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Yoldi-Vergara C, Conget-Donlo I, Cardona-Hernandez R, Ramon-Krauel M. Influence of socioeconomic factors on glycemic control, therapeutic adherence and quality of life in children and adolescents with type 1 diabetes. ENDOCRINOL DIAB NUTR 2024; 71:253-262. [PMID: 38942702 DOI: 10.1016/j.endien.2024.04.003] [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: 02/05/2024] [Revised: 03/11/2024] [Accepted: 04/07/2024] [Indexed: 06/30/2024]
Abstract
OBJECTIVE To stablish the relationship between socioeconomic status of a cohort of children and adolescents with type 1 diabetes (T1D) with glycemic control, therapeutic adherence and diabetes quality of life (DQoL). PATIENTS Y METHODS A cross-sectional, observational study with consecutive inclusion was carried out. Participants aged 8-18 years with T1D duration >1 year. Data on family structure, family income, parents' educational level and parental role on primary diabetes care supervision were registered. Adherence (DMQ-Sp) and DQoL (PedsQl) were analyzed. Linear and logistic regression models adjusted for demographics, family structure and parental role on primary diabetes care responsibility were applied. RESULTS A total of 323 patients (T1D duration 5,3 ± 3,3 years; HbA1c 7,7 ± 1,0%; age 13,3 ± 2,8 years; 49,8% females) were included. Patients living in a nuclear family and those whose main diabetes care supervision was shared by both parents showed lower HbA1c [adjusted for demographics and family structure (7,06; CI 95% 6,52-7,59); adjusted for demographics and role on primary diabetes care supervision (7,43; CI 95% 6,57-8,28)]. DMQ-Sp score (adjusted for demographics and role on main supervision) was higher in patients whose parents shared the diabetes care supervision (84,56; CI 95% 73,93-95,19). Parents sharing diabetes care supervision showed a significantly higher PedsQl score (both 74,63 ± 12,70 vs mother 68,53 ± 14,59; p = 0,001). CONCLUSIONS Children and adolescents with T1D had lower HbA1c, better therapeutic adherence and better DQoL when lived in a nuclear family, with higher socioeconomic status and the responsibility for supervising diabetes care was shared by both parents.
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Affiliation(s)
- Carmen Yoldi-Vergara
- Servicio de Endocrinología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain.
| | - Ignacio Conget-Donlo
- Servicio de Endocrinología y Nutrición, Hospital Clinic i Universitari, Barcelona, Spain; Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Madrid, Spain; Institut d'investigacions biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | | | - Marta Ramon-Krauel
- Servicio de Endocrinología Pediátrica, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Almeida AC, Leandro ME, Pereira MG. Diabetes representations on adherence and quality of life: Do parents and adolescents differ? Psych J 2023; 12:108-118. [PMID: 36100433 DOI: 10.1002/pchj.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
Type 1 diabetes is one of the most frequent chronic diseases in adolescents. To manage diabetes and prevent complications, a set of self-care behaviors needs to be implemented into family daily routines. This study analyzed diabetes representations in adolescents and their parents, the dissimilarities between them, and the relationship between illness dissimilarities and adherence/quality of life (QoL) in adolescents with type 1 diabetes. The sample included 200 participants: 100 adolescents with type 1 diabetes and 100 parents who accompanied the adolescents. Adolescents were assessed on adherence (Self-Care Inventory-Revised), quality of life (Diabetes QoL) and family support (Diabetes Family Behavior Scale). Both adolescents and parents were assessed on illness representations (Brief-Illness Perception Questionnaire). Dissimilarities in illness representations between parents and adolescents were performed using Olsen et al's proposal. Parents showed a more negative representation of diabetes than adolescents. Adolescents' illness representations, the dissimilarities between adolescents' and parents' illness representations, and family support were associated with adolescents' adherence and QoL. Higher family support moderated the relationship between the dissimilarity in timeline representations and QoL, explaining 17.8% of the variance on QoL. Adolescent's gender (male) was a moderator in the relationship between adolescent's coherence and QoL, explaining 18.6% of the variance on QoL. Adolescent's gender (female) was a moderator in the relationship between timeline and QoL, explaining 11.9% of the variance on QoL. Being a male parent was a moderator in the relationship between adolescent's concerns and QoL, explaining 13.5% of the variance on QoL. Intervention programs should focus on illness representations, particularly on the dissimilarities between adolescents and parents, as well as on family support in order to promote adolescents' adherence and QoL.
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Affiliation(s)
- Ana C Almeida
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - M Engrácia Leandro
- Centre for Research and Studies in Sociology, University Institute of Lisbon, Campus da Cidade Universitária de Lisboa, Lisbon, Portugal
| | - M Graça Pereira
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
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Alvarenga CS, La Banca RO, Neris RR, de Cássia Sparapani V, Fuentealba-Torres M, Cartagena-Ramos D, Leal CL, Esper MV, Nascimento LC. Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review. BMC Endocr Disord 2022; 22:43. [PMID: 35183150 PMCID: PMC8858488 DOI: 10.1186/s12902-022-00950-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 01/24/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Among the treatments for type 1 diabetes mellitus (T1DM), Continuous Subcutaneous Insulin Infusion (CSII) is a device that infuses insulin through the subcutaneous tissue in an uninterrupted manner and that comes closest to the physiological secretion of insulin. The use of CSII can provide the family with greater security and children and adolescents have more autonomy in relation to the treatment of T1DM. There is a lack of reviews that systematically gather the mounting evidence about the use of CSII in children and adolescents with T1DM. Therefore, the aim of this review was to group and describe primary and secondary studies on the use of CSII in children and adolescents with T1DM. METHODS A systematic mapping review was performed based on searches in the following databases: PubMed, Embase, CINAHL, Lilacs and PsycINFO, using a combination of descriptors and keywords. The screening of the studies was carried out with the aid of the Rayyan software and reading in full was conducted independently by two reviewers. The data extraction of the studies was performed using an extraction tool adapted and validated by researchers specialized in diabetes. The data were analyzed according to the content analysis technique. The map from geocoding of the studies was produced using the ArcGis 10.5 software. RESULTS A total of 113 studies were included in the review, including primary studies, literature reviews and gray literature publications. The content analysis of the results of the studies allowed for the identification of four categories: 1) metabolic control; 2) support networks; 3) benefits of using CSII; and 4) challenges of using CSII, each category having its respective subcategories. The review also made it possible to conduct a rigorous mapping of the literature on the use of CSII considering the location of development and the design of the studies. CONCLUSIONS The use of CSII should be indicated by health professionals able to prepare children, adolescents, and their families for the treatment of T1DM, and, despite being a technological device, it may not be suitable for the entire pediatric population.
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Affiliation(s)
- Carolina Spinelli Alvarenga
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | | | - Rhyquelle Rhibna Neris
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | | | | | | | - Camila Lima Leal
- Public Health Nursing Graduate Program, University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | - Marcos Venicio Esper
- Interunit Doctoral Program in Nursing, University of São Paulo College of Nursing and the University of São Paulo at Ribeirão Preto College of Nursing, Ribeirão Preto, SP Brazil
| | - Lucila Castanheira Nascimento
- Maternal-Infant and Public Health Nursing Department, University of São Paulo at Ribeirão Preto College of Nursing, PAHO/WHO Collaborating Centre for Nursing Research Development, 3900 Av. Bandeirantes, Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo 14040-902 Brazil
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Höhn C, Metzner G, Waldeck E, Glattacker M. Contextual factors of self-regulation in children and adolescents with chronic diseases - a qualitative analysis. BMC Public Health 2020; 20:1923. [PMID: 33357223 PMCID: PMC7758920 DOI: 10.1186/s12889-020-10056-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 12/11/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In recent decades, the prevalence of chronic diseases in children and adolescents has increased significantly. Contextual factors play a central role in the self-regulation of chronic diseases. They influence illness and treatment representations, disease management, and health outcomes. While previous studies have investigated the influence of contextual factors on children's beliefs about their illness, little is known about subjective contextual factors of treatment representations of children and adolescents with chronic diseases, especially in the context of rehabilitation. Therefore, the aim of this qualitative analysis was to examine the contextual factors reported by chronically ill children and adolescents in relation to their treatment representations. Furthermore, we aimed to assign the identified themes to classifications of environmental and personal contextual factors in the context of the International Classification of Functioning, Disability and Health (ICF). METHODS Between July and September 2018, semi-structured interviews were conducted with N = 13 children and adolescents in rehabilitation to explore their rehab-related treatment representations and associated contextual factors. The interviews started with an open narrative question about expectations and beliefs about rehabilitation, followed by further detailed questions. The interviews were recorded on audio tape, transcribed, and analysed using thematic content analysis. RESULTS Participants raised six themes associated with their rehab-related treatment representations that were interpreted as contextual factors: the living situation before rehabilitation, the idea of rehabilitation, previous solution attempts, rehab pre-experiences, information that the children and adolescents received from the clinic or sought themselves, and the assumed attitudes of their parents concerning rehabilitation. All the themes could be assigned to the classification of environmental and personal factors in the context of the ICF for children and youth. CONCLUSIONS Although contextual factors have an important impact on self-regulation, little attention is paid to their investigation. Personal and environmental factors probably influence patients' treatment representations in terms of expectations and concerns as well as emotions regarding the treatment. Considering contextual factors could lead to the more appropriate allocation of medical care and the better customisation of treatment.
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Affiliation(s)
- Cindy Höhn
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Gloria Metzner
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Edith Waldeck
- Deutsche Rentenversicherung Rheinland-Pfalz, Edelsteinklinik, Fachklinik für Kinder- und Jugendrehabilitation, Lindenstr. 48, 55758, Bruchweiler, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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Vidal Flor M, Jansà I Morató M, Roca Espino D, Viñals Domenech C, Quirós López C, Mesa Pineda Á, Yoldi Vergara C, Cardona-Hernandez R, Giménez Álvarez M, Esmatjes Mompó E, Conget Donlo I. Results of a specific and structured program in the transition of young patients with type 1 diabetes from the paediatric center to an adult hospital. The experience of a decade. ACTA ACUST UNITED AC 2020; 68:82-91. [PMID: 32912806 DOI: 10.1016/j.endinu.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Revised: 06/10/2020] [Accepted: 06/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Evaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. METHODOLOGY This was a prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%). RESULTS A total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin [HbA1c] 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.
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Affiliation(s)
- Mercè Vidal Flor
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España.
| | - Margarida Jansà I Morató
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Daria Roca Espino
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Clara Viñals Domenech
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Carmen Quirós López
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; Servicio de Endocrinología, Mútua de Terrassa, Barcelona, España
| | - Álex Mesa Pineda
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Carmen Yoldi Vergara
- Unidad de Endocrinología pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Roque Cardona-Hernandez
- Unidad de Endocrinología pediátrica, Hospital de Sant Joan de Déu, Esplugues de Llobregat, Barcelona, España
| | - Marga Giménez Álvarez
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS. Institut d'investigacions biomèdiques August Pi i Sunyer, Cataluña, España; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
| | - Enric Esmatjes Mompó
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España
| | - Ignacio Conget Donlo
- Unidad de Diabetes, Endocrinología y Nutrición, Hospital Clínic i Universitari, Barcelona, España; IDIBAPS. Institut d'investigacions biomèdiques August Pi i Sunyer, Cataluña, España; CIBERDEM, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades metabólicas, Madrid, España
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Goethals ER, Jaser SS, Verhaak C, Prikken S, Casteels K, Luyckx K, Delamater AM. Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2020; 163:108153. [PMID: 32325107 PMCID: PMC8008789 DOI: 10.1016/j.diabres.2020.108153] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
AIMS Although research exists on parental communication in adolescents with type 1 diabetes (T1D), the role of communication by health care providers remains understudied. Grounded in Self-Determination Theory, this study examined the role of autonomy-supportive communication (i.e., providing meaningful rationale and offering choices with regard to treatment recommendations) by providers and parents, and how they interact in the prediction of diabetes outcomes. METHODS In this cross-sectional study, 135 adolescents (mean age 14.3 ± 2.1SD years), 171 mothers, and 121 fathers reported on autonomy-supportive communication from health care providers and parents, and on adolescent treatment adherence. HbA1c values were retrieved from the medical record. RESULTS In adolescent reports, perceived autonomy-supportive communication from providers but not from parents was positively related to treatment adherence. A significant interaction between autonomy-supportive communication from providers and parents pointed to the highest level of treatment adherence when adolescents perceived both providers and parents as autonomy-supportive. In contrast, parental reports revealed that parental autonomy-supportive communication was positively related to treatment adherence, whereas autonomy-supportive communication by providers was not. CONCLUSIONS Autonomy-supportive communication by providers and parents is associated with better treatment adherence in adolescents with T1D. Interventions to improve autonomy-supportive communication by parents and providers may improve treatment adherence of adolescents (e.g., communication training).
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Affiliation(s)
- Eveline R Goethals
- KU Leuven, Leuven, Belgium; Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chris Verhaak
- Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Sofie Prikken
- KU Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium
| | | | - Koen Luyckx
- KU Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, FL, USA
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Moons P, Prikken S, Luyckx K. Chronic illness as a ‘family disease’: The need for appropriate scientific methods for dyadic research. Eur J Cardiovasc Nurs 2020; 19:98-99. [DOI: 10.1177/1474515120902376] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Philip Moons
- KU Leuven Department of Public Health and Primary Care, KU Leuven, Belgium
- Institute of Health and Care Sciences, University of Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, South Africa
| | - Sofie Prikken
- School Psychology and Development in Context, KU Leuven, Belgium
- Research Foundation Flanders, Brussels, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
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