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Tilden DR, Anifowoshe K, Jaser SS. Observed collaborative and intrusive parenting behaviours associated with psychosocial outcomes of adolescents with type 1 diabetes and their maternal caregivers. Diabet Med 2024; 41:e15300. [PMID: 38303663 PMCID: PMC11021143 DOI: 10.1111/dme.15300] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 01/11/2024] [Accepted: 01/22/2024] [Indexed: 02/03/2024]
Abstract
AIMS Maternal caregiver involvement is strongly associated with psychosocial and glycemic outcomes amongst adolescents with type 1 diabetes (T1D); however, previous studies have lacked detailed, objective examinations of caregiver involvement. We examined the relationship between observed parenting behaviors and psychosocial and glycemic outcomes amongst youth with T1D. METHODS Data collected from adolescents with T1D (age 11-17) and their female caregivers as a part of a randomized controlled trial were analyzed. These included structured, observation-based scores of adolescent-caregiver dyads engaged in videotaped interactions and selected psychosocial and glycemic outcome measures. RESULTS In adjusted analyses, higher levels of intrusive parenting behaviors during observed interactions were associated with higher diabetes distress in adolescents, but no difference in HbA1c. Associations between intrusive parenting behaviors and psychosocial outcomes were stronger for females compared to males for both diabetes distress and quality of life. Similarly, associations between collaborative parenting behaviors and quality of life were stronger for female adolescents than males. No associations were observed between collaborative parenting behaviors and glycemic outcomes. Consistent with previous work, we noted higher levels of adolescent-reported family conflict were associated with lower adolescent quality of life and higher diabetes distress with no significant difference between male and female adolescents. CONCLUSION These findings indicate that high levels of intrusive parenting behaviors, such as lecturing or over-controlling behaviors, are associated with lower levels of adolescent well-being, particularly among adolescent girls. This work suggests that interventions to reduce intrusive parenting by maternal caregivers could result in improved psychosocial outcomes for adolescents with T1D.
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Affiliation(s)
- Daniel R Tilden
- Division of Endocrinology, Diabetes and Clinical Pharmacology, Department of Medicine, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Kashope Anifowoshe
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Sarah S Jaser
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Tilden DR, French B, Datye KA, Jaser SS. Disparities in Continuous Glucose Monitor Use Between Children With Type 1 Diabetes Living in Urban and Rural Areas. Diabetes Care 2024; 47:346-352. [PMID: 37906202 PMCID: PMC10909681 DOI: 10.2337/dc23-1564] [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] [Received: 08/22/2023] [Accepted: 10/11/2023] [Indexed: 11/02/2023]
Abstract
OBJECTIVE Despite evidence that continuous glucose monitoring (CGM) use is associated with lower HbA1c among children with type 1 diabetes, uptake of this technology remains lower among those with difficulty accessing health care, including those from lower socioeconomic status backgrounds and racial and ethnic minorities. In this study, we sought to explore the impact of rural location in use of CGM technology to guide patient and provider decision making. RESEARCH DESIGN AND METHODS In this retrospective study of electronic health record demographic and visits data from a single diabetes program from 1 January 2018 through 31 December 2021, we compared the odds of completing a visit with (+) and without (-) CGM interpretation between rural-urban commuting area (RUCA) designations. RESULTS Among the 13,645 visits completed by 2,008 patients with type 1 diabetes younger than age 18 years, we found children living in small rural towns had 31% lower odds (6.3% of CGM+ visits, 8.6% of CGM- visits; adjusted odds ratio [aOR] 0.69, 95% CI 0.51-0.94) and those living in isolated rural towns had 49% lower odds (2.0% of CGM+ visits, 3.4% of CGM- visits; aOR 0.51, 95% CI 0.28-0.92) of completing a CGM-billed clinic visit compared with those living in urban areas (70.0% of CGM+ visits, 67.2% of CGM- visits). We also found significant differences in CGM-billed visits by neighborhood deprivation as well as race/ethnicity and insurance payor. CONCLUSIONS Geographic location presents a meaningful barrier to access to care for patients living with type 1 diabetes. Further work is needed to identify and address the needs of children and families living in rural areas to improve the care of these patients.
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Affiliation(s)
- Daniel R. Tilden
- Division of Endocrinology, Diabetes & Clinical Genetics, Department of Medicine, University of Kansas Medical Center, Kansas City, KS
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Karishma A. Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Jaser
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Abadula F, Garretson S, Okonkwo N, LeStourgeon LM, Jaser SS. Detangling Associations Between Maternal Depressive Symptoms and Diabetes Relationship Distress With Adolescents' HbA1c. J Pediatr Psychol 2024; 49:89-94. [PMID: 37794836 PMCID: PMC10874213 DOI: 10.1093/jpepsy/jsad070] [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] [Received: 05/04/2023] [Revised: 09/20/2023] [Accepted: 09/21/2023] [Indexed: 10/06/2023] Open
Abstract
OBJECTIVE Previous research in families of children with type 1 diabetes demonstrates that maternal depressive symptoms are a known risk factor for poor diabetes outcomes. We sought to examine whether maternal diabetes relationship distress or maternal depressive symptoms were more strongly associated with adolescent glycemic outcomes. METHODS Analyses were conducted using data from mothers who consented to screen for a behavioral intervention. The screener included the Patient Health Questionnaire and the Parent Diabetes Distress Scale, Parent/Teen Relationship Distress subscale. Hemoglobin A1c (HbA1c) was extracted from adolescents' medical records. RESULTS Our sample consisted of 390 maternal caregivers of adolescents with type 1 diabetes aged 11-17. Screening data revealed that 35% of mothers reported clinically significant diabetes distress related to their relationship with their adolescents, and 14% of mothers reported clinically significant depressive symptoms. The adolescents of mothers who reported diabetes relationship distress had significantly higher mean HbA1c levels (9.7 ± 2.2%) compared to those whose mothers were not distressed (8.2 ± 1.8%, d = .72). Similarly, adolescents whose mothers reported clinically significant depressive symptoms had higher mean HbA1c levels (9.6 ± 2.4%) than those whose mothers were not depressed (8.6 ± 2.0%, d = .48). After adjusting for clinical and demographic factors, mothers' reports of diabetes relationship distress were more strongly associated with adolescents' HbA1c than maternal depressive symptoms. CONCLUSIONS Our findings suggest that screening for maternal distress-particularly distress related to the caregiver-adolescent relationship-could match families with psychosocial support or other resources to improve both psychosocial and glycemic outcomes.
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Affiliation(s)
- Fayo Abadula
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Sydney Garretson
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Nkemjika Okonkwo
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | | | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, USA
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Bhushan B, Zee PC, Grandner MA, Jaser SS, Hazkani I, Maddalozzo JP, Xu S, Ahluwalia V, Chandra A, Schroeder JW, Sharma M, Suittens DA, Berg CA. Associations of deep sleep and obstructive sleep apnea with family relationships, life satisfaction, and physical stress experience in children: a caregiver perspective. J Clin Sleep Med 2023; 19:2087-2095. [PMID: 37565827 PMCID: PMC10692943 DOI: 10.5664/jcsm.10772] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/09/2023] [Accepted: 08/09/2023] [Indexed: 08/12/2023]
Abstract
STUDY OBJECTIVES Obstructive sleep apnea (OSA) and poor quality of sleep negatively impacts health-related quality of life in adults, but few studies have evaluated the association between sleep disturbance (eg, OSA, inadequate sleep) and health-related quality of life domains (eg, family relations, life satisfaction) in children. METHODS Children ages 8-17 years referred to a sleep center for routine polysomnography from April 2022 to August 2022 were approached to participate in the study, and children visiting the department of pediatrics for their wellness visit were recruited for comparisons. Statistical analysis was conducted using R 3.6.0. RESULTS Ninety-nine children were recruited from the sleep clinic, and 23 children were recruited from the primary care clinic. Of these children, 62 were diagnosed with obstructive sleep apnea (31 mild, 12 moderate, 19 severe), and 37 did not meet criteria for a diagnosis. Health-related quality of life domains did not differ across OSA severity levels. Children in general had lower life satisfaction and higher physical stress experience compared to children visiting for their wellness examination (well-child visitors, P = .05 and P = .005, respectively). Children with severe OSA had significantly lower life satisfaction and significantly higher physical stress experience when compared with well-child visitors (P = .008 and P = .009, respectively). Correlation analysis showed that N3 (deep) sleep was positively associated with family relations and life satisfaction, while it was negatively associated with anger. CONCLUSIONS Based on caregiver response, N3 sleep is positively associated with family relations and life satisfaction and negatively associated with anger. Severe OSA is associated with lower life satisfaction and higher physical stress experience. CITATION Bhushan B, Zee PC, Grandner MA, et al. Associations of deep sleep and obstructive sleep apnea with family relationships, life satisfaction, and physical stress experience in children: a caregiver perspective. J Clin Sleep Med. 2023;19(12):2087-2095.
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Affiliation(s)
- Bharat Bhushan
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Otolaryngology Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis C. Zee
- Center for Circadian and Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michael A. Grandner
- Department of Psychology, The University of Arizona Health Sciences, Tucson, Arizona
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Inbal Hazkani
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - John P. Maddalozzo
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Otolaryngology Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sarah Xu
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Vikas Ahluwalia
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Anjali Chandra
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - James W. Schroeder
- Department of Surgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
- Department of Otolaryngology Head & Neck Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Manoj Sharma
- Department of Social and Behavioral Health, University of Nevada, Las Vegas, Nevada
| | | | - Cynthia A. Berg
- Department of Psychology, College of Social and Behavioral Science, The University of Utah, Salt Lake City, Utah
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5
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Straton E, Inverso H, Moore H, Anifowoshe K, Washington K, Streisand R, Datye K, Jaser SS. Glycemic and Psychosocial Correlates of Continuous Glucose Monitor Use Among Adolescents With Type 1 Diabetes. J Diabetes Sci Technol 2023:19322968231186428. [PMID: 37846485 DOI: 10.1177/19322968231186428] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Abstract
BACKGROUND Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use. METHODS This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (Current Users, Past Users, and Never Users). RESULTS Current Users demonstrated significantly lower HbA1c than Never Users and significantly lower diabetes distress than Past Users. CGM use was not associated with family conflict or quality of life. CONCLUSIONS CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.
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Affiliation(s)
- Emma Straton
- Children's National Hospital, Washington, DC, USA
| | - Hailey Inverso
- Children's National Hospital, Washington, DC, USA
- University of Florida, Gainesville, FL, USA
| | - Hailey Moore
- Children's National Hospital, Washington, DC, USA
| | | | | | - Randi Streisand
- Children's National Hospital, Washington, DC, USA
- School of Medicine, The George Washington University, Washington, DC, USA
| | - Karishma Datye
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
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Cai LY, Del Tufo SN, Barquero L, D'Archangel M, Sachs L, Cutting LE, Glaser N, Ghetti S, Jaser SS, Anderson AW, Jordan LC, Landman BA. Spatiospectral image processing workflow considerations for advanced MR spectroscopy of the brain. bioRxiv 2023:2023.09.07.556701. [PMID: 37745381 PMCID: PMC10515761 DOI: 10.1101/2023.09.07.556701] [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] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Magnetic resonance spectroscopy (MRS) is one of the few non-invasive imaging modalities capable of making neurochemical and metabolic measurements in vivo. Traditionally, the clinical utility of MRS has been narrow. The most common use has been the "single-voxel spectroscopy" variant to discern the presence of a lactate peak in the spectra in one location in the brain, typically to evaluate for ischemia in neonates. Thus, the reduction of rich spectral data to a binary variable has not classically necessitated much signal processing. However, scanners have become more powerful and MRS sequences more advanced, increasing data complexity and adding 2 to 3 spatial dimensions in addition to the spectral one. The result is a spatially- and spectrally-variant MRS image ripe for image processing innovation. Despite this potential, the logistics for robustly accessing and manipulating MRS data across different scanners, data formats, and software standards remain unclear. Thus, as research into MRS advances, there is a clear need to better characterize its image processing considerations to facilitate innovation from scientists and engineers. Building on established neuroimaging standards, we describe a framework for manipulating these images that generalizes to the voxel, spectral, and metabolite level across space and multiple imaging sites while integrating with LCModel, a widely used quantitative MRS peak-fitting platform. In doing so, we provide examples to demonstrate the advantages of such a workflow in relation to recent publications and with new data. Overall, we hope our characterizations will lower the barrier of entry to MRS processing for neuroimaging researchers.
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Affiliation(s)
- Leon Y Cai
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- School of Medicine, Vanderbilt University, Nashville, TN, USA
| | - Stephanie N Del Tufo
- College of Education and Human Development, University of Delaware, Newark, DE, USA
| | - Laura Barquero
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Micah D'Archangel
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lanier Sachs
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Laurie E Cutting
- Vanderbilt Kennedy Center, Vanderbilt University Medical Center, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Nicole Glaser
- Department of Pediatrics, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Simona Ghetti
- Department of Psychology, University of California, Davis, Davis, CA, USA
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Adam W Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A Landman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
- Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
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Abadula F, Jordan LC, LeStourgeon L, Jaser SS. Using Community Engagement Methods to Guide Study Protocol Decisions for School-Aged Children With Type 1 Diabetes. Diabetes Spectr 2023; 37:95-99. [PMID: 38385103 PMCID: PMC10877206 DOI: 10.2337/ds23-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Introduction Many challenges exist in developing multisite protocols for newly diagnosed children with type 1 diabetes. Our research team engaged community members to increase the likelihood of study success during a planning grant for a longitudinal study aimed at understanding risk and protective factors for neurocognitive function in school-aged children newly diagnosed with type 1 diabetes. Methods Two methods were used to obtain caregiver input into study protocol decisions. The first was a survey given to caregivers of children with diabetes (n = 21) about which aspects of the study protocol would make families more or less likely to participate. The second was a Community Engagement (CE) Studio to obtain recommendations from a diverse group of caregivers of children with diabetes (n = 7) on key aspects of recruitment and enrollment. Results Results from both the survey and the CE Studio indicated that caregivers were interested and willing to participate in a longitudinal study of this nature. Both methods resulted in similar preferences for the type and amount of compensation, convenient study visits, flexible scheduling options, and receipt of neurocognitive test results. Recommendations from the CE Studio included additional strategies to minimize participant burden and enhance communication around study participation. Conclusion Both the feasibility survey and the CE Studio were useful mechanisms to obtain caregiver input during the study's planning and design phase. Uniquely, the CE Studio approach offers researchers the ability to gain valuable community member input with minimal staff effort.
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Affiliation(s)
- Fayo Abadula
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Lori C. Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Lauren LeStourgeon
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S. Jaser
- Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Cai LY, Tanase C, Anderson AW, Patel NJ, Lee CA, Jones RS, LeStourgeon LM, Mahon A, Taki I, Juvera J, Pruthi S, Gwal K, Ozturk A, Kang H, Rewers A, Rewers MJ, Alonso GT, Glaser N, Ghetti S, Jaser SS, Landman BA, Jordan LC. Exploratory Multisite MR Spectroscopic Imaging Shows White Matter Neuroaxonal Loss Associated with Complications of Type 1 Diabetes in Children. AJNR Am J Neuroradiol 2023; 44:820-827. [PMID: 37263786 PMCID: PMC10337627 DOI: 10.3174/ajnr.a7895] [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] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/03/2023] [Indexed: 06/03/2023]
Abstract
BACKGROUND AND PURPOSE Type 1 diabetes affects over 200,000 children in the United States and is associated with an increased risk of cognitive dysfunction. Prior single-site, single-voxel MRS case reports and studies have identified associations between reduced NAA/Cr, a marker of neuroaxonal loss, and type 1 diabetes. However, NAA/Cr differences among children with various disease complications or across different brain tissues remain unclear. To better understand this phenomenon and the role of MRS in characterizing it, we conducted a multisite pilot study. MATERIALS AND METHODS In 25 children, 6-14 years of age, with type 1 diabetes across 3 sites, we acquired T1WI and axial 2D MRSI along with phantom studies to calibrate scanner effects. We quantified tissue-weighted NAA/Cr in WM and deep GM and modeled them against study covariates. RESULTS We found that MRSI differentiated WM and deep GM by NAA/Cr on the individual level. On the population level, we found significant negative associations of WM NAA/Cr with chronic hyperglycemia quantified by hemoglobin A1c (P < .005) and a history of diabetic ketoacidosis at disease onset (P < .05). We found a statistical interaction (P < .05) between A1c and ketoacidosis, suggesting that neuroaxonal loss from ketoacidosis may outweigh that from poor glucose control. These associations were not present in deep GM. CONCLUSIONS Our pilot study suggests that MRSI differentiates GM and WM by NAA/Cr in this population, disease complications may lead to neuroaxonal loss in WM in children, and deeper investigation is warranted to further untangle how diabetic ketoacidosis and chronic hyperglycemia affect brain health and cognition in type 1 diabetes.
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Affiliation(s)
- L Y Cai
- From the Department of Biomedical Engineering (L.Y.C., A.W.A., B.A.L.)
| | - C Tanase
- Departments of Psychiatry and Behavioral Sciences (C.T.)
| | - A W Anderson
- From the Department of Biomedical Engineering (L.Y.C., A.W.A., B.A.L.)
- Vanderbilt University Institute of Imaging Science (A.W.A., B.A.L.)
- Departments of Radiology and Radiological Sciences (A.W.A., S.P., B.A.L.)
| | - N J Patel
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
| | | | - R S Jones
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
| | | | - A Mahon
- Psychology (A.M., S.G.), University of California, Davis, Davis, California
| | - I Taki
- Department of Pediatrics (I.T., A.R., M.J.R.)
| | - J Juvera
- Department of Psychiatry (J.J.), University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - S Pruthi
- Departments of Radiology and Radiological Sciences (A.W.A., S.P., B.A.L.)
| | - K Gwal
- Departments of Radiology (K.G., A.O.)
| | - A Ozturk
- Departments of Radiology (K.G., A.O.)
| | - H Kang
- Biostatistics (H.K.), Vanderbilt University Medical Center, Nashville, Tennessee
| | - A Rewers
- Department of Pediatrics (I.T., A.R., M.J.R.)
| | - M J Rewers
- Department of Pediatrics (I.T., A.R., M.J.R.)
| | | | - N Glaser
- Pediatrics (N.G.), University of California Davis Health, University of California Davis School of Medicine, Sacramento, California
| | - S Ghetti
- Psychology (A.M., S.G.), University of California, Davis, Davis, California
| | - S S Jaser
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
| | - B A Landman
- From the Department of Biomedical Engineering (L.Y.C., A.W.A., B.A.L.)
- Vanderbilt University Institute of Imaging Science (A.W.A., B.A.L.)
- Department of Electrical and Computer Engineering (B.A.L.), Vanderbilt University, Nashville, Tennessee
- Departments of Radiology and Radiological Sciences (A.W.A., S.P., B.A.L.)
| | - L C Jordan
- Pediatrics (N.J.P., R.S.J., S.S.J., L.C.J.)
- Neurology (C.A.L., L.C.J.)
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Davis SL, Jaser SS, Ivankova NV, Lemley T, Rice M. Using Mixed Methods Research in Children with Type 1 Diabetes: a Methodological Review. Curr Diab Rep 2023; 23:147-163. [PMID: 37097408 PMCID: PMC10651325 DOI: 10.1007/s11892-023-01509-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2023] [Indexed: 04/26/2023]
Abstract
PURPOSE OF REVIEW Many factors influence disease management and glycemic levels in children with type 1 diabetes (T1D). However, these concepts are hard to examine in children using only a qualitative or quantitative research paradigm. Mixed methods research (MMR) offers creative and unique ways to study complex research questions in children and their families. RECENT FINDINGS A focused, methodological literature review revealed 20 empirical mixed methods research (MMR) studies that included children with T1D and/or their parents/caregivers. These studies were examined and synthesized to elicit themes and trends in MMR. Main themes that emerged included disease management, evaluation of interventions, and support. There were multiple inconsistencies between studies when reporting MMR definitions, rationales, and design. Limited studies use MMR approaches to examine concepts related to children with T1D. Findings from future MMR studies, especially ones that use child-report, may illuminate ways to improve disease management and lead to better glycemic levels and health outcomes.
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Affiliation(s)
- Sara L. Davis
- Maternal Child Health Nursing, University of South Alabama, 5721 USA Dr N, Mobile, AL 36688, USA
| | - Sarah S. Jaser
- Division of Pediatric Endocrinology & Diabetes, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nataliya V. Ivankova
- School of Health Professions, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Trey Lemley
- Biomedical Library, University of South Alabama, Mobile, AL, USA
| | - Marti Rice
- School of Nursing, University of Alabama at Birmingham, Birmingham, AL, USA
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10
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Mackie T, Morrow TD, Abadula FJ, Jaser SS. Importance of caregivers' subjective social status and neighbourhood disadvantage for adolescents with type 1 diabetes. Diabet Med 2023; 40:e15097. [PMID: 36997340 PMCID: PMC10810028 DOI: 10.1111/dme.15097] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 04/01/2023]
Abstract
AIMS Adolescents with type 1 diabetes from low-income populations are more likely to have difficulty in managing their diabetes and ultimately have poorer glycaemic outcomes, but less is known about neighbourhood-level factors or subjective social status (SSS) as risk/protective factors. We examined associations between multiple indicators of socio-economic status with diabetes outcomes. METHODS One hundred and ninety-eight adolescents ages 13-17 (58% female, 58% White, non-Hispanic) experiencing moderate diabetes distress completed measures of diabetes management and diabetes distress, and their caregivers reported on SSS. Glycaemic indicators were extracted from medical records, and participants' addresses were used to determine area deprivation index (ADI). RESULTS Higher levels of neighbourhood disadvantage were significantly associated with higher haemoglobin A1c levels and average glucose levels, but caregivers' SSS was more strongly associated with all glycaemic indicators, diabetes management and diabetes distress. CONCLUSIONS Given strong associations between caregivers' SSS and glycaemic control, diabetes management, and diabetes distress, screening for caregivers' SSS may identify adolescents who would benefit from additional support.
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Affiliation(s)
- Tayler Mackie
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
| | - Troy D Morrow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
| | - Fayo J Abadula
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, 37232, USA
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Tilden DR, Noser AE, Jaser SS. Sedentary Behavior and Physical Activity Associated with Psychosocial Outcomes in Adolescents with Type 1 Diabetes. Pediatr Diabetes 2023; 2023:1395466. [PMID: 37614407 PMCID: PMC10445792 DOI: 10.1155/2023/1395466] [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: 08/25/2023] Open
Abstract
Background Adolescents with type 1 diabetes (T1D) are particularly vulnerable to poor psychosocial outcomes-high rates of diabetes distress and poor quality of life are common among this cohort. Previous work in the general population demonstrated positive associations between quality of life and increases in moderate-to-vigorous physical activity (MVPA), as well as decreased sedentary behavior. While survey-based assessments of young adults with T1D observed similar trends, these studies were limited by their use of subjective assessments of MVPA and sedentary behavior. The use of direct activity monitoring is needed to establish the association between psychosocial outcomes and MVPA and sedentary behavior among adolescents with T1D. Objective To explore the association between objectively measured MVPA and sedentary behavior on psychosocial outcomes among adolescents with T1D. Subjects and Methods The current study is a secondary analysis of baseline data collected for a pilot trial of sleep-promoting intervention for adolescents with T1D. Participants (n = 29, with a mean age of 15.9 ± 1.3 years) completed baseline surveys and wore an actigraph for a week following the baseline visit. We examined minutes per week of MVPA and proportion of awake time spent sedentary in relation to adolescents' diabetes distress, depressive symptoms, and diabetes-related quality of life. Results Participants engaged in a mean of 19.6 ± 22.4 minutes of MVPA per day and spent 68.6 ± 9.9% of their awake time sedentary. MVPA was associated with lower diabetes distress in unadjusted (-3.6; 95% CI: -6.4 to -0.8) and adjusted (-2.6; 95% CI: -5.0--0.3) analyses. Sedentary time was associated with higher diabetes distress in adjusted (6.3; 95% CI: 1.3-11.2) but not unadjusted (6.0; 95% CI: -5.6-12.6) analyses. In secondary analyses, we did not observe significant associations between quality of life or depressive symptoms with either MVPA or sedentary behavior. Discussion Our findings extend previous survey-based work demonstrating an association between decreased diabetes distress with greater weekly MVPA and lower sedentary time. The current study highlights the multifaceted benefits of physical activity in this population and provides preliminary evidence for developing interventions to reduce sedentary time as an alternative method to improve psychosocial outcomes in this at-risk population.
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Affiliation(s)
- Daniel R. Tilden
- Endocrinology, Diabetes, and Clinical Pharmacology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Amy E. Noser
- Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Sarah S. Jaser
- Department of Pediatrics, Division of Pediatric Psychology, Vanderbilt University School of Medicine, Nashville, TN, USA
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12
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Duffus SH, Slaughter JC, Cooley W, Sharif N, Rainer K, Coate KC, Jaser SS, Moore DJ, Niswender KD, Gregory JM. A pragmatic low carbohydrate diet intervention changes neither carbohydrate consumption nor glycemia in adolescents and young adults with type 1 diabetes in a randomized trial. Pediatr Diabetes 2022; 23:1088-1100. [PMID: 36004391 PMCID: PMC10077495 DOI: 10.1111/pedi.13407] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/08/2022] [Accepted: 08/20/2022] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Despite enthusiasm for low carbohydrate diets (LCDs) among patients with type 1 diabetes (T1DM), no prospective study has investigated outcomes in adolescent T1DM. We aimed to quantify a pragmatic LCD intervention's impact on glycemia, lipidemia, and quality of life (QOL) in adolescents with T1DM. RESEARCH DESIGN AND METHODS At an academic center, we randomized 39 patients with T1DM aged 13-21 years to one of three 12-week interventions: an LCD, an isocaloric standard carbohydrate diet (SCD), or general diabetes education without a prescriptive diet. Glycemic outcomes included glycosylated hemoglobin (HbA1c) and continuous glucose monitoring. RESULTS There were no significant differences in glycemic, lipidemic, or QOL parameters between groups at any timepoint. Median HbA1c was similar at baseline between groups and did not change appreciably (7.9%-8.4% in LCDs, 7.9%-7.9% in SCDs, and 8.2%-7.8% in controls). Change in carbohydrate consumption was minimal with only one participant reaching target carbohydrate intake. CONCLUSIONS This pragmatic LCD intervention did not alter carbohydrate consumption or glycemia. Although this study was unable to evaluate a highly controlled LCD, it indicates that adolescents are unlikely to implement an educational LCD intervention in routine clinic settings. Thus, this approach is unlikely to effectively mitigate hyperglycemia in adolescents.
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Affiliation(s)
- Sara H. Duffus
- Department of Pediatrics, Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - James C. Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - William Cooley
- School of Medicine, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
| | - Navila Sharif
- School of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kimberly Rainer
- Department of Pediatrics, Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Katie C. Coate
- Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Sarah S. Jaser
- Department of Pediatrics, Division of Pediatric Psychology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Daniel J. Moore
- Department of Pediatrics, Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Kevin D. Niswender
- Department of Pediatrics, Division of Pediatric Psychology, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
| | - Justin M. Gregory
- Department of Pediatrics, Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, Tennessee, USA
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13
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Tilden DR, French B, Shoemaker AH, Corathers S, Jaser SS. Prolonged lapses between pediatric and adult care are associated with rise in HbA1c and inpatient days among patients with type 1 diabetes. Diabetes Res Clin Pract 2022; 192:110113. [PMID: 36208847 PMCID: PMC9867942 DOI: 10.1016/j.diabres.2022.110113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 05/05/2022] [Revised: 09/16/2022] [Accepted: 09/30/2022] [Indexed: 01/26/2023]
Abstract
AIM To quantify the association between the duration of the pediatric-to-adult care transfer with glycemic control among patients with type 1 diabetes (T1D). METHODS This retrospective cohort study included patients with T1D who completed transfer between pediatric and adult diabetes clinics at a single academic medical center between 2004 and 2020. The primary exposure was time from the last pediatric to first adult diabetes care encounter. The primary outcome was the average HbA1c in the first year after entry into adult care. RESULTS A total of 449 patients (mean age at transfer 19.8yrs, 51.7 % male) were included for analysis. Transfer required a median of nearly 5 months (196 days; IQR:93-251) and in adjusted and unadjusted models was strongly associated with increased HbA1c within 1 year of transfer (0.19 %, 2 mmol/mol; 95 %CI:0.04 %-0.33 %) for each 6 months of latency. In secondary analyses, transfer latency also exhibited a significant association with days spent hospitalized (IRR 1.23 per 6 months; 95 %CI:1.08-1.33). CONCLUSIONS Our findings isolate and quantify the impact of prolonged lapses in care associated with the pediatric-to-adult care transfer. These findings underscore the need for providers and healthcare systems to improve this care transition in order to improve outcomes for this vulnerable patient population.
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Affiliation(s)
- Daniel R Tilden
- Division of Endocrinology, Diabetes, and Clinical Pharmacology, Department of Medicine, University of Kansas Medical Center, Kansas City, KS, United States.
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Ashley H Shoemaker
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States; Division of Pediatric Psychology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
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14
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Morrow T, Bhatia SH, Parmar AM, Baker L, Abadula F, Williamson D, Choudhary A, Jaser SS. Sleep Habits of Early School-Aged Children with Type 1 Diabetes and Their Parents: Family Characteristics and Diabetes Management. Behav Sleep Med 2022; 20:649-658. [PMID: 34559603 PMCID: PMC8943443 DOI: 10.1080/15402002.2021.1977305] [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: 10/20/2022]
Abstract
STUDY OBJECTIVES School-aged children with type 1 diabetes (T1D) and their parents are at risk for sleep disturbances, yet few studies have used objective measures to assess sleep characteristics in young children with T1D. METHODS Forty children (ages 5-9) with T1D and their parents wore actigraph watches and completed sleep diaries for 7 nights. Parents also completed questionnaires about demographic information, diabetes distress, fear of hypoglycemia, and family routines. Children's clinical data (HbA1c and blood glucose data) were extracted from the medical record. RESULTS Most of the children and their parents obtained insufficient sleep. Based on actigraphy data, children slept an average of 7.9 hours/night and parents slept 6.7 hours/night, below the recommendations of 9-11 and 7-9 hours of sleep, respectively. Shorter child sleep latency was significantly associated with better glycemic levels, and parents' sleep duration and efficiency were related to child's glycemic levels. Parental fear of hypoglycemia and lack of family routines were associated with poorer sleep quality in parents and children, and with parental diabetes distress. CONCLUSIONS Sleep duration and quality is a modifiable target for potentially improving glycemic levels and parental distress in early school-aged children with T1D.
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Affiliation(s)
- Troy Morrow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Shivani H Bhatia
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Angelee M Parmar
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Logan Baker
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Fayo Abadula
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Dylan Williamson
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Arjun Choudhary
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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15
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Inverso H, LeStourgeon LM, Parmar A, Bhangui I, Hughes B, Straton E, Alford M, Streisand R, Jaser SS. Demographic and Glycemic Factors Linked With Diabetes Distress in Teens With Type 1 Diabetes. J Pediatr Psychol 2022; 47:1081-1089. [PMID: 35656859 PMCID: PMC9801711 DOI: 10.1093/jpepsy/jsac049] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Diabetes distress (DD) is a negative emotional response related to the burdens of living with type 1 diabetes (T1D) and is linked with diabetes outcomes, such as hemoglobin A1c (A1c). Yet, less is known about how other glycemic indicators, average blood glucose and time in range, relate to DD, and which demographic characteristics are associated with higher DD. METHODS In total, 369 teens (Mage 15.6 ± 1.4, 51% female, MT1D duration 6.7 ± 3.8 years) screened for DD using The Problem Areas in Diabetes-Teen Version to determine eligibility for an ongoing multi-site behavioral trial. The associations of DD, demographic factors, and glycemic indicators (A1c, average blood glucose, and time in range) were analyzed. RESULTS Twenty-nine percent of teens (n = 95) scored above the clinical cutoff (≥44) for DD. Females scored significantly higher on average than males. Black/African American, non-Hispanic youth screened significantly higher compared to youth from other racial/ethnic groups. Higher DD scores were related to higher A1c and average blood glucose, and lower time in range. Logistic regression models revealed that females were significantly more likely to report clinically elevated DD than males, and teens with higher A1c were 1.3 times more likely to report DD. Age and diabetes duration were not significantly associated with clinically elevated DD scores. CONCLUSIONS Results demonstrated that DD is most prevalent in Black, non-Hispanic and female teens, and DD is associated with higher average blood glucose and lower time in range. Further investigation into these disparities is warranted to promote optimal health outcomes for teens with T1D.
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Affiliation(s)
- Hailey Inverso
- Children’s National Hospital, Center for Translational Research, USA
| | | | - Angie Parmar
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Isha Bhangui
- Children’s National Hospital, Center for Translational Research, USA
| | - Bailey Hughes
- Department of Pediatrics, Vanderbilt University Medical Center, USA
| | - Emma Straton
- Children’s National Hospital, Center for Translational Research, USA
| | - Madeleine Alford
- Children’s National Hospital, Center for Translational Research, USA
| | - Randi Streisand
- Children’s National Hospital, Center for Translational Research, USA,The George Washington University School of Medicine, USA
| | - Sarah S Jaser
- All correspondence concerning this article should be addressed to Sarah S. Jaser, PhD, Department of Pediatrics, Vanderbilt University Medical Center, 2146 Belcourt Ave., Nashville, TN 37232, USA. E-mail:
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16
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Gregory JM, Slaughter JC, Duffus SH, Smith TJ, LeStourgeon LM, Jaser SS, McCoy AB, Luther JM, Giovannetti ER, Boeder S, Pettus JH, Moore DJ. Erratum. COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic's Impact in Type 1 and Type 2 Diabetes. Diabetes Care 2021;44:526-532. Diabetes Care 2022; 45:1299. [PMID: 35235947 PMCID: PMC9174957 DOI: 10.2337/dc22-er05c] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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17
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Jaser SS, Hilliard ME. Preventing, Screening, and Treating Suicidality in Pediatric Type 1 Diabetes: Roles for Behavioral Health Care Professionals. Diabetes Care 2022; 45:1035-1037. [PMID: 35561133 PMCID: PMC9375444 DOI: 10.2337/dci22-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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18
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Goethals ER, Bergner EM, Mayberry LS, Novak LL, Erfe F, Jaser SS. Distressed Families Demonstrate Resilience in the Context of COVID-19: Perspectives of Adolescents With Type 1 Diabetes and Their Mothers. Diabetes Spectr 2022; 35:223-226. [PMID: 35668891 PMCID: PMC9160532 DOI: 10.2337/ds21-0026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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19
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Cai LY, Tanase C, Anderson AW, Ramadass K, Rheault F, Lee CA, Patel NJ, Jones S, LeStourgeon LM, Mahon A, Pruthi S, Gwal K, Ozturk A, Kang H, Glaser N, Ghetti S, Jaser SS, Jordan LC, Landman BA. Multimodal neuroimaging in pediatric type 1 diabetes: a pilot multisite feasibility study of acquisition quality, motion, and variability. Proc SPIE Int Soc Opt Eng 2022; 12032:120323U. [PMID: 36303580 PMCID: PMC9604061 DOI: 10.1117/12.2611553] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Type 1 diabetes (T1D) affects over 200,000 children and is associated with an increased risk of cognitive dysfunction. Prior imaging studies suggest the neurological changes underlying this risk are multifactorial, including macrostructural, microstructural, and inflammatory changes. However, these studies have yet to be integrated, limiting investigation into how these phenomena interact. To better understand these complex mechanisms of brain injury, a well-powered, prospective, multisite, and multimodal neuroimaging study is needed. We take the first step in accomplishing this with a preliminary characterization of multisite, multimodal MRI quality, motion, and variability in pediatric T1D. We acquire structural T1 weighted (T1w) MRI, diffusion tensor MRI (DTI), functional MRI (fMRI), and magnetic resonance spectroscopy (MRS) of 5-7 participants from each of two sites. First, we assess the contrast-to-noise ratio of the T1w MRI and find no differences between sites. Second, we characterize intervolume motion in DTI and fMRI and find it to be on the subvoxel level. Third, we investigate variability in regional gray matter volumes and local gyrification indices, bundle-wise DTI microstructural measures, and N-acetylaspartate to creatine ratios. We find the T1-based measures to be comparable between sites before harmonization and the DTI and MRS-based measures to be comparable after. We find a 5-15% coefficient of variation for most measures, suggesting ~150-200 participants per group on average are needed to detect a 5% difference across these modalities at 0.9 power. We conclude that multisite, multimodal neuroimaging of pediatric T1D is feasible with low motion artifact after harmonization of DTI and MRS.
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Affiliation(s)
- Leon Y. Cai
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Costin Tanase
- Department of Psychiatry, University of California, Davis, Davis, CA, USA
| | - Adam W. Anderson
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA,Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA
| | - Karthik Ramadass
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Francois Rheault
- Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA
| | - Chelsea A. Lee
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Niral J. Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sky Jones
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Alix Mahon
- Department of Psychology, University of California, Davis, Davis, CA, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kriti Gwal
- Department of Radiology, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Arzu Ozturk
- Department of Radiology, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Hakmook Kang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicole Glaser
- Department of Pediatrics, UC Davis Health, UC Davis School of Medicine, Sacramento, CA, USA
| | - Simona Ghetti
- Department of Psychology, University of California, Davis, Davis, CA, USA
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Lori C. Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA,Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Bennett A. Landman
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA,Vanderbilt University Institute of Imaging Science, Vanderbilt University, Nashville, TN, USA,Department of Electrical and Computer Engineering, Vanderbilt University, Nashville, TN, USA,Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
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20
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Inverso H, Abadula F, Morrow T, LeStourgeon L, Parmar A, Streisand R, Jaser SS. Pivoting during a pandemic: lessons learned from transitioning a multisite randomized controlled trial to a remote protocol in response to COVID-19. Transl Behav Med 2021; 11:2187-2193. [PMID: 34427687 PMCID: PMC8499798 DOI: 10.1093/tbm/ibab103] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
THR1VE! is an ongoing multisite randomized clinical trial of a positive psychology intervention designed to treat diabetes distress and improve glycemic outcomes in teens with type 1 diabetes. Due to the COVID-19 pandemic restrictions on clinical research and changes in diabetes clinical care, THR1VE! was adapted from an in-person enrollment protocol to a remote protocol through a series of development and testing strategies. We discuss the process of transitioning the protocol and the demonstrated feasibility of ongoing recruitment, enrollment, and retention outcomes. These findings offer support for a remotely transitioned protocol that has larger applications for ongoing and future clinical research.
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Affiliation(s)
| | - Fayo Abadula
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Troy Morrow
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Angelee Parmar
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
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21
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Hilliard ME, Marrero DG, Minard CG, Cao VT, de Wit M, DuBose SN, Verdejo A, Jaser SS, Kruger D, Monzavi R, Shah VN, Wadwa RP, Weinstock RS, Thompson D, Anderson BJ. Corrigendum to "Design and psychometrics for new measures of health-related quality of life in adults with type 1 diabetes: Type 1 Diabetes and Life (T1DAL)" [Diabetes Research and Clinical Practice 174 (2021) 108537]. Diabetes Res Clin Pract 2021; 178:108971. [PMID: 34344519 DOI: 10.1016/j.diabres.2021.108971] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA.
| | | | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, USA
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Davida Kruger
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Medical Center, Detroit, MI, USA
| | - Roshanak Monzavi
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, CA, USA
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, USA
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, USA
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22
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Hilliard ME, Minard CG, Marrero DG, de Wit M, DuBose SN, Verdejo A, Jaser SS, Kruger D, Monzavi R, Shah VN, Wadwa RP, Weinstock RS, Thompson D, Cao VT, Anderson BJ. Health-related quality of life in parents and partners of people with type 1 diabetes: Development and validation of type 1 diabetes and life (T1DAL) measures. Fam Syst Health 2021; 39:234-247. [PMID: 33900103 PMCID: PMC8376806 DOI: 10.1037/fsh0000507] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
INTRODUCTION Despite the significant impact of type 1 diabetes (T1D) on family, few instruments are available to assess health-related quality of life (HRQOL) among family members of people with T1D. This study aimed to develop and evaluate the psychometric properties of new measures of diabetes-specific HRQOL for parents and partners of people with T1D. We report on the multistep development and validation process for the self-report Type 1 Diabetes and Life (T1DAL) measures, with versions for parents of youth age <8, 8-11, 12-17, and 18-25 years, and for partners of people age ≥18 years with T1D. METHOD First, we conducted qualitative interviews (total parents/partners n = 38) to develop draft measures and piloted them (total n = 20). Next, we tested the measures' psychometric properties. Participants (total across versions n = 813) at six T1D Exchange Clinic Network sites completed the appropriate T1DAL measure and validated measures of related constructs. We then reduced each T1DAL measure to 20-30 items in length based on psychometric data and participant feedback. Eleven participants reviewed the final measures via cognitive debriefing. RESULTS The T1DAL measures for parents and partners demonstrated good internal consistency (α = .80-.88) and test-retest reliability (r = .73-.86). Correlations with measures of general quality of life, generic and diabetes-specific HRQOL, and diabetes burden demonstrated construct validity. Factor analyses identified 3-4 subscales/measure. Participants reported being satisfied with the shortened measures, which took 5-10 minutes to complete. DISCUSSION The new T1DAL measures for parents and partners of people with T1D are reliable, valid, and ready for use in research and clinical settings. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | | | | | | | | | | | | | - Davida Kruger
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders
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23
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Tilden DR, Datye KA, Moore DJ, French B, Jaser SS. The Rapid Transition to Telemedicine and Its Effect on Access to Care for Patients With Type 1 Diabetes During the COVID-19 Pandemic. Diabetes Care 2021; 44:1447-1450. [PMID: 33849938 PMCID: PMC8247503 DOI: 10.2337/dc20-2712] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 03/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We compared the uptake of telemedicine for diabetes care across multiple demographic groups during the coronavirus disease 2019 pandemic to understand the impact of telemedicine adoption on access to care. RESEARCH DESIGN AND METHODS The study analyzed demographic information of patients with type 1 diabetes seen between 1 January 2018 and 30 June 2020 at a single center. We compared the odds of completing a visit via telemedicine across multiple demographic characteristics. RESULTS Among 28,977 patient visits, the odds of completing a visit via telemedicine were lower among non-English-speaking (1.7% vs. 2.7%; adjusted odds ratio [aOR] 0.45, 95% CI 0.26-0.79) and Medicaid-insured (32.0% vs. 35.9%; aOR 0.83, 95% CI 0.72-0.95) pediatric patients. No clinically significant differences were observed for other demographic factors. CONCLUSIONS Rapid transition to telemedicine did not significantly impact access to diabetes care for most demographic groups. However, disparities in access to care for historically marginalized groups merit close attention to ensure that use of telemedicine does not exacerbate these inequities.
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Affiliation(s)
- Daniel R Tilden
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN .,Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN
| | - Karishma A Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Daniel J Moore
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Benjamin French
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Datye KA, Tilden DR, Parmar AM, Goethals ER, Jaser SS. Advances, Challenges, and Cost Associated with Continuous Glucose Monitor Use in Adolescents and Young Adults with Type 1 Diabetes. Curr Diab Rep 2021; 21:22. [PMID: 33991264 PMCID: PMC8575075 DOI: 10.1007/s11892-021-01389-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Accepted: 04/27/2021] [Indexed: 02/06/2023]
Abstract
PURPOSE OF REVIEW Continuous glucose monitors (CGM) are transforming diabetes management, yet adolescents and young adults (AYA) with type 1 diabetes (T1D) do not experience the same benefits seen with CGM use in adults. The purpose of this review is to explore advances, challenges, and the financial impact of CGM use in AYA with T1D. RECENT FINDINGS CGM studies in young adults highlight challenges and suggest unique barriers to CGM use in this population. Recent studies also demonstrate differences in CGM use related to race and ethnicity, raising questions about potential bias and emphasizing the importance of patient-provider communication. Cost of these devices remains a significant barrier, especially in countries without nationalized reimbursement of CGM. More research is needed to understand and address the differences in CGM utilization and to increase the accessibility of CGM therapy given the significant potential benefits of CGM in this high-risk group.
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Affiliation(s)
- Karishma A Datye
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA.
| | - Daniel R Tilden
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
- Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angelee M Parmar
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
| | - Eveline R Goethals
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Department of Pediatrics, Vanderbilt University Medical Center, 1500 21st Ave. South Suite 1514, Nashville, TN, 37212-3157, USA
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Gregory JM, Slaughter JC, Duffus SH, Smith TJ, LeStourgeon LM, Jaser SS, McCoy AB, Luther JM, Giovannetti ER, Boeder S, Pettus JH, Moore DJ. Response to Comment on Gregory et al. COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic's Impact in Type 1 and Type 2 Diabetes. Diabetes Care 2021;44:526-532. Diabetes Care 2021; 44:e103-e104. [PMID: 33972321 PMCID: PMC8132332 DOI: 10.2337/dci21-0005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Justin M Gregory
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Sara H Duffus
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - T Jordan Smith
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Lauren M LeStourgeon
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
| | - James M Luther
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Erin R Giovannetti
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Schafer Boeder
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Jeremy H Pettus
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Daniel J Moore
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
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Hilliard ME, Marrero DG, Minard CG, Cao VT, de Wit M, DuBose SN, Verdejo A, Jaser SS, Kruger D, Monzavi R, Shah VN, Wadwa RP, Weinstock RS, Thompson D, Anderson BJ. Design and psychometrics for new measures of health-related quality of life in adults with type 1 diabetes: Type 1 Diabetes and Life (T1DAL). Diabetes Res Clin Pract 2021; 174:108537. [PMID: 33189791 DOI: 10.1016/j.diabres.2020.108537] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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] [Received: 04/22/2020] [Revised: 10/16/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022]
Abstract
AIMS To use a three-phase process to develop and validate new self-report measures of diabetes-specific health-related quality of life (HRQOL) for adults with type 1 diabetes. We report on four versions of the Type 1 Diabetes and Life (T1DAL) measure for people age 18-25, 26-45, 46-60, and over 60 years. METHODS We first conducted qualitative interviews to guide measure creation, then piloted the draft measures. We evaluated psychometric properties at six T1D Exchange Clinic Network sites via completion of T1DAL and validated measures of related constructs. Participants completed the T1DAL again in 4-6 weeks. We used psychometric data to reduce each measure to 23-27 items in length. Finally, we obtained participant feedback on the final measures. RESULTS The T1DAL-Adult measures demonstrated good internal consistency (α = 0.85-0.88) and test-retest reliability (r = 0.77-0.87). Significant correlations with measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, self-management, and glycemic control demonstrated validity. Factor analyses yielded 4-5 subscales per measure. Participants were satisfied with the final measures and reported they took 5-10 min to complete. CONCLUSIONS The strong psychometric properties of the newly developed self-report T1DAL measures for adults with type 1 diabetes make them appropriate for use in clinical research and care.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States.
| | - David G Marrero
- University of Arizona Health Sciences, Tucson AZ, United States
| | - Charles G Minard
- Institute for Clinical and Translational Research, Baylor College of Medicine, Houston, TX, United States
| | - Viena T Cao
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
| | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | | | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, United States
| | - Davida Kruger
- Division of Endocrinology, Diabetes, Bone and Mineral Disorders, Henry Ford Medical Center, Detroit, MI, United States
| | - Roshanak Monzavi
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Viral N Shah
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Ruth S Weinstock
- Department of Medicine, SUNY Upstate Medical University, Syracuse, NY, United States
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine, Houston, TX, United States
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX, United States
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Jaser SS, Bergner EM, Hamburger ER, Bhatia S, Lyttle M, Bell GE, Slaughter JC, Malow BA, Simmons JH. Pilot Trial of a Sleep-Promoting Intervention for Children With Type 1 Diabetes. J Pediatr Psychol 2021; 46:304-313. [PMID: 33180913 DOI: 10.1093/jpepsy/jsaa105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/13/2020] [Accepted: 10/13/2020] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To assess the feasibility and acceptability of an educational sleep-promoting intervention (Sleep Coach Jr.) for school-aged children (ages 5-9) with type 1 diabetes (T1D) and their parents. METHODS Parents and children (N = 39 dyads, mean child age = 8 years, 64% girls,) were randomized to either the Sleep Coach Jr. intervention, consisting of educational materials and three individual phone calls (N = 20), or the Standard Care condition (N = 19). Data were collected at enrollment and 3 months later. Children and parents wore actigraphy devices to obtain an objective measure of sleep characteristics, and parents completed questionnaire measures of sleep quality and psychosocial outcomes. Clinical data (i.e., hemoglobin A1c, glucose data) were obtained from children's medical records. RESULTS Feasibility and acceptability of the study were demonstrated to be high; all three sessions were completed by 80% of parents randomized to the Sleep Coach Jr. intervention, and 90% of parents completed follow-up data at 3 months. Parents reported high levels of satisfaction with the study and identified barriers to participation. No changes were observed in children's sleep or diabetes outcomes, but parental sleep quality and well-being improved. CONCLUSIONS A brief, behavioral sleep-promoting intervention is feasible and acceptable for school-aged children with T1D and their parents. A larger trial is needed to evaluate efficacy of the intervention.
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Affiliation(s)
- Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Erin M Bergner
- Department of Pediatrics, Vanderbilt University Medical Center
| | | | - Shivani Bhatia
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Morgan Lyttle
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Grace E Bell
- Department of Pediatrics, Vanderbilt University Medical Center
| | | | - Beth A Malow
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center
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Abstract
PURPOSE OF REVIEW To synthesize findings from studies of neurocognitive complications in children with type 1 diabetes (T1D) and highlight potential risk and protective factors. RECENT FINDINGS Emerging evidence suggests that hyperglycemia and time in range may be more important for brain development than episodes of hypoglycemia. Further, diabetic ketoacidosis (DKA) at the time of T1D diagnosis appears to be a particular risk factor for neurocognitive complications, particularly deficits in executive function skills and memory, with differences in cerebral white matter microstructure seen via advanced magnetic resonance imaging methods, and lower scores on measures of attention and memory observed among children who were diagnosed in DKA. Other factors that may influence neurocognitive development include child sleep, caregiver distress, and diabetes device use, presumably due to improved glycemic control. We highlight neurocognitive risk and protective factors for children with T1D and priorities for future research in this high-risk population.
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Affiliation(s)
- Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37203, USA.
| | - Lori C Jordan
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37203, USA
- Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Science, Vanderbilt University Medical Center, Nashville, TN, USA
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Gregory JM, Slaughter JC, Duffus SH, Smith TJ, LeStourgeon LM, Jaser SS, McCoy AB, Luther JM, Giovannetti ER, Boeder S, Pettus JH, Moore DJ. COVID-19 Severity Is Tripled in the Diabetes Community: A Prospective Analysis of the Pandemic's Impact in Type 1 and Type 2 Diabetes. Diabetes Care 2021; 44:526-532. [PMID: 33268335 PMCID: PMC7818316 DOI: 10.2337/dc20-2260] [Citation(s) in RCA: 167] [Impact Index Per Article: 55.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 11/10/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To quantify and contextualize the risk for coronavirus disease 2019 (COVID-19)-related hospitalization and illness severity in type 1 diabetes. RESEARCH DESIGN AND METHODS We conducted a prospective cohort study to identify case subjects with COVID-19 across a regional health care network of 137 service locations. Using an electronic health record query, chart review, and patient contact, we identified clinical factors influencing illness severity. RESULTS We identified COVID-19 in 6,138, 40, and 273 patients without diabetes and with type 1 and type 2 diabetes, respectively. Compared with not having diabetes, people with type 1 diabetes had adjusted odds ratios of 3.90 (95% CI 1.75-8.69) for hospitalization and 3.35 (95% CI 1.53-7.33) for greater illness severity, which was similar to risk in type 2 diabetes. Among patients with type 1 diabetes, glycosylated hemoglobin (HbA1c), hypertension, race, recent diabetic ketoacidosis, health insurance status, and less diabetes technology use were significantly associated with illness severity. CONCLUSIONS Diabetes status, both type 1 and type 2, independently increases the adverse impacts of COVID-19. Potentially modifiable factors (e.g., HbA1c) had significant but modest impact compared with comparatively static factors (e.g., race and insurance) in type 1 diabetes, indicating an urgent and continued need to mitigate severe acute respiratory syndrome coronavirus 2 infection risk in this community.
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Affiliation(s)
- Justin M Gregory
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - James C Slaughter
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Sara H Duffus
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - T Jordan Smith
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Lauren M LeStourgeon
- Division of General Internal Medicine and Public Health, Department of Medicine, Vanderbilt University School of Medicine, Nashville, TN
| | - Sarah S Jaser
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
| | - Allison B McCoy
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN
| | - James M Luther
- Division of Clinical Pharmacology, Vanderbilt University School of Medicine, Nashville, TN
| | - Erin R Giovannetti
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Schafer Boeder
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Jeremy H Pettus
- Division of Endocrinology and Metabolism, Department of Medicine, University of California, San Diego, La Jolla, CA
| | - Daniel J Moore
- Ian M. Burr Division of Pediatric Endocrinology and Diabetes, Vanderbilt University School of Medicine, Nashville, TN
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Compas BE, Jaser SS, Dunbar JP, Watson KH, Bettis AH, Gruhn MA, Williams EK. Coping and Emotion Regulation from Childhood to Early Adulthood: Points of Convergence and Divergence. Aust J Psychol 2020; 66:71-81. [PMID: 24895462 DOI: 10.1111/ajpy.12043] [Citation(s) in RCA: 116] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Processes of coping with stress and the regulation of emotion reflect basic aspects of development and play an important role in models of risk for psychopathology and the development of preventive interventions and psychological treatments. However, research on these two constructs has been represented in two separate and disconnected bodies of work. We examine possible points of convergence and divergence between these constructs with regard to definitions and conceptualization, research methods and measurement, and interventions to prevent and treat psychopathology. There is clear evidence that coping and emotion regulation are distinct but closely related constructs in all of these areas. The field will benefit from greater integration of methods and findings in future research.
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Hilliard ME, Minard CG, Marrero DG, de Wit M, Thompson D, DuBose SN, Verdejo A, Monzavi R, Wadwa RP, Jaser SS, Anderson BJ. Assessing Health-Related Quality of Life in Children and Adolescents with Diabetes: Development and Psychometrics of the Type 1 Diabetes and Life (T1DAL) Measures. J Pediatr Psychol 2020; 45:328-339. [PMID: 31665389 DOI: 10.1093/jpepsy/jsz083] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Revised: 09/19/2019] [Accepted: 09/23/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To develop and validate new measures of diabetes-specific health-related quality of life (HRQOL) for people with type 1 diabetes (T1D) that are brief, developmentally appropriate, and usable in clinical research and care. Here we report on the phases of developing and validating the self-report Type 1 Diabetes and Life (T1DAL) measures for children (age 8-11) and adolescents (age 12-17). METHODS Measure development included qualitative interviews with youth and parents (n = 16 dyads) followed by piloting draft measures and conducting cognitive debriefing with youth (n = 9) to refine the measures. To evaluate the psychometric properties, children (n = 194) and adolescents (n = 257) at three T1D Exchange Clinic Network sites completed the age-appropriate T1DAL measure and previously validated questionnaires measuring related constructs. Using psychometric data, the investigators reduced the length of each T1DAL measure to 21 and 23 items, respectively, and conducted a final round of cognitive debriefing with six children and adolescents. RESULTS The T1DAL measures for children and adolescents demonstrated good internal consistency (α = 0.84 and 0.89, respectively) and test-retest reliability (r = 0.78 and 0.80, respectively). Significant correlations between the T1DAL scores and measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, and diabetes strengths demonstrated construct validity. Correlations with measures of self-management (child and adolescent) and glycemic control (adolescent only) demonstrated criterion validity. Factor analyses indicated four developmentally specific subscales per measure. Participants reported satisfaction with the measures. CONCLUSIONS The new T1DAL measures for children and adolescents with T1D are reliable, valid, and suitable for use in care settings and clinical research.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
| | - Charles G Minard
- Dan L Duncan Institute for Clinical and Translational Research, Baylor College of Medicine
| | | | - Maartje de Wit
- Department of Medical Psychology, Amsterdam UMC, Vrije Universiteit Amsterdam
| | - Debbe Thompson
- USDA/ARS Children's Nutrition Research Center, Department of Pediatrics, Baylor College of Medicine
| | | | | | - Roshanak Monzavi
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles and Keck School of Medicine of University of Southern California
| | - R Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center
| | - Barbara J Anderson
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital
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Hamburger ER, Goethals ER, Choudhary A, Jaser SS. Sleep and depressive symptoms in adolescents with type 1 diabetes not meeting glycemic targets. Diabetes Res Clin Pract 2020; 169:108442. [PMID: 32941959 PMCID: PMC7736492 DOI: 10.1016/j.diabres.2020.108442] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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] [Received: 07/14/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
AIMS Adolescents with type 1 diabetes (T1D) are at risk for problems with self-management and suboptimal glycemic control, and depressive symptoms and sleep disturbances predict poorer diabetes outcomes. Despite evidence for associations between adolescent depressive symptoms and sleep in the general population, few studies have investigated this link in the vulnerable group of adolescents with T1D not meeting glycemic targets. The current study sought to assess both depressive symptoms and sleep in relation to diabetes indicators in adolescents with T1D. METHODS 120 adolescents (ages 13-17 years) with above target glycemic control completed measures of depressive symptoms, sleep duration and quality, and self-management; parents also reported on adolescents' diabetes management. Clinical data (i.e., HbA1c) were extracted from medical records. RESULTS In our sample, 40% of adolescents reported at least mild depressive symptoms, and 26% reported clinically significant sleep disturbances. Adolescents with sleep disturbances were more likely to report at least mild symptoms of depression, and both depressive symptoms and sleep quality were associated with poorer diabetes management. No significant differences emerged regarding HbA1c or frequency of blood glucose monitoring. CONCLUSIONS The current findings highlight the importance of clinical assessment of both depressive symptoms and sleep in the vulnerable group of adolescents with T1D.
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Affiliation(s)
| | - Eveline R Goethals
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States; KU Leuven, Leuven, Belgium
| | - Arjun Choudhary
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Abstract
Background: Insufficient sleep is common in youth with type 1 diabetes (T1D) and parents, likely secondary to diabetes-related disturbances, including fear of hypoglycemia, nocturnal glucose monitoring, hypoglycemia, and device alarms. Hybrid closed-loop (HCL) systems improve glycemic variability and potentially reduce nocturnal awakenings. Methods: Adolescents with T1D (N = 37, mean age 13.9 years, 62% female, mean HbA1c 8.3%) and their parents were enrolled in this observational study when starting the Medtronic 670G HCL system. Participants completed study measures (sleep and psychosocial surveys and actigraphy with sleep diaries) before starting auto mode and ∼3 months later. Results: Based on actigraphy data, neither adolescents' nor parents' sleep characteristics changed significantly pre-post device initiation. Adolescents' mean total sleep time decreased from 7 h 16 min (IQR: [6:43-7:47]) to 7 h 9 min (IQR: [6:44-7:52]), while parents' total sleep time decreased from 6 h 47 min (IQR: [6:16-7:10]) to 6 h 38 min (IQR: [5:57-6:57]). Although there were no significant differences in most of the survey measures, there was a moderate effect for improved sleep quality in parents and fear of hypoglycemia in adolescents. In addition, adolescents reported a significant increase in self-reported glucose monitoring satisfaction. Adolescents averaged 44.7% use of auto mode at 3 months. Conclusions: Our data support previous research showing youth with T1D and their parents are not achieving the recommended duration of sleep. Lack of improvement in sleep may be due to steep learning curves involved with new technology. We observed moderate improvements in parental subjective report of sleep quality despite no change in objective measures of sleep duration. Further evaluation of sleep with long-term HCL use and larger sample size is needed.
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Affiliation(s)
- Erin C. Cobry
- Barbara Davis Center for Diabetes, University of Colorado School of Medicine, Aurora, Colorado, USA
- Address correspondence to: Erin C. Cobry, MD, Barbara Davis Center, University of Colorado School of Medicine, 1775 Aurora Court, MSA140, Aurora, CO 80045
| | - Emily Hamburger
- Department of Psychology Univeristy of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Jaser SS, Datye K, Morrow T, Sinisterra M, LeStourgeon L, Abadula F, Bell GE, Streisand R. THR1VE! Positive psychology intervention to treat diabetes distress in teens with type 1 diabetes: Rationale and trial design. Contemp Clin Trials 2020; 96:106086. [PMID: 32682996 DOI: 10.1016/j.cct.2020.106086] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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] [Received: 03/04/2020] [Revised: 07/08/2020] [Accepted: 07/13/2020] [Indexed: 02/07/2023]
Abstract
Adolescents with type 1 diabetes (T1D) experience high rates of diabetes distress, which negatively influence self-management and glycemic control. Building on effective positive psychology interventions to improve adherence in adults, as well as our pilot work to adapt these interventions for adolescents, we developed a positive psychology intervention for adolescents with T1D. The goal of THR1VE! is to reduce diabetes distress in adolescents with T1D and improve their diabetes outcomes. This multi-site randomized controlled trial compares a Diabetes Education + text-message-based Positive Affect intervention, to a Diabetes Education control condition. In the ongoing trial, we are evaluating the effects of the intervention on adolescents' diabetes distress, self-management, and glycemic control. This paper describes the rationale, trial design, and methodology of the THR1VE! Study.
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Jaser SS, Whittemore R, Choi L, Nwosu S, Russell WE. Randomized Trial of a Positive Psychology Intervention for Adolescents With Type 1 Diabetes. J Pediatr Psychol 2020; 44:620-629. [PMID: 30840084 DOI: 10.1093/jpepsy/jsz006] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 01/21/2019] [Accepted: 01/21/2019] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the effects of a positive psychology intervention for adolescents with type 1 diabetes (T1D) on adherence, glycemic control, and quality of life. METHODS Adolescents with T1D (n = 120) and their caregivers were randomized to either an Education (EDU) (n = 60) or Positive Affect (PA) intervention (n = 60). Adolescents in the PA group received the intervention reminders (gratitude, self-affirmation, parental affirmation, and small gifts) via text messages or phone calls over 8 weeks. Questionnaires were completed by adolescents and caregivers and clinical data (glucometer and HbA1c) were collected at baseline 3 and 6 months. Data were analyzed using generalized linear modeling. RESULTS After adjusting for covariates, adolescents in the PA group demonstrated significant improvement in quality of life at 3 months, compared to the EDU group, but this was not sustained at 6 months. Similarly, the PA group showed a significant decrease in disengagement coping at 3 months but not at 6 months. There was no significant intervention effect on blood glucose monitoring, but the odds of clinically significantly improvement (checking at least one more time/day) were about twice as high in the PA group as the EDU group. No significant effects were found for glycemic control. CONCLUSIONS A positive psychology intervention had initial significant, positive effects on coping and quality of life in adolescents with T1D. A more intensive or longer-lasting intervention may be needed to sustain these effects and to improve adherence and glycemic control.
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Affiliation(s)
- Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center
| | | | - Leena Choi
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Samuel Nwosu
- Department of Biostatistics, Vanderbilt University Medical Center
| | - William E Russell
- Department of Pediatrics, Vanderbilt University Medical Center.,Department of Biostatistics, Vanderbilt University Medical Center
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Jaser SS, Hamburger ER, Bergner EM, Williams R, Slaughter JC, Simmons JH, Malow BA. Sleep coach intervention for teens with type 1 diabetes: Randomized pilot study. Pediatr Diabetes 2020; 21:473-478. [PMID: 32003520 PMCID: PMC7670490 DOI: 10.1111/pedi.12991] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 01/21/2020] [Accepted: 01/24/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Teens with type 1 diabetes (T1D) experience increased sleep disturbances, which have been linked to problems with adherence and glycemic control. As such, sleep represents a novel target to improve outcomes in teens. OBJECTIVE To evaluate the feasibility, acceptability, and preliminary efficacy of a sleep-promoting intervention in teens with T1D. RESEARCH DESIGN AND METHODS Teens aged 13 to 17 with T1D (n = 39) completed measures of sleep quality and diabetes management and wore actigraphs to obtain an objective measure of sleep. Hemoglobin A1C (HbA1c) was collected from medical records. Teens were randomized to Usual Care (n = 19) or the Sleep Coach intervention (n = 20). Teens in the Sleep Coach group received educational materials on healthy sleep habits and completed three individual telephone sessions. Follow-up data were collected at 3 months, including exit interviews with teens and parents. RESULTS Feasibility of the study was excellent; 80% of teens in the Sleep Coach group completed all three sessions, and retention was high (90%). Based on actigraphy data, a significant improvement in sleep efficiency and sleep duration was observed (48-minute increase) among teens randomized to the Sleep Coach intervention, and teens in the control group were 7.5 times more likely to report poor sleep quality after 3 months than intervention participants. No change in HbA1c was observed. CONCLUSIONS The Sleep Coach intervention for teens with T1D is a feasible and acceptable program that increased sleep duration and improved sleep quality for this high-risk population.
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Affiliation(s)
- Sarah S. Jaser
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Emily R. Hamburger
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Erin M. Bergner
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Rodayne Williams
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - James C. Slaughter
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Jill H. Simmons
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
| | - Beth A. Malow
- Department of PediatricsVanderbilt University Medical Center Nashville Tennessee
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Goethals ER, Jaser SS, Verhaak C, Prikken S, Casteels K, Luyckx K, Delamater AM. Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes. Diabetes Res Clin Pract 2020; 163:108153. [PMID: 32325107 PMCID: PMC8008789 DOI: 10.1016/j.diabres.2020.108153] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [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] [Received: 12/07/2019] [Revised: 03/20/2020] [Accepted: 04/08/2020] [Indexed: 11/23/2022]
Abstract
AIMS Although research exists on parental communication in adolescents with type 1 diabetes (T1D), the role of communication by health care providers remains understudied. Grounded in Self-Determination Theory, this study examined the role of autonomy-supportive communication (i.e., providing meaningful rationale and offering choices with regard to treatment recommendations) by providers and parents, and how they interact in the prediction of diabetes outcomes. METHODS In this cross-sectional study, 135 adolescents (mean age 14.3 ± 2.1SD years), 171 mothers, and 121 fathers reported on autonomy-supportive communication from health care providers and parents, and on adolescent treatment adherence. HbA1c values were retrieved from the medical record. RESULTS In adolescent reports, perceived autonomy-supportive communication from providers but not from parents was positively related to treatment adherence. A significant interaction between autonomy-supportive communication from providers and parents pointed to the highest level of treatment adherence when adolescents perceived both providers and parents as autonomy-supportive. In contrast, parental reports revealed that parental autonomy-supportive communication was positively related to treatment adherence, whereas autonomy-supportive communication by providers was not. CONCLUSIONS Autonomy-supportive communication by providers and parents is associated with better treatment adherence in adolescents with T1D. Interventions to improve autonomy-supportive communication by parents and providers may improve treatment adherence of adolescents (e.g., communication training).
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Affiliation(s)
- Eveline R Goethals
- KU Leuven, Leuven, Belgium; Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA.
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Chris Verhaak
- Radboud University Medical Center Nijmegen, Nijmegen, Netherlands
| | - Sofie Prikken
- KU Leuven, Leuven, Belgium; Research Foundation Flanders, Brussels, Belgium
| | | | - Koen Luyckx
- KU Leuven, Leuven, Belgium; UNIBS, University of the Free State, Bloemfontein, South Africa
| | - Alan M Delamater
- University of Miami Miller School of Medicine, Mailman Center for Child Development, Miami, FL, USA
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Hamburger ER, Lyttle M, Compas BE, Jaser SS. Performance-based and questionnaire measures of executive function in adolescents with type 1 diabetes. J Behav Med 2019; 42:1041-1049. [PMID: 30879224 PMCID: PMC6746613 DOI: 10.1007/s10865-019-00027-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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] [Received: 12/07/2018] [Accepted: 03/09/2019] [Indexed: 12/16/2022]
Abstract
The purpose of the current study was to examine executive function (EF) in adolescents with type 1 diabetes using both performance-based and questionnaire measures in relation to diabetes indicators. Adolescents age 13-17 completed performance-based measures of EF and measures of adherence. Adolescents' parents reported on adolescents' EF and adherence. HbA1c and frequency of blood glucose monitoring (glucometer data) were obtained from adolescents' medical records. None of the performance-based measures of EF were significantly associated with adherence or with HbA1c. Parent-reported problems with EF were associated with poorer adherence, and adolescents who scored in the impaired range of the Behavioral Regulation Index of EF had significantly poorer adherence (both parent-reported adherence and frequency of blood glucose monitoring) and higher HbA1c than those in the normal range. Our findings suggest that parent-reported measures of EF may be more strongly linked to diabetes indicators than performance-based measures.
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Affiliation(s)
- Emily R Hamburger
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37232, USA
| | - Morgan Lyttle
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37232, USA
| | - Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University, Nashville, TN, USA
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, 2525 West End Ave., Suite 1200, Nashville, TN, 37232, USA.
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Jaser SS, Hamburger ER, Pagoto S, Williams R, Meyn A, Jones AC, Simmons JH. Communication and coping intervention for mothers of adolescents with type 1 diabetes: Rationale and trial design. Contemp Clin Trials 2019; 85:105844. [PMID: 31499228 DOI: 10.1016/j.cct.2019.105844] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/03/2019] [Accepted: 09/04/2019] [Indexed: 12/21/2022]
Abstract
Mothers of adolescents with type 1 diabetes (T1D) experience high rates of depressive symptoms and diabetes distress, which are established risk factors for deteriorating glycemic control, problems with adherence, increased depressive symptoms, and poor quality of life in adolescents. Given that adolescents are a high-risk population for suboptimal glycemic control, novel interventions to improve outcomes in adolescents with T1D are needed. Building on effective interventions to treat depression in adults, and our own pilot work in this population, we developed a cognitive behavioral intervention, Communication & Coping, to target maternal depressive symptoms and parenting behaviors. The randomized controlled trial compares the telephone and Facebook-delivered Communication & Coping intervention, which promotes the use of adaptive coping strategies and positive parenting practices, to a diabetes education control condition on diabetes outcomes and psychosocial outcomes in adolescents with T1D. This paper describes the study rationale, trial design, and methodology.
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Cobry EC, Jaser SS. Brief Literature Review: The Potential of Diabetes Technology to Improve Sleep in Youth With Type 1 Diabetes and Their Parents: An Unanticipated Benefit of Hybrid Closed-Loop Insulin Delivery Systems. Diabetes Spectr 2019; 32:284-287. [PMID: 31462886 PMCID: PMC6695262 DOI: 10.2337/ds18-0098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Erin C Cobry
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN
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Trief PM, Foster NC, Chaytor N, Hilliard ME, Kittelsrud JM, Jaser SS, Majidi S, Corathers SD, Bzdick S, Adkins DW, Weinstock RS. Longitudinal Changes in Depression Symptoms and Glycemia in Adults With Type 1 Diabetes. Diabetes Care 2019; 42:1194-1201. [PMID: 31221694 DOI: 10.2337/dc18-2441] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 04/25/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study assessed longitudinal change in depression symptoms over ≥4 years in adults with type 1 diabetes and examined the association between change in depression symptom status and glycemia. RESEARCH DESIGN AND METHODS Adults in the T1D Exchange registry with HbA1c and Patient Health Questionnaire (PHQ-8) at 1 year (baseline) and 5 years post-enrollment (follow-up; n = 2,744, mean age, 42 years; 57% female, 92% white; mean HbA1c, 7.6% [58 mmol/mol]) were included. Depression status was defined as Persistent Elevated Depression Symptoms (EDS) (EDS at baseline and follow-up), Resolved EDS (EDS at baseline, no EDS at follow-up), New Onset EDS (no EDS at baseline, EDS at follow-up), and Not Depressed (no EDS at baseline or follow-up). RESULTS Overall, 131 (5%) had Persistent EDS, 122 (4%) had Resolved EDS, 168 (6%) had New Onset EDS, and 2,323 (85%) were Not Depressed. Of those with EDS (PHQ ≥ 10) at baseline, 53% had EDS at follow-up; of those not depressed at baseline, 7% had EDS at follow-up. An increase in PHQ-8 was associated with an increase in HbA1c (P < 0.001). Although HbA1c increased in all groups, the increase was less in the Resolved EDS and Not Depressed groups (P = 0.001). Persistent EDS and New Onset EDS groups were more likely to experience diabetic ketoacidosis (DKA) (P < 0.001). CONCLUSIONS T1D Exchange registry data provide evidence for relationships over time between persistently, and newly developing EDSs and worsening glycemic control, and suggest relationships between depression symptoms and the occurrence of severe hypoglycemia and DKA. Successful treatment of depression symptoms may lead to better long-term diabetes outcomes.
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Affiliation(s)
- Paula M Trief
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Naomi Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | | | | | | | - Sarah D Corathers
- Cinncinnati Children's Hospital Medical Center and University of Cincinnati, Cincinnati, OH
| | - Suzan Bzdick
- State University of New York Upstate Medical University, Syracuse, NY
| | | | - Ruth S Weinstock
- State University of New York Upstate Medical University, Syracuse, NY
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Lazow MA, Jaser SS, Cobry EC, Garganta MD, Simmons JH. Stress, Depression, and Quality of Life Among Caregivers of Children With Osteogenesis Imperfecta. J Pediatr Health Care 2019; 33:437-445. [PMID: 30827754 DOI: 10.1016/j.pedhc.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 11/27/2018] [Accepted: 12/16/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION The purpose of this study was to evaluate stress, depressive symptoms, and quality of life (QOL) among caregivers of children with osteogenesis imperfecta (OI) and to determine if associations exist with patient disease-related characteristics. METHODS Psychosocial outcomes were evaluated in 33 caregivers of 31 patients with OI using the Pediatric Inventory for Parents (assessing stress), PedsQL Family Impact Module (assessing QOL), and Center for Epidemiologic Studies Depression Scale (assessing depressive symptoms). RESULTS Higher levels of patient pain and lower patient physical functioning were significantly associated with both higher caregiver stress and poorer QOL (p < .05). Center for Epidemiologic Studies Depression Scale scores were not associated with patient pain or physical functioning. DISCUSSION Parents caring for children with OI with higher levels of pain and/or lower physical functioning are at higher risk of suffering from increased stress and poorer QOL. Interventions should be developed to screen for and target these at-risk caregiver groups with resources and support.
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Bergner EM, Williams R, Hamburger ER, Lyttle M, Davis AC, Malow B, Simmons JH, Lybarger C, Capin R, Jaser SS. Sleep in Teens With Type 1 Diabetes: Perspectives From Adolescents and Their Caregivers. Diabetes Educ 2018; 44:541-548. [PMID: 30193548 DOI: 10.1177/0145721718799086] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study is to identify barriers, facilitators, and consequences of obtaining sufficient sleep in adolescents with type 1 diabetes. METHODS Semistructured interviews were conducted with 25 adolescents (52% female, mean age = 15.6 years) and 25 caregivers. Interviews were transcribed and coded using Atlas.ti. A thematic analytic approach was used to identify and organize significant patterns of meaning (themes) and interpret themes across the data. RESULTS Several barriers were identified, with the most common being the use of electronics before bed and sleep disturbances related to diabetes management. Caregivers described strategies for helping adolescents achieve sufficient sleep, such as enforcing bedtimes and limiting distractions, but many adolescents could not identify facilitators of sleep. Weekday/weekend discrepancies in sleep timing were commonly disclosed. CONCLUSIONS This study is the first to examine the perceptions of barriers and facilitators to obtaining sufficient sleep in adolescents with T1D and their caregivers. Results have the potential to inform providers' recommendations regarding sleep, including possible interventions to promote sleep in this high-risk population.
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Affiliation(s)
- Erin M Bergner
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rodayne Williams
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Emily R Hamburger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Morgan Lyttle
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Angelia C Davis
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Beth Malow
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jill H Simmons
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cindy Lybarger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rose Capin
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Bergner EM, Whittemore R, Patel NJ, Savin KL, Hamburger ER, Jaser SS. Participants' Experience and Engagement in Check It!: a Positive Psychology Intervention for Adolescents with Type 1 Diabetes. Transl Issues Psychol Sci 2018; 4:215-227. [PMID: 30505889 DOI: 10.1037/tps0000161] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Problems with adherence are common among adolescents with type 1 diabetes (T1D), who must follow a complex treatment regimen. Positive psychology interventions increase adherence and improve health outcomes in adults with chronic conditions; however, they have not been translated to pediatric populations. We evaluated the acceptability and feasibility of Check It!, a positive psychology intervention to improve adherence in adolescents with T1D. Adolescents with T1D and their parents were randomized to a positive psychology intervention (via phone or text message) or an attention control (education) group. Exit interviews and satisfaction surveys were conducted with adolescents (n=63) and parents (n=55) to assess the acceptability and feasibility of Check it! from a representative sample of each group. Chi-square, t-tests, ANOVA and content analysis methods were used to analyze data. Parents and adolescents indicated interest in the intervention, and enrollment numbers support feasibility. In terms of intervention delivery, we identified challenges in implementing the positive psychology reminders to adolescents, particularly in the phone group. Parents in the positive psychology group appreciated the reminders to provide affirmations to their children, and adolescents enjoyed the affirmations and reported using the positive psychology exercises. Regarding acceptability, participants in both groups reported high satisfaction with the intervention overall. Participants reported favorable experiences with Check It!, and findings indicate that text messages are more feasible than phone calls for interventions with adolescents. Overall, a positive psychology intervention delivered with automated text messages is feasible and acceptable to adolescents with T1D and their parents.
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Abstract
Over 4 million children in the United States suffer from chronic health conditions, including cancer, sickle cell disease, and diabetes. Because of major advances in the early identification and treatment of these conditions, survival rates for these children continue to rise, and the majority now lives into adulthood. However, increases in survival have come with costs related to long-term effects of disease processes and treatments. Foremost among these consequences is impairment in brain development and neurocognitive function that may affect a substantial portion of children with chronic health conditions and follow many into adulthood. Impaired cognitive function may contribute to impairment in educational and occupational attainment, mental health, and quality of life for children with chronic conditions. Despite the significance and scope of this problem, advances in the identification and understanding of neurocognitive problems and the delivery of effective clinical care have been hindered in part because research has been "siloed"-conducted on each chronic condition in isolation. This review examines, for the first time, neurocognitive problems in a selected set of 6 chronic pediatric health conditions-leukemia, brain tumors, sickle cell disease, congenital heart disease, Type 1 diabetes, and traumatic brain injury-to define the magnitude of the problem and identify directions for future research and clinical care. Psychologists from many areas of specialization, including pediatric psychology, educational and school psychology, neuropsychology, behavioral medicine, and adult primary care, are uniquely positioned to contribute to every phase of this work, including research, identification, and intervention. (PsycINFO Database Record
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Affiliation(s)
- Bruce E Compas
- Department of Psychology and Human Development, Vanderbilt University
| | | | - Kristen Reeslund
- Department of Psychology and Human Development, Vanderbilt University
| | - Niral Patel
- Department of Pediatrics, Vanderbilt University
| | - Janet Yarboi
- Department of Psychology and Human Development, Vanderbilt University
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Zhang S, Hamburger E, Kahanda S, Lyttle M, Williams R, Jaser SS. Engagement with a Text-Messaging Intervention Improves Adherence in Adolescents with Type 1 Diabetes: Brief Report. Diabetes Technol Ther 2018; 20:386-389. [PMID: 29792749 PMCID: PMC5963545 DOI: 10.1089/dia.2018.0015] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 11/12/2022]
Abstract
Adherence to diabetes management is a challenge for adolescents with type 1 diabetes (T1D). Positive psychology interventions have improved adherence to treatment recommendations in adults with chronic health conditions but have not been widely tested in pediatric populations. We hypothesized that higher engagement with a text-messaging intervention to promote positive affect would increase the effects on diabetes management among adolescents with T1D. Adolescents with T1D (n = 48) and their caregivers were randomized to either an attention control condition or a novel positive psychology intervention delivered through personalized automated text messaging. We examined rates of engagement (percent response to text messages) in relation to demographic factors, and we explored the effect of engagement in relation to adherence and glycemic control. Adolescent engagement was good (mean response rate of 76%) over the 8-week intervention. Engagement was related to adolescents' gender, race, baseline glycemic control, and blood glucose monitoring, but not to treatment type (pump vs. injection), diabetes duration, age, or household income. There was a significant effect of level of engagement on better caregiver-reported adherence, but adolescents' engagement was not related to self-reported adherence or glycemic control. These results indicate feasibility and initial efficacy of using automated text-messaging to deliver an intervention aimed at promoting adherence in adolescents with T1D.
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Affiliation(s)
- Shuodan Zhang
- University of Illinois at Chicago, College of Medicine, Chicago, Illinois
| | - Emily Hamburger
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachini Kahanda
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Morgan Lyttle
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Rodayne Williams
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah S. Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Patel NJ, Savin KL, Kahanda SN, Malow BA, Williams LA, Lochbihler G, Jaser SS. Sleep habits in adolescents with type 1 diabetes: Variability in sleep duration linked with glycemic control. Pediatr Diabetes 2018; 19:10.1111/pedi.12689. [PMID: 29708297 PMCID: PMC6207484 DOI: 10.1111/pedi.12689] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 04/17/2018] [Accepted: 04/24/2018] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe adolescents' sleep on school and weekend nights using multiple methods and to examine the links between sleep variability, quality, and duration with diabetes indicators. METHODS Adolescents with type 1 diabetes (N = 65, mean age = 15.0, 52.3% female, mean HbA1c = 8.9% or 74 mmol/mol) wore an actigraph and kept daily diaries recording sleep, activities, and blood glucose monitoring (BGM) habits for at least 7 days. Average daily BGM and blood glucose (BG) levels were obtained through glucometer downloads. HbA1c was obtained as part of clinic visits. Adolescents completed a sleep quality questionnaire (Pittsburgh sleep quality index [PSQI]), and adolescents and caregivers reported on adherence to diabetes treatment. RESULTS Adolescents reported a mean PSQI global score of 5.37, which is above the clinical cutoff for poor sleep quality. Actigraphy data revealed that mean adolescent total sleep time was 6:54 (h:min), and participants slept more on weekend nights than on school nights (P < .001). Additionally, variability in sleep duration was significantly related to HbA1c, frequency of BGM, and average BG. Total sleep time and self-reported sleep quality were not significantly associated with adherence or glycemic control. CONCLUSIONS Few adolescents with type 1 diabetes met recommendations for sleep duration, and many reported poor sleep quality. We identified significant associations between variability in sleep duration with poorer glycemic control and less frequent BGM, supporting the need to consider sleep patterns as a modifiable factor that may affect adherence and glycemic control.
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Affiliation(s)
- Niral J Patel
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kimberly L Savin
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sachini N Kahanda
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Beth A Malow
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Lauren A Williams
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Gray Lochbihler
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah S Jaser
- Pediatric Endocrinology and Diabetes, Vanderbilt University Medical Center, Nashville, Tennessee
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Patel NJ, Datye KA, Jaser SS. Importance of Patient-Provider Communication to Adherence in Adolescents with Type 1 Diabetes. Healthcare (Basel) 2018; 6:E30. [PMID: 29597246 PMCID: PMC6023481 DOI: 10.3390/healthcare6020030] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 03/19/2018] [Accepted: 03/26/2018] [Indexed: 01/15/2023] Open
Abstract
Effective communication between pediatric diabetes patients and their providers has the potential to enhance patient satisfaction and health outcomes, as well as improve diabetes-related self-management. In this review, we highlight the importance of communication between patients and providers, focusing on the effect of communication on adherence in the high-risk population of adolescents with type 1 diabetes. We synthesize the literature describing patient-provider communication in pediatric populations and provide implications for practice that focus on the most relevant, modifiable factors for improving self-management in adolescents with type 1 diabetes.
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Affiliation(s)
- Niral J Patel
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Karishma A Datye
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
| | - Sarah S Jaser
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN 37232, USA.
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Datye KA, Boyle CT, Simmons J, Moore DJ, Jaser SS, Sheanon N, Kittelsrud JM, Woerner SE. Timing of Meal Insulin and Its Relation to Adherence to Therapy in Type 1 Diabetes. J Diabetes Sci Technol 2018; 12:349-355. [PMID: 28895431 PMCID: PMC5851213 DOI: 10.1177/1932296817728525] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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: 12/17/2022]
Abstract
The purpose of this study is to examine timing of meal insulin and further determine whether an association exists between timing of meal insulin and missed meal insulin doses. The cohort included 4768 T1D Exchange clinic registry participants <26 years with type 1 diabetes ≥1 year. Chi-square tests, t-tests, and regression were used to assess the relationship between participant characteristics and timing of meal insulin and missed meal doses, respectively. Timing of meal insulin and association with missed meal doses was analyzed using logistic regression. In all, 21% reported administering insulin several minutes before, 44% immediately before, 10% during, and 24% after meal. Participants who gave insulin prior to a meal had significantly lower HbA1c than those who gave insulin during or after meal (8.4% ± 1.5% vs 8.8% ± 1.6%, adjusted P < .001), but no significant association was observed regarding DKA events. Those who reported missing ≥1 insulin dose per week had higher HbA1c (9.8% ± 1.9% vs 8.3% ± 1.3%, adjusted P < .001) and were more likely to experience at least one DKA event (9% vs 5%, adjusted P = .001) compared with those who rarely missed a meal insulin dose. Participants who reported administering insulin during or after a meal were more likely to report missing ≥1 meal insulin dose per week compared with those who administered insulin before a meal (28% vs 14%, adjusted P < .001). Premeal insulin was associated with lower HbA1c and fewer missed meal insulin doses. Providers may use this information to discuss the benefits of premeal insulin on glycemic control and adherence to therapy.
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Affiliation(s)
| | - Claire T. Boyle
- Jaeb Center for Health Research, Tampa, FL, USA
- Claire T. Boyle, MS, Jaeb Center for Health Research, 15310 Amberly Dr, Ste 350, Tampa, FL 33647, USA.
| | - Jill Simmons
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Sarah S. Jaser
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nicole Sheanon
- Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
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Abstract
PURPOSE OF REVIEW To highlight recent findings from studies of sleep in type 1 diabetes (T1D), with a focus on the role of sleep in self-management, the cognitive and psychosocial outcomes related to sleep disturbances, and factors associated with sleep disturbances specific to T1D. RECENT FINDINGS People with T1D experience higher rates of sleep disturbances than people without diabetes, and these disturbances have negative implications for glycemic control and diabetes management, as well as psychosocial and cognitive outcomes. Inconsistent sleep timing (bedtime and wake time) has emerged as a potential target for interventions, as variability in sleep timing has been linked with poorer glycemic control and adherence to treatment. Sleep-promoting interventions and new diabetes technology have the potential to improve sleep in people with T1D. Sleep is increasingly considered a critical factor in diabetes management, but more multi-method and longitudinal research is needed. We emphasize the importance of sufficient and consistent sleep for people with T1D, and the need for providers to routinely assess sleep among patients with T1D.
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Affiliation(s)
- Katia M Perez
- Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Emily R Hamburger
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA
| | - Morgan Lyttle
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA
| | - Rodayne Williams
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA
| | - Erin Bergner
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA
| | - Sachini Kahanda
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA
| | - Erin Cobry
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Village at Vanderbilt, 1500 21st Ave. South, Suite 1514, Nashville, TN, 37212, USA.
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