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Evans M, Ellis DA, Vesco AT, Feldman MA, Weissberg-Benchell J, Carcone AI, Miller J, Boucher-Berry C, Buggs-Saxton C, Degnan B, Dekelbab B, Drossos T. Diabetes distress in urban Black youth with type 1 diabetes and their caregivers: associations with glycemic control, depression, and health behaviors. J Pediatr Psychol 2024; 49:394-404. [PMID: 38216126 DOI: 10.1093/jpepsy/jsad096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/05/2023] [Accepted: 12/08/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVES Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms. METHODS Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression. RESULTS DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management. CONCLUSIONS Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.
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Affiliation(s)
- Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Deborah A Ellis
- School of Medicine, Wayne State University, Detroit, MI, United States
| | - Anthony T Vesco
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Marissa A Feldman
- Division of Psychology, Johns Hopkins, All Children's Hospital, St Petersburg, FL, United States
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | | | - Jennifer Miller
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital and Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Claudia Boucher-Berry
- Division of Pediatric Endocrinology, University of Illinois at Chicago, Chicago, IL, United States
| | | | - Bernard Degnan
- Pediatric Endocrinology, Ascension St John Children's Hospital, Detroit, MI, United States
| | - Bassem Dekelbab
- Pediatric Endocrinology, Beaumont Health Care, Royal Oak, MI, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, United States
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Allen V, Mahieu A, Kasireddy E, Shouman W, Pourrahmat MM, Collet JP, Cherkas A. Humanistic burden of pediatric type 1 diabetes on children and informal caregivers: systematic literature reviews. Diabetol Metab Syndr 2024; 16:73. [PMID: 38515123 PMCID: PMC10956250 DOI: 10.1186/s13098-024-01310-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 03/09/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Diagnosis of children with type 1 diabetes (T1D) imposes an unprecedented burden on children and their caregivers. OBJECTIVE To assess the burden of T1D on children and their informal caregivers, both after a recent diagnosis or after a longer duration of disease. METHODS A series of systematic literature reviews were performed to explore the burden of T1D on children with the disease and their primary informal caregivers, based on the time of diagnosis. After the extraction of the qualitative and quantitative data from the included studies, two literature-based conceptual frameworks were developed: on the burden of pediatric T1D on children, and on informal caregivers. A third conceptual framework on the shared burden of pediatric T1D on both children and informal caregivers as part of the same family unit was also developed. RESULTS The review of literature has identified a series of factors that affect the quality of life of children with T1D and their informal caregivers, with a direct impact on physical, emotional, and social outcomes. Generally, female patients and older adolescents experience more worry and stress that affects their quality of life. Other categories of factors affecting the child's and caregiver's burden include social, emotional, and physical factors, treatment-related and disease-related factors, as well as their coping abilities. Anxiety, depression, stress, and worry were commonly found among children and caregivers, starting with the diagnosis of T1D and continuing over time in relation to new challenges pertaining to aging or the disease duration. CONCLUSION T1D causes a significant burden to affected children and their caregivers, both independently and through transactional interaction within the family unit. Disease burden can be reduced by strengthening individuals for the benefit of the whole family.
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Affiliation(s)
| | | | | | - Walid Shouman
- Evidinno Outcomes Research Inc., Vancouver, BC, Canada
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3
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Grauslund AC, Lindkvist EB, Thorsen SU, Ballegaard S, Faber J, Svensson J, Berg AK. Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes? World J Clin Pediatr 2024; 13:89619. [PMID: 38596435 PMCID: PMC11000060 DOI: 10.5409/wjcp.v13.i1.89619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/03/2024] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Type 1 diabetes (T1D) is associated with general- and diabetes-specific stress which has multiple adverse effects. Hence measuring stress is of great importance. An algometer measuring pressure pain sensitivity (PPS) has been shown to correlate to certain stress measures in adults. However, it has never been investigated in children and adolescents. The aim of our study was to examine associations between PPS and glycated hemoglobin (HbA1c), salivary cortisol and two questionnaires as well as to identify whether the algometer can be used as a clinical tool among children and adolescents with T1D. Eighty-three participants aged 6-18 years and diagnosed with T1D were included in this study with data from two study visits. Salivary cortisol, PPS and questionnaires were collected, measured, and answered on site. HbA1c was collected from medical files. We found correlations between PPS and HbA1c (rho = 0.35, P = 0.046), cortisol (rho = -0.25, P = 0.02) and Perceived Stress Scale (rho = -0.44, P = 0.02) in different subgroups based on age. Males scored higher in PPS than females (P < 0.001). We found PPS to be correlated to HbA1c but otherwise inconsistent in results. High PPS values indicated either measurement difficulties or hypersensibility towards pain.
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Affiliation(s)
| | | | - Steffen Ullitz Thorsen
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev 2730, Denmark
- Department of Clinical Immunology, Rigshospitalet, University of Copenhagen, Copenhagen 2100, Denmark
| | - Søren Ballegaard
- Department of Endocrinology, Herlev and Gentofte Hospital, Herlev 2730, Denmark
| | - Jens Faber
- Department of Endocrinology, Herlev and Gentofte Hospital, Herlev 2730, Denmark
| | - Jannet Svensson
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev 2730, Denmark
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev 2730, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen 2200, Denmark
| | - Anna Korsgaard Berg
- Department of Pediatrics, Herlev and Gentofte Hospital, Herlev 2730, Denmark
- Copenhagen University Hospital, Steno Diabetes Center Copenhagen, Herlev 2730, Denmark
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4
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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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5
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Lee D, Lee H, Shin Y, Park G. Effectiveness of Non-pharmacological Interventions for Adolescents With Type 1 Diabetes in the Last Five Years: A Systematic Review and Meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:51-59. [PMID: 38307162 DOI: 10.1016/j.anr.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024] Open
Abstract
PURPOSE Evidence on non-pharmacological interventions for adolescents with type 1 diabetes is unclear. This review aimed to evaluate the effectiveness of non-pharmacological intervention in adolescents with type 1 diabetes. METHODS We conducted a search on databases from November 11 to 19, 2022, for randomized controlled trials for the effects of non-pharmacological intervention in adolescents with type 1 diabetes. To identify recent research trends, we included studies published from 2017 to November 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool 2.0. To estimate the effect size, a meta-analysis was performed using RevMan 5.4 program and R Studio. RESULTS A total of 45 studies were included in the systematic review. Among those, 30 studies were included in the meta-analysis. Non-pharmacological interventions were significantly effective in improving Glycated hemoglobin (HbA1c) (standardized mean difference [SMD] = -0.26, 95% confidence interval [CI]: -0.42, -0.09), quality of life (SMD = 0.44, 95% CI: 0.13 to 0.76), and anxiety (SMD = -0.91, 95% CI: -1.26, -0.56). Subgroup analysis showed that duration of intervention was not a covariate related to HbA1c levels. CONCLUSIONS Non-pharmacological interventions have shown effectiveness in improving the HbA1c, quality of life, and anxiety in adolescents with type 1 diabetes. Future studies with more rigorous methodology are needed to confirm and strengthen the validity of these findings. Additionally, attention to changes in the lipid profile and self-care motivation among adolescents with type 1 diabetes is warranted. TRIAL REGISTRATION NUMBER Prospective Register of Systematic Reviews (CRD42022382190).
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Affiliation(s)
- DaeEun Lee
- College of Nursing, Pusan National University, South Korea
| | - Haejung Lee
- College of Nursing/Research Institute of Nursing Science, Pusan National University, South Korea.
| | - YoonYoung Shin
- College of Nursing, Pusan National University, South Korea
| | - Gaeun Park
- College of Nursing/Research Institute of Nursing Science, Pusan National University, South Korea
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6
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Berg CA, Tracy EL, Boggess SB, Butner JE, Loyola MDR, Wiebe DJ. Global stress and daily general and type 1 diabetes stressors and links to daily affect and diabetes outcomes during emerging adulthood. J Behav Med 2024; 47:82-93. [PMID: 37389781 DOI: 10.1007/s10865-023-00425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 05/25/2023] [Indexed: 07/01/2023]
Abstract
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.
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7
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Rebollo-Román Á, Tabernero-Urbieta MC, Villaécija J, Luque-Salas B. Mediterranean diet adherence and glycemic control in children and adolescents with type 1 diabetes. Eur J Pediatr 2024; 183:453-460. [PMID: 37930397 DOI: 10.1007/s00431-023-05325-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 11/07/2023]
Abstract
To effectively manage type 1 diabetes (T1D) insulin is essential, with dosages based on lifestyle. The Mediterranean diet has demonstrated its advantages in preventing and enhancing the management of chronic diseases. Our objective was to investigate the potential mediation of sensor activity on the relationship between adherence to the Mediterranean diet and glycemic control in children and adolescents. A total of 150 children and adolescents (mean age = 13.09, SD = 3.54; 44% female) with T1D were recruited. Adherence to the Mediterranean diet was assessed using the KIDMED questionnaire which evaluates 16 items and gives higher scores when adherence is higher. Glycemic control and the duration of sensor activity were evaluated with data from flash glucose monitoring. The data confirmed our hypothesis by revealing that adherence to the Mediterranean diet positively influenced glycemic control (direct effect = 1.505; P < 0.01) and that this relationship was mediated by the duration of sensor activity (indirect effect = 0.531; P < 0.01). Conclusions: Our results support the increased utilization of glycemic control devices, as they contribute to improve glycemic control and mediate on the positive relationship between adherence to the Mediterranean diet and adequate glycemic control. Furthermore, our findings highlight the importance of incorporating Mediterranean diet recommendations to achieve better glycemic control in children and adolescents with T1D. What is Known: • The Mediterranean diet and glycemic control have proven benefits in improving cardiovascular health in the general population. Scarce evidence exists of these benefits among children and adolescents with T1D. What is New: • Adherence to the Mediterranean diet and greater use of glucose monitoring devices in children and adolescents with T1D are related to better glycemic control. These variables can be enhanced by psychoeducational interventions such as structured diabetes education programs or peer group-based sessions, which highlights the importance of focusing on these aspects.
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Affiliation(s)
- Ángel Rebollo-Román
- Department of Endocrinology and Nutrition, University Hospital Reina Sofía, Avda. Menéndez Pidal S/N, 14004, Córdoba, Spain.
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain.
| | - Mª Carmen Tabernero-Urbieta
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
- Department of Social Psychology and Anthropology, University of Salamanca, Salamanca, Spain
- Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, Salamanca, Spain
| | - Joaquín Villaécija
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
| | - Bárbara Luque-Salas
- Department of Psychology, Faculty of Education Sciences and Psychology, Córdoba University, Córdoba, Spain
- Maimonides Biomedical Research Institute of Córdoba (IMIBIC), Córdoba, Spain
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8
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Titoria R, Fung A, Tang TS, Amed S. Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care. Diabet Med 2023; 40:e15172. [PMID: 37428650 DOI: 10.1111/dme.15172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 06/20/2023] [Accepted: 06/22/2023] [Indexed: 07/12/2023]
Abstract
AIMS There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers. METHODS CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool. RESULTS Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia. CONCLUSIONS Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.
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Affiliation(s)
- Reena Titoria
- Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Andrea Fung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Tricia S Tang
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Zeiler M, Wittek T, Graf T, Bozic I, Nitsch M, Waldherr K, Karwautz A, Wagner G, Berger G. Psychosocial impact of the COVID-19 pandemic for adolescents with type-1-diabetes: a qualitative interview study involving adolescents and parents. Behav Med 2023; 49:412-422. [PMID: 35816425 DOI: 10.1080/08964289.2022.2084358] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 05/02/2022] [Accepted: 05/24/2022] [Indexed: 12/23/2022]
Abstract
This study aims to investigate the psychosocial impact of the COVID-19 pandemic on adolescents with type-1-diabetes (T1D). We conducted 18 semi-structured interviews including adolescents with T1D (n = 10, 50% female, 15-18 years) and their parents (n = 8, 88% mothers). The main topics addressed were experiences during confinement regarding everyday life, lifestyle behaviors, diabetes management and treatment. We applied thematic analysis to identify common patterns of meanings. Being aware of belonging to a potential COVID-19 risk group caused worries especially in parents which resulted in strict adherence to preventive measures. Information from trustworthy sources regarding the actual risk mitigated the concerns. Digital diabetes treatment was well accepted and experienced as highly usable. The pandemic situation either facilitated or hindered the transition from parental control to diabetes self-management. While some patients managed to improve healthy lifestyle behaviors as their everyday lives seemed more predictable, others had difficulties in adapting to changed daily routines resulting in increased sedentary behavior and snacking. The perceived level of stress was directly associated with blood glucose levels. In conclusion, the implementation of psychological interventions (both for adolescents with T1D and their parents) addressing mental health literacy and media literacy seems to be important to promote positive coping skills for dealing with the pandemic situation.
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Affiliation(s)
- Michael Zeiler
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Tanja Wittek
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Theres Graf
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Ina Bozic
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
| | - Martina Nitsch
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Karin Waldherr
- Ferdinand Porsche FernFH - Distance Learning University of Applied Sciences
| | - Andreas Karwautz
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gudrun Wagner
- Eating Disorder Unit, Department of Child and Adolescent Psychiatry, Medical University of Vienna
| | - Gabriele Berger
- Diabetes Unit, Department of Pediatrics and Adolescent Medicine, Medical University of Vienna
- Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf
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10
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Ingrosso DMF, Primavera M, Samvelyan S, Tagi VM, Chiarelli F. Stress and Diabetes Mellitus: Pathogenetic Mechanisms and Clinical Outcome. Horm Res Paediatr 2023; 96:34-43. [PMID: 35124671 DOI: 10.1159/000522431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 02/01/2022] [Indexed: 11/19/2022] Open
Abstract
Evidence suggests that psychological and physical stress are relevant triggering factors for the onset of type 1 diabetes (T1D) and type 2 diabetes (T2D). The underlying mechanisms involve a complex neuroendocrine structure, involving the central nervous system and the periphery. Psychological stress leads to an increase of serum glucocorticoid concentrations and catecholamines release increasing the insulin need and the insulin resistance. According to the β-cell stress hypothesis, also causes of increased insulin demand, such as rapid growth, overweight, puberty, low physical activity, trauma, infections, and glucose overload, are potentially relevant factors in development of T1D. It has also been demonstrated that chronic stress and obesity form a vicious circle which leads to a definitive metabolic failure, increasing the risk of developing T2D. In this review, we will provide the most recent data concerning the role of stress in the outcomes of T1D and T2D, with a focus on the role of physical and psychological stress on the onset of T1D.
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Affiliation(s)
| | | | - Sona Samvelyan
- Paediatric Outpatient Department No. 122, Moscow, Russian Federation
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11
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Grau-Del Valle C, Marco-Expósito JF, Bosch-Sierra N, Zaragoza-Villena B, Solá E, Montoya-Castilla I, Morillas C, Bañuls C. Effect of perceived stress, concern about hypoglycaemia and level of knowledge of management of the disease on glycaemic control in type 1 diabetes mellitus. J Clin Nurs 2023; 32:264-272. [PMID: 35224806 DOI: 10.1111/jocn.16270] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 11/10/2021] [Accepted: 01/10/2022] [Indexed: 12/14/2022]
Abstract
AIMS AND OBJECTIVES To evaluate perceived stress, concern about hypoglycaemia and the level of knowledge of management of the disease in patients with type 1 diabetes mellitus and their relationship with glycaemic control, gender and age. BACKGROUND Perceived stress and concern about hypoglycaemia are significant obstacles to achieving adequate glycaemic control in patients with type 1 diabetes mellitus, and notably influence management of the disease itself. MATERIAL AND METHODS A cross-sectional study was carried out in 193 adult patients with type 1 diabetes mellitus. Study quality was scored using the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cohort studies. Glycaemic control was evaluated by number and type of hypoglycaemic event and glycosylated haemoglobin. Questionnaires about hypoglycaemia concern (HFS II), perceived stress (PSS), unrecognised hypoglycaemia (Clarke Test) and level of knowledge of the disease were completed. RESULTS Perceived stress was significantly associated with glycosylated haemoglobin (p < 0.001) and concern about hypoglycaemia (p < 0.037). With respect to level of knowledge, we observed that an advanced level was associated with lower glycosylated haemoglobin (p < 0.001), number (p < 0.001) and type (p < 0.001) of hypoglycaemic episode, and less perceived stress (p = 0.006). In addition, age was negatively correlated with perceived stress (p < 0.030) and positively correlated with the number of unrecognised hypoglycaemic episodes (p < 0.002), which was associated, in turn, with a higher number of daily glycaemia tests (p < 0.037) and concern about hypoglycaemia (p < 0.006). CONCLUSION In type 1 diabetes mellitus, perceived stress can negatively influence glycaemic control and concern about hypoglycaemia, and level of knowledge about the condition has a bearing on glycosylated haemoglobin levels, perceived stress and number and type of hypoglycaemic events. In addition, higher age is associated with more frequent unrecognised hypoglycaemic events. RELEVANCE TO CLINICAL PRACTICE It is essential to identify and address the psychological needs of patients with type 1 diabetes mellitus with the aim of achieving an adequate management of the disease itself and generating a change in future intervention strategies.
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Affiliation(s)
- Carmen Grau-Del Valle
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - José Francisco Marco-Expósito
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Neus Bosch-Sierra
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Begoña Zaragoza-Villena
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | - Eva Solá
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Departament of Medicine, University of Valencia, Valencia, Spain
| | | | - Carlos Morillas
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.,Departament of Medicine, University of Valencia, Valencia, Spain
| | - Celia Bañuls
- Department of Endocrinology and Nutrition, University Hospital Doctor Peset- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
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12
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Göthesson J, Håkansson L, Olinder AL, Hanberger L, Mörelius E, Nilsson S, Forsner M. Children's and adolescent's narratives about pain and negative experiences in diabetes treatment. J SPEC PEDIATR NURS 2023; 28:e12396. [PMID: 36316154 DOI: 10.1111/jspn.12396] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 08/04/2022] [Accepted: 10/07/2022] [Indexed: 11/09/2022]
Abstract
UNLABELLED Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear. AIM To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives. METHODS Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7-18 years, were subjected to inductive qualitative content analysis. RESULTS Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst. CONCLUSION All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications. CLINICAL IMPLICATIONS When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.
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Affiliation(s)
- Johanna Göthesson
- Department of Clinical Science and Education, Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sweden
| | - Linnéa Håkansson
- Department of Women's & Children's Health, Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Sachs' Children and Youths Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Lena Hanberger
- Division of Nursing, Department of Health, Medicine and Care Sciences, Linköping University, Linköping, Sweden
| | - Evalotte Mörelius
- Department of Nursing and Midwifery, Edith Cowan University and Perth Children's Hospital, Perth, Western, Australia
| | - Stefan Nilsson
- Department of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Maria Forsner
- Department of Nursing, Umeå University, Umeå, Sweden.,Department of Biosciences and Nutrition, Karolinska Instituten, Stockholm, Sweden
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13
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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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14
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Inverso H, Moore HR, Lupini F, Wang CH, Streisand R, Shomaker LB, Mackey ER. Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes. Curr Diab Rep 2022; 22:493-500. [PMID: 35984566 DOI: 10.1007/s11892-022-01492-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D. RECENT FINDINGS Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.
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Affiliation(s)
- Hailey Inverso
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Hailey R Moore
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Francesca Lupini
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Christine H Wang
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Randi Streisand
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
- The George Washington University School of Medicine, Washington, DC, USA
| | - Lauren B Shomaker
- Colorado State University, Fort Collins, CO, USA
- Children's Hospital Colorado/University of Colorado Anschutz, Aurora, CO, USA
- Colorado School of Public Health, Fort Collins and Aurora, CO, USA
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- The George Washington University School of Medicine, Washington, DC, USA.
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15
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Anxiety, Distress and Stress among Patients with Diabetes during COVID-19 Pandemic: A Systematic Review and Meta-Analysis. J Pers Med 2022; 12:jpm12091412. [PMID: 36143195 PMCID: PMC9506161 DOI: 10.3390/jpm12091412] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 08/25/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022] Open
Abstract
The prevalence of mental health disorders has increased during the COVID-19 pandemic. Patients with chronic diseases, such as diabetes, are a particularly vulnerable risk group. This study aims to assess the levels and prevalence of anxiety, distress, and stress in patients with diabetes during the COVID-19 pandemic. A systematic review was conducted in CINAHL, Cochrane, LILACS, Medline, SciELO, and Scopus in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Thirty-seven articles with a total of 13,932 diabetic patients were included. Five meta-analyses were performed. The prevalence of anxiety was 23% (95% CI = 19–28) in T1DM and 20% (95% CI = 6–40) in T2DM patients. For diabetes distress it was 41% (95% CI = 24–60) for T1DM and 36% in T2DM patients (95% CI = 2–84). For stress, the prevalence was 79% (95% CI = 49–98) in T1DM patients. People with diabetes have significant psychiatric comorbidity as well as psychological factors that negatively affect disease management, increasing their vulnerability in an emergency situation. To establish comprehensive care in diabetic patients addressing mental health is essential, as well as including specific policy interventions to reduce the potential psychological harm of the COVID-19 pandemic.
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16
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Koerner R, Rechenberg K. Mindfulness in adolescents and young adults with diabetes: An integrative review. Complement Ther Clin Pract 2022; 49:101659. [PMID: 35986987 DOI: 10.1016/j.ctcp.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Type 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes. METHODS Four databases were searched during May 2021. Included studies were published between 2000 and 2021, evaluated adolescents and young adults, diagnosed with type 1 or type 2 diabetes or prediabetes. Studies were excluded if they were not in English; not original research; evaluated complementary/alternative therapies as a group. To assess for risk of bias, the National Institutes of Health quality assessment tools and the Cochrane Collaboration's tool were utilized. Whittemore and Knafl's (2005) method for conducting an integrative review was utilized to synthesize results. RESULTS We identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes. CONCLUSION Mindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.
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Affiliation(s)
- Rebecca Koerner
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
| | - Kaitlyn Rechenberg
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
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17
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Wang Y, Huang C, Zhang H, Cai Y, Shen Z, Hu X, Zhou B, Yang L, Chen Q. Correlation Among Psychological Resilience, Social Support, and Coping Style in Patients With Complicated Hepatolithiasis. Front Behav Neurosci 2022; 16:939512. [PMID: 35783232 PMCID: PMC9241334 DOI: 10.3389/fnbeh.2022.939512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 05/20/2022] [Indexed: 12/07/2022] Open
Abstract
Objectives: To investigate the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis. Methods: The objective sampling method was used in this study to select a total of 156 patients with complicated hepatolithiasis in a Third-class Grade A hospital in Changsha, Hunan Province from January to December 2019. Self-designed general data questionnaire, the Connor-Davidson Resilience Scale (CD-RISC), the Social Support Rating Scale (SSRS), and the Simplified Coping Style Questionnaire (SCSQ) were used to conduct a questionnaire investigation. Spearman correlation analysis was used to analyze the correlation between psychological resilience, social support, and coping styles in patients with complicated hepatolithiasis. Results: Both the total score of psychological resilience (45.79 ± 16.28) and social support (35.71 ± 9.92) of patients with complicated hepatolithiasis were significantly lower than those of the domestic norm. The total score of psychological resilience of patients with complicated hepatolithiasis was positively correlated with the total score of social support (r = 0.570, p < 0.01). The total score of psychological resilience and its three dimensions were positively correlated with the positive coping (r = 0.682, 0.673, 0.663, 0.535, p < 0.01)and negatively correlated with negative coping (r = −0.240, −0.207, −0.221, −0.286, p < 0.01). Conclusions: This study indicated that strengthening social support and improving the coping style of patients with complicated hepatolithiasis are helpful to improve their psychological resilience, which provided theory basis and reference for further intervention measures to improve social support system and coping styles.
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Affiliation(s)
- Ying Wang
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Chunqiu Huang
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Honghui Zhang
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Yimin Cai
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Zhoumin Shen
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Xiahong Hu
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Bifang Zhou
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Lifen Yang
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
| | - Qian Chen
- Hunan Provincial People's Hospital (The First-Affiliated Hospital of Hunan Normal University), Changsha, China
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18
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Irwin A, Igudesman D, Crandell J, Kichler JC, Kahkoska AR, Burger K, Zaharieva DP, Addala A, Mayer-Davis EJ. Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change (FLEX) intervention trial. Pediatr Diabetes 2022; 23:516-526. [PMID: 35297136 PMCID: PMC9268578 DOI: 10.1111/pedi.13334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 02/28/2022] [Accepted: 03/14/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To assess the relationship between mindfulness and glycemia among adolescents with type 1 diabetes (T1D) with suboptimal glycemia, and evaluate the potential mediation by ingestive behaviors, including disordered eating, and impulsivity. RESEARCH DESIGN AND METHODS We used linear mixed models for hemoglobin A1c (HbA1c) and linear regression for continuous glucose monitoring (CGM) to study the relationship of mindfulness [Child and Adolescent Mindfulness Measure (CAMM)] and glycemia in adolescents with T1D from the 18-month Flexible Lifestyles Empowering Change (FLEX) trial. We tested for mediation of the mindfulness-glycemia relationship by ingestive behaviors, including disordered eating (Diabetes Eating Problem Survey-Revised), restrained eating, and emotional eating (Dutch Eating Behavior Questionnaire); and impulsivity (total, attentional, and motor, Barrett Impulsiveness Scale). RESULTS At baseline, participants (n = 152) had a mean age of 14.9 ± 1.1 years and HbA1c of 9.4 ± 1.2% [79 ± 13 mmol/mol]. The majority of adolescents were non-Hispanic white (83.6%), 50.7% were female, and 73.0% used insulin pumps. From adjusted mixed models, a 5-point increase in mindfulness scores was associated with a -0.19% (95%CI -0.29, -0.08, p = 0.0006) reduction in HbA1c. We did not find statistically significant associations between mindfulness and CGM metrics. Mediation of the relationship between mindfulness and HbA1c by ingestive behaviors and impulsivity was not found to be statistically significant. CONCLUSIONS Among adolescents with T1D and suboptimal glycemia, increased mindfulness was associated with lower HbA1c levels. Future studies may consider mindfulness-based interventions as a component of treatment for improving glycemia among adolescents with T1D, though more data are needed to assess feasibility and efficacy.
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Affiliation(s)
- Ashley Irwin
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Jamie Crandell
- Department of Biostatistics and School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | | | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
| | - Dessi P. Zaharieva
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA 94305
| | - Ananta Addala
- Department of Pediatrics, Division of Endocrinology, Stanford University, Stanford, CA 94305
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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19
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Cui C, Shuang-Zi L, Cheng WJ, Wang T. Mediating effects of coping styles on the relationship between family resilience and self-care status of adolescents with epilepsy transitioning to adult healthcare: A cross-sectional study in China. J Pediatr Nurs 2022; 63:143-150. [PMID: 34844824 DOI: 10.1016/j.pedn.2021.11.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 11/19/2021] [Accepted: 11/19/2021] [Indexed: 02/01/2023]
Abstract
PURPOSE This study aimed to explore the relationship between family resilience, coping styles, and self-care among Chinese adolescents with epilepsy. DESIGN AND METHODS A total of 1238 adolescents with epilepsy in nine tertiary hospitals in China participated in a cross-sectional survey conducted from May 2018 to March 2020. Structural equation modeling was used to analyze the mediating effect. RESULTS The total scores for family resilience and coping styles were positively correlated with the total self-care status score of adolescents with epilepsy during their transition (r = 0.209, 0.202, P < 0.01). Family resilience was positively correlated with coping style (r = 0.450, P < 0.01). The modified model's fit index included χ2/df = 1.970, P = 0.001, RMSEA = 0.054, TLI = 0.973, CFI = 0.978, GFI = 0.941, AGFI = 0.917, NFI = 0.956, and IFI = 0.978. The confidence interval (CI) was 0.004-0.140 for the indirect effect and 0.033-0.306 for the direct effect. CONCLUSIONS The self-care status of adolescents with epilepsy during the transitional period is closely related to coping style and family resilience. Coping style mediates family resilience and self-care status. PRACTICE IMPLICATIONS Healthcare teams should pay attention to the coping ability of adolescents with epilepsy to help them transition smoothly and to improve family functioning. This study provides a theoretical basis for establishing transitional care programs for adolescents with chronic illnesses. The significant mediating effect of coping style should be emphasized in modalities of healthcare that include patient participation.
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Affiliation(s)
- Cui Cui
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, China.
| | - Li Shuang-Zi
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wen-Jin Cheng
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Ting Wang
- Neurological Medical Center, Children's Hospital of Chongqing Medical University, Chongqing, China
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20
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Mahler FL, Konrad D, Landolt MA. Perceived Family Stress Predicts Poor Metabolic Control in Pediatric Patients with Type 1 Diabetes: A Novel Triadic Approach. J Diabetes Res 2022; 2022:3809775. [PMID: 35601018 PMCID: PMC9119771 DOI: 10.1155/2022/3809775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 04/21/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Poor metabolic control and low treatment adherence remain major issues for many pediatric patients with type 1 diabetes. Important risk factors for both include psychosocial variables such as stress. To date, stress in type 1 diabetes patients and their parents has been investigated at an individual level. The present study tested the hypothesis that patients', mothers', and fathers' perceived stress is positively related to each other and therefore is a factor common to the family. This factor was then hypothesized to be related to patients' poorer treatment adherence behavior and metabolic control. Research Design and Methods. This cross-sectional study at the University Children's Hospital Zurich included 190 type 1 diabetes patients (age: 7-18 years; illness duration: ≥1 year) and their families. The Perceived Stress Scale was used to measure the self-reported stress of patients, mothers, and fathers. Patients' treatment adherence was rated by their endocrinologists. HbA1c served as indicator of metabolic control. A structural equation model (SEM) was conducted for analysis. RESULTS The SEM showed adequate model fit. Patients' (β = .567, p ≤ .001), mother's (β = .621, p ≤ .001), and father's (β = .585, p ≤ .001) perceived stress loaded all on a single factor, perceived family stress. This factor was significantly associated with treatment adherence (β = -.384, p ≤ .001) and with HbA1c (β = .210, p = .012) of patients. CONCLUSIONS Results confirmed perceived family stress to be a common family construct. Because perceived family stress might have a negative impact on patients' treatment adherence and HbA1c, subjective stress appraisals of patients and both parents should be considered when counseling children and adolescents with type 1 diabetes.
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Affiliation(s)
- Fiona L. Mahler
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, University of Zurich, Switzerland
- Department of Endocrinology and Diabetes, University Children's Hospital Zurich, University of Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Daniel Konrad
- Department of Endocrinology and Diabetes, University Children's Hospital Zurich, University of Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland
| | - Markus A. Landolt
- Department of Psychosomatics and Psychiatry, University Children's Hospital Zurich, University of Zurich, Switzerland
- Children's Research Center, University Children's Hospital Zurich, University of Zurich, Switzerland
- Division of Child and Adolescent Health Psychology, Department of Psychology, University of Zurich, Zurich, Switzerland
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21
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Hill RM, Gallagher KAS, Eshtehardi SS, Uysal S, Hilliard ME. Suicide Risk in Youth and Young Adults with Type 1 Diabetes: a Review of the Literature and Clinical Recommendations for Prevention. Curr Diab Rep 2021; 21:51. [PMID: 34902071 PMCID: PMC8666467 DOI: 10.1007/s11892-021-01427-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2021] [Indexed: 10/30/2022]
Abstract
PURPOSE OF REVIEW The manuscript reviews the extant literature on suicide-related thoughts and behaviors among youth and young adults with pediatric diabetes. This evidence is presented within the context of current theories of the etiology of suicidal behavior to highlight how diabetes may contribute to suicide risk, and to support providers in understanding the interplay between pediatric diabetes and suicide risk. The manuscript also reviews evidence-based approaches to suicide prevention suitable for use in pediatric healthcare settings, with suggestions for their application to this unique population. RECENT FINDINGS Several recent studies identify heightened rates of suicidal ideation, suicide attempts, and suicide among youth and young adults with pediatric diabetes, as compared with their peers without diabetes. Evidence-based suicide prevention approaches frequently emphasize the importance of reducing suicidal youths' access to potentially lethal means for suicidal behavior. This approach may require special considerations for youth with pediatric diabetes, due to their need to carry sufficient quantities of insulin and the dangers of inaccurate insulin dosing and/or overdose. Suggestions for suicide prevention for this population include risk screening as part of routine diabetes care, early prevention, education for youth and families, and provider awareness of risk factors, warning signs, and implications for diabetes care. Youth and young adults with diabetes reported elevated rates of suicide-related behaviors as compared with their peers without diabetes. Existing suicide prevention approaches may require substantial adaptation for use with youth and young adults with diabetes. Further research is needed to examine how to best prevent suicidal behaviors among this population.
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Affiliation(s)
- Ryan M Hill
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
- College for Health, Community and Policy, University of Texas at San Antonio, San Antonio, TX, USA
| | - Katherine A S Gallagher
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Sahar S Eshtehardi
- Department of Psychological, Health, & Learning Sciences, University of Houston, Houston, TX, USA
| | - Serife Uysal
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, TX, USA.
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22
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Turin A, Drobnič Radobuljac M. Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review. World J Diabetes 2021; 12:1518-1529. [PMID: 34630904 PMCID: PMC8472498 DOI: 10.4239/wjd.v12.i9.1518] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one's life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.
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Affiliation(s)
- Anja Turin
- Department for Child Psychiatry, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Maja Drobnič Radobuljac
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
- Unit for Intensive Child and Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana 1000, Slovenia
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Ohanian DM, Kritikos TK, Clark OE, Shirkey KC, Starnes M, Holmbeck GN. Stress and Coping in Youth With Spina Bifida: A Brief Longitudinal Study in a Summer Camp Setting. Front Psychol 2021; 12:682169. [PMID: 34408702 PMCID: PMC8366057 DOI: 10.3389/fpsyg.2021.682169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 07/12/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction It is well established that youth with chronic conditions experience elevated levels of stress; the manner in which they respond to or cope with this stress is likely to impact both health and psychosocial outcomes. The current study examined stress and coping in youth and young adults with spina bifida (SB) using the response to stress questionnaire-SB version (RSQ-SB; Connor-Smith et al., 2000). Methods Data were collected as part of a camp-based psychosocial intervention for children (ages 7–13), adolescents (ages 14–19), and young adults (ages 20–38) with SB. Participants completed the RSQ-SB as well as questionnaires assessing demographics and condition severity. Data were collected prior to camp (T1) and 1 month (T2) after camp ended. Self-report data were collected from adolescents and young adults; parents of children and adolescents reported on their child’s stress and coping. Ratios of primary control coping, secondary control coping, disengagement coping, involuntary engagement, and involuntary disengagement coping were calculated. Descriptive statistics and t-tests were utilized to describe coping and stress responses and to determine potential change over time. T-tests were also used to compare youth and parent reported coping styles with those of youth with type 1 diabetes (T1D) and sickle cell disease (SCD). Associations between demographic/disease factors and coping styles were also examined. Results Parent and youth report indicated that youth with SB tend to use primary control coping. Youth with SB use more primary control coping and less disengagement coping compared to youth with SCD and youth with T1D. Few significant changes in coping were found between T1 and T2. IQ and socioeconomic status were significantly associated with coping styles. Conclusion Youth with SB use more primary control coping compared to other coping methods and as compared to other pediatric populations. Future studies should examine mechanisms by which primary control coping is advantageous for youth with SB. Future interventions should be more focused on promoting adaptive coping behaviors and be tailored to developmental age and access to resources.
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Affiliation(s)
- Diana M Ohanian
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Tessa K Kritikos
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Olivia E Clark
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Kezia C Shirkey
- Department of Psychology, North Park University, Chicago, IL, United States
| | - Meredith Starnes
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
| | - Grayson N Holmbeck
- Department of Psychology, Loyola University Chicago, Chicago, IL, United States
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Hoffman WH, Whelan SA, Lee N. Tryptophan, kynurenine pathway, and diabetic ketoacidosis in type 1 diabetes. PLoS One 2021; 16:e0254116. [PMID: 34280211 PMCID: PMC8289002 DOI: 10.1371/journal.pone.0254116] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 06/20/2021] [Indexed: 12/22/2022] Open
Abstract
Diabetic ketoacidosis (DKA) is a serious complication of complete insulin deficiency and insulin resistance in Type 1 diabetes (T1D). This results in the body producing high levels of serum ketones in an attempt to compensate for the insulin deficiency and decreased glucose utilization. DKA's metabolic and immunologic dysregulation results in gradual increase of systemic and cerebral oxidative stress, along with low grade systemic and cerebral inflammation and the development of pretreatment subclinical BE. During treatment the early progression of oxidative stress and inflammation is hypothesized to advance the possibility of occurrence of crisis of clinical brain edema (BE), which is the most important cause of morbidity and mortality in pediatric DKA. Longitudinal neurocognitive studies after DKA treatment show progressive and latent deficits of cognition and emphasize the need for more effective DKA treatment of this long-standing conundrum of clinical BE, in the presence of systemic osmotic dehydration, metabolic acidosis and immune dysregulation. Candidate biomarkers of several systemic and neuroinflammatory pathways prior to treatment also progress during treatment, such as the neurotoxic and neuroprotective molecules in the well-recognized tryptophan (TRP)/kynurenine pathway (KP) that have not been investigated in DKA. We used LC-MS/MS targeted mass spectrometry analysis to determine the presence and initiation of the TRP/KP at three time points: A) 6-12 hours after initiation of treatment; B) 2 weeks; and C) 3 months following DKA treatment to determine if they might be involved in the pathogenesis of the acute vasogenic complication of DKA/BE. The Trp/KP metabolites TRP, KYN, quinolinic acid (QA), xanthurnenic acid (XA), and picolinic acid (PA) followed a similar pattern of lower levels in early treatment, with subsequent increases. Time point A compared to Time points B and C were similar to the pattern of sRAGE, lactate and pyruvic acid. The serotonin/melatonin metabolites also followed a similar pattern of lower quantities at the early stages of treatment compared to 3 months after treatment. In addition, glutamate, n-acetylglutamate, glutamine, and taurine were all lower at early treatment compared to 3 months, while the ketones 3-hydroxybutaric acid and acetoacetate were significantly higher in the early treatment compared to 3 months. The two major fat metabolites, L-carnitine and acetyl-L-carnitine (ALC) changed inversely, with ALC significantly decreasing at 2 weeks and 3 months compared to the early stages of treatment. Both anthranilic acid (AA) and 3-OH-anthranilic acid (3OH-AA) had overall higher levels in the early stages of treatment (A) compared to Time points (B and C). Interestingly, the levels of AA and 3OH-AA early in treatment were higher in Caucasian females compared to African American females. There were also differences in the metabolite levels of QA and kynurenic acid (KA) between genders and between races that may be important for further development of custom targeted treatments. We hypothesize that the TRP/KP, along with the other inflammatory pathways, is an active participant in the metabolic and immunologic pathogenesis of DKA's acute and chronic insults.
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Affiliation(s)
- William H. Hoffman
- Department of Pediatrics, Medical College of Georgia, Augusta University, Augusta, Georgia, United States of America
- * E-mail: (WHH); (SAW)
| | - Stephen A. Whelan
- Department of Chemistry, Chemical Instrumentation Center (CIC), Boston University, Boston Massachusetts, United States of America
- * E-mail: (WHH); (SAW)
| | - Norman Lee
- Department of Chemistry, Chemical Instrumentation Center (CIC), Boston University, Boston Massachusetts, United States of America
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Biamonte E, Pegoraro F, Carrone F, Facchi I, Favacchio G, Lania AG, Mazziotti G, Mirani M. Weight change and glycemic control in type 2 diabetes patients during COVID-19 pandemic: the lockdown effect. Endocrine 2021; 72:604-610. [PMID: 33950348 PMCID: PMC8098639 DOI: 10.1007/s12020-021-02739-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 04/21/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE The aim of this study was to evaluate the impact of the COVID-19 lockdown occurred in Italy from March 9th to May 18th, 2020 on anthropometric parameters and glycemic control in patients with type 2 diabetes mellitus (T2DM). METHODS One hundred twenty-eight consecutive patients with T2DM (median age 70 years, 74 males) were retrospectively evaluated at the end of the lockdown period. Data on metabolic control were collected at different time: within three months before the lockdown (visit 0) and within the first six weeks after it (visit 1). RESULTS During the lockdown, a significant increase in body weight (from 79.7 ± 18.7 kg to 81.4 ± 19.4 kg, p < 0.001), body mass index (BMI, from 29.5 ± 6 kg/m2 to 30.1 ± 6.3 kg/m2, p < 0.001), waist circumference (from 103.8 ± 13 cm to 105 ± 13.6 cm, p < 0.001), fasting plasma glucose (FPG; from 138.1 ± 29.4 mg/dL to 146.6 ± 36.4 mg/dL) and glycated hemoglobin (HbA1c; from 7 ± 0.8 to 7.3 ± 0.9%, p < 0.001) was observed. Weight gain was directly associated with HbA1c increase (β 0.085, C.I. 95% 0.05-0.121; p < 0.001) while insulin therapy resulted to be the only significant independent predictor of HbA1c worsening at the multivariate logistic regression analysis (OR 2.40, C.I. 1.06-5.45; p = 0.035). CONCLUSIONS The lockdown due to COVID-19 pandemic had a negative impact on body weight and glucose control in T2DM patients, in particular in those on insulin treatment. This finding provides a further rationale to optimize the diabetes management during eventually new period of home confinement.
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Affiliation(s)
- Emilia Biamonte
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Pegoraro
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Flaminia Carrone
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Isabella Facchi
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Giuseppe Favacchio
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
| | - Andrea Gerardo Lania
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Gherardo Mazziotti
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Marco Mirani
- Endocrinology, Diabetology and Andrology Unit, IRCCS Humanitas Research Hospital, Rozzano (MI), Italy.
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Ferrier L, Ski CF, O'Brien C, Jenkins Z, Thompson DR, Moore G, Ward G, Castle DJ. Bridging the gap between diabetes care and mental health: perspectives of the Mental health IN DiabeteS Optimal Health Program (MINDS OHP). BMC Endocr Disord 2021; 21:96. [PMID: 33964904 PMCID: PMC8105945 DOI: 10.1186/s12902-021-00760-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Mental health problems are highly prevalent in people with type 1 diabetes mellitus (T1DM), which adversely impact physical health and quality of life. This study aimed to explore the experiences of people with T1DM who had completed the Mental health IN DiabeteS Optimal Health Program (MINDS OHP), a novel intervention developed to bridge the gap between physical and mental health care. METHOD Participants with T1DM were invited to take part in a focus group or semi-structured interviews. Participants were recruited from outpatient and community settings. The focus group and interviews were audio-recorded and transcribed verbatim. Thematic content analysis was used and identified themes were cross-validated by researchers and member-checked by participants. RESULTS Ten people with T1DM were included. Two key themes emerged: 'MINDS OHP experiences' and 'lived experiences of diabetes'. MINDS OHP experiences included five sub-themes: program benefits, follow-up and timing, suggested improvements, collaborative partners, and materials suitability. Lived experiences also included five sub-themes: bridging the gap between mental and physical health, support networks, stigma and shame, management intrusiveness, and adolescence and critical life points. CONCLUSIONS The MINDS OHP for people with T1DM was generally well received, though study findings suggest a number of improvements could be made to the program, such as including family members, and consideration being given to its routine early inclusion in diabetes management, ideally in primary care.
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Affiliation(s)
- Lucienne Ferrier
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
| | - Chantal F Ski
- Department of Psychiatry, University of Melbourne, Melbourne, Australia.
- Integrated Care Academy, University of Suffolk, Ipswich, UK.
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK.
| | - Casey O'Brien
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - Zoe Jenkins
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - David R Thompson
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Gaye Moore
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
| | - Glenn Ward
- Department of Endocrinology, St. Vincent's Hospital, Melbourne, Australia
| | - David J Castle
- Department of Psychiatry, University of Melbourne, Melbourne, Australia
- Mental Health Service, St. Vincent's Hospital, Melbourne, Australia
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Sánchez-Urbano C, Pino MJ, Herruzo C. Personality Prototypes in People with Type 1 Diabetes and Their Relationship with Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4818. [PMID: 33946437 PMCID: PMC8124777 DOI: 10.3390/ijerph18094818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/17/2022]
Abstract
Type 1 diabetes (Dm1) is a chronic endocrine and metabolic disease that affects the whole person and requires active, decisive treatment. However, personality traits may influence a patient's adherence to treatment guidelines. The objective of this work is firstly to identify the 3 Asendorpf personality prototypes (resilient, undercontrolled and overcontrolled) in a sample of Dm1 individuals and determine whether there are any differences in comparison with a control sample; and, secondly, to study their association with adherence to self-care guidelines using both physiological indicators (HbA1C) and self-report measures. To achieve these objectives, a descriptive cross-sectional study was carried out. The sample comprised 294 participants, of whom 104 were people with Dm1 and 190 were controls. The participants, aged between 14 and 34 years, were classified by their scores in NEO-FFI-R, according to the personality characteristics inherent to Asendorpf's prototypes. Asendorpf's 3 prototypical personality patterns were found both in the group of people with Dm1 and in the control sample. These patterns showed different degrees of association with adherence to self-care guidelines for this disease and with psychological health factors. Importance should therefore be attached to the personality traits and Asendorpf prototypes of people with Dm1 when proposing interventions to address medical, psychological, and behavioral aspects.
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Affiliation(s)
| | | | - Carlos Herruzo
- Psychology Department, Facultad de Ciencias de la Educación, University of Cordoba, 14071 Cordoba, Spain; (C.S.-U.); (M.J.P.)
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LePage AK, Wise JB, Bell JJ, Tumin D, Smith AW. Distance from the endocrinology clinic and diabetes control in a rural pediatric population. J Pediatr Endocrinol Metab 2021; 34:187-193. [PMID: 33544546 DOI: 10.1515/jpem-2020-0332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/27/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina. METHODS We retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review period. RESULTS The analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c. CONCLUSIONS Patients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits.
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Affiliation(s)
- Ana K LePage
- Department of Psychology, East Carolina University,GreenvilleNC, USA
| | - J Benjamin Wise
- Brody School of Medicine at East Carolina University, GreenvilleNC, USA
| | - Jennifer J Bell
- Department of Pediatrics, Baylor College of Medicine, HoustonTX, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, GreenvilleNC, USA
| | - Aimee W Smith
- Department of Psychology, East Carolina University,GreenvilleNC, USA
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Abela AG, Fava S. Why is the Incidence of Type 1 Diabetes Increasing? Curr Diabetes Rev 2021; 17:e030521193110. [PMID: 33949935 DOI: 10.2174/1573399817666210503133747] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/14/2021] [Accepted: 03/11/2021] [Indexed: 11/22/2022]
Abstract
Type 1 diabetes is a condition that can lead to serious long-term complications and can have significant psychological and quality of life implications. Its incidence is increasing in all parts of the world, but the reasons for this are incompletely understood. Genetic factors alone cannot explain such a rapid increase in incidence; therefore, environmental factors must be implicated. Lifestyle factors have been classically associated with type 2 diabetes. However, there are data implicating obesity and insulin resistance to type 1 diabetes as well (accelerator hypothesis). Cholesterol has also been shown to be correlated with the incidence of type 1 diabetes; this may be mediated by immunomodulatory effects of cholesterol. There is considerable interest in early life factors, including maternal diet, mode of delivery, infant feeding, childhood diet, microbial exposure (hygiene hypothesis), and use of anti-microbials in early childhood. Distance from the sea has recently been shown to be negatively correlated with the incidence of type 1 diabetes. This may contribute to the increasing incidence of type 1 diabetes since people are increasingly living closer to the sea. Postulated mediating mechanisms include hours of sunshine (and possibly vitamin D levels), mean temperature, dietary habits, and pollution. Ozone, polychlorinated biphenyls, phthalates, trichloroethylene, dioxin, heavy metals, bisphenol, nitrates/nitrites, and mercury are amongst the chemicals which may increase the risk of type 1 diabetes. Another area of research concerns the role of the skin and gut microbiome. The microbiome is affected by many of the factors mentioned above, including the mode of delivery, infant feeding, exposure to microbes, antibiotic use, and dietary habits. Research on the reasons why the incidence of type 1 diabetes is increasing not only sheds light on its pathogenesis but also offers insights into ways we can prevent type 1 diabetes.
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Affiliation(s)
- Alexia G Abela
- Department of Medicine, University of Malta & Mater Dei Hospital, Tal-Qroqq, Msida, Malta
| | - Stephen Fava
- Department of Medicine, University of Malta & Mater Dei Hospital, Tal-Qroqq, Msida, Malta
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30
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Paschou SA, Vryonidou A, Melissourgou M, Kosteria I, Goulis D, Chrousos GP, Kanaka-Gantenbein C. Menstrual Disorders and Androgen-Related Traits in Young Women with Type 1 Diabetes Mellitus: a Clinical Study. Endocr Pract 2020; 26:1269-1276. [PMID: 33471656 DOI: 10.4158/ep-2020-0153] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 05/28/2020] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To investigate possible causes of menstrual disorders and androgen-related traits in young women with type 1 diabetes mellitus (T1DM). METHODS Fifty-three women with T1DM (duration 8.0±5.6 years), 41 women with (polycystic ovary syndrome) PCOS, and 51 controls matched for age (19.4±4.3 years vs. 21.2±2.7 years vs. 20.8±3.1 years; P>.05) and body mass index (BMI) (22.2±2.7 kg/m2 vs. 21.9±2.0 kg/m2 vs. 21.4±1.9 kg/m2; P>.05) were prospectively recruited. RESULTS Two women (3.8%) in the T1DM group had not experienced menarche (at 15.5 and 16.6 years); of the rest, 23.5% had oligomenorrhea, 32.1% hirsutism, and 45.3% had acne. The age at menarche was delayed in the T1DM group compared to controls (12.7±1.3 vs. 12.0±1.0 years; P = .004), while no difference was observed with the polycystic ovary syndrome (PCOS) group (12.4±1.2 years). There were no differences in total testosterone (0.43±0.14 ng/mL vs. 0.39±0.14 ng/mL; P>.05), dehydroepiandrosterone sulfate (DHEA-S) (269 ± 112 μg/dL vs. 238 ± 106 μg/dL; P>.05) or Δ4-androstenedione (2.4±1.3 ng/mL vs. 1.9±0.5 ng/mL; P>.05) concentrations between T1DM and controls. However, patients with T1DM had lower sex hormone binding globulin (SHBG) concentrations than controls (61 ± 17 nmol/L vs. 83 ± 18.1 nmol/L; P = .001), which were even lower in the PCOS group (39.5±12.9 nmol/L; P = .001 compared with T1DM). The free androgen index (FAI) was higher in the PCOS group compared with both other groups (T1DM vs. PCOS vs. controls: 2.53±0.54 vs. 7.88±1.21 vs. 1.6 ± 0.68; P<.001). FAI was higher in patients with T1DM compared to controls as well (P = .038). There was no difference in DHEA-S concentrations between T1DM and PCOS patients (269 ± 112 μg/dL vs. 297 ± 100 μg/dL; P>.05). CONCLUSION Menstrual disorders and androgen-related traits in young women with T1DM may be attributed to an increase in androgen bioavailability due to decreased SHBG concentrations.
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Affiliation(s)
- Stavroula A Paschou
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics and University Research Institute on Maternal and Child Health and Precision Medicine, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Andromachi Vryonidou
- Department of Diabetes and Endocrinology, Hellenic Red Cross Hospital, Athens, Greece
| | - Marina Melissourgou
- Department of Diabetes and Endocrinology, Hellenic Red Cross Hospital, Athens, Greece
| | - Ioanna Kosteria
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics and University Research Institute on Maternal and Child Health and Precision Medicine, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - DimitriosG Goulis
- Unit of Reproductive Endocrinology, First Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George P Chrousos
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics and University Research Institute on Maternal and Child Health and Precision Medicine, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Christina Kanaka-Gantenbein
- Division of Endocrinology, Diabetes and Metabolism, First Department of Pediatrics and University Research Institute on Maternal and Child Health and Precision Medicine, Aghia Sophia Children's Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
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Geirhos A, Domhardt M, Galler A, Reinauer C, Warschburger P, Müller-Stierlin AS, Minden K, Temming S, Holl RW, Baumeister H. Psychische Komorbiditäten bei Jugendlichen und jungen Erwachsenen mit Typ-1-Diabetes. DIABETOL STOFFWECHS 2020. [DOI: 10.1055/a-1264-6590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungJugendliche und junge Erwachsene mit Typ-1-Diabetes sind häufig von komorbiden psychischen Störungen betroffen. Dabei zeigt die Studienlage zur Verbreitung ein heterogenes und inkonsistentes Bild. Diagnose und Behandlung der somatopsychischen Begleiterkrankungen beeinflussen den Behandlungs- und Krankheitsverlauf sowie die Lebensqualität der Betroffenen. Trotzdem wird dies in der klinischen Praxis selten frühzeitig berücksichtigt. Das multizentrische Verbundprojekt COACH verfolgt das Ziel, die Erkennung und Behandlung psychischer Komorbidität für diese Zielgruppe in der bundesweiten Routineversorgung zu optimieren.
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Affiliation(s)
- Agnes Geirhos
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Matthias Domhardt
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
| | - Angela Galler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Sozialpädiatrisches Zentrum, Pädiatrische Endokrinologie und Diabetologie, Berlin, Germany
| | - Christina Reinauer
- Klinik für Allgemeine Pädiatrie, Neonatologie und Kinderkardiologie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - Annabel S. Müller-Stierlin
- Sektion Gesundheitsökonomie und Versorgungsforschung, Klinik für Psychiatrie und Psychotherapie II, Universität Ulm, Germany
| | - Kirsten Minden
- Klinik für Rheumatologie und klinische Immunologie, Charité – Universitätsmedizin Berlin, kooperatives Mitglied der Freien Universität Berlin, der Humboldt-Universität zu Berlin und des Berliner Instituts für Gesundheitsforschung, Germany
- Deutsches Rheuma-Forschungszentrum Berlin, Programmbereich Epidemiologie, Germany
| | - Svenja Temming
- Klinik für Pädiatrie mit Schwerpunkt Pneumologie, Immunologie und Intensivmedizin, Charité – Universitätsmedizin Berlin, Germany
| | - Reinhard W. Holl
- ZIBMT, Institut für Epidemiologie und medizinische Biometrie, Universität Ulm, Germany
- Deutsches Zentrum für Diabetesforschung (DZD), München-Neuherburg, Germany
| | - Harald Baumeister
- Klinische Psychologie und Psychotherapie, Institut für Psychologie und Pädagogik, Universität Ulm, Germany
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Shayeghian Z, Moeineslam M, Hajati E, Karimi M, Amirshekari G, Amiri P. The relation of alexithymia and attachment with type 1 diabetes management in adolescents: a gender-specific analysis. BMC Psychol 2020; 8:30. [PMID: 32252831 PMCID: PMC7137281 DOI: 10.1186/s40359-020-00396-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 03/19/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Several studies indicate the role of psychosocial factors in the management and control of chronic diseases in adolescents. In this regard, the roles of attachment and alexithymia in the management of type 1 diabetes in adolescents and related gender-specific patterns have rarely been the focus of empirical research. In this study we investigate the gender-specific relationship of alexithymia and attachment with self-care and blood glucose level in adolescents with type1 diabetes. METHODS This is a cross-sectional study conducted on adolescents aged 12-18 years, with type 1 diabetes. Participants were recruited from diabetes clinics and the Iranian Diabetes Society. Data were collected using the Farsi versions of the Toronto Alexithymia Scale (FTAS-20), the Inventory of Parent and Peer Attachment (IPPA) and the Summary of Diabetes Self-Care Activities Scale (SDSCA). Blood glucose levels were measured by determining HbA1c which were abstracted from medical records. Data were analyzed using SPSS21 software. RESULTS Participants were 150 adolescents (57% female), mean age 14.97 ± 2.30. Alexithymia (β = 0.10, P = 0.01), difficulty identifying feelings (β = 0.15, P = 0.03) and communication with mothers (β = - 0.08, P = 0.03) predicted HbA1c in girls, whereas no significant relationships were observed for HbA1c with alexithymia and attachment in boys. Factors that predicted self-care in girls were alexithymia (β = - 0.04, P = 0.02), difficulty identifying feelings (β = - 0.06, P = 0.04); in boys however in addition to these two factors predicting self-care [alexithymia (β = - 0.07, P = 0.01) and difficulty identifying feelings (β = - 0.11, P = 0.01)], we also found difficulty describing feelings (β = - 0.16, P = 0.02), communication with mother (β = 0.04, P = 0.04), alienation to mother (β = - 0.06, P = 0.03), to father (β = - 0.06, P = 0.01) and to peers (β = - 0.09, P = 0.03). CONCLUSIONS Our results suggest that, in a gender-specific pattern, alexithymia and attachment could affect self-care and blood glucose level in adolescents with type 1 diabetes; findings that can be used to facilitate more effective treatment strategies and interventions in this age group.
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Affiliation(s)
- Zeinab Shayeghian
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Mina Moeineslam
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Elnaz Hajati
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Mehrdad Karimi
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.,Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Golshan Amirshekari
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran
| | - Parisa Amiri
- Research Center for Social Determinants of Health, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, P.O.Box: 19395-4763, Tehran, Iran.
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Iqbal AM, Kumar S, Hansen J, Heyrman M, Spee R, Lteif A. Association of Adverse Childhood Experiences with Glycemic Control and Lipids in Children with Type 1 Diabetes. CHILDREN 2020; 7:children7010008. [PMID: 31963630 PMCID: PMC7022250 DOI: 10.3390/children7010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 01/06/2020] [Accepted: 01/13/2020] [Indexed: 11/23/2022]
Abstract
Adverse childhood experiences (ACE) have been associated with a greater prevalence of risky behaviors and chronic health conditions, such as diabetes in adulthood. While adolescents with risk taking behaviors experience worsening of diabetic metabolic control, it is yet to be determined whether glycemic management in children and adolescents is negatively and independently influenced by ACEs. This study examines the relationship between ACEs in children and adolescents with type 1 diabetes (T1DM) and glycemic control, BMI and lipids. For such children, we hypothesized that hemoglobin A1c (HbA1c) is positively correlated with ACE scores. Parents of children (age 2–18 years) with T1DM completed a validated ACE questionnaire. The associations between parent and child ACE score and HbA1c, lipids and BMI z-scores were assessed using linear regression. The prevalence of any ACE was 27.9% among children and 49.0% among parents. HbA1c was significantly higher in children who had exposure to three or more ACEs (β: 0.63 (4.5 mmol/mol); p = 0.02), in those who had a parent exposed to four or more ACEs (β: 0.87 (7.2 mmol/mol); p = 0.03), in children who had exposure to household incarceration (β: 0.62 (4.4 mmol/mol); p = 0.05) and children who witnessed or had been victim of violence in the neighborhood (β: 0.71 (5.4 mmol/mol); p = 0.02). ACEs were highly prevalent among children with T1DM and had a positive association with glycemic control.
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Affiliation(s)
| | | | | | | | | | - Aida Lteif
- Correspondence: ; Tel.: +1-507-284-3300; Fax: +1-507-284-0727
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Trajectory Analysis of Glycemic Control in Adolescents with Type 1 Diabetes Mellitus at Dammam Medical Complex, Saudi Arabia. Adv Med 2020; 2020:1247294. [PMID: 33490293 PMCID: PMC7803114 DOI: 10.1155/2020/1247294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/25/2020] [Accepted: 12/06/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Saudi Arabia is reported to have the highest number of children and adolescents with T1DM. However, data concerning glycemic control during adolescence are lacking. OBJECTIVES To determine glycemic control at transition stage from pediatric to adult clinics, determine HBA1c patterns during follow-up, and identify any clinical or demographic variables that may predict a distinctive glycemic pattern. DESIGN Observational retrospective study. Setting. Dammam Medical Complex, secondary care hospital. Patients and Method. Adolescents aged ≥12 years, with HbA1c recorded at least once a year over 4 years of follow-up, were eligible for inclusion. A trajectory analysis from 2008 to 2019 was conducted, using latent class growth modelling (LCGM), and two-sample t-tests and Fisher's exact tests were conducted to determine whether there was a statistically significant difference in demographic and clinical variables. Sample Size. 44 patients. RESULTS 61.36% were referred from pediatric clinics, and 84% were on multiple insulin daily injections. For the trajectory prediction, two groups were identified. Group 1 comprised 71.7%, had high HbA1c values at age 13 (HbA1c, 11.28%), and had a significant and stable decrease in HbA1c values with age (-0.32, p < 0.00). Group 2 comprised 28.2%, showed poor HbA1c values at age 13 (HbA1c, 13.28%), and showed increase in HbA1c values slightly by age 15, which then steadily decreased with age (-0.27). Results indicated that the initial HBA1c value was a significant predictor for group trajectory (p=0.01), while the remaining variables did not have any significance. CONCLUSION Our study identified two groups with poorly controlled diabetes; however, the first group performed relatively better than the second group. Both groups almost doubled their targets, with a trend towards HbA1c reduction by the age of 19 in both groups. Limitations. Retrospective study with convenient, small sample size.
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Yang J, Guo J, Tang Y, Huang L, Wiley J, Zhou Z, Whittemore R. The mediating effect of coping styles and self‐efficacy between perceived stress and satisfaction with QOL in Chinese adolescents with type 1 diabetes. J Adv Nurs 2019; 75:1439-1449. [DOI: 10.1111/jan.13933] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 10/19/2018] [Accepted: 11/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Jundi Yang
- Xiangya School of Nursing Central South University Changsha Hunan Province China
| | - Jia Guo
- Xiangya School of Nursing Central South University Changsha Hunan Province China
| | - Yujia Tang
- Xiangya School of Nursing Central South University Changsha Hunan Province China
| | - Lingling Huang
- School of Nursing Shen Zhen University Shen Zhen Guangdong Province China
| | - James Wiley
- School of Nursing University of California, San Francisco San Francisco California
| | - Zhiguang Zhou
- Diabetes Center Institute of Metabolism and Endocrinology, Second Xiangya Hospital, Central South University Changsha China
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Luo JX, Yang JD, Liu F, Guo J. [Stress and coping style in children and adolescents with type 1 diabetes and their influence on disease self-management]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2018; 20:1024-1029. [PMID: 30572992 PMCID: PMC7389492 DOI: 10.7499/j.issn.1008-8830.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 10/15/2018] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To investigate the influence of demographic and clinical characteristics, stress, and coping style on disease self-management in children and adolescents with type 1 diabetes. METHODS A cross-sectional survey was performed to select 149 children and adolescents with type 1 diabetes (aged 8-20 years). Related data were collected using the questionnaires and scales on general information, diabetes self-management, perceived stress, and coping style. RESULTS Of the 149 children and adolescents, 37(24.8%) had high stress. Compared with the school-aged children, the adolescents had higher stress level and were more likely to present with negative coping style (P<0.05). The multiple linear regression analysis showed that the children whose mothers had an educational level at or above senior high school, who had a low stress level, and who adopted positive coping measures had a higher level of diabetes self-management (P<0.05). CONCLUSIONS Nearly a quarter of the children and adolescents with type 1 diabetes have a high stress level. When delivering the education on diabetes self-management to children and adolescents, healthcare workers should focus on the families whose mothers have an educational level at or below junior high school. Strategies should aim at reducing stress by encouraging positive coping styles.
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Affiliation(s)
- Jia-Xin Luo
- Xiangya School of Nursing, Central South University, Changsha 410013, China.
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Rechenberg K, Grey M, Sadler L. "Anxiety and Type 1 diabetes are like cousins": The experience of anxiety symptoms in youth with Type 1 diabetes. Res Nurs Health 2018; 41:544-554. [PMID: 30375003 DOI: 10.1002/nur.21913] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 08/09/2018] [Indexed: 01/09/2023]
Abstract
Type 1 diabetes (T1D) is one of the most common chronic health conditions in youth in the United States, and its incidence is rising worldwide. Youth with T1D are at a high risk of psychological comorbidity, for example, anxiety, depression, and eating disorders. Psychological comorbidities, especially anxiety symptoms, have been correlated with poorer diabetes outcomes, but anxiety symptoms have not been well studied in these youth. The primary aim of this study was to describe the experience of anxiety symptoms in youth with T1D, especially as those symptoms relate to diabetes self-management tasks. We used a qualitative descriptive approach, consisting of an in-depth, semi-structured interview comprising 10 open-ended questions with follow-up probes. The analysis was guided by the principles of thematic analysis. Demographic data, Hemoglobin A1c levels, and the State-Trait Anxiety Inventory for Children survey data were also collected and analyzed. We identified four themes and seven sub-themes. Participants (n = 29, ages 10-16, 55% female) reported that T1D was an extra layer of responsibility that took time away from their ability to participate fully in other aspects of their lives. Some participants were able to integrate diabetes management into their lives, while others were not. Some participants were dependent on parents and the school nurse for diabetes management. Participants described two types of anxiety symptoms, general and diabetes-specific, and they noted that their experience of anxiety was associated with poor quality sleep, general lifestyle factors, and diabetes.
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Affiliation(s)
| | - Margaret Grey
- Yale University School of Nursing, West Haven, Connecticut
| | - Lois Sadler
- Yale University School of Nursing, West Haven, Connecticut
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Edraki M, Rambod M, Molazem Z. The Effect of Coping Skills Training on Depression, Anxiety, Stress, and Self-Efficacy in Adolescents with Diabetes: A Randomized Controlled Trial. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2018; 6:324-333. [PMID: 30465005 PMCID: PMC6226609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Diabetes patients are at risk of psychosocial problems. Some interventions might decrease these problems. This study aimed to evaluate the effect of coping skills training on depression, anxiety, stress, and self-efficacy of adolescents with type I diabetes. METHODS This randomized controlled trial with pre- and post-test design was performed in the diabetes clinic in Shiraz from June to November 2015. This study was conducted on 100 adolescents with type 1 diabetes who were randomly divided into an intervention (receiving coping skills training in groups for eight sessions) and a control group (usual care). Depression, Anxiety, and Stress Scales (42-items, scores=0-42) and General Self-Efficacy questionnaire (17-items, scores=17-85) were used. The variables were measured at baseline and two months after starting the intervention. Data were analyzed using SPSS, version 16 through Chi-square test, independent t-test, and paired t-test. P<0.05 was significant. RESULTS After the intervention, the mean scores of depression, anxiety and stress in the intervention group were 5.41±4.58, 6.44±7.01, and 7.46±7.01, and in the control groups they were 19.73±11.80, 18.28±10.51, 21.10±10.94, respectively. Moreover, after the intervention, the mean scores of self-efficacy were 70.82±10.84, and 50.13±15.42 in the intervention and control groups, respectively. The results showed differences between the two groups regarding depression, anxiety, stress, and self-efficacy after starting the intervention (P<0.001). CONCLUSION As coping skills training reduced depression, anxiety, and stress and improved the patients' self-efficacy, the use of this intervention could be a part of community-based nursing practice for adolescents with diabetes and more research for improving evidence-based practice in this regard are warranted. - Trial Registration Number: IRCT201505011369N4.
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Affiliation(s)
- Mitra Edraki
- Community Based Psychiatric Care Research Center, Department of Pediatrics, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran;
| | - Masoume Rambod
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Zahra Molazem
- Community Based Psychiatric Care Research Center, Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
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Mayer-Davis EJ, Maahs DM, Seid M, Crandell J, Bishop FK, Driscoll KA, Hunter CM, Kichler JC, Standiford D, Thomas JM. Efficacy of the Flexible Lifestyles Empowering Change intervention on metabolic and psychosocial outcomes in adolescents with type 1 diabetes (FLEX): a randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:635-646. [PMID: 30119757 PMCID: PMC6260973 DOI: 10.1016/s2352-4642(18)30208-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND Adolescents with type 1 diabetes commonly have poor glycaemic control. We aimed to test the efficacy of a newly developed adaptive behavioral intervention (Flexible Lifestyles Empowering Change; FLEX) on metabolic and psychosocial outcomes in adolescents with type 1 diabetes. METHODS Young people (13-16 years, type 1 diabetes duration >1 year, HbA1c of 64-119 mmol/mol [8·0-13·0%], and without other serious medical conditions or pregnancy) from two clinical sites (Colorado and Ohio, USA) were eligible for enrolment. One caregiver was required to participate actively in the study. Adolescent participants were randomly assigned to the FLEX intervention, which used motivational interviewing and problem-solving skills training to enhance patients' self-management, or usual care control. Intervention fidelity was assessed by a behavioral psychologist with specific expertise in motivational interviewing and who was not otherwise involved in the study via audiotaped sessions. The primary outcome was measurement of glycated haemoglobin A1c (HbA1c) at 18 months. Secondary outcomes included motivation and intention, problem solving skills, self-management behaviors, symptoms of depression, health related quality of life, fear of hypoglycemia, diabetes family conflict, risk factors for T1D complications (BMI, blood pressure, and plasma lipids), and hypoglycemia derived from continuous glucose monitoring (percent time below 3·0 and 3·9 mmol/l [54 and 70 mg/dl]). Intention-to-treat analyses used mixed effects models, with fixed effects including site, timepoint, intervention group, intervention by timepoint, and baseline level of primary (HbA1c) or secondary outcomes (α=0·05). FLEX is registered on clinicaltrials.gov, number NCT01286350. FINDINGS Young people recruited from May 1, 2014 to April 4, 2016 were randomly assigned to FLEX (n=130) or usual care control (n=128). Mean diabetes duration was 6·4 (SD 3·8) years, and 71% (181 out of 256) of patients used insulin pump therapy. Retention was 93%, with 241 out of 258 completing the 18-month assessment. The intervention fidelity score was 4·40 of 5·00 for motivational interviewing and 97% for session content. At 18 months, HbA1c was not significantly different between intervention (83 [13] mmol/mol at baseline; 84 [19] mmol/mol at follow-up); and control (80 [14] mmol/mol at baseline; 82 [17] mmol/mol at follow-up); change in intervention versus control was -0·7 mmol/mol (95% CI -4·7 to 3·4, p=0·75). The intervention was associated with improved scores for motivation (p=0·011), problem solving (p=0·024), diabetes self-management profile (p=0·013), youth report of overall quality of life (p=0·0089), selected domains related to fear of hypoglycaemia (p=0·036 for youth's helplessness or worry; p=0·0051 for parent's efforts to maintain high blood glucose), parent report of diabetes family conflict (p=0·0001), total cholesterol (p=0·038), and diastolic blood pressure (p=0·015). A total of 54 serious adverse events were identified; 34 of these were diabetes-related, including low blood glucose requiring assistance (n=3) and high blood glucose with diabetic ketoacidosis and emergency response (n=25). INTERPRETATION The FLEX intervention did not significantly change HbA1c among these adolescents with elevated HbA1c, but did positively affect several psychosocial outcomes over 18 months. Further analyses will provide information regarding drivers of positive response to the intervention and will point to future directions for improvement in the approach. FUNDING National Institutes of Health and National Institute of Diabetes Digestive Diseases and Kidney and the Helmsley Charitable Trust.
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Affiliation(s)
- Elizabeth J Mayer-Davis
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David M Maahs
- Department of Pediatrics, School of Medicine, Stanford University, Stanford, CA, USA
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Franziska K Bishop
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO, USA
| | - Kimberly A Driscoll
- Barbara Davis Center for Childhood Diabetes, University of Colorado Denver, Denver, CO, USA
| | - Christine M Hunter
- National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, MD, USA
| | - Jessica C Kichler
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Debra Standiford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA
| | - Joan M Thomas
- Departments of Nutrition and Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abualula NA, Rodan MF, Milligan RA, Jacobsen KH. Self-rated health among American adolescents with type 1 diabetes in the T1D Exchange Clinic Registry. J Diabetes Complications 2018; 32:83-88. [PMID: 29092790 DOI: 10.1016/j.jdiacomp.2017.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/28/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The goal of this study was to examine the self-rated health (SRH) of adolescents with type 1 diabetes (T1D). METHODS A logistic regression analysis of baseline data from adolescents in the United States included in the T1D Exchange Clinic Registry in 2010-2012 was conducted. Participants were 13-18years old at the time of enrollment in the registry and had been diagnosed with T1D at least one year before enrollment (n=5799). RESULTS Half (49.0%) of the participants were female, 46.3% were ages 16-18years, 22.5% were non-white, 35.7% did not have private/military health insurance, and 78.8% had HbA1c levels >7.5%, indicating poor T1D management, 20.7% reported having diabetes-related stress often or very often, and 46.4% used insulin injections or pens rather than a pump. In total, 10.3% (n=600) of the participants rated their health as poor or fair and 59.3% (n=3439) rated their health as very good or excellent. Participants with poor or fair SRH were more likely than those with very good or excellent SRH to be female (adjusted OR=1.7(1.4, 2.1)), 16 to 18years old (OR=2.1(1.7, 2.5)), and non-white (OR=2.7(2.2, 3.4)), to be without private or military insurance (OR=2.4(2.1, 3.0)), to have HbA1c levels >7.5% (OR=3.3(2.4, 4.7)), to report having diabetes-related stress often or very often (OR=6.1(5.1, 7.2)), and to use an injection or pen rather than a pump (OR=2.1(1.6, 2.4)). CONCLUSIONS Because adolescents with T1D who report lower SRH are more likely to have uncontrolled blood glucose and frequent diabetes-related stress, use of pumps and stress-reduction strategies may improve SRH among adolescents with T1D.
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Affiliation(s)
- Nada A Abualula
- College of Nursing, Taibah University, Universities Road, Medina, Saudi Arabia; School of Nursing, George Mason University, Fairfax, VA 22030, USA.
| | - Margaret F Rodan
- School of Nursing, George Mason University, Fairfax, VA 22030, USA.
| | - Renee A Milligan
- School of Nursing, George Mason University, Fairfax, VA 22030, USA.
| | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, VA 22030, USA.
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