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Mitchell AE, Morawska A, Lohan A, Filus A, Batch J. Randomised controlled trial of the Healthy Living Triple P-Positive Parenting Program for families of children with type 1 diabetes. J Child Health Care 2024; 28:235-255. [PMID: 35950339 DOI: 10.1177/13674935221116694] [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] [Indexed: 11/16/2022]
Abstract
This randomised controlled trial examined the efficacy of a brief, group-based parenting program in improving child and family outcomes for families of children with type 1 diabetes. Families (N = 50) of children (2-10 years) with type 1 diabetes were randomly allocated to intervention (n = 22) or care-as-usual (n = 28). Assessments (pre-intervention, post-intervention and 6-month follow-up) evaluated parent- and child-reported parenting behaviour, child behaviour/adjustment and child quality of life (primary outcomes); and metabolic control (routinely-collected blood glucose data), parents' self-efficacy with diabetes management, diabetes-specific child behaviour difficulties, family quality of life, parents' diabetes-related and general parenting stress and observed parent and child behaviour (secondary outcomes). Intent-to-treat analyses indicated greater rate of improvement over time for families allocated to intervention compared to care-as-usual for use of corporal punishment (primary caregivers only), and confidence with managing children's emotions/behaviours, parent-rated child quality of life and adjustment to the child's illness (secondary caregivers only). There were no other intervention effects. Although families found the intervention useful, low levels of psychosocial problems at baseline limited the scope for group-level improvement and there was limited evidence for intervention efficacy. Individually-tailored measures of goal-specific behaviour change may be considered in future research.
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Affiliation(s)
- Amy E Mitchell
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Alina Morawska
- Parenting and Family Support Centre, School of Psychology, The University of Queensland, Brisbane, QLD, Australia
| | - Aditi Lohan
- Institute for Social Science Research, The University of Queensland, Brisbane, QLD, Australia
| | - Ania Filus
- DaVita Clinical Research, San Antonio, TX, USA
| | - Jennifer Batch
- School of Medicine, The University of Queensland, Brisbane, QLD, Australia
- Queensland Children's Hospital, Brisbane, QLD, Australia
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Ellis D, Carcone AI, Templin T, Evans M, Weissberg-Benchell J, Buggs-Saxton C, Boucher-Berry C, Miller JL, Drossos T, Dekelbab MB. Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial. JMIR Diabetes 2024; 9:e55165. [PMID: 38593428 PMCID: PMC11040442 DOI: 10.2196/55165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes. OBJECTIVE Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths' glycemic control. METHODS We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period. RESULTS In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94%; P=.01) and 18-month follow-up (1.42%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up. CONCLUSIONS A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867.
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Affiliation(s)
- Deborah Ellis
- 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
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H Lurie Children's Hospital, 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 and Robert H Lurie Children's Hospital, 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
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Smudja M, Milenković T, Minaković I, Zdravković V, Javorac J, Milutinović D. Self-care activities in pediatric patients with type 1 diabetes mellitus. PLoS One 2024; 19:e0300055. [PMID: 38442115 PMCID: PMC10914259 DOI: 10.1371/journal.pone.0300055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 02/16/2024] [Indexed: 03/07/2024] Open
Abstract
INTRODUCTION Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics. METHODS This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data. RESULTS A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes. CONCLUSIONS Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes.
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Affiliation(s)
- Mirjana Smudja
- Department of Higher Medical School, Academy for Applied Studies Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
| | - Tatjana Milenković
- Department of Endocrinology, Mother and Child Health Care Institute of Serbia "Dr Vukan Čupić", Belgrade, Serbia
| | - Ivana Minaković
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Health Center Novi Sad, Novi Sad, Serbia
| | - Vera Zdravković
- University Children’s Hospital Belgrade, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Jovan Javorac
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Dragana Milutinović
- Department of Nursing, Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
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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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Sparapani VC, Petry ADS, Barber ROLB, Nascimento LC. Prototyping Process and Usability Testing of a Serious Game for Brazilian Children With Type 1 Diabetes. Comput Inform Nurs 2023; 41:941-948. [PMID: 37279040 DOI: 10.1097/cin.0000000000001030] [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: 06/07/2023]
Abstract
This study aims to describe the prototype development and testing of a serious game designed for Brazilian children with diabetes. Following an approach of user-centered design, the researchers assessed game's preferences and diabetes learning needs to develop a Paper Prototype. The gameplay strategies included diabetes pathophysiology, self-care tasks, glycemic management, and food group learning. Diabetes and technology experts (n = 12) tested the prototype during audio-recorded sessions. Next, they answered a survey to evaluate the content, organization, presentation, and educational game aspects. The prototype showed a high content validity ratio (0.80), with three items not achieving the critical values (0.66). Experts recommended improving the game content and food illustrations. This evaluation contributed to the medium-fidelity prototype version, which after testing with diabetes experts (n = 12) achieved high content validity values (0.88). One item did not meet the critical values. Experts suggested increasing the options of outdoor activities and meals. Researchers also observed and video-recorded children with diabetes (n = 5) playing the game with satisfactory interaction. They considered the game enjoyable. The interdisciplinary team plays an important role guiding the designers in the use of theories and real needs of children. Prototypes are a low-cost usability and a successful method for evaluating games.
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Affiliation(s)
- Valéria Cássia Sparapani
- Author Affiliations: Department of Nursing, Federal University of Santa Catarina, Federal University of Santa Catarina, Campus Universitário, Florianopolis (Dr Sparapani); and Federal University of Rio Grande do Norte/UFRN, Federal University of Rio Grande do Norte, Natal (Dr Petry), Brazil; Joslin Diabetes Center, Harvard Medical School and Institute for Nursing and Interprofessional Research, Children's Hospital Los Angeles, Children's Hospital Los Angeles, CA (Dr Barber); and Department of Maternal-Infant and Public Health Nursing, University of São Paulo at Ribeirão Preto College of Nursing, WHO Collaborating Center for Nursing Research Development, São Paulo, Brazil (Dr Nascimento)
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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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Ogilvie SJ, Beierwaltes P, Verchota G, Lee S, Eggenberger S. Family Interviews Inform School-based Nursing for Children with Type 1 Diabetes and their Families. J Sch Nurs 2023:10598405231170686. [PMID: 37098415 DOI: 10.1177/10598405231170686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023] Open
Abstract
The purpose of this study was to better understand the burden(s) associated with type 1 diabetes mellitus (T1DM) on school-aged youth and families and subsequently identify strategies school nurses can adopt to reduce the impact of this disease. Family interviews (n = 5 families, comprised of 15 individual participants) were conducted using a semi-structured interview guide to further explore family members' experiences with T1DM. Directed content analysis was employed for theme identification. Themes reflect individual and family struggles, the importance of teamwork within families, navigating barriers, and facing uncertainty. Select themes provided the impetus for the development of a school-based program directed toward youth and families with T1DM. Plans include developing educational content plus therapeutic conversations with a focus on communication, care coordination, cognition, problem-solving, and strength-building. An emphasis will be placed on participant-directed program content with peer support for youth with T1DM and family members.
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Affiliation(s)
- Sarah J Ogilvie
- School of Nursing, Minnesota State University - Mankato, Mankato, MN, USA
| | - Patricia Beierwaltes
- School of Nursing, Minnesota State University - Mankato, Mankato, MN, USA
- Health Commons at Pond, Bloomington, MN, USA
| | - Gwen Verchota
- School of Nursing, Minnesota State University - Mankato, Mankato, MN, USA
| | - Seonhwa Lee
- Department of Human Development and Family Science, Syracuse University, Syracuse, NY, USA
| | - Sandra Eggenberger
- MSU Graduate and Professional Education Center, Minnesota State University - Mankato, Edina, MN, USA
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Litchfield I, Barrett T, Hamilton-Shield JP, Moore THM, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Developments in the design and delivery of self-management support for children and young people with diabetes: A narrative synthesis of systematic reviews. Diabet Med 2023; 40:e15035. [PMID: 36576331 DOI: 10.1111/dme.15035] [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: 07/27/2022] [Revised: 11/22/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
AIMS Facilitated self-management support programmes have become central to the treatment of chronic diseases including diabetes. For many children and young people with diabetes (CYPD), the impact on glycated haemoglobin (HbA1c ) and a range of self-management behaviours promised by these programmes remain unrealised. This warrants an appraisal of current thinking and the existing evidence to guide the development of programmes better targeted at this age group. METHODS Create a narrative review of systematic reviews produced in the last 3 years that have explored the impact on CYPD of the four key elements of self-management support programmes: education, instruction and advice including peer support; psychological counselling via a range of therapies; self-monitoring, including diaries and telemetric devices; and telecare, the technology-enabled follow-up and support by healthcare providers. RESULTS Games and gamification appear to offer a promising means of engaging and educating CYPD. Psychological interventions when delivered by trained practitioners, appear to improve HbA1c and quality of life although effect sizes were small. Technology-enabled interactive diaries can increase the frequency of self-monitoring and reduce levels of HbA1c . Telecare provided synchronously via telephone produced significant improvements in HbA1c . CONCLUSIONS The cost-effective flexibility of increasing the reliance on technology is an attractive proposition; however, there are resource implications for digital connectivity in underserved populations. The need remains to improve the understanding of which elements of each component are most effective in a particular context, and how to optimise the influence and input of families, caregivers and peers.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Timothy Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
- Department of Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, UK
| | - Julian P Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- The Royal Hospital for Children in Bristol, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - T H M Moore
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK
- Queen Elizabeth Hospital, Birmingham, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, UK
| | - Suma Uday
- Department of Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Malo VF, Ritchwood TD, Hart LJ, Atujuna M. A qualitative analysis of family support for adolescent HIV care in South Africa. AIDS Care 2023; 35:425-430. [PMID: 36120906 PMCID: PMC10020124 DOI: 10.1080/09540121.2022.2121956] [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: 04/21/2021] [Accepted: 09/01/2022] [Indexed: 10/14/2022]
Abstract
Compared to other age groups, South African adolescents living with HIV (ALWH) have the lowest rates of retention in HIV care and medication adherence. While previous research suggests that familial social support may improve treatment retention and adherence within this population, we know little about the influence of differential types of social support on HIV-related outcomes. Thus, the purpose of this study is to qualitatively characterize the influence of type of familial social support on treatment retention and adherence among ALWH. We interviewed adolescents living with perinatally-acquired HIV (n = 20), their caregivers (n = 19), and community stakeholders (n = 20) in Cape Town, South Africa. Data were coded using deductive and inductive approaches to content analysis. We identified four types of familial social support: instrumental, appraisal, emotional, and informational support. Families provided instrumental support through logistical assistance, including transportation to appointments and pill reminders. Families also provided both emotional support and appraisal support, encouraging ALWH to adhere to their medication regimens by reflecting upon its importance to their futures. For informational support, families often educated ALWH about their HIV status and strategies for disease self-management. In characterizing familial social support, our findings highlight potential targets of future interventions to improve HIV-related outcomes among ALWH.
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Affiliation(s)
| | - Tiarney D. Ritchwood
- Duke Global Health Institute, Duke University, Durham, NC, US
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, US
| | - Lauren J. Hart
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC, US
| | - Millicent Atujuna
- Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
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Williford DN, Sweenie R, Ramsey RR, McGrady ME, Crosby LE, Modi AC. Diversity, Equity, and Inclusion within Pediatric Adherence Science. J Clin Psychol Med Settings 2022:10.1007/s10880-022-09922-4. [PMID: 36482056 PMCID: PMC9734315 DOI: 10.1007/s10880-022-09922-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 12/14/2022]
Abstract
Given the long-standing history of systemic racism in psychological science, diversity, equity, and inclusion (DEI) efforts are increasingly vital to the advancement and improvement of the field. This commentary extends the seminal work of the article Upending Racism in Psychological Science: Strategies to Change How Our Science is Conducted, Reported, Reviewed, and Disseminated (Buchanan et al., Am Psychol, https://doi.org/10.31234/osf.io/6nk4x , 2020) by providing tangible applications and recommendations to improve DEI integration into pediatric adherence science. Real-world adherence examples are discussed regarding the challenges faced in systematically integrating DEI principles, potential solutions to overcoming barriers, and the implications of these efforts on scientific advancement in an effort to address and dismantle research practices that perpetuate inequity and White supremacy. Specifically, we provide discourse and practical guidance related to the conduct, reporting, reviewing, and dissemination of pediatric adherence science to promote dialog and produce actionable change toward the promotion of health equity and social justice.
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Affiliation(s)
- Desireé N. Williford
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA
| | - Rachel Sweenie
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA
| | - Rachelle R. Ramsey
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Meghan E. McGrady
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Lori E. Crosby
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Avani C. Modi
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Center for Treatment Adherence and Self-Management, College of Medicine, University of Cincinnati, 3333 Burnet Ave. MLC 7039, Cincinnati, OH 45229 USA ,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH USA
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11
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de Wit M, Gajewska KA, Goethals ER, McDarby V, Zhao X, Hapunda G, Delamater AM, DiMeglio LA. ISPAD Clinical Practice Consensus Guidelines 2022: Psychological care of children, adolescents and young adults with diabetes. Pediatr Diabetes 2022; 23:1373-1389. [PMID: 36464988 PMCID: PMC10107478 DOI: 10.1111/pedi.13428] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Affiliation(s)
- Maartje de Wit
- Amsterdam UMC, Vrije Universiteit Amsterdam, Medical Psychology, Amsterdam Public Health, Amsterdam, Netherlands
| | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland.,School of Public Health, University College Cork, Cork, Ireland
| | | | | | - Xiaolei Zhao
- The Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Given Hapunda
- Department of Psychology, University of Zambia, Lusaka, Zambia
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Linda A DiMeglio
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Riley Hospital for Children, Indianapolis, Indiana, USA
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12
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Rankin D, Kimbell B, Hovorka R, Lawton J. Adolescents' and their parents' experiences of using a closed-loop system to manage type 1 diabetes in everyday life: qualitative study. Chronic Illn 2022; 18:742-756. [PMID: 33472409 PMCID: PMC9643806 DOI: 10.1177/1742395320985924] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Type 1 diabetes can have life-shattering consequences for adolescents and parents. A closed-loop system is a cutting-edge technology which automatically regulates glucose to reduce the burden of diabetes management. We explored adolescents' and parents' experiences of using this technology to understand how it affects their biographies and everyday lives. METHODS In-depth interviews with 18 adolescents newly diagnosed with type 1 diabetes and 21 parents after ≥12 months experience using closed-loop technology. Data were analysed thematically. RESULTS Participants reported very few disruptions to their lives when using a closed-loop. Reports of family conflict were minimal as the closed-loop enabled dietary flexibility and glucose levels to be checked effortlessly. Adolescents described doing 'normal' activities without worrying about high/low glucose, and parents reported allowing them to do so unsupervised because the closed-loop would regulate their glucose and keep them safe. Some adolescents expressed concerns about the visibility of components and, to avoid stigma, described curtailing activities such as swimming. Participants described how the closed-loop enabled adolescents to be in control of, or create distance from, diabetes. DISCUSSION The closed-loop has life-enhancing consequences for both adolescents and parents and helps to reduce the biographical disruption of type 1 diabetes in this age group.
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Affiliation(s)
- D Rankin
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - B Kimbell
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - R Hovorka
- Wellcome Trust - Medical Research Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - J Lawton
- Usher Institute, University of Edinburgh, Edinburgh, UK
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13
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Cheung MC, Law D, Yip J, Cheung JPY. Adolescents' Experience during Brace Treatment for Scoliosis: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10585. [PMID: 36078297 PMCID: PMC9517878 DOI: 10.3390/ijerph191710585] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 08/19/2022] [Accepted: 08/22/2022] [Indexed: 06/15/2023]
Abstract
This study aimed to explore the subjective experiences of adolescents with scoliosis during brace treatment in order to understand their obstacles and make recommendations to enhance brace compliance. Using purposive sampling, 15 adolescents (2 males and 13 females) with scoliosis aged from 10 to 16 years old during brace treatment were recruited to participate in semi-structured in-depth interviews. The data were recorded, transcribed, and coded using thematic analysis with the qualitative software NVivo 10. Significant statements and phrases were organized into categories and themes to understand adolescents' experiences during brace treatment for scoliosis. In general, the adolescents acknowledged that compliance with brace treatment was essential to reduce or prevent the progression of spinal curvature and tried their best to comply with the treatment. Regarding their subjective experiences during brace treatment, three themes were identified and emerged as obstacles negatively affecting their brace compliance, including physical discomfort due to brace materials and design, reluctance caused by the brace's visual appearance, and passive patient participation during the treatment process. This study reveals insights into the experiences of adolescents with scoliosis during brace treatment and what they perceive as hindrances to compliance. In order to have better brace compliance, adolescents' feelings and difficulties during brace treatment should be recognized and addressed. Therefore, active patient participation throughout the treatment process, involving the co-design of a customized brace, psychosocial interventions, and personalized appearance style management should be considered and promoted to facilitate a more acceptable bracing experience to achieve better brace compliance.
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Affiliation(s)
- Mei-Chun Cheung
- Department of Social Work, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, China
| | - Derry Law
- Department of Design, Caritas Institute of Higher Education and Caritas Bianchi College of Careers, Tseung Kwan O, New Territories, Hong Kong SAR, China
| | - Joanne Yip
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
| | - Jason Pui Yin Cheung
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China
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14
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Kavookjian J, LaManna JB, Davidson P, Davis JW, Fahim SM, McDaniel CC, Ekong G, Todd A, Yehl K, Cox C. Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes. Sci Diabetes Self Manag Care 2022; 48:406-436. [PMID: 35899815 DOI: 10.1177/26350106221115450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). METHODS A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists' ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. RESULTS Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. CONCLUSION To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.
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Affiliation(s)
- Jan Kavookjian
- Auburn University Harrison College of Pharmacy, Auburn University, Auburn, Alabama
| | | | | | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, Florida
| | | | - Cassidi C McDaniel
- Auburn University Harrison College of Pharmacy, Auburn University, Auburn, Alabama
| | - Gladys Ekong
- Western New England University, Springfield, Massachusetts
| | - Andrew Todd
- College of Nursing, University of Central Florida, Orlando, Florida
| | - Kirsten Yehl
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
| | - Carla Cox
- Mountain Vista Medicine, South Jordan, Utah
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15
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Neyra Marklund I, Rullander AC, Lindberg K, Ringnér A. Initial Education for Families with Children Diagnosed with Type 1 Diabetes: Consensus from Experts in a Delphi Study. Compr Child Adolesc Nurs 2022. [DOI: 10.1080/24694193.2022.2033351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Affiliation(s)
- Isabel Neyra Marklund
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Anna-Clara Rullander
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Karolina Lindberg
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
| | - Anders Ringnér
- Department of Nursing and Clinical Department of Paediatrics, Umeå University, Umeå, Sweden
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16
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Tseretopoulou X, Viswanath V, Hartnell S, Ware J, Thankamony A, Webb EA, Hysted H, Ashford J, Hendriks E, Teoh Y, Williams RM. Safe and effective use of a hybrid closed-loop system from diagnosis in children under 18 months with type 1 diabetes. Pediatr Diabetes 2022; 23:90-97. [PMID: 34820972 DOI: 10.1111/pedi.13292] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 10/07/2021] [Accepted: 11/15/2021] [Indexed: 11/30/2022] Open
Abstract
The management of type 1 diabetes in infancy presents significant challenges. Hybrid closed loop systems have been shown to be effective in a research setting and are now available for clinical use. There are relatively little reported data regarding their safety and efficacy in a real world clinical setting. We report two cases of very young children diagnosed with type 1 diabetes at ages 18 (Case 1) and 7 months (Case 2), who were commenced on hybrid closed-loop insulin delivery using the CamAPS FX™ system from diagnosis. At diagnosis, total daily dose (TDD) was 6 and 3.3 units for Case 1 and 2, respectively. Closed loop was started during the inpatient stay and weekly follow up was provided via video call on discharge. Seven months from diagnosis, Case 1 has an HbA1C of 49 mmol/mol, 61% time in range (TIR, 3.9-10 mmol/L) with 2% time in hypoglycemia (<3.9 mmol/L) with no incidents of very low blood glucose (BG; <3 mmol/L, 54 mg/dL) over 6 months. Given the extremely small TDD of insulin in Case 2, we elected to use diluted insulin (insulin aspart injection, NovoLog, Novo Nordisk Inc., Plainsboro, NJ, Diluting Medium for NovoLog®). Six months from diagnosis, the estimated HbA1c is 50 mmol/mol, TIR 76% with 1% hypoglycemia and no incidents of very low BG (<3 mmol/L, 54 mg/dL) over 6 months. We conclude that the use hybrid closed-loop can be safe and effective from diagnosis in children under 2 years of age with type 1 diabetes.
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Affiliation(s)
- Xanthippi Tseretopoulou
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Vidya Viswanath
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Sara Hartnell
- Wolfson Diabetes and Endocrine Clinic, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Julia Ware
- Wellcome Trust-MRC Institute of Metabolic Science, University of Cambridge, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Ajay Thankamony
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Emma A Webb
- Department of Paediatric Endocrinology and Diabetes, Norfolk and Norwich University Hospital, Norwich, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
| | - Helen Hysted
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Jennifer Ashford
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Emile Hendriks
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK.,Department of Paediatrics, University of Cambridge, Cambridge, UK
| | - Yun Teoh
- Pharmacy Department, Cambridge University Hospitals NHS Trust, Cambridge, UK
| | - Rachel M Williams
- Department of Paediatric Endocrinology and Diabetes, Cambridge University Hospitals NHS Trust, Cambridge, UK
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17
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Supervising Without Controlling: A New Authority intervention for Adolescents with Type 1 Diabetes. JOURNAL OF CHILD AND FAMILY STUDIES 2022. [DOI: 10.1007/s10826-021-02186-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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18
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Does Type of Social Support Influence Medication Adherence Among South African Adolescents Living With HIV? A Quantitative Analysis of Pilot Data. J Assoc Nurses AIDS Care 2022; 33:492-498. [PMID: 35034084 PMCID: PMC9246954 DOI: 10.1097/jnc.0000000000000325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
ABSTRACT Adolescents living with HIV often experience worse medication adherence than older and younger individuals living with HIV. One factor that may mitigate poor adherence is social support. However, few studies have examined the influence of specific social support constructs on HIV outcomes like medication adherence. In response to this gap, we performed bivariate analyses using data from 104 adolescents living with HIV in Cape Town, South Africa to understand the relationship between three types of social support (emotional, informational, and instrumental support) and four HIV-related outcomes: adherence self-efficacy, last recorded CD4+ count, last recorded viral load, and adherence to clinic appointments in the past year. We found small positive associations between two social support types (emotional and informational support) and adherence self-efficacy, with no other statistically significant associations. In light of our small sample size, future studies should seek to understand the differential effects of specific types of social support on HIV-related outcomes to better inform interventions for adolescents living with HIV.
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Abstract
Millions of children and adolescents are living with a chronic condition. It is common for mental and behavioral health challenges to arise during their courses of illness. With the complexity of care needed, pediatric subspecialty providers have recognized the need to integrate behavioral health interventions into practice. Continued research in this area has allowed for focused behavioral interventions, particularly in diabetes and asthma. Adult congenital heart programs have adapted a similar model of care and have shown promising success in promotion of health. More established programs have been in existence for childhood cancer and cystic fibrosis.
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Affiliation(s)
- Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA.
| | - Gordon Liu
- Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, MI 49008-1284, USA
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20
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Vesco AT, Howard KR, Anderson LM, Papadakis JL, Hood KK, Weissberg-Benchell J. Examining Indirect Effects of Anxiety on Glycated Hemoglobin via Automatic Negative Thinking and Diabetes-Specific Distress in Adolescents With Type 1 Diabetes. Can J Diabetes 2021; 45:473-480. [PMID: 34176611 DOI: 10.1016/j.jcjd.2021.05.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 05/03/2021] [Accepted: 05/04/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVES In this study, we examined the indirect effects of anxiety on glycated hemoglobin (A1C) via automatic negative thinking and diabetes distress among adolescents with type 1 diabetes (T1D) during the follow-up interval of a randomized controlled trial of an intervention targeting resilience promotion/depression prevention. METHODS Adolescents (N=264) participating in the Supporting Teen Problem Solving clinical trial were included and assessed at 8, 12, 16 and 28 months postbaseline. A serial, double-mediation model was used to examine path effects from anxiety to A1C through automatic negative thinking, through diabetes distress and through both automatic negative thinking and diabetes distress. Relevant demographic and clinical covariates were included. RESULTS Anxiety significantly predicted increases in both automatic negative thinking and diabetes distress. Automatic negative thinking was not found to mediate the association between anxiety and A1C, but diabetes distress did mediate the association. The double-mediation path through automatic negative thinking and diabetes distress together was significant. The indirect effect of anxiety on A1C through diabetes distress was significant and greater than the indirect effect of the double-mediator path. Anxiety did not predict A1C independent of its effects on automatic negative thinking and diabetes distress. Inclusion of demographic covariates did not substantively change the results. CONCLUSIONS Analyses suggest that automatic negative thinking and diabetes distress mediate the relationship between anxiety and A1C among adolescents with T1D. Diabetes distress appears to be a robust factor linking anxiety to A1C. Diabetes distress should be further examined as a mediator of glycemic variability in anxious youth with T1D.
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Affiliation(s)
- Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States.
| | - Kelsey R Howard
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Lindsay M Anderson
- Department of Psychology, Barrow Neurological Institute, Phoenix Children's Hospital, Phoenix, Arizona, United States
| | - Jaclyn L Papadakis
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California, United States
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States; Department of Psychiatry & Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
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21
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Velloza J, Kapogiannis B, Bekker LG, Celum C, Hosek S, Delany-Moretlwe S, Baggaley R, Dalal S. Interventions to improve daily medication use among adolescents and young adults: what can we learn for youth pre-exposure prophylaxis services? AIDS 2021; 35:463-475. [PMID: 33252486 PMCID: PMC7855564 DOI: 10.1097/qad.0000000000002777] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 10/30/2020] [Accepted: 11/09/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Oral pre-exposure prophylaxis (PrEP) is an important HIV prevention method and studies have shown that young people ages 15-24 have difficulty adhering to daily PrEP. The field of PrEP delivery for young people is relatively nascent and lessons about potential PrEP adherence interventions could be learned from the larger evidence base of adherence interventions for other daily medications among youth. DESIGN Systematic review of adherence support interventions for adolescents. METHODS We searched PubMed, CINAHL, EMBASE, and PsycINFO through January 2020 for oral contraceptive pill (OCP), antiretroviral therapy (ART), asthma, and diabetes medication adherence interventions. We reviewed primary articles about OCP adherence interventions and reviewed systematic reviews for ART, asthma, and diabetes medication adherence interventions. Studies were retained if they included participants' ages 10-24 years; measured OCP, ART, asthma, or diabetes medication adherence; and were systematic reviews, randomized trials, or quasi-experimental studies. RESULTS Fifteen OCP articles and 26 ART, diabetes, and asthma systematic reviews were included. Interventions that improved medication adherence for OCPs, ART, asthma, and diabetes treatment included reminder text messages, computer-based and phone-based support, and enhanced counseling. Multi-month prescriptions and same-day pill starts also were found to improve OCP adherence and continuation. Adolescent-friendly clinics and peer-based counseling significantly improved ART adherence, and telemedicine interventions improved diabetes medication adherence. CONCLUSION Interventions that improve medication adherence among youth include enhanced counseling, extended pill supply, adolescent-friendly services, and text message reminders. PrEP programs could incorporate and evaluate such interventions for their impact on PrEP adherence and continuation among at-risk adolescents.
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Affiliation(s)
- Jennifer Velloza
- Department of Global Health, University of Washington, Seattle, Washington
| | - Bill Kapogiannis
- Maternal and Pediatric Infectious Disease Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Linda-Gail Bekker
- The Desmond Tutu HIV Centre, University of Cape Town, Cape Town, South Africa
| | - Connie Celum
- Department of Global Health, University of Washington, Seattle, Washington
- Department of Medicine, University of Washington, Seattle, Washington
| | - Sybil Hosek
- Department of Psychiatry, Stroger Hospital of Cook County, Chicago, Illinois, USA
| | - Sinead Delany-Moretlwe
- Wits Reproductive Health and HIV Institute (Wits RHI), Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Rachel Baggaley
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
| | - Shona Dalal
- Global HIV, Hepatitis and STIs Programmes, World Health Organization, Geneva, Switzerland
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22
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Sanjari M, Peyrovi H, Mehrdad N. The Process of Managing the Children with Type 1 Diabetes in the Family: A Grounded Theory Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:25-33. [PMID: 33954095 PMCID: PMC8074732 DOI: 10.4103/ijnmr.ijnmr_5_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 08/02/2020] [Accepted: 08/23/2020] [Indexed: 11/04/2022]
Abstract
Background: Diabetes is a disease that affects all family members. Parents of children with type 1 diabetes are always concerned about all aspects of children's life. The aim of this study was to elucidate the process of managing children with diabetes in the family. Materials and Methods: This is a qualitative grounded theory of a doctoral dissertation, which was done on 2016. The 18 participants were selected through purposive and theoretical sampling until data saturation. The main participants in this study included parents, siblings, and children with type 1 diabetes. The data was gathered by semi-structured interviews as well as field notes and memos. Data analysis was done concurrently with data collection in four levels, including data analysis for concept and contex, bringing the process into the analysis, and integration of categories according to Corbin and Struss (2008). Core category appeared at the end of integrated categories. Results: “The family with diabetes in the child's diabetes orbit” as a core category contains the process of managing children with diabetes within the family, which included three main subcategories, including “entering into the diabetes orbit”, “movement into the diabetes orbit”, and “living into the diabetes orbit”. Conclusions: The family through the concept of “The family with diabetes in the child's diabetes orbit “as a main concern of families with diabetes suffering diabetes attempt to select and practicing appropriate strategies and manage diabetes and children with diabetes.
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Affiliation(s)
- Mahnaz Sanjari
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hamid Peyrovi
- Department of Critical Care Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Neda Mehrdad
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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23
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Pedrinho LR, Shibukawa BMC, Rissi GP, Uema RTB, Merino MDFGL, Higarashi IH. THERAPEUTIC TOY IN PRIMARY CARE: CONTRIBUTIONS FOR THE SYSTEMATIZATION OF NURSING CARE. TEXTO & CONTEXTO ENFERMAGEM 2021. [DOI: 10.1590/1980-265x-tce-2020-0616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the role of the therapeutic toy as a tool for the nursing diagnosis in the setting of care for the child with diabetes. Method: a qualitative multiple-case study conducted with children diagnosed with Type 1 Diabetes mellitus and living in the inland of Paraná. The data were collected in 2018 through interviews, field diary and sessions using the therapeutic toy. Nursing diagnoses were elaborated according to the North American Nursing Diagnosis Association Taxonomy I and a targeted content analysis was performed, resulting in four categories. Results: using the dramatic therapeutic toy allows the child to show their perception of the disease and of the care provided. The sessions with the dramatic therapeutic toy made it possible to identify five nursing diagnoses, which were later worked on by means of an instructional therapeutic toy. Conclusion: systematization of assistance mediated by the use of the toy allows nurses to establish bonds with the child with diabetes and their family, revealing their perceptions of the disease and treatment, thereby stimulating a more active participation of the binomial in the management of this coping process.
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Pedrinho LR, Shibukawa BMC, Rissi GP, Uema RTB, Merino MDFGL, Higarashi IH. Brinquedo terapêutico para crianças com Diabetes Mellitus tipo I: intervenções no domicílio. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo Objetivo Descrever o uso do brinquedo terapêutico no cuidado domiciliar de crianças com Diabetes Mellitus tipo 1. Método Estudo qualitativo do tipo Estudo de Caso, realizado com crianças com diagnóstico de Diabetes Mellitus tipo 1, residentes no interior do Paraná. Os dados foram coletados em 2018, por meio de entrevista com as mães, sessões de brinquedo terapêutico com as crianças e anotações no diário de campo. A análise dos dados foi realizada seguindo os preceitos da análise de conteúdo. Resultados As crianças simularam situações cotidianas com o brinquedo terapêutico com naturalidade, evidenciando que cuidados com a glicemia e aplicação da insulina fazem parte da rotina. Contudo, demonstram sinais de insatisfação com a própria saúde, traçando comparações com crianças que não apresentam a doença e demonstrando suas angústias quando submetidas a procedimentos dolorosos. Conclusão A utilização do brinquedo terapêutico permitiu a abertura de um canal efetivo de comunicação entre criança e profissional, possibilitando ao pesquisador compreender a percepção das crianças sobre sua condição de saúde e desenvolver orientações e cuidados direcionados. Implicações para a prática Ao utilizar o brinquedo terapêutico, recurso de intervenção na assistência de enfermagem, como tecnologia de cuidado, amplia-se as possibilidades de atuação da enfermagem pediátrica, auxiliando crianças em condições crônicas.
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Marchetta CM, Maruyama R, Galifi L, O'Reilly C. Evaluating a multidisciplinary inpatient program for youth with type 1 diabetes mellitus. Pediatr Diabetes 2020; 21:1232-1239. [PMID: 32558988 DOI: 10.1111/pedi.13068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 05/20/2020] [Accepted: 06/10/2020] [Indexed: 01/22/2023] Open
Abstract
Among youth with type 1 diabetes mellitus (T1D), older adolescents demonstrate more dysglycemia and less adherence to disease management. Poor disease management during this time of development can continue into adulthood, perpetuating the economic and health burden to the individual, health care system and society. This study aimed to evaluate the effectiveness of an inpatient multidisciplinary approach to treating youth with T1D. All T1D admissions to the 4 week Chronic Illness Management Program (CIMP) between 1 January 2016 and 31 December 2017 were eligible for inclusion. Data related to physiological and psychosocial outcomes were compared between admission and discharge. Follow-up data, including hemoglobin A1c (HbA1c), psychosocial measures, and health care utilization, were collected at 3, 6, and 12 months after discharge to assess sustained changes. Fifty-seven T1D admissions were included in the sample. There was a significant reduction in mean HbA1c from admission (11.1%/98 mmol/mol) to discharge (9.1%/76 mmol/mol). Patients also demonstrated significant improvements in all psychosocial outcome measures. Improvements in HbA1c were sustained at 3 months follow-up; however, average values returned to baseline by 6 months follow-up. In contrast to preadmission history, the majority of the sample reported reduced crisis health care utilization 1 year after discharge. The inpatient setting provides an intensive treatment model for diabetes management that promotes sustainable behavior change 3 months after discharge. While additional community supports are needed for long-term improvement, this program model may benefit patients who have been unable to manage their diabetes with outpatient treatment and therapy alone.
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Affiliation(s)
| | | | - Lauren Galifi
- Children's Specialized Hospital, New Brunswick, New Jersey, USA
| | - Colin O'Reilly
- Children's Specialized Hospital, New Brunswick, New Jersey, USA
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Galler A, Hilgard D, Bollow E, Hermann T, Kretschmer N, Maier B, Mönkemöller K, Schiel R, Holl RW. Psychological care in children and adolescents with type 1 diabetes in a real-world setting and associations with metabolic control. Pediatr Diabetes 2020; 21:1050-1058. [PMID: 32506592 DOI: 10.1111/pedi.13065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 04/13/2020] [Accepted: 05/27/2020] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND International guidelines recommend psychosocial care for children and adolescents with type 1 diabetes. OBJECTIVE To assess psychological care in children and adolescents with type 1 diabetes in a real-world setting and to evaluate associations with metabolic outcome. METHODS Delivery of psychological care, HbA1c, and rates of severe hypoglycemia and diabetic ketoacidosis (DKA) in children and adolescents with type 1 diabetes from 199 diabetes care centers participating in the German diabetes survey (DPV) were analyzed. RESULTS Overall, 12 326 out of 31 861 children with type 1 diabetes were supported by short-term or continued psychological care (CPC). Children with psychological care had higher HbA1c (8.0% vs 7.7%, P<.001) and higher rates of DKA (0.032 vs 0.021 per patient-year, P<.001) compared with children without psychological care. In age-, sex-, diabetes duration-, and migratory background-matched children, HbA1c stayed stable in children supported by CPC during follow-up (HbA1c 8.5% one year before psychological care started vs 8.4% after two years, P = 1.0), whereas HbA1c was lower but increased significantly by 0.3% in children without psychological care (HbA1c 7.5% vs 7.8% after two years, P <.001). Additional HbA1c-matching showed that the change in HbA1c during follow-up was not different between the groups, but the percentage of children with severe hypoglycemia decreased from 16.3% to 10.7% in children receiving CPC compared with children without psychological care (5.5% to 5.8%, P =.009). CONCLUSIONS In this real-world setting, psychological care was provided to children with higher HbA1c levels. CPC was associated with stable glycemic control and less frequent severe hypoglycemia during follow-up.
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Affiliation(s)
- Angela Galler
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Paediatric Endocrinology and Diabetology, Berlin, Germany
| | | | - Esther Bollow
- Institute for Epidemiology und Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
| | - Thomas Hermann
- Fachklinik Prinzregent Luitpold Scheidegg, Rehaklinik für Kinder und Jugendliche, Pädiatrische Diabetologie, Scheidegg, Germany
| | - Nicole Kretschmer
- AKK-Altonaer Kinderkrankenhaus gGmbH, Subsidiary of Universitätsklinikum Hamburg-Eppendorf (UKE), Paediatric Diabetology and Endocrinology and Child and Adolescent Psychiatry and Psychosomatics, Hamburg, Germany
| | - Berthold Maier
- Diabetes-Klinik Bad Mergentheim GmbH & Co. KG Bad Mergentheim, Kinder- und Jugend-Diabetologie, Bad Mergentheim, Germany
| | - Kirsten Mönkemöller
- Kliniken Köln, Kinderkrankenhaus Amsterdamer Straße, Klinik für Kinder- und Jugendmedizin, Pädiatrische Diabetologie, Köln, Germany
| | - Ralf Schiel
- MEDIGREIF Inselklinik Heringsdorf GmbH, Fachklinik für Kinder und Jugendliche, Heringsdorf, Germany
| | - Reinhard W Holl
- Institute for Epidemiology und Medical Biometry, ZIBMT, University Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Munich, Germany
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Ayar D, Gürkan KP, Bektas M, Böber E, Abaci A. Psychometric properties of a Turkish version of the Collaborative Parent Involvement Scale for youths with type 1 diabetes. CURRENT PSYCHOLOGY 2020. [DOI: 10.1007/s12144-020-00868-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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28
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Schiaffini R, Barbetti F, Rapini N, Inzaghi E, Deodati A, Patera IP, Matteoli MC, Ciampalini P, Carducci C, Lorubbio A, Schiaffini G, Cianfarani S. School and pre-school children with type 1 diabetes during Covid-19 quarantine: The synergic effect of parental care and technology. Diabetes Res Clin Pract 2020; 166:108302. [PMID: 32623034 PMCID: PMC7332425 DOI: 10.1016/j.diabres.2020.108302] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/09/2020] [Accepted: 06/29/2020] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Management of Type 1 Diabetes (T1D) poses numerous challenges, especially for young children and their families. Parental care positively influencesthe outcomesofchildren with T1D, while there are often criticisms in school environment. The COVID-19 pandemic has forced children and parents to spend many hours at home and diabetes care has returned mainly in the hands of parents. AIM OF THE STUDY To evaluate the effectiveness of exclusive return to parental care in pre-school and school children with T1D treated with Tandem Basal IQ system during the COVID-19 pandemic. PATIENTS AND METHODS 22 children (M:F = 14:8) with T1D have been evaluated. We compared insulin and CGM data (TIR, TBR and TAR) of two periods: PRE-COV and IN-COV, in which children have transitioned from normal school attendance to the exclusive care of their parents. RESULTS During the IN-COV period a significantly (p < 0.001) higher median value of TIR (66,41%) was observed as compared to PRE-COV period (61,45%). Patients also showed a statistically significant difference (p < 0.002) between the IN-COV period and the PRE-COV period as concerning the TAR metric: respectively 29,86 ± 10,6% vs 34,73 ± 12,8%. The difference between the bolus insulin doses was statistically significant (PRE-COV 5,3 IU/day, IN-COV 7,9 IU/day - p < 0.05). CONCLUSION Our observational real-life study confirms the positive effect of parental care in T1D very young children and demonstrates that during the COVID-19 pandemic it was possible to obtain a good glycometabolic compensation despite the significant change in lifestyle.
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Affiliation(s)
- Riccardo Schiaffini
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy.
| | - Fabrizio Barbetti
- Department of Experimental Medicine, Tor Vergata University, Rome, Italy
| | - Novella Rapini
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Elena Inzaghi
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Annalisa Deodati
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Ippolita P Patera
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Maria C Matteoli
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Paolo Ciampalini
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Chiara Carducci
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Antonella Lorubbio
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy
| | - Gabriele Schiaffini
- Department of Translational and Precision Medicine, Sapienza University of Rome, Italy
| | - Stefano Cianfarani
- Dipartimento Pediatrico Universitario Ospedaliero "Bambino Gesù" Children's Hospital - Tor Vergata University, Rome, Italy; Department of Women's and Children's Health, Karolinska Institutet and University Hospital, Stockholm, Sweden
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La Banca RO, Brandão MCDM, Sparapani VDC, de Souza NS, Neves ET, Cavicchioli MGS, de Lima RAG, Nascimento LC. A Fun Way to Learn About Diabetes: Using Therapeutic Play in a Brazilian Camp. J Pediatr Nurs 2020; 53:e35-e40. [PMID: 32063429 DOI: 10.1016/j.pedn.2020.02.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 02/04/2020] [Accepted: 02/05/2020] [Indexed: 01/05/2023]
Abstract
PURPOSE Understanding disease mechanisms inside the body is crucial to engage youth with type 1 diabetes (T1D) in self-care behaviors. This study describes how Instructional Therapeutic Play (ITP) group sessions held by nurses in a Brazilian camp can enhance youth's understanding about T1D. DESIGN AND METHODS Youth with T1D participated in video recorded ITP group sessions guided by the Sensitive Creative Method. First, participants were asked to create an artistic production based upon the query "What happens in the body of a young person who has diabetes?". They described their drawings and shared information, providing opportunities to discuss T1D pathophysiology. Second, campers were told a story about a child who had T1D onset using a rag doll and illustrative figures. Participants were asked to create a second artistic production based upon the same initial query. Finally, campers had another presentation of the drawings, discussion, and sharing through the question "How did the story told help you understand your diabetes?" Transcriptions of ITP sessions were submitted to thematic analysis. RESULTS Twenty participants (9-17yo) were assigned to age/gender matched groups. Four themes were built: Designing insulin production; Experiencing the glycemic vigilance in diabetes management; The ITP session as a safe space to share challenges with nurses and peers; and Unraveling the myths of diabetes with the ITP session. CONCLUSION Therapeutic play sessions enhanced youth's knowledge and unraveled myths of T1D pathophysiology. PRACTICE IMPLICATIONS ITP sessions can be developed by nurses in order to deliver age-appropriate diabetes education to pediatric patients.
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Affiliation(s)
| | - Maria Carolina de Moraes Brandão
- University of São Paulo at Ribeirão Preto College of Nursing, Maternal-Infant and Public Health Nursing Department, Ribeirão Preto, SP, Brazil
| | | | - Neila Santini de Souza
- Federal University of Santa Maria, Department of Health Sciences, Palmeira das Missões, Brazil
| | | | | | - Regina Aparecida Garcia de Lima
- University of São Paulo at Ribeirão Preto College of Nursing, Maternal-Infant and Public Health Nursing Department, Ribeirão Preto, SP, Brazil
| | - Lucila Castanheira Nascimento
- University of São Paulo at Ribeirão Preto College of Nursing, Maternal-Infant and Public Health Nursing Department, Ribeirão Preto, SP, Brazil
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30
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McGill DE, Laffel LM, Volkening LK, Butler DA, Levy WL, Wasserman RM, Anderson BJ. Text Message Intervention for Teens with Type 1 Diabetes Preserves HbA1c: Results of a Randomized Controlled Trial. Diabetes Technol Ther 2020; 22:374-382. [PMID: 32357109 PMCID: PMC7196367 DOI: 10.1089/dia.2019.0350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aims: Teens with type 1 diabetes (T1D) often struggle with diabetes self-management, which may lead to suboptimal self-care and worsening hemoglobin A1c (HbA1c). Innovative strategies are needed to improve self-care and protect against glycemic decline, especially during adolescence. We aimed to assess the impact on HbA1c of two interventions, problem-solving and text messaging, in teens with T1D. Methods: In a two-site randomized controlled trial, teens (N = 301) 13-17 years of age with T1D were randomized to one of the four groups using a 2 × 2 factorial design: Teenwork (TW), Text Messaging (Text), TW+Text, or Usual Care. TW intervention included problem-solving aimed at improving T1D self-care for blood glucose (BG) monitoring and insulin bolus dosing. Text intervention involved text reminders to check BG. The primary outcome was change in HbA1c from baseline to 12 months. Results: At baseline, teens (51% female, 78% white, 59% pump-treated) were (mean ± SD) 15.0 ± 1.3 years, had diabetes duration of 6.5 ± 3.7 years, and HbA1c 8.5% ± 1.1%. There was no significant difference in HbA1c over time by study group. Responsiveness to text reminders by teens in the TEXT and TW+TEXT predicted glycemic benefit; TW did not. Conclusions: Despite no HbA1c difference by study group, greater response to text message reminders to check BG led to better glycemic control and no deterioration in HbA1c; the problem-solving intervention did not. Given the high penetration of mobile phones and the wide acceptance of text messaging among teens in general, it is encouraging that a text messaging intervention can preserve HbA1c, thus preventing the expected deterioration in glycemic control often seen in teens with T1D.
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Affiliation(s)
- Dayna E. McGill
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Lori M. Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Lisa K. Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Deborah A. Butler
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Wendy L. Levy
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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31
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Boucher SE, Aum SH, Crocket HR, Wiltshire EJ, Tomlinson PA, de Bock MI, Wheeler BJ. Exploring parental perspectives after commencement of flash glucose monitoring for type 1 diabetes in adolescents and young adults not meeting glycaemic targets: a qualitative study. Diabet Med 2020; 37:657-664. [PMID: 31769551 DOI: 10.1111/dme.14188] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/11/2022]
Abstract
AIMS To explore parental perspectives after flash glucose monitoring commencement in adolescents and young adults with type 1 diabetes who were not meeting glycaemic targets. METHODS Twelve semi-structured interviews were conducted among parents of adolescents and young adults between the ages of 14 and 20 years (inclusive) with type 1 diabetes and not meeting glycaemic targets [HbA1c 81-130 mmol/mol (9.6-14.0%)] participating in a randomized controlled trial. Interviews were transcribed, then thematic analysis was performed to identify themes regarding parental experiences. RESULTS Four key themes were found: flash glucose monitoring improved parental emotional well-being; flash glucose monitoring reduced diabetes-specific conflict within families; flash glucose monitoring facilitated the parental role in diabetes management; and sensor-related challenges, particularly sensors falling off, interfered with using flash glucose monitoring for diabetes management. The cost of self-funded sensors was the only barrier to continuing flash glucose monitoring that parents reported. CONCLUSIONS This study provides new insights into the potential benefits and challenges of flash glucose monitoring use, drawn from the perspective of parents of adolescents and young adults not meeting glycaemic targets. As parents are often key partners in obtaining or purchasing this technology, these findings can be used to further inform parental expectations of this technology.
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Affiliation(s)
- S E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - S Hye Aum
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - H R Crocket
- Faculty of Health, Sport and Human Performance, University of Waikato, Hamilton, New Zealand
| | - E J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
- Capital and Coast District Health Board, Wellington, New Zealand
| | - P A Tomlinson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Southern District Health Board, Invercargill, New Zealand
| | - M I de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Canterbury District Health Board, Christchurch, New Zealand
| | - B J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Southern District Health Board, Dunedin, New Zealand
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de Wit M, Trief PM, Huber JW, Willaing I. State of the art: understanding and integration of the social context in diabetes care. Diabet Med 2020; 37:473-482. [PMID: 31912528 PMCID: PMC7027907 DOI: 10.1111/dme.14226] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2020] [Indexed: 12/15/2022]
Abstract
We review the past 25 years of research addressing challenges people living with diabetes experience in their daily lives related to social contexts, i.e. in their family, at work and in society at large, and identify research gaps. We found that young people with diabetes, as they develop through to adulthood, are exposed to considerable risks to their physical and mental health. Family-system interventions have had mixed outcomes. Research in this area would benefit from attention to ethnic/cultural diversity, and involving fathers and other family members. In adults with diabetes, social support relates to better diabetes outcomes. While family member involvement in care is likely to affect health and psychosocial outcomes of the person with diabetes, key elements and mediators of effective family interventions need to be identified. The challenges of diabetes management at work are under-researched; distress and intentional hyperglycaemia are common. When depression is comorbid with diabetes, there are increased work-related risks, e.g. unemployment, sickness absence and reduced income. Research to support people with diabetes at work should involve colleagues and employers to raise awareness and create supportive environments. Stigma and discrimination have been found to be more common than previously acknowledged, affecting self-care, well-being and access to health services. Guidance on stigma-reducing choice of language has been published recently. Resilience, defined as successful adaptation to adversity such as stigma and discrimination, requires studies relevant to the specific challenges of diabetes, whether at diagnosis or subsequently. The importance of the social context for living well with diabetes is now fully recognized, but understanding of many of the challenges, whether at home or work, is still limited, with much work needed to develop successful interventions.
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Affiliation(s)
- M. de Wit
- Amsterdam UMCVrije Universiteit AmsterdamMedical PsychologyAmsterdam Public HealthAmsterdamThe Netherlands
| | - P. M. Trief
- Department of Psychiatry and Behavioural SciencesState University of New York Upstate Medical UniversitySyracuseNYUSA
| | - J. W. Huber
- School of Health SciencesUniversity of BrightonBrightonUK
| | - I. Willaing
- Diabetes Management ResearchSteno Diabetes Centre CopenhagenGentofteDenmark
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Capistrant BD, Friedemann-Sánchez G, Pendsey S. Diabetes stigma, parent depressive symptoms and Type-1 diabetes glycemic control in India. SOCIAL WORK IN HEALTH CARE 2019; 58:919-935. [PMID: 31675285 DOI: 10.1080/00981389.2019.1679321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 05/27/2023]
Abstract
Diabetes distress and stigma have been associated with worse patient outcomes in developed countries. However, diabetes stigma has not been studied in low and middle-income countries where clinical practices differ, diabetes awareness is lower, and families face different challenges for supporting children with Type 1 Diabetes (T1D). This study assessed the relationship between parental depression and diabetes stigma with a child's glycemic control in a clinic-based survey in Nagpur, India. The association between self-reported T1D stigma, depressive symptoms, and child's measured glycemic control (HbA1C) was assessed with data from 165 of the parents of school-aged (aged 5+) children receiving clinical T1D care at an urban nonprofit organization that provides free clinical care to children with Type-1 Diabetes (T1D) in India. Parents with moderate/severe depressive symptoms who experience stigma associated with their child's diabetes had children with significantly worse glycemic control than parents with no/mild depressive symptoms who experience the same amount of stigma. Higher reports of stigma were associated with an average of 0.65 points higher HbA1C (β = 0.65, 95% Confidence Interval (CI): 0.18, 1.13) for parents with moderate/severe than parents with mild/no depressive symptoms. Indian parents with depressive symptoms who face social stigma associated with their child's diabetes have children with worse T1D outcomes.
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Affiliation(s)
| | | | - Sharad Pendsey
- Diabetes Research, Education And Management (DREAM) Trust, Nagpur, India
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McGill DE, Volkening LK, Butler DA, Wasserman RM, Anderson BJ, Laffel LM. Text-message responsiveness to blood glucose monitoring reminders is associated with HbA 1c benefit in teenagers with Type 1 diabetes. Diabet Med 2019; 36:600-605. [PMID: 30734361 PMCID: PMC6462241 DOI: 10.1111/dme.13929] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2019] [Indexed: 12/21/2022]
Abstract
AIMS To evaluate an 18-month text-messaging intervention in teenagers with Type 1 diabetes and to assess factors associated with text responsiveness and glycaemic benefit. METHODS Teenagers with diabetes (N = 147), aged 13-17 years, received two-way text reminders at self-selected times to check blood glucose levels and reply with blood glucose results. RESULTS At baseline, the participants (48% boys, 78% white, 63% pump-treated) had a mean ± sd age of 14.9 ± 1.3 years, diabetes duration of 7.1 ± 3.9 years and HbA1c concentration of 69 ± 12 mmol/mol (8.5 ± 1.1%). The mean proportion of days with ≥1 blood glucose response declined over time (0-6 months, 60 ± 26% of days, 7-12 months, 53 ± 31% of days, 13-18 months, 43 ± 33% of days). Over 18 months, 49% responded with ≥1 blood glucose result on ≥50% of days (high responders). Regression analysis controlling for baseline HbA1c revealed no significant change in HbA1c from baseline to 18 months in high responders (P = 0.54) compared with a significant HbA1c increase in low responders (+0.3%, P = 0.01). In participants with baseline HbA1c ≥64 mmol/mol (≥8%), high responders were 2.5 times more likely than low responders to have a clinically significant [≥5.5 mmol/mol (≥0.5%)] HbA1c decrease over 18 months (P < 0.05). In participants with baseline HbA1c <64 mmol/mol(<8%), high responders were 5.7 times more likely than low responders to have an 18-month HbA1c <58 mmol/mol (<7.5%; P < 0.05). CONCLUSIONS Teenagers with Type 1 diabetes who responded to text reminders on ≥50% of days over 18 months experienced clinically significant glycaemic benefit. There remains a need to tailor interventions to maintain teenager engagement and optimize improvements.
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Affiliation(s)
- D E McGill
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - L K Volkening
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - D A Butler
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - R M Wasserman
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - B J Anderson
- Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - L M Laffel
- Section on Clinical, Behavioral and Outcomes Research, Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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Vasigh A, Abdi A, Borji M, Tarjoman A. The prevalence of neuropathy among type 1 diabetic adolescents in Iran: a systematic review and meta-analysis. Int J Adolesc Med Health 2019; 33:/j/ijamh.ahead-of-print/ijamh-2018-0223/ijamh-2018-0223.xml. [PMID: 30685741 DOI: 10.1515/ijamh-2018-0223] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 10/28/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION Neuropathy is one of the most common complications of diabetes, which causes many problems for diabetic patients. Thus, the aim of the present study was to investigate the prevalence of neuropathy among type 1 diabetic adolescents by systematic review and meta-analysis. MATERIALS AND METHODS This study is a systematic review and meta-analysis, which reviewed articles published from 2001 to September 1, 2018. The search process was carried out in the Google Scholar search engine and domestic and international databases such as Magiran, SID, Iranmedex, IranDoc, Medlib, PubMed, Scopus, Science Direct, Springer, Wiley Online Library, Web of Science, Ebsco and Cochrane using Persian and English keywords based on MESH conformity. All the research steps were carried out by two members of the research team who were familiar with systematic reviews and meta-analysis data, using the software CMA. Analysis of meta-regression and the use of a random effects model were introduced and analyzed. FINDINGS When a systematic search was carried out on the reviewed articles, five of them were included in the meta-analysis phase. The sample size was 484, and the prevalence of diabetic peripheral neuropathy (DPN) in type 1 diabetic patients was 28.2% [confidence interval (CI) = 19.5-39.1]. The findings of the meta-regression analysis showed that the DPN prevalence rate decreased with increasing age (Q = 5.77 p = 0.016), and the results of more recent studies showed an increase in the DPN incidence rate (Q = 20.62, p < 0.001). CONCLUSION The findings of the present study revealed that although the prevalence of neuropathy in diabetic adolescents was not high, the prevalence was significant. Considering the increasing prevalence of diabetes and its impact on the health status of patients, appropriate interventions should be conducted to prevent diabetes and subsequent diabetic neuropathy.
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Affiliation(s)
- Aminolah Vasigh
- Department of Anaesthesiology, Medicine Faculty, Ilam University of Medical Science, Ilam, Iran
| | - Alireza Abdi
- Critical Care and Emergency Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Borji
- Critical Care and Emergency Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Asma Tarjoman
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
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36
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Forlenza GP, Pinhas-Hamiel O, Liljenquist DR, Shulman DI, Bailey TS, Bode BW, Wood MA, Buckingham BA, Kaiserman KB, Shin J, Huang S, Lee SW, Kaufman FR. Safety Evaluation of the MiniMed 670G System in Children 7-13 Years of Age with Type 1 Diabetes. Diabetes Technol Ther 2019; 21:11-19. [PMID: 30585770 PMCID: PMC6350071 DOI: 10.1089/dia.2018.0264] [Citation(s) in RCA: 136] [Impact Index Per Article: 27.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the safety of in-home use of the MiniMed™ 670G system with SmartGuard™ technology in children with type 1 diabetes (T1D). METHODS Participants (N = 105, ages 7-13 years, mean age 10.8 ± 1.8 years) were enrolled at nine centers (eight in the United States and one in Israel) and completed a 2-week baseline run-in phase in Manual Mode followed by a 3-month study phase with Auto Mode enabled. Sensor glucose (SG), glycated hemoglobin (HbA1c), percentage of SG values across glucose ranges, and SG variability, during the run-in and study phases were compared. Participants underwent frequent sample testing with i-STAT® venous reference measurement during a hotel period (6 days/5 nights) to evaluate the system's continuous glucose monitoring performance. RESULTS Auto Mode was used a median of 81% of the time. From baseline to end of study, overall SG dropped by 6.9 ± 17.2 mg/dL (P < 0.001), HbA1c decreased from 7.9% ± 0.8% to 7.5% ± 0.6% (P < 0.001), percentage of time in target glucose range (70-180 mg/dL) increased from 56.2% ± 11.4% to 65.0% ± 7.7% (P < 0.001), and the SG coefficient of variation decreased from 39.6% ± 5.4% to 38.5% ± 3.8% (P = 0.009). The percentage of SG values within target glucose range was 68.2% ± 9.1% and that of i-STAT reference values was 65.6% ± 17.7%. The percentage of values within 20%/20 of the i-STAT reference was 85.2%. There were no episodes of severe hypoglycemia or diabetic ketoacidosis during the study phase. CONCLUSION In-home use of MiniMed 670G system Auto Mode for 3 months by children with T1D, similar to MiniMed 670G system use by adolescents and adults with T1D, was safe and associated with reduced HbA1c levels and increased time in target glucose range, compared with baseline.
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Affiliation(s)
- Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, Aurora, Colorado
- Address correspondence to: Gregory P. Forlenza, MD, Barbara Davis Center for Childhood Diabetes, 1775 Aurora Court, A140, Aurora, CO 80045
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Aviv, Israel
| | | | - Dorothy I. Shulman
- USF Diabetes Center, Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | | | | | - Bruce A. Buckingham
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
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Delamater AM, de Wit M, McDarby V, Malik JA, Hilliard ME, Northam E, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:237-249. [PMID: 30058247 DOI: 10.1111/pedi.12736] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
MESH Headings
- Adaptation, Psychological/physiology
- Adolescent
- Burnout, Psychological/psychology
- Burnout, Psychological/therapy
- Child
- Consensus
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Endocrinology/organization & administration
- Endocrinology/standards
- Humans
- International Cooperation
- Neurodevelopmental Disorders/therapy
- Pediatrics/organization & administration
- Pediatrics/standards
- Practice Patterns, Physicians'/standards
- Psychotherapy/methods
- Psychotherapy/standards
- Quality of Life/psychology
- Resilience, Psychological
- Societies, Medical/organization & administration
- Societies, Medical/standards
- Stress, Psychological/etiology
- Stress, Psychological/therapy
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Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Maartje de Wit
- Department of Medical Psychology, EMGO Institute for Health & Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Vincent McDarby
- National Children's Research Centre and Our Lady's Children's Hospital, Dublin, Ireland
| | - Jamil A Malik
- Center of Excellence, National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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