Alcohol-associated risks for young adults with Type 1 diabetes: a narrative review

Knowledge, safety, and impact of alcohol consumption in young adults with type 1 diabetes mellitus: a qualitative study

PURPOSE

To explore the lived experiences of alcohol consumption among young adults with type 1 diabetes.

METHODS

Fourteen semi-structured interviews were conducted amongst young adults aged between 18 and 25 years, inclusive, with type 1 diabetes and experience consuming alcohol. Interviews were transcribed verbatim and analysed to identify common themes regarding their experiences.

RESULTS

The interviews confirmed that young adults with type 1 diabetes engage in social, and occasionally excessive, drinking behaviour. Furthermore, the interviews revealed four key themes: (i) Several sources contribute to a widely inconsistent understanding of the impact and management of alcohol consumption; (ii) Perceived inconvenience of maintaining healthy glycaemic control whilst drinking socially; (iii) Engagement in proactive strategies for harm reduction occurred when convenient; and (iv) Impact of modern diabetes technology in overcoming previous burdens and promoting glycaemic safety.

CONCLUSION

Young adults with type 1 diabetes continue to need anticipatory education surrounding safe alcohol consumption and behaviours, as well as ongoing support and encouragement to ensure engagement with traditional self-management tasks. Significant alcohol-diabetes related safety issues, particularly hypoglycaemia do occur, and were captured within this small sample and study. Diabetes technology has an important complementary role along with education and tailored support strategies to support health and safe glucose control during alcohol consumption.

Effect of Ethanol Consumption on the Accuracy of a Glucose Oxidase-Based Subcutaneous Glucose Sensor in Subjects with Type 1 Diabetes

Continuous glucose monitors (CGM) have improved the management of patients with type 1 diabetes (T1D), with glucose oxidase (GOx)-based sensors being the most used. However, they are potentially subject to both electrochemical and enzymatic interferences, including those related to changes of pH. The objective of this study is to investigate the effect of ethanol, given as beer along with a mixed meal, on the accuracy of a commercial GOx-CGM. Data from 12 T1D participants in a randomized crossover trial to evaluate the effect of meal composition and alcohol consumption on postprandial glucose concentration were used. Absolute error (AE) and mean absolute relative difference (MARD) were calculated. The differences between the alcohol and nonalcohol scenarios were assessed using the Mann−Whitney U and Wilcoxon signed-rank tests. The AE in the alcohol study was low, but significantly greater as compared to the study without alcohol (p-value = 0.0418). The MARD was numerically but not significantly greater. However, both variables were greater at pH < 7.36 and significantly affected by time only in the alcohol arm. In T1D, alcohol consumption affects the accuracy of a GOx-CGM. This effect could be at least partially related to the ethanol-induced changes in pH.

Opportunities for Enhanced Transition of Care Preparation for Adolescents and Emerging Adults With Type 1 Diabetes: Use of the READDY Transition Tool

There is an ongoing need to determine best practices for effective transition from pediatric to adult care for adolescents and emerging adults (EAs) with type 1 diabetes given the potential for poor health outcomes post-transfer. This study evaluated self-reported confidence ratings as measured by the Readiness of Emerging Adults with Diabetes Diagnosed in Youth (READDY) tool among adolescents and EAs with type 1 diabetes and the association of the confidence ratings with clinical and demographic characteristics, as well as provider documentation of relevant anticipatory guidance topics. The READDY is a diabetes-specific tool used to collect patient-reported confidence in transition preparation topics to target educational interventions. These interventions are divided into four domains: Diabetes Knowledge, Health System Navigation, Insulin Self-Management, and Health Behaviors. A retrospective chart review was conducted of patients 15-24 years of age with type 1 diabetes who completed the READDY survey between January 2017 and January 2018 at a single center. Overall patient-reported confidence levels were high. However, adolescents and EAs endorsed their lowest levels of confidence on items assessing knowledge of alcohol, tobacco, sexual health, and the impact of diabetes on pregnancy (females only), with the percentages of low scores of 20.7, 25.9, 35.9, and 42.9%, respectively. Documentation of provider counseling about screening and prevention of diabetes comorbidities, alcohol use, and tobacco use was associated with scores in the higher range for the corresponding item in the READDY survey. These findings highlight an opportunity to create interventions related to developmentally important topics for adolescents and EAs with type 1 diabetes to enhance successful transition preparation.

The management of type 1 diabetes in adults. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycaemia, behavioural considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that healthcare professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors. Graphical abstract.

The Management of Type 1 Diabetes in Adults. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)

The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) convened a writing group to develop a consensus statement on the management of type 1 diabetes in adults. The writing group has considered the rapid development of new treatments and technologies and addressed the following topics: diagnosis, aims of management, schedule of care, diabetes self-management education and support, glucose monitoring, insulin therapy, hypoglycemia, behavioral considerations, psychosocial care, diabetic ketoacidosis, pancreas and islet transplantation, adjunctive therapies, special populations, inpatient management, and future perspectives. Although we discuss the schedule for follow-up examinations and testing, we have not included the evaluation and treatment of the chronic microvascular and macrovascular complications of diabetes as these are well-reviewed and discussed elsewhere. The writing group was aware of both national and international guidance on type 1 diabetes and did not seek to replicate this but rather aimed to highlight the major areas that health care professionals should consider when managing adults with type 1 diabetes. Though evidence-based where possible, the recommendations in the report represent the consensus opinion of the authors.

Effect of meal composition and alcohol consumption on postprandial glucose concentration in subjects with type 1 diabetes: a randomized crossover trial

INTRODUCTION

Meal composition is known to affect glycemic variability and glucose control in type 1 diabetes. The objective of this work was to evaluate the effect of high carbohydrate meals of different nutritional composition and alcohol on the postprandial glucose response in patients with type 1 diabetes.

RESEARCH DESIGN AND METHODS

Twelve participants were recruited to this randomized crossover trial. Following a 4-week run-in period, participants received a mixed meal on three occasions with the same carbohydrate content but different macronutrient composition: high protein-high fat with alcohol (0.7g/kg body weight, beer), high protein-high fat without alcohol, and low protein-low fat without alcohol at 2-week intervals. Plasma and interstitial glucose, insulin, glucagon, growth hormone, cortisol, alcohol, free fatty acids, lactate, and pH concentrations were measured during 6 hours. A statistical analysis was then carried out to determine significant differences between studies.

RESULTS

Significantly higher late postprandial glucose was observed in studies with higher content of fats and proteins (p=0.0088). This was associated with lower time in hypoglycemia as compared with the low protein and fat study (p=0.0179), at least partially due to greater glucagon concentration in the same period (p=0.04). Alcohol significantly increased lactate, decreased pH and growth hormone, and maintained free fatty acids suppressed during the late postprandial phase (p<0.001), without significant changes in plasma glucose.

CONCLUSIONS

Our data suggest that the addition of proteins and fats to carbohydrates increases late postprandial blood glucose. Moreover, alcohol consumption together with a mixed meal has relevant metabolic effects without any increase in the risk of hypoglycemia, at least 6 hours postprandially.

TRIAL REGISTRATION NUMBER

NCT03320993.

Psychoeducational Messaging to Reduce Alcohol Use for College Students With Type 1 Diabetes: Internet-Delivered Pilot Trial

Background

College environments promote high-volume or binge alcohol consumption among youth, which may be especially harmful to those with type 1 diabetes (T1D). Little is known about the acceptability and effectiveness of interventions targeting reduced alcohol use by college students with T1D, and it is unclear whether intervention framing (specifically, the narrator of intervention messages) matters with respect to affecting behavior change. Interventions promoted by peer educators may be highly relatable and socially persuasive, whereas those delivered by clinical providers may be highly credible and motivating.

Objective

The aim of this study is to determine the acceptability and impacts of an alcohol use psychoeducational intervention delivered asynchronously through web-based channels to college students with T1D. The secondary aim is to compare the impacts of two competing versions of the intervention that differed by narrator (peer vs clinician).

Methods

We recruited 138 college students (aged 17-25 years) with T1D through web-based channels and delivered a brief intervention to participants randomly assigned to 1 of 2 versions that differed only with respect to the audiovisually recorded narrator. We assessed the impacts of the exposure to the intervention overall and by group, comparing the levels of alcohol- and diabetes-related knowledge, perceptions, and use among baseline, immediately after the intervention, and 2 weeks after intervention delivery.

Results

Of the 138 enrolled participants, 122 (88.4%) completed all follow-up assessments; the participants were predominantly women (98/122, 80.3%), were White non-Hispanic (102/122, 83.6%), and had consumed alcohol in the past year (101/122, 82.8%). Both arms saw significant postintervention gains in the knowledge of alcohol’s impacts on diabetes-related factors, health-protecting attitudes toward drinking, and concerns about drinking. All participants reported significant decreases in binge drinking 2 weeks after the intervention (21.3%; odds ratio 0.48, 95% CI 0.31-0.75) compared with the 2 weeks before the intervention (43/122, 35.2%). Changes in binge drinking after the intervention were affected by changes in concerns about alcohol use and T1D. Those who viewed the provider narrator were significantly more likely to rate their narrator as knowledgeable and trustworthy; there were no other significant differences in intervention effects by the narrator.

Conclusions

The intervention model was highly acceptable and effective at reducing self-reported binge drinking at follow-up, offering the potential for broad dissemination and reach given the web-based format and contactless, on-demand content. Both intervention narrators increased knowledge, improved health-protecting attitudes, and increased concerns regarding alcohol use. The participants’ perceptions of expertise and credibility differed by narrator.

Trial Registration

ClinicalTrials.gov NCT02883829; https://clinicaltrials.gov/ct2/show/NCT02883829

International Registered Report Identifier (IRRID)

RR2-10.1177/1932296819839503

College students' knowledge and management of food allergies

This study explored predictors of food allergy management in college students, including participants' reported allergy severity, history of allergic reactions, and allergy knowledge. Further, we compared allergy knowledge in participants with food allergy to a matched sample of college students without food allergy. Method: Participants were recruited from a larger nationwide study of knowledge and attitudes toward food allergy in college students, with purposeful oversampling of students with food allergies. Participants completed measures assessing their food allergy(ies), symptoms, history of reactions, and current allergy management behaviors. Participants with food allergies and control participants without food allergies completed a measure of food allergy knowledge. Results: Hierarchical regression revealed that food allergy knowledge accounted for an additional 20% of variance in students' allergy management behaviors, above and beyond severity and allergic reactions, R²=.39, F(3,48)=10.09, p<.001. There was not a statistically significant difference in food allergy knowledge between participants with food allergy and matched controls, t(49)=-1.85, p=.07, 95% CI=-1.42 to 0.06. Conclusions: This study suggests allergy knowledge is an important factor in food allergy management. Knowledge significantly predicted food allergy management behaviors above and beyond food allergy severity and recent food allergy reactions. College students with food allergies did not demonstrate greater knowledge than controls, suggesting a need for psychoeducational intervention to target college students' allergy knowledge as they transition to independent allergy management.

Mental and somatic health in university students with type 1 diabetes: new results from DiaSHoT18, a cross sectional national health and well-being survey

OBJECTIVES

To explore mental and somatic health, quality of life, alcohol-related problems, sleep problems, and diabetes related distress in university students with type 1 diabetes (T1D), compared to students without T1D. Further, we evaluated associations with gender, treatment modalities, and achieved metabolic control.

METHODS

All fulltime Norwegian students aged 18-35 years pursuing higher education in 2018 (n=162.512) were invited into a comprehensive national survey on health and well-being. Students that stated having diabetes was asked further questions about their diabetes care.

RESULTS

Of 49,684 participating students, 324 participants stated having T1D. Students with T1D did not show more mental or somatic health symptoms, or report a higher level of loneliness. However, T1D was significantly associated with lower quality of life (QoL). Students with good metabolic control reached the same QoL as students without T1D. Mental disorders and suicidality were associated with lacking metabolic control. The proportion of unhealthy drinking habits was generally low, and even lower in students with T1D. Sleeping patterns were generally good, but students using continuous glucose measurement were awakening more often during sleep. Females with T1D showed higher levels of diabetes related problems and distress, but good metabolic control was associated with lower diabetes distress level.

CONCLUSIONS

Students with T1D scored equally on most mental and somatic health scales. Their quality of life was significantly worse compared to their healthy peers. Knowledge on the impact of metabolic control, gender and the use of CSII and CGM can be valuable for the caretakers of young adults with T1D.

Demographic and socioeconomic patterns in the risk of alcohol-related hospital admission in children and young adults with childhood onset type-1 diabetes from a record-linked longitudinal population cohort study in Wales

BACKGROUND

Little is known about alcohol-related harm in children and young adults with type 1 diabetes (T1D). Education on managing alcohol intake is provided to teenagers with T1D in paediatric clinics in Wales, but its effectiveness is unknown. We compared the patterns in risk of alcohol-related hospital admissions (ARHA) between individuals with and without childhood-onset T1D.

METHODS

We extracted data for 1 791 577 individuals born during 1979 to 2014 with a general practitioner registration in Wales, and record-linked the demographic data to ARHA between 1998 and June 2016 within the Secure Anonymised Information Linkage Databank (SAIL). Linkage to a national T1D register (Brecon Cohort) identified 3575 children diagnosed aged <15 years since 1995. We estimated hazard ratios (HRs) with 95% confidence intervals (95% CIs) for the risk of ARHA using recurrent-event models, including interaction terms.

RESULTS

Individuals with T1D had a higher riskof ARHA (HR: 1.78; 95% CI: 1.60-1.98), adjusted for age group, sex, and deprivation. The risk in people with diabetes was highest aged 14 to 17 years, around three times higher than the peak in non-T1D aged 18 to 22. Females with diabetes had a lower risk generally. The association between deprivation and ARHA was weaker in the T1D group.

CONCLUSION

Young people with T1D had increased risks of ARHA, particularly at school age, and smaller socioeconomic inequalities in ARHA. A review of interventions to reduce alcohol-related harm in T1D is needed, perhaps including modification of current education and guidance for teenagers on managing alcohol consumption and reviewing criteria for hospital admission.

Clinical Trial Recruitment and Retention of College Students with Type 1 Diabetes via Social Media: An Implementation Case Study

BACKGROUND

We sought to quantify the efficiency and acceptability of Internet-based recruitment for engaging an especially hard-to-reach cohort (college-students with type 1 diabetes, T1D) and to describe the approach used for implementing a health-related trial entirely online using off-the-shelf tools inclusive of participant safety and validity concerns.

METHOD

We recruited youth (ages 17-25 years) with T1D via a variety of social media platforms and other outreach channels. We quantified response rate and participant characteristics across channels with engagement metrics tracked via Google Analytics and participant survey data. We developed decision rules to identify invalid (duplicative/false) records (N = 89) and compared them to valid cases (N = 138).

RESULTS

Facebook was the highest yield recruitment source; demographics differed by platform. Invalid records were prevalent; invalid records were more likely to be recruited from Twitter or Instagram and differed from valid cases across most demographics. Valid cases closely resembled characteristics obtained from Google Analytics and from prior data on platform user-base. Retention was high, with complete follow-up for 88.4%. There were no safety concerns and participants reported high acceptability for future recruitment via social media.

CONCLUSIONS

We demonstrate that recruitment of college students with T1D into a longitudinal intervention trial via social media is feasible, efficient, acceptable, and yields a sample representative of the user-base from which they were drawn. Given observed differences in characteristics across recruitment channels, recruiting across multiple platforms is recommended to optimize sample diversity. Trial implementation, engagement tracking, and retention are feasible with off-the-shelf tools using preexisting platforms.

Perspectives on substance use among youth with chronic medical conditions and implications for clinical guidance and prevention: A qualitative study

Increasing numbers of youth globally live with a chronic illness. These youth use alcohol and marijuana at levels equal to or greater than their healthy peers and, when using, are at elevated risk for regular or problem use and adverse consequences to their condition. Little is known about whether behavioral theories commonly invoked to explain adolescent substance use apply to this group, limiting our ability to develop, tailor and target preventive interventions. We interviewed youth ages 16-19 years in care for a chronic disease to gain knowledge of this group's perspectives on substance use risk, decision-making, and preferences for clinical guidance. Interviews were transcribed and thematically analyzed. Three principal themes emerged: first, having a chronic disease frames understanding of and commitment to health protecting behaviors and impacts decisions to avoid behaviors that carry risks for disease complications and flares; second, developmental impulses typical of adolescence can amplify an adolescent's propensity to take risks despite medical vulnerability and direct youth toward maladaptive choices to mitigate risk; and third, poor knowledge about effects of substance use on specific features of a disease shapes perceived risk and undermines health protecting decisions. Youth navigate these issues variously including by avoiding substance use at a specific time or entirely, using while cognitively discounting risks and/or adjusting treatment outside of medical advice. Their perceptions about substance use are complex and reveal tension among choices reflecting a chronic illness frame, developmental impulses, and knowledge gaps. Delivery of targeted guidance in healthcare settings may help youth navigate this complexity and connect patient-centered goals to optimize health with health protecting behavioral decisions.

Health-risk Behaviors and Type 1 Diabetes Outcomes in the Transition from Late Adolescence to Early Emerging Adulthood

This study examined within- and between-person associations between health-risk behaviors (smoking, drinking, insulin withholding) and type 1 diabetes (T1D) outcomes (adherence and HbA1c) during the high-risk transition from late adolescence to early emerging adulthood utilizing a 2-year longitudinal study. Beginning in the senior year of high school, participants (n = 197) with T1D completed measures of health-risk behaviors, adherence, and HbA1c annually at three time points. Health-risk behaviors were associated with poorer diabetes outcomes during the transition from late adolescence to early emerging adulthood. These results highlight the importance of monitoring health-risk behaviors regularly and intervening to reduce health-risk behaviors during this important developmental transition.

Prevalence of alcohol, tobacco, cannabis and other illicit substance use in a population of Canadian adolescents with type 1 diabetes compared to a general adolescent population

Background

Youth with chronic conditions may engage in risky behaviour to the same, if not higher, degree as their healthy peers.

Objectives

To determine the prevalence of alcohol, tobacco, cannabis and illicit substance use in adolescents with type 1 diabetes (T1DM) compared to a general adolescent population.

Methods

Cross-sectional survey of adolescents with T1DM (13 to 18 years). A published contemporary Canadian youth survey on use of alcohol, tobacco and illicit drugs was used as data representative of the general adolescent population. Outcome measures between the T1DM and general group were compared using Chi-square and Fisher's exact test where appropriate.

Results

One hundred and sixty-four adolescents with T1DM (mean 15.6 years [SD 1.5]; 51.3% male) were participated. The proportions of adolescents with T1DM who have tried substances were: alcohol 51.8%, tobacco 27.4%, cannabis 22.6% and other illicit substances 7.3%. Compared to the general population (n=3469), there were no significant differences in the proportion of adolescents that reported ever consuming alcohol, tobacco or cannabis. Reported illicit substance use was significantly lower in adolescents with T1DM compared to general population (7.3% versus 36.0%, P<0.0001).

Conclusions

Proportions reporting having ever consumed alcohol, tobacco or cannabis were not significantly different between the two groups. However, the proportion of adolescents with T1DM who reported ever consuming an illicit substance was different from the comparison group. It is important to explore risky behaviours with adolescents with T1DM and focus on prevention and education during routine clinic visits.

Harm reduction-a systematic review on effects of alcohol reduction on physical and mental symptoms

Based on the knowledge that alcohol misuse causes a multitude of diseases and increased mortality, this systematic review examines whether a reduction of the individual alcohol consumption can contribute to a minimization of health risks within a harm reduction approach. In fact, the reviewed 63 studies indicate that interventions aiming at alcohol reduction (including total abstinence as one possible therapeutic aim) indeed resulted in or were associated with positive effects in harmful, hazardous or alcohol-dependent drinkers. Major benefits were observed for reducing alcohol-associated injuries, recovery of ventricular heart function in alcoholic cardiomyopathy, blood pressure lowering, normalization of biochemical parameter, body weight reduction, histological improvement in pre-cirrhotic alcohol-related liver disease and slowed progression of an already existing alcohol-attributable liver fibrosis. Furthermore, reduced withdrawal symptoms, prevalence of psychiatric episodes and duration of in-patient hospital days, improvement of anxiety and depression symptoms, self-confidence, physical and mental quality of life, fewer alcohol-related adverse consequences as well as lower psychosocial stress levels and better social functioning can result from reduced alcohol intake. The reviewed literature demonstrated remarkable socioeconomic cost benefits in areas such as the medical health-care system or workforce productivity. Individuals with heightened vulnerability further benefit significantly from alcohol reduction (e.g. hypertension, hepatitis C, psychiatric co-morbidities, pregnancy, but also among adolescents and young adults). Concluding, the reviewed studies strongly support and emphasize the importance and benefits of early initial screening for problematic alcohol use followed by brief and other interventions in first contact medical health-care facilities to reduce alcohol intake.

Alcohol Use in Young Adults With Type 1 Diabetes Mellitus

Although fewer individuals with type 1 diabetes mellitus (T1DM) drink alcohol, the potential and severity of harm associated with its consumption is higher in persons with diabetes. Alcohol use affects glucose metabolism and results in various potential adverse effects both from acute ingestion and chronic ingestion in persons with T1DM. The purpose of this article is to describe the effects of alcohol on glucose metabolism and diabetes control in persons with T1DM and propose counseling pearls for providers working with patients in this population.

Illness-Specific Risk-Taking in Adolescence: A Missing Piece of the Nonadherence Puzzle for Youth With Type 1 Diabetes?

Risky behavior is often at its lifetime peak in adolescence. Chronic illness creates additional opportunities for risk because nonadherence behaviors can jeopardize adolescents' health. Adolescents with type 1 diabetes could engage in risky behavior around insulin administration that would put them in danger of severe health consequences. It is possible that some nonadherence behaviors observed in adolescents with type 1 diabetes may result from youth taking risks with their medical treatment. Illness-specific risk-taking behaviors are not captured in most assessments of adherence, which primarily focus on frequency of adherence behaviors. This article reviews current models of general risk-taking and their implications for diabetes management. The authors argue that illness-specific risk-taking may be an important, understudied aspect of illness management that can inform future studies and treatment of nonadherence in adolescents with type 1 diabetes.

Quality of Life of College Students Living With Type 1 Diabetes

The purpose of this phenomenological qualitative study was to examine the quality of life among college students living with Type 1 diabetes (T1D). Inclusion criteria included age 18 to 24, current college student, and a diagnosis of T1D for at least 1 year. Semi-structured interviews were conducted, in-person and by phone. During these interviews, college students shared stories of living with T1D and its impact on their quality of life. Three major themes emerged, which included “planning ahead,” “thinking positive,” and “seeking support.” These findings provide a better understanding of the transitional experience of living with T1D and the impact on perceived quality of life while attending college. Techniques and strategies aimed at the enhancement of perceived quality of life for college students living with T1D were identified. These findings will provide valuable insight for professionals working with this population.

Long-term impact of childhood-onset type 1 diabetes on social life, quality of life and sexuality

AIM

This study describes the socio-professional outcomes, health-related quality of life (HRQOL) and sexuality of adults with childhood-onset type 1 diabetes (T1D).

METHODS

The study participants (n=388), recruited from a nationwide registry (age: 28.5 ± 3.1 years; T1D duration: 17.0 ± 2.7 years), completed a questionnaire (198 items); the results were compared with the French general population using standardized incidence ratios (SIRs) and Z scores matched for age, gender and period with/without education levels and patterns of family life. Linear regression models also investigated correlates of SF-36 Physical (PCS) and Mental Composite Scores (MCS).

RESULTS

Compared with the French general population, education levels of people with T1D were similar, with 68.6% having at least a high-school diploma or higher (SIR: 1.06, 95% CI: 0.93; 1.20), as were also their patterns of family life. Unemployment was higher in T1D women (15.3%, SIR: 1.50, 1.00; 2.05), but not in T1D men (8.6%, SIR: 0.96, 0.51; 1.57). Social discrimination was more common (SIR: 5.64, 4.64; 6.62), and frequency of daily alcohol consumption was higher (SIR: men, 3.34, 2.38; 4.54; women, 6.53, 4.57; 12.99). PCS and MCS were decreased moderately (mean ± SD: 52.0 ± 7.5; mean Z score: -0.2, 95% CI: -0.3; -0.1) and substantially (mean ± SD: 42.1 ± 12.4; mean Z score: -0.7, -0.8; -0.6), respectively. Fatigue and abandoning sports were predictive of a lower HRQOL. Both men and women were more frequently dissatisfied with their sex life. Prevalence of sexual problems was higher in women (SIR for: dysorgasmia, 1.91, 1.21-2.88; decreased/loss of desire: 2.11, 1.35-3.08), but similar in men. Participants with T1D-related complications had preserved social outcomes, but altered HRQOL.

CONCLUSION

Young adults with T1D have satisfactory social participation. However, their higher alcohol consumption, lower MCS and frequent dissatisfaction with sexuality suggest a heavy impact of the disease on morale, especially in women. Improving the everyday well-being of these young adults represents a key challenge for diabetes healthcare.

The Role of Mobile Applications in Improving Alcohol Health Literacy in Young Adults With Type 1 Diabetes: Help or Hindrance?

BACKGROUND

Mobile health (mHealth) is an expanding field which includes the use of social media and mobile applications (apps). Apps are used in diabetes self-management but it is unclear whether these are being used to support safe drinking of alcohol by people with type 1 diabetes (T1DM). Alcohol health literacy is poor among young adults with T1DM despite specific associated risks.

METHODS

Systematic literature review followed by critical appraisal of commercially available apps. An eSurvey investigating access to mHealth technology, attitudes toward apps for diabetes management and their use to improve alcohol health literacy was completed by participants.

RESULTS

Of 315 articles identified in the literature search, 7 met the inclusion criteria. Ten diabetes apps were available, most of which lacked the educational features recommended by clinical guidelines. In all, 27 women and 8 men with T1DM, aged 19-31 years were surveyed. Of them, 32 had access to a smartphone/tablet; 29 used apps; 20 used/had used diabetes apps; 3 had used apps related to alcohol and diabetes; 11 had discussed apps with their health care team; 22 felt more communication with their health care team would increase awareness of alcohol-associated risks.

CONCLUSIONS

Use of mobile apps is commonplace but the use of apps to support safe drinking in this population was rare. Most participants expressed a preference for direct communication with their health care teams about this subject. Further research is needed to determine the preferences of health care professionals and how they can best support young adults in safe drinking.

Alcohol health literacy in young adults with type 1 diabetes and its impact on diabetes management

AIMS

To investigate the knowledge of alcohol and carbohydrate content of commonly consumed alcoholic drinks among young adults with Type 1 diabetes and to explore alcohol consumption while identifying diabetes self-management strategies used to minimize alcohol-associated risk.

METHOD

We conducted an open-access, multiple-choice web survey to investigate knowledge of alcohol and carbohydrate content of typical alcoholic drinks using images. Respondents to the survey also recorded their current alcohol consumption and diabetes self-management strategies when drinking.

RESULTS

A total of 547 people aged 18-30 years responded to the survey (341 women; 192 men; mean (sd) age 24.5 (3.7) years), of whom 365 (66.7%) drank alcohol. In all, 84 (32.9%) women and 31 (22.6%) men scored higher than the cut-off score for increased-risk drinking. Knowledge accuracy of alcohol units was poor: only 7.3% (n = 40) correctly identified the alcohol content of six or more out of 10 drinks. Knowledge of carbohydrate content was also poor: no respondent correctly identified the carbohydrate content of six or more out of 10 drinks. Various and inconsistent strategies to minimize alcohol-associated risk were reported.

CONCLUSIONS

Alcohol consumption was common among the survey respondents, but knowledge of alcohol and carbohydrate content was poor. Greater alcohol-related health literacy is required to minimize alcohol-associated risk. Further research should help develop effective strategies to improve health literacy and support safe drinking for young adults with Type 1 diabetes.

Alcohol use trajectories after high school graduation among emerging adults with type 1 diabetes

OBJECTIVE

To explore alcohol involvement trajectories and associated factors during the year post-high school (HS) graduation among emerging adults with type 1 diabetes.

METHODS

Youth (N = 181) self-reported alcohol use at baseline and every 3 months for 1 year post-HS graduation. Data were also collected on parent-youth conflict, diabetes self-efficacy, major life events, living and educational situations, diabetes management, marijuana use, cigarette smoking, and glycemic control. Trajectories of alcohol use were modeled using latent class growth analysis. Associations between trajectory class and specific salient variables were examined using analysis of variance, chi square, or generalized linear mixed model, as appropriate.

RESULTS

Identified alcohol involvement trajectory classes were labeled as (1) consistent involvement group (n = 25, 13.8%) with stable, high use relative to other groups over the 12 months; (2) growing involvement group (n = 55, 30.4%) with increasing use throughout the 12 months; and (3) minimal involvement group (n = 101, 55.8%) with essentially no involvement until the ninth month. Those with minimal involvement had the best diabetes management and better diabetes self-efficacy than those with consistent involvement. In comparison with those minimally involved, those with growing involvement were more likely to live independently of parents; those consistently involved had more major life events; and both the growing and consistent involvement groups were more likely to have tried marijuana and cigarettes.

CONCLUSIONS

This sample of emerging adults with type 1 diabetes has three unique patterns of alcohol use during the first year after HS.

The Relationship of Worry About Hypoglycemia With Diabetes-specific and Typical Youth Behavior Among Emerging Adults With Type 1 Diabetes

PURPOSE

Little is known about the relationship of worry about hypoglycemia with diabetes-specific and typical youth behaviors among emerging adults with type 1 diabetes. This study's purpose was to examine the relationship among worry about hypoglycemia, diabetes management, and glycemic control within the context of alcohol use, hypoglycemia-related weight control behaviors, depressive symptoms, and impulse control among emerging adults with type 1 diabetes.

RESEARCH DESIGN AND METHODS

The sample was 181 emerging adults with type 1 diabetes who were part of a larger study. Path analysis was used to test associations among worry about hypoglycemia, diabetes management, hypoglycemia-related weight control behaviors (WCB), alcohol use, impulse control, depressive symptoms, and glycemic control.

RESULTS

Path model fit and modification indices suggested that a feedback loop between worry about hypoglycemia and diabetes management should be incorporated into the original model. Youth with fewer depressive symptoms reported fewer hypoglycemia-related WCB and less worry about hypoglycemia; those with higher impulse control had less alcohol use and better diabetes management; those with lower alcohol use had more worry about hypoglycemia; and better glycemic control was associated with better diabetes management.

CONCLUSIONS

Health care professionals need to understand how multiple factors related to worry about hypoglycemia and diabetes management interact in emerging adults. In the context of depressive symptoms, impulse control, alcohol use, and hypoglycemia-related WCB, the path model results suggest several potential avenues for intervening to improve glycemic control in emerging adults.

Social networking and understanding alcohol-associated risk for people with type 1 diabetes: friend or foe?

BACKGROUND

Online communication has become popular in recent years, especially for young people. Limited research exists into how people with type 1 diabetes mellitus (T1DM) discuss risks about diabetes. Alcohol use by people with T1DM, as in the rest of society, is common and may adversely affect diabetes management. This study reviewed the literature on social networking as a communication tool and conducted a systematic search of social networking sites to determine whether people with T1DM use them to discuss risks associated with diabetes and alcohol consumption.

MATERIALS AND METHODS

Systematic literature review was performed followed by an Internet search and forum identification relating to T1DM and alcohol. Qualitative coding and thematic analysis of publicly available data retrieved from social networking sites were undertaken.

RESULTS

In the literature review, 292 articles were identified, of which six met the inclusion criteria. Widespread use of social media for medical advice pertaining to diabetes was reported. The quality and safety of online advice were reported as variable. Ten Web sites with 247 individual postings about alcohol and diabetes were selected for analysis, which revealed six themes ranging from safety and seeking and provision of advice to wider views about behaviors, opinions, and experiences of people with T1DM and alcohol. No specific professional health information was identified on any sites, and inaccurate information was common.

CONCLUSIONS

Online resources are used by people with T1DM to find information about diabetes and alcohol consumption. Easily signposted and accessible professional online resources would ensure people can access appropriate advice to minimize risks of alcohol use.