1
|
Dover S, Ahmet A, Bluth K, Feldman BM, Goldbloom EB, Goldfield GS, Hamilton S, Imran O, Khalif A, Khatchadourian K, Lawrence S, Leonard A, Liu K, Ouyang Y, Peeters C, Shah J, Spector N, Zuijdwijk C, Robinson ME. Teaching Adolescents With Type 1 Diabetes Self-Compassion (TADS) to Reduce Diabetes Distress: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e53935. [PMID: 38048480 PMCID: PMC10777281 DOI: 10.2196/53935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 11/28/2023] [Accepted: 12/04/2023] [Indexed: 12/06/2023] Open
Abstract
BACKGROUND Adolescents living with type 1 diabetes (T1D) often experience diabetes distress (DD), a construct distinct from depression or anxiety that refers to the negative emotions that arise from living with and managing diabetes. Self-compassion, which involves being open to one's own suffering and treating oneself with the same care one would show to loved ones, is associated with better psychological and clinical outcomes among individuals with T1D. Self-compassion is a skill that can be taught and therefore represents an opportunity for intervention. OBJECTIVE The overall aim of this study is to assess the effectiveness of a web-based mindful self-compassion for teens (MSC-T) intervention on improving DD, anxiety, depression, diabetes-related disordered eating, and suicidal ideation experienced by youth with T1D (aged between 12 and 17 years) compared with a waitlist control group (standard of care). We will also explore (1) if the effect of the MSC-T intervention changes over time, (2) if the MSC-T intervention has a positive impact on measures of glycemic control, and (3) if the effect of the MSC-T intervention differs based on self-reported gender. METHODS We will conduct a single-center, parallel-group randomized controlled trial of 140 adolescents with T1D followed for 12 months. Participants will be randomly allocated (using hidden allocation) in a 1:1 ratio to either the MSC-T intervention or the waitlist control group. Our primary outcome is DD, as measured by the Problem Areas in Diabetes-Teen (PAID-T) version at 3 months. Secondary outcomes, assessed at 3 and 12 months, include anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale), depression (Patient Health Questionnaire-9 [PHQ-9]), diabetes-related disordered eating (Diabetes Eating Problem Survey-Revised [DEPS-R] version), and suicidal ideation (using 1 question from the PHQ-9). RESULTS Study recruitment began in October 2022 and was completed in March 2023, with a total of 141 participants enrolling. Data collection will be ongoing until March 2024. The first results are expected in June 2024. CONCLUSIONS This study will be the first randomized trial to assess the effectiveness of the web-based MSC-T intervention on adolescents with T1D. Given that adolescence is a period where individuals are typically required to assume more responsibility for their diabetes care, providing adolescents with the tools they need to better manage the stress that often accompanies T1D management is paramount. TRIAL REGISTRATION ClinicalTrials.gov NCT05463874; https://clinicaltrials.gov/study/NCT05463874. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/53935.
Collapse
Affiliation(s)
- Saunya Dover
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Alexandra Ahmet
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - Brian M Feldman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of Rheumatology, Department of Pediatrics, The Hospital for Sick Children and University of Toronto, Toronto, ON, Canada
| | - Ellen B Goldbloom
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Gary S Goldfield
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Hamilton
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Omar Imran
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Adam Khalif
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
| | - Karine Khatchadourian
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah Lawrence
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Andrew Leonard
- Harvard Extension School, Harvard University, Cambridge, MA, United States
| | - Kuan Liu
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Yongdong Ouyang
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, ON, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Corien Peeters
- Development & Rehabilitation, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Jai Shah
- Department of Psychiatry, McGill University, Montreal, QC, Canada
- Douglas Research Centre, Montreal, QC, Canada
| | - Noah Spector
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Eating Disorders Program, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - Caroline Zuijdwijk
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Marie-Eve Robinson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada
- Division of Endocrinology & Metabolism, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| |
Collapse
|
2
|
Yamaguchi M, Honda J, Fukui M. Effects of Parental Involvement on Glycemic Control in Adolescents With Type 1 Diabetes Mellitus: A Scoping Review. JOURNAL OF FAMILY NURSING 2023; 29:382-394. [PMID: 37211777 DOI: 10.1177/10748407231171842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
Type 1 diabetes mellitus (T1DM) is typically diagnosed in pediatric patients. Transitioning from supported management in childhood to self-management in adolescence is an important step. Parental psychosocial influence is a possible factor in adolescents' disease control. This review summarized the effects of parental involvement on glycemic control in adolescents with T1DM by focusing on hemoglobin A1c (HgbAIc). A scoping review per the Guidance for Systematic Scoping Reviews was conducted with the following inclusion criteria: (a) studies in English, (b) focused on adolescents with T1DM, (c) outcomes included HgbAIc, and (d) focused on parental influence of children with T1DM. Of 476 articles, 14 were included. The study outcomes were classified based on direct or indirect influence. "Parental support for adherence" and "parental conflict" significantly affected HgbAIc control. This study provides current evidence on parental influence on glycemic control in adolescents.
Collapse
Affiliation(s)
| | | | - Minae Fukui
- Mukogawa Women's University, Nishinomiya, Japan
| |
Collapse
|
3
|
Kobos E, Rojkowska S, Szewczyk A, Dziedzic B. Burden of care and a sense of loneliness in caregivers of children with type 1 diabetes. a cross-sectional study. Biopsychosoc Med 2023; 17:34. [PMID: 37803450 PMCID: PMC10559508 DOI: 10.1186/s13030-023-00291-4] [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: 04/17/2023] [Accepted: 09/24/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND Treatment of type 1 diabetes is a process involving not only sick children, but also their caregivers. AIM To assess the burden of care and sense of loneliness in caregivers of children with type 1 diabetes. Also, an analysis was conducted of the connection between sociodemographic factors characterizing caregivers and the clinical factors characterizing sick children and between the burden of care and the sense of loneliness. MATERIALS AND METHODS The study included 125 caregivers of children with type 1 diabetes. In order to collect the research data, the Caregiver Burden Scale and the Revised UCLA Loneliness Scale were used. RESULTS In the research group, the total result in the caregiving burden scale was 2.14, which remains within the average burden level. Caregivers showed the highest burden level in the General Strain Subscale. The analysis showed that mothers experience a greater burden of care than fathers in the General Strain Subscale and that caregivers of younger children are more burdened with care within the Isolation and Disappointment Subscales. Moderate high degree of loneliness was shown in 4.8% of caregivers. A higher burden of care for caregivers of children with type 1 diabetes is accompanied by a higher sense of loneliness. CONCLUSIONS The results of this study may help healthcare professionals plan a holistic, family-centered care program that will take into account factors that increase the burden of care: younger age of the affected child, motherhood, caregiver unemployment, feelings of loneliness, lower education, caregiver unemployment, blood glucose meter measurements, and frequent night-time blood glucose measurements.
Collapse
Affiliation(s)
- Ewa Kobos
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
- Polish Federation for Diabetes Education, Warsaw, Poland
| | | | - Alicja Szewczyk
- Polish Federation for Diabetes Education, Warsaw, Poland
- Children’s Memorial Health Institute, Warsaw, Poland
| | - Beata Dziedzic
- Department of Development of Nursing, Social and Medical Sciences, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
4
|
Schweizer R, Lösch-Binder M, Hayn C, Friz S, Uber J, Ziegler J, Liebrich F, Neu A. Transition From Childhood to Adult Care in Patients with Type 1 Diabetes: 20 Years of Experience From the Tübinger Transition Study. Exp Clin Endocrinol Diabetes 2023; 131:532-538. [PMID: 37467782 DOI: 10.1055/a-2132-9585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
AIMS Transition from pediatric to adult care is difficult for patients with chronic diseases. In this study, factors associated with metabolic control in childhood-onset type 1 diabetes (T1D) after transfer to adult care were analyzed. METHODS Overall, 224 persons with T1D were contacted yearly from 1998 to 2019. They voluntarily answered a questionnaire about their current hemoglobin A1c (HbA1c) levels, diabetes-associated complications, kind of care, living conditions, and family situation. Then, mixed longitudinal-cross-sectional analyses were carried out. RESULTS Overall, 190 patients answered at least once (mean age: 26.6 years). Diabetes complications were mentioned by 10 patients (5 microalbuminuria, 5 retinopathy). Most patients (92.6%) were in diabetes-specific care during the first year after transfer, with a trend to leave diabetes-specific care during the observation period. Patients in diabetes-specific care displayed lower HbA1c levels (%/mmol/mol) (7.1/54 vs. 7.5/58). An important predictor for HbA1c after transfer was HbA1c during the year before transfer (r=0.67, p <0.001). Patients living alone showed no difference in HbA1c levels from those living with their parents. Married patients had lower HbA1c levels (7.0/53 vs. 7.3/56, p<0.05) than unmarried ones. Patients with children (15.8%) presented lower HbA1c levels (6.9/52 vs. 7.3/56, p <0.01) than those without. CONCLUSIONS Good metabolic results are favored in patients followed-up in specialized care, are married, and are parents. We recommend transfer to a diabetologist with experience in T1D at an individual age.
Collapse
Affiliation(s)
- Roland Schweizer
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | | | - Clara Hayn
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Silas Friz
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Julia Uber
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Julian Ziegler
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Franziska Liebrich
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| | - Andreas Neu
- Pediatric Diabetology, University Children's Hospital, Tübingen, Germany
| |
Collapse
|
5
|
Karahan S, Ağadayı E, Sarı SA, Çelik N, Kömürlüoğlu Tan A, Döğer E. Psychometric Properties of the Turkish Validity and Reliability of the Parent Diabetes Distress Scale. J Clin Res Pediatr Endocrinol 2023; 15:293-301. [PMID: 37559365 PMCID: PMC10448560 DOI: 10.4274/jcrpe.galenos.2023.2023-3-20] [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: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Objective The aim of this study was to evaluate the validity and reliability of the Turkish translation of the Parent Diabetes Distress Scale (PDDS). Methods The PDDS is a 5-point Likert-type scale with 20 items. After obtaining permission from the scale developers, the study commenced. First, a systematic adaptation of the scale into the Turkish language was performed including translation, expert panel review, back translation, and pilot study. Test-retest was applied to 35 participants. After these procedures, data collection was undertaken using the adapted PDDS and a demographic data collection form. The collected data were analyzed for reliability, including stability of the scale with test-retest and internal consistency of the scale (Cronbach’s α), and validity including construct validity of the scale with confirmatory factor analysis (CFA). Results The parents of 210 teenagers, aged >11 and <18 years, who had been diagnosed with type 1 diabetes mellitus for at least one year were included. Of these parents, 71.9% (n=151) were mothers and 53.3% (n=112) of the children were girls. The Cronbach’s α value was 0.906. The results of the CFA were χ2/df=4.406, p<0.001, comparative fit test 0.704, and goodness of fit tests 0.749. The mean total PDDS score was 2.2±0.7. These results indicate that scores of 1.6 points or less was evaluated as “little or no distress” 1.7-2.4 as “moderate distress,” and >2.4 points as “high distress”. This showed that the majority of the parents in the study experienced moderate or severe diabetes-related distress. Conclusion The Turkish version of the PDDS fulfilled the validity and reliability tests at an acceptable level.
Collapse
Affiliation(s)
- Seher Karahan
- Sivas Cumhuriyet University Faculty of Medicine, Department of Medical Education, Sivas, Turkey
| | - Ezgi Ağadayı
- Sivas Cumhuriyet University Faculty of Medicine, Department of Medical Education, Sivas, Turkey
| | - Seda Aybüke Sarı
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hatay, Turkey
| | - Nurullah Çelik
- Sivas Cumhuriyet University Faculty of Medicine, Department of Pediatric Endocrinology, Sivas, Turkey
| | - Ayça Kömürlüoğlu Tan
- Sivas Cumhuriyet University Faculty of Medicine, Department of Pediatrics, Sivas, Turkey
| | - Esra Döğer
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
| |
Collapse
|
6
|
Boggiss AL, Consedine NS, Hopkins S, Silvester C, Jefferies C, Hofman P, Serlachius AS. A Self-Compassion Chatbot to Improve the Wellbeing of Adolescents with Type 1 Diabetes During the COVID-19 Pandemic: What do Adolescents and their Healthcare Professionals Want? JMIR Diabetes 2023; 8:e40641. [PMID: 36939680 PMCID: PMC10166132 DOI: 10.2196/40641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/08/2022] [Accepted: 01/30/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Prior to the coronavirus (COVID-19) pandemic, adolescents with type 1 diabetes (T1D) already experienced far greater rates of psychological distress than their peers. With the pandemic further challenging mental health and increasing the barriers to maintaining optimal diabetes self-management, it is vital this population has access to remotely deliverable, evidence-based interventions to improve psychological and diabetes outcomes. Chatbots, defined as digital conversational agents, offer these unique advantages, as well as the ability to engage in empathetic and personalized conversations 24/7. Building on previous work developing a self-compassion program for adolescents with T1D, a self-compassion chatbot was developed for adolescents with T1D to address these concerns. However, the acceptability and potential clinical usability of a chatbot to deliver self-compassion coping tools to adolescents with T1D remained unknown. OBJECTIVE This qualitative study was designed to evaluate the acceptability and potential clinical utility of a novel self-compassion chatbot (called 'COMPASS') among adolescents aged 12 to 16 years with T1D and their diabetes healthcare professionals. METHODS Potential adolescent participants were recruited from previous participant lists, and online and in-clinic study flyers, whereas healthcare professionals were recruited from clinic emails and diabetes research special interest groups. Qualitative Zoom interviews exploring views on a newly developed self-compassion chatbot were conducted with 19 adolescents (in 4 focus groups), and 11 diabetes healthcare professionals (in 2 focus groups and 6 individual interviews), from March to April 2022. Transcripts were analyzed using directed content analysis to examine the features and content of greatest importance to both groups. RESULTS Adolescents were broadly representation of the youth population living with T1D in Aotearoa (58% female, 68% Aotearoa New Zealand European, 11% Māori). Healthcare professionals represented a range of disciplines including Diabetes Nurse Specialists (n = 3), Health Psychologists (n = 3), Dieticians (n = 3), and Endocrinologists (n = 2). Findings offer early insight into what adolescents with T1D and their healthcare professionals see as shared advantages of COMPASS and desired future additions, such as personalization (mentioned by all 19 adolescents), self-management support (mentioned by 13 of 19 adolescents), clinical utility (mentioned by all 11 healthcare professionals), and breadth and flexibility of tools (mentioned by 10 of 11 healthcare professionals). CONCLUSIONS Early data suggest that a self-compassion chatbot for adolescents with T1D is acceptable, relevant to common difficulties, and offers clinical utility during the COVID-19 pandemic. However, shared desired features amongst both groups, including problem-solving and integration with diabetes technology to support self-management, creating a safe peer-to-peer sense of community, and broadening the representation of different cultures, lived experience stories, and diabetes challenges, could further improve the potential of the chatbot. Based on these findings, the COMPASS chatbot is currently being improved to be tested in a future feasibility study. CLINICALTRIAL
Collapse
Affiliation(s)
- Anna Lynette Boggiss
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | - Nathan Sacha Consedine
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | - Sarah Hopkins
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| | | | - Craig Jefferies
- Starship Children's Health, Auckland City Hospital, Auckland, NZ
| | - Paul Hofman
- Liggins Institute, University of Auckland, Auckland, NZ
| | - Anna Sofia Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Level 3, Building 507, 22-30 Park Avenue, Grafton, Auckland, NZ
| |
Collapse
|
7
|
Perfect MM, Silva GE, Chin CN, Wheeler MD, Frye SS, Mullins V, Quan SF. Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemp Clin Trials 2023; 124:106929. [PMID: 36441106 DOI: 10.1016/j.cct.2022.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
Collapse
Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America.
| | - Graciela E Silva
- College of Nursing, University of Arizona, Tucson, AZ 85721, United States of America
| | - Cindy N Chin
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Mark D Wheeler
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Sara S Frye
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Vicky Mullins
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Stuart F Quan
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, United States of America; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
| |
Collapse
|
8
|
Bozbulut R, Küpçü Z, Döğer E, Çamurdan MO, Bideci A. The effects of parental monitoring on the quality of life and diet quality of adolescents with type 1 diabetes. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-022-01085-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
9
|
Jensen MV, Broadley M, Speight J, Chatwin H, Scope A, Cantrell A, Heller S, de Galan BE, Hendrieckx C, Pouwer F. The impact of hypoglycaemia in children and adolescents with type 1 diabetes on parental quality of life and related outcomes: A systematic review. Pediatr Diabetes 2022; 23:390-405. [PMID: 34981624 DOI: 10.1111/pedi.13308] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 12/15/2021] [Accepted: 12/22/2021] [Indexed: 11/28/2022] Open
Abstract
This systematic review aims to summarize and critically evaluate the current evidence regarding the impact of hypoglycaemia in children and adolescents with type 1 diabetes on parental quality of life. MEDLINE, PsycINFO, CINAHL, and the Cochrane Library were searched. Inclusion criteria were: 1) quantitative design, 2) included parents of children or adolescents with type 1 diabetes, 3) assessment of hypoglycemia in children/adolescents with type 1 diabetes, 4) assessment of parent quality of life (or related domains of life), and 5) analysis of the relationship(s) between the child's hypoglycaemia and parents' quality of life. The data were summarised in accordance with Synthesis Without Meta-Analysis Guidelines. Twelve studies were included, reporting data from 1895 parents across six countries. Ten studies were cross-sectional; two included prospective data. Evidence suggested that greater frequency and severity of hypoglycemia was associated with greater parental fear of hypoglycemia, emotional distress and family burden. Children's hypoglycaemia has a negative impact on the well-being of parents, but there is an absence of evidence regarding the impact on their overall quality of life. Research into the hypoglycaemia-specific quality of life of parents is needed to explore the impact on various areas, such as social and physical dimensions.
Collapse
Affiliation(s)
| | - Melanie Broadley
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Jane Speight
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,The Australian Centre for Behavioral Research in Diabetes, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - Hannah Chatwin
- Department of Psychology, University of Southern Denmark, Odense, Denmark
| | - Alison Scope
- School of Health and Related Research, University of Sheffield, UK
| | - Anna Cantrell
- School of Health and Related Research, University of Sheffield, UK
| | - Simon Heller
- Department of Oncology and Metabolism, University of Sheffield, UK
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands.,CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.,Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Christel Hendrieckx
- The Australian Centre for Behavioral Research in Diabetes, Melbourne, Victoria, Australia.,School of Psychology, Deakin University, Geelong, Australia
| | - Frans Pouwer
- Department of Psychology, University of Southern Denmark, Odense, Denmark.,School of Psychology, Deakin University, Geelong, Australia.,Steno Diabetes Center Odense, Odense, Denmark
| | | |
Collapse
|
10
|
O’Donnell NR, Satherley RM, John M, Cooke D, Hale LS, Stewart R, Jones CJ. Development and Theoretical Underpinnings of the PRIORITY Intervention: A Parenting Intervention to Prevent Disordered Eating in Children and Young People With Type 1 Diabetes. FRONTIERS IN CLINICAL DIABETES AND HEALTHCARE 2022; 3:822233. [PMID: 36992722 PMCID: PMC10012129 DOI: 10.3389/fcdhc.2022.822233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 01/21/2022] [Indexed: 11/13/2022]
Abstract
Children and young people (CYP) with type 1 diabetes (T1D) are twice as likely to develop disordered eating (T1DE) and clinical eating disorders than those without. This has significant implications for physical and mental health, with some eating disorders associated with repeated diabetic ketoacidosis and higher HbA1c levels, both of which are life threatening. There is currently limited psychological support for CYP and families with T1D but increasingly, policy and practice are suggesting disordered eating in T1D may be effectively prevented through psychological intervention. We describe the development and theoretical underpinnings of a preventative psychological intervention for parents of CYP aged 11-14, with T1D. The intervention was informed by psychological theory, notably the Information Motivation Behaviour Skills model and Behaviour Change Technique Taxonomy. The intervention was co-developed with an expert advisory group of clinicians, and families with T1D. The manualised intervention includes two online group workshops, and supplementary online materials. The intervention continues to evolve, and feasibility findings will inform how best to align the intervention with routine care in NHS diabetes teams. Early detection and intervention are crucial in preventing T1DE, and it is hoped that the current intervention can contribute to improving the psychological and physical wellbeing of young people and families managing T1D.
Collapse
Affiliation(s)
| | | | - Mary John
- School of Psychology, University of Surrey, Guildford, United Kingdom
- Research and Development Department, Sussex Education Centre, Sussex Partnership NHS Foundation Trust, Brighton & Hove, United Kingdom
| | - Debbie Cooke
- School of Health Sciences, University of Surrey, Guildford, United Kingdom
| | - Lucy S. Hale
- School of Psychology, University of Surrey, Guildford, United Kingdom
| | - Rose Stewart
- Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board, Wrexham, United Kingdom
| | - Christina J. Jones
- School of Psychology, University of Surrey, Guildford, United Kingdom
- *Correspondence: Christina J. Jones,
| |
Collapse
|
11
|
Shilbayeh S. Type 2 diabetes mellitus and its effect on quality of life in adolescents: A retrospective cohort study in Saudi Arabia. Pediatr Endocrinol Diabetes Metab 2022; 28:54-63. [PMID: 35307997 PMCID: PMC10226344 DOI: 10.5114/pedm.2022.113988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 10/24/2021] [Indexed: 06/07/2023]
Abstract
INTRODUCTION Quality of life (QoL) in adolescent patients suffering from type 2 diabetes mellitus (T2DM) has not been thoroughly explored in Saudi Arabia. Herein, we aimed to measure the health-related quality of life (HRQoL) in adolescent patients suffering from T2DM and explore the correlation between adolescents' self- and parent-reporting of QoL scores, and glycaemic control (HbA1c). MATERIAL AND METHODS A retrospective multi-centre cohort study was conducted at 4 hospitals in Riyadh, Saudi Arabia. The Paediatric Quality of Life Inventory (PedsQLTM) Diabetes Module 3.0 was completed by children and their parents in a confidential and anonyms manner through a phone interview. RESULTS We recruited 49 paediatric patients for this study (mean age: 18.45 years; male: 55%). Both children and parents reported low cumulative mean scores for PedsQL™ (58.65 and 57.38, respectively) as compared to previous international studies. The lowest obtained score was noted for the diabetes symptoms domain (53.4). Comparing the magnitude of discrepancy between the adolescents' and parents' subscale scores revealed a non-significant difference, except for the 'worry' subscale, in which parents reported significantly higher mean scores (76.73 vs. 60.54, p = 0.02). Comparison of mean scores reported by adolescents who met the target HbA1c goal (<7%) and their counterparts revealed a non-significant difference, suggesting an irrelevant impact of this parameter on their perspectives or experiences. CONCLUSIONS The study findings emphasized the need to initiate further intensive awareness programs concerning this disease and its clinical implications in T2DM children to improve treatment adherence and symptoms, and consequently improve the perception of the patient and the family for HRQoL.
Collapse
Affiliation(s)
- Sireen Shilbayeh
- Prof. Sireen Shilbayeh Pharmaceutical Practice Princess Nourah bint Abdulrahman University Riyadh, Saudi Arabia e-mail:
| |
Collapse
|
12
|
DeJonckheere M, Joiner KL, Ash GI, Savoye M, Adams M, Weinzimer SA, Sadler LS, Grey M. Youth and Parent Perspectives on the Acceptability of a Group Physical Activity and Coping Intervention for Adolescents With Type 1 Diabetes. Sci Diabetes Self Manag Care 2021; 47:367-381. [PMID: 34610760 DOI: 10.1177/26350106211040429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To examine youth and parent perspectives on the acceptability of Bright 1 Bodies, a group physical activity and coping intervention for adolescents with type 1 diabetes mellitus (T1DM). METHODS Adolescents participated in 12 weekly sessions of moderate to vigorous physical activity and discussion with peers with T1DM. Adolescents completed an exit survey measuring satisfaction with the intervention on a 5-point Likert scale. Semistructured interviews were conducted with adolescents and at least one parent. Qualitative description was used to develop themes that summarize the acceptability of the intervention. RESULTS Mean scores for survey subscales were: 4.5 (SD = 0.39) for program components and strategies, 4.4 (SD = 0.44) for comfort with the intervention, and 4.3 (SD = 0.62) for instructors. Themes included: (1) adolescents and parents valued being around others with T1DM and their families, (2) the intervention helped adolescents gain knowledge and reinforce diabetes self-management behaviors, (3) challenges included convenience and sustaining participant engagement, and (4) adolescents intended to sustain physical activity and diabetes self-management behaviors after the intervention. CONCLUSIONS Adolescents and parents viewed the intervention as acceptable across multiple domains. Participants valued the group aspect of the intervention, and future interventions would benefit from integrating social interactions with others with T1DM.
Collapse
Affiliation(s)
- Melissa DeJonckheere
- Department of Family Medicine, Medical School, University of Michigan, Ann Arbor, Michigan.,Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan
| | - Kevin L Joiner
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, Michigan.,School of Nursing, University of Michigan, Ann Arbor, Michigan
| | - Garrett I Ash
- Veterans Affairs Connecticut Healthcare System, Newington, Connecticut.,Center for Medical Informatics, Yale University, New Haven, Connecticut
| | - Mary Savoye
- Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Mackenzie Adams
- School of Nursing, University of Michigan, Ann Arbor, Michigan
| | | | - Lois S Sadler
- School of Nursing, Yale University, New Haven, Connecticut
| | - Margaret Grey
- School of Nursing, Yale University, New Haven, Connecticut
| |
Collapse
|
13
|
Kahkoska AR, Dabelea D. Diabetes in Youth: A Global Perspective. Endocrinol Metab Clin North Am 2021; 50:491-512. [PMID: 34399958 PMCID: PMC8374087 DOI: 10.1016/j.ecl.2021.05.007] [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: 01/09/2023]
Abstract
Diabetes is a common disease among pediatric populations in the United States and worldwide. The incidence of type 1 and type 2 diabetes is increasing, with disproportional increases in racial/ethnic subpopulations. As the prevalence of obesity continue to increase, type 2 diabetes now represents a major form of pediatric diabetes. The management of diabetes in youth centers on maintaining glycemic control to prevent acute and chronic complications. This article summarizes the epidemiology, etiology, management, and complications of type 1 and type 2 diabetes in youth, as well as future directions and opportunities.
Collapse
Affiliation(s)
- Anna R Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill, McGavran-Greenberg Hall 2205A, Chapel Hill, NC 27599, USA.
| | - Dana Dabelea
- Lifecourse Epidemiology of Adiposity and Diabetes (LEAD) Center, Colorado School of Public Health, University of Colorado School of Medicine, Anschutz Medical Campus, 13001 East 17th Avenue, Box B119, Room W3110, Aurora, CO 80045, USA
| |
Collapse
|
14
|
Perlberg M, Katz I, Loewenthal N, Kahil N, Haim A, Chechik T, Hershkovitz E. The role of autonomy-supportive parenting in the competence, adherence and glycemic control of adolescents with type 1 diabetes. Diabetes Res Clin Pract 2021; 173:108679. [PMID: 33516781 DOI: 10.1016/j.diabres.2021.108679] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 12/11/2020] [Accepted: 01/12/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE To examine the relationships between autonomy support provided to adolescents with Type 1 Diabetes by their parents, and adolescents' competence, adherence to treatment, and glycemic control indicators. METHOD Thirty-seven adolescents, along with one of their parents, completed a set of questionnaires on the level of autonomy support provided by their parents. Adolescents' self-treatment competence and their level of adherence to treatment were also measured. A recent blood test assessing the adolescents' 3-month average glycemic level (HbA1c) was retrieved from their medical records as a glycemic control indicator. RESULTS Structural Equation Modeling suggested that parental autonomy support as reported by parents and adolescents was associated with higher adolescent self-treatment competence and higher adherence to treatment. These in turn were associated with better glycemic control. CONCLUSION Parental autonomy support is crucial and may contribute to the competence, adherence, and physical wellbeing of adolescents with Type 1 Diabetes. Parents should be instructed on ways to better support autonomy but still be involved in their child's life.
Collapse
Affiliation(s)
- Maya Perlberg
- Department of Education, Ben-Gurion University of the Negev, Israel
| | - Idit Katz
- Department of Education, Ben-Gurion University of the Negev, Israel.
| | - Netta Loewenthal
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Nurit Kahil
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Alon Haim
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Tzilla Chechik
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| | - Eli Hershkovitz
- Pediatric Endocrinology and Metabolism Unit, Soroka Medical Center, Ben-Gurion University of the Negev, Israel
| |
Collapse
|
15
|
Lv W, Luo J, Long Q, Yang J, Wang X, Guo J. Factors Associated with Adherence to Self-Monitoring of Blood Glucose Among Young People with Type 1 Diabetes in China: A Cross-Sectional Study. Patient Prefer Adherence 2021; 15:2809-2819. [PMID: 34938070 PMCID: PMC8686228 DOI: 10.2147/ppa.s340971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/03/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Self-monitoring of blood glucose (SMBG) plays a crucial role in the maintenance of glycemic control in young people with type 1 diabetes mellitus (T1DM), but most of them do not perform SMBG as recommended. Few studies comprehensively explored factors that correlate with adherence to SMBG among this population on the basis of a framework. Hence, the aims of this study were to describe adherence to SMBG among young people with T1DM in China and explore its associating factors according to the Self and Family Management (SFM) framework. METHODS A cross-sectional study was conducted on young people with T1DM in Hunan Province of China from July to August 2020. Based on the SFM framework, self-reported questionnaires were organized for the collection of data on adherence to SMBG, socio-demographic and clinical factors, resources, health care system, and personal factors. Factors associated with adherence to SMBG were determined through multivariate logistic regression analysis. RESULTS A total of 165 young people were invited, of which 122 (73.9%) completed the questionnaires. The mean age was 12.41 years (SD = 3.18), and the proportion of young people who adhered to SMBG was 53.3%. Multivariate logistic regression analysis revealed that children aged 8-12 years (OR = 0.188, P = 0.002), from two-parent families (OR = 0.232, P = 0.019), and with better personal factors (eg, with more information of SMBG, OR = 1.072, P = 0.020; lower diabetes-related worry, OR = 0.917, P = 0.031; higher level of pain during SMBG, OR = 1.852, P = 0.001), had better adherence to SMBG. CONCLUSION Nearly half of the young people with T1DM were not adherent to SMBG in China. Clinicians need to pay more attention to adolescents from single-parent families with regard to their adherence to SMBG. Providing management strategies of SMBG, including delivering SMBG-related information, decreasing diabetes-related worry, and relieving pain related to SMBG, may improve adherence.
Collapse
Affiliation(s)
- Wencong Lv
- Clinical Nursing Department, Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jiaxin Luo
- Clinical Nursing Department, Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Qing Long
- Clinical Nursing Department, Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jundi Yang
- Nursing Department, School of Nursing, The University of Hong Kong, Hong Kong, People’s Republic of China
| | - Xin Wang
- Clinical Nursing Department, Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
| | - Jia Guo
- Clinical Nursing Department, Xiangya School of Nursing, Central South University, Changsha, Hunan, People’s Republic of China
- Correspondence: Jia Guo Clinical Nursing Department, Xiangya School of Nursing, Central South University, 172 Tongzipo Road, Changsha, Hunan, 410013, People’s Republic of ChinaTel +86 13875947418 Email
| |
Collapse
|
16
|
Sarteau AC, Crandell J, Seid M, Kichler JC, Maahs DM, Wang J, Mayer-Davis E. Characterization of youth goal setting in the self-management of type 1 diabetes and associations with HbA1c: The Flexible Lifestyle Empowering Change trial. Pediatr Diabetes 2020; 21:1343-1352. [PMID: 32741045 PMCID: PMC7855488 DOI: 10.1111/pedi.13099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 06/05/2020] [Accepted: 07/28/2020] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Youth with type 1 diabetes (T1D) commonly do not meet HbA1c targets. Youth-directed goal setting as a strategy to improve HbA1c has not been well characterized and associations between specific goal focus areas and glycemic control remain unexplored. OBJECTIVE To inform future trials, this analysis characterized intended focus areas of youth self-directed goals and examined associations with change in HbA1c over a 18 months. METHODS We inductively coded counseling session data from youth in the Flexible Lifestyle Empowering Change Intervention (n = 122, 13-16 years, T1D duration >1 year, HbA1c 8-13%) to categorize intended goal focus areas and examine associations between frequency of goal focus areas selected by youth and change in HbA1c between first and last study visit. RESULTS We identified 13 focus areas that categorized youth goal intentions. Each session where youth goal setting concurrently incorporated blood glucose monitoring (BGM), continuous glucose monitoring (CGM), and insulin dosing was associated with a 0.4% (95% CI: -0.77, -0.01; P = .03) lower HbA1c at the end of intervention participation. No association was observed between HbA1c and frequency of sessions where goal intentions focused on BG only (without addressing insulin or CGM) (β: 0.07; 95% CI: -0.07, 0.21; P = .33) nor insulin dosing only (without addressing BGM or CGM) (β: 0.00; 95% CI: -0.11, 0.10; P = .95). CONCLUSIONS Findings exemplify how guiding youth goal development and combining multiple behaviors proximally related to glycemic control into goal setting may benefit HbA1c among youth with T1D. More research characterizing optimal goal setting practices in youth with T1D is needed.
Collapse
Affiliation(s)
| | - Jamie Crandell
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina,Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
| | - Michael Seid
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - Jessica C Kichler
- Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, University of Cincinnati Medical School, Cincinnati, Ohio
| | - David M Maahs
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California,Stanford Diabetes Research Center and Health Research and Policy (Epidemiology), Stanford, California
| | - Jessica Wang
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Elizabeth Mayer-Davis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina,School of Medicine, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
17
|
Almeida AC, Leandro ME, Pereira MG. Individual and Family Management in Portuguese Adolescents with Type 1 Diabetes: a Path Analysis. Int J Behav Med 2020; 27:455-465. [PMID: 32430785 DOI: 10.1007/s12529-020-09884-7] [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: 10/24/2022]
Abstract
BACKGROUND This study evaluates the adequacy of the Revised Self and Family Management Framework (Grey et al., Nurs Outlook 63:162-170, 2015) in Portuguese adolescents with type 1 diabetes and analyzes the effect of parental coping, family support, and adherence in the association between illness representations, school support, metabolic control, quality of life, and family functioning. METHOD One hundred adolescents (aged 12-19) and their parents participated in a cross-sectional study. Adolescents were assessed on school support, adherence to self-care, family support, and quality of life. Parents were assessed on parental coping and family functioning. Both adolescents and parents were assessed on illness representations. Adolescent's metabolic control was evaluated through glycosylate hemoglobin. RESULTS Adolescents' and parents' illness representations were associated with metabolic control, quality of life and family functioning. Parental coping, family support and adherence had an indirect effect between illness representations and diabetes outcomes. CONCLUSION Findings showed the adequacy of Grey and colleagues' model (Nurs Outlook 63:162-170, 2015) in adolescents with type 1 diabetes and how family support, parental coping, and adherence contribute to diabetes management. Interventions to improve adolescents' and family's management of Type 1 diabetes should be designed to change adolescents' and family's representations and enhance their ability and skills in diabetes management.
Collapse
Affiliation(s)
- Ana Cristina Almeida
- Institute of Social Sciences, University of Minho - Campus de Gualtar, 4710-057, Braga, Portugal.
| | - M Engrácia Leandro
- Centre for Research and Studies in Sociology/ISCTE, University Institute of Lisbon, Campus da Cidade Universitária de Lisboa, 1649-026, Lisbon, Portugal
| | - M Graça Pereira
- School of Psychology, University of Minho - Campus de Gualtar, 4710-057, Braga, Portugal
| |
Collapse
|
18
|
Rohan JM, Verma T. Psychological Considerations in Pediatric Chronic Illness: Case Examples. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17051644. [PMID: 32138373 PMCID: PMC7084293 DOI: 10.3390/ijerph17051644] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 02/26/2020] [Accepted: 02/27/2020] [Indexed: 01/01/2023]
Abstract
Despite significant gains in survival rates for pediatric patients and adolescents/young adults (AYA) with chronic illness, patients in this vulnerable age group are also at an increased risk for developing one or more adverse effects related to their disease, treatment, or maladaptive health behaviors. Maladaptive health behaviors ultimately increase the risk for developing adverse effects, including: increased rates of morbidity and mortality, impaired physical functioning, increased fatigue, obesity, increased psychological distress, and poor quality of life. With close attention including participation in preventive and therapeutic health promotion interventions, problematic health behaviors can be mitigated and ultimately prevented over time. It is well known that improved psychological functioning and adaptive coping can result in improved health status. The present paper provides four case examples illustrating various psychological interventions in pediatric chronic illness. As evidenced in the four case examples, pediatric psychologists provide comprehensive interventions for patients with acute and chronic medical conditions through the use of health promotion interventions, adherence and self-management promotion, cognitive behavioral therapy, behavioral therapy, medical coping, parent training, and motivational interviewing. Our case series demonstrates that for the most impactful behavior change to occur, a combination of interventions is often the most effective.
Collapse
Affiliation(s)
- Jennifer M. Rohan
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA;
- Cancer Prevention and Control Program, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23219, USA
- Virginia Commonwealth University School of Medicine, Richmond, VA 23219, USA
- Correspondence:
| | - Tanvi Verma
- Children’s Hospital of Richmond at Virginia Commonwealth University, Richmond, VA 23219, USA;
| |
Collapse
|
19
|
Boggiss AL, Consedine NS, Jefferies C, Bluth K, Hofman PL, Serlachius AS. Protocol for a feasibility study: a brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating. BMJ Open 2020; 10:e034452. [PMID: 32041861 PMCID: PMC7044828 DOI: 10.1136/bmjopen-2019-034452] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Adolescents with type 1 diabetes are at a higher risk of developing psychiatric disorders, particularly eating disorders, compared with their healthy peers. In turn, this increases the risk for sub-optimal glycaemic control and life-threatening diabetes-related complications. Despite these increased risks, standard diabetes care does not routinely provide psychological support to help prevent or reduce mental health risks. There is an urgent need to develop 'clinically usable' psychosocial interventions that are acceptable to patients and can be realistically integrated into clinical care. This study aims to examine the feasibility and acceptability of a brief self-compassion intervention for adolescents with type 1 diabetes and disordered eating behaviour. METHODS AND ANALYSIS This feasibility study will examine the effectiveness of a brief self-compassion intervention, compared with a waitlist control group. Participants aged 12-16 years will be recruited from three diabetes outpatient clinics in Auckland, New Zealand. The brief self-compassion intervention is adapted from the standardised 'Making Friends with Yourself' intervention and will be delivered in a group format over two sessions. Apart from examining feasibility and acceptability through the flow of participants through the study and qualitative questions, we will assess changes to disordered eating behaviour (primary outcome), self-care behaviours, diabetes-related distress, self-compassion, stress and glycaemic control (secondary outcomes). Such data will be used to calculate the required sample size for a fully powered randomised controlled trial. ETHICS AND DISSEMINATION This trial has received ethics approval from the Health and Disability Ethics Committee (research project number A+8467). Study results will be disseminated through peer-reviewed journals and conferences. TRIAL REGISTRATION NUMBER ANZCTR (12619000541101).
Collapse
Affiliation(s)
- Anna L Boggiss
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Nathan S Consedine
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| | - Craig Jefferies
- Starship Children's Health, Auckland City Hospital, Auckland, New Zealand
| | - Karen Bluth
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paul L Hofman
- The Liggins Institute, The University of Auckland, Auckland, New Zealand
| | - Anna S Serlachius
- Department of Psychological Medicine, The University of Auckland Faculty of Medical and Health Sciences, Auckland, New Zealand
| |
Collapse
|
20
|
Indelicato L, Calvo V, Dauriz M, Negri A, Negri C, Trombetta M, Bonora E. Depressive symptoms and glycaemic control in adults with type 1 diabetes: an exploratory study on the role of family functioning. Acta Diabetol 2020; 57:23-30. [PMID: 31119455 DOI: 10.1007/s00592-019-01356-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/02/2019] [Indexed: 10/26/2022]
Abstract
AIMS Psychological distress and family functioning have a considerable impact on diabetes self-management and glycaemic control in individuals with type 1 diabetes (T1D). However, the influence of both individual and family factors on glycaemic control has not been adequately investigated yet. This study aimed at examining the relationship between perceived family functioning and depressive symptoms with the frequency of capillary self-monitoring of blood glucose (SMBG) and glycaemic control (HbA1c) in a large sample of adults with T1D. METHODS In a cross-sectional study design, we consecutively enrolled 90 adults with T1D diagnosis from at least 1 year and currently living in their family of origin or conjugal family from at least 1 year before the enrolment. Questionnaires were administered to assess family functioning and depressive symptoms. The SMBG frequency over the past 3 months and the most recent HbA1c measurement were also collected in each individual. Correlation and mediation analyses were carried out. RESULTS Glycaemic control showed a positive relationship with depressive symptoms and family balanced cohesion, while SMBG frequency was correlated with family balanced flexibility and rigidity, but not with depressive symptoms. Mediation analyses showed that family rigidity mediates the effect of depressive symptoms on glycaemic control. CONCLUSIONS This exploratory study highlighted the significance of a cohesive family context to facilitate the achievement of individual glycaemic goals in individuals with T1D. These observations, if confirmed in larger data sets, would timely call for a comprehensive family care assessment as part of the evaluations routinely carried out in the ambulatory care of these individuals.
Collapse
Affiliation(s)
- Liliana Indelicato
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy.
| | - Vincenzo Calvo
- Department of Philosophy, Sociology, Pedagogy and Applied Psychology, University of Padova, Padua, Italy
| | - Marco Dauriz
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Arianna Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Carlo Negri
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Maddalena Trombetta
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| | - Enzo Bonora
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Verona and Hospital Trust of Verona, Piazzale Stefani, 1, 37126, Verona, Italy
| |
Collapse
|
21
|
Vaid E, Lansing AH, Stanger C. Problems With Self-Regulation, Family Conflict, and Glycemic Control in Adolescents Experiencing Challenges With Managing Type 1 Diabetes. J Pediatr Psychol 2019; 43:525-533. [PMID: 29077875 DOI: 10.1093/jpepsy/jsx134] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 10/13/2017] [Indexed: 01/12/2023] Open
Abstract
Objective This study explored the associations between problems with self-regulation and glycemic control (HbA1c) in teens experiencing challenges with managing type 1 diabetes by examining greater diabetes-related family conflict and poorer adherence as serial mediators of the link between greater problems with self-regulation and higher HbA1c. Methods Teens experiencing challenges with managing type 1 diabetes (n = 93, HbA1c ≥8%, 96% White, 57% male) completed an HbA1c test, and their parents completed assessments including measures of adherence and family conflict related to diabetes management during an intake for a larger Web-based intervention study or fMRI study. Teen problems with self-regulation were indexed the Child Behavior Checklist using the dysregulation profile. Results Bivariate correlations found significant associations between greater problems with self-regulation, greater family conflict about diabetes management, poorer adherence, and higher HbA1c. However, only greater family conflict, and not adherence, significantly explained the association between greater self-regulation problems and higher HbA1c. Conclusions These findings suggest that among teens experiencing challenges with managing type 1 diabetes, interventions that decrease family conflict may be critical to promoting optimal glycemic control in those teens with greater problems with self-regulation.
Collapse
Affiliation(s)
- Esha Vaid
- Center for Technology and Behavioral Health at Dartmouth.,Dartmouth Geisel School of Medicine
| | - Amy Hughes Lansing
- Center for Technology and Behavioral Health at Dartmouth.,Dartmouth Geisel School of Medicine
| | - Catherine Stanger
- Center for Technology and Behavioral Health at Dartmouth.,Dartmouth Geisel School of Medicine
| |
Collapse
|
22
|
Capistrant BD, Friedemann-Sánchez G, Pendsey S. Diabetes stigma, parent depressive symptoms and Type-1 diabetes glycemic control in India. SOCIAL WORK IN HEALTH CARE 2019; 58:919-935. [PMID: 31675285 DOI: 10.1080/00981389.2019.1679321] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 09/19/2019] [Accepted: 10/08/2019] [Indexed: 05/27/2023]
Abstract
Diabetes distress and stigma have been associated with worse patient outcomes in developed countries. However, diabetes stigma has not been studied in low and middle-income countries where clinical practices differ, diabetes awareness is lower, and families face different challenges for supporting children with Type 1 Diabetes (T1D). This study assessed the relationship between parental depression and diabetes stigma with a child's glycemic control in a clinic-based survey in Nagpur, India. The association between self-reported T1D stigma, depressive symptoms, and child's measured glycemic control (HbA1C) was assessed with data from 165 of the parents of school-aged (aged 5+) children receiving clinical T1D care at an urban nonprofit organization that provides free clinical care to children with Type-1 Diabetes (T1D) in India. Parents with moderate/severe depressive symptoms who experience stigma associated with their child's diabetes had children with significantly worse glycemic control than parents with no/mild depressive symptoms who experience the same amount of stigma. Higher reports of stigma were associated with an average of 0.65 points higher HbA1C (β = 0.65, 95% Confidence Interval (CI): 0.18, 1.13) for parents with moderate/severe than parents with mild/no depressive symptoms. Indian parents with depressive symptoms who face social stigma associated with their child's diabetes have children with worse T1D outcomes.
Collapse
Affiliation(s)
| | | | - Sharad Pendsey
- Diabetes Research, Education And Management (DREAM) Trust, Nagpur, India
| |
Collapse
|
23
|
Addala A, Igudesman D, Kahkoska AR, Muntis FR, Souris KJ, Whitaker KJ, Pratley RE, Mayer-Davis E. The interplay of type 1 diabetes and weight management: A qualitative study exploring thematic progression from adolescence to young adulthood. Pediatr Diabetes 2019; 20:974-985. [PMID: 31392807 PMCID: PMC7196280 DOI: 10.1111/pedi.12903] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The impact of weight management in persons with type 1 diabetes (T1D) from childhood into adulthood has not been well described. The purpose of the study was to explore qualitative themes presented by young adults with T1D with respect to the dual management of weight and T1D. METHODS We analyzed focus group data from 17 young adults with T1D (65% female, age 21.7 ± 2.1 years, HbA1c 8.1% ± 1.5) via inductive qualitative analysis methods. Major themes were compared to themes presented by youth with T1D ages 13-16 years in previously published study in order to categorize thematic progression from early adolescence through adulthood. RESULTS Themes from young adults with T1D, when compared to those from youth were categorized as: (a) persistent and unchanged themes, (b) evolving themes, and (c) newly reported themes. Hypoglycemia and a sense of futility around exercise was an unchanged theme. Importance of insulin usage and a healthy relationship with T1D evolved to gather greater conviction. Newly reported themes are unique to integration of adulthood into T1D, such as family planning and managing T1D with work obligations. Young adults also reported negative experiences with providers in their younger years and desire for more supportive provider relationships. CONCLUSIONS Issues identified by youth regarding the dual management of T1D and weight rarely resolve, but rather, persist or evolve to integrate other aspects of young adulthood. Individualized and age-appropriate clinical support and practice guidelines are warranted to facilitate the dual management of weight and T1D in persons with T1D.
Collapse
Affiliation(s)
- Ananta Addala
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Franklin R. Muntis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Katherine J. Souris
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Keri J. Whitaker
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | - Richard E. Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | | |
Collapse
|
24
|
Campbell MS, Wang J, Cheng Y, Cogen FR, Streisand R, Monaghan M. Diabetes-specific family conflict and responsibility among emerging adults with type 1 diabetes. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2019; 33:788-796. [PMID: 31021129 PMCID: PMC6776682 DOI: 10.1037/fam0000537] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Emerging adulthood is a transitional period for type 1 diabetes management, and aspects of family functioning such as family conflict and responsibility for diabetes management likely change following high school graduation. This study examined changes in diabetes-specific family conflict, family responsibility for diabetes management tasks, and associations with glycemic control up to 1 year after high school. Seventy-nine emerging adults with type 1 diabetes (M age = 18.09 ± .43 years; 51% female; 71% Caucasian) and their parents (73% female) completed self-report measures on diabetes-specific family conflict and family responsibility at 3 consecutive clinic visits, beginning in the spring of their senior year of high school. Hemoglobin A1c (HbA1c) was obtained from medical records. Diabetes-specific family conflict was relatively low; scores did not significantly change from baseline to Time 3. Parent responsibility for diabetes care decreased from baseline to Time 3. Higher parent- and emerging adult-reported family conflict and higher parent responsibility for diabetes care were associated with worse glycemic control (ps < .05). Parent-reported family conflict and the interaction between parent-reported family conflict and responsibility predicted HbA1c 1 year after high school. Conversely, HbA1c did not predict diabetes-specific family conflict or responsibility 1 year after high school. Findings indicate that diabetes-specific family conflict is associated with glycemic control after high school, even when emerging adults assume greater responsibility for diabetes self-care. Diabetes-specific family conflict levels were generally low and did not change over time despite this transitional period. If diabetes-specific conflict is present, it should be an important avenue for potential intervention for emerging adults with type 1 diabetes. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Jichuan Wang
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | - Yao Cheng
- Children’s National Health System, Washington, DC
| | - Fran R. Cogen
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | - Randi Streisand
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | - Maureen Monaghan
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
| |
Collapse
|
25
|
Almeida AC, Leandro ME, Pereira MG. Adherence and Glycemic Control in Adolescents with Type 1 Diabetes: The Moderating Role of Age, Gender, and Family Support. J Clin Psychol Med Settings 2019; 27:247-255. [DOI: 10.1007/s10880-019-09662-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
26
|
Afifi T, Granger D, Ersig A, Tsalikian E, Shahnazi A, Davis S, Harrison K, Acevedo Callejas M, Scranton A. Testing the Theory of Resilience and Relational Load (TRRL) in Families with Type I Diabetes. HEALTH COMMUNICATION 2019; 34:1107-1119. [PMID: 29667488 DOI: 10.1080/10410236.2018.1461585] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The theory of resilience and relational load was tested with 60 couples and their adolescent children (ages 11-18) with type I diabetes (T1D). The couples participated in a stress-inducing conversation task in their home, followed by a random assignment to a two-week intervention designed to increase their relationship maintenance. Before the intervention, stronger communal orientation predicted greater maintenance for husbands and wives, but maintenance only reduced T1D stress for wives. The wives' and adolescents' T1D stress were also correlated, but the husbands' T1D stress was not significantly associated with either of them. Better maintenance was associated with less conflict during couples' conversations. Maintenance was also directly associated with less perceived and physiological stress (cortisol) from the conversation. Finally, wives in the intervention reported the most thriving, communal orientation and the least loneliness. The intervention also reduced adolescents' general life stress, but it did not influence their T1D stress or thriving.
Collapse
Affiliation(s)
- Tamara Afifi
- a Department of Communication, University of California Santa Barbara , Santa Barbara , CA , USA
| | - Douglas Granger
- b Department of Psychology and Social Behavior, Pediatrics, and Program in Public Health, University of California , Irvine , CA , USA
| | - Anne Ersig
- c University of Wisconsin-Madison School of Nursing , Madison , WI , USA
- d American Family Children's Hospital in Wisconsin-Madison , Madison , WI , USA
| | - Eva Tsalikian
- e University of Iowa Hospitals , Iowa City , IA , USA
| | - Ariana Shahnazi
- f Department of Communication Studies, University of Iowa , Iowa City , IA , USA
| | - Sharde Davis
- g Department of Communication, University of Connecticut , Storrs , CT , USA
| | - Kathryn Harrison
- a Department of Communication, University of California Santa Barbara , Santa Barbara , CA , USA
| | | | - Audrey Scranton
- f Department of Communication Studies, University of Iowa , Iowa City , IA , USA
| |
Collapse
|
27
|
Baharvand P, Hormozi M. Can parents' educational level and occupation affect perceived parental support and metabolic control in adolescents with type 1 diabetes? JOURNAL OF EDUCATION AND HEALTH PROMOTION 2019; 8:11. [PMID: 30815482 PMCID: PMC6378813 DOI: 10.4103/jehp.jehp_215_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Accepted: 09/08/2018] [Indexed: 06/07/2023]
Abstract
BACKGROUND/AIM Parents have an important role to play in supporting adolescents with type 1 diabetes mellitus (T1DM). Their education and occupation are important factors for the management of this disease. This study aimed to investigate the parental support that Iranian adolescents with T1DM experience and to examine the effect of parents' education and occupation on adolescents' perceived the parental support and metabolic control. METHODS This is a cross-sectional survey. The participants were 98 adolescents (aged 11-18 years) with T1DM referred to Endocrinology Clinics of Shahid Rahimi and Shahid Madani hospitals in Khorramabad, Iran, in 2016. For evaluating the adolescents' perceptions of parental support, the family version of Diabetes Social Support Questionnaire was employed. It measures in five diabetic care areas (insulin administration, blood testing, meal planning, exercise, and emotional support). Data were analyzed in SPSS version 22 software using descriptive statistics and inferential tests including Pearson correlation test, ANOVA, and independent t-test. RESULTS The parents' educational level had a significant relationship with adolescents' perceived parental support and hemoglobin A1c (HbA1c) level (P < 0.05). Occupation of father had no significant influence on his supportive behavior and HbA1c level in adolescents, but mother's occupation significantly influenced them (P < 0.05). In adolescents with higher perceived parental support, the mean HbA1c was lower. CONCLUSIONS Parents with higher educational level can improve the metabolic control and provide better meal planning in adolescents with T1DM.
Collapse
Affiliation(s)
- Parastoo Baharvand
- Department of Social Medicine, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Maryam Hormozi
- Department of Biochemistry, School of Medicine, Lorestan University of Medical Sciences, Khorramabad, Iran
| |
Collapse
|
28
|
Davis V, Telang SB, Jain S, Davis Ramos MV, Ward MA, Jindal I, Aschkenasy JR, Glover CM, Shah RC. Parental Perception of the Factors that Affect Diabetes Management in Youth. Clin Diabetes 2019; 37:50-56. [PMID: 30705497 PMCID: PMC6336120 DOI: 10.2337/cd17-0126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
IN BRIEF Diabetes management is challenging for youth. We developed a theoretical framework for the facilitators and barriers to diabetes management in youth from the perspective of parents.
Collapse
|
29
|
Matos-Melo AL, Cumba-Avilés E. Family Environment Scale Parental Ratings of Conflict among Latino Families of Depressed Adolescents with Type 1 Diabetes. PUERTO RICO HEALTH SCIENCES JOURNAL 2018; 37:200-207. [PMID: 30548055 PMCID: PMC6450648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE Family conflict is related to depression, difficulties with treatment adherence and glycemic control, in adolescents with type 1 diabetes (T1D). We examined the psychometric properties of a parent-rated family conflict measure and the most frequent behaviors endorsed by caregivers of these youths. METHODS Participants were 51 caregivers (86.27% women) of adolescents (aged 12-17) with T1D, recruited during a psychotherapy study for youth depression. Both (caregivers and youths) completed questionnaires during the eligibility evaluation. Caregivers completed the Conflict subscale of the Family Environment Scale, considering to what extent its items described their whole family or its majority. RESULTS The most frequent indicators of conflict where becoming upset, displaying anger openly, believing that something can be achieved by speaking loudly, and criticizing and fighting, although not physically. Internal consistency for the subscale when rating conflict indicators in a dichotomous format was .69 and .76 when rated in an ordinal format. Conflict scores correlated moderately and significantly (p less than or equal .05) with other measures completed by youths and caregivers. Caregivers of youths with the worst glycemic control reported the highest levels of conflict. The subscale also showed a satisfactory sensitivity to change by reflecting a significant reduction in caregivers' reports of family conflict after adolescent group treatment. CONCLUSION Our results confirm the frequent occurrence of conflict (especially verbal conflict) in these families and document the psychometric properties of a measure for its assessment, which may be useful in studies that examine the impact of family conflict in both youth depression and diabetes.
Collapse
Affiliation(s)
- Anthony L Matos-Melo
- Institute for Psychological Research, University of Puerto Rico Río Piedras Campus, San Juan, PR
| | - Eduardo Cumba-Avilés
- Institute for Psychological Research, University of Puerto Rico Río Piedras Campus, San Juan, PR
| |
Collapse
|
30
|
Kristensen LJ, Birkebaek NH, Mose AH, Berg Jensen M, Thastum M. Multi-informant path models of the influence of psychosocial and treatment-related variables on adherence and metabolic control in adolescents with type 1 diabetes mellitus. PLoS One 2018; 13:e0204176. [PMID: 30235290 PMCID: PMC6147740 DOI: 10.1371/journal.pone.0204176] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background We assessed the associations between metabolic control and adherence and a broad range of adolescent and family characteristics (e.g., gender, family structure), treatment-related variables (e.g., disease duration, treatment modality), and psychosocial factors (e.g., symptoms of depression and anxiety, parental support, self-efficacy) in a nationwide study of Danish adolescents (age 12–17 years) with type 1 diabetes mellitus (T1DM). Methods Sixty-four percent of invited families participated by completing a survey and providing a blood sample. Two path models of associations between generic and diabetes-related family factors, adolescent self-efficacy, emotional difficulties, and metabolic control and adherence were tested, one for adolescents and one for caregivers. Demographic variables were included as covariates. Results Both path models demonstrated a satisfying model fit. In both models, metabolic control was associated with adherence, age, and T1DM duration. In the adolescent model, metabolic control was also related to treatment modality, single-parent household, caregiver non-support, and anxiety, whereas in the caregiver model metabolic control was associated with family conflict and caregiver support. In both models, adherence was related to age, duration, treatment modality, family conflict, caregiver support, family functioning, and emotional difficulties of the adolescent. In the adolescent model, adherence was also related to adolescent self-efficacy, whereas in the caregiver model adherence was associated with adolescent gender and caregiver non-support and support. Adolescent self-efficacy, emotional well-being, and difficulties related to adolescent/caregiver interaction appeared to be particularly important, as indicated by their stronger association with adherence and/or metabolic control. Conclusion The results highlight the value of applying a multi-informant approach to address the psychosocial well-being of adolescents with diabetes in a large national sample. Self-efficacy, emotional, and family-related difficulties are important aspects to address in both clinical care and future research regarding adolescents with T1DM.
Collapse
Affiliation(s)
- Lene Juel Kristensen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | | | - Morten Berg Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| |
Collapse
|
31
|
Kick K, Assfalg R, Aydin S, Bechtold-Dalla Pozza S, Böcker D, Braig S, Bunk M, Dunstheimer D, Durmashkina A, Ermer U, Gavazzeni A, Gerstl EM, Heinrich M, Herbst M, Kriesen Y, Kuhnle-Krahl U, Müller H, Nellen-Hellmuth N, Ockert C, Ramminger C, Sindichakis M, Tretter S, Warncke K, Achenbach P, Ziegler AG, Hoffmann VS. Recruiting young pre-symptomatic children for a clinical trial in type 1 diabetes: Insights from the Fr1da insulin intervention study. Contemp Clin Trials Commun 2018; 11:170-173. [PMID: 30197933 PMCID: PMC6126533 DOI: 10.1016/j.conctc.2018.08.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 08/01/2018] [Accepted: 08/13/2018] [Indexed: 11/15/2022] Open
Abstract
Background Although detection of children at high risk of developing type 1 diabetes and diagnosis of early stages is possible, up to now there exists no approved therapy to delay or prevent type 1 diabetes. Thus it is vital to develop evidence-based interventions. For this a sufficient number of trial participants is crucial but difficult to obtain especially in asymptomatic children. Aim Identifying family characteristics that lead to or impede trial participation and analyze reasons stated by families for non-participation. Methods Participants for the Fr1da Insulin Intervention study are recruited from the Fr1da study, a population based screening for early stage type 1 diabetes in Bavaria. Families with eligible children were invited to enroll. We analyzed sex and age of the child, distance of the family to the study center in Munich and the existence of a first degree family member with type 1 as possible influential factors for study participation. We also analyzed reasons stated by families who declined study participation in a phone interview. Results Of 146 eligible children 77 (53%) were enrolled into the trial. None of the tested family characteristics differed significantly between the enrolling and the families not participating, but in general enrolling families lived closer to the study site than families not participating. This is also reflected in the reasons given by non-participating families. The most frequent reason stated were time restrictions. The second most frequent reason was the venous blood draw. Conclusion The factors for non-participation identified in this project need be taken into account for the design of future trials in young children to ensure proper recruitment and thus to generate valid results for medical treatment of children. More research on the reason of participation and non-participation in clinical trials is needed.
Collapse
Affiliation(s)
- Kerstin Kick
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Robin Assfalg
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Susanne Aydin
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | | | | | | | - Melanie Bunk
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | - Alevtina Durmashkina
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Uwe Ermer
- Kliniken St. Elisabeth, Neuburg/Donau, Germany
| | | | | | - Melanie Heinrich
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
| | - Melanie Herbst
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Yvonne Kriesen
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | | | | | | | - Claudia Ramminger
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | | | | | - Katharina Warncke
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Department of Pediatrics, Klinikum rechts der Isar, Technical University Munich, Munich, Germany
| | - Peter Achenbach
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
| | - Anette-G. Ziegler
- Forschergruppe Diabetes, Technical University Munich, at Klinikum rechts der Isar, Munich, Germany
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Forschergruppe Diabetes e.V. at Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Corresponding author. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg , Germany.
| | - Verena S. Hoffmann
- Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Munich-Neuherberg, Germany
- Corresponding author. Institute of Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstraße 1, 85764 Neuherberg , Germany.
| |
Collapse
|
32
|
Kahkoska AR, Shay CM, Crandell J, Dabelea D, Imperatore G, Lawrence JM, Liese AD, Pihoker C, Reboussin BA, Agarwal S, Tooze JA, Wagenknecht LE, Zhong VW, Mayer-Davis EJ. Association of Race and Ethnicity With Glycemic Control and Hemoglobin A 1c Levels in Youth With Type 1 Diabetes. JAMA Netw Open 2018; 1:e181851. [PMID: 30370425 PMCID: PMC6203341 DOI: 10.1001/jamanetworkopen.2018.1851] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/19/2018] [Indexed: 12/18/2022] Open
Abstract
IMPORTANCE Health disparities in the clinical presentation and outcomes among youth with type 1 diabetes exist. Long-term glycemic control patterns in racially/ethnically diverse youth are not well described. OBJECTIVES To model common trajectories of hemoglobin A1c (HbA1c) among youth with type 1 diabetes and test how trajectory group membership varies by race/ethnicity. DESIGN SETTING AND PARTICIPANTS Longitudinal cohort study conducted in 5 US locations. The analysis included data from 1313 youths (aged <20 years) newly diagnosed in 2002 through 2005 with type 1 diabetes in the SEARCH for Diabetes in Youth study (mean [SD] age at diabetes onset, 8.9 [4.2] years) who had 3 or more HbA1c study measures during 6.1 to 13.3 years of follow-up. Data were analyzed in 2017. EXPOSURES Self-reported race/ethnicity. MAIN OUTCOMES AND MEASURES Hemoglobin A1c trajectories identified through group-based trajectory modeling over a mean (SD) of 9.0 (1.4) years of diabetes duration. Multinomial models studied the association of race/ethnicity with HbA1c trajectory group membership, adjusting for demographic characteristics, clinical factors, and socioeconomic position. RESULTS The final study sample of 1313 patients was 49.3% female (647 patients) with mean (SD) age 9.7 (4.3) years and mean (SD) disease duration of 9.2 (6.3) months at baseline. The racial/ethnic composition was 77.0% non-Hispanic white (1011 patients), 10.7% Hispanic (140 patients), 9.8% non-Hispanic black (128 patients), and 2.6% other race/ethnicity (34 patients). Three HbA1c trajectories were identified: group 1, low baseline and mild increases (50.7% [666 patients]); group 2, moderate baseline and moderate increases (41.7% [548 patients]); and group 3, moderate baseline and major increases (7.5% [99 patients]). Group 3 was composed of 47.5% nonwhite youths (47 patients). Non-Hispanic black youth had 7.98 higher unadjusted odds (95% CI, 4.42-14.38) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after full adjustment (adjusted odds ratio of non-Hispanic black race in group 3 vs group 1, 4.54; 95% CI, 2.08-9.89). Hispanic youth had 3.29 higher unadjusted odds (95% CI, 1.78-6.08) than non-Hispanic white youth of being in the highest HbA1c trajectory group relative to the lowest HbA1c trajectory group; the association remained significant after adjustment (adjusted odds ratio of Hispanic ethnicity in group 3 vs group 1, 2.24; 95% CI, 1.02-4.92). In stratified analyses, the adjusted odds of nonwhite membership in the highest HbA1c trajectory remained significant among male patients and youth diagnosed at age 9 years or younger, but not female patients and youth who were older than 9 years when they were diagnosed (P for interaction = .04 [sex] and .02 [age at diagnosis]). CONCLUSIONS AND RELEVANCE There are racial/ethnic differences in long-term glycemic control among youth with type 1 diabetes, particularly among nonwhite male patients and nonwhite youth diagnosed earlier in life.
Collapse
Affiliation(s)
- Anna R. Kahkoska
- Department of Nutrition, University of North Carolina at Chapel Hill
| | | | - Jamie Crandell
- School of Nursing, University of North Carolina at Chapel Hill
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Dana Dabelea
- Department of Epidemiology, Colorado School of Public Health, Aurora
| | - Giuseppina Imperatore
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean M. Lawrence
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Angela D. Liese
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia
| | - Cate Pihoker
- Department of Pediatrics, University of Washington, Seattle
| | - Beth A. Reboussin
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Shivani Agarwal
- Department of Endocrinology, Diabetes, and Metabolism, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Janet A. Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lynne E. Wagenknecht
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Victor W. Zhong
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Elizabeth J. Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill
- Department of Medicine, University of North Carolina at Chapel Hill
| |
Collapse
|
33
|
Noueiri B, Nassif N, Ollek A. Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life. Int J Clin Pediatr Dent 2018; 11:40-45. [PMID: 29805233 PMCID: PMC5968161 DOI: 10.5005/jp-journals-10005-1481] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 11/22/2017] [Indexed: 11/23/2022] Open
Abstract
Introduction Diabetes mellitus type I (DM1) has been increasing at an alarming rate worldwide. Children suffering from this chronic disease are subject to a high risk of systemic and oral complications, due to their young age and the lack of awareness of the relation between diabetes and oral health. Objective The aim of this study is to evaluate the impact of oral and general complications of DM1 on the Lebanese children's quality of life. The goal was to assess the child's behavioral issues on the one hand and the oral issues on the other. Materials and methods About 37 diabetic Lebanese children aged between 6 and 12 years, recruited from the Chronic Care Center (CCC), answered two questionnaires, one related to the disease and the second related to the oral complications. Results A majority of the participants (81.1%) are aware of their disease, 73% know the importance of their treatment and 54.1% are able to control their glycemia; 45.9% are not annoyed with constantly carrying a monitor and 67.5% are bothered by their restricted diet. Only 5.4% of children isolate themselves. Concerning the oral complications About 83.8% of the children do not suffer from oral ulcers, 56.8% are caries-free, and 64.9% have completed their dental treatment; 89.2% do not complain while eating and 94.6% are not able to brush their teeth properly. Conclusion Diabetic patients are found to have good knowledge of the disease and its systemic complications but a little on their increased risk for oral diseases. In order to ensure a good quality of life for the diabetic children and their families, optimal control of diabetes, appropriate oral hygiene, and regular visits to the dentist must be respected.How to cite this article: Noueiri B, Nassif N, Ollek A. Impact of General and Oral Complications of Diabetes Mellitus Type I on Lebanese Children's Quality of Life. Int J Clin Pediatr Dent 2018;11(1):40-45.
Collapse
Affiliation(s)
- Balsam Noueiri
- Associate Professor, Department of Pediatric Dentistry, Lebanese University Beirut, Lebanon
| | - Nahla Nassif
- Assistant Professor, Department of Pediatric Dentistry, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - Abbas Ollek
- Assistant Professor, Department of Life Science, Lebanese University, Beirut Lebanon
| |
Collapse
|
34
|
Savin KL, Hamburger ER, Monzon AD, Patel NJ, Perez KM, Lord JH, Jaser SS. Diabetes-specific family conflict: Informant discrepancies and the impact of parental factors. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2018; 32:157-163. [PMID: 29543490 PMCID: PMC5928789 DOI: 10.1037/fam0000364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Family conflict in adolescents with type 1 diabetes (T1D) has been linked to worse disease management (i.e., glycemic control, adherence to treatment regimen) and reduced quality of life. We sought to examine parental risk factors associated with increased levels of diabetes-specific family conflict and to investigate the discrepancies between parent and adolescent reports of conflict. Adolescents with T1D and their parents (N = 120 dyads) completed measures of diabetes-specific family conflict. Adolescents also reported on health-related quality of life, and parents reported on demographic information. Clinical data were obtained from adolescents' medical records. Adolescents reported significantly greater levels of conflict than their parents around direct diabetes management tasks (e.g., checking blood sugars) and indirect management tasks (e.g., carrying supplies for high or low blood sugars). Several demographic factors were associated with family conflict, including parental education, marital status, and household income. Discrepancies between parent and adolescent reports of family conflict were significantly associated with diabetes-related outcomes. Specifically, higher quality of life was related to discrepancies between parent and adolescent reports of conflict around indirect management tasks. In addition, poorer glycemic control was related to discrepancies between parent and adolescent reports of family conflict around direct diabetes management tasks. These results support obtaining both the adolescent and parent report of conflict for unique information regarding family functioning. (PsycINFO Database Record
Collapse
|
35
|
Husárová D, Kostičová M, Kočišová D, Schusterová I, Gecková AM. Do Adolescents with T1DM Differ from Their Peers in Health, Eating Habits and Social Support? Cent Eur J Public Health 2018; 25:307-312. [PMID: 29346855 DOI: 10.21101/cejph.a4876] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE The aim of this study was to analyse differences in health, eating habits and social support in adolescents with type 1 diabetes mellitus (T1DM) in comparison to peers with another long-term illness or without any medical condition. METHODS We used self-reported data from the cross-sectional Health Behaviour in School-aged Children study collected in 2014 among Slovak adolescents as well as data from adolescents with T1DM collected in outpatient settings (11 to 15 years old, N=8,910, 50.3% of boys). Logistic regression models and general linear models were used to analyse differences between adolescents with T1DM and their peers with and without long-term illness in self-rated health, life satisfaction, health complaints, regular breakfast, sweets and soft drink consumption, and perceived support from family, teachers and classmates. RESULTS Adolescents with T1DM reported worse self-rated health and suffer from more health complaints, but they have lower chance of having breakfast irregularly in comparison to their peers with another long-term illness or without any medical condition. Moreover, compared with their peers, adolescents with T1DM perceived stronger support from teachers and classmates, but weaker support from their family. We did not confirm any differences in life satisfaction, sweets and soft drink consumption between adolescents with T1DM and their peers. CONCLUSIONS Adolescents with T1DM reported more regular eating habits, no difference in life satisfaction and more social support outside the family in comparison to their peers. However, their worse self-rated health, more health complaints and weaker support from family should be considered in interventions targeting psychosocial adjustment of adolescents with T1DM.
Collapse
Affiliation(s)
- Daniela Husárová
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Michaela Kostičová
- Institute of Social Medicine and Medical Ethics, Faculty of Medicine, Comenius University in Bratislava, Bratislava, Slovak Republic
| | - Denisa Kočišová
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Ingrid Schusterová
- Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic
| | - Andrea Madarasová Gecková
- Department of Health Psychology, Faculty of Medicine, Pavol Jozef Šafárik University in Košice, Košice, Slovak Republic.,Olomouc University Social Health Institute, Palacký University Olomouc, Olomouc, Czech Republic
| |
Collapse
|
36
|
Fernandes LTB, Nóbrega VMD, Silva MEDA, Machado AN, Collet N. Supported self-care for children and adolescents with chronic disease and their families. Rev Bras Enferm 2017; 70:1318-1329. [DOI: 10.1590/0034-7167-2016-0553] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 02/10/2017] [Indexed: 11/21/2022] Open
Abstract
ABSTRACT Objective: analyze the scientific production between 2006 and 2015 on strategies for supported self-care by children and adolescents with chronic disease and their families. Method: integrative review of the literature conducted July and August 2016 in the databases: BDENF, LILACS, IBECS, ADOLEC, MEDLINE/PubMed and SCIELO. The 27 selected studies were analyzed and categorized into the five pillars of supported self-care: evaluation, counseling, agreement, care and accompaniment. Results: only two studies covered all five pillars, evaluation was considered most, but accompaniment was essential for adherence to the therapeutics of the goal plan. There was a prevalence of actions to evaluate the emotional state of the child/adolescent/family and technological interventions to empower the individual in self-care. Final considerations: these actions are concentrated in countries with health systems directed to the health needs of people with chronic disease. In Brazil, this is still incipient, since the actions are focused on exacerbation.
Collapse
|
37
|
Sand P, Blom MD, Forsander G, Lundin CS. Family dynamics when a child becomes chronically ill: Impact of type 1 diabetes onset in children and adolescents. NORDIC PSYCHOLOGY 2017. [DOI: 10.1080/19012276.2017.1362990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peter Sand
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Stora Nygatan 171/2, Göteborg 411 08, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gun Forsander
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Stora Nygatan 171/2, Göteborg 411 08, Sweden
| | - Carina Sparud Lundin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
38
|
Perfect MM, Beebe D, Levine-Donnerstein D, Frye SS, Bluez GP, Quan SF. The Development of a Clinically Relevant Sleep Modification Protocol for Youth with Type 1 Diabetes. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2016; 4:227-240. [PMID: 27747146 DOI: 10.1037/cpp0000145] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Findings from type 2 diabetes research indicate that sleep is both a predictor of onset and a correlate of disease progression. However, the role sleep plays in glucose regulation and daytime functioning in youth with type 1 diabetes mellitus (T1DM) has not been systematically investigated. Nonetheless, preliminary findings have supported that various sleep parameters are strongly correlated to health-related and neurobehavioral outcomes in youth with T1DM. This suggests that improving sleep might reduce morbidity. A critical step in developing evidence-based guidelines regarding sleep in diabetes management is to first determine that sleep modification in natural settings is possible (i.e., instructing youth to have a healthy sleep opportunity leads to more total sleep time) and that an increased sleep duration impacts disease and psychosocial outcomes in these youth. This article describes the background, design, and feasibility of an ongoing randomized clinical trial that aims to examine if increasing sleep relative to youth's own sleep routines affects glucose control and daytime functioning.
Collapse
Affiliation(s)
- Michelle M Perfect
- Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ
| | - Dean Beebe
- Department of Pediatrics, Cincinnati's Children's Hospital Medical Center, Cincinnati, OH
| | | | - Sara S Frye
- Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ
| | - Grai P Bluez
- Disability and Psychoeducational Studies, University of Arizona, Tucson, AZ
| | - Stuart F Quan
- Arizona Respiratory Center, University of Arizona, Tucson, AZ; Division of Sleep Medicine, Harvard Medical School, Boston, MA
| |
Collapse
|
39
|
AlBuhairan F, Nasim M, Al Otaibi A, Shaheen NA, Al Jaser S, Al Alwan I. Health related quality of life and family impact of type 1 diabetes among adolescents in Saudi Arabia. Diabetes Res Clin Pract 2016; 114:173-9. [PMID: 26830857 DOI: 10.1016/j.diabres.2016.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2015] [Revised: 11/12/2015] [Accepted: 01/03/2016] [Indexed: 10/22/2022]
Abstract
AIM To measure the health related quality of life (HRQoL) among Saudi Arabian adolescents with type 1 diabetes mellitus (T1DM) and the impact the disease has on the family. METHODOLOGY A cross sectional study was conducted involving 315 adolescent patients (12-18 years) and their caregivers. Adolescent HRQoL was assessed by adolescents and their parents completing the Peds QL™ Diabetes Module 3.0. Family impact was assessed by the parent completing the Peds QL™ Family Impact module (FIM). RESULTS Adolescents reported a cumulative mean HRQoL score of 64.8, while parents reported significantly lower scores of 60.3 (p=0.003). The lowest scores reported by both adolescents and parents were for "Worry". Female gender and late adolescent age were predictors of lower HRQoL for adolescents with T1DM. The FIM showed low scores for "Emotional functioning" (59.8) and high scores for "Family relationships" (80.9). CONCLUSION These findings emphasize the importance of an interdisciplinary, biopsychosocial and family centered care approach to adolescents with a chronic disease. Future work could assess the effectiveness of direct care involvement of adolescent and mental health experts in improving the HRQoL for this population.
Collapse
Affiliation(s)
- Fadia AlBuhairan
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia.
| | - Maliha Nasim
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Ahlam Al Otaibi
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| | - Naila A Shaheen
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Al Jaser
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Internal Medicine, King AbdulAziz Medical City, Riyadh, Saudi Arabia
| | - Ibrahim Al Alwan
- King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatrics, King Abdullah Specialized Children's Hospital, Riyadh, Saudi Arabia
| |
Collapse
|
40
|
Lo FS, Hsu HY, Chen BH, Lee YJ, Chen YT, Wang RH. Factors affecting health adaptation of Chinese adolescents with type 1 diabetes: A path model testing. J Child Health Care 2016; 20:5-16. [PMID: 25013129 DOI: 10.1177/1367493514540815] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Glycemic control and quality of life (QoL) are both considered indicators of health adaptation among adolescents with type 1 diabetes (T1D). The purpose of this study was to construct a path model addressing the influences of individual characteristics, school support, resilience, and self-care behaviors on glycated hemoglobin (HbA1c) and QoL among adolescents with T1D in Taiwan. This was a cross-sectional design study. A structured questionnaire was used to collect information on individual characteristics, school support, resilience, self-care behaviors, and QoL. The latest HbA1c was collected from medical records. Data from 238 adolescents with T1D were analyzed using structural equation modeling to test the hypothesized path model. The findings indicated that self-care behaviors and resilience both directly influenced HbA1c and QoL. School support directly influenced QoL but indirectly influenced HbA1c. We suggest that improving self-care behaviors and resilience could be considered an appropriate intervention for enhancing the health adaptation of adolescents with T1D. Increasing school support might be a strategy to improve QoL among adolescents with T1D.
Collapse
Affiliation(s)
| | - Hsiu-Yueh Hsu
- Hsin Sheng Junior College of Medical Care and Management, Taiwan
| | | | - Yann-Jinn Lee
- Mackay Memorial Hospital, Taiwan; Taipei Medical University, Taiwan
| | | | | |
Collapse
|
41
|
Sawyer SM, Ambresin AE, Bennett KE, Patton GC. A measurement framework for quality health care for adolescents in hospital. J Adolesc Health 2014; 55:484-90. [PMID: 24698286 DOI: 10.1016/j.jadohealth.2014.01.023] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2013] [Revised: 01/29/2014] [Accepted: 01/29/2014] [Indexed: 11/25/2022]
Abstract
PURPOSE Despite growing interest in measurement of health care quality and patient experience, the current evidence base largely derives from adult health settings, at least in part because of the absence of appropriately developed measurement tools for adolescents. To rectify this, we set out to develop a conceptual framework and a set of indicators to measure the quality of health care delivered to adolescents in hospital. METHODS A conceptual framework was developed from the following four elements: (1) a review of the evidence around what young people perceive as "adolescent-friendly" health care; (2) an exploration with adolescent patients of the principles of patient-centered care; (3) a scoping review to identify core clinical practices around working with adolescents; and (4) a scoping review of existing conceptual frameworks. Using criteria for indicator development, we then developed a set of indicators that mapped to this framework. RESULTS Embedded within the notion of patient- and family-centered care, the conceptual framework for adolescent-friendly health care (quality health care for adolescents) was based on the constructs of experience of care (positive engagement with health care) and evidence-informed care. A set of 14 indicators was developed, half of which related to adolescents' and parents' experience of care and half of which related to aspects of evidence-informed care. CONCLUSIONS The conceptual framework and indicators of quality health care for adolescents set the stage to develop measures to populate these indicators, the next step in the agenda of improving the quality of health care delivered to adolescents in hospital settings.
Collapse
Affiliation(s)
- Susan M Sawyer
- Royal Children's Hospital Centre for Adolescent Health, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia.
| | - Anne-Emmanuelle Ambresin
- Royal Children's Hospital Centre for Adolescent Health, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - Kristina E Bennett
- Royal Children's Hospital Centre for Adolescent Health, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| | - George C Patton
- Royal Children's Hospital Centre for Adolescent Health, Melbourne, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Australia; Murdoch Children's Research Institute, Melbourne, Australia
| |
Collapse
|
42
|
Duncan RE, Jekel M, O'Connell MA, Sanci LA, Sawyer SM. Balancing parental involvement with adolescent friendly health care in teenagers with diabetes: are we getting it right? J Adolesc Health 2014; 55:59-64. [PMID: 24518535 DOI: 10.1016/j.jadohealth.2013.11.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 11/25/2013] [Accepted: 11/25/2013] [Indexed: 12/31/2022]
Abstract
PURPOSE Current guidance about adolescent-friendly health care emphasizes the benefits of seeing young people alone for confidential consultations. Yet in young people with Type 1 diabetes mellitus (T1DM), parental involvement has been shown to contribute to better diabetes control. This study aimed to better understand how these apparent tensions are reconciled in clinical practice by identifying how frequently adolescents with T1DM are seen alone and exploring parents' opinions about this. METHODS A convenience sample of consecutive parents of adolescents (aged 12-21 years) with T1DM was recruited from the outpatient clinic of a specialist diabetes service and asked to complete a 30-item written survey. RESULTS A total of 137 surveys were returned from 146 eligible parents (94%) of whom 106 had complete data. Thirteen percent of adolescents with T1DM had ever been seen alone for a confidential consultation with their doctor. The most common concern for parents about confidential care was not being informed about important information, not just about T1DM, but also about common adolescent risk behaviors and mental health states. DISCUSSION These findings suggest that young people with T1DM are not being routinely seen alone for confidential care. This could be attributed to: parents or adolescents declining confidential care; clinicians being time-poor and/or lacking the necessary skills; or a culture of uncertainty about the value of confidential care. A discussion is now required about how best to enact adolescent-friendly care in the chronic-illness outpatient setting, where parental involvement is understood to be important for effective chronic illness management.
Collapse
Affiliation(s)
- Rony E Duncan
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.
| | - Maureen Jekel
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia; Faculty of Social Sciences, Radboud University Nijmegen, Netherlands
| | - Michele A O'Connell
- Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Endocrinology and Diabetes, Royal Children's Hospital, Parkville, Victoria, Australia
| | - Lena A Sanci
- Department of General Practice, The University of Melbourne, Parkville, Victoria, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Parkville, Victoria, Australia; Murdoch Childrens Research Institute, Parkville, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
43
|
Mental health problems among adolescents with early-onset and long-duration type 1 diabetes and their association with quality of life: a population-based survey. PLoS One 2014; 9:e92473. [PMID: 24637957 PMCID: PMC3956941 DOI: 10.1371/journal.pone.0092473] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 02/21/2014] [Indexed: 12/29/2022] Open
Abstract
Objective To evaluate mental health problems and associations between mental health problems and health-related quality of life in adolescents with type 1 diabetes in comparison with the general population. Method A total of 629 11- to 17-year-olds with early-onset and long-lasting type 1 diabetes and their parents completed comprehensive questionnaires. Mental health was assessed using the parent- and self-report versions of the Strengths and Difficulties Questionnaire (SDQ). The Revised Children's Quality of Life Questionnaire (KINDL-R) was used to measure quality of life. The comparison group (n = 6,813) was a representative sample from the German KiGGS study. Results The proportion of youths with mental health problems (defined as abnormal SDQ total difficulties score) was, based on self-reports, 4.4% in the patient group and 2.9% in the general population (adjusted OR = 1.61, p = 0.044); and based on proxy reports, 7.9% in the patient group and 7.2% in the general population (OR = 1.05, p = 0.788). Youths with type 1 diabetes and self-reported mental health problems scored worse in the KINDL-R subscales of physical well-being (adjusted average difference β = −16.74, p<0.001) and family (β = −11.09, p = 0.017), and in the KINDL-R total score (β = −8.09, p<0.001), than peers with self-reported mental health problems. The quality of life of diabetic adolescents and proxy-reported mental health problems did not differ from peers with proxy-reported mental health problems adjusted for confounders. Conclusions Compared with the general population with mental health problems, the quality of life of adolescents with type 1 diabetes who report mental health problems is more severely impaired. This observation calls for early prevention and intervention as part of pediatric diabetes long-term care.
Collapse
|
44
|
Whittemore R, Liberti L, Jeon S, Chao A, Jaser SS, Grey M. Self-management as a mediator of family functioning and depressive symptoms with health outcomes in youth with type 1 diabetes. West J Nurs Res 2013; 36:1254-71. [PMID: 24357648 DOI: 10.1177/0193945913516546] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study examined the relationship of family functioning and depressive symptoms with self-management, glycemic control, and quality of life in a sample of adolescents with type 1 diabetes. It also explored whether self-management mediates family functioning, depressive symptoms, and diabetes-related outcomes. Structural equation modeling was used to estimate parameters in the conceptual causal pathway and test mediation effects. Adolescents (n = 320) were primarily female (55%), younger adolescents (58%), and self-identified as White (63%). Self-management mediated the relationship between family conflict, family warmth-caring, parent guidance-control, and youth depressive symptoms with glycosylated hemoglobin (A1C). In addition, self-management mediated the relationship between family conflict and youth depressive symptoms with quality of life. Supporting optimal family functioning and treating elevated depressive symptoms in adolescents with type 1 diabetes has the potential to improve self-management, glycemic control, and quality of life.
Collapse
Affiliation(s)
| | | | | | - Ariana Chao
- Yale University School of Nursing, Orange, CT, USA
| | | | | |
Collapse
|