1
|
Marks KP, Aalders J, Liu S, Broadley M, Thastum M, Jensen MB, Ibfelt EH, Birkebaek NH, Pouwer F. Associations between Disordered Eating Behaviors and HbA 1c in Young People with Type 1 Diabetes: A Systematic Review and Meta-analysis. Curr Diabetes Rev 2024; 20:e220823220144. [PMID: 37608674 DOI: 10.2174/1573399820666230822095939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/25/2023] [Accepted: 07/03/2023] [Indexed: 08/24/2023]
Abstract
BACKGROUND In type 1 diabetes, disordered eating behaviors (DEB) can adversely impact HbA1c. Diabetes-adapted DEB questionnaires assess intentional insulin omission, whereas generic questionnaires do not. Given the number of studies describing DEB-HbA1c associations published over the past decade, an updated systematic review is warranted. OBJECTIVE The study aimed to examine the associations between DEBs assessed by generic and diabetes- adapted questionnaires (and subscales) and HbA1c among young people (<29 years) with type 1 diabetes. METHODS A systematic search was conducted in PubMed, Embase, PsycInfo, and CINAHL databases. Observational studies examining associations between DEB as assessed by questionnaires and HbA1c were included. Publication information, DEB and HbA1c characteristics, and DEBHbA1c associations were extracted. Hedges' g was calculated for mean HbA1c differences between groups with and without DEB. RESULTS The systematic search yielded 733 reports, of which 39 reports representing 35 unique studies met the inclusion criteria. Nineteen studies assessing DEB by diabetes-adapted questionnaires (n=5,795) and seven using generic questionnaires (n=2,162) provided data for meta-analysis. For diabetes-adapted questionnaires, DEB was associated with higher HbA1c (g=0.62 CI=0.52; 0.73) with a similar effect size when restricted to validated questionnaires (g=0.61; CI=0.50; 0.73). DEB was not associated with HbA1c for generic questionnaires (g=0.19; CI=-0.17; 0.55), but significantly associated with higher HbA1c for validated generic questionnaires (g=0.32; 95% CI=0.16-0.48). Participant and HbA1c collection characteristics were often inadequately described. CONCLUSION Diabetes-adapted DEB questionnaires should be used in youth with type 1 diabetes because they capture intentional insulin omission and are more strongly associated with HbA1c than generic DEB questionnaires.
Collapse
Affiliation(s)
- Kevin P Marks
- Department of Clinical Medicine - Paediatrics, Aarhus University, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Jori Aalders
- Steno Diabetes Center Odense, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Shengxin Liu
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Solna, Sweden
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | | | - Else Helene Ibfelt
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark
| | - Niels H Birkebaek
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Medical Psychology, Amsterdam UMC, The Netherlands
- Steno Diabetes Center Odense, Odense, Denmark
| |
Collapse
|
2
|
Davis SL, Jaser SS, Ivankova NV, Lemley T, Rice M. Using Mixed Methods Research in Children with Type 1 Diabetes: a Methodological Review. Curr Diab Rep 2023; 23:147-163. [PMID: 37097408 PMCID: PMC10651325 DOI: 10.1007/s11892-023-01509-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Many factors influence disease management and glycemic levels in children with type 1 diabetes (T1D). However, these concepts are hard to examine in children using only a qualitative or quantitative research paradigm. Mixed methods research (MMR) offers creative and unique ways to study complex research questions in children and their families. RECENT FINDINGS A focused, methodological literature review revealed 20 empirical mixed methods research (MMR) studies that included children with T1D and/or their parents/caregivers. These studies were examined and synthesized to elicit themes and trends in MMR. Main themes that emerged included disease management, evaluation of interventions, and support. There were multiple inconsistencies between studies when reporting MMR definitions, rationales, and design. Limited studies use MMR approaches to examine concepts related to children with T1D. Findings from future MMR studies, especially ones that use child-report, may illuminate ways to improve disease management and lead to better glycemic levels and health outcomes.
Collapse
Affiliation(s)
- Sara L. Davis
- Maternal Child Health Nursing, University of South Alabama, 5721 USA Dr N, Mobile, AL 36688, USA
| | - Sarah S. Jaser
- Division of Pediatric Endocrinology & Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nataliya V. Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Trey Lemley
- Biomedical Library, University of South Alabama, Mobile, AL, USA
| | - Marti Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
| |
Collapse
|
3
|
McCarthy MM, Yan J, Jared MC, Ilkowitz J, Gallagher MP, Dickson VV. Time, Technology, Social Support, and Cardiovascular Health of Emerging Adults With Type 1 Diabetes. Nurs Res 2023; 72:185-192. [PMID: 37084321 PMCID: PMC10123545 DOI: 10.1097/nnr.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND Emerging adults with Type 1 diabetes (T1DM) face an increased risk of cardiovascular disease; however, there are both barriers and facilitators to achieving ideal cardiovascular health in this stage of their lives. OBJECTIVES The aim of this study was to qualitatively explore the barriers and facilitators of achieving ideal levels of cardiovascular health in a sample of emerging adults with T1DM ages 18-26 years. METHODS A sequential mixed-methods design was used to explore achievement of ideal cardiovascular health using the seven factors defined by the American Heart Association (smoking status, body mass index, physical activity, healthy diet, total cholesterol, blood pressure, and hemoglobin A1C [substituted for fasting blood glucose]). We assessed the frequency of achieving ideal levels of each cardiovascular health factor. Using Pender's health promotion model as a framework, qualitative interviews explored the barriers and facilitators of achieving ideal levels of each factor of cardiovascular health. RESULTS The sample was mostly female. Their age range was 18-26 years, with a diabetes duration between 1 and 20 years. The three factors that had the lowest achievement were a healthy diet, physical activity at recommended levels, and hemoglobin A1C of <7%. Participants described lack of time as a barrier to eating healthy, being physically active, and maintaining in-range blood glucose levels. Facilitators included the use of technology in helping to achieve in-range blood glucose and social support from family, friends, and healthcare providers in maintaining several healthy habits. DISCUSSION These qualitative data provide insight into how emerging adults attempt to manage their T1DM and cardiovascular health. Healthcare providers have an important role in supporting these patients in establishing ideal cardiovascular health at an early age.
Collapse
|
4
|
Rodriguez-Stanley J, Zilioli S, Idalski Carcone A, Slatcher RB, Ellis DA. Naturalistically observed interpersonal problems and diabetes management in older adolescents and young adults with type 1 diabetes. Psychol Health 2023; 38:214-229. [PMID: 34347533 PMCID: PMC8832500 DOI: 10.1080/08870446.2021.1960345] [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: 12/16/2020] [Revised: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated the links between naturalistically observed and self-reported interpersonal problems, diabetes management, and glucose levels in older adolescents and young adults with type 1 diabetes. DESIGN Sixty-eight older adolescents and young adults (aged 17-20 years) participated in a cross-sectional study that consisted of three home visits and a daily diary segment. MAIN OUTCOME MEASURES Participants wore the Electronically Activated Recorder (EAR) for four days to capture interpersonal problems and wore a continuous glucose monitor for blood glucose levels. Researchers also collected HbA1c values, conducted an interview to assess diabetes management, and collected participant-reported severity of interpersonal problems. RESULTS High EAR-observed interpersonal problems were associated with poor diabetes management. Multiple regression analyses revealed that high EAR-observed interpersonal problems continued to explain variance in poor diabetes management after including self-reported interpersonal problems and covariates. CONCLUSION These findings corroborate literature suggesting that negative interactions are associated with type 1 diabetes management. This study is the first to use the EAR to capture naturalistically observed interactions in this population and identify its utility beyond self-reports. These findings highlight the importance of considering naturalistically observed interactions when developing interventions to promote better diabetes management in older adolescents and young adults.
Collapse
Affiliation(s)
| | - Samuele Zilioli
- Department of Psychology, Wayne State University
- Department of Family Medicine and Public Health Science, Wayne State University
| | | | | | - Deborah A. Ellis
- Department of Family Medicine and Public Health Science, Wayne State University
| |
Collapse
|
5
|
Ullah A, Graue M, Haugstvedt A. Adolescent's Experiences with Diabetes Self-Management and the Use of Carbohydrate Counting in Their Everyday Life with Type 1 Diabetes. Patient Prefer Adherence 2022; 16:887-896. [PMID: 35411133 PMCID: PMC8994650 DOI: 10.2147/ppa.s354696] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Accepted: 02/26/2022] [Indexed: 12/02/2022] Open
Abstract
AIM The aim of this study was to describe adolescents' experiences with diabetes self-management and the use of carbohydrate counting as a tool for calculating insulin doses in everyday life with type 1 diabetes. METHODS We used a qualitative study design. Individual interviews were conducted with 14 adolescents (seven boys and seven girls, aged 16-18 years) with type 1 diabetes by using a semi-structured interview guide. We used purposive sampling, recruiting the participants from one paediatric outpatient clinic in Norway. Thematic analysis was used for the data analysis. FINDINGS We identified two main themes, each comprising three subthemes: (1) "Diabetes treatment is difficult but can be well adapted" with subthemes "Diabetes influences my entire life, with a lot of fuss and takes time", "Having diabetes turned out to be manageable", and "Need some help and support, but not too much"; (2) "Carbohydrate counting is useful but often not used" with subthemes "One counts the carbs, then the pump calculates the insulin doses", "Carbohydrate counting gives better blood glucose, but I do not always bother to use it", and "After a while, one just uses one's own experience.". CONCLUSION The study showed that adolescents with type 1 diabetes experienced that the diabetes treatment influenced their entire life in a substantial manner. Nevertheless, the demands of the disease and the treatment tasks were perceived very differently. Some articulated that carbohydrate counting was appreciated as a suitable tool for dosing insulin and optimizing glycaemic control. Others did not use carbohydrate counting at all and described to use their own experience. The findings support the importance of individualizing diabetes follow-up and adapt the training in treatment tools to everyone's situation and preferences.
Collapse
Affiliation(s)
- Aisha Ullah
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Paediatrics, Innlandet Hospital, Elverum, Norway
| | - Marit Graue
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Correspondence: Anne Haugstvedt, Email
| |
Collapse
|
6
|
Commissariat PV, Wentzell K, Tanenbaum ML. Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance. Diabetes Spectr 2021; 34:328-335. [PMID: 34866865 PMCID: PMC8603129 DOI: 10.2337/dsi21-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Young adults (YAs) are often faced with many new transitions and major milestones specific to their life stage. For YAs with diabetes, it can be particularly difficult to balance diabetes management with the age-typical demands of young adulthood. Clinicians can play an important role in helping YAs navigate major life changes and find balance in the competing demands of young adulthood, while protecting their health and well-being.
Collapse
|
7
|
Carreon SA, Duran B, Tang TS, Streisand R, Anderson BJ, Lyons SK, McKay S, Hilliard ME. Here for You: A Review of Social Support Research in Young Adults With Diabetes. Diabetes Spectr 2021; 34:363-370. [PMID: 34866869 PMCID: PMC8603130 DOI: 10.2337/dsi21-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living with and managing diabetes is challenging during young adulthood, and social support may help relieve or minimize the burdens young adults with diabetes experience. This article reviews the types and sources of support young adults with diabetes receive and their associations with behavioral, psychosocial, and glycemic outcomes. Intervention research integrating social support and future directions for care are discussed.
Collapse
Affiliation(s)
| | - Brenda Duran
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Tricia S. Tang
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Randi Streisand
- Children’s National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Sarah K. Lyons
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Siripoom McKay
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Marisa E. Hilliard
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
- Corresponding author: Marisa E. Hilliard,
| |
Collapse
|
8
|
Raymaekers K, Helgeson VS, Prikken S, Vanhalst J, Moons P, Goossens E, Berg CA, Luyckx K. Diabetes-specific friend support in emerging adults with type 1 diabetes: Does satisfaction with support matter? J Behav Med 2021; 44:402-411. [PMID: 33677767 DOI: 10.1007/s10865-021-00211-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 02/19/2021] [Indexed: 01/24/2023]
Abstract
Youth with type 1 diabetes (T1D) must adhere to a complex treatment regimen to prevent health complications. Friends may provide diabetes-specific support to help youth manage diabetes, but evidence on whether youth benefit from diabetes-specific friend support is inconclusive. The present study first investigated whether satisfaction with friend support was linked to psychological distress and diabetes management. Second, it was investigated whether self-esteem mediated these relations. To this end, 324 Dutch-speaking emerging adults (17-28 years) with T1D completed questionnaires on diabetes-specific friend support, self-esteem, diabetes-specific distress, depressive symptoms, and self-care. HbA1c values were obtained from patients' physicians. Receiving diabetes-specific support from friends was associated with more diabetes-specific distress, but not for youth who were satisfied with the received support. Diabetes-specific friend support was not associated with other outcomes. Self-esteem did not mediate these relations. These results suggest that associations between diabetes-specific friend support and diabetes management are limited and that support satisfaction should be taken into consideration when examining the role of friend support for youth with T1D.
Collapse
Affiliation(s)
- Koen Raymaekers
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3717, 3000, Leuven, Belgium.
- Fonds Wetenschappelijk Onderzoek, Flanders, Belgium.
| | | | - Sofie Prikken
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3717, 3000, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek, Flanders, Belgium
| | | | - Philip Moons
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3717, 3000, Leuven, Belgium
- University of Gothenburg, Gothenburg, Sweden
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3717, 3000, Leuven, Belgium
- Fonds Wetenschappelijk Onderzoek, Flanders, Belgium
- Center for Research and Innovation in Care (CRIC), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Koen Luyckx
- Faculty of Psychology and Educational Sciences, KU Leuven, Tiensestraat 102, box 3717, 3000, Leuven, Belgium
- UNIBS, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
9
|
Raymaekers K, Prikken S, Oris L, Vanhalst J, Moons P, Goossens E, Weets I, Luyckx K. A Person-Centered Perspective on the Role of Peer Support and Extreme Peer Orientation in Youth with Type 1 Diabetes: A Longitudinal Study. Ann Behav Med 2020; 54:893-903. [PMID: 32329794 DOI: 10.1093/abm/kaaa025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Despite clear evidence that peers are crucial for youth development, research on the role of peers for youth with Type 1 diabetes (T1D) is scarce. PURPOSE The present study identified trajectory classes of perceived peer functioning in youth with T1D, based on peer support and extreme peer orientation (EPO). Further, classes were compared with respect to their trajectories of depressive symptoms, diabetes-specific distress, treatment adherence, and HbA1c values. METHODS Five hundred and fifty-nine youth (14-25 years) with T1D completed questionnaires at baseline, 1, 2, and 3 years later. Latent class growth analysis identified classes of perceived peer functioning. Multigroup latent growth curve modelling assessed whether these classes were characterized by different trajectories of general and diabetes-specific functioning. RESULTS A socially normative class (48%) was characterized by trajectories of high support and low EPO over time. A socially reserved class (29%) was characterized by low support and EPO, and a socially oriented class (17%) by high support and EPO. Finally, a socially vulnerable class (6%) was characterized by low support and high EPO. The normative class functioned significantly better over time than the other classes. The vulnerable class functioned significantly worse compared to the reserved class, despite experiencing equally low levels of support. CONCLUSIONS The results underscore the need to take youths' orientation toward the peer context into account alongside support when tapping into the role of peers, because individuals with low levels of support and EPO functioned substantially better than individuals with similar low levels of support but high levels of EPO.
Collapse
Affiliation(s)
- Koen Raymaekers
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium
| | - Sofie Prikken
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium
| | - Leen Oris
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium
| | - Janne Vanhalst
- Department of Developmental, Personality, and Social Psychology, Ghent University, Ghent, Belgium
| | - Philip Moons
- Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Pediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Eva Goossens
- Fonds Wetenschappelijk Onderzoek - Vlaanderen, Brussels, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
| | - Ilse Weets
- Diabetes Research Center/Clinical Biology, Free University Brussels, Brussels, Belgium
| | - Koen Luyckx
- School Psychology and Development in Context, KU Leuven, Leuven, Belgium.,UNIBS, University of the Free State, Bloemfontein, South Africa
| |
Collapse
|
10
|
Johansen CB, Rothmann MJ, Andersen A, Beck-Nielsen H, Pouwer F. The role of parental support for emerging adults with type 1 diabetes: A scoping review. Pediatr Diabetes 2020; 21:995-1030. [PMID: 32301182 DOI: 10.1111/pedi.13022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging adults with type 1 diabetes often have poor diabetes self-care and pose a considerable therapeutic challenge. They simultaneously handle a life phase characterized by instability, identity exploration, and transitions and manage a chronic illness that demands structure, self-discipline, and repeated health care contacts. Relation to parents is often ambivalent but typically remains the most stable social support, so parental support could potentially be helpful for diabetes self-care and wellbeing. METHOD This scoping review aimed to identify, summarize and analyze empirical studies (for instance interview studies, questionnaire studies and intervention studies) exploring parental support for emerging adults with type 1 diabetes. Studies were identified in PsycInfo, PubMed, Scopus, and Google Scholar. Data were extracted by one author and checked by another. Study results were synthesized by a convergent mixed methods approach and qualitative thematic analysis. RESULTS We included 26 studies (2829 participants), 16 interview studies, 10 questionnaire studies, and no intervention studies. Five overarching themes were identified: self-care and glycemic control, diabetes-related emotional wellbeing, support characteristics, ambivalence and harms, and core support providers. Parents tended to contribute positively to diabetes self-care, glycemic control, and psychological wellbeing. However, emerging adults did not want to be too dependent on their parents and family, and family could also act unsupportively; when absent, disinterested in diabetes or controlling. CONCLUSION This review underlines that parental support still plays a role for diabetes self-care and wellbeing in emerging adults with type 1 diabetes. Age-appropriate parental support therefore seems a promising path to investigate further.
Collapse
Affiliation(s)
- Clea Bruun Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
11
|
Tomette A, Henderson JN, Hass A, Carson LD, King K. Parental Stress as a Child With Diabetes Transitions From Adolescence to Emerging Adulthood. J Patient Exp 2020; 7:365-371. [PMID: 32821796 PMCID: PMC7410130 DOI: 10.1177/2374373519842963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study examined parental and caregiver distress among families caring for children with type 1 diabetes as the child transitions into Emerging Adulthood. More than 96 hours of semistructured interviews were conducted with 19 adult caregivers including parents, grandparents, and other adult family members of 10 children. Each research partner participated in multiple face-to-face, 1- to 1.5-hour long-evolving interviews over the course of 4.5 years. Paradoxically, caregivers were found to experience significant increase in distress as their child with diabetes entered the developmental stage of Emerging Adulthood, 18 to 25 years old, by which time they should be masters of self-care, and parental distress should begin to decline. This increase in familial distress was associated with the emerging adults leaving the home, being unable to maintain an acceptable level of self-care, and experiencing declining health, frequent visits to the emergency department, and repeated hospitalizations. These findings suggest that parental distress from caring for a child with diabetes continues as the child ages, matures, and transitions into adulthood and may be exacerbated when the emerging adult with type 1 diabetes leaves the home and the direct observation and care of the parent.
Collapse
Affiliation(s)
- Alisa Tomette
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Memory Keepers Medical Discovery Team for Rural and American Indian Health, University of Minnesota Medical School, Duluth, MN, USA
| | - J Neil Henderson
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Memory Keepers Medical Discovery Team for Rural and American Indian Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Amanda Hass
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Memory Keepers Medical Discovery Team for Rural and American Indian Health, University of Minnesota Medical School, Duluth, MN, USA
| | - Linda D Carson
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Kama King
- American Indian Diabetes Prevention Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| |
Collapse
|
12
|
Mello D, Wiebe D, Baker AC, Butner J, Berg C. Neighborhood disadvantage, parent-adolescent relationship quality, and type 1 diabetes in late adolescents transitioning to early emerging adulthood. Soc Sci Med 2020; 255:113010. [PMID: 32353651 PMCID: PMC7268169 DOI: 10.1016/j.socscimed.2020.113010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 03/31/2020] [Accepted: 04/19/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We examined whether neighborhood disadvantage predicted subsequent levels, and longitudinal trajectories, of type 1 diabetes (T1D) outcomes among late adolescents transitioning into early emerging adulthood. We also examined whether such associations occur indirectly through parent-adolescent relationship quality. RESEARCH DESIGN & METHODS Seniors in high school with T1D (N = 236; mean age 17.76 ± 0.39 years; 61% female; 73.7% non-Latino White) completed selfreport measures of relationship quality with mothers and fathers, and adherence to their diabetes regimen; glycemic control was measured using HbA1c assay kits. Both T1D outcomes (i.e. adherence, HbA1c) were assessed annually across three time points (two years). Census tract indicators of neighborhood disadvantage (e.g., % unemployed) were culled from participant addresses at baseline linked to American Community Survey data. Structural Equation Modeling was used to estimate direct and indirect links between neighborhood disadvantage, relationship quality, and both subsequent levels (i.e., intercepts centered at Time 2), and trajectories of T1D outcomes (i.e., slopes across three time points). RESULTS All models showed excellent fit to the data. Greater neighborhood disadvantage associated with lower relationship quality with both parents. Lower relationship quality with fathers (but not with mothers) measured at Time 1 predicted poorer levels of adherence and HbA1c at Time 2, and formed an indirect path linking neighborhood disadvantage to each Time 2 outcome. Neighborhood disadvantage and parent-adolescent relationship quality during high school did not predict longitudinal trajectories of T1D outcomes across all three time points. CONCLUSIONS Parent-adolescent relationship quality (especially with fathers) remains important for T1D outcomes among late adolescents on the cusp of emerging adulthood, but may be at risk among those living within a socioeconomically-disadvantaged neighborhood.
Collapse
Affiliation(s)
- Daniel Mello
- Psychological Sciences, Health Sciences Research Institute, University of California, Merced, USA.
| | - Deborah Wiebe
- Psychological Sciences, Health Sciences Research Institute, University of California, Merced, USA
| | - Ashley C Baker
- Psychological Sciences, Health Sciences Research Institute, University of California, Merced, USA
| | | | - Cynthia Berg
- Department of Psychology, University of Utah, USA
| |
Collapse
|
13
|
van Duinkerken E, Snoek FJ, de Wit M. The cognitive and psychological effects of living with type 1 diabetes: a narrative review. Diabet Med 2020; 37:555-563. [PMID: 31850538 PMCID: PMC7154747 DOI: 10.1111/dme.14216] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/13/2019] [Indexed: 01/09/2023]
Abstract
Across the lifespan, type 1 diabetes mellitus has a profound (neuro)psychological impact. In young people, type 1 diabetes can interfere with psychosocial development and hamper school performance. In adulthood, it can interfere with work life, relationships and parenting. A substantial minority of adults with type 1 diabetes experience coping difficulties and high diabetes-related distress. In youth and adulthood, type 1 diabetes is related to mild cognitive decrements as well as affective disorders, such as depression and anxiety. There is limited literature available that explores the interaction between cognitive and psychological comorbidity and underlying mechanisms. The aims of the present narrative review were to summarize the current state of the literature regarding both cognitive and psychological comorbidities in type 1 diabetes across the lifespan, and to explore potential links between the two domains of interest to make suggestions for future research and clinical practice.
Collapse
Affiliation(s)
- E. van Duinkerken
- Epilepsy CentreInstituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroRJBrazil
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
- Amsterdam Diabetes Centre/Department of Internal MedicineAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| | - F. J. Snoek
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| | - M. de Wit
- Department of Medical PsychologyAmsterdam University Medical CentresVrije UniveristeitAmsterdamThe Netherlands
| |
Collapse
|
14
|
Munion AK, Butner JE, Kelly CS, Wiebe DJ, Turner SL, Lansing AH, Berg CA. The separation in coordination between social- and self-regulation for emerging adults with type 1 diabetes. J Behav Med 2020; 43:892-903. [PMID: 31974750 DOI: 10.1007/s10865-020-00134-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 01/10/2020] [Indexed: 10/25/2022]
Abstract
To examine how self-regulation and social-regulation surrounding type 1 diabetes (T1D) management are coordinated during early emerging adulthood and whether classes of coordination relate to HbA1c and executive functioning (EF). Emerging adult participants (N = 212) with T1D (M age = 18.8 years, SD = .40) completed a 14-day diary to capture components of self-regulation and social-regulation. A mixture multi-level latent coordination model first determined the separate but coordinated factor structure of self- and social-regulation, then determined the number of distinct classes of coordination and how those classes linked to HbA1c and EF. The best-fitting model included three coordinative factors (self, mother, and father) of regulation and two distinct classes. The class with lower HbA1c and higher EF had more stable self- and social-regulation, more connections between self- and social-regulation and reflected more adaptive patterns, consistent with medical management goals. Social connection with parents may aid in regulation during this at-risk transitional time of emerging adulthood.
Collapse
Affiliation(s)
- A K Munion
- Department of Psychology, University of Utah, Salt Lake City, USA.
| | | | - Caitlin S Kelly
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Deborah J Wiebe
- Psychological Sciences, University of California-Merced, Merced, USA
| | - Sara L Turner
- Department of Psychology, University of Utah, Salt Lake City, USA
| | - Amy Hughes Lansing
- Department of Psychology, University of Utah, Salt Lake City, USA.,Department of Psychology, University of Nevada-Reno, Reno, USA
| | - Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, USA
| |
Collapse
|
15
|
Kelly CS, Berg CA, Lansing AH, Turner SL, Munion AK, Tracy EL, Wiebe DJ. Keeping parents connected in early emerging adulthood: Diabetes-related disclosure and solicitation. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2019; 33:809-818. [PMID: 31355650 PMCID: PMC6776686 DOI: 10.1037/fam0000565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Emerging adults with Type 1 diabetes benefit when parents remain knowledgeable of their self-management. Yet how early emerging adults remain connected with parents while they experience normative declines in involvement and move out of the parental home is unclear. The present study examined how disclosure to, and solicitation from, parents may (a) be a way that emerging adults and parents remain connected, (b) occur with different methods of contact (i.e., face-to-face; non-face-to-face), and (c) associate with diabetes management differently for those living in versus outside of the parental home. Early emerging adults with Type 1 diabetes (N = 202; Mage = 18.81 years; 66% female) completed measures of their methods of contact with parents; diabetes-related disclosure to, and solicitation from, parents; and diabetes management as part of a 14-day daily diary. General linear models found that face-to-face contact was associated with greater disclosure to parents, for both those living in and out of the parental home. Individuals who lived outside the parental home used more non-face-to-face contact (e.g., texting) than those in the parental home. Multilevel models revealed that higher disclosure to mothers on a daily basis (within-persons) and to mothers and fathers overall (between-persons) was associated with better diabetes management similarly for those living in versus out of the parental home. Results suggest that face-to-face contact may be most effective for keeping parents "in the know" about diabetes management. Moreover, disclosure and solicitation continue to support diabetes management even as individuals move out of the parental home. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | | | | | | | | | | | - Deborah J. Wiebe
- University of California, Merced, Psychological Sciences
and Health Sciences Research Institute
| |
Collapse
|
16
|
Cox ED, Connolly JR, Palta M, Rajamanickam VP, Flynn KE. Reliability and validity of PROMIS® pediatric family relationships short form in children 8-17 years of age with chronic disease. Qual Life Res 2019; 29:191-199. [PMID: 31401748 DOI: 10.1007/s11136-019-02266-x] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Families play a key role in managing pediatric chronic illness. The PROMIS® pediatric family relationships measure was developed primarily within the general pediatric population. We evaluated the Family Relationships short form in the context of pediatric chronic diseases. METHODS Children aged 8-17 years with asthma (n = 73), type 1 diabetes (n = 122), or sickle cell disease (n = 80) completed the Family Relationships 8a short form and the PROMIS Pediatric Profile-25's six domains representing physical, mental, and social health. Parents (N = 275) of these children completed the parent versions of the same measures. We evaluated reliability of the Family Relationships measure using Cronbach's alpha and IRT-based marginal reliability, and the standard error of measurement (SEM). Convergent/discriminant validity were assessed from correlations between the Family Relationships domain and the PROMIS-25 domains. RESULTS SEM increased for scores above the normative mean of 50. Cronbach's alpha and IRT-estimated marginal reliabilities exceeded 0.80 for children and parents across diseases, except in asthma, where marginal reliability was 0.75 for parents. Scores displayed small to large correlations in the expected directions with social and mental health domains. The largest correlations occurred with parents' proxy reports of children's depressive symptoms in sickle cell disease and asthma, r = - 0.60 (95% CI - 0.74, - 0.48) and r = - 0.58 (95% CI - 0.68, - 0.48) respectively. CONCLUSIONS The Family Relationships 8-item short form demonstrated adequate reliability and convergent/discriminant validity for use in pediatric chronic conditions, though scores above the mean displayed greater uncertainty. Evidence of the measure's reliability and validity in multiple contexts furthers the case for its use.
Collapse
Affiliation(s)
- Elizabeth D Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/558 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA.
| | - Jennifer R Connolly
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, H6/577 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA
| | - Mari Palta
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, 689 Wisconsin Alumni Research Foundation, 610 Walnut Street, Madison, WI, 53726-2336, USA
| | - Victoria P Rajamanickam
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, H6/526 Clinical Science Center, 600 Highland Avenue, Madison, WI, 53792-4108, USA
| | - Kathryn E Flynn
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI, 53226-3522, USA
| |
Collapse
|
17
|
Ramchandani N, Way N, Melkus GD, Sullivan-Bolyai S. Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2019; 45:484-497. [PMID: 31304878 DOI: 10.1177/0145721719861349] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored. METHODS A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected. RESULTS The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM. CONCLUSIONS The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.
Collapse
Affiliation(s)
| | - Niobe Way
- Department of Applied Psychology, New York University Steinhardt, New York, New York
| | | | - Susan Sullivan-Bolyai
- University of Massachusetts Medical School-Graduate School of Nursing, Worcester, Massachusetts
| |
Collapse
|
18
|
Helgeson VS, Orchard TJ, Seltman H, Becker D, Libman I. Psychosocial predictors of diabetes risk factors and complications: An 11-year follow-up. Health Psychol 2019; 38:567-576. [PMID: 30973749 DOI: 10.1037/hea0000730] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
OBJECTIVE The goal of this study was to use the risk and resistance framework to examine whether a set of psychosocial variables measured at age 12 in youth with Type 1 diabetes would predict the emergence of diabetes risk and complication variables 11 years and 13 years later. METHOD We interviewed youth with Type 1 diabetes when they were average age 12 and followed them for 11 years until they were average age 23 and then average age 25. At age 12, we measured personality traits (unmitigated communion, unmitigated agency), relationship variables (parent relationship quality, friend support, friend conflict), indicators of psychological well-being (depressive symptoms, bulimic symptoms, self-worth), and self-care behavior. We used these psychosocial variables assessed at age 12 to predict diabetes risk factors, glycemic control, and the emergence of diabetes complications at follow-up. RESULTS Higher unmitigated agency, poor quality parent relationships, higher friend conflict, bulimic symptoms, and lower self-worth predicted one or more diabetes outcomes. When statistical controls for age 12 glycemic control were employed, unmitigated agency emerged as the most robust predictor of diabetes outcomes. CONCLUSION Unmitigated agency, which involves an overly inflated view of the self and a cynical view of others, predicted poor diabetes outcomes over an 11-year and 13-year period. The processes by which unmitigated agency could influence health are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
|
19
|
Carlsund Å, Söderberg S. Living with type 1 diabetes as experienced by young adults. Nurs Open 2019; 6:418-425. [PMID: 30918692 PMCID: PMC6419143 DOI: 10.1002/nop2.222] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 10/21/2018] [Accepted: 11/01/2018] [Indexed: 12/16/2022] Open
Abstract
AIM Describe young adults` (19-30 years) experiences of living with Type 1 Diabetes (T1D). BACKGROUND Young adulthood is characterized by adaption to adult roles, gradual separation from parental support and leaving the parental home. Living with T1D in young adulthood raises challenges and concerns. DESIGN This study has a qualitative design. METHODS Semistructured interviews with 12 young adults living with T1D for 3-14 years, analysed with qualitative content analysis. RESULTS The analysis revealed contradictory ways of handling the illness, as is illuminated in two main categories (a) and five subcategories (b). Handling the situation and dealing with different opinions (a), (b) managing daily life, emotional roller coaster and general attitudes, own views and apprehensions, ignorance and lack of motivation. Most participants were motivated, had knowledge and were in control of their long-term illness. Planning and structure were an essential part of their daily life. The participants were anxious about losing control of their bodies, the situation, die or be a burden to other people.
Collapse
Affiliation(s)
- Åsa Carlsund
- Department of Nursing SciencesMid‐Sweden UniversityÖstersundSweden
| | - Siv Söderberg
- Department of Nursing SciencesMid‐Sweden UniversityÖstersundSweden
| |
Collapse
|
20
|
Dempster KW, Liu A, Nansel TR. Depression and parenting in youth with type 1 diabetes: Are general and diabetes-specific parenting behaviors associated with depressive symptoms over a 2-year period? J Behav Med 2019; 42:842-850. [PMID: 30694403 DOI: 10.1007/s10865-019-00011-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 01/12/2019] [Indexed: 12/31/2022]
Abstract
To examine cross-sectional and longitudinal associations of general parenting style and diabetes-specific parenting behaviors with depression in youth with type 1 diabetes. Participants (n = 390) completed self-report measures of depression at baseline and 2-year follow-up, general parenting style at baseline, and diabetes-specific parenting (conflict, task involvement, and collaborative involvement) at baseline and every 6 months. Logistic regression examined associations of parenting with depression at baseline and 2-year follow-up. A less authoritative parenting style, lower parent collaborative involvement, and greater diabetes-related conflict were associated with baseline depression in the model simultaneously including all parenting variables and covariates. Lower parent collaborative involvement and higher diabetes-related conflict were associated with depression at 2-year follow-up, adjusting for baseline depression and covariates. Parent task involvement was not associated with depression at either time. Findings suggest a protective role of parenting in reducing the risk of depression in youth with type 1 diabetes.
Collapse
Affiliation(s)
- Katherine W Dempster
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Aiyi Liu
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Tonja R Nansel
- Division of Intramural Population Health Research, Social and Behavioral Sciences Branch (KWD, TRN), Biostatistics and Bioinformatics Branch (AL), Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA.
| |
Collapse
|
21
|
Khandelwal D, Gupta L, Kalra S, Vishwakarma A, Lal PR, Dutta D. Diabetes Distress and Marriage in Type-1 Diabetes. Indian J Community Med 2019; 43:316-319. [PMID: 30662188 PMCID: PMC6319281 DOI: 10.4103/ijcm.ijcm_74_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background In spite of the large number of people with Type-1 diabetes mellitus (T1DM) in India, India is not a diabetes-friendly society. The society suffers from lots of myths regarding diabetes and insulin use. This review highlights challenges faced by young people living with T1DM with regards to marriage, associated diabetes distress, and suggests potential solutions. Methods PubMed, Medline, and Embase search for articles published up to October 2017, using the terms "marriage" (MeSH Terms) OR "diabetes distress" (All Fields) OR "depression" (All Fields) AND "diabetes" (All Fields). The reference lists of the articles thus identified were also searched. The search was not restricted to English-language literature. Results Misconception regarding social, occupational, marital abilities, fertility, genetics, quality of life, sexism in young people living with T1DM raises major barriers to marriage, resulting in significant diabetes distress, depression, and psychological issues in them. People with T1DM are wrongly assumed to be sick, disabled, dependent persons, unsuitable for marriages, and likely to have complicated pregnancies with the possibility of having children with diabetes. Counseling at the level of individual, spouse, family, and society can help in obviating such issues. Conclusion Diabetes distress and psychological issues are major problems related to marriage in young people with T1DM. Counseling of patients, family, relatives, prospective spouse, and increasing social awareness regarding diabetes through mass communication are the keys to their resolution.
Collapse
Affiliation(s)
- Deepak Khandelwal
- Department of Endocrinology and Diabetes, Maharaja Agrasen Hospital, Punjabi Bagh, New Delhi, India
| | - Lovely Gupta
- Department of Food and Nutrition, Lady Irwin College, Delhi University, New Delhi, India
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, Haryana, India
| | - Amit Vishwakarma
- Society for the Promotion of Education in Endocrinology and Diabetes, Dwarka, New Delhi, India
| | - Priti Rishi Lal
- Department of Food and Nutrition, Lady Irwin College, Delhi University, New Delhi, India
| | - Deep Dutta
- Department of Endocrinology, Diabetes and Metabolism, Venkateshwar Hospital, New Delhi, India
| |
Collapse
|
22
|
Prikken S, Oris L, Rassart J, Missotten LC, Weets I, Moons P, Goubert L, Luyckx K. Parental illness intrusiveness and youth glycaemic control in type 1 diabetes: intergenerational associations and processes. Psychol Health 2019; 34:438-455. [PMID: 30636450 DOI: 10.1080/08870446.2018.1538451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE This study examined associations between the functioning of youth with type 1 diabetes and their parents, including parenting dimensions as intervening mechanisms. The study adds to the existing literature by focusing on (1) the concept of parental illness intrusiveness; (2) the (understudied) periods of adolescence and emerging adulthood; and (3) maternal and paternal functioning. DESIGN Questionnaires were completed by 317 patient-mother dyads and 277 patient-father dyads. All patients (aged 14-25) had type 1 diabetes. The hypothesised model was compared to an alternative model using structural equation modelling. MAIN OUTCOME MEASURES Youth reported on depressive symptoms and treatment adherence; Physicians provided HbA1c-values. Parents reported on illness intrusiveness, depressive symptoms, and their child's treatment adherence. Patients and parents reported on psychological control and overprotection. RESULTS The hypothesised path model had a good fit to the data. Parental illness intrusiveness was positively associated with depressive symptoms and both were positively related to overprotection and psychological control. Psychological control was positively related to patients' depressive symptoms and negatively to treatment adherence. Poorer treatment adherence was associated with worse HbA1c-values. CONCLUSION These findings underscore the relevance of parental illness intrusiveness and emphasise the importance of mothers' and fathers' roles throughout adolescence and emerging adulthood.
Collapse
Affiliation(s)
- Sofie Prikken
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | - Leen Oris
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | - Jessica Rassart
- a KU Leuven , Leuven , Belgium.,b Fonds Wetenschappelijk Onderzoek Vlaanderen , Brussels , Belgium
| | | | - Ilse Weets
- c Free University Brussels , Brussels , Belgium
| | - Philip Moons
- a KU Leuven , Leuven , Belgium.,d University of Gothenburg , Gothenburg , Sweden
| | | | | |
Collapse
|
23
|
Pihlaskari AK, Wiebe DJ, Troxel NR, Stewart SM, Berg CA. Perceived peer support and diabetes management from adolescence into early emerging adulthood. Health Psychol 2018; 37:1055-1058. [PMID: 30247063 PMCID: PMC6188824 DOI: 10.1037/hea0000662] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES The objective of the study was to examine longitudinal associations of perceived diabetes-specific peer support with adherence and glycemic control among late adolescents with type 1 diabetes as they transition out of high school and into early emerging adulthood. METHOD As part of a larger study, 211 high school seniors with type 1 diabetes completed confidential online surveys and were reassessed 1 year later. Perceived diabetes-specific peer support and adherence were assessed in each survey. Glycemic control was measured with HbA1c assay kits. RESULTS Perceived diabetes-specific peer support in high school predicted better adherence across the subsequent year while controlling for initial levels of adherence. Perceived peer support during early emerging adulthood was also associated with better adherence across time, after controlling for initial levels of both adherence and peer support. CONCLUSIONS Perceived diabetes-specific peer support may be a protective factor as late adolescents with type 1 diabetes transition out of high school. Building strong peer support during the transition into early emerging adulthood may facilitate better diabetes management during this high-risk time of development. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Collapse
Affiliation(s)
- Andrea K Pihlaskari
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Deborah J Wiebe
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center
| | - Natalie R Troxel
- Psychological Sciences and the Health Sciences Research Institute, University of California
| | - Sunita M Stewart
- Division of Psychology, Department of Psychiatry, University of Texas Southwestern Medical Center
| | | |
Collapse
|
24
|
Berg CA, Wiebe DJ, Suchy Y, Turner SL, Butner J, Munion A, Lansing AH, White PC, Murray M. Executive Function Predicting Longitudinal Change in Type 1 Diabetes Management During the Transition to Emerging Adulthood. Diabetes Care 2018; 41:2281-2288. [PMID: 30131398 PMCID: PMC6196825 DOI: 10.2337/dc18-0351] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 07/19/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The objective of this study was to examine 1) whether teens' glycemic control and adherence to type 1 diabetes treatment regimen worsen during the transition from late adolescence to emerging adulthood, and 2) whether teens' executive function (EF), as measured by performance and self-reported problems with EF, is predictive of these changes (after controlling for general intelligence). RESEARCH DESIGN AND METHODS High school seniors with type 1 diabetes (N = 236; mean age 17.74 years) were assessed at three yearly time points. At baseline, during the senior year of high school, participants completed a self-report measure of problems with EF and performance-based measures of EF and general intelligence (IQ). Glycemic control was determined on the basis of results collected from HbA1c assay kits, and teens reported their adherence at all three time points. RESULTS HbA1c increased significantly across the three time points and adherence declined. EF performance was not associated with adherence or HbA1c at baseline, nor with changes in adherence over time. However, better EF performance predicted slower increases in HbA1c over time (i.e., slope) while controlling for IQ. Teens' self-reported problems with EF were associated with worse glycemic control and poorer adherence at baseline (i.e., intercept), but they did not predict changes in either HbA1c or adherence over time (i.e., slope). CONCLUSIONS Abilities involved in performance on EF tests may be one resource for maintaining better glycemic control during the transition to emerging adulthood. Assessment of such EF abilities may allow for the identification of individuals who are most at risk for deterioration of glycemic control during this transition.
Collapse
Affiliation(s)
- Cynthia A Berg
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Deborah J Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced, Merced, CA
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Yana Suchy
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Sara L Turner
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Jonathan Butner
- Department of Psychology, University of Utah, Salt Lake City, UT
| | - Ascher Munion
- Department of Psychology, University of Utah, Salt Lake City, UT
| | | | - Perrin C White
- The University of Texas Southwestern Medical Center, Dallas, TX
| | - Mary Murray
- Department of Pediatrics, University of Utah Medical School, Salt Lake City, UT
| |
Collapse
|
25
|
Tracy EL, Berg CA, Baker AC, Mello D, Litchman ML, Wiebe DJ. Health-risk Behaviors and Type 1 Diabetes Outcomes in the Transition from Late Adolescence to Early Emerging Adulthood. CHILDRENS HEALTH CARE 2018; 48:285-300. [PMID: 31588160 PMCID: PMC6777546 DOI: 10.1080/02739615.2018.1531758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
This study examined within- and between-person associations between health-risk behaviors (smoking, drinking, insulin withholding) and type 1 diabetes (T1D) outcomes (adherence and HbA1c) during the high-risk transition from late adolescence to early emerging adulthood utilizing a 2-year longitudinal study. Beginning in the senior year of high school, participants (n = 197) with T1D completed measures of health-risk behaviors, adherence, and HbA1c annually at three time points. Health-risk behaviors were associated with poorer diabetes outcomes during the transition from late adolescence to early emerging adulthood. These results highlight the importance of monitoring health-risk behaviors regularly and intervening to reduce health-risk behaviors during this important developmental transition.
Collapse
Affiliation(s)
| | | | - Ashley C. Baker
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | - Daniel Mello
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | | | - Deborah J. Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| |
Collapse
|
26
|
Flynn KE, Kliems H, Saoji N, Svenson J, Cox ED. Content validity of the PROMIS® pediatric family relationships measure for children with chronic illness. Health Qual Life Outcomes 2018; 16:203. [PMID: 30340500 PMCID: PMC6194608 DOI: 10.1186/s12955-018-1030-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 10/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Families play a critical role in supporting the health and well-being of children with chronic illnesses, who face a lifetime of responsibility for self-management of their condition. Our goal was to investigate whether the novel Patient-Reported Outcomes Measurement Information System® (PROMIS®) Pediatric Family Relationships measure, developed primarily within the general pediatric population, reflects the experiences of family relationships for chronically ill children and their parents. METHODS We conducted semi-structured qualitative interviews with children (aged 8-17) with common chronic conditions: asthma (n = 6), type 1 diabetes (n = 5), or sickle cell disease (n = 5), and separately with one of their parents (n = 16). Interviews were recorded, and two team members independently coded the written transcripts facilitated by Nvivo 10. The systematic content analysis used a combination of: 1) pre-specified themes corresponding to the six facets of the domain identified during measure development and reflected in the content of the items (i.e., Sense of Family; Love and Caring; Value and Acceptance; Trust, Dependability, and Support; Communication; Enjoyment), as well as 2) open-coding, allowing participants to define important concepts (i.e., disease impact). RESULTS Family relationships were conceptualized in a similar way to the general population, as evidenced by child and parent responses to open-ended questions about family relationships and to specific probes that corresponded with the item content in the Family Relationship 8-item short form. Children spontaneously discussed the impact of their disease on family relationships less often than parents did. Although participants described how living with a chronic illness positively and negatively impacted aspects of family relationships, nearly all participants believed their responses to the PROMIS® Family Relationships items would not change if they (or their child) did not have a chronic illness. CONCLUSIONS Among a sample of families of children with one of 3 chronic illnesses, participants described family relationships in a way that was consistent with the facets of the PROMIS® Family Relationship domain. This study adds to the content validity of the measure for children with chronic illness.
Collapse
Affiliation(s)
- Kathryn E. Flynn
- Department of Medicine, Medical College of Wisconsin, 9200 W. Wisconsin Ave, Milwaukee, WI 53226 USA
| | - Harald Kliems
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 USA
| | - Nikita Saoji
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 USA
| | - Jacob Svenson
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 USA
| | - Elizabeth D. Cox
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 USA
| |
Collapse
|
27
|
Delamater AM, de Wit M, McDarby V, Malik JA, Hilliard ME, Northam E, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:237-249. [PMID: 30058247 DOI: 10.1111/pedi.12736] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
MESH Headings
- Adaptation, Psychological/physiology
- Adolescent
- Burnout, Psychological/psychology
- Burnout, Psychological/therapy
- Child
- Consensus
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Endocrinology/organization & administration
- Endocrinology/standards
- Humans
- International Cooperation
- Neurodevelopmental Disorders/therapy
- Pediatrics/organization & administration
- Pediatrics/standards
- Practice Patterns, Physicians'/standards
- Psychotherapy/methods
- Psychotherapy/standards
- Quality of Life/psychology
- Resilience, Psychological
- Societies, Medical/organization & administration
- Societies, Medical/standards
- Stress, Psychological/etiology
- Stress, Psychological/therapy
Collapse
Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Maartje de Wit
- Department of Medical Psychology, EMGO Institute for Health & Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Vincent McDarby
- National Children's Research Centre and Our Lady's Children's Hospital, Dublin, Ireland
| | - Jamil A Malik
- Center of Excellence, National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
| |
Collapse
|
28
|
Martire LM, Helgeson VS. Close relationships and the management of chronic illness: Associations and interventions. ACTA ACUST UNITED AC 2018; 72:601-612. [PMID: 28880106 DOI: 10.1037/amp0000066] [Citation(s) in RCA: 103] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Self-management of a chronic illness involves not only monitoring symptoms, adhering to medication regimens, and keeping medical appointments but also making and maintaining difficult lifestyle changes. This article highlights correlational and intervention research suggesting family members are influential in children's and adults' illness management. The argument is made that a dyadic approach to chronic illness management that targets the influence of close relationships may yield more sustainable effects on patient behavior than has been achieved in the past. In particular, dyadic approaches aimed at helping patients and family members to find ways to collaborate in goal setting for these behaviors is recommended. Such dyadic interventions may also benefit family members who are ill or are at risk because of poor health behaviors. (PsycINFO Database Record
Collapse
Affiliation(s)
- Lynn M Martire
- Department of Human Development and Family Studies, The Pennsylvania State University
| | | |
Collapse
|
29
|
Garza KP, Jedraszko A, Weil LEG, Naranjo D, Barnard KD, Laffel LMB, Hood KK, Weissberg-Benchell J. Automated Insulin Delivery Systems: Hopes and Expectations of Family Members. Diabetes Technol Ther 2018; 20:222-228. [PMID: 29565721 PMCID: PMC6422006 DOI: 10.1089/dia.2017.0301] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND This study examines the hopes and expectations that children, adolescents, and adults with type 1 diabetes and their families have for new automated insulin delivery systems. The study also aims to examine how the automated insulin delivery system may impact family functioning and individual members' psychosocial adjustment. METHODS Forty-eight semistructured focus groups (n = 195) and 89 individual interviews were conducted with children, adolescents, and adults with type 1 diabetes and parents and partners. Coders reviewed results in key themes most likely to contain references to the family system. Clusters were analyzed using thematic analysis to identify participants' salient hopes and expectations of how new technology may impact family relationships and individual psychosocial functioning. RESULTS Three main themes emerged for participants' hopes and expectations for implementation of the automated insulin delivery system. First, there is an expectation that this diabetes technology will alleviate diabetes-specific worry and burden for the people with diabetes and other family members. Second, there is also hope that this system may reduce day-to-day stress and, third, improve family relationships. CONCLUSIONS The unique perspective of a broad age group provides insight into how individuals and families creatively address the multiple tasks required in daily diabetes management. Study findings elucidate the very high hopes and expectations held by those managing type 1 diabetes and the impact this new technology may have on family relationships. Awareness of these hopes and expectations is important for developers and clinicians in addressing potential challenges to uptake and to ensure that expectations are set appropriately.
Collapse
Affiliation(s)
- Kimberly P Garza
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Aneta Jedraszko
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
| | - Lindsey E G Weil
- 2 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| | - Diana Naranjo
- 3 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
| | | | - Lori M B Laffel
- 5 Joslin Diabetes Center , Harvard Medical School, Boston, Massachusetts
| | - Korey K Hood
- 3 Department of Psychiatry, Stanford University School of Medicine , Stanford, California
- 6 Department of Pediatrics, Stanford University School of Medicine , Stanford, California
| | - Jill Weissberg-Benchell
- 1 Department of Psychiatry, Ann and Robert H. Lurie Children's Hospital of Chicago , Chicago, Illinois
- 2 Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine , Chicago, Illinois
| |
Collapse
|
30
|
Berg CA, Butner J, Wiebe DJ, Lansing AH, Osborn P, King PS, Palmer DL, Butler JM. Developmental model of parent-child coordination for self-regulation across childhood and into emerging adulthood: Type 1 diabetes management as an example. DEVELOPMENTAL REVIEW 2017; 46:1-26. [DOI: 10.1016/j.dr.2017.09.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
|
31
|
Raymaekers K, Oris L, Prikken S, Moons P, Goossens E, Weets I, Luyckx K. The Role of Peers for Diabetes Management in Adolescents and Emerging Adults With Type 1 Diabetes: A Longitudinal Study. Diabetes Care 2017; 40:1678-1684. [PMID: 29138272 DOI: 10.2337/dc17-0643] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged. However, longitudinal research linking the peer context to diabetes management and outcomes is scarce. The present longitudinal study in a large sample of youths with type 1 diabetes related both positive and negative peer variables to diabetes outcomes over a time interval of 1 year. RESEARCH DESIGN AND METHODS Our sample consisted of 467 adolescents (14-17 years of age) and emerging adults (18-25 years of age) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-related distress, and treatment adherence. HbA1c values were obtained from the treating physicians of patients. Cross-lagged analysis from a structural equation modeling approach was performed to assess the directionality of effects. RESULTS Peer support negatively predicted diabetes-related distress over time. Extreme peer orientation positively predicted treatment distress over time. Parental responsiveness negatively predicted food distress over time. Treatment adherence negatively predicted extreme peer orientation, treatment distress, and HbA1c values over time. For emerging adults specifically, there was a reciprocal relationship between HbA1c values and extreme peer orientation because they positively predicted each other. CONCLUSIONS This study highlights the importance of peers in predicting the functioning of youths with type 1 diabetes. Additionally, treatment adherence at baseline was found to negatively predict extreme peer orientation, treatment distress, and worse glycemic control over time. In sum, the current study underscores the importance of the peer context for adolescents and emerging adults with type 1 diabetes.
Collapse
Affiliation(s)
| | - Leen Oris
- University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | | | - Philip Moons
- University of Leuven, Leuven, Belgium.,University of Gothenburg, Gothenburg, Sweden
| | - Eva Goossens
- University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Ilse Weets
- Free University Brussels, Brussels, Belgium
| | | |
Collapse
|
32
|
Helgeson VS, Vaughn AK, Seltman H, Orchard T, Becker D, Libman I. Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: a mediational model. J Behav Med 2017; 41:186-194. [PMID: 28918521 DOI: 10.1007/s10865-017-9886-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
The study goal was to examine the links of parent knowledge of children's behavior to diabetes outcomes and to test a mediational model that focused on psychological distress and self-care behavior. We recruited 132 adolescents (average age 12) and followed them to average age 23. At age 23 (n = 107), we conducted in-person interviews with these emerging adults to measure parent knowledge, psychological distress, self-care behavior and glycemic control. We used structural equation modeling to test our hypotheses with these cross-sectional data. Higher levels of parent knowledge were linked to better glycemic control, and this path was mediated by reduced psychological distress and enhanced self-care behavior. Parents remain an important influence in the lives of emerging adults with type 1 diabetes. When emerging adults have a relationship with their parents in which they share general information, psychological distress may be reduced which then facilitates self-care and, ultimately, glycemic control.
Collapse
Affiliation(s)
- Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA.
| | - Abigail Kunz Vaughn
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA
| | - Howard Seltman
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA
| | | | - Dorothy Becker
- University of Pittsburgh, Pittsburgh, PA, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Ingrid Libman
- University of Pittsburgh, Pittsburgh, PA, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| |
Collapse
|
33
|
Berg CA, Queen T, Butner JE, Turner SL, Hughes Lansing A, Main A, Anderson JH, Thoma BC, Winnick JB, Wiebe DJ. Adolescent Disclosure to Parents and Daily Management of Type 1 Diabetes. J Pediatr Psychol 2017; 42:75-84. [PMID: 28175323 PMCID: PMC5896607 DOI: 10.1093/jpepsy/jsw056] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 05/26/2016] [Accepted: 05/26/2016] [Indexed: 11/14/2022] Open
Abstract
Objective To examine how adolescents’ daily disclosure to parents about type 1 diabetes management may foster a process whereby parents gain knowledge and are viewed as helpful in ways that may aid diabetes management. Methods A total of 236 late adolescents (M age = 17.76) completed a 14-day diary where they reported daily disclosure to, and solicitation from, their parents, how knowledgeable and helpful parents were, and their self-regulation failures and adherence; blood glucose was gathered from meters. Results Multilevel models revealed that adolescent disclosure occurred in the context of greater parent solicitation and face-to-face contact and was positively associated with adolescents’ perceptions of parental knowledge and helpfulness. Disclosure to mothers (but not to fathers) was associated with better diabetes management (fewer self-regulation failures, better adherence). Conclusions Adolescent disclosure may be an important way that parents remain knowledgeable about diabetes management and provide assistance that serves to support diabetes management.
Collapse
Affiliation(s)
| | - Tara Queen
- Department of Psychology, University of Utah
| | | | | | | | | | | | | | - Joel B. Winnick
- Department of Human Development and Family Studies, Pennsylvania State University
| | | |
Collapse
|
34
|
Wiebe DJ, Helgeson V, Berg CA. The social context of managing diabetes across the life span. AMERICAN PSYCHOLOGIST 2016; 71:526-538. [PMID: 27690482 PMCID: PMC5094275 DOI: 10.1037/a0040355] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Diabetes self-management is crucial to maintaining quality of life and preventing long-term complications, and it occurs daily in the context of close interpersonal relationships. This article examines how social relationships are central to meeting the complex demands of managing Type I and Type 2 diabetes across the life span. The social context of diabetes management includes multiple resources, including family (parents, spouses), peers, romantic partners, and health care providers. We discuss how these social resources change across the life span, focusing on childhood and adolescence, emerging adulthood, and adulthood and aging. We review how diabetes both affects and is affected by key social relationships at each developmental period. Despite high variability in how the social context is conceptualized and measured across studies, findings converge on the characteristics of social relationships that facilitate or undermine diabetes management across the life span. These characteristics are consistent with both Interpersonal Theory and Self-Determination Theory, 2 organizing frameworks that we utilize to explore social behaviors that are related to diabetes management. Involvement and support from one's social partners, particularly family members, is consistently associated with good diabetes outcomes when characterized by warmth, collaboration, and acceptance. Underinvolvement and interactions characterized by conflict and criticism are consistently associated with poor diabetes outcomes. Intrusive involvement that contains elements of social control may undermine diabetes management, particularly when it impinges on self-efficacy. Implications for future research directions and for interventions that promote the effective use of the social context to improve diabetes self-management are discussed. (PsycINFO Database Record
Collapse
|
35
|
Markowitz B, Parsons JA, Advani A. Diabetes in Emerging Adulthood: Transitions Lost in Translation. Can J Diabetes 2016; 41:1-5. [PMID: 27658766 DOI: 10.1016/j.jcjd.2016.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/03/2016] [Accepted: 06/07/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Benjamin Markowitz
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Janet A Parsons
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; Department of Physical Therapy and the Rehabilitation Science Institute, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Advani
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada.
| |
Collapse
|
36
|
Parental and peer support in adolescents with a chronic condition: a typological approach and developmental implications. J Behav Med 2015; 39:107-19. [PMID: 26369633 DOI: 10.1007/s10865-015-9680-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Accepted: 09/07/2015] [Indexed: 12/20/2022]
Abstract
Research has consistently demonstrated that contextual support is crucial towards the psychological functioning of adolescents with chronic conditions. However, the literature has predominantly focused on parental support instead of adopting an integrated approach to parental and peer support. The present manuscript with two longitudinal studies in adolescents with Type 1 diabetes and congenital heart disease examined the extent to which different clusters of maternal, paternal, and peer support at baseline were related to well- and ill-being over time. In both studies, four clusters emerged: combined support, parental support, peer support, and lack of support. Follow-up longitudinal analyses indicated that especially combined support from parents and peers proved to be of crucial importance towards psychological functioning. The present studies demonstrated the value of a typological approach for assessing social support in adolescents with chronic conditions. In addition to focusing on parental support, future research should assess peer support as well in these adolescents.
Collapse
|
37
|
Main A, Wiebe DJ, Van Bogart K, Turner SL, Tucker C, Butner JE, Berg CA. Secrecy From Parents and Type 1 Diabetes Management in Late Adolescence. J Pediatr Psychol 2015; 40:1075-84. [PMID: 26136405 DOI: 10.1093/jpepsy/jsv060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 05/28/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES This study examined (a) associations of parent-adolescent relationship characteristics and adolescent problem behavior with late adolescents' secrecy from parents about type 1 diabetes management, and (b) whether secrecy was associated with diabetes and psychological outcomes independently of these factors. METHODS Adolescents (N = 247, Mage = 17.76 years) completed survey measures of diabetes-related secrecy from parents, disclosure, parental acceptance, parental knowledge, and conduct problems. Mothers and adolescents reported on adolescent adherence to diabetes regimens and adolescents reported their depressive symptoms. Glycemic control was obtained from HbA1c test kits. RESULTS Adolescent-reported disclosure to parents was uniquely negatively associated with secrecy from parents. Controlling for relationship variables, conduct problems, and sociodemographic and illness-related variables, secrecy from mothers was uniquely associated with poorer glycemic control and secrecy from both parents was associated with lower adherence. CONCLUSIONS Secrecy about type 1 diabetes management is uniquely associated with diabetes outcomes independent of other relationship characteristics and problem behaviors.
Collapse
Affiliation(s)
- Alexandra Main
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | - Deborah J Wiebe
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | - Karina Van Bogart
- Psychological Sciences and Health Sciences Research Institute, University of California, Merced
| | | | - Christy Tucker
- Division of Psychology, University of Texas Southwestern Medical Center
| | | | | |
Collapse
|
38
|
Sheehan AM, While AE, Coyne I. The experiences and impact of transition from child to adult healthcare services for young people with Type 1 diabetes: a systematic review. Diabet Med 2015; 32:440-58. [PMID: 25407592 DOI: 10.1111/dme.12639] [Citation(s) in RCA: 107] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/17/2014] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Despite the transition between child and adult services for young people with Type 1 diabetes mellitus being a high-risk period, little is known about the impact of healthcare transition upon young people. METHODS A systematic review was conducted using PubMed, PsycINFO, CINAHL and EMBASE. Papers published between January 2001 and June 2014 that examined the impact or experiences of healthcare transition in young people with Type 1 diabetes were included. Data were extracted by two independent reviewers and integrated by narrative synthesis. RESULTS A total of 8990 citations were reviewed and 43 studies were included in the review, 24 of which explored the impact of transition and 24 examined experiences of transition. There were mixed results in terms of the change in glycaemic control and diabetes-related hospitalizations, but all studies assessing attendance found worse attendance post-transition. Data regarding experiences reported that young people and parents experienced greater difficulty in accessing and maintaining diabetes health care. Young people were required to develop independent self-management and self-advocacy skills to navigate the transition and adult health care, but some were inadequately prepared for this. CONCLUSIONS Although the impact of healthcare transition on outcomes for young people with Type 1 diabetes is unclear due to the paucity of high-quality studies, transition appears to be associated with decreased clinic attendance. There is some preliminary evidence of a positive impact of structured transition programmes. Experiences of healthcare transition illuminate the barriers to smooth transitions and the need for better integration and continuity of care.
Collapse
Affiliation(s)
- A M Sheehan
- School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | | |
Collapse
|
39
|
Helgeson VS, Palladino DK, Reynolds KA, Becker D, Escobar O, Siminerio L. Early adolescent relationship predictors of emerging adult outcomes: youth with and without type 1 diabetes. Ann Behav Med 2015; 47:270-9. [PMID: 24178509 DOI: 10.1007/s12160-013-9552-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging adulthood is a high-risk period for mental health problems and risk behaviors for youth generally and for physical health problems among those with type 1 diabetes. PURPOSE The purpose of this study was to examine whether adolescents' relationships with parents and friends predict health and risk behaviors during emerging adulthood. METHOD Youth with and without diabetes were enrolled at average age 12 and followed for 7 years. Parent and friend relationship variables, measured during adolescence, were used to predict emerging adulthood outcomes: depression, risk behavior, and, for those with diabetes, diabetes outcomes. RESULTS Parent relationship quality predicted decreased depressive symptoms and, for those with diabetes, decreased alcohol use. Parent control predicted increased smoking, reduced college attendance, and, for control participants, increased depressive symptoms. For those with diabetes, parent control predicted decreased depressive symptoms and better self-care. Friend relationship variables predicted few outcomes. CONCLUSIONS Adolescent parent relationships remain an important influence on emerging adults' lives.
Collapse
|
40
|
Monaghan M, Helgeson V, Wiebe D. Type 1 diabetes in young adulthood. Curr Diabetes Rev 2015; 11:239-50. [PMID: 25901502 PMCID: PMC4526384 DOI: 10.2174/1573399811666150421114957] [Citation(s) in RCA: 121] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/24/2015] [Accepted: 03/09/2015] [Indexed: 02/08/2023]
Abstract
Type 1 diabetes has traditionally been studied as a chronic illness of childhood. However, young adulthood is a critical time for the development and integration of lifelong diabetes management skills, and research is starting to identify unique challenges faced by youth with diabetes as they age into adulthood. Most young adults experience multiple transitions during this unstable developmental period, including changes in lifestyle (e.g., education, occupation, living situation), changes in health care, and shifting relationships with family members, friends, and intimate others. Young adults with type 1 diabetes must navigate these transitions while also assuming increasing responsibility for their diabetes care and overall health. Despite these critical health and psychosocial concerns, there is a notable lack of evidence-based clinical services and supports for young adults with type 1 diabetes. We review relevant evolving concerns for young adults with type 1 diabetes, including lifestyle considerations, health care transitions, psychosocial needs, and changes in supportive networks, and how type 1 diabetes impacts and is impacted by these key developmental considerations. Specific avenues for intervention and future research are offered.
Collapse
|
41
|
Delamater AM, de Wit M, McDarby V, Malik J, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2014. Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2014; 15 Suppl 20:232-44. [PMID: 25182317 DOI: 10.1111/pedi.12191] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
CONTENT Orchestrating a seamless transition from pediatric to adult care can be a daunting task in caring for youth with diabetes mellitus. This clinical review focuses on physical and psychosocial aspects affecting the care of adolescents and young adults with diabetes, evaluates how these aspects can be barriers in the process of transitioning these patients to adult diabetes care, and provides clinical approaches to optimizing the transition process in order to improve diabetes care and outcomes. EVIDENCE ACQUISITION AND SYNTHESIS A PubMed search identified articles related to transition to adult diabetes care and physical and psychosocial assessment of adolescents with diabetes. An Internet search for transition of diabetes care identified online transition resources. The synthesis relied on the cumulative experience of the authors. We identify barriers to successful transition and provide a checklist for streamlining the process. CONCLUSIONS Key points in the transition to adult diabetes care include: 1) starting the process at least 1 year before the anticipated transition; 2) assessing individual patients' readiness and preparedness for adult care; 3) providing guidance and education to the patient and family; 4) utilizing transition guides and resources; and 5) maintaining open lines of communication between the pediatric and adult providers. No current single approach is effective for all patients. Challenges remain in successful transition to avoid short- and long-term complications of diabetes mellitus.
Collapse
Affiliation(s)
- Sarah K Lyons
- Children's Hospital of Pittsburgh of University of Pittsburgh Medical Center, Division of Pediatric Endocrinology, 4401 Penn Avenue (FP 8139) Pittsburgh, PA 15224-1334.
| | | | | |
Collapse
|