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Perez D, Sullivan-Bolyai S, Bova C, Fain J. Burnout Among Young Adults With Type 1 Diabetes. Sci Diabetes Self Manag Care 2024; 50:211-221. [PMID: 38812453 DOI: 10.1177/26350106241249746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
PURPOSE The purpose of this qualitative descriptive study was to describe the experience of diabetes burnout in young adults with type 1 diabetes (T1DM). In addition, aims included participant perspectives of risk and protective factors associated with burnout and ways to balance everyday life with diabetes self-management (DSM). METHODS Young adults with T1DM (N = 11) were recruited through social media platforms and modified snowball sampling and interviewed. Informational redundancy was achieved. Qualitative thematic coding and analysis were conducted within and across transcripts. RESULTS Diabetes burnout was described as the willingness to put diabetes and DSM on the "back burner" and let things slide due to exhaustion, frustration, apathy, and the desire to be like everyone else for a while. Risk and protective factors were identified along with strategies to achieve balance of DSM in everyday life. CONCLUSIONS This study identified a clear definition of diabetes burnout and acknowledges this concept as distinct and separate from other psychosocial conditions. Health care providers can utilize this information to identify individuals at risk for diabetes burnout and offer more effective support to lessen the overall burden associated with T1DM.
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Affiliation(s)
| | - Susan Sullivan-Bolyai
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts
| | - Carol Bova
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts
| | - James Fain
- UMass Chan Medical School, Tan Chingfen Graduate School of Nursing, Worcester, Massachusetts
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2
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Saudelli E, Moscatiello S, Baldari M, Bongiorno C, Zucchini S, Maltoni G, Agostini A, Paccapelo A, Nardi E, Ribichini D, Bruco A, Lo Preiato V, Laffi G, Pagotto U, Di Dalmazi G. Sex-driven factors associated with anxiety and depression in autoimmune diabetes. Acta Diabetol 2024:10.1007/s00592-024-02275-4. [PMID: 38743078 DOI: 10.1007/s00592-024-02275-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 03/11/2024] [Indexed: 05/16/2024]
Abstract
AIM To analyze the prevalence of anxiety and depression in a large cohort of adults with autoimmune diabetes, identifying sex-driven associated factors. MATERIALS AND METHODS In this cross-sectional study, we enrolled 553 consecutive adults with Type 1 diabetes mellitus or latent autoimmune diabetes in adults who came to the Division of Endocrinology of the S.Orsola-Malpighi Polyclinic, Bologna (Italy), to receive their second dose of SARS-CoV-2 vaccine. We administered the questionnaires: Hospital Anxiety and Depression Scale, Diabetes Distress Scale, Diabetes-related Quality of Life, Diabetes Treatment Satisfaction Questionnaire. We collected clinical and biochemical data and 14 days glucose metrics in patients with sensor use > 70% in a time span of ± 4 months from the questionnaires' administration. We excluded 119 patients from our analyses with missing data (final cohort n = 434: 79% of those enrolled). RESULTS Anxiety and depression prevalence was respectively 30.4% and 10.8%. According to the multivariate analysis, higher diabete-related emotional burden, lower treatment satisfaction, but not physician-related distress, were risk factors for anxiety and depression; female sex was associated with anxiety (OR 0.51, 95% 0.31-0.81; p = 0.005); in women, depression was associated with increasing age (males vs. females OR 0.96 per 1 year increase, 95% CI 0.92-1.00; p = 0.036), whilst in men with HbA1c (OR 1.08 per 1 mmol/mol increase, 95% CI 1.03-1.13; p = 0.002). CONCLUSION Nearly 1/3 of patients with autoimmune diabetes suffers from anxiety and 1/10 from depression. These conditions are associated with independent modifiable and non-modifiable characteristics. For depression, these characteristics differ between males and females.
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Affiliation(s)
- Enrico Saudelli
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Simona Moscatiello
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Michele Baldari
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Claudio Bongiorno
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Stefano Zucchini
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giulio Maltoni
- Pediatric Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessandro Agostini
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Alexandro Paccapelo
- Research and Innovation Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Elena Nardi
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Danilo Ribichini
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alessia Bruco
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Valentina Lo Preiato
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Gilberto Laffi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Uberto Pagotto
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Guido Di Dalmazi
- Division of Endocrinology and Diabetes Prevention and Care, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.
- Department of Medical and Surgical Sciences (DIMEC), Alma Mater Studiorum University of Bologna, Bologna, Italy.
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Cosoreanu A, Rusu E, Mihai DA, Rusu F, Pantea I, Paunica I, Ungureanu I, Radulian G. Diabetes Distress Among the Roma Population From a Tertiary Care Center in Romania. Cureus 2024; 16:e60348. [PMID: 38756711 PMCID: PMC11097231 DOI: 10.7759/cureus.60348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 05/18/2024] Open
Abstract
Background Distress in patients with diabetes is a condition that has received significant attention in recent years; however, data regarding the psychological assessment and the impact of the emotional burden of diabetes among the Roma population are still scarce in the medical literature. Material and methods We conducted an observational, transversal study that included 310 adult patients with diabetes mellitus, aged between 18 and 85 years old, of which the majority (61%) were women; patients were selected from a tertiary hospital providing diabetes care; diabetes distress was evaluated using a standardized questionnaire, the diabetes distress scale (DDS), validated on Romanian patients. Results In the study population, a great proportion of patients showed diabetes distress, with 24.8% (N=82) having moderate distress and 29.7% (N=121) having severe distress. In the Caucasian group, there were significantly more patients without distress than in the Roma patients,while on the contrary, more Roma patients experienced severe distress compared to the opposite group (64.5%, N=78 versus 35.5%, N=43). In the Caucasian group, a statistical significance was observed regarding interpersonal distress, with Caucasian women having a higher score than men. Concerning the Roma patients, total DDS and all subscales´ scores were statistically significant, with Roma women having higher scores than men. A statistical significance was observed between ethnicity and diabetes distress scores, with the Roma population having higher median values than Caucasian patients. It was also demonstrated that the lack of education, a higher diabetes evolution, and a higher glycated hemoglobin (HbA1c) level (above 8%) have influenced the risk of severe DDS in the Caucasian group, while in the Roma patients, employment status (being unemployed) represents a risk factor for severe DDS. Conclusion The Roma patients included in our study experienced higher distress scores compared to Caucasians. These results are substantial as they emphasize the need to include the evaluation of diabetes distress in clinical practice to facilitate the early initiation of intervention measures. There is nevertheless limited data regarding this particular ethnic group; therefore, further research is still needed.
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Affiliation(s)
- Andrada Cosoreanu
- Diabetes, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, ROU
| | - Emilia Rusu
- Diabetes, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, ROU
| | - Doina Andrada Mihai
- Diabetes, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, ROU
| | - Florin Rusu
- Urology, "Dr. Carol Davila" Central Military Emergency University Hospital, Bucharest, ROU
| | - Ileana Pantea
- Diabetes, Transilvania University of Brasov, Brasov, ROU
| | - Ioana Paunica
- Diabetes, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, ROU
| | - Ioana Ungureanu
- Diabetes, "Nicolae Malaxa" Clinical Hospital, Bucharest, ROU
| | - Gabriela Radulian
- Diabetes, University of Medicine and Pharmacy "Carol Davila" Bucharest, Bucharest, ROU
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Mathias P, Corathers SD, Carreon SA, Hilliard ME, Papadakis JL, Weissberg-Benchell J, Raymond JK, Pyatak EA, Agarwal S. Young Adults with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:39-52. [PMID: 38272597 DOI: 10.1016/j.ecl.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Young adults experience multiple developmental transitions across social, educational, vocational, residential, and financial life domains. These transitions are potential competing priorities to managing a chronic condition such as type 1 diabetes and can contribute to poor psychosocial and medical outcomes. In this narrative review, we describe population outcomes of young adult populations and the unique considerations associated with managing type 1 diabetes in young adulthood. We provide an overview of the current evidence-based strategies to improve care for young adults with type 1 diabetes and recommendations for future directions in the field.
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Affiliation(s)
- Priyanka Mathias
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA
| | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Samantha A Carreon
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Jaclyn L Papadakis
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jennifer K Raymond
- Division of Pediatric Endocrinology, Children's Hospital Los Angeles, 4650 Sunset Boulevard. MS 61, Los Angeles, CA, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP-133, Los Angeles, CA 90089-9003, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA; NY Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10467, USA.
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Renaud-Charest O, Mok E, Frei J, Brunet ML, Henderson M, Rahme E, Dasgupta K, Nakhla M. Diabetes duration, perceived comfort with self-management and glycaemic control in adolescents with type 1 diabetes: A cross-sectional study. Diabet Med 2024; 41:e15237. [PMID: 37838827 DOI: 10.1111/dme.15237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 09/11/2023] [Accepted: 10/02/2023] [Indexed: 10/16/2023]
Abstract
AIMS Evidence is lacking on whether diabetes duration is associated with type 1 diabetes (T1D) self-management during late adolescence before transfer from paediatric to adult care. We examined associations of diabetes duration with dimensions of perceived comfort with diabetes self-management (self-efficacy, transition readiness, diabetes distress) and glycaemic control in late adolescence. METHODS Using a cross-sectional design, we conducted a secondary analysis of baseline data of adolescents (ages 16-17 years) with T1D followed at paediatric diabetes academic hospitals in Montreal and enrolled in the Group Education Trial to Improve Transition (GET-IT-T1D). Participants completed validated questionnaires on self-efficacy (Self-Efficacy for Diabetes Self-Management Measure [SEDM], score 1 to 10), diabetes distress and transition readiness, as well as a haemoglobin (HbA1c) capillary blood test. Our primary outcome was self-efficacy. We examined associations of diabetes duration with self-efficacy, diabetes distress, transition readiness and HbA1c using linear and logistic regression models adjusted for sex, socioeconomic status, insulin pump use, glucose sensor use and psychiatric comorbidity. RESULTS Of 203 adolescents with T1D, mean diabetes duration (SD) was 7.57 (4.44) years. Mean SEDM score was 6.83 (SD 1.62). Diabetes duration was not associated with self-efficacy, diabetes distress or transition readiness. Each additional year of diabetes duration was associated with 0.11% (95% CI, 0.05 to 0.16) higher HbA1c. CONCLUSIONS Although diabetes duration is not associated with dimensions of perceived comfort with diabetes self-management, adolescents with longer diabetes duration are at risk for higher HbA1c and may need additional support to improve glycaemic control before transition to adult care.
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Affiliation(s)
- Olivier Renaud-Charest
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Elise Mok
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Jennifer Frei
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Marie-Laurence Brunet
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Québec, Canada
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
| | - Mélanie Henderson
- Department of Paediatrics, Université de Montréal, Montreal, Québec, Canada
- CHU Sainte-Justine Research Centre, Montreal, Québec, Canada
- School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Elham Rahme
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Clinical Epidemiology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Meranda Nakhla
- Centre for Outcomes Research and Evaluation, Research Institute of the McGill University Health Centre, Montreal, Québec, Canada
- Division of Endocrinology, Department of Paediatrics, McGill University Health Centre, Montreal, Québec, Canada
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6
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Bisno DI, Reid MW, Pyatak EA, Flores Garcia J, Salcedo-Rodriguez E, Torres Sanchez A, Fox DS, Hiyari S, Fogel JL, Marshall I, Bachmann G, Raymond JK. Virtual Peer Groups Reduce HbA1c and Increase Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes. Diabetes Technol Ther 2023; 25:589-601. [PMID: 37335751 DOI: 10.1089/dia.2023.0199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Background: Adolescents and young adults (AYA) from diverse and marginalized backgrounds with type 1 diabetes (T1D) generally have higher hemoglobin A1c (HbA1c) levels and less frequent continuous glucose monitor (CGM) use than AYA from more privileged backgrounds. Further, scant data address the impact of virtual peer groups (VPG) on health-related outcomes for ethnically and racially diverse AYA with T1D. Methods: CoYoT1 to California was a 15-month randomized controlled trial for AYA aged 16-25 years. In this study, AYA were randomized to receive standard care (n = 28), or CoYoT1 care (n = 40), which consisted of person-centered provider visits and bimonthly VPG. VPG were AYA-driven discussions. AYA completed the Diabetes Distress Scale (DDS), Center for Epidemiologic Studies Depression (CES-D), and Diabetes Empowerment Scale-Short Form (DES-SF) scales at baseline and all study visits. Results: Participants were 50% Latinx and 75% publicly insured. Among CoYoT1 care participants, 19 attended at least 1 VPG session (VPG attendees) and 21 did not attend any VPG sessions. VPG attendees participated in 4.1 VPG sessions on average. VPG attendees had a relative reduction in HbA1C (treatment effect -1.08%, effect sizes values [ES] = -0.49, P = 0.04) and increase in CGM use (treatment effect +47%, ES = 1.00, P = 0.02) compared to standard care. VPG participation was not associated with statistically significant changes in DDS, CES-D, and DES-SF scores. Conclusions: In a 15-month randomized controlled trial, AYA with T1D who participated in VPG reported significant improvements in HbA1c and CGM use. Peer interactions may support unmet needs of AYA with T1D from diverse and marginalized backgrounds. ClinicalTrials.gov Identifier: NCT03793673.
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Affiliation(s)
- Daniel I Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Mark W Reid
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | | | | | | | - D Steven Fox
- School of Pharmacy, University of Southern California, Los Angeles, California, USA
| | - Sarah Hiyari
- Children's Hospital Los Angeles, Los Angeles, California, USA
| | | | - Ian Marshall
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Gloria Bachmann
- Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, Los Angeles, California, USA
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
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7
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Babbott KM, Serlachius A. Developing digital mental health tools for youth with diabetes: an agenda for future research. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2023; 4:1227332. [PMID: 37497385 PMCID: PMC10367007 DOI: 10.3389/fcdhc.2023.1227332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 06/26/2023] [Indexed: 07/28/2023]
Abstract
Youth living with diabetes face a concurrent challenge: managing a chronic health condition and managing the psychosocial and developmental changes that are characteristic of adolescence and young adulthood. Despite these unique challenges, psychological support is often difficult for youth with diabetes to access due to a lack of trained mental health professionals and other resource constraints. Digital wellbeing tools offer the potential to improve access to psychological support for this population. However, very few digital wellbeing tools exist for youth with diabetes. Of those that do exist, very few are evidence-based therapies, undermining their contribution to the field. Given the increasing global prevalence of diabetes in young people, the support necessitated by the challenges experienced by this population is not always accessible in a face-to-face setting and cannot be effectively scaled to meet demand. To support the health and wellbeing of youth with diabetes, there is a clear need to develop digital interventions that are widely accessible to users, but, more saliently, grounded in empirical evidence that supports their efficacy. Thus, the purpose of this paper is to offer an agenda for future research, including insights into which psychological techniques and behavioral change theories may be a good conceptual fit for digital mental health interventions, and how these tools may be best developed and utilized by the individuals that need them. Scalable, evidence-based wellbeing tools for this population are urgently required to improve psychological outcomes, and potentially, improve the equity of service access.
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8
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Crossen SS, Wagner DV. Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities. J Diabetes Sci Technol 2023; 17:901-908. [PMID: 36896887 PMCID: PMC10348000 DOI: 10.1177/19322968231157367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David V. Wagner
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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9
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Shaw S, Khan J. The risk of experiencing depression among older adults in India: A cross-sectional study. J Diabetes Metab Disord 2023; 22:629-638. [PMID: 37255784 PMCID: PMC10225437 DOI: 10.1007/s40200-023-01185-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 01/08/2023] [Indexed: 06/01/2023]
Abstract
Background The comorbidity of diabetes and depression poses a major challenge to older adults. While a few small scale studies have investigated the diabetes associated risk of experiencing depression, there is no national-level study available for India on the same. In this context, this study estimates the burden and risk of depression due to diabetes among older adults aged 45 and above in India while adjusting for socio-economic and demographic characteristics of the individuals. Methods Longitudinal Ageing Study in India (LASI), 2017-2018 wave 1 data was utilised in this study. The prevalence of depression and diabetes were estimated by background characteristics using bivariate cross-tabulation. In addition, multivariate logistic regression was applied to examine the likelihood of depression associated with diabetes and other covariates. Result Empirical estimation demonstrated that 14% of males and 8% of females with diabetes suffer from depression in the 45-59 age group. A diabetic person aged 45 and above was 16% more likely to suffer from depression than a non-diabetic person; whereas, a diabetic elderly aged 60 and above was 24% more likely to experience depression than their non-diabetic counterparts. The multivariate analysis confirmed a highly statistically significant association between diabetes and depression indicating a substantial risk to experience depression among those older adults and elderly who suffer from diabetes. Conclusion Elderly population (60 +) is at higher risk of experiencing depression due to diabetes. Therefore, public health care awareness should be raised, particularly among endocrinologists or specialist doctors who provide treatment at the tertiary-care hospitals in India. The health care experts should refer/recommend the diabetic patients to screen for depressive symptoms. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01185-6.
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Affiliation(s)
- Subhojit Shaw
- International Institute for Population Sciences, Deonar, 88 Mumbai, India
| | - Junaid Khan
- International Institute for Population Sciences, Deonar, 88 Mumbai, India
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Patience M, Janssen X, Kirk A, McCrory S, Russell E, Hodgson W, Crawford M. 24-Hour Movement Behaviours (Physical Activity, Sedentary Behaviour and Sleep) Association with Glycaemic Control and Psychosocial Outcomes in Adolescents with Type 1 Diabetes: A Systematic Review of Quantitative and Qualitative Studies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:4363. [PMID: 36901373 PMCID: PMC10001999 DOI: 10.3390/ijerph20054363] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/21/2023] [Accepted: 02/22/2023] [Indexed: 06/18/2023]
Abstract
Type 1 Diabetes (T1D) is a condition requiring 24-hour management. The way in which an individual combines their 24-hour movement behaviours (24-h MBs), which is comprised of physical activity (PA), sedentary behaviour (SB), and sleep, throughout the day can have a significant impact on physical and mental health. This mixed methods systematic review aimed to investigate 24-h MBs' relationship with glycaemic control and psychosocial outcomes in adolescents (11-18 years) with T1D. Ten databases were searched for quantitative and qualitative English language articles reporting at least one of the behaviours and their relationship with outcomes. There were no restrictions on article publication dates or study design. Articles were subjected to title and abstract screening, full text screening, data extraction and quality assessment. Data were summarised narratively, and a meta-analysis was conducted where possible. From 9922 studies, 84 were included for data extraction (quantitative (n = 76), qualitative (n = 8)). Meta-analyses revealed a significant favourable association between PA and HbA1c (-0.22 [95% CI: -0.35, -0.08; I2 = 92.7%; p = 0.001). SB had an insignificant unfavourable association with HbA1c (0.12 [95% CI: -0.06, 0.28; I2 = 86.1%; p = 0.07]) and sleep had an insignificant favourable association (-0.03 [95% CI: -0.21, 0.15; I2 = 65.9%; p = 0.34]). Importantly, no study investigated how combinations of behaviours collectively interacted and impacted on outcomes.
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Affiliation(s)
- Mhairi Patience
- Psychology Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Xanne Janssen
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Alison Kirk
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Stephanie McCrory
- Psychology Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Eilidh Russell
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - William Hodgson
- Physical Activity for Health Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
| | - Megan Crawford
- Psychology Group, Faculty of Humanities & Social Sciences, School of Psychological Sciences & Health, University of Strathclyde, Glasgow G1 1XP, UK
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Affiliation(s)
- Sze May Ng
- Paediatric department, Southport and Ormskirk NHS Trust, Ormskirk, UK
- Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | | | | | | | - Partha Kar
- Diabetes and endocrine department, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
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12
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Morrissey EC, Byrne M, Casey B, Casey D, Gillespie P, Hobbins A, Lowry M, McCarthy E, Newell J, Roshan D, Sharma S, Dinneen SF. Improving outcomes among young adults with type 1 diabetes: the D1 Now pilot cluster randomised controlled trial. Pilot Feasibility Stud 2022; 8:56. [PMID: 35260182 PMCID: PMC8902268 DOI: 10.1186/s40814-022-00986-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 01/19/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The D1 Now intervention is designed to improve outcomes in young adults living with type 1 diabetes. It consists of three components: an agenda-setting tool, an interactive messaging system and a support worker. The aim of the D1 Now pilot cluster randomised controlled trial (RCT) was to gather and analyse acceptability and feasibility data to allow (1) further refinement of the D1 Now intervention, and (2) determination of the feasibility of evaluating the D1 Now intervention in a future definitive RCT. METHODS A pilot cluster RCT with two intervention arms and a control arm was conducted over 12 months. Quantitative data collection was based on a core outcome set and took place at baseline and 12 months. Semi-structured interviews with participants took place at 6, 9 and 12 months. Fidelity and health economic costings were also assessed. RESULTS Four diabetes centres and 57 young adults living with type 1 diabetes took part. 50% of eligible young adults were recruited and total loss to follow-up was 12%. Fidelity, as measured on a study delivery checklist, was good but there were three minor processes that were not delivered as intended in the protocol. Overall, the qualitative data demonstrated that the intervention was considered acceptable and feasible, though this differed across intervention components. The agenda-setting tool and support worker intervention components were acceptable to both young adults and staff, but views on the interactive messaging system were mixed. CONCLUSIONS Some modifications are required to the D1 Now intervention components and research processes but with these in place progression to a definitive RCT is considered feasible. TRIAL REGISTRATION ISRCTN (ref: ISRCTN74114336 ).
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Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Bláthín Casey
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Dympna Casey
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Paddy Gillespie
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
- CURAM, Science Foundation Ireland (SFI) Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
| | - Anna Hobbins
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
- CURAM, Science Foundation Ireland (SFI) Research Centre for Medical Devices, National University of Ireland, Galway, Ireland
| | - Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Elizabeth McCarthy
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- School of Medicine, National University of Ireland, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Davood Roshan
- School of Mathematics, Statistics & Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Shikha Sharma
- Health Economics & Policy Analysis Centre, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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13
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Wongyai W, Boonchaya-Anant P, Laichuthai N, Aroonparkmongkol S, Veerapong V, Leepulsup S, Teeratongdee C, Anunapibut N, Sahakitrungruang T. Outcomes of a multidisciplinary transition clinic for youth with type 1 diabetes. Pediatr Int 2022; 64:e15356. [PMID: 36564347 DOI: 10.1111/ped.15356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/20/2022] [Accepted: 09/09/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Emerging adults with type 1 diabetes (T1D) have several challenges regarding diabetes management and care transition from pediatric to adult services. In this study we aimed to assess the effectiveness of the newly established transition clinic for emerging adults with T1D. METHODS We conducted an observational study of emerging adults with T1D treated in a transition clinic jointly operated by a pediatric and adult multidisciplinary care team during 2019-2021. A retrospective chart review of hemoglobin A1c (HbA1c), frequency of clinic attendance, acute diabetes-related complications, assessment of gaps in knowledge and behavior, and psychosocial outcomes was analyzed. RESULTS A total of 21 patients with T1D were included. Median age at the transfer to the transition clinic was 24 years (range 21-34). Fifteen patients (71%) were successfully transferred to adult services; mean duration of follow-up at the transition clinic was 9.2 months (SD 3.9). None of the patients was lost to follow-up or experienced serious diabetes related complications. Mean (95% confidence interval) HbA1c levels decreased from 8.97% (7.87-10.07) at baseline to 8.25% (7.45-9.05) at the most recent visit (p = 0.01). A proportion of patients achieving the glycemic target (HbA1c < 7.5%) was increased from 24% at the first visit to 38% at the most recent visits. Patients' HbA1c levels at the adult clinic continued a favorable trend. Seven patients (33%) were identified as having symptoms of depression. Knowledge and behavioral gaps were identified and counselled by clinical care team. CONCLUSION The multidisciplinary transition clinic has shown to be beneficial in terms of improving glycemic control, maintaining continuity of care and clinic attendance.
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Affiliation(s)
- Wariya Wongyai
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Patchaya Boonchaya-Anant
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nitchakarn Laichuthai
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand.,Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Suphab Aroonparkmongkol
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Varaporn Veerapong
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Suwaputr Leepulsup
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Chantaporn Teeratongdee
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Nuntawan Anunapibut
- Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
| | - Taninee Sahakitrungruang
- Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Excellence Center for Diabetes, Hormone and Metabolism, King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand
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14
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Sattoe J, Peeters M, Bronner M, van Staa A. Transfer in care and diabetes distress in young adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/2/e002603. [PMID: 34969691 PMCID: PMC8719139 DOI: 10.1136/bmjdrc-2021-002603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diabetes distress (DD) is a serious problem in many people with diabetes and is associated with unfavorable clinical and psychosocial outcomes in children and adults. Little is known about DD in young adults (YAs) with type 1 diabetes mellitus (T1DM) who transferred to adult care. This study aimed to explore the differences between YAs with/without DD regarding transfer experiences, self-management and health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Cross-sectional online questionnaire completed by YAs with T1DM after transfer. DD was measured with the short-form Problem Areas in Diabetes scale. Descriptive analyses were followed by t-tests and χ2 tests to explore differences between the groups with/without DD. Effect sizes were calculated. RESULTS Of 164 respondents with mean age 22.7 (±1.56) years, 60.7% was female. The total sample scored low on DD (6.52±4.67; range: 0-17), but 57 (34.8%) had a score ≥8, indicating DD. YAs with DD felt less ready to transfer to adult care than those without DD and scored lower on alliance between pediatric and adult care and reception in adult care. They also reported poorer self-management skills and lower HRQoL in all domains of functioning. CONCLUSIONS More than one-third YAs experienced DD after transfer; this was associated with less favorable transition, self-management and psychosocial outcomes. Transfer in care seems to be a source of DD. Systematic screening on DD and attention for YAs' worries is recommended in both pediatric and adult care.
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Affiliation(s)
- Jane Sattoe
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Mariëlle Peeters
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Madelon Bronner
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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15
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Ingersgaard MV, Hoeeg D, Willaing I, Grabowski D. An exploratory study of how young people experience and perceive living with type 1 diabetes during late adolescence and emerging adulthood. Chronic Illn 2021; 17:475-492. [PMID: 31739683 DOI: 10.1177/1742395319886487] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Suboptimal glycemic control and psychosocial challenges are significant concerns for adolescents and emerging adults (collectively young people) with type 1 diabetes. Knowledge about young peoples' attitudes towards living with type 1 diabetes is inadequate, but the issue is important in the development of strategies to improve glycemic control and psychosocial well-being. This study explored young peoples' perceptions of living with type 1 diabetes. METHODS An exploratory, qualitative design was employed. Data were collected through five participatory workshops with 19 young people (age 15-25). Data were thematically analyzed. RESULTS The overall depiction of living with type 1 diabetes was paradoxical; it affected everything and nothing. Living with type 1 diabetes was a balancing act between accommodating a "normal" way of living and self-management tasks of the treatment regimen. Participants' perceptions reflected shifting accounts that could be divided into five themes: (1) special rules during youth, (2) striving for autonomy, (3) an uncertain future, (4) social support, and (5) stigma and disclosure. DISCUSSION It is important to probe for the multiple and interrelated social contexts that underlie young peoples' motives for adhering to and deviating from treatment regimens. Future studies should focus on relational aspects, including stigma mechanisms, the role of friends, and facilitation of balanced parental involvement.
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Affiliation(s)
| | | | | | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Health Promotion, Gentofte, Denmark
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16
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Pérez-Fernández A, Fernández-Berrocal P, Gutiérrez-Cobo MJ. The Relationship Between Emotional Intelligence and Diabetes Management: A Systematic Review. Front Psychol 2021; 12:754362. [PMID: 34803836 PMCID: PMC8599587 DOI: 10.3389/fpsyg.2021.754362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
Diabetes has been associated with affective disorders which complicate the management of the disease. Emotional intelligence (EI), or the ability to perceive, facilitate, understand, and regulate emotions, has shown to be a protective factor of emotional disorders in general population. The main objective of this study was to systematically review the role of the EI construct in Type 1 and Type 2 diabetics and to observe how EI is related to biological and psychological variables. Comprehensive searches were conducted in PubMed, Scopus, PsycInfo, and Cochrane without time limitations, for studies examining the link between diabetes and EI. A total of 12 eligible studies were selected according to the inclusion criteria. We divided the results into four sections: (1) EI and hemoglobin glycosylated (HbA1c), (2) EI training effects, (3) differences in EI between persons with diabetes and without diabetes, and (4) EI and psychological adjustment and well-being. The results showed negative correlations between EI and HbA1c, positive effects of EI training on quality of life, anxiety, and glycemic control, no differences in EI between people with diabetes and healthy individuals, and, finally, negative correlations between EI and different psychological variables such as diabetes-related anxiety and distress, and positive correlations with quality of life, well-being, and marital satisfaction. This systematic review offers a starting point for a theoretical and practical understanding of the role played by EI in the management of diabetes and reveals that EI is a promising protective factor for biological and psychological variables in this population.
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Affiliation(s)
- Aida Pérez-Fernández
- Department of Basic Psychology, Faculty of Psychology, University of Málaga, Málaga, Spain
| | | | - María José Gutiérrez-Cobo
- Department of Developmental and Educational Psychology, Faculty of Psychology, University of Málaga, Málaga, Spain
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17
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Garcia JF, Fogel J, Reid M, Bisno DI, Raymond JK. Telehealth for Young Adults With Diabetes: Addressing Social Determinants of Health. Diabetes Spectr 2021; 34:357-362. [PMID: 34866868 PMCID: PMC8603121 DOI: 10.2337/dsi21-0011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Type 1 diabetes is a challenging chronic condition and can lead to diabetes-related distress and disengagement. Historically disadvantaged, racially and ethnically diverse young adults (YAs) with type 1 diabetes experience higher blood glucose levels and encounter more barriers to care than their White counterparts. Current research shows that telehealth may provide a route for improving psychosocial issues and diabetes care among YAs.
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Affiliation(s)
| | - Jennifer Fogel
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Mark Reid
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
| | - Daniel I. Bisno
- Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | - Jennifer K. Raymond
- Children’s Hospital Los Angeles, University of Southern California, Los Angeles, CA
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18
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Pierce JS. Meeting the Psychosocial Needs of Young Adults With Diabetes in the Clinic and Beyond: Preface. Diabetes Spectr 2021; 34:324-326. [PMID: 34866863 PMCID: PMC8603132 DOI: 10.2337/dsi21-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Carreon SA, Duran B, Tang TS, Streisand R, Anderson BJ, Lyons SK, McKay S, Hilliard ME. Here for You: A Review of Social Support Research in Young Adults With Diabetes. Diabetes Spectr 2021; 34:363-370. [PMID: 34866869 PMCID: PMC8603130 DOI: 10.2337/dsi21-0013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living with and managing diabetes is challenging during young adulthood, and social support may help relieve or minimize the burdens young adults with diabetes experience. This article reviews the types and sources of support young adults with diabetes receive and their associations with behavioral, psychosocial, and glycemic outcomes. Intervention research integrating social support and future directions for care are discussed.
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Affiliation(s)
| | - Brenda Duran
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Tricia S. Tang
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Randi Streisand
- Children’s National Hospital, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | - Sarah K. Lyons
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Siripoom McKay
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
| | - Marisa E. Hilliard
- Baylor College of Medicine & Texas Children’s Hospital, Houston, TX
- Corresponding author: Marisa E. Hilliard,
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20
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Morrissey EC, Casey B, Hynes L, Dinneen SF, Byrne M. Supporting self-management and clinic attendance in young adults with type 1 diabetes: development of the D1 Now intervention. Pilot Feasibility Stud 2021; 7:186. [PMID: 34641975 PMCID: PMC8513171 DOI: 10.1186/s40814-021-00922-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 09/29/2021] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Self-management of type 1 diabetes (T1D) is complex and can be particularly challenging for young adults. This is reflected in the high blood glucose values and rates of clinic non-attendance in this group. There is a gap for a theory-based intervention informed by key stakeholder opinions to support and improve self-management in young adults with T1D. PURPOSE The aim of the work was to systematically co-develop an evidence-based and stakeholder-led intervention to support self-management and clinic engagement in young adults living with T1D in Ireland. Co-development was led by the Young Adult Panel. METHODS The Behaviour Change Wheel was used to guide the development. Five evidence sources were used to inform the process. An iterative co-design process was used with the Young Adult Panel. Initial intervention components were refined and feasibility tested using qualitative methods. RESULTS Environmental restructuring, education and training were selected as appropriate intervention functions. The co-design process, along with qualitative refinement and feasibility work, led to the final intervention content which consisted of 17 behaviour change techniques. The final D1 Now intervention consists of three components: a support worker, an agenda setting tool and an interactive messaging service. CONCLUSIONS The D1 Now intervention is now at pilot evaluation stage. Its transparent and systematic development will facilitate evaluation and future replications.
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Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland.
- School of Medicine, National University of Ireland, Galway, Ireland.
| | - Bláthín Casey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- Health Research Institute, University of Limerick, Limerick, Ireland
| | - Lisa Hynes
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
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21
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Barakat C, Yousufzai SJ, Booth A, Benova L. Prevalence of and risk factors for diabetes mellitus in the school-attending adolescent population of the United Arab Emirates: a large cross-sectional study. BMJ Open 2021; 11:e046956. [PMID: 34526335 PMCID: PMC8444241 DOI: 10.1136/bmjopen-2020-046956] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES The prevalence of diabetes has reportedly increased among adolescents in low-income and middle-income countries of the Middle East and may be linked to social, demographic and economic contextual factors. This study aimed: (1) to estimate the prevalence of self-reported diagnosis of diabetes in the adolescent population of the United Arab Emirates (UAE); (2) to assess differences in the prevalence based on gender and (3) to identify other characteristics of those with diabetes including parental marital status, smoking/illegal drug use, quality of life and nationality. DESIGN A secondary data analysis was performed on data from the National Study of Population Health in the UAE, conducted between 2007 and 2009. SETTING Large cross-sectional population-based survey study. PARTICIPANTS Survey was administered to a stratified random sample of 151 public and private schools from the UAE, across 7 emirates. 6365 school-attending adolescents (12-22 years; mean=16 years) participated. OUTCOMES Multivariable logistic regression analysis was used to examine the relationships between diabetes diagnosis and characteristics of participants after adjusting for confounding from other predictors. RESULTS The overall prevalence of self-reported diabetes was 0.9% (95% CI 0.7% to 1.2%) and was higher in males 1.5% (95% CI 1.0% to 2.1%) than females 0.5% (95% CI 0.3% to 0.8%), (p<0.001). Children of parents who were not currently married had more than twice the odds of self-reporting diabetes (p=0.031) compared with those with married parents. Adolescents who reported ever smoking/using illegal drugs had more than three times the odds of diabetes (p<0.001). CONCLUSION We found a positive association between certain characteristics of adolescents and their diabetes status, including male gender, parental marital status and smoking/illegal drug use. The high prevalence of smoking/illegal drug use among those reporting a diagnosis of diabetes suggests the need for behavioural and mental health interventions for adolescents with diabetes, as well as strong parental support and involvement.
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Affiliation(s)
- Caroline Barakat
- Faculty of Health Science, Ontario Tech University, Oshawa, Ontario, Canada
| | | | - Alison Booth
- London School of Hygiene and Tropical Medicine Faculty of Epidemiology and Population Health, London, UK
| | - Lenka Benova
- Department of Public Health, Institute of Tropical Medicine, Antwerpen, Belgium
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22
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Sullivan-Myers C, Sherman KA, Beath AP, Duckworth TJ, Cooper MJW. Delineating sociodemographic, medical and quality of life factors associated with psychological distress in individuals with endometriosis. Hum Reprod 2021; 36:2170-2180. [PMID: 34166496 DOI: 10.1093/humrep/deab138] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/26/2021] [Indexed: 12/23/2022] Open
Abstract
STUDY QUESTION What is the relationship between specific quality of life domains and depression, anxiety and stress in the endometriosis population? SUMMARY ANSWER Psychosocial domains of quality of life, such as a perception of social support and self-image, are more strongly associated with depression, anxiety and stress than pain and medical factors. WHAT IS KNOWN ALREADY Prior research indicates a high prevalence of anxiety and depression in individuals with endometriosis. Pain is thought to be critical in the development of psychological distress, however prior research has investigated this association without consideration of psychosocial quality of life domains such as social functioning, perceived social support and self-image. STUDY DESIGN, SIZE, DURATION This study is a cross-sectional analysis of baseline data collected in a longitudinal study exploring psychological distress in endometriosis (n = 584). PARTICIPANTS/MATERIALS, SETTING, METHODS Individuals living with endometriosis participated in this study and were recruited via online platforms of community organizations and support groups. Demographic and medical information concerning endometriosis treatment and diagnosis was self-reported. Psychological distress and quality of life was measured using the Depression, Anxiety and Stress Scale (DASS-21), Endometriosis Health Profile-30 (EHP-30) and the Short Form Survey (SF-36v2). A series of linear regression analyses explored the relationship between specific quality of life domains and the primary outcomes of depression, anxiety and stress. MAIN RESULTS AND THE ROLE OF CHANCE Approximately half of the participants in this sample reported moderate to severe anxiety, depression and stress. Quality of life domains, particularly perceived social support, social functioning and self-image, were more strongly associated with psychological distress than medical or demographic factors. Pain was associated with anxiety, but not depression or stress. A greater number of endometriosis symptoms was only associated with depression. LIMITATIONS, REASONS FOR CAUTION These data are cross-sectional and, therefore, causality cannot be inferred from this analysis. Information about endometriosis diagnosis and treatment was self-reported, and not verified against medical records. WIDER IMPLICATIONS OF THE FINDINGS This study indicates that psychosocial factors may be more salient factors underlying depression, anxiety and stress in the endometriosis population than pain and medical factors. There is a need for interventions that target psychological distress in this population with a focus on the broader impact of endometriosis beyond pain and physical symptomatology. STUDY FUNDING/COMPETING INTEREST(S) This research was supported by the Research Training Program (RTP) Scholarship awarded to C.S.M. by Macquarie University. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER ACTRN12619001508167.
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Affiliation(s)
- C Sullivan-Myers
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - K A Sherman
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - A P Beath
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, NSW, Australia
| | - T J Duckworth
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Camperdown, NSW, Australia.,Applied Cognition and Experimental Psychology (ACEP) Research Group, Faculty of Health and Medical Sciences, School of Psychology, The University of Adelaide, Adelaide, SA, Australia
| | - M J W Cooper
- Department of Obstetrics and Gynaecology, The University of Sydney, Sydney, NSW, Australia
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23
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Jurgen B, Baker CN, Kamps JL, Hempe JM, Chalew SA. Associations Between Depressive Symptoms, Fear of Hypoglycemia, Adherence to Management Behaviors and Metabolic Control in Children and Adolescents with Type 1 Diabetes. J Clin Psychol Med Settings 2021; 27:385-395. [PMID: 31728880 DOI: 10.1007/s10880-019-09676-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined the relationship between two malleable risk factors, depressive symptoms and fear of hypoglycemia, in children and adolescents with Type 1 diabetes and their relationship to two important outcomes, adherence behaviors and metabolic control. To assess this relationship, we used a multidimensional measure of adherence, assessing frequency of both blood glucose monitoring and healthy behaviors including diet and exercise. We predicted that higher levels of depressive symptoms and higher levels of fear of hypoglycemia would be associated with worse metabolic control as mediated by poor adherence. Eighty-three children and adolescents ages 8 to 20 (M = 13.87, SD 3.21) were recruited from March 2014 to October 2014 at an outpatient diabetes clinic in a moderately sized Southeastern city within the USA. Nested models were evaluated using structural equation modeling. Adherence significantly mediated the relationship between depressive symptoms and metabolic control with more depressive symptoms leading to worse metabolic control. Adherence marginally mediated the relationship between fear of hypoglycemia and metabolic control; however, less fear of hypoglycemia was associated with worse metabolic control. In a combined model, adherence continued to significantly mediate the relationship between depressive symptoms and metabolic control, while also independently significantly mediating the relationship between fear of hypoglycemia and metabolic control. This finding was also contrary to the predicted relationship with less fear of hypoglycemia leading to worse metabolic control. The results indicate that youth with fewer depressive symptoms and more fear of hypoglycemia had better adherence to their treatment regimen, which was associated with better metabolic control. The results of this study highlight the importance of screening for depression and fear of hypoglycemia during routine clinic visits to optimize adherence and metabolic control.
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Affiliation(s)
- Brittney Jurgen
- Department of Psychology, Tulane University, New Orleans, LA, USA. .,, Boston, USA.
| | - Courtney N Baker
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Jodi L Kamps
- Department of Psychology, Children's Hospital of New Orleans, New Orleans, LA, USA.,Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Research Institute for Children, Children's Hospital, New Orleans, LA, USA
| | - Stuart A Chalew
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, LA, USA
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Nicholas JA, Yeap BB, Cross D, Burkhardt MS. Psychological flexibility is associated with less diabetes distress and lower glycated haemoglobin in adults with type 1 diabetes. Intern Med J 2021; 52:952-958. [PMID: 33646630 DOI: 10.1111/imj.15250] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 02/17/2021] [Accepted: 02/21/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Diabetes distress, self-efficacy and health literacy are associated with diabetes self-management and health outcomes. Measures of coping styles and their impact on diabetes self-management and diabetes-related distress may add value in identifying those at risk of poorer health outcomes. Current evidence of associations between psychological flexibility/inflexibility and diabetes related health outcomes is limited. AIMS To measure associations of psychological flexibility, self-efficacy and health literacy with diabetes distress and HbA1c, in adults with type 1 diabetes. METHODS We surveyed 105 adults with type 1 diabetes attending a tertiary diabetes outpatient clinic (mean age 27±7.1 years, 53% men, duration of diabetes 12.6±8.5 years, HbA1c 72±22 mmol/mol, 8.7± 2.0 %, 34% using insulin pumps). We assessed psychological flexibility, self-efficacy, health literacy and diabetes distress. Regression models explored the relative contributions of different factors to diabetes distress and HbA1c. RESULTS The majority of health literacy scores were in the low risk range. Those with greater psychological flexibility had higher self-efficacy (r=0.34, p<0.01) and reported less diabetes distress (r=-0.54, p<0.001). In multiple regression analyses, psychological flexibility and self-efficacy accounted for 36% of the variance in distress score (p<0.001). Shorter duration of diabetes (p<0.001) and greater psychological flexibility (p<0.01) correlated with lower HbA1c . A 10-point (one standard deviation) higher psychological flexibility score corresponded to a 0.5% lower HbA1c. CONCLUSIONS Greater psychological flexibility was associated with less diabetes distress and lower HbA1c. The psychological flexibility construct may inform alternative interventional approaches aiming to improve wellbeing and glycaemic control. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Jennifer A Nicholas
- Medical School, University of Western Australia, Perth, Western Australia, Australia
| | - Bu B Yeap
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia
| | - Donna Cross
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Telethon Kids Institute, Perth, Western Australia, Australia
| | - Melanie S Burkhardt
- Medical School, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia.,Department of Clinical Psychology and Clinical Neuropsychology, Fiona Stanley Fremantle Hospitals Group, Perth, Western Australia, Australia
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25
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Pals RAS, Coyne I, Skinner T, Grabowski D. A delicate balance between control and flexibility: Experiences of care and support among pre-teenage children with type 1 diabetes and their families. SOCIOLOGY OF HEALTH & ILLNESS 2021; 43:369-391. [PMID: 33338277 DOI: 10.1111/1467-9566.13223] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 09/20/2020] [Accepted: 11/03/2020] [Indexed: 06/12/2023]
Abstract
For children with type 1 diabetes, the period of adolescence is associated with higher blood glucose levels and increased psychological distress compared to other age groups. Focusing on pre-teens (9-12 years) with type 1 diabetes and their families has been suggested as key to understanding and reducing these challenges. The aim of this study was to explore: 1, how diabetes affects family life, 2, experiences of and needs for support and 3, how care responsibilities are negotiated among pre-teens with type 1 diabetes and their families. Data were obtained from four interactive workshops with pre-teens (n = 17), their parents (n = 26) and their siblings (n = 14). Dialogue tools, for example quotes and picture cards, were used to facilitate discussion and reflection concerning family life with type 1 diabetes. Data analysis resulted in three themes: 1, diabetes takes up 'a lot of space', 2, giving and receiving support and 3, balancing control and flexibility. While diabetes took up significant space in the families, family members protected each other from their respective frustrations. The findings point to the significance of considering all key family members and their interactions in diabetes interventions. This includes balancing control and flexibility, negotiating responsibilities and building trust.
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Affiliation(s)
- Regitze Anne Saurbrey Pals
- Steno Diabetes Center Copenhagen, Gentofte, Denmark
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Timothy Skinner
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
- Department of Rural Health, La Trobe University, Bendigo, Victoria, Australia
- Department of Rural Health, The Australian Centre for Behavioural Research in Diabetes, Melbourne, Victoria, Australia
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26
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Lowry M, Morrissey EC, Dinneen SF. Piloting an Intervention to Improve Outcomes in Young Adults Living With Type 1 Diabetes: The Experience of the D1 Now Support Worker. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2021; 2:799589. [PMID: 36994338 PMCID: PMC10012156 DOI: 10.3389/fcdhc.2021.799589] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/17/2021] [Indexed: 11/13/2022]
Abstract
Introduction D1 Now is a novel intervention which aims to support self-management and clinic engagement and improve outcomes in young adults (18-25 years) living with type 1 diabetes in Ireland. It has been developed using a systematic, theoretical, user-centred approach. The specific role of the Support Worker, one of three components of the D1 Now intervention, was developed to provide continuity and build relationships between young adults and their diabetes team. Methods A Support Worker - an Occupational Therapist, who had a background in youth mental health - was hired as part of the D1 Now pilot randomised controlled trial and was based in one intervention site to join the existing diabetes team. Discussion The Support Worker aimed to provide an accessible and consistent point of contact for young adults, facilitated conversations about distress, and encouraged graded goal setting and collaborative problem solving. The role afforded her with a unique window into the lived experiences of young adults with type 1 diabetes where she observed the ongoing negotiation of life and living alongside diabetes care and management. The prevalence of diabetes distress was high in the study cohort with particular challenges associated with 'all or nothing' thinking patterns as well as disordered eating behaviours. The Support Worker also played an advocacy role in supporting the diabetes team's awareness of young adults' needs and explored current barriers to care. Preliminary findings from the D1 Now pilot have identified that the role of the Support Worker was viewed positively from the perspective of young adults with type 1 diabetes.
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Affiliation(s)
- Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Ireland
| | - Eimear C. Morrissey
- School of Medicine, National University of Ireland, Galway, Ireland
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Sean F. Dinneen
- School of Medicine, National University of Ireland, Galway, Ireland
- Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
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27
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Zhu L, Chandran SR, Tan WB, Xin X, Goh SY, Gardner DSL. Persistent Anxiety Is Associated with Higher Glycemia Post-Transition to Adult Services in Asian Young Adults with Diabetes. Diabetes Metab J 2021; 45:67-76. [PMID: 32602276 PMCID: PMC7850875 DOI: 10.4093/dmj.2019.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is little longitudinal information on psychological burden and metabolic outcomes in young adults with diabetes (YAD) in Asia. We aimed to evaluate the association between psychological status and glycemia at baseline and 2 years following transition in a cohort of YAD in Singapore. METHODS Subjects with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), aged 17 to 25 years, were recruited from the YAD clinic in Singapore General Hospital. The Hospital Anxiety and Depression and Problem Areas for Diabetes scales were administered at transition (baseline) and at 18 to 24 months. Glycosylated hemoglobin (HbA1c) assessed during routine visits was tracked longitudinally. RESULTS A total of 98 T1DM (74.8%) and 33 T2DM (25.2%) subjects were recruited between January 2011 and November 2017. At baseline, mean HbA1c was 8.6%±1.7%. Only 26.0% achieved HbA1c of ≤7.5% and 16.8% achieved HbA1c of <7%. At baseline, prevalence of anxiety was 29.8%. At 24 months, 14.1% had persistent anxiety. Those with persistent anxiety had the highest mean HbA1c, particularly at 6 months (persistently anxious vs. persistently non-anxious: 9.9%±1.2% vs. 8.2%±1.9%, P=0.009). At baseline, 9.2% of subjects had depression. This group also had poorer glycemia at baseline (HbA1c of depressed vs non-depressed: 9.6%±2.1% vs. 8.5%±1.6%, P=0.04), which persisted up to 24 months. CONCLUSION The majority of YAD in Singapore have suboptimal glycemia. Psychological distress is a critical harbinger of poorer metabolic outcomes.
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Affiliation(s)
- Ling Zhu
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | - Wee Boon Tan
- Academic Clinical Program, Division of Medicine, Singapore General Hospital, Singapore
| | - Xiaohui Xin
- Academic Clinical Program, Division of Medicine, Singapore General Hospital, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
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28
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Hackworth NJ, Hamilton VE, Moore SM, Northam EA, Bucalo Z, Cameron FJ. Predictors of Diabetes Self‐care, Metabolic Control, and Mental Health in Youth with Type 1 Diabetes. AUSTRALIAN PSYCHOLOGIST 2020. [DOI: 10.1111/ap.12007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Affiliation(s)
- Naomi J Hackworth
- Parenting Research Centre,
- Faculty of Life and Social Sciences, Swinburne University of Technology,
| | - Victoria E Hamilton
- Parenting Research Centre,
- Faculty of Life and Social Sciences, Swinburne University of Technology,
| | - Susan M Moore
- Faculty of Life and Social Sciences, Swinburne University of Technology,
| | - Elisabeth A Northam
- Hormone Research, Murdoch Children's Research Institute,
- Department of Psychology, Royal Children's Hospital,
- School of Psychology, University of Melbourne,
| | | | - Fergus J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital,
- Murdoch Children's Research Institute,
- Department of Pediatrics, University of Melbourne,
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29
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McDowell ME, Litchman ML, Guo JW. The transition experiences of adolescents with type 1 diabetes from paediatric to adult care providers. Child Care Health Dev 2020; 46:692-702. [PMID: 32697881 DOI: 10.1111/cch.12798] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 06/14/2020] [Accepted: 07/13/2020] [Indexed: 12/12/2022]
Abstract
PURPOSE Emerging adults with type 1 diabetes (T1D) are at increased risk for poor health outcomes as they transition from paediatric to adult healthcare providers. This is in part due to the complexities of young adult life as individuals with T1D enter the workforce, leave home or start college while learning to manage the disease on their own. We sought to identify the barriers and facilitators adolescents face during their emerging adult years with T1D. METHODS Young adults, aged 24-35, who lived with T1D during their adolescent years were recruited online to complete a survey regarding their experience with care transition. Categorical data were analysed using descriptive statistics. A thematic analysis, guided by the Framework for Emerging Adults with T1D, was used to explore the free-text data. RESULTS In total, 25 adults (84% female) with mean age of 28 ± 3.2 years participated. Themes that arose from the analysis of the paediatric to adult care transition experiences included (1) importance of support from key players, (2) challenges navigating the healthcare system, (3) mental health needs of emerging adults with T1D, (4) managing day-to-day life with T1D and (5) early independence to ease transition. CONCLUSION Individuals with T1D face a variety of challenges as they transition from paediatric to adult care providers. A proactive approach in educating adolescents is needed.
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Affiliation(s)
- Megan E McDowell
- Department of Pediatrics, School of Medicine, University of Utah, Salt Lake City, Utah, USA.,College of Nursing, University of Utah, Salt Lake City, Utah, USA
| | - Michelle L Litchman
- College of Nursing, University of Utah, Salt Lake City, Utah, USA.,University of Utah Health, Utah Diabetes and Endocrinology Center, Salt Lake City, Utah, USA
| | - Jia-Wen Guo
- College of Nursing, University of Utah, Salt Lake City, Utah, USA
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30
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Kim AR, Sin JE. Genetic and environmental contributions to psychopathological symptoms in adulthood: Clarifying the role of individual and parental risk factors. Asian J Psychiatr 2020; 53:102195. [PMID: 32563947 DOI: 10.1016/j.ajp.2020.102195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 04/27/2020] [Accepted: 06/02/2020] [Indexed: 10/24/2022]
Abstract
Psychopathology-related suicide attempts and deaths are increasing, and the research focus remains on mental disorder in childhood and adolescence. We examined the genetic and environmental contributions to internalizing, externalizing, and general psychopathological distress to clarify the role of individual/parental risk factors for suicide in young adults. Data from 1206 young adults were obtained from a publicly available dataset from the Human Connectome Project. Heritability estimates were analyzed by twin modelling using OpenMx and data from a subsample of 402 monozygotic and dizygotic twins. The estimated prevalence of psychopathological symptoms ranged from 9 to 16%. The heritability of internalizing, externalizing, and general psychopathological distress reached significance, with estimates ranging from 22 to 46%. Shared (common) environments contributed to aggressive behavior (30 %). Determining factors for psychopathological distress (internalizing, externalizing, general) were evaluated using logistic regression analysis. Household income (<$50,000), childhood conduct problems, and maternal drug or alcohol problems were common risk factors of internalizing, externalizing, and general psychopathological distress. Marijuana dependence and maternal anxiety were additional risk factors of externalizing distress. The presence of alcohol and maternal drug or alcohol problems was linked to general psychopathological distress. The results highlight risk factors associated with psychopathological symptoms that should be considered in the early detection of high-risk groups and implementation of family-based interventions. Providing continuous care and/or follow-up in at-risk children and young adults may improve mental health and well-being.
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Affiliation(s)
- Ah Rim Kim
- Department of Nursing, Far East University, 76-32 Daehak-gil, Gamgok-myeon, Eumseong-gun, Chungbuk, 27601, Republic of Korea.
| | - Jae Eun Sin
- Division of Cancer Control & Policy, National Cancer Control Institute, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang, Gyeonggi-do, 10408, Republic of Korea.
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31
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Johansen CB, Rothmann MJ, Andersen A, Beck-Nielsen H, Pouwer F. The role of parental support for emerging adults with type 1 diabetes: A scoping review. Pediatr Diabetes 2020; 21:995-1030. [PMID: 32301182 DOI: 10.1111/pedi.13022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging adults with type 1 diabetes often have poor diabetes self-care and pose a considerable therapeutic challenge. They simultaneously handle a life phase characterized by instability, identity exploration, and transitions and manage a chronic illness that demands structure, self-discipline, and repeated health care contacts. Relation to parents is often ambivalent but typically remains the most stable social support, so parental support could potentially be helpful for diabetes self-care and wellbeing. METHOD This scoping review aimed to identify, summarize and analyze empirical studies (for instance interview studies, questionnaire studies and intervention studies) exploring parental support for emerging adults with type 1 diabetes. Studies were identified in PsycInfo, PubMed, Scopus, and Google Scholar. Data were extracted by one author and checked by another. Study results were synthesized by a convergent mixed methods approach and qualitative thematic analysis. RESULTS We included 26 studies (2829 participants), 16 interview studies, 10 questionnaire studies, and no intervention studies. Five overarching themes were identified: self-care and glycemic control, diabetes-related emotional wellbeing, support characteristics, ambivalence and harms, and core support providers. Parents tended to contribute positively to diabetes self-care, glycemic control, and psychological wellbeing. However, emerging adults did not want to be too dependent on their parents and family, and family could also act unsupportively; when absent, disinterested in diabetes or controlling. CONCLUSION This review underlines that parental support still plays a role for diabetes self-care and wellbeing in emerging adults with type 1 diabetes. Age-appropriate parental support therefore seems a promising path to investigate further.
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Affiliation(s)
- Clea Bruun Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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32
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Anderzén J, Hermann JM, Samuelsson U, Charalampopoulos D, Svensson J, Skrivarhaug T, Fröhlich-Reiterer E, Maahs DM, Akesson K, Kapellen T, Fritsch M, Birkebaek NH, Drivvoll AK, Miller K, Stephenson T, Hofer SE, Fredheim S, Kummernes SJ, Foster N, Amin R, Hilgard D, Rami-Merhar B, Dahl-Jørgensen K, Clements M, Hanas R, Holl RW, Warner JT. International benchmarking in type 1 diabetes: Large difference in childhood HbA1c between eight high-income countries but similar rise during adolescence-A quality registry study. Pediatr Diabetes 2020; 21:621-627. [PMID: 32249476 DOI: 10.1111/pedi.13014] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Revised: 03/24/2020] [Accepted: 03/29/2020] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES To identify differences and similarities in HbA1c levels and patterns regarding age and gender in eight high-income countries. SUBJECTS 66 071 children and adolescents below18 years of age with type 1 diabetes for at least 3 months and at least one HbA1c measurement during the study period. METHODS Pediatric Diabetes Quality Registry data from Austria, Denmark, England, Germany, Norway, Sweden, the United States, and Wales were collected between 2013 and 2014. HbA1c, gender, age, and duration were used in the analysis. RESULTS Distribution of gender and age groups was similar in the eight participating countries. The mean HbA1c varied from 60 to 73 mmol/mol (7.6%-8.8%) between the countries. The increase in HbA1c between the youngest (0-9 years) to the oldest (15-17 years) age group was close to 8 mmol/mol (0.7%) in all countries (P < .001). Females had a 1 mmol/mol (0.1%) higher mean HbA1c than boys (P < .001) in seven out of eight countries. CONCLUSIONS In spite of large differences in the mean HbA1c between countries, a remarkable similarity in the increase of HbA1c from childhood to adolescence was found.
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Affiliation(s)
- Johan Anderzén
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden
| | - Julia M Hermann
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Ulf Samuelsson
- Department of Clinical and Experimental Medicine, Division of Paediatrics and Diabetes, Research Centre, Linköping University Hospital, Linköping, Sweden
| | | | - Jannet Svensson
- Paediatric Department, CPH-Direct, Herlev University Hospital, Herlev, Denmark
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | | | - David M Maahs
- Division of Pediatric Endocrinology and Stanford Diabetes Research Center, Stanford, California, USA
| | - Karin Akesson
- Department of Paediatrics, County Hospital Ryhov, Jönköping, Sweden.,Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | | | - Maria Fritsch
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Niels H Birkebaek
- Department of Paediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Ann K Drivvoll
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kellee Miller
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Terence Stephenson
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Sabine E Hofer
- Department of Paediatrics, Medical University of Innsbruck, Innsbruck, Austria
| | - Siri Fredheim
- Paediatric Department, CPH-Direct, Herlev University Hospital, Herlev, Denmark
| | - Siv J Kummernes
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nicole Foster
- Jaeb Center for Health Research, Tampa, Florida, USA
| | - Rakesh Amin
- Great Ormond Street Institute of Child Health, University College London, London, UK
| | | | - Birgit Rami-Merhar
- Department of Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Knut Dahl-Jørgensen
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mark Clements
- Children's Mercy Hospital, Kansas City, Missouri, USA.,University of Missouri, Kansas City, Missouri, USA.,University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ragnar Hanas
- Department of Paediatrics, NU Hospital Group, Uddevalla, Sweden and the Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Justin T Warner
- Department of Paediatric Endocrinology and Diabetes, Children's Hospital for Wales, Cardiff, UK
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33
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Morrissey EC, Casey B, Dinneen SF, Lowry M, Byrne M. Diabetes Distress in Adolescents and Young Adults Living With Type 1 Diabetes. Can J Diabetes 2020; 44:537-540. [PMID: 32507646 DOI: 10.1016/j.jcjd.2020.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 03/05/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Eimear C Morrissey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Galway, Ireland; School of Nursing and Midwifery, National University of Ireland, Galway, Galway, Ireland.
| | - Blathin Casey
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland; School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Sean F Dinneen
- School of Medicine, National University of Ireland, Galway, Galway, Ireland; Centre for Diabetes, Endocrinology and Metabolism, Galway University Hospitals, Galway, Ireland
| | - Michelle Lowry
- School of Medicine, National University of Ireland, Galway, Galway, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Galway, Ireland
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34
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Wong SKW, Smith HE, Chua JJS, Griva K, Cartwright EJ, Soong AJ, Dalan R, Tudor Car L. Effectiveness of self-management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta-analysis. Diabet Med 2020; 37:229-241. [PMID: 31769532 DOI: 10.1111/dme.14190] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
AIM Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes. METHODS We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). RESULTS In total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between self-management interventions and controls in post-intervention HbA1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision. CONCLUSIONS Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes.
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Affiliation(s)
- S K W Wong
- Lee Kong Chian School of Medicine, Singapore
- National Healthcare Group Polyclinics, Singapore
| | - H E Smith
- Lee Kong Chian School of Medicine, Singapore
| | - J J S Chua
- Lee Kong Chian School of Medicine, Singapore
| | - K Griva
- Lee Kong Chian School of Medicine, Singapore
| | | | - A J Soong
- Lee Kong Chian School of Medicine, Singapore
| | - R Dalan
- Lee Kong Chian School of Medicine, Singapore
- Tan Tock Seng Hospital, Singapore
| | - L Tudor Car
- Lee Kong Chian School of Medicine, Singapore
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35
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Al Hayek AA, Al Dawish MA. The Potential Impact of the FreeStyle Libre Flash Glucose Monitoring System on Mental Well-Being and Treatment Satisfaction in Patients with Type 1 Diabetes: A Prospective Study. Diabetes Ther 2019; 10:1239-1248. [PMID: 31066017 PMCID: PMC6612356 DOI: 10.1007/s13300-019-0616-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION This study assessed the treatment satisfaction and sense of well-being attained when patients with type 1 diabetes use the FreeStyle Libre flash glucose monitoring system (FSL; Abbott Diabetes Care, Inc., Alameda, CA, USA). METHODS A 12-week prospective study was conducted from January 2018 to May 2018 at the Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia. Study participants (aged 14-21 years) were treated for type 1 diabetes with an insulin pump (IP) (n = 10) or multiple dose injections (MDI) (n = 23), and used the conventional finger-pricking method for glucose self-testing. At the baseline visit, FSL sensors were placed on each participant by a trained diabetes educator. At baseline and 12 weeks, a trained interviewer administered the Arabic version of the Diabetes Treatment Satisfaction Questionnaire (DTSQ) and the WHO-5 Well-Being Index (WHO-5) (1998 version) questionnaire. RESULTS As compared with the baseline, positive differences were found after 12 weeks of FSL use for all of the items in the DTSQ (p < 0.001) and the WHO-5 questionnaire (p < 0.001). The overall score for the DTSQ improved from a mean (SD) of 14.4 ± 6.5 at baseline to 32.1 ± 1.8 at 12 weeks. For the WHO-5 questionnaire, the overall well-being percentage score improved from 45.1% at baseline to 93.6% at 12 weeks (p < 0.001). CONCLUSION Use of the FSL along with IP or MDI led to higher treatment satisfaction and a greater sense of mental well-being compared with the baseline conventional finger-pricking method. FUNDING No funding or sponsorship was received for this study. The article processing charges were funded by Abbott Diabetes Care.
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Affiliation(s)
- Ayman A Al Hayek
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia.
| | - Mohamed A Al Dawish
- Department of Endocrinology and Diabetes, Diabetes Treatment Center, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
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Shen X, Shen X. The Role of Occupational Therapy in Secondary Prevention of Diabetes. Int J Endocrinol 2019; 2019:3424727. [PMID: 31428147 PMCID: PMC6681589 DOI: 10.1155/2019/3424727] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Accepted: 06/28/2019] [Indexed: 01/23/2023] Open
Abstract
Diabetes mellitus is becoming a global health concern due to its prevalence and projected growth. Despite a growing number of interventions for secondary prevention of diabetes, there is a persistent poor glycemic control and poor adherence to the prescribed diabetes management regimen. In light of the tremendous costs of diabetes to both individuals and the society, it is pressing to find effective ways to improve diabetes self-management (DSM) and treatment adherence. Occupational therapists can bring values to the diabetes care team by evaluating multiple levels of influence on DSM, addressing personal and environmental barriers to well-being and DSM, and supporting patients to develop of a highly complex competences and skills to satisfactorily self-manage diabetes. This article summarizes two evidence-based, well-structured occupational therapy (OT) programs that use activity-based treatments and psychosocial strategies, respectively, to improve DSM abilities and to enhance quality of life. As the needs of adolescents with diabetes are quite different from other diabetic populations, this article also provides a summary of pediatric OT interventions that aim to facilitate autonomy and development of DSM ability among adolescents with diabetes. Evidence indicates that OT interventions can improve the quality of life and treatment adherence in patients with diabetes and hence should be continued and built on to address the increasing needs of diabetic populations.
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Affiliation(s)
- Xizi Shen
- Schools of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Xingping Shen
- Department of Endocrinology, Zhongshan Hospital Xiamen University, Xiamen, Fujian, China
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Bakhach M, Reid MW, Pyatak EA, Berget C, Cain C, Thomas JF, Klingensmith GJ, Raymond JK. Home Telemedicine (CoYoT1 Clinic): A Novel Approach to Improve Psychosocial Outcomes in Young Adults With Diabetes. DIABETES EDUCATOR 2019; 45:420-430. [PMID: 31244396 DOI: 10.1177/0145721719858080] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To assess the impact of a home telemedicine clinic model (CoYoT1 Clinic) on psychosocial and behavioral outcomes designed for young adults (YAs) with type 1 diabetes (T1D). METHODS YAs self-selected to participate in the CoYoT1 Clinic or serve as a usual care control. CoYoT1 Clinic visits consisted of an individual appointment with a provider and a group appointment with other YAs with T1D using home telemedicine. Psychosocial and behavioral functioning was assessed by 4 measures: Diabetes Distress Scale, Self-Efficacy for Diabetes Scale, Self-Management of Type 1 Diabetes in Adolescence Scale, and Center for Epidemiologic Studies Depression Scale. RESULTS Forty-two patients participated in the CoYoT1 Clinic and 39 patients served as controls. CoYoT1 participants reported lower levels of distress (P = .03), increased diabetes self-efficacy (P = .01), and improved ability to communicate with others about diabetes (P = .04) over the study period compared to controls. YA males in the control group reported increases in depressive symptoms (P = .03) during the study period, but CoYoT1 participants showed no changes. CONCLUSION Group home telemedicine for YAs with T1D positively affects diabetes distress, self-efficacy, and diabetes-specific communication. These positive findings have the potential to also affect the YAs' long-term diabetes outcomes. Further investigation of the model is needed.
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Affiliation(s)
- Marwan Bakhach
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Mark W Reid
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, California
| | - Cari Berget
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Cindy Cain
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - John Fred Thomas
- Department of Telehealth, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Psychiatry, School of Medicine, University of Colorado, Aurora, Colorado.,Department of Epidemiology, School of Public Health, University of Colorado, Aurora, Colorado
| | - Georgeanna J Klingensmith
- Barbara Davis Center for Diabetes, University of Colorado, Department of Pediatrics, Anschutz Medical Campus, Aurora, Colorado
| | - Jennifer K Raymond
- Children's Hospital Los Angeles, University of Southern California, Keck School of Medicine, Los Angeles, California
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Højen AA, Søgaard M, Melgaard L, Lane DA, Sørensen EE, Goldhaber SZ, Larsen TB. Psychotropic drug use following venous thromboembolism versus diabetes mellitus in adolescence or young adulthood: a Danish nationwide cohort study. BMJ Open 2019; 9:e026159. [PMID: 31092651 PMCID: PMC6530366 DOI: 10.1136/bmjopen-2018-026159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Critical and chronic illness in youth such as diabetes can lead to impaired mental health. Despite the potentially traumatic and life-threatening nature of venous thromboembolism (VTE), the long-term mental health of adolescents and young adults with VTE is unclear. We compared the long-term mental health of adolescents and young adults with VTE versus adolescents and young adults with insulin-dependent diabetes mellitus (IDDM) using psychotropic drug purchase as proxy for mental health. DESIGN Nationwide registry-based cohort study. SETTING Denmark 1997-2015. PARTICIPANTS All patients aged 13-33 years with an incident diagnosis of VTE (n=5065) or IDDM (n=6609). EXPOSURE First time primary hospital diagnosis of VTE or IDDM. PRIMARY AND SECONDARY OUTCOME MEASURES Adjusted absolute risk and risk difference at 1 and 5 years follow-up for first psychotropic drug purchase comparing patients with VTE and patients with IDDM. RESULTS The absolute 1 year risk of psychotropic drug use was 6.2% among VTE patients versus 3.6% among patients with IDDM, at 5 years this was 19.3%-14.7%, respectively. After adjusting for the effect of sex, age and risk factors for VTE this corresponded to a 1 year risk differences of 1.9% (95 % CI 0.1% to 3.3%). At 5 years follow-up the risk difference was 1.9% (95% CI 0.5% to 3.3%). CONCLUSION One-fifth of adolescents and young adults with incident VTE had claimed a prescription for a psychotropic drug within 5 years, a risk comparable to that of young patients with IDDM.
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Affiliation(s)
- Anette Arbjerg Højen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Mette Søgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Line Melgaard
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
| | - Deirdre A Lane
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
| | - Erik Elgaard Sørensen
- Clinical Nursing Research Unit, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Samuel Zachary Goldhaber
- Thrombosis Research Group, Cardiovascular Medicine Division, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Torben Bjerregaard Larsen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
- Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, Aalborg, Denmark
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Downie GA, Mullan BA, Boyes ME, McEvoy PM. The effect of psychological distress on self-care intention and behaviour in young adults with type 1 diabetes. J Health Psychol 2019; 26:543-555. [PMID: 30666886 DOI: 10.1177/1359105318824795] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
An extended theory of planned behaviour including psychological distress was used to predict blood glucose monitoring in young adults with type 1 diabetes. Participants completed two surveys, a week apart (n = 167). Attitudes and perceived behavioural control were significantly associated with intention but subjective norm was not. Intention predicted blood glucose monitoring at T2. Higher scores in psychological distress significantly predicted poorer blood glucose monitoring at T2 but did not moderate the intention-behaviour relationship. Findings demonstrate some concerns with the theory of planned behaviour to predict self-care behaviour, yet highlight the importance of addressing psychological distress in diabetes self-management.
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40
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Ehrmann D, Kulzer B, Schipfer M, Lippmann-Grob B, Haak T, Hermanns N. Efficacy of an Education Program for People With Diabetes and Insulin Pump Treatment (INPUT): Results From a Randomized Controlled Trial. Diabetes Care 2018; 41:2453-2462. [PMID: 30305343 DOI: 10.2337/dc18-0917] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 09/12/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) is the most advanced form of insulin delivery, but it requires structured education to provide users with the necessary knowledge/skills and to support their motivation. Currently, no structured education program designed to provide this training has been evaluated. We developed a CSII-specific, structured education program (Insulin Pump Treatment [INPUT]) and evaluated its impact on glycemic control, behavior, and psychosocial status. RESEARCH DESIGN AND METHODS This was a multicenter, randomized, parallel trial with a 6-month follow-up. Eligible participants (age 16-75 years) currently were treated with insulin pump therapy. Participants were randomly assigned (1:1) to the INPUT program or to usual care using a computer-generated algorithm, with study center as the stratification factor. The primary outcome was HbA1c change from baseline to 6 months. Secondary outcomes were incidence of severe hypoglycemia and changes in behavioral and psychosocial measures. RESULTS Between 1 April 2016 and 26 April 2016, 268 people with diabetes and a mean duration of CSII therapy of 9.5 years were randomly assigned to the INPUT group (n = 135) or control group (n = 133). At 6 months, HbA1c improved in the INPUT group (8.33 ± 0.8 vs. 8.04 ± 0.9; P < 0.0001) but not in the control group (8.33 ± 1.0 vs. 8.27 ± 1.0; P = 0.11). The between-group difference in HbA1c reduction was significant, favoring INPUT (-0.28% vs. -0.06%, Δ -0.22%, 95% CI -0.38 to -0.06; P = 0.0029). The incidence rate ratio of severe hypoglycemia was 3.55 times higher for participants in the control group than for those in the INPUT group (95% CI 1.50-8.43; P = 0.0041). CONCLUSIONS The INPUT education program led to a significant improvement in glycemic control and incidence of severe hypoglycemia in insulin pump users.
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Affiliation(s)
- Dominic Ehrmann
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany
| | - Bernhard Kulzer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany.,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Melanie Schipfer
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany
| | | | - Thomas Haak
- Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
| | - Norbert Hermanns
- Research Institute Diabetes Academy Mergentheim, Bad Mergentheim, Germany .,Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.,Diabetes Clinic Mergentheim, Bad Mergentheim, Germany
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Vigen CLP, Carandang K, Blanchard J, Sequeira PA, Wood JR, Spruijt-Metz D, Whittemore R, Peters AL, Pyatak EA. Psychosocial and Behavioral Correlates of A1C and Quality of Life Among Young Adults With Diabetes. DIABETES EDUCATOR 2018; 44:489-500. [PMID: 30295170 DOI: 10.1177/0145721718804170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PURPOSE The purpose of this study was to evaluate relationships between behavioral and psychosocial constructs, A1C, and diabetes-dependent quality of life (DQoL) among low-socioeconomic status, ethnically diverse young adults with diabetes. METHODS Using baseline data of 81 participants in the Resilient, Empowered, Active Living (REAL) randomized controlled trial, behavioral, cognitive, affective, and experiential variables were correlated with A1C and DQoL while adjusting for demographic characteristics, and these relationships were examined for potential effect modification. RESULTS The data indicate that depressive symptoms and satisfaction with daily activities are associated with both A1C and DQoL, while diabetes knowledge and participation in daily activities are associated with neither A1C nor DQoL. Two constructs, diabetes distress and life satisfaction, were associated with DQoL and were unrelated to A1C, while 2 constructs, self-monitoring of blood glucose and medication adherence, were associated with A1C but unrelated to DQoL. These relationships were largely unchanged by adjusting for demographic characteristics, while numerous effect modifications were found. CONCLUSION The data suggest that when tailoring interventions, depressive symptoms and satisfaction with daily activities may be particularly fruitful intervention targets, as they represent modifiable risk factors that are associated with both A1C and DQoL.
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Affiliation(s)
- Cheryl L P Vigen
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Kristine Carandang
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Paola A Sequeira
- Department of Pediatrics, University of Southern California, Los Angeles, California
| | - Jamie R Wood
- Children's Hospital Los Angeles, Los Angeles, California
| | - Donna Spruijt-Metz
- Dornsife Center for Economic and Social Research, University of Southern California, Los Angeles, California
| | | | - Anne L Peters
- Division of Endocrinology, University of Southern California, Beverly Hills, California
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
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Wisting L, Skrivarhaug T, Dahl-Jørgensen K, Rø Ø. Prevalence of disturbed eating behavior and associated symptoms of anxiety and depression among adult males and females with type 1 diabetes. J Eat Disord 2018; 6:28. [PMID: 30214804 PMCID: PMC6131775 DOI: 10.1186/s40337-018-0209-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 07/27/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The increased prevalence of disturbed eating behaviors (DEB), depression, and anxiety in type 1 diabetes (T1D) is generally well established; however the majority of existing research to date has focused on female adolescents and young adults. Data on males and older females is scarce. The aim of this study was to assess prevalence of DEB and symptoms of depression and anxiety among adult males and females with type 1 diabetes, to investigate differences between individuals scoring below and above the cut-off on psychopathology, and to examine patterns of eating disorder psychopathology by age and weight. METHODS A total of 282 adults with type 1 diabetes aged 18-79 years participated in the study. Measures included the Diabetes Eating Problem Survey - Revised (DEPS-R), the Hospital Anxiety and Depression Scale (HADS), and clinical data from the Norwegian Quality Improvement of Laboratory Examinations (NOKLUS) system. RESULTS A total of 20.3% of the whole sample (13.3% among males and 24.8% among females) scored above the DEPS-R cut-off score for DEB. As for depression and anxiety, the prevalence in the whole sample was 6.2% and 19.0%, respectively. The prevalence was generally higher in females than males across all psychopathology measures. HbA1c was significantly associated with the DEPS-R total score (p < .01) among females, but not with depression and anxiety. Mean DEPS-R score decreased with increasing age, and when our previous reported data from children and adolescents are included, a peak prevalence in DEB in adolescence and young adult age is demonstrated. CONCLUSIONS The results of this study point to the need for increased awareness of psychological comorbidity among adults with type 1 diabetes, in particular young adult females. Screening is recommended to secure early detection and subsequent intervention for these individuals.
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Affiliation(s)
- Line Wisting
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
| | - Torild Skrivarhaug
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
- The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Knut Dahl-Jørgensen
- Oslo Diabetes Research Centre, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Department of Paediatric and Adolescent Medicine, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
- The Norwegian Diabetic Centre, Sponhoggveien 19, N-0284 Oslo, Norway
| | - Øyvind Rø
- Regional Department for Eating Disorders, Division of Mental Health and Addiction, Oslo University Hospital, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway
- Institute of Clinical Medicine, Mental Health and Addiction, University of Oslo, Problemveien 7, N-0315 Oslo, Norway
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Abstract
PURPOSE OF REVIEW This review summarizes the literature on care and outcome disparities in young adults (YA) with type 1 and type 2 diabetes, and outlines remaining needs and suggestions to reduce disparities and improve care. RECENT FINDINGS Despite well-documented disparities and data from large national and international diabetes populations, the role that social determinants of health play in disease management is largely unstudied. Further, mechanisms of how these risk factors interact with the unique developmental needs of racial-ethnic minority and economically vulnerable young adults with diabetes remain unknown. Little intervention research has focused on improving outcomes in this vulnerable population. More research needs to focus on identifying and addressing risk factors in racial-ethnic minority and economically vulnerable young adults with diabetes. Interventions need to be adapted and developed to meet the unique needs of this high-risk population. Clinicians and healthcare systems must recognize the inequity in care and outcomes for this group and structure clinical programs and policies to promote their optimal care.
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Affiliation(s)
- Shivani Agarwal
- Endocrinology, Diabetes, and Metabolism, University of Pennsylvania, Smilow Translational Research Center Room 12-142 3400 Civic Center Blvd., Philadelphia, PA, USA.
| | - Marisa Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
| | - Ashley Butler
- Baylor College of Medicine and Texas Children's Hospital, Feigin Tower 1102 Bates Ave., Suite 940, Houston, TX, 77030, USA
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Helgeson VS, Vaughn AK, Seltman H, Orchard T, Becker D, Libman I. Relation of parent knowledge to glycemic control among emerging adults with type 1 diabetes: a mediational model. J Behav Med 2017; 41:186-194. [PMID: 28918521 DOI: 10.1007/s10865-017-9886-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/11/2017] [Indexed: 11/29/2022]
Abstract
The study goal was to examine the links of parent knowledge of children's behavior to diabetes outcomes and to test a mediational model that focused on psychological distress and self-care behavior. We recruited 132 adolescents (average age 12) and followed them to average age 23. At age 23 (n = 107), we conducted in-person interviews with these emerging adults to measure parent knowledge, psychological distress, self-care behavior and glycemic control. We used structural equation modeling to test our hypotheses with these cross-sectional data. Higher levels of parent knowledge were linked to better glycemic control, and this path was mediated by reduced psychological distress and enhanced self-care behavior. Parents remain an important influence in the lives of emerging adults with type 1 diabetes. When emerging adults have a relationship with their parents in which they share general information, psychological distress may be reduced which then facilitates self-care and, ultimately, glycemic control.
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Affiliation(s)
- Vicki S Helgeson
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA.
| | - Abigail Kunz Vaughn
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA
| | - Howard Seltman
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA, 15213, USA
| | | | - Dorothy Becker
- University of Pittsburgh, Pittsburgh, PA, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
| | - Ingrid Libman
- University of Pittsburgh, Pittsburgh, PA, USA.,Children's Hospital of Pittsburgh of UPMC, Pittsburgh, PA, USA
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45
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Hessler DM, Fisher L, Polonsky WH, Masharani U, Strycker LA, Peters AL, Blumer I, Bowyer V. Diabetes distress is linked with worsening diabetes management over time in adults with Type 1 diabetes. Diabet Med 2017; 34:1228-1234. [PMID: 28498610 PMCID: PMC5561505 DOI: 10.1111/dme.13381] [Citation(s) in RCA: 102] [Impact Index Per Article: 14.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/08/2017] [Indexed: 12/20/2022]
Abstract
AIM To determine the cross-sectional and longitudinal associations between diabetes distress and diabetes management. METHODS In a non-interventional study, 224 adults with Type 1 diabetes were assessed for diabetes distress, missed insulin boluses, hypoglycaemic episodes, and HbA1c at baseline and 9 months. RESULTS At baseline, greater distress was associated with higher HbA1c and a greater percentage of missed insulin boluses. Longitudinally, elevated baseline distress was related to increased missed insulin boluses, and decreases in distress were associated with decreases in HbA1c . In supplementary analyses, neither depression symptoms nor a diagnosis of major depressive disorder was associated with missed insulin boluses, HbA1c or hypoglycaemic episodes in cross-sectional or longitudinal analyses. CONCLUSIONS Significant cross-sectional and longitudinal associations were found between diabetes distress and management; in contrast, no parallel associations were found for major depressive disorder or depression symptoms. Findings suggest that elevated distress may lead to more missed insulin boluses over time, suggesting a potential intervention target. The covarying association between distress and HbA1c points to the complex and likely interactive associations between these constructs. Findings highlight the need to address distress as an integral part of diabetes management in routine care.
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Affiliation(s)
- D M Hessler
- Department of Family & Community Medicine, San Francisco, USA
| | - L Fisher
- Department of Family & Community Medicine, San Francisco, USA
| | - W H Polonsky
- Behavioral Diabetes Institute, San Francisco, USA
| | - U Masharani
- Department of Medicine, University of California-San Francisco, San Francisco, USA
| | | | - A L Peters
- University of Southern California, Los Angeles, USA
| | - I Blumer
- Charles H. Best Diabetes Centre, Ontario, Canada
| | - V Bowyer
- Department of Family & Community Medicine, San Francisco, USA
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46
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Pastor A, Conn J, Teng J, O'Brien CL, Loh M, Collins L, MacIsaac R, Bonomo Y. Alcohol and recreational drug use in young adults with type 1 diabetes. Diabetes Res Clin Pract 2017. [PMID: 28646702 DOI: 10.1016/j.diabres.2017.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol and other recreational drug use reaches peak prevalence in young adulthood, including for those with chronic medical conditions such as type 1 diabetes. This review summarises the current literature on the patterns of substance use amongst young adults with type 1 diabetes and the mechanisms through which alcohol and recreational drugs may affect diabetes related health outcomes. These include the direct physical effect of intoxication, as well as the effects of alcohol and drugs on mental health and glucose metabolism. Evidence for increased associated mortality and morbidity is also presented, and current guidelines, management strategies and directions for further research are discussed.
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Affiliation(s)
- Adam Pastor
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Jennifer Conn
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia
| | - Jessie Teng
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia
| | - Casey L O'Brien
- Mental Health Services, St Vincent's Hospital Melbourne, Australia; Department of Psychiatry, University of Melbourne, Australia
| | - Margaret Loh
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia
| | - Lisa Collins
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia
| | - Richard MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
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47
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Brady PJ, Song HJ, Butler J. Using an Expert Panel to Develop Social Support Program Sequencing for Young Adults With Type 1 Diabetes. Health Promot Pract 2017; 18:789-797. [PMID: 28760008 DOI: 10.1177/1524839917720934] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Young adults living with type 1 diabetes (T1DM) often encounter poor health outcomes, such as uncontrolled blood glucose levels. Social support programs can be a helpful method to support T1DM self-management. Effectively planning and tailoring social support programs for young adults living with T1DM are crucial for improving these programs and associated outcomes. OBJECTIVES This study convened an expert panel primarily composed of young adults living with T1DM to generate ideas and key components for sequential inclusion in social support programs prioritizing them. METHOD Exploratory expert panel meetings consisting of four individuals living with T1DM were held where Nominal Group Technique and Ideawriting exercises were used to develop themes and discussion points. RESULTS Six themes emerged from the meetings representing areas of difficulty for young adults living with T1DM. Topics such as following self-care recommendations, nutrition, handling stress, coping with social situations, and navigating the health care system were identified as important issues facing young adults. CONCLUSIONS By incorporating this approach into new or existing support group improved program discussions for young adults can be achieved and pertinent issues addressed, thus leading to improved health care outcomes.
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Garvey KC, Foster NC, Agarwal S, DiMeglio LA, Anderson BJ, Corathers SD, Desimone ME, Libman IM, Lyons SK, Peters AL, Raymond JK, Laffel LM. Health Care Transition Preparation and Experiences in a U.S. National Sample of Young Adults With Type 1 Diabetes. Diabetes Care 2017; 40:317-324. [PMID: 28007779 PMCID: PMC5319474 DOI: 10.2337/dc16-1729] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/03/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Young adults with type 1 diabetes transitioning from pediatric to adult care are at risk for adverse outcomes. We developed a survey to evaluate transition experiences in two groups of young adults with type 1 diabetes, before (PEDS) and after (ADULT) transition to adult care. RESEARCH DESIGN AND METHODS We fielded an electronic survey to young adults (18 to <30 years) at 60 T1D Exchange Clinic Registry centers. RESULTS Surveys were completed by 602 young adults, 303 in the PEDS group (60% female, age 20 ± 2 years) and 299 in the ADULT group (62% female, age 24 ± 3 years). In the PEDS group, mean anticipated transition age was 22 ± 2 years; 64% remained in pediatric care because of emotional attachment to the provider. The ADULT group transitioned at age 19 ± 2 years, mainly after pediatric provider recommendation. More than 80% of respondents reported receiving counseling on type 1 diabetes self-management and screening tests from pediatric providers, but less than half (43% PEDS and 33% ADULT) reported discussing reproductive health. In the PEDS group, half had discussed transfer with pediatric providers. Of the ADULT participants, 63% received an adult provider referral, and 66% felt mostly/completely prepared to transition. ADULT participants with fewer pretransition pediatric visits or who felt unprepared for transition had increased odds of gaps >6 months between pediatric and adult care. Receipt of transition preparation counseling was not associated with self-reported hemoglobin A1c <7.0% in either group. CONCLUSIONS These results support the need for intensive efforts to integrate transition preparation counseling and care coordination into pediatric type 1 diabetes care.
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Affiliation(s)
| | | | - Shivani Agarwal
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | | | | | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Marisa E Desimone
- State University of New York Upstate Medical University, Syracuse, NY
| | | | | | - Anne L Peters
- Keck School of Medicine of the University of Southern California, Los Angeles, CA
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King KM, King PJ, Nayar R, Wilkes S. Perceptions of Adolescent Patients of the "Lived Experience" of Type 1 Diabetes. Diabetes Spectr 2017; 30:23-35. [PMID: 28270712 PMCID: PMC5309904 DOI: 10.2337/ds15-0041] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The care and management of adolescents with type 1 diabetes presents numerous challenges that are inherent to the fears, attitudes, and perceptions of their illness. This qualitative study aimed to explore the "lived experience" of individuals with type 1 diabetes. In-depth interviews were conducted with 20 patients diagnosed with type 1 diabetes in their adolescent years to elicit their views, perceptions, and concerns regarding living with diabetes. All interviews were conducted and analyzed using the principles of grounded theory. Five categories defining the patients' lived experience were elicited: Barriers, Develop Skills, Manage Emotion, Social World, and Health Care Professionals. The problems experienced by adolescents with type 1 diabetes are multifactorial. Existentially, type 1 diabetes affects their daily activities and impinges on their academic achievement and personal aspirations. They have great difficulty coping with their health status and highlight a lack of empathy from health care professionals (HCPs). Their major fear is of hypoglycemia, resulting in their subsequent focus of preventing hypoglycemic episodes. Indeed, regardless of consequence, blood glucose levels are often deliberately kept above recommended levels, which serves to decrease the effectiveness of their health care management. This study shows that the quality of care provided for adolescent patients with type 1 diabetes is failing to meet their expectations and falls short of the essential standards commensurate with current health care policy. Improvements in long-term care management for these patients require changes in both patients' and professionals' understanding of the disease and of the ways it is managed.
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Affiliation(s)
| | | | - Rahul Nayar
- Sunderland Royal Hospital, Sunderland, Tyne and Wear, UK
| | - Scott Wilkes
- University of Sunderland, Sunderland, Tyne and Wear, UK
- Coquet Medical Group, Amble Health Centre, Amble, Northumberland, UK
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Osan JK, Punch JD, Watson M, Chan YX, Barrie P, Fegan PG, Yeap BB. Associations of demographic and behavioural factors with glycaemic control in young adults with type 1 diabetes mellitus. Intern Med J 2016; 46:332-8. [PMID: 26748888 DOI: 10.1111/imj.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 11/23/2015] [Accepted: 12/23/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Despite recognised benefits of optimal glycaemic control in patients with type 1 diabetes mellitus (T1DM), good control is still difficult to achieve, particularly for adolescents and young adults. Recognition of factors that may assist early optimisation of glycaemic control is therefore important. AIMS We explored associations of demographic, social and behavioural factors with glycosylated haemoglobin (HbA1c) levels in participants with T1DM aged 18-25 years. METHODS A cross-sectional analysis was performed on young adults attending a dedicated multidisciplinary clinic at Fremantle Hospital, Western Australia from January to August 2014. RESULTS Data from 93 participants were analysed. Mean age was 21.4 ± 2.3 years, and 39.8% of the cohort were female. Longer duration of diabetes was associated with higher HbA1c (r = 0.25, P = 0.04). Men had lower HbA1c than women (8.2 ± 1.6 vs 9.2 ± 2.0%, P = 0.01). Increased frequency of clinic attendance was associated with lower HbA1c (r = -0.27, P = 0.02). Those engaged in work or study had better HbA1c compared with those who were not (8.9 ± 2.1 vs 10.5 ± 2.1%, P = 0.03). Socioeconomic disadvantage, risk-taking behaviour, insulin pump use and distance travelled to clinic were not associated with differences in HbA1c. CONCLUSION In young adults with T1DM, geographical separation, socioeconomic disadvantage and risk-taking behaviours did not influence glycaemic control. Longer duration of diabetes identifies young adults at higher risk of poor control, while attendance at a multidisciplinary clinic and engagement in work or study was associated with better glycaemic control. Additional studies are warranted to clarify the role of behavioural interventions to improve diabetes management in young adults.
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Affiliation(s)
- J K Osan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - J D Punch
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - M Watson
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia
| | - Y X Chan
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
| | - P Barrie
- Diabetes Education Unit, Fiona Stanley and Fremantle Hospitals, Perth, Western Australia, Australia
| | - P G Fegan
- Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
| | - B B Yeap
- School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia, Australia.,Department of Endocrinology and Diabetes, Perth, Western Australia, Australia
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