1
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Padoan F, Colombrino C, Sciorio F, Piacentini G, Gaudino R, Pietrobelli A, Pecoraro L. Concerns Related to the Consequences of Pediatric Cannabis Use: A 360-Degree View. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1721. [PMID: 38002812 PMCID: PMC10670833 DOI: 10.3390/children10111721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/22/2023] [Indexed: 11/26/2023]
Abstract
Cannabis, a plant known for its recreational use, has gained global attention due to its widespread use and addiction potential. Derived from the Cannabis sativa plant, it contains a rich array of phytochemicals concentrated in resin-rich trichomes. The main cannabinoids, delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD), interact with CB1 and CB2 receptors, influencing various physiological processes. Particularly concerning is its prevalence among adolescents, often driven by the need for social connection and anxiety alleviation. This paper provides a comprehensive overview of cannabis use, its effects, and potential health risks, especially in adolescent consumption. It covers short-term and long-term effects on different body systems and mental health and highlights the need for informed decision making and public health initiatives, particularly regarding adolescent cannabis use.
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Affiliation(s)
| | | | | | | | | | | | - Luca Pecoraro
- Pediatric Unit, Department of Surgical Sciences, Dentistry, Gynecology and Pediatrics, University of Verona, 37126 Verona, Italy
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2
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Politi C, Gabbin A, Cecchetto G, Montisci M, Viel G, Pascali JP. A case study on MDMA. Two fatal cases involving young adults. AUST J FORENSIC SCI 2021. [DOI: 10.1080/00450618.2021.1921267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Caterina Politi
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Andrea Gabbin
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanni Cecchetto
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Massimo Montisci
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Guido Viel
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Jennifer P. Pascali
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padova, Padova, Italy
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3
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Pancer J, Dasgupta K. Effects of Cannabis Use in Youth and Young Adults With Type 1 Diabetes: The Highs, the Lows, the Don't Knows. Can J Diabetes 2019; 44:121-127. [PMID: 31401053 DOI: 10.1016/j.jcjd.2019.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 04/04/2019] [Accepted: 05/06/2019] [Indexed: 12/25/2022]
Abstract
Our objective was to address the request by our Diabetes Canada/Canadian Institutes of Health Research-funded Virtual Patient Network (VPN) of youth and young adults with type 1 diabetes for information on the impact of cannabis use on type 1 diabetes. To respond to this patient-initiated request, we conducted a literature search in PubMed, with search terms relevant to the following: cannabis use in youth with type 1 diabetes, effects of cannabis use on glycemic control and diabetic emergencies and immune-modulating properties of cannabis. These were synthesized in a narrative review. The number of studies is limited and is based largely on self-report and cross-sectional assessment. The existing literature indicates that 10% to 30% of youth and young adults with type 1 diabetes report ever using cannabis, similarly to the general population. Use appears to be associated with higher glycated hemoglobin and greater diabetic ketoacidosis incidence. There is some evidence of poorer self-management during episodes of use. Cannabis has been shown to be protective against type 1 diabetes in animal models, but such findings have yet to be replicated in humans. Existing cross-sectional studies suggest adverse effects of cannabis use on glycemic control and self-management. However, it is not clear if the associations identified are due to use itself or other patient or contextual factors. Nonetheless, given high use rates, health-care providers should query use, discuss its potential impact on diabetes management and outcomes, and codevelop an action plan.
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Affiliation(s)
- Jill Pancer
- Division of Endocrinology and Metabolism, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada; Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Kaberi Dasgupta
- Centre for Outcomes Research and Evaluation (CORE), Research Institute of the McGill University Health Centre, Montréal, Québec, Canada; Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada.
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4
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Abstract
PURPOSE OF REVIEW The purpose of the study is to examine and summarize studies reporting on the epidemiology, the risk of developing diabetes, and the cardiovascular effects on individuals with diabetes of different levels of alcohol consumption. RECENT FINDINGS Men consume more alcohol than women in populations with and without diabetes. Light-to-moderate alcohol consumption decreases the incidence of diabetes in the majority of the studies, whereas heavy drinkers and binge drinkers are at increased risk for diabetes. Among people with diabetes, light-to-moderate alcohol consumption reduces risks of cardiovascular diseases and all-cause mortality. Alcohol consumption is less common among populations with diabetes compared to the general population. Moderate alcohol consumption reduces the risk of diabetes and, as in the general population, improves cardiovascular health in patients with diabetes. Type of alcoholic beverage, gender, and body mass index are factors that affect these outcomes.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Court, MS A140, Aurora, CO, 80045, USA.
| | - Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Court, MS A140, Aurora, CO, 80045, USA
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5
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Buschur EO, Glick B, Kamboj MK. Transition of care for patients with type 1 diabetes mellitus from pediatric to adult health care systems. Transl Pediatr 2017; 6:373-382. [PMID: 29184818 PMCID: PMC5682376 DOI: 10.21037/tp.2017.09.06] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Planning for the transition from pediatric to adult healthcare is broadly understood to be beneficial to the quality of care of patients with chronic illness. Due to the level of self-care that is necessary in the maintenance of most chronic diseases, it is important that pediatric settings can offer support during a time when adolescents are beginning to take more responsibility in all areas of their lives. Lack of supportive resources for adolescents with chronic conditions often results in both decreased access to care and impaired health and function likely leading to increased medical costs later. Additionally, fundamental differences in health care delivery exist between pediatric and adult care settings. There is limited empiric data and information on best practices in transition care. In this article we address the importance of bridging pediatric and adult care settings and highlight the challenges and successes of the implementation of the young adult transition clinic program for patients with type 1 diabetes at our facility. We provide recommendations for further research and program implementation with the transition population.
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Affiliation(s)
- Elizabeth O Buschur
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
| | - Bethany Glick
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
| | - Manmohan K Kamboj
- Department of Endocrinology, Diabetes, and Metabolism, the Ohio State University Wexner Medical Center/Nationwide Children's Hospital, Columbus, OH, USA
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6
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Gilbert JD, Byard RW. Fatal Diabetic Ketoacidosis-A Potential Complication of MDMA (Ecstasy) Use. J Forensic Sci 2017; 63:939-941. [DOI: 10.1111/1556-4029.13602] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 06/22/2017] [Accepted: 06/23/2017] [Indexed: 11/28/2022]
Affiliation(s)
- John D. Gilbert
- Forensic Science SA; 21 Divett Place Adelaide 5000 Australia
| | - Roger W. Byard
- Forensic Science SA; 21 Divett Place Adelaide 5000 Australia
- School of Medicine; The University of Adelaide; Frome Rd Adelaide 5005 Australia
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7
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Abstract
Although fewer individuals with type 1 diabetes mellitus (T1DM) drink alcohol, the potential and severity of harm associated with its consumption is higher in persons with diabetes. Alcohol use affects glucose metabolism and results in various potential adverse effects both from acute ingestion and chronic ingestion in persons with T1DM. The purpose of this article is to describe the effects of alcohol on glucose metabolism and diabetes control in persons with T1DM and propose counseling pearls for providers working with patients in this population.
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Affiliation(s)
- Nicole D White
- Pharmacy Practice, Creighton University School of Pharmacy and Health Professions, Omaha, Nebraska
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8
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Agarwal S, Jawad AF, Miller VA. A multivariate model exploring the predictive value of demographic, adolescent, and family factors on glycemic control in adolescents with type 1 diabetes. Pediatr Diabetes 2016; 17:500-508. [PMID: 26486450 PMCID: PMC4840099 DOI: 10.1111/pedi.12331] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/02/2015] [Accepted: 09/23/2015] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The current study examined how a comprehensive set of variables from multiple domains, including at the adolescent and family level, were predictive of glycemic control in adolescents with type 1 diabetes (T1D). METHODS Participants included 100 adolescents with T1D ages 10-16 yrs and their parents. Participants were enrolled in a longitudinal study about youth decision-making involvement in chronic illness management of which the baseline data were available for analysis. Bivariate associations with glycemic control (HbA1C) were tested. Hierarchical linear regression was implemented to inform the predictive model. RESULTS In bivariate analyses, race, family structure, household income, insulin regimen, adolescent-reported adherence to diabetes self-management, cognitive development, adolescent responsibility for T1D management, and parent behavior during the illness management discussion were associated with HbA1c. In the multivariate model, the only significant predictors of HbA1c were race and insulin regimen, accounting for 17% of the variance. Caucasians had better glycemic control than other racial groups. Participants using pre-mixed insulin therapy and basal-bolus insulin had worse glycemic control than those on insulin pumps. CONCLUSIONS This study shows that despite associations of adolescent and family-level variables with glycemic control at the bivariate level, only race and insulin regimen are predictive of glycemic control in hierarchical multivariate analyses. This model offers an alternative way to examine the relationship of demographic and psychosocial factors on glycemic control in adolescents with T1D.
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Affiliation(s)
- Shivani Agarwal
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Abbas F. Jawad
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
| | - Victoria A. Miller
- Department of Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, PA 19104
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104
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9
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Snyder LL, Truong YKN, Law JR. Evaluating Substance Use and Insulin Misuse in Adolescents With Type 1 Diabetes. DIABETES EDUCATOR 2016; 42:529-37. [PMID: 27480524 DOI: 10.1177/0145721716659149] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE Substance use behaviors often emerge during adolescence, and adolescents with type 1 diabetes (T1D) may be at risk for engaging in traditional substance use (eg, alcohol, tobacco, and illicit substances) as well as a unique form of substance use: insulin misuse. The purpose of this exploratory study was to examine substance use and insulin misuse in adolescents with T1D. METHODS Sixty adolescents aged 12 to 20 years with T1D (n = 60) completed surveys on substance use, insulin misuse, and diabetes self-management during a routine diabetes appointment. Demographic measures were summarized by mean (SD) or percentage. Prevalence of substance use and insulin misuse was calculated and stratified by demographic and clinical characteristics. Two-sample t test (continuous variables) and chi-square analysis (categorical variables) determined statistically significant differences. RESULTS The prevalence of ever using substances was 36.7%, and that for ever misusing insulin was 19%. Older participants (17.1 ± 1.8 vs 15.6 ± 1.9 years; P < .01) and those with depression (31.8% vs 7.9%; P = .02) were more likely to use substances. Disordered eating behaviors were the most frequently reported reason for insulin misuse. Self-harm intent was reported by one-third of insulin misusers. Substance use and insulin misuse were not related to glycemic control or diabetes self-management behaviors. CONCLUSIONS The diabetes care team should be aware that substance use and insulin misuse are common in adolescents with T1D. Screening for these risky behaviors is critical in those who are older or have mental health disorders. Effective education, prevention, and treatment strategies targeted at these behaviors are needed to improve the overall health of this population.
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Affiliation(s)
- Lydia L Snyder
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Snyder, Dr Law)
| | - Young Kinh-Nhue Truong
- Department of Biostatistics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Truong)
| | - Jennifer R Law
- Division of Pediatric Endocrinology, Department of Pediatrics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA (Dr Snyder, Dr Law)
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10
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Abstract
Like their peers in the general youth population, youth with chronic medical conditions (YCMC) are at risk for substance use, including nonmedical use of prescription medications. However, given dangerous disease-substance interactions, the stakes for detecting and intervening on substance use are perhaps even higher for YCMC. Given the risk for nonadherence with chronic disease management, it is incumbent on primary care providers, specialty providers, and behavioral health specialists to be vigilant in asking about substance use and providing brief counseling and referral to substance use treatment when appropriate.
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Affiliation(s)
- Scott E Hadland
- Division of Adolescent/Young Adult Medicine, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Health Policy and Management, Harvard T. H. Chan School of Public Health, Kresge Building, 677 Huntington Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
| | - Leslie Renee Walker
- Division of Adolescent Medicine, Seattle Children's Hospital, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, University of Washington, 1959 Northeast Pacific Street, Box 356320, Seattle, WA 98195, USA
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11
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Ely SF. Sudden Death Related to Diabetes Mellitus: Current and Emerging Relevance to the Forensic Pathologist. Acad Forensic Pathol 2016; 6:154-163. [PMID: 31239887 PMCID: PMC6506998 DOI: 10.23907/2016.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 04/01/2016] [Accepted: 04/25/2016] [Indexed: 11/12/2022]
Abstract
While diabetes mellitus (DM) has historically accounted for substantial worldwide morbidity and mortality, new and evolving epidemiologic trends are forcing the scientific community to view it as a type of emerging disease. This review will summarize the pathophysiology of the disease, present an update of current national statistics and changing epidemiologic patterns, discuss how DM might specifically lead to acute deaths falling under the jurisdiction of the medical examiner/coroner, and suggest a medicolegal standard of practice to maximize their capture and reporting.
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Affiliation(s)
- Susan F. Ely
- Office of Chief Medical Examiner of the City of New York -
Forensic Medicine
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12
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Hogendorf AM, Fendler W, Sieroslawski J, Bobeff K, Wegrewicz K, Malewska KI, Przudzik MW, Szmigiero-Kawko M, Sztangierska B, Mysliwiec M, Szadkowska A, Mlynarski W. Breaking the Taboo: Illicit Drug Use among Adolescents with Type 1 Diabetes Mellitus. J Diabetes Res 2016; 2016:4153278. [PMID: 26858959 PMCID: PMC4709623 DOI: 10.1155/2016/4153278] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 10/11/2015] [Accepted: 10/18/2015] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim of the study was to explore the prevalence of illicit drug use in a group of Polish adolescents with type 1 diabetes (DM1) in comparison with a national cohort of their healthy peers. METHODS Two hundred and nine adolescents with DM1, aged 15-18 years, were studied in 2013 with an anonymous questionnaire prepared for the European School Survey Project on Alcohol and Other Drugs (ESPAD). The control group was a representative sample of 12114 students at the same age who took part in ESPAD in 2011. Metabolic control was regarded as good if self-reported HbA1c was <8% or poor if HbA1c was ≥8%. RESULTS Lifetime prevalence of illicit drug use was lower among adolescents with DM1 than in the control group [58 (28%) versus 5524 (46%), p = 10(-5)]. Cannabis preparations were the most frequently used substances [38 (18.3%) versus 3976 (33.1%), p = 10(-5)], followed by tranquilizers, sedatives, and amphetamine. Lifetime and last 12-month use of cannabis were associated with poorer glycemic control (HbA1c ≥ 8%), p < 0.01 and 0.02, respectively. CONCLUSIONS Adolescents with DM1 report using illicit drugs to a lesser extent than their healthy peers. The use of cannabis is associated with a poorer metabolic control in teens with DM1.
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Affiliation(s)
- Anna M. Hogendorf
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
- *Anna M. Hogendorf:
| | - Wojciech Fendler
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
| | - Janusz Sieroslawski
- Department of Studies on Alcoholism and Other Dependencies, Institute of Psychiatry and Neurology, 02-957 Warsaw, Poland
| | - Katarzyna Bobeff
- Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
| | - Krzysztof Wegrewicz
- Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
| | - Kamila I. Malewska
- Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
| | - Maciej W. Przudzik
- Students' Scientific Circle at the Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
| | - Malgorzata Szmigiero-Kawko
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Beata Sztangierska
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Malgorzata Mysliwiec
- Department of Pediatrics, Diabetology and Endocrinology, Medical University of Gdańsk, 80-211 Gdańsk, Poland
| | - Agnieszka Szadkowska
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
| | - Wojciech Mlynarski
- Department of Pediatrics, Oncology, Hematology and Diabetology, Medical University of Lodz, 91-738 Lodz, Poland
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13
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Hanna KM, Weaver MT, Stump TE, Fortenberry JD, DiMeglio LA. The Relationship of Worry About Hypoglycemia With Diabetes-specific and Typical Youth Behavior Among Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2014; 40:533-542. [PMID: 24676275 DOI: 10.1177/0145721714528997] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE Little is known about the relationship of worry about hypoglycemia with diabetes-specific and typical youth behaviors among emerging adults with type 1 diabetes. This study's purpose was to examine the relationship among worry about hypoglycemia, diabetes management, and glycemic control within the context of alcohol use, hypoglycemia-related weight control behaviors, depressive symptoms, and impulse control among emerging adults with type 1 diabetes. RESEARCH DESIGN AND METHODS The sample was 181 emerging adults with type 1 diabetes who were part of a larger study. Path analysis was used to test associations among worry about hypoglycemia, diabetes management, hypoglycemia-related weight control behaviors (WCB), alcohol use, impulse control, depressive symptoms, and glycemic control. RESULTS Path model fit and modification indices suggested that a feedback loop between worry about hypoglycemia and diabetes management should be incorporated into the original model. Youth with fewer depressive symptoms reported fewer hypoglycemia-related WCB and less worry about hypoglycemia; those with higher impulse control had less alcohol use and better diabetes management; those with lower alcohol use had more worry about hypoglycemia; and better glycemic control was associated with better diabetes management. CONCLUSIONS Health care professionals need to understand how multiple factors related to worry about hypoglycemia and diabetes management interact in emerging adults. In the context of depressive symptoms, impulse control, alcohol use, and hypoglycemia-related WCB, the path model results suggest several potential avenues for intervening to improve glycemic control in emerging adults.
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Affiliation(s)
- Kathleen M Hanna
- Indiana University School of Nursing, Indianapolis, Indiana (Dr Hanna, Dr Weaver) .,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (Mr Stump) .,Indiana University School of Medicine, Indianapolis, Indiana (Dr Fortenberry, Dr DiMeglio)
| | - Michael T Weaver
- Indiana University School of Nursing, Indianapolis, Indiana (Dr Hanna, Dr Weaver).,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (Mr Stump).,Indiana University School of Medicine, Indianapolis, Indiana (Dr Fortenberry, Dr DiMeglio)
| | - Timothy E Stump
- Indiana University School of Nursing, Indianapolis, Indiana (Dr Hanna, Dr Weaver).,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (Mr Stump).,Indiana University School of Medicine, Indianapolis, Indiana (Dr Fortenberry, Dr DiMeglio)
| | - J Dennis Fortenberry
- Indiana University School of Nursing, Indianapolis, Indiana (Dr Hanna, Dr Weaver).,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (Mr Stump).,Indiana University School of Medicine, Indianapolis, Indiana (Dr Fortenberry, Dr DiMeglio)
| | - Linda A DiMeglio
- Indiana University School of Nursing, Indianapolis, Indiana (Dr Hanna, Dr Weaver).,Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana (Mr Stump).,Indiana University School of Medicine, Indianapolis, Indiana (Dr Fortenberry, Dr DiMeglio)
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Isidro ML, Jorge S. Recreational drug abuse in patients hospitalized for diabetic ketosis or diabetic ketoacidosis. Acta Diabetol 2013; 50:183-7. [PMID: 21136122 DOI: 10.1007/s00592-010-0243-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 11/25/2010] [Indexed: 11/25/2022]
Abstract
To evaluate the association between recreational drug use and diabetic ketosis (DK) and diabetic ketoacidosis (DKA) in our area. Retrospective examination of records from a 1,450 bed urban teaching hospital in Spain. All adult admissions for DK or DKA from January 1, 2005, to December 31, 2009 in our hospital were included. Demographic, exploratory (blood pressure, heart rate, respiratory rate), and analytical data (glucose, urea, creatinine, corrected Na(+), K(+), pH, HCO3(-) and HbA1c) at admittance were recorded. In 152 patients, 253 episodes of DK or DKA occurred. Screening for drug use was performed in 40.3% of the events; 20.6% of the episodes (n = 52) were shown to be substance abuse. Cocaine, followed by cannabis and alcohol, was the most frequently involved drug. Poly-substance abuse occurred in 67.3% of them. Comorbidities were present in 11.5 and 39.8% of the cases shown and not shown to be related to drug use (P = 0.00). Seventy percent of the patients who were at least once shown to have consumed drugs, and 15.9% of those who were never shown to have done so, were admitted more than once (P = 0.00). The frequency of recent drug misuse in patients presenting with DK or DKA was high. Substance abuse screening was frequently neglected. Adverse profile, most significantly in readmission to hospital, was found in the patients with positive drug findings. History taking in this context should routinely include questions on substance abuse, and toxicology screening may be worthwhile, particularly in those with the history of frequent readmissions.
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Affiliation(s)
- María L Isidro
- Endocrine Department, Complexo Hospitalario Universitario A Coruña, As Xubias 84, 15006, A Coruña, Spain.
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15
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Engler PA, Ramsey SE, Smith RJ. Alcohol use of diabetes patients: the need for assessment and intervention. Acta Diabetol 2013; 50:93-9. [PMID: 20532803 PMCID: PMC2954251 DOI: 10.1007/s00592-010-0200-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
It is well known that diabetes self-care behaviors are critical to disease progression. Unfortunately, many patients do not adhere to diabetes self-care recommendations despite their importance. Alcohol use has been identified as a barrier to diabetes self-care adherence. Excessive alcohol consumption not only negatively impacts diabetes self-care adherence but also affects the course of diabetes. Diabetes patients who are at-risk drinkers are likely to have poor diabetes treatment adherence, leading to increased morbidity and mortality. Alcohol consumption by diabetes patients is often inadequately assessed and addressed in their medical care. Brief interventions to reduce at-risk drinking have been well validated in a variety of patient populations and offer the potential to improve diabetes treatment adherence and outcome. Assessment and treatment of at-risk drinking could be readily incorporated into routine diabetes care. Strategies for brief assessment of and intervention for at-risk drinking are offered.
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Affiliation(s)
- Patricia A Engler
- Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, DGIM, 111 Plain Street Building, Providence, RI, 02903, USA.
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16
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Dedert EA, Harper LA, Calhoun PS, Dennis MF, Beckham JC. The impact of race on metabolic disease risk factors in women with and without posttraumatic stress disorder. J Clin Psychol Med Settings 2013; 20:46-55. [PMID: 23179072 PMCID: PMC3608190 DOI: 10.1007/s10880-012-9305-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
The literature on PTSD and metabolic disease risk factors has been limited by lacking investigation of the potential influence of commonly comorbid disorders and the role of race. In this study data were provided by a sample of 134 women (63 PTSD and 71 without PTSD). Separate sets of models examining associations of psychiatric disorder classifications with metabolic disease risk factors were used. Each model included race (African American or Caucasian), psychiatric disorder, and their interaction. There was an interaction of race and PTSD on body mass index, abdominal obesity, and triglycerides. While PTSD was not generally associated with deleterious health effects in African American participants, PTSD was related to worse metabolic disease risk factors in Caucasians. MDD was associated with metabolic disease risk factors, but there were no interactions with race. Results support the importance of race in the relationship between PTSD and metabolic disease risk factors. Future research would benefit from analysis of cultural factors to explain how race might influence metabolic disease risk factors in PTSD.
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MESH Headings
- Adult
- Black or African American/psychology
- Blood Pressure/physiology
- Body Mass Index
- Cholesterol, HDL/blood
- Cholesterol, LDL/blood
- Comorbidity
- Depressive Disorder, Major/blood
- Depressive Disorder, Major/ethnology
- Depressive Disorder, Major/psychology
- Diabetes Mellitus, Type 2/blood
- Diabetes Mellitus, Type 2/ethnology
- Diabetes Mellitus, Type 2/psychology
- Female
- Humans
- Middle Aged
- Obesity, Abdominal/ethnology
- Obesity, Abdominal/psychology
- Risk Factors
- Statistics as Topic
- Stress Disorders, Post-Traumatic/blood
- Stress Disorders, Post-Traumatic/ethnology
- Stress Disorders, Post-Traumatic/psychology
- Substance-Related Disorders/blood
- Substance-Related Disorders/ethnology
- Substance-Related Disorders/psychology
- Triglycerides/blood
- Waist-Hip Ratio
- White People/psychology
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Affiliation(s)
- Eric A Dedert
- Durham Veterans Affairs Medical Center, 508 Fulton St. (116 B), Durham, NC 27705, USA.
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Barnard K, Sinclair JMA, Lawton J, Young AJ, Holt RIG. Alcohol-associated risks for young adults with Type 1 diabetes: a narrative review. Diabet Med 2012; 29:434-40. [PMID: 22248115 DOI: 10.1111/j.1464-5491.2012.03579.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM To undertake a narrative review of the impact and pattern of alcohol consumption in young adults with Type 1 diabetes. DATA SOURCES MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of the European Association for the Study of Diabetes, the American Diabetes Association and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK Clinical Research Network, scrutiny of bibliographies of retrieved papers and contact with experts in the field. INCLUSION CRITERIA relevant studies of any design of alcohol consumption and young adults with Type 1 diabetes (age 14-25 years) were included. The key outcomes were the quantity, pattern and impact of alcohol consumption, the effect on diabetes control and the effect of interventions to minimize the risks of alcohol for this population. RESULTS Six articles and two conference abstracts met the inclusion criteria. There were six cross-sectional studies, one qualitative study and one within-subjects design study. Quality of studies was variable. Alcohol use amongst young adults with Type 1 diabetes was reported to be common and potentially harmful. There was a paucity of evidence on interventions to minimize the risks of alcohol in this target group. CONCLUSIONS Research is required to understand the social context of alcohol consumption in this population with a view to developing appropriate interventions to minimize the risks associated with its use.
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Affiliation(s)
- K Barnard
- NETSCC, University of Southampton, Faculty of Medicine, University of Southampton, Southampton, UK.
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18
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Lee P, Greenfield JR, Gilbert K, Campbell LV. Recreational drug use in type 1 diabetes: an invisible accomplice to poor glycaemic control? Intern Med J 2012; 42:198-202. [DOI: 10.1111/j.1445-5994.2011.02653.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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19
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Peters A, Laffel L. Diabetes care for emerging adults: recommendations for transition from pediatric to adult diabetes care systems: a position statement of the American Diabetes Association, with representation by the American College of Osteopathic Family Physicians, the American Academy of Pediatrics, the American Association of Clinical Endocrinologists, the American Osteopathic Association, the Centers for Disease Control and Prevention, Children with Diabetes, The Endocrine Society, the International Society for Pediatric and Adolescent Diabetes, Juvenile Diabetes Research Foundation International, the National Diabetes Education Program, and the Pediatric Endocrine Society (formerly Lawson Wilkins Pediatric Endocrine Society). Diabetes Care 2011; 34:2477-85. [PMID: 22025785 PMCID: PMC3198284 DOI: 10.2337/dc11-1723] [Citation(s) in RCA: 398] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Anne Peters
- University of Southern California Keck School of Medicine, Los Angeles, California, USA
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20
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Psychosocial problems in adolescents with type 1 diabetes mellitus. DIABETES & METABOLISM 2009; 35:339-50. [PMID: 19700362 DOI: 10.1016/j.diabet.2009.05.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 05/11/2009] [Accepted: 05/11/2009] [Indexed: 12/11/2022]
Abstract
Adolescents with diabetes are at increased risk of developing psychiatric (10-20%) or eating disorders (8-30%), as well as substance abuse (25-50%), leading to non-compliance with treatment and deterioration of diabetic control. At high risk are female adolescents with family problems and other comorbid disorders. Impaired cognitive function has also been reported among children with diabetes, mainly in boys, and especially in those with early diabetes diagnosis (< 5 years), or with episodes of severe hypoglycaemia or prolonged hyperglycaemia. Type 1 diabetes mellitus contributes to the development of problems in parent-child relationships and employment difficulties, and negatively affects the quality of life. However, insulin pumps appear to improve patients' metabolic control and lifestyle. The contributions of family and friends to the quality of metabolic control and emotional support are also crucial. In addition, the role of the primary-care provider is important in identifying patients at high risk of developing psychosocial disorders and referring them on to health specialists. At high risk are patients in mid-adolescence with comorbid disorders, low socioeconomic status or parental health problems. Multisystem therapy, involving the medical team, school personnel, family and peer group, is also essential. The present review focuses on the prevalence of nutritional and psychosocial problems among adolescents with diabetes, and the risk factors for its development, and emphasizes specific goals in their management and prevention.
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Lee P, Greenfield JR, Campbell LV. Managing young people with Type 1 diabetes in a 'rave' new world: metabolic complications of substance abuse in Type 1 diabetes. Diabet Med 2009; 26:328-33. [PMID: 19388960 DOI: 10.1111/j.1464-5491.2009.02678.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The taxing transition from adolescence towards adulthood intensifies the impact of a chronic illness such as Type 1 diabetes. It is not uncommon for young people with Type 1 diabetes to use recreational drugs for emotional relief to escape the day-to-day burden of chronic disease. Despite increasing use, especially in the setting of 'rave' parties, there is professional lack of understanding of the impact of recreational drug use on glycaemia and metabolic complications. The current review describes the prevalence of substance abuse in Type 1 diabetes and the acute impact of designer drugs on its management. We propose a practical approach to improve care of young people with Type 1 diabetes using designer drugs.
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Affiliation(s)
- P Lee
- Department of Endocrinology, St Vincent's Hospital, Sydney, NSW, Australia.
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22
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Ramsey SE, Engler PA. At-risk drinking among diabetic patients. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2009; 3:15-23. [PMID: 24357927 PMCID: PMC3864951 DOI: 10.4137/sart.s2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diabetes Mellitus is a serious chronic disease, affecting an increasing number of individuals worldwide. Adherence to diabetes self-care behaviors is key to the successful management of the disease. At-risk drinking is common among diabetic patients and is associated with inferior diabetes treatment adherence and outcomes, resulting in increased mortality and morbidity. Furthermore, individuals with diabetes who engage in at-risk drinking are also in danger of incurring the negative consequences of at-risk drinking found in the general population. Research suggests that alcohol use screening and intervention do not commonly occur during the course of primary care treatment for diabetes. While methods for reducing alcohol use in this population have been largely unexplored to date, brief interventions to reduce at-risk drinking have been well-validated in other patient populations and offer the promise to reduce at-risk drinking among diabetic patients, resulting in improved diabetes treatment adherence and outcomes.
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Affiliation(s)
- Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, U.S. ; Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, U.S
| | - Patricia A Engler
- Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, U.S
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23
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Virmani A, Binienda Z, Ali S, Gaetani F. Links between nutrition, drug abuse, and the metabolic syndrome. Ann N Y Acad Sci 2007; 1074:303-14. [PMID: 17105926 DOI: 10.1196/annals.1369.027] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Nutritional deficiency in combination with drug abuse may increase risk of developing the metabolic syndrome by augmenting cell damage, excitotoxicity, reducing energy production, and lowering the antioxidant potential of the cells. We have reviewed here the following points: effects of drugs of abuse on nutrition and brain metabolism; effects of nutrition on actions of the drugs of abuse; drug abuse and probability of developing metabolic syndrome; role of genetic vulnerability in nutrition/drug abuse and brain damage; and the role of neuroprotective supplements in drug abuse. Nutrition education is an essential component of substance abuse treatment programs and can enhance substance abuse treatment outcomes. The strategies available, in particular the nutritional approach to protect the drug abusers from the metabolic syndrome and other diseases are discussed.
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Affiliation(s)
- Ashraf Virmani
- Sigma tau-HealthScience, Via Treviso 4, Pomezia, 00040, Italy.
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24
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Pedersen-Bjergaard U, Reubsaet JLE, Nielsen SL, Pedersen-Bjergaard S, Perrild H, Pramming S, Thorsteinsson B. Psychoactive drugs, alcohol, and severe hypoglycemia in insulin-treated diabetes: analysis of 141 cases. Am J Med 2005; 118:307-10. [PMID: 15745730 DOI: 10.1016/j.amjmed.2004.07.054] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Accepted: 07/26/2004] [Indexed: 10/25/2022]
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25
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26
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Abstract
BACKGROUND Diabetic ketoacidosis (DKA) and poor glycaemic control in young adults with Type 1 diabetes may be associated with street drug use. There are few studies in the UK looking at the prevalence of drug use in young adults with diabetes. METHODS One hundred and fifty-eight young adults, aged sixteen to thirty years, with Type 1 diabetes attending an urban diabetes clinic were sent an anonymous confidential postal questionnaire to determine the prevalence of street drug use. RESULTS We received 85 completed responses. Twenty-nine percent of respondents admitted to using street drugs. Of those, 68 percent habitually took street drugs more than once a month. Seventy-two percent of users were unaware of the adverse effects on diabetes. INTERPRETATION Self-reported street drug usage in young adults with Type 1 diabetes is common and may contribute to poor glycaemic control and serious complications of diabetes.
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Affiliation(s)
- R S H Ng
- Diabeticare, Hillingdon Hospital, London, UK
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27
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La Greca AM, Bearman KJ, Moore H. Peer relations of youth with pediatric conditions and health risks: promoting social support and healthy lifestyles. J Dev Behav Pediatr 2002; 23:271-80. [PMID: 12177575 DOI: 10.1097/00004703-200208000-00013] [Citation(s) in RCA: 126] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Peer relations and close friendships play important roles in youngsters' emotional development and take on special significance when a child or adolescent has a chronic disease. This article reviews the key ways that peer relations have been examined in youth with chronic pediatric conditions and specifically focuses on (1) the role of peers and close friends as a source of support, (2) friends' influence on treatment adherence, and (3) peers' and friends' impact on health-promoting and health-risk behaviors. In general, youngsters with chronic conditions do not have more problems in their peer relations than other youth, although children with medical conditions that are stigmatizing or that involve the central nervous system (CNS) may encounter peer difficulties. Social support from friends and classmates appears to facilitate youngsters' disease adaptation and may help with the lifestyle aspects of treatment regimens. Adolescent peer-crowd affiliations (e.g., "brains," "jocks") that are linked with health-promoting behaviors may prove beneficial to youngsters' disease management and health. The findings underscore the need for helping children and adolescents disclose their medical condition to peers in positive ways and for including youngsters' close friends in the treatment process and in school-reentry programs after extended medical care. Additional research is needed to develop strategies for incorporating youngsters' peers and friends into the medical management of youth with chronic pediatric conditions.
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Affiliation(s)
- Annette M La Greca
- Department of Psychology, University of Miami, Coral Gables, Florida 33124, USA.
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28
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Coffin CM, Hamilton MS, Pysher TJ, Bach P, Ashwood E, Schweiger J, Monahan D, Perry D, Rogers BB, Brugnara C, Rutledge J, Weiss R, Ash O, Hill H, Meikle W, Roberts W, Geaghan S. Pediatric Laboratory Medicine. Am J Clin Pathol 2002. [DOI: 10.1309/c52d-by0u-vxxu-r360] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Hanna KM, Guthrie DW. Health-compromising behavior and diabetes mismanagement among adolescents and young adults with diabetes. DIABETES EDUCATOR 2001; 27:223-30. [PMID: 11913004 DOI: 10.1177/014572170102700208] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE This study examined the relationship between health-compromising behavior, age, gender, and diabetes mismanagement. METHODS A total of 107 adolescents and young adults, 12 to 24 years old, with type 1 diabetes were asked to complete a health-compromising behavior scale and a diabetes mismanagement scale. RESULTS Based upon participants' responses, the study population was divided into 2 different groups: those involved in health-compromising behavior and those not involved in such behavior. A multiple regression analysis was performed using age, gender, and health-compromising behavior as predictor variables and diabetes mismanagement as the outcome variable. Variables that accounted for significant variance in diabetes mismanagement were being female and being involved in health-compromising behavior. CONCLUSIONS Adolescents and young adults with diabetes appear to be either involved or not involved in health-compromising behavior. Being female and being involved in health-compromising behavior were associated with diabetes mismanagement.
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Affiliation(s)
- K M Hanna
- Indiana University School of Nursing, Indianapolis (Dr Hanna)
| | - D W Guthrie
- University of Kansas School of Medicine Wichita (Dr Guthrie)
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30
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Valencia LS, Cromer BA. Sexual activity and other high-risk behaviors in adolescents with chronic illness: a review. J Pediatr Adolesc Gynecol 2000; 13:53-64. [PMID: 10869964 DOI: 10.1016/s1083-3188(00)00004-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
This article is a literature review of high-risk behaviors, including sexual activity, in adolescents with chronic illness. Three different models describing biopsychosocial constructs for risky behaviors are discussed. Regarding specific behaviors, findings from the literature include a substantial prevalence of sexual activity, but low level of knowledge and low prevalence of contraceptive use, in youth with chronic illness. Regarding substance use, alcohol was the most commonly used substance regardless of medical condition. Overall, substance use, as well as delinquent behavior, was lower among youth with chronic illness when compared to that in comparison groups. Results were mixed regarding the prevalence and determinants of unhealthy eating habits in these populations. Although high-risk behaviors in teenagers with chronic illness may be a normal part of development, awareness of their prevalence, along with early identification and counseling are important in order to anticipate adverse effects on their medical conditions.
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Affiliation(s)
- L S Valencia
- The Ohio State University, College of Medicine and Public Health, Columbus, OH, USA
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31
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Sochett E, Daneman D. Early diabetes-related complications in children and adolescents with type 1 diabetes. Implications for screening and intervention. Endocrinol Metab Clin North Am 1999; 28:865-82. [PMID: 10609124 DOI: 10.1016/s0889-8529(05)70106-7] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Although children and adolescents with type 1 diabetes are faced with the threat of the acute complications of hypoglycemia and ketoacidosis on a day-to-day basis, in the long-term, the microvascular and macrovascular complications of the disease place them at greatest risk for serious morbidity and earlier than expected mortality. The families of children with diabetes should be provided with information about the complications of diabetes beginning at the time of diagnosis, and this information needs to be reinforced throughout the follow-up period. Appropriate surveillance for the earliest evidence of microvascular disease should begin at the onset of puberty and after 3 to 5 years of diabetes. Therapeutic interventions, particularly excellent metabolic control, may be exceedingly effective in preventing complication onset or significantly retarding the rate of progression.
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Affiliation(s)
- E Sochett
- Department of Pediatrics, University of Toronto, Canada
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32
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Abstract
PURPOSE The purpose of this study was to examine involvement in a broad range of health behaviors among adolescents and young adults with diabetes. METHODS The sample consisted of 107 adolescents and young adults (12 to 24 years old) with Type 1 diabetes mellitus. Participants were asked to report involvement in health-enhancing, health-compromising, and diabetes mismanagement behaviors. RESULTS The participants reported low levels of health-compromising behaviors and high levels of health-enhancing behaviors. Females reported significantly higher levels of diabetes mismanagement than males. Males in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than males in early (12 to 14 years) and middle (15 to 17 years) adolescence. Females in late adolescence (18 to 24 years) reported significantly higher levels of health-compromising behaviors than females in early adolescence (12 to 14 years). CONCLUSIONS Diabetes educators who work with youth may want to assess all of these health behaviors, keeping in mind age and gender differences.
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Affiliation(s)
- K M Hanna
- The School of Nursing, University of Wyoming, Laramie, (Dr Hanna)
- Dr. Hanna also is a postdoctoral fellow at Indiana University Schools of Nursing and Medicine, Adolescent Section, Indianapolis
| | - D W Guthrie
- The Department of Pediatrics/Psychiatry, University of Kansas School of Medicine Wichita (Dr Guthrie)
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33
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Danne T, Kordonouri O, Enders I, Hövener G. Monitoring for retinopathy in children and adolescents with type 1 diabetes. ACTA PAEDIATRICA (OSLO, NORWAY : 1992). SUPPLEMENT 1998; 425:35-41. [PMID: 9822192 DOI: 10.1111/j.1651-2227.1998.tb01250.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
In children with an average diabetes onset at 11 y of age, the first retinal changes can be expected after a median diabetes duration of 9 y, while the median time until clinically relevant background retinopathy is 14 y. Periodic examinations of the retinal status become necessary with the onset of puberty or after 5 y of diabetes duration. Only sensitive methods should be used for retinopathy screening; the minimum recommended standard is a stereoscopic slit-lamp biomicroscopic examination in mydriasis. The degree of glycaemic control, both before and after puberty, appears to be of outstanding importance for the development of retinopathy, but the contribution of other factors (arterial blood pressure, lipid abnormalities, sex steroids, smoking and genetic factors) may be of varying relevance in the individual patient. Thus, to improve the long-term prognosis for children with diabetes appropriate screening for retinopathy and associated risk factors is mandatory.
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Affiliation(s)
- T Danne
- Kliniken und Polikliniken für Kinderheilkunde und Kinderchirurgie, Charité-Virchow-Klinikum, Medizinische Fakultät der Humboldt Universität zu Berlin, Germany
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34
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Abstract
PURPOSE To determine: (1) the frequency of risky behaviors (alcohol and other drug use, smoking cigarettes, smokeless tobacco use, and unprotected intercourse); (2) the perception of general risks and diabetes-related risks from risky behaviors; (3) if perception of risk is related to engaging in risky behaviors; and (4) if perception of general risks and diabetes-related risks are influenced by age, gender, or race in adolescents with insulin dependent diabetes mellitus (IDDM). Decreasing risky behaviors in youth with IDDM is important because of their increased vulnerability to specific disease related physiologic and pathologic changes. METHODS A descriptive, cross-sectional design was used. Data on risky behavior and perception of risk were obtained by self-report during a regularly scheduled clinic visit. One hundred and fifty-five adolescents between ages of 10-20 years participated. Correlational and student's t-test analyses were used to test relationships and group differences (age, race, gender). RESULTS Thirty-nine percent of the sample reported alcohol use, 34% reported smoking cigarettes, 8% reported smokeless tobacco use, 10% reported drug use, and 29% reported unprotected intercourse. Perception of risk to peers from these behaviors was significantly higher (t = 8.1, df 153; p < .001) than risk to self. Females reported significantly lower (t = 3.08, df 52; p < .002) risk to self than males. There was no difference in perception of risk between youth who reported participating in risky behaviors (N = 38%) and those who did not (62%). Not surprisingly, the frequency of risky behavior increased with age (F = 15.46; p < .001). CONCLUSIONS Compared to community samples of middle school children, our sample had lower rates for most risky behaviors. As with community samples, the physical risks were known and perceived to be higher for peers than self. Perception of risk was not related to self-reports of risky behaviors. The lower rate of risky behaviors might reflect the success of educational efforts directed toward diabetes management or may be due to later initiation of behaviors, especially if personal social development is delayed. Additional research is indicated in order to understand the timing and trajectory of risky behavior and whether or not perception of risk deters youth with IDDM from engaging in risky behavior.
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Affiliation(s)
- M A Frey
- University of Michigan, School of Nursing, USA
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35
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Abstract
Alcohol and drug use frequency was assessed by means of an anonymous, self-administered questionnaire in 79 diabetic adolescents who attended a diabetic sleep away camp. More than half of the participants reported using tobacco or alcohol at least once and 12%-25% reported greater that five times use in their lifetime. The overall frequency of drug and alcohol use was less than the general adolescent population. A modified Michigan Alcohol Screening Test (MAST) was used to evaluate abnormal drinking patterns, and 40%-50% of 12- and 16-year-old campers had an abnormal score, indicating that almost one-quarter of diabetic teens drink dangerously. There was a high correlation between campers who use drugs or alcohol and a positive family history of alcohol or substance abuse. Few campers perceived alcohol or drug use to affect their diabetic control, and the majority believed their control to be good to excellent, thus demonstrating the impact of denial in diabetic adolescent substance use. Adolescent diabetic assessments should include a psychosocial history, with emphasis on patterns of substance use, family substance abuse, and use of the MAST to identify high-risk individuals.
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Affiliation(s)
- M A Gold
- Department of Pediatrics, University of Maryland School of Medicine, Baltimore
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Passeri LA, Ellis E, Sinn DP. Relationship of substance abuse to complications with mandibular fractures. J Oral Maxillofac Surg 1993; 51:22-5. [PMID: 8419570 DOI: 10.1016/s0278-2391(10)80383-0] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
This retrospective study analyzed the relationship between complications and substance abuse following mandibular fracture. Over a 2-year period, the records of 352 patients with 589 mandibular fractures were reviewed for methods of treatment and other variables, including chronic abuse of drugs. An overall complication rate of 18.5% was found. Positive associations between complications and chronic abuse of alcohol and nonintravenous and intravenous drugs were found. Intravenous drug abusers had a 30%, nonintravenous drug abusers had a 19%, and chronic alcohol abusers had a 15.5% incidence of complications. Those individuals who did not use any drug chronically had a 6.2% complication rate. The results of this study show that chronic substance abuse can significantly affect treatment outcomes for management of mandibular fractures.
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Affiliation(s)
- L A Passeri
- Division of Oral and Maxillofacial Surgery, University of Texas Southwestern Medical Center, Dallas 75235-9031
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