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Coyne I, Sleath B, Surdey J, Pembroke S, Hilliard C, Chechalk K, Rafferty S, Rogerson S, Hughes M M, Murphy M, Cody D, Roche E. Intervention to promote adolescents' communication and engagement in diabetes clinic encounters: A pilot randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2024; 126:108322. [PMID: 38772095 DOI: 10.1016/j.pec.2024.108322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 04/26/2024] [Accepted: 05/13/2024] [Indexed: 05/23/2024]
Abstract
AIM To conduct a pilot randomized trial of an intervention to improve adolescent question-asking and provider education during paediatric diabetes visits. METHODS Adolescents aged 11 to 17 with type 1 diabetes and their parents were enrolled from two urban tertiary paediatric clinics. Adolescents were randomised to the intervention group or control group. Adolescent consultations were audio-recorded, their HbA1c level was recorded, and they completed surveys after three clinic appointments. The intervention group completed a question prompt list and watched a video on a tablet with their parents before meeting their doctor and completed a short evaluation after each visit. RESULTS Six consultant endocrinologists and ninety-nine adolescents and their parents participated. The intervention increased adolescents' question asking and provider education in diabetes encounters. Total patient question-asking across the 3 consultations and a higher baseline HbA1c at time one was significantly associated with HbA1c at time three. CONCLUSIONS Question prompt lists and an educational video are useful tools to increase adolescents' question-asking and communication between adolescents and their providers. PRACTICE IMPLICATIONS Interventions that encourage adolescents' question-asking in healthcare encounters may lead to more meaningful providers-adolescents' communication and tailored education. Interventions to improve professionals' listening, communication and educational skills are also required.
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Affiliation(s)
- I Coyne
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland.
| | - B Sleath
- University of North Carolina at Chapel Hill, Division of Pharmaceutical Outcomes and Policy, UNC Eshelman School of Pharmacy, Chapel Hill, NC, United States
| | - J Surdey
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Pembroke
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - C Hilliard
- Children's Health Ireland, Dublin 8, Ireland
| | - K Chechalk
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland
| | - S Rafferty
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - S Rogerson
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Hughes M
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - M Murphy
- Trinity College Dublin, School of Nursing and Midwifery, Dublin 2, Ireland
| | - D Cody
- Children's Health Ireland, Department of Diabetes and Endocrinology, Crumlin, Dublin 12, Ireland
| | - E Roche
- Trinity College Dublin, School of Medicine, Dublin 2, Ireland; Children's Health Ireland, Department of Endocrinology and Diabetes, Tallaght, Dublin 24, Ireland
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Ellis D, Carcone AI, Templin T, Evans M, Weissberg-Benchell J, Buggs-Saxton C, Boucher-Berry C, Miller JL, Drossos T, Dekelbab MB. Moderating Effect of Depression on Glycemic Control in an eHealth Intervention Among Black Youth With Type 1 Diabetes: Findings From a Multicenter Randomized Controlled Trial. JMIR Diabetes 2024; 9:e55165. [PMID: 38593428 PMCID: PMC11040442 DOI: 10.2196/55165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 02/22/2024] [Accepted: 02/28/2024] [Indexed: 04/11/2024] Open
Abstract
BACKGROUND Black adolescents with type 1 diabetes (T1D) are at increased risk for suboptimal diabetes health outcomes; however, evidence-based interventions for this population are lacking. Depression affects a high percentage of youth with T1D and increases the likelihood of health problems associated with diabetes. OBJECTIVE Our aim was to test whether baseline levels of depression moderate the effects of a brief eHealth parenting intervention delivered to caregivers of young Black adolescents with T1D on youths' glycemic control. METHODS We conducted a multicenter randomized controlled trial at 7 pediatric diabetes clinics located in 2 large US cities. Participants (N=149) were allocated to either the intervention group or a standard medical care control group. Up to 3 intervention sessions were delivered on a tablet computer during diabetes clinic visits over a 12-month period. RESULTS In a linear mixed effects regression model, planned contrasts did not show significant reductions in hemoglobin A1c (HbA1c) for intervention adolescents compared to controls. However, adolescents with higher baseline levels of depressive symptoms who received the intervention had significantly greater improvements in HbA1c levels at 6-month follow-up (0.94%; P=.01) and 18-month follow-up (1.42%; P=.002) than those with lower levels of depression. Within the intervention group, adolescents had a statistically significant reduction in HbA1c levels from baseline at 6-month and 18-month follow-up. CONCLUSIONS A brief, culturally tailored eHealth parenting intervention improved health outcomes among Black adolescents with T1D and depressive symptoms. TRIAL REGISTRATION ClinicalTrials.gov NCT03168867; https://clinicaltrials.gov/study/NCT03168867.
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Affiliation(s)
- Deborah Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, MI, United States
| | - Thomas Templin
- College of Nursing, Wayne State University, Detroit, MI, United States
| | - Meredyth Evans
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H Lurie Children's Hospital, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Jill Weissberg-Benchell
- Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H Lurie Children's Hospital, Chicago, IL, United States
- Department of Psychiatry and Behavioral Sciences, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Colleen Buggs-Saxton
- Department of Pediatrics, Wayne State University School of Medicine, Detroit, MI, United States
| | - Claudia Boucher-Berry
- Department of Pediatrics, University of Illinois School of Medicine at Chicago, Chicago, IL, United States
| | - Jennifer L Miller
- Department of Pediatrics, Northwestern Feinberg School of Medicine, Chicago, IL, United States
| | - Tina Drossos
- Department of Psychiatry and Behavioral Neurosciences, University of Chicago Pritzker School of Medicine, Chicago, IL, United States
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Chandran SR, Ho C, Yeoh E, Gardner D. Type 1 Diabetes in Singapore: Self-Care Challenges, Diabetes Technology Awareness, Current Use, and Satisfaction, an Online Survey. Indian J Endocrinol Metab 2024; 28:167-176. [PMID: 38911114 PMCID: PMC11189278 DOI: 10.4103/ijem.ijem_369_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 08/15/2023] [Accepted: 11/04/2023] [Indexed: 06/25/2024] Open
Abstract
Introduction To describe the self-care challenges, diabetes technology awareness, current use, and satisfaction among adults with type 1 diabetes and parents of children with type 1 diabetes in Singapore. Methods An anonymous online survey was administered between November 2020 and October 2021. Data are presented as mean (standard deviation) or count (percentages). Comparisons between groups were done using the independent samples T-test. Results 251 people (176 adults, 75 parents) participated. The most challenging self-care burdens were carbohydrate counting (24.4%) among adults and insulin dose calculations (28%) among parents. Nocturnal awakenings for diabetes care of their child were a common event (25.3%). Despite high awareness about continuous glucose monitoring devices (77.8% adults, 78.7% parents) the use (24.9% adults, 55% children) remained low. Both adults and parents of children with type 1 diabetes found continuous glucose monitoring to be liberating and less restrictive. Despite overall low insulin pump use (23.9% adults, 29.3% children); satisfaction scores were higher among insulin pump users than insulin pen users (P = 0.02). Conclusion Carbohydrate counting and insulin dose calculations were the most challenging self-care tasks among people with type 1 diabetes in Singapore. Diabetes technology use was relatively low in Singapore. Continuous glucose monitoring and Insulin pump users found them to be beneficial.
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Affiliation(s)
- Suresh Rama Chandran
- Department of Endocrinology, Singapore General Hospital, Singapore
- Duke-National University of Singapore (NUS) Medical School, Singapore
| | - Cindy Ho
- Khoo Teck Puat – National University Children’s Medical Institute, National University Health System, Singapore
- Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ester Yeoh
- Diabetes Centre, Admiralty Medical Centre, Singapore
- Department of General Medicine, Division of Endocrinology, Khoo Teck Puat Hospital, Singapore
| | - Daphne Gardner
- Department of Endocrinology, Singapore General Hospital, Singapore
- Duke-National University of Singapore (NUS) Medical School, Singapore
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Lee D, Lee H, Shin Y, Park G. Effectiveness of Non-pharmacological Interventions for Adolescents With Type 1 Diabetes in the Last Five Years: A Systematic Review and Meta-analysis. Asian Nurs Res (Korean Soc Nurs Sci) 2024; 18:51-59. [PMID: 38307162 DOI: 10.1016/j.anr.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 01/14/2024] [Accepted: 01/29/2024] [Indexed: 02/04/2024] Open
Abstract
PURPOSE Evidence on non-pharmacological interventions for adolescents with type 1 diabetes is unclear. This review aimed to evaluate the effectiveness of non-pharmacological intervention in adolescents with type 1 diabetes. METHODS We conducted a search on databases from November 11 to 19, 2022, for randomized controlled trials for the effects of non-pharmacological intervention in adolescents with type 1 diabetes. To identify recent research trends, we included studies published from 2017 to November 2022. The risk of bias was assessed using the Cochrane risk-of-bias tool 2.0. To estimate the effect size, a meta-analysis was performed using RevMan 5.4 program and R Studio. RESULTS A total of 45 studies were included in the systematic review. Among those, 30 studies were included in the meta-analysis. Non-pharmacological interventions were significantly effective in improving Glycated hemoglobin (HbA1c) (standardized mean difference [SMD] = -0.26, 95% confidence interval [CI]: -0.42, -0.09), quality of life (SMD = 0.44, 95% CI: 0.13 to 0.76), and anxiety (SMD = -0.91, 95% CI: -1.26, -0.56). Subgroup analysis showed that duration of intervention was not a covariate related to HbA1c levels. CONCLUSIONS Non-pharmacological interventions have shown effectiveness in improving the HbA1c, quality of life, and anxiety in adolescents with type 1 diabetes. Future studies with more rigorous methodology are needed to confirm and strengthen the validity of these findings. Additionally, attention to changes in the lipid profile and self-care motivation among adolescents with type 1 diabetes is warranted. TRIAL REGISTRATION NUMBER Prospective Register of Systematic Reviews (CRD42022382190).
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Affiliation(s)
- DaeEun Lee
- College of Nursing, Pusan National University, South Korea
| | - Haejung Lee
- College of Nursing/Research Institute of Nursing Science, Pusan National University, South Korea.
| | - YoonYoung Shin
- College of Nursing, Pusan National University, South Korea
| | - Gaeun Park
- College of Nursing/Research Institute of Nursing Science, Pusan National University, South Korea
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Salam RA, Khan MH, Meerza SSA, Das JK, Lewis-Watts L, Bhutta ZA. An evidence gap map of interventions for noncommunicable diseases and risk factors among children and adolescents. Nat Med 2024; 30:290-301. [PMID: 38195753 DOI: 10.1038/s41591-023-02737-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/27/2023] [Indexed: 01/11/2024]
Abstract
Substance misuse, obesity, mental health conditions, type 1 diabetes, cancers, and cardiovascular and chronic respiratory diseases together account for 41% of disability-adjusted life years linked to noncommunicable diseases (NCDs) among children and adolescents worldwide. However, the evidence on risk factors and interventions for this age group is scarce. Here we searched four databases to generate an evidence gap map of existing interventions and research gaps for these risk factors and NCDs. We mapped 159 reviews with 2,611 primary studies; most (96.2%) were conducted in high-income countries, and only 100 studies (3.8%) were from low- and middle-income countries (LMICs). The efficacy of therapeutic interventions on biomarkers and adverse events for NCDs appears to be well evidenced. Interventions for mental health conditions appear to be moderately evidenced, while interventions for obesity and substance misuse appear to be moderate to very low evidenced. Priority areas for future research include evaluating digital health platforms to support primary NCD prevention and management, and evaluating the impact of policy changes on the prevalence of obesity and substance misuse. Our findings highlight the wide disparity of evidence between high-income countries and LMICs. There is an urgent need for increased, targeted financing to address the research gaps in LMICs.
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Affiliation(s)
- Rehana A Salam
- The Daffodil Centre, The University of Sydney, a joint venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - Maryam Hameed Khan
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Syed Saqlain Ali Meerza
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University Hospital, Karachi, Pakistan
| | - Laura Lewis-Watts
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Zulfiqar A Bhutta
- Centre for Global Child Health, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada.
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Knapp P, Martin-Kerry J, Moe-Byrne T, Sheridan R, Coleman E, Roche J, Young B, Higgins S, Preston J, Bower P, Gamble C, Stones C. The effectiveness and acceptability of multimedia information when recruiting children and young people to trials: the TRECA meta-analysis of SWATs. HEALTH AND SOCIAL CARE DELIVERY RESEARCH 2023; 11:1-112. [PMID: 38140894 DOI: 10.3310/htpm3841] [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: 12/24/2023]
Abstract
Background The information provided to potential trial participants plays a crucial role in their decision-making. Printed participant information sheets for trials have received recurrent criticism as being too long and technical, unappealing and hard to navigate. An alternative is to provide information through multimedia (text, animations, video, audio, diagrams and photos). However, there is limited evidence on the effects of multimedia participant information on research recruitment rates, particularly in children and young people. Objectives The study objectives were as follows: 1. to develop template multimedia information resources through participatory design, for use when recruiting children and young people to trials 2. to evaluate the multimedia information resources in a series of Studies Within A Trial, to test their effects on recruitment and retention rates, and participant decision-making, by comparing the provision of multimedia information resources instead of printed participant information sheets, and comparing the provision of multimedia information resources in addition to printed participant information sheets. Design Two-phase study: 1. multimedia information resources development including qualitative study; user testing study; readability metrics; enhanced patient and public involvement 2. multimedia information resources' evaluation comprising Studies Within A Trial undertaken within host trials recruiting children and young people. Setting United Kingdom trials involving patients aged under 18. Participants Development phase: n = 120 (children and young people, parents, clinicians, trial personnel). Evaluation phase: n = 1906 (children and young people being asked to take part in trials). Interventions Multimedia information resources (comprising text, audio, 'talking heads' video, trial-specific and trial-generic animations). Printed participant information sheets. Main outcome measures Primary outcome: trial recruitment rate comparing multimedia information resource-only with printed participant information sheet-only provision. Secondary outcomes: trial recruitment rate comparing combined multimedia information resource and printed participant information sheet with printed participant information sheet-only provision; trial retention rate; quality of participant decision-making. Results for each trial were calculated and combined in a two-stage random-effects meta-analysis. Results Phase 1 generated two multimedia information resource templates: (1) for children aged 6-11 years; (2) for children aged 12-18 years and parents. In the Phase 2 Studies Within A Trial the multimedia information resources improved trial recruitment, when compared to printed information alone [odds ratio (OR) = 1.54; 95% confidence interval (CI) 1.05 to 2.28; p = 0.03; I2 = 0%]. When printed participant information sheet-only provision was compared to combined multimedia information resource and printed participant information sheet provision, there was no effect on trial recruitment (OR = 0.89; 95% CI 0.53 to 1.50; I2 = 0%). There were no differences between multimedia information resource and printed participant information sheet on trial retention or participant decision-making quality. In a study within a hypothetical trial setting, multimedia information resource-only provision produced higher ratings of 'information was easy to understand' (Z = 3.03; p = 0.003) and 'I had confidence in decision-making' (Z = 2.00; p = 0.044) than printed participant information sheet-only provision. Limitations It was not possible to include data from three Studies Within A Trial in the meta-analysis due to limited sample size, and questionnaire return rates were low, which reduced the strength of the findings. Conclusions Use of multimedia information increased the rate of recruitment to trials involving children and young people compared to standard patient information sheets. Future work There should be further evaluation of the effects of multimedia information on recruitment to trials involving children and young people. It would be valuable to assess any impacts of multimedia information resources on communication between trial recruiters, children and young people, and parents. Study registration This trial is registered as TRECA ISRCTN 73136092 and Northern Ireland Hub for Trials Methodology Research SWAT Repository (SWAT 97). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 14/21/21) and is published in full in Health and Social Care Delivery Research; Vol. 11, No. 24. See the NIHR Funding and Awards website for further award information.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences and Hull York Medical School, University of York, York, UK
- Department of Health Sciences, University of York, York, UK
| | - Jacqueline Martin-Kerry
- Department of Health Sciences, University of York, York, UK
- School of Allied Health Professions, College of Life Sciences, University of Leicester, Leicester, UK
| | | | | | | | - Jenny Roche
- York Trials Unit, University of York, York, UK
| | - Bridget Young
- Institute of Population Health, University of Liverpool, Liverpool, UK
| | | | - Jennifer Preston
- NIHR Alder Hey Clinical Research Facility, Alder Hey Children's Hospital NHS Foundation Trust, Liverpool, UK
| | - Peter Bower
- NIHR School for Primary Care Research, University of Manchester, Manchester, UK
| | - Carrol Gamble
- Centre for Medical Statistics and Health Evaluation, University of Liverpool, Liverpool, UK
| | - Catherine Stones
- School of Design, Clothworkers' Central, University of Leeds, Leeds, UK
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Knapp P, Moe-Byrne T, Martin-Kerry J, Sheridan R, Roche J, Coleman E, Bower P, Higgins S, Stones C, Graffy J, Preston J, Gamble C, Young B, Perry D, Dahlmann-Noor A, Abbas M, Khandelwal P, Ludden S, Azuara-Blanco A, McConnell E, Mandall N, Lawson A, Rogers CA, Smartt HJM, Heys R, Stones SR, Taylor DH, Ainsworth S, Ainsworth J. Providing multimedia information to children and young people increases recruitment to trials: pre-planned meta-analysis of SWATs. BMC Med 2023; 21:244. [PMID: 37403173 PMCID: PMC10320935 DOI: 10.1186/s12916-023-02936-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/12/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Randomised controlled trials are often beset by problems with poor recruitment and retention. Information to support decisions on trial participation is usually provided as printed participant information sheets (PIS), which are often long, technical, and unappealing. Multimedia information (MMI), including animations and videos, may be a valuable alternative or complement to a PIS. The Trials Engagement in Children and Adolescents (TRECA) study compared MMI to PIS to investigate the effects on participant recruitment, retention, and quality of decision-making. METHODS We undertook six SWATs (Study Within A Trial) within a series of host trials recruiting children and young people. Potential participants in the host trials were randomly allocated to receive MMI-only, PIS-only, or combined MMI + PIS. We recorded the rates of recruitment and retention (varying between 6 and 26 weeks post-randomisation) in each host trial. Potential participants approached about each host trial were asked to complete a nine-item Decision-Making Questionnaire (DMQ) to indicate their evaluation of the information and their reasons for participation/non-participation. Odds ratios were calculated and combined in a meta-analysis. RESULTS Data from 3/6 SWATs for which it was possible were combined in a meta-analysis (n = 1758). Potential participants allocated to MMI-only were more likely to be recruited to the host trial than those allocated to PIS-only (OR 1.54; 95% CI 1.05, 2.28; p = 0.03). Those allocated to combined MMI + PIS compared to PIS-only were no more likely to be recruited to the host trial (OR = 0.89; 95% CI 0.53, 1.50; p = 0.67). Providing MMI rather than PIS did not impact on DMQ scores. Once children and young people had been recruited to host trials, their trial retention rates did not differ according to intervention allocation. CONCLUSIONS Providing MMI-only increased the trial recruitment rate compared to PIS-only but did not affect DMQ scores. Combined MMI + PIS instead of PIS had no effect on recruitment or retention. MMIs are a useful tool for trial recruitment in children and young people, and they could reduce trial recruitment periods.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK.
| | | | | | | | - Jenny Roche
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Elizabeth Coleman
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Peter Bower
- Centre for Primary Care, University of Manchester, Manchester, UK
| | | | | | | | - Jenny Preston
- Institute of Child Health, University of Liverpool, Liverpool, UK
| | - Carrol Gamble
- Department of Biostatistics, University of Liverpool, Liverpool, UK
| | - Bridget Young
- Department of Psychology, University of Liverpool, Liverpool, UK
| | - Daniel Perry
- Nuffield Department of Orthopaedics, University of Oxford, Oxford, UK
| | | | - Mohamed Abbas
- Moorfields Eye Hospital NHS Foundation Trust, London, UK
| | | | | | | | | | | | - Anna Lawson
- Clinical Trials Unit, University of Birmingham, Birmingham, UK
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Bakir E, Sezer TA. The efficacy of interventions provided by nurses to improve glycemic control of children with type 1 diabetes: A systematic review. J SPEC PEDIATR NURS 2023; 28:e12397. [PMID: 36371673 DOI: 10.1111/jspn.12397] [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: 09/21/2022] [Accepted: 10/20/2022] [Indexed: 11/14/2022]
Abstract
PURPOSE Nurses have a very important role in diabetes education of children and adolescents, however, no systematic review has been performed that evaluates the effectiveness of the independent interventions of the nurses. This systematic review aims to identify and assess randomized controlled trials (RCT) that included interventions implemented by nurses to improve glycemic control for children and adolescents with type 1 diabetes. ELIGIBILITY CRITERIA PubMed, the Cochrane Central Register of Controlled Trials, Scopus, Web of Science, Science Direct databases were systematically searched up to 2022. Interventions provided by nurses for any child ≤18 years diagnosed with type 1 diabetes mellitus were included. SAMPLE Seven RCT articles met our review criteria. RESULTS All included studies were published between 2005 and 2021. Studies varied in terms of intervention type; telephone case management, coping skills training, motivational interview as well as home visit education programs. Interventions were found to significantly decrease the HbA1c level in three of seven studies. CONCLUSIONS Our systematic review suggests that nurses can improve the glycemic control of children with type 1 diabetes by conducting care interventions. According to current evidence, this study suggests that telephone contact by nurses and motivational interviewing can be beneficial in improving glycemic control in this population. IMPLICATIONS Nurses may encourage children and adolescents with diabetes to engage in self-management of their glucose levels. There is a need for more randomized controlled studies assessing the efficacy of nursing interventions for children with type 1 diabetes.
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Affiliation(s)
- Elif Bakir
- Department of Pediatric Nursing, Faculty of Nursing, Hacettepe University, Ankara, Turkey
| | - Tufan Aslı Sezer
- Department of Pediatric Nursing, Faculty of Nursing, Ankara University, Ankara, Turkey
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Mechanick JI, Christofides EA, Marchetti AE, Hoddy KK, Joachim J, Hegazi R, Hamdy O. The syndromic triad of COVID-19, type 2 diabetes, and malnutrition. Front Nutr 2023; 10:1122203. [PMID: 36895277 PMCID: PMC9988958 DOI: 10.3389/fnut.2023.1122203] [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: 12/12/2022] [Accepted: 01/30/2023] [Indexed: 02/25/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic challenges our collective understanding of transmission, prevention, complications, and clinical management of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Risk factors for severe infection, morbidity, and mortality are associated with age, environment, socioeconomic status, comorbidities, and interventional timing. Clinical investigations report an intriguing association of COVID-19 with diabetes mellitus and malnutrition but incompletely describe the triphasic relationship, its mechanistic pathways, and potential therapeutic approaches to address each malady and their underlying metabolic disorders. This narrative review highlights common chronic disease states that interact epidemiologically and mechanistically with the COVID-19 to create a syndromic phenotype-the COVID-Related Cardiometabolic Syndrome-linking cardiometabolic-based chronic disease drivers with pre-, acute, and chronic/post-COVID-19 disease stages. Since the association of nutritional disorders with COVID-19 and cardiometabolic risk factors is well established, a syndromic triad of COVID-19, type 2 diabetes, and malnutrition is hypothesized that can direct, inform, and optimize care. In this review, each of the three edges of this network is uniquely summarized, nutritional therapies discussed, and a structure for early preventive care proposed. Concerted efforts to identify malnutrition in patients with COVID-19 and elevated metabolic risks are needed and can be followed by improved dietary management while simultaneously addressing dysglycemia-based chronic disease and malnutrition-based chronic disease.
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Affiliation(s)
- Jeffrey I Mechanick
- The Wiener Cardiovascular Institute/Marie-Josée and Henry R. Kravis Center for Cardiovascular Health at Mount Sinai Heart, New York, NY, United States.,Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | - Albert E Marchetti
- Medical Education and Research Alliance (Med-ERA, Inc.), New York, NY, United States.,Rutgers New Jersey Medical School, Newark, NJ, United States
| | | | - Jim Joachim
- Internal Medicine and Medical Nutrition, San Diego, CA, United States
| | | | - Osama Hamdy
- Joslin Diabetes Center, Boston, MA, United States.,Harvard Medical School, Boston, MA, United States
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Schmidt M, Lu J, Luo W, Cheng L, Lee M, Huang R, Weng Y, Kichler JC, Corathers SD, Jacobsen LM, Albanese-O′Neill A, Smith L, Westen S, Gutierrez-Colina AM, Heckaman L, Wetter SE, Driscoll KA, Modi A. Learning experience design of an mHealth self-management intervention for adolescents with type 1 diabetes. EDUCATIONAL TECHNOLOGY RESEARCH AND DEVELOPMENT : ETR & D 2022; 70:2171-2209. [PMID: 36278247 PMCID: PMC9580427 DOI: 10.1007/s11423-022-10160-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/03/2022] [Indexed: 06/16/2023]
Abstract
Type 1 diabetes (T1D) is a lifelong and chronic condition that can cause severely compromised health. The T1D treatment regimen is complex, and is a particular challenge for adolescents, who frequently experience a number of treatment adherence barriers (e.g., forgetfulness, planning and organizational challenges, stress). Diabetes Journey is a gamified mHealth program designed to improve T1D self-management through a specific focus on decreasing adherence barriers and improving executive functioning skills for adolescents. Grounded in situativity theory and guided by a sociotechnical-pedagogical usability framework, Diabetes Journey was designed, developed, and evaluated using a learning experience design approach. This approach applied design thinking methods within a Successive Approximation Model design process. Iterative design and formative evaluation were conducted across three design phases, and improvements were implemented following each phase. Findings from the user testing phase indicate Diabetes Journey is a user-friendly mHealth program with high usability that holds promise for enhancing adolescents' T1D self-management. Implications for future designers and researchers are discussed regarding the social dimension of the sociotechnical-pedagogical usability framework. An extension to the framework is proposed to extend the social dimension to include socio-cultural and contextual considerations when designing mHealth applications. Consideration of the pedagogical and sociocultural dimensions of learning is imperative when developing psychoeducational interventions.
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Affiliation(s)
- Matthew Schmidt
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Jie Lu
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Wenjing Luo
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Li Cheng
- Worcester Polytechnic Institute, Worcester, USA
| | - Minyoung Lee
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Rui Huang
- College of Education, University of Florida, 2423 Norman Hall, PO BOX 117048, Gainesville, FL 32611 USA
| | - Yueqi Weng
- College of Education, Purdue University, West Lafayette, USA
| | | | - Sarah D. Corathers
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | | | | | - Laura Smith
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sarah Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | | | - Leah Heckaman
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
| | - Sara E. Wetter
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Kimberly A. Driscoll
- University of Florida Diabetes Institute, Gainesville, USA
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, USA
| | - Avani Modi
- Cincinnati Children’s Hospital Medical Center, University of Cincinnati, Cincinnati, USA
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11
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical Activity and Nutrition Interventions for Type 1 Diabetes: A Meta-analysis. Pediatrics 2022; 150:188758. [PMID: 35953465 DOI: 10.1542/peds.2022-056540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Current evidence is lacking on physical activity and nutrition-based interventions focusing on the management of type 1 diabetes mellitus (T1DM) and health-related quality of life among children. To assess the effects of physical activity interventions and nutrition-based interventions for children with T1DM. METHODS Data sources include the Cochrane Central Register of Controlled Trials, Medline, clinicaltrials.gov, the World Health Organization International Clinical Trials Registry Platform, CINAHL through January 2022. Study selection includes randomized controlled trials of children aged 18 years and below with T1DM comparing either a physical activity intervention, a nutrition-based intervention, or hybrid physical activity and nutrition-based intervention with placebo or no-treatment control. Data were pooled using a random-effects model. Primary outcomes were hemoglobin A1c (HbA1c), and health-related quality of life. RESULTS Eighteen trials were included. Physical activity compared with the no-treatment group showed a lack of effect on HbA1c (mean difference = -0.58, 95% confidence interval -1.20 to 0.05; P value = .07). Nutrition-based intervention compared with no-treatment control for HbA1c level revealed a lack of effect (mean difference = -0.61, 95% confidence interval -1.48 to 0.26; P value = .17). Limitations include paucity of studies and low quality of evidence caused by the risk of bias. CONCLUSIONS Despite the lack of significant evidence, the generally favorable results highlight the potential of such interventions in enhancing glycemic control and health-related quality of life. Additionally, promising results from a single physical activity-nutrition-based hybrid intervention in terms of glycemic control indicate the plausible effectiveness of a mixed intervention.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies.,National University Health System, Singapore
| | | | - Evelyn C Law
- Departments of Pediatrics.,National University Health System, Singapore.,Translational Neuroscience Program, Agency for Science, Technology, and Research, Singapore Institute for Clinical Sciences, Singapore
| | - John C M Wong
- Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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12
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Pembroke S, Cody D, Roche EF, Sleath B, Hilliard C, Brenner M, Coyne I. Encouraging adolescents' participation during paediatric diabetes clinic visits: Design and development of a question prompt list intervention. Diabetes Res Clin Pract 2022; 190:109985. [PMID: 35809690 DOI: 10.1016/j.diabres.2022.109985] [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: 05/10/2022] [Revised: 06/27/2022] [Accepted: 07/04/2022] [Indexed: 11/30/2022]
Abstract
AIMS To investigate adolescents' communication with healthcare providers (HCPs) and co- design a question prompt list as one part of an intervention to increase patient participation and communication at diabetes clinic visits. METHODS Using an adolescent-led co-design approach we conducted interviews and focus groups with adolescents, parents, and healthcare providers (HCPs) and held workshops with both a Youth Advisory Group (YAG) and a Parent Advisory Group (PAG). RESULTS Adolescents and parents identified challenges categorised into four themes: negative experience communicating with HCPs, lacking patient education leading to disinterest, low self-confidence out of fear of being wrong and forgetting to ask question(s). Adolescents identified that a Question Prompt List (QPL) could help them to ask questions, be more confident and participate more. The design process was an iterative development that engaged all stakeholders. Parents and HCPs assumed adolescents had greater knowledge about diabetes than they had in reality. CONCLUSIONS Divergence in perceptions between adults and adolescents regarding patient knowledge of diabetes care demonstrates the importance of encouraging adolescents to ask the questions that matter to them. The QPL could be a useful means of supporting adolescents to actively participate in clinic encounters with healthcare providers.
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Affiliation(s)
- Sinead Pembroke
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
| | - Declan Cody
- Children's Health Ireland Crumlin, Cooley Road, Dublin 12, Ireland
| | - Edna F Roche
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland and Children's Health Ireland, Tallaght, Tallaght, Dublin 24, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Carol Hilliard
- Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland and University College Dublin, Belfield, Dublin 4, Ireland
| | - Maria Brenner
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Imelda Coyne
- Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland.
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13
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Moe-Byrne T, Knapp P, Perry D, Achten J, Spoors L, Appelbe D, Roche J, Martin-Kerry JM, Sheridan R, Higgins S. Does digital, multimedia information increase recruitment and retention in a children's wrist fracture treatment trial, and what do people think of it? A randomised controlled Study Within A Trial (SWAT). BMJ Open 2022; 12:e057508. [PMID: 35831055 PMCID: PMC9280884 DOI: 10.1136/bmjopen-2021-057508] [Citation(s) in RCA: 3] [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: 12/02/2022] Open
Abstract
OBJECTIVES To evaluate digital, multimedia information (MMI) for its effects on trial recruitment, retention, decisions about participation and acceptability by patients, compared with printed information. DESIGN Study Within A Trial using random cluster allocation within the Forearm Fracture Recovery in Children Evaluation (FORCE) study. SETTING Emergency departments in 23 UK hospitals. PARTICIPANTS 1409 children aged 4-16 years attending with a torus (buckle) fracture, and their parents/guardian. Children's mean age was 9.2 years, 41.0% were female, 77.4% were ethnically White and 90.0% spoke English as a first language. INTERVENTIONS Participants and their parents/guardian received trial information either via multimedia, including animated videos, talking head videos and text (revised for readability and age appropriateness when needed) on tablet computer (MMI group; n=681), or printed participant information sheet (PIS group; n=728). OUTCOME MEASURES Primary outcome was recruitment rate to FORCE. Secondary outcomes were Decision-Making Questionnaire (nine Likert items, analysed summatively and individually), three 'free text' questions (deriving subjective evaluations) and trial retention. RESULTS MMI produced a small, not statistically significant increase in recruitment: 475 (69.8%) participants were recruited from the MMI group; 484 (66.5%) from the PIS group (OR=1.35; 95% CI 0.76 to 2.40, p=0.31). A total of 324 (23.0%) questionnaires were returned and analysed. There was no difference in total Decision-Making Questionnaire scores: adjusted mean difference 0.05 (95% CI -1.23 to 1.32, p=0.94). The MMI group was more likely to report the information 'very easy' to understand (89; 57.8% vs 67; 39.4%; Z=2.60, p=0.01) and identify information that was explained well (96; 62.3% vs 71; 41.8%). Almost all FORCE recruits were retained at the 6 weeks' timepoint and there was no difference in retention rate between the information groups: MMI (473; 99.6%); PIS (481; 99.4%). CONCLUSIONS MMI did not increase recruitment or retention in the FORCE trial, but participants rated multimedia as easier to understand and were more likely to evaluate it positively. TRIAL REGISTRATION NUMBER ISRCTN73136092 and ISRCTN13955395.
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Affiliation(s)
| | - Peter Knapp
- Health Sciences and the Hull York Medical School, University of York, York, UK
| | | | | | - Louise Spoors
- NDORMS, University of Oxford, Oxford, UK
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Jenny Roche
- Health Sciences, University of York, York, UK
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14
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Rabbone I, Savastio S, Pigniatiello C, Carducci C, Berioli MG, Cherubini V, Lo Presti D, Maltoni G, Mameli C, Marigliano M, Minuto N, Mozzillo E, Piccinno E, Predieri B, Rigamonti A, Ripoli C, Schiaffini R, Lombardo F, Tinti D, Toni S, Zanfardino A, Scaramuzza AE. Significant and persistent improvements in time in range and positive emotions in children and adolescents with type 1 diabetes using a closed-loop control system after attending a virtual educational camp. Acta Diabetol 2022; 59:837-842. [PMID: 35312860 PMCID: PMC8935105 DOI: 10.1007/s00592-022-01878-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the six-month impact of the advanced automated functions of a closed-loop control (CLC) system (Control-IQ) and a virtual educational camp (vEC) on emotions and time in range (TIR) of children and adolescents with type 1 diabetes. METHODS Children and their parents participated in a three-day vEC. Clinical, glucose, and emotion data were evaluated before, just after, and six months after the vEC. Emotions were evaluated using adapted Plutchik's and Geneva Emotion Wheels. RESULTS Forty-three children and adolescents (7-16 years) showed significant improvements in positive emotions immediately and six months after the vEC (67% and 65% vs 38%, p < 0.05, respectively), while mixed emotions were reduced (32% and 15% vs 61%, p < 0.05 and p < 0.001, respectively). The median percentage TIR increased from 64% (IQR 54-72) to 75% (IQR 70-82) with Control-IQ (p < 0.001) six months after the vEC. CONCLUSIONS Positive emotions (joy, serenity, and satisfaction) significantly improved while mixed emotions were significantly worse six months after the initiation of a CLC system (Control-IQ) and a vEC.
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Affiliation(s)
- Ivana Rabbone
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Silvia Savastio
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | - Ciro Pigniatiello
- Department of Health and Science, University of Piemonte Orientale, Novara, Italy
| | | | | | - Valentino Cherubini
- Department of Women's and Children's Health, G. Salesi Hospital, Ancona, Italy
| | | | - Giulio Maltoni
- Pediatric Unit, IRCCS, Azienda Ospedaliero-Universitaria, Bologna, Italy
| | - Chiara Mameli
- Department of Pediatrics, Buzzi Children's Hospital, Università Di Milano, Milan, Italy
| | - Marco Marigliano
- Pediatric Diabetes and Metabolic Disorders Unit, University of Verona, Verona, Italy
| | | | - Enza Mozzillo
- Department of Translational Medical Science, Section of Pediatrics, Regional Center of Pediatric Diabetes, University of Naples Federico II, Napoli, Italy
| | - Elvira Piccinno
- Metabolic Diseases and Diabetology, Children's Hospital Giovanni XXIII, Bari, Italy
| | - Barbara Predieri
- Department of Medical and Surgical Sciences of the Mother, Children and Adults, University of Mdena and Reggio Emilia, Modena, Italy
| | - Andrea Rigamonti
- Department of Pediatrics, Diabetes Research Institute, San Raffaele Institute, Milano, Italy
| | - Carlo Ripoli
- Department of Pediatrics and Microcythemia, ARNAS G. Brotzu, Cagliari, Italy
| | | | - Fortunato Lombardo
- Department of Human Pathology in adult and developmental age, University of Messina, Messina, Italy
| | - Davide Tinti
- Department of Pediatrics, University of Torino, Torino, Italy
| | - Sonia Toni
- Pediatric Diabetology and Endocrinology Unit, Meyer Children's Hospital, Firenze, Italy
| | - Angela Zanfardino
- Regional Center of Pediatric Diabetology, University of Campania "L. Vanvitelli", Napoli, Italy
| | - Andrea Enzo Scaramuzza
- Pediatric Diabetes, Endocrinology and Nutrition, Division of Pediatrics, ASST Cremona, Cremona, Italy.
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15
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Granado-Casas M, Solà I, Hernández M, Rojo-López MI, Julve J, Mauricio D. Effectiveness of medical nutrition therapy in adolescents with type 1 diabetes: a systematic review. Nutr Diabetes 2022; 12:24. [PMID: 35459205 PMCID: PMC9033775 DOI: 10.1038/s41387-022-00201-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/23/2022] [Accepted: 04/07/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Medical nutrition therapy (MNT) has an integral role in overall diabetes management. During adolescence, consideration of physiological and psychosocial changes is essential for implementing an optimal diabetes treatment. OBJECTIVES Our aim was to identify, summarize, and interpret the published literature about MNT in adolescents with type 1 diabetes. METHODS The Medline (PubMed) and EMBASE databases were searched from January 1959 to December 2021. The inclusion criteria were interventional studies with MNT in adolescents with type 1 diabetes with a disease duration over 1 year, including the following outcomes: dietary intake and daily eating patterns (assessed with validated tools, two or more 24 h dietary recall or 3-day dietary records), the diabetes self-management education and support (DSMES), glycemic control, lipid profile and body mass index (BMI). The exclusion criteria were studies without a control group (except for pre-post studies), the lack of randomization and those studies that assessed only a single nutrient, food or meal consumption, as well as reviews, and in-vitro/in-vivo studies. The risk of bias assessment was performed using the Cochrane risk-of-bias tool for randomized trials. A narrative synthesis was performed to present the results. The quality of evidence was assessed with the GRADE guidance. RESULTS From a total of 5377 records, 12 intervention studies (9 RCT and 3 pre-post intervention studies) were included. The data were assessed in order to perform a meta-analysis; however, the studies were too heterogeneous. The studies showed conflicting results about the effectiveness of MNT on dietary pattern, DSMES, glycemic control, lipid profile and BMI. CONCLUSIONS Clinical research studies on the effectiveness of MNT in adolescents with type 1 diabetes are scarce. The limited number of studies with a high risk of bias precludes establishing robust conclusions on this issue. Further research is warranted.
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Affiliation(s)
- Minerva Granado-Casas
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Ivan Solà
- Institut d'Investigació Biomèdica Sant Pau (IIB Sant Pau), 08041, Barcelona, Spain.,Center for Biomedical Research on Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
| | - Marta Hernández
- Lleida Institute for Biomedical Research Dr. Pifarré Foundation IRBLleida, University of Lleida, Lleida, Spain.,Department of Endocrinology and Nutrition, University Hospital Arnau de Vilanova, Lleida, Spain
| | - Marina Idalia Rojo-López
- Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Josep Julve
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain.,Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Didac Mauricio
- Center for Biomedical Research on Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III, Barcelona, Spain. .,Department of Endocrinology and Nutrition, Hospital de la Santa Creu i Sant Pau & Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain. .,Faculty of Medicine, University of Vic (UVIC/UCC), Vic, Spain.
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16
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Garner K, Boggiss A, Jefferies C, Serlachius A. Digital health interventions for improving mental health outcomes and wellbeing for youth with type 1 diabetes: A systematic review. Pediatr Diabetes 2022; 23:258-269. [PMID: 34913548 DOI: 10.1111/pedi.13304] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/04/2021] [Accepted: 12/09/2021] [Indexed: 01/20/2023] Open
Abstract
Digital health interventions are a promising alternative to face-to-face psychosocial interventions that may improve psychological outcomes in youth with diabetes. Several reviews have explored the efficacy of digital health interventions for adults and youth with some chronic health conditions; however, their efficacy among youth with type 1 diabetes is not known. This systematic review aims to assess digital health interventions targeting both psychological and physical health outcomes in youth with type 1 diabetes as well as to evaluate study quality and efficacy, and provide directions for future research in this area. Relevant studies were identified through searches conducted in MEDLINE, Embase, APA PsycInfo, Scopus, Cochrane Central, and CINAHL Plus up until February 2021. Studies were included if they were randomized; reported at least one psychological outcome that was assessed at ≥2 time points; included a digital health intervention; and were conducted in youth aged 5 to 25 years with type 1 diabetes. The revised Cochrane risk-of-bias (RoB 2) tool was used to assess risk of bias. Of the 5159 articles found, 15 met the inclusion criteria and were included in the review. Self-efficacy improved in 2 of the 3 studies which assessed self-efficacy; however, no consistent improvements were found for other psychological, behavioral, or physical outcomes. All studies showed some risk of bias concerns. More research is needed to make firm conclusions on the efficacy of digital health interventions for youth with diabetes. More specifically, interventions based on psychological theories are needed and studies of higher quality methodologies.
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Affiliation(s)
- Katie Garner
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Anna Boggiss
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Liggins Institute, University of Auckland, Auckland, New Zealand.,Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, School of Medicine, University of Auckland, Auckland, New Zealand
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17
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Cabral MD, Patel DR, Greydanus DE, Deleon J, Hudson E, Darweesh S. Medical perspectives on pediatric sports medicine–Selective topics. Dis Mon 2022; 68:101327. [DOI: 10.1016/j.disamonth.2022.101327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Rohilla L, Kaur S, Duggal M, Malhi P, Bharti B, Dayal D. Diabetes Self-Management Education and Support to Improve Outcomes for Children and Young Adults With Type 1 Diabetes: An Umbrella Review of Systematic Reviews. Sci Diabetes Self Manag Care 2021; 47:332-345. [PMID: 34338051 DOI: 10.1177/26350106211031809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. METHODS An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. RESULTS Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. CONCLUSION The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.
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Affiliation(s)
- Latika Rohilla
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Sukhpal Kaur
- National Institute of Nursing Education, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Mona Duggal
- Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Prahbhjot Malhi
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Bhavneet Bharti
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Devi Dayal
- Department of Pediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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19
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Dunkel L, Fernandez-Luque L, Loche S, Savage MO. Digital technologies to improve the precision of paediatric growth disorder diagnosis and management. Growth Horm IGF Res 2021; 59:101408. [PMID: 34102547 DOI: 10.1016/j.ghir.2021.101408] [Citation(s) in RCA: 3] [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: 04/07/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/27/2022]
Abstract
Paediatric disorders of impaired linear growth are challenging to manage, in part because of delays in the identification of pathological short stature and subsequent referral and diagnosis, the requirement for long-term therapy, and frequent poor adherence to treatment, notably with human growth hormone (hGH). Digital health technologies hold promise for improving outcomes in paediatric growth disorders by supporting personalisation of care, from diagnosis to treatment and follow up. The value of automated systems in monitoring linear growth in children has been demonstrated in Finland, with findings that such a system is more effective than a traditional manual system for early diagnosis of abnormal growth. Artificial intelligence has potential to resolve problems of variability that may occur during analysis of growth information, and augmented reality systems have been developed that aim to educate patients and caregivers about growth disorders and their treatment (such as injection techniques for hGH administration). Adherence to hGH treatment is often suboptimal, which negatively impacts the achievement of physical and psychological benefits of the treatment. Personalisation of adherence support necessitates capturing individual patient adherence data; the use of technology to assist with this is exemplified by the use of an electronic injection device, which shares real-time recordings of the timing, date and dose of hGH delivered to the patient with the clinician, via web-based software. The use of an electronic device is associated with high levels of adherence to hGH treatment and improved growth outcomes. It can be anticipated that future technological advances, coupled with continued 'human interventions' from healthcare providers, will further improve management of paediatric growth disorders.
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Affiliation(s)
- Leo Dunkel
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London Medical School, 1st Floor, John Vane Science Centre, Charterhouse Square, London ECe1M 6BQ, UK.
| | | | - Sandro Loche
- SSD Pediatric Endocrinology and Neonatal Screening Centre, Microcitemico Pediatric Hospital, ARNAS G. Brotzu, via Jenner, 09121 Cagliari, Italy.
| | - Martin O Savage
- Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Charterhouse Square, London EC1M 6BQ, UK.
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20
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Knapp P, Mandall N, Hulse W, Roche J, Moe-Byrne T, Martin-Kerry J, Sheridan R, Higgins S. Evaluating the use of multimedia information when recruiting adolescents to orthodontics research: A randomised controlled trial. J Orthod 2021; 48:343-351. [PMID: 34227411 PMCID: PMC8652365 DOI: 10.1177/14653125211024250] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective: To compare two methods of providing information about the Bone Anchored Maxillary Protraction (BAMP) trial: standard printed information and multimedia websites, for their quality and ease of understanding, and impact on decision-making. Design: Randomised controlled trial. Setting: Orthodontic outpatient clinic in the UK. Methods: Participants were 109 adolescents (aged 11–14 years) attending for orthodontic treatment. While awaiting treatment they were asked to imagine being recruited to the BAMP clinical trial. They were individually randomised to receive the printed or the multimedia website information (comprising text, animations and ‘talking head’ videos). After reading or viewing the information, they completed a 9-item Likert scale Decision-Making Questionnaire (DMQ) (score range 0–36) plus three free-text questions on their evaluation of the information. Results: A total of 104 participants completed the questionnaire. Mean total DMQ scores were higher (more positive) in the website group (28.1 vs. 27.0), although the difference was small and not statistically significant (P = 0.20). Analysis of individual questionnaire items showed two statistically significant differences: the website information had higher ratings on ‘easy to understand’ (Z = 3.03; P = 0.003) and ‘confidence in decision-making’ (Z = 2.00; P = 0.044). On the three free-text questions, more positive and fewer negative comments were made about the websites than the printed information. Conclusion: In this hypothetical trial setting, adolescent patients found that trial information conveyed on a multimedia website was easier to understand and made them more confident in their decision about trial participation. Their subjective evaluations of the website were also more positive and less negative than about the printed information. Multimedia information has the potential to increase the quality of engagement and information exchange when seeking consent for research.
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Affiliation(s)
- Peter Knapp
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK
| | - Nicky Mandall
- Tameside General Hospital, Ashton-under-Lyne, Tameside, UK
| | - Wendy Hulse
- Tameside General Hospital, Ashton-under-Lyne, Tameside, UK
| | - Jenny Roche
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
| | - Thirimon Moe-Byrne
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
| | - Jacqueline Martin-Kerry
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
| | - Rebecca Sheridan
- Department of Health Sciences & the Hull York Medical School, University of York, York, UK.,Department of Health Sciences, University of York, York, UK
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Maharaj A, Lim D, Murphy R, Serlachius A. Comparing Two Commercially Available Diabetes Apps to Explore Challenges in User Engagement: Randomized Controlled Feasibility Study. JMIR Form Res 2021; 5:e25151. [PMID: 34132640 PMCID: PMC8277312 DOI: 10.2196/25151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/16/2020] [Accepted: 05/07/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Diabetes apps represent a promising addition to face-to-face self-management interventions, which can be time and resource intensive. However, few randomized controlled trials have evaluated the efficacy of diabetes apps, in particular as a stand-alone intervention without additional clinical support. OBJECTIVE We used a feasibility randomized trial design to investigate differences in user engagement between 2 commercially available apps (free versions of Glucose Buddy and mySugr) over 2 weeks in adults with type 2 diabetes. Feasibility was assessed based on recruitment uptake, adherence to the diabetes apps, and follow-up rates. We also hypothesized that the diabetes app mySugr would demonstrate higher user engagement at follow-up due to its use of gamification. We also predicted higher user engagement would be associated with improved self-care behaviors and illness beliefs. METHODS Adults with type 2 diabetes attending outpatient diabetes clinics in Auckland were recruited and randomized (1:1 without blinding) to use either the Glucose Buddy or mySugr diabetes apps. User engagement, self-care behaviors, and illness beliefs were measured 2 weeks after baseline. Spearman rank correlations, Mann-Whitney tests, and Wilcoxon signed-rank tests were used to explore associations between the outcome measures and to investigate possible changes between and within groups. Six participants were interviewed to further explore acceptability and usability. RESULTS In total, 58 participants (29 per group) completed the 2-week follow-up, of whom only 38 reported using the apps (Glucose Buddy: n=20; mySugr: n=18). Both groups reported low engagement (Glucose Buddy: median 4 days; mySugr: median 6.5 days; P=.06; use for both groups: median 10 minutes). No changes were observed in self-care or illness beliefs in either group. Out of the self-care behaviors, only blood glucose testing was significantly associated with minutes of app use (P=.02). The interviews suggested that although both apps were deemed acceptable, they were generally viewed as time-consuming and too complicated to use. CONCLUSIONS Low engagement with both Glucose Buddy and mySugr reflect the challenges associated with engaging users with diabetes apps. Due to low engagement and loss to follow-up, the changes in outcome measures should be interpreted with caution. The results highlight the need for more clinical support as well as involvement from end users and behavior change specialists in order to incorporate evidence-based behavior change techniques to motivate and provide value to users. TRIAL REGISTRATION Australia New Zealand Clinical Trials Registry ACTRN12618000424202; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=374671.
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Affiliation(s)
- Alita Maharaj
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - David Lim
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Rinki Murphy
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Anna Serlachius
- Department of Psychological Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
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22
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Handu D, Piotrowski M. Nutrition Interventions in Pediatric Patients with Type 1 Diabetes: An Evidence Analysis Center Scoping Review. J Acad Nutr Diet 2021; 122:424-431. [PMID: 33865801 DOI: 10.1016/j.jand.2021.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 11/28/2022]
Abstract
The objective of this scoping review was to identify and characterize studies examining the effect of nutrition management interventions and effectiveness of medical nutrition therapy to improve nutrition-related outcomes in children and adolescents with type 1 diabetes. An in-depth electronic search was conducted by a medical librarian in six databases: Medline, Embase, Cochrane Central Register of Controlled Trials, PsycINFO, The Cumulative Index to Nursing and Allied Health Literature, and Web of Science Core Collection. The literature search resulted in 5,122 records, and five records were identified through hand search. Of these 5,127 records, 22 articles and eight systematic reviews met our inclusion criteria. An equal number of the studies were experimental (ie, randomized or nonrandomized controlled trials, or noncontrolled trials) (n = 11) and observational (cohort, case-control, and cross-sectional) (n = 11) with the remaining studies being systematic reviews/meta-analyses (n = 8). Most of these studies were conducted in United States or Europe. Based on this scoping review, the majority of studies focus on either carbohydrate counting or evaluation of dietary intake patterns with little emphasis on tailored patient education/counseling services specifically designed to meet a young child's or his/her family's individual needs. Indeed, only four studies in this scoping review used dietary counseling and/or medical nutrition therapy. As such, there remains a significant gap in the literature as it relates to the efficacy and long-term management implications of tailored nutrition interventions in young children with type 1 diabetes.
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Affiliation(s)
- Deepa Handu
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL.
| | - Megan Piotrowski
- Evidence Analysis Center, Academy of Nutrition and Dietetics, Chicago, IL; Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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de Oliveira FM, Calliari LEP, Feder CKR, de Almeida MFO, Pereira MV, de Almeida Fagundes Alves MTT, Garcia SAD, Reis LDD, Salles JEN. Efficacy of a glucose meter connected to a mobile app on glycemic control and adherence to self-care tasks in patients with T1DM and LADA: a parallel-group, open-label, clinical treatment trial. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2021; 65:185-197. [PMID: 33905630 DOI: 10.20945/2359-3997000000334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Objective The main aim of the study was to evaluate the patients' glycemic control and adherence to self-care tasks. Methods Patients with type 1 diabetes mellitus (T1DM) or latent autoimmune diabetes of the adult (LADA) using a multiple daily injection (MDI) regimen with carbohydrate counting (n = 25, Subgroup B) or fixed insulin dose (n = 25, Subgroup C) were allocated to use the application (app) for 12 weeks. Both subgroups were compared with each other and against a control group (n = 25, Group A) comprising patients with T1DM or LADA treated with continuous subcutaneous insulin infusion (CSII) in a parallel-group, open-label, clinical treatment trial. All patients had glycated hemoglobin (A1C) levels measured and were asked to fill out the Diabetes Self-Management Profile (DSMP) questionnaire at study start and end. The patients were instructed to measure capillary glucose six times daily in study weeks 4, 8, and 12. Results Mean A1C levels decreased 0.725% in Subgroup C in intragroup analysis (p = 0.0063), and had a mean variation of 0.834% compared with Group A (p = 0.003). Mean DSMP scores increased 5.77 points in Subgroup B in intragroup analysis (p = 0.0004) and increased by a mean of 6.815 points in relation to Group A (p = 0.002). Conclusion OneTouch Reveal improved both A1C levels and DSMP scores in patients with T1DM or LADA compared with standard treatment (CSII).
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24
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Shorey S, Ng ED, Law EC, Wong JCM, Loke KY, Tam WWS. Physical activity interventions and nutrition-based interventions for children and adolescents with type 1 diabetes mellitus. Hippokratia 2021. [DOI: 10.1002/14651858.cd013858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Evelyn C Law
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
- Translational Neuroscience Programme; Agency for Science, Technology and Research Singapore Institute for Clinical Sciences; Singapore Singapore
| | - John CM Wong
- Department of Psychological Medicine; Yong Loo Lin School of Medicine, National University of Singapore; Singapore Singapore
| | - Kah Yin Loke
- Paediatrics, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
| | - Wilson Wai San Tam
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine; National University of Singapore, National University Health System; Singapore Singapore
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Prasad H, Lohiya N, White S, Prasanna B, Sangalalingam T, Krishnamoorthy N. Utility of an Internet-based short message service in the care of children and adolescents with type 1 diabetes mellitus. JOURNAL OF DIABETOLOGY 2021. [DOI: 10.4103/jod.jod_65_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Quirk H, Heller B, Wright N. Feasibility and Acceptability of Physical Activity Monitoring as an Educational Tool in Management of Pediatric Type 1 Diabetes. Can J Diabetes 2020; 44:688-696. [PMID: 33023835 DOI: 10.1016/j.jcjd.2020.06.013] [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: 03/23/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The spontaneous, sporadic and sometimes unpredictable nature of children's physical activity causes fluctuations in blood glucose level and challenges for children with type 1 diabetes. Physical activity monitoring has potential utility. In this study, we explored the perceptions of physical activity monitoring among health-care professionals and assessed the feasibility and acceptability of using it in the management of pediatric type 1 diabetes. METHODS Seven health-care professionals from 1 pediatric diabetes centre in the United Kingdom were involved in a focus group. Data were analyzed thematically. Physical activity monitoring using a wrist-worn monitor was tested for feasibility with 13 children aged 7 to 11 years with type 1 diabetes. The primary outcome was feasibility (i.e. recruitment, adherence, data completion, adverse events and acceptability). Secondary measures were glycemic control, parental self-efficacy for diabetes management and parental fear of hypoglycemia. RESULTS Health-care professionals valued having an awareness of the level, type and intensity of children's physical activity. They identified unmet training and resource needs that would facilitate them in being able to give physical activity advice to children and families. Recruitment rate was 20%, adherence to the activity monitoring was good and the study completion rate was 62%. No adverse events were reported. Physical activity monitoring was considered acceptable by parents. CONCLUSIONS Physical activity monitoring could be a feasible part of routine clinical practice, but further research is needed to understand whether health-care professionals are best placed to implement it and what impact it has on health outcomes.
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Affiliation(s)
- Helen Quirk
- Academy of Sport and Physical Activity, Sheffield Hallam University, United Kingdom.
| | - Ben Heller
- Sports Engineering Research Group (SERG), Sport and Physical Activity Research Centre, Advanced Wellbeing Research Centre, Sheffield Hallam University, United Kingdom
| | - Neil Wright
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
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Lau Y, Chee DGH, Chow XP, Wong SH, Cheng LJ, Lau ST. Humanoid robot-assisted interventions among children with diabetes: A systematic scoping review. Int J Nurs Stud 2020; 111:103749. [PMID: 32911362 DOI: 10.1016/j.ijnurstu.2020.103749] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 08/03/2020] [Accepted: 08/08/2020] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although the humanoid robot is highly engaging for children, whether humanoid robot-assisted interventions could help in diabetes management is still unclear. OBJECTIVES This review aimed to elucidate the roles of humanoid robot in managing diabetes and observe the effects of humanoid robot-assisted interventions among children with type I diabetes mellitus. METHODS Arksey and O'Malley's methodological framework was used to conduct this scoping review. DATA RESOURCE We conducted a comprehensive search in 10 databases, including IEEE Xplore Digital Library, CINAHL, Cochrane Library, EMBASE, PubMed, Scopus, Web of Science, ProQuest, WanFang, and CNKI, from May 1, 1989 to February 1, 2020. The reference lists of key texts were examined and citation chaining was conducted. In addition, our team searched gray literature and relevant journals to maximise the searching. REVIEW METHODS Two independent reviewers examined all full articles for fitness with the eligibility criteria. Items of data extraction included the characteristics of articles, description of intervention, and mechanism of humanoid robot in improving the management of children with diabetes. RESULTS A total of 2,755 articles were retrieved, 22 of which were included from five countries across different ethnicities. Five roles of humanoid robots in managing diabetes among children with type I diabetes mellitus were identified: disease manager, educator, advocator, emotional supporter, and communicator. To some extent, effects seem to be related to the positive improvement of affective, experiential, relational, cognitive, and behavioral perspectives from humanoid robot-assisted intervention. CONCLUSIONS The roles of humanoids have been designed to perform their multidomain functionality. Although many positive effects were observed, the majority of selected articles have methodological issues. Future studies need an improved methodology for large-scale controlled trials.
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Affiliation(s)
- Ying Lau
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive 117597, Singapore.
| | | | - Xue Ping Chow
- Staff Nurse I, Nursing Division, Singapore General Hospital, SingHealth, Singapore.
| | - Sai Ho Wong
- Nursing student, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
| | - Ling Jie Cheng
- Nursing Research Unit, Department of Nursing, Khoo Teck Puat Hospital, Yishun Health Campus, National Healthcare Group, Singapore.
| | - Siew Tiang Lau
- Associate Professor, Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Abstract
As avid users of technology, adolescents are a key demographic to engage when designing and developing technology applications for health. There are multiple opportunities for improving adolescent health, from promoting preventive behaviors to providing guidance for adolescents with chronic illness in supporting treatment adherence and transition to adult health care systems. This article will provide a brief overview of current technologies and then highlight new technologies being used specifically for adolescent health, such as artificial intelligence, virtual and augmented reality, and machine learning. Because there is paucity of evidence in this field, we will make recommendations for future research.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.,Division of Hematology, Oncology, Neurooncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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29
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Rey Velasco E, Pals RAS, Skinner TC, Grabowski D. Pre-empting the challenges faced in adolescence: A systematic literature review of effects of psychosocial interventions for preteens with type 1 diabetes. Endocrinol Diabetes Metab 2020; 3:e00120. [PMID: 32318638 PMCID: PMC7170454 DOI: 10.1002/edm2.120] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/03/2020] [Accepted: 02/09/2020] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Numerous psychosocial interventions have been conducted in children and adolescents with type 1 diabetes, aiming to improve their self-management and autonomy acquisition. However, these tend to address family conflict and parental perspectives, and a scarce number of interventions explore the outcomes among preteens. This review examined the outcomes of psychosocial interventions for preteens with type 1 diabetes, as an under-researched field to date. METHODS A systematic literature review of intervention studies with randomized controlled trial design, targeting preteens with type 1 diabetes, was conducted. Six databases were searched for publication periods from 1995 to October 2019. Quality of the interventions according to the International Society for Pediatric and Adolescent Diabetes (ISPAD), as well as reporting and effect sizes, were assessed. RESULTS Twelve studies were selected, covering ten interventions. According to the topics identified, four of these interventions were categorized as self-care programmes, three as psychosocial programmes and three as mixed. All of the interventions, except for one, covered ≥50% of the ISPAD recommendations. Reporting adequacy was negative only in one intervention. Main outcomes were glycemic control and self-management, but effect sizes could only be calculated for half of the interventions with no overall significant effect. CONCLUSIONS This review shows a lack of adequate psychosocial interventions targeting preteens with type 1 diabetes and actively involving them as participants. These intervention's educational programmes and methods should be standardized to guarantee successful results. New technologies and peer support implementation could be a promising pathway when designing these studies.
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Affiliation(s)
| | - Regitze Anne Saurbrey Pals
- Steno Diabetes Center CopenhagenGentofteDenmark
- Department of PsychologyUniversity of CopenhagenKøbenhavn KDenmark
| | - Timothy Charles Skinner
- Steno Diabetes Center CopenhagenGentofteDenmark
- Department of PsychologyUniversity of CopenhagenKøbenhavn KDenmark
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30
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Smartphone App as Motivational Intervention to Improve Glycemic Control in Adolescents with Type 1 Diabetes. Indian J Pediatr 2019; 86:1118-1123. [PMID: 31353430 DOI: 10.1007/s12098-019-03035-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 07/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Type 1 diabetes (T1D) adolescents often do not achieve good glycemic control. In the context of growing number of technologically savvy adolescents, this study was done to examine the effectiveness of a motivational smartphone app to improve their glycemic control. METHODS Eleven to eighteen year old adolescents, treated by Pediatric endocrine team of CMC, Vellore, who had T1D ≥ 1 y duration with poor glycemic control (mean HbA1c ≥ 8.5% in preceding 12 mo) were recruited. An app programmed to provide 3 reminders per day regarding insulin, meals and physical exercise was installed on their phone. Diabetes management was continued as per the standard of care. HbA1C was measured after 3 mo. RESULTS Thirty seven adolescents were recruited; 3 were excluded as the app became non-functional. Seventeen were boys, mean age was 13.8 y (11-18 y) and mean duration of diabetes was 4.9 y (0.8-16 y). The mean HbA1c levels over preceding 12 mo and at recruitment were 10.75% (1.88) and 10.6% (2.08) respectively. Twenty eight participants returned for repeat HbA1C after 3-4 mo. As compared to baseline there was significant reduction in HbA1c level: 10.6% (2.08) vs. 9.65% (1.6); p = 0.004. Twenty two of twenty eight participants showed reduction in HbA1c after app installation. The magnitude of change in HbA1c levels over a 3 mo period before and after the app use was analyzed. There was significant difference between mean HbA1c levels before and after app use; +0.28 (2.06) vs. -0.914 (1.52); p = 0.019. CONCLUSIONS Following usage of smartphone app as a motivational intervention in adolescents with Type 1 diabetes, there was significant reduction in HbA1c level after 3 mo. With continued use, this may benefit them to achieve target HbA1c levels. Use of mobile phone apps as motivational interventions is feasible in adolescents with Type 1 diabetes in India.
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Knox E, Glazebrook C, Randell T, Leighton P, Guo B, Greening J, Davies EB, Amor L, Blake H. SKIP (Supporting Kids with diabetes In Physical activity): Feasibility of a randomised controlled trial of a digital intervention for 9-12 year olds with type 1 diabetes mellitus. BMC Public Health 2019; 19:371. [PMID: 30943939 PMCID: PMC6446303 DOI: 10.1186/s12889-019-6697-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 03/25/2019] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Physical activity and self-monitoring are important for children with type 1 diabetes mellitus (T1DM) but it is unclear whether interventions delivered online are feasible, acceptable to patients and efficacious. The aim was to assess the feasibility and acceptability of an internet-based physical activity and self-monitoring programme for children with T1DM, and of a randomised controlled trial (RCT) to evaluate efficacy. METHODS A total of 49 children aged 9-12 with T1DM were randomly assigned to usual care only or to an interactive intervention group combining a website (STAK-D) and a PolarActive activity watch (PAW; Polar Electro (UK) Ltd.), alongside usual care. Participants completed self-report measures on their health, self-efficacy and physical activity at baseline (T0), eight weeks (T1) and six months (T2). They also wore a PAW to measure physical activity for one week at the end of T0, T1 and T2. Intervention participants were interviewed about their experiences at T2. Explanatory variables were examined using multi-level modelling and examination of change scores, 95% confidence intervals and p-values with alpha set at 0.95. Descriptive analysis was undertaken of the 'end-of-study questionnaire'. Qualitative analysis followed a framework approach. RESULTS Completion rates for all self-report items and objective physical activity data were above 85% for the majority of measures. HbA1c data was obtained for 100% of participants, although complete clinical data was available for 63.3% to 63.5% of participants at each data collection time-point. Recruitment and data collection processes were reported to be acceptable to participants and healthcare professionals. Self-reported sedentary behaviour (-2.28, p=0.04, 95% CI=-4.40, -0.16; p = 0.04; dppc2 = 0.72) and parent-reported physical health of the child (6.15, p=0.01, 95%CI=1.75, 10.55; p = 0.01; dppc2 = 0.75) improved at eight weeks in the intervention group. CONCLUSIONS The trial design was feasible and acceptable to participants and healthcare providers. Intervention engagement was low and technical challenges were evident in both online and activity watch elements, although enjoyment was high among users. Reported outcome improvements were observed at 8 weeks but were not sustained. TRIAL REGISTRATION ISRCTN 48994721 (prospectively registered). Date of registration: 28.09.2016.
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Affiliation(s)
- Emily Knox
- University of Nottingham, School of Health Sciences, Nottingham, UK
| | - Cris Glazebrook
- University of Nottingham, School of Medicine, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, UK
| | | | - Paul Leighton
- University of Nottingham, School of Medicine, Nottingham, UK
| | - Boliang Guo
- University of Nottingham, School of Medicine, Nottingham, UK
| | - James Greening
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - E Bethan Davies
- University of Nottingham, School of Medicine, Nottingham, UK.,NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, UK
| | - Lori Amor
- NIHR MindTech MedTech Co-operative, Institute of Mental Health, University of Nottingham, Triumph Road, Nottingham, UK
| | - Holly Blake
- University of Nottingham, School of Health Sciences, Nottingham, UK. .,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
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