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Abild CB, Vestergaard ET, Bruun JM, Kristensen K, Støving RK, Clausen L. Mechanisms underlying the development of eating disorders and disordered eating in adolescent females with type 1 diabetes. Diabet Med 2024; 41:e15397. [PMID: 38946057 DOI: 10.1111/dme.15397] [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: 01/23/2024] [Revised: 05/29/2024] [Accepted: 06/17/2024] [Indexed: 07/02/2024]
Abstract
OBJECTIVE People with Type 1 diabetes (T1D) face an increased risk of eating disorders/disordered eating (ED/DE), with adolescents being particularly vulnerable. Empirical knowledge on the mechanisms underlying development of ED/DE in T1D is crucial for evolving prevention strategies. RESEARCH DESIGN AND METHODS Fourteen semi-structured interviews with adolescent females with T1D and ED/DE between 14 and 18 years were conducted and analyzed using reflexive thematic analysis. RESULTS Analyses identified four main themes; 'Interconnected afflictions', 'Judgment', 'Feeling Different', and 'Chaos & Control', These themes explore the interconnectedness of T1D and ED/DE, with shame and guilt emerging as common underlying mechanism. The development of a biopsychosocial model was based on the integration of these data with existing models. CONCLUSIONS The study extends previous developmental pathways of ED/DE in adolescents with T1D. We propose a biopsychosocial model that incorporates various factors: predisposing factors such as parental management of T1D and weight gain during adolescence; precipitating factors including comments on weight, frequency of weighing, perceptions of surveillance; the perpetuating bilateral influence of ED/DE and T1D and finally highlighting the protective mechanisms of disease acceptance encompassing parental handling of diagnosis and the contribution of healthcare professionals (HCP's) role in psychoeducation. The present study highlight the vulnerability of adolescence in the presence of T1D, particularly concerning issues related to eating, weight, and body. It offers clinically relevant insights, with the aim to improve communication and management strategies for this very specific group.
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Affiliation(s)
- Caroline Bruun Abild
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish National Center for Obesity, Aarhus, Denmark
| | - Esben Thyssen Vestergaard
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Pediatrics, Aarhus University Hospital, Aarhus, Denmark
| | - Jens Meldgaard Bruun
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Danish National Center for Obesity, Aarhus, Denmark
| | - Kurt Kristensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Rene Klinkby Støving
- Center for Eating Disorders, Odense University Hospital, Odense, Denmark
- Research Unit for Medical Endocrinology, Odense University Hospital, Odense, Denmark
- Mental Health Services in the Region of Southern Denmark, Odense, Denmark
| | - Loa Clausen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Child and Adolescent Psychiatry-Research unit, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
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2
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Gradinjan Centner M, Čačić Kenjerić D, Schönberger E, Centner H, Sladić Rimac D, Steiner K, Marušić R, Bakula M, Fabris Vitković D, Mihaljević I, Ćurčić IB, Canecki Varžić S. The Interplay between Dietary Habits and Glycemic Control in Type 1 Diabetes: A Comprehensive Prospective FGM Study. Life (Basel) 2024; 14:1153. [PMID: 39337936 PMCID: PMC11432966 DOI: 10.3390/life14091153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 09/05/2024] [Accepted: 09/06/2024] [Indexed: 09/30/2024] Open
Abstract
Type 1 diabetes has become prevalent among the adult population, who have increasingly gained access to sensing technology. This study delved into the impact of diet, nutritional status, and the use of a continuous glucose monitoring system (CGM) on glycemic regulation among adults diagnosed with T1D. Employing a prospective design, data were gathered from 151 participants aged 18-60 across multiple cycles. Participants utilized the FreeStyle Libre (FSL) Flash Glucose Monitoring (FGM) System and provided dietary details via questionnaires and diaries. The findings unveiled correlations between dietary patterns and glycemic control, with higher protein intake associated with improved glycated hemoglobin A1C values (p = 0.019), yet elevated fat and protein consumption was linked to heightened rates of hyperglycemia. Conversely, no significant relationship was observed between dietary variables and hypoglycemia occurrence. Interestingly, subjects with more readings of glucose levels consumed fewer carbohydrates (p = 0.004) and more proteins (p = 0.000). Furthermore, physical activity and marital status correlated with glycemic stability, while higher education was associated with enhanced glycemic control (p = 0.021). This study confirmed the importance of structured education on glycemic regulation and the importance of dietary patterns in glucose management. Also, the educational role of the FGM system in changing dietary habits was confirmed, which is one of the key factors for improving glycemic regulation in continuous glucose monitoring system users.
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Affiliation(s)
- Maja Gradinjan Centner
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (M.G.C.); (E.S.); (D.S.R.); (K.S.); (S.C.V.)
- Faculty of Food Technology Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia;
| | | | - Ema Schönberger
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (M.G.C.); (E.S.); (D.S.R.); (K.S.); (S.C.V.)
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
| | - Hrvoje Centner
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
| | - Daria Sladić Rimac
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (M.G.C.); (E.S.); (D.S.R.); (K.S.); (S.C.V.)
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia
| | - Kristina Steiner
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (M.G.C.); (E.S.); (D.S.R.); (K.S.); (S.C.V.)
| | - Romana Marušić
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
- National Memorial Hospital “Dr. Juraj Njavro”, 32000 Vukovar, Croatia
| | - Miro Bakula
- Division of Endocrinology, Diabetes and Metabolic Diseases, Department of Internal Medicine, Sveti Duh University Hospital, 10000 Zagreb, Croatia;
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia
| | | | - Ivica Mihaljević
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
- Department of Nuclear Medicine, University Hospital Center Osijek, 31000 Osijek, Croatia
- Academy of Medical Sciences of Croatia, 10000 Zagreb, Croatia
| | - Ines Bilić Ćurčić
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (M.G.C.); (E.S.); (D.S.R.); (K.S.); (S.C.V.)
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
| | - Silvija Canecki Varžić
- Department of Endocrinology, Clinical Hospital Center Osijek, 31000 Osijek, Croatia; (M.G.C.); (E.S.); (D.S.R.); (K.S.); (S.C.V.)
- Faculty of Medicine Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia; (H.C.); (R.M.); (I.M.)
- Department of Nursing and Palliative Medicine, Faculty of Dental Medicine and Health Osijek, University J. J. Strossmayer, 31000 Osijek, Croatia
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3
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Pierce JS, Enlow P, Thomas C, Price J, Rachel W, Wysocki T, Alderfer MA. Parent and adolescent perspectives on a novel transdisciplinary model of healthcare delivery for type 1 diabetes. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2024; 12:279-290. [PMID: 39310916 PMCID: PMC11415229 DOI: 10.1037/cpp0000512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024]
Abstract
Objective We aimed to obtain pre-adolescent/adolescent and parent input on a proposed transdisciplinary model for routine type 1 diabetes (T1D) healthcare in which an advanced practice nurse, dietitian, and psychologist with expertise in T1D and extensive cross-discipline training co-deliver care during quarterly T1D care visits using a family-focused approach. Methods Participants were 17 parent-youth dyads plus one additional adolescent who responded to open-ended questions about the structure and format of the proposed transdisciplinary care model via an online, private social network. A six-member coding team developed and revised a codebook, coded question responses through iterative cycles of inductive coding, and distilled major recurring themes to obtain perspectives on the transdisciplinary care model and feedback on improving the model. Results We identified nine themes regarding reactions to our proposed transdisciplinary care model, which fell into three broad categories: 1) General Perceptions of Transdisciplinary Care (e.g., Transdisciplinary Care may facilitate improved communication and collaboration among providers and result in more holistic care); 2) Perceptions about Transdisciplinary Care Providers (e.g., Perspectives on the inclusion of dietitians and psychologists as members of the transdisciplinary care team were mixed); and 3) Suggestions for Improving the Transdisciplinary Care Model (e.g., Ensure care is patient/family centered and holistic). Conclusions The present findings provided important feedback to modify our transdisciplinary care model and on parent and youth preferences for T1D healthcare delivery.
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Affiliation(s)
- Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Florida
- University Central Florida College of Medicine
| | - Paul Enlow
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Courtney Thomas
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware
| | - Julia Price
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware
- Sidney Kimmel Medical College at Thomas Jefferson University
| | - Wasserman Rachel
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Florida
- University Central Florida College of Medicine
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children's Health, Jacksonville
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children's Hospital, Delaware
- Sidney Kimmel Medical College at Thomas Jefferson University
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Wetter-Wren SE, Himelhoch AC, Driscoll KA. A Systematic Review of the Effects of Provider Bias on Health in Youth and Young Adults with Type 1 Diabetes. Curr Diab Rep 2024; 24:45-60. [PMID: 38233705 DOI: 10.1007/s11892-023-01527-x] [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] [Accepted: 11/03/2023] [Indexed: 01/19/2024]
Abstract
PURPOSE OF REVIEW Although pervasive inequities in the health outcomes of youth and young adults with type 1 diabetes (T1D) exist, the role of provider bias in these inequities is not well-understood. The purpose of this review is to synthesize evidence from existing studies on the associations between patient characteristics, provider bias, and patient health. RECENT FINDINGS Fourteen articles were included. Determining the extent of the effects of provider bias on patient health is limited by a lack of consensus on its definition. Experiences of provider bias (e.g., shaming, criticism) negatively affects self-esteem, relationships with medical providers, and depressive symptoms. Provider bias also impacts diabetes technology recommendations, insulin regimen intensity, and risk for life-threatening T1D complications. Future studies are needed to develop questionnaires and interviews that better account for diverse experiences and interpretations of bias in T1D healthcare. More research is also needed to investigate mitigating factors to reduce provider bias as a way to improve psychological and physical health in individuals with T1D.
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Affiliation(s)
- Sara E Wetter-Wren
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA
| | - Alexandra C Himelhoch
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA
| | - Kimberly A Driscoll
- Department of Clinical and Health Psychology, University of Florida, 1225 Center Dr., Gainesville, FL, 32610, USA.
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Núñez-Baila MÁ, Gómez-Aragón A, Marques-Silva AM, González-López JR. Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review. Healthcare (Basel) 2024; 12:309. [PMID: 38338194 PMCID: PMC10855310 DOI: 10.3390/healthcare12030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.
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Affiliation(s)
- María-Ángeles Núñez-Baila
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Armando-Manuel Marques-Silva
- Department of Nursing, Escola Superior de Enfermagem de Coimbra, 3004-011 Coimbra, Portugal;
- Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA: E), 3004-011 Coimbra, Portugal
| | - José Rafael González-López
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
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Tanenbaum ML, Addala A, Hanes S, Ritter V, Bishop FK, Cortes AL, Pang E, Hood KK, Maahs DM, Zaharieva DP. "It changed everything we do": A mixed methods study of youth and parent experiences with a pilot exercise education intervention following new diagnosis of type 1 diabetes. J Diabetes Complications 2024; 38:108651. [PMID: 38043358 PMCID: PMC10843536 DOI: 10.1016/j.jdiacomp.2023.108651] [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: 09/30/2023] [Revised: 11/06/2023] [Accepted: 11/19/2023] [Indexed: 12/05/2023]
Abstract
AIMS This pilot study delivered a comprehensive exercise education intervention to youth with new-onset type 1 diabetes (T1D) and their parents to increase knowledge and confidence with physical activity (PA) shortly after diagnosis. METHODS Youth initiated continuous glucose monitoring (CGM) and PA trackers within 1 month of diagnosis. Youth and their parents received the 4-session intervention over 12 months. Participants completed self-report questionnaires at baseline, 6- and 12-months. Surveys were analyzed using linear mixed effects models. Semi-structured interviews and focus groups explored experiences with the exercise education intervention. Groups and interviews were audio-recorded, transcribed, and analyzed using content analysis. RESULTS A total of 16 parents (aged 46 ± 7 years; 88 % female; 67 % non-Hispanic White) and 17 youth (aged 14 ± 2 years; 41 % female; 65 % non-Hispanic White) participated. Worry about hypoglycemia did not worsen throughout the study duration. Parents and youth reported increased knowledge and confidence in managing T1D safely and preventing hypoglycemia during PA following receiving the tailored exercise education intervention. CONCLUSION This study assessed a novel structured exercise education program for youth and their parents shortly following T1D diagnosis. These results support the broad translation and acceptability of a structured exercise education program in new-onset T1D.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology, Gerontology, & Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA; Stanford Diabetes Research Center, Stanford, CA, USA; Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ananta Addala
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Victor Ritter
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University, Stanford, CA, USA.
| | - Franziska K Bishop
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Ana L Cortes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Erica Pang
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Korey K Hood
- Stanford Diabetes Research Center, Stanford, CA, USA; Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - David M Maahs
- Stanford Diabetes Research Center, Stanford, CA, USA; Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Dessi P Zaharieva
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
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Tran T, Igudesman D, Burger K, Crandell J, Maahs DM, Seid M, Mayer-Davis EJ. Eating behaviors and estimated body fat percentage among adolescents with type 1 diabetes. Diabetes Res Clin Pract 2024; 207:111070. [PMID: 38142747 PMCID: PMC10922665 DOI: 10.1016/j.diabres.2023.111070] [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: 07/13/2023] [Revised: 11/30/2023] [Accepted: 12/19/2023] [Indexed: 12/26/2023]
Abstract
AIMS Estimate associations between select eating behaviors and estimated body fat percentage (eBFP) and explore effect modification by sex among adolescents with type 1 diabetes (T1D). METHODS This analysis included 257 adolescents (mean age 14.9 ± 1.14 years; 49.8 % female) with baseline hemoglobin A1c (HbA1c) between 8 and 13 % (64 mmol/mol-119 mmol/mol) from a randomized trial designed to improve glycemia. Eating behaviors and eBFP were determined from surveys and validated equations respectively. Linear mixed models were used to estimate associations. Effect modification was assessed via stratified plots, stratified associations, and interaction terms. RESULTS Disordered eating, dietary restraint, and eBFP were significantly higher among females while external eating was higher among males. Disordered eating (β: 0.49, 95 %CI: 0.24, 0.73, p = 0.0001) and restraint (β: 1.11, 95 %CI: 0.29, 1.92, p = 0.0081) were positively associated with eBFP while external eating was not (β: -0.19, 95 %CI: -0.470, 0.096, p = 0.20). Interactions with sex were not significant (p-value range: 0.28-0.64). CONCLUSION Disordered eating and dietary restraint were positively associated with eBFP, highlighting the potential salience of these eating behaviors to cardiometabolic risk for both female and male adolescents. Prospective studies should investigate whether these eating behaviors predict eBFP longitudinally to inform obesity prevention strategies in T1D.
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Affiliation(s)
- Thanh Tran
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Daria Igudesman
- Translational Research Institute, AdventHealth, Orlando, FL, USA.
| | - Kyle Burger
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Jamie Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA.
| | - Michael Seid
- Cincinnati Children's Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, OH, USA.
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
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Muntis FR, Mayer-Davis EJ, Shaikh SR, Crandell J, Evenson KR, Smith-Ryan AE. Post-Exercise Protein Intake May Reduce Time in Hypoglycemia Following Moderate-Intensity Continuous Exercise among Adults with Type 1 Diabetes. Nutrients 2023; 15:4268. [PMID: 37836552 PMCID: PMC10574378 DOI: 10.3390/nu15194268] [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: 09/12/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 10/15/2023] Open
Abstract
Little is known about the role of post-exercise protein intake on post-exercise glycemia. Secondary analyses were conducted to evaluate the role of post-exercise protein intake on post-exercise glycemia using data from an exercise pilot study. Adults with T1D (n = 11), with an average age of 33.0 ± 11.4 years and BMI of 25.1 ± 3.4, participated in isoenergetic sessions of high-intensity interval training (HIIT) or moderate-intensity continuous training (MICT). Participants completed food records on the days of exercise and provided continuous glucose monitoring data throughout the study, from which time in range (TIR, 70-180 mg/dL), time above range (TAR, >180 mg/dL), and time below range (TBR, <70 mg/dL) were calculated from exercise cessation until the following morning. Mixed effects regression models, adjusted for carbohydrate intake, diabetes duration, and lean mass, assessed the relationship between post-exercise protein intake on TIR, TAR, and TBR following exercise. No association was observed between protein intake and TIR, TAR, or TBR (p-values ≥ 0.07); however, a borderline significant reduction of -1.9% (95% CI: -3.9%, 0.0%; p = 0.05) TBR per 20 g protein was observed following MICT in analyses stratified by exercise mode. Increasing post-exercise protein intake may be a promising strategy to mitigate the risk of hypoglycemia following MICT.
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Affiliation(s)
- Franklin R. Muntis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (F.R.M.); (S.R.S.)
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (F.R.M.); (S.R.S.)
- Department of Medicine, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Saame R. Shaikh
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (F.R.M.); (S.R.S.)
| | - Jamie Crandell
- School of Nursing, University of North Carolina, Chapel Hill, NC 27599, USA;
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Kelly R. Evenson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA;
| | - Abbie E. Smith-Ryan
- Department of Exercise & Sports Science, University of North Carolina, Chapel Hill, NC 27599, USA;
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Warnick J, Darling KE, Topor LS, Jelalian E. Formative Development of a Weight Management Intervention for Adolescents with Type 1 Diabetes Mellitus and Obesity. Pediatr Diabetes 2023; 2023:9584419. [PMID: 37614408 PMCID: PMC10445778 DOI: 10.1155/2023/9584419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes. Unfortunately, youth with T1D are often excluded from and/or not referred to standard behavioral lifestyle interventions. This is often attributed to the complexities of managing T1D and an effort not to overburden persons who have T1D. Furthermore, standard behavioral weight management intervention recommendations can be perceived as contradicting T1D disease management (e.g., removing sugar-sweetened beverages from diet, energy balance with exercise, and caloric restriction). A weight management intervention specifically designed for youth with T1D is needed to provide treatment to youth with comorbid T1D and overweight/obesity. The current study interviewed adolescents with T1D and overweight/obesity (n = 12), their caregivers (n = 12), and pediatric endocrinologists (n = 9) to understand (a) whether they would be interested in a weight management intervention adapted for youth with T1D and (b) specific adaptations they would want and need. Five central themes emerged following applied thematic analysis: (1) program content, (2) programmatic messaging, (3) program structure, (4) social support, and (5) eating disorder risk. Results provide detailed recommendations for the adaptation of a behavioral weight management intervention for youth with T1D.
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Affiliation(s)
- Jennifer Warnick
- Alpert Medical School of Brown University, Providence, USA
- The Miriam Hospital, Providence, USA
| | - Katherine E. Darling
- Alpert Medical School of Brown University, Providence, USA
- The Miriam Hospital, Providence, USA
| | | | - Elissa Jelalian
- Alpert Medical School of Brown University, Providence, USA
- The Miriam Hospital, Providence, USA
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Corbin KD, Igudesman D, Addala A, Casu A, Crandell J, Kosorok MR, Maahs DM, Pokaprakarn T, Pratley RE, Souris KJ, Thomas J, Zaharieva DP, Mayer-Davis E. Design of the advancing care for type 1 diabetes and obesity network energy metabolism and sequential multiple assignment randomized trial nutrition pilot studies: An integrated approach to develop weight management solutions for individuals with type 1 diabetes. Contemp Clin Trials 2022; 117:106765. [PMID: 35460915 DOI: 10.1016/j.cct.2022.106765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 03/07/2022] [Accepted: 04/14/2022] [Indexed: 11/30/2022]
Abstract
Young adults with type 1 diabetes (T1D) often have difficulty co-managing weight and glycemia. The prevalence of overweight and obesity among individuals with T1D now parallels that of the general population and contributes to dyslipidemia, insulin resistance, and risk for cardiovascular disease. There is a compelling need to develop a program of research designed to optimize two key outcomes-weight management and glycemia-and to address the underlying metabolic processes and behavioral challenges unique to people with T1D. For an intervention addressing these dual outcomes to be effective, it must be appropriate to the unique metabolic phenotype of T1D, and to biological and behavioral responses to glycemia (including hypoglycemia) that relate to weight management. The intervention must also be safe, feasible, and accepted by young adults with T1D. In 2015, we established a consortium called ACT1ON: Advancing Care for Type 1 Diabetes and Obesity Network, a transdisciplinary team of scientists at multiple institutions. The ACT1ON consortium designed a multi-phase study which, in parallel, evaluated the mechanistic aspects of the unique metabolism and energy requirements of individuals with T1D, alongside a rigorous adaptive behavioral intervention to simultaneously facilitate weight management while optimizing glycemia. This manuscript describes the design of our integrative study-comprised of an inpatient mechanistic phase and an outpatient behavioral phase-to generate metabolic, behavioral, feasibility, and acceptability data to support a future, fully powered sequential, multiple assignment, randomized trial to evaluate the best approaches to prevent and treat obesity while co-managing glycemia in people with T1D. Clinicaltrials.gov identifiers: NCT03651622 and NCT03379792. The present study references can be found here: https://clinicaltrials.gov/ct2/show/NCT03651622 https://clinicaltrials.gov/ct2/show/NCT03379792?term=NCT03379792&draw=2&rank=1 Submission Category: "Study Design, Statistical Design, Study Protocols".
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Affiliation(s)
- Karen D Corbin
- AdventHealth, Translational Research Institute, Orlando, FL, United States of America
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Ananta Addala
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, United States of America; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Anna Casu
- AdventHealth, Translational Research Institute, Orlando, FL, United States of America
| | - Jamie Crandell
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - David M Maahs
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, United States of America; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Teeranan Pokaprakarn
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Richard E Pratley
- AdventHealth, Translational Research Institute, Orlando, FL, United States of America
| | - Katherine J Souris
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Joan Thomas
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Dessi P Zaharieva
- Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, CA, United States of America; Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, United States of America
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
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11
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Montali L, Zulato E, Cornara M, Ausili D, Luciani M. Barriers and facilitators of type 1 diabetes self-care in adolescents and young adults. J Pediatr Nurs 2022; 62:136-143. [PMID: 34561133 DOI: 10.1016/j.pedn.2021.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/12/2021] [Accepted: 09/12/2021] [Indexed: 11/19/2022]
Abstract
PURPOSE This study explores the disease experience of adolescents and young adults with T1DM focusing on the barriers and facilitators that characterise their disease self-care. Self-care requires complex decision making and cooperation between patients, their families, the healthcare team, and the social support system. Personal and social factors affect self-care, and specific challenges impact adolescents and young adults, putting them at a higher risk of poor glycaemic control and more severe complications. DESIGN AND METHODS The study uses a qualitative description approach. Twenty-two people (15 women; 10-30 years old; 2-24 years from diagnosis) were purposefully recruited through snowballing techniques. Data were collected with semi-structured interviews and analysed inductively with semantic thematic analysis. RESULTS Four themes and nine subthemes conceptualise the patients' experience as a life-long journey that has its difficult beginning at the time of diagnosis and continues through the resolution of the initial crisis by integrating disease at the identity level and acquiring expertise. Technology and social environment act both as self-care barriers and facilitators. CONCLUSIONS Findings highlight the importance of designing and improving technology related to diabetes accounting for patients' experiences. Second, it is imperative to work towards a de-stigmatisation of diabetes. Finally, health professionals should work with people with T1DM on the psychological aspects of the disease and identity integration. PRACTICE IMPLICATIONS Diabetes-related technology should promote usability and acceptability while addressing visibility and device burden issues. Clinicians should pay particular attention during the transition from the paediatric to the adult centres and offer global assessments and treatment.
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Affiliation(s)
- Lorenzo Montali
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy.
| | - Edoardo Zulato
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy.
| | - Mattia Cornara
- Department of Psychology, University of Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milan, Italy.
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, Monza, Italy.
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12
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Freeman NLB, Sperger J, El-Zaatari H, Kahkoska AR, Lu M, Valancius M, Virkud AV, Zikry TM, Kosorok MR. Beyond Two Cultures: Cultural Infrastructure for Data-driven Decision Support. OBSERVATIONAL STUDIES 2021; 7:77-94. [PMID: 35106520 PMCID: PMC8802367 DOI: 10.1353/obs.2021.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
In the twenty years since Dr. Leo Breiman's incendiary paper Statistical Modeling: The Two Cultures was first published, algorithmic modeling techniques have gone from controversial to commonplace in the statistical community. While the widespread adoption of these methods as part of the contemporary statistician's toolkit is a testament to Dr. Breiman's vision, the number of high-profile failures of algorithmic models suggests that Dr. Breiman's final remark that "the emphasis needs to be on the problem and the data" has been less widely heeded. In the spirit of Dr. Breiman, we detail an emerging research community in statistics - data-driven decision support. We assert that to realize the full potential of decision support, broadly and in the context of precision health, will require a culture of social awareness and accountability, in addition to ongoing attention towards complex technical challenges.
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Affiliation(s)
- Nikki L B Freeman
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - John Sperger
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Helal El-Zaatari
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Anna R Kahkoska
- Department of Nutrition, University of North Carolina School of Medicine
| | - Minxin Lu
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Michael Valancius
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Arti V Virkud
- Department of Epidemiology, University of North Carolina at Chapel Hill
| | - Tarek M Zikry
- Department of Biostatistics, University of North Carolina at Chapel Hill
| | - Michael R Kosorok
- Department of Biostatistics, University of North Carolina at Chapel Hill
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13
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Zaharieva DP, Addala A, Simmons KM, Maahs DM. Weight Management in Youth with Type 1 Diabetes and Obesity: Challenges and Possible Solutions. Curr Obes Rep 2020; 9:412-423. [PMID: 33108635 PMCID: PMC8087153 DOI: 10.1007/s13679-020-00411-z] [Citation(s) in RCA: 6] [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] [Accepted: 10/05/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE OF REVIEW This review highlights challenges associated with weight management in children and adolescents with type 1 diabetes (T1D). Our purpose is to propose potential solutions to improve weight outcomes in youth with T1D. RECENT FINDINGS A common barrier to weight management in T1D is reluctance to engage in exercise for fear of hypoglycemia. Healthcare practitioners generally provide limited guidance for insulin dosing and carbohydrate modifications to maintain stable glycemia during exercise. Adherence to dietary guidelines is associated with improved glycemia; however, youth struggle to meet recommendations. When psychosocial factors are addressed in combination with glucose trends, this often leads to successful T1D management. Newer medications also hold promise to potentially aid in glycemia and weight management, but further research is necessary. Properly addressing physical activity, nutrition, pharmacotherapy, and psychosocial factors while emphasizing weight management may reduce the likelihood of obesity development and its perpetuation in this population.
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Affiliation(s)
- Dessi P Zaharieva
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA.
| | - Ananta Addala
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
| | - Kimber M Simmons
- Barbara Davis Center for Diabetes, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - David M Maahs
- Division of Endocrinology, Department of Pediatrics, Stanford University, School of Medicine, Stanford, CA, USA
- Stanford Diabetes Research Center, Stanford, CA, USA
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