Self-Regulation as a Protective Factor for Diabetes Distress and Adherence in Youth with Type 1 Diabetes During the COVID-19 Pandemic

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: 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.

Adolescents' Diabetes Self-Management Regimens and Outcomes During the COVID-19 Pandemic: A Scoping Review

Adolescents with diabetes mellitus (DM) experience poorer glycemic outcomes and lower adherence to self-management regimens compared to other age groups. The coronavirus 2019 (COVID-19) pandemic posed new barriers to DM self-management, including social distancing measures and additional stressors. We conducted a scoping review of peer-reviewed literature to examine self-management regimens and outcomes among adolescents aged 10-17 years with type 1 and type 2 DM during the pandemic. Our scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three online databases, screened articles through a rigorous process, and assessed bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The findings from the included articles were categorized into six thematic areas: glycemic control/monitoring, insulin administration/regimens, weight/lifestyle behaviors, inpatient care/acute complications, outpatient care/telemedicine utilization, and psychosocial well-being. The findings from the included articles (n = 32) varied. Adolescents who used continuous glucose monitoring (CGM), regularly adjusted insulin doses, and utilized telemedicine generally maintained or improved glycemic control during the pandemic. However, many adolescents gained weight, reduced their physical activities, worsened their diet and sleep habits, and experienced increased stress, all of which negatively impacted glycemic control. Rates of acute complications and hospitalizations varied among adolescents. Telemedicine was widely used and viewed positively by adolescents with DM. Adolescents with DM faced various physical, behavioral, and psychosocial challenges during the COVID-19 pandemic. Further research is needed to assess the long-term impacts of the pandemic on this population. Multilevel interventions and preparedness efforts are required to improve and sustain adolescents' DM self-management outcomes during public health emergencies, particularly focused on promoting CGM use, increasing physical activity levels, improving dietary habits, and reducing stress.

Changes in Self-Efficacy During COVID-19 Among Adolescents With Type 1 Diabetes Mellitus: A Qualitative Study

INTRODUCTION

The purpose of this longitudinal, qualitative study was to examine the impact of the COVID-19 pandemic on self-efficacy and diabetes management among youth diagnosed with type 1 diabetes mellitus (T1DM).

METHODS

We conducted two semi-structured interviews with adolescents diagnosed with T1DM (n = 18) and their maternal caregivers (n = 20) over 6-9 months, to understand how their confidence in the adolescent's ability to manage their diabetes changed during the pandemic. Interviews were transcribed and coded by four raters, establishing inter-reliability.

RESULTS

Four themes emerged: Preventing Adverse Glycemic Events, Useful Glucose Trend Information, Improved Diabetes Management, and Downsides of Technology. Most adolescents (63%) reported increased confidence in their ability to manage diabetes during the pandemic. Over half of these adolescents were already using an insulin pump, and a substantial number (33%) updated their insulin delivery method. Both adolescents and caregivers cited diabetes devices as a factor in their self-efficacy for diabetes management.

DISCUSSION

Findings illustrate the importance of diabetes management in the daily lives of adolescents diagnosed with T1DM, and the potential benefits of diabetes devices during disruptions to care.

Navigating the Challenges and Resilience in the Aftermath of the COVID-19 Pandemic in Adolescents with Chronic Diseases: A Scoping Review

BACKGROUND/OBJECTIVES

The COVID-19 pandemic has profoundly affected the lives of adolescents worldwide, especially those living with chronic diseases. This study aims to explore the impact of the COVID-19 pandemic on the daily lives of adolescents with chronic diseases.

METHODS

This is a scoping review that follows the guidelines proposed by JBI. Eligibility criteria include articles focusing on adolescents aged 10 to 19 during the COVID-19 pandemic, regardless of chronic diseases. Searches were performed in PUBMED, LILACS, CINAHL, SCOPUS, grey literature, and manual searches in March 2024.

RESULTS

This review is composed of 35 articles. The analysis revealed two main categories: (1) Adolescents facing social isolation, school closure, and new family interactions, striving to reinvent themselves, and (2) Chasing the best decision: following up the chronic disease while fighting the COVID-19 pandemic. These categories encompass subcategories highlighting changes in social and family interactions and lifestyle habits. The findings suggest a multifaceted interaction of factors influencing adolescents' well-being, including improved family bonding, heightened disease management, and increased stress and strains on resources.

CONCLUSIONS

This review emphasizes the importance of long-term follow-up and social inclusion efforts for adolescents with chronic diseases and their families, addressing their unique needs during public health crises.

Diabetes distress in urban Black youth with type 1 diabetes and their caregivers: associations with glycemic control, depression, and health behaviors

OBJECTIVES

Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms.

METHODS

Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression.

RESULTS

DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management.

CONCLUSIONS

Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.

The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition

The Protective Role of Self-Regulation for HRQOL of Adolescents with a Chronic Physical Health Condition A physical chronic condition comes with many challenges and negatively impacts the healthrelated quality of life (HRQOL) of those affected. Self-regulation plays an important role in successfully coping with the demands of a chronic condition. In line with a resource-oriented approach, this study aimed to investigate themoderating effect of self-regulation on the relationship between disease severity andHRQOL. For this, 498 adolescents with cystic fibrosis, juvenile idiopathic arthritis, or type-1 diabetes aged of 12-21 years (M= 15.43, SD= 2.07) were recruited through three patient registers. Subjective disease severity, self-regulation (Brief Self-Control- Scale), andHRQOL (DISABKIDSChronicGenericMeasure)were examined at two time points (T₁ and T₂, one year apart). Cross-sectional analysis showed significant effects of subjective disease severity and self-regulation on HRQOL. Prospective analysis, in which HRQOL at T₁ was controlled for, revealed that disease severity only predicted emotion-related HRQOL at T₂; selfregulation emerged as a predictor for HRQOL subscales independence, emotion, inclusion, exclusion, and treatment. A significantmoderation effect of self-regulation was found on the relationship between disease severity and HRQOL emotion. Our results highlight the positive impact of self-regulation on quality of life, specifically in the context of chronic conditions and represent a starting point for prevention and intervention approaches.

5. Facilitating Positive Health Behaviors and Well-being to Improve Health Outcomes: Standards of Care in Diabetes-2024

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.

Anxiety, Distress and Stress among Patients with Diabetes during COVID-19 Pandemic: A Systematic Review and Meta-Analysis

The prevalence of mental health disorders has increased during the COVID-19 pandemic. Patients with chronic diseases, such as diabetes, are a particularly vulnerable risk group. This study aims to assess the levels and prevalence of anxiety, distress, and stress in patients with diabetes during the COVID-19 pandemic. A systematic review was conducted in CINAHL, Cochrane, LILACS, Medline, SciELO, and Scopus in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Thirty-seven articles with a total of 13,932 diabetic patients were included. Five meta-analyses were performed. The prevalence of anxiety was 23% (95% CI = 19–28) in T1DM and 20% (95% CI = 6–40) in T2DM patients. For diabetes distress it was 41% (95% CI = 24–60) for T1DM and 36% in T2DM patients (95% CI = 2–84). For stress, the prevalence was 79% (95% CI = 49–98) in T1DM patients. People with diabetes have significant psychiatric comorbidity as well as psychological factors that negatively affect disease management, increasing their vulnerability in an emergency situation. To establish comprehensive care in diabetic patients addressing mental health is essential, as well as including specific policy interventions to reduce the potential psychological harm of the COVID-19 pandemic.