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Fayyaz F, Mardi P, Sobhani S, Sokoty L, Aghamahdi F, Qorbani M. Association of quality of life with medication adherence and glycemic control in patients with type 1 diabetes. J Diabetes Metab Disord 2024; 23:783-788. [PMID: 38932841 PMCID: PMC11196443 DOI: 10.1007/s40200-023-01351-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 11/09/2023] [Indexed: 06/28/2024]
Abstract
Background and objectives Psychological factors and patients' health-related quality of life (HRQOL) affect the outcome of patients with type 1 diabetes mellitus (T1DM). In this study, we aimed to determine the HRQOL status in patients with T1DM and its association with glycemic control and medication adherence. Methods In this cross-sectional study, 227 T1DM patients were selected from the diabetes clinic, Imam Ali Hospital, Alborz University of Medical Sciences, and the Gabric database registry from 2020 to 2022. Demographic and diabetes characteristic checklist, medication adherence questionnaire (8-item Morisky Medication Adherence Scale (MMAS)), and QOL questionnaires (Short-Form-12 and PedsQL) were filled. Independent sample T-test was used to assess mean of QOL subscales with glycemic control and medication adherence. A logistic regression model was used to evaluate the association between glycemic control and medication adherence with QOl. Results Overall QOL scores in adults and children were 33.4 ± 7.1 based on Short-Form-12 and 76.2 ± 17.8 based on PedsQL, respectively. It was demonstrated that adults with Moderate/High adherence had higher QOL (p-value = 0.007). Likewise, Children with good glycemic control had higher psychosocial health scores (0.048). Logistic regression analysis did not reveal a significant association between adherence and QOL or Glycemic control and QOL in both adjusted and crude models. Conclusion Better glycemic control and medication adherence in children and adults, respectively, are related to the psychological aspects of QOL. We suggest that emotional intelligence, which is replaced by other predictors during adulthood, may contribute to glycemic control in children in the early years following diagnosis.
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Affiliation(s)
- Farimah Fayyaz
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Parham Mardi
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
| | - Sahar Sobhani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Leily Sokoty
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Aghamahdi
- Department of Pediatric Endocrinology and Metabolism, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
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Deveci AC, Gurnani M, Wolfe-Wylie MC, Regina A, Cordeiro K, Dave MG, Mahmud FH, Hamilton J. Looking at Diabetes Through Different Lenses: Focus Groups Conducted With Somali Canadian Families and Their Health-care Providers. Can J Diabetes 2024; 48:112-119.e3. [PMID: 38056690 DOI: 10.1016/j.jcjd.2023.11.004] [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: 06/19/2023] [Revised: 11/16/2023] [Accepted: 11/25/2023] [Indexed: 12/08/2023]
Abstract
OBJECTIVES In Toronto, many families with Somali backgrounds have children living with type 1 diabetes (T1D). At our clinic, children with African and Caribbean backgrounds have higher glycated hemoglobin than children from European backgrounds. In this study, we explored the experiences and perspectives of Somali Canadian families with children living with T1D, as well as health-care professionals (HCPs) who care for them, to better understand how T1D impacts these families. METHODS We conducted 3 separate focus groups with Somali Canadian parents of children with T1D (n=11), Somali Canadian adolescents with T1D (n=5), and HCPs who treat patients with diabetes (n=9), respectively. A grounded theory approach to data analysis was applied to identify themes. RESULTS Four key themes emerged: 1) the general impact of living with diabetes, 2) the challenges of self-management, 3) uncertainty on whose job it is to manage the diabetes, and 4) how cultural differences between Canada and Somalia impact diabetes management. There was discordance in the perspectives of families and HCPs for all themes, but especially themes 1 and 3. Parents focussed on the social impact of diabetes and behavioural indicators of management success, whereas HCPs emphasized clinical measures. Families believed children should take charge of their diabetes self-management early on, whereas HCPs believed the children were not developmentally ready for this responsibility. CONCLUSIONS Differing perspectives of patients, families, and HCPs may lead to diverging expectations for treatment and management. Families and practitioners must work together to identify barriers to care and build strategies to promote competency and resilience in the self-management of T1D.
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Affiliation(s)
- Arin C Deveci
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Muskaan Gurnani
- University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada
| | - Margaret C Wolfe-Wylie
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Neonatal & Paediatric Medicine, Orillia Soldiers' Memorial Hospital, Orillia, Ontario, Canada
| | - Andrea Regina
- University of Toronto, Toronto, Ontario, Canada; Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Kristina Cordeiro
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; Department of Psychology, York University, Toronto, Ontario, Canada
| | - Malini G Dave
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada; Black Creek Community Health Centre, Toronto, Ontario, Canada
| | - Farid H Mahmud
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada
| | - Jill Hamilton
- Division of Endocrinology, The Hospital for Sick Children, Toronto, Ontario, Canada; University of Toronto, Toronto, Ontario, Canada.
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Yayah Jones NH, Cole I, Hart KJ, Corathers S, Agarwal S, Odugbesan O, Ebekozien O, Kamboj MK, Harris MA, Fantasia KL, Mansour M. Social Determinants of Health Screening in Type 1 Diabetes Management. Endocrinol Metab Clin North Am 2024; 53:93-106. [PMID: 38272601 DOI: 10.1016/j.ecl.2023.09.006] [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] [Indexed: 01/27/2024]
Abstract
Type 1 diabetes management is intricately influenced by social determinants of health. Economic status impacts access to vital resources like insulin and diabetes technology. Racism, social injustice, and implicit biases affect equitable delivery of care. Education levels affect understanding of self-care, leading to disparities in glycemic outcomes. Geographic location can limit access to health care facilities. Stressors from discrimination or financial strain can disrupt disease management. Addressing these social factors is crucial for equitable diabetes care, emphasizing the need for comprehensive strategies that go beyond medical interventions to ensure optimal health outcomes for all individuals with type 1 diabetes.
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Affiliation(s)
- Nana-Hawa Yayah Jones
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH 45229-3039, USA.
| | - India Cole
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 15018, Cincinnati, OH 45229-3039, USA
| | - Kelsey J Hart
- James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 15018, Cincinnati, OH 45229-3039, USA
| | - Sarah Corathers
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH 45229-3039, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, New York Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10467, USA
| | - Ori Odugbesan
- T1D Exchange, QI & Population Health Department, 101 Federal Street Suite 440, Boston, MA 02110, USA
| | - Osagie Ebekozien
- T1D Exchange, QI & Population Health Department, 101 Federal Street Suite 440, Boston, MA 02110, USA
| | - Manmohan K Kamboj
- The Ohio State University College of Medicine, Section of Endocrinology, Quality Improvement for Endocrinology, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA
| | - Michael A Harris
- Oregon Health & Science University, Harold Schnitzer Diabetes Health Center, 707 SW Gaines Street, Portland, OR 97239, USA
| | - Kathryn L Fantasia
- Section of Endocrinology, Diabetes, and Nutrition, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E Concord, C3, Boston, MA 02118, USA
| | - Mona Mansour
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 7012, Cincinnati, OH 45229-3039, USA; University of Cincinnati College of Medicine, Department of Pediatrics, Population Health- CCHMC, Division of General and Community Pediatrics, Community Engagement- HealthVine, CCHMC Coordinated School Strategy, Cincinnati Children's Hospital Medical Center, University of Cincinnati, 3333 Burnet Avenue, MLC 15018, Cincinnati, OH 45229-3039, USA
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Alhamed A. Assessing the readiness to transition to adult care, perceived medication barriers, and glycemic control among teens with type 1 diabetes. Appl Nurs Res 2024; 75:151772. [PMID: 38490800 DOI: 10.1016/j.apnr.2024.151772] [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: 07/28/2023] [Revised: 10/07/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
AIM This study assessed the readiness to transition (RT) from pediatric to adult care, perceived medication barriers (PMB), and glycemic control in teens with type one diabetes (T1D). BACKGROUND During the transition from pediatric to adult care, teens with T1D are at risk of long-term complications related to impaired adherence. With the increasing prevalence of T1D in Saudi Arabia, research is required to identify the challenges facing teens with T1D during their transition. METHODS This was a cross-sectional study with a convenient sample of 83 adolescents (12-17 years old) diagnosed with T1D for ≥6 months, their parents, and their pediatric endocrinologists from the pediatric endocrinology clinic in a tertiary hospital in Riyadh. The RT Questionnaire was used to measure RT, and the Medication Barriers Scale was used to measure PMB. Glycemic control was measured using hemoglobin A1c (HbA1c). RESULTS About 96 % of teens had HbA1c > 7 %. Male teens had higher HbA1c than female teens. Teens and their parents reported high PMB and low RT. PMB (teens), disease duration, family history of diabetes mellitus, and comorbidity were significant predictors of RT (parents). PMB (teens), teens' age, and having a family history of diabetes mellitus were significant predictors of RT (providers). RT (parents) and RT (providers) were the only significant predictors of HbA1c, with RT (providers) being the strongest predictors of HbA1c. CONCLUSIONS Health policy reform is required to develop national RT programs to prepare teens with T1D to take full responsibility for managing their medical conditions while ensuring adherence.
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Affiliation(s)
- Arwa Alhamed
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Pironetti R, Saha M, Luukkaala T, Keskinen P. Sociodemographic factors affecting glycaemic control in Finnish paediatric patients with type 1 diabetes. Endocrinol Diabetes Metab 2023; 6:e452. [PMID: 37749959 PMCID: PMC10638615 DOI: 10.1002/edm2.452] [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: 07/03/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 09/27/2023] Open
Abstract
AIMS Socioeconomic problems may present significant challenges when trying to reach optimal glycaemic control in paediatric patients with type 1 diabetes. We examined sociodemographic factors affecting metabolic control in patients in one of the biggest paediatric diabetes clinics in Finland. METHODS One hundred ninety-one children (age 2-15 years; median 11 years; 47% female) with type 1 diabetes and their families were recruited during outpatient visits in the paediatric diabetes clinic of Tampere University Hospital, Finland. The participants completed a questionnaire on the family's sociodemographic background. The child's glycaemic control was assessed by both glycosylated haemoglobin (HbA1c) and time in range (TIR). Risk factors for poor (HbA1c ≥75 mmol/mol; TIR <40%) and optimal (HbA1c <53 mmol/mol; TIR ≥70%) metabolic control were searched using logistic regression analyses. RESULTS Living in a nuclear family, male gender, younger age and a school assistant for diabetes management were associated with the simultaneous presence of both indicators of optimal metabolic control. Poor glycaemic control, as estimated by HbA1c, was associated with lower parental education and the child's older age. Parental smoking and the child's older age were associated with poor TIR. CONCLUSION This study confirms the importance of sociodemographic factors in care of Finnish paediatric patients with type 1 diabetes. Sociodemographic status markers of the family could be used as triggers to alert paediatric diabetes teams to offer more tailored care to families with new-onset type 1 diabetes mellitus.
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Affiliation(s)
- Riina Pironetti
- Department of PaediatricsTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Marja‐Terttu Saha
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
| | - Tiina Luukkaala
- Research, Development and Innovation CenterTampere University HospitalTampereFinland
- Faculty of Sciences, Health SciencesTampere UniversityTampereFinland
| | - Päivi Keskinen
- Department of PaediatricsTampere University HospitalTampereFinland
- Faculty of Medicine and Health TechnologyTampere UniversityTampereFinland
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Crossen SS, Wagner DV. Narrowing the Divide: The Role of Telehealth in Type 1 Diabetes Care for Marginalized Communities. J Diabetes Sci Technol 2023; 17:901-908. [PMID: 36896887 PMCID: PMC10348000 DOI: 10.1177/19322968231157367] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
Widespread uptake of telehealth in response to the COVID-19 pandemic has highlighted geographic, demographic, and economic disparities in access to virtual care. However, research studies and clinical programs that predate the pandemic demonstrate the potential for telehealth-based interventions to improve access to and outcomes of type 1 diabetes (T1D) care for individuals in geographically or socially marginalized communities. In this expert commentary, we discuss telehealth-based care models that have been successful in improving care for marginalized T1D populations. We also outline the policy changes needed to expand access to such interventions to reduce established disparities in T1D care and promote better health equity among people living with T1D.
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Affiliation(s)
- Stephanie S. Crossen
- Division of Pediatric Endocrinology, University of California Davis School of Medicine, Sacramento, CA, USA
| | - David V. Wagner
- Department of Pediatrics, Oregon Health & Science University, Portland, OR, USA
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