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Kelleher J, LaQuaglia R, Heddings J, Ely B, Jones E, Shaffer T, Duncan CL. Transition readiness and coping styles in adolescents with type 1 diabetes. J Pediatr Nurs 2024:S0882-5963(24)00285-9. [PMID: 39127590 DOI: 10.1016/j.pedn.2024.07.023] [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: 11/21/2023] [Revised: 06/06/2024] [Accepted: 07/21/2024] [Indexed: 08/12/2024]
Abstract
PURPOSE Although promoting positive coping and reducing negative coping improves health, little research has examined how types of coping relate to transition readiness in adolescents with type 1 diabetes (T1D). This study aimed to clarify the direct and indirect relations between coping style and transition readiness. We first examined which coping styles predict transition readiness in adolescents with T1D and then explored whether diabetes distress mediates the relation between disengagement coping and transition readiness. DESIGN AND METHODS Using a cross-sectional observational design, 68 families with an adolescent with T1D were recruited during routine clinic appointments. Surveys on family demographics, coping styles, transition readiness, and diabetes distress were completed electronically. Medical information was extracted from electronic health records. RESULTS Neither primary control, secondary control, nor disengagement coping had a direct significant association with transition readiness after controlling for HbA1c. There was a significant indirect effect of disengagement coping on transition readiness through greater diabetes distress (adolescent report β = -0.13; 95% CI, LL = -0.27, UL = -0.02; parent report β = -0.12; 95% CI, LL = -0.26, UL = -0.02). CONCLUSIONS Coping style did not have a direct effect on transition readiness. However, disengagement coping was associated with diabetes distress, which in turn was significantly related to transition readiness. PRACTICE IMPLICATIONS Clinicians and researchers should consider incorporating coping strategies within transition readiness interventions to decrease distress and improve transition readiness. Disease-specific psychosocial screening may enhance routine diabetes transition education.
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Affiliation(s)
- Jennifer Kelleher
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA.
| | - Rebecca LaQuaglia
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA
| | - Janelle Heddings
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Brian Ely
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Evan Jones
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Tebony Shaffer
- West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
| | - Christina L Duncan
- West Virginia University, Department of Psychology, 1124 Life Sciences Building, P.O. Box 6040, Morgantown, WV 26506-6040, USA; West Virginia University, Health Sciences, 1 Medical Center Drive, Morgantown, WV 26506, USA
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2
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Pedersen ZO, Jacobsen SS, Ewers B, Grabowski D. Exploring Family Perspectives on a Group-Based Hands-on Advanced Carbohydrate Counting Education Program for Children and Adolescents with Type 1 Diabetes: A Qualitative Study. Nutrients 2024; 16:1618. [PMID: 38892551 PMCID: PMC11174676 DOI: 10.3390/nu16111618] [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] [Received: 05/07/2024] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/21/2024] Open
Abstract
The care needs of children and adolescents with type 1 diabetes and their families are frequently approached as if they were identical to those of adults, overlooking the distinct challenges young people may face. It has been stated that children and adolescents often find conventional conversations with diabetes specialists tiresome and unpleasant. The present study focuses on familial experiences of an advanced carbohydrate counting program tailored to children and adolescents. The data encompass semi-structured interviews with families who participated in a group-based child-centered advanced carbohydrate counting program. The analysis revealed five themes: (1) peer-to-peer interaction is an essential determinant of sharing and learning; (2) illness perception significantly influences dietary intake; (3) normalization of diabetes in everyday life eases the disease burden; (4) repetition of dietary knowledge is important for retention; and (5) creating a safe and playful learning environment is crucial to engaging children and adolescents in their own treatment. The present findings suggest that it would be beneficial to explore and consider alternative teaching approaches that are adapted to a more interactive and engaging learning environment that is specifically tailored to children and adolescents. This entails moving away from traditional individual approaches.
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Affiliation(s)
- Zandra Overgaard Pedersen
- Steno Diabetes Center Copenhagen, Department of Diabetes Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (S.S.J.); (B.E.)
- Copenhagen Neuromuscular Center, Department of Neurology, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen, Denmark
| | - Sabine Schade Jacobsen
- Steno Diabetes Center Copenhagen, Department of Diabetes Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (S.S.J.); (B.E.)
| | - Bettina Ewers
- Steno Diabetes Center Copenhagen, Department of Diabetes Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark; (S.S.J.); (B.E.)
| | - Dan Grabowski
- Steno Diabetes Center Copenhagen, Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital—Steno Diabetes Center Copenhagen, Borgmester Ib Juuls Vej 83, 2730 Herlev, Denmark;
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Straton E, Bryant BL, Kang L, Wang C, Barber J, Perkins A, Gallant L, Marks B, Agarwal S, Majidi S, Monaghan M, Streisand R. ROUTE-T1D: A behavioral intervention to promote optimal continuous glucose monitor use among racially minoritized youth with type 1 diabetes: Design and development. Contemp Clin Trials 2024; 140:107493. [PMID: 38460913 PMCID: PMC11065587 DOI: 10.1016/j.cct.2024.107493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 02/13/2024] [Accepted: 03/05/2024] [Indexed: 03/11/2024]
Abstract
BACKGROUND Type 1 diabetes management is often challenging during adolescence, and many youth with type 1 diabetes struggle with sustained and optimal continuous glucose monitor (CGM) use. Due to racial oppression and racially discriminatory policies leading to inequitable access to quality healthcare and life necessities, racially minoritized youth are significantly less likely to use CGM. METHODS ROUTE-T1D: Research on Optimizing the Use of Technology with Education is a pilot behavioral intervention designed to promote optimal CGM use among racially minoritized youth with type 1 diabetes. Intervention strategies include problem solving CGM challenges and promoting positive caregiver-youth communication related to CGM data. RESULTS This randomized waitlist intervention provides participants with access to three telemedicine sessions with a Certified Diabetes Care and Education Specialist. Caregiver participants are also connected with a peer-parent coach. CONCLUSION Hypothesized findings and anticipated challenges are discussed. Future directions regarding sustaining and optimizing the use of diabetes technology among racially minoritized pediatric populations are reviewed.
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Affiliation(s)
- Emma Straton
- Children's National Hospital, Washington DC, United States of America
| | - Breana L Bryant
- Children's National Hospital, Washington DC, United States of America
| | - Leyi Kang
- Children's National Hospital, Washington DC, United States of America
| | - Christine Wang
- Children's National Hospital, Washington DC, United States of America
| | - John Barber
- Children's National Hospital, Washington DC, United States of America
| | - Amanda Perkins
- Children's National Hospital, Washington DC, United States of America
| | - Letitia Gallant
- Children's National Hospital, Washington DC, United States of America
| | - Brynn Marks
- Children's Hospital of Philadelphia, Philadelphia, PA, United States of America
| | - Shivani Agarwal
- Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Shideh Majidi
- Children's National Hospital, Washington DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Maureen Monaghan
- National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, United States of America
| | - Randi Streisand
- Children's National Hospital, Washington DC, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
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4
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Swaney EE, McCombe J, Donath S, Cameron FJ. Correlation between centre size, metabolic variation and mean HbA1c in major paediatric diabetes centres. J Paediatr Child Health 2024; 60:94-99. [PMID: 38605449 DOI: 10.1111/jpc.16531] [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] [Received: 06/27/2023] [Revised: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024]
Abstract
AIM To exploit a relatively homogeneous national health care context and a national diabetes database to address the questions: Is there an optimal clinic/centre size in determining outcomes?; and Can improvement in median centre outcomes be driven by reducing variability in outcome? METHODS Using the Australasian Diabetes Database Network, data from seven tertiary hospital paediatric diabetes clinics for patients with type one diabetes from Australia were recorded from 6-month uploads: September 2017, March 2018, September 2018 and March 2019. Data from 25 244 patient visits included demographic variables, HbA1C, number of patient visits and insulin regimens. RESULTS There was no association between centre size and median HbA1C. On the other hand, there was a significant association between or median absolute deviation of HbA1C outcomes and the median HbA1C result between centres. On average every two thirds of a median absolute deviation increase in clinic HbA1C was associated with a 1.0% (10.9 mmol/mol) increase in median clinic HbA1C. CONCLUSIONS Our data have shown that it is likely difficult for centres to have a low median HbA1C if there is high variance of HbA1C's within centres or within centre treatment groups. This appears to be true regardless of centre size. These findings need to be carefully considered by teams who wish to lower their clinic median HbA1C.
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Affiliation(s)
- Ella Ek Swaney
- Diabetes Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- The Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Julia McCombe
- Diabetes Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- The Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Susan Donath
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Fergus J Cameron
- Diabetes Research Group, Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, Victoria, Australia
- The Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- The Department of Endocrinology and Diabetes, Royal Children's Hospital, Melbourne, Victoria, Australia
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Ghazaiean M, Najafi B, Zamanfar D, Alipour MJ. Risk factors for suboptimal glycemic control in pediatrics with type 1 diabetes mellitus: a cross-sectional study. Sci Rep 2024; 14:7492. [PMID: 38553464 PMCID: PMC10980686 DOI: 10.1038/s41598-024-57205-9] [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] [Received: 12/22/2023] [Accepted: 03/15/2024] [Indexed: 04/02/2024] Open
Abstract
The objective of this research is to analyze the influence of various factors on glycemic control in pediatrics with type 1 diabetes mellitus (T1DM). The study, a cross-sectional analysis, involved 221 T1DM patients below 18 years old who visited our clinic between 2011 and 2020, predating the COVID-19 outbreak. Out of the initial pool, 204 participants were chosen based on specific criteria. By computing odds ratios and 95% confidence intervals, we determined the correlation between these factors and achieving optimal glycemic control (HbA1c < 7.5%). Of the 204 individuals, 55.9% (113 patients) were female. The average age at diagnosis was 6.93 ± 3.9 years. Mean HbA1c (A1C) level of optimal and suboptimal groups were 6.97, 95% CI 6.84 to 7.1 and 8.86, 95% CI 8.68 to 9.03, respectively (p-value < 0.001). Fifty patients had optimal glycemic control and 154 people experienced suboptimal glycemic control during the follow-up that the prevalence of each of them was 24.51, 95% CI 18.7 to 31 and 75.49, 95% CI 68.99 to 81.22, respectively. In the assessment of risk factors associated with suboptimal glycemic control, patients aged 10-14 years had the highest likelihood of experiencing suboptimal glycemic control (crude odds ratio [COR] 3.12, 95% CI 1.04 to 9.3), followed by duration of diabetes (COR 2.85, 95% CI 1.2 to 6.8), which both were significant. By utilizing multivariable logistic regression analysis, a noteworthy finding emerged. It was revealed that patients aged 10-14 years exhibited a significant association with suboptimal glycemic control, [adjusted odds ratio (AOR) 4.85, 95% CI 1.32 to 17.7]. Additionally, a statistically significant correlation was identified between individuals with a body mass index (BMI) falling within the ≥ 95th percentile category and suboptimal glycemic control, Cramer's V = 0.21, p-value = 0.01. Our research has revealed a significant correlation between patients aged 10-14 years and obese individuals (BMI ≥ 95th) with suboptimal glycemic control. It is crucial to consider these factors as they can offer valuable insights during diagnosis, highlighting the increased risk of long-term suboptimal glycemic control.
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Affiliation(s)
- Mobin Ghazaiean
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
- Gut and Liver Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Behnam Najafi
- Gastrointestinal Research Center, Non-Communicable Disease Institute, Mazandaran University of Medical Sciences, Sari, Iran
| | - Daniel Zamanfar
- Department of Pediatric Endocrinology, Diabetes Research Center of Mazandaran, Mazandaran University of Medical Sciences, Sari, Iran.
| | - Mohammad Javad Alipour
- Student Research Committee, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran
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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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7
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Visentin R, Cobelli C, Sieber J, Dalla Man C. Short- and Long-Term Effects on Glucose Control of Nonadherence to Insulin Therapy in People With Type 2 Diabetes An In Silico Study. J Diabetes Sci Technol 2024; 18:309-317. [PMID: 38284154 DOI: 10.1177/19322968231223936] [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: 01/30/2024]
Abstract
BACKGROUND Strict adherence to multiple daily insulin (MDI) therapy is a cornerstone for the achievement of good glucose control in people with advanced type 2 diabetes (T2D). Here, we aim to in silico assess glucose control in T2D subjects with poor adherence to MDI therapy. METHODS We tuned the Padova T2D Simulator, originally describing early-stage T2D physiology, around advanced T2D people. One hundred in silico advanced T2D subjects were generated and equipped with optimal MDI therapy: specifically, basal and bolus insulin amounts and injection times were individualized for each subject by applying titration algorithms that iteratively update insulin dose based on glucose deviation from its target. Then, the effect of nonadhering to MDI therapy was assessed using standard glucose control metrics calculated in two 6-month 3-meal/day in silico scenarios: in Scenario 1, subjects received the optimal basal and prandial insulin bolus at each meal; in Scenario 2, subjects received optimal basal insulin and randomly delayed or skipped the prandial insulin bolus in 3 lunches during working days and 1 dinner during weekends. RESULTS A statistically significant degradation was found in all glucose control outcome metrics in Scenario 2 versus Scenario 1: e.g., percent time above 180 mg/dL increased by 22.2% and glucose management index by 0.2%. CONCLUSIONS Impaired adherence to MDI therapy in T2D leads to glucose control deteriorations in both short and long terms. Interestingly, short-term hyperglycemia seems being contrasted by residual endogenous insulin secretion, which statistically increased by 3-fold after delayed/skipped insulin boluses compared with optimal ones.
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Affiliation(s)
- Roberto Visentin
- Department of Information Engineering, University of Padua, Padua, Italy
| | - Claudio Cobelli
- Department of Woman and Child's Health, University of Padua, Padua, Italy
| | | | - Chiara Dalla Man
- Department of Information Engineering, University of Padua, Padua, Italy
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Wibaek R, Ibfelt EH, Andersen GS, Hulman A, Dabelea D, Jørgensen ME, Svensson J, Vistisen D, Rønn PF. Heterogeneity in glycaemic control in children and adolescents with type 1 diabetes: A latent class trajectory analysis of Danish nationwide data. Diabet Med 2024; 41:e15275. [PMID: 38157300 DOI: 10.1111/dme.15275] [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: 09/25/2023] [Revised: 11/28/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
AIMS Suboptimal glycaemic control in children and adolescents with type 1 diabetes is prevalent and associated with increased risk of diabetes-related complications and mortality later in life. First, we aimed to identify distinct glycated haemoglobin (HbA1c) trajectories in children and adolescents (2-19 years) with type 1 diabetes. Second, we examined their associations with clinical and socio-demographic factors. METHODS Data were obtained from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) comprising all Danish children and adolescents diagnosed with type 1 diabetes from 1996 to 2019. Subgroups of distinct mean trajectories of HbA1c were identified using data-driven latent class trajectory modelling. RESULTS A total of 5889 children (47% female) had HbA1c measured a median of 6 times (interquartile range 3-8) and contributing to 36,504 measurements. We identified four mean HbA1c trajectories, referred to as 'Stable but elevated HbA1c' (83%), 'Increasing HbA1c' (5%), 'Late HbA1c peak' (7%), and 'Early HbA1c peak' (5%). Compared to the 'Stable but elevated HbA1c' group, the three other groups presented rapidly deteriorating glycaemic control during late childhood or adolescence, had higher HbA1c at study entry, and included fewer pump users, higher frequency of inadequate blood glucose monitoring, more severe hypoglycaemic events, lower proportions with Danish origin, and worse educational status of parents. The groups also represented significant differences by healthcare region. CONCLUSIONS Children and adolescents with type 1 diabetes experience heterogenous trajectories with different timings and magnitudes of the deterioration of HbA1c levels, although the majority follow on average a stable, yet elevated HbA1c trajectory. The causes and long-term health implications of these heterogenous trajectories need to be addressed.
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Affiliation(s)
- Rasmus Wibaek
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Else H Ibfelt
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Gregers S Andersen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Marit E Jørgensen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Centre for Public Health in Greenland, National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Steno Diabetes Center Greenland, Nuuk, Greenland
| | - Jannet Svensson
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Dorte Vistisen
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Pernille Falberg Rønn
- Clinical Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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Sartika RAD, Sigit FS, Purwanto E, Aris N, Marjan AQ, Putra WKY, Hastono SP. Association of birth weight with risk of diabetes mellitus in adolescence and early adulthood: analysis of the Indonesian Family Life Survey. Ann Pediatr Endocrinol Metab 2023; 28:267-274. [PMID: 38173382 PMCID: PMC10765023 DOI: 10.6065/apem.2346146.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 08/13/2023] [Accepted: 08/26/2023] [Indexed: 01/05/2024] Open
Abstract
PURPOSE We aimed to investigate the association of birth weight with the risk of diabetes mellitus in adolescence and early adulthood in the Indonesian population. METHODS This study analyzed data from the Indonesian Family Life Survey, a longitudinal study of the Indonesian population with repeated measurements at 3 time points (1997, 2007, and 2014). The subjects observed were children aged 0-59 months in 1997, who were 10-15 years old in 2007, and 17-22 years in 2014. We performed a generalized linear model to investigate the association between birth weight at baseline and the level of hemoglobin A1c (HbA1c) at the 2 follow-up periods. We adjusted the association for the characteristics of the children, parents, and household. RESULTS The mean±standard deviation level of HbA1c was 7.35%±0.95% in 2007 and decreased to 5.30%±0.85% in 2014. The crude β (95% confidence interval [CI]) of the association between birth weight and HbA1c was 0.150 (-0.076, 0.377) in 2007 and 0.146 (-0.060, 0.351) in 2014. After adjustment for the sociodemographic characteristics of the children, parents, and confounding factors, the adjusted β (95% CI) was 1.12 (0.40-1.85) in 2007 and 0.92 (0.35-1.48) in 2014. The HbA1c of the parents, father's employment status, percentage of food expenditure, and underweight were the covariates that had significant associations with HbA1c. CONCLUSION HbA1c level was higher in adolescence than in early adulthood. Birth weight was associated with HbA1c level in both periods. The HbA1c of the parents, father's employment, percentage of food expenditure, and underweight partly explained the association between birth weight and the HbA1c level.
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Affiliation(s)
- Ratu Ayu Dewi Sartika
- Department of Public Health Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Fathimah Sulistyowati Sigit
- Department of Public Health Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
- Metabolic Disorder, Cardiovascular Diseases, and Aging Research Cluster, Indonesia Medical Education and Research Institute – Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Edy Purwanto
- Department of Economics, Faculty of Economics and Business, Airlangga University, Surabaya, Indonesia
| | - Norliyana Aris
- Faculty of Food Science and Nutrition, Universiti Malaysia Sabah, Sabah, Malaysia
| | - Avliya Quratul Marjan
- Faculty of Health Sciences, Universitas Pembangunan Nasional Veteran Jakarta, Jakarta, Indonesia
| | - Wahyu Kurnia Yusrin Putra
- Department of Public Health Nutrition, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
| | - Sutanto Priyo Hastono
- Department of Biostatistics and Population, Faculty of Public Health, Universitas Indonesia, Depok, Indonesia
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Sergel-Stringer OT, Al-Sallami HS, Styles SE, Boucsein A, de Bock MI, Wheeler BJ. Knowledge, safety, and impact of alcohol consumption in young adults with type 1 diabetes mellitus: a qualitative study. BMC Endocr Disord 2023; 23:229. [PMID: 37864225 PMCID: PMC10588012 DOI: 10.1186/s12902-023-01471-7] [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: 03/22/2023] [Accepted: 09/27/2023] [Indexed: 10/22/2023] Open
Abstract
PURPOSE To explore the lived experiences of alcohol consumption among young adults with type 1 diabetes. METHODS Fourteen semi-structured interviews were conducted amongst young adults aged between 18 and 25 years, inclusive, with type 1 diabetes and experience consuming alcohol. Interviews were transcribed verbatim and analysed to identify common themes regarding their experiences. RESULTS The interviews confirmed that young adults with type 1 diabetes engage in social, and occasionally excessive, drinking behaviour. Furthermore, the interviews revealed four key themes: (i) Several sources contribute to a widely inconsistent understanding of the impact and management of alcohol consumption; (ii) Perceived inconvenience of maintaining healthy glycaemic control whilst drinking socially; (iii) Engagement in proactive strategies for harm reduction occurred when convenient; and (iv) Impact of modern diabetes technology in overcoming previous burdens and promoting glycaemic safety. CONCLUSION Young adults with type 1 diabetes continue to need anticipatory education surrounding safe alcohol consumption and behaviours, as well as ongoing support and encouragement to ensure engagement with traditional self-management tasks. Significant alcohol-diabetes related safety issues, particularly hypoglycaemia do occur, and were captured within this small sample and study. Diabetes technology has an important complementary role along with education and tailored support strategies to support health and safe glucose control during alcohol consumption.
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Affiliation(s)
- Oscar T Sergel-Stringer
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, 9016, New Zealand
| | | | - Sara E Styles
- Department of Human Nutrition, Division of Sciences, University of Otago, Dunedin, 9016, New Zealand
| | - Alisa Boucsein
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, 9016, New Zealand
| | - Martin I de Bock
- Department of Paediatrics, University of Otago, Christchurch, 8011, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, 9016, New Zealand.
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Gandhi K, Ebekozien O, Noor N, McDonough RJ, Hsieh S, Miyazaki B, Dei-Tutu S, Golden L, Desimone M, Hardison H, Rompicherla S, Akturk HK, Kamboj MK. Insulin Pump Utilization in 2017-2021 for More Than 22,000 Children and Adults With Type 1 Diabetes: A Multicenter Observational Study. Clin Diabetes 2023; 42:56-64. [PMID: 38230341 PMCID: PMC10788665 DOI: 10.2337/cd23-0055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Abstract
This large type 1 diabetes cohort study showed that insulin pump utilization has increased over time and that use differs by sex, insurance type, and race/ethnicity. Insulin pump use was associated with more optimal A1C, increased use of continuous glucose monitoring (CGM), and lower rates of diabetic ketoacidosis and severe hypoglycemia. People who used an insulin pump with CGM had lower rates of acute events than their counterparts who used an insulin pump without CGM. These findings highlight the need to improve access of diabetes technology through provider engagement, multidisciplinary approaches, and efforts to address health inequities.
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Affiliation(s)
| | - Osagie Ebekozien
- T1D Exchange, Boston, MA
- University of Mississippi School of Population Health, Jackson, MS
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12
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Omenuko NJ, Tafesse Y, Magacha HM, Nriagu VC, Anazor SO, Nwaneki CM, Okeke F, Ezeano C, Jideofor C. Racial Disparities In In-Hospital Mortality of Children and Adolescents Under 20 Years With Type 1 Diabetes Mellitus. Cureus 2023; 15:e43999. [PMID: 37746475 PMCID: PMC10517728 DOI: 10.7759/cureus.43999] [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: 08/23/2023] [Indexed: 09/26/2023] Open
Abstract
BACKGROUND In the United States, racial disparities in health outcomes continue to be a major problem with far-reaching effects on equity in healthcare and public health. Children and teenagers with type 1 diabetes are a disadvantaged demographic that has particular difficulties in managing their condition and getting access to healthcare. Despite improvements in the treatment of diabetes, little study has examined how much racial disparities in in-hospital mortality affect this particular demographic. By examining racial differences in in-hospital mortality rates among children and adolescents with type 1 diabetes in the United States, this study seeks to close this gap. METHODS This cross-sectional study utilized data from the Healthcare Cost and Utilization Project's (HCUP) Kids' Inpatient Database (KID) for 2012. The KID is a nationally representative sample of pediatric discharges from US hospitals. A total of 20,107 patients who were admitted with type 1 diabetes were included in this study. The primary outcome was the patient's in-hospital mortality status. The primary predictor variable was the race of the patient. Six potential confounders were chosen based on previous literature: age, sex, hospital location, obesity, weight loss, electrolyte disorders status, and median household income. Descriptive statistics and bivariate analyses were done. Multivariate analysis was conducted while controlling for potential confounders. Odd ratios with a 95% confidence interval and probability value were reported. Statistical Analysis System (SAS) version 9.4 for Windows (SAS Institute Inc., Cary, NC, USA) was used for the statistical analysis. RESULTS A total of 20,107 patients were included in this study. Of the patients included, 78.6%, 5.3%, 5.9%, and 10.2% were of age groups <4, 5-9, 10-14, and 15-18, respectively. Among the patients, 64.3% were female. Whites stood at 54.3%, while Hispanic, Black, and other races accounted for 17.2%, 21.8%, and 6.7% respectively. After adjusting for all other variables, children, and young adults of Asian and Pacific Islanders (OR=1.948; 95% CI 1.015,3.738) had 94% higher odds of in-hospital mortality compared to their White counterparts. Children and young adults aged 5-9 (OR=0.29; 95% CI 0.13,0.649) had 71% lower odds of in-hospital mortality compared to those aged 4 or under. Those aged 10-14 (OR=0.155; 95% CI 0.077,0.313) had 85% lower odds of in-hospital mortality compared to those aged 4 or under, while those aged 15-19 (OR=0.172; 95% CI 0.100,0.296) had 83% lower odds of in-hospital mortality compared to those aged 4 or under. Children and young adults who had weight loss (OR=4.474; 95% CI 2.557,7.826) had almost five times higher odds of in-hospital mortality compared to those without weight loss, while children and young adults who had electrolyte disorders (OR=5.131; 95% CI 3.429,7.679) had five times higher odds of in-hospital mortality compared to those without electrolyte disorders. CONCLUSION The results show young adults of Asian and Pacific Islanders have higher odds of in-hospital mortality compared to their White counterparts and this study highlights the urgent need for focused measures designed to lessen these inequalities and enhance health equity. The implementation of culturally sensitive healthcare practices, addressing social determinants of health, and enhancing access to high-quality diabetes care should all be priorities.
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Affiliation(s)
- Nnamdi J Omenuko
- Hematology and Oncology, The University of Chicago Medicine, Chicago, USA
| | - Yordanos Tafesse
- Hematology and Oncology, The University of Chicago Medicine, Chicago, USA
| | - Hezborn M Magacha
- Internal Medicine, East Tennessee State University, Johnson City, USA
| | - Valentine C Nriagu
- Epidemiology and Public Health, East Tennessee State University, Johnson City, USA
- Internal Medicine, Maimonides Medical Center, New York, USA
| | - Sandra O Anazor
- Obstetrics and Gynecology, Corewell Health West/Michigan State University, Grand Rapids, USA
- Public Health, East Tennessee State University, Johnson City, USA
| | - Chisom M Nwaneki
- Internal Medicine, Saint Peter's University Hospital, New Brunswick, USA
| | - Francis Okeke
- Epidemiology and Public Health, East Tennessee State University, Johnson City, USA
| | - Chimezirim Ezeano
- Epidemiology and Public Health, University of North Texas Health Science Center, Fort Worth, USA
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13
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Pabedinskas KL, Courtney J, Barrowman N, Zankar S, Richardson C, Stevens L, Goldbloom EB, Lawrence SE, Zuijdwijk C, Lawson ML, Robinson ME, Dover S, Ahmet A. Implementation and evaluation of a longitudinal diabetes educational programme for adolescents. BMJ Open Qual 2023; 12:e002361. [PMID: 37507143 PMCID: PMC10387648 DOI: 10.1136/bmjoq-2023-002361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION International guidelines recommend structured and continuous educational programmes to expand diabetes knowledge and self-efficacy in youth. To address these recommendations within a paediatric diabetes clinic, we conducted a three-phase quality improvement project aimed at improving adolescents' confidence in diabetes self-management skills. METHODS In phase 1, the Diabetes Learning Centre (DLC), an educational programme for adolescents with type 1 diabetes (T1D) ages 13-17 years, was developed and implemented. Programme feasibility was evaluated through programme attendance rates. Phase 2 aimed to guide ongoing programme development and optimisation. DLC attendees rated their baseline confidence in overall and individual T1D self-management skills on a 5-point Likert scale. Patient characteristics were summarised using descriptive statistics and the association between patient characteristics and overall confidence in T1D self-management was evaluated. Phase 3 used patient surveys to evaluate patient satisfaction and reported change in confidence in self-management skills following DLC attendance. RESULTS In phase 1, 232 (81%) of eligible adolescents attended the DLC during the study period. In phase 2, median overall confidence in diabetes management on a Likert scale (0-4) was 3, representing 'quite confident', although confidence was low in some essential self-management skills. Higher confidence was associated with lower HbA1c (p<0.001). In phase 3, 77 (85%) of participants reported high levels of satisfaction with the DLC. 106 (82%) of completed worksheets were associated with improved confidence in the diabetes self-management skill addressed. CONCLUSIONS Implementation of a longitudinal T1D educational model was feasible with good uptake in an existing T1D programme. While confidence at baseline was quite high for overall T1D self-management, it was low in some essential self-management skills, highlighting the need for this programme and specific educational gaps. Adolescents reported improvements in confidence and high levels of satisfaction following DLC attendance. Our model provides a replicable programme template to address longitudinal education needs.
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Affiliation(s)
| | - Jennilea Courtney
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Nicholas Barrowman
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Sarah Zankar
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Christine Richardson
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Liz Stevens
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Ellen B Goldbloom
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Sarah E Lawrence
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Caroline Zuijdwijk
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Margaret L Lawson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Marie-Eve Robinson
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Saunya Dover
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Alexandra Ahmet
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
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Grundman JB, Perkins A, Monaghan M, Meighan S, Streisand R, Marks BE. Differences in positive expectancy of hybrid closed loop (HCL) insulin delivery systems do not explain racial differences in HCL use. J Clin Transl Endocrinol 2023; 32:100319. [PMID: 37273975 PMCID: PMC10238440 DOI: 10.1016/j.jcte.2023.100319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 06/06/2023] Open
Abstract
Aims Hybrid closed loop (HCL) insulin delivery systems improve glycemia and quality of life among youth with type 1 diabetes (T1D), however there are inequities in use. We aimed to evaluate whether differences in positive expectancy of HCL systems may explain differences in use. Methods Fifteen publicly-insured, non-Hispanic Black (NHB) youth with hemoglobin A1C (HbA1c) ≥ 10% enrolled in a study exploring changes in glycemia and person reported outcomes (PRO) during 6 months of Tandem t:slim X2 insulin pump with Control-IQ technology. At baseline youth and parents completed PROs, including Insulin Delivery Systems: Perceptions, Ideas, Reflections and Expectations (INSPIRE) survey assessing positive expectancy of HCL use, and Problem Areas in Diabetes (PAID) survey assessing diabetes-related distress. Differences between this cohort and the Tandem Control-IQ pediatric pivotal trial (DCLP5) cohort were assessed. Results As compared to the DCLP5 cohort (0% NHB, 10% publicly-insured), baseline glycemic indicators were suboptimal (MHbA1c 11.9 ± 1.4% vs 7.6 ± 0.9%, p < 0.0001; continuous glucose monitor (CGM) time-above-range > 180 mg/dL 82 ± 15% vs 45 ± 18%, p < 0.0001). INSPIRE scores in both cohorts were equally high among youth (80 ± 10 vs 77 ± 13, p = 0.41) and parents (88 ± 14 vs 85 ± 11, p = 0.37). PAID scores were higher among parents (68 ± 19 vs 43 ± 16, p < 0.0001), but not youth (43 ± 16 vs 35 ± 16, p = 0.09) in the historically marginalized cohort as compared to the DCLP5 cohort. Conclusions Despite differences in glycemic control and diabetes related burden, positive expectancy of HCL systems is comparable among historically marginalized youth with T1D and the predominantly non-Hispanic White, privately insured DCLP5 cohort. These findings suggest that differences in perceptions of HCL technology may not explain inequities in use.
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Affiliation(s)
- Jody B. Grundman
- Children’s National Hospital, 111 Michigan Ave NW, Washington DC 20010, USA
| | - Amanda Perkins
- Children’s National Hospital, 111 Michigan Ave NW, Washington DC 20010, USA
| | - Maureen Monaghan
- Children’s National Hospital, 111 Michigan Ave NW, Washington DC 20010, USA
- George Washington University School of Medicine, 3200 I St NW, Washington DC 20052, USA
| | - Seema Meighan
- Children’s Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Randi Streisand
- Children’s National Hospital, 111 Michigan Ave NW, Washington DC 20010, USA
- George Washington University School of Medicine, 3200 I St NW, Washington DC 20052, USA
| | - Brynn E. Marks
- Children’s Hospital of Philadelphia, 3501 Civic Center Boulevard, Philadelphia, PA 19104, USA
- Perelman School of Medicine at the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Vonheim Madsen T, Cooper JG, Carlsen S, Loevaas K, Rekdal M, Igland J, Sandberg S, Ueland GÅ, Iversen MM, Sølvik U. Intensified follow-up of patients with type 1 diabetes and poor glycaemic control: a multicentre quality improvement collaborative based on data from the Norwegian Diabetes Register for Adults. BMJ Open Qual 2023; 12:bmjoq-2022-002099. [PMID: 37308253 DOI: 10.1136/bmjoq-2022-002099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Accepted: 05/27/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Patients with type 1 diabetes mellitus (T1DM) and poor glycaemic control are at high risk of developing microvascular and macrovascular complications. The aim of this study was to determine if a quality improvement collaborative (QIC) initiated by the Norwegian Diabetes Register for adults (NDR-A) could reduce the proportion of patients with T1DM with poor glycaemic control (defined as glycated haemoglobin (HbA1c)≥75 mmol/mol) and reduce mean HbA1c at participating clinics compared with 14 control clinics. METHOD Multicentre study with controlled before and after design. Representatives of 13 diabetes outpatient clinics (n=5145 patients with T1DM) in the intervention group attended four project meetings during an 18-month QIC. They were required to identify areas requiring improvement at their clinic and make action plans. Continuous feedback on HbA1c outcomes was provided by NDR-A during the project. In total 4084 patients with type 1 diabetes attended the control clinics. RESULTS Between 2016 and 2019, the overall proportion of patients with T1DM and HbA1c≥75 mmol/mol in the intervention group were reduced from 19.3% to 14.1% (p<0.001). Corresponding proportions in the control group were reduced from 17.3% (2016) to 14.4% (2019) (p<0.001). Between 2016 and 2019, overall mean HbA1c decreased by 2.8 mmol/mol (p<0.001) at intervention clinics compared with 2.3 mmol/mol (p<0.001) at control clinics. After adjusting for the baseline differences in glycaemic control, there were no significant differences in the overall improvement in glycaemic control between intervention and control clinics. CONCLUSIONS The registry linked QIC did not result in a significantly greater improvement in glycaemic control at intervention clinics compared with control clinics. However, there has been a sustained improvement in glycaemic control and importantly a significant reduction in the proportion of patients with poor glycaemic control at both intervention and control clinics during and after the QIC time frame. It is possible that some of this improvement may be due to a spillover effect from the QIC.
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Affiliation(s)
- Tone Vonheim Madsen
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Western Norway University of Applied Sciences Faculty of Health and Social Sciences, Bergen, Norway
| | - John Graham Cooper
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Siri Carlsen
- Department of Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Karianne Loevaas
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Jannicke Igland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Sverre Sandberg
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway, Bergen, Norway, Norway
| | - Grethe Åstrøm Ueland
- The Norwegian Organization for Quality Improvement of Laboratory Examinations (Noklus), Haraldsplass Deaconess Hospital, Bergen, Norway
| | | | - Una Sølvik
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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16
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Matejko B, Juza A, Kiec-Wilk B, Cyranka K, Krzyżowska S, Cohen O, Malecki MT, Klupa T. One-year follow-up of advance hybrid closed-loop system in adults with type 1 diabetes previously naive to diabetes technology: The effect of switching to a calibration-free sensor. Diabetes Technol Ther 2023. [PMID: 37184526 DOI: 10.1089/dia.2023.0059] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
The aim of this study was to observe the one-year clinical outcomes of people with type 1 diabetes (T1D) who switched from Multiple Daile Injection + Blood Glucose Meter to an advanced hybrid closed-loop (AHCL) system (Medtronic MiniMedTM 780G system (MM 780G). Additionally, the effect of changing at month 6 to a calibration free sensor (GuardianTM 4 Sensor (G4S) was evaluated. 18 participants (10 men, age 40.9±7.6 years) completed 1 year of MM 780G use. Time in range (70-180 mg/dL) (TIR) remained stable and ranged from 83.2% in month 9 to 84.8% in month 3. There was no difference between TIR at 3 months before switching vs 3 months after switching to G4S (p=0.614). AHCL system in adults significantly improves glycemic outcomes. This improved glycemic control was maintained over the 12 months. Switching to a calibration free sensor (G4S) did not affect outcomes but required less patient involvement.
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Affiliation(s)
- Bartlomiej Matejko
- Jagiellonian University Medical College, 49573, Krakow, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Anna Juza
- Specialist Voivodship Hospital Frederic Chopin in Rzeszow, 206088, ul. Saska 61/6, Rzeszów, Poland, 35-615;
| | - Beata Kiec-Wilk
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Katarzyna Cyranka
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Sabina Krzyżowska
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Department of Metabolic Diseases, Krakow, Małopolskie, Poland;
| | - Ohad Cohen
- Medtronic International Trading Sàrl, Toluchenaz, Tolochenaz, Switzerland, 46733;
| | - Maciej Tadeusz Malecki
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
| | - Tomasz Klupa
- Jagiellonian University Medical College, 49573, Department of Metabolic Diseases, Krakow, Małopolskie, Poland
- University Hospital in Krakow Metabolic Diseases and Diabetology Clinical Department, 574410, Krakow, Małopolskie, Poland;
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Diaz JVR, Figueroa J, Felner EI. A pilot study of mealtime insulin administration and parental stress in youth with new-onset type 1 diabetes. Diabet Med 2023; 40:e15039. [PMID: 36617389 DOI: 10.1111/dme.15039] [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] [Received: 08/14/2022] [Revised: 12/27/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023]
Abstract
AIMS To compare the stress level in parents of children with new-onset type 1 diabetes receiving a fixed insulin dose for a fixed range of carbohydrates (CHOs) to parents of children receiving a precise insulin dose for a precise number of CHOs using an insulin-to-carbohydrate ratio (ICR). METHODS Twenty-four participants (8-14 years) were randomized to receive a fixed dose of insulin for a fixed range of CHOs (FD group) or a precise dose of insulin for a precise number of carbohydrates using an ICR (ICR group). The primary endpoint was parental stress measured with the parental stress survey (PSS) 1 to 4 months after diagnosis. Secondary endpoints included glycemic variability, glycated haemoglobin (HbA1C ) and safety. RESULTS Compared to parents of children in the ICR group, those from the FD group reported less stress during the first 4 months after diagnosis (p = 0.022). Glycemic variability and HbA1C were similar in both groups. None of the patients from either group required an emergency department visit or hospitalization. CONCLUSIONS In comparison to precise insulin dosing using an ICR, fixed insulin dosing for a fixed range of CHOs may be less stressful for parents to learn and employ when initially taught diabetes management skills for their child with new-onset type 1 diabetes.
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Affiliation(s)
- Jacqueline V Reyes Diaz
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
- Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia, United States
| | - Janet Figueroa
- Department of Pediatrics, Pediatric Biostatistics Core, Emory University School of Medicine, Atlanta, Georgia, United States
| | - Eric I Felner
- Department of Pediatrics, Division of Endocrinology, Emory University School of Medicine, Atlanta, Georgia, United States
- Children's Healthcare of Atlanta (CHOA), Atlanta, Georgia, United States
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18
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Hodnekvam K, Iversen HH, Gani O, Brunborg C, Skrivarhaug T. Do adolescents and emerging adults receive the diabetes care they truly need? A nationwide study of the quality of diabetes health care during the transition from paediatric to adult care. Diabet Med 2023:e15091. [PMID: 36932850 DOI: 10.1111/dme.15091] [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: 04/06/2022] [Revised: 02/14/2023] [Accepted: 03/13/2023] [Indexed: 03/19/2023]
Abstract
AIMS The aim of this study was to assess the paediatric and adult diabetes care provided to adolescents and young adults with childhood-onset type 1 diabetes during the transition. METHODS This nationwide population-based cohort study included 776 individuals with type 1 diabetes who were last registered in the Norwegian Childhood Diabetes Registry (NCDR) between 2009 and 2012 and had received adult health care for at least 2 years. The patients' experiences were reported in a validated questionnaire. Clinical data from the annual registrations in the NCDR were coupled with data from the medical records in adult diabetes care. The longitudinal measures of glycaemic control were analysed using a growth mixture model. RESULTS A total of 321 young people answered the questionnaire and provided written informed consent for the collection of their data from their medical records. The mean age at transfer was 18.0 years (range = 15.0-23.5 years), and the mean age at participation was 22.7 years (range = 20.9-26.7 years). Significant differences (p < 0.001) in patient experiences were found between paediatric and adult diabetes care in several areas: contact with health-care personnel, continuity of care, interval between consultations and overall satisfaction. Registry and medical records data confirmed the patient-reported experiences. The longitudinal analyses identified two groups with distinctly different trajectories of glycaemic outcome over time. Patient-provider continuity and perceived preparedness for transfer were the most influential predictors. CONCLUSIONS This study highlights several areas to be addressed for improving health care and the transition to adult diabetes care in adolescents and young adults with type 1 diabetes, including provider continuity, individualised care and involvement of multidisciplinary teams.
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Affiliation(s)
- Kristin Hodnekvam
- Department of Paediatric and Adolescent Medicine, Telemark Hospital, Skien, Norway
- The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway
| | - Hilde H Iversen
- Division of Health Services, Department for Research and Analysis of Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Osman Gani
- The Norwegian Childhood Diabetes Registry, Oslo University Hospital, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
| | - Torild Skrivarhaug
- Division of Paediatric and Adolescent Medicine, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Oslo Diabetes Research Centre, Oslo University Hospital, Oslo, Norway
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19
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Marks KP, Birkebæk NH, Pouwer F, Ibfelt EH, Thastum M, Jensen MB. Adherence in Diabetes Questionnaire (ADQ) score as predictor of 11-year HbA 1c trajectories in children and adolescents with type 1 diabetes: A population-based longitudinal study. Diabetes Res Clin Pract 2023; 197:110558. [PMID: 36738832 DOI: 10.1016/j.diabres.2023.110558] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/18/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023]
Abstract
AIMS To identify 11-year HbA1c trajectories in children/adolescents with type 1 diabetes and determine whether baseline caregiver- and/or child/adolescent-reported Adherence in Diabetes Questionnaire (ADQ) scores and multiple covariates predict HbA1c trajectory membership. METHODS For a 2009 population-based cohort of children/adolescents with type 1 diabetes, we analyzed HbA1c follow-up (2010-2020) data from Danish diabetes registries. HbA1c trajectories were identified with group-based trajectory modeling. Using multinomial logistic regression, we tested whether ADQ scores predicted trajectory membership when adjusting for sex, age at diabetes diagnosis, diabetes duration, family structure, and caregiver education. RESULTS For 671 children/adolescents (10-17 years at baseline) with 5644 HbA1c observations over 11 years, four trajectories/groups were identified: 1) "on target, gradual decrease" (27%), 2) "above target, mild increase then decrease" (39%), 3) "above target, moderate increase then decrease" (25%), and 4) "well above target, large increase then decrease" (9%). Using group one as the reference, lower caregiver-reported ADQ scores predicted group 2, 3, and 4 membership. Lower child/adolescent-reported ADQ scores predicted group 3 and 4 membership. Low caregiver education predicted group 3 and 4 membership. Single-parent status predicted group 4 membership. CONCLUSIONS ADQ scores and socio-demographics may serve as tools to predict glycemic control in youth with type 1 diabetes.
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Affiliation(s)
- Kevin P Marks
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.
| | - Niels H Birkebæk
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark; Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark; Steno Diabetes Center Odense, Odense, Denmark; Department of Medical Psychology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Else H Ibfelt
- The Danish Clinical Quality Program - National Clinical Registries (RKKP), Copenhagen, Denmark.; Steno Diabetes Center Copenhagen, The Capital Region, Denmark
| | - Mikael Thastum
- Department of Psychology, Aarhus University, Aarhus, Denmark
| | - Morten B Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
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An Integrated Care Model to Support Adolescents With Diabetes-related Quality-of-life Concerns: An Intervention Study. Can J Diabetes 2023; 47:3-10. [PMID: 35843836 DOI: 10.1016/j.jcjd.2022.05.004] [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: 08/04/2021] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Our aim in this study was to determine whether participating in an integrated stepped care model for adolescents with type 1 diabetes (T1D) would lead to improvements in overall quality of life (QoL), diabetes-related quality of life (DRQoL) and glycated hemoglobin (A1C) levels compared with usual care. METHODS A nonrandomized, 2-group, pre/post, delayed-intervention design was used for this study. The Mind Youth Questionnaire (MY-Q) was used to assess QoL and DRQoL. Adolescents attending the diabetes clinic using the stepped care model formed the intervention group (n=77). These adolescents completed the MY-Q, and the identified concerns were discussed and addressed with them by their care team as part of the care model. Adolescents attending a pediatric diabetes clinic on another site completed the MY-Q as a comparison group (n=39), results were not shared with their care team, and they received the standard care. RESULTS There were 116 adolescents between 13 to 17 years of age, who completed the MY-Q on 2 occasions. Baseline data were obtained on the first occasion, and, on the second occasion, an average of 12 months later, there was a follow-up assessment. At follow-up, adolescents in the intervention group had a significantly higher overall QoL and reported significantly fewer concerns on DRQoL domains than those in the comparison group. Participation in the intervention group, however, did not lead to improvements in A1C. CONCLUSION This study shows that implementing an integrated stepped care model within an interprofessional pediatric diabetes clinic can lead to the improvement of adolescents' overall QoL and DRQoL.
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Bailly-Bourbigot M, Mignot B, Ridley A, Vinel V. Characteristics of adolescents with chronic poorly controlled type 1 diabetes – A qualitative study. Arch Pediatr 2022; 29:548-553. [DOI: 10.1016/j.arcped.2022.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/10/2022] [Accepted: 09/24/2022] [Indexed: 11/17/2022]
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Gregory JW, Cameron FJ, Joshi K, Eiswirth M, Garrett C, Garvey K, Agarwal S, Codner E. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence. Pediatr Diabetes 2022; 23:857-871. [PMID: 36250644 PMCID: PMC9828225 DOI: 10.1111/pedi.13408] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 01/12/2023] Open
Affiliation(s)
- John W. Gregory
- Division of Population Medicine, School of MedicineCardiff UniversityCardiffUK
| | - Fergus J. Cameron
- Royal Children's HospitalMelbourneAustralia,Murdoch Children's Research InstituteMelbourneAustralia,Department of PaediatricsUniversity of MelbourneMelbourneAustralia
| | - Kriti Joshi
- Department of Endocrinology & DiabetesQueensland Children's HospitalSouth BrisbaneAustralia
| | - Mirjam Eiswirth
- Department of Anglophone StudiesUniversität Duisburg EssenEssenGermany
| | - Christopher Garrett
- Institute of Psychiatry, Psychology and NeuroscienceBart's Health and East London Foundation TrustLondonUK
| | - Katharine Garvey
- Division of EndocrinologyBoston Children's HospitalBostonMassachusettsUSA
| | - Shivani Agarwal
- Department of Medicine (Endocrinology), Albert Einstein College of MedicineMontefiore Medical CenterBronxNew YorkUSA
| | - Ethel Codner
- Instituto de Investigaciones Materno Infantil, Facultad de MedicinaUniversity of ChileSantiagoChile
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23
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Wasserman RM, Patton SR, Clements MA, Guffey D, Schwartz DD, Anderson BJ. Risky self-management behaviors in adolescents with type 1 diabetes: Measurement validation for the Diabetes-Specific Risk-Taking Inventory. Pediatr Diabetes 2022; 23:1113-1121. [PMID: 35752878 PMCID: PMC9588552 DOI: 10.1111/pedi.13387] [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: 02/25/2022] [Revised: 05/24/2022] [Accepted: 06/23/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Among persons with type 1 diabetes (T1D), adolescents often experience the greatest challenge achieving optimal treatment engagement and glycemic targets. Risk-taking behaviors often increase during adolescence and may interfere with engagement in T1D care. We developed the Diabetes-Specific Risk-Taking Inventory (DSRI) to assess risky T1D self-management behaviors in adolescents with T1D. In the current study, we aimed to examine the DSRI's psychometric properties. RESEARCH DESIGN AND METHODS We surveyed a national sample of 224 adolescents from the T1D Exchange registry (M age = 16.9 ± 1.1, 49% female, M A1c = 8.5% ± 1.3, 76.8% on insulin pumps) in a cross-sectional design. Participants completed the DSRI and measures of engagement, general risk-taking, and executive functioning and reported on incidence of severe hypoglycemia and diabetic ketoacidosis over the past year. RESULTS The DSRI demonstrated reliability (internal consistency: α = 0.89; test-retest reliability: r = 0.86, p < 0.01). Concurrent validity was demonstrated through significant associations between the DSRI and T1D engagement (r = -0.75), general risk-taking (r = 0.57), executive dysfunction (r = 0.34), and report of severe hypoglycemia over the past year (r = 0.22). The DSRI accounted for unique variance in adolescents' most recent glycated hemoglobin, above and beyond other variables, indicating its incremental validity. CONCLUSIONS Overall, initial psychometrics suggest the DSRI is a reliable and valid measure of risks that adolescents may take with their T1D care. This innovative self-report measure has potential to be an actionable clinical tool to screen for high-risk behaviors not routinely assessed in T1D clinical care.
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Affiliation(s)
- Rachel M. Wasserman
- Nemours Children’s Health, Florida, Center for Healthcare Delivery Science, Orlando, FL, USA
| | - Susana R. Patton
- Nemours Children’s Health, Florida, Center for Healthcare Delivery Science, Jacksonville, FL, USA
| | - Mark A. Clements
- Children’s Mercy Kansas City, Division of Endocrinology, Kansas City, MO, USA
| | - Danielle Guffey
- Baylor College of Medicine, Institute for Clinical and Translational Research, Houston, TX, USA
| | - David D. Schwartz
- Baylor College of Medicine, Department of Pediatrics/ Texas Children’s Hospital, Houston, TX, USA
| | - Barbara J. Anderson
- Baylor College of Medicine, Department of Pediatrics/ Texas Children’s Hospital, Houston, TX, USA
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Garvey KC, Finkelstein JA, Zhang F, LeCates R, Laffel L, Wharam JF. Health Care Utilization Trends Across the Transition Period in a National Cohort of Adolescents and Young Adults With Type 1 Diabetes. Diabetes Care 2022; 45:2509-2517. [PMID: 36001755 PMCID: PMC9679267 DOI: 10.2337/dc22-0152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 08/01/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Lack of effective transition from pediatric to adult care may contribute to adverse outcomes in young adults with type 1 diabetes. The understanding of outpatient and acute care utilization patterns across the adolescent to young adult transition age in type 1 diabetes populations is suboptimal in the U.S. RESEARCH DESIGN AND METHODS We studied claims data from 14,616 individuals diagnosed with type 1 diabetes, aged 16-24 years, and enrolled in a large national health plan for ≥1 year from 2005 to 2012. Annual outpatient and emergency department visits and hospitalization rates were calculated at each age. Generalized estimating equations were used to assess the association of age-group (adolescents [age 16-18 years] vs. young adults [age 19-24 years]), outpatient visits, and sociodemographic variables with emergency department visit and hospitalization rates. RESULTS Endocrinologist visits declined from 2.3 per year at age 16 years to 1.5 per year by age 22. Emergency department rates increased per year from 45 per 100 at age 16 to 63 per 100 at age 20, then decreased to 60 per 100 by age 24. Hospitalizations per year climbed from 14 per 100 at age 16 to 21 per 100 at age 19, then decreased to 17 per 100 by age 24. In statistical models, young adults experienced higher rates of emergency department visits (incidence rate ratio [IRR] 1.24 [95% CI 1.18, 1.31]) and hospitalizations (IRR 1.25 [95% CI 1.15, 1.36]) than adolescents. Additional significant predictors of emergency department visits and hospitalizations included female sex and Black race. Individuals with two or more endocrinologist visits per year were less likely to have emergency department visits and hospitalizations; higher income was also protective. CONCLUSIONS Results highlight concerning increases in acute care utilization for young adults with type 1 diabetes who are less engaged with outpatient diabetes care and highlight socioeconomic risk factors that warrant further study.
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Affiliation(s)
| | - Jonathan A. Finkelstein
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - Fang Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Robert LeCates
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Lori Laffel
- Division of Endocrinology, Boston Children’s Hospital, Boston, MA
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA
| | - James F. Wharam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute, Boston, MA
- Department of Medicine, Duke University, Durham, NC
- Duke-Margolis Center for Health Policy, Durham, NC
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25
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Faulds ER, Rayo M, Lewis C, Noble CW, Gifford R, Happ MB, Joyce L, Dungan K. Simulation Platform Development for Diabetes and Technology Self-Management. J Diabetes Sci Technol 2022; 16:1451-1460. [PMID: 34293963 PMCID: PMC9631530 DOI: 10.1177/19322968211029303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Specialized education is critical for optimal insulin pump use but is not widely utilized or accessible. We aimed to (1) test the usability and acceptability of A1Control, a simulation platform supporting insulin pump education, and (2) determine predictors of performance. METHOD Rural adult insulin pump users with type 1 diabetes (T1D) participated in a mixed methods usability study in 2 separate rounds. Participants navigated 3 simulations (ie, infusion site occlusion, hypoglycemia, exercise). Net Promoter Score (NPS) and Systems Usability Scale (SUS) were administered. Semi-structured interviews and direct observation were used to assess perceived usability, acceptability and performance. Synthetic Minority Oversampling Technique was used to fit predictive models for visualization of patterns leading to good or poor A1Control performance. RESULTS Participants (N = 13) were 28-70 years old, 10 used automated insulin delivery and 12 used continuous glucose monitoring (CGM). Mean NPS was 9.5 (range 9-10) and positive sentiment during interviews indicated very high acceptability. SUS (mean 88.5, range 70-100) indicted a high perceived usability. CGM percent wear ≥ 94%, time spent in hypoglycemia ≤ 54 mg/dl of <0.01%, and <70 mg/dl of 0.5% predicted successful site-occlusion scenario performance with 100% accuracy. BOLUS score ≥ 2, TDD ≥ 34, and technology brand predicted exercise scenario success with 100% accuracy. There were an insufficient number of failed hypoglycemia scenarios to assess predictors. CONCLUSION A1Control shows potential to increase access and frequency of self-management and technology education. Additional study is needed to determine sustained engagement and benefit.
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Affiliation(s)
- Eileen R. Faulds
- The Ohio State University College of
Nursing, Columbus, OH, USA
- The Ohio State University Medical
Center, Columbus, OH, USA
- Eileen R. Faulds, The Ohio State University
College of Nursing, 560 McCampbell Hall, 5 South, 1581 Dodd Dr. Columbus, OH
43210, USA.
| | - Michael Rayo
- The Ohio State University College of
Engineering, Columbus, OH, USA
| | - Claudia Lewis
- Wake Forest School of Medicine,
Winston-Salem, NC, USA
| | - Carl W Noble
- University of Cincinnati Medical
Center, Cincinnati, OH, USA
| | - Ryan Gifford
- The Ohio State University College of
Engineering, Columbus, OH, USA
| | - Mary Beth Happ
- The Ohio State University College of
Nursing, Columbus, OH, USA
| | - Lilly Joyce
- The Ohio State University College of
Nursing, Columbus, OH, USA
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Association of HbA1c with VO 2max in Individuals with Type 1 Diabetes: A Systematic Review and Meta-Analysis. Metabolites 2022; 12:metabo12111017. [PMID: 36355100 PMCID: PMC9697838 DOI: 10.3390/metabo12111017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 10/12/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this systematic review and meta-analysis was to evaluate the association between glycemic control (HbA1c) and functional capacity (VO2max) in individuals with type 1 diabetes (T1DM). A systematic literature search was conducted in EMBASE, PubMed, Cochrane Central Register of Controlled Trials, and ISI Web of Knowledge for publications from January 1950 until July 2020. Randomized and observational controlled trials with a minimum number of three participants were included if cardio-pulmonary exercise tests to determine VO2max and HbA1c measurement has been performed. Pooled mean values were estimated for VO2max and HbA1c and weighted Pearson correlation and meta-regression were performed to assess the association between these parameters. We included 187 studies with a total of 3278 individuals with T1DM. The pooled mean HbA1c value was 8.1% (95%CI; 7.9−8.3%), and relative VO2max was 38.5 mL/min/kg (37.3−39.6). The pooled mean VO2max was significantly lower (36.9 vs. 40.7, p = 0.001) in studies reporting a mean HbA1c > 7.5% compared to studies with a mean HbA1c ≤ 7.5%. Weighted Pearson correlation coefficient was r = −0.19 (p < 0.001) between VO2max and HbA1c. Meta-regression adjusted for age and sex showed a significant decrease of −0.94 mL/min/kg in VO2max per HbA1c increase of 1% (p = 0.024). In conclusion, we were able to determine a statistically significant correlation between HbA1c and VO2max in individuals with T1DM. However, as the correlation was only weak, the association of HbA1c and VO2max might not be of clinical relevance in individuals with T1DM.
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27
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Tilden DR, French B, Shoemaker AH, Corathers S, Jaser SS. Prolonged lapses between pediatric and adult care are associated with rise in HbA1c and inpatient days among patients with type 1 diabetes. Diabetes Res Clin Pract 2022; 192:110113. [PMID: 36208847 PMCID: PMC9867942 DOI: 10.1016/j.diabres.2022.110113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
AIM To quantify the association between the duration of the pediatric-to-adult care transfer with glycemic control among patients with type 1 diabetes (T1D). METHODS This retrospective cohort study included patients with T1D who completed transfer between pediatric and adult diabetes clinics at a single academic medical center between 2004 and 2020. The primary exposure was time from the last pediatric to first adult diabetes care encounter. The primary outcome was the average HbA1c in the first year after entry into adult care. RESULTS A total of 449 patients (mean age at transfer 19.8yrs, 51.7 % male) were included for analysis. Transfer required a median of nearly 5 months (196 days; IQR:93-251) and in adjusted and unadjusted models was strongly associated with increased HbA1c within 1 year of transfer (0.19 %, 2 mmol/mol; 95 %CI:0.04 %-0.33 %) for each 6 months of latency. In secondary analyses, transfer latency also exhibited a significant association with days spent hospitalized (IRR 1.23 per 6 months; 95 %CI:1.08-1.33). CONCLUSIONS Our findings isolate and quantify the impact of prolonged lapses in care associated with the pediatric-to-adult care transfer. These findings underscore the need for providers and healthcare systems to improve this care transition in order to improve outcomes for this vulnerable patient population.
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Affiliation(s)
- Daniel R Tilden
- Division of Endocrinology, Diabetes, and Clinical Pharmacology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ashley H Shoemaker
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
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28
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Inverso H, Moore HR, Lupini F, Wang CH, Streisand R, Shomaker LB, Mackey ER. Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes. Curr Diab Rep 2022; 22:493-500. [PMID: 35984566 DOI: 10.1007/s11892-022-01492-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/28/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D. RECENT FINDINGS Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.
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Affiliation(s)
- Hailey Inverso
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Hailey R Moore
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Francesca Lupini
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Christine H Wang
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
| | - Randi Streisand
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA
- The George Washington University School of Medicine, Washington, DC, USA
| | - Lauren B Shomaker
- Colorado State University, Fort Collins, CO, USA
- Children's Hospital Colorado/University of Colorado Anschutz, Aurora, CO, USA
- Colorado School of Public Health, Fort Collins and Aurora, CO, USA
| | - Eleanor R Mackey
- Center for Translational Research, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, USA.
- The George Washington University School of Medicine, Washington, DC, USA.
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29
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James S, Perry L, Lowe J, Harris M, Craig ME. Suboptimal glycemic control in adolescents and young adults with type 1 diabetes from 2011 to 2020 across Australia and New Zealand: Data from the Australasian Diabetes Data Network registry. Pediatr Diabetes 2022; 23:736-741. [PMID: 35561056 DOI: 10.1111/pedi.13364] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 05/02/2022] [Accepted: 05/09/2022] [Indexed: 10/18/2022] Open
Abstract
BACKGROUND Competing challenges in adolescence and young adulthood can distract from optimal type 1 diabetes (T1D) self-management, and increase risks of premature morbidity and mortality. There are limited data mapping the glycemic control of people with T1D in this age group, across Australasia. RESEARCH DESIGN AND METHODS Clinical data were extracted from the Australasian Diabetes Data Network, a prospective clinical diabetes registry. Inclusion criteria were individuals with T1D aged 16-25 years at their last recorded T1D healthcare visit (from 1st January 2011 to 31st December 2020), with T1D duration of at least 1 year. Data were stratified by two last recorded T1D healthcare visit ranges, while generalized estimated equation (GEE) modeling was used to examine factors associated with HbA1c across visits during the 10 year period. RESULTS Data from 6329 young people (52.6% male) attending 24 diabetes centers across Australasia were included. At the last visit within the most recent 5 years, mean ± SD age was 18.5 ± 2.3 years, T1D duration was 8.8 ± 4.7 years and HbA1c was 8.8 ± 1.8% (72.2 ± 19.9 mmol/mol); only 12.3% had an HbA1c below the international target of <7.0% (53 mmol/mol). Across all T1D healthcare visits, in GEE modeling, higher HbA1c was associated with female sex (B = 0.20; 95% CI 0.12 to 0.29, p < 0.001), longer T1D duration (B = 0.04, 0.03 to 0.05, p < 0.001). Lower HbA1c was associated with attendance at a pediatric T1D healthcare setting (B = -0.33, -0.45 to -0.21, p < 0.001) and use of CSII versus BD/MDI therapy (B = -0.49, -0.59 to 0.40, p < 0.001). CONCLUSIONS This Australasian study demonstrates widespread and persistent sub-optimal glycemic control in young people with T1D, highlighting the urgent need to better understand how healthcare services can support improved glycemic control in this population.
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Affiliation(s)
- Steven James
- University of the Sunshine Coast, School of Nursing, Midwifery and Paramedicine, Petrie, Queensland, Australia.,University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Parkville, Victoria, Australia
| | - Lin Perry
- University of Technology Sydney, School of Nursing and Midwifery, Ultimo, New South Wales, Australia.,Prince of Wales Hospital, Randwick, New South Wales, Australia
| | - Julia Lowe
- University of Newcastle, School of Medicine and Public Health, Callaghan, New South Wales, Australia
| | - Margaret Harris
- University of Newcastle, School of Nursing and Midwifery, New South Wales, Australia
| | - Maria E Craig
- Children's Hospital at Westmead, Endocrinology, Westmead, New South Wales, Australia.,University of Sydney, Faculty of Health and Medicine, Sydney, New South Wales, Australia.,University of New South Wales, School of Women's and Children's Health, Kensington, New South Wales, Australia
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30
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Ibfelt EH, Wibaek R, Vistisen D, Andersen GS, Jørgensen ME, Hulman A, Dabelea D, Birkebaek NH, Svensson J, Rønn PF. Trajectory and predictors of HbA1c in children and adolescents with type 1 diabetes-A Danish nationwide cohort study. Pediatr Diabetes 2022; 23:721-728. [PMID: 35366046 DOI: 10.1111/pedi.13337] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 02/21/2022] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Poor glycemic control in type 1 diabetes increases the risk of chronic complications and it is essential to identify life periods and predictors associated with deteriorating HbA1c . The aim was to describe specific HbA1c trajectories in Danish children and adolescents with type 1 diabetes and study associations with clinical and sociodemographic factors. RESEARCH DESIGN AND METHODS 5889 children with type 1 diabetes were included from the nationwide Danish Registry of Childhood and Adolescent Diabetes with annual visits during 1996-2019. Trajectories of HbA1c were modeled with linear mixed-effects models (using age as time scale, included as cubic spline) and with an individual-specific random intercept and slope. The following cofactors were included stepwise into the model: sex, age at diagnosis, calendar year, parental education, immigrant status, health care region, blood glucose monitoring (BGM) frequency, treatment modalities: continuous subcutaneous insulin infusion (pump) versus multiple daily insulin injection therapy (pen) and continuous glucose monitoring. RESULTS HbA1c overall increased during age while there was a significant decreasing secular trend. Older age at diagnosis was associated with a steeper trajectory, and non-Danish origin and shorter parental education were each associated with higher levels of HbA1c across age. A lower BGM frequency was associated with a markedly poorer HbA1c trajectory, while no significant differences were shown for different treatment modalities. CONCLUSIONS Glycemic outcome worsened with age during childhood and adolescence, which is of clinical concern. Important predictors for a poorer glycemic trajectory were later age at diabetes diagnosis, shorter parental education, non-Danish origin and, in particular low BGM frequency.
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Affiliation(s)
- Else Helene Ibfelt
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Rasmus Wibaek
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Dorte Vistisen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Gregers S Andersen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
| | - Marit E Jørgensen
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark.,National Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Adam Hulman
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Dana Dabelea
- Colorado School of Public Health, Aurora, Colorado, USA
| | - Niels H Birkebaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark.,Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | | | - Pernille F Rønn
- Clinical Epidemiological Research, Steno Diabetes Center Copenhagen, Gentofte, Denmark
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31
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Abstract
PURPOSE OF REVIEW Epidemiological research on type 1 diabetes (T1D) has traditionally focussed on the paediatric age group, but recent data in adults has confirmed it to be a disease of all ages with a wide clinical spectrum. We review the epidemiology and clinical features of T1D across the lifespan. RECENT FINDINGS While the peak incidence of T1D is still in early adolescence, T1D is now diagnosed more commonly in adulthood than childhood due to increasing recognition of adult-onset T1D and the length of the adult lifespan. It still follows the known geographic variations in incidence, being highest in Northern Europe and lowest in Asia. The onset of T1D in adulthood is usually less acute than in childhood and confers a lower, although still substantial, risk of complications and early mortality. Interventions to delay T1D onset are emerging and screening for those at risk at birth is increasingly available. Type 1 diabetes can develop at any age and may not present with ketosis or an immediate insulin requirement in adults. Macro- and microvascular complications are the greatest cause of excess morbidity and mortality in this population.
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32
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Scott SR, O’Donnell M, Manczak EM, Fladeboe K, Ellisor B, Rosenberg AR, Malik FS, Yi-Frazier JP. Resilience and Diabetes Distress at 3 Months Following Diagnosis Predict A1C Trajectories in Youth With Type 1 Diabetes: An Argument for Early Intervention. J Pediatr Psychol 2022; 47:1125-1134. [PMID: 35689646 PMCID: PMC9801710 DOI: 10.1093/jpepsy/jsac046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 05/02/2022] [Accepted: 05/04/2022] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE Youth and adolescents with type 1 diabetes (T1D) are at risk for poor health outcomes. Understanding if psychological factors shortly following diagnosis, such as diabetes distress and resilience, predict glycated hemoglobin (A1C) trajectories may help inform both optimal timing and content of psychosocial interventions for youth with T1D. METHODS Youth and adolescents (N = 34) with newly diagnosed T1D completed distress and resilience measures at baseline and 3 months following diagnosis. Using multilevel modeling, we predicted A1C trajectories up to 3 years following diagnosis. RESULTS We found that in separate models, higher 3-month diabetes distress and lower 3-month resilience predicted larger increases in A1C years 1-3 following diagnosis. CONCLUSIONS Our findings suggest that targeting resilience and diabetes distress within 3 months following diagnosis has implications for the yearly rate of A1C increase up to 3 years later.
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Affiliation(s)
- Samantha R Scott
- Department of Psychology, University of Denver, USA,Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | - Maeve O’Donnell
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | | | - Kaitlyn Fladeboe
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | - Britney Ellisor
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA
| | - Abby R Rosenberg
- Palliative Care and Resilience Lab, Center for Clinical and Translational Research, Seattle Children’s Research Institute, USA,Department of Pediatrics, University of Washington School of Medicine, USA,Fred Hutchinson Cancer Research Center, USA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington School of Medicine, USA
| | - Joyce P Yi-Frazier
- All correspondence concerning this article should be addressed to Joyce P. Yi-Frazier, PhD, Palliative Care and Resilience Research Lab, Seattle Children’s Research Institute, 1920 Terry Ave, Cure 4, Seattle, WA 98101, USA. E-mail:
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Evans M, Welsh Z, Seibold A. Reductions in HbA1c with Flash Glucose Monitoring Are Sustained for up to 24 Months: A Meta-Analysis of 75 Real-World Observational Studies. Diabetes Ther 2022; 13:1175-1185. [PMID: 35476279 PMCID: PMC9174370 DOI: 10.1007/s13300-022-01253-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 03/11/2022] [Indexed: 02/08/2023] Open
Abstract
INTRODUCTION Real-world evidence (RWE) confirms that reductions in HbA1c for children and adults with type 1 diabetes (T1DM) and adults with type 2 diabetes (T2DM) are associated with use of the FreeStyle Libre system. This current meta-analysis aims to investigate whether HbA1c benefits are sustained over 24 months and to identify patterns of change in HbA1c for users of the FreeStyle Libre system for people living with T1DM or T2DM. METHODS A bibliographic search up to December 2020 identified 75 studies reporting data on change in lab HbA1c in 30,478 participants with type 1 (n = 28,063; 62 trials) or type 2 diabetes (n = 2415; 13 trials) using the FreeStyle Libre system, including observations on children, adolescents and adults. Meta-analysis was performed using a random effects model. RESULTS Reductions in HbA1c at 3-4 months were similar for adults with T1DM (- 0.53%, 95% CI - 0.69 to - 0.38) or with T2DM (- 0.45%, 95% CI - 0.57 to - 0.33), continuing through 4.5-7.5 months in T1DM (- 0.42%, 95% CI - 0.58 to - 0.27) and in T2DM (- 0.59%, 95% CI - 0.80 to - 0.39). Meta-regression analysis shows that higher starting HbA1c is correlated with greater reductions in HbA1c in T1DM and in T2DM. These patterns of change in HbA1c were sustained for 24 months in T1DM and for at least 12 months in T2DM. CONCLUSIONS Meta-analysis of RWE confirms that using the FreeStyle Libre system is associated with significant reductions in HbA1c for adults with T1DM or with T2DM. Reductions are greater for people with higher baseline HbA1c and are sustained for 24 and 12 months in T1DM and TD2M respectively.
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Affiliation(s)
- Mark Evans
- Wellcome Trust/MRC Institute of Metabolic Science, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Addenbrookes Hospital, Hills Road, IMS MRL Box 289, Cambridge, CB2 0QQ UK
| | - Zoë Welsh
- Abbott Diabetes Care, Range Road, Witney, Oxfordshire, OX28 3FP UK
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Hu TY, Price J, Pierce JS, Gannon AW. The association between pediatric mental health disorders and type 1 diabetes-related outcomes. Pediatr Diabetes 2022; 23:507-515. [PMID: 35249249 DOI: 10.1111/pedi.13330] [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: 07/10/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Transition from pediatric to adult healthcare systems is a difficult process for young adults with Type 1 Diabetes (T1D) and most patients experience a deterioration in disease control. Mental health (MH) disorders are common in individuals with T1D and are believed to play a role in disease control and transition of care. We evaluated the association between the presence of pediatric MH disorder and measures of success in diabetes care in young adults who recently transitioned to adult care. RESEARCH DESIGN AND METHODS Retrospective cohort study of young adults in a large adult endocrinology system who transitioned from a pediatric hospital system after 2009. MH disorders were diagnosed by clinical pediatric psychologists during routine care at the pediatric hospital. Measurements of Hemoglobin A1c, diabetes-related emergencies, clinic attendance and intervals in transition were assessed and compared between the pediatric and adult hospital systems. RESULTS 237 young adults were identified and 100 (42%) of these were diagnosed with a MH disorder during pediatric care. Presence of a MH disorder was associated with higher Hemoglobin A1c levels prior to transition and increased rates of diabetes-related hospitalizations during the transition interval. Patients with a MH disorder were less likely to establish a pattern of consistent follow up after transition (p = 0.021). CONCLUSIONS MH disorders are common and predict greater challenges with diabetes management and less effective transition into the adult endocrinology system. Early recognition of MH disorders may allow for allocation of more proactive and intensive support for affected patients.
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Affiliation(s)
- Tina Y Hu
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julia Price
- Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware, USA
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida, USA.,Department of Pediatrics, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Anthony W Gannon
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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Troncone A, Chianese A, Cascella C, Zanfardino A, Piscopo A, Rollato S, Iafusco D. Eating Problems in Youths with Type 1 Diabetes During and After Lockdown in Italy: An 8-Month Follow-Up Study. J Clin Psychol Med Settings 2022; 30:227-237. [PMID: 35635607 PMCID: PMC9148941 DOI: 10.1007/s10880-022-09884-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/02/2022] [Indexed: 01/09/2023]
Abstract
AbstractEighty-five youths with T1D and 176 controls aged 8–19 years were asked to complete online questionnaires (ChEAT and EAT-26) measuring disordered eating behaviors (DEBs) during (baseline) and after (8-month follow-up) the lockdown. DEB symptoms in all participants (especially younger than 13 years), glycemic control, and zBMI were found unchanged from baseline to follow-up (all p > .05). After 8 months, the ChEAT/EAT-26 critical score frequency decreased significantly in controls (p = .004), as was the score for the ChEAT/EAT-26’s Oral Control subscale in both groups (T1D: p = .005; controls: p = .01). Participants with T1D, especially those older than 13 years, had higher ChEAT/EAT-26 Dieting scores (p = .037) and lower ChEAT/EAT-26 Oral Control scores (p = .046) than controls. Unchanged DEB symptoms suggest that the COVID-19 restrictions did not significantly affect participants’ eating behaviors and that a general adaptation to the challenges of lockdown and other pandemic containment measures occurred in both T1D and control participants.
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Affiliation(s)
- Alda Troncone
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Antonietta Chianese
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Crescenzo Cascella
- Department of Psychology, University of Campania "Luigi Vanvitelli", Caserta, Italy
| | - Angela Zanfardino
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138, Naples, Italy.
| | - Alessia Piscopo
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138, Naples, Italy
| | - Serena Rollato
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138, Naples, Italy
| | - Dario Iafusco
- Department of the Woman, of the Child and of the General and Specialized Surgery, University of Campania "Luigi Vanvitelli", Via L. De Crecchio 2, 80138, Naples, Italy
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Halper JB, Yazel LG, El Mikati H, Hatton A, Tully J, Li X, Carroll AE, Hannon TS. Patient and Parent Well-Being and Satisfaction With Diabetes Care During a Comparative Trial of Mobile Self-Monitoring Blood Glucose Technology and Family-Centered Goal Setting. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:769116. [PMID: 36992766 PMCID: PMC10012089 DOI: 10.3389/fcdhc.2022.769116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 03/17/2022] [Indexed: 06/19/2023]
Abstract
Patient engagement in the process of developing a diabetes treatment plan is associated with person-centered care and improved treatment outcomes. The objective of the present study was to evaluate the self-reported patient and parent-centered satisfaction and well-being outcomes associated with the three treatment strategies utilized in a comparative effectiveness trial of technology-enhanced blood glucose monitoring and family-centered goal setting. We evaluated data from 97 adolescent-parent pairs at baseline and 6-months during the randomized intervention. Measures included: Problem Areas in Diabetes (PAID) child and parent scales, pediatric diabetes-related quality of life, sleep quality, and satisfaction with diabetes management. Inclusion criteria were 1) ages 12-18 years, 2) a T1D diagnosis for at least six months and 3) parent/caregiver participation. Longitudinal changes in survey responses were measured at 6 months from baseline. Differences between and within participant groups were evaluated using ANOVA. The average age of youth participants was 14.8 ± 1.6 years with half of the participants being female (49.5%). The predominant ethnicity/race was Non-Hispanic (89.9%) and white (85.9%). We found that youth perceived 1) greater of diabetes-related communication when using a meter capable of transmitting data electronically, 2) increased engagement with diabetes self-management when using family-centered goal setting, and 3) worse sleep quality when using both strategies together (technology-enhanced meter and family-centered goal setting). Throughout the study, scores for self-reported satisfaction with diabetes management were higher in youth than parents. This suggests that patients and parents have different goals and expectations regarding their diabetes care management and care delivery. Our data suggest that youth with diabetes value communication via technology and patient-centered goal setting. Strategies to align youth and parent expectations with the goal of improving satisfaction could be utilized as a strategy to improve partnerships in diabetes care management.
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Tauschmann M, Schwandt A, Prinz N, Becker M, Biester T, Hess M, Holder M, Karges B, Näke A, Kuss O, von Sengbusch S, Holl RW. Three-variate trajectories of metabolic control, body mass index, and insulin dose: Heterogeneous response to initiation of pump therapy in youth with type 1 diabetes. Pediatr Diabetes 2022; 23:330-340. [PMID: 35084795 PMCID: PMC9303587 DOI: 10.1111/pedi.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 01/12/2022] [Accepted: 01/17/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) in youths with type 1 diabetes (T1D) is often associated with lower HbA1c, lower total daily insulin dose (TDD), and lower body mass index (BMI) compared with multiple daily injections (MDI). Individual responses to CSII are diverse. The aim was to identify unique three-variate patterns of HbA1c, BMI standard deviation score (SDS), and TDD after switching to CSII. METHODS Five thousand one hundred and thirty-three youths (≤20 years; 48% boys; median age at pump start 12.5 years) with T1D duration ≥3 years at CSII initiation were selected from the multicenter DPV registry. We applied group-based multitrajectory modeling to identify groups of individuals following similar trajectories. Measurements were aggregated quarterly during a 3-year follow-up period. Trajectory variables were changes of HbA1c, BMI-SDS, and TDD from baseline (delta = quarterly aggregated values at each time point [i] minus the respective baseline value). RESULTS Four groups of diverging Delta-HbA1c, Delta-BMI-SDS, and Delta-TDD patterns were identified. All showed improvements in HbA1c during the first 3 months. Group 1 (12%) was characterized by modest HbA1c increase thereafter, TDD reduction, and stable BMI-SDS. In Group 2 (39%), increasing HbA1c, decreasing BMI-SDS, and stable TDD were found. By contrast, sustainably improved HbA1c, increasing BMI-SDS, and stable TDD were observed in Group 3 (32%). Group 4 (17%) was characterized by increasing levels for HbA1c, BMI-SDS, and TDD. Between-group differences in baseline HbA1c, BMI-SDS, TDD as well as in sex ratio, age at diabetes onset and at pump start were observed. CONCLUSIONS Definite trajectories of glycemic control, BMI, and TDD over 3 years after CSII initiation were identified in youths with T1D allowing a more personalized treatment recommendation.
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Affiliation(s)
- Martin Tauschmann
- Department of Pediatrics and Adolescent MedicineMedical University of ViennaViennaAustria
| | - Anke Schwandt
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Nicole Prinz
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
| | - Marianne Becker
- DECCPClinique Pédiatrique Centre Hospitalier de LuxembourgLuxembourgLuxembourg
| | - Torben Biester
- Diabetes‐Center for Children and AdolescentsChildren's Hospital "Auf der Bult"HannoverGermany
| | - Melanie Hess
- Pediatric Endocrinology and DiabetologyUniversity Children's Hospital BaselBaselSwitzerland
| | - Martin Holder
- Klinikum Stuttgart, OlgahospitalDepartment of Pediatric Endocrinology and DiabetologyStuttgartGermany
| | - Beate Karges
- Division of Endocrinology and Diabetes, Medical FacultyRWTH Aachen UniversityAachenGermany
| | - Andrea Näke
- Children's Hospital Carl Gustav CarusTechnical University DresdenDresdenGermany
| | - Oliver Kuss
- German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany,Institute of Biometrics and Epidemiology, German Diabetes CentreLeibniz Centre for Diabetes Research at Heinrich Heine UniversityDüsseldorfGermany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent MedicineUniversity Hospital Schleswig‐Holstein, Campus LuebeckLuebeckGermany
| | - Reinhard W. Holl
- Institute of Epidemiology and Medical BiometryZIBMT, University of UlmUlmGermany,German Center for Diabetes Research (DZD)Munich‐NeuherbergGermany
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Mencher SR, Weinzimer SA, Nally LM, Van Name M, Nunez-Smith M, Sadler LS. Technology Utilization in Black Adolescents with Type 1 Diabetes: Exploring the Decision-Making Process. Diabetes Technol Ther 2022; 24:249-257. [PMID: 35085444 PMCID: PMC11074720 DOI: 10.1089/dia.2021.0413] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Significant disparities in diabetes device (DD) use exist for Black adolescents with type 1 diabetes (T1D), meriting further exploration. We sought to describe how Black adolescents with T1D and their parents make decisions about using DDs and understand personal, familial, and cultural beliefs that may influence use. Materials and Methods: Nineteen Black adolescents with T1D and 17 parents participated in individual qualitative semistructured interviews. Adolescents were purposively sampled for a range of socioeconomic and clinical demographics. Interview data were recorded, transcribed, and coded for thematic analysis, analyzed separately for parents and adolescents, and then compared across groups. Data collection continued until thematic saturation was achieved. Results: Adolescents and parents reported similar themes related to the (1) intersectionality of multiple identities: T1D experience of Black adolescents; (2) decision to use DDs: complexities of T1D management and easing the burden; and (3) reasons for differential uptake of DDs in Black adolescents. Adolescents reported lacking peers with T1D "who look like me," leading to stigmatization, exacerbated by device visibility and alarms. Cultural and familial traditions as well as individual factors were described as both facilitators and barriers in DD use. Lack of familiarity with T1D, limited exposure to DDs, and mistrust of the medical community, both historically and currently, were brought up as reasons for inequities in DD use. Conclusions: Understanding the decision-making process surrounding DDs in one sample of Black adolescents and their parents is critical to guide further research to improve equity in DD use and glycemic outcomes.
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Affiliation(s)
- Shana R. Mencher
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Stuart A. Weinzimer
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
- School of Nursing, Yale University, Orange, Connecticut, USA
| | - Laura M. Nally
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Michelle Van Name
- Department of Pediatrics, Division of Endocrinology, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Marcella Nunez-Smith
- Equity Research and Innovation Center, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Lois S. Sadler
- School of Nursing, Yale University, Orange, Connecticut, USA
- Yale Child Study Center, New Haven, Connecticut, USA
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Prahalad P, Schwandt A, Besançon S, Mohan M, Obermannova B, Kershaw M, Bonfanti R, Lyckå AP, Hanas R, Casteels K. Hemoglobin A1c trajectories in the first 18 months after diabetes diagnosis in the SWEET diabetes registry. Pediatr Diabetes 2022; 23:228-236. [PMID: 34779090 DOI: 10.1111/pedi.13278] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Revised: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 11/30/2022] Open
Abstract
AIM A majority of youth with type 1 diabetes do not meet recommended hemoglobin A1c (HbA1c) targets. The SWEET diabetes registry is a multi-national registry of youth with diabetes. We used data from this registry to identify characteristics associated with glycemic control. METHODS Patients in the SWEET diabetes registry with at least one HbA1c value within 10 days of diagnosis and three follow up measurements in the first 18 months of diagnosis were included (~10% of the SWEET diabetes registry). Locally weighted scatterplot smoothing was used to generate curves of HbA1c. Wilcoxon, Kruskal-Wallis, or χ2-tests were used to calculate differences between groups. RESULTS The mean HbA1c of youth in the SWEET diabetes registry is highest at diagnosis and lowest between months 4 and 5 post-diabetes diagnosis. HbA1c continues to increase steadily through the first 18 months of diagnosis. There are no differences in HbA1c trajectories based on sex or use of diabetes technology. Youth in North America/Australia/New Zealand had the highest HbA1c throughout the first 18 months of diagnosis. The trajectory of youth from countries with nationalized health insurance was lower than those countries without nationalized health insurance. Youth from countries with the highest gross domestic product (GDP) had the highest HbA1c throughout the first 18 months of diagnosis. CONCLUSIONS In this subset of patients, the trajectory of youth from countries with nationalized health insurance was lower than those countries without nationalized health insurance. High GDP and high use of technology did not seem to protect from a higher trajectory.
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Affiliation(s)
- Priya Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, California, USA.,Stanford Diabetes Research Center, Stanford, California, USA
| | - Anke Schwandt
- Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Neuherberg, Germany
| | - Stéphane Besançon
- NGO Santé Diabète Headquarter France and Delegation in Mali, Grenoble, France
| | - Meena Mohan
- Department of Endocrinology, PSG Super Speciality Hospitals, Coimbatore, India
| | - Barbora Obermannova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic
| | - Melanie Kershaw
- Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Riccardo Bonfanti
- Pediatric Diabetes, Diabetes Research Institute, Ospedale San Raffaele Milano, Milan, Italy
| | - Auste Pundziute Lyckå
- Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ragnar Hanas
- Department of Pediatrics, NU Hospital Group, Uddevalla, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Kristina Casteels
- Department of Pediatrics, University Hospitals Leuven, Leuven, Belgium.,Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Cristello Sarteau A, Mayer-Davis E. Too Much Dietary Flexibility May Hinder, Not Help: Could More Specific Targets for Daily Food Intake Distribution Promote Glycemic Management among Youth with Type 1 Diabetes? Nutrients 2022; 14:nu14040824. [PMID: 35215477 PMCID: PMC8877269 DOI: 10.3390/nu14040824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 01/28/2022] [Accepted: 02/09/2022] [Indexed: 01/09/2023] Open
Abstract
Average glycemic levels among youth with type 1 diabetes (T1D) have worsened in some parts of the world over the past decade despite simultaneous increased uptake of diabetes technology, thereby highlighting the persistent need to identify effective behavioral strategies to manage glycemia during this life stage. Nutrition is fundamental to T1D management. We reviewed the evidence base of eating strategies tested to date to improve glycemic levels among youth with T1D in order to identify promising directions for future research. No eating strategy tested among youth with T1D since the advent of flexible insulin regimens—including widely promoted carbohydrate counting and low glycemic index strategies—is robustly supported by the existing evidence base, which is characterized by few prospective studies, small study sample sizes, and lack of replication of results due to marked differences in study design or eating strategy tested. Further, focus on macronutrients or food groups without consideration of food intake distribution throughout the day or day-to-day consistency may partially underlie the lack of glycemic benefits observed in studies to date. Increased attention paid to these factors by future observational and experimental studies may facilitate identification of behavioral targets that increase glycemic predictability and management among youth with T1D.
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Affiliation(s)
- Angelica Cristello Sarteau
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- Correspondence:
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA;
- School of Medicine, University of North Carolina at Chapel Hill, 245 Rosenau Drive, Chapel Hill, NC 27599, USA
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Tumini S, Fioretti E, Rossi I, Cipriano P, Franchini S, Guidone PI, Petrosino MI, Saggino A, Tommasi M, Picconi L, Gonder-Frederick L. Fear of hypoglycemia in children with type 1 diabetes and their parents: Validation of the Italian version of the Hypoglycemia Fear Survey for Children and for Parents. Pediatr Diabetes 2022; 23:126-138. [PMID: 34897924 DOI: 10.1111/pedi.13301] [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: 10/19/2021] [Accepted: 11/25/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Currently, Italian versions of the Hypoglycemia Fear Survey for Children (CHFS) and for Parents (PHFS) quantifying Fear of Hypoglycemia (FoH) in pediatric diabetes are not available. OBJECTIVE To validate the Italian version of the CHFS and PHFS. SUBJECTS AND METHODS One hundred and seventy-four children with type 1 diabetes aged 6-18 and 178 parents completed the CHFS and PHFS, the PedsQL 3.0 Diabetes module and the KIDSCREEN-10. Internal consistency was good (α = 0.85 for CHFS, α = 0.88 for PHFS); validity was supported by correlations of CHFS total score (CHFS-T r = -0.50; p < 0.001, CI = -0.62 to -0.35) and Worry subscale (CHFS-W r = -0.49; p < 0.001, CI = -0.62 to -0.32) with measures of health-related quality of life (QoL), which were not related to PHFS scores. Factor analyses justified the structure and the separate scoring of Behavior and Worry subscales. Children's age was negatively correlated with CHFS-T (r = -0.16; p = 0.03, CI = -0.36 to 0.00), CHFS-W (r = -0.29; p = 0.02, CI = -0.39 to -0.07), PHFS-T (r = -0.20; p = 0.006, CI = -0.35 to -0.04), PHFS-B (r = -0.30; p = 0.001, CI = -0.43 to -0.17). Mean (SD) item scores of CHFS-T (1.47 ± 0.56 vs. 1.27 ± 0.57; p < 0.05) and CHFS-W (1.20 ± 0.73 vs. 0.96 ± 0.68; p < 0.05) were higher in children with HbA1c ≥7.5%. Higher levels of distress for upsetting hypoglycemia were associated with lower child's QoL scores as perceived by children (Peds-QL: 72.6 ± 12.8 vs. 80.4 ± 11.9; p < 0.001) and parents (Peds-QL: 70.6 ± 13.8 vs. 75.8 ± 12.9; p < 0.05). CONCLUSION The Italian version of CHFS and PHFS appears to be a valid measure to assess FoH in clinical practice and factor analysis supports separate scoring for the Worry and Behavior subscales.
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Affiliation(s)
- Stefano Tumini
- Department of Maternal and Child Health, UOSD Regional Center of Pediatric Diabetology, Chieti Hospital, Chieti, Italy
| | - Elisabetta Fioretti
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Ilaria Rossi
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Paola Cipriano
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Simone Franchini
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Paola Irma Guidone
- Department of Pediatrics, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | | | - Aristide Saggino
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Marco Tommasi
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Laura Picconi
- Department of Medicine and Aging Sciences, "G. d'Annunzio" University of Chieti-Pescara, Chieti, Italy
| | - Linda Gonder-Frederick
- Center for Diabetes Technology, Center for Behavioral Health and Technology, University of Virginia, Charlottesville, Virginia, USA
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McClintock JM, Blackmore T, Chepulis LM, Fraser S, Paul RG. The psychological profile of youth and young adults with type 1 diabetes in New Zealand. Pediatr Diabetes 2022; 23:150-156. [PMID: 34773333 DOI: 10.1111/pedi.13289] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 09/23/2021] [Accepted: 10/29/2021] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND The psychological status of New Zealanders living with type 1 diabetes (T1D) is unknown. This study's purpose is to determine the prevalence of general wellbeing, diabetes-specific distress, and disordered eating, and explore their relationships with glycemic control. METHODS Participants were patients aged 15-24 years with T1D (N = 200) who attended their routine multidisciplinary clinic at the Waikato Regional Diabetes Service. They completed questionnaires including the World Health Organization Well-Being Index, the Problem Areas in Diabetes scales, and the Diabetes Eating Problem Survey-Revised. Clinical and demographic information were also collected. RESULTS Median age of participants was 19.3 years and 14% identified as Māori (indigenous people of Aotearoa New Zealand). Median HbA1c was 73 mmol/mol. One fifth of participants experienced low emotional wellbeing, including 7.5% who experienced likely depression. Diabetes distress was found in 24.1%, and 30.7% experienced disordered eating behaviors. Differences were identified between Māori and non-Māori in measures of diabetes distress and disordered eating, with Māori more likely to score in clinically significant ranges (50% vs. 19.9%; 53.6% vs. 26.7%, p < 0.05). Disordered eating was correlated with HbA1c , body mass index, and social deprivation; diabetes distress was associated with HbA1c and inversely with age (all p < 0.05). CONCLUSIONS This study is the first of its kind to determine that New Zealanders living with T1D experience significant psychological distress. Research with larger Māori representation is needed to more closely review identified inequities. Replication in other local clinics will help contribute to the ongoing development of normative data for Aotearoa New Zealand.
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Affiliation(s)
- Joanna M McClintock
- Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
| | - Tania Blackmore
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Lynne M Chepulis
- Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
| | - Sonya Fraser
- Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand
| | - Ryan G Paul
- Waikato Regional Diabetes Service, Waikato District Health Board, Hamilton, New Zealand.,Waikato Medical Research Centre, University of Waikato, Hamilton, New Zealand
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Harmer MJ, Everitt LH, Parker L, Davis N, Connett G, Nagra A. Structured transition is associated with improved outcomes in diabetes. PRACTICAL DIABETES 2022. [DOI: 10.1002/pdi.2375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Matthew J Harmer
- Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
- University of Southampton Southampton UK
- NIHR Southampton Biomedical Research Centre – Nutrition University Hospital Southampton NHS Foundation Trust Southampton General Hospital UK
| | - Lucy H Everitt
- Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
- Health Education England Wessex School of Quality Improvement UK
| | - Lillie Parker
- Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
- University of Southampton Southampton UK
| | - Nikki Davis
- Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Gary Connett
- Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
| | - Arvind Nagra
- Southampton Children's Hospital University Hospital Southampton NHS Foundation Trust Southampton UK
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Ali N, Longson J, Myszka R, Park K, Low GKK, Leong GM, Bhurawala H, Liu A. Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes.
Methods
A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered.
Results
Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p<0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p<0.01) in the IRG vs. ERG group.
Conclusions
Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.
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Affiliation(s)
- Naushad Ali
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Julie Longson
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Rickie Myszka
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Kris Park
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary K. K. Low
- Research Operations , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary M. Leong
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Habib Bhurawala
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Anthony Liu
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
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Shi M, Ji X, Xie Y, Zhong T, Tang R, Fan L, Li X. Using Glycated Albumin and Stimulated C-Peptide to Define Partial Remission in Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 13:938059. [PMID: 35928900 PMCID: PMC9344919 DOI: 10.3389/fendo.2022.938059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To propose a new definition of partial remission (PR) for patients with type 1 diabetes (T1D) of all-ages using insulin dose and glycated albumin (GA), and find the optimal cut-off values for stimulated C-peptide to diagnose PR in different age-groups. RESEARCH DESIGN AND METHODS Patients with newly diagnosed T1D (n=301) were included. GA/insulin dose was used to diagnose PR, and insulin dose-adjusted glycated albumin (IDAGA) was proposed to facilitate clinical application. The optimal diagnostic levels of IDAGA and stimulated C-peptide were determined in different age-groups (≤ 12y, 12-18y and ≥ 18y). Furthermore, the diagnostic consistency between different PR definitions was studied. RESULTS GA≤ 23%/insulin dose ≤ 0.5u/kg/day was used to define PR, and IDAGA (GA (%) + 40 * insulin dose(u/kg/day)) ≤ 40 was feasible in all age-groups. Whereas, the optimal diagnostic level showed difference for stimulated C-peptide (265.5, 449.3 and 241.1 pmol/L for the ≤ 12y, 12-18y and ≥ 18y age-group, respectively). About 40% of patients met the PR definition by stimulated C-peptide but not GA/insulin dose or IDAGA, who showed dyslipidemia and higher insulin resistance. CONCLUSIONS A new definition of the PR phase is proposed using GA/insulin dose, and the calculated IDAGA≤ 40 applies to all age-groups. The stimulated C-peptide to diagnose PR is the highest in the 12-18y age-group, which reflects the effect of puberty on metabolism. For patients with insulin resistance, it is not recommended to use stimulated C-peptide alone to diagnose PR.
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Khadilkar A, Oza C. Glycaemic Control in Youth and Young Adults: Challenges and Solutions. Diabetes Metab Syndr Obes 2022; 15:121-129. [PMID: 35046683 PMCID: PMC8759988 DOI: 10.2147/dmso.s304347] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 12/22/2021] [Indexed: 04/20/2023] Open
Abstract
Diabetes is the third most prevalent severe chronic disease of youth. Management of any chronic condition like type-1 diabetes (T1D) during adolescence, a time of rapid growth and physiological changes accompanied by important individuation and socialization processes, constitutes a major challenge for the youth, their family and the health-care team. The increasing prevalence of T1D in the adolescent age group and deteriorating glycaemic control from childhood to adolescence and youth, as well as the secular trend of worsening glycaemic control in youth and young adults with T1D, are a matter of real concern. Lack of monitoring, insufficient self-control, psychosocial factors, lack of family support and parental supervision, inadequate adherence to treatment, pubertal increase in insulin resistance and incompetent transition from paediatric to adult care are likely causes of deteriorating glycaemic control in youth. Efforts to improve insulin sensitivity by using pharmacological agents such as metformin are insufficient in resolving this problem. Interventions such as structured intervention, motivational interviews, development of youth friendly services and organization of diabetes camps for peer support can improve adherence in these individuals. Innovative technologies such as continuous subcutaneous insulin infusion and continuous glucose monitoring, comprehensive multidisciplinary teams with effective communication, parental support and supervision with planned transition from paediatric to adult care will not only reduce the risk of micro- and macrovascular complications in young adults with T1D but will also cause significant improvement in their quality of life.
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Affiliation(s)
- Anuradha Khadilkar
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
- Correspondence: Anuradha Khadilkar Hirabai Cowasji Jehangir Medical Research Institute, Block V Lower Basement Jehangir Hospital, 32 Sassoon Road, Pune, 411001, IndiaTel +91 206057004 Email
| | - Chirantap Oza
- Hirabai Cowasji Jehangir Medical Research Institute, Jehangir Hospital, Pune, Maharashtra, 411 001, India
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The added value of transition programs in Dutch diabetes care: A controlled evaluation study. J Pediatr Nurs 2022; 62:155-163. [PMID: 34419327 DOI: 10.1016/j.pedn.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The desirability of evaluating transition programs is widely acknowledged. This study aimed to explore the added value of transitional care investments for young adults with type 1 diabetes mellitus. DESIGN AND METHODS Based on qualitative data, two groups of diabetes teams were created through cluster analysis: paying more (HI-ATT) versus less attention (LO-ATT) to transitional care. Retrospective controlled evaluation included chart reviews on healthcare use and clinical outcomes; and a survey on young adults' experiences, satisfaction with care, and self-management skills. RESULTS Data from 320 patients in fifteen diabetes teams were collected; 123 young adults (38.4%) completed a questionnaire. Self-reported outcomes showed that young adults treated by a HI-ATT team felt better prepared for transfer (p < .05). Self-management outcomes did not differ between groups. HI-ATT teams had more scheduled consultations in the year after transfer (p < .05); only 10.6% of all measurements had reached targeted HbA1c scores. CONCLUSIONS Current transitional care investments in Dutch diabetes care did not lead to notable improvements in experiences and outcomes, except for preparation for transfer. The period after transfer, however, is just as important. Attention is required for parent involvement. PRACTICE IMPLICATIONS Transitional care investments should extend beyond the transfer. By educating young adults about the importance of regular clinic attendance and introducing additional person-centered consultations in adult care, nurses may help ensure continuity of care. Nurses could also introduce support programs for parents to prepare for the transition and their change in role, taking into account their continuing partnership.
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Momani AM, Callery P, Lin YL, Abduelkader RH, Khalil H. "I Like People to Treat Me Normally": Barriers to Type 1 Diabetes Self-Management Among Adolescents. Clin Diabetes 2022; 40:196-203. [PMID: 35669300 PMCID: PMC9160554 DOI: 10.2337/cd20-0116] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Adolescents with type 1 diabetes face barriers that can have a negative influence on self-management behaviors. This study was an analysis of semi-structured interviews with adolescents, parents, and health care providers to better understand these barriers among adolescents in Jordan. Adolescents with type 1 diabetes reported individual-level barriers including feeling labeled, pitied, and stigmatized for having type 1 diabetes. They also discussed the system-level barrier of an education system that does not adapt to meet their needs. Individual- and system-level barriers are interrelated and could influence adolescents' decisions regarding whether to disclose their condition to others.
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Affiliation(s)
- Aaliyah M. Momani
- Applied Science Private University, Amman, Jordan
- School of Biology, Medicine and Health, University of Manchester, Manchester, U.K
- Corresponding author: Aaliyah M. Momani,
| | - Peter Callery
- School of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | - Yin-Ling Lin
- School of Biology, Medicine and Health, University of Manchester, Manchester, U.K
| | | | - Heba Khalil
- Faculty of Health Sciences, Higher Colleges of Technology, Fujairah, United Arab Emirates
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Momani AM, Callery P, Lin YL, Abduelkader RH, Al Akash HY. "It [Diabetes] is From God and I Need to Take Care of Myself": Type 1 Diabetes Self-Management Among Adolescents and Their Parents in Jordan. Curr Diabetes Rev 2022; 18:e140222201109. [PMID: 35156585 DOI: 10.2174/1573399818666220214114908] [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] [Received: 03/18/2021] [Revised: 10/28/2021] [Accepted: 11/04/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Type 1 diabetes is the most common endocrine condition among adolescents. Diabetes self-management can be challenging during adolescence. OBJECTIVE The objective of this study is to understand how adolescents and their parents manage type 1 diabetes in Jordan. METHODS Constructivist grounded theory methodology principles were used to achieve the study aim. A total of 48 participants were recruited using purposive and theoretical sampling techniques, including adolescents and their parents. Data were collected (October 2016 - April 2017) using 38 semi-structured, audio-recorded interviews (one-to-one or joint interviews based on participants' preferences). Data were collected and analyzed concurrently using different levels of coding, constant comparative analysis, and memo writing. This study was approved by relevant ethics committees from the University of Manchester and Jordan University Hospital. RESULTS The theme of living with diabetes is presented and discussed in this article. Culture emerged as the central theme; two aspects of culture are presented in this article: collectivism and cultural beliefs. CONCLUSION This study identified that diabetes self-management could be influenced by the culture in which Jordanian adolescents live in as well as being shaped by their religious beliefs. These findings are potentially transferable to other Arab and non-Arab countries that share similar cultural aspects and religious beliefs.
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Affiliation(s)
| | - Peter Callery
- School of Biology, Medicine and Health, Division of Nursing, Midwifery and Social Work at the University of Manchester, Manchester, UK
| | - Yin-Ling Lin
- School of Biology, Medicine and Health, Division of Dentistry at the University of Manchester, Manchester, UK
| | | | - Hekmat Y Al Akash
- School of Nursing at the Applied Science Private University, Amman, Jordan
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