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Chad-Friedman E, Clary L, Jhe G. Disordered eating in adolescents with type 1 diabetes: risk factors and screening recommendations. Curr Opin Pediatr 2024; 36:351-357. [PMID: 38655800 DOI: 10.1097/mop.0000000000001353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
PURPOSE OF REVIEW Adolescents with Type 1 diabetes (T1D) are at significantly greater risk for disordered eating behaviors compared to their peers without T1D. Given that this is a dangerous and potentially lethal combination, this review aims to support pediatric medical providers in increasing competence in identification, assessment, and prevention of disordered eating behaviors in adolescents with T1D. RECENT FINDINGS This review provides an up-to-date synthesis of unique risk factors for disordered eating behaviors in adolescents with T1D, including the daily diabetes management tasks, effects of insulin on weight and hunger, family conflict, and reinforcement from their environment for disordered behaviors. This review recommends two brief screening tools, the Diabetes Eating Problems Survey-Revised (DEPS-R) and Modified SCOFF (mSCOFF), to be used in busy practices; it also provides practical strategies for providersto use with patients in the form of effective, nonjudgmental language. SUMMARY A clear understanding of unique experiences impacting adolescents with T1D may increase use of evidence-based screening tools and identification of disordered eating behaviors among a high-risk population in clinic/practice. In addition, providers' intentional use of nonjudgmental and de-stigmatizing language may lead to more positive interactions for adolescents and willingness to engage in further treatment.
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Affiliation(s)
- Emma Chad-Friedman
- Adolescent and Young Adult Medicine
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital
| | - Lauren Clary
- Children's National Hospital
- George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Grace Jhe
- Adolescent and Young Adult Medicine
- Department of Psychiatry and Behavioral Sciences, Boston Children's Hospital
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Luo D, Cai X, Wang H, Wang Y, Xu J. The role of peer social relationships in psychological distress and quality of life among adolescents with type 1 diabetes mellitus: a longitudinal study. BMC Psychiatry 2024; 24:270. [PMID: 38605327 PMCID: PMC11010305 DOI: 10.1186/s12888-024-05692-5] [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: 06/21/2023] [Accepted: 03/18/2024] [Indexed: 04/13/2024] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes mellitus suffer from diabetes distress and poor health-related quality of life (HRQOL) since living with the condition that differentiates them from their peers. The present study investigated the effects of peer support and stress on diabetes distress and HRQOL and whether positive coping mediated the effects. METHODS We used a prospective study design. A total of 201 adolescents with type 1 diabetes mellitus from 20 cities in 4 provinces were recruited.Participants complete two separate surveys at approximately 18-month intervals. The scales employed at both Time 1 and Time 2 included the Diabetes-Specific Peer Support Measure, Diabetes Stress Questionnaire for Youths, Simplified Coping Style Questionnaire, 5-item Problem Areas in Diabetes Scale, and the Diabetes Quality of Life for Youth scale. RESULTS Baseline peer stress directly predicted diabetes distress and HRQOL at 18 months, even controlling for age, gender, and peer support. However, the direct effect of baseline peer support on 18-month diabetes distress and HRQOL was insignificant. Baseline peer support indirectly affected diabetes distress and HRQOL at 18 months through positive coping, indicating that positive coping plays a mediating role. CONCLUSION The findings suggest that peer social relationships, especially peer stress, and positive coping are promising intervention targets for adolescents facing challenges in psychosocial adaptation.
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Affiliation(s)
- Dan Luo
- School of Nursing, Nanjing University of Chinese Medicine, Jiangsu Province, Nanjing, China.
| | - Xue Cai
- Nursing Department, Zhongda Hospital, Southeast University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China
| | - Yubing Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Jingjing Xu
- Department of Nursing, The First Affiliated Hospital with Nanjing Medical University, Nanjing, China.
- School of Public Health, Nanjing Medical University, Nanjing, China.
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Karahan S, Ağadayı E, Sarı SA, Çelik N, Kömürlüoğlu Tan A, Döğer E. Psychometric Properties of the Turkish Validity and Reliability of the Parent Diabetes Distress Scale. J Clin Res Pediatr Endocrinol 2023; 15:293-301. [PMID: 37559365 PMCID: PMC10448560 DOI: 10.4274/jcrpe.galenos.2023.2023-3-20] [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: 04/19/2023] [Accepted: 07/26/2023] [Indexed: 08/11/2023] Open
Abstract
Objective The aim of this study was to evaluate the validity and reliability of the Turkish translation of the Parent Diabetes Distress Scale (PDDS). Methods The PDDS is a 5-point Likert-type scale with 20 items. After obtaining permission from the scale developers, the study commenced. First, a systematic adaptation of the scale into the Turkish language was performed including translation, expert panel review, back translation, and pilot study. Test-retest was applied to 35 participants. After these procedures, data collection was undertaken using the adapted PDDS and a demographic data collection form. The collected data were analyzed for reliability, including stability of the scale with test-retest and internal consistency of the scale (Cronbach’s α), and validity including construct validity of the scale with confirmatory factor analysis (CFA). Results The parents of 210 teenagers, aged >11 and <18 years, who had been diagnosed with type 1 diabetes mellitus for at least one year were included. Of these parents, 71.9% (n=151) were mothers and 53.3% (n=112) of the children were girls. The Cronbach’s α value was 0.906. The results of the CFA were χ2/df=4.406, p<0.001, comparative fit test 0.704, and goodness of fit tests 0.749. The mean total PDDS score was 2.2±0.7. These results indicate that scores of 1.6 points or less was evaluated as “little or no distress” 1.7-2.4 as “moderate distress,” and >2.4 points as “high distress”. This showed that the majority of the parents in the study experienced moderate or severe diabetes-related distress. Conclusion The Turkish version of the PDDS fulfilled the validity and reliability tests at an acceptable level.
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Affiliation(s)
- Seher Karahan
- Sivas Cumhuriyet University Faculty of Medicine, Department of Medical Education, Sivas, Turkey
| | - Ezgi Ağadayı
- Sivas Cumhuriyet University Faculty of Medicine, Department of Medical Education, Sivas, Turkey
| | - Seda Aybüke Sarı
- Hatay Mustafa Kemal University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Hatay, Turkey
| | - Nurullah Çelik
- Sivas Cumhuriyet University Faculty of Medicine, Department of Pediatric Endocrinology, Sivas, Turkey
| | - Ayça Kömürlüoğlu Tan
- Sivas Cumhuriyet University Faculty of Medicine, Department of Pediatrics, Sivas, Turkey
| | - Esra Döğer
- Gazi University Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkey
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Campbell MS, Butner JE, Wiebe DJ, Berg CA. Daily diabetes-specific family conflict, problems, and blood glucose during adolescence. JOURNAL OF FAMILY PSYCHOLOGY : JFP : JOURNAL OF THE DIVISION OF FAMILY PSYCHOLOGY OF THE AMERICAN PSYCHOLOGICAL ASSOCIATION (DIVISION 43) 2023; 37:223-231. [PMID: 36521134 PMCID: PMC9972298 DOI: 10.1037/fam0001055] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Diabetes-related family conflict is widely regarded as a risk factor for diabetes outcomes, yet it has not been examined on a daily basis. Parental acceptance may attenuate the degree to which family conflict is associated with diabetes outcomes. The present study examined (a) within- and between-person fluctuations in diabetes problems and family conflict, (b) within- and between-person links between conflict and blood glucose (BG) mean, and (c) whether parental acceptance moderated these associations. One hundred eighty adolescents (Mage = 12.92 years) with T1D completed a 14-day diary measuring diabetes problems, conflict with mother, conflict with father, and parental acceptance at the end of each day. Daily average BG values were calculated from glucometer readings. Higher diabetes problems on average across the 14-day diary were associated with more average conflict with mothers (between-person), but daily fluctuations in the number of diabetes problems were not related to daily conflict (within-person). Adolescents with higher conflict with mothers and fathers on average across the 14 days had higher BG means (between-person); however, on days when adolescents reported higher conflict, they had greater risk for low BG (within-person). Daily parental acceptance did not moderate associations between problems and conflict nor conflict and BG mean. This study was the first to examine daily diabetes-specific conflict with mothers and fathers during adolescence. The number of diabetes problems did not predict daily conflict. Fluctuations in daily conflict were associated with greater risk for low BG, underscoring the need for future research examining in-the-moment relations among conflict and BG extremes. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
| | | | - Deborah J. Wiebe
- Psychological Sciences and the Health Sciences Research Institute, University of California, Merced, Merced, CA
| | - Cynthia A. Berg
- Department of Psychology, University of Utah, Salt Lake City, UT
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Rodriguez-Stanley J, Zilioli S, Idalski Carcone A, Slatcher RB, Ellis DA. Naturalistically observed interpersonal problems and diabetes management in older adolescents and young adults with type 1 diabetes. Psychol Health 2023; 38:214-229. [PMID: 34347533 PMCID: PMC8832500 DOI: 10.1080/08870446.2021.1960345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 06/09/2021] [Accepted: 07/20/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study investigated the links between naturalistically observed and self-reported interpersonal problems, diabetes management, and glucose levels in older adolescents and young adults with type 1 diabetes. DESIGN Sixty-eight older adolescents and young adults (aged 17-20 years) participated in a cross-sectional study that consisted of three home visits and a daily diary segment. MAIN OUTCOME MEASURES Participants wore the Electronically Activated Recorder (EAR) for four days to capture interpersonal problems and wore a continuous glucose monitor for blood glucose levels. Researchers also collected HbA1c values, conducted an interview to assess diabetes management, and collected participant-reported severity of interpersonal problems. RESULTS High EAR-observed interpersonal problems were associated with poor diabetes management. Multiple regression analyses revealed that high EAR-observed interpersonal problems continued to explain variance in poor diabetes management after including self-reported interpersonal problems and covariates. CONCLUSION These findings corroborate literature suggesting that negative interactions are associated with type 1 diabetes management. This study is the first to use the EAR to capture naturalistically observed interactions in this population and identify its utility beyond self-reports. These findings highlight the importance of considering naturalistically observed interactions when developing interventions to promote better diabetes management in older adolescents and young adults.
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Affiliation(s)
| | - Samuele Zilioli
- Department of Psychology, Wayne State University
- Department of Family Medicine and Public Health Science, Wayne State University
| | | | | | - Deborah A. Ellis
- Department of Family Medicine and Public Health Science, Wayne State University
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Ispriantari A, Agustina R, Konlan KD, Lee H. Family-centered interventions for children and adolescents with type 1 diabetes mellitus: an integrative review. CHILD HEALTH NURSING RESEARCH 2023; 29:7-23. [PMID: 36760109 PMCID: PMC9925297 DOI: 10.4094/chnr.2023.29.1.7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 12/26/2022] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The purpose of this study was to investigate the effect of family-centered interventions on improving health outcomes in children and adolescents with type 1 diabetes mellitus (T1DM). METHODS A literature search was conducted according to the PRISMA guidelines, using six electronic databases: EMBASE, CINAHL, Medline, CENTRAL, Scopus, and Web of Science. The inclusion criteria encompassed studies with populations of children and adolescents (age <18 years) and at least one parent/caregiver, or only parents/caregivers if the children were very young, and studies that investigated the health outcomes of children and parents/caregivers diagnosed with T1DM. RESULTS From 2,746 published studies, only nine studies met the inclusion criteria. The key interventions were non-technology-based interventions (n=4), technology-based interventions (n=2), and combined technology- and non-technologybased interventions (n=3). The interventions had effects on glycated hemoglobin, adherence to diabetes management, diabetes self-management behaviors, and parentchild teamwork in diabetes management. Other essential effects were children's quality of life, children's problem-solving skills, parents' quality of life, and parents' coping and depression. CONCLUSION Family-centered interventions can effectively improve health outcomes in children and adolescents with T1DM. In the future, family-centered interventions integrated with other approaches, theories, and models should be developed to achieve the best possible outcomes.
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Affiliation(s)
- Aloysia Ispriantari
- Graduate Student, College of Nursing ․ Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea ․ Assistant Professor, Department of Nursing, Institute of Technology and Health Science, Malang, Indonesia
| | - Rismia Agustina
- Graduate Student, Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan ․ Assistant Professor, School of Nursing, Faculty of Medicine, Lambung Mangkurat University, Banjarbaru, Indonesia
| | - Kennedy Diema Konlan
- Graduate Student, College of Nursing ․ Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea ․ Lecturer, Department of Public Health Nursing, School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana
| | - Hyejung Lee
- Associate Professor, College of Nursing ․ Mo-Im Kim Nursing Research Institute, Yonsei University, Seoul, Korea,Corresponding author Hyejung Lee College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea TEL: +82-2-2228-3345 FAX: +82-2-392-5440 E-MAIL:
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Matsumoto H, Nio K, Kawamura T, Obayashi Y, Hotta Y, Yuyama Y, Nishikawa N. Perceptions of diabetes management among adolescents with type 1 diabetes and their caregivers: development and validation of the Japanese version of the diabetes family responsibility questionnaire. Diabetol Int 2022; 14:155-164. [PMID: 36533089 PMCID: PMC9734505 DOI: 10.1007/s13340-022-00609-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 11/24/2022] [Indexed: 12/12/2022]
Abstract
The shift in diabetes management responsibility is critical for adolescents with type 1 diabetes (T1D). Currently, in Japan, there is insufficient progress in the development of scales for evaluating diabetes management responsibility. We developed the Japanese version of the Diabetes Family Responsibility Questionnaire (DFRQ), a scale to evaluate diabetes management responsibility, and verified its reliability and validity. We recruited 12-18-year-old adolescents with T1D and their caregivers. The DFRQ questionnaires (DFRQ-A for adolescents and DFRQ-C for caregivers) were distributed. The responses of 31 pairs were analyzed (adolescents: 9 males, 22 females; mean age: 14.8 ± 1.5 years). The median total DFRQ scores of adolescents (30.0) and caregivers (32.0) were not significantly different (p = 0.269). The internal consistencies (Cronbach's α) were 0.784 and 0.687 for DFRQ-A and DFRQ-C, respectively. DFRQ-A scores and adolescent age demonstrated a weak statistically significant negative correlation (r = - 0.397, p = 0.027), whereas DFRQ-C scores and adolescent age demonstrated a weak negative correlation not statistically significant (r = - 0.311, p = 0.089). Both scores were significantly negatively correlated with self-efficacy for diabetes self-management scores (r = - 0.390, p = 0.030; r = - 0.478, p = 0.006, respectively). Furthermore, a significantly moderate positive correlation was found between these scores (r = 0.624, p < 0.001). We confirmed the reliability and validity of the Japanese version of DFRQ. DFRQ is expected to be used as a dyadic scale to evaluate the status of diabetes management responsibility and its transition during adolescence in Japan.
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Affiliation(s)
- Hiro Matsumoto
- Course of Nursing Science, Graduate School of Medicine, Mie University, Tsu, Mie Japan
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
| | - Kaori Nio
- Graduate School of Nursing, Osaka Metropolitan University, Habikino, Osaka Japan
| | - Tomoyuki Kawamura
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
| | - Yoko Obayashi
- Department of Nursing, School of Health Sciences, Toyohashi Sozo University, Toyohashi, Aichi Japan
| | - Yuko Hotta
- Kashiwara Municipal Hospital, Kashiwara, Osaka Japan
| | - Yoshihiko Yuyama
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
| | - Naoko Nishikawa
- Department of Pediatrics, Graduate School of Medicine, Osaka Metropolitan University, Abeno-Ku, Osaka, Japan
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Koerner R, Rechenberg K. Mindfulness in adolescents and young adults with diabetes: An integrative review. Complement Ther Clin Pract 2022; 49:101659. [PMID: 35986987 DOI: 10.1016/j.ctcp.2022.101659] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Type 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes. METHODS Four databases were searched during May 2021. Included studies were published between 2000 and 2021, evaluated adolescents and young adults, diagnosed with type 1 or type 2 diabetes or prediabetes. Studies were excluded if they were not in English; not original research; evaluated complementary/alternative therapies as a group. To assess for risk of bias, the National Institutes of Health quality assessment tools and the Cochrane Collaboration's tool were utilized. Whittemore and Knafl's (2005) method for conducting an integrative review was utilized to synthesize results. RESULTS We identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes. CONCLUSION Mindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.
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Affiliation(s)
- Rebecca Koerner
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
| | - Kaitlyn Rechenberg
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
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Yi-Frazier JP, Senturia K, Wright DR, Lind C, Malik FS. The clock is ticking: Parental stress around emerging adulthood for adolescents with type 1 diabetes. J Pediatr Nurs 2022; 62:164-170. [PMID: 34294485 PMCID: PMC9273159 DOI: 10.1016/j.pedn.2021.07.012] [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: 12/09/2020] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Our goal was to explore parental views on the challenges and stressors of transition to young adulthood for adolescents with type 1 diabetes and to describe specific strategies used to reduce parents' own stress during this time. DESIGN AND METHODS Focus groups with 39 parents of adolescents with type 1 diabetes were conducted in the greater Seattle area. Semi-structured prompts addressed adolescents' self-care tasks, parental assistance with care, challenges and barriers with self-care tasks, and stress/pressure around self-care. Data was analyzed using qualitative methods for emerging themes. RESULTS Parental stress was heightened when adolescents were approaching common developmental milestones such as driving, moving out, and engaging in risky behaviors that could be exacerbated by poor diabetes management. Thus, most parents reported providing assistance even late into adolescence. Parents shared strategies for guiding adolescents' transition from assisted to independent care with an emphasis on active behaviors parents could continue, thereby lowering their own stress. CONCLUSIONS Parents of adolescents with type 1 diabetes experienced significant stress around their children's transition to independent diabetes self-care management. PRACTICE IMPLICATIONS As part of overall preparation for transition, care providers should be encouraged to communicate with parents about these common stressors and promising avenues for nurturing a teen's independence.
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Affiliation(s)
- Joyce P Yi-Frazier
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA.
| | - Kirsten Senturia
- Center for Clinical and Translational Research, Seattle Children's Research Institute, Seattle, WA, USA
| | - Davene R Wright
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Cara Lind
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA
| | - Faisal S Malik
- Center for Child Health Behavior and Development, Seattle Children's Research Institute, Seattle, WA, USA; Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA
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Commissariat PV, Wentzell K, Tanenbaum ML. Competing Demands of Young Adulthood and Diabetes: A Discussion of Major Life Changes and Strategies for Health Care Providers to Promote Successful Balance. Diabetes Spectr 2021; 34:328-335. [PMID: 34866865 PMCID: PMC8603129 DOI: 10.2337/dsi21-0009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Young adults (YAs) are often faced with many new transitions and major milestones specific to their life stage. For YAs with diabetes, it can be particularly difficult to balance diabetes management with the age-typical demands of young adulthood. Clinicians can play an important role in helping YAs navigate major life changes and find balance in the competing demands of young adulthood, while protecting their health and well-being.
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Case H, Williams DD, Majidi S, Ferro D, Clements MA, Patton SR. Longitudinal associations between family conflict, parent engagement, and metabolic control in children with recent-onset type 1 diabetes. BMJ Open Diabetes Res Care 2021; 9:9/1/e002461. [PMID: 34645616 PMCID: PMC8515442 DOI: 10.1136/bmjdrc-2021-002461] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 09/26/2021] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We prospectively investigated the associations between diabetes-related family conflict, parent engagement in child type 1 diabetes (T1D) care, and child glycated hemoglobin (HbA1c) in 127 families of school-age children who we recruited within the first year of their T1D diagnosis. RESEARCH DESIGN AND METHODS Parents completed the Diabetes Family Conflict Scale-Revised (DFCS-R) to assess for diabetes-related family conflict and the Diabetes Self-Management Questionnaire-Brief (DSMQ-Brief) to assess parent engagement in child T1D care at the initial study visit (T1) and at 12 (T2) and 27 (T3) months later. We also collected child HbA1c at these time points. Our analyses included Pearson correlations and repeated measures linear mixed models controlling for child age, sex, and T1D duration at T1. RESULTS Parents' DFCS-R scores negatively correlated with DSMQ-Brief scores (r=-0.13, p<0.05) and positively correlated with children's HbA1c (r=0.26, p<0.001). In our linear mixed models, parents' DSMQ-Brief scores were unchanged at T2 (β=-0.71, 95% CI -1.59 to 0.16) and higher at T3 (β=8.01, 95% CI 6.89 to 9.13) compared with T1, and there was an association between increasing DFCS-R and decreasing DSMQ-Brief scores (β=-0.14, 95% CI -0.21 to -0.06). Child HbA1c values were significantly higher at T2 (β=0.66, 95% CI 0.38 to 0.94) and T3 (β=0.95, 95% CI 0.63 to 1.27) compared with T1, and there was an association between increasing DFCS-R scores and increasing child HbA1c (β=0.04, 95% CI 0.02 to 0.06). CONCLUSIONS Increasing diabetes-specific family conflict early in T1D may associate with decreasing parent engagement in child T1D care and increasing child HbA1c, suggesting a need to assess and intervene on diabetes-specific family conflict. Trial registration number NCT03698708.
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Affiliation(s)
- Hannah Case
- Mayo Clinic Alix School of Medicine, Mayo Clinic Hospital Jacksonville, Jacksonville, Florida, USA
| | - David D Williams
- Division of Health Services and Health Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Shideh Majidi
- Barbara Davis Center for Diabetes and the University of Colorado Anschutz School of Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA
| | - Diana Ferro
- Division of Health Services and Health Outcomes Research, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Mark Allen Clements
- Pediatrics, Endocrinology, Children's Mercy Hospitals and Clinics, Kansas City, Missouri, USA
| | - Susana R Patton
- Center for Healthcare Delivery Science, Nemours Children's Health System, Jacksonville, Florida, USA
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Kruger S, Deacon E, van Rensburg E, Segal DG. Young adult women's meaning-making of living with type 1 diabetes: towards growth and optimism. Psychol Health 2021; 38:573-590. [PMID: 34510968 DOI: 10.1080/08870446.2021.1977303] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objective: Type 1 diabetes is primarily researched as a medical condition; an examination of the subjective experience of it appears to be neglected. This study explored young women's meaning-making of living with type 1 diabetes in an attempt to uncover possible positive outcomes of growth and optimism.Design: Interpretative phenomenological analysis (IPA) enabled the in-depth exploration of the journeys of a group of young female adults living with type 1 diabetes from distress to positive outcomes. Six participants between the ages of 18 and 25 were recruited from a Centre for Diabetes and Endocrinology, in Parktown, South Africa, to participate in semi-structured interviews about their meaning-making process.Results: Three superordinate themes emerged: (1) the process of reappraising a life with diabetes; (2) the development of diabetes as a lifestyle; and (3) positive outcomes of living with diabetes.Conclusion: Findings in this study demonstrate how the meaning-making process has a significant impact on positive adjustment to living with diabetes. While participants experienced distress, they reframed living with diabetes as an opportunity for empowerment and personal growth. Actively seeking and promoting of the positive outcomes of meaning-making could assist young adults to improve their quality of life while living with diabetes.
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Affiliation(s)
- Sylvia Kruger
- Department of Psychosocial Health, North-West University, Potchefstroom, South Africa and Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
| | - Elmari Deacon
- Department of Psychosocial Health, North-West University, Potchefstroom, South Africa and Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
| | - Esmé van Rensburg
- Department of Psychosocial Health, North-West University, Potchefstroom, South Africa
| | - David Grant Segal
- Optentia Research Focus Area, North-West University, Vaal Triangle Campus, Vanderbijlpark, South Africa
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Main A, Kho C, Miramontes M, Wiebe DJ, Çakan N, Raymond JK. Parents' Empathic Accuracy: Associations With Type 1 Diabetes Management and Familism. J Pediatr Psychol 2021; 47:59-68. [PMID: 34333656 DOI: 10.1093/jpepsy/jsab073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/04/2021] [Accepted: 06/04/2021] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To (1) test associations between parents' empathic accuracy for their adolescents' positive and negative emotions and adolescents' physical and mental health (HbA1c, diabetes self-care, and depressive symptoms) in a predominantly Latinx sample of adolescents with type 1 diabetes and their parents, and (2) explore how familism values were associated with parent empathic accuracy and adolescent physical and mental health in this population. METHODS Parents and adolescents engaged in a discussion about a topic of frequent conflict related to the adolescents' diabetes management. Parents and adolescents subsequently completed a video recall task in which they rated their own and their partner's emotions once per minute; parents' empathic accuracy was calculated from an average discrepancy between parent and adolescent ratings of the adolescent's emotions. Adolescents reported on their depressive symptoms and both parents and adolescents reported on adolescents' diabetes self-care and their own familism values; HbA1c was obtained from medical records. RESULTS Results from structural equation modeling revealed that parents' empathic accuracy for adolescents' negative (but not positive) emotions was uniquely associated with adolescents' HbA1c, self-care, and depressive symptoms. There was limited evidence that familism was related to parent empathic accuracy or adolescent physical and mental health. CONCLUSIONS Promoting parents' empathic accuracy for adolescents' negative emotions in the context of type 1 diabetes management may have important implications for adolescents' mental and physical health.
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Affiliation(s)
| | | | | | | | | | - Jennifer K Raymond
- Children's Hospital Los Angeles, USA.,University of Southern California, USA
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14
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Hickling A, Dingle GA, Barrett HL, Cobham VE. Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes. J Pediatr Psychol 2021; 46:1091-1109. [PMID: 34313769 DOI: 10.1093/jpepsy/jsab052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 04/27/2021] [Accepted: 04/28/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To investigate the relationships between diabetes-specific family conflict and health outcomes of young people with type 1 diabetes (T1D). METHODS A systematic review was performed according to the PRISMA statement (registration number: CRD42020164988). PubMed, Embase, PsycNET, reference lists of included studies, and other relevant reviews were searched (1990-2020). Two independent reviewers screened titles, abstracts, and full-texts. Studies were included if they sampled young people with T1D (mean age between 14 and 25 years) and examined the relationship between diabetes-specific family conflict and the following outcomes: glycated hemoglobin (HbA1c), treatment adherence, blood glucose monitoring, depression, anxiety, quality of life, and/or well-being. RESULTS A total of 20 studies met the predetermined inclusion criteria. Greater diabetes-specific family conflict was significantly related to higher HbA1c values in 17 studies. Seven studies reported a significant association between greater diabetes family conflict and suboptimal treatment adherence and/or less frequent blood glucose monitoring. However, significant relationships between conflict and HbA1c and/or treatment adherence were not found in four studies. Seven studies in total reported that greater diabetes family conflict was significantly related to poorer quality of life or well-being and greater depressive and/or anxiety symptoms in young people. CONCLUSIONS Diabetes-specific family conflict is associated with some adverse health outcomes for young people with T1D. However, more longitudinal studies of young people aged older than 16 years are needed. Screening for and addressing diabetes-specific family conflict is recommended, given the growing number of studies linking family conflict to various adverse health outcomes in young people with T1D.
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Affiliation(s)
- Anna Hickling
- School of Psychology, The University of Queensland.,Mater Research Institute, The University of Queensland.,Children's Hospital Foundation (Queensland)
| | | | - Helen L Barrett
- Mater Research Institute, The University of Queensland.,Department of Endocrinology, Mater Health Services, Mater Hospital
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland.,Child and Youth Mental Health Service, Children's Health Queensland Hospital and Health Service
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15
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Tremolada M, Cusinato M, Bonichini S, Fabris A, Gabrielli C, Moretti C. Health-Related Quality of Life, Family Conflicts and Fear of Injecting: Perception Differences between Preadolescents and Adolescents with Type 1 Diabetes and Their Mothers. Behav Sci (Basel) 2021; 11:bs11070098. [PMID: 34356715 PMCID: PMC8301019 DOI: 10.3390/bs11070098] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/28/2021] [Accepted: 07/01/2021] [Indexed: 01/09/2023] Open
Abstract
Good management of diabetes requires at the same time self-regulation behaviour and a balanced involvement of family components. This cross-sectional study’s aims were: understanding fear of injections and perceptions of family conflicts in preadolescents and adolescents with type 1 diabetes mellitus and their mothers, comparing their perceptions, and identifying the risk factors impacting patients’ quality of life. Eligibility criteria were: treatment for diabetes mellitus type I, currently aged 10–18 years, attending the hospital for annual hospital follow-ups. Exclusion criteria were: intellectual disabilities, inability to complete questionnaires alone and neuropsychiatric illness with active pharmacotherapy. The study design was cross-sectional. Participants were one hundred and two patients (Mean age = 14.6, SD = 2.4; age range = 10–19 years; Females = 52 and Males = 50) and their mothers (Mean age = 46.9, SD = 6.2, age range = 27–63 years), who filled in self and proxy-report questionnaires (N total= 204). The results showed that 20% of patients and 14.7% of their mothers reported clinical scores for fear of self-injection and blood testing. The mothers reported lower fear of injecting and higher family conflicts compared with the patients. Age, fear of injecting and family conflicts were significantly associated with patients’ quality of life perceptions. Clinical considerations and recommendations are given based on the empirical results.
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Affiliation(s)
- Marta Tremolada
- Department of Development and Social Psychology, University of Padua, 35131 Padova, Italy;
- Correspondence: ; Tel.: +39-3474-868-835
| | - Maria Cusinato
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
| | - Sabrina Bonichini
- Department of Development and Social Psychology, University of Padua, 35131 Padova, Italy;
| | - Arianna Fabris
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
| | - Claudia Gabrielli
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
| | - Carlo Moretti
- Pediatric Diabetes Unit, Department of Women’s and Children’s Health, Azienda Ospedale Università di Padova, 35127 Padova, Italy; (M.C.); (A.F.); (C.G.); (C.M.)
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16
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Campbell MS, Berg CA. Topical Review: Developmental Framework of Moderators of Family Conflict for Type 1 Diabetes Outcomes. J Pediatr Psychol 2021; 47:94-98. [PMID: 34414445 DOI: 10.1093/jpepsy/jsab081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/13/2021] [Accepted: 07/17/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To present a developmental framework of family conflict in youth with type 1 diabetes (T1D) that aims to guide future research. METHODS Developmental and pediatric literature are reviewed to highlight family factors that may modify the degree to which diabetes-related family conflict is related to adolescent health outcomes. RESULTS Developmental literature suggests that family conflict is not inherently bad; rather, conflict that arises under optimal conditions (moderate frequency, warm and accepting relationships) can be adaptive for adolescents. However, family conflict is consistently associated with poor disease outcomes in youth with T1D, with few researchers examining specific moderators of these associations. In this topical review, we highlight moderators of family conflict and developmental outcomes identified in adolescents without chronic illness (e.g., cultural factors, parent-child relationship quality, conflict characteristics) and how these moderators may operate for a pediatric chronic illness such as T1D. CONCLUSIONS Incorporating conceptualizations of family conflict from mainstream developmental research has important implications for future research and intervention adaptations on family conflict in pediatric populations.
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17
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Klostermann S, Iskander J, Enlow P, Delamater AM, Dolan L, Pendley JS. Predicting healthcare utilization in youth with type 1 diabetes: The importance of family level variables. Pediatr Diabetes 2021; 22:294-302. [PMID: 33169899 DOI: 10.1111/pedi.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Little is known about how family factors impacting treatment adherence in type 1 diabetes are directly associated with unplanned healthcare utilization (e.g., emergency room visits and hospital admissions). Given the substantial financial burden of diabetes, understanding predictors of healthcare utilization in particular is important to inform behavioral interventions aimed toward improving adherence. RESEARCH DESIGN AND METHODS The current study examined the relationship between family-level variables and healthcare utilization in a sample of 239 youth with type 1 diabetes and their parents. Healthcare utilization was determined via parent report and chart review. Parent- and youth-reports regarding levels of family conflict, youth autonomy, and parent support related to diabetes management were obtained via questionnaire, and negative reciprocity was obtained by coding observations of parent and youth interactions. Generalized Estimating Equations were used to examine the longitudinal association between healthcare utilization and family-level factors. RESULTS Higher levels of observed negative reciprocity were associated with more frequent hospital admissions, while higher levels of youth-reported parent involvement in diabetes management were associated with fewer hospital admissions and ED visits. CONCLUSIONS These findings highlight how family-level factors are directly related to healthcare utilization and point to the continued importance of integrating family-focused behavioral interventions in routine medical care for improving type 1 diabetes outcomes and reducing healthcare costs.
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Affiliation(s)
- Susan Klostermann
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Paul Enlow
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Shroff Pendley
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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18
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Holmbeck GN, Kritikos TK, Stern A, Ridosh M, Friedman CV. The Transition to Adult Health Care in Youth With Spina Bifida: Theory, Measurement, and Interventions. J Nurs Scholarsh 2021; 53:198-207. [PMID: 33482054 DOI: 10.1111/jnu.12626] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE This article focuses on the transition to adult health care in youth with spina bifida (SB) from the perspective of theory, measurement, and interventions. METHODS The purpose of this article is to discuss (a) a theory of linkages between the transfer of medical responsibility from parent to child and the transition from pediatric to adult health care, as mediated by transition readiness; (b) measurement issues in the study of self-management and the transition to adult health care; and (c) U.S.-based and international interventions focused on the transition to adult health care in young adults with SB. FINDINGS Individuals with SB must adhere to a complex multicomponent treatment regimen while at the same time managing a unique array of cognitive and psychosocial challenges and comorbidities that hinder self-management, medical adherence, and the transition to adult health care. Moreover, such youth endure multiple transitions to adult health care (e.g., in the areas of urology, orthopedics, neurosurgery, and primary care) that may unfold across different time frames. Finally, three transition-related constructs need to be assessed, namely, transition readiness, transition completion, and transition success. CONCLUSIONS SB provides an important exemplar that highlights the complexities of conducting research on the transition to adult health care in youth with chronic health conditions. Many transition trajectories are possible, depending on the functioning level of the child and a host of other factors. Also, no single transition pathway is optimal for all patients with SB. CLINICAL RELEVANCE The success of the process by which a child with SB transitions from pediatric to adult health care can have life-sustaining implications for the patient.
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Affiliation(s)
- Grayson N Holmbeck
- Professor, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Tessa K Kritikos
- Postdoctoral Research Fellow, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Alexa Stern
- Graduate Student, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
| | - Monique Ridosh
- Assistant Professor, Marcella Niehoff School of Nursing, Loyola University Chicago, Chicago, IL, USA
| | - Catherine V Friedman
- Research Assistant, Department of Psychology, Loyola University Chicago, Chicago, IL, USA
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19
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Kayle M, Chu DI, Stern A, Pan W, Holmbeck GN. Predictors of Distinct Trajectories of Medical Responsibility in Youth with Spina Bifida. J Pediatr Psychol 2020; 45:1153-1165. [PMID: 32895710 PMCID: PMC7588101 DOI: 10.1093/jpepsy/jsaa065] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To determine if there are distinct developmental trajectories of medical responsibility in youth with spina bifida (SB) across ages 8-17 years and to identify condition-related, parental, and family systems predictors of membership in these trajectory groups. METHODS Participants were 140 youth with SB and their parents who participated in four waves of a longitudinal study across 6 years (ages 8-15 years at Time 1). Multi-method (questionnaires and observed family interactions) and multi-respondent assessments were conducted during home visits. RESULTS Findings revealed that there were two distinct developmental trajectories that characterized this sample, with one being labeled "high increasing" (two thirds of the sample) and one labeled "low increasing" (one third of the sample). Most predictor variables were significantly associated with trajectory group membership, with the exception of ethnicity, SES, and measures of conflict. When all significant univariate predictors were included in the same model, only intelligence quotient (IQ), family stress, and gender were retained as significant. CONCLUSIONS Most youth exhibited relatively rapid increases in responsibility over the course of late childhood and adolescence, but there was a smaller portion of the sample that did not exhibit this type of developmental trajectory. The magnitude of the IQ effect on group differentiation appeared to attenuate the effects of most other predictors. It will be important for clinicians working with youth with SB to recognize that the transfer of medical responsibility from parent to child cannot be expected to unfold in the same manner for all families of youth with SB.
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Affiliation(s)
| | - David I Chu
- Division of Pediatric Urology at Ann & Robert H. Lurie Children's Hospital of Chicago
| | | | - Wei Pan
- School of Nursing, Duke University
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20
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Johansen CB, Rothmann MJ, Andersen A, Beck-Nielsen H, Pouwer F. The role of parental support for emerging adults with type 1 diabetes: A scoping review. Pediatr Diabetes 2020; 21:995-1030. [PMID: 32301182 DOI: 10.1111/pedi.13022] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 03/25/2020] [Accepted: 04/06/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Emerging adults with type 1 diabetes often have poor diabetes self-care and pose a considerable therapeutic challenge. They simultaneously handle a life phase characterized by instability, identity exploration, and transitions and manage a chronic illness that demands structure, self-discipline, and repeated health care contacts. Relation to parents is often ambivalent but typically remains the most stable social support, so parental support could potentially be helpful for diabetes self-care and wellbeing. METHOD This scoping review aimed to identify, summarize and analyze empirical studies (for instance interview studies, questionnaire studies and intervention studies) exploring parental support for emerging adults with type 1 diabetes. Studies were identified in PsycInfo, PubMed, Scopus, and Google Scholar. Data were extracted by one author and checked by another. Study results were synthesized by a convergent mixed methods approach and qualitative thematic analysis. RESULTS We included 26 studies (2829 participants), 16 interview studies, 10 questionnaire studies, and no intervention studies. Five overarching themes were identified: self-care and glycemic control, diabetes-related emotional wellbeing, support characteristics, ambivalence and harms, and core support providers. Parents tended to contribute positively to diabetes self-care, glycemic control, and psychological wellbeing. However, emerging adults did not want to be too dependent on their parents and family, and family could also act unsupportively; when absent, disinterested in diabetes or controlling. CONCLUSION This review underlines that parental support still plays a role for diabetes self-care and wellbeing in emerging adults with type 1 diabetes. Age-appropriate parental support therefore seems a promising path to investigate further.
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Affiliation(s)
- Clea Bruun Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
| | - Mette Juel Rothmann
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark.,Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,Department of Endocrinology, Odense University Hospital, Odense, Denmark
| | - Anette Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | | | - Frans Pouwer
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Psychology, University of Southern Denmark, Odense, Denmark
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21
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Wong SKW, Smith HE, Chua JJS, Griva K, Cartwright EJ, Soong AJ, Dalan R, Tudor Car L. Effectiveness of self-management interventions in young adults with type 1 and 2 diabetes: a systematic review and meta-analysis. Diabet Med 2020; 37:229-241. [PMID: 31769532 DOI: 10.1111/dme.14190] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/22/2019] [Indexed: 12/27/2022]
Abstract
AIM Diabetes in young adulthood has been associated with poor outcomes. Self-management is fundamental to good diabetes care, and self-management interventions have been found to improve outcomes in older adults. We performed a systematic review and meta-analysis to assess the effectiveness of self-management interventions in young adults (aged 15-39 years) with type 1 or type 2 diabetes. METHODS We searched five databases and two clinical trial registries from 2003 to February 2019, without language restrictions. We included randomized controlled trials (RCTs) comparing the effectiveness of self-management interventions with usual care or enhanced usual care in young adults. Outcomes of interest included clinical outcomes, psychological health, self-care behaviours, diabetes knowledge and self-efficacy. Pairwise meta-analysis was conducted using a random effects model and quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. We followed Cochrane gold standard systematic review methodology and reported this systematic review according to PRISMA guidelines. The protocol was registered with PROSEPRO (CRD42018110868). RESULTS In total, 13 studies (1002 participants) were included. Meta-analysis showed no difference between self-management interventions and controls in post-intervention HbA1c levels, BMI, depression, diabetes-related distress, overall self-care, diabetes knowledge and self-efficacy. Quality of evidence ranged from very low to moderate due to study limitations, inconsistency and imprecision. CONCLUSIONS Current self-management interventions did not improve outcomes in young adults with diabetes. Our findings, which contrast with those from systematic reviews in older adults, highlight the need for the development of more effective interventions for young adults with diabetes.
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Affiliation(s)
- S K W Wong
- Lee Kong Chian School of Medicine, Singapore
- National Healthcare Group Polyclinics, Singapore
| | - H E Smith
- Lee Kong Chian School of Medicine, Singapore
| | - J J S Chua
- Lee Kong Chian School of Medicine, Singapore
| | - K Griva
- Lee Kong Chian School of Medicine, Singapore
| | | | - A J Soong
- Lee Kong Chian School of Medicine, Singapore
| | - R Dalan
- Lee Kong Chian School of Medicine, Singapore
- Tan Tock Seng Hospital, Singapore
| | - L Tudor Car
- Lee Kong Chian School of Medicine, Singapore
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22
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Luo D, Xu JJ, Cai X, Zhu M, Wang H, Yan D, Li MZ. The effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes. J Clin Nurs 2019; 28:4478-4487. [PMID: 31410916 DOI: 10.1111/jocn.15033] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 06/24/2019] [Accepted: 08/03/2019] [Indexed: 12/11/2022]
Abstract
AIMS AND OBJECTIVES To examine the effects of family functioning and resilience on self-management and glycaemic control among youth with type 1 diabetes and to determine whether resilience mediates the effects of family functioning on self-management and glycaemic control. BACKGROUND Poor self-management and glycaemic control are common in youth with type 1 diabetes. Family functioning and resilience are known to be important psychosocial factors that contribute to individual health and development. However, no studies have explored the effects of family functioning and resilience on self-management and glycaemic control among youths with type 1 diabetes in mainland China. DESIGN This study was conducted using a survey with a convenience sample following the STROBE guidelines. METHODS A total of 204 Chinese youth who had been diagnosed with type 1 diabetes for at least 6 months were recruited. Family functioning, resilience, self-management and diabetes distress were measured using self-reports and standard measurement tools. Glycaemic control was assessed by glycated haemoglobin (HbA1C ) levels. A structural equation model was used to test the hypothesised model. RESULTS The final model accounted for 52.1% and 19.5% of the total variance of self-management and HbA1C level, respectively. Resilience had a direct effect on self-management and an indirect effect on control of HbA1C . Family functioning had an indirect effect on both self-management and control of HbA1C through resilience. The model remained invariant across the mild-distress and severe-distress groups. CONCLUSION In Chinese youth with type 1 diabetes, resilience positively affected self-management and ultimately optimised glycaemic control, even in the presence of diabetes distress. Family functioning positively affected self-management and glycaemic control by promoting resilience. RELEVANCE TO CLINICAL PRACTICE This study found that family functioning and resilience had positive effects on self-management and glycaemic control in youth. This study confirms the importance of incorporating resilience assessments and family-based resilience interventions into clinical nursing practice with youth with type 1 diabetes.
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Affiliation(s)
- Dan Luo
- School of Nursing, Peking University, Beijing, China
| | - Jing-Jing Xu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xue Cai
- School of Nursing, Peking University, Beijing, China
| | - Min Zhu
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Wang
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Dan Yan
- Department of Endocrinology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ming-Zi Li
- School of Nursing, Peking University, Beijing, China
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