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Litchfield I, Barrett T, Hamilton-Shield J, Moore T, Narendran P, Redwood S, Searle A, Uday S, Wheeler J, Greenfield S. Current evidence for designing self-management support for underserved populations: an integrative review using the example of diabetes. Int J Equity Health 2023; 22:188. [PMID: 37697302 PMCID: PMC10496394 DOI: 10.1186/s12939-023-01976-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/26/2023] [Indexed: 09/13/2023] Open
Abstract
AIMS With numerous and continuing attempts at adapting diabetes self-management support programmes to better account for underserved populations, its important that the lessons being learned are understood and shared. The work we present here reviews the latest evidence and best practice in designing and embedding culturally and socially sensitive, self-management support programmes. METHODS We explored the literature with regard to four key design considerations of diabetes self-management support programmes: Composition - the design and content of written materials and digital tools and interfaces; Structure - the combination of individual and group sessions, their frequency, and the overall duration of programmes; Facilitators - the combination of individuals used to deliver the programme; and Context - the influence and mitigation of a range of individual, socio-cultural, and environmental factors. RESULTS We found useful and recent examples of design innovation within a variety of countries and models of health care delivery including Brazil, Mexico, Netherlands, Spain, United Kingdom, and United States of America. Within Composition we confirmed the importance of retaining best practice in creating readily understood written information and intuitive digital interfaces; Structure the need to offer group, individual, and remote learning options in programmes of flexible duration and frequency; Facilitators where the benefits of using culturally concordant peers and community-based providers were described; and finally in Context the need to integrate self-management support programmes within existing health systems, and tailor their various constituent elements according to the language, resources, and beliefs of individuals and their communities. CONCLUSIONS A number of design principles across the four design considerations were identified that together offer a promising means of creating the next generation of self-management support programme more readily accessible for underserved communities. Ultimately, we recommend that the precise configuration should be co-produced by all relevant service and patient stakeholders and its delivery embedded in local health systems.
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Affiliation(s)
- Ian Litchfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Tim Barrett
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, B15 2TT, UK
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
| | - Julian Hamilton-Shield
- Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 2NT, UK
- The Royal Hospital for Children in Bristol, Bristol, BS2 8BJ, UK
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Theresa Moore
- The National Institute for Health and Care Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Parth Narendran
- Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK
- Queen Elizabeth Hospital, Birmingham, B15 2GW, UK
| | - Sabi Redwood
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Aidan Searle
- NIHR Bristol BRC Nutrition Theme, University Hospitals Bristol and Weston Foundation Trust, Bristol, B52 8AE, UK
| | - Suma Uday
- Diabetes and Endocrinology, Birmingham Women's and Children's Hospital, Birmingham, B4 6NH, UK
- Institute of Metabolism and Systems Research, University of Birmingham, Birmingham, B15 2TT, UK
| | - Jess Wheeler
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 1TH, B52 8EA, UK
| | - Sheila Greenfield
- Institute of Applied Health Research, University of Birmingham, Birmingham, B15 2TT, UK
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2
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Campbell MS, Berg CA. Topical Review: Developmental Framework of Moderators of Family Conflict for Type 1 Diabetes Outcomes. J Pediatr Psychol 2021; 47:94-98. [PMID: 34414445 DOI: 10.1093/jpepsy/jsab081] [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: 02/25/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To present a developmental framework of family conflict in youth with type 1 diabetes (T1D) that aims to guide future research. METHODS Developmental and pediatric literature are reviewed to highlight family factors that may modify the degree to which diabetes-related family conflict is related to adolescent health outcomes. RESULTS Developmental literature suggests that family conflict is not inherently bad; rather, conflict that arises under optimal conditions (moderate frequency, warm and accepting relationships) can be adaptive for adolescents. However, family conflict is consistently associated with poor disease outcomes in youth with T1D, with few researchers examining specific moderators of these associations. In this topical review, we highlight moderators of family conflict and developmental outcomes identified in adolescents without chronic illness (e.g., cultural factors, parent-child relationship quality, conflict characteristics) and how these moderators may operate for a pediatric chronic illness such as T1D. CONCLUSIONS Incorporating conceptualizations of family conflict from mainstream developmental research has important implications for future research and intervention adaptations on family conflict in pediatric populations.
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Baechle C, Stahl-Pehe A, Castillo K, Selinski S, Holl RW, Rosenbauer J. Association of family structure with type 1 diabetes management and outcomes in adolescents: A population-based cross-sectional survey. Pediatr Diabetes 2021; 22:482-494. [PMID: 33259124 DOI: 10.1111/pedi.13166] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 09/09/2020] [Accepted: 11/11/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Diabetes therapies have enormously changed during past decades, but only few studies have analyzed the association between family structure and diabetes management and outcomes. OBJECTIVE To analyze cross-sectionally the associations of family structure with type 1 diabetes (T1D) management and various diabetes outcomes. METHODS A total of 1635 11- to 17-year-old participants and their parents completed one of three baseline surveys as part of a nationwide, population-based cohort study on early-onset, long-standing T1D. Associations between family structure and outcome variables were analyzed by multivariable linear/logistic regression. RESULTS Compared to adolescents living with both parents (reference), HbA1c was 0.48% (95% confidence interval 0.24; 0.71) / 5.2 (2.6; 7.8) mmol/mol higher in adolescents living with one parent and 0.34% (0.08; 0.59) / 3.7 (0.9; 6.5) mmol/mol higher in those living with one parent and her/his partner. The blood glucose self-monitoring (SMBG) frequency was lower (single parent: -0.6 (-1.1; -0.2), parent and partner:-0.5 (-1.0; 0.0)) and parents reported more long-term consequences related to school or work (ORsingle-parent 1.52 (0.90; 2.57), ORparent + partner 1.50 (0.86; 2.60)). While living with one parent was associated with increased odds of insulin injection vs. insulin pump therapy (OR 1.61 [1.13; 2.29]), the odds of low hypoglycemia awareness (OR 1.75 [1.00; 3.08]) and diabetes complications (1.32 [0.78; 2.22]) were higher in people living with a parent and her/his partner. CONCLUSIONS Living with only one parent with or without a new partner was associated with less SMBG and pump use and poor diabetes outcomes. Future studies to explore the underlying mechanisms are required.
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Affiliation(s)
- Christina Baechle
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Anna Stahl-Pehe
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Katty Castillo
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Silvia Selinski
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Reinhard W Holl
- University of Ulm, Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm, Germany.,German Center for Diabetes Research, Neuherberg, Germany
| | - Joachim Rosenbauer
- German Diabetes Center, Institute for Biometrics and Epidemiology, Düsseldorf, Germany.,German Center for Diabetes Research, Neuherberg, Germany
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4
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Ladha S, Fox D, Bone JN, Amed S. An Analysis of Self-Reported Barriers to Type 1 Diabetes Care in a Pediatric Population in British Columbia, Canada. Can J Diabetes 2020; 45:383-389. [PMID: 33358268 DOI: 10.1016/j.jcjd.2020.10.015] [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: 07/02/2020] [Revised: 09/22/2020] [Accepted: 10/24/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Our aim in this study was to identify patient-level barriers to attending pediatric type 1 diabetes mellitus (T1DM) clinic and to better understand the demographic and clinical characteristics of these reporting barriers. METHODS Patients were recruited from pediatric T1DM clinics throughout British Columbia. Barriers to attending clinic were identified through a survey. Demographic and clinical characteristics of patients who reported difficulty attending clinic appointments were compared with those who did not. RESULTS Of the 197 study participants, 31% reported difficulty attending appointments. Commonly reported barriers were distance to clinic and missing work. Younger child age and residing in northern regions increased the odds of reporting a barrier, whereas residing on Vancouver Island decreased odds of reporting a barrier. There were no differences in glycated hemoglobin levels between the 2 groups. CONCLUSIONS Approximately 1 in 3 patients identified challenges in attending T1DM appointments in British Columbia. Further research is needed to determine whether similar challenges exist in other provinces.
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Affiliation(s)
- Safia Ladha
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Danya Fox
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Jeffrey N Bone
- Department of Obstetrics and Gynecology, University of British Columbia, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Shazhan Amed
- Department of Pediatrics, University of British Columbia, BC Children's Hospital, Vancouver, British Columbia, Canada.
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5
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Ellis DA, Carcone AI, Naar-King S, Rajkumar D, Palmisano G, Moltz K. Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial. J Pediatr Psychol 2020; 44:110-125. [PMID: 29186562 DOI: 10.1093/jpepsy/jsx144] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 11/09/2017] [Indexed: 11/14/2022] Open
Abstract
Objective To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Results Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Conclusions Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.
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Affiliation(s)
- Deborah A Ellis
- Department of Family Medicine and Public Health Sciences, Wayne State University
| | | | - Sylvie Naar-King
- Center for Translational Behavioral Research, Florida State University
| | - Dixy Rajkumar
- Department of Family Medicine and Public Health Sciences, Wayne State University
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6
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Carcone AI, Naar S, Clark J, MacDonell K, Zhang L. Provider behaviors that predict motivational statements in adolescents and young adults with HIV: a study of clinical communication using the Motivational Interviewing framework. AIDS Care 2019; 32:1069-1077. [PMID: 31621396 DOI: 10.1080/09540121.2019.1679709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Medical care providers' use of Motivational Interviewing (MI) is linked to improved medication adherence, viral load, and associated behaviors in adolescents and young adults living with HIV. Mastering MI is difficult for busy providers; however, tailoring MI training to the specific MI communication strategies most relevant for HIV treatment context may be a strategy to increase proficiency. The present study aimed to identify communication strategies likely to elicit motivational statements among adolescent-young adult patients living with HIV. Language used by MI-exposed providers during 80 HIV medical clinic visits was transcribed and coded to characterize patient-provider communication within the MI framework. Sequential analysis, an approach to establish empirical support for the order of behavioral events, found patients were more likely to express motivational statements after provider questions phrased to elicit motivation, reflections of motivational statements, and statements emphasizing patients' decision-making autonomy. Patients were more likely to express amotivational statements when providers asked questions phrased to elicit amotivational statements or reflected amotivational language. Training providers to strategically phrase their questions and reflections to elicit change language and to emphasize patients' autonomy may be critical skills for working with adolescents and young adults living with HIV.
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Affiliation(s)
- April Idalski Carcone
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Sylvie Naar
- Department of Behavioral Sciences and Social Medicine, Center for Translational Behavioral Research, Florida State University, Tallahassee, Florida, USA
| | - Jamie Clark
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Karen MacDonell
- Department of Family Medicine and Public Health Sciences, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Liying Zhang
- Biostatistics and Epidemiology Research Design Core, Wayne State University School of Medicine, Detroit, Michigan, USA
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7
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Mönkemöller K, Müller-Godeffroy E, Lilienthal E, Heidtmann B, Becker M, Feldhahn L, Freff M, Hilgard D, Krone B, Papsch M, Schumacher A, Schwab KO, Schweiger H, Wolf J, Bollow E, Holl RW. The association between socio-economic status and diabetes care and outcome in children with diabetes type 1 in Germany: The DIAS study (diabetes and social disparities). Pediatr Diabetes 2019; 20:637-644. [PMID: 30912245 DOI: 10.1111/pedi.12847] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Revised: 01/31/2019] [Accepted: 03/11/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To evaluate the association between socioeconomic status (SES) and diabetes outcomes in German children and adolescents. METHODS A total of 1829 subjects <18 years old with type 1 diabetes mellitus from 13 German diabetes centers were included from June 2013 until June 2014. Data were collected within the multicenter DPV (Diabetes Prospective Follow-up) registry. SES was measured with a composite index. Multivariable regression models were applied to analyze the association of SES and outcomes adjusted for age, sex, diabetes duration, and migration status. RESULTS Low SES was significantly associated with worse diabetes outcomes: higher hemoglobin A1C (HbA1c) (64.3 mmol/mol), lower proportion of insulin pump therapy (43.6%), fewer daily self-monitored blood glucose (SMBG) measurements (5.7), more inpatient days per patient-year (5.8) compared to patients with medium/high SES (HbA1c: 61.3 mmol/mol, P < 0.001/59.8 mmol/mol, P < 0.0001; proportion of pump therapy: 54.5%, P < 0.01/ 54.9%, P < 0.01; SMBG: 6.0, P < 0.01/ 6.1, P < 0.01; inpatient days: 4.5, P < 0.0001/3.4, P < 0.0001). The inclusion of migration status in the models resulted in only minor changes in the outcomes. CONCLUSION Despite free health care, low SES is associated with unfavorable diabetes outcomes in Germany. The poorer diabetes outcomes of children with diabetes have been attributed to their migration status and may be partly explained by low SES. Both factors must become part of targeted diabetes care in children and adolescents with type 1 diabetes.
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Affiliation(s)
- Kirsten Mönkemöller
- Department of Pediatrics, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | | | - Eggert Lilienthal
- Department of Pediatrics, University Hospital St. Josef Bochum, Bochum, Germany
| | - Bettina Heidtmann
- Department of Pediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Marianne Becker
- Department of Pediatrics, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Lutz Feldhahn
- Department of Pediatrics, Klinik für Kinder- und Jugendmedizin Böblingen, Böblingen, Germany
| | - Markus Freff
- Department of Pediatrics, Kinderkliniken Prinzessin Margaret, Darmstadt, Germany
| | - Dörte Hilgard
- Department of Pediatrics, Pediatric Practice, Witten, Germany
| | - Beate Krone
- Department of Pediatrics, Klinikum Bremen-Nord, Bremen, Germany
| | - Matthias Papsch
- Department of Pediatrics, Marienhospital, Gelsenkirchen, Germany
| | - Andrea Schumacher
- Department of Pediatric Endocrinology, Medical Center, Endokrinologikum, Ulm, Germany
| | - Karl O Schwab
- Department of Pediatrics and Adolescent Medicine, University Medical Center, Freiburg, Germany
| | | | - Johannes Wolf
- Department of Pediatrics, St. Vincenz-Krankenhaus, Paderborn, Germany
| | - Esther Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Center for Diabetes Research (DZD), Neuherberg, Germany
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8
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Kristensen LJ, Birkebaek NH, Mose AH, Berg Jensen M, Thastum M. Multi-informant path models of the influence of psychosocial and treatment-related variables on adherence and metabolic control in adolescents with type 1 diabetes mellitus. PLoS One 2018; 13:e0204176. [PMID: 30235290 PMCID: PMC6147740 DOI: 10.1371/journal.pone.0204176] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 09/03/2018] [Indexed: 12/12/2022] Open
Abstract
Background We assessed the associations between metabolic control and adherence and a broad range of adolescent and family characteristics (e.g., gender, family structure), treatment-related variables (e.g., disease duration, treatment modality), and psychosocial factors (e.g., symptoms of depression and anxiety, parental support, self-efficacy) in a nationwide study of Danish adolescents (age 12–17 years) with type 1 diabetes mellitus (T1DM). Methods Sixty-four percent of invited families participated by completing a survey and providing a blood sample. Two path models of associations between generic and diabetes-related family factors, adolescent self-efficacy, emotional difficulties, and metabolic control and adherence were tested, one for adolescents and one for caregivers. Demographic variables were included as covariates. Results Both path models demonstrated a satisfying model fit. In both models, metabolic control was associated with adherence, age, and T1DM duration. In the adolescent model, metabolic control was also related to treatment modality, single-parent household, caregiver non-support, and anxiety, whereas in the caregiver model metabolic control was associated with family conflict and caregiver support. In both models, adherence was related to age, duration, treatment modality, family conflict, caregiver support, family functioning, and emotional difficulties of the adolescent. In the adolescent model, adherence was also related to adolescent self-efficacy, whereas in the caregiver model adherence was associated with adolescent gender and caregiver non-support and support. Adolescent self-efficacy, emotional well-being, and difficulties related to adolescent/caregiver interaction appeared to be particularly important, as indicated by their stronger association with adherence and/or metabolic control. Conclusion The results highlight the value of applying a multi-informant approach to address the psychosocial well-being of adolescents with diabetes in a large national sample. Self-efficacy, emotional, and family-related difficulties are important aspects to address in both clinical care and future research regarding adolescents with T1DM.
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Affiliation(s)
- Lene Juel Kristensen
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
- * E-mail:
| | | | | | - Morten Berg Jensen
- Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
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9
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Lindner LME, Gontscharuk V, Bächle C, Castillo K, Stahl-Pehe A, Tönnies T, Yossa R, Holl RW, Rosenbauer J. Severe hypoglycemia and diabetic ketoacidosis in young persons with preschool onset of type 1 diabetes mellitus: An analysis of three nationwide population-based surveys. Pediatr Diabetes 2018; 19:713-720. [PMID: 29498171 DOI: 10.1111/pedi.12628] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/14/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To describe incidence rates and temporal trends of severe hypoglycemia (SH) and of hospitalizations for SH or diabetic ketoacidosis (DKA) in persons with early-onset, long-term type 1 diabetes (T1D) and associations of these short-term complications with potential risk factors. METHODS This study includes data of 1,875 persons 11.2 to 21.9 years of age with early-onset (<5 years) and long-term (>10 years) T1D from 3 cross-sectional nationwide, population-based surveys conducted in 2009/2010, 2012/2013 and 2015/2016 using standardized questionnaires. Negative binomial regression was used to estimate incidence rates per 100 person-years (py), temporal trends and associations between potential risk factors and outcomes. RESULTS The crude incidence rate of SH showed a decreasing trend over time (P for trend = .004), disappearing after adjustment for confounders (P for trend = .341). In contrast, adjusted rates of SH- and DKA-associated hospitalizations did not change significantly between 2009 and 2016 (P for trend = .306 and .774, respectively). Associations between sex, diabetes duration, insulin treatment regimen, hypoglycemia awareness as well as physical activity and SH were found, while family structure was associated with hospitalizations for SH. Family structure, socioeconomic status (SES), diabetes duration, and hemoglobin A1c values showed associations with DKA-related hospitalizations. CONCLUSIONS After adjustment, rates of SH and SH- or DKA-associated hospitalization showed no significant changes in recent years. Structured education programs focusing on high-risk groups as, for example, persons with T1D living with 1 biological parent and the parents' partner or those with a low SES, should be implemented to reduce incidence rates of hospitalizations.
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Affiliation(s)
- Lena M E Lindner
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
| | - Veronika Gontscharuk
- Department of Statistics in Medicine, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Center for Health and Society, Faculty of Medicine, Institute for Health Services Research and Health Economics, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DDZ), Institute for Health Services Research and Health Economics, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Christina Bächle
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
| | - Katty Castillo
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
| | - Anna Stahl-Pehe
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
| | - Thaddäus Tönnies
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
| | - Rhuphine Yossa
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
| | - Reinhard W Holl
- German Diabetes Center (DZD), München-Neuherberg, Germany.,Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Joachim Rosenbauer
- German Diabetes Center (DDZ), Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Diabetes Center (DZD), München-Neuherberg, Germany
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10
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Rose M, Aronow L, Breen S, Tully C, Hilliard ME, Butler AM, Streisand R. Considering Culture: A Review of Pediatric Behavioral Intervention Research in Type 1 Diabetes. Curr Diab Rep 2018; 18:16. [PMID: 29473103 DOI: 10.1007/s11892-018-0987-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE OF REVIEW Type 1 diabetes (T1D) incidence in youth is growing across all racial/ethnic backgrounds, with the most marked increase in African-American youth under 5. Underrepresented racial/ethnic minorities are at an increased risk for health complications. This review focuses on the reported disparities, demographics of samples in behavioral interventions, and study design considerations. RECENT FINDINGS Recruitment data from two ongoing behavioral intervention trials for young children with T1D are presented to compare enrolled/non-enrolled individuals and to discuss culturally appropriate study design considerations. Data were compared to the demographics of children (ages 1-6) with T1D in the clinic populations from the recruitment sites. Enrolling a representative sample and designing culturally appropriate behavioral interventions are important for generalizability, yet there is a gap between the individuals participating in T1D research and those who are most negatively affected by T1D. Suggestions are offered for ways to expand inclusion of diverse samples in behavioral intervention research in T1D.
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Affiliation(s)
- Meredith Rose
- Children's National Medical Center, 111 MI Ave NW, Washington, DC, 20010, USA
| | - Laura Aronow
- Children's National Medical Center, 111 MI Ave NW, Washington, DC, 20010, USA
| | - Sarah Breen
- Children's National Medical Center, 111 MI Ave NW, Washington, DC, 20010, USA
| | - Carrie Tully
- Children's National Medical Center, 111 MI Ave NW, Washington, DC, 20010, USA
- The George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX, 77030, USA
| | - Ashley M Butler
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX, 77030, USA
| | - Randi Streisand
- Children's National Medical Center, 111 MI Ave NW, Washington, DC, 20010, USA.
- The George Washington University School of Medicine, 2300 I St NW, Washington, DC, 20052, USA.
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11
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Sand P, Blom MD, Forsander G, Lundin CS. Family dynamics when a child becomes chronically ill: Impact of type 1 diabetes onset in children and adolescents. NORDIC PSYCHOLOGY 2017. [DOI: 10.1080/19012276.2017.1362990] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Peter Sand
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Stora Nygatan 171/2, Göteborg 411 08, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Gun Forsander
- Department of Pediatrics, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Stora Nygatan 171/2, Göteborg 411 08, Sweden
| | - Carina Sparud Lundin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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12
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Watson SE, Kuhl EA, Foster MB, Omoruyi AO, Kingery SE, Woods C, Wintergerst KA. The impact of insurance coverage and the family on pediatric diabetes management. Pediatr Diabetes 2017; 18:315-319. [PMID: 27161659 DOI: 10.1111/pedi.12394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2016] [Revised: 03/04/2016] [Accepted: 04/06/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/OBJECTIVE The impact of family composition on glycemic control in children with type 1 diabetes remains unclear. We sought to evaluate the relationship between health insurance coverage, family composition, and insulin management, and assess their impact on glycemic control in a pediatric type 1 diabetes population. METHODS A retrospective chart review was completed for patients seen in the Pediatric Endocrinology Clinic at the University of Louisville in 2012. RESULTS The analysis included 729 patients with type 1 diabetes; 268 (37%) had public insurance while 461(63%) had private insurance. Compared with publicly insured patients, privately insured patients had higher rates of intensive insulin management with multiple daily injections (MDI) plans or pump devices (88 vs. 83.2%, p = 0.066) and lower HbA1c levels [8.57 vs. 9.39% (70 vs. 79 mmol/mol), p < 0.001]. Of the 729 patients, 243 were in single-adult homes (33%). Single-adult homes had higher HbA1c levels than two-adult homes, [9.3 vs. 8.6% (78 vs. 70 mmol/mol), p < 0.001]. Among publicly insured, there was no difference in HbA1c levels for single-adult vs. two-adult homes [9.4 (79 mmol/mol), p = 0.868]. For privately insured, patients in single-adult homes had higher HbA1c levels than peers in two-adult homes [9.2 vs. 8.4% (77 vs. 68), p < 0.001]. CONCLUSION Insurance type and family composition have significant associative effects on glycemic control and insulin management that may be mitigated by insulin pump therapy. Identifying and addressing factors such as availability of resources, family education, and adult support and supervision, may help improve glycemic control in high-risk pediatric diabetes patients.
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Affiliation(s)
- Sara E Watson
- Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA
| | - Evan A Kuhl
- Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA
| | - Michael B Foster
- Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA
| | - Adetokunbo O Omoruyi
- Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA
| | - Suzanne E Kingery
- Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA
| | - Charles Woods
- Department of Pediatrics, Division of Infectious Disease, University of Louisville, Louisville, KY, USA
| | - Kupper A Wintergerst
- Department of Pediatrics, Division of Endocrinology, University of Louisville, Louisville, KY, USA
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13
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Khanolkar AR, Amin R, Taylor-Robinson D, Viner RM, Warner JT, Stephenson T. Young people with Type 1 diabetes of non-white ethnicity and lower socio-economic status have poorer glycaemic control in England and Wales. Diabet Med 2016; 33:1508-1515. [PMID: 26802317 DOI: 10.1111/dme.13079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2016] [Indexed: 12/12/2022]
Abstract
BACKGROUND The impact of ethnicity and socio-economic status (SES) on glycaemic control during childhood Type 1 diabetes is poorly understood in England and Wales. METHODS We studied 18 478 children with Type 1 diabetes (< 19 years) attending diabetes clinics and included in the 2012-2013 National Paediatric Diabetes Audit. Self-identified ethnicity was categorized as white, Asian, black, mixed, other and 'not-stated' (did not to divulge ethnicity). A small area measure of SES was estimated from the Index of Multiple Deprivation. Multiple linear regression was used to assess associations between ethnicity, SES and glycaemic control (mean HbA1c levels) accounting for age, gender and diabetes duration. The impact of insulin pump use on the ethnicity/SES-HbA1c associations was tested in 13 962 children. RESULTS All children from minority ethnic groups had higher mean HbA1c compared with white children, with largest differences observed in black and mixed ethnicities [8 mmol/mol (2.9%), 95% CI 5-11 and 7 mmol/mol (2.8%), 95% CI 5-9, respectively]. Lower SES was associated with higher mean HbA1c with a dose effect. The lowest SES group had a mean HbA1c that was 7 mmol/mol (2.8%) (95% CI 6-8) higher compared with the highest SES group, adjusted for ethnicity. Estimates for ethnicity were attenuated, but significant on adjustment for SES. Fewer non-white (white 20.3 vs. black 5.5%) and deprived (least deprived 21.1 vs. most deprived 13.2%) children were on insulin pump therapy. Ethnicity and SES remained significant predictors of HbA1c after accounting for insulin pump use. CONCLUSION The association between ethnicity and glycaemic control persists after adjustment for deprivation and pump use. An alternative approach to intensive insulin therapy might benefit these vulnerable children.
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Affiliation(s)
- A R Khanolkar
- Institute of Child Health, University College London (UCL), London, UK.
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
| | - R Amin
- Institute of Child Health, University College London (UCL), London, UK
| | - D Taylor-Robinson
- Institute of Child Health, University College London (UCL), London, UK
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - R M Viner
- Institute of Child Health, University College London (UCL), London, UK
| | - J T Warner
- Department of Child Health, University Hospital of Wales, Cardiff, UK
| | - T Stephenson
- Institute of Child Health, University College London (UCL), London, UK
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14
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Paz R, Rouhanian M, Vogt K. Glycemic control and sponsor rank of military dependents with type 1 diabetes mellitus. Pediatr Diabetes 2016; 17:449-57. [PMID: 26315782 DOI: 10.1111/pedi.12306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 07/20/2015] [Accepted: 07/29/2015] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Disparities in glycemic control are reported in children with type 1 diabetes related to differences in access to health care and socioeconomic status. In the US military, rank is an indicator of socioeconomic status, but all have complete health care access without cost. OBJECTIVE We sought to determine if glycemic control in children with type 1 diabetes differs if their sponsor (parent) is an officer vs. enlisted military service member. METHODS We performed a cross-sectional retrospective chart review of children with type 1 diabetes >1 yr duration whose parent is a military service member. RESULTS A total of 281 subjects met study criteria, 136 (48.4%) having an enlisted and 145 (51.6%) having an officer sponsor. The groups differed by race with 38.2% black in the enlisted and 9% black in the officer group (p < 0.001). The median enlisted average hemoglobin A1c (HbA1c) over the most recent year of available data was significantly higher than the officer group (9.2 vs. 8.4%, p < 0.001). The difference remained significant when controlled for age and race. Diabetes-related hospitalizations were greater in the enlisted group (39.0 vs. 19.3%, p < 0.001). More subjects in the officer group were on insulin pumps (54.5 vs. 28.7%, p < 0.001). CONCLUSION Dependent children of enlisted service members with type 1 diabetes have higher HbA1c levels, more diabetes-related hospitalizations, and are less likely to use insulin pumps than children of officers. These differences are likely linked to socioeconomic status and education levels given the universal access to health care within the military system.
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Affiliation(s)
- Rachael Paz
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Minoo Rouhanian
- Biostatistics Section, Department of Research Programs, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Karen Vogt
- Department of Pediatrics, Walter Reed National Military Medical Center, Bethesda, MD, USA
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15
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Lado JJ, Lipman TH. Racial and Ethnic Disparities in the Incidence, Treatment, and Outcomes of Youth with Type 1 Diabetes. Endocrinol Metab Clin North Am 2016; 45:453-61. [PMID: 27241975 DOI: 10.1016/j.ecl.2016.01.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Type 1 diabetes mellitus (T1DM) is the third most common chronic childhood disease in the United States. As more Hispanic and non-Hispanic black children are diagnosed with T1DM, racial and ethnic disparities in the treatment and outcomes of T1DM are increasing. This article reviews the increasing incidence and prevalence of T1DM in non-Hispanic white, non-Hispanic black, and Hispanic children. In addition, the racial and ethnic disparities in diabetes treatment, such as blood glucose monitoring, insulin therapy, and continuous glucose monitoring, and outcomes, including glycemic control, diabetic ketoacidosis, severe hypoglycemia, retinopathy, nephropathy, neuropathy, and diabetes-related mortality, are highlighted.
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Affiliation(s)
- Juan J Lado
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Terri H Lipman
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Rechenberg K, Whittemore R, Grey M, Jaser S. Contribution of income to self-management and health outcomes in pediatric type 1 diabetes. Pediatr Diabetes 2016; 17:120-6. [PMID: 25545117 PMCID: PMC4550560 DOI: 10.1111/pedi.12240] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2014] [Revised: 09/11/2014] [Accepted: 10/15/2014] [Indexed: 01/05/2023] Open
Abstract
Low income has been established as a risk factor for poorer outcomes in youth with type 1 diabetes; however, the effect of moderate income has not been studied. The purpose of this secondary analysis of baseline data from a multi-site study was to compare glycemic control, self-management, and psychosocial outcomes [depression, stress, and quality of life (QOL)] at different income levels in adolescents with type 1 diabetes. Youth (n = 320, mean age = 12.3 + 1.1, 55% female, 64% white, mean A1C = 8.3 ± 1.4) completed established self-management and psychosocial measures. A1C levels were collected from medical records. Caregivers reported annual family income, categorized as high (>$80K), moderate ($40-80K), or low (<$40K). Youth from high-income families had significantly lower A1C (mean = 7.9 ± 1.2) than those from the moderate-income group (8.6 ± 1.7, p < 0.001) or the low-income group (mean A1C = 8.6 ± 1.5, p = 0.003). Youth from the high-income group reported significantly better diabetes problem solving and more self-management goals than those from the moderate- or low-income groups (both p < 0.01). Youth from the high-income group also reported significantly fewer symptoms of depression, lower levels of perceived stress, and better QOL than those in the moderate or low-income groups (all p < 0.05). Multivariate linear regression models were used to test psychological and behavioral predictors of A1C and QOL. Parents' education status (p < 0.05) and self-management activities (p < 0.01) were significant predictors of hemoglobin A1c, while income (p < 0.01) and self-management activities (p < 0.05) were significant predictors of QOL.
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Affiliation(s)
| | | | - Margaret Grey
- School of Nursing; Yale University; West Haven CT USA
| | - Sarah Jaser
- School of Nursing; Yale University; West Haven CT USA
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17
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Abstract
Diabetic ketoacidosis (DKA) is associated with negative health outcomes and high costs for patients, families, and communities. Interventions developed to effectively reduce DKA and related costs should target the multiple risk factors associated with DKA and adherence difficulties. Certain demographic, psychological, and family factors are associated with increased risk for adherence problems and DKA. Individuals with a combination of risk factors (e.g., mental health problems, low socioeconomic status, high family conflict) may be particularly vulnerable to DKA. Although several different interventions have demonstrated promise in improving adherence and/or decreasing the risk of DKA, the generalizability of treatment results to those individuals most vulnerable to DKA is limited. Approaches which include multiple evidence-based components of care, are flexible in treatment delivery (e.g., home- and community-based, utilize technology), and target the multiple risk factors across relevant systems (e.g., individual, family, school, medical) are warranted to effectively reduce DKA in vulnerable populations.
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Affiliation(s)
- David V Wagner
- Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA
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18
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Caccavale LJ, Weaver P, Chen R, Streisand R, Holmes CS. Family Density and SES Related to Diabetes Management and Glycemic Control in Adolescents With Type 1 Diabetes. J Pediatr Psychol 2015; 40:500-8. [PMID: 25596386 DOI: 10.1093/jpepsy/jsu113] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2014] [Accepted: 12/02/2014] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Youth with Type 1 diabetes (T1D) from single-parent families have poorer glycemic control; a finding confounded with socioeconomic status (SES). Family density (FD), or youth:adult ratio, may better characterize family risk status. METHODS Structural equation modeling assessed the relation of single-parent status, SES, and FD to parenting stress, diabetes-related conflict, parental monitoring, adherence, and glycemic control using cross-sectional parent and youth data (n = 257). RESULTS Single-parent status exhibited similar relations as SES and was removed. Lower FD was associated with better glycemic control (β = -.29, p = .014) via less conflict (β = .17, p = .038) and greater adherence (β = -.54, p < .001). CONCLUSIONS Beyond SES, FD plays a significant role in adherence and glycemic control via diabetes-related conflict. In contrast, the effects of single-parent status were indistinguishable from those of SES. FD provides distinct information related to adolescent glycemic control.
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Affiliation(s)
- Laura J Caccavale
- Virginia Commonwealth University, Georgetown University, and Children's National Medical Center, Washington, DC, USA
| | - Patrick Weaver
- Virginia Commonwealth University, Georgetown University, and Children's National Medical Center, Washington, DC, USA
| | - Rusan Chen
- Virginia Commonwealth University, Georgetown University, and Children's National Medical Center, Washington, DC, USA
| | - Randi Streisand
- Virginia Commonwealth University, Georgetown University, and Children's National Medical Center, Washington, DC, USA
| | - Clarissa S Holmes
- Virginia Commonwealth University, Georgetown University, and Children's National Medical Center, Washington, DC, USA Virginia Commonwealth University, Georgetown University, and Children's National Medical Center, Washington, DC, USA
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Lord JH, Young MT, Gruhn MA, Grey M, Delamater AM, Jaser SS. Effect of race and marital status on mothers' observed parenting and adolescent adjustment in youth with type 1 diabetes. J Pediatr Psychol 2014; 40:132-43. [PMID: 25248850 DOI: 10.1093/jpepsy/jsu078] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To examine demographic differences in parenting behaviors and adjustment in youth with type 1 diabetes. METHODS Adolescents' psychosocial adjustment was assessed via self-reports and parent reports, and clinical data were obtained from adolescents' medical records. Mother-adolescent dyads (N = 93) engaged in a videotaped discussion task, which was coded for observed parenting behaviors. RESULTS Single and non-White mothers exhibited significantly more overinvolved and less collaborative parenting behaviors. Higher levels of overinvolved parenting and lower levels of collaborative parenting were associated with poorer adolescent adjustment (i.e., higher levels of externalizing problems). Observed parenting was not significantly associated with glycemic control. There was an indirect effect of marital status and race/ethnicity on externalizing behaviors through parenting. CONCLUSIONS The current study highlights parenting as a potential target for interventions, especially in single and minority mothers, to improve adjustment in this population.
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Affiliation(s)
- Jadienne H Lord
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Mackenzie T Young
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Meredith A Gruhn
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Margaret Grey
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Alan M Delamater
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University, School of Nursing, Yale University, and Department of Pediatrics, University of Miami
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20
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Hill KE, Gleadle JM, Pulvirenti M, McNaughton DA. The social determinants of health for people with type 1 diabetes that progress to end-stage renal disease. Health Expect 2014; 18:2513-21. [PMID: 24938493 DOI: 10.1111/hex.12220] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2014] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Self-management of type 1 diabetes over a lifetime is complex and challenging even in the best of circumstances, and the social environment can be a powerful determinant of health behaviours and outcomes. The aim of this study was to identify how social determinants of health can impact on the capacity of young people to manage their glycaemic control. METHODS The findings emerged from a constructivist grounded theory approach through an in-depth examination of life course events that were recounted through qualitative interviews. The rich descriptive detail obtained from this enquiry locates common experiences and the context in which concordance with therapies occurs and health behaviours develop. RESULTS This qualitative study of young people with type 1 diabetes who have developed end-stage renal disease demonstrates that there are many factors beyond individual control that can contribute to health outcomes. The social determinants of childhood environment, education, socio-economic status, gender and the culture of public health can contribute to disengagement from treatment regimens and the health-care system and to the development of microvascular complications at a comparatively young age. CONCLUSION These findings challenge the assumptions of health-care practitioners about individual responsibility and highlight the importance of considering how social determinants can shape lives, behaviours and health.
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Affiliation(s)
- Kathleen E Hill
- Renal Unit, Flinders Medical Centre, Bedford Park, SA, Australia
| | | | - Mariastella Pulvirenti
- Discipline of Public Health, School of Medicine, Flinders University, Adelaide, SA, Australia
| | - Darlene A McNaughton
- Discipline of Public Health, School of Medicine, Flinders University, Adelaide, SA, Australia
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21
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Holmes CS, Chen R, Mackey E, Grey M, Streisand R. Randomized clinical trial of clinic-integrated, low-intensity treatment to prevent deterioration of disease care in adolescents with type 1 diabetes. Diabetes Care 2014; 37:1535-43. [PMID: 24623027 PMCID: PMC4030089 DOI: 10.2337/dc13-1053] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To evaluate the efficacy of two office-based treatments designed to prevent deterioration in glycemic control in young adolescents with type 1 diabetes in a randomized clinical trial. An individualized, more intensive family teamwork Coping skills program was compared with a diabetes Education treatment. RESEARCH DESIGN AND METHODS A baseline assessment was followed by four brief treatment sessions and immediate posttesting over the course of 1.5 years. Families of 226 early adolescents (ages 11-14) were randomized to receive either individualized coping skills education or diabetes education as adjunctive treatment to quarterly medical appointments. Continued follow-up occurred at 3.5-month intervals for a long-term follow-up of up to 3 years. A post hoc Usual Care group facilitated comparisons of glycemic control. RESULTS Growth curve analysis showed that both treatment groups successfully prevented deterioration in adolescent disease care and simultaneously improved adolescent and parent quality of life that included indicators of more effective communication and reduced adherence barriers-without a concomitant increase in diabetes-related or general family conflict. However, contrary to expectation, the Education group was more efficacious than the Coping group in improvement of disease adherence and glycemic control over a 3-year follow-up. CONCLUSIONS Low-intensity office-based quarterly treatment can maintain or improve disease care adherence in early adolescence when provided to adolescent/parent dyads. Better outcomes are achieved when treatment goals and techniques match the needs of the targeted population.
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Affiliation(s)
- Clarissa S Holmes
- Department of Psychology, Pediatrics and Psychiatry, Virginia Commonwealth University, Richmond, VACenter for New Designs in Leadership and Scholarship, Georgetown University, Washington, DC
| | - Rusan Chen
- Center for New Designs in Leadership and Scholarship, Georgetown University, Washington, DC
| | - Eleanor Mackey
- Center for Translational Science, Children's National Health System, Washington, DC
| | - Margaret Grey
- Yale School of Nursing, Yale University, New Haven, CT
| | - Randi Streisand
- Center for Translational Science, Children's National Health System, Washington, DC
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Redondo MJ, Connor CG, Ruedy KJ, Beck RW, Kollman C, Wood JR, Buckingham B, Klingensmith G, Silverstein J, Tamborlane WV. Pediatric Diabetes Consortium Type 1 Diabetes New Onset (NeOn) Study: factors associated with HbA1c levels one year after diagnosis. Pediatr Diabetes 2014; 15:294-302. [PMID: 23889707 PMCID: PMC3858510 DOI: 10.1111/pedi.12061] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/10/2013] [Accepted: 06/12/2013] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To identify determinants of hemoglobin A1c (HbA1c) levels 1 yr after the diagnosis of type 1 diabetes (T1D) in participants in the Pediatric Diabetes Consortium (PDC) T1D New Onset (NeOn) Study. RESEARCH DESIGN AND METHODS Diabetes-specific as well as socioeconomic factors during the first year following diagnosis were analyzed in 857 participants (mean age 9.1 yrs, 51% female, 66% non-Hispanic White) not participating in an intervention study who had an HbA1c value at 12 months. RESULT Mean ± SD HbA1c at 1 yr was 62 ± 16 mmol/mol (7.8% ± 1.5). In univariate and multivariate analyses, clinical center, non-Hispanic White race, private health insurance, living with both parents, higher frequency of self-monitoring of blood glucose (SMBG), and lower insulin requirements were associated with lower HbA1c concentrations at 1 yr (p < 0.01). No association was found with gender, age, Tanner stage, body mass index (BMI), diabetic ketoacidosis (DKA) at onset, number of positive autoantibodies or HbA1c at onset, or number of visits to diabetes physician during the first year. CONCLUSIONS White race, higher socioeconomic status, two-parent household, more frequent SMBG, and low insulin requirements are associated with lower HbA1c concentration 1 yr after the onset of T1D in children.
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Affiliation(s)
- Maria J. Redondo
- Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, TX, US, 77030
| | | | | | - Roy W. Beck
- Jaeb Center for Health Research, Tampa, FL, US, 33647
| | - Craig Kollman
- Jaeb Center for Health Research, Tampa, FL, US, 33647
| | - Jamie R. Wood
- Center for Endocrinology, Diabetes, and Metabolism, Children’s Hospital Los Angeles, Los Angeles, CA, US, 90027
| | - Bruce Buckingham
- Pediatric Endocrinology, Stanford University, Stanford, CA, US, 94305
| | - Georgeanna Klingensmith
- Pediatrics, Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO, US, 80045
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Mackey ER, Struemph K, Powell PW, Chen R, Streisand R, Holmes CS. Maternal depressive symptoms and disease care status in youth with type 1 diabetes. Health Psychol 2014; 33:783-91. [PMID: 24799001 DOI: 10.1037/hea0000066] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The current study assessed relations among maternal depressive symptoms, poorer youth diabetes adherence, and glycemic control. Specifically, hypothesized mediating links of lowered expectations of parental involvement, less parental monitoring, and more conflict were examined. METHOD Participants included 225 mothers and their young adolescents, aged 11-14 years (M = 12.73 years, SD = 1.2) diagnosed with T1D. Maternal depressive symptoms and outcome expectancies for maternal involvement were evaluated with self-report questionnaires. Multisource, parent/youth, and multimethod assessment of adherence, parental monitoring, and conflict were evaluated during a baseline assessment from a larger randomized clinical trial. RESULTS The first hypothesized structural equation model demonstrated a good fit and indicated that more maternal depressive symptoms were directly associated with less parental monitoring and more conflict, which in turn each were associated with poorer adherence and glycemic control. Although higher involvement expectancies were associated with more monitoring and less conflict, they were not associated with other model variables. A second alternative model also fit the data well; poorer youth adherence was associated with more conflict that in turn related to maternal depressive symptoms. CONCLUSIONS Two models were tested by which maternal depressive symptoms and poorer youth adherence were interrelated via less monitoring and more conflict. Follow-up longitudinal evaluation can best characterize the full extent of these relations.
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Affiliation(s)
| | - Kari Struemph
- Department of Psychology, Virginia Commonwealth University
| | | | - Rusan Chen
- Center For New Designs In Learning & Scholarship, Georgetown University
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Young MT, Lord JH, Patel NJ, Gruhn MA, Jaser SS. Good cop, bad cop: quality of parental involvement in type 1 diabetes management in youth. Curr Diab Rep 2014; 14:546. [PMID: 25212099 PMCID: PMC4283591 DOI: 10.1007/s11892-014-0546-5] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.
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25
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Hilliard ME, Rohan JM, Rausch JR, Delamater A, Pendley JS, Drotar D. Patterns and predictors of paternal involvement in early adolescents' type 1 diabetes management over 3 years. J Pediatr Psychol 2013; 39:74-83. [PMID: 24013966 DOI: 10.1093/jpepsy/jst067] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To document trajectories of paternal involvement in diabetes management and examine bidirectional associations with diabetes outcomes across early adolescence. METHODS 3-year prospective assessment of paternal involvement, diabetes self-management, and glycemic control among 136 youth (age 9-12 at baseline) and their mothers and fathers. RESULTS Unconditional growth curves demonstrated decreasing amount (maternal report: F(1,128) = 14.79; paternal report: F(1,111) = 12.95, ps < 0.01) and level of contribution (maternal report: F(1,131) = 23.6, p < .01) of paternal involvement. Controlling for covariates, lower youth self-management predicted an increasing slope in fathers' self-reported amount of involvement (b = -0.15 to -0.22, p < .05), and higher levels of fathers' self-reported level of contribution predicted a decreasing slope in youths' self-reported self-management (b = -0.01, p < .05). CONCLUSIONS Like mothers, fathers' involvement declines modestly during early adolescence. Different aspects of paternal involvement influence or are influenced by youths' self-management. Communication about ways to enhance fathers' involvement before this transition may help prevent or reduce declining diabetes management and control common in adolescence.
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Affiliation(s)
- Marisa E Hilliard
- PhD, Baylor College of Medicine/Texas Children's Hospital, 1102 Bates Street, Suite 940, Houston, TX 77030, USA.
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Levin L, Kichler JC, Polfuss M. The relationship between hemoglobin A1C in youth with type 1 diabetes and chaos in the family household. DIABETES EDUCATOR 2013; 39:696-704. [PMID: 23963098 DOI: 10.1177/0145721713496872] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE The purpose of the study was to examine how physical and social environments, as measured by household chaos, affect the diabetes control (i.e., A1C) in youth with type 1 diabetes (T1DM). METHODS One hundred and four patients (53 male, 51 female) with T1DM (aged 1-13 years) and their caregivers were recruited from a diabetes clinic at a Midwestern children's hospital. The caregivers completed a demographic questionnaire as well as a questionnaire pertaining to chaos in the household. A medical record review at baseline and 3- and 6-month follow-up was also conducted. RESULTS Results found that above and beyond the demographic covariates, there still remained a significant relationship between household chaos and glycemic control. Those who scored more than 1 standard deviation above the mean Confusion, Hubbub, and Order Scale (CHAOS) measure score showed significantly worse glycemic control at 6-month follow-up. CONCLUSIONS This study demonstrated the relationship of family environment and glycemic control for youth with T1DM. The findings highlight the need to individually assess the youth's home environment to promote diabetes management and care during clinic visits.
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Affiliation(s)
- Laura Levin
- Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Levin, Dr Polfuss)
| | - Jessica C Kichler
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio (Dr Kichler)
| | - Michele Polfuss
- Medical College of Wisconsin, Milwaukee, Wisconsin (Dr Levin, Dr Polfuss)
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Powell PW, Chen R, Kumar A, Streisand R, Holmes CS. Sociodemographic effects on biological, disease care, and diabetes knowledge factors in youth with type 1 diabetes. J Child Health Care 2013. [PMID: 23197386 DOI: 10.1177/1367493512456105] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Sociodemographic risk factors place youth with type 1 diabetes at higher risk for immediate and long-term health complications, yet research has still to disentangle the confounding effects of ethnicity, socioeconomic status (SES), and parental marital status. Group-oriented and variable-oriented analyses were conducted to investigate sociodemographic differences in biological, disease care, and diabetes knowledge factors in youth with type 1 diabetes. The sample included 349 youth, age 9-17 years (79.9% Caucasian, 71.3% lived with two biological parents, M SES = 46.24). Group t-tests confirmed commonly reported ethnic differences in HbA1c and disease care behaviors. However, variable-oriented analyses controlling for confounding sociodemographic influences showed most disease care effects attributed to ethnicity were better explained by SES. Results may inform development of diabetes literacy programs that integrate culturally sensitive lifestyle and language components for families of youth at risk of poor metabolic control.
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Affiliation(s)
- Priscilla W Powell
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284-2018, USA
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Hilliard ME, Wu YP, Rausch J, Dolan LM, Hood KK. Predictors of deteriorations in diabetes management and control in adolescents with type 1 diabetes. J Adolesc Health 2013; 52:28-34. [PMID: 23260831 PMCID: PMC4467546 DOI: 10.1016/j.jadohealth.2012.05.009] [Citation(s) in RCA: 168] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2012] [Revised: 05/16/2012] [Accepted: 05/17/2012] [Indexed: 02/06/2023]
Abstract
PURPOSE Deteriorating type 1 diabetes management and control are common among adolescents; however, clinical evidence suggests that individual trajectories can vary. The aim of this study was to examine patterns and predictors of blood glucose monitoring (BGM) frequency and glycemic control (hemoglobin A1c). METHODS Prospective data analysis spanning 18-24 months was conducted with 150 adolescent-parent pairs. Latent group-based trajectory modeling identified subgroups and determined medical, demographic, psychological, and family predictors of subgroup membership. RESULTS Three subgroups emerged, representing diabetes management and control that are "meeting treatment targets" (40%; A1c at baseline = 7.4%, BGM frequency at baseline = 4.8 checks/day) and two levels "not meeting targets":"normatively similar" youth (40%; A1c = 9.2%, BGM frequency = 2.8 checks/day), and "high-risk" youth (20%; A1c = 11.2%, BGM frequency = 2.9 checks/day). Subgroup membership was maintained over 18-24 months. There was minimal change across time, although only one-third of adolescents met treatment targets. Older age, longer diabetes duration, ethnic minority status, unmarried caregiver status, insulin delivery via injections versus continuous subcutaneous insulin infusion, greater depressive symptoms, negative affect about BGM, and diabetes-specific family conflict each predicted membership in a subgroup with poorer diabetes management and control. CONCLUSIONS Among the nearly two-thirds of adolescents with management and control that do not meet treatment targets, modifiable and nonmodifiable factors may signal the need for prevention or intervention. Demographic and medical factors may call for proactive efforts to prevent deterioration, and psychological symptoms and family conflict signal opportunities for clinical intervention to promote improved diabetes management and control in adolescence.
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Affiliation(s)
- Marisa E. Hilliard
- Johns Hopkins Adherence Research Center, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Yelena P. Wu
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
| | - Joseph Rausch
- Division of Behavioral Medicine and Clinical Psychology, Center for the Promotion of Treatment Adherence and Self-Management, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Lawrence M. Dolan
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Korey K. Hood
- Division of Endocrinology, Department of Pediatrics, University of California San Francisco, San Francisco, CA
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Hilliard ME, Harris MA, Weissberg-Benchell J. Diabetes resilience: a model of risk and protection in type 1 diabetes. Curr Diab Rep 2012; 12:739-48. [PMID: 22956459 DOI: 10.1007/s11892-012-0314-3] [Citation(s) in RCA: 112] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Declining diabetes management and control are common as children progress through adolescence, yet many youths with diabetes do remarkably well. Risk factors for poor diabetes outcomes are well-researched, but fewer data describe processes that lead to positive outcomes such as engaging in effective diabetes self-management, experiencing high quality of life, and achieving in-range glycemic control. Resilience theory posits that protective processes buffer the impact of risk factors on an individual's development and functioning. We review recent conceptualizations of resilience theory in the context of type 1 diabetes management and control and present a theoretical model of pediatric diabetes resilience. Applications to clinical care and research include the development of preventive interventions to build or strengthen protective skills and processes related to diabetes and its management. The ultimate goal is to equip youths with diabetes and their families with the tools to promote both behavioral and health-related resilience in diabetes.
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Affiliation(s)
- Marisa E Hilliard
- Johns Hopkins Adherence Research Center, Johns Hopkins University School of Medicine, 5501 Hopkins Bayview Circle, JHAAC 3B.24, Baltimore, MD 21224, USA.
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Care delivery and outcomes among Belgian children and adolescents with type 1 diabetes. Eur J Pediatr 2012; 171:1679-85. [PMID: 22875314 DOI: 10.1007/s00431-012-1809-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 01/15/2023]
Abstract
UNLABELLED We aimed to investigate care processes and outcomes among children and adolescents with type 1 diabetes treated in hospital-based multidisciplinary paediatric diabetes centres. Our retrospective cross-sectional study among 12 Belgian centres included data from 974 patients with type 1 diabetes, aged 0-18 years. Questionnaires were used to collect data on demographic and clinical characteristics, as well as process of care completion and outcomes of care in 2008. Most patients lived with both biological or adoption parents (77 %) and had at least one parent of Belgian origin (78 %). Nearly all patients (≥95 %) underwent determination of HbA(1c) and BMI. Screening for retinopathy (55 %) and microalbuminuria (73 %) was less frequent, but rates increased with age and diabetes duration. Median HbA(1c) was 61 mmol/mol (7.7 %) [interquartile range 54-68 mmol/mol (7.1-8.4 %)] and increased with age and insulin dose. HbA(1c) was higher among patients on insulin pump therapy. Median HbA(1c) significantly differed between centres [from 56 mmol/mol (7.3 %) to 66 mmol/mol (8.2 %)]. Incidence of severe hypoglycaemia was 30 per 100 patient-years. Admissions for ketoacidosis had a rate of 3.2 per 100 patient-years. Patients not living with both biological or adoption parents had higher HbA(1c) and more admissions for ketoacidosis. Parents' country of origin was not associated with processes and outcomes of care. CONCLUSION Outcomes of care ranked well compared to other European countries, while complication screening rates were intermediate. The observed centre variation in HbA(1c) remained unexplained. Outcomes were associated with family structure, highlighting the continuing need for strategies to cope with this emerging challenge.
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Hanberger L, Samuelsson U, Berterö C, Ludvigsson J. The influence of structure, process, and policy on HbA(1c) levels in treatment of children and adolescents with type 1 diabetes. Diabetes Res Clin Pract 2012; 96:331-8. [PMID: 22326692 DOI: 10.1016/j.diabres.2012.01.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2011] [Revised: 01/08/2012] [Accepted: 01/10/2012] [Indexed: 12/18/2022]
Abstract
AIMS To identify factors which improve glycaemic control measured as HbA(1c) in children and adolescents with diabetes treated at paediatric departments. METHODS Through data from the Swedish paediatric diabetes quality registry, SWEDIABKIDS, five centres respectively with the lowest, highest, and largest decrease in centre mean HbA(1c) (Low, High, Decrease HbA(1c) centres) were identified. Diabetes team members completed questionnaires (109 of 128 responded) and reported team structure, process and policy. Open-ended questions were analysed with summative content analysis. RESULTS Compared to the High HbA(1c) centres, the Low and Decrease HbA(1c) centres showed higher compliance with guidelines, although they had shorter professional experience and lower proportion of special diabetes-educated team members. A clear message was given and the centres aimed at a lower HbA(1c) target value. Team members were devoted, had a positive attitude and perception of a well-functioning team. Trends for higher mean insulin dose and larger centre size were found. High HbA(1c) centres gave a vague message and had a perception of lack of cooperation in the team. CONCLUSIONS Team members' policy and approaches affect glycaemic control in children and adolescents. Team members need to be aware of their approach and of the importance of using resources within the team.
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Affiliation(s)
- L Hanberger
- Department of Clinical and Experimental Medicine, Linköping University, Sweden.
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Hilliard ME, Holmes CS, Chen R, Maher K, Robinson E, Streisand R. Disentangling the roles of parental monitoring and family conflict in adolescents' management of type 1 diabetes. Health Psychol 2012; 32:388-396. [PMID: 22545980 DOI: 10.1037/a0027811] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Less parental monitoring of adolescents' diabetes self-care and more family conflict are each associated with poorer diabetes outcomes. However, little is known about how these two family factors relate with one another in the context of self-care and glycemic control. Diabetes self-care was evaluated as a mediator of the associations among parental monitoring, family conflict, and glycemic control in early adolescents with type 1 diabetes. METHODS Adolescent-parent dyads (n = 257) reported on the frequency of parental monitoring, family conflict, and diabetes self-care. Hemoglobin A1c was abstracted from medical charts. Structural equation modeling was used for mediation analysis. RESULTS A mediation model linking parental involvement and family conflict with A1c through diabetes self-care fit the data well. Monitoring and conflict were inversely correlated (β = -0.23, p < .05) and each demonstrated indirect associations with A1c (standardized indirect effects -0.13 and 0.07, respectively) through their direct associations with self-care (β = 0.39, p < .001 and β = -0.19, p < .05, respectively). Conflict also was positively associated with higher A1c (β = 0.31, p < .01). CONCLUSIONS Elevated family conflict and less parental monitoring are risk factors for poorer glycemic control, and diabetes self-care is one mediator linking these variables. Interventions to promote parental monitoring of diabetes management during early adolescence may benefit from emphasizing strategies to prevent or reduce family conflict.
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Affiliation(s)
- Marisa E Hilliard
- Department of Psychiatry and Behavioral Sciences, Children's National Medical Center
| | | | - Rusan Chen
- Center for New Designs in Learning and Scholarship, Georgetown University
| | - Kathryn Maher
- Department of Psychology, Virginia Commonwealth University
| | | | - Randi Streisand
- Department of Psychiatry and Behavioral Sciences, Division of Behavioral Medicine and Clinical Psychology, Children's National Medical Center
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Bahati R, Guy S, Gwadry-Sridhar F. Analysis of Treatment Compliance of Patients with Diabetes. KNOWLEDGE REPRESENTATION FOR HEALTH-CARE 2012. [DOI: 10.1007/978-3-642-27697-2_8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
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Shields CG, Finley MA, Chawla N, Meadors WP. Couple and family interventions in health problems. JOURNAL OF MARITAL AND FAMILY THERAPY 2012; 38:265-80. [PMID: 22283390 DOI: 10.1111/j.1752-0606.2011.00269.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Intervention research for couples and families managing chronic health problems is in an early developmental stage. We reviewed randomized clinical trials of family interventions for common neurological diseases, cardiovascular diseases, cancer, and diabetes, which is similar to the content of previous reviews discussed later. One overriding theme of these studies is that patients with chronic illnesses and their families face a variety of challenges to which researchers have responded with an array of treatment modalities. Very few of the interventions reviewed, with the exception of treatment for adolescents with diabetes, tested family psychotherapy models. Most interventions were time-limited therapeutic interventions that trained families to improve their communication and problem-solving skills, individual and family coping skills, and medical management. Researchers more clearly described mechanisms of change in intervention studies with cancer and diabetes than with other diseases, and not surprisingly, they found greater empirical support for their interventions. Family interventions show promise to help patients and family members manage chronic illnesses. To develop an empirical base for family approaches to managing chronic illnesses, interventions must be based on theories that delineate mechanisms of change in family processes and skills in medical management necessary to maintain patients' and family members' health.
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Affiliation(s)
- Cleveland G Shields
- Purdue University, Human Development and Family Studies Department, Marriage and Family Therapy Program.
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Abstract
Adaptation to type 1 diabetes is optimized in the presence of ongoing family support and supervision. Therefore, it is particularly important to understand how family interactions influence adaptation to the illness. The purpose of this paper is to review the current literature on family interaction in youth with type 1 diabetes. Recent advancements in the literature include greater specificity of types of parental involvement, attention to the role of fathers, acknowledgment of the impact of parental distress, increased use of observational methods, and awareness of the impact of culture. Continued parental involvement-particularly monitoring-in the management of diabetes care is important as children transition into adolescence, and the best outcomes are evident when this involvement occurs in a warm, collaborative manner. Parents need support in managing their own distress to maintain this type of involvement.
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Valenzuela JM, La Greca AM, Hsin O, Taylor C, Delamater AM. Prescribed regimen intensity in diverse youth with type 1 diabetes: role of family and provider perceptions. Pediatr Diabetes 2011; 12:696-703. [PMID: 21457425 DOI: 10.1111/j.1399-5448.2011.00766.x] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Recent literature suggests that disparities in prescribed treatments may exist for youth with type 1 diabetes. There is limited research to date examining factors associated with prescribed regimen intensity in this population. In this study, we examined racial/ethnic differences in regimen intensity and predictors of regimen intensity in youth with type 1 diabetes. We expected that minority youth would have less intensive regimens and that caregiver and physician perceptions would be associated with regimen intensity. This cross-sectional study included 178 families of 10- to 17-yr-old youth at three endocrinology clinics. Caregivers reported perceived costs and benefits of intensive regimens. Physicians described the prescribed treatment and their perceptions of family/child competence and self-management. Analyses included analysis of covariance and hierarchical multiple linear regression. Findings indicate a disparity in regimen intensity for minority youth. Caregiver perceptions of costs associated with intensive regimens and physician perceptions of family competence are associated with prescribed regimen intensity. Interventions targeting disparities in prescribed regimen intensity should be considered. Further research is needed to understand the role of family perceptions of treatments and physician clinical decision making in addressing health disparities in type 1 diabetes.
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Affiliation(s)
- Jessica M Valenzuela
- Division of Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45209, USA.
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Cutfield SW, Derraik JGB, Reed PW, Hofman PL, Jefferies C, Cutfield WS. Early markers of glycaemic control in children with type 1 diabetes mellitus. PLoS One 2011; 6:e25251. [PMID: 21966469 PMCID: PMC3180292 DOI: 10.1371/journal.pone.0025251] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 08/30/2011] [Indexed: 01/08/2023] Open
Abstract
Background Type 1 diabetes mellitus (T1DM) may lead to severe long-term health consequences. In a longitudinal study, we aimed to identify factors present at diagnosis and 6 months later that were associated with glycosylated haemoglobin (HbA1c) levels at 24 months after T1DM diagnosis, so that diabetic children at risk of poor glycaemic control may be identified. Methods 229 children <15 years of age diagnosed with T1DM in the Auckland region were studied. Data collected at diagnosis were: age, sex, weight, height, ethnicity, family living arrangement, socio-economic status (SES), T1DM antibody titre, venous pH and bicarbonate. At 6 and 24 months after diagnosis we collected data on weight, height, HbA1c level, and insulin dose. Results Factors at diagnosis that were associated with higher HbA1c levels at 6 months: female sex (p<0.05), lower SES (p<0.01), non-European ethnicity (p<0.01) and younger age (p<0.05). At 24 months, higher HbA1c was associated with lower SES (p<0.001), Pacific Island ethnicity (p<0.001), not living with both biological parents (p<0.05), and greater BMI SDS (p<0.05). A regression equation to predict HbA1c at 24 months was consequently developed. Conclusions Deterioration in glycaemic control shortly after diagnosis in diabetic children is particularly marked in Pacific Island children and in those not living with both biological parents. Clinicians need to be aware of factors associated with poor glycaemic control beyond the remission phase, so that more effective measures can be implemented shortly after diagnosis to prevent deterioration in diabetes control.
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Affiliation(s)
| | | | - Peter W. Reed
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Paul L. Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand
| | - Craig Jefferies
- Starship Children's Hospital, Auckland District Health Board, Auckland, New Zealand
| | - Wayne S. Cutfield
- Liggins Institute, University of Auckland, Auckland, New Zealand
- National Research Centre for Growth and Development, University of Auckland, Auckland, New Zealand
- * E-mail:
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Anderson BJ, McKay SV. Barriers to glycemic control in youth with type 1 diabetes and type 2 diabetes. Pediatr Diabetes 2011; 12:197-205. [PMID: 20561243 DOI: 10.1111/j.1399-5448.2010.00667.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
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Whittemore R, Jaser S, Guo J, Grey M. A conceptual model of childhood adaptation to type 1 diabetes. Nurs Outlook 2011; 58:242-51. [PMID: 20934079 DOI: 10.1016/j.outlook.2010.05.001] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Indexed: 12/01/2022]
Abstract
The Childhood Adaptation Model to Chronic Illness: Diabetes Mellitus was developed to identify factors that influence childhood adaptation to type 1 diabetes (T1D). Since this model was proposed, considerable research has been completed. The purpose of this article is to update the model on childhood adaptation to T1D using research conducted since the original model was proposed. The framework suggests that, in individuals and families, characteristics such as age and socioeconomic status as well as the individuals' and families' responses (self-management, coping, self-efficacy, family functioning, social competence) influence the level of adaptation; in children with T1D, characteristics such as treatment modality (pump vs injections) and psychosocial responses (depressive symptoms and anxiety) also influence the level of adaptation. Adaptation has both physiologic (metabolic control) and psychosocial (Quality of Life [QOL]) components. This revised model provides greater specificity to the factors that influence adaptation to chronic illness in children. Research and clinical implications are discussed.
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Affiliation(s)
- Robin Whittemore
- Yale University, School of Nursing, 100 Church Street South, PO Box 9740, New Haven, CT 06536-0740, USA.
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Shalitin S, Gil M, Nimri R, de Vries L, Gavan MY, Phillip M. Predictors of glycaemic control in patients with Type 1 diabetes commencing continuous subcutaneous insulin infusion therapy. Diabet Med 2010; 27:339-47. [PMID: 20536498 DOI: 10.1111/j.1464-5491.2009.02925.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS To identify variables that predict glycaemic control in Type 1 diabetic patients switched to a continuous subcutaneous insulin infusion (CSII) regimen, in order to improve patient selection for this treatment. METHODS The notes of 421 Type 1 diabetic patients aged 2.6-39.8 years (median 19.4) who initiated CSII treatment in 1998-2007 and used it for > or = 1 year were reviewed. Details about their background and disease-related and treatment-related variables were recorded. At pump initiation, the mean age was 15.9 +/- 7.2 years, mean diabetes duration 6.4 +/- 5.8 years. Mean time of CSII use was 4.1 +/- 2.1 years. Good glycaemic control was defined by glycated haemoglobin (HbA(1c)) stratified by age (American Diabetes Association target levels). Improvement in glycaemic control was defined as a reduction of > or = 0.5% in HbA(1c) from baseline. The change in the rate of severe hypoglycaemic or diabetic ketoacidosis events was also determined. RESULTS There was a significant sustained decrease in HbA(1c) with CSII for an average of 6 years, without increased rates of hypoglycaemia. Achievement of target HbA(1c) was significantly associated with the following parameters at pump initiation: lower HbA(1c) (P < 0.001), younger age (< 12 years), shorter diabetes duration (P < 0.001) and more frequent daily self blood glucose monitoring (SBGM) (P < 0.01). Improved glycaemic control was associated with longer CSII use (P = 0.032) and higher HbA(1c) at CSII initiation (P < 0.001). CONCLUSIONS Switching patients to CSII resulted in sustained decrease in HbA(1c) and improved glycaemic control in patients with high HbA(1c). Young age, frequent SBGM and lower HbA(1c) at pump initiation were identified as predictors of achieving glycaemic targets with CSII.
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Affiliation(s)
- S Shalitin
- The Jesse Z and Lea Shafer Institute of Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petach Tikva, Israel.
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Carter PJ, Cutfield WS, Hofman PL, Gunn AJ, Wilson DA, Reed PW, Jefferies C. Ethnicity and social deprivation independently influence metabolic control in children with type 1 diabetes. Diabetologia 2008; 51:1835-42. [PMID: 18679654 DOI: 10.1007/s00125-008-1106-9] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Accepted: 06/19/2008] [Indexed: 11/29/2022]
Abstract
AIMS/HYPOTHESIS This study was performed to evaluate the influence of ethnicity and socioeconomic status (SES) on metabolic control in a population-based cohort of children with type 1 diabetes mellitus, and to evaluate whether any relationship between ethnicity and HbA(1c) is mediated by SES. METHODS We performed a retrospective review of all patients under age 16 years with type 1 diabetes (n = 555) from 1995 to 2005 in the greater Auckland region, New Zealand. Diabetes care variables and HbA(1c) values were collected prospectively, during clinic visits. RESULTS The mean population HbA(1c) was 8.3 +/- 1.3%. Maori and Pacific patients had poorer metabolic control than their European counterparts (9.1% and 9.3% vs 8.1%, p < 0.001) and higher rates of moderate to severe hypoglycaemia (31.1 and 24.8 vs 14.9 events/100 patient-years, p = 0.03). In multiple linear regression analysis, both ethnicity and SES were independently associated with HbA(1c) (p < 0.001). Other factors associated with higher HbA(1c) level were longer duration of diabetes, higher insulin dose, lower BMI z score and less frequent blood glucose monitoring (p < 0.001). CONCLUSIONS/INTERPRETATION Both ethnicity and SES independently influenced metabolic control in a large, unselected population of children with type 1 diabetes. Irrespective of SES, Maori and Pacific youth with type 1 diabetes were at greater risk of both moderate to severe hypoglycaemia and long-term complications associated with poor metabolic control.
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Affiliation(s)
- P J Carter
- Paediatric Diabetes Service, Greenlane Clinical Centre, Starship Children's Health, Auckland, New Zealand
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