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Albright D, Wardell J, Harrison A, Mizokami-Stout K, Hirschfeld E, Garrity A, Thomas I, Lee J. Screening for diabetes distress and depression in routine clinical care for youth with type 1 diabetes. J Pediatr Psychol 2024:jsae016. [PMID: 38647266 DOI: 10.1093/jpepsy/jsae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Revised: 02/22/2024] [Accepted: 02/22/2024] [Indexed: 04/25/2024] Open
Abstract
OBJECTIVE The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults. METHODS In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c). RESULTS Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress. CONCLUSIONS In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.
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Affiliation(s)
- Dana Albright
- Health Services and Informatics Research, Parkview Health, Fort Wayne, IN, United States
| | - Joseph Wardell
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Annalise Harrison
- Health Services and Informatics Research, Parkview Health, Fort Wayne, IN, United States
| | - Kara Mizokami-Stout
- Division of Metabolism, Endocrinology, and Diabetes, University of Michigan, Ann Arbor, MI, United States
- VA Ann Arbor Healthcare System, Ann Arbor, MI, United States
| | - Emily Hirschfeld
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
| | - Ashley Garrity
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
| | - Inas Thomas
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
| | - Joyce Lee
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, United States
- Division of Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, United States
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2
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Wardell J, Albright D, Chang C, Plegue MA, Lee JE, Hirschfeld E, Garrity A, Lee JM, DeJonckheere M. Association Between Psychosocial Acuity and Glycemic Control in a Pediatric Type 1 Diabetes Clinic. Sci Diabetes Self Manag Care 2024; 50:116-129. [PMID: 38456252 PMCID: PMC11042759 DOI: 10.1177/26350106241232634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
PURPOSE The purpose of this study was to describe the frequency of psychosocial risk and its associations with glycemic levels in youth with type 1 diabetes (T1D) seen by social work staff during regular clinical care. METHODS A retrospective longitudinal analysis of observational clinical data was conducted. Individuals (1-26 years) with known T1D who were seen at a pediatric diabetes clinic in a US academic medical center between 2014 and 2021 were included. Variables included psychosocial acuity, A1C, and demographic characteristics. Chi-square tests, Wilcoxon rank sum tests, and mixed linear regressions were used to examine associations between demographic variables, psychosocial acuity, and A1C. RESULTS Of 966 patients, 513 (53.1%) were male, 76 (7.9%) were non-Hispanic Black, and 804 (83.2%) were non-Hispanic White. There was a mean of 6.9 annual social work encounters per patient, with 3 psychosocial domains measured at each visit. Results showed that as psychosocial acuity level increased, glycemic control decreased. There were significant differences in A1C according to race/ethnicity, insurance, age, and psychosocial acuity. CONCLUSIONS In a real-world clinical population, psychosocial acuity was associated with glycemic control. Presenting for psychosocial issues in their diabetes clinic was associated with reduced glycemic control among youth with T1D. There is an opportunity to connect pediatric patients with appropriate mental health services and psychosocial supports.
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Affiliation(s)
- Joseph Wardell
- School of Public Health, University of Michigan, Ann Arbor, Michigan
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Dana Albright
- Parkview Mirro Center for Research and Innovation, Fort Wayne, Indiana
| | - Claire Chang
- University of Michigan Medical School, Ann Arbor, Michigan
| | - Melissa A Plegue
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jung Eun Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Joyce M Lee
- Susan B. Meister Child Health Evaluation and Research Center, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
- Pediatric Endocrinology, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
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3
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Erfani K, Grabowski A, Parker G, Garrity A, Peterson KE, Lee JM, Nanda U. Point of Decision Design to Address Adolescent Overweight and Obesity. HERD 2023; 16:182-194. [PMID: 36946329 PMCID: PMC11042780 DOI: 10.1177/19375867231153365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
OBJECTIVES This study aims to utilize the point of decision design framework to understand how, where, and why adolescents and families make decisions about diet and physical activity and to explore how modifications to the environment can help to promote healthier choices and reduce obesity. BACKGROUND Child and adolescent obesity is a critical public health problem. As environmental factors are a primary contributor, understanding the role of design in our surrounding environment highlights an important area of interdisciplinary study. Design strategies have been used successfully to increase stair use and reduce sedentary behavior and can be used to further promote healthier diet and activity choices among adolescents and families. METHODS We leveraged the human-centered design-thinking process through (1) qualitative interviews and survey instruments, (2) persona and prompt development, and (3) a design workshop with multidisciplinary stakeholders. RESULTS Five personas were developed from the qualitative data and used in a design-thinking workshop. During the workshop, participants generated 12 influential factors and nine points of decision which were used to generate 33 solutions spanning the design continuum (from information and policy design to the design of urban, architectural, and interior environments) aimed at improving nutrition and physical activity among adolescents. Additionally, a tool kit was prototyped, which includes interview guides, a persona framework, and a workshop facilitation guide. CONCLUSIONS Our novel process led to the generation of design solutions that can be implemented to expand and improve upon existing interventions for childhood obesity and create environments that encourage positive health outcomes.
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Affiliation(s)
- Kimia Erfani
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Aria Grabowski
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Grant Parker
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Karen E. Peterson
- Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Division of Pediatric Endocrinology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Upali Nanda
- A. Alfred Taubman College of Architecture and Urban Planning, University of Michigan, Ann Arbor, MI, USA
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4
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Lavik AR, Ebekozien O, Noor N, Alonso GT, Polsky S, Blackman SM, Chen J, Corathers SD, Demeterco-Berggren C, Gallagher MP, Greenfield M, Garrity A, Rompicherla S, Rapaport R, Yayah Jones NH. Trends in Type 1 Diabetic Ketoacidosis During COVID-19 Surges at 7 US Centers: Highest Burden on non-Hispanic Black Patients. J Clin Endocrinol Metab 2022; 107:1948-1955. [PMID: 35380700 PMCID: PMC8992309 DOI: 10.1210/clinem/dgac158] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Indexed: 12/26/2022]
Abstract
CONTEXT The impact of the COVID-19 pandemic on individuals with type 1 diabetes remains poorly defined. OBJECTIVE We examined United States trends in diabetic ketoacidosis (DKA) among individuals with type 1 diabetes (T1D) during the COVID-19 pandemic at 7 large US medical centers and factors associated with these trends. METHODS We compared DKA events among children and adults with T1D during COVID-19 surge 1 (March-May 2020) and COVID-19 surge 2 (August-October 2020) to the same periods in 2019. Analysis was performed using descriptive statistics and chi-square tests. RESULTS We found no difference in the absolute number of T1D patients experiencing DKA in 2019 vs 2020. However, a higher proportion of non-Hispanic Black (NHB) individuals experienced DKA in 2019 than non-Hispanic White (NHW) individuals (44.6% vs 16.0%; P < .001), and this disparity persisted during the COVID-19 pandemic (48.6% vs 18.6%; P < .001). DKA was less common among patients on continuous glucose monitor (CGM) or insulin pump in 2020 compared to 2019 (CGM: 13.2% vs 15.0%, P < .001; insulin pump: 8.0% vs 10.6%, P < .001). In contrast to annual DKA totals, a higher proportion of patients had DKA during COVID-19 surges 1 and 2 compared to the same months in 2019 (surge 1: 7.1% vs 5.4%, P < .001; surge 2: 6.6% vs 5.7%, P = .001). CONCLUSION DKA frequency increased among T1D patients during COVID-19 surges with highest frequency among NHB patients. DKA was less common among patients using CGM or insulin pumps. These findings highlight the urgent need for improved strategies to prevent DKA among patients with T1D-not only under pandemic conditions, but under all conditions-especially among populations most affected by health inequities.
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Affiliation(s)
- Andrew R Lavik
- Correspondence: Andrew R. Lavik, MD, PhD, Department of Pediatrics, Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, Cincinnati, OH 45229, USA.
| | | | - Nudrat Noor
- T1D Exchange, Boston, Massachusetts 02111, USA
| | - G Todd Alonso
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Sarit Polsky
- University of Colorado, Barbara Davis Center for Diabetes, Aurora, Colorado 80045, USA
| | - Scott M Blackman
- Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA
| | - Justin Chen
- SUNY Upstate Medical University, Syracuse, New York 13210, USA
| | - Sarah D Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
| | | | - Mary Pat Gallagher
- Hassenfeld Children’s Hospital at NYU Langone, New York, New York 10016, USA
| | | | - Ashley Garrity
- Division of Pediatric Endocrinology, C. S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan 48109, USA
| | | | | | - Nana-Hawa Yayah Jones
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA
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5
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Lee JM, Rusnak A, Garrity A, Hirschfeld E, Thomas IH, Wichorek M, Lee JE, Rioles NA, Ebekozien O, Corathers SD. Feasibility of Electronic Health Record Assessment of 6 Pediatric Type 1 Diabetes Self-management Habits and Their Association With Glycemic Outcomes. JAMA Netw Open 2021; 4:e2131278. [PMID: 34709387 PMCID: PMC8554640 DOI: 10.1001/jamanetworkopen.2021.31278] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
IMPORTANCE A low-burden electronic health record (EHR) workflow has been devised to systematize the collection and validation of 6 key diabetes self-management habits: (1) checks glucose at least 4 times/day or uses continuous glucose monitor (CGM); (2) gives at least 3 rapid-acting insulin boluses per day; (3) uses insulin pump; (4) delivers boluses before meals; (5) reviewed glucose data since last clinic visit, and (6) has changed insulin doses since the last clinic visit. OBJECTIVE To describe the performance of these habits and examine their association with hemoglobin A1c (HbA1c) levels and time in range (TIR). DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included individuals with known type 1 diabetes who were seen in a US pediatric diabetes clinic in 2019. MAIN OUTCOMES AND MEASURES Habit performance, total habit score (sum of 6 habits per person), HbA1c levels, and TIR. RESULTS Of 1344 patients, 1212 (609 [50.2%] males; 66 [5.4%] non-Hispanic Black; 1030 [85.0%] non-Hispanic White; mean [SD] age, 15.5 [4.5] years) were included, of whom 654 (54.0%) were using CGM and had a TIR. Only 105 patients (8.7%) performed all 6 habits. Habit performance was lower among older vs younger patients (age ≥18 years vs ≤12 years: 17 of 411 [4.1%] vs 57 of 330 [17.3%]; P < .001), Black vs White patients (3 [4.5%] vs 95 [9.2%]; P < .001), those with public vs private insurance (14 of 271 [5.2%] vs 91 of 941 [9.7%]; P < .001), and those with lower vs higher parental education levels (<college degree vs ≥college degree: 35 of 443 [7.9%] vs 66 of 574 [11.5%]; P < .001). After adjustment for demographic characteristics and disease duration, for every 1-unit increase in total habit score, we found a mean (SE) 0.6% (0.05) decrease in HbA1c among all participants and a mean (SE) 2.86% (0.71) increase in TIR among those who used CGMs. Multiple regression models revealed that performing each habit was associated with a significantly lower HbA1c level (habit 1: -0.16% [95% CI, -1.91% to -1.37%]; habit 2: -1.01% [-1.34% to -0.69%]; habit 3: -0.71% [95% CI, -0.93% to -0.49%]; habit 4: -0.97% [95% CI, -1.21% to -0.73%]; habit 5: -0.44% [95% CI, -0.71% to -0.17%]; habit 6: -0.75% [95% CI, -0.96% to -0.53%]; all P < .001). There were differences in HbA1c according to race, insurance, and parental education, but these associations were attenuated with the inclusion of the 6 habits, which had more robust associations with HbA1c levels than the demographic characteristics. CONCLUSIONS AND RELEVANCE These findings suggest that a focus on increasing adherence to the 6 habits could be critical for improving disparities in glycemic outcomes; these metrics have been adopted by the Type 1 Diabetes Exchange Quality Improvement Collaborative for continuous quality improvement.
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Affiliation(s)
- Joyce M. Lee
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Andrea Rusnak
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor
| | - Inas H. Thomas
- Pediatric Endocrinology, University of Michigan, Ann Arbor
| | - Michelle Wichorek
- Brehm Center for Diabetes Research, University of Michigan, Ann Arbor
| | | | | | | | - Sarah D. Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio
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6
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Lyons SK, Ebekozien O, Garrity A, Buckingham D, Odugbesan O, Thomas S, Rioles N, Gallagher K, Sonabend RY, Lorincz I, Alonso GT, Kamboj MK, Lee JM. Increasing Insulin Pump Use Among 12- to 26-Year-Olds With Type 1 Diabetes: Results From the T1D Exchange Quality Improvement Collaborative. Clin Diabetes 2021; 39:272-277. [PMID: 34421202 PMCID: PMC8329008 DOI: 10.2337/cd21-0027] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Insulin pump therapy in pediatric type 1 diabetes has been associated with better glycemic control than multiple daily injections. However, insulin pump use remains limited. This article describes an initiative from the T1D Exchange Quality Improvement Collaborative aimed at increasing insulin pump use in patients aged 12-26 years with type 1 diabetes from a baseline of 45% in May 2018 to >50% by February 2020. Interventions developed by participating centers included increasing in-person and telehealth education about insulin pump technology, creating and distributing tools to assist in informed decision-making, facilitating insulin pump insurance approval and onboarding processes, and improving clinic staff knowledge about insulin pumps. These efforts yielded a 13% improvement in pump use among the five participating centers, from 45 to 58% over 22 months.
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Affiliation(s)
- Sarah K Lyons
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | | | - Ashley Garrity
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
| | - Don Buckingham
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | | | - Sarah Thomas
- Barbara Davis Center, University of Colorado, Aurora, CO
| | | | | | - Rona Y Sonabend
- Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Ilona Lorincz
- Hospital of the University of Pennsylvania, Philadelphia, PA
| | - G Todd Alonso
- Barbara Davis Center, University of Colorado, Aurora, CO
| | - Manmohan K Kamboj
- Nationwide Children's Hospital, The Ohio State University, Columbus, OH
| | - Joyce M Lee
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI
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7
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Abstract
BACKGROUND The Nightscout Project is a leading example of patient-designed, do-it-yourself (DIY), open-source technology innovations to support type 1 diabetes management. We are unaware of studies that have described the evolution of patient-driven innovations from the Nightscout Project to date. METHODS We identified patient-driven, DIY innovations from posts and comments in the "CGM in the Cloud" private Facebook group as well as data from Twitter, GitHub, and the Nightscout website. For each innovation, we described its intent or its unaddressed need as well as the associated features and improvements. We conducted a thematic analysis to identify overarching patterns among the innovations, features, and improvements, and compared the timeline of innovations in the DIY space with the timing of similar innovations in the commercial space. RESULTS We identified and categorized innovations in Nightscout with the most commonly appearing themes of: visualization improvements, equipment improvements, and user experience improvements. Other emerging themes included: Care Portal support, safety, remote monitoring, decision support, international support, artificial pancreas, pushover notifications, and open-source collaboration. CONCLUSIONS This rapid development of patient-designed DIY innovations driven by unmet needs in the type 1 diabetes community reflects a revolutionary, bottom-up approach to medical innovation. Nightscout users accessed features earlier than if they had waited for commercial products, and they also personalized their tools and devices, empowering them to become the experts of their own care.
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Affiliation(s)
- Michelle Ng
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Emily Borst
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
| | - Joyce Lee
- Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
- Joyce Lee, MD, MPH, Pediatric Endocrinology and Susan B. Meister Child Health Evaluation and Research Center (CHEAR), University of Michigan, 300 North Ingalls Building, Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-5456, USA.
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8
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Abstract
BACKGROUND Caregivers and individuals living with type 1 diabetes (T1D) who are members of CGM in the Cloud, a Facebook group associated with the Nightscout Project, were interviewed to assess how the online community impacted peer support. METHODS Semistructured qualitative interviews were conducted with caregivers and patients who are part of CGM in the Cloud Facebook group. Interview transcripts were analyzed to identify various themes related to peer support in the online group. RESULTS Members of the CGM in the Cloud Facebook group identified peer support through giving and receiving technical, emotional, and medical support, as well as giving back to the larger community by paying it forward. Peer support also extended beyond the online forum, connecting people in person, whether they were local or across the country. CONCLUSIONS An online community can provide many avenues for peer support through emotional and technical support, as well as serve as a tool of empowerment. The community as a whole also had a spirit of altruism that bolstered confidence in others as well as those who paid it forward.
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Affiliation(s)
- Valerie Gavrila
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Ashley Garrity
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Breann Edwards
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of Michigan, Ann Arbor, MI, USA
- Joyce M. Lee, MD, MPH, Child Health Evaluation and Research Center, University of Michigan, 300 NIB, Room 6E14, Campus Box 5456, Ann Arbor, MI 48109-5456, USA.
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9
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White K, Gebremariam A, Lewis D, Nordgren W, Wedding J, Pasek J, Garrity A, Hirschfeld E, Lee JM. Motivations for Participation in an Online Social Media Community for Diabetes. J Diabetes Sci Technol 2018; 12:712-718. [PMID: 29310448 PMCID: PMC6154236 DOI: 10.1177/1932296817749611] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our objectives were to describe individuals' motivations for participation in an online social media community and to assess their level of trust in medical information provided by medical professionals and community members. METHODS A purposive survey was delivered to participants recruited through posts on the CGM in the Cloud group, Twitter, and blogs. Individuals were asked a series of demographic and social media use questions. RESULTS A total of 1268 members of the CGM in the Cloud community responded to the survey. The majority were non-Hispanic White (92.1%) and caregivers of an individual with diabetes (80.9%). Mean age was 41 years old, and 74.8% were female. Primary goals of the Facebook group were to learn more about Nightscout technology and to receive technological assistance. Individuals provided assistance to the community through spreading awareness, technical assistance, support, and donation. Respondents put a high level of trust in their peers versus health professionals in many health situations with nearly 40% of individuals reported to be helped by following advice found in the Facebook group, and 99% reported no harm. CONCLUSIONS Our findings suggest that patients with diabetes and their caregivers use social media for many health-related purposes including medical recommendations and technical support for medical devices and systems as well as emotional support.
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Affiliation(s)
- Katherine White
- Child Health Evaluation and Research
Center, University of Michigan, Ann Arbor, MI, USA
| | | | | | | | | | - Josh Pasek
- Communication Studies, Center for
Political Studies, Institute for Social Research, University of Michigan, Ann Arbor,
MI, USA
| | - Ashley Garrity
- Child Health Evaluation and Research
Center, University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of
Michigan, Ann Arbor, MI, USA
| | - Emily Hirschfeld
- Child Health Evaluation and Research
Center, University of Michigan, Ann Arbor, MI, USA
| | - Joyce M. Lee
- Child Health Evaluation and Research
Center, University of Michigan, Ann Arbor, MI, USA
- Pediatric Endocrinology, University of
Michigan, Ann Arbor, MI, USA
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10
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Lee JM, Newman MW, Gebremariam A, Choi P, Lewis D, Nordgren W, Costik J, Wedding J, West B, Gilby NB, Hannemann C, Pasek J, Garrity A, Hirschfeld E. Real-World Use and Self-Reported Health Outcomes of a Patient-Designed Do-it-Yourself Mobile Technology System for Diabetes: Lessons for Mobile Health. Diabetes Technol Ther 2017; 19:209-219. [PMID: 28245152 DOI: 10.1089/dia.2016.0312] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND The aim of this study is to compare demographic/disease characteristics of users versus nonusers of a do-it-yourself (DIY) mobile technology system for diabetes (Nightscout), to describe its uses and personalization, and to evaluate associated changes in health behaviors and outcomes. METHODS A cross-sectional, household-level online survey was used. Of 1268 household respondents who were members of the CGM in the Cloud Facebook group, there were 1157 individuals with diabetes who provided information about Nightscout use. RESULTS The majority of individuals with diabetes in the household sample were 6-12 years old (followed by 18 years and above, and 13-17 years), non-Hispanic whites (90.2%), with type 1 diabetes (99.4%). The majority used an insulin pump (85.6%) and CGM (97.0%) and had private health insurance (83.8%). Nightscout use was more prevalent among children compared with adolescents and adults. Children used Nightscout for nighttime, school, sporting events, and travel; adults used it for nighttime, work, travel, and sporting events. Whereas the majority of adults viewed their own data without assistance from others, among pediatric users, a median of three individuals (range: 0-8) viewed Nightscout, with a median of three devices per viewer (range: 0-7). Individuals reported that after Nightscout adoption, they checked blood glucose values with a meter less often; bolused more frequently; gave more boluses without checking first with a blood glucose meter; and experienced significant improvements in HbA1c and quality of life. CONCLUSIONS The Nightscout Project is a patient-driven mobile technology for health and may have beneficial effects on glycemic control and quality of life.
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Affiliation(s)
- Joyce M Lee
- 1 Pediatric Endocrinology, University of Michigan , Ann Arbor, Michigan
- 2 Child Health Evaluation and Research Center, University of Michigan , Ann Arbor, Michigan
| | - Mark W Newman
- 3 School of Information, University of Michigan , Ann Arbor, Michigan
| | - Achamyeleh Gebremariam
- 2 Child Health Evaluation and Research Center, University of Michigan , Ann Arbor, Michigan
| | - Preciosa Choi
- 2 Child Health Evaluation and Research Center, University of Michigan , Ann Arbor, Michigan
| | | | | | - John Costik
- 6 Center for Clinical Innovation, University of Rochester , Rochester, New York
| | | | | | | | | | - Josh Pasek
- 8 Communication Studies and Center for Political Studies, Institute for Social Research, University of Michigan , Ann Arbor, Michigan
| | - Ashley Garrity
- 2 Child Health Evaluation and Research Center, University of Michigan , Ann Arbor, Michigan
| | - Emily Hirschfeld
- 2 Child Health Evaluation and Research Center, University of Michigan , Ann Arbor, Michigan
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Janevic MR, Baptist AP, Bryant-Stephens T, Lara M, Persky V, Ramos-Valencia G, Uyeda K, Hazan R, Garrity A, Malveaux FJ. Effects of pediatric asthma care coordination in underserved communities on parent perceptions of care and asthma-management confidence. J Asthma 2016; 54:514-519. [PMID: 27901627 DOI: 10.1080/02770903.2016.1242136] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Disparities by race and socioeconomic status persist in pediatric asthma morbidity, mortality, and treatment. Improving parent/provider communication and parents' asthma-management confidence may result in better asthma control in vulnerable populations. The Merck Childhood Asthma Network, Inc. funded an initiative to implement medical-social care coordination to improve asthma outcomes at sites in four low-income, urban communities (Los Angeles, CA; Philadelphia, PA; Chicago, IL; and San Juan, PR.) As part of a cross-site evaluation of this effort, pre- post-program changes in parents' reports of asthma care and management were assessed. METHODS Across sites, 805 parents or other caregivers responded to a baseline survey that was repeated one year later following their child's participation in care coordination. Parents' asthma-management confidence, as well as their perceptions of provider access, trust, and communication, were measured with Likert scales. Linear mixed models were used to assess improvement in these variables, across and within sites, adjusting for sociodemographics. RESULTS Pooled across sites, the adjusted mean estimate for all outcomes showed a significant improvement (p <.05) from baseline to follow-up. Knowledge and Between-Provider Communication improved significantly (p <.05) within all four sites; Access improved significantly in Chicago, Philadelphia, and Puerto Rico; Trust improved significantly in Chicago, Los Angeles, and Philadelphia; and Patient-Provider Communication improved significantly in Philadelphia only. CONCLUSION Pediatric asthma care coordination, as implemented variously in diverse settings, was associated with improvement in parents' perceptions of asthma care and self-reported asthma-management knowledge and confidence. This positive impact on parents may help sustain care coordination's impact on children.
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Affiliation(s)
- Mary R Janevic
- a School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Alan P Baptist
- b Division of Allergy and Clinical Immunology , University of Michigan Medical School , Ann Arbor , MI , USA
| | | | - Marielena Lara
- d Children's Hospital of Los Angeles, University of Southern California , Los Angeles , CA , USA.,e RAND Corporation , Santa Monica , CA , USA
| | - Victoria Persky
- f University of Illinois at Chicago School of Public Health , Chicago , IL , USA
| | | | - Kimberly Uyeda
- h Los Angeles Unified School District , Los Angeles , CA , USA
| | - Rebecca Hazan
- a School of Public Health, University of Michigan , Ann Arbor , MI , USA
| | - Ashley Garrity
- a School of Public Health, University of Michigan , Ann Arbor , MI , USA
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Coker VS, Garrity A, Wennekes WB, Roesink HDW, Cutting RS, Lloyd JR. Cr(VI) and azo dye removal using a hollow-fibre membrane system functionalized with a biogenic Pd-magnetite catalyst. Environ Technol 2014; 35:1046-1054. [PMID: 24645489 DOI: 10.1080/09593330.2013.859738] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
This study investigates the application of a hybrid system combining hollow-fibre membrane technology with the reductive abilities of magnetic nanoparticles for the remediation of toxic Cr(VI) and the azo dye, Remazol Black B. Nano-scale biogenic magnetite (Fe3O4), formed by microbial reduction of the mineral ferrihydrite, has a high reductive capacity due to the presence of Fe(II) in the mineral structure. The magnetic nanoparticles (approximately 20 nm) can be arrayed with Pd0 nanoparticles (approximately 5 nm) making a catalytically active nanomaterial. Membrane units, with and without nanoparticles, were challenged with either Cr(VI) or azo dye and some were supplemented with sodium formate, as an electron donor for contaminant reduction promoted by the Pd. The combination of Pd-magnetite with formate resulted in the most effective remediation strategy for both contaminants and the lifetime of the membrane unit was also increased, with 55% (19 days) and 70% (23 days) removal of the azo dye and Cr(VI), respectively. Low flow rates of 0.1 ml/min resulted in improved efficiencies due to increased contact time with the membrane/nanoparticle unit, with 70-75% removal of each contaminant. Chemical analyses of the nanoparticles post-exposure to Cr(VI) in the membrane modules indicated Pd to be more oxidized when Cr removal was maximized, and that the Cr was partially reduced to Cr(III) at the surface of the magnetite. These results have demonstrated that hollow-fibre membrane units can be enhanced for the removal of soluble, redox sensitive contaminants by incorporation of a layer of palladized biogenic nanoparticulate magnetite.
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Andrews G, Garrity A. Anxiety disorders. Recognition and management. Aust Fam Physician 2000; 29:337-41. [PMID: 10800218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Anxiety disorders are common and disabling. Yet they often go unnoticed: sufferers do not always complain of symptoms, and when they do they often present with primarily somatic concerns. Also, they are sometimes dismissed as being 'just anxious', 'very shy', or 'worriers' rather than being recognized as suffering from very treatable disorders. OBJECTIVE To briefly describe the assessment, diagnosis, differential diagnosis, and management of the major anxiety disorders. DISCUSSION Anxiety disorders are common and treatable. Cognitive behavioural therapy and medications are the two main treatment modalities. Ways of increasing skills with psychological techniques are also discussed.
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Affiliation(s)
- G Andrews
- Clinical Research Unit for Anxiety Disorders, School of Psychiatry, University of New South Wales, St Vincent's Hospital, Sydney.
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