Diabetes Nurse Educators and Preconception Counseling

Risky sexual behaviors in adolescents and young adult women with type 1 diabetes: An overlooked problem

The presence of unprotected sex activity in women living with type 1 diabetes (T1D) who have insufficient glycemic control should be considered as a specific risky behavior. To evaluate risky behaviors, including unprotected sexual activity, sources of information and knowledge related to reproductive health in adolescents and young adult women with T1D (PwT1D) compared to a group of adolescents and young adult women without diabetes (Comparison group). PwT1D and the Comparison group completed a questionnaire with validated measures that assessed reproductive health. PwT1D (n = 115, age = 17.7 ± 3.2 years) and Comparison group (n = 386, age = 18.3 ± 2.9) were recruited. The proportion of women reporting having sex without any contraceptive was similar in both groups (57.1% and 50%, in PwT1D and Comparison group, respectively). The use of non-effective contraceptive was reported in 63.2% and 63.6% of the PwT1D and Comparison group, respectively. Among PwT1D, parents, formal sex education, and friends were the primary source of information on reproductive health. Low levels of knowledge about diabetes and pregnancy were observed in PwT1D. HbA1c level was associated with having at least one sexual activity without any contraception (OR = 1.63, p = 0.039). PwT1D have similar rates of risky behaviors compared to a Comparison group. Sexual risky behaviors should be especially considered in PwT1D with glycemic control above the optimal level. Parents are an important source of reproductive health information for PwT1D. Use of effective contraception should be reinforced in sexually active PwT1D.

Current practice and perspectives of healthcare providers regarding preconception care for women with type 1 diabetes in China

AIMS

We aimed to investigate the current practice and perspectives of healthcare providers (HCPs) regarding preconception care (PCC) for women with type 1 diabetes (T1D) in China.

MATERIALS AND METHODS

A questionnaire based on in-depth interviews with HCPs involved in PCC was released online and advertised via doctor unions in China. The data were categorical variables and were analysed by multivariable logistic regression, Chi-square test, or Wilcoxon rank-sum test.

RESULTS

From November 2016 to January 2017, 992 responses from 31 provinces of China were received (77.3% doctors and 22.7% nurses). Regarding the current status of PCC for T1D, 62.5% of HCPs treated ≤1 woman with T1D monthly on average. Only 16.5% thought they provided proper PCC, and 29.6% reported having sufficient knowledge. Regarding attitudes towards pregnancy with T1D, 92.2% were in favour of women with T1D getting pregnant after proper glycaemic control, and 94.7% perceived their worries regarding pregnancy. Regarding doctor-patient communication, 56.6% spent <10 min per visit, while 58.3% thought ≥20 min was required for adequate communication. HCPs emphasised the importance of multidisciplinary PCC, professional training, and social support. PCC practice was associated with hospital level (OR = 2.450, 95%CI: 1.580-3.799, p < 0.001), HCPs' experience of treating women with T1D (OR = 2.196, 95%CI: 1.516-3.180, p < 0.001), and their communication sufficiency (OR = 3.706, 95%CI: 2.550-5.387, p < 0.001).

CONCLUSIONS

The current PCC practice for T1D in China was suboptimal and it was associated with hospital level, HCPs' experience and communication. It is necessary to reinforce professional training and appeal for social resources to improve PCC.

Delivering family planning and preconception care to women with diabetes: Implementation challenges and promising strategies

Diabetes is increasingly prevalent among women of reproductive age and during pregnancy. The American Diabetes Association, which has called for improvements in the patient-centeredness of care, recommends preconception counseling and care for women of reproductive age with diabetes. However, data suggests this care is not sufficiently delivered. In this article, we describe demographic shifts in the need for preconception care and outline several changes at the clinical encounter as well as the health system- and community-levels that can help improve the delivery of diabetes-specific preconception care.

Preconception Counseling for Adolescents and Young Adults with Diabetes: a Literature Review of the Past 10 Years

PURPOSE OF REVIEW

Women with diabetes who have unplanned pregnancies and uncontrolled blood sugars are at a higher risk for maternal and fetal morbidities and mortalities. Preconception counseling (PC) has been shown to decrease the risks and improve health outcomes. From 2009 to 2017, the American Diabetes Association has recommended that preconception counseling be given at each clinic visit for all women with diabetes of childbearing age starting at puberty (prior to sexual debut).

RECENT FINDINGS

This article reports both national and international progress in PC efforts for adolescents and young adults (12-34 years) with diabetes over the past decade. Twenty-eight publications were identified and included in this article (11 were research, 12 clinical guidelines, and 5 reviews). Despite recommendations to start PC at puberty, only four studies had interventions that targeted the adolescent and young adult age group. Three of them were associated with the same PC awareness program. Positive outcomes were reported in all of these studies. Greater family vigilance was observed in a long-term follow-up of a cohort of women who received PC as teens. Adolescents should receive awareness PC. More early PC interventions and cohort follow-up studies are needed among adolescents and young adults, using technology that appeals to this age group. Programs should be expanded to include other populations like males with diabetes and females from other cultures and religions that would require program modification.

Race and Religious Beliefs Are Associated With Communication Regarding Reproductive Health and Preconception Counseling in Young Women With Diabetes

Purpose

The purpose of this study was to examine the relationship between selected internal and external characteristics and communication (intended and actual) with health care providers (HCPs) about reproductive health and preconception counseling among adolescent females with diabetes.

Methods

A descriptive, correlational design was employed to conduct a secondary analysis of baseline data from a multisite, randomized controlled trial. Participants were 110 female adolescents (92% type 1 diabetes). Analysis included multiple linear regression and multivariate binary logistic regression analyses to examine the association of internal characteristics (age, race, religion, and religious beliefs) and external characteristics (ever sexually active, social support, and type of routine HCP).

Results

Participants were from 13.3 to 20.0 years of age, 82% were Caucasian, 80% had never been sexually active, and 58% perceived low to moderate amounts of social support. For both internal and external characteristics, no significant main effects were found for actual or intended communication. For internal characteristics, there was an interaction between race and religious beliefs for the probability of actual communication. African American women who reported that their religious beliefs did not influence their sexual behavior had the lowest probability of actual communication compared to all other participants.

Conclusion

Race and religious beliefs should be considered when providing reproductive health information to young women with diabetes. Further research with a larger, more diverse sample is warranted. These results may be considered for future development of novel interventions with targeted messages based on these personal characteristics to empower young women to initiate conversations with HCPs about reproductive health and preconception counseling.

Attitudes towards preconception care in Maltese women with type 1 diabetes mellitus

INTRODUCTION

The aim of this study was to assess the level of knowledge and awareness related to preconception care among Maltese women of reproductive age with type 1 diabetes mellitus (T1DM).

METHODS

Thirty-seven T1DM women, aged 12-30 years, were self-administered a questionnaire related to diabetes self-management and preconception care. The participants then underwent an educational intervention and re-took the same questionnaire.

RESULTS

Before the intervention, 26 participants (70%) claimed they did not have any knowledge about the preconception care of diabetes. Of the remaining 11 participants, the main reported source of information about diabetes care was the diabetologist (n = 8; 6.7%). The response rate was 70% (26 out of 37 participants completed the questionnaire after the educational intervention). Six of the participants who initially reported no preconception care knowledge claimed an increased awareness after the event. There was a statistically significant increase in the knowledge scores after the intervention.

CONCLUSION

It is evident that there is a lack of awareness of the importance of pre-pregnancy planning to avoid pregnancy-related complications with diabetes. This emphasizes the need for more education and it is imperative for healthcare professionals to address these issues with adolescent female patients.

Implications of type 2 diabetes on adolescent reproductive health risk: an expert model

PURPOSE

The purpose of this article was to summarize scientific knowledge from an expert panel on reproductive health among adolescents with type 2 diabetes (T2D).

METHODS

Using a mental model approach, a panel of experts--representing perspectives on diabetes, adolescents, preconception counseling, and reproductive health--was convened to discuss reproductive health issues for female adolescents with T2D.

RESULTS

Several critical issues emerged. Compared with adolescents with type 1 diabetes, (1) adolescents with T2D may perceive their disease as less severe and have less experience managing it, putting them at risk for complications; (2) T2D is more prevalent among African Americans, who may be less trusting of the medical establishment; (3) T2D is associated with obesity, and it is often difficult to change one's lifestyle within family environments practicing sedentary and dietary behaviors leading to obesity; (4) teens with T2D could be more fertile, because obesity is related to earlier puberty; (5) although obese teens with T2D have a higher risk of polycystic ovary syndrome, which is associated with infertility, treatment with metformin can increase fertility; and (6) women with type 2 diabetes are routinely transferred to insulin before or during pregnancy to allow more intensive management.

CONCLUSIONS

Findings from the expert panel provide compelling reasons to provide early, developmentally appropriate, culturally sensitive preconception counseling for teens with T2D.

A Self-instructional Program for Diabetes Educators on Preconception Counseling for Women With Diabetes

Purpose

The purpose of this study was to develop, implement, and evaluate the effectiveness of a self-instructional preconception counseling (PC) training program for Certified Diabetes Educators (CDEs) to enhance PC knowledge and self-efficacy.

Methods

A 1-group, pre-post test study was conducted with 31 CDEs from a large medical center in western Pennsylvania. The self-instructional program included selected readings, such as the American Diabetes Association's position statement on PC of women with diabetes and an interactive CD-ROM, “Reproductive-Health Awareness for Teenage Women With Diabetes” (“READY-Girls”). Paper-and-pencil knowledge and self-efficacy questionnaires regarding PC and pregnancies of women with diabetes were completed by the CDEs before and immediately following the self-instructional program. Upon completion, participants received 5.0 Continuing Nursing Education contact hours (CNEs) from the State Nurses Association.

Results

Prior to receiving the program, all of the participants indicated they would benefit from further training on PC. Pretest knowledge scores averaged in the 70th percentile; following the program, the participants significantly increased (P < .01) PC knowledge and self-efficacy in providing PC to women with diabetes, including adolescents.

Conclusions

Although CDEs knew relevant information, they lacked some specific knowledge about PC, and they lacked confidence in their knowledge and in their ability to counsel patients. Diabetes educators can benefit from an education program to provide PC to their female patients, including adolescents. Computer or Web-based accessibility could make this a low-cost and easily disseminated program.

Preconception planning: are we making progress?

According to the American Diabetes Association, unplanned pregnancies in women with diabetes could lead to abnormal metabolic control, which causes fetal and maternal complications. Preconception planning can decrease these risks. This article reports on the progress in preconception planning over the past 2 years.

Knowledge, attitudes and behaviors related to sexuality and family planning in adolescent women with and without diabetes

BACKGROUND

Sexually active adolescents with diabetes are at high risk for unplanned pregnancies and reproductive complications.

OBJECTIVE

Knowledge, attitudes, intentions, and behaviors regarding diabetes and reproductive issues, sexuality, and contraception were examined in teens with diabetes in relation to a non-diabetic group.

METHODS

A multisite, case-control, theory-based structured telephone interview was conducted on adolescent women: 80 with diabetes mellitus (DM) and 37 matched controls without diabetes (non-DM).

RESULTS

Teens with diabetes appeared to lack an understanding of critical information that could prevent unplanned pregnancies and pregnancy-related complications. Although they scored significantly higher than the non-DM group on diabetes-related information, the DM group had their lowest mean average of 59% for the diabetes and pregnancy score. They did not appear to have greater protective attitudes regarding reproductive health issues than the non-DM group. The DM group felt that they were only moderately susceptible to becoming pregnant and that severe complications would not happen to them. The DM group perceived greater severity to sex-related outcomes (p = 0.001). The DM group did not report safer and more effective family planning behaviors (mean age coitus = 15.7 yr), which for them could be more detrimental. Similar trends were noted between groups regarding contraceptive methods; only a single method (e.g., pill only) rather than a dual method (e.g., pill and condom) was most frequently used.

CONCLUSION

Having diabetes did not appear to significantly decrease the risk-taking behavior of the teens. Early and some unsafe sexual practices may increase their risk for an unplanned pregnancy that could result in pregnancy-related complications. Enhancing awareness, knowledge, and attitudes through preconception counseling and reproductive health education may reduce these risks by empowering young women to plan healthy future pregnancies.