The associations between physical activity, health-related quality of life, regimen adherence, and glycemic control in adolescents with type 1 diabetes: A cross-sectional study

Type 1 diabetes mellitus in children: Patient reported outcomes

The global prevalence of type 1 diabetes mellitus (T1DM) is increasing. Poor glycemic control in children and adolescents leads to both acute and chronic problems, reduced Health Related Quality of Life (HRQoL), and higher healthcare utilization. This study aimed to assess patient-reported outcomes related to self-management adherence, QoL, diabetes-related stigma, glycemic control, and other clinical outcomes along with their determinants, in insulin-treated pediatric T1DM patients in Jordan. A cross-sectional study was conducted from April to October 2023 at two health centers in Northern Jordan. Eligible pediatric T1DM patients attending outpatient clinics were enrolled. Trained pharmacists conducted face-to-face interviews with both children and their guardians, using validated tools that were translated into Arabic. Adherence was evaluated using the Diabetes Management Questionnaire, HRQoL was measured using the Pediatric Quality of Life Inventory 3.0 Diabetes Module, stigma was assessed using the Child Attitude Toward Illness Scale and glycemic control was determined by glycated hemoglobin levels. A total of 150 patients participated in the study. The mean adherence score was 57.4 ± 18.13. Factors such as younger age (P-value = 0.01), higher monthly income (P-value = 0.022) and shorter disease duration (P-value = 0.008) were associated with improved adherence. The mean pediatric QoL score was 63.27 ± 11.86, with male gender (P-value = 0.021) and the absence of disease-related factors (P-value = 0.004) linked to lower QoL scores. Additionally, body mass index (P-value = 0.041) and a family history of DM (P-value = 0.047) were linked to stigma. Most patients (76%) had uncontrolled diabetes, with disease duration (P-value = 0.019) and maternal educational level (P-value = 0.013) influencing glycemic control. These findings highlight that, despite widespread poor glycemic control, insulin adherence and QoL among pediatric T1DM patients in Jordan are above average. Targeted interventions are recommended to improve adherence and, in turn, overall patient outcomes.

Improving Self-Efficacy, Quality of Life, and Glycemic Control in Adolescents With Type 1 Diabetes: Randomized Controlled Trial for the Evaluation of the Family-Centered Empowerment Model

BACKGROUND

Poor glycemic management in adolescents with type 1 diabetes mellitus (T1DM) increases complications. Enhanced control is associated with other factors, such as cultural, socioeconomic, and health care system disparities specific to the Middle East, which can greatly influence individuals' ability to get and use health care services as well as their reaction to treatment approaches.

OBJECTIVE

This study aims to evaluate the impact of the family-centered empowerment model on Jordanian adolescents with T1DM, focusing on their glycosylated hemoglobin levels, self-efficacy, and quality of life (QOL).

METHODS

A randomized controlled trial involved 68 adolescents with T1DM visiting Jordanian Royal Medical Services' clinics. Two sets of participant groups were created: control (n=34) and intervention (n=34). Participants were randomly assigned to either the intervention group, receiving the family-centered empowerment model intervention, or the control group, receiving standard care. Data were collected through face-to-face interviews and medical records.

RESULTS

From April to October 2023, a total of 68 adolescents with T1DM participated in the study at the Jordanian Royal Medical Services. QOL had significant improvement among 13 (38%) of the 34 participants in the intervention group, and the program significantly improved moderate self-efficacy levels in 12 (35%) patients (P<.001). In addition, the average glycosylated hemoglobin levels dropped from 11.25% to 10.23% (P<.001). Additionally, improvements were seen in stress management, communication, and treatment adherence, with a substantial decrease in treatment obstacles. The intervention was successful in improving both clinical and psychosocial outcomes, as evidenced by the fact that the control group showed no noticeable improvements in these parameters.

CONCLUSIONS

The study suggests that patients with T1DM should receive continuous care education sessions, including self-care training, to improve their health. Nurses should also incorporate this training into treatment plans and educational programs for adolescents to enhance their QOL.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06694467; https://clinicaltrials.gov/study/NCT06694467.

The effect of social support and parental monitoring on glycaemic control in adolescents with type 1 diabetes mellitus

RATIONALE

Glycaemic control is a crucial aspect of managing type 1 diabetes mellitus (T1DM). Strict glycaemic control has been proven to reduce the long-term complications of the disease.

AIMS

The aim of this study was to investigate the effect of parental involvement in diabetes care and social support on glycaemic control in adolescents with T1DM.

METHODS

In this cross-sectional study, 94 adolescents and their parents admitted to a university hospital between January and July 2023 were included in the study. The Multidimensional Scale of Perceived Social Support (PMDC-R) and Parental Monitoring Scale (MSPSS) in Diabetes Care of Adolescents with T1DM were used as data collection tools.

RESULTS

Females constituted 63.8% of the adolescents who participated in the study and the glycaemic control of females was significantly lower than males (p < 0.05). The mean HbA1c of the adolescents was 8.65 + 1.57. In the study, PMDC-R and MSPSS scores of adolescents with good and poor glycaemic control were compared. The PMDC-R of the good control group were statistically significantly higher than the poor control group (p < 0.05), but there was no significant difference between the MSPSS scores.

CONCLUSION

Parental supervision plays a protective role in adolescents, and glycaemic control is better as parental supervision increases. Paediatric nurses should collaborate with parents in diabetes management. This approach may help adolescents to be more successful in diabetes management.

Psychological and Clinical Challenges in the Management of Type 1 Diabetes during Adolescence: A Narrative Review

Adolescence, a critical period of physical and psychological development, presents unique challenges in type 1 diabetes (T1D) management due to endocrinological changes, reduced therapeutic adherence, and elevated susceptibility to psychological issues such as depression, anxiety, and eating disorders. This narrative review explores the impact of psychological and behavioral factors on glycemic control in adolescents with T1D. We examine the prevalence and influence of mental health disorders, lifestyle factors, harmful behaviors, and social dynamics on diabetes management and glycemic outcomes. Strategies for improving metabolic control are also reviewed, including cognitive behavioral therapy, technological devices, and educational interventions. The importance of tailored psychological support, family involvement, and targeted interventions to improve adherence to treatment and glycemic control in adolescents with T1D should be emphasized.

Self-care activities in pediatric patients with type 1 diabetes mellitus

INTRODUCTION

Effective diabetes self-management and collaborative responsibility sharing with parents are imperative for pediatric patients with type 1 diabetes mellitus, particularly as they gradually assume more self-care responsibilities. The primary goal of this study was to assess differences in adherence to self-care activities regarding sociodemographics and clinical characteristics in pediatric patients with type 1 diabetes. The secondary goal of this study was to understand the level of parental involvement in diabetes management and to assess the pediatric patients' behaviors (independent or dependent on disease self-management) that relate to sociodemographic and clinical characteristics.

METHODS

This was a comparative cross-sectional and correlational study. The study sample included 182 children and adolescents who had been diagnosed with type 1 diabetes at least 3 months prior. Data collection instruments included a sociodemographic and questionnaire about Adherence to self-care activities and parental involvement in diabetes self-management, as well as a documentation sheet for recording clinical data.

RESULTS

A majority of participants (71%) exhibited non-adherence to self-care tasks, despite 78.0% asserting their independence in diabetes self-management. Notably, insufficient parental involvement in administering insulin therapy significantly predicted severe hypoglycemic episodes.

CONCLUSIONS

Pediatric patients dealing with type 1 diabetes demonstrate a substantial degree of autonomy in managing their condition, paradoxically coupled with self-reported non-adherence to critical self-care responsibilities. Notably, children (aged 8-12) rely more heavily on parental support, especially concerning insulin therapy administration. The study underscores the crucial role of parental engagement in insulin therapy, as its deficiency significantly predicts the likelihood of severe hypoglycemic episodes.