Systematic Review: Diabetes Family Conflict in Young People With Type 1 Diabetes

Glycemic and Psychosocial Correlates of Continuous Glucose Monitor Use Among Adolescents With Type 1 Diabetes

BACKGROUND

Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use.

METHODS

This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (Current Users, Past Users, and Never Users).

RESULTS

Current Users demonstrated significantly lower HbA1c than Never Users and significantly lower diabetes distress than Past Users. CGM use was not associated with family conflict or quality of life.

CONCLUSIONS

CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.

Emotional Contagion Among Adolescents with Type 1 Diabetes Mellitus (T1DM) and Their Primary Caregivers: Benefits of Psychological Support for Family Systems in Pilot Study

BACKGROUND

T1DM is a significant chronic condition that necessitates regular medical monitoring, dietary and physical activity supervision, and daily blood glucose monitoring and insulin therapy. The management of this disease and the transition to adolescence often have a significant psychosocial impact on the individual and their family.

OBJECTIVE

The objective of this correlational study was to examine the reciprocal influence between adolescents and their caregivers, with a particular focus on the beneficial effect of receiving psychological support sessions from family members and adolescents with T1DM in a pilot study.

METHODS

An indicator variable was developed to facilitate an analysis of changes occurring prior to, as well as following, the administration of the treatment in question. Family caregivers received two therapy sessions, and we analyzed their perceived caregiver stress. Adolescents had five sessions, and the reduction in emotional distress was studied in them.

RESULTS

The sample comprised 15 adolescent-family caregiver dyads. All parents were mothers of adolescents, with a mean age of 47.67 and 13.47 years, respectively. Descriptive statistics and Spearman correlations were conducted. Following the completion of the psychological counseling sessions, the data revealed a significant positive correlation between the perceived reduction in global stress experienced by the caregiver and the adolescent's emotional distress, with correlation coefficients of 0.74 and 0.61, respectively. Furthermore, a positive relationship was observed between the reduction in existing difficulties in family role adjustment and the reduction in emotional distress among diabetic youth, with correlation coefficients of 0.72 and 0.57. The frequency of emotional distress of the caregiver also correlated with adolescent emotional distress, with a coefficient of 0.60.

CONCLUSIONS

The findings of this study provide evidence for the circularity of family systems change. A positive emotional contagion effect is observed in the improvements in stress and emotional distress experienced during adolescence and in the family's adjustment to T1DM, as reported by caregivers and their children who received psychological support sessions.

American Diabetes Association Professional Practice Committee, ElSayed NA, McCoy RG, Aleppo G, Balapattabi K, Beverly EA, Briggs Early K, Bruemmer D, Echouffo-Tcheugui JB, Ekhlaspour L, Garg R, Khunti K, Lal R, Lingvay I, Matfin G, Pandya N, Pekas EJ, Pilla SJ, Polsky S, Segal AR, Seley JJ, Srinivasan S, Stanton RC, Bannuru RR. 14. Children and Adolescents: Standards of Care in Diabetes-2025

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.

Updated Psychosocial Surveys With Continuous Glucose Monitoring Items for Youth With Type 1 Diabetes and Their Caregivers

AIM

We added items relevant to continuous glucose monitoring (CGM) to the Diabetes Family Conflict Scale (DFC), Diabetes Family Responsibility Questionnaire (DFR), and Blood Glucose Monitoring Communication Questionnaire (GMC) and evaluated the psychometric properties of the updated surveys.

RESEARCH DESIGN AND METHODS

Youth with type 1 diabetes who recently started CGM and their parents completed the updated surveys and additional psychosocial surveys. Medical data were collected from self-reports and review of the medical record.

RESULTS

Youth (N = 114, 49% adolescent girls) were aged 13.3 ± 2.7 years and had mean glycated hemoglobin (HbA1c) 7.9 ± 0.9%; 87% of them used pump therapy. The updated surveys demonstrated high internal consistency (DFC youth: α = .91, parent: α = .81; DFR youth: α = .88, parent: α = .93; and GMC youth: α = .88, parent: α = .86). Higher youth and parent DFC scores (more diabetes-specific family conflict) and GMC scores (more negative affect related to glucose monitoring) were associated with more youth and parent depressive symptoms (r = 0.28-0.60, P ≤ .003), more diabetes burden (r = 0.31-0.71, P ≤ .0009), more state anxiety (r = 0.24 to r = 0.46, P ≤ .01), and lower youth quality of life (r = -0.29 to -0.50, P ≤ .002). Higher youth and parent DFR scores (more parent involvement in diabetes management) were associated with younger youth age (youth: r = -0.76, P < .0001; parent: r = -0.81, P < .0001) and more frequent blood glucose monitoring (youth: r = 0.27, P = .003; parent: r = 0.35, P = .0002).

CONCLUSIONS

The updated DFC, DFR, and GMC surveys maintain good psychometric properties. The addition of CGM items expands the relevance of these surveys for youth with type 1 diabetes who are using CGM and other diabetes technologies.

Psychosocial factors associated with anxiety and depression in adolescents with epilepsy: A systematic review

Anxiety and depression are common in adolescents with epilepsy. Identifying psychosocial risk factors for anxiety and depression is essential for adolescents with epilepsy to receive appropriate support. This systematic review synthesised findings of studies examining the relationship between psychosocial factors and anxiety and/or depression in adolescents with epilepsy. Outcomes were anxiety, depression, and mixed anxiety & depression. Six electronic databases were searched for studies which: used cross-sectional or prospective designs; quantitatively evaluated the relationship between psychosocial factors and anxiety and/or depression; presented results for adolescents with epilepsy aged 9-18 years; and used validated measures of anxiety and/or depression. Psychosocial factors were categorised as intrapersonal, interpersonal, or parent-specific factors. Sixteen studies (23 articles) were included. All but one were cross-sectional. Regarding intrapersonal factors, alternative mental health difficulties were consistently positively associated with all three outcomes. Negative attitude towards epilepsy, lower seizure self-efficacy, lower self-esteem and stigma were consistently positively associated with depression. Interpersonal factors (i.e., lower family functioning assessed from an adolescent's perspective) and parent-specific factors (i.e., parental stigma, stress, anxiety and psychopathology) were positively associated with at least one outcome. Adolescent epilepsy management should exceed assessment of biological/biomedical factors and incorporate assessment of psychosocial risk factors. Prospective studies examining the interplay between biological/biomedical factors and the psychosocial factors underpinning anxiety and depression in adolescents with epilepsy are needed.

Lived experience of CamAPS FX closed loop system in youth with type 1 diabetes and their parents

AIM

To examine changes in the lived experience of type 1 diabetes after use of hybrid closed loop (CL), including the CamAPS FX CL system.

MATERIALS AND METHODS

The primary study was conducted as an open-label, single-period, randomized, parallel design contrasting CL versus insulin pump (with or without continuous glucose monitoring). Participants were asked to complete patient-reported outcomes before starting CL and 3 and 6 months later. Surveys assessed diabetes distress, hypoglycaemia concerns and quality of life. Qualitative focus group data were collected at the completion of the study.

RESULTS

In this sample of 98 youth (age range 6-18, mean age 12.7 ± 2.8 years) and their parents, CL use was not associated with psychosocial benefits overall. However, the subgroup (n = 12) using the CamAPS FX system showed modest improvements in quality of life and parent distress, reinforced by both survey (p < .05) and focus group responses. There were no negative effects of CL use reported by study participants.

CONCLUSIONS

Closed loop use via the CamAPS FX system was associated with modest improvements in aspects of the lived experience of managing type 1 diabetes in youth and their families. Further refinements of the system may optimize the user experience.

Electrospun nanofiber-based glucose sensors for glucose detection

Diabetes is a chronic, systemic metabolic disease that leads to multiple complications, even death. Meanwhile, the number of people with diabetes worldwide is increasing year by year. Sensors play an important role in the development of biomedical devices. The development of efficient, stable, and inexpensive glucose sensors for the continuous monitoring of blood glucose levels has received widespread attention because they can provide reliable data for diabetes prevention and diagnosis. Electrospun nanofibers are new kinds of functional nanocomposites that show incredible capabilities for high-level biosensing. This article reviews glucose sensors based on electrospun nanofibers. The principles of the glucose sensor, the types of glucose measurement, and the glucose detection methods are briefly discussed. The principle of electrospinning and its applications and advantages in glucose sensors are then introduced. This article provides a comprehensive summary of the applications and advantages of polymers and nanomaterials in electrospun nanofiber-based glucose sensors. The relevant applications and comparisons of enzymatic and non-enzymatic nanofiber-based glucose sensors are discussed in detail. The main advantages and disadvantages of glucose sensors based on electrospun nanofibers are evaluated, and some solutions are proposed. Finally, potential commercial development and improved methods for glucose sensors based on electrospinning nanofibers are discussed.