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Gutiérrez-Domingo T, Farhane-Medina NZ, Villaécija J, Vivas S, Tabernero C, Castillo-Mayén R, Luque B. Effectiveness of Mindfulness-Based Interventions with Respect to Psychological and Biomedical Outcomes in Young People with Type 1 Diabetes: A Systematic Review. Healthcare (Basel) 2024; 12:1876. [PMID: 39337217 PMCID: PMC11430895 DOI: 10.3390/healthcare12181876] [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] [Received: 07/30/2024] [Revised: 08/28/2024] [Accepted: 09/01/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Type 1 diabetes is a chronic disease especially affecting young people. Mindfulness-based psychological interventions might reduce emotional symptoms post-diagnosis, but the evidence is limited. OBJECTIVES This systematic review aimed to evaluate the effectiveness of mindfulness interventions on psychological well-being and biomedical variables in young people with type 1 diabetes. METHODS A systematic review of trials was conducted that involved a bibliographic search in electronic databases (Web of Science, MEDLINE, SciELO, Scopus, PsycINFO, and Cochrane Library) considering studies published between 2013 and 2024. RESULTS A total of 434 records were identified, of which 252 underwent selection according to title and abstract, leaving 32 that were evaluated for eligibility and 7 included in this review. From Google Scholar, six more studies were identified and evaluated, and two were selected. Finally, nine studies were subjected to full reading and a detailed analysis of the inclusion criteria. A total of 66.6% of the studies were evaluated as having a methodological quality of moderate or optimal, but the samples analysed tended to be small, and only two articles carried out short-term follow-up evaluations. CONCLUSIONS Mindfulness-based interventions, upon reviewing the preliminary results, may be posited as a viable strategy to enhance psychological (anxiety, diabetes distress, perceived stress, depression, self-efficacy, psychological well-being, and quality of life) and biomedical outcomes (glycaemic control, blood glucose levels, and diastolic blood pressure) for type 1 diabetes in young people. Although promising, further research is required to improve the quality, methodology, and design of studies.
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Affiliation(s)
- Tamara Gutiérrez-Domingo
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Naima Z. Farhane-Medina
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Joaquín Villaécija
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Sebastián Vivas
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Carmen Tabernero
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Reina Sofia University Hospital, 14071 Córdoba, Spain
- Department of Psychology, University of Salamanca, 37007 Salamanca, Spain
- Institute of Neurosciences of Castilla y León (INCYL), University of Salamanca, 37007 Salamanca, Spain
| | - Rosario Castillo-Mayén
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
| | - Bárbara Luque
- Maimonides Biomedical Research Institute of Cordoba (IMIBIC), 14071 Córdoba, Spain; (N.Z.F.-M.); (J.V.); (S.V.); (C.T.); (R.C.-M.); (B.L.)
- Department of Psychology, University of Cordoba, 14071 Córdoba, Spain
- Reina Sofia University Hospital, 14071 Córdoba, Spain
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Chatzinikolaou A, Kazakos K, Owens DA, Galli-Tsinopoulou A, Kleisarchaki A, Lavdaniti M. Parental Resilience and Physical Health in Parents of Children With Type 1 Diabetes in Northern Greece. Cureus 2023; 15:e35149. [PMID: 36949972 PMCID: PMC10027411 DOI: 10.7759/cureus.35149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2023] [Indexed: 02/20/2023] Open
Abstract
BACKGROUND Type 1 diabetes mellitus (T1DM) is the most common endocrine and metabolic disorder in children. On the other hand, little is known regarding the health of parents whose children suffer from T1DM. AIM The study aims to investigate the mental resilience and physical health of parents of children with type 1 diabetes. METHODS The sample consisted of 80 parents of children and adolescents with T1DM.The study was conducted with the contribution of associations of parents of children with type 1 diabetes in a large hospital in Northern Greece between April 2021 and September 2021. A demographic and clinical questionnaire, the Wagnild and Young Resilience Scale-14 (RS-14), and the General Health 28 Physical Health Measurement Questionnaire (GHQ-28) were used to collect the research data. RESULTS Of the parents, 18.8% were male while 65% were female. The mean age of the parents was 44.02±6.71 years while the age of their children with diabetes was 13.13±6.05 years. Almost half of the children followed intensive insulin treatment (47.5%) whereas 22,5% reported that their children received insulin via a pump. A higher percentage of parents reported measuring their children's blood sugar more than six times a day (46,3%) and having their glycated hemoglobin (HbA1c) levels checked four times a year (51.2%). Finally, statistically significant effects on the physical symptoms and severe depression of parents of children with type 1 diabetes were observed. CONCLUSIONS Additional research is needed to assess the Greek parent population's resilience and physical health. This study will help healthcare providers to expand their knowledge and meet parents' needs.
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Affiliation(s)
| | - Kyriakos Kazakos
- Diabetes Mellitus Care, Department of Nursing, International Hellenic University, Thessaloniki, GRC
| | - Dimitra-Anna Owens
- Medical School, National and Kapodistrian University of Athens, Athens, GRC
| | - Assimina Galli-Tsinopoulou
- 2nd Department of Pediatrics, Department of Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Aggeliki Kleisarchaki
- 2nd Department of Pediatrics, Department of Medicine, AHEPA University General Hospital, Aristotle University of Thessaloniki, Thessaloniki, GRC
| | - Maria Lavdaniti
- Diabetes Mellitus Care, Department of Nursing, International Hellenic University, Thessaloniki, GRC
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Almeida AC, Leandro ME, Pereira MG. Diabetes representations on adherence and quality of life: Do parents and adolescents differ? Psych J 2023; 12:108-118. [PMID: 36100433 DOI: 10.1002/pchj.591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 07/20/2022] [Indexed: 02/04/2023]
Abstract
Type 1 diabetes is one of the most frequent chronic diseases in adolescents. To manage diabetes and prevent complications, a set of self-care behaviors needs to be implemented into family daily routines. This study analyzed diabetes representations in adolescents and their parents, the dissimilarities between them, and the relationship between illness dissimilarities and adherence/quality of life (QoL) in adolescents with type 1 diabetes. The sample included 200 participants: 100 adolescents with type 1 diabetes and 100 parents who accompanied the adolescents. Adolescents were assessed on adherence (Self-Care Inventory-Revised), quality of life (Diabetes QoL) and family support (Diabetes Family Behavior Scale). Both adolescents and parents were assessed on illness representations (Brief-Illness Perception Questionnaire). Dissimilarities in illness representations between parents and adolescents were performed using Olsen et al's proposal. Parents showed a more negative representation of diabetes than adolescents. Adolescents' illness representations, the dissimilarities between adolescents' and parents' illness representations, and family support were associated with adolescents' adherence and QoL. Higher family support moderated the relationship between the dissimilarity in timeline representations and QoL, explaining 17.8% of the variance on QoL. Adolescent's gender (male) was a moderator in the relationship between adolescent's coherence and QoL, explaining 18.6% of the variance on QoL. Adolescent's gender (female) was a moderator in the relationship between timeline and QoL, explaining 11.9% of the variance on QoL. Being a male parent was a moderator in the relationship between adolescent's concerns and QoL, explaining 13.5% of the variance on QoL. Intervention programs should focus on illness representations, particularly on the dissimilarities between adolescents and parents, as well as on family support in order to promote adolescents' adherence and QoL.
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Affiliation(s)
- Ana C Almeida
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
| | - M Engrácia Leandro
- Centre for Research and Studies in Sociology, University Institute of Lisbon, Campus da Cidade Universitária de Lisboa, Lisbon, Portugal
| | - M Graça Pereira
- Psychology Research Center, School of Psychology, University of Minho, Braga, Portugal
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Cui Y, Yang T, Li R, Wang H, Jin S, Liu N, Liu X, Liu H, Zhang Y. Network structure of family function and self-management in patients with early chronic kidney disease amid the COVID-19 pandemic. Front Public Health 2023; 10:1073409. [PMID: 36703816 PMCID: PMC9871502 DOI: 10.3389/fpubh.2022.1073409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/23/2022] [Indexed: 01/11/2023] Open
Abstract
Background Family function plays a pivotal role in self-management among patients with early chronic kidney disease (CKD), which has been especially important during the COVID-19 pandemic. Previous studies have investigated the relationships between family function and self-management using total scores through self-report questionnaires while ignoring the different components in both family function and self-management. The specific objective of this study was to explore the network structure of family function and self-management at the component level. Methods A total of 360 patients with early CKD from three tertiary hospitals were enrolled in our cross-sectional survey from September to December 2021 in China. Components of family function were measured by the Family Adaptation Partnership Growth and Resolve Index, and components of self-management were measured by the Chronic Kidney Disease Self-management Instrument. Network analysis was used to establish the network structure. Results Edges across the community of family function and self-management were mainly positive. Edges between F3 "Growth" and M1 "Self-integration", F2 "Partnership" and M3 "Seeking social support," F5 "Resolve" and M3 "Seeking social support" were the strongest. F3 "Growth" had the greatest positive bridge expected influence of family function community (0.12), and M3 "Seeking social support" had the greatest positive bridge expected influence of self-management community (0.16). Conclusion We explored the potential pathways between different components of family function and self-management among patients with early CKD during the COVID-19 pandemic and found fine-grained relationships between them. The two nodes F3 "Growth" and M3 "Seeking social support" may provide a new idea from the perspective of family function for interventions to improve self-management.
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Affiliation(s)
- Yi Cui
- Department of Nursing, Air Force Medical University, Xi'an, China
| | - Tianqi Yang
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China
| | - Rong Li
- Department of Nephrology, The First Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Hua Wang
- Department of Nephrology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Shasha Jin
- Department of Nephrology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China
| | - Na Liu
- Department of Nursing, Air Force Medical University, Xi'an, China
| | - Xufeng Liu
- Department of Military Medical Psychology, Air Force Medical University, Xi'an, China,*Correspondence: Xufeng Liu ✉
| | - Hongbao Liu
- Department of Nephrology, The Second Affiliated Hospital of Air Force Medical University, Xi'an, China,Hongbao Liu ✉
| | - Yinling Zhang
- Department of Nursing, Air Force Medical University, Xi'an, China,Yinling Zhang ✉
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Małachowska M, Gosławska Z, Rusak E, Jarosz-Chobot P. The role and need for psychological support in the treatment of adolescents and young people suffering from type 1 diabetes. Front Psychol 2023; 13:945042. [PMID: 36687959 PMCID: PMC9845699 DOI: 10.3389/fpsyg.2022.945042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 12/05/2022] [Indexed: 01/06/2023] Open
Abstract
Psychological support might be perceived as one of the most important factors in the treatment of people suffering from type 1 diabetes, particularly among vulnerable groups such as adolescents and young people. Problems arising from extreme pressure put on young patients, high expectations, and specific limitations associated with diabetes often reflect in negative wellbeing and affect patients' behavior, resulting in lower self-esteem, mood swings, depression, or even eating disorders. Therefore, the need for a more holistic approach to the treatment of diabetes and caring about psychological support can be observed, which may contribute to better functioning and management of the disease. Differentiation of certain approach methods such as the positive approach (PA) discussed in the text may help young patients in motivation and coping with their disease as well as accepting limitations caused by type 1 diabetes. This would decrease the risk of potential revolt against medical recommendations, common for patients at the mentioned age, and help raise awareness of the problem. Maintaining life balance through undertaking regular physical activities and being open to new strategies such as telenursing can also result in the improvement of glycemic control. The studies presented have proven the great effectiveness of personalized care adjusted to the patient with psychological support, as well as the invaluable role of education in diabetes, which includes not only standard procedures such as calculating an appropriate insulin dose but also the invention of effective coping mechanisms, which influence patients' performance and wellbeing.
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Affiliation(s)
- Magdalena Małachowska
- Students' Scientific Association at the Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland,Faculty of Medicine, The Medical University of Warsaw, Warsaw, Poland,*Correspondence: Magdalena Małachowska ✉
| | - Zuzanna Gosławska
- Department of Clinical Endocrinology, Independent Public Health Care Central Clinical Hospital of the Medical University, Łódź, Poland
| | - Ewa Rusak
- Department of Children's Diabetology, Medical University of Silesia, Katowice, Poland
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ABDOLLAHI FARIBA, BIKDELI HAMED, ZEABADI SAKINEHMOGHADDAM, SEPASI RANAREZAI, KALHOR ROGHAYE, MOTALEBI SEYEDEHAMENEH. Predicting role of illness perception in treatment self-regulation among patients with type 2 diabetes. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2022; 63:E604-E610. [PMID: 36890999 PMCID: PMC9986977 DOI: 10.15167/2421-4248/jpmh2022.63.4.2727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/12/2022] [Indexed: 03/10/2023]
Abstract
Background and Objective Impaired self-regulation negatively impacts self-efficacy, self-management, blood sugar control, and quality of life among patients with diabetes. Hence, identifying the predictors of self-regulation is a necessity for healthcare providers. The current study aimed to determine the predictive role of illness perception in treatment self-regulation in patients with type 2 diabetes. Methods The current study is a descriptive cross-sectional study. A total of 200 patients with type 2 diabetes, who were referred to the only specialized clinic for endocrinology and diabetes affiliated with Qazvin University of Medical Sciences in 2019-2020, were recruited through a convenience sampling method. For data collection, the brief Illness Perception Questionnaire and the Treatment Self-Regulation Questionnaire were used. Collected data were analyzed by SPSS v21 using a multivariable regression model. Results Mean and standard deviation scores of self-regulation and illness perception were 69.11 ± 17.61 and 36.21 ± 7.05, respectively. Results of the multivariate regression model revealed the significant correlations of self-regulation with illness perception, age, cardiovascular complications, diabetic retinopathy, and diabetic foot ulcers. Conclusions In this study, participants presented a moderate level of self-regulation. The results also revealed that illness perception could be a predictor of improving patients' self-regulation. Therefore, providing infrastructure programs such as continuous education and appropriate care programs for diabetic patients to improve their illness perception can effectively improve their self-regulation behaviors.
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Affiliation(s)
- FARIBA ABDOLLAHI
- Department of Medical Sciences, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - HAMED BIKDELI
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - SAKINEH MOGHADDAM ZEABADI
- Department of Medical Emergencies, School of Paramedical Sciences, Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
| | - RANA REZAI SEPASI
- Department of Medical Sciences, Qazvin Branch, Islamic Azad University, Qazvin, Iran
| | - ROGHAYE KALHOR
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - SEYEDEH AMENEH MOTALEBI
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
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Miller AL, Albright D, Bauer KW, Riley HO, Hilliard ME, Sturza J, Kaciroti N, Lo SL, Clark KM, Lee JM, Fredericks EM. Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic. J Pediatr Psychol 2022; 47:873-882. [PMID: 35609567 PMCID: PMC9213854 DOI: 10.1093/jpepsy/jsac045] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The COVID-19 pandemic increased economic, social, and health stressors for families, yet its impacts on families of youth with chronic conditions, such as type 1 diabetes (T1D), are not well understood. Self-regulation (SR)-or the capacities to control emotions, cognition, and behavior in response to challenge-is known to support T1D management and coping in the face of stress. Strong SR may have protected youth with T1D from the impacts of pandemic-related stressors. This study compared youth and parent emotional functioning and T1D management before and after the pandemic's onset in relation to family pandemic-related stress and youth SR. METHODS Parents of youth with T1D (N = 88) and a subset of these youth (N = 43; Mean age 15.3 years [SD 2.2]) completed surveys regarding SR, stress, emotional functioning, and T1D-related functioning prior to and after March 2020. Outcomes were compared using mixed effects models adjusting for covariates. Family pandemic-related stress experiences and youth SR were tested as moderators of change. RESULTS Parents' responsibility for T1D management increased across pandemic onset and their diabetes-related distress decreased. Family pandemic-related stress was associated with decreased emotional functioning over time. Youth SR, particularly emotional and behavioral aspects, predicted better emotional and T1D-related functioning. DISCUSSION While youth with T1D whose families experienced higher pandemic-related stress had poorer adjustment, strong emotional and behavioral SR appeared to protect against worsening youth mood and adherence across pandemic onset. Both social-contextual and individual factors are important to consider when working with families managing T1D.
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Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Dana Albright
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Katherine W Bauer
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, Michigan, USA
| | - Hurley O Riley
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX, USA
| | - Julie Sturza
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Niko Kaciroti
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Sharon L Lo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Katy M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Joyce M Lee
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
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Ingersgaard MV, Hoeeg D, Willaing I, Grabowski D. An exploratory study of how young people experience and perceive living with type 1 diabetes during late adolescence and emerging adulthood. Chronic Illn 2021; 17:475-492. [PMID: 31739683 DOI: 10.1177/1742395319886487] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Suboptimal glycemic control and psychosocial challenges are significant concerns for adolescents and emerging adults (collectively young people) with type 1 diabetes. Knowledge about young peoples' attitudes towards living with type 1 diabetes is inadequate, but the issue is important in the development of strategies to improve glycemic control and psychosocial well-being. This study explored young peoples' perceptions of living with type 1 diabetes. METHODS An exploratory, qualitative design was employed. Data were collected through five participatory workshops with 19 young people (age 15-25). Data were thematically analyzed. RESULTS The overall depiction of living with type 1 diabetes was paradoxical; it affected everything and nothing. Living with type 1 diabetes was a balancing act between accommodating a "normal" way of living and self-management tasks of the treatment regimen. Participants' perceptions reflected shifting accounts that could be divided into five themes: (1) special rules during youth, (2) striving for autonomy, (3) an uncertain future, (4) social support, and (5) stigma and disclosure. DISCUSSION It is important to probe for the multiple and interrelated social contexts that underlie young peoples' motives for adhering to and deviating from treatment regimens. Future studies should focus on relational aspects, including stigma mechanisms, the role of friends, and facilitation of balanced parental involvement.
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Affiliation(s)
| | | | | | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion, Gentofte, Denmark
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Case H, Williams DD, Majidi S, Ferro D, Clements MA, Patton SR. Longitudinal associations between family conflict, parent engagement, and metabolic control in children with recent-onset type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002461. [PMID: 34645616 PMCID: PMC8515442 DOI: 10.1136/bmjdrc-2021-002461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We prospectively investigated the associations between diabetes-related family conflict, parent engagement in child type 1 diabetes (T1D) care, and child glycated hemoglobin (HbA1c) in 127 families of school-age children who we recruited within the first year of their T1D diagnosis. RESEARCH DESIGN AND METHODS Parents completed the Diabetes Family Conflict Scale-Revised (DFCS-R) to assess for diabetes-related family conflict and the Diabetes Self-Management Questionnaire-Brief (DSMQ-Brief) to assess parent engagement in child T1D care at the initial study visit (T1) and at 12 (T2) and 27 (T3) months later. We also collected child HbA1c at these time points. Our analyses included Pearson correlations and repeated measures linear mixed models controlling for child age, sex, and T1D duration at T1. RESULTS Parents' DFCS-R scores negatively correlated with DSMQ-Brief scores (r=-0.13, p<0.05) and positively correlated with children's HbA1c (r=0.26, p<0.001). In our linear mixed models, parents' DSMQ-Brief scores were unchanged at T2 (β=-0.71, 95% CI -1.59 to 0.16) and higher at T3 (β=8.01, 95% CI 6.89 to 9.13) compared with T1, and there was an association between increasing DFCS-R and decreasing DSMQ-Brief scores (β=-0.14, 95% CI -0.21 to -0.06). Child HbA1c values were significantly higher at T2 (β=0.66, 95% CI 0.38 to 0.94) and T3 (β=0.95, 95% CI 0.63 to 1.27) compared with T1, and there was an association between increasing DFCS-R scores and increasing child HbA1c (β=0.04, 95% CI 0.02 to 0.06). CONCLUSIONS Increasing diabetes-specific family conflict early in T1D may associate with decreasing parent engagement in child T1D care and increasing child HbA1c, suggesting a need to assess and intervene on diabetes-specific family conflict. Trial registration number NCT03698708.
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Affiliation(s)
- Hannah Case
- Mayo Clinic Alix School of Medicine, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - David D Williams
- Division of Health Services and Health Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Shideh Majidi
- Barbara Davis Center for Diabetes and the University of Colorado Anschutz School of Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Diana Ferro
- Division of Health Services and Health Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Mark Allen Clements
- Pediatrics, Endocrinology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
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Turin A, Drobnič Radobuljac M. Psychosocial factors affecting the etiology and management of type 1 diabetes mellitus: A narrative review. World J Diabetes 2021; 12:1518-1529. [PMID: 34630904 PMCID: PMC8472498 DOI: 10.4239/wjd.v12.i9.1518] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 05/26/2021] [Accepted: 07/26/2021] [Indexed: 02/06/2023] Open
Abstract
Type 1 diabetes (T1D) is one of the most common chronic diseases in children and adolescents worldwide. Its etiopathogenesis results from the interplay of genetic and environmental variables. Among the latter, psychological stress has been implicated in disease onset as well as disease management. Various studies, including large population-based studies, have highlighted the role of stressful life events in the etiopathogenesis of T1D. In this article, we also emphasize the importance of attachment in the early child-caregiver relationship, which can be seen as a measure of the quality of the relationship and is crucial for stress and emotional regulation. It serves as a model for all subsequent relationships in one's life. We summarize some of the few studies performed in the field of attachment and T1D etiopathogenesis or management. T1D management demands a lifelong therapeutic regimen to prevent acute and chronic complications. In addition to psychological stress, psychological factors such as family functioning, developmental adjustment, autonomy, mental health problems and other factors have been found to relate to metabolic control. Psychological factors need to be understood not as a single directional causality-based principle but as a dynamic bi- or multidirectional system that is affected by the normal developmental transitions of childhood and adolescence.
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Affiliation(s)
- Anja Turin
- Department for Child Psychiatry, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
| | - Maja Drobnič Radobuljac
- Department of Psychiatry, Faculty of Medicine, University of Ljubljana, Ljubljana 1000, Slovenia
- Unit for Intensive Child and Adolescent Psychiatry, University Psychiatric Clinic Ljubljana, Ljubljana 1000, Slovenia
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11
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Hickling A, Dingle GA, Barrett HL, Cobham VE. Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes. J Pediatr Psychol 2021; 46:1091-1109. [PMID: 34313769 DOI: 10.1093/jpepsy/jsab052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). METHODS A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. RESULTS A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. CONCLUSIONS Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.
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Affiliation(s)
- Anna Hickling
- School of Psychology, The University of Queensland.,Mater Research Institute, The University of Queensland.,Children's Hospital Foundation (Queensland)
| | | | - Helen L Barrett
- Mater Research Institute, The University of Queensland.,Department of Endocrinology, Mater Health Services, Mater Hospital
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland.,Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service
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12
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Tremolada M, Cusinato M, Bonichini S, Fabris A, Gabrielli C, Moretti C. Health-Related Quality of Life, Family Conflicts and Fear of Injecting: Perception Differences between Preadolescents and Adolescents with Type 1 Diabetes and Their Mothers. Behav Sci (Basel) 2021; 11:bs11070098. [PMID: 34356715 PMCID: PMC8301019 DOI: 10.3390/bs11070098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 01/09/2023] Open
Abstract
Good management of diabetes requires at the same time self-regulation behaviour and a balanced involvement of family components. This cross-sectional study’s aims were: understanding fear of injections and perceptions of family conflicts in preadolescents and adolescents with type 1 diabetes mellitus and their mothers, comparing their perceptions, and identifying the risk factors impacting patients’ quality of life. Eligibility criteria were: treatment for diabetes mellitus type I, currently aged 10–18 years, attending the hospital for annual hospital follow-ups. Exclusion criteria were: intellectual disabilities, inability to complete questionnaires alone and neuropsychiatric illness with active pharmacotherapy. The study design was cross-sectional. Participants were one hundred and two patients (Mean age = 14.6, SD = 2.4; age range = 10–19 years; Females = 52 and Males = 50) and their mothers (Mean age = 46.9, SD = 6.2, age range = 27–63 years), who filled in self and proxy-report questionnaires (N total= 204). The results showed that 20% of patients and 14.7% of their mothers reported clinical scores for fear of self-injection and blood testing. The mothers reported lower fear of injecting and higher family conflicts compared with the patients. Age, fear of injecting and family conflicts were significantly associated with patients’ quality of life perceptions. Clinical considerations and recommendations are given based on the empirical results.
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Affiliation(s)
- Marta Tremolada
- Department of Development and Social Psychology, University of Padua, 35131 Padova, Italy;
- Correspondence: ; Tel.: +39-3474-868-835
| | - Maria Cusinato
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
| | - Sabrina Bonichini
- Department of Development and Social Psychology, University of Padua, 35131 Padova, Italy;
| | - Arianna Fabris
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
| | - Claudia Gabrielli
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
| | - Carlo Moretti
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
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13
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Hall R, Keeble L, Sünram-Lea SI, To M. A review of risk factors associated with insulin omission for weight loss in type 1 diabetes. Clin Child Psychol Psychiatry 2021; 26:606-616. [PMID: 34121470 PMCID: PMC8264633 DOI: 10.1177/13591045211026142] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D.
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Affiliation(s)
- Rebecca Hall
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | - Leanna Keeble
- Department of Psychology, 4396Lancaster University, Lancaster, UK
| | | | - Michelle To
- Department of Psychology, 4396Lancaster University, Lancaster, UK
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14
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Bayless AK, Wyatt TH, Raynor H. Self-Regulation in Pediatric Nursing Literature: An Evolutionary Concept Exploration. Res Theory Nurs Pract 2021; 35:RTNP-D-20-00084. [PMID: 34162760 DOI: 10.1891/rtnp-d-20-00084] [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] [Indexed: 11/25/2022]
Abstract
The concept of self-regulation appears frequently in nursing literature. Although the concept is well developed in nonnursing theories, its application in nursing has not been explored adequately. Most nursing authors address self-regulation in one of two ways. Some publish findings without a strong theoretical understanding of self-regulation. Others publish studies using a conglomeration of theorists' self-regulatory explanations without properly contextualizing the theoretical elements for nursing practice. For this concept exploration, the authors used Rodgers, B. L. (2005). Developing nursing knowledge: Philosophical traditions and influences Lippincott, Williams & Wilkins, evolutionary concept analysis method to determine the current use of self-regulation in pediatric nursing literature and trace the concept's recent development, changes, and expansion. This work provides a representation of self-regulation based on existing healthcare studies and suggests steps for concept clarification that could promote accurate use of the concept in future research.
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Affiliation(s)
| | - Tami H Wyatt
- College of Nursing, University of Tennessee, Knoxville, TN
| | - Hollie Raynor
- College of Education, Health, and Human Sciences, University of Tennessee, Knoxville, TN
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15
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Brodar KE, Davis EM, Lynn C, Starr-Glass L, Lui JHL, Sanchez J, Delamater AM. Comprehensive psychosocial screening in a pediatric diabetes clinic. Pediatr Diabetes 2021; 22:656-666. [PMID: 33604976 DOI: 10.1111/pedi.13193] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center. RESEARCH DESIGN AND METHODS Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c). RESULTS Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eighty-three percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented. CONCLUSIONS Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.
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Affiliation(s)
- Kaitlyn E Brodar
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Eileen M Davis
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Courtney Lynn
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lolly Starr-Glass
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joyce H L Lui
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Janine Sanchez
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alan M Delamater
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
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16
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Luo D, Gu W, Bao Y, Cai X, Lu Y, Li R, Wang Y, Li M. Resilience outstrips the negative effect of caregiver burden on quality of life among parents of children with type 1 diabetes: An Application of Johnson-Neyman Analysis. J Clin Nurs 2021; 30:1884-1892. [PMID: 33656212 DOI: 10.1111/jocn.15739] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 11/26/2020] [Accepted: 02/19/2021] [Indexed: 11/27/2022]
Abstract
AIMS AND OBJECTIVES To determine whether resilience buffers the deleterious consequences of caregiver burden on quality of life among parents of children with type 1 diabetes. BACKGROUND The burden of caring for a child with type 1 diabetes can be a form of stress and damage parents' quality of life. Resilience is a crucial psychological variable that contributes to individual health in the context of extraordinary challenges. However, no studies in paediatric diabetes have focused on the effects of parent resilience on caregiving burden and quality of life. DESIGN This was a descriptive cross-sectional study with a convenience sample following the STROBE guidelines. METHODS A total of 227 parents were invited to participate during the children's routine outpatient visit. Parents completed measures of resilience, caregiver burden and quality of life. The disease characteristics of children were extracted from the electronic medical records. We performed hierarchical multiple regression and Johnson-Neyman statistical analysis to probe the moderating effect of resilience. RESULTS The parents reported poorer mental and physical health as compared with the general population. Caregiver burden was significantly negatively associated with parents' quality of life, while resilience demonstrated a positive correlation with life quality. Resilience served as a moderator between caregiver burden and mental health. When parents experienced a high caregiver burden, the benefit of high resilience for better mental health was apparent. CONCLUSIONS The present study underscores the protective role of resilience in reducing caregiving burden and improving parents' quality of life. RELEVANCE TO CLINICAL PRACTICE Regular psychosocial assessment for parents of children with type 1 diabetes should be incorporated into clinical nursing practice. This study confirms that resilience is a promising intervention target for parents with heavy caregiver burden and unsatisfactory life quality.
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Affiliation(s)
- Dan Luo
- School of nursing, Peking University, Beijing, China
| | - Wei Gu
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Ying Bao
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Cai
- School of nursing, Peking University, Beijing, China
| | - Yanhui Lu
- School of nursing, Peking University, Beijing, China
| | - Ruxue Li
- School of nursing, Peking University, Beijing, China
| | - Yubing Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Mingzi Li
- School of nursing, Peking University, Beijing, China
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17
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“Sometimes You Just Need People around You Who Understand You”: A Qualitative Study of Everyday Life at a Residential Care Unit for Young People with Diabetes. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10020078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Solglimt is the only long-term residential care facility in Denmark for young people with diabetes who, for various reasons, are particularly exposed or vulnerable. This target group is characterized by poorly regulated diabetes and psychosocial challenges. As this unique setting and specific target group has not been studied before, we designed a qualitative sociological study of the experiences and perceptions of everyday life from the perspectives of current and former residents as well as from those of the residential care social workers (RCSWs). We also studied the specific care practices at Solglimt. The dataset consists of nine days of participatory observations, 29 semi-structured individual interviews with three target groups (9 current residents, 8 former residents and 12 RCSWs) and three participatory workshops. All data were analyzed using radical hermeneutics. The analysis produced four main themes: (1) In it together, like a family—feeling different among peers, (2) Social workers as substitutes for parents and healthcare professionals, (3) Individualization—Increased self-confidence and autonomy, and (4) Tacit knowledge and illness behavior automation. The findings show that the residential care facility is a family-like setting with a strong focus on individualization, which enables new illness behaviors and perceptions. The results offer important steps towards developing improved diabetes care strategies through individualized informal knowledge sharing. Furthermore, the results are applicable to general clinical diabetes care for vulnerable or low-resource children and young people with diabetes.
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18
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Pals RAS, Coyne I, Skinner T, Grabowski D. A delicate balance between control and flexibility: Experiences of care and support among pre-teenage children with type 1 diabetes and their families. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:369-391. [PMID: 33338277 DOI: 10.1111/1467-9566.13223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/20/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
For children with type 1 diabetes, the period of adolescence is associated with higher blood glucose levels and increased psychological distress compared to other age groups. Focusing on pre-teens (9-12 years) with type 1 diabetes and their families has been suggested as key to understanding and reducing these challenges. The aim of this study was to explore: 1, how diabetes affects family life, 2, experiences of and needs for support and 3, how care responsibilities are negotiated among pre-teens with type 1 diabetes and their families. Data were obtained from four interactive workshops with pre-teens (n = 17), their parents (n = 26) and their siblings (n = 14). Dialogue tools, for example quotes and picture cards, were used to facilitate discussion and reflection concerning family life with type 1 diabetes. Data analysis resulted in three themes: 1, diabetes takes up 'a lot of space', 2, giving and receiving support and 3, balancing control and flexibility. While diabetes took up significant space in the families, family members protected each other from their respective frustrations. The findings point to the significance of considering all key family members and their interactions in diabetes interventions. This includes balancing control and flexibility, negotiating responsibilities and building trust.
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Affiliation(s)
- Regitze Anne Saurbrey Pals
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Rural Health, La Trobe University, Bendigo, Victoria, Australia
- Department of Rural Health, The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
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19
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Sarteau AC, Crandell J, Seid M, Kichler JC, Maahs DM, Wang J, Mayer-Davis E. Characterization of youth goal setting in the self-management of type 1 diabetes and associations with HbA1c: The Flexible Lifestyle Empowering Change trial. Pediatr Diabetes 2020; 21:1343-1352. [PMID: 32741045 PMCID: PMC7855488 DOI: 10.1111/pedi.13099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/05/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Youth with type 1 diabetes (T1D) commonly do not meet HbA1c targets. Youth-directed goal setting as a strategy to improve HbA1c has not been well characterized and associations between specific goal focus areas and glycemic control remain unexplored. OBJECTIVE To inform future trials, this analysis characterized intended focus areas of youth self-directed goals and examined associations with change in HbA1c over a 18 months. METHODS We inductively coded counseling session data from youth in the Flexible Lifestyle Empowering Change Intervention (n = 122, 13-16 years, T1D duration >1 year, HbA1c 8-13%) to categorize intended goal focus areas and examine associations between frequency of goal focus areas selected by youth and change in HbA1c between first and last study visit. RESULTS We identified 13 focus areas that categorized youth goal intentions. Each session where youth goal setting concurrently incorporated blood glucose monitoring (BGM), continuous glucose monitoring (CGM), and insulin dosing was associated with a 0.4% (95% CI: -0.77, -0.01; P = .03) lower HbA1c at the end of intervention participation. No association was observed between HbA1c and frequency of sessions where goal intentions focused on BG only (without addressing insulin or CGM) (β: 0.07; 95% CI: -0.07, 0.21; P = .33) nor insulin dosing only (without addressing BGM or CGM) (β: 0.00; 95% CI: -0.11, 0.10; P = .95). CONCLUSIONS Findings exemplify how guiding youth goal development and combining multiple behaviors proximally related to glycemic control into goal setting may benefit HbA1c among youth with T1D. More research characterizing optimal goal setting practices in youth with T1D is needed.
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Affiliation(s)
| | - Jamie Crandell
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Seid
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - Jessica C Kichler
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California,Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, California
| | - Jessica Wang
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina,School of Medicine, University of North Carolina, Chapel Hill, North Carolina
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20
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Silva K, Miller VA. Does Self-Efficacy Mediate the Link Between Impulse Control and Diabetes Adherence? J Pediatr Psychol 2020; 45:445-453. [PMID: 32106299 DOI: 10.1093/jpepsy/jsaa007] [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: 09/13/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The goal of this study was to test the hypothesis that diabetes self-efficacy mediates the relationship between impulse control and type 1 diabetes (T1D) management from ages 8 to 18 years, using multilevel modeling. METHODS Participants included 117 youth with T1D and their parents. Youth (aged 8-16 years at baseline) and parents were assessed 5 times over 2 years. Using a cohort sequential design, we first estimated the growth trajectory of adherence from age 8 to 18 years, then specified a multilevel mediation model using impulse control as the main predictor, diabetes self-efficacy as the mediator, and changes in adherence (both within- and between-individuals) as the outcome. RESULTS According to youth-reported adherence only, self-efficacy partially mediated the within-person effect of impulse control on adherence. On occasions when youth reported increases in impulse control, they tended to report higher adherence, and this was, in part, due to increases in youths' perceived self-efficacy. Self-efficacy accounted for approximately 21% of the within-person relationship between impulse control and youth-reported adherence. There was no association between impulse control and adherence between-individuals. Impulse control and self-efficacy were not related to parent-reported adherence. CONCLUSION Environments that enrich youth with confidence in their own diabetes-related abilities may benefit self-care behaviors in youth with T1D, but such increases in youths' perceived competence do not fully account for, or override, the behavioral benefits of impulse control. Efforts to improve adherence in youth with T1D will benefit from consideration of both impulse control and self-efficacy.
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Affiliation(s)
- Karol Silva
- Department of Pediatrics, Children's Hospital of Philadelphia
| | - Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia.,Perelman School of Medicine, University of Pennsylvania
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21
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Luo D, Xu JJ, Cai X, Zhu M, Wang H, Yan D, Li MZ. The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes. J Clin Nurs 2019; 28:4478-4487. [PMID: 31410916 DOI: 10.1111/jocn.15033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.
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Affiliation(s)
- Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Jing-Jing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Yan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Zi Li
- School of Nursing, Peking University, Beijing, China
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