Maternal Experiences of Transitioning Their Emerging Adult With Type 1 Diabetes to College

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

OBJECTIVE

Only 17% of adolescents with type 1 diabetes (T1D) are currently meeting their glycemic targets despite advances in diabetes technologies. Self-management behaviors and challenges specific to use of diabetes technologies are insufficiently studied in adolescents. We aimed to describe the experience of diabetes technology self-management, including facilitators and barriers, among preteens/adolescents with low and high A1C.

RESEARCH DESIGN AND METHODS

Youth (10-18 years of age) with T1D who use insulin pump therapy were recruited from the larger quantitative cohort of a mixed methods study for participation in semi-structured qualitative interviews. Maximum variability sampling was used to recruit youth with A1C <7.5% (n = 5) and A1C >9% (n = 5). Participants' personal insulin pump and continuous glucose monitoring data were downloaded and served as a visual reference. Interviews were analyzed using a qualitative descriptive approach.

RESULTS

Participants were 50% female with a median age of 14.9 years and 80% used CGM. The sample was predominantly white (90.0%). Analysis produced four major themes, Bad Day, Expect the Unexpected, Nighttime Dependence, and Unpredictability, It's Really a Team and interconnecting subthemes. Youth characterized ''Bad Days'' as those requiring increased diabetes focus and self-management effort. The unpredictability (''Expect the Unexpected'') of glucose outcomes despite attention to self-management behaviors was considerable frustration.

CONCLUSIONS

Diabetes devices such as insulin pumps are complex machines that rely heavily on individual proficiency, surveillance, and self-management behaviors to achieve clinical benefit. Our findings highlight the dynamic nature of self-management and the multitude of factors that feed youths' self-management behaviors.

Use of the self- and family management framework and implications for further development

BACKGROUND

The Self- and Family Management Framework (SFMF) was created in 2006 and revised in 2015 to guide research on self- and family management of chronic conditions. There has been no review of use of the SFMF.

PURPOSE

We reviewed articles citing the SFMF to identify the frequency and nature of use.

METHOD

We conducted a citation analysis, searching Web of Science, Scopus, and Google Scholar databases and extracted key data from identified articles.

FINDINGS

Of 126 articles, 84(66%) cited the 2006 SFMF, 37(29%) cited the 2015 SFMF, and 6(5%) cited both. The SFMF was used most to inform study design. Users noted strengths (e.g., considers family context) and limitations (e.g., non-specification of patient- family caregiver synergies) of the framework.

DISCUSSION

The SFMF has been used broadly to guide research on self- and family management of chronic conditions. Findings will inform development of a third version of the SFMF.

Experiences and perspectives of the parents of emerging adults living with type 1 diabetes

INTRODUCTION

Whereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child's diabetes 'self'-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Semi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach.

RESULTS

Analysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; negotiating parent-child roles, responsibilities and relationships; and new and evolving fears. Parents spoke in detail about the time surrounding their child's diagnosis of type 1 diabetes to emphasize the complexity of diabetes care and the need to establish a 'new normal' for the family. In turn, adolescence and emerging adulthood required a renegotiation of roles and responsibilities, with many parents continuing to play a role in high-level diabetes management. Several parents of emerging adults with type 1 diabetes (particularly those of young men) vocalized worries about their child's readiness to assume responsibility for their self-care, and some expressed frustration with the apparent dichotomy in the role expectations of parents between the pediatric and adult care settings.

CONCLUSIONS

Adult healthcare providers should recognize both the ongoing involvement of parents in the 'self'-management of emerging adults with type 1 diabetes and the unique aspects of the caregiver burden that they experience.

Challenges Experienced by Parents of Emerging Young Adults With Type 1 Diabetes Mellitus During the Transition to College

PURPOSE

The purpose of this study is to gain a deeper understanding of the challenges experienced by parents of emerging young adults (EYAs) with type 1 diabetes mellitus (T1DM) who completed their freshman or sophomore year of college.

METHODS

Using a descriptive, qualitative design, 16 parents participated in semistructured interviews that explored factors impacting the college transition for parents of college freshmen and sophomores with T1DM. Participants were recruited from local endocrinology clinics as well as the College Diabetes Network (CDN) Parent Facebook page, the CDN Facebook page, the CDN Twitter feed, and the Delaware Chapter of the JDRF (formerly Juvenile Diabetes Research Foundation). Researchers used a thematic analysis to analyze the data and develop categories. Interviews were conducted and recorded via video conferencing from July 2019 to September 2019.

RESULTS

Results represent data from 16 interviews comprising 15 (94%) mothers and 1 father. Thematic analysis resulted in the emergence of 3 themes: managing parental concerns, changes in the parental role, and identifying sources of parental support. Parents identified several challenges including the EYAs' ability to manage T1DM at college, communication with the EYA, and the availability of support for parents.

CONCLUSION

Parents experience several challenges during their EYA's transition to college with T1DM. Supporting the needs of parents and EYAs during this time may serve to reduce diabetes-related complications for EYAs and increase overall quality of life for both members of the dyad.

An eHealth Program for Parents of Adolescents With T1DM Improves Parenting Stress: A Randomized Control Trial

PURPOSE

The purpose of this study was to evaluate the short-term effects of the Type 1 Teamwork program for parents of adolescents with type 1 diabetes mellitus (T1DM) on the primary outcome of psychosocial stress.

METHODS

The study was a randomized wait-list control trial evaluating an eHealth program to reduce parenting stress around T1DM management during adolescence through interactive sessions on the safe transfer of responsibility, positive communication, and stress management. The primary outcome was psychosocial stress (parenting stress specific to child illness and general stress). Secondary outcomes included depressive and anxiety symptoms, parent support for adolescent autonomy, family conflict, and adolescent metabolic control (A1C). Data were collected at baseline, 3 months, and 6 months online. Mixed-model analyses were conducted, using intent-to-treat procedures.

RESULTS

Parents (n = 162) had a mean age of 45.6 (±5.3) years, were 98% female, 91% white, 91% married/partnered, 51% of high income, and geographically dispersed around the United States. Parents reported that adolescents had a mean A1C of 7.9% (±1.2%) and T1DM duration of 5.08 (±3.62) years. At 6 months, parents in the Type 1 Teamwork group demonstrated less parenting stress compared with the control group. There were no differences between groups on general stress or secondary outcomes. Attrition at 6 months was 32% in the treatment group and 11% in the control group.

CONCLUSIONS

An eHealth program for parents of adolescents with T1DM improves parenting stress in a sample of parents from across the United States.

Sleep, Nutrition, Disordered Eating, Problematic Tobacco and Alcohol Use, and Exercise in College Students With and Without Diabetes

The purpose of the current study was to examine the health behaviors of college students with diabetes and compare behaviors to college students without diabetes. This descriptive study used the American College Health Association-National College Health Assessment II and included 1,216 students between ages 18 and 24. Health behaviors related to sleep, nutrition, disordered eating, problematic tobacco and alcohol use, and exercise were examined. Students with diabetes (n = 528) reported a higher frequency of meeting exercise recommendations and less healthy behaviors related to nutrition and problematic tobacco and alcohol use. Both groups of students reported inadequate sleep. Students with diabetes reported more academic problems due to sleep difficulties, disordered eating, and problematic alcohol use. Health behaviors in both groups showed similar needs for improvement. Nurses are in a position to guide new, prospective, and continuing college students with diabetes in practicing behaviors associated with positive health outcomes. Opportunities for interventions are numerous. [Journal of Psychosocial Nursing and Mental Health Services, 57(12), 23-32.].

Barriers and Facilitators Influencing Parental Transition of College-Bound Youth with Type 1 Diabetes Mellitus: An Integrative Review

PURPOSE OF REVIEW

The purpose of this review was to synthesize current research about potential barriers impacting parents as they transition their college-bound youth with type 1 diabetes mellitus (T1DM) to college.

RECENT FINDINGS

Seven studies, 5 qualitative and 2 quantitative, met the qualifications for inclusion in this study by focusing on parents and were included in this review. Three potential barriers impacting the parental experience during the transition of their youth with T1DM to college were identified: developing and promoting autonomy, evolving relationships and roles in the parent/youth dyad, and distress. Parents consistently indicated concern about their youth's ability to self-manage their T1DM and lack of support for their own transition. This review indicates that several barriers may influence parents of adolescents with T1DM as they transition to becoming the parent of a college-bound youth with T1DM. The parental transition of launching their youth to college is more complex and unique for parents of youth with T1DM parents of youth without chronic conditions. Additional research focusing on the identification of desired supports for parents and the development of specific interventions to assist parents as they transition with their college-bound youth with T1DM is recommended.

An Exploratory Study: Transition to Adulthood for College Students with Type 1 Diabetes and Their Parents

PURPOSE

The transition to college and adulthood can be challenging for young adults with chronic health conditions and their parents. Few studies have simultaneously explored the experiences of college students and their parents during the transition to college. The purpose of this study was to explore the transition to adulthood for college students with type 1 diabetes (T1D) and their parents.

DESIGN AND METHODS

A descriptive exploratory study was conducted with college students with T1D and their parents. Data were collected online using quantitative surveys and open-ended questions. Descriptive statistics were generated for quantitative measures. Analysis of responses to open-ended questions used qualitative description.

RESULTS

College students (18-24 years) and parents described challenges with life-stage stress, diabetes management worries, and concern about T1D-related long-term complications. Respondents also described the critical role of the college peer network for support and help in case of crisis situations. Students reported stress related to uncertainty in diabetes management, while parents described constant worry about their child's diabetes.

CONCLUSIONS

Findings support the importance of assessing anticipated and current stressors of college students with T1D and other chronic health conditions and their parents during and after transition to college.

PRACTICE IMPLICATIONS

Nurses can support students and parents by providing anticipatory guidance about the transition to college. Assistance identifying established sources of support on college campuses, as well as planning for potential crisis situations, may help reduce stress experienced by students and parents.