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Di Cianni F, Mastrolia MV, Biancalana E, Marinello D, Emmi G, Mosca M, Simonini G, Talarico R. Challenges and opportunities in transitional care process in Behçet's syndrome. Front Med (Lausanne) 2024; 11:1456063. [PMID: 39359917 PMCID: PMC11444993 DOI: 10.3389/fmed.2024.1456063] [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: 06/27/2024] [Accepted: 09/04/2024] [Indexed: 10/04/2024] Open
Abstract
Behçet's syndrome (BS) is a rare chronic multi-systemic inflammatory disorder that usually involves adults between third and fourth decades of life, while pediatric and juvenile onset are relatively rare. BS young patients (YP) often develop a full-blown disease late after onset, requiring careful diagnostic workup and regular follow-up while they grow up. In this regard, the purpose of transitional programs is to ensure continuous high-quality care to YP with chronic conditions, providing them with the skills necessary to become independent and empowered adults able to chronically self-manage their disease. EULAR/PReS released the first set of standards and recommendations for transitional care (TC) of YP with juvenile-onset rheumatic diseases, but the appropriate timing for transition, the tools to evaluate patients' readiness, and indicators of transition plans effectiveness still need to be identified. Although little is known regarding TC in BS, it is easy to assume that BS YP will benefit from developmentally and disease-specifically appropriate transition plans, which may promote continuity of care, improve perceived quality of life and prevent poor disease outcomes. This perspective article discusses the key concepts and the goals of TC, addressing the potential challenges and opportunities of TC for YP with BS in clinical practice.
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Affiliation(s)
- Federica Di Cianni
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - Maria Vincenza Mastrolia
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children’s Hospital IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Edoardo Biancalana
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Diana Marinello
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Giacomo Emmi
- Department of Medical, Surgery and Health Sciences, University of Trieste, Italy, and Clinical Medicine and Rheumatology Unit, Cattinara University Hospital, Trieste, Italy
- Centre for Inflammatory Diseases, Monash University Department of Medicine Monash Medical Centre, Melbourne, VIC, Australia
| | - Marta Mosca
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Gabriele Simonini
- Rheumatology Unit, ERN ReCONNET Center, Meyer Children’s Hospital IRCCS, Florence, Italy
- NEUROFARBA Department, University of Florence, Florence, Italy
| | - Rosaria Talarico
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
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Kallio MM, Tornivuori A, Kolho KL, Culnane E, Loftus H, Sawyer SM, Kosola S. Changes in health-related quality of life during transition to adult healthcare: an international prospective cohort study. Arch Dis Child 2024; 109:659-665. [PMID: 38768988 PMCID: PMC11287528 DOI: 10.1136/archdischild-2024-327017] [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: 02/16/2024] [Accepted: 04/26/2024] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To study changes in health-related quality of life (HRQoL) in adolescents and young adults (AYAs) with chronic medical conditions across the transfer to adult healthcare and associations of HRQoL with transition readiness and experience of care. METHODS Participants in this international (Finland, Australia) prospective cohort study were recruited in the year prior to transfer to adult health services and studied 12 months later. In addition to two HRQoL scales (Pediatric Quality of Life inventory (PedsQL), 16D), the Am I ON TRAC for Adult Care Questionnaire and Adolescent Friendly Hospital Survey measured transition readiness and experience of care and categorised by quartile. Data were compared before and after transfer to adult healthcare. RESULTS In total, 512 AYAs completed the first survey (0-12 months before transfer of care) and 336 AYAs completed it 1 year later (retention rate 66%, mean ages 17.8 and 18.9 years, respectively). Mean total PedsQL scores (76.5 vs 78.3) showed no significant change, although the social and educational subdomains improved after transfer of care. The mean single-index 16D score remained the same, but in Finland, distress increased and the ability to interact with friends decreased after transfer. AYAs within the best quartiles of experience of care and transition readiness had better HRQoL than AYAs within the worst quartiles. CONCLUSIONS Overall HRQoL of AYAs remained unchanged across the transfer to adult healthcare. Recognising and supporting AYAs with unsatisfactory experience of care and poor transition readiness could improve overall HRQoL during the transition process. TRIAL REGISTRATION NUMBER NCT04631965.
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Affiliation(s)
- Mira Marianne Kallio
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Anna Tornivuori
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Nursing Science, University of Turku, Turku, Finland
| | - Kaija-Leena Kolho
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Hayley Loftus
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susan Margaret Sawyer
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Silja Kosola
- New Children's Hospital, Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Research, Development and Innovations, Western Uusimaa Wellbeing Services County, Espoo, Finland
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Silverstein J, Goyal N, Tsai KK. For the Long Haul: Management of Long-Term Survivors after Melanoma Systemic Therapy. Curr Oncol Rep 2024; 26:804-817. [PMID: 38780676 DOI: 10.1007/s11912-024-01541-6] [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] [Accepted: 04/29/2024] [Indexed: 05/25/2024]
Abstract
PURPOSE OF REVIEW This review summarizes the latest advancements in survivorship care for patients with advanced melanoma who received systemic therapy and emphasizes the areas where more research is needed. RECENT FINDINGS Over the last decade there have been remarkable advances in the treatment of advanced and metastatic melanoma. Due to these novel treatments, including several immune checkpoint inhibitors and tyrosine kinase inhibitors, there are and will continue to be increasing numbers of long-term melanoma survivors who have been treated with systemic therapy. These patients will navigate new challenges are they are essentially among the first long term survivors after these novel therapies. Survivorship care focuses on improving the health-related quality of life of patients including the physical, emotional, social and functional effects of cancer that begin at diagnosis and continue through the end of life. Survivorship also includes screening for cancer recurrence and second cancers. As the number of melanoma survivors who received systemic therapy continues to grow, the survivorship care plan will become increasingly important for optimal care of patients even after their cancer treatments. Understanding the many domains of survivorship care for this group of patients is imperative for their care now and to identify unmet needs for future research.
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Affiliation(s)
- Jordyn Silverstein
- Department of Medicine, Division of Hematology/Oncology, University of California, Los Angeles (UCLA), 757 Westwood Plaza, Los Angeles, CA, 90095, USA.
| | - Neha Goyal
- Department of Psycho-Oncology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco (UCSF), San Francisco, CA, USA
| | - Katy K Tsai
- Department of Medicine, Division of Hematology/Oncology, University of California, San Francisco (UCSF), San Francisco, CA, USA
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Kallio M, Tornivuori A, Miettinen PJ, Kolho KL, Relas H, Culnane E, Loftus H, Sawyer SM, Kosola S. Health-related quality of life and self-reported health status in adolescents with chronic health conditions before transfer of care to adult health care: an international cohort study. BMC Pediatr 2024; 24:163. [PMID: 38459510 PMCID: PMC10921592 DOI: 10.1186/s12887-024-04629-x] [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: 06/12/2023] [Accepted: 02/07/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND Heath-related quality of life (HRQoL) is lower in adolescents with chronic health conditions compared to healthy peers. While there is evidence of some differences according to the underlying condition and gender, differences by measure and country are poorly understood. In this study we focus on the differences in HRQoL in adolescents with various chronic medical conditions in the year before transfer of care to adult health services. We also study the associations of two different HRQoL measurements to each other and to self-reported health. METHODS We recruited 538 adolescents from New Children`s Hospital, Helsinki, Finland, and the Royal Children`s Hospital, Melbourne, Australia in 2017-2020. We used two validated HRQoL measurement instruments, Pediatric Quality of Life Inventory (PedsQL) and 16D, and a visual analog scale (VAS) for self-reported health status. RESULTS In total, 512 adolescents (50.4% female, mean age 17.8 [SD 1.2] years), completed the survey measures. Higher HRQoL was reported in males than females in both countries (PedsQL 79.4 vs. 74.1; 16D 0.888 vs. 0.846), and in adolescents from Finland than Australia (80.6 vs. 72.2 and 0.905 vs. 0.825, p < 0.001 for all). Adolescents with diabetes, rheumatological, nephrological conditions and/or organ transplants had higher HRQoL than adolescents with neurological conditions or other disease syndromes (p < 0.001). PedsQL and 16D scores showed a strong correlation to each other (Spearman correlation coefficient r = 0.81). Using the 7-point VAS (1-7), 52% (248 of 479) considered their health status to be good (6-7) and 10% (48 of 479) rated it poor (1-2). Better self-reported health was associated with higher HRQoL. CONCLUSIONS The HRQoL of transition aged adolescents varies between genders, diagnostic groups, and countries of residence. The association between self-reported health and HRQoL suggests that brief assessment using the VAS could identify adolescents who may benefit from in-depth HRQoL evaluation. TRIAL REGISTRATION Trial registration name The Bridge and registration number NCT04631965 ( https://clinicaltrials.gov/ct2/show/NCT04631965 ).
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Affiliation(s)
- Mira Kallio
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Anna Tornivuori
- Department of Nursing Science, University of Turku, Turku, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Päivi J Miettinen
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Kaija-Leena Kolho
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heikki Relas
- Department of Rheumatology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Australia
| | - Hayley Loftus
- Transition Support Service, The Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Susan M Sawyer
- Centre for Adolescent Health, Royal Children's Hospital, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Australia
| | - Silja Kosola
- Department of Pediatrics, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Pediatric Research Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Research, Development and Innovations, Western Uusimaa Wellbeing Services County, Espoo, Finland
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Laursen MG, Rahbaek MØ, Jensen SD, Praetorius T. Experiences of young people living with type 1 diabetes in transition to adulthood: The importance of care provider familiarity and support. Scand J Caring Sci 2024; 38:126-135. [PMID: 37726958 DOI: 10.1111/scs.13214] [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: 03/10/2023] [Accepted: 09/03/2023] [Indexed: 09/21/2023]
Abstract
BACKGROUND During the developmental transition from childhood to adulthood, young people living with type 1 diabetes (T1D) are more likely to take less care of their chronic disease. Alongside the developmental transition, young people with T1D also experience an organisational transition in which the care responsibility changes from a family-based approach in paediatric care to an individualised approach in adult care. Little is known from the perspective of the young people about what their interactions with the healthcare providers mean during these transitions. AIM The aim of this study is to explore how young people living with T1D experience interactions with their care providers, and what it means for their developmental transition. METHOD Semi-structured interviews with 10 respondents aged 18-20 living with T1D who were recruited from a youth outpatient diabetes clinic in Denmark. Recorded audio data were transcribed and analysed using an interpretative phenomenological analysis approach. RESULTS Young people experience continuity in the relationship with the diabetes nurse from the paediatric clinic and a personal patient-provider relationship with their well-known and new care providers. This creates a feeling of familiarity and contributes to a seamless transition. The young people express that becoming more involved in diabetes treatment increases their willingness to take more responsibility for their own health. They also express that care providers should support them in managing their diabetes and talk about sensitive topics. CONCLUSION Continuity in the relationship with the diabetes nurse makes the transition from paediatric to adult care more satisfying and seamless. To support the developmental transition, care providers should gradually involve young people more in diabetes management and be supportive as they become more independent during the developmental transition.
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Affiliation(s)
| | - Marie Ørts Rahbaek
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
| | - Sissel Due Jensen
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Thim Praetorius
- Steno Diabetes Center Aarhus, Aarhus University Hospital, Aarhus, Denmark
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AlBurno H, Schneider F, de Vries H, Al Mohannadi D, Mercken L. Determinants of adherence to insulin and blood glucose monitoring among adolescents and young adults with type 1 diabetes in Qatar: a qualitative study. F1000Res 2024; 11:907. [PMID: 38515508 PMCID: PMC10955191 DOI: 10.12688/f1000research.123468.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 03/23/2024] Open
Abstract
Background Adherence to insulin and blood glucose monitoring (BGM) is insufficient in adolescents and young adults (AYAs) with type 1 diabetes (T1D) worldwide and in Qatar. Little is known about the factors related to being aware of suboptimal adherence and the beliefs related to suboptimal adherence in this group. This qualitative study investigated factors related to awareness of, and beliefs about suboptimal adherence, as well as the existence of specific action plans to combat suboptimal adherence using the I-Change model. Methods The target group was comprised of 20 Arab AYAs (17-24 years of age) with T1D living in Qatar. Participants were interviewed via semi-structured, face-to-face individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using the Framework Method. Results Suboptimal adherence to insulin, and particularly to BGM, in AYAs with T1D was identified. Some AYAs reported to have little awareness about the consequences of their suboptimal adherence and how this can adversely affect optimal diabetes management. Participants also associated various disadvantages to adherence ( e.g., hypoglycemia, pain, among others) and reported low self-efficacy in being adherent ( e.g., when outside home, in a bad mood, among others). Additionally, goal setting and action-planning often appeared to be lacking. Factors facilitating adherence were receiving support from family and healthcare providers, being motivated, and high self-efficacy. Conclusions Interventions that increase awareness concerning the risks of suboptimal adherence of AYAs with T1D are needed, that increase motivation to adhere by stressing the advantages, creating support and increasing self-efficacy, and that address action planning and goal parameters.
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Affiliation(s)
- Hanan AlBurno
- Care and Public Health Research Institute, Maastricht University, Maastricht, P.O. Box 616, The Netherlands
| | - Francine Schneider
- Care and Public Health Research Institute, Maastricht University, Maastricht, P.O. Box 616, The Netherlands
| | - Hein de Vries
- Care and Public Health Research Institute, Maastricht University, Maastricht, P.O. Box 616, The Netherlands
| | - Dabia Al Mohannadi
- Endocrinology and Diabetes Department, Hamad Medical Corporation, Doha, P.O. Box 3050, Qatar
| | - Liesbeth Mercken
- Care and Public Health Research Institute, Maastricht University, Maastricht, P.O. Box 616, The Netherlands
- Department of Health Psychology, Open University of the Netherlands, Heerlen, P.O. Box 2960, The Netherlands
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Núñez-Baila MÁ, Gómez-Aragón A, González-López JR. Sociodemographic and Clinical Determinants on Health-Related Quality of Life in Emerging Andalusian Adults with Type 1 Diabetes: A Cross-Sectional Study. J Clin Med 2023; 13:240. [PMID: 38202247 PMCID: PMC10779847 DOI: 10.3390/jcm13010240] [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: 11/30/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Having type 1 diabetes during emerging adulthood can impact quality of life due to the challenge of balancing optimal glycemic blood levels with a period of transition and exploration. The purpose of this study was to characterize the quality of life of emerging adults aged 18 to 29 years with type 1 diabetes and to determine the associations between dimensions of Health-Related Quality of Life in type 1 diabetes and sociodemographic and diabetes-related variables. (2) Methods: This cross-sectional descriptive study was conducted in Andalusia, Spain, from October 2021 to July 2022. A total of 362 emerging adults with type 1 diabetes (67.4% women, mean age 22.8 ± 3.4 years) participated. Data were gathered via sociodemographic information form and the ViDa1 scale. Statistical evaluations, encompassing descriptive analyses, t-tests, ANOVA, Pearson correlations, and logistic regression, were conducted using SPSSv26, adhering to STROBE guidelines. (3) Results: Among the participants, 52.1% have a glycosylated hemoglobin level over 7%. Interference with Life is correlated with sex, age, and age at diagnosis, with age being the only predictor. Self-Care is correlated with and predicted by glycosylated hemoglobin levels. Well-being is correlated with and predicted by sex, Body Mass Index, and glycosylated hemoglobin levels. Concern about the Condition is correlated with and predicted by sex and glycosylated hemoglobin levels. (4) Conclusions: Despite concerns about their disease, participants generally maintain optimal levels of Health-Related Quality of Life in type 1 diabetes. Predictive factors for Health-Related Quality of Life in type 1 diabetes in this group include sex, age, Body Mass Index, and glycosylated hemoglobin.
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Affiliation(s)
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
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Pyatak EA, Ali A, Khurana AR, Lee PJ, Sideris J, Fox S, Diaz J, Granados G, Blanchard J, McGuire R, Salazar Plascencia E, Salcedo-Rodriguez E, Flores-Garcia J, Linderman M, Taylor EE, Tapia V, Nnoli N, Sequeira PA, Freeby MJ, Raymond JK. Research design and baseline participant characteristics of the Resilient, Empowered, Active Living with Diabetes - Telehealth (REAL-T) Study: A randomized controlled trial for young adults with type 1 diabetes. Contemp Clin Trials 2023; 135:107386. [PMID: 37931702 PMCID: PMC10846480 DOI: 10.1016/j.cct.2023.107386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/16/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023]
Abstract
BACKGROUND Type 1 diabetes (T1D) is a chronic condition affecting nearly 1.9 million people in the United States. Young adults (YAs) with T1D face unique challenges in managing their condition, experiencing poorer health and well-being than other age groups. The current study is evaluating the Resilient, Empowered, Active Living (REAL) intervention, previously shown to improve glucose levels and quality of life among YAs with diabetes, using telehealth delivery (REAL-T) to expand reach and accessibility. This paper reports on the methodology and baseline participant characteristics of the REAL-T study. METHODS REAL-T is a two-arm randomized controlled trial that recruited 18-30 year olds with T1D via clinics and social media advertising. Data collection, which was adapted to be fully remote due to COVID-19, occurs every three months for one year. Participants receive either usual care or a 6-month telehealth occupational therapy intervention. The primary outcome is glycated hemoglobin (A1c); secondary outcomes include diabetes distress, quality of life, and continuous glucose monitor-derived measures. RESULTS The study enrolled a diverse sample of 209 YAs with T1D. Analysis of baseline data indicates equivalence between the intervention and control groups. Study participants have notably higher diabetes distress and poorer mental well-being than similar populations. CONCLUSION The REAL-T study successfully adapted to remote implementation during the COVID-19 pandemic. By examining long-term outcomes, mediating pathways, and cost-effectiveness, the study will contribute knowledge of the impact of tailored interventions for YAs with T1D, designed to reduce disparities and improve health and well-being in this population.
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Affiliation(s)
- Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America.
| | - Aina Ali
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Anya R Khurana
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Pey-Jiuan Lee
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - John Sideris
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Steven Fox
- Leonard D. Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, CA, United States of America
| | - Jesus Diaz
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Gabrielle Granados
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Jeanine Blanchard
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Riley McGuire
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Elia Salazar Plascencia
- Alpha Clinic, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | | | | | - Megan Linderman
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Elinor E Taylor
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Valerie Tapia
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Ngozi Nnoli
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, United States of America
| | - Paola A Sequeira
- Department of Endocrinology, Los Angeles General Medical Center, Los Angeles, CA, United States of America
| | - Matthew J Freeby
- David Geffen UCLA School of Medicine, Los Angeles, CA, United States of America
| | - Jennifer K Raymond
- Alpha Clinic, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America; Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
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Lafontaine S, Mok E, Frei J, Henderson M, Rahme E, Dasgupta K, Nakhla M. Associations of Diabetes-related and Health-related Quality of Life With Glycemic Levels in Adolescents With Type 1 Diabetes Preparing to Transition to Adult Care. Can J Diabetes 2023; 47:525-531. [PMID: 37182591 DOI: 10.1016/j.jcjd.2023.05.002] [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: 11/04/2022] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES As adolescents with type 1 diabetes (T1D) progress to adulthood, they assume responsibility for diabetes self-management while dealing with competing life demands, decreasing parental support, and the transfer to adult care. Lower perceived quality of life (QOL) may hamper diabetes management, which is associated with suboptimal glycemic levels. Our objective was to determine associations of diabetes- and health-related QOL with glycemic management (glycated hemoglobin [A1C]) in adolescents with T1D before their transfer to adult care. METHODS We conducted a cross-sectional analysis of baseline data from the Group Education Trial to Improve Transition (GET-IT- T1D) in adolescents with T1D (16 to 17 years of age). Participants completed validated questionnaires measuring diabetes-related QOL (PedsQL 3.2 Diabetes Module) and health-related QOL (PedsQL 4.0 Generic Core Scales). Associations of QOL Total and subscale scores with A1C were assessed using linear regression models adjusted for sex, diabetes duration, socioeconomic status, insulin pump use, and mental health comorbidity. RESULTS One hundred fifty-three adolescents with T1D were included (mean age, 16.5 [standard deviation, 0.3] years). Diabetes-related QOL Total scores (adjusted β=-0.04; 95% confidence interval [CI], -0.05 to -0.02) as well as subscale scores for Diabetes Symptoms (adjusted β=-0.02; 95% CI, -0.04 to -0.00) and Diabetes Management (adjusted β=-0.04; 95% CI, -0.05 to -0.02) were inversely associated with A1C. Health-related QOL Total scores were not associated with A1C, but Psychosocial Health subscale scores were (adjusted β=-0.01; 95% CI, -0.03 to -0.00). CONCLUSION Our results suggest that strategies focussing on diabetes-related QOL and psychosocial health may help prepare adolescents for the increasing responsibility of diabetes self-care.
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Affiliation(s)
- Simon Lafontaine
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montréal, Québec, Canada
| | - Elise Mok
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Jennifer Frei
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Mélanie Henderson
- Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada; Centre de Recherche CHU Sainte-Justine, Montréal, Québec, Canada; School of Public Health, Department of Social and Preventive Medicine, Université de Montréal, Montréal, Québec, Canada
| | - Elham Rahme
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Meranda Nakhla
- Division of Endocrinology, Department of Pediatrics, McGill University Health Centre, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Montréal, Québec, Canada.
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Knoll C, Schipp J, O'Donnell S, Wäldchen M, Ballhausen H, Cleal B, Gajewska KA, Raile K, Skinner T, Braune K. Quality of life and psychological well-being among children and adolescents with diabetes and their caregivers using open-source automated insulin delivery systems: Findings from a multinational survey. Diabetes Res Clin Pract 2023; 196:110153. [PMID: 36423699 DOI: 10.1016/j.diabres.2022.110153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 11/01/2022] [Accepted: 11/07/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Open-source automated insulin delivery (AID) systems have shown to be safe and effective in children and adolescents with type 1 diabetes (T1D) in real-world studies. However, there is a lack of evidence on the effect on their caregivers' quality-of-life (QoL) and well-being. The aim of this study was to assess the QoL of caregivers and children and adolescents using open-source AID systems using validated measures. METHODS In this cross-sectional online survey we examined the caregiver-reported QoL and well-being of users and non-users. Validated questionnaires assessed general well-being (WHO-5), diabetes-specific QoL (PAID, PedsQL) and sleep quality (PSQI). RESULTS 168 caregivers from 27 countries completed at least one questionnaire, including 119 caregivers of children using open-source AID and 49 not using them. After inclusion of covariates, all measures but the PAID and one subscale of the PedsQL showed significant between-group differences with AID users reporting higher general (WHO-5: p = 0.003), sleep-related (PSQI: p = 0.001) and diabetes-related QoL (PedsQL: p < 0.05). CONCLUSIONS The results show the potential impact of open-source AID on QoL and psychological well-being of caregivers and children and adolescents with T1D, and can therefore help to inform academia, regulators, and policymakers about the psychosocial health implications of open-source AID.
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Affiliation(s)
- Christine Knoll
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany.
| | - Jasmine Schipp
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia; University of Copenhagen, Centre for Medical Science and Technology Studies, Department of Public Health Copenhagen, Denmark; La Trobe University, Bendigo, Australia.
| | - Shane O'Donnell
- University College Dublin, School of Sociology, Belfield, Ireland.
| | - Mandy Wäldchen
- University College Dublin, School of Sociology, Belfield, Ireland.
| | - Hanne Ballhausen
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; #dedoc° Diabetes Online Community, Dedoc Labs GmbH, Berlin, Germany.
| | - Bryan Cleal
- Steno Diabetes Center Copenhagen, Diabetes Management Research, Herlev, Denmark.
| | - Katarzyna A Gajewska
- Diabetes Ireland, Dublin, Ireland; School of Public Health, University College Cork, Ireland.
| | - Klemens Raile
- Vivantes Klinikum Neukölln, Clinic for Pediatrics and Adolescent Medicine, Berlin, Germany.
| | - Timothy Skinner
- Australian Centre for Behavioural Research in Diabetes, Melbourne, Australia; La Trobe University, Bendigo, Australia.
| | - Katarina Braune
- Charité - Universitätsmedizin Berlin, Department of Paediatric Endocrinology and Diabetes, Berlin, Germany; Berlin Institute of Health (BIH), Berlin, Germany; #dedoc° Diabetes Online Community, Dedoc Labs GmbH, Berlin, Germany; Charité - Universitätsmedizin Berlin, Institute of Medical Informatics, Berlin, Germany.
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11
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Matejko B, Juza A, Kieć-Wilk B, Cyranka K, Krzyżowska S, Chen X, Cohen O, Da Silva J, Malecki MT, Klupa T. Transitioning of People With Type 1 Diabetes From Multiple Daily Injections and Self-Monitoring of Blood Glucose Directly to MiniMed 780G Advanced Hybrid Closed-Loop System: A Two-Center, Randomized, Controlled Study. Diabetes Care 2022; 45:2628-2635. [PMID: 35972259 PMCID: PMC9862281 DOI: 10.2337/dc22-0470] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 07/25/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The aim of this study was to evaluate the outcomes of transitioning to the MiniMed 780G advanced hybrid closed-loop (AHCL) system in adult individuals with type 1 diabetes mellitus (T1DM) naive to continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) technologies. RESEARCH DESIGN AND METHODS This was a two-center, randomized, controlled, parallel-group trial with evaluation of individuals with T1DM aged 26-60 years managed with multiple daily injections (MDI) and self-monitoring of blood glucose (BGM) with HbA1c <10%. RESULTS A total of 41 participants were recruited and randomized to either the AHCL (n = 20) or the MDI+BGM (n = 21) group, and 37 participants (mean ± SD age 40.3 ± 8.0 years, duration of diabetes 17.3 ± 12.1 years, BMI 25.1 ± 3.1 kg/m2, HbA1c 7.2 ± 1.0%) completed the study. Time spent with glucose levels in target range increased from 69.3 ± 12.3% at baseline to 85.0 ± 6.3% at 3 months in the AHCL group, while remaining unchanged in the control group (treatment effect 21.5% [95% CI 15.7, 27.3]; P < 0.001). The time with levels below range (<70 mg/dL) decreased from 8.7 ± 7.3% to 2.1 ± 1.7% in the AHCL group and remained unchanged in the MDI+BGM group (treatment effect -4.4% [95% CI -7.4, -2.1]; P < 0.001). Participants from the AHCL group also had significant improvements in HbA1c levels (treatment effect -0.6% [95% CI -0.9, -0.2]; P = 0.005) and in quality of life (QoL) in specific subscales compared with the MDI+BGM group. CONCLUSIONS People with T1DM naive to CSII and CGM technologies initiating AHCL significantly and safely improved their glycemic control, as well as their QoL and psychological well-being.
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Affiliation(s)
- Bartłomiej Matejko
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Anna Juza
- Clinical Provincial Hospital of Frederic Chopin No. 1 in Rzeszów, Rzeszów, Poland.,College of Medical Sciences, University of Rzeszów, Rzeszów, Poland
| | - Beata Kieć-Wilk
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Katarzyna Cyranka
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland.,Department of Psychiatry, Jagiellonian University Medical College, Krakow, Poland
| | | | | | - Ohad Cohen
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Julien Da Silva
- Medtronic International Trading Sàrl, Tolochenaz, Switzerland
| | - Maciej T Malecki
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
| | - Tomasz Klupa
- Department of Metabolic Diseases, Jagiellonian University Medical College, Krakow, Poland.,University Hospital in Krakow, Krakow, Poland
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12
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Alzahrani AM, Magliah SF, Turkistani HA, Abulaban BA, Sabban MF, Mashat MA, Al Shaikh AM. Perception of primary caregiver toward virtual pediatric clinics for type 1 diabetes mellitus during COVID-19 pandemic in Jeddah, Saudi Arabia: A cross-sectional study. Ann Med Surg (Lond) 2022; 81:104550. [PMID: 36147155 PMCID: PMC9486846 DOI: 10.1016/j.amsu.2022.104550] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/24/2022] [Accepted: 08/27/2022] [Indexed: 12/04/2022] Open
Abstract
Background Virtual phone clinics were adopted at King Abdulaziz Medical City, Jeddah, Saudi Arabia, as an alternative to in-person routine outpatient visits amid the COVID-19 pandemic. This study aimed to assess primary caregiver perceptions of the virtual phone clinics towards routine care of pediatric patients with type 1 diabetes mellitus (T1DM). Methods A cross-sectional research design was employed through a web-based research tool where the primary caregivers of pediatric patients with T1DM participated. Data were analyzed descriptively and statistically using independent t-tests and one-way analysis of variance. Results In total, 214 participants were included in this study. The average primary caregiver perception value towards virtual phone clinics was 66.71 ± 23.1%, which suggested a satisfactory perception of their experience. Statistically significant differences (p > 0.05) were not found between the mean perception values and demographic characteristics. Higher mean primary caregiver perception values were associated with those who: (1) agreed or strongly agreed to be contented with their current state of health, (2) did not ask their physicians to be physically seen during a virtual visit, (3) preferred having four virtual visits or more, and (4) preferred having single to no in-person visits at all. Conclusion This study revealed a generally acceptable primary caregiver perception regarding virtual clinics. Telemedicine is recommended for routine treatment alongside regular in-clinic appointments to improve the quality of care for pediatric patients with T1DM. Most subjects showed interest in having many as four or more virtual visits per year. Almost three-fourths of subjects demonstrated satisfaction with phone consultations. Virtual clinics may be implemented for diabetes care alongside regular in-clinic visits.
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Affiliation(s)
- Abdullah M. Alzahrani
- Department of Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
| | - Sultan F. Magliah
- Department of Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
- Corresponding author.
| | - Haneen A. Turkistani
- Department of Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
| | - Bahaa A. Abulaban
- Department of Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
| | - Mahmoud F. Sabban
- Department of Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
| | - Manar A. Mashat
- Department of Family Medicine, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
| | - Adnan M. Al Shaikh
- Department of Pediatrics, Ministry of the National Guard-Health Affairs, King Abdulaziz Medical City, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
- King Abdullah International Medical Research Center, P.O. Box 9515, Jeddah, 21423, Saudi Arabia
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13
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Hapunda G. Coping strategies and their association with diabetes specific distress, depression and diabetes self-care among people living with diabetes in Zambia. BMC Endocr Disord 2022; 22:215. [PMID: 36031626 PMCID: PMC9420272 DOI: 10.1186/s12902-022-01131-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 08/16/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Utilising coping strategies to reduce and manage the intensity of negative and distressing emotions caused by diabetes is essential. However, little is known about the use of coping strategies among people living with diabetes in Sub-Saharan African countries like Zambia. This study investigates coping strategies used by people with diabetes in Zambia and how these are associated with diabetes-specific emotional distress, depression and diabetes self-care. METHODS Cross-sectional data from 157 people with diabetes aged between 12 and 68 years were collected. Of the 157, 59% were people with type 1 diabetes and 37% with type 2 diabetes. About 4% had missing information in their record but had either type 1 or type 2 diabetes. Coping styles were measured using the Brief Version of the Coping Orientation to Problems Experienced (Brief COPE), diabetes specific-distress using the Problem Areas in Diabetes, depression using the Major Depression Inventory and self-care using the Diabetes Self-Care scale. RESULTS Data showed that adaptive coping strategies such as religious coping, acceptance among others, were the most frequently used coping strategies among Zambian individuals with diabetes. Maladaptive coping strategies e.g., self-blame and self-distraction were related to increased diabetes specific-distress and depression. Emotional support was related to better diabetes self-care, while self-blame was related to poor diabetes self-care. CONCLUSION There is need to help individuals with diabetes identify adaptive strategies that work best for them in order to improve their quality of life.
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Affiliation(s)
- Given Hapunda
- Department of Psychology, School of Humanities and Social Sciences, University of Zambia, P.O Box 32379, Lusaka, Zambia.
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14
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Baechle C, Stahl-Pehe A, Prinz N, Meissner T, Kamrath C, Holl RW, Rosenbauer J. Prevalence trends of type 1 and type 2 diabetes in children and adolescents in North Rhine-Westphalia, the most populous federal state in Germany, 2002-2020. Diabetes Res Clin Pract 2022; 190:109995. [PMID: 35853531 DOI: 10.1016/j.diabres.2022.109995] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/28/2022] [Accepted: 07/12/2022] [Indexed: 12/28/2022]
Abstract
AIMS To estimate the prevalence and temporal trends of type 1 and type 2 diabetes mellitus in children and adolescents (type 1 diabetes: 0-19 years, type 2 diabetes: 10-19 years) in North Rhine-Westphalia (NRW), Germany, from 2002 to 2020. METHODS The NRW Diabetes Registry records new cases based on three data sources (median completeness of ascertainment 99% for type 1 diabetes, 94% for type 2 diabetes). We determined age- and/or sex-standardized prevalence estimates (95% confidence intervals) per 100,000 individuals. Differences in age and sex, as well as time trends, were examined by Poisson regression. Furthermore, joinpoint regression was used to evaluate changes in prevalence trends over time. RESULTS At the end of 2020, the estimated type 1 diabetes prevalence was 247.1 (240.3; 253.9) with an annual increase of 2.9% (2.7%; 3.1%). The type 2 diabetes prevalence was 12.7 (10.6; 14.9) and increased by 6.4% (5.6%; 7.3%) per year. The prevalence trends were not uniform over the total period and flattened considerably in recent years. CONCLUSIONS The prevalence of type 1 and type 2 diabetes has increased significantly but at a lower rate in recent years. Continued surveillance of the prevalence is essential for the planning of health care resources and prevention measures.
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Affiliation(s)
- C Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - A Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
| | - N Prinz
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - T Meissner
- University Children's Hospital, Department of General Paediatrics, Neonatology and Paediatric Cardiology, Medical Faculty at Heinrich Heine University, Moorenstraße 5, D-40225 Düsseldorf, Germany.
| | - C Kamrath
- Justus Liebig University, Center of Child and Adolescent Medicine, Division of Paediatric Endocrinology and Diabetology, Feulgenstraße 10-12, D-35392 Giessen, Germany.
| | - R W Holl
- German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Albert-Einstein-Allee 41, D-89081 Ulm, Germany.
| | - J Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Auf'm Hennekamp 65, D-40225 Düsseldorf, Germany; German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany.
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15
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Hu TY, Price J, Pierce JS, Gannon AW. The association between pediatric mental health disorders and type 1 diabetes-related outcomes. Pediatr Diabetes 2022; 23:507-515. [PMID: 35249249 DOI: 10.1111/pedi.13330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Transition from pediatric to adult healthcare systems is a difficult process for young adults with Type 1 Diabetes (T1D) and most patients experience a deterioration in disease control. Mental health (MH) disorders are common in individuals with T1D and are believed to play a role in disease control and transition of care. We evaluated the association between the presence of pediatric MH disorder and measures of success in diabetes care in young adults who recently transitioned to adult care. RESEARCH DESIGN AND METHODS Retrospective cohort study of young adults in a large adult endocrinology system who transitioned from a pediatric hospital system after 2009. MH disorders were diagnosed by clinical pediatric psychologists during routine care at the pediatric hospital. Measurements of Hemoglobin A1c, diabetes-related emergencies, clinic attendance and intervals in transition were assessed and compared between the pediatric and adult hospital systems. RESULTS 237 young adults were identified and 100 (42%) of these were diagnosed with a MH disorder during pediatric care. Presence of a MH disorder was associated with higher Hemoglobin A1c levels prior to transition and increased rates of diabetes-related hospitalizations during the transition interval. Patients with a MH disorder were less likely to establish a pattern of consistent follow up after transition (p = 0.021). CONCLUSIONS MH disorders are common and predict greater challenges with diabetes management and less effective transition into the adult endocrinology system. Early recognition of MH disorders may allow for allocation of more proactive and intensive support for affected patients.
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Affiliation(s)
- Tina Y Hu
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Julia Price
- Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Center for Healthcare Delivery Science, Nemours Children's Health System, Wilmington, Delaware, USA
| | - Jessica S Pierce
- Center for Healthcare Delivery Science, Nemours Children's Health System, Orlando, Florida, USA.,Department of Pediatrics, University of Central Florida College of Medicine, Orlando, Florida, USA
| | - Anthony W Gannon
- Department of Pediatrics, Nemours Children's Hospital, Delaware, Wilmington, Delaware, USA.,Department of Internal Medicine, ChristianaCare Health System, Newark, Delaware, USA.,Departments of Internal Medicine and Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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16
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Peeters MAC, de Haan HG, Bal RA, van Staa A, Sattoe JNT. Active involvement of young people with T1DM during outpatient hospital consultations: Opportunities and challenges in transitional care services. PATIENT EDUCATION AND COUNSELING 2022; 105:1510-1517. [PMID: 34649751 DOI: 10.1016/j.pec.2021.09.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 07/23/2021] [Accepted: 09/27/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Little is known about active involvement of young people (YP) with type 1 diabetes (T1DM) in transitional care. This study aims to gain insight into patient-provider interactions during outpatient hospital consultations. METHODS Semi-structured observations (n = 61) of outpatient consultations with YP with T1DM (15-25 years) treated in 12 hospitals in the Netherlands. The consultations concerned pediatric care (n = 23), adult care (n = 17), and joint consultations (n = 21). Thematic data analysis focused on whether professionals engaged in open, in-depth conversations; used motivational interviewing techniques; involved YP in shared decision-making; and addressed non-medical topics. RESULTS Apart from some good examples, the healthcare professionals generally had difficulty interacting adequately with YP. They paid little attention to the YP's individual attitudes and priorities regarding disease management; non-medical topics remained generally underexposed. Conversations about daily life often remained shallow, as YP's cues were not taken up. Furthermore, decisions about personal and health-related goals were often not made together. CONCLUSION By adopting a more person-centered approach, professionals could empower YP to take an active role in their diabetes management. PRACTICE IMPLICATIONS Using a structured conversation model combined with a tool to encourage YP's agenda-setting and shared decision-making is recommended for more person-centered transitional care in T1DM.
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Affiliation(s)
- Mariëlle A C Peeters
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Hielke G de Haan
- Nutrition and Dietetics, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Roland A Bal
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - AnneLoes van Staa
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
| | - Jane N T Sattoe
- Research Centre (American English) Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands; Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.
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17
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Braune K, Krug N, Knoll C, Ballhausen H, Thieffry A, Chen Y, O'Donnell S, Raile K, Cleal B. Emotional and Physical Health Impact in Children and Adolescents and their Caregivers Using Open-Source Automated Insulin Delivery: Qualitative Analysis of Lived Experiences. (Preprint). J Med Internet Res 2022; 24:e37120. [PMID: 35834298 PMCID: PMC9335170 DOI: 10.2196/37120] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 04/21/2022] [Accepted: 05/29/2022] [Indexed: 01/15/2023] Open
Abstract
Background Given the limitations in the access and license status of commercially developed automated insulin delivery (AID) systems, open-source AID systems are becoming increasingly popular among people with diabetes, including children and adolescents. Objective This study aimed to investigate the lived experiences and physical and emotional health implications of children and their caregivers following the initiation of open-source AID, their perceived challenges, and sources of support, which have not been explored in the existing literature. Methods Data were collected through 2 sets of open-ended questions from a web-based multinational survey of 60 families from 16 countries. The narratives were thematically analyzed, and a coding framework was identified through iterative alignment. Results A range of emotions and improvements in quality of life and physical health were reported, as open-source AID enabled families to shift their focus away from diabetes therapy. Caregivers were less worried about hypoglycemia at night and outside their family homes, leading to increased autonomy for the child. Simultaneously, the glycemic outcomes and sleep quality of both the children and caregivers improved. Nonetheless, the acquisition of suitable hardware and technical setup could be challenging. The #WeAreNotWaiting community was the primary source of practical and emotional support. Conclusions Our findings show the benefits and transformative impact of open-source AID and peer support on children with diabetes and their caregivers and families, where commercial AID systems are not available or suitable. Further efforts are required to improve the effectiveness and usability and facilitate access for children with diabetes, worldwide, to benefit from this innovative treatment. International Registered Report Identifier (IRRID) RR2-10.2196/15368
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Affiliation(s)
- Katarina Braune
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- Institute of Medical Informatics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Niklas Krug
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christine Knoll
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Hanne Ballhausen
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
- Berlin Institute of Health, Berlin, Germany
- #dedoc° Diabetes Online Community, Berlin, Germany
| | - Axel Thieffry
- Jay Keasling Faculty, BioInnovation Institute, Center for Biosustainability, Technical University of Denmark, Copenhagen, Denmark
- Intomics A/S, Kongens Lyngby, Denmark
| | - Yanbing Chen
- School of Public Health, Physiotherapy & Sports Science, University College Dublin, Belfield, Ireland
| | - Shane O'Donnell
- School of Sociology, University College Dublin, Dublin, Ireland
| | - Klemens Raile
- Department of Paediatric Endocrinology and Diabetes, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Bryan Cleal
- Diabetes Management Research, Steno Diabetes Center Copenhagen, Herlev, Denmark
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18
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The added value of transition programs in Dutch diabetes care: A controlled evaluation study. J Pediatr Nurs 2022; 62:155-163. [PMID: 34419327 DOI: 10.1016/j.pedn.2021.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/22/2022]
Abstract
PURPOSE The desirability of evaluating transition programs is widely acknowledged. This study aimed to explore the added value of transitional care investments for young adults with type 1 diabetes mellitus. DESIGN AND METHODS Based on qualitative data, two groups of diabetes teams were created through cluster analysis: paying more (HI-ATT) versus less attention (LO-ATT) to transitional care. Retrospective controlled evaluation included chart reviews on healthcare use and clinical outcomes; and a survey on young adults' experiences, satisfaction with care, and self-management skills. RESULTS Data from 320 patients in fifteen diabetes teams were collected; 123 young adults (38.4%) completed a questionnaire. Self-reported outcomes showed that young adults treated by a HI-ATT team felt better prepared for transfer (p < .05). Self-management outcomes did not differ between groups. HI-ATT teams had more scheduled consultations in the year after transfer (p < .05); only 10.6% of all measurements had reached targeted HbA1c scores. CONCLUSIONS Current transitional care investments in Dutch diabetes care did not lead to notable improvements in experiences and outcomes, except for preparation for transfer. The period after transfer, however, is just as important. Attention is required for parent involvement. PRACTICE IMPLICATIONS Transitional care investments should extend beyond the transfer. By educating young adults about the importance of regular clinic attendance and introducing additional person-centered consultations in adult care, nurses may help ensure continuity of care. Nurses could also introduce support programs for parents to prepare for the transition and their change in role, taking into account their continuing partnership.
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19
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Association between the Level of Physical Activity and Health-Related Quality of Life in Type 1 Diabetes Mellitus. A Preliminary Study. J Clin Med 2021; 10:jcm10245829. [PMID: 34945126 PMCID: PMC8706820 DOI: 10.3390/jcm10245829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/02/2021] [Accepted: 12/07/2021] [Indexed: 12/14/2022] Open
Abstract
Type 1 Diabetes Mellitus (T1D) is a chronic autoimmune disease characterized by the selective destruction of the beta cells of the pancreas causing an absolute deficiency of insulin for life. This pathology carries associated risks so that it is essential to measure Health-Related Quality of Life (HRQoL) in this population. The aim was to analyse associations between the level of physical activity and HRQoL in people with T1D. The sample consisted of 172 participants with T1D diagnoses, between 18 and 49 years (31.29 ± 8.17). The participants answered different questionnaires related to physical activity (IPAQ) and HRQoL (EsDQOL, ViDa1, 15D, and EQ-5D-5L). The results showed significant correlations between the level of physical activity and HRQoL. Vigorous physical activity had an impact on the HRQoL questionnaires, such as the well-being dimension (rho = 0.349; p < 0.001) of the ViDa1 questionnaire. A significant correlation between total physical activity and levels of anxiety and depression was observed: anxiety (15D) (rho = 0.328; p < 0.001) and anxiety/depression (EQ-5D-5L) (rho = 0.324; p < 0.001). The present study showed associations between higher levels of physical activity and higher HRQoL parameters in the population with T1D, which can be erected as a reason for exercise prescription in these patients.
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Sattoe J, Peeters M, Bronner M, van Staa A. Transfer in care and diabetes distress in young adults with type 1 diabetes mellitus. BMJ Open Diabetes Res Care 2021; 9:9/2/e002603. [PMID: 34969691 PMCID: PMC8719139 DOI: 10.1136/bmjdrc-2021-002603] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/23/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Diabetes distress (DD) is a serious problem in many people with diabetes and is associated with unfavorable clinical and psychosocial outcomes in children and adults. Little is known about DD in young adults (YAs) with type 1 diabetes mellitus (T1DM) who transferred to adult care. This study aimed to explore the differences between YAs with/without DD regarding transfer experiences, self-management and health-related quality of life (HRQoL). RESEARCH DESIGN AND METHODS Cross-sectional online questionnaire completed by YAs with T1DM after transfer. DD was measured with the short-form Problem Areas in Diabetes scale. Descriptive analyses were followed by t-tests and χ2 tests to explore differences between the groups with/without DD. Effect sizes were calculated. RESULTS Of 164 respondents with mean age 22.7 (±1.56) years, 60.7% was female. The total sample scored low on DD (6.52±4.67; range: 0-17), but 57 (34.8%) had a score ≥8, indicating DD. YAs with DD felt less ready to transfer to adult care than those without DD and scored lower on alliance between pediatric and adult care and reception in adult care. They also reported poorer self-management skills and lower HRQoL in all domains of functioning. CONCLUSIONS More than one-third YAs experienced DD after transfer; this was associated with less favorable transition, self-management and psychosocial outcomes. Transfer in care seems to be a source of DD. Systematic screening on DD and attention for YAs' worries is recommended in both pediatric and adult care.
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Affiliation(s)
- Jane Sattoe
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Mariëlle Peeters
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Madelon Bronner
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - AnneLoes van Staa
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Research Centre Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
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Boscari F, Avogaro A. Current treatment options and challenges in patients with Type 1 diabetes: Pharmacological, technical advances and future perspectives. Rev Endocr Metab Disord 2021; 22:217-240. [PMID: 33755854 PMCID: PMC7985920 DOI: 10.1007/s11154-021-09635-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2021] [Indexed: 12/14/2022]
Abstract
Type 1 diabetes mellitus imposes a significant burden of complications and mortality, despite important advances in treatment: subjects affected by this disease have also a worse quality of life-related to disease management. To overcome these challenges, different new approaches have been proposed, such as new insulin formulations or innovative devices. The introduction of insulin pumps allows a more physiological insulin administration with a reduction of HbA1c level and hypoglycemic risk. New continuous glucose monitoring systems with better accuracy have allowed, not only better glucose control, but also the improvement of the quality of life. Integration of these devices with control algorithms brought to the creation of the first artificial pancreas, able to independently gain metabolic control without the risk of hypo- and hyperglycemic crisis. This approach has revolutionized the management of diabetes both in terms of quality of life and glucose control. However, complete independence from exogenous insulin will be obtained only by biological approaches that foresee the replacement of functional beta cells obtained from stem cells: this will be a major challenge but the biggest hope for the subjects with type 1 diabetes. In this review, we will outline the current scenario of innovative diabetes management both from a technological and biological point of view, and we will also forecast some cutting-edge approaches to reduce the challenges that hamper the definitive cure of diabetes.
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Affiliation(s)
- Federico Boscari
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy.
| | - Angelo Avogaro
- Department of Medicine, Unit of Metabolic Diseases, University of Padova, Padova, Italy
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