INTRODUCTION Diabetes distress (DD) describes the unrelenting emotional and behavioral challenges of living with, and caring for someone living with, type 1 diabetes (T1D). We investigated associations between parent-reported and child-reported DD, T1D device use, and child glycated hemoglobin (HbA1c) in 157 families of school-age children. RESEARCH DESIGN AND METHODS Parents completed the Parent Problem Areas in Diabetes-Child (PPAID-C) and children completed the Problem Areas in Diabetes-Child (PAID-C) to assess for DD levels. Parents also completed a demographic form where they reported current insulin pump or continuous glucose monitor (CGM) use (ie, user/non-user). We measured child HbA1c using a valid home kit and central laboratory. We used correlations and linear regression for our analyses. RESULTS Children were 49% boys and 77.1% non-Hispanic white (child age (mean±SD)=10.2±1.5 years, T1D duration=3.8±2.4 years, HbA1c=7.96±1.62%). Most parents self-identified as mothers (89%) and as married (78%). Parents' mean PPAID-C score was 51.83±16.79 (range: 16-96) and children's mean PAID-C score was 31.59±12.39 (range: 11-66). Higher child HbA1c correlated with non-pump users (r=-0.16, p<0.05), higher PPAID-C scores (r=0.36, p<0.001) and higher PAID-C scores (r=0.24, p<0.001), but there was no association between child HbA1c and CGM use. A regression model predicting child HbA1c based on demographic variables, pump use, and parent-reported and child-reported DD suggested parents' PPAID-C score was the strongest predictor of child HbA1c. CONCLUSIONS Our analyses suggest parent DD is a strong predictor of child HbA1c and is another modifiable treatment target for lowering child HbA1c.
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Affiliation(s)
- Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Nicole Kahhan
- Pediatrics, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida, USA
| | - Matthew Benson
- Pediatrics, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Larry A Fox
- Pediatrics, Nemours Children's Health System, Jacksonville, Florida, USA
| | - Mark A Clements
- Pediatrics, Endocrinology, Children's Mercy Hospital & Clinics, Kansas City, Missouri, USA
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Wyld K, Hendrieckx C, Griffin A, Barrett H, D'Silva N. Agenda-setting by young adults with type 1 diabetes and associations with emotional well-being/social support: results from an observational study. Intern Med J 2023; 53:1347-1355. [PMID: 36008367 DOI: 10.1111/imj.15919] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 08/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Diabetes Psychosocial Assessment Tool (DPAT) was developed to assess the psychosocial well-being of young adults with type 1 diabetes in clinical practice. The DPAT includes three validated questionnaires (assessing diabetes distress, anxiety/depressive symptoms and emotional well-being) and an agenda-setting tool. It is currently used by the Queensland Statewide Diabetes Clinical Network (available at Clinical Excellence Queensland). AIMS To describe agenda items set by young adults with type 1 diabetes and investigate their association with emotional well-being/social support. METHODS The DPAT was completed by young adults attending routine diabetes outpatient appointments at the Mater Hospital (Brisbane) between November 2016 and January 2020. For the current analysis, data included responses on agenda-setting and outcomes from three validated questionnaires. RESULTS Responses of 277 young adults (15-26 years) were analysed. Ninety-four (34%) reported one to three agenda item(s). Common agenda items were diabetes technology and medications, but other topics raised included pregnancy, body image and eating concerns. Participants with moderate diabetes distress or anxiety symptoms were more likely to list at least one agenda item (P = 0.006; P = 0.002), as were females and older participants. CONCLUSION Several agenda items for young adults with type 1 diabetes were identified and were more likely to be raised by those with elevated diabetes distress and anxiety symptoms. The DPAT is a valuable and convenient tool that can be easily applied in routine clinical practice to enable clinicians to understand the concerns of the young adult population and deliver personalised medicine to optimise long-term outcomes.
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Affiliation(s)
- Katherine Wyld
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
| | - Christel Hendrieckx
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Helen Barrett
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - Neisha D'Silva
- Queensland Diabetes and Endocrine Centre, Mater Hospital, Brisbane, Brisbane, Queensland, Australia
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Babbott KM, Serlachius A. Developing digital mental health tools for youth with diabetes: an agenda for future research. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1227332. [PMID: 37497385 PMCID: PMC10367007 DOI: 10.3389/fcdhc.2023.1227332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023]
Abstract
Youth living with diabetes face a concurrent challenge: managing a chronic health condition and managing the psychosocial and developmental changes that are characteristic of adolescence and young adulthood. Despite these unique challenges, psychological support is often difficult for youth with diabetes to access due to a lack of trained mental health professionals and other resource constraints. Digital wellbeing tools offer the potential to improve access to psychological support for this population. However, very few digital wellbeing tools exist for youth with diabetes. Of those that do exist, very few are evidence-based therapies, undermining their contribution to the field. Given the increasing global prevalence of diabetes in young people, the support necessitated by the challenges experienced by this population is not always accessible in a face-to-face setting and cannot be effectively scaled to meet demand. To support the health and wellbeing of youth with diabetes, there is a clear need to develop digital interventions that are widely accessible to users, but, more saliently, grounded in empirical evidence that supports their efficacy. Thus, the purpose of this paper is to offer an agenda for future research, including insights into which psychological techniques and behavioral change theories may be a good conceptual fit for digital mental health interventions, and how these tools may be best developed and utilized by the individuals that need them. Scalable, evidence-based wellbeing tools for this population are urgently required to improve psychological outcomes, and potentially, improve the equity of service access.
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Bruggeman BS, Walker AF, Peters AL, D’Avolio LW, Haller MJ. Blue Circle Health: A Novel Patient-Centered Model of Health Care Delivery for Low-Income Patients With Type 1 Diabetes. J Diabetes Sci Technol 2023; 17:925-934. [PMID: 36710449 PMCID: PMC10348005 DOI: 10.1177/19322968221149008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Analog insulins, insulin pumps, and continuous glucose monitors (CGM) have revolutionized type 1 diabetes (T1D) treatment over the last 50 years. Nevertheless, less than 20% of patients in the United States reach guideline-based HbA1c targets. The dysfunctional delivery of U.S. health care has further worsened glycemic outcomes among structurally disadvantaged groups such as non-Hispanic Black and low-income populations. Administrative complexities resulting from mixed insurance coverage and delivery systems, incongruity between effective policies and reimbursement, structural racism, and implicit biases have led to high diabetes care-related costs, provider scarcity and burnout, and patient diabetes distress. The Extension for Community Healthcare Outcomes (ECHO) Diabetes tele-education outreach model was created to increase self-efficacy among primary care providers through a combination of weekly didactic sessions led by a team of diabetes experts and access to community-based peer coaches. As an evolution of ECHO Diabetes, Blue Circle Health has been established as a philanthropically funded health care delivery system, using a whole-person, individualized approach to T1D care for adults living in underserved communities. The program will provide direct-to-patient telehealth services, including diabetes education, management, and related psychological care regardless of ability to pay. Community-based diabetes support coaches will serve as the primary point of contact, or guide on the "Blue Circle Health Member Journey." Access to needed insulins, supplies, and CGMs will be provided at no cost to the individual. Through a continuous learning and improvement model, a person-centered, equitable, accessible, and effective health care delivery model will be built for people living with T1D.
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Affiliation(s)
| | - Ashby F. Walker
- College of Public Health & Health Professions, University of Florida, Gainesville, FL, USA
| | - Anne L. Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
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Robinson DJ, Hanson K, Jain AB, Kichler JC, Mehta G, Melamed OC, Vallis M, Bajaj HS, Barnes T, Gilbert J, Honshorst K, Houlden R, Kim J, Lewis J, MacDonald B, MacKay D, Mansell K, Rabi D, Sherifali D, Senior P. Diabetes and Mental Health. Can J Diabetes 2023; 47:308-344. [PMID: 37321702 DOI: 10.1016/j.jcjd.2023.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
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Racey M, Whitmore C, Alliston P, Cafazzo JA, Crawford A, Castle D, Dragonetti R, Fitzpatrick-Lewis D, Jovkovic M, Melamed OC, Naeem F, Senior P, Strudwick G, Ramdass S, Vien V, Selby P, Sherifali D. Technology-Supported Integrated Care Innovations to Support Diabetes and Mental Health Care: Scoping Review. JMIR Diabetes 2023; 8:e44652. [PMID: 37159256 DOI: 10.2196/44652] [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: 11/28/2022] [Revised: 02/23/2023] [Accepted: 04/01/2023] [Indexed: 05/10/2023] Open
Abstract
BACKGROUND For individuals living with diabetes and its psychosocial comorbidities (eg, depression, anxiety, and distress), there remains limited access to interprofessional, integrated care that includes mental health support, education, and follow-up. Health technology, broadly defined as the application of organized knowledge or skill as software, devices, and systems to solve health problems and improve quality of life, is emerging as a means of addressing these gaps. There is thus a need to understand how such technologies are being used to support, educate, and help individuals living with co-occurring diabetes and mental health distress or disorder. OBJECTIVE The purpose of this scoping review was to (1) describe the literature on technology-enabled integrated interventions for diabetes and mental health; (2) apply frameworks from the Mental Health Commission of Canada and World Health Organization to elucidate the components, type, processes, and users of technology-enabled integrated interventions for diabetes and mental health; and (3) map the level of integration of interventions for diabetes and mental health. METHODS We searched 6 databases from inception to February 2022 for English-language, peer-reviewed studies of any design or type that used technology to actively support both diabetes and any mental health distress or disorder in succession or concurrently among people with diabetes (type 1 diabetes, type 2 diabetes, and gestational diabetes). Reviewers screened citations and extracted data including study characteristics and details about the technology and integration used. RESULTS We included 24 studies described in 38 publications. These studies were conducted in a range of settings and sites of care including both web-based and in-person settings. Studies were mostly website-based (n=13) and used technology for wellness and prevention (n=16) and intervention and treatment (n=15). The primary users of these technologies were clients and health care providers. All the included intervention studies (n=20) used technology for clinical integration, but only 7 studies also used the technology for professional integration. CONCLUSIONS The findings of this scoping review suggest that there is a growing body of literature on integrated care for diabetes and mental health enabled by technology. However, gaps still exist with how to best equip health care professionals with the knowledge and skills to offer integrated care. Future research is needed to continue to explore the purpose, level, and breadth of technology-enabled integration to facilitate an approach to overcome or address care fragmentation for diabetes and mental health and to understand how health technology can further drive the scale-up of innovative integrated interventions.
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Affiliation(s)
- Megan Racey
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Carly Whitmore
- School of Nursing, McMaster University, Hamilton, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Paige Alliston
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Joseph A Cafazzo
- Healthcare Human Factors, University Health Network, Toronto, ON, Canada
- eHealth Innovation, University Health Network, Toronto, ON, Canada
| | - Allison Crawford
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - David Castle
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | | | | | - Milos Jovkovic
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
| | - Osnat C Melamed
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Farooq Naeem
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Senior
- Clinical Islet Transplant Program, University of Alberta, Edmonton, AB, Canada
- Department of Medicine, Division of Endocrinology, University of Alberta, Edmonton, AB, Canada
| | - Gillian Strudwick
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Seeta Ramdass
- Diabetes Action Canada, Toronto, ON, Canada
- McGill University, Montreal, QC, Canada
| | - Victor Vien
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Selby
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Diana Sherifali
- McMaster Evidence Review and Synthesis Team, McMaster University, Hamilton, ON, Canada
- School of Nursing, McMaster University, Hamilton, ON, Canada
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McCarthy MM, Yan J, Jared MC, Ilkowitz J, Gallagher MP, Dickson VV. Time, Technology, Social Support, and Cardiovascular Health of Emerging Adults With Type 1 Diabetes. Nurs Res 2023; 72:185-192. [PMID: 37084321 PMCID: PMC10123545 DOI: 10.1097/nnr.0000000000000645] [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] [Indexed: 04/23/2023]
Abstract
BACKGROUND Emerging adults with Type 1 diabetes (T1DM) face an increased risk of cardiovascular disease; however, there are both barriers and facilitators to achieving ideal cardiovascular health in this stage of their lives. OBJECTIVES The aim of this study was to qualitatively explore the barriers and facilitators of achieving ideal levels of cardiovascular health in a sample of emerging adults with T1DM ages 18-26 years. METHODS A sequential mixed-methods design was used to explore achievement of ideal cardiovascular health using the seven factors defined by the American Heart Association (smoking status, body mass index, physical activity, healthy diet, total cholesterol, blood pressure, and hemoglobin A1C [substituted for fasting blood glucose]). We assessed the frequency of achieving ideal levels of each cardiovascular health factor. Using Pender's health promotion model as a framework, qualitative interviews explored the barriers and facilitators of achieving ideal levels of each factor of cardiovascular health. RESULTS The sample was mostly female. Their age range was 18-26 years, with a diabetes duration between 1 and 20 years. The three factors that had the lowest achievement were a healthy diet, physical activity at recommended levels, and hemoglobin A1C of <7%. Participants described lack of time as a barrier to eating healthy, being physically active, and maintaining in-range blood glucose levels. Facilitators included the use of technology in helping to achieve in-range blood glucose and social support from family, friends, and healthcare providers in maintaining several healthy habits. DISCUSSION These qualitative data provide insight into how emerging adults attempt to manage their T1DM and cardiovascular health. Healthcare providers have an important role in supporting these patients in establishing ideal cardiovascular health at an early age.
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Troncone A, Cascella C, Chianese A, Zanfardino A, Pizzini B, Iafusco D. Psychological consequences of the COVID-19 pandemic in people with type 1 diabetes: A systematic literature review. J Psychosom Res 2023; 168:111206. [PMID: 36913765 PMCID: PMC9972771 DOI: 10.1016/j.jpsychores.2023.111206] [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: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/25/2023] [Indexed: 03/02/2023]
Abstract
OBJECTIVE A comprehensive picture of the data on the impact of COVID-19 on the mental health of individuals with type 1 diabetes (T1D) is currently lacking. The purpose of this systematic review was to synthesize extant literature reporting on the effects of COVID-19 on psychological outcomes in individuals with T1D and to identify associated factors. METHODS A systematic search was conducted with PubMed, Scopus, PychInfo, PsycArticles, ProQuest, and WoS using a selection procedure according to the PRISMA methodology. Study quality was assessed using a modified Newcastle-Ottawa Scale. In all, 44 studies fulfilling the eligibility criteria were included. RESULTS Findings suggest that during the COVID-19 pandemic, people with T1D had impaired mental health, with relatively high rates of symptoms of depression (11.5-60.7%, n = 13 studies), anxiety (7-27.5%, n = 16 studies), and distress (14-86.6%, n = 21 studies). Factors associated with psychological problems include female gender, lower income, poorer diabetes control, difficulties in diabetes self-care behaviors, and complications. Of the 44 studies, 22 were of low methodological quality. CONCLUSIONS Taking appropriate measures to improve medical and psychological services is needed to support individuals with T1D in appropriately coping with the burden and difficulties caused by the COVID-19 pandemic and to prevent mental health problems from enduring, worsening, or having a long-term impact on physical health outcomes. Heterogeneity in measurement methods, lack of longitudinal data, the fact that most included studies did not aim to make a specific diagnosis of mental disorders limit the generalizability of the findings and have implications for practice.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy.
| | - Barbara Pizzini
- Department of Psychology, University of Campania "Luigi Vanvitelli", 81100, Viale Ellittico 31, Caserta, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138 Naples, Italy
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DeBoer MD, Valdez R, Corbett JP, Krauthause K, Wakeman CA, Luke AS, Oliveri MC, Cherñavvsky DR, Patek SD. Effect of an Automated Advice Algorithm (CloudConnect) on Adolescent-Parent Diabetes-Specific Communication and Glycemic Management: A Randomized Trial. Diabetes Ther 2023; 14:899-913. [PMID: 37027118 PMCID: PMC10080500 DOI: 10.1007/s13300-023-01401-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 03/22/2023] [Indexed: 04/08/2023] Open
Abstract
INTRODUCTION Because adolescence is a time of difficult management of Type 1 diabetes (T1D) in part from adolescent-parent shared responsibility of T1D management, our objective was to assess the effects of a decision support system (DSS) CloudConnect on T1D-related communication between adolescents and their parents and on glycemic management. METHODS We followed 86 participants including 43 adolescents with T1D (not on automated insulin delivery systems, AID) and their parents/care-giver for a 12-week intervention of UsualCare + CGM or CloudConnect, which included a Weekly Report of automated T1D advice, including insulin dose adjustments, based on data from continuous glucose monitors (CGM), Fitbit and insulin use. Primary outcome was T1D-specific communication and secondary outcomes were hemoglobin A1c, time-in-target range (TIR) 70-180 mg/dl, and additional psychosocial scales. RESULTS Adolescents and parents reported a similar amount of T1D-related communication in both the UsualCare + CGM or CloudConnect groups and had similar levels of final HbA1c. Overall blood glucose time in range 70-180 mg/dl and time below 70 mg/dl were not different between groups. Parents but not children in the CloudConnect group reported less T1D-related conflict; however, compared to the UsualCare + CGM group, adolescents and parents in the CloudConnect reported a more negative tone of T1D-related communication. Adolescent-parent pairs in the CloudConnect group reported more frequent changes in insulin dose. There were no differences in T1D quality of life between groups. CONCLUSIONS While feasible, the CloudConnect DSS system did not increase T1D communication or provide improvements in glycemic management. Further efforts are needed to improve T1D management in adolescents with T1D not on AID systems.
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Affiliation(s)
- Mark D. DeBoer
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
- Department of Pediatrics, University of Virginia, Charlottesville, VA USA
| | - Rupa Valdez
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA USA
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA USA
| | - John P. Corbett
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
| | - Katie Krauthause
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
| | - Christian A. Wakeman
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
| | - Alexander S. Luke
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
| | - Mary C. Oliveri
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
| | - Daniel R. Cherñavvsky
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA USA
| | - Stephen D. Patek
- Division of Pediatric Endocrinology and Center for Diabetes Technology, University of Virginia, School of Medicine, PO Box 800386, Charlottesville, VA 22908 USA
- Department of Engineering Systems and Environment, University of Virginia, Charlottesville, VA USA
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