Diabetes self-care: lessons from research on the family and broader contexts

Digital health technologies and innovation patterns in diabetes ecosystems

Background

The global rise in type-2 diabetes (T2D) has prompted the development of new digital technologies for diabetes management. However, despite the proliferation of digital health companies for T2D care, scaling their solutions remains a critical challenge. This study investigates the digital transformation of T2D ecosystems and seeks to identify key innovation patterns. We examine: (1) What are emerging organizations in digital diabetes ecosystems? (2) What are the value streams in digital T2D ecosystems? (3) Which innovation patterns are present in digital T2D ecosystems?

Methods

We conducted a literature review and market analysis to characterize organizations and value streams in T2D ecosystems, pre- and post-digital transformation. We used the e3-value methodology to visualize T2D ecosystems (RQ1 and RQ2) and conducted expert interviews to identify emerging innovation patterns in digital diabetes ecosystems (RQ3).

Results

Our analyses revealed the emergence of eight organization segments in digital diabetes ecosystems: real-world evidence analytics, healthcare management platforms, clinical decision support, diagnostic and monitoring, digital therapeutics, wellness, online community, and online pharmacy (RQ1). Visualizing the value streams among these organizations highlights the crucial importance of individual health data (RQ2). Furthermore, our analysis revealed four major innovation patterns within the digital diabetes ecosystem: open ecosystem strategies, outcome-based payment models, platformization, and user-centric software (RQ3).

Conclusions

Our findings illustrate the transition from traditional value chains in T2D care to platform-based and outcome-oriented models. These innovation patterns can inform strategic decisions for companies and healthcare providers, potentially helping anticipate new digital trends in diabetes care and across other chronic disease ecosystems.

Peer support in paediatrics: A literature review

AIM

Creating an overview of the existing literature about peer support in paediatrics, with a focus on children with chronic diseases.

METHODS

An online search was conducted in MEDLINE and Web of Science. English, Dutch or French articles published between 1 January 2000 and 10 May 2023 were included, based on title and abstract.

RESULTS

In this review, 47 articles were included, identifying following themes: Health-Related Quality of Life (n = 8), peer support for parents/siblings (n = 6), social environment (n = 2), and peer support programme for children (n = 31) subdivided in: general concept (n = 13), online (n = 11), camps (n = 6), and development of a peer support programme (n = 1). Peer support aims to improve disease-related knowledge, coping, and management of the disease, as well as creating a positive mindset and decreasing the disease burden. There is no consensus regarding which peer group design was superior.

CONCLUSIONS

Peer groups aim to increase knowledge and psychological adaptation, and decrease physical symptoms and side effects. It is desired to start the peer mentor programme within 1 year after diagnosis or during a critical incident. Further investigation needs to determine the optimal age to start these groups and the format (online or in-person). Communication between mentors and their mentees was crucial in the succeeding of the programme, as well as creating a safe environment to share experiences. Even though research is still needed concerning peer-to-peer support for children, there is already a lot known about similar programmes for parents of children with chronic diseases.

Individual and Family Management in Portuguese Adolescents with Type 1 Diabetes: a Path Analysis

BACKGROUND

This study evaluates the adequacy of the Revised Self and Family Management Framework (Grey et al., Nurs Outlook 63:162-170, 2015) in Portuguese adolescents with type 1 diabetes and analyzes the effect of parental coping, family support, and adherence in the association between illness representations, school support, metabolic control, quality of life, and family functioning.

METHOD

One hundred adolescents (aged 12-19) and their parents participated in a cross-sectional study. Adolescents were assessed on school support, adherence to self-care, family support, and quality of life. Parents were assessed on parental coping and family functioning. Both adolescents and parents were assessed on illness representations. Adolescent's metabolic control was evaluated through glycosylate hemoglobin.

RESULTS

Adolescents' and parents' illness representations were associated with metabolic control, quality of life and family functioning. Parental coping, family support and adherence had an indirect effect between illness representations and diabetes outcomes.

CONCLUSION

Findings showed the adequacy of Grey and colleagues' model (Nurs Outlook 63:162-170, 2015) in adolescents with type 1 diabetes and how family support, parental coping, and adherence contribute to diabetes management. Interventions to improve adolescents' and family's management of Type 1 diabetes should be designed to change adolescents' and family's representations and enhance their ability and skills in diabetes management.

The Experience of Partners of Adults with Type 1 Diabetes: an Integrative Review

PURPOSE OF REVIEW

The purpose of this review was to synthesize the research on the experience of partners living with adults with type 1 diabetes (T1D).

RECENT FINDINGS

Eleven studies were included in the review. Three themes on the experience of living with a person with T1D were identified: the undercurrent of hypoglycemia, partners' involvement in diabetes care, and the impact on partners' lives. Due to considerable fear of hypoglycemia, partners had pervasive and deliberate ways in which they made attempts to minimize hypoglycemia in the person with diabetes and its cascade to a health emergency. As a result, partners of adults with T1D experienced considerable distress and disrupted lives. Partners also expressed a need for more support from family, friends, and health professionals. Research is needed on the partner experience across the lifespan and the specific supportive services they need in order to optimize their health outcomes.

Families Living with Blood-Borne Viruses: The Case for Extending the Concept of "Serodiscordance"

The concept of “serodiscordance” (mixed infection status) is primarily associated with epidemiological concerns about HIV transmission risk in couples. We make the case for extending this concept to include families with mixed HIV and viral hepatitis status. Social research on couples with mixed HIV and hepatitis C status has laid an important foundation for illuminating how experiences of serodiscordance within intimate partnerships are much broader than concerns about risk. This body of work attests to serodiscordance holding promise as a valuable concept for understanding viral infections as socially situated and intensely relational phenomena. However, serodiscordance is still limited as a concept because of its near universal focus on couples. It is rarely applied to wider relationships, including family networks beyond the couple. Despite evidence in the literature that families are affected by blood-borne viruses in multiple social, emotional, financial, and generational ways, the concept of serodiscordance does not capture these broader dynamics. Making serodiscordance more inclusive is an important step in recognising the diverse ways families' everyday lives, relationships, and futures can be entangled with HIV, hepatitis C, and hepatitis B, and for understanding how today's era of effective treatment options might shape the “family life” of viral infections.

Multisystemic Therapy Improves the Patient-Provider Relationship in Families of Adolescents with Poorly Controlled Insulin Dependent Diabetes

The purpose of this study was to determine if multisystemic therapy (MST), an intensive, home and community-based family treatment, significantly improved patient-provider relationships in families where youth had chronic poor glycemic control. One hundred forty-six adolescents with type 1 or 2 diabetes in chronic poor glycemic control (HbA1c ≥8 %) and their primary caregivers were randomly assigned to MST or a telephone support condition. Caregiver perceptions of their relationship with the diabetes multidisciplinary medical team were assessed at baseline and treatment termination with the Measure of Process of Care-20. At treatment termination, MST families reported significant improvement on the Coordinated and Comprehensive Care scale and marginally significant improvement on the Respectful and Supportive Care scale. Improvements on the Enabling and Partnership and Providing Specific Information scales were not significant. Results suggest MST improves the ability of the families and the diabetes treatment providers to work together.

Interrelation between adult persons with diabetes and their family: a systematic review of the literature

Diabetes mellitus is a common chronic disease all over the world. Self-management plays a crucial role in diabetes management. The purpose of this systematic review was to summarize what is known about the interactions between adult persons with diabetes, their family, and diabetes self-management. MEDLINE, CINAHL, PSYCHINFO, LINDA, and MEDIC databases were searched for the years 2000 to 2011 and for English language articles, and the reference lists of the studies included were reviewed to capture additional studies. The findings indicate that family members have influence on the self-management of adult persons with diabetes. The support from family members plays a crucial role in maintaining lifestyle changes and optimizing diabetes management. Diabetes and its treatment also affect the life of family members in several ways, causing, for example, different types of psychological distress. More attention should be paid to family factors in diabetes management among adult persons.

Insulin use, prescription patterns, regimens and costs.-a narrative from a developing country

BACKGROUND

Achieving good glycemic control is of paramount importance in the reduction of diabetes mellitus (DM) associated morbidity and mortality. Insulin plays a key role in the management of DM but unfortunately whilst some healthcare providers present insulin as a treatment of last resort , patients on insulin often have insulin related issues such as needle phobias, fear of hypoglycaemia, weight gain and in developing countries, costs. This Report aims at assessing insulin prescription pattern, insulin costs and issues associated with adherence.

METHODS

This was a Cross-sectional observation Study whereby 160 patients with DM who were on insulin solely or in combination with oral hypoglycaemic agents were recruited over a 6 month period. Information obtained from the Study subjects pertained to their histories of DM, types of insulin, insulin costs, adherence issues and insulin delivery devices. Long and short term glycaemic control were determined and evaluated for possible relation to insulin adherence. Test statistics used were chi square, t test and binary regression.

RESULTS

Insulin adherence was noted in 123-77% of the Study subjects and this was comparable between persons with type 1 DM and those with type 2 DM. The mean glycosylated haemoglobin values were significantly higher in those who admitted to non insulin adherence compared to those who adhered to their insulin regimen (9.7% (2.3) Vs 8.6% (2.1), p = 0.01). Reasons proffered by Respondents for non insulin adherence included high costs-15(41%), inconvenience -15 (41%) and needle pain-79)18%. A greater proportion of persons who self injected insulin adhered to insulin prescriptions compared to those who did not self inject and thus had better glycaemic control. Shorter duration of DM and older age were found to be predictors of adherence to insulin prescription.The monthly mean costs of insulin for those who earned an income was 5212.8 Nigerian naira which is equivalent to 33.1 US dollars and we estimated that persons on a minimum wage would spend 29% of their monthly income on the procurement of insulin.

CONCLUSIONS

Health related costs, age, duration of DM and insulin associated side effects are some of the factors implicated in adherence to insulin prescription.

Social support for diabetes illness management: supporting adolescents and caregivers

OBJECTIVE

The aim of this research study was to examine the relationship between 4 sources of social support (support for the adolescent from family, support for the adolescent from friends, support for the caregiver from another adult, and support to the family from the health care provider) and adolescents' diabetes outcomes (illness management behavior and health status) using a diverse sample of urban adolescents.

METHOD

One hundred forty-one adolescents with insulin-managed diabetes and their primary caregivers completed questionnaires assessing social support and illness management behavior. Glucose meters were downloaded and hemoglobin A1c assays were obtained. Structural equation modeling was used to test a model social support informed by social ecological theory.

RESULTS

The results of the structural equation modeling indicated that support for the caregiver from another adult was directly and positively related to support for the adolescent from family and indirectly related to better illness management. Support for the adolescent from family was directly related to better diabetes management and, through better management, to better diabetes health. Support to the family from the health care provider was not related to support for the adolescent and support to the adolescent from friends was not related to illness management, as hypothesized.

CONCLUSION

This study identifies a novel target for social support intervention to improve adolescents' illness management behavior-the caregivers of adolescents with diabetes. By enhancing the social support caregivers receive from other adults in their lives, caregivers' ability to support their adolescent children with diabetes might also be improved which, in turn, improves adolescents' illness outcomes.

The transition to young adulthood in youth with type 1 diabetes on intensive treatment

OBJECTIVE

We sought to examine prospectively patterns of clinical and psychosocial outcomes during the transition from adolescence to young adulthood in a cohort initiating intensive therapy after the Diabetes Control and Complications Trial.

RESEARCH DESIGN AND METHODS

We conducted a prospective, descriptive analysis of data from a randomized intervention study with 117 adolescents (45 males and 72 females, mean age at entry = 14.4 +/- 2.0 yr, mean diabetes duration at entry = 5.7 +/- 3.7 yr) recruited from a large pediatric diabetes clinic. Data were collected for each subject over periods of up to 5 yr at 6-month intervals using measures of depressive symptoms, quality of life, and metabolic control, with chart review for prevalence of diabetes complications.

RESULTS

Metabolic control worsens during adolescence but returns to early adolescent levels in young adulthood. The negative impact of diabetes on quality of life, disease-related worries, and life satisfaction did not change significantly with age. These results did not vary with treatment group or gender. Participants who showed high levels of depressive symptoms as adolescents were somewhat more likely to be depressed when older. Despite relatively long duration of diabetes, relatively few complications were observed in young adulthood.

CONCLUSIONS

These data suggest that youth who begin intensive treatment as adolescents generally have good metabolic and psychosocial outcomes as young adults. However, those who have high levels of depressive symptoms in adolescence tend to continue to have such symptoms in early adulthood.

Psychometric properties of questionnaires measuring associations between behavioral factors and diabetes care for youth with type 2 diabetes

BACKGROUND

Because of the recency of the large numbers of youth diagnosed with type 2 diabetes (T2D), measures of adherence behavior and family response to diabetes have not been developed or tested.

OBJECTIVE

The objective of this study is to identify whether questionnaires on personal and family behaviors regarding the care of diabetes previously used with youth with type 1 diabetes (T1D) are reliable and related to metabolic control among youth with T2D.

DESIGN/METHODS

During a regularly scheduled visit, youth with T2D and a parent/guardian were invited to participate in the study. Youth and a parent completed questionnaires and one 24-h dietary recall at the visit. During the following 2 wk, each youth completed two telephone dietary recalls and physical activity questionnaires.

RESULTS

Child-reported scales measuring parental reminding, positive family behavior, self-care behaviors, and self-efficacy and maternal report of child self-care behaviors and maternal self-efficacy were found to have adequate internal consistency. Only parental reminding was related to metabolic control. Those youth reporting higher parental reminding were in poorer metabolic control.

CONCLUSIONS

These scales appear to be reliable with youth with T2D in south Texas.

Social support and diabetes management in childhood and adolescence: influence of parents and friends

This paper reviews the empirical research literature on the role of social support in children and adolescents with diabetes. Studies on the role of parental involvement in diabetes management suggest that premature withdrawal of parental involvement is associated with poor diabetes outcomes, whereas continued parental support and monitoring is associated with better outcomes among adolescents. Research on social support from friends suggests that friends can be a unique source of support that complements parents' involvement and improves adolescents' diabetes management.

The influence of participant's self-perceived role on metabolic outcomes in a diabetes group education program

We investigated the demographic, biomedical, and perceptional factors influencing HbA(1c) 2 years after baseline in an educational program for persons with type 2 diabetes. Patients (N = 259) participated in a year-long group educational program led by specially trained pharmacists. There was a significant reduction of HbA(1c) (-0.15% unit; p < 0.05) on the group level after 24 months. Answers to open-ended questions on self-perceived role in diabetes management and occasions for testing blood glucose were analyzed qualitatively and used in a regression equation. Belonging to the "active" category of self-perceived role in diabetes management was associated with better outcomes compared to having a "passive" role. In addition, testing blood glucose levels for different purposes identified by the respondents was better than not to test blood glucose levels at all. The influence of these variables was striking; of the range of demographic and biomedical factors tested, only initial HbA(1c) and treatment entered the model.