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Hanna KM, Alazri Z, Eisenhauer CM. A Theory of Transitions Influencing Diabetes Self-management Among Emerging Adults With Type 1 Diabetes. ANS Adv Nurs Sci 2024:00012272-990000000-00090. [PMID: 38687035 DOI: 10.1097/ans.0000000000000524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2024]
Abstract
Emerging adults with type 1 diabetes are experiencing numerous transitions, potentially affecting diabetes self-management. For example, when transitioning to college, these emerging adults may experience changes in their daily routines and usual reminders or triggers for habitual behavior such as checking blood glucose levels. In turn, these emerging adults may omit checking glucose levels, impacting decisional and adaptational diabetes self-management behavior associated with their insulin dose or bolus. Thus, we propose a theory on transitions influencing daily routines, diabetes self-management habitual behavior triggers, and, in turn, diabetes self-management habitual and decisional/adaptational behaviors for emerging adults with type 1 diabetes.
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Affiliation(s)
- Kathleen M Hanna
- University of Nebraska College of Nursing-Omaha Division (Dr Hanna); College of Nursing, Sultan Qaboos University, Al-khoud, Sultanate of Oman (Dr Alazri); and 53671 883 Way, Center, Nebraska (Dr Eisenhauer)
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2
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Majidi S, Roberts AJ, Suerken CK, Reboussin BA, Malik FS, Marcovina SM, Corathers S, Reynolds K, Imperatore G, Wadwa RP, Pihoker C. Health Care Transition to Adult Care in Type 1 Diabetes: Associations With Student and Employment Status-The SEARCH for Diabetes in Youth Study. Clin Diabetes 2023; 41:510-517. [PMID: 37849515 PMCID: PMC10577504 DOI: 10.2337/cd22-0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
Successful transition from a pediatric to adult diabetes care provider is associated with reduced ambulatory diabetes care visits and increased acute complications. This study aimed to determine whether the degree of independence in diabetes care and the rate of acute complications after transition to adult diabetes care were associated with individuals' student or employment status. Nonstudents were found to be less likely than students to be independent with diabetes care, and employed nonstudents were at lower risk of diabetic ketoacidosis than unemployed nonstudents. Additional support may be needed for young adults who are not students or are unemployed to improve independence and reduce the risk for acute complications.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
- Division of Endocrinology, Children’s National Hospital, Washington, DC
| | - Alissa J. Roberts
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Cynthia K. Suerken
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Beth A. Reboussin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Faisal S. Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | | | - Sarah Corathers
- Division of Endocrinology, Cincinnati Children’s Hospital, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Giuseppina Imperatore
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA
| | - R. Paul Wadwa
- Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
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Hagger V, J. Lake A, Singh T, Hamblin PS, Rasmussen B. The experiences and support needs of students with diabetes at university: An integrative literature review. Diabet Med 2023; 40:e14943. [PMID: 36001083 PMCID: PMC10087720 DOI: 10.1111/dme.14943] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/10/2022] [Accepted: 08/18/2022] [Indexed: 12/01/2022]
Abstract
AIMS Commencing university presents particular challenges for young adults with diabetes. This integrative literature review aimed to synthesise the research exploring the experiences and support needs of university students with diabetes. METHODS Medline, CINAHL, PsychInfo and EMBASE databases were searched for quantitative and qualitative studies, among undergraduate and postgraduate students with type 1 or type 2 diabetes conducted in the university setting. Two reviewers independently screened titles, abstracts and full-text articles. Data were analysed thematically and synthesised narratively utilising the ecological model as a framework for interpreting findings and making recommendations. RESULTS We identified 25 eligible papers (20 studies) utilising various methods: individual interview, focus group, survey, online forum. Four themes were identified: barriers to self-care (e.g. lack of structure and routine); living with diabetes as a student; identity, stigma and disclosure; and strategies for managing diabetes at university. Students in the early years at university, recently diagnosed or moved away from home, reported more self-care difficulties, yet few accessed university support services. Risky alcohol-related behaviours, perceived stigma and reluctance to disclose diabetes inhibited optimal diabetes management. CONCLUSION Despite the heterogeneity of studies, consistent themes related to diabetes self-care difficulties and risky behaviours were reported by young adults with diabetes transitioning to university life. No effective interventions to support students with diabetes were identified in this setting. Multilevel approaches to support students to balance the competing demands of study and diabetes self-care are needed, particularly in the early years of university life.
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Affiliation(s)
- Virginia Hagger
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
- The Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
| | - Amelia J. Lake
- The Australian Centre for Behavioural Research in DiabetesDiabetes VictoriaMelbourneVictoriaAustralia
- School of PsychologyDeakin UniversityGeelongVictoriaAustralia
| | - Tarveen Singh
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
| | - Peter S. Hamblin
- Western HealthSt. AlbansVictoriaAustralia
- Department of Medicine, Western HealthUniversity of MelbourneSt. AlbansVictoriaAustralia
| | - Bodil Rasmussen
- School of Nursing and MidwiferyDeakin UniversityBurwoodVictoriaAustralia
- The Centre for Quality and Patient Safety Research in the Institute for Health TransformationDeakin UniversityGeelongVictoriaAustralia
- Faculty of Health and Medical SciencesUniversity of CopenhagenCopenhagenDenmark
- Faculty of Health SciencesUniversity of Southern Denmark and Steno Diabetes CentreOdenseDenmark
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Kamoun C, Khoury JC, Beal SJ, Crimmins N, Corathers SD. Opportunities for Enhanced Transition of Care Preparation for Adolescents and Emerging Adults With Type 1 Diabetes: Use of the READDY Transition Tool. Diabetes Spectr 2022; 35:57-65. [PMID: 35308159 PMCID: PMC8914586 DOI: 10.2337/ds20-0104] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
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.
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Affiliation(s)
- Camilia Kamoun
- Pediatric Residency Program, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH
- Corresponding author: Camilia Kamoun,
| | - Jane C. Khoury
- Division of Endocrinology, CCHMC, Cincinnati, OH
- Division of Biostatistics and Epidemiology, CCHMC, Cincinnati, OH
- Department of Environmental Health, Division of Epidemiology, University of Cincinnati, Cincinnati, OH
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Sarah J. Beal
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
- Division of Behavioral Medicine and Clinical Psychology, CCHMC, Cincinnati, OH
| | - Nancy Crimmins
- Division of Endocrinology, CCHMC, Cincinnati, OH
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
| | - Sarah D. Corathers
- Division of Endocrinology, CCHMC, Cincinnati, OH
- Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH
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Ravert RD, Russell LT. College students' intentions to assist peers with chronic medical conditions. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2022; 70:355-362. [PMID: 32343192 DOI: 10.1080/07448481.2020.1751170] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 01/27/2020] [Accepted: 03/29/2020] [Indexed: 06/11/2023]
Abstract
Objective This study identified influences on college students' intentions to assist peers with chronic medical conditions. Participants: A panel of 293 U.S. full-time college students completed online surveys in July, 2017. Methods: Participants reported the number of people they knew with chronic medical conditions, and completed measures of general empathy, stigma toward chronic conditions, self-efficacy to provide support, and expected likelihood of assisting a peer with a chronic medical condition. Path Analysis and mediation tests were performed. Results: Low stigma, and high confidence in providing support were directly associated with intentions to assist student peers if needed. Empathy and number of people known with chronic conditions were additional indirect predictors. Conclusions: Peer support is important for students with chronic medical conditions. Intention to provide assistance if needed is partially explained by holding low stigma and high confidence in providing support, both of which may be enhanced through education and intervention.
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Affiliation(s)
- Russell D Ravert
- Human Development & Family Science, University of Missouri, Columbia, Missouri, USA
| | - Luke T Russell
- Family and Consumer Sciences, Illinois State University, Normal, Illinois, USA
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Rodrigues R, Rossi ICB, Rossi BF, Gomes DC, Penha-Silva N. New glycemic metrics and traditional clinical and laboratory profiles of children and adolescents with type 1 diabetes mellitus in an outpatient follow-up. Diabetes Res Clin Pract 2021; 173:108680. [PMID: 33516782 DOI: 10.1016/j.diabres.2021.108680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 01/08/2021] [Accepted: 01/14/2021] [Indexed: 12/26/2022]
Abstract
INTRODUCTION This study evaluated the demographic, clinical, and laboratory data - including traditional (as glycated hemoglobin, HbA1c) and new glycemic metrics (as time in range, TiR) - and the complications present in children and adolescents (CA) in outpatient follow-up, as well as their possible associations. METHODS This retrospective observational study's data were compiled from the CA's medical records with T1DM (n = 78) being followed up at the Pediatric Endocrinology Service of the Federal University of Uberlândia. RESULTS The average participants' age was 10.2 years (1-16), most of them (55%) being male, with a diagnosis time of 4.5 years (1-13), and a body mass index of 18 kg/m2. The group had HbA1c levels of 9.6% and an estimated average glycemia of 229.5 ± 103 mg/dL. TiR was 25% (7-54%); the short- (CV%) and medium-term (ΔHbA1c) glycemic variability was 45.7% and 1.5%, respectively. Approximately 10% had diabetes ketoacidosis in the last year of follow-up, about 6% had chronic complications, such as nephropathy or retinopathy, and 20% had some other associated autoimmune disease. 49% of the participants reported regular physical activity. CONCLUSION The high values of HbA1c and glycemic variability amplitude, short TiR, and the early presence of chronic complications reveal that the treatment did not reach its goal in this population. Better education of patients and their families about the disease and greater adherence to intensive insulin treatment can optimize the control of diabetes in pediatric patients.
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Affiliation(s)
- Ricardo Rodrigues
- Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil.
| | - Isabela Cristina Borges Rossi
- Pós-Graduação em Ciências da Saúde, Faculdade de Medicina, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
| | | | | | - Nilson Penha-Silva
- Instituto de Biotecnologia, Universidade Federal de Uberlândia, Uberlândia, MG, Brazil
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Dedefo MG, Abate SK, Ejeta BM, Korsa AT. Predictors of poor glycemic control and level of glycemic control among diabetic patients in west Ethiopia. Ann Med Surg (Lond) 2020; 55:238-243. [PMID: 32528672 PMCID: PMC7283090 DOI: 10.1016/j.amsu.2020.04.034] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 04/19/2020] [Accepted: 04/25/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. This study aims to assess the level of glycemic control and factors contributing to uncontrolled glycemia among diabetic patients at the Nekemte Referral Hospital, West Ethiopia. METHODS A cross sectional study was conducted on diabetic patients attending the diabetes clinic of Nekemte Referral Hospital. A total of 252 study participants were included in the study. Data were collected by interviewing patients during hospital visits and reviewing respective databases. The association between dependent and independent variables was assessed using bivariable and stepwise multivariable logistic regression. A variable with a p-value < 0.05 was considered as an independent predictor. A patient's written informed consent was obtained after explaining the purpose and procedures of the study. RESULTS Mean age of the participants was 41.7 ± 17.6 years. The majority of the participants (67.1%) had poor knowledge about diabetes. The glycemic rate control was 40.5%; while more than half of the participants (59.5%) had poor glycemic control. On multivariable logistic analysis poor glycemic control was more likely to occur among unemployed (p < 0.001), patients with no family/social support (p = 0.024), duration of diabetes >10 years (p = 0.005), poor knowledge about diabetes (p = 0.012), taking insulin (p = 0.004) and taking metformin plus glibenclamide (p < 0.001). CONCLUSION A finding of this study revealed that a glycemic control of study participants was poor. Thus greater effort is needed to improve glycemic control. Health care professionals should work on improving the adherence to anti-diabetic medications of diabetic patients and knowledge of diabetic patients on diabetes by providing education to the patients during follow up to improve glycemic control.
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Affiliation(s)
- Mohammed Gebre Dedefo
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Selamu Kebamo Abate
- Pharmacology Unit, Department of Pharmacy, College of Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Balisa Mosisa Ejeta
- Pharmaceutics Unit, Department of Pharmacy, College of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
| | - Ayana Tadesse Korsa
- Clinical Pharmacy Unit, Department of Pharmacy, College of Health Sciences, Wollega University, Nekemte, Oromia, Ethiopia
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Walker AF, Atkinson MA, Lee AM, Aulisio G, Brusko TM, Haller MJ, Schatz DA. Teaching Type 1 Diabetes: Creating Stakeholder Engagement in Biomedical Careers Through Undergraduate Research Curriculum. MEDICAL SCIENCE EDUCATOR 2020; 30:69-73. [PMID: 34457640 PMCID: PMC8368109 DOI: 10.1007/s40670-019-00877-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Undergraduate students living with chronic diseases attending universities where major biomedical research takes place are critical stakeholders in these programs, yet they often remain sequestered from them. A directed research curriculum about Type 1 Diabetes (T1D) was developed to better engage undergraduate students with personal connections to the disease in a large medical university setting world renowned for its research in this area. The course had the following student learning outcomes: (1) gain knowledge of major T1D research programs; (2) exposure to careers in T1D research and clinical care; and (3) recognize bioethical issues in T1D research.
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Affiliation(s)
- Ashby F. Walker
- University of Florida Diabetes Institute, University of Florida, PO Box 100309, Gainesville, FL 32610 USA
- Department of Health Services Research, Management and Policy, University of Florida, PO Box 100195, Gainesville, FL 32610 USA
| | - Mark A. Atkinson
- University of Florida Diabetes Institute, University of Florida, PO Box 100309, Gainesville, FL 32610 USA
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, PO Box 100275, Gainesville, FL 32610 USA
| | - Alexandra M. Lee
- Department of Health Outcomes and Biomedical Informatics, University of Florida, PO Box 100177, Gainesville, FL 32610 USA
| | - Gina Aulisio
- University of Florida Diabetes Institute, University of Florida, PO Box 100309, Gainesville, FL 32610 USA
- College of Public Health and Health Professions, University of Florida, PO Box 100185, Gainesville, FL 32610 USA
| | - Todd M. Brusko
- University of Florida Diabetes Institute, University of Florida, PO Box 100309, Gainesville, FL 32610 USA
- Department of Pathology, Immunology, and Laboratory Medicine, University of Florida, PO Box 100275, Gainesville, FL 32610 USA
| | - Michael J. Haller
- University of Florida Diabetes Institute, University of Florida, PO Box 100309, Gainesville, FL 32610 USA
- Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610 USA
| | - Desmond A. Schatz
- University of Florida Diabetes Institute, University of Florida, PO Box 100309, Gainesville, FL 32610 USA
- Department of Pediatrics, University of Florida, PO Box 100296, Gainesville, FL 32610 USA
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Walker AF, Haller MJ, Gurka MJ, Morris HL, Bruggeman B, Miller K, Foster N, Anez Zabala C, Schatz DA. Addressing health disparities in type 1 diabetes through peer mentorship. Pediatr Diabetes 2020; 21:120-127. [PMID: 31617648 DOI: 10.1111/pedi.12935] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 10/08/2019] [Accepted: 10/08/2019] [Indexed: 02/06/2023] Open
Abstract
Pronounced health disparities exist in type 1 diabetes (T1D) based on socioeconomic status (SES) yet there are a lack of programs designed to promote health equity for vulnerable communities. The All for ONE (Outreach, Networks, and Education) mentoring program was piloted pairing college students and publicly insured teenagers with T1D to assess feasibility as a possible intervention. There were 22 mentors recruited (mean age 20 ± 2 years; 17 [77%] females; mean HbA1c 8.4 ± 1.5%) and matched with mentees based on gender. There were 42 teens randomized to treatment and control groups including 22 teens in the treatment group (age 14 ± 2 years; 17 [77%] females; HbA1c 9.8 ± 2.3%) and 20 teens in the control group (age 14 ± 2 years; 15 [75%] females; HbA1c 8.9 ± 2.0%) followed over 9 months. Outcome measures included HbA1c and the Children's Hope Scale. The intervention included automated text reminders for blood glucose monitoring, text exchanges, social events with education, and clinic visits with mentors/mentees. Mean change in HbA1c for teens was +0.09% in the intervention group, compared with +0.28% in the control group (P = .61); college students had a reduction in HbA1c of -0.22% (P = .38). Treatment group teens had marked improvement in their hope for the future compared to control group teens (P = .04) and were more likely to attend clinic visits (P = .02). This program established feasibility for a model that could be replicated and modified for other types of settings. Additional research is warranted to study the potential long-term benefits of participating in the All for ONE mentoring program.
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Affiliation(s)
- Ashby F Walker
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida.,Department of Health Services Research, Management and Policy, University of Florida, Gainesville, Florida
| | - Michael J Haller
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida.,Department of Pediatrics, University of Florida, Gainesville, Florida
| | - Matthew J Gurka
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
| | - Heather L Morris
- Department of Health Outcomes and Biomedical Informatics, University of Florida, Gainesville, Florida
| | | | | | | | | | - Desmond A Schatz
- University of Florida Diabetes Institute, University of Florida, Gainesville, Florida.,Department of Pediatrics, University of Florida, Gainesville, Florida
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Mullan BA, Dzidic P, Boyes M, Hasking P, Slabbert A, Johnson R, Scott A. The lived experience of young Australian adults with type 1 diabetes. PSYCHOL HEALTH MED 2019; 25:480-485. [PMID: 31847575 DOI: 10.1080/13548506.2019.1705989] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The purpose of the research was to explore the challenges, frustrations and experiences faced by young Australian adults with type 1 diabetes. We focused on the navigation of health behaviours (e.g. eating out, consuming alcohol, physical activity), which impact blood glucose levels, posing particular challenges for people with type 1 diabetes. Semi-structured interviews were conducted with 25 young adults with type 1 diabetes, between May and August 2016. Interviews were transcribed verbatim, and coded using thematic analysis. Participants reported that the experience of type 1 diabetes made simple things complicated and involved constant vigilance and control. Difficult experiences in social situations were also mentioned; participants felt that their privacy was often threatened, that people voiced misunderstandings about type 1 diabetes, and that members of the public often judge and critique their health behaviours or lifestyle choices. Simple behaviours like eating out with friends, responsible alcohol consumption, and engaging in physical activity pose particular challenges for young people with type 1 diabetes. Public education may reduce stigma and improve health behaviour.
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Affiliation(s)
- Barbara A Mullan
- Health Psychology and Behavioural Medicine Research Group, School of Psychology & Speech Pathology, Curtin University, Perth, Australia.,School of Psychology, University of Sydney, Sydney, Australia
| | - Peta Dzidic
- Health Psychology and Behavioural Medicine Research Group, School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | - Mark Boyes
- Health Psychology and Behavioural Medicine Research Group, School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | - Penelope Hasking
- Health Psychology and Behavioural Medicine Research Group, School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | - Ashley Slabbert
- Health Psychology and Behavioural Medicine Research Group, School of Psychology & Speech Pathology, Curtin University, Perth, Australia
| | | | - Amelia Scott
- Health Psychology and Behavioural Medicine Research Group, School of Psychology & Speech Pathology, Curtin University, Perth, Australia
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Ramchandani N, Way N, Melkus GD, Sullivan-Bolyai S. Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes. DIABETES EDUCATOR 2019; 45:484-497. [PMID: 31304878 DOI: 10.1177/0145721719861349] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
PURPOSE The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored. METHODS A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected. RESULTS The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM. CONCLUSIONS The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.
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Affiliation(s)
| | - Niobe Way
- Department of Applied Psychology, New York University Steinhardt, New York, New York
| | | | - Susan Sullivan-Bolyai
- University of Massachusetts Medical School-Graduate School of Nursing, Worcester, Massachusetts
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Djonou C, Tankeu AT, Dehayem MY, Tcheutchoua DN, Mbanya JC, Sobngwi E. Glycemic control and correlates in a group of sub Saharan type 1 diabetes adolescents. BMC Res Notes 2019. [PMID: 30670077 DOI: 10.1186/s13104‐019‐4054‐1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES This study aims to describe the prevalence of glycemic control and related factors in a population of Sub-Saharan African T1D patients. We carried out a cross-sectional study including children and adolescents from seven different centers of the Changing Diabetes in Children (CDiC) program. All children enrolled in the program where recruited after parental consent. Diabetes history, daily practice anthropometrics parameters and HbA1c were assessed for each participant. RESULTS We enrolled 95 children adolescents, aged from 06 to 19 years. The mean HbA1c was 9.2 ± 2.5% and 67.4% of participant had poor glycemic control. There was an association between study level of the patients (p = 0.03), healthy eating habits (p < 0.001), diabetes duration (p < 0.001) and level of glycemic control on univariate analysis. On multivariate analysis, diabetes diagnosed for more than 2 years was associated to a good control compared to those with diagnosis that is more recent. Glycemic control of adolescents with type1 diabetes remain very poor in Cameroon despite the implementation of free diabetes care through the program CDiC.
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Affiliation(s)
- Cathy Djonou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Aurel T Tankeu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Mesmin Y Dehayem
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Daryl N Tcheutchoua
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon. .,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon.
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Djonou C, Tankeu AT, Dehayem MY, Tcheutchoua DN, Mbanya JC, Sobngwi E. Glycemic control and correlates in a group of sub Saharan type 1 diabetes adolescents. BMC Res Notes 2019; 12:50. [PMID: 30670077 PMCID: PMC6341641 DOI: 10.1186/s13104-019-4054-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Accepted: 01/08/2019] [Indexed: 01/19/2023] Open
Abstract
Objectives This study aims to describe the prevalence of glycemic control and related factors in a population of Sub-Saharan African T1D patients. We carried out a cross-sectional study including children and adolescents from seven different centers of the Changing Diabetes in Children (CDiC) program. All children enrolled in the program where recruited after parental consent. Diabetes history, daily practice anthropometrics parameters and HbA1c were assessed for each participant. Results We enrolled 95 children adolescents, aged from 06 to 19 years. The mean HbA1c was 9.2 ± 2.5% and 67.4% of participant had poor glycemic control. There was an association between study level of the patients (p = 0.03), healthy eating habits (p < 0.001), diabetes duration (p < 0.001) and level of glycemic control on univariate analysis. On multivariate analysis, diabetes diagnosed for more than 2 years was associated to a good control compared to those with diagnosis that is more recent. Glycemic control of adolescents with type1 diabetes remain very poor in Cameroon despite the implementation of free diabetes care through the program CDiC.
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Affiliation(s)
- Cathy Djonou
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Aurel T Tankeu
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Mesmin Y Dehayem
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Daryl N Tcheutchoua
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Jean Claude Mbanya
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon.,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon
| | - Eugene Sobngwi
- Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Yaoundé, Cameroon. .,National Obesity Center, Yaounde Central Hospital, Yaoundé, Cameroon.
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14
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Saylor J, Hanna KM, Calamaro CJ. Experiences of College Students Who Are Newly Diagnosed With Type 1 Diabetes Mellitus. J Pediatr Nurs 2019; 44:74-80. [PMID: 30683284 DOI: 10.1016/j.pedn.2018.10.020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/26/2018] [Accepted: 10/26/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To gain insight and understanding of emerging adult experiences after a diagnosed with type 1 diabetes mellitus (T1DM) and prior to or during college life experiences. DESIGN AND METHODS A qualitative research design using a focus group was conducted with 12 college students recently diagnosed with T1DM during emerging adulthood. The focus group took place during a College Diabetes Network retreat. Using Braun and Clarke's six phase process, two researchers independently conducted a thematic analysis from the transcribed, verbatim audiotaped narratives. RESULTS The 12 participants attended colleges in 11 different states. The mean age was 21 years (SD = 6.3) and the majority were female (n = 7). Qualitative analysis revealed four themes: 1) diabetes affects all aspects of life and complicates college living; 2) college environment affects diabetes management; 3) diabetes diagnosis facilitates growth and maturity; and 4) strategies used for diabetes management in college. CONCLUSION T1DM is complex to manage in the college environment. However, these emerging adults newly diagnosed with T1DM highlight strategies for diabetes management while in college and the pivotal role of pediatric providers play in the successful management of T1DM. PRACTICE IMPLICATIONS Diabetes education for emerging adults in college requires an adaptive focus that supports the developmental needs of this population. Nurses should focus on teaching healthy, modifiable behaviors of sleep, physical activity, and nutrition to improve glycemic control as well as adapting to the college life choices.
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Affiliation(s)
| | - Kathleen M Hanna
- University of Nebraska Medical Center, College of Nursing, NE, USA
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15
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Habenicht AE, Gallagher S, O’Keeffe MC, Creaven AM. Making the leap and finding your feet: A qualitative study of disclosure and social support in university students with type 1 diabetes. J Health Psychol 2018; 26:260-269. [DOI: 10.1177/1359105318810875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
University poses unique challenges surrounding disclosure for students living with type 1 diabetes, with implications for social support and self-management. Semi-structured interviews with students and peer interviewers living with type 1 diabetes explored university experiences of disclosure and social support. Thematic analysis identified three major themes: disclosure as a measured process, the need for lived experience for true understanding and personal growth and self-awareness. Findings emphasize the need to scaffold the university transition for individuals with type 1 diabetes as disclosure can elicit effective social support. In addition, the importance of lived experience suggests support from students with type 1 diabetes could considerably impact diabetes management.
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16
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Albanese-O'Neill A, Beauchamp G, Thomas N, Westen SC, Johnson N, Schatz D, Haller MJ. Transition Education for Young Adults With Type 1 Diabetes: Pilot Feasibility Study for a Group Telehealth Intervention. JMIR Diabetes 2018; 3:e10909. [PMID: 30401674 PMCID: PMC6246967 DOI: 10.2196/10909] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 08/01/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022] Open
Abstract
Background Young adults with type 1 diabetes (T1D) experience a decline in glycemic outcomes and gaps in clinical care. A diabetes education and support program designed for young adults was delivered through group videoconference and mobile Web. Objective The objective of our study was to assess the feasibility, acceptability, and preliminary efficacy of the program as measured by attendance and webpage views, satisfaction, and pre- and postintervention psychosocial outcomes, respectively. Methods Young adults aged 18-25 years were recruited to attend five 30-minute group diabetes education videoconferences during an 8-week period. Videoconferences included an expert presentation followed by a moderated group discussion. Within 48 hours of each videoconference, participants were sent a link to more information on the study website. Feasibility was assessed using data on videoconference attendance and webpage views. Acceptability was assessed via a Satisfaction Survey completed at the conclusion of the study. Descriptive statistics were generated. Preliminary efficacy was assessed via a survey to measure changes in diabetes-specific self-efficacy and diabetes distress. Pre- and postintervention data were compared using paired samples t tests. Results In this study, 20 young adults (mean age 19.2 [SD 1.1] years) attended an average of 5.1 (SD 1.0) videoconferences equivalent to 153 (SD 30.6) minutes of diabetes education per participant during an 8-week period. Average participant satisfaction scores were 62.2 (SD 2.6) out of a possible 65 points. A total of 102 links sent via text message (short message service) or email resulted in 504 webpage views. There was no statistically significant difference between pre- and postintervention diabetes-specific self-efficacy or diabetes-related distress. Conclusions Delivery of diabetes education via group videoconference using mobile Web follow-up is feasible and acceptable to young adults with T1D. This model of care delivery has the potential to improve attendance, social support, and patient-reported satisfaction. Nevertheless, further research is required to establish the effect on long-term psychosocial and glycemic outcomes.
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Affiliation(s)
- Anastasia Albanese-O'Neill
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Giovanna Beauchamp
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, United States
| | - Nicole Thomas
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Sarah C Westen
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | | | - Desmond Schatz
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
| | - Michael J Haller
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Florida, Gainesville, FL, United States
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17
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Kellett J, Sampson M, Swords F, Murphy HR, Clark A, Howe A, Price C, Datta V, Myint KS. Young people's experiences of managing Type 1 diabetes at university: a national study of UK university students. Diabet Med 2018; 35:1063-1071. [PMID: 29687498 DOI: 10.1111/dme.13656] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2018] [Indexed: 01/30/2023]
Abstract
AIM Little is known about the challenges of transitioning from school to university for young people with Type 1 diabetes. In a national survey, we investigated the impact of entering and attending university on diabetes self-care in students with Type 1 diabetes in all UK universities. METHODS Some 1865 current UK university students aged 18-24 years with Type 1 diabetes, were invited to complete a structured questionnaire. The association between demographic variables and diabetes variables was assessed using logistic regression models. RESULTS In total, 584 (31%) students from 64 hospitals and 37 university medical practices completed the questionnaire. Some 62% had maintained routine diabetes care with their home team, whereas 32% moved to the university provider. Since starting university, 63% reported harder diabetes management and 44% reported higher HbA1c levels than before university. At university, 52% had frequent hypoglycaemia, 9.6% reported one or more episodes of severe hypoglycaemia and 26% experienced diabetes-related hospital admissions. Female students and those who changed healthcare provider were approximately twice as likely to report poor glycaemic control, emergency hospital admissions and frequent hypoglycaemia. Females were more likely than males to report stress [odds ratio (OR) 4.78, 95% confidence interval (CI) 3.19-7.16], illness (OR 3.48, 95% CI 2.06-5.87) and weight management issues (OR 3.19, 95% CI 1.99-5.11) as barriers to self-care. Despite these difficulties, 91% of respondents never or rarely contacted university support services about their diabetes. CONCLUSION The study quantifies the high level of risk experienced by students with Type 1 diabetes during the transition to university, in particular, female students and those moving to a new university healthcare provider.
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Affiliation(s)
- J Kellett
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Clinical Research and Trials Unit, Norwich, UK
| | - M Sampson
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Clinical Research and Trials Unit, Norwich, UK
| | - F Swords
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Clinical Research and Trials Unit, Norwich, UK
| | - H R Murphy
- University Medical Centre, University of East Anglia, Norwich, UK
| | - A Clark
- Norwich Medical School, Faculty of Health and Medical Sciences, Norwich, UK
| | - A Howe
- Norwich Medical School, Faculty of Health and Medical Sciences, Norwich, UK
| | - C Price
- University Medical Centre, University of East Anglia, Norwich, UK
| | - V Datta
- Department of Paediatrics, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | - K S Myint
- Department of Diabetes and Endocrinology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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18
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Saylor J, Lee S, Ness M, Ambrosino JM, Ike E, Ziegler M, Roth CL, Calamaro C. Positive Health Benefits of Peer Support and Connections for College Students With Type 1 Diabetes Mellitus. DIABETES EDUCATOR 2018; 44:340-347. [PMID: 29949457 DOI: 10.1177/0145721718765947] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study is to examine the characteristics and health outcomes of college students with type 1 diabetes mellitus (T1DM) as it relates to membership in a local university-based diabetes student organization. Methods This descriptive, correlational research design is a secondary analysis of data. The sample consisted of nationally representative young adults in college (n = 317) between 18 and 30 years of age who were diagnosed with T1DM. Data were collected during April 2017 using a secure electronic diabetes management survey to inquire about self-reported barriers to diabetes management, hypoglycemia, and diabetic ketoacidosis of members of a diabetes organization. Results Students were evenly distributed from freshman to senior year of college with a slight decrease at the graduate level. Students who were affiliated members of a student-led diabetes student organization were less likely to report increased levels of isolation, depressive symptoms, and anxiety related to their diabetes than were general members. Conclusion Participation in a university-based diabetes student organization on campus and connecting with other college students with diabetes may have health benefits. In conclusion, the current study underscores the potential importance of peer-led, diabetes-specific support for adolescents emerging into adulthood.
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Affiliation(s)
| | - Sara Lee
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Michelle Ness
- School of Nursing, University of Delaware, Newark, Delaware
| | - Jodie M Ambrosino
- Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut
| | - Emily Ike
- The College Diabetes Network, Boston, Massachusetts
| | - Melissa Ziegler
- University of Delaware, College of Health Sciences, Biostatistics Core, Newark, Delaware
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19
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Raymaekers K, Oris L, Prikken S, Moons P, Goossens E, Weets I, Luyckx K. The Role of Peers for Diabetes Management in Adolescents and Emerging Adults With Type 1 Diabetes: A Longitudinal Study. Diabetes Care 2017; 40:1678-1684. [PMID: 29138272 DOI: 10.2337/dc17-0643] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 09/09/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged. However, longitudinal research linking the peer context to diabetes management and outcomes is scarce. The present longitudinal study in a large sample of youths with type 1 diabetes related both positive and negative peer variables to diabetes outcomes over a time interval of 1 year. RESEARCH DESIGN AND METHODS Our sample consisted of 467 adolescents (14-17 years of age) and emerging adults (18-25 years of age) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-related distress, and treatment adherence. HbA1c values were obtained from the treating physicians of patients. Cross-lagged analysis from a structural equation modeling approach was performed to assess the directionality of effects. RESULTS Peer support negatively predicted diabetes-related distress over time. Extreme peer orientation positively predicted treatment distress over time. Parental responsiveness negatively predicted food distress over time. Treatment adherence negatively predicted extreme peer orientation, treatment distress, and HbA1c values over time. For emerging adults specifically, there was a reciprocal relationship between HbA1c values and extreme peer orientation because they positively predicted each other. CONCLUSIONS This study highlights the importance of peers in predicting the functioning of youths with type 1 diabetes. Additionally, treatment adherence at baseline was found to negatively predict extreme peer orientation, treatment distress, and worse glycemic control over time. In sum, the current study underscores the importance of the peer context for adolescents and emerging adults with type 1 diabetes.
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Affiliation(s)
| | - Leen Oris
- University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | | | - Philip Moons
- University of Leuven, Leuven, Belgium.,University of Gothenburg, Gothenburg, Sweden
| | - Eva Goossens
- University of Leuven, Leuven, Belgium.,Research Foundation Flanders, Brussels, Belgium
| | - Ilse Weets
- Free University Brussels, Brussels, Belgium
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20
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Abstract
PURPOSE OF REVIEW The purpose of the study is to examine and summarize studies reporting on the epidemiology, the risk of developing diabetes, and the cardiovascular effects on individuals with diabetes of different levels of alcohol consumption. RECENT FINDINGS Men consume more alcohol than women in populations with and without diabetes. Light-to-moderate alcohol consumption decreases the incidence of diabetes in the majority of the studies, whereas heavy drinkers and binge drinkers are at increased risk for diabetes. Among people with diabetes, light-to-moderate alcohol consumption reduces risks of cardiovascular diseases and all-cause mortality. Alcohol consumption is less common among populations with diabetes compared to the general population. Moderate alcohol consumption reduces the risk of diabetes and, as in the general population, improves cardiovascular health in patients with diabetes. Type of alcoholic beverage, gender, and body mass index are factors that affect these outcomes.
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Affiliation(s)
- Sarit Polsky
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Court, MS A140, Aurora, CO, 80045, USA.
| | - Halis K Akturk
- Barbara Davis Center for Diabetes, University of Colorado Denver, 1775 Aurora Court, MS A140, Aurora, CO, 80045, USA
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21
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Use of the Hage framework for theory construction: Factors affecting glucose control in the college-aged student with type 1 diabetes. Appl Nurs Res 2017; 37:61-66. [DOI: 10.1016/j.apnr.2017.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/29/2017] [Accepted: 08/04/2017] [Indexed: 11/24/2022]
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22
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Pastor A, Conn J, Teng J, O'Brien CL, Loh M, Collins L, MacIsaac R, Bonomo Y. Alcohol and recreational drug use in young adults with type 1 diabetes. Diabetes Res Clin Pract 2017. [PMID: 28646702 DOI: 10.1016/j.diabres.2017.05.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Alcohol and other recreational drug use reaches peak prevalence in young adulthood, including for those with chronic medical conditions such as type 1 diabetes. This review summarises the current literature on the patterns of substance use amongst young adults with type 1 diabetes and the mechanisms through which alcohol and recreational drugs may affect diabetes related health outcomes. These include the direct physical effect of intoxication, as well as the effects of alcohol and drugs on mental health and glucose metabolism. Evidence for increased associated mortality and morbidity is also presented, and current guidelines, management strategies and directions for further research are discussed.
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Affiliation(s)
- Adam Pastor
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia.
| | - Jennifer Conn
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Australia
| | - Jessie Teng
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia
| | - Casey L O'Brien
- Mental Health Services, St Vincent's Hospital Melbourne, Australia; Department of Psychiatry, University of Melbourne, Australia
| | - Margaret Loh
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia
| | - Lisa Collins
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia
| | - Richard MacIsaac
- Department of Endocrinology and Diabetes, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
| | - Yvonne Bonomo
- Department of Addiction Medicine, St Vincent's Hospital Melbourne, Australia; Department of Medicine, University of Melbourne, Australia
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23
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Monaghan M, King MM, Alvarez V, Cogen FR, Wang J. Changes in type 1 diabetes health indicators from high school to college. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:157-161. [PMID: 26199180 PMCID: PMC4723297 DOI: 10.1080/07448481.2015.1068780] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/20/2023]
Abstract
OBJECTIVE Evaluate trajectories of type 1 diabetes health indicators from high school through the first year of college. PARTICIPANTS Seventy-four students with type 1 diabetes who maintained pediatric endocrinology care during the first year of college. METHODS Hemoglobin A1c (HbA1c), blood glucose monitoring frequency, body mass index (BMI), and clinic attendance data were collected via retrospective medical chart review in spring 2012. Group-based trajectory models evaluated diabetes-related health indicators over time and identified distinct growth trajectory groups. RESULTS BMI increased and clinic attendance decreased in the first year of college. Trajectories for other health indicators were heterogeneous and stable over time; 69% of students were classified as having stable good glycemic control. Racial minority youth and youth on conventional insulin regimens were disproportionally represented in higher-risk groups. CONCLUSIONS Diabetes health indicators are stable or decline upon college entrance. Results signal the need for targeted support for college students with type 1 diabetes.
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Affiliation(s)
- Maureen Monaghan
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | | | | | - Fran R. Cogen
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
| | - Jichuan Wang
- Children’s National Health System, Washington, DC
- George Washington University School of Medicine, Washington, DC
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24
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Abstract
Objective. The purpose of this study is to investigate the meaning of living with an insulin pump for the management of type 1 diabetes during the period of emerging adulthood. Through a phenomenological narrative, this study contributes to the reflective understanding of the everyday life experiences of this population. Methods. A hermeneutic phenomenological design was used for this study of nine emerging adults (aged 19-24 years). Data were generated through face-to-face interviews and analyzed using the phenomenological approach of Max van Manen. Results. Four themes represent the essence of the day-to-day experiences of these emerging adults: seeking control, becoming responsible, staying connected, and accepting me. Conclusions. An in-depth understanding of the meaning of daily experiences with insulin pump technology has the potential to promote a developmentally appropriate approach to this age-group. The human understanding gained through this study is essential to the development of evidence-based practice guidelines and resources for this vulnerable population.
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Affiliation(s)
- Donna G. Hood
- Division of Nursing, Louisiana Tech University, Ruston, LA
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25
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Monaghan M, Helgeson V, Wiebe D. Type 1 diabetes in young adulthood. Curr Diabetes Rev 2015; 11:239-50. [PMID: 25901502 PMCID: PMC4526384 DOI: 10.2174/1573399811666150421114957] [Citation(s) in RCA: 117] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 02/24/2015] [Accepted: 03/09/2015] [Indexed: 02/08/2023]
Abstract
Type 1 diabetes has traditionally been studied as a chronic illness of childhood. However, young adulthood is a critical time for the development and integration of lifelong diabetes management skills, and research is starting to identify unique challenges faced by youth with diabetes as they age into adulthood. Most young adults experience multiple transitions during this unstable developmental period, including changes in lifestyle (e.g., education, occupation, living situation), changes in health care, and shifting relationships with family members, friends, and intimate others. Young adults with type 1 diabetes must navigate these transitions while also assuming increasing responsibility for their diabetes care and overall health. Despite these critical health and psychosocial concerns, there is a notable lack of evidence-based clinical services and supports for young adults with type 1 diabetes. We review relevant evolving concerns for young adults with type 1 diabetes, including lifestyle considerations, health care transitions, psychosocial needs, and changes in supportive networks, and how type 1 diabetes impacts and is impacted by these key developmental considerations. Specific avenues for intervention and future research are offered.
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26
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Ravert RD, Boren SA, Wiebke E. Transitioning through college with diabetes: themes found in online forums. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2015; 63:258-267. [PMID: 25693002 DOI: 10.1080/07448481.2015.1015026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Content analysis of Internet-based diabetes forum text was used to examine the experiences encountered by students with diabetes transitioning into and through college. PARTICIPANTS Forum posts (N = 238) regarding attending college with diabetes were collected and analyzed. METHODS Thematic coding was used to identify prominent topics, followed by analysis of theme distribution across college transitional stages. Three students with diabetes were recruited to review results and corroborate findings. RESULTS Twenty thematic categories were identified. Preparation for college involved efforts to move toward autonomous diabetes management. Transitioning in was marked by adjusting to a college lifestyle, then working to manage issues such as busy schedules and alcohol use as continuing students, and turning attention toward future career options and finances while transitioning out. CONCLUSIONS As they move into and through college, students with diabetes negotiate developmental and diabetes-specific tasks within an environment that presents unique logistical, lifestyle, and psychological challenges.
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27
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Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW. An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in educational settings. BMC Pediatr 2014; 14:228. [PMID: 25213220 PMCID: PMC4263204 DOI: 10.1186/1471-2431-14-228] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. METHOD Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3-25 years in educational settings. RESULTS Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. CONCLUSION This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.
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Affiliation(s)
- Deborah Edwards
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jane Noyes
- />School of Social Sciences, Bangor University, Bangor, LL57 2EF UK
| | - Lesley Lowes
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Llinos Haf Spencer
- />School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - John W Gregory
- />Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
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28
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Singh H, Gonder-Frederick L, Schmidt K, Ford D, Vajda KA, Hawley J, Cox DJ. Assessing hyperglycemia avoidance in people with Type 1 diabetes. ACTA ACUST UNITED AC 2014. [DOI: 10.2217/dmt.14.3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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29
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Lee PY, Lee YK, Khoo EM, Ng CJ. How do health care professionals assess patients when initiating insulin therapy? A qualitative study. Prim Care Diabetes 2014; 8:49-55. [PMID: 24315732 DOI: 10.1016/j.pcd.2013.11.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Revised: 11/07/2013] [Accepted: 11/09/2013] [Indexed: 01/28/2023]
Abstract
AIMS To explore how health care professionals (HCPs) assess patients when initiating insulin therapy in type 2 diabetes. METHODS Focus group discussions and in-depth interviews were conducted with 41 health care professionals in Malaysia in 2010-2011. A semi-structured topic guide was used for the interview. The interviews were transcribed verbatim and analysed using the Nvivo9 software based on a thematic approach. RESULTS HCPs were less likely to initiate insulin therapy in patients who were older, with irregular dietary patterns and poor financial status. They also assessed patients' knowledge, views and misconceptions of insulin. However, there was a variation in how doctors assessed patients' comorbidities before starting insulin therapy. Medical officers were more likely to initiate insulin therapy in patients with comorbidities and complications, whereas family medicine specialists were more cautious. In addition, most HCPs considered patients' psychosocial status, including self-care ability, social support and quality of life. CONCLUSIONS HCPs' assessment of patients' need to start insulin therapy depends on their perception rather than objective evaluation of patients' background, knowledge, perception and abilities. The background and the type of practice of HCPs influence their assessment.
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Affiliation(s)
- Ping Yein Lee
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 UPM Serdang, Selangor, Malaysia.
| | - Yew Kong Lee
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chirk Jenn Ng
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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Balfe M, Brugha R, Smith D, Sreenan S, Doyle F, Conroy R. Why do young adults with Type 1 diabetes find it difficult to manage diabetes in the workplace? Health Place 2014; 26:180-7. [DOI: 10.1016/j.healthplace.2013.12.016] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 12/05/2013] [Accepted: 12/19/2013] [Indexed: 10/25/2022]
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Noyes JP, Lowes L, Whitaker R, Allen D, Carter C, Edwards RT, Rycroft-Malone J, Sharp J, Edwards D, Spencer LH, Sylvestre Y, Yeo ST, Gregory JW. Developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multicentre randomised controlled trial. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jane P Noyes
- Centre for Health-Related Research, Bangor University, Bangor, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cynthia Carter
- Cardiff School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, UK
| | - Rhiannon T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Janice Sharp
- Media Resources Centre, University Hospital of Wales, Cardiff, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Yvonne Sylvestre
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - John W Gregory
- Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
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Helgeson VS, Palladino DK, Reynolds KA, Becker DJ, Escobar O, Siminerio L. Relationships and health among emerging adults with and without Type 1 diabetes. Health Psychol 2013; 33:1125-33. [PMID: 23914816 DOI: 10.1037/a0033511] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study's goal was to examine the impact of parent and peer relationships on health behaviors and psychological well-being of those with and without Type 1 diabetes over the transition to emerging adulthood. Emerging adulthood is an understudied developmental period and a high-risk period--especially for those with Type 1 diabetes. METHOD Youth with (n = 117) and without Type 1 diabetes (n = 122) completed questionnaires during their senior year of high school and 1 year later. Measures included supportive and problematic aspects of parent and peer relationships, health behaviors, psychological well-being, and, for those with diabetes, self-care behavior and glycemic control. RESULTS Prospective multiple and logistic regression analysis revealed that friend conflict was a more potent predictor than friend support of changes in health behaviors and psychological well-being. Parent support was associated with positive changes in psychological well-being and decreases in smoking, whereas parent control was related to increases in smoking and depressive symptoms. There was some evidence of cross-domain buffering such that supportive relationships in one domain buffered adverse effects of problematic relationships in the other domain on health outcomes. CONCLUSIONS This longitudinal study showed that parent relationships remain an important influence on, and peer relationships continue to influence, the health behaviors and psychological well-being of emerging adults with and without Type 1 diabetes. Parent relationships also have the potential to buffer the adverse effects of difficulties with peers.
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Affiliation(s)
| | | | | | - Dorothy J Becker
- Department of Pediatric Endocrinology, Children's Hospital of Pittsburgh
| | - Oscar Escobar
- Department of Pediatric Endocrinology, Children's Hospital of Pittsburgh
| | - Linda Siminerio
- Department of Medicine, University of Pittsburgh Medical Center
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Hill S, Gingras J, Gucciardi E. The Lived Experience of Canadian University Students with Type 1 Diabetes Mellitus. Can J Diabetes 2013; 37:237-242. [DOI: 10.1016/j.jcjd.2013.04.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2012] [Revised: 03/28/2013] [Accepted: 04/23/2013] [Indexed: 10/26/2022]
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Quick VM, Byrd-Bredbenner C, Neumark-Sztainer D. Chronic illness and disordered eating: a discussion of the literature. Adv Nutr 2013; 4:277-86. [PMID: 23674793 PMCID: PMC3650496 DOI: 10.3945/an.112.003608] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This paper describes the prevalence of eating disorders and disordered eating behaviors, the reasons why these practices are endorsed, and the potential consequences in youths and young adults with selected diet-related chronic health conditions (DRCHCs) and provides recommendations for eating disorder prevention interventions and research efforts. Although it remains unclear whether the prevalence of eating disorders is higher in those with DRCHCs compared with the general population, overall findings suggest that young people with DRCHCs may be at risk of endorsing disordered eating behaviors that may lead to diagnosis of an eating disorder and other health problems over the course of their treatment. Thus, health care providers should be aware that young people with DRCHCs may be at risk of eating disorders and carefully monitor psychological changes and the use of unhealthy weight control methods. It is also important to develop and evaluate theory-based interventions and disease-specific eating disorder risk screening tools that are effective in halting the progression of eating disorders and negative health outcomes in young people with chronic health conditions.
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Affiliation(s)
- Virginia M. Quick
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Division of Epidemiology, Statistics, and Prevention Research, NIH, DHHS, Bethesda, MD
| | | | - Dianne Neumark-Sztainer
- School of Public Health, Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, MN
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Angamo MT, Melese BH, Ayen WY. Determinants of glycemic control among insulin treated diabetic patients in Southwest Ethiopia: hospital based cross sectional study. PLoS One 2013; 8:e61759. [PMID: 23620789 PMCID: PMC3631159 DOI: 10.1371/journal.pone.0061759] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Accepted: 03/12/2013] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Good glycemic control reduces the risk of diabetic complications. Despite this, achieving good glycemic control remains a challenge in diabetic patients. The objective of this study is to identify determinants of glycemic control among insulin treated diabetic patients at Jimma University Hospital, Southwest Ethiopia. METHODS Hospital-based cross-sectional study was conducted on systematically sampled 284 insulin-treated diabetic patients with a regular follow up. Data was collected by interviewing patients during hospital visits and reviewing respective databases of September 2010 to December 2011. Data collection took place from February 20 to May 20, 2012. Poor glycemic control was defined as fasting blood sugar (FBS) ≥126 mg/dL. Binary logistic regression analysis was conducted to identify predictors of poor glycemic control. RESULTS Patients had a mean age of 41.37 (±15.08) years, 58.5% were males, the mean duration of insulin treatment was 4.9 (±5.1) years, 18.3% achieved good glycemic control (FBS≤126 mg/dL), 95% self-reported repeated use of disposable insulin syringe-needle and 48% correctly rotating insulin injection sites. Most (83.1%) of study participants had one or more complications. On multivariable logistic regression analyses, body weight of >70 Kg (AOR = 0.21; P<0.001), total daily dose of insulin ≤35 IU/day (AOR = 0.26; P<0.001), total daily dose variation without checking glycemic level (AOR = 3.39; P = 0.020), knowledge deficit about signs and symptoms of hyperglycemia (AOR = 3.60; P = 0.004), and non-adherence to dietary management (AOR = 0.35; P = 0.005) were independent predictors of poor glycemic control. CONCLUSIONS The proportion of patients with poor glycemic control was high, which resulted in the development of one or more complications regardless of duration on insulin treatment. Hence, appropriate management of patients focusing on the relevant associated factors and independent predictors of poor glycemic control would be of great benefit in glycemic control.
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Engler PA, Ramsey SE, Smith RJ. Alcohol use of diabetes patients: the need for assessment and intervention. Acta Diabetol 2013; 50:93-9. [PMID: 20532803 PMCID: PMC2954251 DOI: 10.1007/s00592-010-0200-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 05/17/2010] [Indexed: 10/19/2022]
Abstract
It is well known that diabetes self-care behaviors are critical to disease progression. Unfortunately, many patients do not adhere to diabetes self-care recommendations despite their importance. Alcohol use has been identified as a barrier to diabetes self-care adherence. Excessive alcohol consumption not only negatively impacts diabetes self-care adherence but also affects the course of diabetes. Diabetes patients who are at-risk drinkers are likely to have poor diabetes treatment adherence, leading to increased morbidity and mortality. Alcohol consumption by diabetes patients is often inadequately assessed and addressed in their medical care. Brief interventions to reduce at-risk drinking have been well validated in a variety of patient populations and offer the potential to improve diabetes treatment adherence and outcome. Assessment and treatment of at-risk drinking could be readily incorporated into routine diabetes care. Strategies for brief assessment of and intervention for at-risk drinking are offered.
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Affiliation(s)
- Patricia A Engler
- Alpert Medical School of Brown University and Rhode Island Hospital, 593 Eddy Street, DGIM, 111 Plain Street Building, Providence, RI, 02903, USA.
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37
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Hendricks M, Monaghan M, Soutor S, Chen R, Holmes CS. A profile of self-care behaviors in emerging adults with type 1 diabetes. DIABETES EDUCATOR 2013; 39:195-203. [PMID: 23396184 DOI: 10.1177/0145721713475840] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study is to characterize daily diabetes self-care behaviors and to evaluate associations among self-care behaviors, psychosocial adjustment, and glycemic control in an understudied sample of emerging adults with type 1 diabetes. METHODS Forty-nine emerging adults (65% women; ages 18-26 years) completed 2 diabetes interviews to assess self-care behaviors and self-report measures of psychosocial adjustment. Glycemic control was assessed via hemoglobin A1C. RESULTS Diabetes self-care behaviors varied widely and were largely suboptimal; only a small percentage of participants demonstrated self-care behaviors consistent with national and international recommendations. Psychosocial adjustment was within normal limits and was unrelated to frequency of self-care behaviors in this sample. Mean glycemic control (8.3%) was higher than the recommended A1C level (< 7.0%) for this age group. Use of intensive (e.g., multiple daily injections or pump) insulin regimens was related to better glycemic control. CONCLUSIONS The majority of emerging adults in this sample did not engage in optimal daily diabetes self-care. Intensive insulin therapy was associated with better glycemic control without corresponding psychosocial distress. Diabetes care behaviors could be improved in this age group, and emerging adults may benefit from targeted education and behavioral support to enhance diabetes self-management and optimize health outcomes.
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Affiliation(s)
- Melissa Hendricks
- Virginia Commonwealth University, Richmond, Virginia (Drs Hendricks, Soutor, Holmes)
| | - Maureen Monaghan
- Children’s National Medical Center, Washington, DC (Dr Monaghan)
| | - Sari Soutor
- Virginia Commonwealth University, Richmond, Virginia (Drs Hendricks, Soutor, Holmes)
| | - Rusan Chen
- Georgetown University, Washington, DC (Drs Chen, Holmes)
| | - Clarissa S Holmes
- Virginia Commonwealth University, Richmond, Virginia (Drs Hendricks, Soutor, Holmes),Georgetown University, Washington, DC (Drs Chen, Holmes)
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38
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Stupiansky NW, Hanna KM, Slaven JE, Weaver MT, Fortenberry JD. Impulse control, diabetes-specific self-efficacy, and diabetes management among emerging adults with type 1 diabetes. J Pediatr Psychol 2012; 38:247-54. [PMID: 23115219 DOI: 10.1093/jpepsy/jss110] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To explore the relationships among impulse control, diabetes-specific self-efficacy, and diabetes management behaviors among emerging adults with type 1 diabetes. METHODS A total of 204 high school seniors (M = 18.25 years, SD = .45, 55.9% females) with type 1 diabetes self-reported on impulse control, diabetes-specific self-efficacy, and diabetes management behaviors during the past 3 months. Mediation and path analyses were used to address aims. RESULTS Greater impulse control was associated with better diabetes management among these emerging adults. In addition, diabetes-specific self-efficacy partially mediated the relationship between impulse control and diabetes management. CONCLUSIONS Impulse control and diabetes-specific self-efficacy may be important in the management of type 1 diabetes among emerging adults. Diabetes-specific self-efficacy may play an important role in successful diabetes management among youth with lower impulse control.
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Affiliation(s)
- Nathan W Stupiansky
- Section of Adolescent Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
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39
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Barnard K, Sinclair JMA, Lawton J, Young AJ, Holt RIG. Alcohol-associated risks for young adults with Type 1 diabetes: a narrative review. Diabet Med 2012; 29:434-40. [PMID: 22248115 DOI: 10.1111/j.1464-5491.2012.03579.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
AIM To undertake a narrative review of the impact and pattern of alcohol consumption in young adults with Type 1 diabetes. DATA SOURCES MEDLINE, EMBASE, PsycINFO, The Cochrane Library, Web of Science, meeting abstracts of the European Association for the Study of Diabetes, the American Diabetes Association and Diabetes UK, Current Controlled Trials, ClinicalTrials.gov, UK Clinical Research Network, scrutiny of bibliographies of retrieved papers and contact with experts in the field. INCLUSION CRITERIA relevant studies of any design of alcohol consumption and young adults with Type 1 diabetes (age 14-25 years) were included. The key outcomes were the quantity, pattern and impact of alcohol consumption, the effect on diabetes control and the effect of interventions to minimize the risks of alcohol for this population. RESULTS Six articles and two conference abstracts met the inclusion criteria. There were six cross-sectional studies, one qualitative study and one within-subjects design study. Quality of studies was variable. Alcohol use amongst young adults with Type 1 diabetes was reported to be common and potentially harmful. There was a paucity of evidence on interventions to minimize the risks of alcohol in this target group. CONCLUSIONS Research is required to understand the social context of alcohol consumption in this population with a view to developing appropriate interventions to minimize the risks associated with its use.
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Affiliation(s)
- K Barnard
- NETSCC, University of Southampton, Faculty of Medicine, University of Southampton, Southampton, UK.
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Muchmore DB, Vaughn DE. Review of the mechanism of action and clinical efficacy of recombinant human hyaluronidase coadministration with current prandial insulin formulations. J Diabetes Sci Technol 2010; 4:419-28. [PMID: 20307403 PMCID: PMC2864178 DOI: 10.1177/193229681000400223] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
For patients with type 1 or type 2 diabetes, achieving good glycemic control is critical for successful treatment outcomes. As many patients remain unable to reach glycemic goals with currently available rapid-acting analog insulins, ultrafast insulin products are being developed that provide an even faster pharmacokinetic profile compared with current rapid prandial insulin products. The overall strategy of these ultrafast insulin products is to better mimic the normal physiologic response to insulin that occurs in healthy individuals to further improve glycemic control. Recombinant human hyaluronidase (rHuPH20) is a genetically engineered soluble hyaluronidase approved by the U.S. Food and Drug Administration as an adjuvant to increase the absorption and dispersion of other injected drugs; mammalian hyaluronidases as a class have over 6 decades of clinical use supporting the safety and/or efficacy of hyaluronidase coadministration. Clinical findings have demonstrated that coadministration of rHuPH20 with insulin or an insulin analog achieved faster systemic absorption, reduced inter- and intrapatient variability of insulin absorption, and achieved faster metabolic effects compared with injection of either insulin formulation alone. The magnitude of this acceleration is similar to the incrementally faster absorption of prandial insulin analogs as compared with regular insulin. In addition, coadministration of rHuPH20 with regular insulin or insulin analog also improved the achievement of prandial glycemic targets. Thus, rHuPH20 coadministration shows promise as a method of establishing a more rapid insulin profile to prandial insulin in patients with diabetes and has the potential to yield substantial improvements in postprandial glycemic excursion.
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Ravert RD. Alcohol management strategies of college students with diabetes. PATIENT EDUCATION AND COUNSELING 2009; 77:97-102. [PMID: 19303733 DOI: 10.1016/j.pec.2009.02.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Revised: 12/06/2008] [Accepted: 02/01/2009] [Indexed: 05/27/2023]
Abstract
OBJECTIVE Alcohol management strategies of college undergraduates with diabetes were studied in order to identify which strategies were associated with decreased alcohol consumption and consequences. METHODS Data came from 450 undergraduates with diabetes who were among 90,000 students from 123 postsecondary institutions who completed the Spring, 2006 National College Health Assessment. RESULTS A majority of respondents (68.0%) reported alcohol use in the previous month, with 41.8% consuming five or more drinks in one sitting during the previous 2 weeks. High alcohol management strategy use in the past year was associated with fewer heavy drinking episodes and fewer alcohol-related consequences. Two strategies, avoiding drinking games and pacing one's drinking, were especially strong predictors of reduced consumption and consequences, and were more common among older students. CONCLUSION Developing effective strategies to manage alcohol intake is especially important for students with diabetes due to short- and long-term hazards of excessive drinking. PRACTICAL IMPLICATIONS Alcohol use is a common aspect of college culture and may hold perceived social benefits for students. Healthcare clinicians should help students with diabetes to identify alcohol management strategies that are perceived as effective and feasible. Avoiding drinking games and pacing drinks appear to be strategies especially worthy of promotion.
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Affiliation(s)
- Russell D Ravert
- Department of Human Development & Family Studies, University of Missouri, Columbia, MO 65211, USA.
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Abstract
TITLE Healthcare routines of university students with Type 1 diabetes. AIM This paper is a report of a study examining the benefits that university students with Type 1 diabetes associate with diabetes self-care routines, and the barriers that they experience in enacting self-care routines in the university environment. BACKGROUND Many young adults with Type 1 diabetes attend university, and it is thought that these students might experience difficulties with their self-care routines while they are there. METHOD A qualitative method was chosen to explore students' own perspectives. Seventeen students with diabetes were interviewed twice, and each kept a research diary for a 2-week period. Interviews and diaries were analyzed using standard qualitative techniques. The study was conducted in 2004-2005. FINDINGS Routines had a number of identity-producing benefits for students. However, students often experienced difficulties routinizing their self-care practices at university. These difficulties stemmed both from the irregular nature of university life and from students' desires not to let their diabetes interfere with their student lives. Most participants learned to adjust to university and enact self-care routines, although they could still experience routine difficulties during times of transition and stress. CONCLUSION Healthcare professionals need to be aware of the difficulties that university students with Type 1 diabetes experience with their self-care routines. This awareness needs to encompass older students in the second, third and fourth years of their undergraduate degrees and postgraduate students as well as students in their first year at university.
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Affiliation(s)
- Myles Balfe
- Department of Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland.
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Ramsey SE, Engler PA. At-risk drinking among diabetic patients. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2009; 3:15-23. [PMID: 24357927 PMCID: PMC3864951 DOI: 10.4137/sart.s2243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Diabetes Mellitus is a serious chronic disease, affecting an increasing number of individuals worldwide. Adherence to diabetes self-care behaviors is key to the successful management of the disease. At-risk drinking is common among diabetic patients and is associated with inferior diabetes treatment adherence and outcomes, resulting in increased mortality and morbidity. Furthermore, individuals with diabetes who engage in at-risk drinking are also in danger of incurring the negative consequences of at-risk drinking found in the general population. Research suggests that alcohol use screening and intervention do not commonly occur during the course of primary care treatment for diabetes. While methods for reducing alcohol use in this population have been largely unexplored to date, brief interventions to reduce at-risk drinking have been well-validated in other patient populations and offer the promise to reduce at-risk drinking among diabetic patients, resulting in improved diabetes treatment adherence and outcomes.
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Affiliation(s)
- Susan E Ramsey
- Department of Psychiatry and Human Behavior, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, U.S. ; Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, U.S
| | - Patricia A Engler
- Department of Medicine, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, Rhode Island, U.S
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Balfe M. Diets and discipline: the narratives of practice of university students with type 1 diabetes. SOCIOLOGY OF HEALTH & ILLNESS 2007; 29:136-53. [PMID: 17286710 DOI: 10.1111/j.1467-9566.2007.00476.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Type 1 diabetes is one of the most common chronic conditions of adolescence and young adulthood. It is characterised by a demanding and complex management regime. Individuals with diabetes must engage in continual self-care actions such as eating healthily and exercising if they are to minimise their risks of developing long-term diabetes' complications. Research has demonstrated, however, that many young adults experience difficulties with exercising and eating healthily. Narrative approaches could provide important insights into the reasons why young people do or do not experience difficulties here. In this article I examine the food consumption and exercise narratives of a particular group of young adults with type 1 diabetes, university students, to see what personal, social and cultural factors influence their practices.
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Affiliation(s)
- Myles Balfe
- Department of Geography, University of Sheffield.
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45
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Geddes J, McGeough E, Frier BM. Young adults with Type 1 diabetes in tertiary education: do students receive adequate specialist care? Diabet Med 2006; 23:1155-7. [PMID: 16978384 DOI: 10.1111/j.1464-5491.2006.01933.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To examine the clinical characteristics of, and diabetes management provided for, young people with Type 1 diabetes in tertiary education. METHODS The medical case records of a group of 55 students aged 18-24 years, all of whom had Type 1 diabetes and had been referred to a hospital diabetes clinic, were examined. RESULTS A mean (SD) attendance of 80% (28%) was observed for all clinic appointments. Despite greater use of intensified insulin therapy (increasing from 37% to 83%) of students neither mean HbA1c nor mean body mass index changed significantly. Microvascular complications were infrequent. Documentation in the case notes of the frequency of home blood glucose monitoring was inadequate in 25% of patients as was the recorded frequency of mild (self-treated) hypoglycaemia in (20%) of patients. CONCLUSIONS Despite a satisfactory frequency of clinic attendance and organisation of insulin regimens by medical staff, glycaemic control remained unchanged throughout University attendance. The inadequate documentation of dietary habits, frequency of home blood glucose monitoring, hypoglycaemia, social habits and activities in both groups may provide a partial explanation, as other variables were not addressed. Young adults with Type 1 diabetes may benefit from receiving specialist care in a clinic dedicated to their particular needs.
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Affiliation(s)
- J Geddes
- Department of Diabetes, The Royal Infirmary, Edinburgh, UK
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Tkacs NC, Thompson HJ. From bedside to bench and back again: research issues in animal models of human disease. Biol Res Nurs 2006; 8:78-88. [PMID: 16766631 PMCID: PMC2366101 DOI: 10.1177/1099800406289717] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
To improve outcomes for patients with many serious clinical problems, multifactorial research approaches by nurse scientists, including the use of animal models, are necessary. Animal models serve as analogies for clinical problems seen in humans and must meet certain criteria, including validity and reliability, to be useful in moving research efforts forward. This article describes research considerations in the development of rodent models. As the standard of diabetes care evolves to emphasize intensive insulin therapy, rates of severe hypoglycemia are increasing among patients with type 1 and type 2 diabetes mellitus. A consequence of this change in clinical practice is an increase in rates of two hypoglycemia-related diabetes complications: hypoglycemia-associated autonomic failure (HAAF) and resulting hypoglycemia unawareness. Work on an animal model of HAAF is in an early developmental stage, with several labs reporting different approaches to model this complication of type 1 diabetes mellitus. This emerging model serves as an example illustrating how evaluation of validity and reliability is critically important at each stage of developing and testing animal models to support inquiry into human disease.
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Gerich J, Becker RHA, Zhu R, Bolli GB. Fluctuation of serum basal insulin levels following single and multiple dosing of insulin glargine. Diabetes Technol Ther 2006; 8:237-43. [PMID: 16734552 DOI: 10.1089/dia.2006.8.237] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The large fluctuations in blood concentrations and activity observed with insulin therapies such as NPH insulin or insulin ultralente may result in hyper- or hypoglycemia. METHODS We compared the fluctuations of these insulins with the long-acting basal insulin analog insulin glargine as a re-analysis of three Phase I studies: (I) glargine with NPH or ultralente [single-dose (0.4 IU/kg), randomized study in healthy volunteers (n = 36)]; (II) glargine or NPH [single-dose (0.3 IU/kg), randomized study in patients with diabetes mellitus Type 1 (DMT1) (n = 20)]; and (III) glargine (tailor-made dose) plus insulin lispro in DMT1 (n = 15 over 11 days). Percent deviation around average serum concentration over 24 h (PF24) was used to determine within-patient fluctuation and mean fluctuation value for each treatment group. RESULTS Mean PF24 in healthy volunteers (Study I) was significantly lower with glargine (19.8%) than with NPH and ultralente (31.9% and 47.2%, respectively; both P < 0.001 vs. glargine). Similarly, about half the fluctuation observed with NPH (PF24 25.8%) was seen with glargine (PF24 14.2%; P < 0.001) in DMT1 (Study II). In ambulatory DMT1 patients receiving multiple glargine doses, PF24 values demonstrated that the same low fluctuations (PF24 20%) were retained throughout near-maintenance treatment (Study III). CONCLUSIONS Glargine provided less diurnal fluctuation in serum insulin levels than NPH and ultralente in healthy volunteers and patients with DMT1. This lower fluctuation of glargine over NPH or ultralente can help to reduce hyper- or hypoglycemia risks associated with insulin therapy and accordingly encourage achievement of better blood glucose control.
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Affiliation(s)
- John Gerich
- University of Rochester Medical Center, Rochester, New York, USA
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Dubé MC, Valois P, Prud'homme D, Weisnagel SJ, Lavoie C. Physical activity barriers in diabetes: development and validation of a new scale. Diabetes Res Clin Pract 2006; 72:20-7. [PMID: 16256239 DOI: 10.1016/j.diabres.2005.08.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Accepted: 08/19/2005] [Indexed: 11/19/2022]
Abstract
To develop and validate a questionnaire measuring perceived Barriers to Physical Activity in Diabetes (type 1) or BAPAD1. Initially, an open-ended questionnaire was filled by 36 patients. The modal accessible beliefs obtained on this pilot study were analysed and a scale composed of 12 items (BAPAD1) was developed and validated. Seventy-four type 1 diabetic patients filled the BAPAD1 scale. Cronbach alpha coefficient was 0.85 and the correlation between the test-retest scores was 0.84, both indicating adequate reliability of the barriers scale. Each item of BAPAD1 scale displayed very good item characteristic curve except for item 12, which was withdrawn. The test reliability curve indicated that the BAPAD1 scale is informative (value>or=0.82) at all levels of perceived barriers toward physical activity. Moreover, among diabetic-related items, the risk of hypoglycemia showed a particularly good item characteristic curve. In summary, the BAPAD1 scale presents excellent psychometric proprieties and among diabetic-related items, the risk of hypoglycemia should be considered as a significant target to overcome in order to increase physical activity. This new validated tool should be useful in identifying the most salient barriers toward the practice of physical activity and thus, permit more focused intervention in order to overcome those barriers.
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Affiliation(s)
- M-C Dubé
- Faculty of Medicine, Department of Physiology and Endocrinology, Laval University, Qué., Canada
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Davies M. The reality of glycaemic control in insulin treated diabetes: defining the clinical challenges. Int J Obes (Lond) 2004; 28 Suppl 2:S14-22. [PMID: 15306833 DOI: 10.1038/sj.ijo.0802745] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The benefits of good glycaemic control in both type I and type II diabetes mellitus are undoubtedly proven. Most national bodies have recommended glycaemic targets, with an HbA(1c) to achieve between 6.5 and 7.5%. However, it is well known that even in clinical trials, and routinely in clinical practice, the majority of patients fail to achieve optimal glycaemic control. The reasons for this failure are complex and multifactorial. Healthcare providers often delay the initiation and intensification of insulin unnecessarily. This stems from a fear of causing hypoglycaemia or weight gain in patients, from doubts about patients' self-care abilities and/or from inadequate resources to provide the necessary structured education to support patient self-management. Patients may be poorly adherent to treatment advice-particularly behavioural aspects such as self-monitoring, diet and exercise-although this may itself derive from inadequate access to effective diabetes education. There is, however, a limit to what can be achieved with existing exogenous insulin therapies due to their imperfect pharmacokinetic and pharmacodynamic profiles. Prominent among these imperfections is the problem of variability of effect from injection to injection with basal insulin formulations. Improvements in this area should benefit control and tolerability.
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Affiliation(s)
- M Davies
- Leicester Royal Infirmary, Infirmary Square, Leicester, UK
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Miller-Hagan RS, Janas BG. Drinking perceptions and management strategies of college students with diabetes. DIABETES EDUCATOR 2002; 28:233-44. [PMID: 11924301 DOI: 10.1177/014572170202800209] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE The purpose of this research was to explore how college students with diabetes perceive and manage alcohol consumption. METHODS Fifteen college students with diabetes attending a large northeastern university participated in a single semistructured interview that focused on the impact of starting college on diabetes management and situational obstacles to diet-related self-care. Interviews were audiotaped, transcribed verbatim, and analyzed using the constant comparative method of analysis. RESULTS Students perceived alcohol as a pervasive part of the university environment and felt strong peer pressure to drink in alcohol-related social situations. Students described 3 distinct drinking practices and identified factors that shaped decisions about drinking. Most students developed personal strategies to manage drinking, usually without guidance. CONCLUSIONS Some of the students' strategies appeared reasonable for avoiding adverse outcomes of drinking; however, other strategies may have increased their risk of hypoglycemia or poor glucose control. More research is needed to understand how students' management strategies influence diabetes control and to explore how education and counseling from healthcare providers can improve students' management of drinking.
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Affiliation(s)
| | - Bernadette G Janas
- Department of Nutritional Sciences, Rutgers University, The State University of New Jersey, New Brunswick
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