Expect the unexpected: Adolescent and pre-teens' experience of diabetes technology self-management

Identification of psychological constructs for a positive psychology intervention to assist with the adjustment to closed loop technology among adolescents living with type 1 diabetes

Aim

Adolescents have been identified as the group who struggle most with successful adjustment to closed loop technology. This study aims to identify the psychological constructs that should form part of a positive psychology intervention to assist with the adjustment to closed loop technology among adolescents living with type 1 diabetes.

Method

Qualitative document analysis was employed to integrate findings from two documents: a published ongoing intervention study and a recent phenomenological study by the authors. Reflexive thematic analysis was used to identify themes from the documents.

Findings

The following themes were identified as important psychological constructs that aid adjustment: the importance of knowledge and education; the process of positive adjustment to closed loop technology; a positive outlook; and building a relationship with diabetes.

Conclusion

Interventions are needed to assist adolescents in their adjustment to closed loop technology. The psychological constructs identified served as a starting point in designing an effective, evidence-based intervention grounded in data and theory. Knowledge and education, responsibility, identity, positive affect, gratitude, support, and trust are psychological constructs that need to be included in an intervention program.

Experience with burdens of diabetes device use that affect uptake and optimal use in people with type 1 diabetes

Diabetes technology continues to advance, with more individuals with type 1 diabetes (T1D) adopting insulin pumps, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems that integrate real-time glucose data with an algorithm to assist with insulin dosing decisions. These technologies are linked with benefits to glycemic outcomes (e.g. increased time in target range), diabetes management behaviors, and quality of life. However, current devices and systems are not without barriers and hassles for the user. The intent of this review is to describe the personal challenges and reactions that users experience when interacting with current diabetes technologies, which can affect their acceptance and motivation to engage with their devices. This review will discuss user experiences and strategies to address three main areas: (i) the emotional burden of utilizing a wearable device; (ii) the perceived and experienced negative social consequences of device use; and (iii) the practical challenges of wearing devices.

Using Mixed Methods Research in Children with Type 1 Diabetes: a Methodological Review

PURPOSE OF REVIEW

Many factors influence disease management and glycemic levels in children with type 1 diabetes (T1D). However, these concepts are hard to examine in children using only a qualitative or quantitative research paradigm. Mixed methods research (MMR) offers creative and unique ways to study complex research questions in children and their families.

RECENT FINDINGS

A focused, methodological literature review revealed 20 empirical mixed methods research (MMR) studies that included children with T1D and/or their parents/caregivers. These studies were examined and synthesized to elicit themes and trends in MMR. Main themes that emerged included disease management, evaluation of interventions, and support. There were multiple inconsistencies between studies when reporting MMR definitions, rationales, and design. Limited studies use MMR approaches to examine concepts related to children with T1D. Findings from future MMR studies, especially ones that use child-report, may illuminate ways to improve disease management and lead to better glycemic levels and health outcomes.

Children's and adolescent's narratives about pain and negative experiences in diabetes treatment

Pain and fear associated with needle procedures have been found to be more common among children and adolescents treated for type 1 diabetes (T1D) than among others in their age group. Furthermore, high glycated haemoglobin (HbA1c) values are associated with needle-related fear.

AIM

To describe negative experiences of needle procedures in childhood diabetes treatment from children's and adolescents' own perspectives.

METHODS

Short written narratives (n = 83) and drawings (n = 2) from children and adolescents treated for T1D, aged 7-18 years, were subjected to inductive qualitative content analysis.

RESULTS

Negative experiences with needle procedures had many facets, such as pain and fear, changing over time and affecting everyday life. All kinds of needle procedures caused difficulties, but venipunctures were described as the worst.

CONCLUSION

All needle procedures involved in diabetes treatment are potentially experienced as creating pain and fear, but the negative experiences are multifaceted and vary between individuals. These experiences create suffering for children and adolescents, and influence their daily lives. Besides finding techniques to decrease the number of needle procedures in the treatment, research should focus on implementing methods to decrease pain, fear, and other negative experiences as well as to promote self-coping. This is urgent, since needle-related fear has an impact on glycaemic control and therefore increases the risk of long-term complications.

CLINICAL IMPLICATIONS

When caring for children and adolescents with diabetes, their previous experiences with needle procedures need to be considered.