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Yu J, Wang H, Zhu M, Zhou M, Xu J. Patient-Centered Positive Factors Influencing Glycemic Control in Adolescents with Type 1 Diabetes Mellitus in China: A Cross-Sectional and Longitudinal Study. Patient Prefer Adherence 2024; 18:1039-1046. [PMID: 38826503 PMCID: PMC11141705 DOI: 10.2147/ppa.s460104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 05/08/2024] [Indexed: 06/04/2024] Open
Abstract
Objective This study aimed to explore the stable longitudinal patient-centered self-protective factors of glycosylated hemoglobin (HbA1c) in adolescents with type 1 diabetes mellitus (T1DM). Methods We used both cross-sectional and longitudinal datasets at the Diabetes Education Center and National Endocrine and Metabolism Centre of a university hospital in China from April 2020 to July 2022. Participants were assessed using the Adolescent Diabetic Behavior Rating Scale (DBRS), Diabetes Strengths and Resilience Measure for Adolescents (DSTAR-Teen). HbA1c and other clinical variables were obtained from the medical record at the same time. 266 adolescents (131 male, age 14.1±3.9 years) completed the cross-sectional assessments and 131 (62 male, age 14.6±3.3 years) participated in a follow-up at a 1-year visit interval. Results Logistic regression analysis of cross-sectional data of 266 cases showed that there were significant positive effects between pump treatment (β=0.090, OR 2.460, P=0.005), DBRS scores (β=2.593, OR 13.366, P=0.002) and the meeting of standard HbA1c (<7.5%, 58 mmol/mol). Disease duration (β=-0.071, OR 0.932, P=0.033) was negatively correlated with it. The longitudinal multivariate generalized estimation equation model showed that DBRS scores (β=3.165, OR 23.681, P=0.009) and DSTAR-Teen scores (β=0.050, OR 1.051, P=0.012) had a positive influence on the meeting of standard HbA1c over one year time of 131 cases. Conclusion Self-care and resilience had higher cross-temporal stability in influencing glycemic control over time. To reach a better glycemic control and improve long-term health outcomes, attention should be paid to the detection and enhancement of these patient-centered promoters.
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Affiliation(s)
- Jian Yu
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China
| | - Meijing Zhou
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China
| | - Jingjing Xu
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210029, People’s Republic of China
- Department of Nursing, The First Affiliated Hospital with Nanjing Medical University (Jiangsu Province Hospital), Nanjing, LA, 210036, People’s Republic of China
- School of Public Health, Nanjing Medical University, Nanjing, LA, 210036, People’s Republic of China
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Stapleton C, Watkins E, Hare MJL, Timms F, Wood AJ, Titmuss A. The prevalence of diabetes distress and its association with glycaemia in young people living with insulin-requiring-diabetes in a regional centre in Australia. J Paediatr Child Health 2022; 58:2273-2279. [PMID: 36206303 PMCID: PMC10092535 DOI: 10.1111/jpc.16221] [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: 06/15/2022] [Revised: 08/30/2022] [Accepted: 09/05/2022] [Indexed: 01/09/2023]
Abstract
AIM Emotional responses, such as feeling overwhelmed with diabetes-related treatment, burnt-out and anxiety, are known as 'diabetes distress'. This study aimed to determine diabetes distress among children, adolescents and parents/carers managing insulin-requiring diabetes in a regional Australian setting, and to assess association with glycaemia. METHODS All children, adolescents and their parents/carers attending a regional hospital outpatient diabetes clinic between March 2018 and June 2019 were invited to complete a validated child, adolescent or parent/carer diabetes distress questionnaire. Demographics and time-matched clinical data were obtained from hospital records. A cross-sectional analysis was performed. RESULTS A total of 43 young people and 30 parents/carers completed a diabetes distress questionnaire during the study period. Diabetes distress was common, with 63% of young people and 67% of parents/carers nominating at least one serious concern. After adjustment for potential confounding factors, higher glycaemia (HbA1c %) was associated with higher distress scores among both young people (ß 6.2, 95% confidence interval (CI): 3.2-9.2, P < 0.001) and carers/parents (ß 5.6, 95% CI:1.5-9.8, P < 0.001). Diabetes distress did not differ by child age, duration of diagnosis or mode of insulin administration. For children, adolescents and carers, 'serious concerns' most commonly related to the impact of diabetes upon family and peer relationships. CONCLUSIONS Diabetes distress was common and associated with sub-optimal glycaemia. Routine screening for diabetes distress should be considered in paediatric services. Development of strategies to minimise diabetes distress for youth and families is required.
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Affiliation(s)
- Ciara Stapleton
- Paediatric Department, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Elizabeth Watkins
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Matthew J L Hare
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Francesca Timms
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Anna J Wood
- Endocrinology Department, Division of Medicine, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Angela Titmuss
- Paediatric Department, Division of Women, Children and Youth, Royal Darwin Hospital, Darwin, Northern Territory, Australia.,Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
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