Camp for Youth With Type 1 Diabetes

Improved Glycemic Control during a One-Week Adventure Camp in Adolescents with Type 1 Diabetes-The DIACAMP Study

Adolescence remains a crucial age associated with diabetes distress in individuals living with type 1 diabetes (T1D). The Austrian organization "Diabär" regularly hosts a one-week adventure camp for adolescents (12-18 years) living with T1D. The camp focuses on "fun activities" without a structured educational protocol in order to minimize diabetes distress and increase diabetes management skills. In contrast to educational camps, training is kept to a minimum. However, attendees analyze the glycemic data of the previous day with their medical supervisor once daily during the camp. All subjects used a standardized real-time continuous glucose monitoring (CGM) system (DexcomG7) throughout the whole study. Glycemic metrics were prospectively analyzed during three periods: week 1 = home phase, week 2 = adventure camp, and week 3 = after the camp. Safety (time below range 1 [TBR1], 69-54 mg/dL, and time below range 2 [TBR2], <54 mg/dL) and efficacy (time in range [TIR], 70-180 mg/dL) were assessed by comparing the CGM data during weeks 1-3. The CGM data of 14 participants were analyzed. The TIR was higher during the camp week versus week 1 (70.4 ± 11.1% vs. 53.1 ± 20.2%; p = 0.001). The TBR1 significantly increased during camp compared to week 1 (2.5 ±1.7% vs. 1.3 ± 1.2%; p = 0.009), whereas the TBR2 did not differ. No serious adverse events occurred. This adventure camp without a main focus on education showed feasibility and safety in adolescents with T1D.

Addressing disparities in technology use among patients with type 1 diabetes: a review

PURPOSE OF REVIEW

The benefits of continuous glucose monitors (CGMs) and insulin pumps in the management of type 1 diabetes (T1D) are widely recognized. However, glaring disparities in access exist, particularly in marginalized and economically disadvantaged groups that stand to benefit significantly from diabetes technology use. We will review recent data describing drivers of these disparities and approaches to address the disparities.

RECENT FINDINGS

Several qualitative studies were published in recent years that have investigated the drivers of disparities reported over the past decades. These studies report that in addition to typical barriers seen in the diabetes technology, marginalized patients have unique challenges that make insulin pumps and CGMs less accessible.

SUMMARY

Barriers to technology use in these groups include stigmatization, lack of support, financial constraints, provider biases, stringent insurance policies, and clinic infrastructure. To address inequities, multifaceted strategies across community, healthcare, and provider sectors are essential. Key initiatives include enhancing public awareness, refining health policies, ensuring access to high-quality care, and emphasizing patient-centered approaches. The equitable use of technology can narrow the gap in T1D outcomes. The social and economic implications of suboptimal T1D management further underscore the urgency of these efforts for both improved health outcomes and cost-efficient care.

National survey of educational impact on pharmacy learners by volunteering at camps for children with diabetes

INTRODUCTION

Current literature on pharmacy students' and residents' experience attending camps for children with diabetes focuses on the experience at an individual campsite. The objective of this study was to examine the demographics and gains in understanding that pharmacy learners achieve when volunteering as medical staff at camps for children with type 1 diabetes (T1D).

METHODS

National listservs were used to identify pharmacists who precept pharmacy students and residents at diabetes camps. These self-identified pharmacists shared pre- and post-camp electronic surveys with their respective pharmacy learners. Statistical analysis was completed using SPSS Version 25 (IBM, Corp.).

RESULTS

Eighty-six pharmacy learners completed the pre-camp survey and 69 completed the post-camp survey. Most were Caucasian, in their fourth professional year, and participated in residential camps that lasted six and one-half days on average. Learners consistently engaged in patient care activities including: carbohydrate counting (87%), bolus insulin dose calculations (86%), treatment of hypo/hyperglycemic episodes (86%), blood glucose testing (83%), blood sugar trend evaluation (78%), basal insulin dosing calculations (74%), and insulin pump site changes (72%). Learners demonstrated statistically significant gains in every index measured with the exception of glucometer use. Eighty-seven percent indicated they learned how to appropriately manage T1D, 37% gained empathy for those living with T1D, and 13% learned how to work in a medical team.

CONCLUSIONS

Pharmacy learners who volunteered at diabetes camps experienced large gains in their understanding of concepts and devices, comfort with performing patient care tasks, and compassion for children and their families living with T1D.

High engagement in mobile peer support is associated with better glycemic control in type 1 diabetes: a real-world study

AIMS

Peer support for diabetes has become convenient and interactive following the emergence of mobile health (mHealth). We aimed to evaluate the association between engagement in peer support via mHealth app and glycemic control in type 1 diabetes (T1D).

METHODS

This retrospective study included adults with T1D who had joined the mobile community "TangTangQuan (TTQ)" since May 2018 for at least one year. "Like", "comment" and "share" were the major interaction indicators of mobile community and were used to assess engagement in peer support. The patients were divided into four engagement groups by quartile. The primary outcome was the change in HbA_1c , mean fasting blood glucose (FBG) and postprandial blood glucose (PBG) from baseline to the 12th month. Other outcomes included the change of self-monitoring of blood glucose frequency, hypoglycemia frequency, and the proportion of reaching optimal glycemic control.

RESULTS

Among the 693 individuals, the HbA_1c , mean FBG and PBG improved in the 12th month. Multiple regression analysis showed that higher engagement in peer support was associated with a greater reduction of HbA_1c (β=-0.45, P<0.001) and mean FBG (β=-0.82, P<0.001). In the subgroup of poor glycemic control, the association between engagement in peer support and glycemic improvement still remained (HbA_1c : β=-0.86, P=0.002; FBG: β=-1.36, P=0.001). The engagement in mobile peer support was positively correlated with educational level (OR=1.42, P=0.042), household income (OR=1.43, P=0.013), and the use of continuous subcutaneous insulin infusion (OR=1.73, P=0.009).

CONCLUSION

High engagement in mobile peer support was associated with better glycemic control in adults with T1D.

Significant and persistent improvements in time in range and positive emotions in children and adolescents with type 1 diabetes using a closed-loop control system after attending a virtual educational camp

OBJECTIVE

To evaluate the six-month impact of the advanced automated functions of a closed-loop control (CLC) system (Control-IQ) and a virtual educational camp (vEC) on emotions and time in range (TIR) of children and adolescents with type 1 diabetes.

METHODS

Children and their parents participated in a three-day vEC. Clinical, glucose, and emotion data were evaluated before, just after, and six months after the vEC. Emotions were evaluated using adapted Plutchik's and Geneva Emotion Wheels.

RESULTS

Forty-three children and adolescents (7-16 years) showed significant improvements in positive emotions immediately and six months after the vEC (67% and 65% vs 38%, p < 0.05, respectively), while mixed emotions were reduced (32% and 15% vs 61%, p < 0.05 and p < 0.001, respectively). The median percentage TIR increased from 64% (IQR 54-72) to 75% (IQR 70-82) with Control-IQ (p < 0.001) six months after the vEC.

CONCLUSIONS

Positive emotions (joy, serenity, and satisfaction) significantly improved while mixed emotions were significantly worse six months after the initiation of a CLC system (Control-IQ) and a vEC.

Changes in attitudes toward diabetes in nursing students at diabetes camp

AIM

The research purpose was to determine whether exposure to residential diabetes camps affects attitudes toward diabetes care and management in nursing students.

BACKGROUND

Summer camp for children with type 1 diabetes mellitus (T1D) provides a unique and engaging clinical environment for nursing students to learn about evolving diabetes care and to help children develop diabetes management skills.

METHODS

This prospective, pretest/posttest study assessed student nurses' attitudes about diabetes, who attended one of four residential summer camps in the United States, using the Diabetes Attitude Survey 3 (DAS3). The survey was administered before and after clinical experience designed to fulfill experiential curricula requirements from various nursing programs.

RESULTS

After attending diabetes camp, nursing students (N = 73) had a positive change in their attitudes regarding the need for special training and the psychosocial impact of diabetes.

DISCUSSION

The diabetes camp clinical experience impacted nursing students' attitudes. Diabetes camps are a unique clinical setting that uses learned clinical knowledge and judgment to promote health and prevent disease and disability, supporting the integration of primary care and public health nursing.

Changes in glycated hemoglobin, diabetes knowledge, quality of life, and anxiety in children and adolescents with type 1 diabetes attending summer camps: A systematic review and meta-analysis

Diabetes summer camps provide children and adolescents with type 1 diabetes opportunities to learn about the disease and its management in a supportive environment to help improve glycemic control, self-reliance, and quality of life. The objective of this quantitative review was to assess the advantages of attending summer camps and study any adverse psychological effects. Studies with a pre/post study design in children and adolescents attending summer camp were systematically reviewed. Five bibliographic databases were searched and relevant data extracted. Random effects meta-analyses were used to combine the individual study results to derive pooled estimates and meta-regression was used to explore between-study heterogeneity. Studies in the literature report short-term improvements in the glycemic control, diabetes knowledge (DK), quality of life (QOL) anxiety, diabetes self-management, and self-esteem. Thirty-three studies were identified, and those outcomes reported in five or more studies were included in meta-analyses. There were significant benefits with a pooled mean change for glycated hemoglobin (95% CI) of -0.59(-0.95,-0.23)% (-6.4[-10.4,-2.5]mmol/mol), and for standardized DK score of 1.99(1.28,2.70) but corresponding changes for QOL 0.17(-0.06,0.39) and for anxiety -0.32(-0.70, 0.06) were not significant. However, all outcomes showed considerable between-study heterogeneity little of which was explained by study characteristics. The findings suggest short-term benefits of camp on metabolic control, DK, QOL and anxiety in T1D children and adolescents, although the latter two were not statistically significant. Further research is warranted with more methodological rigor and longer-term follow-up to determine if there are long-term benefits associated with camp attendance.

Psychological Outcomes in Children and Early Adolescents With Type 1 Diabetes Following Pediatric Diabetes Summer Camp: A 3-Month Follow-Up Study

Objective: The aim of this study was to assess general psychosocial adjustment to diabetes and perceived disease management among patients with type 1 diabetes (T1D) and their parents before and after patients' participation in a diabetes summer camp. Methods: In this follow-up study, 20 children and adolescents with T1D (eight boys; mean age = 11.01 ± 0.94 years; mean diabetes duration = 3.02 ± 2.27) attending a southern Italian diabetic center, along with their parents, were assessed prior to and 3 months after the youths participated in a 1 week camp-based intervention involving didactic and interactive child-centered education and recreational activities. Patients and their parents completed measures assessing patients' quality of life and strategies employed by patients to cope with pain. Patients also completed measures evaluating their diabetes psychosocial adjustment, diabetes self-efficacy management, and illness perception; also, their parents completed measures of caregivers' perceived diabetes burden and treatment satisfaction. Youths' glycated hemoglobin (HbA1c) and standardized body mass index (z-BMI) values were also assessed. Within-subjects repeated-measures analyses of variance evaluated pre- and post-camp changes. Results: Camp attendance showed no beneficial effects on glycemic control, as indicated by HbA1c values both before (7.02%) and after (7.28%) camp being lower than 7.5%. HbA1c values were found to have increased after camp (pre-camp = 7.02%, post-camp = 7.28%; p = 0.010), but since they still fell within an acceptable range, they did not reveal clinically relevant changes in glycemic control. No substantial significant improvement in psychosocial measures was observed in children or parents (all p > 0.05). According to the parents' evaluation, social support-seeking as a patient pain-coping strategy was slightly increased (p = 0.044) after attending the camp. Conclusions: This study does not provide empirical evidence of benefits of participating in a diabetes camp for either patients or their parents. These findings suggest that healthcare providers rethink such camps as an experience for youths with T1D that actively involves parents and that includes both youth- and parent-focused psychological interventions.

Impact of insulin reduction on glycemic control in children attending a residential diabetes camp

BACKGROUND/OBJECTIVES

Children attending diabetes camp are more active, increasing the risk of hypoglycemia. Decreasing initial insulin doses may reduce this risk. The objectives of our study were to compare glycemic control between campers receiving multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and analyze the impact of decreasing basal insulin by 10%.

METHODS

We analyzed 849 camp sessions (599 children, 5-19 years old) from Camp Sweeney's 2016/2017 summers. Campers were separated into groups by year and insulin route (MDI_2016, MDI_2017, CSII_2016, and CSII_2017). The MDI_2016 group had initial basal insulin decreased 10%, while CSII_2016, MDI_2017, and CSII_2017 did not. Time spent in blood glucose ranges and area under the curve (AUC) were compared by year and insulin route using ANOVA. We also performed repeated measures ANOVA using campers who attended both years.

RESULTS

No significant differences in time spent in any glucose range could be attributed to the initial 10% basal decrease, including on paired analysis. MDI_2017 had more decreases to basal insulin than the other groups. CSII campers had higher AUC and more hyperglycemia than MDI campers.

CONCLUSIONS

Campers on MDI may benefit from decreasing basal insulin, either at the beginning of camp or during the first week. Future research is needed to optimize glycemic control in the camp setting.

Diabetes camp still matters: Relationships with diabetes-specific distress, strengths, and self-care skills

OBJECTIVE

Prior studies suggest diabetes camps improve psychosocial well-being in youth with type 1 diabetes but these studies suffer from variable levels of rigor. The present study assessed associations between camp participation and diabetes distress, perceived independence in diabetes self-care, and diabetes strengths in a large sample of children, adolescents, and their parents across 44 camps in the United States. Analyses compared viewpoints of study participants, identified moderators of change, and assessed perceived benefits of camp participation.

METHODS

There were 2488 youth and 2563 parents consented for participation in the online survey. Participants reported diabetes distress and perceived independence in youth care, their new experiences and best parts of camp, and changes in behavior following camp. T-tests, regressions, Cohen's d, and relative frequencies were used as appropriate to assess baseline differences between reporters, pre-post outcome differences, and moderators of change.

RESULTS

Parents as compared to youth reported higher pre-camp distress and lower perception of youth independence in self-care. Youth experienced a statistically significant decrease in distress and increase in independence in self-care. Diabetes strengths did not change. Higher A1c prior to camp was associated with higher levels of distress across camp participation. Campers and their parents endorsed a high frequency of positive firsts, bests, and benefits of camp.

CONCLUSIONS

Data from a large sample youth with type 1 diabetes across multiple camps showed broad-based psychosocial benefits of camp participation.