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Zainal Abidin Z, Noor E, Mohd Nor NS, Mohamed Nazari NS, Anuar Zaini A, Azizi NZ, Soelar SA, Shahrizad MM, Abdul Halim R. Type 1 Diabetes Mellitus Patients' Self-perception of Periodontal Diseases. Eur J Dent 2024; 18:534-543. [PMID: 38049120 PMCID: PMC11132774 DOI: 10.1055/s-0043-1772777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/06/2023] Open
Abstract
OBJECTIVES The study aimed to evaluate type 1 diabetes mellitus (T1DM) patients' self-perceived periodontal health status and to identify the association between periodontal disease (PD) and DM. MATERIALS AND METHODS This cross-sectional study included 113 T1DM children between 3 and 18 years old from the Universiti Teknologi MARA and the University of Malaya. Periodontal health parameters, including plaque index, gingival index, probing pocket depth, simplified basic periodontal examination, and clinical attachment loss, were recorded. Self-perceived periodontal health status was assessed with questionnaires. STATISTICAL ANALYSIS Statistical analysis was performed to evaluate the sensitivity of the questionnaire and the relationship between T1DM and periodontal parameters. RESULTS The median age was 11.4 years. Half of them (50.4%) were females. A total of 83.5% rated their oral condition as good, whereas 27.5% reported a history of gingival bleeding. Clinical examination revealed that 48.7% had healthy gingiva, whereas 47.8% had gingivitis. The question "Do you have bleeding when brushing, flossing, or eating food?" showed good accuracy in the evaluation of PD (p < 0.001). CONCLUSION The questionnaire has a high potential to be used by medical professionals in identifying T1DM patients at risk of PD to guide nondental health care providers in making appropriate referrals to dental services.
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Affiliation(s)
- Zaridah Zainal Abidin
- Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Erni Noor
- Centre of Studies for Periodontology, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | - Noor Shafina Mohd Nor
- Department of Paediatrics, Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
- Institute for Pathology, Laboratory and Forensic Medicine (I-PPerForM), Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
| | | | - Azriyanti Anuar Zaini
- Paediatric Department, Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Nurul Zeety Azizi
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Shahrul Aiman Soelar
- Clinical Research Centre, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia
| | - Marshah Mohamad Shahrizad
- Kuching Division Dental Office, Sarawak State Dental Health Department, Braang Bayur Dental Clinic, Sarawak, Malaysia
| | - Rohaida Abdul Halim
- Centre of Paediatric Dentistry and Orthodontics Studies, Faculty of Dentistry, Universiti Teknologi MARA, Sungai Buloh, Selangor, Malaysia
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2
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O'Donnell HK, Trojanowski PJ, Alonso GT, Majidi S, Snell-Bergeon J, Wadwa RP, Vigers T, Pyle L, Gurka MJ, Shaffer E, Driscoll KA. A randomized controlled clinical trial to improve health outcomes in youth with type 1 diabetes: Study design and baseline characteristics. Contemp Clin Trials 2023; 131:107270. [PMID: 37348599 DOI: 10.1016/j.cct.2023.107270] [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: 12/28/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Most adolescents with T1D do not meet glycemic recommendations or consistently perform the required self-management behaviors to prevent acute- and long-term deleterious health outcomes. In addition, most youth with T1D do not have access to behavioral health services to address T1D management barriers. Thus, delivering behavioral interventions during routine medical appointments may hold promise for improving T1D outcomes in adolescents. The overall objective of this study was to examine the effect of behavioral interventions, either a Personalized T1D Self-Management Behaviors Feedback Report or Problem-Solving Skills, delivered by a T1D behavioral health provider and a T1D medical provider during a joint, fully integrated appointment to improve health outcomes in youth with T1D. This paper describes the study rationale, design, and baseline characteristics for the 109 adolescent-caregiver dyads who participated. Primary and secondary outcomes include hemoglobin A1c (A1C), T1D self-management behaviors, and biological indicators of complications.
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Affiliation(s)
- Holly K O'Donnell
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Paige J Trojanowski
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - G Todd Alonso
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Shideh Majidi
- Children's National, Pediatric Endocrinology, 111 Michigan Ave NW, Washington DC, United States of America.
| | - Janet Snell-Bergeon
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - R Paul Wadwa
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Tim Vigers
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Laura Pyle
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Matthew J Gurka
- University of Florida, College of Medicine, Department of Pediatrics, PO Box 100177, Gainesville, FL, United States of America.
| | - Emily Shaffer
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America.
| | - Kimberly A Driscoll
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America; University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America; University of Florida Diabetes Institute, United States of America.
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3
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Majidi S, Roberts AJ, Suerken CK, Reboussin BA, Malik FS, Marcovina SM, Corathers S, Reynolds K, Imperatore G, Wadwa RP, Pihoker C. Health Care Transition to Adult Care in Type 1 Diabetes: Associations With Student and Employment Status-The SEARCH for Diabetes in Youth Study. Clin Diabetes 2023; 41:510-517. [PMID: 37849515 PMCID: PMC10577504 DOI: 10.2337/cd22-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Successful transition from a pediatric to adult diabetes care provider is associated with reduced ambulatory diabetes care visits and increased acute complications. This study aimed to determine whether the degree of independence in diabetes care and the rate of acute complications after transition to adult diabetes care were associated with individuals' student or employment status. Nonstudents were found to be less likely than students to be independent with diabetes care, and employed nonstudents were at lower risk of diabetic ketoacidosis than unemployed nonstudents. Additional support may be needed for young adults who are not students or are unemployed to improve independence and reduce the risk for acute complications.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Washington, DC
| | - Alissa J. Roberts
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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4
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Wolverson M, O'Hare P, Patel V. An eye opener: improving attendance rates of retinopathy screening within the paediatric diabetes clinic. PRACTICAL DIABETES 2023. [DOI: 10.1002/pdi.2433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | - Paul O'Hare
- Warwick Medical School University of Warwick Warwick UK
| | - Vinod Patel
- Warwick Medical School University of Warwick Warwick UK
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5
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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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6
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Kofoed P, Timm S. The impact of COVID-19 lockdown on glycaemic control and use of health services among children followed at a Danish diabetes clinic. Acta Paediatr 2022; 111:368-375. [PMID: 34586678 PMCID: PMC8653272 DOI: 10.1111/apa.16128] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/22/2021] [Accepted: 09/28/2021] [Indexed: 12/12/2022]
Abstract
Aim During COVID‐19 restrictions, the paediatric clinic only accepted essential outpatient visits, schools closed, sports activities and social life were limited. Most employees worked at home. This quasi‐experiment evaluates how this affected glycaemic control and use of health services among children with diabetes. Methods Paired t‐tests were used to compare HbA1c‐values before, during and after lockdown. Sub‐analyses were stratified by pre‐lockdown HbA1c‐values. Results Overall mean HbA1c decreased from 58.3 to 56.9 mmol/mol (p = 0.025) from pre‐ to post‐lockdown, a decrease also seen during the same season the previous year. HbA1c decreased by −4.2 mmol/mol (p = 0.002) for patients with pre‐lockdown HbA1c > 59 mmol/mol, but increased slightly by 0.8 mmol/mol (p = 0.176) for patients with HbA1c < 52 mmol/mol. HbA1c measured 8 months post‐lockdown increased again, most pronounced for patients with lowest HbA1c. During lockdown, virtual contacts increased from 0.1 to 0.5 contacts/patient/month and stayed post‐lockdown at 0.3 contacts/patient/month. Conclusion Compared to 2019, overall the COVID‐19 restrictions did not influence the glycaemic control negatively. However, patients with pre‐lockdown HbA1c < 52 mmol/mol experienced a deterioration, whereas those with HbA1c > 59 mmol/mol experienced an improvement. Less stress and more contact with parents may contribute to the last‐mentioned finding. The lockdown enforced more virtual contacts between patients and the clinic.
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Affiliation(s)
- Poul‐Erik Kofoed
- Department of Paediatrics and Adolescent Medicine Lillebaelt HospitalUniversity Hospital of Southern Denmark Kolding Denmark
- Department of Regional Health Research University of Southern Denmark Odense Denmark
| | - Signe Timm
- Department of Regional Health Research University of Southern Denmark Odense Denmark
- Research unit Lillebaelt HospitalUniversity Hospital of Southern Denmark Kolding Denmark
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7
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Middleton T, Constantino M, McGill M, D'Souza M, Twigg SM, Wu T, Thiagalingam A, Chow C, Wong J. An Enhanced SMS Text Message-Based Support and Reminder Program for Young Adults With Type 2 Diabetes (TEXT2U): Randomized Controlled Trial. J Med Internet Res 2021; 23:e27263. [PMID: 34524102 PMCID: PMC8569538 DOI: 10.2196/27263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 06/24/2021] [Accepted: 07/21/2021] [Indexed: 01/15/2023] Open
Abstract
Background Clinic attendance, metabolic control, engagement in self-management, and psychological health are suboptimal in young-onset (age of onset <40 years) type 2 diabetes. Objective We examined the effectiveness of an enhanced SMS text message–based support and reminder program in improving clinic attendance, metabolic control, engagement in self-management, and psychological health in young-onset type 2 diabetes. Methods A 12-month, parallel-arm, randomized controlled trial comparing an enhanced, semipersonalized SMS text message–based intervention (incorporating 1-8 supportive and/or informative text messages per month) against standard care was conducted in a specialized clinic for young adult type 2 diabetes. The primary outcome was maintenance of 100% attendance at scheduled quarterly clinical appointments. Secondary outcomes included (1) metabolic indices, (2) pathology and self-monitored blood glucose (SMBG) data availability, and (3) psychosocial well-being. Results A total of 40 participants were randomized, and 32 completed their 12-month study visit. The average participant age was 32.7 (SD 5.1) years, 50% (20/40) were male, and baseline glycated hemoglobin A1c (HbA1c) was 7.3% (SD 1.9%) (56 mmol/mol, SD 20). A higher proportion of the intervention group achieved 100% attendance (12/21, 57%, vs 5/19, 26%, for the control group); Kaplan-Meier analysis demonstrated significantly greater cumulative attendance in the intervention group (P=.04). There were no between-group differences in HbA1c, BMI, lipids, or availability of pathology and SMBG data. Odds of recording an improvement in the Diabetes Empowerment Scale–Short Form score were higher in the intervention group at 6 months (odds ratio [OR] 4.3, 95% CI 1.1-17), with attenuation of this effect at study end (OR 3.1, 95% CI 0.9-11). Program acceptability was high; >90% of participants would recommend the program to new patients. Conclusions An enhanced SMS text message–based support and reminder program doubled scheduled clinic attendance rates for patients with young-onset type 2 diabetes. The program was highly acceptable and provided early support for patient empowerment but had no significant effect on measures of metabolic control or self-management. Trial Registration Australian and New Zealand Clinical Trials Registry (ACTRN12618000479202); https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373579
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Affiliation(s)
- Timothy Middleton
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Maria Constantino
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Margaret McGill
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Mario D'Souza
- Sydney Local Health District Clinical Research Centre, Camperdown, Australia
| | - Stephen M Twigg
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Ted Wu
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
| | - Aravinda Thiagalingam
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Department of Cardiology, Westmead Hospital, Westmead, Australia.,Westmead Applied Research Centre, The University of Sydney, Westmead, Australia
| | - Clara Chow
- Faculty of Medicine and Health, University of Sydney, Camperdown, Australia.,Department of Cardiology, Westmead Hospital, Westmead, Australia.,Westmead Applied Research Centre, The University of Sydney, Westmead, Australia.,Cardiovascular Division, The George Institute for Global Health, Sydney, Australia
| | - Jencia Wong
- Diabetes Centre, Royal Prince Alfred Hospital, Camperdown, Australia.,Royal Prince Alfred Clinic, Charles Perkins Centre, The University of Sydney, Camperdown, Australia.,Faculty of Medicine and Health, University of Sydney, Camperdown, Australia
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8
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Rueter P, Farrell K, Phelan H, Colman P, Craig ME, Gunton J, Holmes-Walker DJ. Benchmarking care outcomes for young adults with type 1 diabetes in Australia after transition to adult care. ENDOCRINOLOGY DIABETES & METABOLISM 2021; 4:e00295. [PMID: 34505422 PMCID: PMC8502218 DOI: 10.1002/edm2.295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 07/25/2021] [Accepted: 07/30/2021] [Indexed: 11/09/2022]
Abstract
AIM To determine advantages conferred by a youth-specific transition clinic model for young adults with type 1 diabetes (T1D) at Westmead Hospital (WH) as compared with Australian registry data. METHODS Prospectively collected data included age, diabetes duration, visit frequency, post code, BMI, mode of insulin delivery, continuous glucose monitoring, HbA1c, albumin creatinine ratio, BP, retinopathy and diabetic ketoacidosis (DKA) for all WH T1D clinic attendees aged 16-25 between January 2017 and June 2018 (n = 269). Results were compared with data collected during the same time period from 2 separate Australian data registries, one longitudinal (Australasian Diabetes Data Network, ADDN) and one a spot survey (the Australian National Diabetes Audit, ANDA). RESULTS Across the three cohorts, HbA1c was similar (respectively, WH, ADDN, ANDA; 8.7%[72mmol/mol], 8.7%[72mmol/mol], 8.5%[69mmol/mol]) and HbA1c was significantly higher in young adults <21 years (8.7-8.9%[73-75mmol/mol]) as compared with ≥21 years (8.5%[69mmol/mol], p < .002). In the WH cohort, median interval between visits was shorter than in ADDN (4.5 vs. 9.0 months) and DKA was lower (respectively, 3.6 and 9.2/100 patient years; p < .001). CONCLUSIONS While suboptimal HbA1c was recorded in all centres, the WH model of care saw increased attendance and reduced admissions with DKA as compared with other Australian adult centres.
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Affiliation(s)
- Phidias Rueter
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Kaye Farrell
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
| | - Helen Phelan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,John Hunter Children's Hospital, Newcastle, NSW, Australia
| | - Peter Colman
- Department Diabetes and Endocrinology, Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Maria E Craig
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead, Westmead, NSW, Australia.,Charles Perkins Centre Westmead, University of Sydney, Sydney, NSW, Australia.,School of Women's and Children's Health, University of NSW, Sydney, NSW, Australia
| | - Jenny Gunton
- Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia.,Westmead Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - D Jane Holmes-Walker
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia.,Department of Diabetes and Endocrinology, Westmead Hospital, Westmead, NSW, Australia
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9
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Kim JH, Yoo JH. A national survey of transition from pediatric to adult healthcare providers for adolescents and young adults with type 1 diabetes: perspectives of pediatric endocrinologists in Korea. Ann Pediatr Endocrinol Metab 2021; 26:112-117. [PMID: 33626630 PMCID: PMC8255862 DOI: 10.6065/apem.2040194.097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 09/06/2020] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Transition from pediatric to adult healthcare for adolescents and young adults with type 1 diabetes (T1D) increases the risk for poor outcomes. This study aimed to describe the circumstances and clinical practice patterns associated with this transition of care based on a nationwide survey of pediatric endocrinologists in Korea. METHODS An electronic survey regarding the healthcare transition of T1D patients was administered to 143 pediatric endocrinologists registered in the Korean Society of Pediatric Endocrinology. RESULTS The response rate was 50.2% (n=72). Among responders, 58.3% (n=42) were females, and 70.8% (n=51) worked in academic medical centers. The main reasons for transfer to adult care were request from a patient or family (69.6%) and age ≥18 years (42.0%). Impediments to transition were a long-lasting therapeutic relationship (72.9%) and lack of adult specialists in T1D care (62.9%). Communication between pediatric and adult endocrinologists was via nonstructured patient summary (68.6%) and telephone or email (27.1%). Responders reported that successful transition requires development of transition protocols (79.2%) and a multidisciplinary team approach for transition care (52.8%). CONCLUSION Transition care of T1D patients is a challenge to pediatric endocrinologists in Korea. Development of transition care protocols for healthcare providers and improvement of diabetes self-management skills for patients are needed.
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Affiliation(s)
- Jae Hyun Kim
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea,Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Jae-Ho Yoo
- Department of Pediatrics, Dong-A University College of Medicine, Busan, Korea,Address for correspondence: Jae-Ho Yoo Department of Pediatrics, Dong-A University College of Medicine, 32 Daesingongwon-ro, Seo-gu, Busan 49201, Korea
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10
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LePage AK, Wise JB, Bell JJ, Tumin D, Smith AW. Distance from the endocrinology clinic and diabetes control in a rural pediatric population. J Pediatr Endocrinol Metab 2021; 34:187-193. [PMID: 33544546 DOI: 10.1515/jpem-2020-0332] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/27/2020] [Indexed: 01/05/2023]
Abstract
OBJECTIVE We analyzed the impact of geographic distance from the clinic on adherence to recommended clinic visits and diabetes control among patients with type 1 diabetes (T1D) seen in a pediatric endocrinology clinic serving a rural region in eastern North Carolina. METHODS We retrospectively included patients with T1D age ≤20 years seen in our clinic during 2017. Outcomes were tracked until June 2018. Distance from the clinic was determined according to the zone improvement plan (ZIP) code of patient address. Visit adherence was defined based on the number of attended visits during the study period, aiming for 1 every 3 months. Glycated hemoglobin (HbA1c) was measured at the first and last visits during the review period. RESULTS The analysis included 368 patients, of whom 218 (59%) completed at least 1 visit every 3 months. The median HbA1c was 9.1 (interquartile range [IQR]: 8.0, 10.3) at the initial visit, and 9.3 (IQR: 8.0, 11.1) at the final visit. Median distance from the clinic was 56 km (IQR: 35, 86). On multivariable logistic regression, greater distance from the clinic was associated with lower odds of visit adherence (odds ratio per 10 km: 0.93; 95% confidence interval: 0.87, 0.99; p=0.030). Neither distance to the clinic nor clinic visit adherence were associated with HbA1c. CONCLUSIONS Patients living further away from the clinic were less likely to adhere to the recommended visit schedule, but distance was not correlated with HbA1c levels. Further work is needed to assist families living far from the clinic with adhering to recommended visits.
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Affiliation(s)
- Ana K LePage
- Department of Psychology, East Carolina University,GreenvilleNC, USA
| | - J Benjamin Wise
- Brody School of Medicine at East Carolina University, GreenvilleNC, USA
| | - Jennifer J Bell
- Department of Pediatrics, Baylor College of Medicine, HoustonTX, USA
| | - Dmitry Tumin
- Department of Pediatrics, Brody School of Medicine at East Carolina University, GreenvilleNC, USA
| | - Aimee W Smith
- Department of Psychology, East Carolina University,GreenvilleNC, USA
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11
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Zhu L, Chandran SR, Tan WB, Xin X, Goh SY, Gardner DSL. Persistent Anxiety Is Associated with Higher Glycemia Post-Transition to Adult Services in Asian Young Adults with Diabetes. Diabetes Metab J 2021; 45:67-76. [PMID: 32602276 PMCID: PMC7850875 DOI: 10.4093/dmj.2019.0226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 03/30/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is little longitudinal information on psychological burden and metabolic outcomes in young adults with diabetes (YAD) in Asia. We aimed to evaluate the association between psychological status and glycemia at baseline and 2 years following transition in a cohort of YAD in Singapore. METHODS Subjects with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), aged 17 to 25 years, were recruited from the YAD clinic in Singapore General Hospital. The Hospital Anxiety and Depression and Problem Areas for Diabetes scales were administered at transition (baseline) and at 18 to 24 months. Glycosylated hemoglobin (HbA1c) assessed during routine visits was tracked longitudinally. RESULTS A total of 98 T1DM (74.8%) and 33 T2DM (25.2%) subjects were recruited between January 2011 and November 2017. At baseline, mean HbA1c was 8.6%±1.7%. Only 26.0% achieved HbA1c of ≤7.5% and 16.8% achieved HbA1c of <7%. At baseline, prevalence of anxiety was 29.8%. At 24 months, 14.1% had persistent anxiety. Those with persistent anxiety had the highest mean HbA1c, particularly at 6 months (persistently anxious vs. persistently non-anxious: 9.9%±1.2% vs. 8.2%±1.9%, P=0.009). At baseline, 9.2% of subjects had depression. This group also had poorer glycemia at baseline (HbA1c of depressed vs non-depressed: 9.6%±2.1% vs. 8.5%±1.6%, P=0.04), which persisted up to 24 months. CONCLUSION The majority of YAD in Singapore have suboptimal glycemia. Psychological distress is a critical harbinger of poorer metabolic outcomes.
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Affiliation(s)
- Ling Zhu
- Department of Endocrinology, Singapore General Hospital, Singapore
| | | | - Wee Boon Tan
- Academic Clinical Program, Division of Medicine, Singapore General Hospital, Singapore
| | - Xiaohui Xin
- Academic Clinical Program, Division of Medicine, Singapore General Hospital, Singapore
| | - Su-Yen Goh
- Department of Endocrinology, Singapore General Hospital, Singapore
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Chin-Jung L, Hsiao-Yean C, Yeu-Hui C, Kuan-Chia L, Hui-Chuan H. Effects of mobile health interventions on improving glycemic stability and quality of life in patients with type 1 diabetes: A meta-analysis. Res Nurs Health 2020; 44:187-200. [PMID: 33368403 DOI: 10.1002/nur.22094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022]
Abstract
This meta-analysis aimed to examine the effects of mobile-health-based (mHealth) interventions on improving glycemic stability and quality of life (QOL) in patients with type 1 diabetes (T1D). Various databases, including PubMed, Embase, CINAHL, Cochrane Library, ProQuest, Chinese Electronic Periodical Services, and China Knowledge Resource Integrated, were used to search for relevant articles. A fixed-effects model or random-effects model was used to examine the overall effect. Various methods, including Egger's test, Begg's test, and trim-and-fill, were adopted to examine publication bias. In total, 26 studies were recruited. Results of the random-effects model showed that the use of mHealth-based interventions significantly decreased glycated hemoglobin (HbA1c) (mean difference = -0.37, 95% confidence interval (CI) = -0.53 to -0.22, p < .001), and improved life satisfaction (Hedges' g = 0.30, 95% CI = 0.10 to 0.50, p = .003), worry of diabetes (Hedges' g = -0.25, 95% CI = -0.41 to 0.08, p = .004), and mental health (Hedges' g = 0.36, 95% CI = 0.08 to 0.64, p = .012). Both adults and youths with T1D can benefit from mHealth-based interventions to improve HbA1c (Hedges' g = -0.44, p = .002 vs. -0.30, p = .003). The effect of mHealth-based interventions on improving QOL in both adults and youths could not be examined due to only one study published in adults with T1D. Moreover, those studies that included the function of feedback from professionals showed a significant effect of decreasing HbA1c compared to those without that function (Hedges' g = -0.48 vs. -0.16, p = .019). Mobile devices are convenient, instantaneous, and easy to use to communicate. Applying mHealth-based interventions with the function of feedback from professionals can be considered an alternative healthcare service to achieve optimal glycemic stability in adults and youths with T1D.
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Affiliation(s)
- Liu Chin-Jung
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Cathy General Hospital, Taipei, Taiwan
| | - Chiu Hsiao-Yean
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chuang Yeu-Hui
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Lin Kuan-Chia
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Beitou, Taiwan.,Community Research Center, National Yang-Ming University, Beitou, Taiwan
| | - Huang Hui-Chuan
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan
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Kofoed PE, Thomsen J. Leaving the responsibility of booking appointments to parents in a paediatric diabetes outpatient clinic resulted in a deterioration of metabolic control. Pediatr Diabetes 2020; 21:390-394. [PMID: 31854481 DOI: 10.1111/pedi.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/16/2019] [Accepted: 12/16/2019] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED It is recommended that children and adolescents with diabetes are seen at paediatric diabetes clinics at least four times a year. This study examined whether an increased involvement of parents in planning the contacts would help them take more responsibility and thus lead to better metabolic control. METHODS Patients with type 1 diabetes at the paediatric outpatient clinic at Lillebaelt Hospital were included in a before-after study. During the intervention, the parents were asked to contact the clinic whenever they needed help or wanted to book a consultation. HbA1c levels 1 year before, at the start of, and 1 year after the intervention were compared, as were the number of consultations and telephone contacts during the year prior to and during the intervention. RESULTS 139 patients were included in the analyses. The mean HbA1c levels were 1 year before the start of the intervention (HbA1c-1) 61.8 mmol/mol (7.8%), and at the start of the intervention (HbA1c-2) 59.9 mmol/mol (7.6%) (P = .01), and after the end of the intervention (HbA1c-3) 63.1 mmol/mol (7.9%) (HbA1c-2 vs HbA1c-3: P = .0002). During the year prior to the intervention, the mean number of consultations was 5.8, and during the intervention period, the mean was 4.4 (P = .0001); the mean number of telephone calls was 1.8 and 3.8 (P < .0001), respectively. CONCLUSION Children were seen less often when parents were responsible for booking appointments, leading to higher HbA1c levels indicating that frequent consultations are essential for good metabolic control and cannot be replaced by frequent telephone contacts.
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Affiliation(s)
- Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital/Kolding and IRS, University of Southern Denmark, Denmark
| | - Jane Thomsen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital/Kolding and IRS, University of Southern Denmark, Denmark
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Magsamen-Conrad K, Dillon JM, Billotte Verhoff C, Joa CY. Toward a Theory of HealthIT Adoption Across the Lifespan: Findings from Five Years in the Community. HEALTH COMMUNICATION 2020; 35:308-321. [PMID: 30652503 DOI: 10.1080/10410236.2018.1563027] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Mediated communication enabled by information technology has immense potential to positively affect personal health. Although existing theories of technology use and adoption have advanced our understanding of information technology, they do not fully address voluntary adoption in community settings, adoption across the lifespan, and privacy concerns. Drawing on evidence collected during more than five years of field research, we start to address those issues, especially as they pertain to HealthIT (e.g. mHealth, e-Health, and/or connected health) use. Our goals include advancing theoretical discussions on technology acceptance and offering practical applications useful for medical professionals serving patients of all ages. We discuss our findings related to mandatory adoption learning heuristics, pressured voluntary adoption, digital immigrants' self-reported technology use and skill, perceived versus actual support, concerns about online privacy and information sharing, potential loss of control over personal information, online-offline boundary incongruence, and adoption barriers related to technological features.
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Affiliation(s)
- Kate Magsamen-Conrad
- School of Communication and Information, Rutgers University
- Department of Communication Studies, The University of Iowa
| | | | - China Billotte Verhoff
- Lamb School of Communication, Purdue University
- School of Communication Studies, Ohio University
| | - Claire Youngnyo Joa
- School of Media and Communication, Bowling Green State University
- Department of Arts and Media, Louisiana State University Shreveport
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