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Othman N, Wong YY, Lean QY, Mohd Noor N, Neoh CF. Factors affecting self-management among adolescents and youths with type 2 diabetes mellitus: A meta-synthesis. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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2
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Linder C, Neideman M, Gambell‐Barroso M, Gustafsson LL, Wide K, Pohanka A, Bastholm‐Rahmner P. Parents' perspectives on dried blood spot self-sampling from children with epilepsy: A mixed-method study. Acta Paediatr 2020; 109:2789-2798. [PMID: 32198892 DOI: 10.1111/apa.15264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/02/2020] [Accepted: 03/17/2020] [Indexed: 01/21/2023]
Abstract
AIM Children with epilepsy often have concomitant diagnoses. Dried blood spot samples for drug monitoring can be collected by parents at home as an alternative to traditional sampling. This mixed-method study aimed to understand the parents' perspectives on blood self-sampling from their children and to identify factors contributing to successful sampling. METHOD Parents who had collected a sample from their child during a visit to the neuropediatric clinic were asked to fill in a questionnaire. To get in-depth information and individual perspectives, parents and nurses participated in semi-structured interviews and analysed with thematic analysis. RESULTS The results from questionnaires (n = 64) and interviews (n = 9) were interpreted together. Watching an instruction video and practical training contributed to successful sampling. 97% of the parents managed to collect a sample, 72% thought it was easy to perform, and 80% found self-sampling at home desirable. Factors for success were as follows: high motivation, prepared parents with pre-understanding, a pragmatic attitude, flexible education, effective communication and willingness to take on the role as a performer. Risk factors were as follows: conflict, fear, unprepared parents, confused or worried children. CONCLUSION Voluntary self-sampling at home for parents of children with epilepsy is feasible and can reduce stress factors in everyday life.
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Affiliation(s)
- Camilla Linder
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Clinical Pharmacology Karolinska University Hospital Stockholm Sweden
| | - Mirja Neideman
- Department of Paediatrics Sachsska Children's Hospital Stockholm Sweden
| | | | - Lars L. Gustafsson
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
| | - Katarina Wide
- Department of Clinical Science, Technology and Intervention (CLINTEC) Division of Paediatrics Karolinska Institutet Stockholm Sweden
- Department of Paediatrics Karolinska University Hospital Stockholm Sweden
| | - Anton Pohanka
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
- Department of Clinical Pharmacology Karolinska University Hospital Stockholm Sweden
| | - Pia Bastholm‐Rahmner
- Department of Laboratory Medicine Division of Clinical Pharmacology Karolinska Institutet Stockholm Sweden
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3
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Initial experiences of adolescents and young adults with type 1 diabetes and high-risk glycemic control after starting flash glucose monitoring - a qualitative study. J Diabetes Metab Disord 2019; 19:37-46. [PMID: 32550154 DOI: 10.1007/s40200-019-00472-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 11/20/2019] [Indexed: 12/18/2022]
Abstract
Purpose This study explored early experiences with a flash glucose monitoring system among adolescents and young adults with type 1 diabetes and high-risk glycemic control. Methods Adolescents and young adults with high-risk glycemic control (HbA1c ≥ 75 mmol/mol (9.0%) in the previous 6 months) who had recently commenced on flash glucose monitoring as part of a trial took part in a semi-structured interview exploring their experiences with the technology. All interviews were recorded, transcribed and analyzed using an inductive approach. Results Fifteen interviews were conducted. Overall, participants enjoyed flash glucose monitoring and planned to continue using their system. Key findings included flash glucose monitoring reduced diabetes management burden and increased glucose monitoring. Other impacts of flash glucose monitoring use included perceived improved mood and energy, increased capacity for physical activity and less parental conflict. While participants reported healthier glycemic control, participants' mean interstitial glucose level remained above the target range of 3.9-10.0 mmol/L (70-180 mg/dL) over the first month of flash glucose monitoring. Common challenges included premature sensor loss and decreased scanning over the first month of use. Conclusions Flash glucose monitoring may be an acceptable self-management tool to increase monitoring frequency in adolescents and young adults with type 1 diabetes and high-risk glycemic control, with the potential to improve long-term glycemic control. Initial support efforts should focus on practical strategies to prolong sensor wear and motivate frequent scanning as well as education on interpreting glucose data and making informed treatment decisions to maximize the benefits of this technology.
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Boucher SE, Gray AR, de Bock M, Wiltshire EJ, Galland BC, Tomlinson PA, Rayns J, MacKenzie KE, Wheeler BJ. Effect of 6 months' flash glucose monitoring in adolescents and young adults with type 1 diabetes and suboptimal glycaemic control: managing diabetes in a 'flash' randomised controlled trial protocol. BMC Endocr Disord 2019; 19:50. [PMID: 31109342 PMCID: PMC6528266 DOI: 10.1186/s12902-019-0378-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 05/09/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Teenagers and young adults with type 1 diabetes (T1D) experience significant burden managing this serious chronic condition and glycaemic control is at its unhealthiest during this life stage. Flash glucose monitoring (FGM) is a new technology that reduces the burden of glucose monitoring by easily and discreetly displaying glucose information when an interstitial glucose sensor worn on the upper arm is scanned with a handheld reader, as opposed to traditional capillary glucose sampling by finger prick (otherwise known as self-monitored blood glucose, SMBG). The effectiveness of this technology and impacts of its long-term use in youth with pre-existing suboptimal glycaemic control are unknown. This study therefore aims to investigate the effectiveness of FGM in addition to standard care in young people with T1D. METHODS This is a two phase study programme including a multi-centre randomised, parallel-group study consisting of a 6-month comparison between SMBG and FGM, with an additional 6-month continuation phase. We will enrol adolescents with T1D aged 13-20 years (inclusive), with suboptimal glycaemic control (mean glycated haemoglobin (HbA1c) in past 6 months ≥75 mmol/mol [≥9%]). Participants will be randomly allocated (1:1) to FGM (FreeStyle Libre; intervention group) or to continue SMBG with capillary blood glucose testing (usual care group). All participants will continue other aspects of standard care with the study only providing the FreeStyle Libre. At 6 months, the control group will cross over to the intervention. The primary outcome is the between group difference in changes in HbA1c at 6 months. Additional outcomes include a range of psychosocial and health economic measures as well as FGM acceptability. DISCUSSION >If improvements are found, this will further encourage steps towards integrating FGM into regular diabetes care for youth with unhealthy glycaemic control, with the expectation it will reduce daily diabetes management burden and improve short- and long-term health outcomes in this high-risk group. TRIAL REGISTRATION This trial was registered with the Australian New Zealand Clinical Trials Registry on 5 March 2018 ( ACTRN12618000320257p ) and the World Health Organization International Clinical Trials Registry Platform (Universal Trial Number U1111-1205-5784).
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Affiliation(s)
- Sara E. Boucher
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R. Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Martin de Bock
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Esko J. Wiltshire
- Department of Paediatrics and Child Health, University of Otago Wellington, Wellington, New Zealand
- Paediatric Department, Capital and Coast District Health Board, Wellington, New Zealand
| | - Barbara C. Galland
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul A. Tomlinson
- Paediatric Department, Southern District Health Board, Invercargill, New Zealand
| | - Jenny Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E. MacKenzie
- Department of Paediatrics, University of Otago, Christchurch, New Zealand
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Benjamin J. Wheeler
- Department of Women’s and Children’s Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Paediatric Department, Southern District Health Board, Dunedin, New Zealand
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Hannon TS, Moore CM, Cheng ER, Lynch DO, Yazel-Smith LG, Claxton GE, Carroll AE, Wiehe SE. Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test. J Particip Med 2018; 10:e8. [PMID: 33052121 PMCID: PMC7434065 DOI: 10.2196/jopm.9652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/14/2018] [Accepted: 04/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents’ thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution’s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus.
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Affiliation(s)
- Tamara S Hannon
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney M Moore
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Erika R Cheng
- Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dustin O Lynch
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Lisa G Yazel-Smith
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gina Em Claxton
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Aaron E Carroll
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sarah E Wiehe
- Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
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Thabrew H, Stasiak K, Garcia-Hoyos V, Merry SN. Game for health: How eHealth approaches might address the psychological needs of children and young people with long-term physical conditions. J Paediatr Child Health 2016; 52:1012-1018. [PMID: 27529150 DOI: 10.1111/jpc.13271] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 03/08/2016] [Accepted: 04/04/2016] [Indexed: 12/28/2022]
Abstract
AIM The aim of this study was to describe the psychological experiences of children and young people with long term physical conditions, their families and clinicians and to explore if these may be improved using eHealth interventions, including online information, support and e-therapy. METHODS Totally 11 children (7-12 years), 11 young people (13-18 years), 7 parents, 11 paediatricians and 10 general practitioners participated in a series of seven semi-structured digitally recorded focus groups. A general inductive approach was used to analyse interview data. RESULTS Feedback consisted of five main themes: (i) the experience of long-term physical conditions as an anxiety-provoking journey, (ii) limited access to information and eHealth-related interventions to support this journey, (iii) desires for interventions that assist with multiple aspects of the illness experience, (iv) diversity of preferences regarding the format and vehicle of such interventions, (v) the importance of trust regarding the source of interventions for children, young people and families and the sustainability of new interventions for clinicians. CONCLUSIONS eHealth interventions are currently being used in a limited manner by children and young people with long-term physical conditions and their families. Despite some concern expressed mainly by clinicians, there is overall support from all groups for the future development of eHealth interventions to address psychological issues for this audience, particularly anxiety. Relatable content, technological appeal and ease of access/referral to such interventions are likely to improve the uptake of these relatively new interventions.
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Affiliation(s)
- Hiran Thabrew
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Karolina Stasiak
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Vanessa Garcia-Hoyos
- Department of Health Psychology, Counties Manukau District Health Board, Auckland, New Zealand
| | - Sally N Merry
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Child and Adolescent Psychiatry, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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Commissariat PV, Kenowitz JR, Trast J, Heptulla RA, Gonzalez JS. Developing a Personal and Social Identity With Type 1 Diabetes During Adolescence: A Hypothesis Generative Study. QUALITATIVE HEALTH RESEARCH 2016; 26:672-84. [PMID: 26893304 PMCID: PMC9639364 DOI: 10.1177/1049732316628835] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
This study explored the incorporation of type 1 diabetes mellitus (T1DM) into self-identity among adolescents. Guided interviews explored 40 adolescents' views of T1DM in relation to their sense of self and relationships with others. Responses were analyzed using thematic analysis. Results revealed that the entire sample described T1DM as a significant burden; many described how T1DM made them feel less "normal." Adolescents described both positive and negative aspects of self-management in social relationships, though most reported benefits in sharing T1DM with friends. Females were more likely to share information about T1DM and to describe positive changes in self-perception as a result of T1DM. The psychosocial processes related to integration of T1DM into self-identity described in these qualitative data provide hypothesis-generating findings that can guide future quantitative research examining incorporation of T1DM into adolescent self-identity in relation to measures of self-esteem, peer orientation, self-management, and glycemic control.
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Affiliation(s)
| | | | | | - Rubina A Heptulla
- Yeshiva University, Bronx, New York, USA Montefiore Medical Center, Bronx, New York, USA
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Monaghan M, Clary L, Mehta P, Stern A, Sharkey C, Cogen FR, Vaidyanathan P, Streisand R. Checking In: A Pilot of a Physician-Delivered Intervention to Increase Parent-Adolescent Communication About Blood Glucose Monitoring. Clin Pediatr (Phila) 2015; 54:1346-53. [PMID: 25896723 PMCID: PMC4615374 DOI: 10.1177/0009922815581833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Low-cost, translatable interventions to promote adherence in adolescents with type 1 diabetes are needed. This study evaluated a brief physician-delivered intervention designed to increase parent-adolescent communication about blood glucose monitoring. Thirty adolescent-parent dyads completed baseline questionnaires and received the physician-delivered intervention. Participants completed follow-up questionnaires at 12 weeks; HbA1c and glucometer data were abstracted from medical charts. Parent-reported conflict surrounding diabetes management decreased from pre- to postintervention. Participants who reported adhering to the intervention plan (n = 15) demonstrated an increase in blood glucose monitoring frequency and trends in improved HbA1c and parental diabetes collaboration from pre- to postintervention. Participants and physicians reported overall satisfaction with the program. Results demonstrate initial feasibility as well as a trend toward improvement in diabetes-specific health indicators for parent-adolescent dyads who adhered to program components. Frequent joint review of glucometer data can be a useful strategy to improve type 1 diabetes-related health outcomes and parent-adolescent communication.
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Affiliation(s)
- Maureen Monaghan
- Children's National Health System, Washington, DC, USA George Washington University School of Medicine, Washington, DC, USA
| | - Lauren Clary
- Department of Endocrinology and Metabolism, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010,Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, 2300 Eye St NW, Washington, DC, 20037
| | - Priya Mehta
- Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St NW, Washington, DC, 20037
| | - Alexa Stern
- Center for Translational Science, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010
| | - Christina Sharkey
- Center for Translational Science, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010
| | - Fran R. Cogen
- Department of Endocrinology and Metabolism, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St NW, Washington, DC, 20037
| | - Priya Vaidyanathan
- Department of Endocrinology and Metabolism, Children’s National Health System, 111 Michigan Ave NW, Washington, DC, 20010,Department of Pediatrics, George Washington University School of Medicine, 2300 Eye St NW, Washington, DC, 20037
| | - Randi Streisand
- Center for Translational Science, Children’s National Health System, 111 Michigan Ave NW, Washington, DC 20010,Department of Psychiatry and Behavioral Sciences, George Washington University School of Medicine, 2300 Eye St NW, Washington, DC, 20037
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9
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Carroll AE, DiMeglio LA, Stein S, Marrero DG. Contracting and monitoring relationships for adolescents with type 1 diabetes: a pilot study. Diabetes Technol Ther 2011; 13:543-9. [PMID: 21406011 PMCID: PMC3132067 DOI: 10.1089/dia.2010.0181] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Adolescents are developmentally in a period of transition-from children cared for by their parents to young adults capable of self-care, independent judgment, and self-directed problem solving. We wished to develop a behavioral contract for adolescent diabetes management that addresses some negotiable points of conflict within the parent-child relationship regarding self-monitoring and then assess its effectiveness in a pilot study as part of a novel cell phone-based glucose monitoring system. METHODS In the first phase of this study we used semistructured interview techniques to determine the major sources of diabetes-related conflict in the adolescent-parent relationship, to identify factors that could facilitate or inhibit control, and to determine reasonable goals and expectations. These data were then used to inform development of a behavioral contract that addressed the negotiable sources of conflict between parents and their adolescent. The second phase of this research was a 3-month pilot study to measure how a novel cell phone glucose monitoring system would support the contract and have an effect on glucose management, family conflict, and quality of life. RESULTS Interviews were conducted with 10 adolescent-caregiver pairs. The major theme of contention was nagging about diabetes management. Two additional themes emerged as points of negotiation for the behavioral contract: glucose testing and contact with the diabetes clinical team. Ten adolescent-parent pairs participated in the pilot test of the system and contract. There was a significant improvement in the Diabetes Self-Management Profile from 55.2 to 61.1 (P < 0.01). A significant reduction in hemoglobin A1c also occurred, from 8.1% at the start of the trial to 7.6% at 3 months (P < 0.04). CONCLUSIONS This study confirms previous findings that mobile technologies do offer significant potential in improving the care of adolescents with type 1 diabetes. Moreover, behavioral contracts may be an important adjunct to reduce nagging and improve outcomes with behavioral changes.
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Affiliation(s)
- Aaron E Carroll
- Children's Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana 46202, USA.
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10
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Carroll AE, DiMeglio LA, Stein S, Marrero DG. Using a cell phone-based glucose monitoring system for adolescent diabetes management. DIABETES EDUCATOR 2010; 37:59-66. [PMID: 21106908 DOI: 10.1177/0145721710387163] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Mobile technology may be useful in addressing several issues in adolescent diabetes management. PURPOSE To assess the feasibility and acceptability of a cell phone glucose monitoring system for adolescents with type 1 diabetes and their parents. METHODS The authors recruited patients with type 1 diabetes who had been diagnosed for at least 1 year. Each adolescent used the system for 6 months, filling out surveys every 3 months to measure their usability and satisfaction with the cell phone glucose monitoring system, as well as how use of the system might affect quality of family functioning and diabetes management. RESULTS Adolescents reported positive feelings about the technology and the service, even though a concerning number of them had significant technical issues that affected continued use of the device. Nearly all thought that the clinic involvement in monitoring testing behavior was quite acceptable. The use of the Glucophone™ did not, however, significantly change the quality of life of the adolescents, their level of conflict with their parents, their reported self-management of diabetes, or their average glycemic control within the short time frame of the study. CONCLUSIONS As a feasibility study of the technology, this work was successful in demonstrating that cell phone glucose monitoring technology can be used in an adolescent population to track and assist in self-monitoring behavior. The authors speculate that explicitly attempting to change behavior, perhaps with the use of behavioral contracts, would enhance the technology's ability to improve outcomes.
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Affiliation(s)
- Aaron E Carroll
- The Children’s Health Services Research, Indiana University School of Medicine, Indianapolis, Indiana (Carroll),The Regenstrief Institute for Health Care, Indianapolis, Indiana (Carroll, Marrero)
| | - Linda A DiMeglio
- The Section of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis, Indiana (DiMeglio, Stein)
| | - Stephanie Stein
- The Section of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis, Indiana (DiMeglio, Stein)
| | - David G Marrero
- The Regenstrief Institute for Health Care, Indianapolis, Indiana (Carroll, Marrero),The Diabetes Prevention and Control Center, Indiana University School of Medicine, Indianapolis, Indiana (Marreno)
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McIntosh B, Gauthier B, Lal A, Singh SR, Virani A. Perspectives and Experiences of Health Care Professionals and Patients with Diabetes regarding Self-Monitoring of Blood Glucose in Canada. Can Pharm J (Ott) 2010. [DOI: 10.3821/1913-701x-143.5.218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Objective: To explore the current perspectives and experiences of Canadian health care professionals and patients with diabetes regarding self-monitoring of blood glucose (SMBG). Design: Qualitative analysis of focus groups in Ottawa, Vancouver and Edmonton. Methods: Seventeen focus groups involving 59 health care professionals (19 pharmacists, 18 certified diabetes educators and 22 physicians) and 40 patients with type 1 or type 2 diabetes were held, using separate moderator's guides. Thematic analysis was used to analyze responses. Results: Health care professionals reported recommending SMBG to most patients with diabetes, regardless of insulin use. They also reported periodically reviewing glucometer results, providing education on interpreting the results and proper use of SMBG devices. The majority of patients with diabetes indicated that they regularly monitored their blood glucose levels and recorded their results. Advantages of SMBG cited by health care professionals included a sense of control over diabetes, the ability to make lifestyle and treatment choices and increased patient confidence. Patients listed expense, discomfort and inconvenience as disadvantages to SMBG. Although patients discussed SMBG readings with their health care professionals, many reported that treating physicians were often uninterested in SMBG results. Physicians tended to refer to SMBG in the context of disease-specific benefits, while certified diabetes educators more often cited the psychological and educational benefits of SMBG. Compared with physicians, pharmacists focused more on the lifestyle and educational benefits of SMBG rather than on changes to medications. Conclusion: SMBG is commonly recommended by health care professionals and regularly performed by most patients with diabetes. Pharmacists and other health care professionals play an important role in educating patients on the appropriate use of SMBG and interpretation of results. To ensure optimal use, pharmacists and other health care providers should review the desired outcomes of SMBG with patients on a regular basis.
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Affiliation(s)
- Brendan McIntosh
- Canadian Agency for Drugs and Technologies in Health, Ottawa (McIntosh, Lal, Singh); Vision Research Inc., Ottawa (Gauthier); COMPUS Expert Review Committee, Ottawa, Ontario (Virani); Pharmacy Services, Fraser Health Authority, Vancouver (Virani); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia (Virani). Contact
| | - Bernard Gauthier
- Canadian Agency for Drugs and Technologies in Health, Ottawa (McIntosh, Lal, Singh); Vision Research Inc., Ottawa (Gauthier); COMPUS Expert Review Committee, Ottawa, Ontario (Virani); Pharmacy Services, Fraser Health Authority, Vancouver (Virani); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia (Virani). Contact
| | - Avtar Lal
- Canadian Agency for Drugs and Technologies in Health, Ottawa (McIntosh, Lal, Singh); Vision Research Inc., Ottawa (Gauthier); COMPUS Expert Review Committee, Ottawa, Ontario (Virani); Pharmacy Services, Fraser Health Authority, Vancouver (Virani); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia (Virani). Contact
| | - Sumeet R. Singh
- Canadian Agency for Drugs and Technologies in Health, Ottawa (McIntosh, Lal, Singh); Vision Research Inc., Ottawa (Gauthier); COMPUS Expert Review Committee, Ottawa, Ontario (Virani); Pharmacy Services, Fraser Health Authority, Vancouver (Virani); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia (Virani). Contact
| | - Adil Virani
- Canadian Agency for Drugs and Technologies in Health, Ottawa (McIntosh, Lal, Singh); Vision Research Inc., Ottawa (Gauthier); COMPUS Expert Review Committee, Ottawa, Ontario (Virani); Pharmacy Services, Fraser Health Authority, Vancouver (Virani); Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia (Virani). Contact
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12
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Spencer J, Cooper H, Milton B. Qualitative studies of type 1 diabetes in adolescence: a systematic literature review. Pediatr Diabetes 2010; 11:364-75. [PMID: 19895566 DOI: 10.1111/j.1399-5448.2009.00603.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joy Spencer
- University of Chester, Faculty of Health and Social Care, Chester, UK.
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13
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Abstract
BACKGROUND Type I diabetes is a common chronic disease of childhood. Both the growing influence of peers and the shifting away from parental influence have been implicated as prime elements contributing to poor glycemic outcomes in adolescents. Mobile technology that can be directed towards providing self-management support and modifying potentially negative child parent interaction holds promise to improve control in adolescents with diabetes. METHODS HealthPia, Inc. (Palisades Park, NJ) has developed a prototype system, the HealthPia GlucoPack Diabetes Monitoring System, which integrates a small blood glucose monitoring device into the battery pack of a cell phone. A pilot study used mixed quantitative and qualitative methods to evaluate user satisfaction with the integrated system, including the potential of the device to transmit self-monitoring data to a website for review and analysis by clinicians, parents, and patients. RESULTS Adolescents in our study liked the integration of the two technologies and agreed that the glucometer was easy to use and that the tool was useful in the management of their diabetes. CONCLUSIONS Future work will focus on the utilization of the diabetes phone as a component of a care delivery system for adolescents with diabetes, including involvement of the health care team and enhancement of the web services that support the use of the phone.
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Affiliation(s)
- Aaron E Carroll
- Children's Health Services Research, Indiana UNiversity School of Medicine, Indianapolis, Indiana 46202, USA.
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