Identity formation in adolescents and emerging adults with type 1 diabetes

Reviewing identity development in young people living with Type 1 Diabetes Mellitus

INTRODUCTION

Type 1 Diabetes Mellitus (T1DM) is a chronic condition increasing among young people. Identity development occurs during an individual's life and can be significantly influenced by a chronic disease such as T1DM. We have critically reviewed the relevant scientific literature to understand young people's identity development with T1DM.

METHODS

A critical review design was employed to answer the research question: "What does scientific literature state regarding identity development in young people living with Type 1 Diabetes Mellitus?" Numerous databases were searched to include the most relevant scientific literature to answer the research questions. Boolean operator phrases were ultimately used to search for the literature. The initial screening produced 1319 scientific literature, among which seven articles were analyzed thematically.

RESULTS

Analysis revealed several significant themes: The identity of young people with T1DM develops differently from those without this chronic condition; young people can either incorporate or contain their T1DM in their identity development, highlighting the complex nature of this process; and numerous external factors significantly influence identity development in young people living with a chronic condition such as T1DM.

CONCLUSION

The study underscores that identity develops differently in young people living with T1DM than in those without chronic conditions. However, the existing studies and literature exploring the experiences of young people living with T1DM have relied on information from caregivers and health professionals. This reliance on secondary sources underscores the urgent need for more research to obtain data from young people living with T1DM as a primary source. Such a shift in research practices is crucial to gaining a more comprehensive and accurate understanding of their experiences.

Identification of psychological constructs for a positive psychology intervention to assist with the adjustment to closed loop technology among adolescents living with type 1 diabetes

Aim

Adolescents have been identified as the group who struggle most with successful adjustment to closed loop technology. This study aims to identify the psychological constructs that should form part of a positive psychology intervention to assist with the adjustment to closed loop technology among adolescents living with type 1 diabetes.

Method

Qualitative document analysis was employed to integrate findings from two documents: a published ongoing intervention study and a recent phenomenological study by the authors. Reflexive thematic analysis was used to identify themes from the documents.

Findings

The following themes were identified as important psychological constructs that aid adjustment: the importance of knowledge and education; the process of positive adjustment to closed loop technology; a positive outlook; and building a relationship with diabetes.

Conclusion

Interventions are needed to assist adolescents in their adjustment to closed loop technology. The psychological constructs identified served as a starting point in designing an effective, evidence-based intervention grounded in data and theory. Knowledge and education, responsibility, identity, positive affect, gratitude, support, and trust are psychological constructs that need to be included in an intervention program.

Improvement of Selected Psychological Parameters and Quality of Life of Patients With Type 1 Diabetes Mellitus Undergoing Transition From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to the MiniMed 780G Advanced Hybrid Closed-Loop System: Post hoc Analysis of a Randomized Control Study

BACKGROUND

While introducing new technologies and methods of treatment for type 1 diabetes mellitus (T1DM), it seems essential to monitor whether modern technologies in diabetes treatment may improve the psychological and emotional status of patients.

OBJECTIVE

This study aims to assess the baseline psychological parameters of patients with T1DM during investigation of the direct transition from multiple daily injections (MDI) and self-monitoring of blood glucose (SMBG) to the MiniMed 780G advanced hybrid closed-loop (AHCL) system and to evaluate changes in the psychological well-being and quality of life (QoL) after the transition in these individuals versus the control group.

METHODS

The trial was a 2-center, randomized controlled, parallel group study. In total, 41 patients with T1DM managed with MDI or SMBG were enrolled and randomized either to the AHCL or the MDI+SMBG group. Of these, 37 (90%) participants (mean age 40.3 years, SD 8.0 years; mean duration of diabetes 17.3, SD 12.1 years; mean hemoglobin A_1c [HbA_1c] 7.2%, SD 1.0%) completed the study (AHCL: n=20, 54%; MDI+SMBG: n=17, 46%). Psychological parameters (level of stress, coping mechanisms, level of anxiety, self-efficacy level, acceptance of illness, locus of control of illness, life satisfaction, QoL) were measured at baseline and at the end of the study using 10 psychological questionnaires.

RESULTS

At baseline, the general level of stress of the examined patients was higher than in the general healthy Polish population (P=.001), but coping strategies used in stressful situations were significantly more effective and the level of self-efficacy (P<.001) was much higher than in the general population. The patients in this study accepted their illness more than patients with diabetes from the general Polish population (P<.001), but they felt that their health does not depend on them compared to the general population (P<.001). The overall life satisfaction was similar to that of the general population (P=.161). After 3 months from transition, the AHCL group reported an increase in 4 scales of the QoL-feeling well (P=.042), working (P=.012), eating as I would like (P=.011), and doing normal things (P=.034)-in comparison to the control group, where no significant change occurred. The level of both state anxiety and trait anxiety decreased in the AHCL group: State-Trait Anxiety Inventory (STAI) X1 scores (P=.009), STAI X1 stens (P=.013), and STAI X2 scores (P=.022). The AHCL group became more emotion oriented in stressful situations (Coping Inventory for Stressful Situations [CISS] E; P=.043) and significantly less self-blaming after 3 months of the study (P=.020).

CONCLUSIONS

The results indicate that the patients who decided to take part in the transition study were characterized by higher levels of stress than the general healthy population but had better coping strategies and self-efficacy. Furthermore, transitioning from MDI+SMBG treatment to the AHCL in patients naive to technology may significantly improve psychological well-being and QoL within 3 months. The rapidity of these changes suggests that they may be related to the significant improvement in glycemic outcomes but also significantly less burdened diabetes self-management.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04616391; https://clinicaltrials.gov/ct2/show/NCT04616391.

Identity formation in adolescent and emerging adult cancer survivors: a differentiated perspective and associations with psychosocial functioning

OBJECTIVE

Identity formation was investigated in adolescent and emerging adult cancer survivors from a (neo-)Eriksonian perspective by comparing survivors to control participants. In survivors, associations between identity and clinical/demographical variables and general and illness-specific functioning were investigated.

DESIGN

Childhood cancer survivors (n = 125; M_age: 19.54; 47% male) were matched on age and gender with healthy controls (2:1).

MAIN OUTCOME MEASURES

All participants completed identity questionnaires. Survivors reported on demographics, well-being (depressive symptoms, life satisfaction, physical functioning), and illness-specific experiences (PTSS, illness centrality, cancer self-identity, benefit finding, cancer-related worries). Medical records provided clinical information.

RESULTS

Survivors did not differ from controls on identity synthesis or confusion or on the identity statuses resulting from cluster analysis on the identity dimensions (achievement, foreclosure, moratorium, diffusion). Identity synthesis related to better well-being and illness experiences, whereas confusion related to worse well-being and illness experiences. Youth in moratorium and diffusion reported lower well-being and more negative illness experiences. Associations between identity and demographical and clinical characteristics were inconsistent.

CONCLUSIONS

This study revealed no significant differences in identity formation between cancer survivors and controls. However, survivors who struggle in their identity quest should be identified as they are at risk for poorer well-being and negative illness experiences.

Psychosocial Outcomes in Adolescents With Type 1 Diabetes: Associations With Grade Level and Disease Duration

INTRODUCTION

The purpose of this study was to examine anxiety and depressive symptoms in adolescents with type 1 diabetes (T1D) to determine differences based on grade level and disease duration.

METHOD

We conducted a secondary data analysis of adolescents with T1D, which included demographic characteristics, general anxiety symptoms, and depressive symptoms.

RESULTS

Of the 147 adolescents included in the analysis, 32% (n=47) were in middle school and 68% (n=100) were in high school. Most had been diagnosed with diabetes for less than 3 years (67.3%, n=99). When controlling for covariates, middle schoolers were more likely to report clinically significant depressive symptoms compared to their high school peers (β = 0.83, p = 0.008).

DISCUSSION

Younger adolescents may be at a higher risk of a clinically significant symptom burden from depression and should be screened regularly. Future research should include tailoring psychosocial interventions specifically to an adolescent's age and disease duration.

Smile with diabetes: reflections on illness perception and diabetes management behaviors of adolescents in private health care in South Africa

Background

The association between illness perception and diabetes management has been well established in adults but is not clearly understood for adolescents. This article reflects on qualitative findings on illness perception from the perspective of adolescents, and suggests future research to operationalize findings.

Methods

Qualitative document analysis was conducted on four research projects forming part of the Smile with Diabetes project, which aims to investigate psychosocial variables in diabetes management, including illness perception, within the adolescent and youth populations. Thematic analysis was used to derive four themes from the qualitative and review studies examined in the document analysis.

Results

The voices of the adolescents were evident as four prominent themes: 1) living with diabetes leads to a sense of being different; 2) integration of diabetes into identity is critical, but difficult to achieve; 3) fear of potential negative consequences motivates adherence to treatment; 4) diabetes management is difficult, but possible.

Conclusion

The findings not only confirmed the importance of illness perception in the management of diabetes by adolescents, but also indicate that illness perceptions should be investigated from a developmental perspective, specifically taking identity development into consideration in this group. Adolescents should be made aware of how their thinking about diabetes and its management affects their experience of living with diabetes and its future management. This study further contributes to the literature by focusing on the patient's voice in understanding living with a chronic condition, and reassures that positive outcomes are possible when living with a chronic condition such as diabetes.

Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance

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.

Real-world performance of hybrid closed loop in youth, young adults, adults and older adults with type 1 diabetes: Identifying a clinical target for hybrid closed-loop use

AIM

To describe real-world hybrid closed loop (HCL) use and glycaemic outcomes across the lifespan and identify a clinical threshold for HCL use associated with meeting the internationally recommended target of 70% sensor glucose time in range (TIR; 70-180 mg/dL).

MATERIALS AND METHODS

Mixed models examined MiniMed 670G HCL use and glycaemic outcomes in 276 people with type 1 diabetes from four age groups: youth (aged <18 years), young adults (18-25 years), adults (26-49 years) and older adults (≥50 years) for 1 year. ROC analysis identified the minimum percentage HCL use associated with meeting the TIR goal of 70%.

RESULTS

HCL use at month 1 was 70.7% ± 2.9% for youth, 71.0% ± 3.8% for young adults, 78.9% ± 2.1% for adults and 84.7% ± 3.8% in older adults. HCL use declined significantly at 12 months to 49.3% ± 3.2% in youth (P < .001) and 55.7% ± 4.3% in young adults (P = .002). HCL use was sustained at 12 months in adults (76.4% ± 2.2%, P = .36) and older adults (80.4% ± 3.9%, P = .36). HCL use of 70.6% was associated with 70% TIR (sensitivity 58.3%, specificity 85%, AUC 0.77). Older age, 80% or higher continuous glucose monitor use and four or more blood glucose checks per day were associated with attaining the HCL-use threshold.

CONCLUSIONS

HCL use of 70% or higher may be a useful target for clinicians to use to assist people with diabetes in attaining glycaemic goals. Youth may struggle with HCL use more than adults and require clinical intervention to help sustain HCL use across time.

Use of Factory-Calibrated Real-time Continuous Glucose Monitoring Improves Time in Target and HbA1c in a Multiethnic Cohort of Adolescents and Young Adults With Type 1 Diabetes: The MILLENNIALS Study

OBJECTIVE

International type 1 diabetes registries have shown that HbA_1c levels are highest in young people with type 1 diabetes; however, improving their glycemic control remains a challenge. We propose that use of the factory-calibrated Dexcom G6 CGM system would improve glycemic control in this cohort.

RESEARCH DESIGN AND METHODS

We conducted a randomized crossover trial in young people with type 1 diabetes (16-24 years old) comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded continuous glucose monitoring (CGM) was worn by each participant for 10 days at the start, week 4, and week 7 of the control period. HbA_1c measurements were drawn after enrollment and before and after each treatment period. The primary outcome was time in range 70-180 mg/dL.

RESULTS

Time in range was significantly higher during CGM compared with control (35.7 ± 13.5% vs. 24.6 ± 9.3%; mean difference 11.1% [95% CI 7.0-15.2]; P < 0.001). CGM use reduced mean sensor glucose (219.7 ± 37.6 mg/dL vs. 251.9 ± 36.3 mg/dL; mean difference -32.2 mg/dL [95% CI -44.5 to -20.0]; P < 0.001) and time above range (61.7 ± 15.1% vs. 73.6 ± 10.4%; mean difference 11.9% [95% CI -16.4 to -7.4]; P < 0.001). HbA_1c level was reduced by 0.76% (95% CI -1.1 to -0.4) (-8.5 mmol/mol [95% CI -12.4 to -4.6]; P < 0.001). Times spent below range (<70 mg/dL and <54 mg/dL) were low and comparable during both study periods. Sensor wear was 84% during the CGM period.

CONCLUSIONS

CGM use in young people with type 1 diabetes improves time in target and HbA_1c levels compared with SMBG.