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Aouchiche K, Bernoux D, Baechler Sadoul E, Haine E, Joubert F, Epstein S, Faure Galon N, Dalla-Vale F, Combe JC, Samper M, Simonin G, Castets S, Marquant E, Vergier J, Reynaud R. Impact of continuous glucose monitoring on everyday life of young children with type 1 diabetes and their parents: An evaluation of 114 families. Prim Care Diabetes 2024; 18:91-96. [PMID: 38000979 DOI: 10.1016/j.pcd.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/08/2023] [Accepted: 11/03/2023] [Indexed: 11/26/2023]
Abstract
INTRODUCTION The prevalence of type 1 diabetes is increasing worldwide. The advent of new monitoring devices has enabled tighter glycemic control. AIM To study the impact of glucose monitoring devices on the everyday life of young children with type 1 diabetes (T1D) and their parents. METHODS A questionnaire was addressed to parents of children with T1D under the age of 6 years with an insulin pump treated in one of the hospitals of the ADIM network in France between January and July 2020. RESULTS Among the 114 families included in the study, 53% of parents (26/49) woke up every night to monitor blood glucose levels when their child had flash glucose monitoring (FGM), compared with 23% (13/56) of those whose child had continuous glucose monitoring (CGM). Overall, 81% of parents (86/108) found that glucose monitoring improved their own sleep and parents whose child had CGM were significantly more likely to report improved sleep (86% vs 73%, p = 0.006). Forty-nine percent of parents (55/113) declared that they (in 87% of cases, the mother only) had reduced their working hours or stopped working following their child's T1D diagnosis. Maternal unemployment was significantly associated with the presence of siblings (p = 0.001) but not with glycemic control (p = 0,87). Ninety-eight percent of parents (105/107) think that glucose monitoring improves school integration. CONCLUSION In these families of children with T1D, new diabetes technologies reduced the burden of care but sleep disruption remained common. Social needs evaluation, particularly of mothers, is important at initial diagnosis of T1D in children.
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Affiliation(s)
- K Aouchiche
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France.
| | - D Bernoux
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - E Baechler Sadoul
- Nice-Lenval University Hospital, Department of Pediatrics, 57 Avenue de la Californie, Nice, France
| | - E Haine
- Nice-Lenval University Hospital, Department of Pediatrics, 57 Avenue de la Californie, Nice, France
| | - F Joubert
- Avignon Hospital, Department of Pediatrics, 305 Rue Raoul Follereau, 84902 Avignon, France
| | - S Epstein
- Aubagne Hospital, Department of Pediatrics, 179 Av des Sœurs Gastine, 13677 Aubagne, France
| | - N Faure Galon
- Aix-en-Provence Pertuis Hospital, Department of Pediatrics, Avenue des Tamaris, Aix-en Provence, France
| | - F Dalla-Vale
- Montpellier University Hospital, Department of Pediatrics, Arnaud De Villeneuve Hospital, 371 avenue Doyen Gaston Giraud, 34295 Montpellier, France; Saint-Pierre Institute, Department of Pediatrics, 371 Avenue de l'évêché de Maguelone, 34250 Palavas-les-Flots, France
| | - J C Combe
- Hyères hospital, Depatment of Pediatrics, Bd Maréchal Juin, 83400 Hyères, France
| | - M Samper
- Pediatric Val Pré Vert Rehabilitation and Recuperative Care Facilities, 929 route de Gardanne, 13105 Mimet, France
| | - G Simonin
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - S Castets
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - E Marquant
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - J Vergier
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
| | - R Reynaud
- Assistance-Publique des Hôpitaux de Marseille (APHM), Multidisciplinary Pediatric Service - La Timone Children's Hospital, 264 rue Saint Pierre, 13385 Marseille, France
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Averbuch S, Yackobovitch-Gavan M, Ben Simon A, Interator H, Lopez A, Borger O, Laurian I, Dorfman A, Chorna E, Oren A, Eyal O, Brener A, Lebenthal Y. Muscle-to-fat ratio in children and adolescents with type 1 diabetes in predicting glycaemic control and partial clinical remission. Diabetes Metab Res Rev 2024; 40:e3767. [PMID: 38407547 DOI: 10.1002/dmrr.3767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 11/13/2023] [Accepted: 01/15/2024] [Indexed: 02/27/2024]
Abstract
BACKGROUND Advances in treatment could mitigate the expected adverse changes in the body composition of children and adolescents with type 1 diabetes (T1D). OBJECTIVES To examine the evolution of weight status and body composition and their association with glycaemic control and partial clinical remission in youth with T1D. METHODS Ninety-nine participants with T1D (median age 9.5 years [interquartile range 7.3, 12.9], 59.6% boys) were longitudinally followed for 3 years since diagnosis. Data at seven pre-determined time points were extracted from medical files. Outcome measures included body mass index (BMI) z-scores, muscle-to-fat ratio (MFR) z-scores, haemoglobin A1c (HbA1c) levels, continuous glucose monitoring metrics, and insulin dose-adjusted HbA1c (IDAA1c) levels. RESULTS The BMI z-scores increased significantly (p < 0.001) for both sexes, with no significant change in MFR z-scores over time. The girls had higher BMI z-scores (p < 0.001) and lower MFR z-scores than the boys (p = 0.016). The mean HbA1c levels decreased during the first month and at 3 months since diagnosis (p < 0.001), then plateaued and achieved a median overall HbA1c of 7.1% for the entire cohort. At 12 months, 37 participants (37.6%) were in partial clinical remission, as evidenced by IDAA1c ≤ 9. The odds of partial clinical remission at 2 years increased by 2.1-fold for each standard deviation increase in the MFR z-score (p < 0.001). Higher MFR z-scores were associated with better metabolic control. CONCLUSIONS Integration of body composition assessments could mitigate adverse body changes in paediatric patients with T1D.
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Affiliation(s)
- Shay Averbuch
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Yackobovitch-Gavan
- Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Asaf Ben Simon
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hagar Interator
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Nutrition & Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Adar Lopez
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Nutrition & Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ophir Borger
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- The Nutrition & Dietetics Unit, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Irina Laurian
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Nursing Services, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Anna Dorfman
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Nursing Services, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Efrat Chorna
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Social Services, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Asaf Oren
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ori Eyal
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Avivit Brener
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Lebenthal
- The Institute of Pediatric Endocrinology, Diabetes and Metabolism, "Dana-Dwek" Children's Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Moghadam YH, Zeinaly Z, Alhani F. How mothers of a child with type 1 diabetes cope with the burden of care: a qualitative study. BMC Endocr Disord 2022; 22:129. [PMID: 35562744 PMCID: PMC9107259 DOI: 10.1186/s12902-022-01045-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 05/09/2022] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Caregiver burden is a complex construct that depends heavily on the context and culture of the community in which care takes place. This study aimed to explore the lived experience of being mothers of a child with type 1 diabetes aged 6 to 18 years. MATERIALS AND METHODS We used a qualitative methodology utilizing conventional content analysis. We conducted 24 interviews with 20 mothers who had a child with type 1 diabetes aged 6 to 17 years. RESULTS The mean age of mothers and children were 36.3 and 12.3 years, respectively. The mean of years with the disease was 4.3 years. Thirteen children were girls. The essential theme was coping with the burden of care through personalized coping and active acquisition of social support. The main theme consists of four sub-themes including Crisis in the family and burden of care, Losing the family equilibrium, Personalized coping strategies, and Active acquisition of social support. Mothers used personalized strategies and every support they could get to reach their aim. CONCLUSIONS Families of children with type 1 diabetes need extensive and personalized care plans.
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Affiliation(s)
- Yusef Haghighi Moghadam
- Faculty of Nursing & Midwifery School, Urmia University of Medical Sciences, UMSU Central Site: Orjhans Street, Resalat Blvd, Urmia, 571478334, Iran
| | - Zhaleh Zeinaly
- Faculty of Nursing & Midwifery School, Urmia University of Medical Sciences, UMSU Central Site: Orjhans Street, Resalat Blvd, Urmia, 571478334, Iran.
| | - Fatemah Alhani
- Faculty of Medical Sciences, Department of Nursing, Tarbiat Modares University, Tehran, Iran
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Schierloh U, Aguayo GA, Schritz A, Fichelle M, De Melo Dias C, Vaillant MT, Cohen O, Gies I, de Beaufort C. Intermittent Scanning Glucose Monitoring or Predicted Low Suspend Pump Treatment: Does It Impact Time in Glucose Target and Treatment Preference? The QUEST Randomized Crossover Study. Front Endocrinol (Lausanne) 2022; 13:870916. [PMID: 35712259 PMCID: PMC9193969 DOI: 10.3389/fendo.2022.870916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 04/12/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To compare glycemic control and treatment preference in children with type 1 diabetes (T1D) using sensor augmented pump (SAP) with predictive low glucose suspend (SmartGuard®) or pump with independent intermittent scanning continuous glucose monitoring (iscCGM, Freestyle libre ®). METHODS In this open label, cross-over study, children 6 to 14 years of age, treated with insulin pump for at least 6 months, were randomized to insulin pump and iscCGM (A) or SAP with SmartGuard® (B) for 5 weeks followed by 5 additional weeks. The difference in percentages of time in glucose target (TIT), (3.9 - 8.0 mmol/l), <3 mmol/l, > 8 and 10 mmol/l, were analyzed using linear mixed models during the final week of each arm and were measured by blinded CGM (IPro2®). RESULTS 31 children (15 girls) finished the study. With sensor compliance > 60%, no difference in TIT was found, TIT: A 37.86%; 95% CI [33.21; 42.51]; B 37.20%; 95% CI [32.59; 41.82]; < 3 mmol/l A 2.27% 95% CI [0.71; 3.84] B 1.42% 95% CI [-0.13; 2.97]; > 8 mmol/l A 0.60% 95% CI [0.56, 0.67]; B 0.63% [0.56; 0.70]. One year after the study all participants were on CGM compared to 80.7% prior to the study, with a shift of 13/25 participants from iscCGM to SAP. CONCLUSIONS In this study, no significant difference in glycemic control was found whether treated with SAP (SmartGuard®) or pump with iscCGM. The decision of all families to continue with CGM after the study suggests a positive impact, with preference for SmartGuard®. CLINICAL TRIAL REGISTRATION [clinicaltrials.gov], identifier NCT03103867.
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Affiliation(s)
- Ulrike Schierloh
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier, Luxembourg City, Luxembourg
- *Correspondence: Ulrike Schierloh,
| | - Gloria A. Aguayo
- Deep Digital Phenotyping Research Unit, Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Anna Schritz
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Muriel Fichelle
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier, Luxembourg City, Luxembourg
| | - Cindy De Melo Dias
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier, Luxembourg City, Luxembourg
| | - Michel T. Vaillant
- Competence Center for Methodology and Statistics, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Ohad Cohen
- Institute of Endocrinology, Sheba Medical Center, Tel Hashomer, Israel
| | - Inge Gies
- Pediatric Endocrinology, KidZ Health Castle, UZ Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Carine de Beaufort
- Department of Pediatric Diabetes and Endocrinology, Clinique Pédiatrique, Centre Hospitalier, Luxembourg City, Luxembourg
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Silva RAE, Ganen ADP, Fernandes VDFT, Evangelista NMDA, Figueiredo CC, Pacheco LDA, Colares Neto GDP. Evaluation of sleep characteristics of children and adolescents with type 1 diabetes mellitus. REVISTA PAULISTA DE PEDIATRIA 2021; 40:e2020407. [PMID: 34614139 PMCID: PMC8543827 DOI: 10.1590/1984-0462/2022/40/2020407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 02/14/2021] [Indexed: 12/02/2022]
Abstract
Objective: To evaluate sleep characteristics of children and adolescents with type 1 diabetes mellitus (T1DM) and their relationship with glycemic control. Methods: A cross-sectional study was conducted at a public hospital in São Paulo, Brazil. It included 86 patients with T1DM, aged between 10 and 18 years old, who were on insulin therapy, had performed at least three measurements of capillary blood glucose throughout the day, and had normal thyroid function. The clinical, anthropometric, and laboratory data of each patient were evaluated. The Pediatric Daytime Sleepiness Scale (PDSS) and the Munich Chronotype Questionnaire (MCTQ) were used to assess the sleep characteristics. Results: The mean level of glycated hemoglobin (HbA1c) was 9.2±2.1%, and it was higher in adolescents than in children. The mean score of PDSS was 13.9±4.7. Patients with HbA1c<7.5% had lower PDSS scores and longer sleep duration on weekdays than patients with HbA1c≥7.5%. HbA1c levels were negatively correlated with chronotype values and sleep duration on weekdays and positively correlated with social jet lag. Patients who had had T1DM for less than three years had a higher prevalence of daytime sleepiness. The regression analysis showed that higher HbA1c (≥7.5%) and shorter time since the diagnosis of T1DM increased the chance of daytime sleepiness, regardless of age and sex. Conclusions: Patients with higher HbA1c had more daytime sleepiness, a morning chronotype, shorter sleep duration on weekdays and a more significant social jet lag. The shorter diagnosis time for T1DM and greater levels of HbA1c increased the chance of daytime sleepiness.
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Griggs S, Redeker NS, Jeon S, Grey M. Daily variations in sleep and glucose in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:1493-1501. [PMID: 32902901 PMCID: PMC7642150 DOI: 10.1111/pedi.13117] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/21/2020] [Accepted: 09/02/2020] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE We used multilevel models (MLMs) to determine person (between-persons) and day level (within-person) associations between glucose variability indices and sleep characteristics in adolescents with type 1 diabetes (T1D). METHODS Adolescents with T1D (Mean age 13.4 ± 1.8 years; 37.8% male; mean HbA1c 8.2 ± 1.2%, 66 mmol/mol) monitored their sleep and glucose patterns concurrently for 3-7 days with a wrist actigraph on their non-dominant wrist and a continuous glucose monitor (CGM) (their own or a provided, blinded CGM). Glucose variability indices included J index, coefficient of variation, low and high blood glucose risk indices (LBGI and HBGI), time in range, and sleep characteristics, including bedtime, wake time, total sleep time, sleep efficiency, wake after sleep onset, awakenings, and sleep fragmentation index. RESULTS More overall glucose variability was associated within person, more sleep disruptions (more awakenings and more fragmentation) or poorer sleep in our study (earlier wake time or longer wake after sleep onset). Also, more time spent in hypoglycemia <70 mg/dL and a higher LBGI was associated within person with earlier wake time indicating poorer sleep. However, a lower LBGI was associated with a later between-persons wake time. CONCLUSIONS Monitoring over a longer period of time in subsequent studies would allow researchers to determine the within person association between habitual short sleep duration and glucose variability. Providers should regularly assess sleep habits in adolescents as a way to improve glycemic control. Targeting a euglycemic range overnight is also important to promote better sleep and to decrease sleep disruptions.
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Affiliation(s)
- Stephanie Griggs
- Instructor of Nursing, Frances Payne Bolton School of Nursing, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, Ohio 44106
| | - Nancy S. Redeker
- Beatrice Renfield Term Professor of Nursing & Professor of Medicine, Yale University, School of Nursing and School of Medicine, West Haven, Connecticut, USA 06477
| | - Sangchoon Jeon
- Research Scientist, Yale University, School of Nursing, West Haven, Connecticut, USA 06477
| | - Margaret Grey
- Annie Goodrich Professor of Nursing and Professor of Pediatrics, Yale University, School of Nursing and School of Medicine, West Haven, Connecticut, USA 06477
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When Low Blood Sugars Cause High Anxiety: Fear of Hypoglycemia Among Parents of Youth With Type 1 Diabetes Mellitus. Can J Diabetes 2020; 45:403-410.e2. [PMID: 33046404 DOI: 10.1016/j.jcjd.2020.08.098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVES Hypoglycemia is the most common acute complication of type 1 diabetes (T1D), and the potential short- and long-term sequelae can cause children and parents to develop significant fear of hypoglycemia (FOH). FOH and associated anxiety can be disruptive to activities of daily living and lead to reduced quality of life. We sought to determine the extent of FOH among parents of children with T1D within our clinic and to identify factors associated with greater FOH. METHODS Two hundred sixty-four parents of youth (2 to 18 years of age; mean ± standard deviation, 12.4±3.5 years) with T1D completed a survey that included demographic and disease-specific questions, the Spielberger State-Trait Anxiety Inventory and the Hypoglycemia Fear Survey---Parent version (HFS-P). RESULTS Of the 264 participants, 207 completed the full HFS-P, with a mean score of 67±19 (range, 31 to 119). The most frequent worries related to the child being hypoglycemic while alone or asleep. Higher HFS-P scores were also associated with more frequent and severe hypoglycemic episodes, higher state-trait anxiety scores, use of a continuous glucose monitor and more frequent blood glucose checks. Higher HFS-P scores were also associated with worse parental sleep quality and less parental engagement with treatment plans. CONCLUSIONS Parents of children with T1D experience FOH, especially during times of high vulnerability. Moreover, FOH could potentially impact clinical care (with parents being reluctant to administer suggested insulin doses) and quality of life (due to parental/child sleep disruption). Further studies are needed to develop and evaluate interventions aimed at reducing FOH in parents of youth with T1D.
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Griggs S, Whittemore R, Redeker NS, Grey M. Facilitators and Barriers of Sleep in Young Adults With Type 1 Diabetes. THE DIABETES EDUCATOR 2020; 46:242-251. [PMID: 32383625 PMCID: PMC7329586 DOI: 10.1177/0145721720916179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to explore the perceived facilitators and barriers for obtaining sufficient sleep in young adults with type 1 diabetes (T1D). METHODS A qualitative descriptive approach was used to generate data. In-depth semi-structured interviews with 30 young adults with T1D (66.7% female, mean age = 22.1 years) were conducted. Interviews were transcribed verbatim and coded using NVivo. RESULTS Young adults with T1D reported feeling challenged at bedtime and overnight by the demands of a complex disease management regimen. General and diabetes-specific barriers and facilitators to obtaining sufficient sleep were the overarching themes in the present study. Young adults perceived that electronic device use was a facilitator for relaxation before bed and a barrier to sleep by some participants. Delays in bedtime or disruptions in sleep were common diabetes-specific barriers. CONCLUSIONS When designing sleep-promoting interventions for young adults with T1D, researchers should consider diabetes-specific challenges and solutions in addition to those present in the general young adult population.
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Griggs S, Redeker NS, Grey M. Sleep characteristics in young adults with type 1 diabetes. Diabetes Res Clin Pract 2019; 150:17-26. [PMID: 30790611 PMCID: PMC6525057 DOI: 10.1016/j.diabres.2019.02.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 01/18/2019] [Accepted: 02/13/2019] [Indexed: 01/14/2023]
Abstract
Only 14% of young adults with Type 1 Diabetes (T1D) achieve targets for glycemic control (HbA1C < 7.0%), with deterioration over time. Complex cognitive processes required to manage glycemia are vulnerable to sleep deficiency. Using Whittemore and Knafl's approach, we conducted an integrative review of research literature on sleep characteristics and glycemia in these young adults. Quality was assessed using the Mixed Methods Appraisal Tool (v. 2011). Multiple databases were searched for articles published in English in peer-reviewed journals from 2003 to 2018, using search terms 'sleep' and 'T1D' with age limiters 18-40. Of 218 studies initially retrieved, 17 original studies met the inclusion criteria. The following themes were identified in young adults with T1D: (1) They had poorer objective and subjective sleep quality, more variability, and impaired awakening response to hypoglycemia compared with controls; (2) They had poorer glycemic control that was associated with shorter sleep duration, poorer sleep quality, and less time in deep sleep; and (3) Hypoglycemia negatively impacted diabetes management, sleep quality, and next day functioning. Sleep deficiency, as indicated by short sleep duration is associated with a range of negative health outcomes for people with T1D; therefore, optimizing sleep should be a priority in practice and research.
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