An internet coping skills training program for youth with type 1 diabetes: six-month outcomes

Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial

BACKGROUND

Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes.

OBJECTIVE

Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths' glycemic control.

METHODS

We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period.

RESULTS

In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94%; P=.01) and 18-month follow-up (1.42%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up.

CONCLUSIONS

A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867.

Systematic review of technology-mediated peer support interventions in paediatric type 1 diabetes care

AIMS

There is increasing interest in the role of peer support in diabetes care. However, technology-mediated peer support in paediatric type 1 diabetes remains understudied.We aimed todescribe technology-mediated peer support interventions for children living with type 1 diabetes, their caregivers and healthcare providers.

METHODS

CINAHL, Embase and MEDLINE (Ovid) were searched from Jan 2007 to June 2022. We included randomised and non-randomised trials with peer support interventions for children living with diabetes, their caregivers and/or healthcare providers. Studies examining clinical, behavioural or psychosocial outcomes were included. Quality was assessed with the Cochrane risk of bias tool.

RESULTS

Twelve of 308 retrieved studies were included, with a study duration range of 3 weeks to 24 months and most were randomised trials (n = 8, 66.67%). Four technology-based interventions were identified: phone-based text messages, video, web portal and social media, or a hybrid peer support model. Most (58.6%, n = 7) studies exclusively targeted children with diabetes. No significant improvement was observed in psychosocial outcomes (quality of life, n = 4; stress and coping, n = 4; social support, n = 2). Mixed findings were observed in HbA1c (n = 7) and 28.5% studies (n = 2/7) reported reduced incidence of hypoglycaemia.

CONCLUSIONS

Technology-mediated peer support interventions may have the potential to improve diabetes care and outcomes. However, further well-designed studies are necessary that address the needs of diverse populations and settings, and the sustainability of intervention effects.

Designing a brief and simple intervention to help young people with type 1 diabetes to live well: Protocol for developing a novel intervention with participation from young people

Young people living with type 1 diabetes (T1D) navigate daily complex diabetes related tasks as they take on increasing (and eventually full) responsibility for managing their condition, in addition to developing their lives as independent adults. Alongside the need for careful day-to-day diabetes management, the psychosocial burden and mental health impact and stigma are well recognised. Despite advances in psychological care, many young people with diabetes still experience a greater mental health burden than those without diabetes. This study aims to develop a brief and simple intervention for young people with T1D that will support their wellbeing day to day, as required, and grow their ability to live confidently with their condition that requires lifelong meticulous management. Insights gained in this participatory study will guide the development and focus of the intervention which may involve a toolkit containing self-guided resources or which could be a series of recommendations on how to design a healthcare service with a support network that is tailored to the needs of young people. This study will consist of qualitative research and collaboration with young people with T1D and their siblings, friends, and peers to co-create a testable intervention. In Part 1, research interviews will be conducted with young people (16-24 years old) with T1D and, where possible, their siblings/peers to understand the day-to-day challenges of type 1 and what a novel intervention should address. Thematic analysis of interviews will inform the generation of a prototype intervention to take into part two, focus group discussions. Focus groups with (i) young people with T1D and, separately (ii) carers (comprising parents, carers, teachers, specialist nurses). Collaborative principles will be used to review, redesign and evolve the intervention to meet user needs. A blend of narrative and thematic analysis will inform the findings and report. Insights from Parts 1 and 2 will shape a user-defined and formatively analysed brief and simple intervention and future study design ready for pilot testing. The aim of this part of the research is to maximise acceptability and usability of a testable intervention by the target population. To aim of the future intervention will be to demonstrate effectiveness in helping young adults to live well with T1D.

Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis

BACKGROUND

This study aimed to analyze the efficacy of resilience-promoting interventions among adolescents and youth aged 10-24 years with any type of diabetes.

METHODS

A systematic literature search was performed using the PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO databases from inception to May 25, 2022. The Cochrane risk of bias tool (version 2) was used to assess the quality of the included studies. A meta-analysis was performed to calculate the pooled effects of resilience-promoting interventions.

RESULTS

Nineteen articles were included covering an overall sample of 2048 adolescents with diabetes. When analyzing the effectiveness of resilience-promoting interventions, hemoglobin A1c (HbA1c) at six months [mean difference = - 0.47, 95% confidence interval (CI) = - 0.83 to - 0.12, P = 0.009] after the intervention was improved. However, long-term (≥ 12 months) improvement in HbA1c was not significant. In addition, comparing the control group, there were significant differences in the effect size for stress [standardized mean difference (SMD) = - 0.87, 95% CI = - 1.25 to -0.48, P < 0.05], self-efficacy (SMD = 0.50, 95% CI = 0.02-0.98, P = 0.04) and quality of life (SMD = 0.27, 95% CI = 0.03-0.51, P = 0.03).

CONCLUSIONS

Resilience-promoting intervention is a promising way for adolescent diabetes management to improve HbA1c, stress, self-efficacy, and quality of life. Incorporating resilience-promoting components into diabetes education and re-enforcing these contents every six months are recommended for implementation in clinical practice.

Evaluation of the Effectiveness of a Technology-Based Psychosocial Education and Counseling Program for Adolescent Survivors of Childhood Leukemia: A Randomized Controlled Trial

BACKGROUND

In addition to increased survivorship in childhood leukemia, a small but significant number of survivors experience psychosocial challenges that affect their health-related quality of life (QOL) that require interventions to address these challenges.

OBJECTIVE

The aim of this study was to evaluate the efficacy of the technology-based, psychosocial education and counseling program on survivors' QOL, self-efficacy, and coping skills within the scope of a health promotion model for adolescent survivors of childhood leukemia.

METHODS

The randomized controlled trial was conducted with adolescent survivors of childhood leukemia who were between the ages of 12 and 18 and had completed treatment at least 2 years previously. Survivors were randomized to a technology-based intervention (n = 24) or a control group (n = 31). Survivors' QOL, self-efficacy, and coping skills were measured at 4 time points (baseline, postintervention, 1 month postintervention, and 3 months postintervention).

RESULTS

The 3-month postintervention QOL total and psychosocial subscale scores in the intervention group were significantly higher than those in the control group ( P < .05). In addition, the emotional self-efficacy subscale scores and the active coping scores of the intervention group adolescents were significantly higher than those in the control group ( P < .05). Negative coping scores were lower in the intervention group than in the control group ( P < .05).

CONCLUSION

Technology-based, psychosocial counseling and education positively affects the QOL, emotional self-efficacy, and coping skills of adolescent survivors of childhood leukemia.

IMPLICATIONS FOR PRACTICE

This program could be integrated into follow-up care and used as one of the support methods in providing and maintaining long-term follow-up care by pediatric oncology nurses.

The efficacy of interventions provided by nurses to improve glycemic control of children with type 1 diabetes: A systematic review

PURPOSE

Nurses have a very important role in diabetes education of children and adolescents, however, no systematic review has been performed that evaluates the effectiveness of the independent interventions of the nurses. This systematic review aims to identify and assess randomized controlled trials (RCT) that included interventions implemented by nurses to improve glycemic control for children and adolescents with type 1 diabetes.

ELIGIBILITY CRITERIA

PubMed, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science, Science Direct databases were systematically searched up to 2022. Interventions provided by nurses for any child ≤18 years diagnosed with type 1 diabetes mellitus were included.

SAMPLE

Seven RCT articles met our review criteria.

RESULTS

All included studies were published between 2005 and 2021. Studies varied in terms of intervention type; telephone case management, coping skills training, motivational interview as well as home visit education programs. Interventions were found to significantly decrease the HbA1c level in three of seven studies.

CONCLUSIONS

Our systematic review suggests that nurses can improve the glycemic control of children with type 1 diabetes by conducting care interventions. According to current evidence, this study suggests that telephone contact by nurses and motivational interviewing can be beneficial in improving glycemic control in this population.

IMPLICATIONS

Nurses may encourage children and adolescents with diabetes to engage in self-management of their glucose levels. There is a need for more randomized controlled studies assessing the efficacy of nursing interventions for children with type 1 diabetes.

Using Momentary Assessment and Machine Learning to Identify Barriers to Self-management in Type 1 Diabetes: Observational Study

Background

For adolescents living with type 1 diabetes (T1D), completion of multiple daily self-management tasks, such as monitoring blood glucose and administering insulin, can be challenging because of psychosocial and contextual barriers. These barriers are hard to assess accurately and specifically by using traditional retrospective recall. Ecological momentary assessment (EMA) uses mobile technologies to assess the contexts, subjective experiences, and psychosocial processes that surround self-management decision-making in daily life. However, the rich data generated via EMA have not been frequently examined in T1D or integrated with machine learning analytic approaches.

Objective

The goal of this study is to develop a machine learning algorithm to predict the risk of missed self-management in young adults with T1D. To achieve this goal, we train and compare a number of machine learning models through a learned filtering architecture to explore the extent to which EMA data were associated with the completion of two self-management behaviors: mealtime self-monitoring of blood glucose (SMBG) and insulin administration.

Methods

We analyzed data from a randomized controlled pilot study using machine learning–based filtering architecture to investigate whether novel information related to contextual, psychosocial, and time-related factors (ie, time of day) relate to self-management. We combined EMA-collected contextual and insulin variables via the MyDay mobile app with Bluetooth blood glucose data to construct machine learning classifiers that predicted the 2 self-management behaviors of interest.

Results

With 1231 day-level SMBG frequency counts for 45 participants, demographic variables and time-related variables were able to predict whether daily SMBG was below the clinical threshold of 4 times a day. Using the 1869 data points derived from app-based EMA data of 31 participants, our learned filtering architecture method was able to infer nonadherence events with high accuracy and precision. Although the recall score is low, there is high confidence that the nonadherence events identified by the model are truly nonadherent.

Conclusions

Combining EMA data with machine learning methods showed promise in the relationship with risk for nonadherence. The next steps include collecting larger data sets that would more effectively power a classifier that can be deployed to infer individual behavior. Improvements in individual self-management insights, behavioral risk predictions, enhanced clinical decision-making, and just-in-time patient support in diabetes could result from this type of approach.

Perceived Discrimination, Coping Styles, and Internalizing Symptoms Among a Community Sample of Hispanic and Somali Adolescents

PURPOSE

Perceived discrimination, perceptions of receiving differential treatment due to negative attitudes, and stereotypes about one's racial/ethnic group can increase vulnerability to depression and anxiety. Although ethnic minority youth now represent over half of the U.S. youth population, few studies have investigated potential protective factors in the relationship between perceived discrimination and mental health across diverse ethnic minority immigrant youth from different cultural backgrounds.

METHODS

We examined the association between perceived discrimination and past week symptoms of depression and anxiety and whether patterns of problem and emotion-focused coping moderate these relationships among Somali and Hispanic immigrant youth (N = 353) in an urban midwestern setting (mean age = 15; 53% male, 39% first generation, 75% low income). Path analysis models examined the main effects of perceived discrimination for depression and anxiety and whether problem and emotion-focused coping moderated these associations.

RESULTS

Path analysis models suggest that perceived discrimination was positively associated with past week symptoms of depression (β = .37, standard error = .06) and anxiety (β = .16, standard error = .06) across ethnicity. However, adolescents who reported high levels of discrimination and who used predominantly problem-focused coping strategies experienced fewer internalizing problems than youth who relied predominantly on emotion-focused coping strategies.

CONCLUSIONS

Our findings suggest that strengthening youths' problem-focused coping strategies in the face of discriminatory stress is a promising health promotion and risk prevention approach.

Clinical Utility of Psychoeducational Interventions for Youth with Type 1 Diabetes: A Scoping Review

Adolescence is a challenging time for the medical management of type 1 diabetes. Thus, a range of psychoeducational interventions have been developed to improve diabetes management among youth. Systematic reviews of this literature have emphasized the effectiveness of interventions for improving patient outcomes. However, knowledge beyond what works is required for interventions to be adopted into routine clinical practice. The objective of this scoping review was to map the clinical utility of the literature based on a variety of indicators, including the problem base, context placement, information gain, transparency, pragmatism, and patient-centeredness of the research. This lens for reviewing research is consistent with the biopsychosocial model and an increasing focus on reducing disability, including activity limitation and participation restriction. PsycINFO, MEDLINE, and CINHAL databases were searched for evaluative psychoeducational intervention studies published between January 2005 and October 2020. Two cited reference searches and one reference list search were also performed. Fifty studies describing 46 different interventions were identified. The clinical utility of the interventions was highly variable. A detailed overview of the clinical utility of the literature is provided with an emphasis on current gaps and shortcomings to be addressed in future research. This work helps advance the translation of clinical knowledge into practice in schools, homes, and communities; and, ultimately, improve the health and well-being of adolescents with T1D.

The influence of stress and coping on diabetes self-care activities among college students

OBJECTIVE

The purpose of this pilot study was to examine relationships between perceived stress, coping, and diabetes self-care activities among college students with type 1 diabetes.

PARTICIPANTS

College students, self-reported as diagnosed with type 1 diabetes.

METHODS

Students responded to an online self-report questionnaire (Perceived Stress Scale, Brief COPE, Summary of Diabetes Self-Care Activities).

RESULTS

ANOVA analysis showed significant differences between levels of perceived stress for healthy diet and foot care. Simple linear regression analysis showed significant relationships between healthy diet and active coping, positive reframing, and planning; between exercise and humor; between blood glucose testing and active coping, planning, and acceptance; and between foot care and active coping and positive reframing.

CONCLUSIONS

Our results indicate that effective stress management and coping skills will positively impact diabetes self-care. Educational programs for college students with type 1 diabetes should address self-care activities as well as psychosocial factors that affect health.

Feasibility of the Web-Based Intervention Designed to Educate and Improve Adherence Through Learning to Use Continuous Glucose Monitor (IDEAL CGM) Training and Follow-Up Support Intervention: Randomized Controlled Pilot Study

Background

Proper training and follow-up for patients new to continuous glucose monitor (CGM) use are required to maintain adherence and achieve diabetes-related outcomes. However, CGM training is hampered by the lack of evidence-based standards and poor reimbursement. We hypothesized that web-based CGM training and education would be effective and could be provided with minimal burden to the health care team.

Objective

The aim of this study was to perform a pilot feasibility study testing a theory-driven, web-based intervention designed to provide extended training and follow-up support to adolescents and young adults newly implementing CGM and to describe CGM adherence, glycemic control, and CGM-specific psychosocial measures before and after the intervention.

Methods

The “Intervention Designed to Educate and improve Adherence through Learning to use CGM (IDEAL CGM)” web-based training intervention was based on supporting literature and theoretical concepts adapted from the health belief model and social cognitive theory. Patients new to CGM, who were aged 15-24 years with type 1 diabetes for more than 6 months were recruited from within a public university’s endocrinology clinic. Participants were randomized to enhanced standard care or enhanced standard care plus the IDEAL CGM intervention using a 1:3 randomization scheme. Hemoglobin A_1c levels and psychosocial measures were assessed at baseline and 3 months after start of the intervention.

Results

Ten eligible subjects were approached for recruitment and 8 were randomized. Within the IDEAL CGM group, 4 of the 6 participants received exposure to the web-based training. Half of the participants completed at least 5 of the 7 modules; however, dosage of the intervention and level of engagement varied widely among the participants. This study provided proof of concept for use of a web-based intervention to deliver follow-up CGM training and support. However, revisions to the intervention are needed in order to improve engagement and determine feasibility.

Conclusions

This pilot study underscores the importance of continued research efforts to optimize the use of web-based intervention tools for their potential to improve adherence and glycemic control and the psychosocial impact of the use of diabetes technologies without adding significant burden to the health care team. Enhancements should be made to the intervention to increase engagement, maximize responsiveness, and ensure attainment of the skills necessary to achieve consistent use and improvements in glycemic control prior to the design of a larger well-powered clinical trial to establish feasibility.

Trial Registration

ClinicalTrials.gov NCT03367351, https://clinicaltrials.gov/ct2/show/NCT03367351.

Psychological interventions for adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes: a systematic review

BACKGROUND

The aim of this review was to summarize and identify the variations in the effectiveness of psychological interventions on adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes (T1D).

METHODS

An electronic search of literature was performed using PubMed (NLM), Embase (Ovid), CINAHL Plus (EBSCOhost), PsycINFO (Ovid), and Google Scholar. The search was limited to include articles reported the effect of one of the psychological interventions: cognitive behavioral therapy (CBT), coping skills training (CST), stress management, or psychotherapy intervention. The report included peer-reviewed articles published in English from January 1990 until May 2019 in adolescents with T1D, and summarizes the results of 24 studies that met the inclusion criteria.

RESULTS

Psychological interventions showed differential effects on adherence, metabolic control, and coping with stress in adolescents with T1D. Behavioral interventions using principles of CBT appear to have a superior positive effect on regimen adherence compared with other types of psychological protocols. In contrast, metabolic control was significantly improved with the implementation of CST and some forms of CBT. Stress management and psychotherapy interventions showed significant promises for adolescents to cope with their diabetes-related daily stressors.

CONCLUSIONS

However, the findings may add some promises to diabetes management in adolescents, additional research to understand the effect of these interventions is needed.

Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP): Protocol for a Randomized Clinical Trial to Test a Video-Based Telehealth Intervention

Background

Despite the introduction of new insulin analogs, insulin pumps, and continuous glucose monitoring (CGM), young children with type 1 diabetes mellitus (T1D) remain vulnerable to episodes of hypoglycemia because of their unpredictable eating and activity patterns and high degree of insulin sensitivity. Caregivers and young children living with T1D learn to fear hypoglycemia because it is uncomfortable, unpredictable, and dangerous. Up to 60% of caregivers of young children with T1D report moderate to severe levels of fear of hypoglycemia, and caregiver fear of hypoglycemia relates to lower quality of life for families and suboptimal child glycemic control. Yet, until recently, there have been no studies reporting on a targeted intervention to treat caregiver fear of hypoglycemia in families of young children.

Objective

The aim of this project is to conduct a randomized clinical trial of an innovative, video-based telehealth intervention to treat fear of hypoglycemia in caregivers of young children with T1D versus a relevant, age-appropriate attention control intervention.

Methods

We created the Reducing Emotional Distress for Childhood Hypoglycemia in Parents (REDCHiP) intervention by merging age-appropriate T1D education and behavioral parenting strategies with cognitive behavioral therapy strategies that are effective for reducing fear and promoting adaptive coping. REDCHiP uses 10 video-based telehealth sessions that are a combination of group and individual sessions. We will recruit up to 180 families of young children with T1D to participate in this clinical trial from two pediatric diabetes clinics located in the midwestern and southern United States. Once families have been enrolled, we will randomize caregivers based on child age (age 2-3 years or 4-5 years), child sex, and family CGM use to participate in the REDCHiP or attention control intervention. Families will complete 3 assessment visits that coincide with study entry, end of treatment, and 3-month posttreatment. At each assessment visit, we will collect questionnaire data from caregivers, accelerometry data from caregivers and children, CGM data from children, and a blood sample to measure glycated hemoglobin levels from children.

Results

Recruitment began in July 2019, and enrollment is ongoing. The first wave of intervention delivery began in December 2019. We anticipate completing enrollment in 2023. Final reporting of results will occur within 12 months of the primary completion date.

Conclusions

If the REDCHiP intervention is efficacious, next steps will be to examine multiple implementation strategies to determine how best to disseminate the intervention to pediatric diabetes clinics around the world.

Trial Registration

ClinicalTrials.gov NCT03914547; https://clinicaltrials.gov/ct2/show/NCT03914547

International Registered Report Identifier (IRRID)

PRR1-10.2196/17877

Health Equity in the Effectiveness of Web-Based Health Interventions for the Self-Care of People With Chronic Health Conditions: Systematic Review

Background

Web-based self-care interventions have the potential to reduce health inequalities by removing barriers to access to health care. However, there is a lack of evidence about the equalizing effects of these interventions on chronic conditions.

Objective

This study investigated the differences in the effectiveness of web-based behavioral change interventions for the self-care of high burden chronic health conditions (eg, asthma, chronic obstructive pulmonary disease [COPD], diabetes, and osteoarthritis) across socioeconomic and cultural groups.

Methods

A systematic review was conducted, following Cochrane review guidelines. We conducted searches in Ovid Medical Literature Analysis and Retrieval System Online and Cumulative Index to Nursing and Allied Health Literature databases. Studies with any quantitative design were included (published between January 1, 2006, and February 20, 2019) if they investigated web-based self-care interventions targeting asthma, COPD, diabetes, and osteoarthritis; were conducted in any high-income country; and reported variations in health, behavior, or psychosocial outcomes across social groups. Study outcomes were investigated for heterogeneity, and the possibility of a meta-analysis was explored. A narrative synthesis was provided together with a novel figure that was developed for this review, displaying heterogeneous outcomes.

Results

Overall, 7346 records were screened and 18 studies were included, most of which had a high or critical risk of bias. Important study features and essential data were often not reported. The meta-analysis was not possible due to the heterogeneity of outcomes. There was evidence that intervention effectiveness was modified by participants’ social characteristics. Minority ethnic groups were found to benefit more from interventions than majority ethnic groups. Single studies with variable quality showed that those with higher education, who were employed, and adolescents with divorced parents benefited more from interventions. The evidence for differences by age, gender, and health literacy was conflicting (eg, in some instances, older people benefited more, and in others, younger people benefited more). There was no evidence of differences in income, numeracy, or household size.

Conclusions

There was evidence that web-based self-care interventions for chronic conditions can be advantageous for some social groups (ie, minority ethnic groups, adolescents with divorced parents) and disadvantageous for other (ie, low education, unemployed) social groups who have historically experienced health inequity. However, these findings should be treated with caution as most of the evidence came from a small number of low-quality studies. The findings for gender and health literacy were mixed across studies on diabetes, and the findings for age were mixed across studies on asthma, COPD, and diabetes. There was no evidence that income, numeracy, or the number of people living in the household modified intervention effectiveness. We conclude that there appear to be interaction effects, which warrant exploration in future research, and recommend a priori consideration of the predicted interaction effects.

Trial Registration

PROSPERO CRD42017056163; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=56163

School-aged children with type 1 diabetes benefit more from a coping skills training program than adolescents in China: 12-month outcomes of a randomized clinical trial

BACKGROUND

Managing type 1 diabetes can be challenging, especially for youth, so there is a need for effective interventions to help youth live with diabetes.

OBJECTIVE

To determine the efficacy of a coping skills training (CST) program for Chinese youth with type 1 diabetes and to explore whether the efficacy of the program was different for school-aged children than for adolescents with type 1 diabetes.

METHODS

A total of 100 youth with type 1 diabetes aged 8 to 20 years were randomly placed in either an intervention group (CST + standard care [SC]) or a control group (SC). Data were collected at baseline, 6-month, and 12-month follow-ups on primary outcomes of perceived stress, coping, and self-efficacy and secondary outcomes of diabetes self-management, quality of life, and glycated hemoglobin A1c (HbA1c). A generalized estimating equation analysis for repeated measures was used to determine the program effects and differential effects by age group.

RESULTS

The CST program had no significant effect on primary or secondary outcomes over 12 months. However, there was a significant increase in positive coping (P < .001), self-efficacy (P = .017), diabetes problem-solving and goals of diabetes self-management (P = .007, P = .001), and quality of life (P = .016) of school-aged children in the intervention group compared with the control group. There were no significant differences in primary or secondary outcomes between the intervention group and the control group (P > .05).

CONCLUSIONS

The CST program was effective for school-aged children, improving psychosocial and diabetes self-management outcomes. Further research is needed to develop programs that improve outcomes in adolescents with type 1 diabetes.

Monetary reinforcement for self-monitoring of blood glucose among young people with type 1 diabetes: evaluating effects on psychosocial functioning

AIMS

To explore the auxiliary psychosocial effects of a monetary reinforcement intervention targeting self-monitoring of blood glucose among young people with Type 1 diabetes.

METHODS

Sixty young people with Type 1 diabetes, HbA_1c concentrations between 58 and 119 mmol/mol (7.5-13.0%), and average self-monitoring of blood glucose <4 times per day were randomized to either enhanced usual care or a 24-week intervention of monetary rewards for self-monitoring of blood glucose and associated behaviours (e.g. uploading glucose meters). Data were collected from the young people and their parents at baseline, during the intervention (6, 12 and 24 weeks) and after the intervention (36 weeks).

RESULTS

Linear mixed models were used to evaluate the intervention effects on psychosocial outcomes, adjusting for corresponding baseline levels and potential moderation by baseline level. The intervention reduced diabetes distress at week 6 among young people who had average and high baseline distress. It also reduced diabetes distress at weeks 12 and 24 among those with low baseline distress. The intervention also reduced young person-reported diabetes-related family conflict and diabetes-related interference among those with high baseline scores in these areas; however, the intervention worsened young person-reported diabetes interference among those with low baseline interference. Effects were medium-sized and time-limited.

CONCLUSIONS

Findings indicate predominantly positive impacts of monetary reinforcement interventions on psychosocial outcomes, although effects varied by outcome and time point. Whereas early improvements in diabetes distress were observed for all who received the intervention, improvements in other areas varied according to the level of psychosocial challenge at baseline. Incorporating psychosocial interventions may bolster and maintain effects over time.

Intervention in emotional abilities for adolescents with type 1 diabetes mellitus in a hospital setting: a study protocol for a randomised controlled trial

INTRODUCTION

Type 1 diabetes mellitus (T1DM) is one of the most frequent chronic endocrine diseases in the paediatric population. As a result, this disease has a strong impact on psychological well-being. In line with this, emotional factors play an important role in adaptation. The aim of the present study protocol is to design an emotional abilities programme to improve metabolic control assessed by haemoglobin A1c (HbA1c) samples. Specifically, this intervention will be focused on adaptive coping strategies to deal with unpleasant emotions associated with T1DM. The primary aim of this project is to assess whether the employment of this new psychological intervention improves the emotional abilities of adolescents with T1DM.

METHODS AND ANALYSIS

Two focus groups will be carried out for the design and evaluation of the programme following the APEASE criteria (affordability, practicability, effectiveness, acceptability, side effects/safety and equity). Behavioural change will be based on the Behaviour Change Wheel. Sixty-two participants from 12 to 18 years of age will be recruited at a public hospital and randomised to either an intervention or a control group. The intervention group will receive an emotional abilities training programme. The control group will receive usual educational intervention. The primary outcomes are metabolic control and emotional abilities. The secondary outcomes include emotional distress control, positive and negative affect, healthy habits, and quality of life. Data will be collected at baseline, immediately postintervention, and at follow-up visits at 6 and 12 months. A feasibility analysis will be conducted.

ETHICS AND DISSEMINATION

The study has been approved by the Ethics Committee of Universidad Loyola Andalucía. Results will be submitted for publication in peer-reviewed journals and disseminated across the scientific community.

TRIAL REGISTRATION NUMBER

NCT03734367.

State and Trait Anxiety and Diabetes Outcomes in Youth With Type 1 Diabetes

PURPOSE

The purpose of this exploratory pilot study was to examine the associations of state and trait anxiety with glycemic control, self-management, and diabetes-specific quality of life (QOL) in youth 10 to 16 years of age with type 1 diabetes (T1D).

METHODS

Bivariate Pearson correlations and multiple linear regression modeling were conducted to examine the relationship among anxiety symptoms, hemoglobin A1C (A1C), self-management, QOL, and covariates.

RESULTS

A sample of 67 adolescents was 50.7% female, and 87.1% were non-Hispanic white, with a mean ± SD age of 13.4 ± 1.85 years and an A1C of 8.3% ± 1.2% (67 mmol/mol). Higher state anxiety was correlated with older age. Better self-management was correlated with lower trait anxiety and lower state anxiety. Higher state and trait anxiety were associated with poorer self-management. Higher state anxiety was associated with higher A1C. Higher trait anxiety was associated with poorer diabetes-specific QOL.

CONCLUSIONS

State and trait anxiety may differentially affect diabetes outcomes. State anxiety may be a modifiable target for physiologic (A1C) and psychosocial (QOL) outcomes in youth with T1D, while trait anxiety may be a modifiable target for psychosocial outcomes (QOL). Anxiety symptoms should be assessed at regular clinic visits. Interventions to improve anxiety symptoms may in turn improve physiologic and psychosocial outcomes.

Systematic review of sociodemographic representation and cultural responsiveness in psychosocial and behavioral interventions with adolescents with type 1 diabetes

BACKGROUND

The increasing incidence of type 1 diabetes (T1D) in youth aged less than 20 years in the USA is a mounting public health concern. Specific sociodemographic characteristics-racial/ethnic minority, low socioeconomic status (SES), single-parent home and underinsured-have been associated with increased risk for poor glycemic control and poor self-management in adolescents with T1D.

METHODS

Sample demographic and cultural responsiveness methods in psychosocial and behavioral interventions focused on improving self-management and glycemic control in adolescents with T1D were systematically evaluated, to identify if studies were targeting these high-risk groups. Keyword searches of PsychInfo, PubMed and CINAHL identified 259 studies published between 2006 and 2016, of adolescents (13-18 years old) with T1D; 28 studies met inclusion criteria.

RESULTS

Samples focused predominantly on White adolescents with fair glycemic control, from middle-high income, two-parent households with private insurance. The majority of studies scored poorly in cultural responsiveness and moderately in culturally responsive reporting. Studies lacked descriptions of culturally inclusive recruitment and sampling methods, and use of culturally responsive assessments for diverse groups. The majority of studies recruited and enrolled homogeneous adolescent samples from the lowest risk groups.

CONCLUSION

T1D intervention researchers must increase targeted recruitment and sampling methods to include more high-risk pediatric T1D groups, expand sociodemographic reporting, and increase the use of culturally responsive recruitment and sampling methods, such as those used in community-based participatory research. Such efforts have the potential to reduce T1D disparities by making interventions more relevant to the unique needs, goals and priorities of highest risk groups.

Effect of Telehealth System on Glycemic Control in Children and Adolescents with Type 1 Diabetes

OBJECTIVE

A close diabetes team-patient relationship is required for establishing satisfactory metabolic control. The purpose of this study was to investigate the effect of a telehealth system on diabetes control.

METHODS

The study was carried out between June 2015 and January 2016 at the Gazi University Faculty of Medicine, Pediatric Endocrinology Department. The telehealth system was developed by the diabetes team. The demographic characteristics, frequency of use and hemoglobin A1c (HbA1c) changes of type 1 diabetic (T1DM) patients using this communication network were analysed.

RESULTS

Eighty two patients [43 (52.4%) females, mean (±standard deviation) age 10.89±4 years] used the telehealth system. Fourteen (17.1%) of the cases were on pump therapy and 59 (72.0%) were counting carbohydrates. The individuals with diabetes or their families preferred WhatsApp communication. Whatsapp provided a means for instant messaging in most instances (57.3%), contact with diabetes education nurse (32.9%) and consultation with the diabetes team about insulin doses and blood glucose regulation (42.7%). HbA1c values after six months were significantly lower in patients/parents calling frequently (p<0.001) compared with HbA1c values recorded at the beginning of the study.

CONCLUSION

Increase in frequency of counselling by the diabetes team led to improved blood glucose control in T1DM patients. A telehealth system is useful for early detection of the need for changes in treatment and for intervention. It also promoted better self care.

Diabetes and Behavior in the 21st Century: Things That Make You Go "Hmmm . . . "

Editor's Note: This article is adapted from the address Dr. Wysocki delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2018. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Wysocki delivered the address in June 2018 at the association's 78th Scientific Sessions in Orlando, Fla.

Impact of technology-based interventions for children and young people with type 1 diabetes on key diabetes self-management behaviours and prerequisites: a systematic review

BACKGROUND

The role of technology in the self-management of type 1 diabetes mellitus (T1DM) among children and young people is not well understood. Interventions should aim to improve key diabetes self-management behaviours (self-management of blood glucose, insulin administration, physical activity and dietary behaviours) and prerequisites (psychological outcomes and HbA1c) highlighted in the UK guidelines of the National Institute for Health and Care Excellence (NICE) for management of T1DM. The purpose was to identify evidence to assess the effectiveness of technological tools in promoting aspects of these guidelines amongst children and young people.

METHODS

A systematic review of English language articles was conducted using the following databases: Web of Science, PubMed, Scopus, NUSearch, SAGE Journals, SpringerLink, Google Scholar, Science Direct, Sport Discus, Embase, Psychinfo and Cochrane Trials. Search terms included paediatric, type one diabetes, technology, intervention and various synonyms. Included studies examined interventions which supplemented usual care with a health care strategy primarily delivered through a technology-based medium (e.g. mobile phone, website, activity monitor) with the aim of engaging children and young people with T1DM directly in their diabetes healthcare. Studies did not need to include a comparator condition and could be randomised, non-randomised or cohort studies but not single-case studies.

RESULTS

Of 30 included studies (21 RCTs), the majority measured self-monitoring of blood glucose monitoring (SMBG) frequency, clinical indicators of diabetes self-management (e.g. HbA1c) and/or psychological or cognitive outcomes. The most positive findings were associated with technology-based health interventions targeting SMBG as a behavioural outcome, with some benefits found for clinical and/or psychological diabetes self-management outcomes. Technological interventions were well accepted by children and young people. For the majority of included outcomes, clinical relevance was deemed to be little or none.

CONCLUSIONS

More research is required to assess which elements of interventions are most likely to produce beneficial behavioural outcomes. To produce clinically relevant outcomes, interventions may need to be delivered for at least 1 year and should consider targeting individuals with poorly managed diabetes. It is not possible to determine the impact of technology-based interventions on insulin administration, dietary habits and/or physical activity behaviour due to lack of evidence.

Theory-Based Health Behavior Interventions for Pediatric Chronic Disease Management: A Systematic Review

IMPORTANCE

Pediatric chronic conditions have become a major public health challenge, and behavioral change plays an important role in overcoming this problem. Many health behavior interventions are described as theory-based, but evidence that such programs properly use theoretical constructs is scant.

OBJECTIVE

To identify effective theory-based behavioral interventions that motivate patients and families to adopt better self-management behaviors for chronic disease, to review theoretical constructs from each theory and identify the common elements for action, and to rate the level of evidence for each theory-based chronic disease intervention.

EVIDENCE REVIEW

Medline and PsycINFO electronic databases were searched for relevant randomized clinical trial articles published between January 1, 2000, and June 30, 2016, with English language and article type restrictions. These articles reported original data on children and young adults aged 21 years or younger, measured interventions for a pediatric chronic health problem, and assessed the association between interventions and health behavior, knowledge, and outcomes. The Jadad scale was used to evaluate the methods of each article. Articles that explicitly identified the theoretical basis for the intervention and scored 3 points or higher on the Jadad scale were included in the final analysis.

FINDINGS

The database search yielded a total of 36 187 articles, from which duplicates and those that did not meet the inclusion criteria were eliminated, leaving 129 studies for the full review. Of the 129 studies, 29 (22.5%) had higher Jadad scale scores of 3 or 4 points and underwent the final detailed data abstraction and qualitative synthesis. Five chronic conditions were represented, including asthma (55% [16 of 29]), type 1 diabetes (21% [6 of 29]), obesity (14% [4 of 29]), attention-deficit/hyperactivity disorder (7% [2 of 29]), and autistic spectrum disorder (3% [1 of 29]). Most studies (55% [16 of 29]) used Social Cognitive Theory as the theoretical basis for intervention. The following intervention outcomes were reported: 23 (80%) saw a positive association with health-related behaviors (eg, adherence), 8 (28%) with knowledge, 7 (24%) with attitudes, and 26 (90%) with clinical outcomes. Ten studies (34%) showed results in both health behaviors and health outcomes. Twenty-two studies (76%) demonstrated short-term effects (within 6 months), whereas 12 (41%) reported longer-term changes.

CONCLUSIONS AND RELEVANCE

Identifying effective theory-based behavioral interventions can empower those who are involved in the care of children and young adults with chronic conditions.

Self-Management: A Comprehensive Approach to Management of Chronic Conditions

For both clinical and economic reasons, the increasing number of persons living with chronic conditions represents a public health issue of growing importance. Emphasizing patient responsibility, and acting in concert with the provider community, self-management represents a promising strategy for treating chronic conditions—moving beyond education to teaching individuals to actively identify challenges and solve problems associated with their illness. Self-management also shows potential as an effective paradigm across the prevention spectrum (primary, secondary, and tertiary) by establishing a pattern for health early in life and providing strategies for mitigating illness and managing it in later life. We suggest ways to advance research methods and practical applications of self-management as steps in its future development and implementation.

A Web-Delivered Multicomponent Intervention for Adolescents with Poorly Controlled Type 1 Diabetes: A Pilot Randomized Controlled Trial

Background

Type 1 diabetes is associated with significant mortality and economic cost. Management of type 1 diabetes involves completing multiple daily adherence behaviors, and many adolescents struggle with self-management and show poor glycemic control.

Purpose

The purpose was to conduct an unblinded pilot randomized controlled parallel-group study of a web-delivered multicomponent intervention targeting self-monitoring of blood glucose, working memory, and parent supervision of diabetes care among adolescents with type 1 diabetes. Intervention components included high magnitude incentives for adolescents and parents, motivational and cognitive behavioral therapy and working memory training for adolescents, and training in contingency contracting for parents.

Methods

Adolescents (N = 114) with poorly controlled type 1 diabetes were screened, and N = 61 were randomized using minimum likelihood allocation to usual care (usual care, N = 31) or to a 25-week/15-session web-delivered intervention (WebRx, N = 30).

Results

At the end of treatment, adolescents in WebRx had higher self-monitoring of blood glucose (d = 0.58) (primary outcome), better visual spatial working memory (d = 0.48) and inhibition (d = 0.98), and lower HbA1c (d = 0.45) than those in usual care. WebRx parents reported more frequent review of the adolescent's glucometer (d = 1.30) and reduced family conflict (d = 0.56). Between-condition differences were maintained 6 months later in self-monitoring of blood glucose (d = 0.42), visual spatial working memory (d = 0.76), family conflict (d = 0.50), and HbA1c (d = 0.44).

Conclusions

Results showing sustained effects on self-monitoring of blood glucose and HbA1c support moving forward with a larger trial to test this innovative web-delivered and multicomponent intervention. ClinicalTrials.gov Number (NCT01722643).

The Effect of Coping Skills Training on Depression, Anxiety, Stress, and Self-Efficacy in Adolescents with Diabetes: A Randomized Controlled Trial

BACKGROUND

Diabetes patients are at risk of psychosocial problems. Some interventions might decrease these problems. This study aimed to evaluate the effect of coping skills training on depression, anxiety, stress, and self-efficacy of adolescents with type I diabetes.

METHODS

This randomized controlled trial with pre- and post-test design was performed in the diabetes clinic in Shiraz from June to November 2015. This study was conducted on 100 adolescents with type 1 diabetes who were randomly divided into an intervention (receiving coping skills training in groups for eight sessions) and a control group (usual care). Depression, Anxiety, and Stress Scales (42-items, scores=0-42) and General Self-Efficacy questionnaire (17-items, scores=17-85) were used. The variables were measured at baseline and two months after starting the intervention. Data were analyzed using SPSS, version 16 through Chi-square test, independent t-test, and paired t-test. P<0.05 was significant.

RESULTS

After the intervention, the mean scores of depression, anxiety and stress in the intervention group were 5.41±4.58, 6.44±7.01, and 7.46±7.01, and in the control groups they were 19.73±11.80, 18.28±10.51, 21.10±10.94, respectively. Moreover, after the intervention, the mean scores of self-efficacy were 70.82±10.84, and 50.13±15.42 in the intervention and control groups, respectively. The results showed differences between the two groups regarding depression, anxiety, stress, and self-efficacy after starting the intervention (P<0.001).

CONCLUSION

As coping skills training reduced depression, anxiety, and stress and improved the patients' self-efficacy, the use of this intervention could be a part of community-based nursing practice for adolescents with diabetes and more research for improving evidence-based practice in this regard are warranted. - Trial Registration Number: IRCT201505011369N4.

Significant effect of group education in patients with diabetes type 1

OBJECTIVE

Type 1 diabetes mellitus (T1DM) constitutes a real challenge in everyday practice for both physicians and patients. Due to the complexity of the disease and its unpredictable nature, structured education and training programs are nowadays implemented that ensure active patient involvement and self-care behaviors to achieve adequate glycemic control, prevent diabetic complications, and improve the quality of life of patients. These programs provide patients with the necessary knowledge and skills to self-monitor and self-manage the disease and its associated metabolic conditions. The aim of the study was to evaluate the effect of a structured 12-month education program that motivated patients to follow a healthy Mediterranean diet and exercise regularly as well as to adjust carbohydrate intake and insulin dose according to their needs.

DESIGN

The education group (EG) was comprised of 62 patients (45 males) with type 1 DM, mean age 36 ± 4.2 years and BMI 24.2 ± 3.1 kg/m². An age- and BMI-matched control group (CG, n = 25, mean age 41 ± 6.4 years, BMI 25.7 ± 4.2 kg/m²) was composed of patients referred but not enrolled in the project.

RESULTS

At the end of this program, HbA1C levels were significantly decreased (8.5 ± 2.1% vs. 7.08 ± 0.79%, p < 0.0001) as was also the incidence of hypoglycemic episodes (p < 0.05). Regarding daily glucose fluctuations, significant improvement (p < 0.05) was observed, as reflected in low, high, and daily median glucose values. On the other hand, the above parameters remained stable in the CG.

CONCLUSIONS

These results strongly support the need for long-lasting structured education group courses for adult diabetic patients keen to change their habits in order to achieve self-management of the disease.

Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers

Multiple sources of burden for youth with type 1 diabetes (T1D) impact key outcomes including quality of life, self-management, and glycemic control. Professional diabetes organizations recommend diabetes care providers screen for psychosocial and behavioral challenges and implement strategies to support youth with T1D. The purpose of this article is to review the literature and recommend practical strategies medical providers can use for screening and behavioral support for youth with diabetes and their families. As part of their routine medical care, diabetes care providers are well-positioned to identify and intervene to address emotional distress related to the burdens of living with diabetes. In collaboration with multidisciplinary team members, including psychologists and mental health professionals, medical providers may be able to successfully implement brief behavioral strategies for screening and providing emotional support.

Distal technologies and type 1 diabetes management

Type 1 diabetes requires intensive self-management to avoid acute and long-term health complications. In the past two decades, substantial advances in technology have enabled more effective and convenient self-management of type 1 diabetes. Although proximal technologies (eg, insulin pumps, continuous glucose monitors, closed-loop and artificial pancreas systems) have been the subject of frequent systematic and narrative reviews, distal technologies have received scant attention. Distal technologies refer to electronic systems designed to provide a service remotely and include heterogeneous systems such as telehealth, mobile health applications, game-based support, social platforms, and patient portals. In this Review, we summarise the empirical literature to provide current information about the effectiveness of available distal technologies to improve type 1 diabetes management. We also discuss privacy, ethics, and regulatory considerations, issues of global adoption, knowledge gaps in distal technology, and recommendations for future directions.

A Systematic Review of Digital Interventions for Improving the Diet and Physical Activity Behaviors of Adolescents

Many adolescents have poor diet and physical activity behaviors, which can lead to the development of noncommunicable diseases in later life. Digital platforms offer inexpensive means of delivering health interventions, but little is known about their effectiveness. This systematic review was conducted to synthesize evidence on the effectiveness of digital interventions to improve diet quality and increase physical activity in adolescents, to effective intervention components and to assess the cost-effectiveness of these interventions. Following a systematic search, abstracts were assessed against inclusion criteria, and data extraction and quality assessment were performed for included studies. Data were analyzed to identify key features that are associated with significant improvement in behavior. A total of 27 studies met inclusion criteria. Most (n = 15) were Web site interventions. Other delivery methods were text messages, games, multicomponent interventions, emails, and social media. Significant behavior change was often seen when interventions included education, goal setting, self-monitoring, and parental involvement. None of the publications reported cost-effectiveness. Due to heterogeneity of studies, meta-analysis was not feasible.It is possible to effect significant health behavior change in adolescents through digital interventions that incorporate education, goal setting, self-monitoring, and parental involvement. Most of the evidence relates to Web sites and further research into alternate media is needed, and longer term outcomes should be evaluated. There is a paucity of data on the cost-effectiveness of digital health interventions, and future trials should report these data.

General and diabetes-specific stress in adolescents with type 1 diabetes

BACKGROUND

Type 1 diabetes (T1D) is one of the most common chronic health conditions in adolescents in the United States. Adherence to the recommended treatment regimen has been reported as a source of stress for adolescents.

AIM

The purpose of this study was to examine the associations among general and diabetes-specific stress and glycemic control (HbA1c), self-management, and diabetes-specific quality of life (QOL) in adolescents with T1D.

METHODS

A secondary analysis of baseline data (N=320) from a randomized controlled trial was conducted. Adolescents completed validated measures of general and diabetes-specific stress, self-management, and diabetes-specific QOL. HbA1c levels were obtained from medical records.

RESULTS

Over 50% of the sample scored at or above criteria for high general and diabetes-specific stress. Higher general and diabetes-specific stress was significantly associated with higher HbA1c, poorer self-management activities, and lower diabetes-specific QOL. Diabetes-specific stress accounted for a significant proportion of the variance in HbA1c, while general stress did not. General and diabetes-specific stress accounted for 40% of the variance in diabetes-specific QOL.

CONCLUSIONS

General and diabetes-specific stress are common in adolescents with T1D. Healthcare providers must be mindful of the sources of stress that adolescents with T1D face on a daily basis. General stress and diabetes-specific stress should be differentiated and may require different interventions to improve coping and outcomes.

The impact of the Nurse Faculty Scholars program on schools of nursing

BACKGROUND

The Robert Wood Johnson Foundation Nurse Faculty Scholars program was conceptualized as not only promoting the growth and development of early-career faculty but as enhancing the research infrastructure of scholars' schools of nursing.

PURPOSE

At the completion of the scholars' three years of support, deans/directors were asked to provide feedback regarding the institutional impact of the scholars' participation in the program.

METHODS

Phone interviews were conducted on the first five completed cohorts and a six-item questionnaire was developed to obtain some quantitative data.

DISCUSSION

The program was viewed as having accelerated the scholars' leadership and scholarship, and their influence within the school/university and regionally/nationally. Deans/directors generally agreed that the scholars' experience helped build the school's research portfolio.

CONCLUSION

Looking back on how the participating schools of nursing fared, one can say that the program's institutional expectations were achieved most of the time. The program helped scholars build their own reputations and that in turn had consequences for the school's standing as a whole. A number of components are described that can be replicated singly or in various combinations by schools/universities interested in adopting aspects of this program.

Brief Computer-Delivered Intervention to Increase Parental Monitoring in Families of African American Adolescents with Type 1 Diabetes: A Randomized Controlled Trial

BACKGROUND

African American adolescents with type 1 diabetes (T1D) are at elevated risk for poor diabetes management and metabolic control. Parental supervision and monitoring of adolescent diabetes management have been shown to promote better diabetes management among adolescents, but parents typically decrease their oversight during the transition to independent diabetes care.

INTRODUCTION

The purpose of the study was to conduct a randomized clinical trial to test the feasibility and efficacy of a three-session, computer-delivered motivational intervention (The 3Ms) to promote increased parental monitoring among primary caregivers of young African American adolescents with T1D. The intervention was brief and optimized for delivery during routine diabetes clinic visits.

MATERIALS AND METHODS

Sixty-seven adolescents with T1D aged 11-14 and their primary caregiver were randomly assigned to one of three arms: adolescent and parent motivational intervention (Arm 1), adolescent control and parent motivational intervention (Arm 2), or adolescent and parent control (Arm 3). Intervention effects were assessed 1 month after intervention completion.

RESULTS

Parents in Arm 1 and Arm 2 had significant increases in knowledge of the importance of monitoring adolescents' diabetes care. Parents in Arm 2 also had trend to significant increases in direct observation and monitoring of adolescent diabetes care, and adolescents in Arm 2 had significant improvements in glycemic control.

DISCUSSION AND CONCLUSIONS

Findings from the present study provide preliminary support for the efficacy of a brief, computer-delivered parenting intervention for improving family management practices and adolescent health outcomes among African American adolescents with T1D and their caregivers.

An Integrative Review of the Quality and Outcomes of Diabetes Education Programs for Children and Adolescents

Purpose

The purpose of this study was twofold: (1) to describe the content of recent diabetes education programs and their outcomes in terms of glycemic control, disease management, and psychosocial criteria for children and adolescents with type 1 diabetes and (2) to gauge the match between these programs and the recommendations of the International Society for Pediatric and Adolescent Diabetes (ISPAD).

Methods

The integrative review was carried out according to the Cochrane recommendations. Thirteen databases were searched for evaluations of education programs published from 2009 to 2014. Program characteristics and outcomes were described. Quality of studies was assessed, and program match with ISPAD recommendations was gauged.

Results

Of 2528 studies found, 43 covering 36 education programs intended for youth with type 1 diabetes were retained for review. Nine of these centered on self-care competencies, 18 on psychosocial competencies, and 9 on both types of competency (mixed program). Programs varied widely in terms of organization, procedure, and content. Glycemic control was an indicator assessed in the majority of programs, but only half of these (for the most part, self-care programs) reported positive findings in this regard. Few programs seemed to affect psychosocial indicators. An online mixed program, which was the program that best met the ISPAD recommendations, proved to have an influence on glycemic control and several psychosocial criteria.

Conclusions

Various avenues can be considered to improve participant engagement in education programs and to align these programs more closely with international recommendations. Further research is required to enhance knowledge in this field.

Stress and A1c Among People with Diabetes Across the Lifespan

Stress is known to negatively affect health and is a potentially serious barrier to diabetes-related health outcomes. This paper synthesizes what is known about stress and glycemic control among people with type 1 and type 2 diabetes across the lifespan. Chronic stress-especially in relation to living with diabetes-was most strongly associated with A1c, particularly among subgroups that face disproportionate stress, such as minority groups or adolescents/young adults. Mechanisms of the stress-A1c association include physiological, psychological, behavioral, and environmental links. Understanding the dimensions of stress as they relate to health in diabetes can be of significant clinical importance, and interventions targeting mechanisms that either exacerbate or buffer stress have reported modest improvements in A1c.

Evaluating Diabetes Educational Interventions With a Skill Development Component in Adolescents With Type 1 Diabetes: A Systematic Review Focusing on Quality of Life

PURPOSE

Adolescents with type 1 diabetes mellitus (T1DM) may have reduced quality of life (QOL) when compared with their peers. This systematic review evaluated the effectiveness of diabetes self-management education (DSME) interventions with a skills development component on the QOL of adolescents with T1DM.

METHODS

Six databases were systematically searched for studies on the QOL outcomes of DSME interventions for adolescents with T1DM. Fourteen studies published between 1994 and 2014 met the inclusion criteria.

RESULTS

Of the 14 studies, only 4 had significant QOL outcomes for the intervention participants. Successful DSME interventions had indirect behavioral skills foci or a combination of indirect and direct behavioral skills foci and a duration ≥2 months.

CONCLUSION

This review provides evidence that educational interventions with an indirect behavioral skills development that facilitates diabetes management may improve QOL among adolescents with T1DM. Structured interventions targeting adolescents' QOL are needed to determine which are most effective in improving QOL. Adolescents with T1DM should be routinely screened and monitored for low QOL and referred to QOL-improving interventions.

Mental Health Smartphone Apps: Review and Evidence-Based Recommendations for Future Developments

BACKGROUND

The number of mental health apps (MHapps) developed and now available to smartphone users has increased in recent years. MHapps and other technology-based solutions have the potential to play an important part in the future of mental health care; however, there is no single guide for the development of evidence-based MHapps. Many currently available MHapps lack features that would greatly improve their functionality, or include features that are not optimized. Furthermore, MHapp developers rarely conduct or publish trial-based experimental validation of their apps. Indeed, a previous systematic review revealed a complete lack of trial-based evidence for many of the hundreds of MHapps available.

OBJECTIVE

To guide future MHapp development, a set of clear, practical, evidence-based recommendations is presented for MHapp developers to create better, more rigorous apps.

METHODS

A literature review was conducted, scrutinizing research across diverse fields, including mental health interventions, preventative health, mobile health, and mobile app design.

RESULTS

Sixteen recommendations were formulated. Evidence for each recommendation is discussed, and guidance on how these recommendations might be integrated into the overall design of an MHapp is offered. Each recommendation is rated on the basis of the strength of associated evidence. It is important to design an MHapp using a behavioral plan and interactive framework that encourages the user to engage with the app; thus, it may not be possible to incorporate all 16 recommendations into a single MHapp.

CONCLUSIONS

Randomized controlled trials are required to validate future MHapps and the principles upon which they are designed, and to further investigate the recommendations presented in this review. Effective MHapps are required to help prevent mental health problems and to ease the burden on health systems.

General Life and Diabetes-Related Stressors in Early Adolescents With Type 1 Diabetes

INTRODUCTION

To examine general and diabetes-related stressors in early adolescents with type 1 diabetes (T1D).

METHOD

Data were from 205 participants (58% female; 33% minority; 11-14 years) enrolled in a clinical trial. Teens identified their top 3 stressors and responded to open-ended questions. A content analysis method was used to identify themes across stressor categories.

RESULTS

Eight-two percent of teens reported that school was a top stressor, followed by social life (49%) and diabetes (48%). We identified 5 themes of general life stressors (fitting in, having friends, balancing competing demands, living with family, and feeling pressure to do well) and 3 themes of diabetes-specific stressors (just having diabetes, dealing with emotions, and managing diabetes).

DISCUSSION

Though teens with T1D experienced stressors specific to T1D, they perceived stress related to normal adolescent growth and development more frequently. Teens with T1D may need psychosocial support that holistically addresses both typical developmental and diabetes-related stressors.

Cognitive, behavioral and goal adjustment coping and depressive symptoms in young people with diabetes: a search for intervention targets for coping skills training

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for young people with Type 1 (T1) diabetes. A wide range of coping techniques was studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 78 young people with T1 diabetes participated. They were contacted through a social networking website, several Internet sites, and flyers. A wide range of coping techniques appeared to be related to depressive symptoms. Especially the cognitive coping strategies self-blame, rumination, refocus positive, and other-blame, together with goal adjustment coping, were of importance. A large proportion of the variance of depressive symptoms could be explained (65 %). These findings suggest that these specific coping strategies should be part of coping skills trainings for young people with T1 diabetes.

Depressive Symptoms in a Trial Behavioral Family Systems Therapy for Diabetes: A Post Hoc Analysis of Change

OBJECTIVE

The objective was to test whether Behavioral Family Systems Therapy for Diabetes (BFST-D), an evidence-based family therapy, produces individual changes in depressive symptoms for adolescents with type 1 diabetes in suboptimal glycemic control (HbA(1c) ≥9.0% [≥74.9 mmol/mol]).

RESEARCH DESIGN AND METHODS

Data were from a randomized controlled trial (RCT) comparing two modes of BFST-D delivery: in clinic versus Internet videoconferencing. There were no significant differences between groups in the RCT, so groups were collapsed into a within-group prepost design for secondary analyses. A multiple regression analysis was performed to test for mediation of treatment outcomes by changes in family processes.

RESULTS

Significant improvements in glycemic control, depressive symptoms, and family functioning were found from pre- to posttreatment. A multiple regression analysis for within-subject mediation indicated that improvements in depressive symptoms were partially mediated by improvements in parent-youth conflict; however, family process changes did not mediate diabetes health outcomes.

CONCLUSIONS

In addition to improving treatment adherence and glycemic control, BFST-D has collateral benefits on depressive symptoms.

Diabetes and Behavioral Learning Principles: Often Neglected yet Well-Known and Empirically Validated Means of Optimizing Diabetes Care Behavior

Managing diabetes is known to be invasive, pervasive, and unrelenting, making adherence to the treatment regimen difficult to accomplish. Ongoing clinical and research efforts have attempted to address the struggles faced by youth and adults with diabetes. Recent research supports the integration of behavioral interventions into clinical practice to assist patients and families with the goal of improving health outcomes. Empirically supported and well-documented behavioral learning principles, particularly positive reinforcement, are often underutilized in modern diabetes care. We posit that most diabetes care providers are aware of these principles. However, the constraints of today's medical systems have become significant barriers to purposefully and consistently applying them to promote improved diabetes care. We provide a brief overview of basic behavioral principles and common barriers to implementation, discuss relevant interventions, and present several examples of applications in clinical settings. We conclude with recommendations to raise awareness regarding the importance of consistently integrating relevant behavioral learning principles and interventions into diabetes care settings.

A critical review of the use of technology to provide psychosocial support for children and young people with long-term conditions

Advances in technology have offered health professionals alternative mediums of providing support to patients with long-term conditions. This critical review evaluated and assessed the benefit of electronic media technologies in supporting children and young people with long-term conditions. Of 664 references identified, 40 met the inclusion criteria. Supportive technology tended to increase disease-related knowledge and improve aspects of psychosocial function. Supportive technology did not improve quality of life, reduce health service use or decrease school absences. The poor methodological quality of current evidence and lack of involvement of users in product development contribute to the uncertainty that supportive technology is beneficial.