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Gardener L, Desha L, Bourke-Taylor H, Ziviani J. Responsibility sharing for adolescents with type 1 diabetes: A scoping review. Chronic Illn 2022; 18:6-21. [PMID: 32998528 DOI: 10.1177/1742395320959406] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND The term 'Responsibility Sharing', albeit poorly defined, has emerged from the diabetes literature, to describe a distinct mechanism for comprehensively managing the characteristic shift in responsibility that underpins the transition to self-management for adolescents. METHODS A scoping review, following the PRISMA-ScR guidelines, distilled the literature from seven databases to answer the questions: What is responsibility sharing? Who are the key stakeholders? What factors affect responsibility transaction? What are its recognized outcomes? How is responsibility shared? RESULTS Responsibility sharing is a transactional arrangement between youth and their caregiver/s that functions to repeatedly and flexibly apply ownership to the management of diabetes care tasks, across the course of adolescence. In the main, responsibility sharing was associated with better metabolic and/or psychosocial outcomes. Effective responsibility sharing was seen as being responsive to adolescent capacity and driven by autonomy supportive, sustained communication patterns that enable mutually agreeable responsibility assumption by all stakeholders. CONCLUSION Different perspectives on responsibility sharing for adolescents with Type 1 diabetes, and the lack of a universal definition, have led to discordance within the literature about its operationalization and measurement. This paper proposes a definition of responsibility sharing for future researchers to apply.
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Affiliation(s)
- Lisa Gardener
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Laura Desha
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Helen Bourke-Taylor
- School of Primary and Allied Health Care, Faculty of Medicine, Nursing and Health Sciences, Monash University - Peninsula Campus, Frankston, Australia
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
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2
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Berget C, Akturk HK, Messer LH, Vigers T, Pyle L, Snell-Bergeon J, Driscoll KA, Forlenza GP. Real-world performance of hybrid closed loop in youth, young adults, adults and older adults with type 1 diabetes: Identifying a clinical target for hybrid closed-loop use. Diabetes Obes Metab 2021; 23:2048-2057. [PMID: 34010499 DOI: 10.1111/dom.14441] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 04/23/2021] [Accepted: 05/03/2021] [Indexed: 01/05/2023]
Abstract
AIM To describe real-world hybrid closed loop (HCL) use and glycaemic outcomes across the lifespan and identify a clinical threshold for HCL use associated with meeting the internationally recommended target of 70% sensor glucose time in range (TIR; 70-180 mg/dL). MATERIALS AND METHODS Mixed models examined MiniMed 670G HCL use and glycaemic outcomes in 276 people with type 1 diabetes from four age groups: youth (aged <18 years), young adults (18-25 years), adults (26-49 years) and older adults (≥50 years) for 1 year. ROC analysis identified the minimum percentage HCL use associated with meeting the TIR goal of 70%. RESULTS HCL use at month 1 was 70.7% ± 2.9% for youth, 71.0% ± 3.8% for young adults, 78.9% ± 2.1% for adults and 84.7% ± 3.8% in older adults. HCL use declined significantly at 12 months to 49.3% ± 3.2% in youth (P < .001) and 55.7% ± 4.3% in young adults (P = .002). HCL use was sustained at 12 months in adults (76.4% ± 2.2%, P = .36) and older adults (80.4% ± 3.9%, P = .36). HCL use of 70.6% was associated with 70% TIR (sensitivity 58.3%, specificity 85%, AUC 0.77). Older age, 80% or higher continuous glucose monitor use and four or more blood glucose checks per day were associated with attaining the HCL-use threshold. CONCLUSIONS HCL use of 70% or higher may be a useful target for clinicians to use to assist people with diabetes in attaining glycaemic goals. Youth may struggle with HCL use more than adults and require clinical intervention to help sustain HCL use across time.
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Affiliation(s)
- Cari Berget
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Halis Kaan Akturk
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Laurel H Messer
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Timothy Vigers
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Laura Pyle
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, Colorado, USA
| | - Janet Snell-Bergeon
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Gregory P Forlenza
- University of Colorado Anschutz Medical Campus, Barbara Davis Center for Diabetes, Aurora, Colorado, USA
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3
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Datye KA, Tilden DR, Parmar AM, Goethals ER, Jaser SS. Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes. Curr Diab Rep 2021; 21:22. [PMID: 33991264 PMCID: PMC8575075 DOI: 10.1007/s11892-021-01389-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Continuous glucose monitors (CGM) are transforming diabetes management, yet adolescents and young adults (AYA) with type 1 diabetes (T1D) do not experience the same benefits seen with CGM use in adults. The purpose of this review is to explore advances, challenges, and the financial impact of CGM use in AYA with T1D. RECENT FINDINGS CGM studies in young adults highlight challenges and suggest unique barriers to CGM use in this population. Recent studies also demonstrate differences in CGM use related to race and ethnicity, raising questions about potential bias and emphasizing the importance of patient-provider communication. Cost of these devices remains a significant barrier, especially in countries without nationalized reimbursement of CGM. More research is needed to understand and address the differences in CGM utilization and to increase the accessibility of CGM therapy given the significant potential benefits of CGM in this high-risk group.
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Affiliation(s)
- Karishma A Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA.
| | - Daniel R Tilden
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angelee M Parmar
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
| | - Eveline R Goethals
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
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4
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Wasserman RM, Eshtehardi SS, Anderson BJ, Weissberg-Benchell JA, Hilliard ME. Profiles of Depressive Symptoms and Diabetes Distress in Preadolescents With Type 1 Diabetes. Can J Diabetes 2021; 45:436-443. [PMID: 33771448 DOI: 10.1016/j.jcjd.2021.01.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 01/08/2021] [Accepted: 01/24/2021] [Indexed: 01/24/2023]
Abstract
OBJECTIVES Diabetes distress and depressive symptoms are common psychosocial concerns for people with diabetes. These are related, yet distinct, mood states, which have each been related to diabetes management and glycated hemoglobin (A1C) among adolescents and adults with diabetes. However, they have not been examined concurrently in preadolescents with type 1 diabetes. Understanding the overlaps and distinctions between diabetes distress and depressive symptoms in youth would help guide decisions about psychosocial screening in diabetes clinical practice. In this study, we aimed to categorize preadolescents based on clinical cutoffs of concurrently administered measures of depressive symptoms and diabetes distress, and identify clinical and demographic characteristics of each group. METHODS One hundred eighty youth (age range, 9 to 13 years; age [mean ± standard deviation], 11.3±1.3 years; 55% female; 56% Caucasian; mean A1C, 8.4±1.6% [68 mmol/mol]) completed measures of diabetes distress, depressive symptoms and quality of life. Daily blood glucose monitoring frequency was calculated from meter download. A1C values were obtained from electronic medical records. RESULTS Depressive symptoms and diabetes distress each significantly correlated with A1C and quality of life. Although most (69%) participants had no clinically significant elevations in either diabetes distress or depressive symptoms, 14% had elevated depressive symptoms only and 17% had elevated distress without concurrent elevated depressive symptoms. Groups differed based on A1C, quality of life and insurance status. CONCLUSIONS Routine assessment of both depressive symptoms and diabetes distress may help to identify preadolescents with type 1 diabetes who require psychosocial support.
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Affiliation(s)
- Rachel M Wasserman
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Orlando, Florida, United States
| | - Sahar S Eshtehardi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States; Department of Psychological, Health, & Living Services, University of Houston, Houston, Texas, United States
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States
| | - Jill A Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, United States
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, United States.
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5
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Wagner G, Zeiler M, Karwautz A, Schneider A, Rami-Merhar B, Berger G. Personality, Coping and Developmental Conditions in Female Adolescents and Young Adults with Type 1 Diabetes: Influence on Metabolic Control and Quality of Life. Front Psychiatry 2021; 12:809015. [PMID: 35356383 PMCID: PMC8960069 DOI: 10.3389/fpsyt.2021.809015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 12/06/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To assess personality factors, coping, developmental conditions and quality of life in female adolescents and young adults with type 1 diabetes (T1D) and high vs.low HbA1c. METHODS Patients were approached at the Department for Pediatrics, Medical University of Vienna; n = 129 female adolescents (10 to 23 years, mean age 15.21 ± 2.91) with type 1 diabetes were included. HIGH-A1c was defined as HbA1c > 7.5%, LOW-A1c as HbA1c ≤ 7.5% and compared to a sample of 56 age-matched female healthy controls. Self-rating questionnaires were used to assess psychosocial factors: Children's Depression Inventory (CDI); Junior Temperament and Character Inventory (J-TCI); Eating Disorders Inventory-2 (EDI-2); KIDCOPE; Subjective Family Image Test (SFIT) and Inventory of Life Quality in Children and Adolescents(ILC). RESULTS T1D patients with HIGH-A1c were younger at the age of diabetes onset, had a longer diabetes duration, a higher maximum BMI, higher depression score, and higher frequency of diabetic ketoacidosis in the last year. They showed significantly higher levels of fatigue, lower levels of taking responsibility, lower ability to set goals and lower self-acceptance, as well as higher levels of ineffectiveness, lower levels of emotional attachment within the family, in particular with the fathers, and used negative coping strategies more often compared to patients with LOW-A1c. Furthermore, they reported significantly higher burden of illness and lower quality of life. CONCLUSIONS Disadvantageous personality and coping styles as well as developmental conditions should be addressed in the treatment of female adolescents with T1D with management problems.
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Affiliation(s)
- Gudrun Wagner
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Michael Zeiler
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andreas Karwautz
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Andrea Schneider
- Eating Disorders Unit at the Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Birgit Rami-Merhar
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Gabriele Berger
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, Vienna, Austria.,Pediatric Diabetes Outpatient Clinic, Health Care Centre Vienna Floridsdorf, Vienna, Austria
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6
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Malik FS, Senturia KD, Lind CD, Chalmers KD, Yi-Frazier JP, Shah SK, Pihoker C, Wright DR. Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:533-551. [PMID: 31863541 PMCID: PMC7663046 DOI: 10.1111/pedi.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | - Cara D. Lind
- Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | | | - Seema K. Shah
- Northwestern University, 680 N Lake Shore Drive, Chicago, IL, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | - Davene R. Wright
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
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7
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Johnston K, Wheeler G, Rosolowsky E. A Comparison of Structured Education Programs for Pediatric Patients With Type 1 Diabetes: Multiple Daily Injection Therapy Delivered by Group Workshop vs. Self-Study Course. Can J Diabetes 2019; 43:290-293. [DOI: 10.1016/j.jcjd.2018.08.060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 07/12/2018] [Accepted: 08/02/2018] [Indexed: 10/28/2022]
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8
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Trudeau B, Trudeau C, Polfuss ML, Sullivan-Bolyai S. A Developmental Milestones Map of Type 1 Diabetes Self-Management Transition From Parents to Adolescents. Diabetes Spectr 2019; 32:21-29. [PMID: 30853761 PMCID: PMC6380240 DOI: 10.2337/ds18-0003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Transitional diabetes self-management (DSM) for children and their families is complicated. This article was undertaken to provide an exemplar of DSM strategies used by one family that were based on developmental milestones from preschool through college age. Two brothers who were both diagnosed with type 1 diabetes before the age of 2 years reflected on how their parents began a DSM navigation process during their early preschool years. Personal strategies and recommendations successfully resulted in both youths transitioning to college. With the parents serving as DSM coaches to the boys, an interdependent relationship was built. Key recommendations include 1) starting early, 2) being consistent and flexible, 3) using "invisible actions" and "what ifs," 4) incorporating technology and community resources into DSM, and 5) building confidence with shared problem-solving.
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Affiliation(s)
- Bobby Trudeau
- Undergraduate student, Rensselaer Polytechnic Institute, Troy, NY
| | - Cameron Trudeau
- Undergraduate student, University of Massachusetts Amherst, Amherst, MA
| | - Michele Lynn Polfuss
- University of Wisconsin–Milwaukee College of Nursing, Milwaukee, WI
- Children’s Hospital of Wisconsin, Wauwatosa, WI
| | - Susan Sullivan-Bolyai
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA
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9
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Berger G, Waldhoer T, Barrientos I, Kunkel D, Rami‐Merhar BM, Schober E, Karwautz A, Wagner G. Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria. Pediatr Diabetes 2019; 20:127-136. [PMID: 30267464 PMCID: PMC7379731 DOI: 10.1111/pedi.12784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. METHODS Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. RESULTS Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation. CONCLUSIONS This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
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Affiliation(s)
- Gabriele Berger
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Thomas Waldhoer
- Department of Public Health, EpidemiologyMedical University ViennaViennaAustria
| | - Irene Barrientos
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Daniela Kunkel
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Birgit M. Rami‐Merhar
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Edith Schober
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Andreas Karwautz
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Gudrun Wagner
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
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10
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Patel NJ, Datye KA, Jaser SS. Importance of Patient-Provider Communication to Adherence in Adolescents with Type 1 Diabetes. Healthcare (Basel) 2018; 6:E30. [PMID: 29597246 PMCID: PMC6023481 DOI: 10.3390/healthcare6020030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023] Open
Abstract
Effective communication between pediatric diabetes patients and their providers has the potential to enhance patient satisfaction and health outcomes, as well as improve diabetes-related self-management. In this review, we highlight the importance of communication between patients and providers, focusing on the effect of communication on adherence in the high-risk population of adolescents with type 1 diabetes. We synthesize the literature describing patient-provider communication in pediatric populations and provide implications for practice that focus on the most relevant, modifiable factors for improving self-management in adolescents with type 1 diabetes.
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Affiliation(s)
- Niral J Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Karishma A Datye
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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11
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Johnson EL, Frias JP, Trujillo JM. Anticipatory guidance in type 2 diabetes to improve disease management; next steps after basal insulin. Postgrad Med 2018; 130:365-374. [PMID: 29569978 DOI: 10.1080/00325481.2018.1452515] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The alarming rise in the number of people living with type 2 diabetes (T2D) presents primary care physicians with increasing challenges associated with long-term chronic disease care. Studies have shown that the majority of patients are not achieving or maintaining glycemic goals, putting them at risk of a wide range of diabetes-related complications. Disease- and self-management programs have been shown to help patients improve their glycemic control, and are likely to be of particular benefit for patients with diabetes dealing with these issues. Anticipatory guidance is an individualized, proactive approach to patient education and counseling by a health-care professional to support patients in better coping with problems before they arise. It has been shown to improve disease outcomes in a variety of chronic conditions, including diabetes. While important at all stages, anticipatory guidance may be of particular importance during changes in treatment regimens, and especially during transition to, and escalation of, insulin-based regimens. The aim of this article is to provide advice to physicians on anticipatory guidance for basal-insulin dosing, focusing on appropriate basal-insulin-dose increase and prevention of potentially deleterious basal-insulin doses, so called overbasalization. It also provides an overview of new treatment options for patients with T2D who are not well controlled on basal-insulin therapy, fixed-ratio combinations of basal insulin and glucagon-like peptide-1 receptor agonists, and advice on the type of anticipatory guidance needed to ensure safe and appropriate switching to these therapies.
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Affiliation(s)
- Eric L Johnson
- a Department of Family and Community Medicine , University of North Dakota , Grand Forks , ND , USA
| | - Juan P Frias
- b National Research Institute , Los Angeles , CA , USA
| | - Jennifer M Trujillo
- c Skaggs School of Pharmacy and Pharmaceutical Sciences , University of Colorado , Aurora , CO , USA
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12
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Shulman R, Stukel TA, Miller FA, Newman A, Daneman D, Guttmann A. Insulin pump use and discontinuation in children and teens: a population-based cohort study in Ontario, Canada. Pediatr Diabetes 2017; 18:33-44. [PMID: 26748950 DOI: 10.1111/pedi.12353] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/04/2015] [Accepted: 12/12/2015] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To describe insulin pump use by youth since introduction of universal funding in Ontario, Canada and to explore the relationship between pump use and pediatric diabetes center characteristics and the relationship between discontinuation and center and patient characteristics. RESEARCH DESIGN AND METHODS Observational, population-based cohort study of youth with type 1 diabetes (<19 yr) who received pump funding from 2006 to 2013 (n = 3700). We linked 2012 survey data from 33 pediatric diabetes centers to health administrative databases. We tested the relationship between center-level pump uptake and center characteristics (center type, physician model, and availability of 24-h support) using an adjusted negative binomial model; we studied center- and patient-level factors (socioeconomic status and baseline glycemic control) associated with discontinuation using a Cox proportional hazards model with generalized estimating equations. RESULTS Pump users were more likely to be in the highest income quintile than non-pump users (29.6 vs. 19.1%, p < 0.0001). In 2012, mean percent pump use was 38.0% with variability across centers. There was no association between uptake and center characteristics. Discontinuation was low (0.42/100 person-yr) and was associated with being followed at a small community center [hazard ratio (HR): 2.24 (1.05-4.76)] and being more deprived [HR: 2.36 (1.14-1.48)]. Older age was associated with a lower rate of discontinuation [HR: 0.31 (0.14-0.66)]. CONCLUSIONS Rates of pump use have increased since 2006 and discontinuation is rare. Large variation in uptake across centers was not explained by the factors we examined but may reflect variation in patient populations or practice patterns, and should be further explored.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Therese A Stukel
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Canada
| | - Alice Newman
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Health Sciences Building, Toronto, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Canada
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13
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Shulman R, Miller FA, Daneman D, Guttmann A. Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes. Health Policy 2015; 120:64-71. [PMID: 26563632 DOI: 10.1016/j.healthpol.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.
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Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada.
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
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14
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Klonoff D, Nayberg I, Rabbone I, Landgraf W, Domenger C, Danne T. Evaluation of the JuniorSTAR ® Half-unit Insulin Pen in Young People with Type 1 Diabetes - User Perspectives. EUROPEAN ENDOCRINOLOGY 2013; 9:82-85. [PMID: 29922358 DOI: 10.17925/ee.2013.09.02.82] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 08/05/2013] [Indexed: 11/24/2022]
Abstract
This paper discusses the results of a survey on the usability of a new half-unit insulin pen, JuniorSTAR® (CE mark pending, under the responsibility of Haselmeier), in children with type 1 diabetes. Insulin pen devices have advantages over the traditional vial-and-syringe method of insulin delivery, including improved patient satisfaction and adherence, greater ease of use and superior accuracy, especially when delivering small doses of insulin. The accuracy and design of insulin pens is particularly important in the paediatric population. Young children often require half-unit adjustments. As the incidence of type 1 diabetes is expected to increase in the coming years in children less than 5 years old, a higher use of half-unit dosing pens may be anticipated. A survey with JuniorSTAR half-unit insulin pen has shown that it is easy to use, read, carry and dial back. This was confirmed by patients and also by nurses. In conclusion, the JuniorSTAR half-unit pen is well suited to the lifestyle of young people with type 1 diabetes and could help them to gain autonomy to self-inject.
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Affiliation(s)
- David Klonoff
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California, US
| | - Irina Nayberg
- Diabetes Research Institute, Mills-Peninsula Health Services, San Mateo, California, US
| | - Ivana Rabbone
- Department of Paediatrics, University of Turin, Italy
| | | | | | - Thomas Danne
- Auf der Bult Children and Youth Hospital, Hannover, Germany
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15
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Abstract
Chronic illnesses and medical conditions present millions of children and adolescents with significant stress that is associated with risk for emotional and behavioral problems and interferes with adherence to treatment regimens. We review research on the role of child and adolescent coping with stress as an important feature of the process of adaptation to illness. Recent findings support a control-based model of coping that includes primary control or active coping (efforts to act on the source of stress or one's emotions), secondary control or accommodative coping (efforts to adapt to the source of stress), and disengagement or passive coping (efforts to avoid or deny the stressor). Evidence suggests the efficacy of secondary control coping in successful adaptation to chronic illness in children and adolescents, disengagement coping is associated with poorer adjustment, and findings for primary control coping are mixed. Avenues for future research are highlighted.
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Affiliation(s)
- Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennessee 37203, USA.
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16
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Schober E, Wagner G, Berger G, Gerber D, Mengl M, Sonnenstatter S, Barrientos I, Rami B, Karwautz A, Fritsch M. Prevalence of intentional under- and overdosing of insulin in children and adolescents with type 1 diabetes. Pediatr Diabetes 2011; 12:627-31. [PMID: 21435136 DOI: 10.1111/j.1399-5448.2011.00759.x] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The aim of this study was to evaluate the prevalence of insulin under- and overdosing in paediatric patients. RESEARCH DESIGN AND METHODS Cross-sectional study including 241 patients (age 14.0 + 2.7 yr, 42.5% males) with type 1 diabetes from 21 diabetic outpatient clinics. Haemoglobin A1c (HbA1c), height, and weight were available from clinical records. Patients were interviewed with the Diabetes Self-Management Profile (DSMP) interview. T test, U test, and chi-squared test were used for comparison. RESULTS On the basis of the DSMP, 103 (42.7%) patients (group A) showed adherence to the therapeutic insulin regimen, while 71 (29.5%) patients (group B) confessed intentional over and/or under-dosing of insulin. Sixty-seven (27.8%) adolescents (group C) reported management problems leading to unintended inappropriate insulin dosages. In group B, 55 (22.8%) injected higher insulin doses and 58 (24.1%) omitted insulin. Patients of group B compared to group A were older 15.0 (±2.5) vs. 14.0 (±2.5) yr (p < 0.01), older at onset 9.5 (±3.6) vs. 8.3 (±3.8) yr (p = 0.05), were more often girls (69 vs. 45.6%), had a higher actual HbA1c (8.7 ± 1.7 vs. 7.8 ± 1.2%), and a higher average HbA1c in the previous year (8.3 ± 1.6 vs. 7.9 ± 1.2%) (p < 0.01). No significant differences could be found between group A and group C. CONCLUSION Intentional overdosing of insulin is almost as prevalent in children and adolescents as insulin omission. Females are more at risk.
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Affiliation(s)
- Edith Schober
- Department of Pediatrics and Adolescent Medicine, Medical University Vienna, Vienna, Austria.
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