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Lupini F, Basch M, Cooke F, Vagadori J, Gutierrez-Colina A, Kelly KP, Streisand R, Shomaker L, Mackey ER. BREATHE-T1D: Using iterative mixed methods to adapt a mindfulness-based intervention for adolescents with type 1 diabetes: Design and development. Contemp Clin Trials 2024; 142:107551. [PMID: 38692428 PMCID: PMC11180588 DOI: 10.1016/j.cct.2024.107551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 04/02/2024] [Accepted: 04/27/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND Negative affect is prevalent among adolescents with type 1 diabetes (T1D) and may impact diabetes self-management and outcomes through stress-related behaviors such as disordered eating. METHODS We describe the development of and design for the adaptation of a mindfulness-based intervention (MBI) for adolescents with T1D and negative affect. BREATHE-T1D is an MBI designed to target negative affect that has been tailored to address the unique lived experiences of adolescents with T1D. Qualitative interviews with stakeholders and participants were used to inform iterative adaptations to the intervention and control curricula over the course of the study. The primary aim of this paper is to describe the design, development, and protocol of the present pilot feasibility trial. CONCLUSIONS Iterative, qualitative methodology throughout the adaptation of an intervention is important for ensuring the resulting intervention is relevant and meaningful for the target population. CLINICAL TRIAL REGISTRATION NUMBER NCT05268393.
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Affiliation(s)
- Francesca Lupini
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America.
| | - Molly Basch
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America
| | - Frances Cooke
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America.
| | - Jack Vagadori
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America.
| | - Ana Gutierrez-Colina
- Colorado State University, Fort Collins, CO, United States of America; University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America.
| | - Katherine Patterson Kelly
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
| | - Randi Streisand
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
| | - Lauren Shomaker
- Colorado State University, Fort Collins, CO, United States of America; University of Colorado Anschutz Medical Campus, Aurora, CO, United States of America; Children's Hospital Colorado, Aurora, CO, United States of America.
| | - Eleanor R Mackey
- Children's National Hospital, 111 Michigan Avenue, Washington, DC 20010, United States of America; The George Washington University School of Medicine, Washington, DC, United States of America.
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Dabas H, Sarin J, Madhu S. Insulin Adherence in Adolescents with Type 1 Diabetes Mellitus. Indian J Endocrinol Metab 2023; 27:394-397. [PMID: 38107739 PMCID: PMC10723607 DOI: 10.4103/ijem.ijem_294_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 04/29/2023] [Accepted: 06/09/2023] [Indexed: 12/19/2023] Open
Abstract
Adherence to medication, especially insulin, is a key contributor to diabetes treatment outcomes. Lack of adherence is common among patients with type 1 diabetes mellitus (T1DM) ranging from 23% to 77%, with a higher frequency in developing countries. Poor adherence results in worse glycaemic control and increased mortality and morbidity due to diabetes complications. The objective of this study is to discuss insulin adherence among adolescents with T1DM. The review was conducted through search engines such as PubMed, Medline, Embase and Google Scholar. Search terms used were 'type 1diabetes mellitus', 'insulin dependent diabetes mellitus', 'Juvenile diabetes mellitus', 'adherence', 'compliance', 'non adherence', 'barriers', 'omission', 'medical adherence', 'adolescents', 'teenagers' and 'insulin'. T1DM is challenging for adolescents due to its lifelong treatment regimens. Educational programmes and specific interventions which can improve affordability, accessibility and administration of insulin should be implemented to improve insulin adherence among adolescents.
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Affiliation(s)
- Heena Dabas
- Florence Nightingale College of Nursing, Guru Teg Bahadur Hospital, Delhi, India
| | - Jyoti Sarin
- Maharishi Markendshwar College of Nursing, Ambala, Haryana, India
| | - S.V. Madhu
- Centre for Diabetes, Endocrinology and Metabolism, UCMS-GTB Hospital, Delhi, India
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O'Donnell HK, Trojanowski PJ, Alonso GT, Majidi S, Snell-Bergeon J, Wadwa RP, Vigers T, Pyle L, Gurka MJ, Shaffer E, Driscoll KA. A randomized controlled clinical trial to improve health outcomes in youth with type 1 diabetes: Study design and baseline characteristics. Contemp Clin Trials 2023; 131:107270. [PMID: 37348599 DOI: 10.1016/j.cct.2023.107270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 05/31/2023] [Accepted: 06/19/2023] [Indexed: 06/24/2023]
Abstract
Most adolescents with T1D do not meet glycemic recommendations or consistently perform the required self-management behaviors to prevent acute- and long-term deleterious health outcomes. In addition, most youth with T1D do not have access to behavioral health services to address T1D management barriers. Thus, delivering behavioral interventions during routine medical appointments may hold promise for improving T1D outcomes in adolescents. The overall objective of this study was to examine the effect of behavioral interventions, either a Personalized T1D Self-Management Behaviors Feedback Report or Problem-Solving Skills, delivered by a T1D behavioral health provider and a T1D medical provider during a joint, fully integrated appointment to improve health outcomes in youth with T1D. This paper describes the study rationale, design, and baseline characteristics for the 109 adolescent-caregiver dyads who participated. Primary and secondary outcomes include hemoglobin A1c (A1C), T1D self-management behaviors, and biological indicators of complications.
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Affiliation(s)
- Holly K O'Donnell
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Paige J Trojanowski
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - G Todd Alonso
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Shideh Majidi
- Children's National, Pediatric Endocrinology, 111 Michigan Ave NW, Washington DC, United States of America.
| | - Janet Snell-Bergeon
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - R Paul Wadwa
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Tim Vigers
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Laura Pyle
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America.
| | - Matthew J Gurka
- University of Florida, College of Medicine, Department of Pediatrics, PO Box 100177, Gainesville, FL, United States of America.
| | - Emily Shaffer
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America.
| | - Kimberly A Driscoll
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO, United States of America; University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL, United States of America; University of Florida Diabetes Institute, United States of America.
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Warnick J, Darling KE, Topor LS, Jelalian E. Formative Development of a Weight Management Intervention for Adolescents with Type 1 Diabetes Mellitus and Obesity. Pediatr Diabetes 2023; 2023:9584419. [PMID: 37614408 PMCID: PMC10445778 DOI: 10.1155/2023/9584419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023] Open
Abstract
The prevalence of overweight and obesity in youth with type 1 diabetes mellitus (T1D) now exceeds that of youth without T1D. Comorbid T1D and excess adiposity are associated with multiple serious negative health outcomes. Unfortunately, youth with T1D are often excluded from and/or not referred to standard behavioral lifestyle interventions. This is often attributed to the complexities of managing T1D and an effort not to overburden persons who have T1D. Furthermore, standard behavioral weight management intervention recommendations can be perceived as contradicting T1D disease management (e.g., removing sugar-sweetened beverages from diet, energy balance with exercise, and caloric restriction). A weight management intervention specifically designed for youth with T1D is needed to provide treatment to youth with comorbid T1D and overweight/obesity. The current study interviewed adolescents with T1D and overweight/obesity (n = 12), their caregivers (n = 12), and pediatric endocrinologists (n = 9) to understand (a) whether they would be interested in a weight management intervention adapted for youth with T1D and (b) specific adaptations they would want and need. Five central themes emerged following applied thematic analysis: (1) program content, (2) programmatic messaging, (3) program structure, (4) social support, and (5) eating disorder risk. Results provide detailed recommendations for the adaptation of a behavioral weight management intervention for youth with T1D.
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Affiliation(s)
- Jennifer Warnick
- Alpert Medical School of Brown University, Providence, USA
- The Miriam Hospital, Providence, USA
| | - Katherine E. Darling
- Alpert Medical School of Brown University, Providence, USA
- The Miriam Hospital, Providence, USA
| | | | - Elissa Jelalian
- Alpert Medical School of Brown University, Providence, USA
- The Miriam Hospital, Providence, USA
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Perfect MM, Silva GE, Chin CN, Wheeler MD, Frye SS, Mullins V, Quan SF. Extending sleep to improve glycemia: The Family Routines Enhancing Adolescent Diabetes by Optimizing Management (FREADOM) randomized clinical trial protocol. Contemp Clin Trials 2023; 124:106929. [PMID: 36441106 DOI: 10.1016/j.cct.2022.106929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 09/12/2022] [Accepted: 09/15/2022] [Indexed: 02/06/2023]
Abstract
Sleep deficiencies amongst individuals with type 1 diabetes mellitus (T1DM) have been linked with dysregulated glycemic control and greater morbidities. Sleep extension (EXT) has been identified as a viable intervention target to improve adolescent outcomes. The intervention aims to emphasize collaborative work with families to engage in behaviors that increase the likelihood of the youth increasing their sleep duration consistently. This study will randomize up to 175 youth with T1DM and at least one caregiver to either an EXT intervention or a family routines support (FRS) consultation. It is hypothesized that the EXT condition will lead to improvements in sleep, which in turn, will contribute to improved glycemic control. The primary endpoint is improved glycemic control assessed via a continuous glucose monitor (CGM) to ascertain average glucose levels across a week, glycemic variability, and percent time in the target range at one month and HbA1c at three months. Analyses will control for co-morbid conditions, including sleep-disordered breathing and obesity. This study will provide the needed data to support addressing sleep as part of the standards of care in youth with T1DM.
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Affiliation(s)
- Michelle M Perfect
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America.
| | - Graciela E Silva
- College of Nursing, University of Arizona, Tucson, AZ 85721, United States of America
| | - Cindy N Chin
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Mark D Wheeler
- Pediatrics, Division of Endocrinology, 1501 N. Campbell, Tucson, AZ 85724, United States of America
| | - Sara S Frye
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Vicky Mullins
- Department of Disability and Psychoeducational Studies, College of Education, 1430 E 2nd St., University of Arizona, Tucson, AZ 85721, United States of America
| | - Stuart F Quan
- Asthma and Airway Disease Research Center, University of Arizona College of Medicine, Tucson, AZ 85724, United States of America; Division of Sleep and Circadian Disorders, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, United States of America
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Goncerz D, Mazurek E, Piasny M, Surówka A, Starzyk JB, Wójcik M, Makara-Studzińska M. Depressive and anxiety symptoms in adolescents with type 1 diabetes - a single-centre observational study. Pediatr Endocrinol Diabetes Metab 2023; 29:231-236. [PMID: 38282491 PMCID: PMC10826696 DOI: 10.5114/pedm.2023.133121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 04/02/2023] [Indexed: 01/30/2024]
Abstract
INTRODUCTION Type 1 diabetes mellitus (T1DM) significantly affects the everyday functioning of the child and its family. This study aimed to assess the prevalence of symptoms of depression and anxiety and estimate their potential association with various clinical parameters. MATERIAL AND METHODS 59 adolescents with T1DM (age 15-18) and their parents answered validated questionnaires (Children's Depression Inventory 2, The State-Trait Anxiety Inventory) and a survey assessing everyday functioning. RESULTS There were no significant differences in the occurrence of symptoms of depression in children and their parents (p = 0.975), but significant differences were found for anxiety. The distribution of the sten X1 and X2 values of adolescents and parents were different (p = 0.021 and p = 0.001, respectively). Girls were characterized by a higher level of depression both based on the overall score (p = 0.010) and the emotional problems (p = 0.022), and functional problems (p = 0.012). There was no significant correlation between diabetes duration time, glycaemic control, the occurrence of acute diabetes complications, and the parameters assessing anxiety and depression. Optimal glycaemic control, defined as HbA1c below 6.5% and TIR above 70%, was associated with sex (p = 0.001) and a high level of functional problems (p = 0.048). CONCLUSIONS In the studied population, adolescent girls with T1DM presented depressive symptoms more often than boys, and anxiety symptoms in adolescents were described more frequently by parents than by the teenagers themselves. Higher HbA1c was correlated with a higher level of functional problems.
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Affiliation(s)
- Dawid Goncerz
- Students’ Scientific Group, Department of Paediatric and Adolescents Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Edyta Mazurek
- Department of Statistics, Faculty of Economics and Finance, Wroclaw University of Economics and Business, Poland
| | - Marta Piasny
- Students’ Scientific Group, Department of Paediatric and Adolescents Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Anna Surówka
- Students’ Scientific Group, Department of Paediatric and Adolescents Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University Medical College, Kraków, Poland
| | - Jerzy B. Starzyk
- Department of Paediatric and Adolescents Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University Medical College, Krakow, Poland
| | - Małgorzata Wójcik
- Department of Paediatric and Adolescents Endocrinology, Chair of Paediatrics, Paediatric Institute, Jagiellonian University Medical College, Krakow, Poland
| | - Marta Makara-Studzińska
- Department of Health Psychology, Faculty of Health Science, Jagiellonian University, Medical College, Krakow, Poland
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Delamater AM. Forty Years of Behavioral Diabetes Research: A Personal Journey. Diabetes Spectr 2023; 36:88-96. [PMID: 36818415 PMCID: PMC9935293 DOI: 10.2337/ds22-0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This article was adapted from the address Dr. Delamater delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2022. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Delamater delivered the address in June 2022 at the Association's virtual 82nd Scientific Sessions. A webcast of this speech is available for viewing on the DiabetesPro website (https://professional.diabetes.org/webcast/stigma-diabetes-care%E2%80%94evidence-and-solutions-richard-r-rubin-award-lecture).
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Waist-to-hip circumference and waist-to-height ratio could strongly predict glycemic control than body mass index among adult patients with diabetes in Ethiopia: ROC analysis. PLoS One 2022; 17:e0273786. [DOI: 10.1371/journal.pone.0273786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/15/2022] [Indexed: 11/11/2022] Open
Abstract
Background
Poorly controlled blood glucose is prevalent and contributes to the huge burden of diabetes related morbidity, and central obesity has a great role in the pathogenesis of diabetes and its adverse complications, which could predict such risks, yet evidence is lacking. Hence, this paper is to evaluate the predictive performance of central obesity indices for glycemic control among adult patients with diabetes in eastern Ethiopia.
Methods
A survey of 432 randomly chosen patients with diabetes was conducted using a pretested questionnaire supplemented by chart review, anthropometrics, and biomarkers by trained data collectors. The poor glycemic control was assessed using a fasting blood glucose (FBS) level of above 130 and/or an HgA1c level above 7%. Weight, height, waist circumference (WC), and hip circumference (HC) were measured under standard procedures and we calculated waist-to-hip circumference ratio (WHR) and waist-to-height ratio (WHtR). The receiver operating characteristics curve was used to assess the predictive performance of obesity indices for glycemic control using area under the curve (AUC) and corresponding validity measures.
Results
A total of 432 (92%) patients with diabetes were enrolled with a mean age of 49.6 (±12.4) years. The mean fasting blood glucose level was 189 (±72) mg dl-1 where 330 (76.4%) (95% CI: 74.4–78.4%) and 93.3% of them had poor glycemic control based on FBS and HgA1c, respectively. WC (AUC = 0.90; 95% CI: 0.85–0.95), WHR (AUC = 0.64; 95% CI: 0.43–0.84), and WHtR (AUC = 0.87; 95% CI: 0.83–0.94) have a higher predictive performance for poor glycemic control at cut-off points above 100 cm, 0.95, and 0.62, respectively. However, obesity indices showed a lower predictive performance for poor glycemic control based on FBS. Body mass index (BMI) had a poor predictive performance for poor glycemic control (AUC = 0.26; 95% CI: 0.13–0.40).
Conclusions
Poor glycemic control is a public health concern and obesity indicators, typically WC, WHR, and WHtR, have a better predictive performance for poor glycemic control than BMI.
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Farthing P, Bally JMG, Leurer MD, Holtslander L, Nour MA, Rennie D. Managing the unmanageable through interdependence in adolescents living with type 1 diabetes and their parents: A constructivist grounded theory. J Pediatr Nurs 2022; 67:e191-e200. [PMID: 35927116 DOI: 10.1016/j.pedn.2022.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/14/2022] [Accepted: 07/16/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Management of T1D is complex and requires continuous care and monitoring that place many demands on adolescents with T1D and their parents. The purpose of this study was to explore the nature of interdependence with T1D management with adolescents and their parents. METHODS Using a constructivist grounded theory methodology, 32 open-ended interviews were conducted, transcribed, and analyzed from 11 adolescents aged 10-18 years with T1D and eight parents. FINDINGS The data were coded using three coding phases: initial, focused, and theroetical and this process continued until theroetical saturation was reached. The substantive theory that emerged from the data describing parents' and adolescents' main concern of Maintaining Optimal Glycemic Control was Managing the Unmanageable through Interdependence. Four related subprocesses were found: Completing T1D Tasks, Attaining Support, Balancing Independence, and Reconciling Reality. These subprocesses occurred within the context of the ever-changing, Nature of the Illness. DISCUSSION There is a dynamic relationship associated with interdependence between adolescents with T1D and their parents that varied situationally and by age. Participants also indicated interdependence occurs or they would like it to occur, with others beyond themselves and the health-care team to others willing to be involved. APPLICATION TO PRACTICE Interdependence is a dynamic process and requires ongoing evaluation by health-care professionals of its function in the daily management of T1D by parents and adolescents. Additional research into of the roles of health professionals and others in promoting interdependence is needed.
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Nasrallah M, Tamim H, Mailhac A, AlBuhairan F. Lifestyle habits in Saudi adolescents with diagnosed diabetes: An opportunity for health promotion. PLoS One 2022; 17:e0270807. [PMID: 35925967 PMCID: PMC9352005 DOI: 10.1371/journal.pone.0270807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/21/2022] [Indexed: 11/18/2022] Open
Abstract
Aims This study assessed lifestyle and health behavior habits among a representative sample of Saudi adolescents with self-reported diabetes and compared them to non-diabetic peers. Methods This was a nested case-control study, from the Jeeluna cohort, a nationwide, cross-sectional study of 12,575 Saudi boys and girls aged 10–19 years. Non-diabetic adolescents were matched to those with diabetes on a ratio of 4:1 based on age, gender and region. Retained information from the original study included: socio-demographics, lifestyle behaviors, tobacco/substance use, screen use, anthropometric measurements, and laboratory results. Results The prevalence of diabetes was 0.7% (n = 87). Overall, 65% of diabetic participants were males, and 22.4% aged ≤14 years. Overall, both groups had low rates of healthful habits in their diet and physical activity. Both groups had similar rates of tobacco use, and high digital screen time. Adolescents with diabetes had more consistent sleeping pattern, were more likely to be on a diet, thought they spent enough time with their physician and obtained medical information more often from their health clinic. They were also more likely to feel down and to chat more often. Conclusion Adolescents with diabetes remain far from guideline targets but seem predisposed to better lifestyle and have more access to health as compared to their non-diabetic peers.
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Affiliation(s)
- Mona Nasrallah
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
| | - Hani Tamim
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Aurelie Mailhac
- Department of Internal Medicine, Division of Endocrinology and Metabolism, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadia AlBuhairan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
- Health Sector Transformation Program, Riyadh, Saudi Arabia
- * E-mail:
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User-centred development of an mHealth app for youth with type 1 diabetes: the challenge of operationalizing desired features and feasibility of offering financial incentives. HEALTH AND TECHNOLOGY 2022. [DOI: 10.1007/s12553-022-00656-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Hakonen E, Varimo T, Tuomaala AK, Miettinen PJ, Pulkkinen MA. The effect of COVID-19 lockdown on the glycemic control of children with type 1 diabetes. BMC Pediatr 2022; 22:48. [PMID: 35045807 PMCID: PMC8766349 DOI: 10.1186/s12887-022-03115-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 01/10/2022] [Indexed: 12/05/2022] Open
Abstract
Background Between March 18th and May 13th 2020, the COVID-19 pandemic outbreak in Finland resulted in the closure of schools and the limitation of daycare (i.e. lockdown). Social distancing changed the daily routines of children with type 1 diabetes (T1D). Healthcare professionals were forced to adapt to the pandemic by replacing physical outpatient visits with virtual visits. However, the influence of the lockdown on glycemic control in these patients remained unknown. Methods In this retrospective register study from a pediatric diabetes outpatient clinic, we analyzed the glycemic data of T1D patients (n = 245; aged 4 to 16 years) before and under the lockdown. All the participants used continuous glucose monitoring (rtCGM or iCGM), two-thirds were on insulin pumps (CSII), and one-third on multiple daily insulin injections (MDI) therapy. Results In our patient cohort, time in range (TIR, n = 209) and mean glucose levels (n = 214) were similar prior to and under the lockdown (mean change 0.44% [95%CI: -1.1–2.0], p = 0.56 and -0.13 mmol/mol [95%CI: -0.3–0.1], p = 0.17, respectively). However, children treated with CSII improved their glycemic control significantly during the lockdown: TIR improved on average 2.4% [0.6–4.2] (p = 0.010) and mean blood glucose level decreased -0.3 mmol/mol [-0.6-(-0.1)] (p = 0.008). The difference was more pronounced in girls, adolescents and patients using conventional insulin pumps. Conclusions The glycemic control in T1D children did not deteriorate under the lockdown, and patients on CSII even improved their control, which suggests that social distancing might have allowed families to use the insulin pump more accurately as out-of-home activities were on hold.
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Ali N, Longson J, Myszka R, Park K, Low GKK, Leong GM, Bhurawala H, Liu A. Comparison of compliance and outcomes in adolescents with type 1 diabetes mellitus attending a co-located pediatric and transition diabetes service. JOURNAL OF TRANSITION MEDICINE 2022. [DOI: 10.1515/jtm-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Objectives
Adolescence is a challenging period for diabetes management, particularly when transitioning to adult care. There are reports highlighting concerns that transition to adult care may lead to poor glycemic control and clinic engagement. Our aim was to determine if a co-located pediatric and transition diabetes service would lead to better transition outcomes.
Methods
A retrospective medical records review was conducted on patients with type 1 diabetes attending a transition clinic in a metropolitan teaching hospital in Sydney, Australia. Patients referred from the hospital’s co-located pediatric diabetes clinic to the transition clinic were compared to those referred from external sources regarding important clinical outcomes such as glycosylated haemoglobin (HbA1c), clinic attendances, and complication rates between referral sources. Confounders such as age, gender, duration of diabetes and socioeconomic status were considered.
Results
Data was collected from 356 patients of which 121 patients were referred from the co-located pediatric diabetes clinic (IRG) and 235 patients from external sources (ERG). Improvements in HbA1c were only seen in the ERG at 6 and 12 months (p<0.001). Altogether 93% attended one or more medical appointments in the IRG compared to 83% in the ERG (p=0.03). There were more admissions for acute diabetes complications (17 vs. 8%, p=0.01) and more microvascular complications (20 vs. 9%, p<0.01) in the IRG vs. ERG group.
Conclusions
Although co-location of a pediatric and transition clinic improved medical engagement, this did not equate to better glycemic control or complication rates. Further research is warranted to determine what other strategies are required to optimise the transition process in diabetes care.
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Affiliation(s)
- Naushad Ali
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Julie Longson
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Rickie Myszka
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Kris Park
- Department of Endocrinology and Diabetes , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary K. K. Low
- Research Operations , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
| | - Gary M. Leong
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Habib Bhurawala
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
| | - Anthony Liu
- Department of Paediatrics , Nepean Hospital , Nepean Blue Mountain Local Health District , Derby St , Kingswood , NSW , 2750 , Australia
- Discipline of Paediatrics , The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney , Derby St , Kingswood , NSW , 2750 , Australia
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14
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Shi M, Ji X, Xie Y, Zhong T, Tang R, Fan L, Li X. Using Glycated Albumin and Stimulated C-Peptide to Define Partial Remission in Type 1 Diabetes. Front Endocrinol (Lausanne) 2022; 13:938059. [PMID: 35928900 PMCID: PMC9344919 DOI: 10.3389/fendo.2022.938059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 06/20/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To propose a new definition of partial remission (PR) for patients with type 1 diabetes (T1D) of all-ages using insulin dose and glycated albumin (GA), and find the optimal cut-off values for stimulated C-peptide to diagnose PR in different age-groups. RESEARCH DESIGN AND METHODS Patients with newly diagnosed T1D (n=301) were included. GA/insulin dose was used to diagnose PR, and insulin dose-adjusted glycated albumin (IDAGA) was proposed to facilitate clinical application. The optimal diagnostic levels of IDAGA and stimulated C-peptide were determined in different age-groups (≤ 12y, 12-18y and ≥ 18y). Furthermore, the diagnostic consistency between different PR definitions was studied. RESULTS GA≤ 23%/insulin dose ≤ 0.5u/kg/day was used to define PR, and IDAGA (GA (%) + 40 * insulin dose(u/kg/day)) ≤ 40 was feasible in all age-groups. Whereas, the optimal diagnostic level showed difference for stimulated C-peptide (265.5, 449.3 and 241.1 pmol/L for the ≤ 12y, 12-18y and ≥ 18y age-group, respectively). About 40% of patients met the PR definition by stimulated C-peptide but not GA/insulin dose or IDAGA, who showed dyslipidemia and higher insulin resistance. CONCLUSIONS A new definition of the PR phase is proposed using GA/insulin dose, and the calculated IDAGA≤ 40 applies to all age-groups. The stimulated C-peptide to diagnose PR is the highest in the 12-18y age-group, which reflects the effect of puberty on metabolism. For patients with insulin resistance, it is not recommended to use stimulated C-peptide alone to diagnose PR.
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15
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Tienhaara E, Falck AAK, Pokka TML, Tossavainen PH. The natural history of emerging diabetic retinopathy and microalbuminuria from prepuberty to early adulthood in Type 1 diabetes: A 19-year prospective clinical follow-up study. Diabet Med 2022; 39:e14732. [PMID: 34687245 DOI: 10.1111/dme.14732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 10/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the impact of long-term glycaemic control and glycaemic variability on microvascular complications in adolescents and young adults with childhood-onset Type 1 diabetes. METHODS Twenty-six participants took part in a prospective follow-up study. We used univariate generalised estimating equations (GEE) analysis with first-order autoregressive AR(1) covariance structure for repeated measurements to evaluate the relationship between emerging diabetic retinopathy (DR) and each single explanatory variable, namely age at developmental stages from late prepuberty until early adulthood, duration of diabetes and long-term HbA1c . Thereafter, the simultaneous effect of these three explanatory variables to DR was analysed in a multivariate model. RESULTS Twenty-five participants developed DR by early adulthood after a median diabetes duration of 16.2 years (range 6.3-24.0). No participants had DR during prepuberty. Each of the three variables was independently associated with emerging DR: age (OR 1.47, 95% CI to 1.25 to 1.74, p < 0.001) stronger than diabetes duration (OR 1.42, 95% CI 1.23 to 1.63, p < 0.001) and HbA1c (OR 1.02, 95% CI 1.001 to 1.05, p = 0.041) in this population. In the multivariate analysis of these three explanatory variables, only age was associated with DR (adjusted OR 1.52, 95% CI 1.10 to 2.10, p = 0.012). CONCLUSIONS The emergence of DR during adolescence and early adulthood is not rare and increases with age in patients with deteriorating metabolic control during puberty and thereafter. This underpins the need to prevent deterioration of glycaemic control from taking place during puberty-seen again in this follow-up study-in children with diabetes.
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Affiliation(s)
- Emmi Tienhaara
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Aura A K Falck
- Department of Ophthalmology, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Tytti M-L Pokka
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
| | - Päivi H Tossavainen
- Department of Pediatrics, PEDEGO Research Unit and Medical Research Center, University of Oulu and Oulu University Hospital, Oulu, Finland
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16
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Söderström H, Rehn J, Cervin M, Ahlstermark C, Bybrant MC, Carlsson A. Compliance to a Gluten-Free Diet in Swedish Children with Type 1 Diabetes and Celiac Disease. Nutrients 2021; 13:nu13124444. [PMID: 34959996 PMCID: PMC8709103 DOI: 10.3390/nu13124444] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 12/01/2021] [Accepted: 12/09/2021] [Indexed: 12/25/2022] Open
Abstract
Children with type 1 diabetes (T1D) are at increased risk of celiac disease (CD). The replacement of insulin in T1D, and the exclusion of gluten in CD, are lifelong, burdensome treatments. Compliance to a gluten-free diet (GFD) in children with CD is reported to be high, while compliance in children with both diseases has scarcely been studied. To examine compliance to a GFD in children with both T1D and CD, we analyzed tissue transglutaminase IgA-antibodies (tTGA). Moreover, associations between compliance and age, sex, glycemic control, ketoacidosis (DKA), body mass index (BMI), and time of CD diagnosis were investigated. Of the 743 children diagnosed with T1D in southern Sweden between 2005 and 2012, 9% were also diagnosed with CD. Of these, 68% showed good compliance to a GFD, 18% showed intermediate compliance, and 14% were classified as non-compliant. Higher age, poorer HbA1c, and more DKAs were significantly (p < 0.05) associated with poorer compliance. In conclusion, we found that compliance to a GFD in children with T1D and CD is likely be lower than in children with CD only. Our results indicate that children with both T1D and CD could need intensified dietary support and that older children and children with poor metabolic control are especially vulnerable subgroups.
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Affiliation(s)
- Hanna Söderström
- Department of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden; (J.R.); (M.C.); (A.C.)
- Skåne University Hospital, 221 85 Lund, Sweden;
- Correspondence:
| | - Julia Rehn
- Department of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden; (J.R.); (M.C.); (A.C.)
| | - Matti Cervin
- Department of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden; (J.R.); (M.C.); (A.C.)
| | | | - Mara Cerqueiro Bybrant
- Department of Women’s and Children’s Health, Division of Pediatric Endocrinology, Karolinska Institutet, 171 76 Stockholm, Sweden;
| | - Annelie Carlsson
- Department of Clinical Sciences Lund, Lund University, 221 00 Lund, Sweden; (J.R.); (M.C.); (A.C.)
- Skåne University Hospital, 221 85 Lund, Sweden;
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17
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Mason KA, Marks BE, Wood CL, Le TN. Cystic fibrosis-related diabetes: The patient perspective. J Clin Transl Endocrinol 2021; 26:100279. [PMID: 34926167 PMCID: PMC8649788 DOI: 10.1016/j.jcte.2021.100279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 11/11/2021] [Accepted: 11/13/2021] [Indexed: 11/25/2022] Open
Abstract
Cystic fibrosis-related diabetes (CFRD) affects nearly 20% of adolescents and 40-50% of adults. However, the impact on patients and their families is poorly understood. Here, we examine how patients perceive CFRD and identify gaps in our understanding of the patient experience. Despite its relatively high prevalence, data suggest that many individuals are not aware of the possibility of developing CFRD or compare it to other types of diabetes. Annual oral glucose tolerance testing (OGTT) may serve as an opportunity to provide education and prepare individuals for the possibility of developing abnormalities in glucose tolerance. Many cite lack of awareness of CFRD as the most difficult part of the diagnosis. While factors such as older age and a strong support system promote acceptance, most individuals view the diagnosis negatively and struggle to balance the demands of diabetes with other obligations, including airway clearance, nebulizer therapies, supplementation nutrition, and administration of vitamins and medications. Relatively few people with CFRD monitor their blood glucoses consistently, which is attributed to time constraints or an attempt to avoid pain. In addition, many feel that they are not prone to hypoglycemia and are not concerned with long-term complications, anticipating that they will succumb to their pulmonary disease before these become problematic. The adolescent period presents unique challenges for adherence as children work to develop autonomy. Factors that promote CFRD adherence include incorporating management into daily CF routines and the support of knowledgeable providers to help develop an individualized approach to management. Diabetes technology has the potential to reduce treatment burden and improve glycemic control, but data in CFRD are limited, and additional study is needed. Given that CFRD is associated with a decline in health-related quality of life, it is critical that providers understand patients' perspectives and address gaps in understanding and barriers to management.
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Affiliation(s)
- Kelly A. Mason
- University of Virginia, Department of Pediatric Endocrinology, PO Box 800386, Charlottesville, VA 22908, USA
| | - Brynn E. Marks
- Children’s National Hospital, Division of Endocrinology and Diabetes, 111 Michigan Avenue NW, Washington District of Columbia 20010, USA
- George Washington University School of Medicine & Health Sciences, Department of Pediatrics, Ross Hall, 2300 Eye Street, NW, Washington DC 20037, USA
| | - Colleen L. Wood
- Billings Clinic, Pediatric Subspecialties Department, Pediatric Diabetes and Endocrinology, 2800 Tenth Avenue North P.O. Box 37000, Billings, MT 59107, USA
| | - Trang N. Le
- Virginia Commonwealth University, Department of Internal Medicine and Pediatrics, Division of Pediatric Endocrinology, Diabetes, and Metabolism, 2305 N. Parham Road Suite 1, Richmond, VA 23229, USA
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18
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Stromberg SE, Boone DM, Healy A, Feldman M, Grishman EK, Faith MA. Social self-efficacy associated with HbA1c through physical activity and diabetes quality of life: A serial mediation study. Pediatr Diabetes 2021; 22:1081-1091. [PMID: 34455658 DOI: 10.1111/pedi.13261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/06/2021] [Accepted: 08/16/2021] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE Type 1 diabetes (T1D) is one of the most common pediatric chronic illnesses and increasing worldwide in prevalence. Physical activity has been positively linked with better glycemic control in youth with T1D. Although not yet studied, children's social self-efficacy may be a parameter related to physical activity in youth with diabetes. The current study investigated associations among social self-efficacy, physical activity, diabetes quality of life, and hemoglobin A1c (HbA1c) among youth with T1D utilizing mediation and serial mediation models. RESEARCH DESIGN AND METHODS Participants were 144 youth (M age = 14.95) with T1D (53.5% girls) and their caregivers. Youth completed the PedsQL Diabetes Module, the Physical Activity Questionnaire for Older Children and Adolescents and the Self-Efficacy Questionnaire for Social Skills for Children. Youths' HbA1c values were also measured. RESULTS Physical activity significantly mediated the relationship between greater youth social self-efficacy and better diabetes quality of life. Diabetes quality of life mediated the relationship between greater physical activity and lower HbA1c. The serial mediation model demonstrated greater social self-efficacy is related to greater physical activity, which in turn is related to better diabetes quality of life and ultimately resulting in lower HbA1c. CONCLUSIONS Physical activity, social self-efficacy, and diabetes-related quality of life may be modifiable factors related to HbA1c for youth with T1D. Findings indicate a need for healthcare providers to consider youth physical activity, quality of life, and social self-efficacy when evaluating and intervening in youth diabetes treatment adherence.
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Affiliation(s)
| | - Dianna M Boone
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ashly Healy
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Marissa Feldman
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Ellen K Grishman
- University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Melissa A Faith
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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19
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Versloot J, Ali A, Minotti SC, Ma J, Sandercock J, Marcinow M, Lok D, Sur D, de Wit M, Mansfield E, Parks S, Zenlea I. All together: Integrated care for youth with type 1 diabetes. Pediatr Diabetes 2021; 22:889-899. [PMID: 34173306 PMCID: PMC9290723 DOI: 10.1111/pedi.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 06/14/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE We describe the implementation and evaluation of an integrated, stepped care model aimed to identify and address the concerns of adolescents with type 1 diabetes (T1D) associated with diabetes-related quality of life (DRQoL), emotional well-being, and depression. RESEARCH DESIGN AND METHODS The care model with 4 steps: (1) Systematic identification and discussion of concerns salient to adolescents; (2) Secondary screening for depressive symptoms when indicated; (3) Developing collaborative treatment plans with joint physical and mental health goals; and (4) Psychiatric assessment and embedded mental health treatment; was implemented into an ambulatory pediatric diabetes clinic and evaluated using quantitative and qualitative methods. RESULTS There were 236 adolescents (aged 13-18 years) with T1D that were enrolled in the care model. On average adolescents identified three concerns associated with their DRQoL and 25% indicated low emotional well-being. Fifteen adolescents received a psychiatric assessment and embedded mental health treatment. Both adolescents and caregivers were appreciative of a broader, more holistic approach to their diabetes care and to the greater focus of the care model on adolescents, who were encouraged to self-direct the conversation. Parents also appreciated the extra level of support and the ability to receive mental health care for their adolescents from their own diabetes care team. CONCLUSION The initial findings from this project indicate the acceptability and, to limited extent, the feasibility of an integrated stepped care model embedded in an ambulatory pediatric diabetes clinic led by an interdisciplinary care team. The care model facilitated the identification and discussion of concerns salient to youth and provided a more holistic approach.
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Affiliation(s)
- Judith Versloot
- Institute for Better HealthTrillium Health PartnersMississaugaCanada,Institute for Health Policy, Evaluation and ManagementUniversity of TorontoTorontoCanada
| | - Amna Ali
- Institute for Better HealthTrillium Health PartnersMississaugaCanada
| | - Simona C. Minotti
- Institute for Better HealthTrillium Health PartnersMississaugaCanada,Department of Statistics and Quantitative MethodsUniversity of Milano‐BicoccaMilanItaly
| | - Julia Ma
- Institute for Better HealthTrillium Health PartnersMississaugaCanada,Precision AnalyticsQuebecCanada
| | - Jane Sandercock
- Institute for Better HealthTrillium Health PartnersMississaugaCanada
| | - Michelle Marcinow
- Institute for Better HealthTrillium Health PartnersMississaugaCanada
| | - Daphne Lok
- Women's and Children's Health ProgramTrillium Health PartnersMississaugaCanada
| | - Deepy Sur
- Ontario Association of Social WorkerTorontoCanada
| | - Maartje de Wit
- Department of Medical PsychologyAmsterdam University Medical Center, Vrije Universiteit AmsterdamAmsterdamNetherlands
| | - Elizabeth Mansfield
- Institute for Better HealthTrillium Health PartnersMississaugaCanada,Department of Occupational Science and Occupational Therapy, Faculty of MedicineUniversity of TorontoTorontoCanada
| | - Sheryl Parks
- Women's and Children's Health ProgramTrillium Health PartnersMississaugaCanada
| | - Ian Zenlea
- Institute for Better HealthTrillium Health PartnersMississaugaCanada,Department of Paediatrics, Temerty Faculty of MedicineUniversity of TorontoTorontoCanada
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20
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Dovey-Pearce G, Flannery H. Integrating psychology into paediatric healthcare: A UK perspective. Clin Child Psychol Psychiatry 2021; 26:313-322. [PMID: 33761794 DOI: 10.1177/13591045211000786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, London, UK
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21
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Klostermann S, Iskander J, Enlow P, Delamater AM, Dolan L, Pendley JS. Predicting healthcare utilization in youth with type 1 diabetes: The importance of family level variables. Pediatr Diabetes 2021; 22:294-302. [PMID: 33169899 DOI: 10.1111/pedi.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Little is known about how family factors impacting treatment adherence in type 1 diabetes are directly associated with unplanned healthcare utilization (e.g., emergency room visits and hospital admissions). Given the substantial financial burden of diabetes, understanding predictors of healthcare utilization in particular is important to inform behavioral interventions aimed toward improving adherence. RESEARCH DESIGN AND METHODS The current study examined the relationship between family-level variables and healthcare utilization in a sample of 239 youth with type 1 diabetes and their parents. Healthcare utilization was determined via parent report and chart review. Parent- and youth-reports regarding levels of family conflict, youth autonomy, and parent support related to diabetes management were obtained via questionnaire, and negative reciprocity was obtained by coding observations of parent and youth interactions. Generalized Estimating Equations were used to examine the longitudinal association between healthcare utilization and family-level factors. RESULTS Higher levels of observed negative reciprocity were associated with more frequent hospital admissions, while higher levels of youth-reported parent involvement in diabetes management were associated with fewer hospital admissions and ED visits. CONCLUSIONS These findings highlight how family-level factors are directly related to healthcare utilization and point to the continued importance of integrating family-focused behavioral interventions in routine medical care for improving type 1 diabetes outcomes and reducing healthcare costs.
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Affiliation(s)
- Susan Klostermann
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Paul Enlow
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Shroff Pendley
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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22
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O'Donnell HK, Vigers T, Johnson SB, Pyle L, Wright N, Deeb LC, Driscoll KA. Pump It Up! A randomized clinical trial to optimize insulin pump self-management behaviors in adolescents with type 1 diabetes. Contemp Clin Trials 2021; 102:106279. [PMID: 33440262 DOI: 10.1016/j.cct.2021.106279] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/29/2020] [Accepted: 12/30/2020] [Indexed: 10/22/2022]
Abstract
Individuals with type 1 diabetes (T1D) must engage in a variety of complex and burdensome self-management behaviors daily to maintain near normal blood glucose levels and prevent complications. There is a need for interventions to improve use of sophisticated diabetes technologies, such as insulin pumps, during adolescence - a very high-risk developmental period for individuals with T1D. All diabetes devices, including insulin pumps, store large amounts of behavioral data that can be downloaded and analyzed to evaluate adherence to recommended T1D self-management behaviors. The overall objective of the present study, Pump it Up!, was to use objectively downloaded insulin pump data to inform and test two interventions to optimize insulin pump use in adolescents with T1D and their caregivers. Multiphase Optimization Strategy (MOST) was used to achieve the overall goal of this study - to separately test the main effect of the Pump It Up! Personalized T1D Self-Management Behaviors Feedback Report and the main effect of Pump It Up! Problem-Solving Skills intervention to improve T1D self-management behaviors using a 2 × 2 factorial design. The purpose of this paper is to describe the Pump It Up! study design and rationale, and participant baseline characteristics. Longitudinal data analyses will be conducted, and moderating effects of psychosocial factors will be examined in relation to primary (insulin pump self-management behaviors) and secondary (A1C) outcomes.
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Affiliation(s)
- Holly K O'Donnell
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO 80045, United States.
| | - Tim Vigers
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO 80045, United States.
| | - Suzanne Bennett Johnson
- Florida State University, College of Medicine, Department of Clinical Sciences, 1115 W. Call Street, Tallahassee, FL 32306, United States.
| | - Laura Pyle
- University of Colorado School of Medicine, Department of Pediatrics, Barbara Davis Center for Diabetes, 1775 Aurora Ct., Aurora, CO 80045, United States.
| | - Nancy Wright
- Florida State University, College of Medicine, Department of Clinical Sciences, 1115 W. Call Street, Tallahassee, FL 32306, United States.
| | - Larry C Deeb
- Florida State University College of Medicine, Department of Medical Humanities and Social Sciences, 1115 W. Call Street, Tallahassee, FL 32306, United States.
| | - Kimberly A Driscoll
- University of Florida, Department of Clinical and Health Psychology, 1225 Center Dr., Gainesville, FL 32610, United States; University of Florida Diabetes Institute, College of Medicine, 1275 Center Dr., Gainesville, FL 32610, United States.
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23
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Tuomaala AK, Hero M, Tuomisto MT, Lähteenmäki M, Miettinen PJ, Laine T, Wehkalampi K, Kiiveri S, Ahonen P, Ojaniemi M, Kaunisto K, Tossavainen P, Lapatto R, Sarkola T, Pulkkinen MA. Motivational Interviewing and Glycemic Control in Adolescents With Poorly Controlled Type 1 Diabetes: A Randomized Controlled Pilot Trial. Front Endocrinol (Lausanne) 2021; 12:639507. [PMID: 33776935 PMCID: PMC7994365 DOI: 10.3389/fendo.2021.639507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 02/23/2021] [Indexed: 11/13/2022] Open
Abstract
A multicenter randomized controlled pilot trial investigated whether motivational interviewing (MI) by diabetes physicians improves glycemic control and variability in the context of follow-up for adolescent patients with poorly controlled type 1 diabetes. Patients (n = 47) aged 12 to 15.9 years who showed poor glycemic control (HbA1c >75 mmol/mol/9.0%) were randomized to standard education (SE) only or MI+SE, with study physicians randomized to employ MI+SE (N = 24 patients) or SE only (N = 23). For one year of follow-up, the main outcome measurements were obtained at three-month visits (HbA1c) or six-monthly: time in range (TIR) and glycemic variability (CV). Mean adjusted 12-month change in HbA1c was similar between the MI+SE and SE-only group (-3.6 vs. -1.0 mmol/mol), and no inter-group differences were visible in the mean adjusted 12-month change in TIR (-0.8 vs. 2.6%; P = 0.53) or CV (-0.5 vs. -6.2; P = 0.26). However, the order of entering the study correlated significantly with the 12-month change in HbA1c in the MI+SE group (r = -0.5; P = 0.006) and not in the SE-only group (r = 0.2; P = 0.4). No link was evident between MI and changes in quality of life. The authors conclude that MI's short-term use by diabetes physicians managing adolescents with poorly controlled type 1 diabetes was not superior to SE alone; however, improved skills in applying the MI method at the outpatient clinic may produce greater benefits in glycemic control.
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Affiliation(s)
- Anna-Kaisa Tuomaala
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Hero
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Martti T. Tuomisto
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Maria Lähteenmäki
- Faculty of Social Sciences (Psychology), Tampere University, Tampere, Finland
| | - Päivi J. Miettinen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tiina Laine
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Karoliina Wehkalampi
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Sanne Kiiveri
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Pekka Ahonen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Marja Ojaniemi
- Department of Pediatrics and Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Kari Kaunisto
- Department of Pediatrics and Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Päivi Tossavainen
- Department of Pediatrics and Research Unit for Pediatrics, Pediatric Neurology, Pediatric Surgery, Child Psychiatry, Dermatology, Clinical Genetics, Obstetrics and Gynecology, Otorhinolaryngology and Ophthalmology, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Risto Lapatto
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Taisto Sarkola
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Mari-Anne Pulkkinen
- Children’s Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- *Correspondence: Mari-Anne Pulkkinen,
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Chin-Jung L, Hsiao-Yean C, Yeu-Hui C, Kuan-Chia L, Hui-Chuan H. Effects of mobile health interventions on improving glycemic stability and quality of life in patients with type 1 diabetes: A meta-analysis. Res Nurs Health 2020; 44:187-200. [PMID: 33368403 DOI: 10.1002/nur.22094] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 11/05/2020] [Accepted: 11/30/2020] [Indexed: 12/29/2022]
Abstract
This meta-analysis aimed to examine the effects of mobile-health-based (mHealth) interventions on improving glycemic stability and quality of life (QOL) in patients with type 1 diabetes (T1D). Various databases, including PubMed, Embase, CINAHL, Cochrane Library, ProQuest, Chinese Electronic Periodical Services, and China Knowledge Resource Integrated, were used to search for relevant articles. A fixed-effects model or random-effects model was used to examine the overall effect. Various methods, including Egger's test, Begg's test, and trim-and-fill, were adopted to examine publication bias. In total, 26 studies were recruited. Results of the random-effects model showed that the use of mHealth-based interventions significantly decreased glycated hemoglobin (HbA1c) (mean difference = -0.37, 95% confidence interval (CI) = -0.53 to -0.22, p < .001), and improved life satisfaction (Hedges' g = 0.30, 95% CI = 0.10 to 0.50, p = .003), worry of diabetes (Hedges' g = -0.25, 95% CI = -0.41 to 0.08, p = .004), and mental health (Hedges' g = 0.36, 95% CI = 0.08 to 0.64, p = .012). Both adults and youths with T1D can benefit from mHealth-based interventions to improve HbA1c (Hedges' g = -0.44, p = .002 vs. -0.30, p = .003). The effect of mHealth-based interventions on improving QOL in both adults and youths could not be examined due to only one study published in adults with T1D. Moreover, those studies that included the function of feedback from professionals showed a significant effect of decreasing HbA1c compared to those without that function (Hedges' g = -0.48 vs. -0.16, p = .019). Mobile devices are convenient, instantaneous, and easy to use to communicate. Applying mHealth-based interventions with the function of feedback from professionals can be considered an alternative healthcare service to achieve optimal glycemic stability in adults and youths with T1D.
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Affiliation(s)
- Liu Chin-Jung
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Department of Nursing, Cathy General Hospital, Taipei, Taiwan
| | - Chiu Hsiao-Yean
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - Chuang Yeu-Hui
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan.,Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Lin Kuan-Chia
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Beitou, Taiwan.,Community Research Center, National Yang-Ming University, Beitou, Taiwan
| | - Huang Hui-Chuan
- School of Nursing and Institute of Hospital and Health Care Administration, Taipei Medical University, Taipei, Taiwan
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25
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Hilliard ME, Cao VT, Eshtehardi SS, Minard CG, Saber R, Thompson D, Karaviti LP, Anderson BJ. Type 1 Doing Well: Pilot Feasibility and Acceptability Study of a Strengths-Based mHealth App for Parents of Adolescents with Type 1 Diabetes. Diabetes Technol Ther 2020; 22:835-845. [PMID: 32379496 PMCID: PMC7698853 DOI: 10.1089/dia.2020.0048] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Background: We evaluated the feasibility and acceptability of a pilot behavioral intervention delivered to parents of adolescents with type 1 diabetes (T1D) via mobile-friendly web app. The Type 1 Doing Well app aimed to promote supportive family diabetes management by helping parents recognize and reinforce teens' positive diabetes-related behaviors ("strengths"). Methods: Parents (n = 80, 74% recruitment) of adolescents (age range = 12-17 years, M = 15.3 ± 1.5 years, 59% female, 56% insulin pump, M hemoglobin A1c (HbA1c) = 9.0% ± 2.1%) were randomized 2:1 to intervention or control (i.e., usual medical care with or without app) for 3-4 months between diabetes appointments. The app prompted parents daily to track adolescents' strengths and generated weekly summaries of their teen's top strengths. Parents could access a library of text messages to praise their teens. Exploratory pre/post data included questionnaires (98% completed) and HbA1c. Results: Parents used the app for M = 106.1 ± 37.1 days, logging in ≥once/day on 80% of days. Ninety-one percent of parents used the app ≥2 days/week on average. Parents viewed M = 5.6 ± 4.7 weekly summaries and "favorited" 15 praise texts in the library. App acceptability ratings (7-point scale) were high: Satisfaction 5.0 ± 1.5, Usefulness 4.8 ± 1.5, Ease of Use 6.2 ± 0.8, and Ease of Learning 6.5 ± 0.8. Parents (n = 48) and adolescents (n = 47) gave positive feedback and suggestions via qualitative interviews. There were no significant between-group differences for change in exploratory outcomes (HbA1c, questionnaires). Conclusions: Type 1 Doing Well was feasible to deliver and highly acceptable and engaging for parents of adolescents with T1D. It may have a larger impact on behavioral or clinical outcomes as part of a multicomponent intervention protocol. Trial Registration: ClinicalTrials.gov NCT02877680.
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Affiliation(s)
- Marisa E. Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- Address correspondence to: Marisa E. Hilliard, PhD, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030
| | - Viena T. Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Sahar S. Eshtehardi
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- College of Education, University of Houston, Houston, Texas, USA
| | - Charles G. Minard
- Dan L. Duncan Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, Texas, USA
| | - Rana Saber
- Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Debbe Thompson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, Texas, USA
| | - Lefkothea P. Karaviti
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
| | - Barbara J. Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas, USA
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26
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Ibrahim SA, ElHajj M, Zidan A, Owusu Y, Awaisu A. Barriers to Diabetes Adherence: Translation and Cultural Adaptation of the Instrument Into Arabic Context. Value Health Reg Issues 2020; 22:49-53. [PMID: 32795934 DOI: 10.1016/j.vhri.2020.03.005] [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: 09/21/2019] [Revised: 01/15/2020] [Accepted: 03/26/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Barriers to Diabetes Adherence (BDA) instrument is a measure developed in English to assess barriers to adherence in adolescents with type 1 diabetes (T1DM). The main objectives of the present study were to translate and culturally adapt the BDA tool into Arabic for the assessment of barriers to adherence in adolescents with T1DM in Arabic-speaking populations. METHODS The International Society for Pharmacoeconomics and Outcomes Research guidelines for the translation and cultural adaptation of patient-reported outcome measures were used for the process. Permission to use the instrument was obtained from the developers. This was followed by 2 forward translations of the tool into Arabic. The 2 Arabic versions were combined into a reconciled Arabic version that was then back-translated into English. This was then tested against the original tool. The resultant Arabic version underwent a cognitive debriefing process to assess its comprehension and appropriateness among potential users, and this resulted in further refinements, leading to the final Arabic version of the tool. RESULTS The translation and cognitive debriefing processes revealed issues related to the cultural or conceptual equivalence of the tool that were addressed and resolved by rewording, restructuring, or addition or elimination of words or phrases that in certain circumstances necessitated communications with the developers for further clarifications of the intended meaning of relevant items. This process generated an easy, comprehensive, clear, and culturally acceptable tool as proven by the cognitive debriefing and clinical review processes. CONCLUSION A culturally acceptable Arabic translation of the BDA tool was developed to be used in adolescent Arabic population with T1DM.
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Affiliation(s)
| | - Maguy ElHajj
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Amani Zidan
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Yaw Owusu
- College of Pharmacy, Qatar University, Doha, Qatar
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha, Qatar.
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27
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Schache KR, Hofman PL, Serlachius AS. A pilot randomized controlled trial of a gratitude intervention for adolescents with Type 1 diabetes. Diabet Med 2020; 37:1352-1356. [PMID: 31315150 DOI: 10.1111/dme.14078] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/13/2019] [Indexed: 01/09/2023]
Abstract
AIM Cost-effective psychosocial interventions that can feasibly be implemented into busy clinical settings are needed to improve psychological and physical health outcomes in adolescents with Type 1 diabetes. We examined the efficacy of a gratitude journalling intervention to improve psychological well-being and glycaemic control in adolescents aged 10-16 years with Type 1 diabetes. METHODS Eighty adolescents were randomized to the 8-week gratitude intervention (N = 40) or standard care (N = 40). Self-reported measures of stress, quality of life, self-care, depression and gratitude were assessed at baseline and 8 weeks after baseline. Glycaemic control (HbA1c ) was assessed at baseline and 12 weeks after baseline. A per-protocol analysis was conducted with the adolescents who completed all questionnaires (N = 60). Analysis of covariance (ANCOVA) was used to examine differences between treatment arms at follow-up adjusting for baseline scores. RESULTS There was no evidence of any between-group differences in the psychological or behavioural measures at follow-up (all P-values > 0.05). Glycaemic control slightly increased in the control group while remaining stable in the gratitude group, with a between-group difference of 6.1 mmol/mol [95% confidence interval (CI) -2.6 to 14.7; 0.6%, 95% CI -0.2 to 1.3] at 12 weeks after baseline. After adjusting for baseline HbA1c , this between-group difference was significant (P = 0.048). CONCLUSIONS This is the first randomized trial of a gratitude journalling intervention for adolescents with Type 1 diabetes. Gratitude journalling interventions represent a clinically usable approach. If and how it helps to stabilise glycaemic control in adolescents with Type 1 diabetes remains to be confirmed in future research.
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Affiliation(s)
- K R Schache
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
| | - P L Hofman
- Liggins Institute, University of Auckland, Auckland, New Zealand
| | - A S Serlachius
- Department of Psychological Medicine, University of Auckland, Auckland, New Zealand
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28
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Pulkkinen MA, Tuomaala AK, Hero M, Gordin D, Sarkola T. Motivational Interview to improve vascular health in Adolescents with poorly controlled type 1 Diabetes (MIAD): a randomized controlled trial. BMJ Open Diabetes Res Care 2020; 8:8/1/e001216. [PMID: 32723754 PMCID: PMC7388880 DOI: 10.1136/bmjdrc-2020-001216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 06/05/2020] [Accepted: 06/16/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION We studied if motivational interviewing (MI) added to standard educational care (SEC) improves vascular health in adolescents with poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS 47 adolescents with type 1 diabetes of at least 2 years duration and hemoglobin A1c >75 mmol/mol (>9.0%) on two visits were randomized to MI+SEC or SEC. We also compared vascular health parameters of patients with type 1 diabetes at trial baseline with a group of healthy historical controls matched for age and body size. RESULTS 39 adolescents (20 MI+SEC) completed the vascular health study. At 12 months, parameter changes were not statistically significantly different between MI+SEC and SEC (carotid-femoral pulse wave velocity (cfPWV): mean difference 0.052 m/s (95% CI -0.395 to 0.500, p=0.81); carotid-radial PWV (crPWV): 0.118 m/s (95% to 0.478 to 0.713, p=0.69), carotid intima-media thickness (IMT): 0.002 mm (95% CI -0.37 to 0.40, p=0.93), systolic blood pressure (BP) z-score: 0.495 (95% CI -0.099 to 1.09, p=0.10). At baseline, duration of type 1 diabetes was associated with radial IMT (r=0.430, p=0.007) and cfPWV (r=0.373, p=0.018), and carotid, femoral and brachial IMT were correlated with continuous glucose monitoring (CGM) SD (r=0.440, p=0.017; r=0.377, p=0.048; r=0.387, p=0.038). There was an inverse association between CGM time-in-range (3.9-10.0 mmol/L) and crPWV (r=-0.476, p=0.022) changes. Systolic BP change was associated with body mass index change (r=0.374, p=0.019) and IMT change (r=0.461, p=0.016 for carotid IMT; r=0.498, p=0.010 for femoral IMT). PWVs were higher and common carotid compliance lower among patients with type 1 diabetes at baseline compared with healthy controls, but no other differences were found. CONCLUSION There was no effect of MI added to SEC on vascular health parameters. Although disease duration and glycemic control were associated with vascular health at baseline, there were only limited associations between glycemic control and vascular health parameter changes. Vascular health parameter changes were interrelated suggesting clustering of cardiovascular risk. TRIAL REGISTRATION NUMBER NCT02637154.
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Affiliation(s)
- Mari-Anne Pulkkinen
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Anna-Kaisa Tuomaala
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Matti Hero
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Daniel Gordin
- Folkhälsan Research Center, Folkhälsan Institute of Genetics, Helsinki, Finland
- Abdominal Center Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Diabetes and Obesity, Research Programs Unit, University of Helsinki, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
- Minerva Foundation Institute for Medical Research, Helsinki, Finland
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29
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Flannery H, Jacob J. Measuring psychological outcomes in paediatric settings: Making outcomes meaningful using client-defined perspectives. Clin Child Psychol Psychiatry 2020; 25:594-603. [PMID: 32046508 DOI: 10.1177/1359104520904120] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is a growing drive to develop and implement patient-reported outcome measures within paediatric health services, particularly for young people living with chronic health conditions; however, there is little consensus on how best to do this in meaningful ways within psychological services working alongside medical teams. This reflective commentary considers some of the challenges of collecting psychological outcome measures in paediatric services and considers alternative approaches to making outcome measurement meaningful. All measures have their limitations; however, they become meaningless if they are not used in meaningful and considered ways with young people. Client-defined outcome measurement, such as goal-based outcome measures, alongside other types of measurement, can capture outcomes of meaning to young people living with chronic health conditions, and can enable them to feed into a shared decision-making process.
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Affiliation(s)
- Halina Flannery
- Child and Adolescent Psychology Team, Paediatric and Adolescent Division, University College London Hospitals NHS Foundation Trust, UK
| | - Jenna Jacob
- Child Outcomes Research Consortium, Anna Freud National Centre for Children and Families, University College London, UK
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30
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Nicholl MC, Valenzuela JM, Lit K, DeLucia C, Shoulberg AM, Rohan JM, Shroff Pendley J, Dolan L, Delamater AM. Featured Article: Comparison of Diabetes Management Trajectories in Hispanic versus White Non-Hispanic Youth with Type 1 Diabetes across Early Adolescence. J Pediatr Psychol 2020; 44:631-641. [PMID: 30916748 DOI: 10.1093/jpepsy/jsz011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Revised: 02/01/2019] [Accepted: 02/04/2019] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Ethnic minority youth with type 1 diabetes (T1D) often have poorer glycemic control and lower rates of adherence compared to White Non-Hispanic (WNH) youth. Variables such as family conflict, autonomy support, and youth regimen responsibility have been shown to change over adolescence and impact diabetes management. However, these factors have been investigated in predominantly White samples. Few studies have examined potential differences in these variables and their trajectories for Hispanic youth over early adolescence. METHODS Youth with T1D (178 WNH and 33 Hispanic youth participants), as well as their maternal caregivers (174 WNH and 32 Hispanic maternal caregivers), completed measures of diabetes-specific autonomy support, diabetes-related family conflict, regimen responsibility, and blood glucose monitoring frequency at 4 timepoints over a 3-year period. RESULTS At baseline, Hispanic youth had significantly poorer glycemic control, more family conflict, and fewer blood glucose checks on average compared to WNH youth. Similar to WNH youth, Hispanic youth have increasing independence for regimen tasks and decreasing parent autonomy support during this developmental period. However, while Hispanic youth had worsening diabetes management during early adolescence (as did WNH youth), Hispanic parents reported a more gradual change in youth's diabetes management over early adolescence. CONCLUSIONS This study presents an important contribution to the existing literature on youth with T1D. Findings suggest potential strengths and targets for Hispanic youth navigating diabetes management during the adolescent period. It is important to continue to investigate the trajectories of ethnic minority youth with diabetes.
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Affiliation(s)
- Meg C Nicholl
- Department of Pediatrics, Kennedy Krieger Institute/Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Jessica M Valenzuela
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Keith Lit
- Department of Psychology, Jackson Health System, Miami, FL, USA
| | - Christian DeLucia
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Amanda M Shoulberg
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer M Rohan
- Division of Hematology and Oncology, Children's Hospital of Richmond at VCU, Richmond, VA, USA
| | - Jennifer Shroff Pendley
- Division of Behavioral Health, Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA
| | - Lawrence Dolan
- Division of Behavioral Medicine and Clinical Psychology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.,Division of Endocrinology, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami, Miller School of Medicine, Miami, FL, USA
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31
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Malik FS, Senturia KD, Lind CD, Chalmers KD, Yi-Frazier JP, Shah SK, Pihoker C, Wright DR. Adolescent and parent perspectives on the acceptability of financial incentives to promote self-care in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:533-551. [PMID: 31863541 PMCID: PMC7663046 DOI: 10.1111/pedi.12970] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2019] [Revised: 10/02/2019] [Accepted: 11/25/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND An understanding of acceptability among potential intervention participants is critical to the design of successful real-world financial incentive (FI) programs. The purpose of this qualitative study was to explore adolescent and parent perspectives on the acceptability of using FI to promote engagement in diabetes self-care in adolescents with type 1 diabetes (T1D). METHODS Focus groups with 46 adolescents with T1D (12-17 years old) and 39 parents of adolescents with T1D were conducted in the Seattle metropolitan area. Semistructured questions addressed participants' current use of incentives to promote change in diabetes self-care and receptivity to a theoretical incentive program administered by a third-party. Qualitative data were analyzed and emergent themes identified. RESULTS Three thematic categories informed participant views about the acceptability of FI programs: (a) the extent to which using FIs in the context of diabetes management fit comfortably into a family's value system, (b) the perceived effectiveness for FIs to promote improved diabetes self-care, and (c) the urgent need for improved self-care due to the threat of diabetes-related health complications. These factors together led most parents and adolescents to be open to FI program participation. CONCLUSIONS The results from this qualitative study suggest that well-designed FI programs to support diabetes management are acceptable to families with adolescents with T1D. Additionally, the use of FIs may have the potential to support adolescents with T1D in developing strong self-care habits and ease the often-turbulent transition to independent self-care.
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Affiliation(s)
- Faisal S. Malik
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | - Cara D. Lind
- Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | | | | | - Seema K. Shah
- Northwestern University, 680 N Lake Shore Drive, Chicago, IL, USA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
| | - Davene R. Wright
- Department of Pediatrics, University of Washington, 1959 NE Pacific St, Seattle, WA, USA,Seattle Children’s Research Institute, 2001 8th Ave #400, Seattle, WA, USA
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McGill DE, Laffel LM, Volkening LK, Butler DA, Levy WL, Wasserman RM, Anderson BJ. Text Message Intervention for Teens with Type 1 Diabetes Preserves HbA1c: Results of a Randomized Controlled Trial. Diabetes Technol Ther 2020; 22:374-382. [PMID: 32357109 PMCID: PMC7196367 DOI: 10.1089/dia.2019.0350] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Aims: Teens with type 1 diabetes (T1D) often struggle with diabetes self-management, which may lead to suboptimal self-care and worsening hemoglobin A1c (HbA1c). Innovative strategies are needed to improve self-care and protect against glycemic decline, especially during adolescence. We aimed to assess the impact on HbA1c of two interventions, problem-solving and text messaging, in teens with T1D. Methods: In a two-site randomized controlled trial, teens (N = 301) 13-17 years of age with T1D were randomized to one of the four groups using a 2 × 2 factorial design: Teenwork (TW), Text Messaging (Text), TW+Text, or Usual Care. TW intervention included problem-solving aimed at improving T1D self-care for blood glucose (BG) monitoring and insulin bolus dosing. Text intervention involved text reminders to check BG. The primary outcome was change in HbA1c from baseline to 12 months. Results: At baseline, teens (51% female, 78% white, 59% pump-treated) were (mean ± SD) 15.0 ± 1.3 years, had diabetes duration of 6.5 ± 3.7 years, and HbA1c 8.5% ± 1.1%. There was no significant difference in HbA1c over time by study group. Responsiveness to text reminders by teens in the TEXT and TW+TEXT predicted glycemic benefit; TW did not. Conclusions: Despite no HbA1c difference by study group, greater response to text message reminders to check BG led to better glycemic control and no deterioration in HbA1c; the problem-solving intervention did not. Given the high penetration of mobile phones and the wide acceptance of text messaging among teens in general, it is encouraging that a text messaging intervention can preserve HbA1c, thus preventing the expected deterioration in glycemic control often seen in teens with T1D.
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Affiliation(s)
- Dayna E. McGill
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Lori M. Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Lisa K. Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Deborah A. Butler
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, Massachusetts
| | - Wendy L. Levy
- Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
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Wilt L. The Role of School Nurse Presence in Parent and Student Perceptions of Helpfulness, Safety, and Satisfaction With Type 1 Diabetes Care. J Sch Nurs 2020; 38:161-172. [PMID: 32292117 DOI: 10.1177/1059840520918310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescents with type 1 diabetes (TID) and their parents depend on school nurses to keep students safe in school. Parent satisfaction with T1D care is impacted by school factors including school nurse presence. The purpose of this study was to determine the relationships among parental satisfaction with diabetes care in school, parental report of diabetes-related safety, adolescent report of school nurse helpfulness, and school nurse presence represented by school nurse to student ratios. The sample consisted of 89 parent-adolescent dyads. Adolescents 10-16 years old with T1D completed a questionnaire that included perceptions of school nurse helpfulness. Parents completed a questionnaire that included perceptions of T1D safety and satisfaction. Diabetes-related safety was positively correlated with parental satisfaction and school nurse helpfulness and inversely correlated with age and school nurse to student ratios. Findings validate the importance of school nurse presence to adolescents with T1D and their parents with implications for school nursing policy, practice, and research.
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Affiliation(s)
- Lori Wilt
- Seton Hall University, South Orange, NJ, USA
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34
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Miller VA, Jawad AF. Decision-Making Involvement and Prediction of Adherence in Youth With Type 1 Diabetes: A Cohort Sequential Study. J Pediatr Psychol 2020; 44:61-71. [PMID: 29788441 DOI: 10.1093/jpepsy/jsy032] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/26/2018] [Indexed: 11/12/2022] Open
Abstract
Objective To assess developmental trajectories of decision-making involvement (DMI), defined as the ways in which parents and children engage each other in decision-making about illness management, in youth with type 1 diabetes (T1D) and examine the effects of DMI on levels of and changes in adherence with age. Methods Participants included 117 youth with T1D, enrolled at ages 8-16 years and assessed five times over 2 years. The cohort sequential design allowed for the approximation of the longitudinal curve from age 8 to 19 from overlapping cohort segments. Children and parents completed the Decision-Making Involvement Scale, which yields subscales for different aspects of DMI, and a self-report adherence questionnaire. Mixed-effects growth curve modeling was used for analysis, with longitudinal measures nested within participant and participants nested within cohort. Results Most aspects of DMI (Parent Express, Parent Seek, Child Express, and Joint) increased with child age; scores on some child report subscales (Parent Express, Child Seek, and Joint) decreased after age 12-14 years. After accounting for age, Child Seek, Child Express, and Joint were associated with overall higher levels of adherence in both child (estimates = 0.08-0.13, p < .001) and parent (estimates = 0.07- 0.13, p < .01) report models, but they did not predict changes in adherence with age. Conclusion These data suggest that helping children to be more proactive in T1D discussions, by encouraging them to express their opinions, share information, and solicit guidance from parents, is a potential target for interventions to enhance effective self-management.
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Affiliation(s)
- Victoria A Miller
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
| | - Abbas F Jawad
- Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania
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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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Driscoll KA, Johnson SB, Wang Y, Wright N, Deeb LC. Blood Glucose Monitoring Before and After Type 1 Diabetes Clinic Visits. J Pediatr Psychol 2020; 44:32-39. [PMID: 29294062 DOI: 10.1093/jpepsy/jsx151] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Accepted: 12/05/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To determine patterns of blood glucose monitoring in children and adolescents with type 1 diabetes (T1D) before and after routine T1D clinic visits. Methods Blood glucose monitoring data were downloaded at four consecutive routine clinic visits from children and adolescents aged 5-18 years. Linear mixed models were used to analyze patterns of blood glucose monitoring in patients who had at least 28 days of data stored in their blood glucose monitors. Results In general, the frequency of blood glucose monitoring decreased across visits, and younger children engaged in more frequent blood glucose monitoring. Blood glucose monitoring increased before the T1D clinic visits in younger children, but not in adolescents. It declined after the visit regardless of age. Conclusions Members of the T1D care team need to consider that a T1D clinic visit may prompt an increase in blood glucose monitoring when making treatment changes and recommendations. Tailored interventions are needed to maintain that higher level of adherence across time.
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Affiliation(s)
- Kimberly A Driscoll
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine
| | - Suzanne Bennett Johnson
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University
| | - Yuxia Wang
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University
| | - Nancy Wright
- Department of Clinical Sciences, College of Medicine, Florida State University
| | - Larry C Deeb
- Department of Clinical Sciences, College of Medicine, Florida State University
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Miller AL, Lo SL, Albright D, Lee JM, Hunter CM, Bauer KW, King R, Clark KM, Chaudhry K, Kaciroti N, Katz B, Fredericks EM. Adolescent Interventions to Manage Self-Regulation in Type 1 Diabetes (AIMS-T1D): randomized control trial study protocol. BMC Pediatr 2020; 20:112. [PMID: 32145739 PMCID: PMC7060523 DOI: 10.1186/s12887-020-2012-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 02/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-regulation (SR), or the capacity to control one's thoughts, emotions, and behaviors in order to achieve a desired goal, shapes health outcomes through many pathways, including supporting adherence to medical treatment regimens. Type 1 Diabetes (T1D) is one specific condition that requires SR to ensure adherence to daily treatment regimens that can be arduous and effortful (e.g., monitoring blood glucose). Adolescents, in particular, have poor adherence to T1D treatment regimens, yet it is essential that they assume increased responsibility for managing their T1D as they approach young adulthood. Adolescence is also a time of rapid changes in SR capacity and thus a compelling period for intervention. Promoting SR among adolescents with T1D may thus be a novel method to improve treatment regimen adherence. The current study tests a behavioral intervention to enhance SR among adolescents with T1D. SR and T1D medical regimen adherence will be examined as primary and secondary outcomes, respectively. METHODS We will use a randomized control trial design to test the impact of a behavioral intervention on three SR targets: Executive Functioning (EF), Emotion Regulation (ER), and Future Orientation (FO); and T1D medical regimen adherence. Adolescents with T1D (n = 94) will be recruited from pediatric endocrinology clinics and randomly assigned to treatment or control group. The behavioral intervention consists of working memory training (to enhance EF), biofeedback and relaxation training (to enhance ER), and episodic future thinking training (to enhance FO) across an 8-week period. SR and treatment regimen adherence will be assessed at pre- and post-test using multiple methods (behavioral tasks, diabetes device downloads, self- and parent-report). We will use an intent-to-treat framework using generalized linear mixed models to test our hypotheses that: 1) the treatment group will demonstrate greater improvements in SR than the control group, and 2) the treatment group will demonstrate better treatment regimen adherence outcomes than the control group. DISCUSSION If successful, SR-focused behavioral interventions could improve health outcomes among adolescents with T1D and have transdiagnostic implications across multiple chronic conditions requiring treatment regimen adherence. TRIAL REGISTRATION ClinicalTrials.gov: NCT03688919; registered September 28, 2018.
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Affiliation(s)
- Alison L Miller
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA.
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA.
| | - Sharon L Lo
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
| | - Dana Albright
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Joyce M Lee
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Christine M Hunter
- Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD, USA
| | - Katherine W Bauer
- Center for Human Growth and Development, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rosalind King
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Katy M Clark
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA
| | - Kiren Chaudhry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, 1415 Washington Heights, SPH I Room 3718, Ann Arbor, MI, 48109-2029, USA
| | - Niko Kaciroti
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Benjamin Katz
- Department of Human Development and Family Science, Virginia Tech, Blacksburg, VA, USA
| | - Emily M Fredericks
- Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI, USA
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
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Logel SN, Bekx MT, Rehm JL. Potential association between type 1 diabetes mellitus and gender dysphoria. Pediatr Diabetes 2020; 21:266-270. [PMID: 31747094 PMCID: PMC7978411 DOI: 10.1111/pedi.12947] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/25/2019] [Accepted: 11/01/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND/OBJECTIVE Multiple factors have been proposed to explain the increasing prevalence of type 1 diabetes mellitus (T1DM), including psychological stress. The prevalence of gender dysphoria (GD) in youth is also growing. Identifying environmental triggers, such as psychological minority stress experienced by youth with GD, that may influence the pathogenesis and management of T1DM could have important clinical implications. The objective of this study was to determine the prevalence of concurrent diagnosis of T1DM and GD in adolescents evaluated at a university-based children's hospital. METHODS An electronic data extraction was conducted at the University of Wisconsin Hospital and Clinics from 1 November 2007 to 1 November 2017. Inclusion criteria included age 10 to 21 years and diagnosis of T1DM and/or GD. Prevalence rates were calculated for T1DM and GD. For adolescents with T1DM and GD, information related to diagnosis, treatment, and psychiatric history was collected. RESULTS The prevalence for T1DM was 2.69 per 1000; the prevalence for GD was 0.42 per 1000. Eight adolescents had T1DM and GD. In adolescents with GD, the prevalence of T1DM was 9.4-fold higher than the prevalence of T1DM alone (24.77 vs 2.68 per 1000). Five adolescents were seen in GD clinic and their glycemic control initially improved after the first GD clinic visit. CONCLUSIONS There was an increased prevalence of a concurrent diagnosis of T1DM in those with GD compared to the general population. Glycemic control improved after the first GD clinic visit in adolescents with T1DM and GD, which may be secondary to stress reduction.
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Affiliation(s)
- Santhi N. Logel
- Division of Pediatric Endocrinology and Diabetes, University of Wisconsin-Madison School of Medicine and Public Health
| | - M. Tracy Bekx
- Division of Pediatric Endocrinology and Diabetes, University of Wisconsin-Madison School of Medicine and Public Health
| | - Jennifer L. Rehm
- Division of Pediatric Endocrinology and Diabetes, University of Wisconsin-Madison School of Medicine and Public Health
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Le Jeannic A, Maoulida H, Guilmin-Crépon S, Alberti C, Tubiana-Rufi N, Durand-Zaleski I. How to collect non-medical data in a pediatric trial: diaries or interviews. Trials 2020; 21:36. [PMID: 31910885 PMCID: PMC6947947 DOI: 10.1186/s13063-019-3997-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 12/13/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-medical data, such as the amount of time that patients and caregivers spend managing their condition, may be relevant when assessing therapeutic strategies. For chronic pediatric conditions, the time that patients and caregivers spend in seeking and providing care (which are the indirect costs in an economic evaluation) can be significantly different depending on the treatment arm. To explore methods for collecting information on the care burden for caregivers and patients, we investigated whether a patient diary provided additional information compared to retrospective investigator-led interviews and whether a diary that was completed intermittently produced more or less information than a diary completed continually. The main objective of this study was to identify which type of data collection was most effective for measuring the time spent by caregivers and for estimating indirect treatment costs over 9 months. METHODS Start-In! is a randomized controlled trial comparing the efficacy of three strategies of real-time continuous glucose monitoring for 12 months in children and adolescents with type 1 diabetes. We designed an ancillary study to assess methods of collecting information on the time spent by patients and caregivers in managing their condition (indirect costs). Data were entered retrospectively in case report forms (CRFs) by investigators during quarterly follow-up visits, which were supplemented with diaries completed prospectively by children or caregivers either continuously or intermittently. Data about absences from school and work as well as the time that caregivers spent on diabetes care were collected and the three collection methods were compared. RESULTS At the end of the 9-month study, 42% of the study participants failed to return their diary. For the diaries that were received, less than 10% of expected data were collected versus 82% during investigators'interviews. Based on all the information collected, we calculated that over 9 months, caregivers lost on average 3.9 days of working time (€786) and 4 days of personal time, i.e. the equivalent of €526, and spent around 15 min of time on care per day, i.e. the equivalent of €1700. CONCLUSIONS The CRFs completed by investigators during quarterly visits cannot be replaced by a diary. Completing the diaries appeared to represent an important additional burden to children and their caregivers, and the diaries provided little additional information compared to investigators' entries in the CRF. TRIAL REGISTRATION ClinicalTrials.gov, NCT00949221. Registered on 30 July 2009. Registry name: Study of Insulin Therapy Augmented by Real Time Sensor in Type 1 Children and Adolescents (START-IN!).
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Affiliation(s)
- Anaïs Le Jeannic
- AP-HP, Groupe hospitalier Hôtel-Dieu, URC Economie de la Santé Ile de France, Paris, France. .,Inserm, ECEVE UMR-S 1123, Paris, France. .,URC Eco IdF (Paris health economics and health services research unit) and Inserm, ECEVE UMR-S 1123, Paris, France.
| | - Hassani Maoulida
- AP-HP, Groupe hospitalier Hôtel-Dieu, URC Economie de la Santé Ile de France, Paris, France
| | - Sophie Guilmin-Crépon
- Inserm, ECEVE UMR-S 1123, Paris, France.,AP-HP, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie clinique, Paris, France.,Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Robert Debré, Service d'Endocrinologie-Diabétologie pédiatrique et Centre de référence des Maladies Endocriniennes Rares de la Croissance, Paris, France.,CIC-EC 1426, Paris, France
| | - Corinne Alberti
- Inserm, ECEVE UMR-S 1123, Paris, France.,AP-HP, Hôpital Universitaire Robert Debré, Unité d'Epidémiologie clinique, Paris, France.,Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,CIC-EC 1426, Paris, France
| | - Nadia Tubiana-Rufi
- Université Paris Diderot, PRES Sorbonne Paris Cité, Paris, France.,AP-HP, Hôpital Robert Debré, Service d'Endocrinologie-Diabétologie pédiatrique et Centre de référence des Maladies Endocriniennes Rares de la Croissance, Paris, France
| | - Isabelle Durand-Zaleski
- AP-HP, Groupe hospitalier Hôtel-Dieu, URC Economie de la Santé Ile de France, Paris, France.,AP-HP, Groupe hospitalier Albert Chenevier- Henri Mondor, Service de Santé Publique, Créteil, France.,Inserm METHODS CRESS UMR 1153, Paris, France
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Addala A, Igudesman D, Kahkoska AR, Muntis FR, Souris KJ, Whitaker KJ, Pratley RE, Mayer-Davis E. The interplay of type 1 diabetes and weight management: A qualitative study exploring thematic progression from adolescence to young adulthood. Pediatr Diabetes 2019; 20:974-985. [PMID: 31392807 PMCID: PMC7196280 DOI: 10.1111/pedi.12903] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Revised: 08/04/2019] [Accepted: 08/05/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The impact of weight management in persons with type 1 diabetes (T1D) from childhood into adulthood has not been well described. The purpose of the study was to explore qualitative themes presented by young adults with T1D with respect to the dual management of weight and T1D. METHODS We analyzed focus group data from 17 young adults with T1D (65% female, age 21.7 ± 2.1 years, HbA1c 8.1% ± 1.5) via inductive qualitative analysis methods. Major themes were compared to themes presented by youth with T1D ages 13-16 years in previously published study in order to categorize thematic progression from early adolescence through adulthood. RESULTS Themes from young adults with T1D, when compared to those from youth were categorized as: (a) persistent and unchanged themes, (b) evolving themes, and (c) newly reported themes. Hypoglycemia and a sense of futility around exercise was an unchanged theme. Importance of insulin usage and a healthy relationship with T1D evolved to gather greater conviction. Newly reported themes are unique to integration of adulthood into T1D, such as family planning and managing T1D with work obligations. Young adults also reported negative experiences with providers in their younger years and desire for more supportive provider relationships. CONCLUSIONS Issues identified by youth regarding the dual management of T1D and weight rarely resolve, but rather, persist or evolve to integrate other aspects of young adulthood. Individualized and age-appropriate clinical support and practice guidelines are warranted to facilitate the dual management of weight and T1D in persons with T1D.
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Affiliation(s)
- Ananta Addala
- Department of Pediatric Endocrinology, Stanford University, Stanford, California
| | - Daria Igudesman
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Anna R. Kahkoska
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Franklin R. Muntis
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Katherine J. Souris
- Department of Nutrition, University of North Carolina, Chapel Hill, North Carolina
| | - Keri J. Whitaker
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
| | - Richard E. Pratley
- AdventHealth Translational Research Institute for Metabolism and Diabetes, Orlando, Florida
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Thompson D, Callender C, Gonynor C, Cullen KW, Redondo MJ, Butler A, Anderson BJ. Using Relational Agents to Promote Family Communication Around Type 1 Diabetes Self-Management in the Diabetes Family Teamwork Online Intervention: Longitudinal Pilot Study. J Med Internet Res 2019; 21:e15318. [PMID: 31538940 PMCID: PMC6754689 DOI: 10.2196/15318] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/30/2019] [Accepted: 08/13/2019] [Indexed: 01/19/2023] Open
Abstract
Background Family conflict can reduce adolescent adherence to type 1 diabetes management tasks. The Family Teamwork in-person intervention was shown to be efficacious in reducing conflict and low adherence to diabetes-related tasks. Its reach and potential impact, however, were limited by the need to deliver the intervention sessions in person. Relational agents (ie, computerized versions of humans) have been shown to appeal to diverse audiences and may be an acceptable replacement for a human in technology-based behavior change interventions. Objective The purpose of this paper is to present the results of a pilot study assessing feasibility and acceptability of Diabetes Family Teamwork Online, an adapted version of the Family Teamwork intervention, delivered over the internet and guided by a relational agent. Methods Parent-adolescent dyads were recruited through a diabetes care clinic at a large tertiary care hospital in the southwestern United States. A one-group design, with assessments at baseline, immediate postintervention, and 3 months later, was used to assess feasibility. A priori feasibility criteria included an assessment of recruitment, completion, attrition, program satisfaction, therapeutic alliance, attitudes toward the relational agent, and data collection. The institutional review board at Baylor College of Medicine approved the protocol (H-37245). Results Twenty-seven adolescents aged 10 to 15 years with type 1 diabetes and their parents were enrolled. Criteria used to assess feasibility were (1) recruitment goals were met (n=20), (2) families completed ≥75% of the modules, (3) attrition rate was ≤10%, (4) program satisfaction was high (≥80% of families), (5) therapeutic alliance was high (average score of ≥60/84), (6) families expressed positive attitudes toward the relational agent (average item score of ≥5 on ≥4 items), (7) ≥80% of data were collected at post 1 and post 2, and (8) few technical issues (≤10%) occurred during intervention delivery. All feasibility criteria were met. Qualitative data confirmed that adolescents and parents had positive reactions to both the content and approach. Conclusions The Diabetes Family Teamwork Online intervention proved to be a feasible and acceptable method for enhancing communication around diabetes management tasks in families with an adolescent who has type 1 diabetes. International Registered Report Identifier (IRRID) RR2-10.2196/resprot.5817
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Affiliation(s)
- Debbe Thompson
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Chishinga Callender
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Caroline Gonynor
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Karen W Cullen
- United States Department of Agriculture/Agricultural Research Service Children's Nutrition Research Center, Baylor College of Medicine, Houston, TX, United States
| | - Maria J Redondo
- Diabetes and Endocrinology Section, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Ashley Butler
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
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Tsai TH, Huang N, Lin IF, Chou YJ. Variation in the 11-year trajectories of medical care seeking behaviors in diabetes patients under a single payer system: persisting gaps to be filled. BMC Health Serv Res 2019; 19:580. [PMID: 31426781 PMCID: PMC6699076 DOI: 10.1186/s12913-019-4399-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 08/02/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.
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Affiliation(s)
- Tzu-Ho Tsai
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
- Department of Intensive Care, Cheng-Hsin Hospital, No. 45, Cheng Hsin Street, Taipei, Taiwan
| | - Nicole Huang
- Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - I-Feng Lin
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
| | - Yiing-Jenq Chou
- Institute of Public Health, School of Medicine, National Yang-Ming University, No.115, Sec. 2, Linong Street, Taipei, Taiwan
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Wilt L. The Relationships Among School Nurse to Student Ratios, Self-Efficacy, and Glycemic Control in Adolescents With Type 1 Diabetes. J Sch Nurs 2019; 37:230-240. [DOI: 10.1177/1059840519870314] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Adolescents with Type 1 diabetes (T1D) experience unique self-management challenges, which can lead to poor glycemic control and sequelae. School nurses may impact student self-efficacy behaviors for T1D management in adolescents. The purpose of this study was to determine the relationships among school nurse staffing patterns, measured by school nurse to student ratios, self-efficacy, and glycemic control in adolescents with T1D. The sample consisted of 89 parent–adolescent dyads. Adolescents aged 10–16 years old with T1D completed the Self-Efficacy for Diabetes Self-Management (SEDM) Scale. Parents completed a demographic questionnaire. Higher school nurse to student ratios correlated with better glycemic control and older age. Higher SEDM scores correlated with older age, and females scored significantly higher. Findings contribute new knowledge to the paucity of literature on school nursing and adolescents with T1D, with implications for nursing practice, education, research, and policy.
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Affiliation(s)
- Lori Wilt
- Seton Hall University, South Orange, NJ, USA
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45
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Diabetes management mediates the association between sleep duration and glycemic control in youth with type 1 diabetes mellitus. Sleep Med 2019; 60:132-138. [DOI: 10.1016/j.sleep.2019.01.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 10/28/2018] [Accepted: 01/31/2019] [Indexed: 01/28/2023]
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Thalange N, Biester T, Danne T. Clinical Use of Degludec in Children and Adolescents with T1D: A Narrative Review with Fictionalized Case Reports. Diabetes Ther 2019; 10:1219-1237. [PMID: 31187420 PMCID: PMC6612349 DOI: 10.1007/s13300-019-0641-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Indexed: 12/11/2022] Open
Abstract
The use of insulin in children and adolescents with type 1 diabetes (T1D) is a challenge because of the heterogeneity of these patients and their lifestyles, with consequent unpredictability in blood glucose levels. A new ultra-long-acting basal insulin, insulin degludec (degludec), has the potential to mitigate some of these challenges, notably variability in the glucose-lowering action of the basal insulin component of an insulin regimen, and consequent risks of hypo- and hyperglycemia. However, the protracted half-life and steady state pharmacokinetics of degludec potentially bring some new challenges. In particular, the adjustment of therapy in response to commonly encountered clinical situations might require a different approach when degludec is used in place of other currently used basal insulins in this challenging patient population. The purpose of this article is to guide clinicians through a series of case histories in the use of this insulin. These include, but are not limited to, how to initiate, titrate, switch from other basal insulin or pump therapy; how to alleviate difficulties arising as a result of unpredictable lifestyle/habits; and how to maintain treatment following diabetic ketoacidosis. The guidance presented in this review illustrates that degludec is a good option for a diverse range of children and adolescents with T1D, providing much needed flexibility in the treatment of this challenging patient population.Funding Novo Nordisk.
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Affiliation(s)
- Nandu Thalange
- Al Jalila Children's Specialty Hospital, Al Jaddaf, Dubai, United Arab Emirates.
| | - Torben Biester
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Hannover, Germany
| | - Thomas Danne
- Diabetes Centre for Children and Adolescents, AUF DER BULT, Hannover, Germany
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Enlow PT, Wysocki T. JPP Student Journal Club Commentary: A Commentary on Self-Management Trajectories in Hispanic Adolescents with Type 1 Diabetes. J Pediatr Psychol 2019; 44:642-644. [DOI: 10.1093/jpepsy/jsz045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 11/14/2022] Open
Affiliation(s)
- Paul T Enlow
- Center for Healthcare Delivery Science, Nemours/A.I. duPont Hospital for Children
| | - Tim Wysocki
- Center for Healthcare Delivery Science, Nemours Children’s Health System
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Malik FS, Panlasigui N, Gritton J, Gill H, Yi-Frazier JP, Moreno MA. Adolescent Perspectives on the Use of Social Media to Support Type 1 Diabetes Management: Focus Group Study. J Med Internet Res 2019; 21:e12149. [PMID: 31199310 PMCID: PMC6592493 DOI: 10.2196/12149] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 12/23/2018] [Accepted: 03/29/2019] [Indexed: 01/08/2023] Open
Abstract
Background A majority of adolescents report the use of some form of social media, and many prefer to communicate via social networking sites. Social media may offer new opportunities in diabetes management, particularly in terms of how health care teams provide tailored support and treatment to adolescents with diabetes. Objective The aim of this study was to explore the experiences and perspectives of adolescents with type 1 diabetes on the feasibility of social media use as a tool to collaboratively manage their diabetes with their diabetes care team. Methods Focus groups of adolescents with type 1 diabetes were conducted in the Seattle metropolitan area in Washington State. Semistructured questions were used to elicit views around the preferred means of communication with the adolescents’ diabetes care team, how to best support diabetes self-management, and how social media could be used outside of the clinic setting by the diabetes care team to engage with adolescents with type 1 diabetes. Focus groups were audio recorded and transcribed verbatim. Qualitative content analysis was carried out, and emergent themes were subsequently mapped onto 4 domains of feasibility, which included acceptability, demand, implementation, and practicality. Results Participants included 45 adolescents with type 1 diabetes (mean age 15.9, SD 1.7 years; 58% male; diabetes duration mean 6.2, SD 3.6 years; 76% on insulin pumps; 49% wore continuous glucose monitors; 93% reported use of social media; 84% used smartphones as the primary means for social media access). A total of 7 major topics were identified and mapped onto areas consistent with our focus on feasibility. For acceptability and demand, participants expressed how communication over social media could help facilitate (1) improved communication outside of clinic visits to optimize diabetes management, (2) independence in diabetes self-management, (3) connection to other youth with diabetes for additional diabetes support, and (4) delivery of more timely and personalized care. Addressing implementation and practicality, participants shared the need to (1) ensure patient privacy, (2) maintain professional nature of provider-patient relationship, and (3) recognize that social media is not currently used for medical care by youth with diabetes. Conclusions Adolescents with type 1 diabetes expressed interest in the use of social media as a tool to support diabetes management and increase engagement with their diabetes care team. Specific implementation measures around privacy and professionalism should be considered when developing a social media intervention to facilitate communication between adolescents and care teams.
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Affiliation(s)
- Faisal S Malik
- Division of Endocrinology and Diabetes, Department of Pediatrics, University of Washington, Seattle, WA, United States.,Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Neil Panlasigui
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Jesse Gritton
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Harsimrat Gill
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA, United States
| | - Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, United States
| | - Megan A Moreno
- Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of Wisconsin-Madison, Madison, WI, United States
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Silva K, Miller VA. The Role of Cognitive and Psychosocial Maturity in Type 1 Diabetes Management. J Adolesc Health 2019; 64:622-630. [PMID: 30655120 PMCID: PMC6478514 DOI: 10.1016/j.jadohealth.2018.10.294] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 10/17/2018] [Accepted: 10/17/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of the article was to explore the longitudinal relationship between treatment responsibility and type 1 diabetes management (i.e., adherence and glycemic control) in adolescence and to examine whether indicators of cognitive and psychosocial maturity moderate the link between youth responsibility and diabetes outcomes. METHODS Participants included 117 youth with type 1 diabetes and their parents. Youth (aged 8-16 years) and parents were assessed five times over 2 years. Using a cohort sequential design, we estimated the growth trajectory of adherence and glycemic control (i.e., hemoglobin A1c [HbA1c]) from age 8 to 18 years. Treatment responsibility, verbal ability, and impulse control were used as predictors of within-person variability and between-person differences in the growth parameters (i.e., intercept and slope). RESULTS Adherence and HbA1c declined linearly from ages 8 to 18 years. Significant within-person interactions between impulse control and responsibility revealed that on occasions when youth experienced increases in both responsibility and impulse control, adherence and HbA1c were higher than would be predicted by the age-related trajectory. For adherence only, when youth acquired more responsibility, without experiencing contemporaneous gains in impulse control, adherence worsened. For glycemic control only, a significant within-person interaction indicated that time-specific increases in both youth responsibility and verbal capacity were associated with a concurrent decline in HbA1c. CONCLUSIONS The present findings underscore that the associations between treatment responsibility and diabetes management depend on youths' maturational context. Intervention efforts to enhance impulse control skills in youth with diabetes may prevent the decline in diabetes management that tends to occur as youth acquire more responsibility for diabetes-related tasks.
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Affiliation(s)
- Karol Silva
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA
| | - Victoria A. Miller
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA, and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
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Caccavale LJ, Corona R, LaRose JG, Mazzeo SE, Sova AR, Bean MK. Exploring the role of motivational interviewing in adolescent patient-provider communication about type 1 diabetes. Pediatr Diabetes 2019; 20:217-225. [PMID: 30575237 PMCID: PMC7196323 DOI: 10.1111/pedi.12810] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 12/04/2018] [Accepted: 12/10/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Adolescents with type 1 diabetes (T1D) frequently experience deterioration in glycemic control. Providers have unique opportunities to address diabetes self-management, yet little is known about the most effective way to communicate with adolescents. This investigation used a motivational interviewing (MI) framework to characterize naturally-occurring adolescent patient-provider communication in medical encounters and examined relations between adolescent patient-provider communication and (a) T1D self-management and (b) glycemic control (hemoglobin A1c [HbA1c]). METHODS Medical encounters between pediatric endocrine providers and 55 adolescents with T1D (49% female; M age = 14.8 years; M baseline HbA1c = 8.6%) were audio recorded and coded using standardized rating instruments. Patients and parents completed measures assessing T1D care behaviors and self-efficacy. Assessments were completed at routine endocrinology visits (baseline) and 1 and 3-month post-baseline; HbA1c was obtained from medical records at baseline and 3-month. RESULTS Hierarchical multiple regressions showed that greater provider use of MI non-adherent behaviors (eg, confronting, persuading) was associated with (a) poorer 3-month HbA1c, P < 0.001; (b) worse 1-month adolescent diabetes adherence P < 0.001, and (c) lower diabetes self-efficacy at 1-month (P < 0.001) follow-up. Lower patient self-efficacy for diabetes self-management mediated the relation between provider use of MI non-adherent language and lower diabetes adherence (P = 0.020). CONCLUSION Providers' use of persuasion and confrontation regarding risks of non-adherence was associated with poorer glycemic control and adherence. Communication training for providers that targets reductions in MI-inconsistent language may have the potential to improve diabetes self-care in this vulnerable population.
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Affiliation(s)
- Laura J Caccavale
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
| | - Rosalie Corona
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Jessica G LaRose
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Suzanne E Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Alexandra R Sova
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Melanie K Bean
- Department of Pediatrics, Children's Hospital of Richmond at Virginia Commonwealth University, Richmond, Virginia
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