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Nassar M, Chaudhuri A, Ghanim H, Dandona P. Glucagon-like peptide-1 receptor agonists as a possible intervention to delay the onset of type 1 diabetes: A new horizon. World J Diabetes 2024; 15:133-136. [PMID: 38464377 PMCID: PMC10921167 DOI: 10.4239/wjd.v15.i2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 12/17/2023] [Accepted: 01/16/2024] [Indexed: 02/04/2024] Open
Abstract
Type 1 diabetes (T1D) is a chronic autoimmune condition that destroys insulin-producing beta cells in the pancreas, leading to insulin deficiency and hyper-glycemia. The management of T1D primarily focuses on exogenous insulin replacement to control blood glucose levels. However, this approach does not address the underlying autoimmune process or prevent the progressive loss of beta cells. Recent research has explored the potential of glucagon-like peptide-1 receptor agonists (GLP-1RAs) as a novel intervention to modify the disease course and delay the onset of T1D. GLP-1RAs are medications initially developed for treating type 2 diabetes. They exert their effects by enhancing glucose-dependent insulin secretion, suppressing glucagon secretion, and slowing gastric emptying. Emerging evidence suggests that GLP-1RAs may also benefit the treatment of newly diagnosed patients with T1D. This article aims to highlight the potential of GLP-1RAs as an intervention to delay the onset of T1D, possibly through their potential immunomodulatory and anti-inflammatory effects and preservation of beta-cells. This article aims to explore the potential of shifting the paradigm of T1D management from reactive insulin replacement to proactive disease modification, which should open new avenues for preventing and treating T1D, improving the quality of life and long-term outcomes for individuals at risk of T1D.
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Affiliation(s)
- Mahmoud Nassar
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14221, United States
| | - Ajay Chaudhuri
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14221, United States
| | - Husam Ghanim
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14221, United States
| | - Paresh Dandona
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, Jacobs School of Medicine and Biomedical Sciences, University of Buffalo, Buffalo, NY 14221, United States
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2
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Rubinstein TB, Dionizovik-Dimanovski M, Davis AM, Smith C, Faust L, Rutstein B, Mitchell M, Jones JT, Harris JG, Rodriguez M, Tesher M, Onel K, Gabbay V, Stein REK, von Scheven E, Knight AM. Multicenter Study of Utility and Acceptability of Depression and Anxiety Screening in Adolescents and Young Adults With Childhood-Onset Systemic Lupus. Arthritis Care Res (Hoboken) 2023; 75:724-733. [PMID: 34806329 PMCID: PMC10544846 DOI: 10.1002/acr.24825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/28/2021] [Accepted: 11/18/2021] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To determine the utility and acceptability for depression and anxiety screening of adolescents and young adults (AYA) with childhood-onset systemic lupus erythematosus (cSLE) in the pediatric rheumatology setting. METHODS AYA with cSLE, ages 12-21 years, from 8 collaborating sites, were consecutively screened for depression and anxiety with the Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder 7-item scale (GAD-7). Demographic and disease characteristics were collected, as well as patient-reported outcome measures using the Patient Reported Outcomes Measurement Information System (PROMIS) pediatric profile-25. Acceptability of screening was assessed with postscreening surveys completed by AYA and parents. Chi-square and Wilcoxon rank sum tests examined the relationship between patient characteristics and history of previous screening. Spearman correlations examined relationships between screening scores, PROMIS domains, and other disease factors. RESULTS Among 106 AYA screened, 64 (60%) had been previously screened, 25 (24%) by general pediatricians. Thirty-two (30%) AYA screened positive, including 24% for depression, 17% for anxiety, and 14% for suicidal ideation. Depression and anxiety symptom severity were highly correlated with increased PROMIS domain scores for fatigue and pain interference and moderately correlated with increased pain severity, decreased mobility, and decreased peer relationships. Eighty-six percent of AYA and 95% of parents expressed comfort with screening in the pediatric rheumatology setting. CONCLUSION Depression, anxiety, and suicidal ideation are common among AYA with cSLE, and symptoms are correlated with important patient-reported outcomes. Mental health screening in the pediatric rheumatology setting was highly acceptable among AYA with cSLE and their parents.
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Affiliation(s)
- Tamar B Rubinstein
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | | | - Alaina M Davis
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | | | - Lauren Faust
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Beth Rutstein
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Manda Mitchell
- Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, Tennessee
| | | | | | | | | | - Karen Onel
- Hospital for Special Surgery, New York, New York
| | - Vilma Gabbay
- Albert Einstein College of Medicine, Bronx, New York, and Nathan Kline Institute for Psychiatric Research, Orangeburg, New York
| | - Ruth E K Stein
- Albert Einstein College of Medicine and Children's Hospital at Montefiore, Bronx, New York
| | | | - Andrea M Knight
- SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada, Perelman School of Medicine, University of Pennsylvania, Philadelphia, and Center for Pediatric Clinical Effectiveness & PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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3
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Pygott N, Hartley A, Seregni F, Ford TJ, Goodyer IM, Necula A, Banu A, Anderson JK. Research Review: Integrated healthcare for children and young people in secondary/tertiary care - a systematic review. J Child Psychol Psychiatry 2023. [PMID: 36941107 DOI: 10.1111/jcpp.13786] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/20/2023] [Indexed: 03/23/2023]
Abstract
BACKGROUND Children and young people (CYP) with comorbid physical and/or mental health conditions often struggle to receive a timely diagnosis, access specialist mental health care, and more likely to report unmet healthcare needs. Integrated healthcare is an increasingly explored model to support timely access, quality of care and better outcomes for CYP with comorbid conditions. Yet, studies evaluating the effectiveness of integrated care for paediatric populations are scarce. AIM AND METHODS This systematic review synthesises and evaluates the evidence for effectiveness and cost-effectiveness of integrated care for CYP in secondary and tertiary healthcare settings. Studies were identified through systematic searches of electronic databases: Medline, Embase, PsychINFO, Child Development and Adolescent Studies, ERIC, ASSIA and British Education Index. FINDINGS A total of 77 papers describing 67 unique studies met inclusion criteria. The findings suggest that integrated care models, particularly system of care and care coordination, improve access and user experience of care. The results on improving clinical outcomes and acute resource utilisation are mixed, largely due to the heterogeneity of studied interventions and outcome measures used. No definitive conclusion can be drawn on cost-effectiveness since studies focused mainly on costs of service delivery. The majority of studies were rated as weak by the quality appraisal tool used. CONCLUSIONS The evidence of on clinical effectiveness of integrated healthcare models for paediatric populations is limited and of moderate quality. Available evidence is tentatively encouraging, particularly in regard to access and user experience of care. Given the lack of specificity by medical groups, however, the precise model of integration should be undertaken on a best-practice basis taking the specific parameters and contexts of the health and care environment into account. Agreed practical definitions of integrated care and associated key terms, and cost-effectiveness evaluations are a priority for future research.
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Affiliation(s)
- Naomi Pygott
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Alex Hartley
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- Department of Psychology, University of Bath, Bath, UK
| | - Francesca Seregni
- Department of Paediatrics, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Tamsin J Ford
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Ian M Goodyer
- Department of Psychiatry, University of Cambridge, Cambridge, UK
| | - Andreea Necula
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
| | - Arina Banu
- Faculty of Medicine, Titu Maiorescu University, Bucharest, Romania
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4
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Price J, Lewis AM, Pierce JS, Enlow PT, Okonak K, Kazak AE. Psychosocial Staffing and Implementation of the International Society for Pediatric and Adolescent Diabetes Psychological Care Guidelines in U.S. Pediatric Diabetes Clinics. Diabetes Spectr 2023; 36:219-227. [PMID: 37583560 PMCID: PMC10425227 DOI: 10.2337/ds22-0047] [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: 01/25/2023]
Abstract
Background Few studies have examined the implementation of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines for the Psychological Care of Children and Adolescents with Type 1 Diabetes. Objective To collect benchmark data on psychosocial staffing and implementation of the ISPAD guidelines across U.S. pediatric diabetes clinics. Methods Medical (n = 95; 77 endocrinologists and 18 advance practice providers) and psychosocial (n = 86; 43 social workers and 43 psychologists) providers from 98 of 115 contacted clinics completed an online survey (85% response rate). Providers reported the number of psychosocial staff and rated the adequacy of psychosocial staffing, quality of psychosocial care, and adherence to the ISPAD guidelines in their clinics. χ2 Tests and ANOVA were used to examine differences across clinic size and across medical and psychosocial providers. Results Clinics averaged a total of ∼4 hours per week of psychosocial provider time per 100 patients with type 1 diabetes. Only 27% of providers agreed that psychosocial staffing was adequate, and 35% described their psychosocial care as comprehensive. Implementation of the ISPAD guidelines varied across clinics, with minimal differences across clinic size. Medical providers reported that evidence-based psychological assessment and interventions were delivered consistently by <55% of clinics. Psychosocial, compared with medical, providers were more likely to report frequent implementation of psychosocial assessment and intervention guidelines. Conclusion Psychological care in U.S. pediatric type 1 diabetes clinics does not consistently meet the ISPAD guidelines, and many clinics lack adequate psychosocial staff. These benchmark data are a foundational step to improve psychosocial care for pediatric patients with type 1 diabetes.
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Affiliation(s)
- Julia Price
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, and Orlando, FL
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Amanda M. Lewis
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, and Orlando, FL
| | - Jessica S. Pierce
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, and Orlando, FL
- University of Central Florida College of Medicine, Orlando, FL
| | - Paul T. Enlow
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, and Orlando, FL
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
| | - Katherine Okonak
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, and Orlando, FL
| | - Anne E. Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, Wilmington, DE, and Orlando, FL
- Department of Pediatrics, Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA
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5
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Marker AM, Patton SR, Clements MA, Egan AE, McDonough RJ. Adjusted Cutoff Scores Increase Sensitivity of Depression Screening Measures in Adolescents With Type 1 Diabetes. Diabetes Care 2022; 45:2501-2508. [PMID: 35984419 DOI: 10.2337/dc22-0275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 07/28/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To measure the acceptability and diagnostic accuracy of commonly used depression screening measures to determine ideal cutoff scores that sensitively identify depressive disorders in adolescents with type 1 diabetes (T1D). RESEARCH DESIGN AND METHODS One hundred adolescents (12-17 years old) completed a reference standard, semistructured diagnostic interview and both long and short versions of five commonly used depression screening measures in the United States. To assess feasibility and acceptability, we used screener completion time and participant ratings, respectively. We used descriptive statistics, area under the receiver operating characteristic (ROC) curve analyses, and paired-sample area differences under the ROC curve to assess each measure's diagnostic validity against our reference standard and to determine ideal cutoff scores for this sample. RESULTS Adolescents had a mean age of 15.0 ± 1.7 years, time since T1D diagnosis of 6.0 ± 4.1 years, and glycated hemoglobin (HbA1c) of 8.9 ± 1.8%. Sixty percent of adolescents were male, 15% endorsed a current depressive disorder, and 15% endorsed lifetime suicidality. Measures demonstrated low sensitivity (0.33-0.67) to detect current depressive disorders using preexisting cutoff scores. However, adjusted cutoff scores increased sensitivity and reduced false negatives. All depression screening measures demonstrated "good" to "excellent" predictive validity, and the Children's Depression Inventory-2 Short version demonstrated significantly greater diagnostic accuracy than the Patient Health Questionnare-2 item version for adolescents. CONCLUSIONS Clinics should consider using screening measures with the greatest diagnostic accuracy as identified in this study and adjusting measure cutoff scores to increase sensitivity and reduce false negatives.
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Affiliation(s)
| | | | | | - Anna E Egan
- Children's Mercy-Kansas City, Kansas City, MO
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6
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Holder M, Kapellen T, Ziegler R, Bürger-Büsing J, Danne T, Dost A, Holl RW, Holterhus PM, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Neu A. Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2022; 130:S49-S79. [PMID: 35913059 DOI: 10.1055/a-1624-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Holder
- Klinikum Stuttgart, Olgahospital, Department of Pediatric Endocrinology and Diabetology, Germany
| | - Thomas Kapellen
- Department of Paediatrics and Adolescent Medicine, University Hospital, Leipzig, Germany
| | - Ralph Ziegler
- Practice for Paediatrics and Adolescent Medicine, Focus on Diabetology, Münster, Germany
| | - Jutta Bürger-Büsing
- Association of Diabetic Children and Adolescents, Diabetes Center, Kaiserslautern, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Axel Dost
- Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital Schleswig-Holstein, Kiel Campus, Germany
| | - Beate Karges
- Endocrinology and Diabetology Section, University Hospital, RWTH Aachen University, Germany
| | - Olga Kordonouri
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Klemens Raile
- Virchow Hospital, University Medicine, Berlin, Germany
| | - Roland Schweizer
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Rainer Stachow
- Sylt Specialist Hospital for Children and Adolescents, Westerland, Germany
| | - Verena Wagner
- Joint Practice for Paediatrics and Adolescent Medicine, Rostock, Germany
| | | | - Andreas Neu
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
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7
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Schwartz DD, Vakharia M, Uysal S, Hendrix KR, Fegan-Bohm K, Lyons SK, Sonabend R, Gunn SK, Banuelos R, Dei-Tutu S. A Comprehensive System for Identifying Patients With Type 1 Diabetes at Increased Risk for Diabetic Ketoacidosis at Texas Children's Hospital. Clin Diabetes 2022; 40:92-96. [PMID: 35221478 PMCID: PMC8865789 DOI: 10.2337/cd21-0072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Quality Improvement Success Stories are published by the American Diabetes Association in collaboration with the American College of Physicians and the National Diabetes Education Program. This series is intended to highlight best practices and strategies from programs and clinics that have successfully improved the quality of care for people with diabetes or related conditions. Each article in the series is reviewed and follows a standard format developed by the editors of Clinical Diabetes. The following article describes a project at Texas Children's Hospital aimed at improving identification of patients with type 1 diabetes at high risk for diabetic ketoacidosis.
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Affiliation(s)
- David D. Schwartz
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Corresponding author: David D. Schwartz,
| | - Mili Vakharia
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Serife Uysal
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Kristen R. Hendrix
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
- Piedmont Physicians Endocrinology, Columbus, GA
| | - Kelly Fegan-Bohm
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sarah K. Lyons
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rona Sonabend
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Sheila K. Gunn
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rosa Banuelos
- Texas Children’s Hospital Quality Outcomes and Analytics, Houston, TX
| | - Selorm Dei-Tutu
- Section of Pediatric Diabetes and Endocrinology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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8
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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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9
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Younes ZMH, Abuali AM, Tabba S, Farooqi MH, Hassoun AAK. Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates. Pediatr Diabetes 2021; 22:683-691. [PMID: 33745208 DOI: 10.1111/pedi.13204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/11/2021] [Accepted: 03/05/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Diabetes distress and depression have been shown to be prevalent among adolescents with type 1 diabetes and screening for these parameters should be a routine part of diabetes care. To assess the prevalence of diabetes distress and depression and their association with glycemic control in a sample of adolescents with type 1 diabetes attending a diabetes center in Dubai, United Arab Emirates. All adolescents aged 13 to 18 years with type 1 diabetes that were seeking treatment at the Dubai Diabetes Center from the period of September 1, 2018 to May 1, 2019. A total of 72 participants completed the study. RESEARCH DESIGN AND METHODS Adolescents were asked to fill in questionnaires assessing diabetes distress and depression. Multivariate linear regression analysis was used to assess the relationships between the subsets of socio-demographic and clinical characteristics, and the scores of the questionnaires. RESULTS The mean HbA1c of the study sample was 9.61% [82 mmol/mol] with higher levels found in females as compared with males (p<0.05). Females showed significantly greater levels of distress as compared with males. Although adolescents with HbA1c≥7.5% scored higher for diabetes distress and depression, the difference was not statistically significant to those with an HbA1c of <7.5%. Higher levels of diabetes distress were highly correlated with depressive symptoms, with distress and depression both being significant predictors of one another. CONCLUSIONS Our results highlight the importance of implementing and sustaining psycho-educational interventions to aid in alleviating diabetes distress and depression in this subgroup of the population.
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Affiliation(s)
| | - Alaa M Abuali
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
| | - Shadi Tabba
- Dubai Diabetes Center, Dubai Health Authority, Dubai, UAE
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10
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Tully C, Clary L, Monaghan M, Levy W, Hilliard ME, Streisand R. Implementation and Preliminary Feasibility of an Individualized, Supportive Approach to Behavioral Care for Parents of Young Children Newly Diagnosed With Type 1 Diabetes. COGNITIVE AND BEHAVIORAL PRACTICE 2021; 28:293-308. [PMID: 34025105 PMCID: PMC8136148 DOI: 10.1016/j.cbpra.2020.06.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
There are significant stressors related to parenting a young child with newly diagnosed type 1 diabetes (T1D). Despite these challenges, there are not yet clearly defined interventions to help promote psychological health and adherence for families with young children with T1D. First STEPS is a tailored stepped care design intervention to positively impact parents' emotional functioning and children's glycemic control in young children newly diagnosed with T1D. The First STEPS intervention is derived from a combination of Cognitive Behavioral Theory and Social Cognitive Theory to support family adjustment to T1D, promote parental mastery over T1D tasks, increase coping skills to manage stressors associated with T1D, and build on the strengths of families newly diagnosed with T1D to help them achieve positive health and wellbeing outcomes. We present details about the intervention and describe two pilot participants as case studies. Results indicated that the treatment and delivery model were acceptable to the pilot participants, as evidenced by treatment completion and satisfaction ratings. Future directions for this work include testing the efficacy of this new treatment in a randomized controlled trial.
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Affiliation(s)
- Carrie Tully
- Children's National Health System and George Washington University
| | - Lauren Clary
- Children's National Health System and George Washington University
| | - Maureen Monaghan
- Children's National Health System and George Washington University
| | - Wendy Levy
- Texas Children's Hospital and Baylor College of Medicine
| | | | - Randi Streisand
- Children's National Health System and George Washington University
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11
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Klostermann S, Iskander J, Enlow P, Delamater AM, Dolan L, Pendley JS. Predicting healthcare utilization in youth with type 1 diabetes: The importance of family level variables. Pediatr Diabetes 2021; 22:294-302. [PMID: 33169899 DOI: 10.1111/pedi.13146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 10/29/2020] [Accepted: 11/06/2020] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE Little is known about how family factors impacting treatment adherence in type 1 diabetes are directly associated with unplanned healthcare utilization (e.g., emergency room visits and hospital admissions). Given the substantial financial burden of diabetes, understanding predictors of healthcare utilization in particular is important to inform behavioral interventions aimed toward improving adherence. RESEARCH DESIGN AND METHODS The current study examined the relationship between family-level variables and healthcare utilization in a sample of 239 youth with type 1 diabetes and their parents. Healthcare utilization was determined via parent report and chart review. Parent- and youth-reports regarding levels of family conflict, youth autonomy, and parent support related to diabetes management were obtained via questionnaire, and negative reciprocity was obtained by coding observations of parent and youth interactions. Generalized Estimating Equations were used to examine the longitudinal association between healthcare utilization and family-level factors. RESULTS Higher levels of observed negative reciprocity were associated with more frequent hospital admissions, while higher levels of youth-reported parent involvement in diabetes management were associated with fewer hospital admissions and ED visits. CONCLUSIONS These findings highlight how family-level factors are directly related to healthcare utilization and point to the continued importance of integrating family-focused behavioral interventions in routine medical care for improving type 1 diabetes outcomes and reducing healthcare costs.
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Affiliation(s)
- Susan Klostermann
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | - Paul Enlow
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lawrence Dolan
- Division of Endocrinology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Jennifer Shroff Pendley
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware, USA.,Department of Pediatrics, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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12
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Price J, Beidas RS, Wolk CB, Genuario K, Kazak AE. Implementation Science in Pediatric Psychology: The Example of Type 1 Diabetes. J Pediatr Psychol 2020; 44:1068-1073. [PMID: 31045228 DOI: 10.1093/jpepsy/jsz030] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/07/2019] [Accepted: 04/08/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Evidence-based screening, assessment, and intervention practices for youth with type 1 diabetes (T1D) are underutilized. Implementation science (IS) offers theoretical models and frameworks to guide rigorous mixed methods research to advance comprehensive care for children and families. METHODS We conducted a targeted review of applications of IS to T1D. RESULTS Pediatric T1D research offers initial, but still limited studies on implementation of evidence-based psychosocial care. IS designates approaches to understanding multi-level factors that influence implementation, ways to alter these factors, and methods to evaluate strategies to improve implementation. CONCLUSIONS IS is promising for advancing the translation of pediatric psychology approaches into clinical care. Following the science of implementation, further documentation of the reach of evidence-based care and establishing practice guidelines are important initial steps. Examining the barriers and facilitators of evidence-based psychosocial care can guide the development of testable implementation strategies to improve integration of care. Successful strategies can be evaluated through multi-site controlled implementation trials to explore their effectiveness. These lines of inquiry can be considered within pediatric populations, but may also be used to examine similarities and differences in effectiveness of implementation strategies across populations and settings. Such research has the potential to improve the health and well-being of children and families.
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Affiliation(s)
- Julia Price
- Nemours Children's Health System, Sidney Kimmel Medical School of Thomas Jefferson University
| | - Rinad S Beidas
- Department of Psychiatry, University of Pennsylvania
- Department of Medical Ethics and Health Policy, University of Pennsylvania
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics, University of Pennsylvania
| | | | | | - Anne E Kazak
- Nemours Children's Health System, Sidney Kimmel Medical School of Thomas Jefferson University
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13
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Barry-Menkhaus SA, Wagner DV, Riley AR. Small Interventions for Big Change: Brief Strategies for Distress and Self-Management Amongst Youth with Type 1 Diabetes. Curr Diab Rep 2020; 20:3. [PMID: 32002682 PMCID: PMC7083649 DOI: 10.1007/s11892-020-1290-7] [Citation(s) in RCA: 8] [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] [Indexed: 10/25/2022]
Abstract
PURPOSE OF REVIEW Diabetes self-management and diabetes distress are complex processes implicated in glycemic control and other health outcomes for youth with type 1 diabetes. Growing integration of medical and behavioral care provides opportunities for brief psychosocial interventions during routine diabetes care. This review focuses on interventions for self-management and diabetes distress that can be delivered alongside usual medical care or via a single-patient encounter. RECENT FINDINGS Recent research underscores the potential of brief interventions delivered by both medical providers and integrated behavioral health professionals, but little is known regarding the comparative effectiveness of different interventions or the factors that impact dissemination and implementation. This article asserts that brevity is critical to maximizing the reach, scalability, and impact of psychosocial interventions for youth with type 1 diabetes. The authors review existing evidence for brief interventions, describe several untested clinical strategies, and make recommendations for accelerating the translational study of brief interventions.
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Affiliation(s)
- Samantha A Barry-Menkhaus
- The Madison Clinic for Pediatric Diabetes and Benioff Children's Hospital, University of California, San Francisco, San Francisco, CA, USA
| | - David V Wagner
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA
| | - Andrew R Riley
- Institute on Development & Disability, Department of Pediatrics, Oregon Health & Science University, 707 SW Gaines St., Portland, OR, 97239, USA.
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14
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Ida S, Kaneko R, Imataka K, Okubo K, Shirakura Y, Azuma K, Fujiwara R, Takahashi H, Murata K. Preparation, Reliability, and Validity of a Japanese Version of the "Satisfaction of Treatment among Caregivers of Dependent Type 2 Diabetic Patients" Questionnaire. J Diabetes Res 2020; 2020:4960130. [PMID: 32656267 PMCID: PMC7317323 DOI: 10.1155/2020/4960130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 12/16/2022] Open
Abstract
The aim of this study was to prepare a Japanese version of the "Satisfaction of Treatment among Caregivers of Dependent Type 2 Diabetic Patients" (STCD2-J) questionnaire, which is used to assess the satisfaction of family caregivers with respect to the treatment for elderly patients with type 2 diabetes mellitus who require support. In addition, the reliability and validity of the STCD2-J questionnaire were analyzed. A Japanese version of the original STCD2 questionnaire was prepared, revised, and back-translated; the back-translated version was sent to the authors of the original version for confirmation. Family caregivers of patients with type 2 diabetes mellitus aged ≥65 years who regularly underwent medical examinations at the diabetes mellitus outpatient clinic of Ise Red Cross Hospital were included. Cronbach's α coefficient was calculated to assess internal consistency. Exploratory factor analyses were performed to assess construct validity, and Pearson's correlation coefficients between STCD2-J score and HbA1c as well as the degree of satisfaction with patients' blood glucose levels, depression, and negative self-assessment of nursing care were calculated to assess criterion-related validity. This study included 208 individuals (55 males and 153 females). Cronbach's α coefficient was 0.88. Factor analyses showed a single-factor structure both with and without rotation. The STCD2-J scores were significantly inversely correlated with HbA1c (r = -0.27, P < 0.001). Significant correlations were observed between the STCD2-J scores and degree of satisfaction with patients' blood glucose levels (r = 0.43, P < 0.001), depression (r = -0.20, P = 0.003), and negative self-assessment of nursing care (r = -0.19, P = 0.004). The reliability and validity of the STCD2-J questionnaire were confirmed. The STCD2-J questionnaire can be used in Japan as a tool to assess the satisfaction of family caregivers with the treatment of elderly patients with type 2 diabetes mellitus requiring support.
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Affiliation(s)
- Satoshi Ida
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Ryutaro Kaneko
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Kanako Imataka
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Kaoru Okubo
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Yoshitaka Shirakura
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Kentaro Azuma
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Ryoko Fujiwara
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Hiroka Takahashi
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
| | - Kazuya Murata
- Department of Diabetes and Metabolism, Ise Red Cross Hospital, 1-471-2 Funae, 1-Chome, Ise-shi, Mie 516-8512, Japan
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15
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Glick BA, Hong KMC, Buckingham D, Moore-Clingenpeel M, Salvator A, Kamboj MK. Validation of a risk screening tool for pediatric type 1 diabetes patients: a predictor of increased acute health care utilization. J Pediatr Endocrinol Metab 2019; 32:1155-1162. [PMID: 31490774 DOI: 10.1515/jpem-2019-0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 07/03/2019] [Indexed: 11/15/2022]
Abstract
Background Both psychosocial and socioeconomic risk factors contribute to poor glycemic control (GC). Previous research has identified that diabetes care behaviors are generally 'set' by late childhood, further highlighting the importance of psychosocial screening and intervention in the early course of disease management. The purpose of the current study was to determine whether this brief risk assessment tool is associated with GC and acute health care (HC) utilization, and to evaluate the discriminatory utility of the tool for predicting poor outcomes. Methods This was a retrospective cohort design in which we compared risk assessment scores with health outcomes at 6, 12, and 18 months after new-onset type 1 diabetes diagnosis for 158 patients between 2015 and 2017. The two primary outcome variables were GC and acute HC utilization. Results Our data demonstrate that the greatest utility of the tool is for predicting increased acute HC utilization. It was most useful in differentiating between patients with vs. without any acute HC utilization, with excellent discriminatory ability (area under the receiver operator characteristic curve [AUC] = 0.93), sensitivity (90%), and specificity (97%). Conclusions Knowledge of the risk category in addition to identification of individual risk factors within each domain allows for not only clear treatment pathways but also individualized interventions. The risk assessment tool was less effective at differentiating patients with poor GC; however, the tool did have high specificity (83%) for predicting poor GC at 18 months which suggests that the tool may also be useful for predicting patients at risk for poor GC.
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Affiliation(s)
- Bethany A Glick
- Nationwide Children's Hospital, Pediatric Endocrinology, 700 Children's Drive, Columbus, OH 43205, USA, Phone: +614-722-8836, Fax: +614-722-4440
| | - K Ming Chan Hong
- Nationwide Children's Hospital, Pediatric Endocrinology, Columbus, OH, USA
| | - Don Buckingham
- Nationwide Children's Hospital, Service Line Quality Improvement, Columbus, OH, USA
| | | | - Ann Salvator
- Nationwide Children's Hospital, Biostatistics Core and Critical Care Medicine, Columbus, OH, USA
| | - Manmohan K Kamboj
- Nationwide Children's Hospital, Ohio State University, Pediatric Endocrinology, Columbus, OH, USA
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16
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Goldstein-Leever A, Bass JA, Goyal A, Maddux MH. Health-Related Quality of Life Predicts Psychology Referral in Youth with Inflammatory Bowel Disease. J Pediatr Nurs 2019; 47:73-77. [PMID: 31054370 DOI: 10.1016/j.pedn.2019.04.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 04/09/2019] [Accepted: 04/14/2019] [Indexed: 01/10/2023]
Abstract
PURPOSE The current study sought to explore psychosocial data gathered from routine screening within an interdisciplinary IBD program, with two-fold aims: 1) to examine parent-child agreement across health-related quality of life domains and 2) to evaluate the differential predictive value of child and parent ratings of health-related quality of life domains on referrals for psychological services. DESIGN AND METHODS A convenience sample of 92 youth (ages 8-18) and their parents completed the Pediatric Quality of Life Inventory. RESULTS Children and parents showed moderate to good agreement across health-related quality of life domains. Additionally, regression analyses revealed that child and parent-proxy reports of emotional difficulties, parent report of school difficulties, and child report of physical symptoms were significantly predictive of psychology referral status. CONCLUSIONS Study findings suggest moderate to good agreement among child and parent-proxy reporters and support the shared value of both child and parent ratings of health-related quality of life in predicting psychology referrals in youth with IBD. PRACTICE IMPLICATIONS Routine psychosocial screening among youth with IBD can promote the early identification of emotional and behavioral needs, and family receipt of appropriate, evidence-based intervention.
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Affiliation(s)
- Alana Goldstein-Leever
- Division of Pediatric Psychology and Neuropsychology, Nationwide Children's Hospital, Columbus, OH, United States of America; Department of Pediatrics, The Ohio State University, Columbus, OH, United States of America
| | - Julie A Bass
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, United States of America; Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Alka Goyal
- Division of Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, United States of America; Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States of America
| | - Michele H Maddux
- Department of Pediatrics, University of Missouri-Kansas City, Kansas City, MO, United States of America; Division of Developmental and Behavioral Sciences, Children's Mercy Kansas City, Kansas City, MO, United States of America.
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17
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Hawkes CP, Willi SM, Murphy KM. A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control. Pediatr Diabetes 2019; 20:460-467. [PMID: 30932293 DOI: 10.1111/pedi.12849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The diagnosis of type 1 diabetes (T1D) brings significant medical, psychosocial, and educational challenges for the child, family, and medical team. We developed a structured certified diabetes educator (CDE) led program spanning the year after diagnosis with the goal of supporting families as their understanding of this chronic disease and its management evolves. OBJECTIVE The aim of this study was to determine the effect of this program upon hemoglobin A1c (HbA1c), and how this effect is mitigated by socioeconomic status (SES). METHODS Patients enrolled in the type 1 year 1 (T1Y1) program were assigned a CDE who provided intensive coaching, tailored to family lifestyle, and readiness to assume independence. We identified all patients diagnosed with T1D in the 2 years before (controls) and after (T1Y1 group) the start of the T1Y1 program on January 7, 2014. RESULTS There were 675 patients diagnosed with T1D between July 2012 and June 2016 (284 controls, 391 T1Y1). HbA1c was significantly lower in the T1Y1 group at 6 (6.7% vs. 7.1%, P < 0.001), 12 (7.3% vs. 7.8%, P < 0.001) and 18 (7.6% vs. 7.9%, P = 0.01) months, but not 24 (7.8% vs. 8%, P = 0.14) months after diagnosis. This effect was not observed in patients with lower SES. CONCLUSION Additional structured education and support in the year after diagnosis can improve short-term outcomes in children with T1D, but this effect may not persist after discontinuing intensive coaching. Families of lower SES did not benefit from this approach.
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Affiliation(s)
- Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven M Willi
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn M Murphy
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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18
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Due-Christensen M, Willaing I, Ismail K, Forbes A. Learning about Type 1 diabetes and learning to live with it when diagnosed in adulthood: two distinct but inter-related psychological processes of adaptation A qualitative longitudinal study. Diabet Med 2019; 36:742-752. [PMID: 30329176 DOI: 10.1111/dme.13838] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2018] [Indexed: 11/27/2022]
Abstract
AIM To explore the experiences of adults with newly diagnosed Type 1 diabetes in order to understand the adaptive processes that occur in the early phase of the condition. METHODS We conducted longitudinal semi-structured interviews with 30 adults newly diagnosed with Type 1 diabetes (age range 20-67 years; 16 men; median diabetes duration 23.5 months), recruited from hospitals in Denmark and the UK. The data were analysed using a narrative approach. RESULTS The narratives could be grouped into three thematic areas: the diagnosis; learning about diabetes; and learning to live with diabetes. Diabetes was characterized as a major disruptor to the established and future life plans of participants, causing significant emotional distress. The narratives showed how early experiences triggered the development of ongoing psychological problems (fear of complications or hypoglycaemia) and diabetes distress, and that navigating different social scenarios (relationships and employment) could be challenging, leading to suboptimal self-management behaviours. The narratives also showed that health professionals often did not attend effectively to participants' emotional needs after diagnosis, and that the language used frequently triggered negative feelings, such as fear or a sense of failure. CONCLUSIONS Many of the common psychosocial problems associated with Type 1 diabetes seem to gestate in the early phase of life with the condition. There appear to be opportunities to enhance the support provided in this phase to minimize these problems.
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Affiliation(s)
- M Due-Christensen
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - I Willaing
- Steno Diabetes Centre Copenhagen, Gentofte, Denmark
| | - K Ismail
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience at King's College London, London, UK
| | - A Forbes
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
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19
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Wysocki T. Diabetes and Behavior in the 21st Century: Things That Make You Go "Hmmm . . . ". Diabetes Spectr 2019; 32:76-80. [PMID: 30853768 PMCID: PMC6380233 DOI: 10.2337/dsi18-0001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Editor's Note: This article is adapted from the address Dr. Wysocki delivered as the recipient of the American Diabetes Association's Richard R. Rubin Award for 2018. This award recognizes a behavioral researcher who has made outstanding, innovative contributions to the study and understanding of the behavioral aspects of diabetes in diverse populations. Dr. Wysocki delivered the address in June 2018 at the association's 78th Scientific Sessions in Orlando, Fla.
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Affiliation(s)
- Tim Wysocki
- Nemours Children's Health System, Jacksonville, FL
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20
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Delamater AM, de Wit M, McDarby V, Malik JA, Hilliard ME, Northam E, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2018: Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2018; 19 Suppl 27:237-249. [PMID: 30058247 DOI: 10.1111/pedi.12736] [Citation(s) in RCA: 157] [Impact Index Per Article: 26.2] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 07/16/2018] [Indexed: 01/09/2023] Open
MESH Headings
- Adaptation, Psychological/physiology
- Adolescent
- Burnout, Psychological/psychology
- Burnout, Psychological/therapy
- Child
- Consensus
- Diabetes Mellitus, Type 1/complications
- Diabetes Mellitus, Type 1/psychology
- Diabetes Mellitus, Type 1/therapy
- Endocrinology/organization & administration
- Endocrinology/standards
- Humans
- International Cooperation
- Neurodevelopmental Disorders/therapy
- Pediatrics/organization & administration
- Pediatrics/standards
- Practice Patterns, Physicians'/standards
- Psychotherapy/methods
- Psychotherapy/standards
- Quality of Life/psychology
- Resilience, Psychological
- Societies, Medical/organization & administration
- Societies, Medical/standards
- Stress, Psychological/etiology
- Stress, Psychological/therapy
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Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida
| | - Maartje de Wit
- Department of Medical Psychology, EMGO Institute for Health & Care Research, VU University Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Vincent McDarby
- National Children's Research Centre and Our Lady's Children's Hospital, Dublin, Ireland
| | - Jamil A Malik
- Center of Excellence, National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
| | - Marisa E Hilliard
- Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | | | - Carlo L Acerini
- Department of Paediatrics, University of Cambridge, Cambridge, UK
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21
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Guttmann-Bauman I, Thornton P, Adhikari S, Reifschneider K, Wood MA, Hamby T, Rubin K. Pediatric endocrine society survey of diabetes practices in the United States: What is the current state? Pediatr Diabetes 2018; 19:859-865. [PMID: 29582520 DOI: 10.1111/pedi.12677] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 02/13/2018] [Accepted: 03/22/2018] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND The Practice Management Committee (PMC) of the Pediatric Endocrine Society (PES) conducted a survey of its membership in February/March, 2016 to assess the current state of pediatric diabetes care delivery across multiple practice types in the United States. METHODS The PES distributed an anonymous electronic survey (Survey Monkey) via email to its membership and requested that only one survey be completed for each practice. RESULTS Ninety-three unique entries from the US were entered into analysis. Care is predominantly delivered by multidisciplinary teams, based at academic institutions (65.6%), with >85% of the provider types being physicians. Each 1.0 full time equivalent certified diabetes educators serves on average 367 diabetic youth. Fee-for-service remains the standard method of reimbursement with 57% of practices reporting financial loss. Survey respondents identified under-reimbursement as a major barrier to improving patient outcomes and lack of behavioral health (BH) providers as a key gap in services provided. CONCLUSIONS Our survey reveals wide variation in all aspects of pediatric diabetes care delivery in the United States. Pediatric Endocrinologists responding to the survey identified a lack of resources and the current fee for service payment model as a major impediment to practice and the lack of integrated BH staff as a key gap in service. The respondents strongly support its organizations' involvement in the dissemination of standards for care delivery and advocacy for a national payment model aligned with chronic diabetes care in the context of our emerging value-based healthcare system.
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Affiliation(s)
- I Guttmann-Bauman
- Department of Pediatrics, Oregon Health and Science University (OHSU), Portland, Oregon
| | - P Thornton
- Cook Children's Medical Center, Fort Worth, Texas
| | - S Adhikari
- UT Medical Center, Children's Medical Center, Dallas, Texas
| | - K Reifschneider
- Eastern Virginia Medical School - Children's Hospital of the Kings Daughters, Norfolk, Virginia
| | - M A Wood
- University of Michigan Medical School, Ann Arbor, Michigan
| | - T Hamby
- Department of Research Operations, Cook Children's Health Care System, Fort Worth, Texas
| | - K Rubin
- University of Connecticut School of Medicine, Department of Pediatrics and Head of Clinical Care Innovation, Connecticut Children's Medical Center, Hartford, Connecticut
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22
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Hilliard ME, De Wit M, Wasserman RM, Butler AM, Evans M, Weissberg-Benchell J, Anderson BJ. Screening and support for emotional burdens of youth with type 1 diabetes: Strategies for diabetes care providers. Pediatr Diabetes 2018; 19:534-543. [PMID: 28940936 PMCID: PMC5862727 DOI: 10.1111/pedi.12575] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 08/14/2017] [Accepted: 08/16/2017] [Indexed: 01/09/2023] Open
Abstract
Multiple sources of burden for youth with type 1 diabetes (T1D) impact key outcomes including quality of life, self-management, and glycemic control. Professional diabetes organizations recommend diabetes care providers screen for psychosocial and behavioral challenges and implement strategies to support youth with T1D. The purpose of this article is to review the literature and recommend practical strategies medical providers can use for screening and behavioral support for youth with diabetes and their families. As part of their routine medical care, diabetes care providers are well-positioned to identify and intervene to address emotional distress related to the burdens of living with diabetes. In collaboration with multidisciplinary team members, including psychologists and mental health professionals, medical providers may be able to successfully implement brief behavioral strategies for screening and providing emotional support.
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Affiliation(s)
- Marisa E Hilliard
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Maartje De Wit
- Department of Medical Psychology, VU University Medical Center, Amsterdam, The Netherlands
| | - Rachel M Wasserman
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Ashley M Butler
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Meredyth Evans
- Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Jill Weissberg-Benchell
- Northwestern University's Feinberg School of Medicine, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Barbara J Anderson
- Department of Pediatrics, Psychology Section, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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23
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Boogerd E, Maas-Van Schaaijk NM, Sas TC, Clement-de Boers A, Smallenbroek M, Nuboer R, Noordam C, Verhaak CM. Sugarsquare, a Web-Based Patient Portal for Parents of a Child With Type 1 Diabetes: Multicenter Randomized Controlled Feasibility Trial. J Med Internet Res 2017; 19:e287. [PMID: 28830853 PMCID: PMC5585595 DOI: 10.2196/jmir.6639] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Revised: 11/25/2016] [Accepted: 12/18/2016] [Indexed: 12/31/2022] Open
Abstract
Background Raising a child with type 1 diabetes (T1D) means combining the demands of the disease management with everyday parenting, which is associated with increased levels of distress. A Web-based patient portal, Sugarsquare, was developed to support parents, by providing online parent-professional communication, online peer support and online disease information. Objective The first aim of this study was to assess the feasibility of conducting a multicenter, randomized controlled trial in Dutch parents of a child with T1D. The second aim was to assess the feasibility of implementing Sugarsquare in clinical practice. Methods The parents of 105 children (N=105) with T1D below the age of 13 participated in a 6-month multicenter randomized controlled feasibility trial. They were randomly assigned to an experimental (n=54, usual care and Sugarsquare) or a control group (n=51, usual care). Attrition rates and user statistics were gathered to evaluate feasibility of the trial and implementation. To determine potential efficacy, the parenting stress index (PSI-SF) was assessed at baseline (T0) and after 6 months (T1). Results Of a potential population of parents of 445 children, 189 were willing to participate (enrollment refusal=57.5%, n=256), 142 filled in the baseline questionnaire (baseline attrition rate=25%, n=47), and 105 also filled in the questionnaire at T1 (post randomization attrition rate during follow-up=26%, n=32). As such, 24% of the potential population participated. Analysis in the experimental group (n=54) revealed a total of 32 (59%) unique users, divided into 12 (38%) frequent users, 9 (28%) incidental users, and 11 (34%) low-frequent users. Of the total of 44 professionals, 34 (77%) logged in, and 32 (73%) logged in repeatedly. Analysis of the user statistics in the experimental group further showed high practicability and integration in all users, moderate acceptability and demand in parents, and high acceptability and demand in health care professionals. Baseline parenting stress index scores were related to the parents’ frequency of logging on (ρ=.282, P=.03) and page-views (ρ=.304, P=.01). No significant differences in change in parenting stress between experimental and control group were found (F3,101=.49, P=.49). Conclusions The trial can be considered feasible, considering the average enrollment refusal rate, baseline attrition rate and postrandomization attrition rate, compared to other eHealth studies, although lower than hypothesized. Implementing Sugarsquare in clinical practice was partly feasible, given moderate demand and acceptability in parent users and lack of potential efficacy. Parents who reported higher levels of parenting stress used Sugarsquare more often than other parents, although Sugarsquare did not reduce parenting stress. These results indicate that Web-based interventions are a suitable way of providing parents of children with T1D with additional support. Future studies should determine how Sugarsquare could reduce parenting stress, for instance by adding targeted interventions. Factors potentially contributing to successful implementation are suggested. Trial Registration Nederlands Trial Register Number: NTR3643; http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=3643 (Archived by WebCite at http://www.webcitation.org/6qihOVCi6)
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Affiliation(s)
- Emiel Boogerd
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
| | - Nienke M Maas-Van Schaaijk
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands.,Children's Diabetes Center Nijmegen, Nijmegen, Netherlands
| | - Theo C Sas
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, Netherlands
| | | | - Mischa Smallenbroek
- Department of Pediatrics, Medical Center Leeuwarden, Leeuwarden, Netherlands
| | - Roos Nuboer
- Department of Pediatrics, Meander Medical Center, Amersfoort, Netherlands
| | - Cees Noordam
- Children's Diabetes Center Nijmegen, Nijmegen, Netherlands.,Department of Pediatrics, Radboud University Medical Center, Nijmegen, Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, Netherlands
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24
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Pierce JS, Kozikowski C, Lee JM, Wysocki T. Type 1 diabetes in very young children: a model of parent and child influences on management and outcomes. Pediatr Diabetes 2017; 18:17-25. [PMID: 26712357 PMCID: PMC7418073 DOI: 10.1111/pedi.12351] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/03/2015] [Accepted: 12/07/2015] [Indexed: 12/29/2022] Open
Abstract
The incidence of type 1 diabetes (T1D) in very young children (YC-T1D) is increasing globally. Managing YC-T1D is challenging from both a medical and psychosocial perspective during this vulnerable developmental period when complete dependence upon parental caretaking is normative and child behavior is unpredictable. The consequences of suboptimal glycemic control during this age range are substantial since these children will have T1D for many years and they are prone to adverse neuropsychological sequelae. Poor adaptation to T1D during these early years may engender a persistent trajectory of negative outcomes that can be very resistant to change. The empirical research on the YC-T1D population (age <6 yr) has indicated multiple mechanisms through which parent characteristics, parent coping skills, and child characteristics interact to yield a pattern of T1D management behaviors that affect T1D outcomes. However, this research has not yet led to a well-conceived conceptual model for identifying and understanding these mechanisms or for specifying research gaps and future research directions. The aim of this review is to propose such a conceptual model linking parent characteristics, parent coping, and child characteristics to T1D management behaviors and outcomes. This article reviews the literature focusing on research pertinent to YC-T1D and elements of our proposed model, identifies and discusses gaps in the literature, offers directions for future research, and considers a range of possible interventions targeting the unique needs of this special population.
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Affiliation(s)
- Jessica S Pierce
- Nemours Research Institute, Center for Health Care Delivery Science, Nemours Children’s Health System, Orlando, FL, USA
| | - Chelsea Kozikowski
- Department of Biomedical Research, Center for Health Care Delivery Science, Nemours Children’s Health System, Jacksonville, FL, USA
| | - Joyce M Lee
- Division of Pediatric Endocrinology, Child Health Evaluation and Research Unit, University of Michigan, Ann Arbor, MI, USA
| | - Tim Wysocki
- Department of Biomedical Research, Center for Health Care Delivery Science, Nemours Children’s Health System, Jacksonville, FL, USA
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Wasserman RM, Anderson BJ, Schwartz DD. Screening of Neurocognitive and Executive Functioning in Children, Adolescents, and Young Adults With Type 1 Diabetes. Diabetes Spectr 2016; 29:202-210. [PMID: 27899871 PMCID: PMC5111527 DOI: 10.2337/ds16-0037] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Affiliation(s)
- Rachel M Wasserman
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Barbara J Anderson
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - David D Schwartz
- Section of Psychology, Department of Pediatrics, Baylor College of Medicine, Houston, TX
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Guzek LM, Fadel WF, Golomb MR. A Pilot Study of Reasons and Risk Factors for "No-Shows" in a Pediatric Neurology Clinic. J Child Neurol 2015; 30:1295-9. [PMID: 25503257 DOI: 10.1177/0883073814559098] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 10/14/2014] [Indexed: 11/15/2022]
Abstract
Missed clinic appointments lead to decreased patient access, worse patient outcomes, and increased healthcare costs. The goal of this pilot study was to identify reasons for and risk factors associated with missed pediatric neurology outpatient appointments ("no-shows"). This was a prospective cohort study of patients scheduled for 1 week of clinic. Data on patient clinical and demographic information were collected by record review; data on reasons for missed appointments were collected by phone interviews. Univariate and multivariate analyses were conducted using chi-square tests and multiple logistic regression to assess risk factors for missed appointments. Fifty-nine (25%) of 236 scheduled patients were no-shows. Scheduling conflicts (25.9%) and forgetting (20.4%) were the most common reasons for missed appointments. When controlling for confounding factors in the logistic regression, Medicaid (odds ratio 2.36), distance from clinic, and time since appointment was scheduled were associated with missed appointments. Further work in this area is needed.
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Affiliation(s)
- Lindsay M Guzek
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - William F Fadel
- Department of Biostatistics, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN, USA
| | - Meredith R Golomb
- Division of Pediatric Neurology, Department of Neurology, Indiana University School of Medicine, Indianapolis, IN, USA
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Boogerd EA, Maas-van Schaaijk NM, Noordam C, Marks HJG, Verhaak CM. Parents' experiences, needs, and preferences in pediatric diabetes care: Suggestions for improvement of care and the possible role of the Internet. A qualitative study. J SPEC PEDIATR NURS 2015; 20:218-29. [PMID: 26076888 DOI: 10.1111/jspn.12118] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/28/2015] [Accepted: 04/20/2015] [Indexed: 11/28/2022]
Abstract
PURPOSE To investigate the needs and preferences of parents of children with type 1 diabetes (T1D) concerning pediatric diabetes care and use of Internet in care. DESIGN AND METHODS Parents of 34 children, aged 2-12, with T1D participated in seven focus group interviews. RESULTS Analysis revealed provision of tailored care, disease information, peer support, and accessibility of healthcare professionals as major needs in parents. Internet could be used to satisfy these needs. PRACTICAL IMPLICATIONS According to parents, diabetes teams should focus on the impact of the disease, parents' experience, and the child's development, and provide online professional and peer support.
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Affiliation(s)
- Emiel A Boogerd
- Department of Medical Psychology, Radboud university medical center, Nijmegen, the Netherlands
| | | | - Cees Noordam
- Department of Pediatrics, Radboud university medical center, Nijmegen, the Netherlands.,Children's Diabetes Center Nijmegen, Nijmegen, the Netherlands
| | - Hans J G Marks
- Department of Cultural Anthropology and Development Studies, Radboud University, Nijmegen, the Netherlands
| | - Chris M Verhaak
- Department of Medical Psychology, Radboud university medical center, Nijmegen, the Netherlands
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García-Aparicio J, Herrero-Herrero JI. Development, validation, and administration of a treatment-satisfaction questionnaire for caregivers of dependent type 2 diabetic patients. Clin Interv Aging 2015; 10:969-77. [PMID: 26124650 PMCID: PMC4476422 DOI: 10.2147/cia.s83086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Satisfaction with treatment is considered a relevant factor for assessing results in clinical practice. However, when assessing satisfaction in dependent patients, the opinion of their caregivers becomes crucial, since implicit in satisfaction is the degree of caregiver involvement, of adherence to treatment, and lastly of better care of these patients. PURPOSE The purpose of this study was to develop, validate, and administer two versions of a specific questionnaire to assess satisfaction with blood glucose-lowering treatment in caregivers of dependent type 2 diabetic patients. PATIENTS AND METHODS This was an observational, descriptive, epidemiological study conducted in the Los Montalvos Internal Medicine Department at the University Hospital of Salamanca (Spain). Two versions of the questionnaire to assess caregivers' satisfaction with current treatment and after introducing changes in therapy were created and validated according to model procedures. Once validated, the questionnaires were implemented in 219 cases. RESULTS Cronbach's α-coefficient, correlation between all the items, intraclass correlation coefficient, and correlation between the obtained scores and satisfaction with blood glucose levels all satisfied the standard for validation. Significant levels of correlation were observed between the degree of satisfaction and the number of daily administrations of the blood glucose-lowering medication (Spearman's r=-0.21, P<0.05). Caregivers of patients receiving more frequent administration of their antidiabetic medication prior to the change were more satisfied with the change (r=0.24, P<0.001). Similarly, significant correlation was found between the number of daily administrations for blood glucose-lowering medication after the change and the degree of satisfaction (r=-0.43, P<0.001). CONCLUSION A useful novel instrument to assess caregivers' satisfaction was validated. When applied to our cohort of cases, the obtained data suggest that simplicity in antidiabetic therapy should be considered in the management of dependent type 2 diabetic patients when caregivers' satisfaction is an additional objective.
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Affiliation(s)
- Judit García-Aparicio
- Los Montalvos Internal Medicine Department, University Hospital of Salamanca, Salamanca, Spain
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29
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Boogerd EA, Damhuis AMA, van Alfen-van der Velden JAAEM, Steeghs MCCH, Noordam C, Verhaak CM, Vermaes IPR. Assessment of psychosocial problems in children with type 1 diabetes and their families: the added value of using standardised questionnaires in addition to clinical estimations of nurses and paediatricians. J Clin Nurs 2015; 24:2143-51. [DOI: 10.1111/jocn.12789] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Emiel A Boogerd
- Children's Diabetes Center Nijmegen; Nijmegen The Netherlands
- Department of Psychology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Anouk MA Damhuis
- Children's Diabetes Center Nijmegen; Nijmegen The Netherlands
- Department of Paediatric Psychology; Tilburg University; Tilburg The Netherlands
- Department of Psychology; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | | | - Marley CCH Steeghs
- Children's Diabetes Center Nijmegen; Nijmegen The Netherlands
- Department of Psychology; Canisius Wilhelmina Hospital; Nijmegen The Netherlands
| | - Cees Noordam
- Children's Diabetes Center Nijmegen; Nijmegen The Netherlands
- Department of Paediatrics; Radboud University Medical Center; Nijmegen The Netherlands
| | - Chris M Verhaak
- Department of Psychology; Radboud University Medical Center; Nijmegen The Netherlands
| | - Ignace PR Vermaes
- Department of Paediatric Psychology; Tilburg University; Tilburg The Netherlands
- Behavioural Science Institute; Radboud University; Nijmegen The Netherlands
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Ducat L, Rubenstein A, Philipson LH, Anderson BJ. A review of the mental health issues of diabetes conference. Diabetes Care 2015; 38:333-8. [PMID: 25614689 PMCID: PMC4302262 DOI: 10.2337/dc14-1383] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Individuals with type 1 diabetes are at increased risk for depression, anxiety disorder, and eating disorder diagnoses. People with type 1 diabetes are also at risk for subclinical levels of diabetes distress and anxiety. These mental/behavioral health comorbidities of diabetes are associated with poor adherence to treatment and poor glycemic control, thus increasing the risk for serious short- and long-term physical complications, which can result in blindness, amputations, stroke, cognitive decline, decreased quality of life, as well as premature death. When mental health comorbidities of diabetes are not diagnosed and treated, the financial cost to society and health care systems is catastrophic, and the human suffering that results is profound. This review summarizes state-of-the-art presentations and working group scholarly reports from the Mental Health Issues of Diabetes Conference (7-8 October 2013, Philadelphia, PA), which included stakeholders from the National Institutes of Health, people living with type 1 diabetes and their families, diabetes consumer advocacy groups, the insurance industry, as well as psychologists, psychiatrists, endocrinologists, and nurse practitioners who are all nationally and internationally recognized experts in type 1 diabetes research and care. At this landmark conference current evidence for the incidence and the consequences of mental health problems in type 1 diabetes was presented, supporting the integration of mental health screening and mental health care into routine diabetes medical care. Future research directions were recommended to establish the efficacy and cost-effectiveness of paradigms of diabetes care in which physical and mental health care are both priorities.
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Affiliation(s)
- Lee Ducat
- The Mental Health Issues of Diabetes Foundation, Philadelphia, PA
| | - Arthur Rubenstein
- Division of Endocrinology, Diabetes and Metabolism, Raymond and Ruth Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Barbara J Anderson
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX
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Serlachius AS, Scratch SE, Northam EA, Frydenberg E, Lee KJ, Cameron FJ. A randomized controlled trial of cognitive behaviour therapy to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes. J Health Psychol 2014; 21:1157-69. [DOI: 10.1177/1359105314547940] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
We evaluated a cognitive behaviour therapy–based programme to improve glycaemic control and psychosocial wellbeing in adolescents with type 1 diabetes. A total of 147 adolescents aged 13–16 years were randomized to the intervention ( n = 73) or standard care ( n = 74). The primary outcome was glycaemic control at 3 and 12 months post randomization, and secondary measures were stress, self-efficacy and quality of life. Mixed-effects regression models were used to assess differences in means between groups at each time point. There was little evidence of differences in glycaemic control between groups. However, psychosocial wellbeing improved in the intervention group compared to the control group. Recommendations for future programmes are discussed. The trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12608000368336).
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Affiliation(s)
- Anna S Serlachius
- Royal Children’s Hospital, Australia
- Murdoch Childrens Research Institute, Australia
| | | | - Elisabeth A Northam
- Murdoch Childrens Research Institute, Australia
- The University of Melbourne, Australia
| | | | - Katherine J Lee
- Royal Children’s Hospital, Australia
- Murdoch Childrens Research Institute, Australia
- The University of Melbourne, Australia
| | - Fergus J Cameron
- Royal Children’s Hospital, Australia
- Murdoch Childrens Research Institute, Australia
- The University of Melbourne, Australia
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32
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Delamater AM, de Wit M, McDarby V, Malik J, Acerini CL. ISPAD Clinical Practice Consensus Guidelines 2014. Psychological care of children and adolescents with type 1 diabetes. Pediatr Diabetes 2014; 15 Suppl 20:232-44. [PMID: 25182317 DOI: 10.1111/pedi.12191] [Citation(s) in RCA: 117] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2014] [Accepted: 06/17/2014] [Indexed: 02/06/2023] Open
Affiliation(s)
- Alan M Delamater
- Department of Pediatrics, University of Miami Miller School of Medicine, Miami, FL, USA
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Schwartz DD, Axelrad ME, Anderson BJ. Neurocognitive functioning in children and adolescents at the time of type 1 diabetes diagnosis: associations with glycemic control 1 year after diagnosis. Diabetes Care 2014; 37:2475-82. [PMID: 24969580 DOI: 10.2337/dc14-0103] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To determine whether impairments in neurocognitive functioning are detectable at type 1 diabetes diagnosis and associated with subsequent glycemic control. RESEARCH DESIGN AND METHODS Children/adolescents (N = 147) aged 5-18 years completed neuropsychological testing during their inpatient hospitalization for new-onset type 1 diabetes. Test scores were compared with normative data using one-sample Student t tests. Children with onset before 8 years of age were compared with children aged 9-18 years using ANOVA, and associations between neurocognitive performance at diagnosis and glycemic control 1 year postdiagnosis were examined using regression analyses. RESULTS Children with type 1 diabetes performed significantly below expectations on most neurocognitive measures (P values <0.0001), with large decrements from the normative mean evident in psychomotor speed (>1 SD), visuomotor integration (0.7 SD), and phonemic fluency (0.8 SD). High incidence of impairment (scores less than second percentile) was evident on all tasks except digit span. Dominant-hand psychomotor speed was significantly associated with poor glycemic control (A1C ≥9.5% [80 mmol/mol]; P = 0.032) 1 year postdiagnosis, controlling for race/ethnicity, sex, and reading ability. Impaired psychomotor speed was associated with a 0.77% increase in mean A1C (8.4 mmol/mol). CONCLUSIONS Deficits were evident in neurocognitive functioning within days of diabetes diagnosis that were associated with diabetes outcomes over 1 year postdiagnosis. Impairment was most apparent in psychomotor speed, consistent with research implicating damage to posterior white matter tracts and associated gray matter regions in type 1 diabetes. Psychomotor impairment may be an early marker for a broader neurobehavioral vulnerability that has implications for long-term diabetes management.
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Affiliation(s)
- David D Schwartz
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX Psychology Service, Texas Children's Hospital, Houston, TX
| | - Marni E Axelrad
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX Psychology Service, Texas Children's Hospital, Houston, TX
| | - Barbara J Anderson
- Department of Pediatrics, Section of Psychology, Baylor College of Medicine, Houston, TX Psychology Service, Texas Children's Hospital, Houston, TX
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Zenlea IS, Mednick L, Rein J, Quinn M, Wolfsdorf J, Rhodes ET. Routine behavioral and mental health screening in young children with type 1 diabetes mellitus. Pediatr Diabetes 2014; 15:384-8. [PMID: 24274235 PMCID: PMC4033709 DOI: 10.1111/pedi.12099] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2013] [Revised: 09/30/2013] [Accepted: 10/23/2013] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The American Diabetes Association and International Society for Pediatric and Adolescent Diabetes recommend that providers of diabetes care receive training in the recognition of psychosocial problems related to diabetes. OBJECTIVE To report the results of routine behavioral/mental health screening for children with type 1 diabetes mellitus (T1D) seen in a multidisciplinary pediatric diabetes program. SUBJECTS AND METHODS This was a cross-sectional study of children with T1D ages 4-11 years, who underwent behavioral/mental health screening as part of their diabetes care. Screening utilized the Strengths and Difficulties Questionnaire (SDQ) Parent Proxy Version, and scores were reviewed by a social worker. SDQ scale and total difficulties scores were compared by gender, visit type, age, T1D duration, and HbA1c. Scores were also compared to age-appropriate normative data for children in United States of America (US). RESULTS SDQ Parent Proxy Version total difficulties and scale scores did not differ by patient or visit characteristics. Compared with normative data for US children, a greater proportion of children with T1D ages 4-7 and 8-10 years had borderline/abnormal scores on the emotional symptoms scale (p = 0.01 and p = 0.03, respectively), suggesting risk for psychological disorders, such as anxiety and depression. CONCLUSIONS Our findings suggest that children less than 11 years old with T1D may have greater emotional symptoms as compared to their age-matched healthy peers. Pediatric diabetes care providers, with access to mental health services, should consider incorporating routine behavioral/mental health screening for children less than 12 years old in their practice.
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Affiliation(s)
- Ian Spencer Zenlea
- Division of Endocrinology, Boston Children’s Hospital, 333 Longwood Avenue, 6 Floor, Boston, MA, United States, 02115
| | - Lauren Mednick
- Department of Psychology, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, United States, 02115
| | - Jennifer Rein
- Division of Endocrinology, Boston Children’s Hospital, 333 Longwood Avenue, 6 Floor, Boston, MA, United States, 02115
| | - Maryanne Quinn
- Division of Endocrinology, Boston Children’s Hospital, 333 Longwood Avenue, 6 Floor, Boston, MA, United States, 02115,Department of Pediatrics, Harvard Medical School, 250 Longwood Ave, Boston, MA, United States 02115
| | - Joseph Wolfsdorf
- Division of Endocrinology, Boston Children’s Hospital, 333 Longwood Avenue, 6 Floor, Boston, MA, United States, 02115,Department of Pediatrics, Harvard Medical School, 250 Longwood Ave, Boston, MA, United States 02115
| | - Erinn T. Rhodes
- Division of Endocrinology, Boston Children’s Hospital, 333 Longwood Avenue, 6 Floor, Boston, MA, United States, 02115,Department of Pediatrics, Harvard Medical School, 250 Longwood Ave, Boston, MA, United States 02115
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35
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Psychological Support for Children with Diabetes: Are the Guidelines Being Met? J Clin Psychol Med Settings 2014; 21:190-9. [DOI: 10.1007/s10880-014-9395-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Schwartz DD, Axelrad ME, Anderson BJ. A psychosocial risk index for poor glycemic control in children and adolescents with type 1 diabetes. Pediatr Diabetes 2014; 15:190-7. [PMID: 24118977 DOI: 10.1111/pedi.12084] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/08/2013] [Accepted: 08/28/2013] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The aim of this study was to develop and validate a psychosocial screening tool to predict risk for poor glycemic control in children with type 1 diabetes. METHODS Participants seen for psychological screening were 196 children aged 3-18 yr at diabetes diagnosis. A psychosocial risk index was developed to predict poor glycemic control [mean hemoglobin A1c (HbA1c) ≥ 9.5%; 80 mmol/mol] 1-4 yr post diagnosis. Cutoff scores were derived for multiple levels of risk from receiver operating characteristic (ROC) curves and likelihood ratios (LRs). Discrimination and calibration were examined in the sample, and validated in 1000 bootstrap samples. Ability to predict diabetes-related emergency-room (ER) visits and diabetic ketoacidosis (DKA) was also tested. RESULTS The risk index accounted for 16.2% of variance in mean HbA1c, discriminated between children with and without poor glycemic control [area under the receiver operating characteristic curve (AUC) = 0.814, 0.713-0.915; p < 0.001], ER visits (AUC = 0.655, 0.561-0.748; p = 0.001), and DKA(AUC = 0.709, 0.588-0.830; p = 0.001), and was well-calibrated. Every one-point increase in score was associated with an absolute increase in risk for poor glycemic control of approximately 10% (LRs = 1.7, 3.2, 5.8, and 9.3). Sensitivity and specificity were 0.68 (0.43-0.86) and 0.79 (0.72-0.84) for detecting patients at moderate risk, and 0.53 (0.29-0.75) and 0.91 (0.85-0.95) for detecting high-risk patients. The index performed equally well in validation samples. CONCLUSIONS This paper presents the first psychosocial risk index for poor glycemic control in children newly diagnosed with type 1 diabetes. It is brief, easily administered, and provides a single score that translates directly into an estimate of risk that can help guide routine diabetes care.
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Affiliation(s)
- David D Schwartz
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
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37
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Abstract
The incidence of type 1 diabetes (T1D) in young children (age <6 years) is rising. Diabetes management guidelines offered by the American Diabetes Association and health care teams understandably place a high burden of responsibility on caregivers to check young children's blood glucose levels, administer insulin, and monitor diet and physical activity with the ultimate goal of maintaining tight glycemic control. Unfortunately, this tight control is needed during a vulnerable developmental period when behavior is unpredictable, T1D can be physiologically difficult to control, parenting stress can be elevated, and caregivers are strained by normal child caretaking routines. Despite the potentially different management needs, specific education and clinical services for managing diabetes in young children are rarely offered, and behavioral research with this young child age group has been limited in scope and quantity. Research findings pertinent to young children with T1D are reviewed, and potential clinical implications, as well as areas for future research, are discussed.
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Affiliation(s)
- Randi Streisand
- Center for Translational Science Children's National Medical Center 111 Michigan Ave NW Washington, DC 20010 (202) 476-2730 (phone); (202) 476-3966 (fax)
| | - Maureen Monaghan
- Center for Translational Science Children's National Medical Center 111 Michigan Ave NW Washington, DC 20010 (202) 476-4726 (phone); (202) 476-3966 (fax)
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38
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Yafi M. Two cases of type 1 diabetes in adolescents: to test blood glucose or not to test? PRACTICAL DIABETES 2013. [DOI: 10.1002/pdi.1796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Varni JW, Curtis BH, Abetz LN, Lasch KE, Piault EC, Zeytoonjian AA. Content validity of the PedsQL™ 3.2 Diabetes Module in newly diagnosed patients with Type 1 diabetes mellitus ages 8-45. Qual Life Res 2012; 22:2169-81. [PMID: 23269541 DOI: 10.1007/s11136-012-0339-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES The content validity of the 28-item PedsQL™ 3.0 Diabetes Module has not been established in research on pediatric and adult patients with newly diagnosed Type 1 diabetes across a broad age range. This study aimed to document the content validity of three age-specific versions (8-12 years, 13-18 years, and 18-45 years) of the PedsQL™ Diabetes Module in a population of newly diagnosed patients with Type 1 diabetes. METHODS The study included in-depth interviews with 31 newly diagnosed patients with Type 1 diabetes between the ages of 8 and 45 years, as well as 14 parents and/or caregivers of child and teenage patients between the ages of 8 and 18 years of age; grounded theory data collection and analysis methods; and review by clinical and measurement experts. RESULTS Following the initial round of interviews, revisions reflecting patient feedback were made to the Child and Teen versions of the Diabetes Module, and an Adult version of the Diabetes Module was drafted. Cognitive interviews of the modified versions of the Diabetes Module were conducted with an additional sample of 11 patients. The results of these interviews support the content validity of the modified 33-item PedsQL™ 3.2 Diabetes Module for pediatric and adult patients, including interpretability, comprehensiveness, and relevance suitable for all patients with Type 1 Diabetes. CONCLUSIONS Qualitative methods support the content validity of the modified PedsQL™ 3.2 Diabetes Module in pediatric and adult patients. It is recommended that the PedsQL™ 3.2 Diabetes Module replaces version 3.0 and is suitable for measuring patient-reported outcomes in all patients with newly diagnosed, stable, or long-standing diabetes in clinical research and practice.
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Affiliation(s)
- James W Varni
- Department of Pediatrics, College of Medicine, Department of Landscape Architecture and Urban Planning, College of Architecture, Texas A&M University, 3137 TAMU, College Station, TX, 77843-3137, USA,
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Gray JS, Spear Filigno S, Santos M, Ward WL, Davis AM. The status of billing and reimbursement in pediatric obesity treatment programs. J Behav Health Serv Res 2012; 40:378-85. [PMID: 23224661 DOI: 10.1007/s11414-012-9308-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.
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Affiliation(s)
- Jane Simpson Gray
- Texas Center for the Prevention and Treatment of Childhood Obesity, Texas Child Study Center, Dell Children's MedicalCenter, 4900 Mueller Blvd, Austin, TX 78723, USA.
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Anderson BJ. Behavioral research in pediatric diabetes: putting the evidence to work for advocacy and education. Pediatr Diabetes 2012; 13:77-80. [PMID: 21545676 DOI: 10.1111/j.1399-5448.2011.00778.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Dr Henri Lestradet was a founding member of the International Study Group for Diabetes (in childhood and adolescence) (ISGD), and his influence on the scope and vision of this organization was profound. A brief biography of Dr Lestradet and a summary of how his original ISGD evolved into the current International Society for Pediatric and Adolescent Diabetes (ISPAD) will be presented first. Second, consistent with Dr Lestradet's vision for children with diabetes worldwide, I will suggest five areas of behavioral research in diabetes in which there is strong evidence that can be used to create educational and advocacy initiatives for children with diabetes. Finally, I will recommend several priorities for behavioral research in the next decade which will help to strengthen Prof. Lestradet's legacy of support for children with diabetes and their families.
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Affiliation(s)
- Barbara J Anderson
- Baylor College of Medicine, Department of Pediatrics, Psychology Section, Houston, TX 77030, USA.
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Cline GD, Schwartz DD, Axelrad ME, Anderson B. A Pilot Study of Acute Stress Symptoms in Parents and Youth Following Diagnosis of Type I Diabetes. J Clin Psychol Med Settings 2011; 18:416-22. [DOI: 10.1007/s10880-011-9266-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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