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Lin YK, Hepworth E, de Zoysa N, McCurley J, Vajravelu ME, Ye W, Piatt GA, Amiel SA, Fisher SJ, Pop-Busui R, Aikens JE. Relationships of hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring glycemic profiles with anxiety and depression symptoms in adults with type 1 diabetes using continuous glucose monitoring systems. Diabetes Res Clin Pract 2024; 209:111596. [PMID: 38428746 PMCID: PMC10960959 DOI: 10.1016/j.diabres.2024.111596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/22/2024] [Indexed: 03/03/2024]
Abstract
AIMS To evaluate relationships of hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles with anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM. METHODS A cross-sectional survey and data collections were completed with 196 T1D adults who used CGM (59% also used automated insulin delivery devices (AIDs)). We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Analysis included simple and multiple linear regression analyses. RESULTS Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs were independently associated with higher anxiety symptoms (P < 0.05), with similar trends in both subgroups using and not using AIDs. Lower hypoglycemia awareness were independently associated with greater depression symptoms (P < 0.05). In participants not using AIDs, more time in hypoglycemia was related to less anxiety and depression symptoms (P < 0.05). Being female and younger were independently associated with higher anxiety symptoms, while being younger was also independently associated with greater depression symptoms (P < 0.05). CONCLUSION Our findings revealed relationships of impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia with anxiety and depression symptoms in T1D adults who use CGMs.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jessica McCurley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK
| | - Simon J Fisher
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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2
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Chao EC, Zhang M, Houle MA, Rataj H. Collaboratively Designing an App for a More Personalized, Community-Endorsed Continuous Glucose Monitoring Onboarding Experience: An Early Study. J Diabetes Sci Technol 2024; 18:14-21. [PMID: 37978817 PMCID: PMC10899834 DOI: 10.1177/19322968231213654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
BACKGROUND Acclimating to a new technology device, such as a continuous glucose monitor (CGM), can be challenging. Current resources may not sufficiently answer questions patients living with diabetes (PWD) may have. We asked how we might improve the process to onboard a PWD to CGM. Our specific aims were (1) to develop, employing a co-designing approach, a prototype of an app for facilitating onboarding to CGM and (2) to obtain early feedback on its usability. METHODS We applied a human-centered design (HCD) approach; this process first seeks to deeply understand the unmet needs and frustrations users face. After wearing a demonstration CGM; observing PWD onboarding with health care professionals (HCPs) in clinic; and interviewing 8 PWD and 2 HCP, we developed, tested, and refined a low-fidelity prototype of a clickable app. With insights from this initial round of feedback, we then created a high-fidelity prototype with 3 key features: (1) individual entry of goals and questions; (2) a daily progress tracker for these goals; and (3) a community portal that facilitates exchange of questions and answers. We used the validated System Usability Scale (SUS) to quantify user feedback. RESULTS Focus group participants found our early app to be usable and acceptable. Measurement of usability by the SUS yielded a score of 74, which is above average (68) reported for all applications tested, per usability.gov. CONCLUSIONS Our early prototype app is a more personalized, additional tool that could bridge an information and support gap for patients who are new to CGM. This app could also help PWD on an ongoing basis, by evolving with them to enhance ease and engagement with diabetes self-management.
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Affiliation(s)
- Edward C. Chao
- University of California, San
Diego and Veterans Administration San Diego Healthcare System, San Diego,
CA, USA
| | - Mingjin Zhang
- University of California, San
Diego, San Diego, CA, USA
| | - Mary A. Houle
- Center for Health Design,
University of California, San Diego, San Diego, CA, USA
| | - Heidi Rataj
- Diabetes Design Initiative, UCSD
Design Lab, San Diego, CA, USA
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3
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Kuei Lin Y, Hepworth E, de Zoysa N, McCurley J, Ellen Vajravelu M, Ye W, Piatt GA, Amiel SA, Fisher SJ, Pop-Busui R, Aikens JE. Associations Between Hypoglycemia Awareness, Hypoglycemia Beliefs, and Continuous Glucose Monitoring Glycemic Profiles and Anxiety and Depression Symptoms in Adults with Type 1 Diabetes Using Advanced Diabetes Technologies. Diabetes Res Clin Pract 2023:111059. [PMID: 38104898 DOI: 10.1016/j.diabres.2023.111059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/13/2023] [Indexed: 12/19/2023]
Abstract
AIMS To evaluate relationships between hypoglycemia awareness, hypoglycemia beliefs, and continuous glucose monitoring (CGM) glycemic profiles and anxiety and depression symptoms in adults with type 1 diabetes (T1D) who use CGM or automated insulin delivery devices. METHODS A cross-sectional survey and data collections were completed with 196 T1D adults who used advanced diabetes technologies. We assessed hypoglycemia awareness (Gold instrument), hypoglycemia beliefs (Attitudes to Awareness of Hypoglycemia instrument), CGM glycemic profiles, demographics, and anxiety and depression symptoms (Hospital Anxiety and Depression Scale). Data were processed via regression analyses and receiver operating characteristic analyses. RESULTS Lower hypoglycemia awareness, weaker "hypoglycemia concerns minimized" beliefs, stronger "hyperglycemia avoidance prioritized" beliefs, female, and younger age were independently associated with higher anxiety symptoms (P<0.05). Lower hypoglycemia awareness, less time in hypoglycemia, and younger age were independently associated with greater depression symptoms (P<0.05). Age of <50 years had 77.8% sensitivity and 48.8% specificity in detecting elevated anxiety symptoms. Spending ≥35% of time with glucose levels >180 mg/dL on CGMs had 85.7% sensitivity and 54.3% specificity in detecting elevated depression symptoms. CONCLUSION Our findings revealed relationships between impaired hypoglycemia awareness, hypoglycemia beliefs, CGM-detected hypoglycemia and anxiety and depression symptoms in T1D adults who use advanced diabetes technologies.
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Affiliation(s)
- Yu Kuei Lin
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
| | - Emily Hepworth
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Nicole de Zoysa
- Department of Diabetes, King's College Hospital NHS Foundation Trust, London SE5 9RS, UK
| | - Jessica McCurley
- Department of Psychology, San Diego State University, San Diego, CA 92182, USA
| | - Mary Ellen Vajravelu
- Center for Pediatric Research in Obesity and Metabolism, University of Pittsburgh School of Medicine, Pittsburgh, PA 15224, USA
| | - Wen Ye
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI 48105, USA
| | - Gretchen A Piatt
- Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - Stephanie A Amiel
- Department of Diabetes, School of Cardiovascular and Metabolic Medicine and Sciences, Kings College London, London SE5 9RJ, UK
| | - Simon J Fisher
- Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY 40508, USA
| | - Rodica Pop-Busui
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
| | - James E Aikens
- Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA
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4
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Natale P, Chen S, Chow CK, Cheung NW, Martinez‐Martin D, Caillaud C, Scholes‐Robertson N, Kelly A, Craig JC, Strippoli G, Jaure A. Patient experiences of continuous glucose monitoring and sensor-augmented insulin pump therapy for diabetes: A systematic review of qualitative studies. J Diabetes 2023; 15:1048-1069. [PMID: 37551735 PMCID: PMC10755613 DOI: 10.1111/1753-0407.13454] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 05/31/2023] [Accepted: 07/22/2023] [Indexed: 08/09/2023] Open
Abstract
AIMS Blood glucose control is central to the management of diabetes, and continuous glucose monitoring (CGM) improves glycemic control. We aimed to describe the perspectives of people with diabetes using CGM. MATERIALS AND METHODS We performed a systematic review of qualitative studies. RESULTS Fifty-four studies involving 1845 participants were included. Six themes were identified: gaining control and convenience (reducing pain and time, safeguarding against complications, achieving stricter glucose levels, and sharing responsibility with family); motivating self-management (fostering ownership, and increasing awareness of glycemic control); providing reassurance and freedom (attaining peace of mind, and restoring social participation); developing confidence (encouraged by the endorsement of others, gaining operational skills, customizing settings for ease of use, and trust in the device); burdened with device complexities (bewildered by unfamiliar technology, reluctant to rely on algorithms, overwhelmed by data, frustrated with malfunctioning and inaccuracy, distressed by alerts, and bulkiness of machines interfering with lifestyle); and excluded by barriers to access (constrained by cost, lack of suppliers). CONCLUSIONS CGM can improve self-management and confidence in patients managing diabetes. However, the technical issues, uncertainty in readings, and cost may limit the uptake. Education and training from the health professionals may help to reduce the practical and psychological burden for better patient outcomes.
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Affiliation(s)
- Patrizia Natale
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE‐J)University of Bari Aldo MoroBariItaly
- Nephrology, Dialysis and Transplantation Unit, Department of Medical and Surgical SciencesUniversity of FoggiaFoggiaItaly
| | - Sharon Chen
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
| | - Clara K. Chow
- Westmead Applied Research CentreWestmead HospitalSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyAustralia
| | - Ngai Wah Cheung
- Westmead Applied Research CentreWestmead HospitalSydneyAustralia
- Sydney Medical SchoolThe University of SydneySydneyAustralia
- Westmead Clinical SchoolWestmead HospitalSydneyAustralia
| | - David Martinez‐Martin
- The University of Sydney Nano Institute (Sydney Nano)The University of SydneySydneyAustralia
- School of Biomedical EngineeringThe University of SydneySydneyAustralia
| | - Corinne Caillaud
- Charles Perkins CentreThe University of SydneySydneyAustralia
- School of Medical SciencesThe University of SydneySydneyAustralia
| | - Nicole Scholes‐Robertson
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
| | - Ayano Kelly
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
- School of Health and Medicine, South Western Sydney CampusUniversity of New South WalesSydneyAustralia
- Rheumatology DepartmentLiverpool HospitalSydneyAustralia
- Ingham Institute of Applied Medical ResearchSydneyAustralia
| | - Jonathan C. Craig
- College of Medicine and Public HealthFlinders UniversityAdelaideAustralia
| | - Giovanni Strippoli
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Department of Precision and Regenerative Medicine and Ionian Area (DIMEPRE‐J)University of Bari Aldo MoroBariItaly
| | - Allison Jaure
- Sydney School of Public HealthThe University of SydneySydneyAustralia
- Centre for Kidney ResearchThe Children's Hospital at WestmeadSydneyAustralia
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5
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Tanenbaum ML, Commissariat PV. Experience with burdens of diabetes device use that affect uptake and optimal use in people with type 1 diabetes. Endocr Connect 2023; 12:e230193. [PMID: 37522857 PMCID: PMC10503226 DOI: 10.1530/ec-23-0193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Accepted: 07/31/2023] [Indexed: 08/01/2023]
Abstract
Diabetes technology continues to advance, with more individuals with type 1 diabetes (T1D) adopting insulin pumps, continuous glucose monitoring (CGM), and automated insulin delivery (AID) systems that integrate real-time glucose data with an algorithm to assist with insulin dosing decisions. These technologies are linked with benefits to glycemic outcomes (e.g. increased time in target range), diabetes management behaviors, and quality of life. However, current devices and systems are not without barriers and hassles for the user. The intent of this review is to describe the personal challenges and reactions that users experience when interacting with current diabetes technologies, which can affect their acceptance and motivation to engage with their devices. This review will discuss user experiences and strategies to address three main areas: (i) the emotional burden of utilizing a wearable device; (ii) the perceived and experienced negative social consequences of device use; and (iii) the practical challenges of wearing devices.
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Affiliation(s)
- Molly L Tanenbaum
- Division of Endocrinology, Gerontology, and Metabolism, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Persis V Commissariat
- Section on Clinical, Behavioral, and Outcomes Research, Joslin Diabetes Center, Boston, Massachusetts, USA
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6
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Winterdijk P, Aanstoot HJ, Nefs G. The impact of real-time sensor technology on quality of life for adults with type 1 diabetes: A Dutch national survey. Diabetes Res Clin Pract 2023; 203:110886. [PMID: 37604282 DOI: 10.1016/j.diabres.2023.110886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/19/2023] [Accepted: 08/18/2023] [Indexed: 08/23/2023]
Abstract
AIMS To examine the impact of real-time continuous glucose monitoring (RT-CGM) on quality of life in Dutch adults with type 1 diabetes, inside/outside automated insulin delivery (AID) systems. METHODS In this cross-sectional retrospective observational study, RT-CGM users completed an online survey including (adapted) validated questionnaires, study-specific items and open-ended questions. RESULTS Of 893 participating adults, 69% used the RT-CGM as part of AID. The overall sample reported improvements in quality of life related to RT-CGM use (irrespective of initial indication), particularly with respect to physical health, emotional wellbeing and energy. Merits for sleep, intimacy and cognitive diabetes load lagged somewhat behind, mostly when RT-CGM was not integrated in AID. Users of AID had significantly larger improvements in overall quality of life, fatigue and diabetes-specific distress than users of sensor-augmented pump or Open Loop treatment. In regression analyses, user evaluations were associated with perceptions of benefit and burden. In qualitative content analysis, benefits (e.g. life 'normalization', increased perceptions of control) outweighed burdens (e.g. technology frustrations, confrontation with diabetes). CONCLUSIONS RT-CGM positively impacted the quality of life of adults with type 1 diabetes. This justifies a (re-)consideration of broader access. Increased support to maximize device benefits and minimize burdens is also warranted.
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Affiliation(s)
- Per Winterdijk
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Henk-Jan Aanstoot
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands.
| | - Giesje Nefs
- Diabeter, Center for Type 1 Diabetes Care and Research, Blaak 6, 3011 TA Rotterdam, the Netherlands; Radboud University Medical Center, Department of Medical Psychology, Huispost 926, PO Box 9101, 6500 HB Nijmegen, the Netherlands; Tilburg University, Center of Research on Psychological Disorders and Somatic Diseases (CoRPS), Department of Medical and Clinical Psychology, PO Box 90153, 5000 LE Tilburg, the Netherlands.
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7
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Jahrami H, Trabelsi K, Vitiello MV, BaHammam AS. The Tale of Orthosomnia: I Am so Good at Sleeping that I Can Do It with My Eyes Closed and My Fitness Tracker on Me. Nat Sci Sleep 2023; 15:13-15. [PMID: 36713639 PMCID: PMC9875581 DOI: 10.2147/nss.s402694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 01/19/2023] [Indexed: 01/22/2023] Open
Affiliation(s)
- Haitham Jahrami
- Department of Psychiatry, Ministry of Health, Manama, Kingdom of Bahrain.,Department of Psychiatry, College of Medicine and Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | - Khaled Trabelsi
- High Institute of Sport and Physical Education of Sfax, University of Sfax, Sfax, 3000, Tunisia.,Research Laboratory: Education, Motricity, Sport and Health, EM2S, LR19JS01, University of Sfax, Sfax, 3000, Tunisia
| | - Michael V Vitiello
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Ahmed S BaHammam
- Department of Medicine, College of Medicine, University Sleep Disorders Center, King Saud University, Riyadh, Saudi Arabia.,The Strategic Technologies Program of the National Plan for Sciences and Technology and Innovation in the Kingdom of Saudi Arabia, Riyadh, Saudi Arabia
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8
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Tanenbaum ML, Commissariat PV. Barriers and Facilitators to Diabetes Device Adoption for People with Type 1 Diabetes. Curr Diab Rep 2022; 22:291-299. [PMID: 35522355 PMCID: PMC9189072 DOI: 10.1007/s11892-022-01469-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW Diabetes technology (insulin pumps, continuous glucose monitoring, automated insulin delivery systems) has advanced significantly and provides benefits to the user. This article reviews the current barriers to diabetes device adoption and sustained use, and outlines the known and potential facilitators for increasing and sustaining device adoption. RECENT FINDINGS Barriers to diabetes device adoption continue to exist at the system-, provider-, and individual-level. Known facilitators to promote sustained adoption include consistent insurance coverage, support for providers and clinics, structured education and support for technology users, and device user access to support as needed (e.g., through online resources). Systemic barriers to diabetes device adoption persist while growing evidence demonstrates the increasing benefits of newest devices and systems. There are ongoing efforts to develop evidence-based structured education programs to support device adoption and sustained use.
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Affiliation(s)
- Molly L Tanenbaum
- Department of Pediatrics, Division of Endocrinology and Diabetes, Stanford University School of Medicine, Stanford, CA, USA.
| | - Persis V Commissariat
- Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA
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