Psychological interventions for adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes: a systematic review

Supporting healthy sleep: a qualitative assessment of adolescents with type 1 diabetes and their parents

OBJECTIVE

Poor sleep health is common in adolescence due to a combination of physiological, psychosocial, and environmental factors. Adolescents with type 1 diabetes (T1D) may be at increased risk for poor sleep health due to physiological and behavioral aspects of diabetes and its management. This article describes a qualitative analysis of interviews with adolescents with T1D and their parents about facilitators and barriers to sleep health and family strategies to balance teens' sleep with competing demands.

METHODS

Separate interviews were conducted with 20 adolescents with T1D and 20 parents. Interviews were recorded and transcribed verbatim and analyzed thematically. Participants were on average 15.8 ± 1.2 years old, 45% female, and 85% non-Hispanic White.

RESULTS

Overnight diabetes management was the most frequently reported barrier to sleep. Families reported different strategies for taking responsibility of overnight diabetes management, which differentially impacted sleep. Families worked to balance diabetes management and sleep with other aspects of adolescent life, including school demands, social activities, and electronics use. Facilitators to healthy sleep identified by families included diabetes assistive technology and maintaining a consistent sleep/wake schedule. Both adolescents and parents voiced beliefs that their diabetes care team is not able to help with sleep health.

CONCLUSIONS

Pediatric psychologists should be aware of the specific sleep barriers experienced by adolescents with T1D and their parents. A focus on overnight diabetes management strategies may facilitate psychologists' support of families in the adolescent's transition to independent diabetes management. Research is needed on the impact of optimizing sleep health in adolescents with T1D.

Global stress and daily general and type 1 diabetes stressors and links to daily affect and diabetes outcomes during emerging adulthood

We examined how global stress and general stressors of daily life relate to emotional well-being and type 1 diabetes (T1D) outcomes and amplify the effects of diabetes stressors in emerging adults. Two-hundred and seven 18-19-year-olds with T1D (duration 8.47 years) completed the Perceived Stress Scale (global stress) and a daily diary assessing daily diabetes and general stressors, positive and negative affect, self-care behaviors, and blood glucose (BG). Multi-level analyses indicated that global stress and within-person daily general and diabetes stressors were associated with more negative and less positive affect. In addition, general stress (between-person) was associated with more negative affect. Global stress amplified the association between daily diabetes stressors and negative affect, with greater affect reactivity to stress for those experiencing higher global stress. Global stress and both within- and between-person diabetes stressors were associated with lower self-care and higher BG. Emerging adults' general stressors in their daily lives relate to poorer well-being beyond the experience of diabetes stressors.

An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents

Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.

Teaching Adolescents With Type 1 Diabetes Self-Compassion (TADS) to Reduce Diabetes Distress: Protocol for a Randomized Controlled Trial

BACKGROUND

Adolescents living with type 1 diabetes (T1D) often experience diabetes distress (DD), a construct distinct from depression or anxiety that refers to the negative emotions that arise from living with and managing diabetes. Self-compassion, which involves being open to one's own suffering and treating oneself with the same care one would show to loved ones, is associated with better psychological and clinical outcomes among individuals with T1D. Self-compassion is a skill that can be taught and therefore represents an opportunity for intervention.

OBJECTIVE

The overall aim of this study is to assess the effectiveness of a web-based mindful self-compassion for teens (MSC-T) intervention on improving DD, anxiety, depression, diabetes-related disordered eating, and suicidal ideation experienced by youth with T1D (aged between 12 and 17 years) compared with a waitlist control group (standard of care). We will also explore (1) if the effect of the MSC-T intervention changes over time, (2) if the MSC-T intervention has a positive impact on measures of glycemic control, and (3) if the effect of the MSC-T intervention differs based on self-reported gender.

METHODS

We will conduct a single-center, parallel-group randomized controlled trial of 140 adolescents with T1D followed for 12 months. Participants will be randomly allocated (using hidden allocation) in a 1:1 ratio to either the MSC-T intervention or the waitlist control group. Our primary outcome is DD, as measured by the Problem Areas in Diabetes-Teen (PAID-T) version at 3 months. Secondary outcomes, assessed at 3 and 12 months, include anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale), depression (Patient Health Questionnaire-9 [PHQ-9]), diabetes-related disordered eating (Diabetes Eating Problem Survey-Revised [DEPS-R] version), and suicidal ideation (using 1 question from the PHQ-9).

RESULTS

Study recruitment began in October 2022 and was completed in March 2023, with a total of 141 participants enrolling. Data collection will be ongoing until March 2024. The first results are expected in June 2024.

CONCLUSIONS

This study will be the first randomized trial to assess the effectiveness of the web-based MSC-T intervention on adolescents with T1D. Given that adolescence is a period where individuals are typically required to assume more responsibility for their diabetes care, providing adolescents with the tools they need to better manage the stress that often accompanies T1D management is paramount.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05463874; https://clinicaltrials.gov/study/NCT05463874.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/53935.

Provision of continuous subcutaneous insulin infusion to type 1 diabetes 'frequent flyers'

A few people with type 1 diabetes undergo multiple hospital admissions for acute glycaemic events. We report on a series of five such 'frequent flyers' who were provided with continuous subcutaneous insulin infusion (CSII) therapy. Mean HbA1c decreased from 9.7 ± 2.5% (83 ± 27 mmol/mol) to 7.9 ± 0.4% (63 ± 4.7 mmol/mol) after 2-4 months. Frequency of admissions for acute glycaemic events reduced in three but increased in two patients within 6 months. Total insulin dose and body mass index decreased in some patients and satisfaction was anecdotally higher. Some, but not all, 'frequent flyers' benefited from a trial of CSII.

Family Interviews Inform School-based Nursing for Children with Type 1 Diabetes and their Families

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.

The efficacy of interventions provided by nurses to improve glycemic control of children with type 1 diabetes: A systematic review

PURPOSE

Nurses have a very important role in diabetes education of children and adolescents, however, no systematic review has been performed that evaluates the effectiveness of the independent interventions of the nurses. This systematic review aims to identify and assess randomized controlled trials (RCT) that included interventions implemented by nurses to improve glycemic control for children and adolescents with type 1 diabetes.

ELIGIBILITY CRITERIA

PubMed, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science, Science Direct databases were systematically searched up to 2022. Interventions provided by nurses for any child ≤18 years diagnosed with type 1 diabetes mellitus were included.

SAMPLE

Seven RCT articles met our review criteria.

RESULTS

All included studies were published between 2005 and 2021. Studies varied in terms of intervention type; telephone case management, coping skills training, motivational interview as well as home visit education programs. Interventions were found to significantly decrease the HbA1c level in three of seven studies.

CONCLUSIONS

Our systematic review suggests that nurses can improve the glycemic control of children with type 1 diabetes by conducting care interventions. According to current evidence, this study suggests that telephone contact by nurses and motivational interviewing can be beneficial in improving glycemic control in this population.

IMPLICATIONS

Nurses may encourage children and adolescents with diabetes to engage in self-management of their glucose levels. There is a need for more randomized controlled studies assessing the efficacy of nursing interventions for children with type 1 diabetes.

Glycemic Control and Its Relationship with Diabetes Self-Care Behaviors Among Patients with Type 2 Diabetes in Northern Jordan: A Cross-Sectional Study

BACKGROUND

Type 2 diabetes mellitus (T2DM) is a chronic progressive disease that significantly impacts morbidity and mortality worldwide. Glycemic control is central in diabetes management, yet complex and challenging to achieve; it can be affected by various factors. Diabetes self-care behaviors are vital strategies for effective T2DM management.

PURPOSE

To evaluate the levels of glycemic control and diabetes self-care behaviors, and the significance of each behavior on glycemic control among patients with T2DM in Jordan.

PATIENTS AND METHODS

This cross-sectional study was conducted in medical and endocrinology outpatient clinics of three hospitals in northern Jordan. A convenience sample of 520 patients with T2DM participated in the study. Diabetes self-care behaviors, including diet, exercise, blood glucose testing, taking medication, and foot care behaviors, were measured using the Arabic version of the Summary of Diabetes Self-Care Activities (SDSCA-Arabic) questionnaire. Psychological distress was measured using the Arabic version of the 4-items Patient Health Questionnaire (PHQ-4). Glycated hemoglobin (HbA1c) levels were used to assess glycemic control.

RESULTS

Out of 520 participants, 92.7% (n= 482) had poor glycemic control (HbA1c ≥7%), with a mean of 9.29% (SD=2.06) for HbA1c. The SDSCA overall mean score was 3.25 days (SD=0.88), indicating an unsatisfactory level, with 79.2% of participants having performed self-care activities 4-days/week. Greater adherence to diabetes self-care behaviors was associated with better glycemic control. Exercise was the most important predictor of HbA1c (p<0.001), followed by general diet (p<0.001), specific diet (p<0.001), and blood sugar testing (p<0.001). Moreover, the Body Mass Index (p<0.001), treatment type (p<0.001), and income (p=0.03) were significant predictors.

CONCLUSION

The proportions of poor glycemic control and unsatisfactory self-care behaviors were high among T2DM patients. To enhance patients' self-care behaviors and lifestyles changes, the patients need tailored diabetes self-care management educational and supportive programs, conducted by qualified diabetes educators using culturally sensitive strategies.

A century past the discovery of insulin: global progress and challenges for type 1 diabetes among children and adolescents in low-income and middle-income countries

Type 1 diabetes is on the rise globally; however, the burden of mortality remains disproportionate in low-income and middle-income countries (LMICs). As 2021 marks 100 years since the discovery of insulin, we revisit progress, global burden of type 1 diabetes trends, and understanding of the pathogenesis and management practices related to the disease. Despite much progress, inequities in access and availability of insulin formulations persist and are reflected in differences in survival and morbidity patterns related to the disease. Some of these inequities have also been exacerbated by health-system challenges during the COVID-19 pandemic. There is a clear opportunity to improve access to insulin and related essential technologies for improved management of type 1 diabetes in LMICs, especially as a part of universal health coverage. These improvements will require concerted action and investments in human resources, community engagement, and education for the timely diagnosis and management of type 1 diabetes, as well as adequate health-care financing. Further research in LMICs, especially those in Africa, is needed to improve our understanding of the burden, risk factors, and implementation strategies for managing type 1 diabetes.

Psychotherapeutic Interventions to Improve Psychological Adjustment in Type 1 Diabetes: A Systematic Review

Background: International clinical practice guidelines highlight the importance of improving the psychological and mental health care of patients with Type 1 diabetes mellitus (T1DM). Psychological interventions can promote adherence to the demands of diabetes self-care, promoting high quality of life and wellbeing. Methods: A systematic review was carried out to determine whether psychological treatments with a specific focus on emotional management have an impact on glycemic control and variables related to psychological adjustment. Comprehensive literature searches of PubMed Medline, Psycinfo, Cochrane Database, Web of Science, and Open Grey Repository databases were conducted, from inception to November 2019 and were last updated in December 2020. Finally, eight articles met inclusion criteria. Results: Results showed that the management of emotions was effective in improving the psychological adjustment of patients with T1DM when carried out by psychologists. However, the evidence regarding the improvement of glycemic control was not entirely clear. When comparing adolescent and adult populations, findings yielded slightly better results in adolescents. Conclusions: More rigorous studies are needed to establish what emotional interventions might increase glycemic control in this population.