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Corathers S, Williford DN, Kichler J, Smith L, Ospelt E, Rompicherla S, Roberts A, Prahalad P, Basina M, Muñoz C, Ebekozien O. Implementation of Psychosocial Screening into Diabetes Clinics: Experience from the Type 1 Diabetes Exchange Quality Improvement Network. Curr Diab Rep 2023; 23:19-28. [PMID: 36538250 PMCID: PMC9763798 DOI: 10.1007/s11892-022-01497-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE OF REVIEW Although advances in diabetes technology and pharmacology have significantly and positively impacted diabetes management and health outcomes for some, diabetes care remains burdensome and can be challenging to balance with other life priorities. The purpose of this article is to review the rationale for assessment of psychosocial domains in diabetes care settings and strategies for the implementation of psychosocial screening into routine practice. Survey data from the Type 1 Diabetes Exchange Quality Improvement Network is highlighted. RECENT FINDINGS Implementation of psychosocial screening requires identifying the population; selecting validated tools to assess target domains; determining frequency of screening and mode of survey delivery; and scoring, interpreting, documenting, and facilitating referrals such that these processes are part of clinical workflows. Recognizing the influence of psychosocial factors for people with diabetes (PWD), professional society guidelines for comprehensive diabetes care recommend the integration of psychosocial screening into routine care.
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Affiliation(s)
- Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Desireé N Williford
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | - Laura Smith
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | - Priya Prahalad
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Marina Basina
- Stanford University School of Medicine, Palo Alto, CA, USA
| | - Cynthia Muñoz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Center for Endocrinology, Diabetes, and Metabolism, Children's Hospital Los Angeles, Los Angeles, CA, USA
- University Center for Excellence in Developmental Disabilities, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA, USA
- University of Mississippi School of Population Health, Jackson, MS, USA
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Grundman JB, Majidi S, Perkins A, Streisand R, Monaghan M, Marks BE. Applying the use of shared medical appointments (SMAs) to improve continuous glucose monitor (CGM) use, glycemic control, and quality of life in marginalized youth with type 1 diabetes: Study protocol for a pilot prospective cohort study. Contemp Clin Trials Commun 2023; 32:101067. [PMID: 36698741 PMCID: PMC9868328 DOI: 10.1016/j.conctc.2023.101067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 12/08/2022] [Accepted: 01/14/2023] [Indexed: 01/18/2023] Open
Abstract
Background Continuous glucose monitors (CGMs) have been associated with improved glycemic control and diabetes-related quality of life in youth with type 1 diabetes (T1D), however use is lowest among youth from low-income households and racial/ethnic minorities. Shared medical appointments (SMAs) have been shown to improve glycemic control and reduce diabetes distress in adolescents with T1D, but a focus on marginalized youth has been lacking. This prospective cohort pilot study will assess feasibility and acceptability of the SMA intervention and impact on CGM uptake and sustained use, glycemic control, and diabetes distress in marginalized youth with elevated hemoglobin A1c (HbA1C). Methods The pilot study will recruit 20 publicly insured youth with T1D aged 8-12 years who identify as non-Hispanic Black or Latinx and have had at least one HbA1C value > 8% in the past year and their primary caretaker. The trial will employ an enrollment visit, SMA visits every 3 months over a 12-month study period, and a 6-month follow-up observational period. Feasibility measures include proportion of eligible youth successfully recruited for participation, proportion initiating CGM, SMA attendance, and retention through study completion. Acceptability will be assessed using satisfaction surveys. Changes in glycemic control will be assessed using CGM metrics and A1c from baseline to completion of the 12-month SMA intervention, as well as 3 and 6-months after completion of the SMA intervention. Conclusion Implementing SMAs for marginalized youth has the potential to address diabetes disparities by optimizing clinical and psychosocial outcomes for the most vulnerable youth living with T1D.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05431686.
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Affiliation(s)
- Jody B. Grundman
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,Corresponding author.
| | - Shideh Majidi
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Amanda Perkins
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA
| | - Randi Streisand
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA,George Washington University School of Medicine and Health Sciences, 2300 I St NW, Washington, DC, 20052, USA
| | - Maureen Monaghan
- Division of Endocrinology, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, USA
| | - Brynn E. Marks
- Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA, 19104, USA
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Temmen CD, Lu R, Gee BT, Chen Z, Nansel TR. Latent classifications of parental involvement in diabetes management for youth with type 1 diabetes: A randomized clinical trial. Pediatr Diabetes 2022; 23:1133-1142. [PMID: 36250647 PMCID: PMC11090373 DOI: 10.1111/pedi.13397] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/27/2022] [Accepted: 07/29/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Understanding how parent-child relationships influence diabetes management in youth with type 1 diabetes is critical for minimizing the risk of short- and long-term complications. We examined how classes of diabetes-specific parenting behaviors are associated with disease management and well-being for youth with type 1 diabetes. RESEARCH DESIGN AND METHODS The Family Management of Diabetes clinical trial tested the efficacy of a 2-year behavioral intervention for families of youth with type 1 diabetes. Three hundred and ninety youth diagnosed with type 1 diabetes and their primary caregiver were recruited from four pediatric endocrinology centers in the US Classifications of parental involvement utilized baseline parent and youth reports of task involvement, collaborative involvement, and parent-youth conflict. Class differences in baseline glycemic control (HbA1c), regimen adherence, general and diabetes quality of life, and depressive symptoms, and 2-year change in HbA1c were examined. RESULTS Latent profile analysis identified three classes: (1) high in task and collaborative involvement, low in conflict (Harmonious), (2) low in task involvement, collaborative involvement, and conflict (Indifferent), (3) high in task involvement and conflict, low in collaborative involvement (Inharmonious). The Harmonious group demonstrated the best adherence, glycemic control, and psychosocial well-being. The Inharmonious and Indifferent groups had similar diabetes management, but youth from Inharmonious families showed poorer psychosocial well-being. The intervention effect on glycemic control did not differ across the classes. CONCLUSIONS The interplay of parental involvement and conflict resulted in distinct parenting classes that differed in disease management and well-being. However, the classes benefitted similarly from the behavioral intervention.
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Affiliation(s)
- Chelsie D. Temmen
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
- Department of Counseling and Human Development, University of Louisville, Louisville, Kentucky, USA
| | - Ruijin Lu
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Benjamin T. Gee
- Kaiser Permanente, SCPMG Riverside, Riverside, California, USA
| | - Zhen Chen
- Biostatistics and Bioinformatics Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
| | - Tonja R. Nansel
- Social and Behavioral Sciences Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland, USA
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Shiau CWC, Lim SM, Cheng LJ, Lau Y. Effectiveness of Game-Based Self-Management Interventions for Individuals with Diabetes: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Games Health J 2021; 10:371-382. [PMID: 34860133 DOI: 10.1089/g4h.2020.0203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objective: Self-management is essential for individuals with diabetes. However, traditional self-management interventions may be hard to follow for other patients. Although games can stimulate extrinsic motivations, its application on self-management remains unclear. This review aims to evaluate the effects of game-based self-management interventions on health outcomes. Materials and Methods: We utilize PubMed, CINAHL, Cochrane Central, EMBASE, ProQuest Dissertation and Theses, PsycINFO, and Scopus from their inception until January 20, 2020. Meta-analyses are performed using Comprehensive Meta-analysis 3.0 software. The overall effect is measured using Hedges' g and determined using Z-statistics at significance level of P < 0.05. Heterogeneity is assessed using χ2 and I2 statistics. The risk of bias tool and the grades of recommendation, assessment, development, and evaluation system are used to assess individual and overall quality of evidence, respectively. Results: A total of 2150 records are identified, and 13 randomized controlled trials are selected. Meta-analyses revealed that game-based self-management interventions significantly improved patients' change in glycated hemoglobin (HbA1c) level (g = 0.18, P = 0.02), adherence to physical activities (g = 0.59, P < 0.001), balance (g = 0.94-1.14, P < 0.001), and fall efficacy (g = 1.01, P < 0.001). Significant results were only found for the three-trial meta-analysis for HbA1c changes, but not for the two other HbA1c meta-analyses that included more trials. Furthermore, negligible improvements were observed in glycated hemoglobin at postintervention and follow-up assessments, diabetes knowledge, and self-efficacy. Conclusion: Game-based self-management can consider a supplementary intervention. Overall evidence is ranging from very low to low. Future studies can consider a large sample size with high-quality design according to the Consolidated Standards of Reporting Trials statement criteria.
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Affiliation(s)
| | - Shi Min Lim
- Department of Nursing, National University Hospital, National University Health System, Singapore
| | - Ling Jie Cheng
- Health Systems and Behavioural Sciences Domain, Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Ying Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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Kalra S, Das AK, Priya G, Joshi A, Punyani H, Krishna N, Gaurav K. An Expert Opinion on "Glycemic Happiness": Delineating the Concept and Determinant Factors for Persons with Type 2 Diabetes Mellitus. Clin Pract 2021; 11:543-560. [PMID: 34449577 PMCID: PMC8395426 DOI: 10.3390/clinpract11030071] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/19/2021] [Accepted: 06/28/2021] [Indexed: 01/18/2023] Open
Abstract
The importance of the psychological impact of diabetes is globally well-documented. Evidence suggests that there is a high level of psychosocial burden of diabetes in India. Moreover, there is a lack of relevant knowledge among the patients and caregivers regarding the psychological impact of diabetes and how to cope with it, as compared to the majority of other countries. “Happiness of the patient” is an essential component of diabetes management, which potentially affects the treatment outcome, treatment adherence, self-care, and lifelong management of diabetes. Although several validated tools and scales exist for measuring psychological outcomes both in patients and physicians, tools to assess “happiness in diabetes care” are still lacking. With this background, an expert group meeting was held in India in September 2019, involving nine expert diabetologists and endocrinologists across the country to discuss the concept of “glycemic happiness”. This article summarizes the expert opinion on the factors affecting psychological outcomes in diabetes, introduces the concept of glycemic happiness, describes available scales and tools to measure general happiness, and delineates the five sets of questionnaires developed with questions that may help correlate with “glycemic happiness”. The questionnaires are based on a five-point Likert method. The experts also discussed and decided upon the study design for a proposed observational survey to assess glycemic happiness of persons with type 2 diabetes mellitus (T2DM) based on the developed five sets of questionnaires. Given the huge burden of diabetes in India, the introduction of the concept of glycemic happiness will help in the optimization of diabetes care in the country.
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Affiliation(s)
- Sanjay Kalra
- Department of Endocrinology, Bharti Hospital and BRIDE, Karnal 132001, India;
| | - Ashok Kumar Das
- Department of Endocrinology and Medicine, Pondicherry Institute of Medical Sciences, Puducherry 605014, India;
| | - Gagan Priya
- Department of Endocrinology, Fortis Hospital, Chandigarh 160011, India;
| | - Ameya Joshi
- Department of Endocrinology, Bhaktivedanta Hospital, Mumbai 401107, India;
| | - Hitesh Punyani
- Department of Medicine, Chaitanya Cardio Diabetes Centre, New Delhi 110026, India;
| | - Nareen Krishna
- Department of Medical Affairs, Dr. Reddy’s Laboratories Limited, Hyderabad 500034, India;
- Correspondence: ; Tel.: +91-96-7640-0086
| | - Kumar Gaurav
- Department of Medical Affairs, Dr. Reddy’s Laboratories Limited, Hyderabad 500034, India;
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Cho MK, Kim MY. What Affects Quality of Life for People with Type 1 Diabetes?: A Cross-Sectional Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7623. [PMID: 34300074 PMCID: PMC8304448 DOI: 10.3390/ijerph18147623] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 12/11/2022]
Abstract
This study investigated the association between the quality of life (QOL) and type 1 diabetes mellitus (DM), a lifelong disease that requires constant management. A complex set of factors influence the QOL of people with type 1 DM, and understanding these factors requires further research. This research is a cross-sectional descriptive study. A survey on related variables such as acceptance of disease and efficacy for self-management of diabetes, was conducted among 111 participants with type 1 DM. The collected data were analyzed using PASW Statistics program, and factors influencing participants' QOL were identified through hierarchical multiple regression. The study followed the Guidelines of Systematic Reporting of Examination in the STROBE checklist. The results showed that four variables exerted a significant effect on QOL (blood glucose level at hypoglycemia and complications in Model 1; efficacy for self-management of diabetes and acceptance and action in Model 2), and all the variables explained a majority of the variance in QOL. The results indicate that management of severe hypoglycemia and prevention of complications is crucial. Interventions should be developed to enhance coping abilities to improve efficacy for self-management for those with diabetes and promote their acceptance of the disease.
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Affiliation(s)
- Mi-Kyoung Cho
- Department of Nursing Science, Chungbuk National University, 1 Chungdae-ro, Seowon-gu, Cheongju 28644, Korea;
| | - Mi-Young Kim
- College of Nursing, Hanyang University, 222 Wangsimni-ro, Seongdong-gu, Seoul 04763, Korea
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Luo J, Wang H, Li X, Zhou Z, Valimaki M, Whittemore R, Grey M, Guo J. Factors associated with diabetes distress among adolescents with type 1 diabetes. J Clin Nurs 2021; 30:1893-1903. [PMID: 33829586 DOI: 10.1111/jocn.15742] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 02/01/2021] [Accepted: 02/26/2021] [Indexed: 01/20/2023]
Abstract
AIMS To describe the specific domains of diabetes distress and factors associated with these domains. BACKGROUND Diabetes distress is a common problem but not well recognised in adolescents by healthcare providers or adolescents themselves. There is insufficient evidence on how specific domains of diabetes distress exist in adolescents, making it challenging to select precise components to alleviate diabetes stress. DESIGN A quantitative, descriptive and cross-sectional study. METHODS Data were collected on socio-demographic and clinical characteristics, diabetes distress, perceived stress, self-efficacy and diabetes self-management using established questionnaires. Multivariate linear regression was conducted to examine the associations between specific factors and four domains in diabetes distress. STROBE checklist was used as the guideline for this study. RESULTS A total of 100 adolescents with type 1 diabetes aged 12 to 18 years participated in this study. Adolescents experienced the highest levels of distress in the regimen-related distress [2.41 (SD =0.82)] and physician-related distress [2.40 (SD =0.80)] domains. Older age, female gender, more diabetes problem-solving and higher levels of perceived stress were associated with higher regimen-related distress (β = 0.21 ~ 0.45, p < 0.05). Older age, female gender, a lower degree of endorsement of relevant diabetes-related goals and higher levels of perceived stress were associated with higher physician-related distress (β = -0.29 ~ 0.34, p < 0.05). CONCLUSIONS Diabetes distress was reported more on regimen-related and physician-related domains among adolescents with type 1 diabetes in China, associating with older age, female, increased perceived stress and poor diabetes-related problem-solving. RELEVANCE TO CLINICAL PRACTICE Nurses need to screen the specific domains of diabetes distress among adolescents with type 1 diabetes, especially for the older adolescents and girls. This study highlighted the importance of incorporating diabetes-related problem-solving support and stress management strategies into diabetes management for adolescents with type 1 diabetes, which could help relieve diabetes distress.
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Affiliation(s)
- Jiaxin Luo
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Hongjuan Wang
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Xia Li
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Zhiguang Zhou
- Institute of Metabolism and Endocrinology, The Second Xiangya Hospital, Key Laboratory of Diabetes Immunology, Ministry of Education, Central South University, National Clinical Research Center for Metabolic Diseases, Changsha, China
| | - Maritta Valimaki
- Xiangya School of Nursing, Central South University, Changsha, China
| | | | - Margaret Grey
- Yale University School of Nursing, New Haven, CT, USA
| | - Jia Guo
- Xiangya School of Nursing, Central South University, Changsha, China
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Sethe D, Büssing A, Hilgard D, Berger B. [Validation of the German Version of Pediatric Self-Efficacy for Diabetes-Type-1 Scale]. Psychother Psychosom Med Psychol 2020; 70:349-357. [PMID: 32069510 DOI: 10.1055/a-1088-1316] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Since there is no suitable tool for measuring the specific, diabetes-related self-efficacy in children with type-1-diabetes in German language, this paper presents the construction and validation of Pediatric Self-Efficacy for Diabetes-Type-1 Scale (PSEDT-1). The intention was to develop a guideline-compliant, pediatric, revised self-efficacy scale on the basis of Grossman, Brink and Hauser̓s SED. DESIGN Children with type 1 diabetes (N=221) were included in a clinical, multi-centre validation study. To assess sensitivity to change, 85 of these children were asked to complete the PSEDT-1 before, immediately after, and 6 months after inpatient diabetes training. PSEDT-1 has been associated with scales that measure constructs that are similar and different in terms of content. The interpretation of the correlation results should provide information on validity. The PSEDT-1 was thus reviewed using the German Multidimensional Self-Assessment Scale (MSWS), the German questionnaire on health and illness-related control beliefs (KKG). RESULTS The reliability results showed a good internal consistency with Cronbach's α=0,87; the discriminatory power of the items was acceptable. Exploratory factor analysis identified 4 factors that account for 54% of the variance: 1) diabetes self-management skill, 2) (medical) insulin management competence, 3) (general) self-assertiveness, 4) autonomous self-regulation. The construct validity of PSEDT-1 has been evaluated by estimating its association with other variables. It was possible to verify the theoretically expected correlation patterns. In addition, the study results showed indications of sufficiently high sensitivity to change. DISCUSSION The results suggest that PSEDT-1 is a valid and reliable tool that, in addition to the scale values of the competence areas of diabetes self-management, medical management, and general self-assertion, also determines the scale value of autonomous self-regulation to assess diabetes-related self-efficacy.
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Affiliation(s)
- Dominik Sethe
- Department für Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten
| | - Arndt Büssing
- Department für Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten
| | | | - Bettina Berger
- Department für Humanmedizin, Universität Witten/Herdecke Fakultät für Gesundheit, Witten
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