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Romeo GR, Bennetti M, Votta J, Gibson C, Gatti S, Toschi E. Overcoming Barriers to Diabetes Management in Young Adults with Type 1 Diabetes by Leveraging Telehealth: A Pilot Study. Endocr Pract 2024; 30:135-140. [PMID: 38008258 DOI: 10.1016/j.eprac.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE The LIFT-YA (leveraging intensive follow-up treatment in young adults) quality improvement program was developed to address clinical and social barriers in young adults (YA) with type 1 diabetes (T1D), using telehealth visits to promote clinic attendance and improve diabetes care. METHODS LIFT-YA enrolled YA aged 18-30 with T1D and HbA1c >8% (64 mmol/mol) who had established adult care in our diabetes clinic. The 6-month, 7-visit hybrid program was facilitated by a case manager serving as the liaison between participants and the care team. The primary end-points were within-group and between-group changes from the baseline in HbA1c at the last visit and adoption of continuous glucose monitoring (CGM). RESULTS Of the 57 eligible YA, 24 were enrolled and 33 were unable to participate (UTP). Thirteen of the enrolled participants attended at least 4/7 visits ("completers", C), whereas 11 were noncompleters (NC). HbA1c at the end of the program was significantly lower in the C versus UTP group [median -1.0; IQR (-0.6, -2.5) vs -0.25 (0.2, -1.0) in UTP; P < .05]. The percentage of CGM users significantly increased by 70% in the C group (P < .05), but did not change in the NC and UTP groups. Limited access to telehealth and the high cost of frequent visits were the main hurdles preventing enrollment into or completion of the program. CONCLUSIONS The LIFT-YA pathway was associated with a significant HbA1c reduction and an increase in the adoption of CGM. Policy changes are necessary to expand access to LIFT-YA and other programs for high-risk YA with T1D in underserved communities and across all backgrounds.
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Affiliation(s)
- Giulio R Romeo
- Joslin Diabetes Center, Boston, Massachusetts; Beth Israel Deaconess Medical Center, Division of Endocrinology, Boston, Massachusetts (both at Harvard Medical School)
| | | | | | | | - Sarah Gatti
- Joslin Diabetes Center, Boston, Massachusetts
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Alhamed A. Assessing the readiness to transition to adult care, perceived medication barriers, and glycemic control among teens with type 1 diabetes. Appl Nurs Res 2024; 75:151772. [PMID: 38490800 DOI: 10.1016/j.apnr.2024.151772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 10/07/2023] [Accepted: 02/18/2024] [Indexed: 03/17/2024]
Abstract
AIM This study assessed the readiness to transition (RT) from pediatric to adult care, perceived medication barriers (PMB), and glycemic control in teens with type one diabetes (T1D). BACKGROUND During the transition from pediatric to adult care, teens with T1D are at risk of long-term complications related to impaired adherence. With the increasing prevalence of T1D in Saudi Arabia, research is required to identify the challenges facing teens with T1D during their transition. METHODS This was a cross-sectional study with a convenient sample of 83 adolescents (12-17 years old) diagnosed with T1D for ≥6 months, their parents, and their pediatric endocrinologists from the pediatric endocrinology clinic in a tertiary hospital in Riyadh. The RT Questionnaire was used to measure RT, and the Medication Barriers Scale was used to measure PMB. Glycemic control was measured using hemoglobin A1c (HbA1c). RESULTS About 96 % of teens had HbA1c > 7 %. Male teens had higher HbA1c than female teens. Teens and their parents reported high PMB and low RT. PMB (teens), disease duration, family history of diabetes mellitus, and comorbidity were significant predictors of RT (parents). PMB (teens), teens' age, and having a family history of diabetes mellitus were significant predictors of RT (providers). RT (parents) and RT (providers) were the only significant predictors of HbA1c, with RT (providers) being the strongest predictors of HbA1c. CONCLUSIONS Health policy reform is required to develop national RT programs to prepare teens with T1D to take full responsibility for managing their medical conditions while ensuring adherence.
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Affiliation(s)
- Arwa Alhamed
- College of Nursing, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia.
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Iyengar JJ, Ang L, Rodeman KB, Rao A, Lin YK, Broome DT, Fanous N, Reinert RB, Konigsberg A, Weatherup E, Hagar C, Rogosch D, Florek J, Carey B, Wyckoff J, Lee J, Thomas IH, Soleimanpour SA. A Novel Receivership Model for Transition of Young Adults With Diabetes: Experience From a Single-center Academic Transition Program. Endocr Pract 2024; 30:113-121. [PMID: 38029926 DOI: 10.1016/j.eprac.2023.11.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/08/2023] [Accepted: 11/21/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVE The transition from pediatric to adult care for young adults with diabetes represents an important but often challenging time characterized by a shift from a family-centered care model of pediatrics to a patient-centered care model of adult medicine. We developed a structured transition program based on an adult receivership model at a large academic medical center to improve care coordination and patient satisfaction with the transition process. METHODS From 2016 to 2020, we implemented a series of quality improvement efforts for young adults aged 18 to 23 years with diabetes by incorporating best practices from the American Diabetes Association guidelines on care for emerging adults. We measured transition orientation attendance, patient satisfaction, hemoglobin A1c (HbA1c) pre- and post-transfer, and care gaps to determine the impact of the program. RESULTS In this study, 307 individuals with type 1 diabetes and 16 individuals with type 2 diabetes were taken care of by the adult endocrinology department at the University of Michigan between January 1, 2016 and October 31, 2020. We observed high attendance rates (86% among internal transfers) and favorable patient satisfaction scores for the transition orientation session. Despite the glycemic challenges posed during the transition, HbA1c modestly yet significantly improved 1-year after transfer (-0.4%, P < .01). CONCLUSION We successfully established and maintained a young adult diabetes transition program using a quality improvement approach. Future work will focus on reducing care gaps at the time of transfer, assessing long-term retention rates, and enhancing care coordination for patients referred from outside the health network.
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Affiliation(s)
- Jennifer J Iyengar
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Lynn Ang
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Kathryn Bux Rodeman
- Department of Maternal Fetal Medicine and Endocrinology, Promedica Physicians Group, Perrysburg, Ohio
| | - Amith Rao
- Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | - Yu Kuei Lin
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - David T Broome
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Nada Fanous
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Rachel B Reinert
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Anna Konigsberg
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Emily Weatherup
- Adult Diabetes Education Program, Michigan Medicine, Ann Arbor, Michigan
| | - Christine Hagar
- Adult Diabetes Education Program, Michigan Medicine, Ann Arbor, Michigan
| | - Danielle Rogosch
- Adult Diabetes Education Program, Michigan Medicine, Ann Arbor, Michigan
| | - Jacinta Florek
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Brittany Carey
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jennifer Wyckoff
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Joyce Lee
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan; Susan B. Meister Child Health Evaluation and Research Center, University of Michigan, Ann Arbor, Michigan
| | - Inas H Thomas
- Division of Endocrinology, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, Michigan
| | - Scott A Soleimanpour
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan; Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, Michigan; Medicine Service, Endocrinology and Metabolism Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan.
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ElSayed NA, Aleppo G, Bannuru RR, Bruemmer D, Collins BS, Ekhlaspour L, Hilliard ME, Johnson EL, Khunti K, Lingvay I, Matfin G, McCoy RG, Perry ML, Pilla SJ, Polsky S, Prahalad P, Pratley RE, Segal AR, Seley JJ, Stanton RC, Gabbay RA. 14. Children and Adolescents: Standards of Care in Diabetes-2024. Diabetes Care 2024; 47:S258-S281. [PMID: 38078582 PMCID: PMC10725814 DOI: 10.2337/dc24-s014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
The American Diabetes Association (ADA) "Standards of Care in Diabetes" includes the ADA's current clinical practice recommendations and is intended to provide the components of diabetes care, general treatment goals and guidelines, and tools to evaluate quality of care. Members of the ADA Professional Practice Committee, an interprofessional expert committee, are responsible for updating the Standards of Care annually, or more frequently as warranted. For a detailed description of ADA standards, statements, and reports, as well as the evidence-grading system for ADA's clinical practice recommendations and a full list of Professional Practice Committee members, please refer to Introduction and Methodology. Readers who wish to comment on the Standards of Care are invited to do so at professional.diabetes.org/SOC.
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Núñez-Baila MÁ, Gómez-Aragón A, González-López JR. Sociodemographic and Clinical Determinants on Health-Related Quality of Life in Emerging Andalusian Adults with Type 1 Diabetes: A Cross-Sectional Study. J Clin Med 2023; 13:240. [PMID: 38202247 PMCID: PMC10779847 DOI: 10.3390/jcm13010240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/16/2023] [Accepted: 12/27/2023] [Indexed: 01/12/2024] Open
Abstract
(1) Background: Having type 1 diabetes during emerging adulthood can impact quality of life due to the challenge of balancing optimal glycemic blood levels with a period of transition and exploration. The purpose of this study was to characterize the quality of life of emerging adults aged 18 to 29 years with type 1 diabetes and to determine the associations between dimensions of Health-Related Quality of Life in type 1 diabetes and sociodemographic and diabetes-related variables. (2) Methods: This cross-sectional descriptive study was conducted in Andalusia, Spain, from October 2021 to July 2022. A total of 362 emerging adults with type 1 diabetes (67.4% women, mean age 22.8 ± 3.4 years) participated. Data were gathered via sociodemographic information form and the ViDa1 scale. Statistical evaluations, encompassing descriptive analyses, t-tests, ANOVA, Pearson correlations, and logistic regression, were conducted using SPSSv26, adhering to STROBE guidelines. (3) Results: Among the participants, 52.1% have a glycosylated hemoglobin level over 7%. Interference with Life is correlated with sex, age, and age at diagnosis, with age being the only predictor. Self-Care is correlated with and predicted by glycosylated hemoglobin levels. Well-being is correlated with and predicted by sex, Body Mass Index, and glycosylated hemoglobin levels. Concern about the Condition is correlated with and predicted by sex and glycosylated hemoglobin levels. (4) Conclusions: Despite concerns about their disease, participants generally maintain optimal levels of Health-Related Quality of Life in type 1 diabetes. Predictive factors for Health-Related Quality of Life in type 1 diabetes in this group include sex, age, Body Mass Index, and glycosylated hemoglobin.
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Affiliation(s)
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
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