1
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Harazneh L, Malak MZ, Ayed A. Adolescents and type 1 diabetes: A grounded theory on adolescents' experiences of adaptation to type 1 diabetes. J Pediatr Nurs 2024; 76:e159-e166. [PMID: 38453544 DOI: 10.1016/j.pedn.2024.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/27/2023] [Accepted: 02/24/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Type 1 diabetes influences adolescents' health status and therapeutic management. Adaptation for adolescents with type 1 diabetes is considered a significant issue for this cohort group and is based on many factors, including availability of resources, and family and community support. Thus, this study aimed to explore Palestinian adolescents' experiences of adaptation to type 1 diabetes in the West Bank. DESIGN AND METHODS A qualitative grounded theory approach was adopted. The purposive sample consisted of fourteen adolescents aged from 12 to 18 years and diagnosed with type 1 diabetes. The data were collected using semi-structured and face-to-face individual interviews during the period from March to June 2023. A constant comparative method was used to analyze data. FINDINGS The core category had emerged with categories and subcategories. There were three categories and ten subcategories including difficulties in the management of type 1 diabetes, for example, "insulin injections, dietary management, and control of HbA1c levels", burdens of type1 diabetes, for example, "burden regarding follow-up treatment, the burden of interaction and communication, emotional burden, and economic burden", and fears and worries of unexpected future life, for example, "worries about disease complications, worries regarding social relationships, and worries about marriage and parenthood". CONCLUSION Adolescents diagnosed with type 1 diabetes suffer from difficult experiences influencing their adaptation to this disease. PRACTICE IMPLICATIONS Counseling programs concerning self-care management for those adolescents need to be developed in addition to support programs. Health education programs are needed to develop their adaptation and coping skills to these experiences.
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Affiliation(s)
- Lobna Harazneh
- Psychiatric and Mental Health Nursing, Faculty of Nursing, Arab American University, Jenin, Palestine
| | - Malakeh Z Malak
- Community Health Nursing, Faculty of Nursing, Al-Zaytoonah University of Jordan, Amman, Jordan.
| | - Ahmad Ayed
- Pediatric Health Nursing, Faculty of Nursing, Arab American University, Jenin, Palestine
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2
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Edmondson EK, Garcia SM, Gregory EF, Vajravelu ME, Szalda D, Shea JA, Virudachalam S. Emerging Adults With Type 2 Diabetes: Understanding Illness Experience and Transition to Adult Care. J Adolesc Health 2024:S1054-139X(24)00111-3. [PMID: 38520432 DOI: 10.1016/j.jadohealth.2024.02.021] [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: 10/27/2023] [Revised: 02/09/2024] [Accepted: 02/14/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE Youth-onset type 2 diabetes (T2D) is increasingly common and is often diagnosed shortly before transition from pediatric to adult care. Little is known about the experience of emerging adults (EAs) with T2D and the readiness, barriers, and facilitators to transition. This study sought to describe the illness experience of EAs with T2D and perceptions about transition, and explore themes by "transition readiness," measured by the Transition Readiness Assessment Questionnaire (TRAQ). METHODS In this mixed-methods study, we conducted semi-structured interviews with EAs with T2D using a guide grounded in the health belief model, administered the TRAQ, and collected disease metrics from the electronic medical record. We developed a coding scheme using a directed content-analysis approach and triangulated qualitative and quantitative data to compare themes stratified by mean TRAQ score. RESULTS Participants described modifying factors like adjusting to life with a chronic illness and coping with mental health issues as critical elements of the illness experience that influence transition. Individual beliefs emerged including the perceived risk of disease complications being informed by experience of family members, self-efficacy in diabetes care hinging on the ability to be highly organized, and transition as a daunting obstacle with numerous emotional and logistical barriers. Participants emphasized the need for support from caregivers and providers throughout transition. Themes did not vary significantly by TRAQ score. DISCUSSION Experiences of EAs with T2D suggest more assistance is needed in the transition period to address factors such as mental health, organizational skills, and identifying support people to facilitate care.
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Affiliation(s)
- Emma K Edmondson
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.
| | - Stephanie M Garcia
- Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Emily F Gregory
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania
| | - Mary Ellen Vajravelu
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Dava Szalda
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Judy A Shea
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Senbagam Virudachalam
- Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Policy Lab and Clinical Futures, Children's Hospital of Philadelphia, Roberts Center for Pediatric Research, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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3
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Berot A, Morsa M, De Andrade V, Gagnayre R, Bihan H. Lack of consideration of socioeconomic factors in transition programme of adolescents with type 1 diabetes: A systematic review. Diabet Med 2024; 41:e15225. [PMID: 37714193 DOI: 10.1111/dme.15225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/05/2023] [Accepted: 09/10/2023] [Indexed: 09/17/2023]
Abstract
The transition of adolescents with type 1 diabetes should be organized such that loss of follow-up and deterioration of patients' metabolic control are minimized. OBJECTIVE Our study aimed to ascertain whether socioeconomic status is featured in the characteristics of adolescents with type 1 diabetes in transition programmes and their inclusion in transition programmes. RESEARCH DESIGN AND METHODS A systematic review of the literature was performed according to PRISMA recommendations. All articles published between 2010 and 2023 were considered. Studies that described a transition programme for adolescents or young adults with T1DM were included. RESULTS After screening, 18 studies were included. Different transition programmes were proposed (exchanges between professionals, coordinators, and transition clinics). Nine articles described socio-economic factors. The educational level was the most frequently reported. Only three studies evaluated the impact of one parameter on transition success: a lower education level was associated with more hospital visits for hyperglycaemia, and the other did not report any socioeconomic factor associated with clinic attendance. CONCLUSIONS The socioeconomic status of type 1 diabetes is poorly described in transition programmes, and the few that do make mention of it, offer little information about patient management.
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Affiliation(s)
- Aurelie Berot
- CHU Reims - American Memorial Hospital - Pediatrics, Reims, France
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Maxime Morsa
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Vincent De Andrade
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Remi Gagnayre
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
| | - Hélène Bihan
- University Sorbonne Paris Nord, Laboratoire Éducations et Promotion de la Santé, LEPS, Villetaneuse, France
- Endocrinology, Diabetology, Nutrition, Avicenne Hospital, APHP, Bobigny, France
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4
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Park J, Tang S, Mendez I, Barrett C, Danielson ML, Bitsko RH, Holliday C, Bullard KM. Prevalence of diagnosed depression, anxiety, and ADHD among youth with type 1 or type 2 diabetes mellitus. Prim Care Diabetes 2023; 17:658-660. [PMID: 37743208 PMCID: PMC11000495 DOI: 10.1016/j.pcd.2023.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 09/06/2023] [Accepted: 09/18/2023] [Indexed: 09/26/2023]
Abstract
We examined the prevalence of diagnosed depression, anxiety, and ADHD among youth by diabetes type, insurance type, and race/ethnicity. These mental disorders were more prevalent among youth with diabetes, particularly those with type 2 diabetes, with non-Hispanic White youth with Medicaid and diabetes having a higher prevalence than other races/ethnicities.
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Affiliation(s)
- Joohyun Park
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Shichao Tang
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Isabel Mendez
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Catherine Barrett
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Melissa L Danielson
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Rebecca H Bitsko
- Division of Human Development and Disability, National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Christopher Holliday
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Kai McKeever Bullard
- Division of Diabetes Translation, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, United States
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5
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Rodriquez IM, O’Sullivan KL. Youth-Onset Type 2 Diabetes: Burden of Complications and Socioeconomic Cost. Curr Diab Rep 2023; 23:59-67. [PMID: 36961664 PMCID: PMC10037371 DOI: 10.1007/s11892-023-01501-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/08/2023] [Indexed: 03/25/2023]
Abstract
PURPOSE OF REVIEW With the rise in prevalence of youth-onset type 2 diabetes (T2DM), it is imperative to understand the clinical burden of the disease and the socioeconomic burden this disease imposes. We review the most recent data on youth-onset T2DM, including its pathophysiology, complications, and treatment. We also review existing data to determine the socioeconomic burden of youth-onset T2DM. RECENT FINDINGS The incidence of youth-onset T2DM is rising, and significantly accelerated following the COVID-19 pandemic. Youth with T2DM are more frequently from families of racial/ethnic minorities and lower socioeconomic status. Youth-onset T2DM has more rapid disease progression compared to adult-onset type 2 diabetes. It results in earlier and more severe microvascular and macrovascular complications compared to both adult-onset T2DM and youth-onset type 1 diabetes (T1DM). While there is a lack of data describing the socioeconomic cost of youth-onset T2DM, based on extrapolation from analyses of the burden of T2DM in adults and T1DM in youth, we propose that youth-onset T2DM has higher direct and indirect costs than adult-onset T2DM. Youth-onset T2DM presents a significant clinical and socioeconomic burden due to its aggressive presentation and earlier appearance of complications. Additional research is needed regarding the cost of illness in this population.
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Affiliation(s)
- Isabella Marranzini Rodriquez
- Medical Center, Section of Adult & Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago, 5841 S. Maryland Avenue, MC 5053, Chicago, IL 60637 USA
| | - Katie L. O’Sullivan
- Medical Center, Section of Adult & Pediatric Endocrinology, Diabetes & Metabolism, University of Chicago, 5841 S. Maryland Avenue, MC 5053, Chicago, IL 60637 USA
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6
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Salama M, Biggs BK, Creo A, Prissel R, Al Nofal A, Kumar S. Adolescents with Type 2 Diabetes: Overcoming Barriers to Effective Weight Management. Diabetes Metab Syndr Obes 2023; 16:693-711. [PMID: 36923685 PMCID: PMC10010139 DOI: 10.2147/dmso.s365829] [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: 11/25/2022] [Accepted: 02/09/2023] [Indexed: 03/12/2023] Open
Abstract
The prevalence of type 2 diabetes (T2DM) among children and adolescents has remarkably increased in the last two decades, particularly among ethnic minorities. Management of T2DM is challenging in the adolescent population due to a constellation of factors, including biological, socioeconomic, cultural, and psychological barriers. Weight reduction is an essential component in management of T2DM as weight loss is associated with improvement in insulin sensitivity and glycemic status. A family centered and culturally appropriate approach offered by a multidisciplinary team is crucial to address the biological, psychosocial, cultural, and financial barriers to weight management in youth with T2DM. Lifestyle interventions and pharmacotherapy have shown modest efficacy in achieving weight reduction in adolescents with T2DM. Bariatric surgery is associated with excellent weight reduction and remission of T2DM in youth. Emerging therapies for weight reduction in youth include digital technologies, newer GLP-1 agonists and endoscopic procedures.
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Affiliation(s)
- Mostafa Salama
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Ana Creo
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Rose Prissel
- Division of Endocrinology and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Alaa Al Nofal
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
| | - Seema Kumar
- Division of Pediatric Endocrinology, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
- Correspondence: Seema Kumar, Email
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7
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McVoy M, Hardin H, Fulchiero E, Caforio K, Briggs F, Neudecker M, Sajatovic M. Mental health comorbidity and youth onset type 2 diabetes: A systematic review of the literature. Int J Psychiatry Med 2023; 58:37-55. [PMID: 35026126 DOI: 10.1177/00912174211067335] [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] [Indexed: 11/17/2022]
Abstract
BACKGROUND Type 2 diabetes (T2D) is a burgeoning epidemic in children and adolescents. Adult T2D doubles the risk of depression and mental health comorbidity, makes it more difficult to make the lifestyle, medication adherence and health behavior changes needed to optimize outcomes. There is limited research on the impact of depression and depressive symptoms on youth T2D. METHODS A search of the literature in the last 10 years regarding youth with depression and T2D was conducted. Abstracts were screened by 2 randomly assigned authors for inclusion, and disagreement was resolved by a third author. Selected full-text articles were divided among all authors for review. RESULTS 13 publications from 8 studies (N=2244, age 6-17) were included. 6 of 13 publications utilized Treatment Options for Type 2 Diabetes in Youth (TODAY) study data. While studies included evaluation of depressive symptoms, most did not formally assess for major depressive disorder (MDD) and excluded participants with a previous diagnosis of MDD. Depressive symptoms were common in this population and were associated with negative T2D outcomes. CONCLUSIONS While there is a growing body of adult literature highlighting the extensive relationship between T2D and mental health, there is a dearth of data in youth. Future studies are needed that include, 1.) youth with diagnosed MDD, 2.) treatment studies of both T2D and MDD, 3.) larger, more racially diverse samples of youth with T2D, and 4.) studies that evaluate the impact of social determinants of health, including mental health comorbidity on outcomes of T2D.
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Affiliation(s)
- Molly McVoy
- Department of Psychiatry, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,12304Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Neurological and Behavioral Outcomes Center, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Child and Adolescent Psychiatry, Cleveland, OH, USA
| | - Heather Hardin
- Frances Payne Bolton School of Nursing, 15735Case Western Reserve University, Cleveland, OH, USA
| | - Erin Fulchiero
- Department of Psychiatry, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Kate Caforio
- 2546Case Western Reserve University, Cleveland, OH, USA
| | - Farren Briggs
- Neurological and Behavioral Outcomes Center, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Child and Adolescent Psychiatry, Cleveland, OH, USA
| | - Mandy Neudecker
- University Hospitals Cleveland Medical Center, 159284Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Martha Sajatovic
- Department of Psychiatry, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Neurological and Behavioral Outcomes Center, 24575University Hospitals Cleveland Medical Center, Cleveland, OH, USA.,Division of Child and Adolescent Psychiatry, Cleveland, OH, USA.,Department of Neurology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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8
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Sellers EAC, McLeod L, Prior HJ, Dragan R, Wicklow BA, Ruth C. Mental health comorbidity is common in children with type 2 diabetes. Pediatr Diabetes 2022; 23:991-998. [PMID: 35838140 DOI: 10.1111/pedi.13389] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/08/2022] [Accepted: 07/10/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To describe the prevalence of mental health comorbidity in children with type 2 diabetes compared to a matched population without diabetes and children with type 1 diabetes. RESEARCH DESIGN AND METHODS Population-based cohorts of 528 youth (7-18 years of age) with prevalent type 2 diabetes, 1519 matched children without diabetes and 778 youth with type 1 diabetes were identified from a clinical registry and linked to provincial health care records to assess the prevalence of mental health comorbidity using ICD-9CM, ICD-10CA and ATC codes. RESULTS The majority of children with type 2 diabetes were of First Nations heritage. Compared to their matched peers, children with type 2 diabetes where more likely to have a mood or anxiety disorder before and after diagnosis [RR 2.38 (1.63, 3.48) p < 0.001 and 1.70 (1.39, 2.08) p < 0.001 respectively], to attempt/complete suicide [RR 3.18 (1.30, 7.81) p = 0.012 and 2.18 (1.32, 3.60) p = 0.0002 respectively] and be prescribed an antipsychotic [RR 2.33 (1.23, 4.39) p = 0.009 and 1.76 (1.23, 2.52) p = 0.002 respectively]. Following adjustment for age and sex, children with type 2 diabetes, compared to children with type 1 diabetes where more likely to have a mood or anxiety disorder and be prescribed an antipsychotic after diagnosis [RR 1.43 (1.07, 1.91) p = 0.015; RR 2.41 (1.44, 4.06) p = 0.0009 respectively]. CONCLUSIONS Children with type 2 diabetes have high rates of comorbid mental illness. Programs to provide care, support, and education must address the mental health comorbidity in the context of the demographic, socioeconomic, and psycho-cultural characteristics of the population.
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Affiliation(s)
- Elizabeth A C Sellers
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Lorraine McLeod
- First Nations Health & Social Secretariat of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather J Prior
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Roxana Dragan
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy A Wicklow
- Department of Pediatrics and Child Health, University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Chelsea Ruth
- Department of Pediatrics, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada.,Department of Child Health, Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Manitoba, Canada
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9
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Shah AS, Zeitler PS, Wong J, Pena AS, Wicklow B, Arslanian S, Chang N, Fu J, Dabadghao P, Pinhas-Hamiel O, Urakami T, Craig ME. ISPAD Clinical Practice Consensus Guidelines 2022: Type 2 diabetes in children and adolescents. Pediatr Diabetes 2022; 23:872-902. [PMID: 36161685 DOI: 10.1111/pedi.13409] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 08/29/2022] [Indexed: 11/29/2022] Open
Abstract
Since the 2018 ISPAD guidelines on this topic, follow-up of large cohorts from around the globe have continued informing the current incidence and prevalence of co-morbidities and complications in young adults with youth-onset type 2 diabetes (T2D). This chapter focuses on the risk factors, diagnosis and presentation of youth-onset T2D, the initial and subsequent management of youth-onset T2D, and management of co-morbidities and complications. We include key updates from the observational phase of the multi-center Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial, the SEARCH for Diabetes in Youth (SEARCH) study and new data from the Restoring Insulin Secretion (RISE) study, a head-to-head comparison of youth onset vs adult-onset T2D. We also include an expanded section on risk factors associated with T2D, algorithms and tables for treatment, management, and assessment of co-morbidities and complications, and sections on recently approved pharmacologic therapies for the treatment of youth-onset T2D, social determinants of health, and settings of care given COVID-19 pandemic.
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Affiliation(s)
- Amy S Shah
- Division of Pediatric Endocrinology, Cincinnati Children's Hospital Medical Center and the University of Cincinnati, Cincinnati, Ohio, USA
| | - Philip S Zeitler
- Division of Pediatric Endocrinology, Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jencia Wong
- Department of Endocrinology, Royal Prince Alfred Hospital and Central Clinical School, Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Alexia S Pena
- The University of Adelaide, Robinson Research Institute, North Adelaide, South Australia, Australia
| | - Brandy Wicklow
- Division of Endocrinology, Winnipeg Children's Hospital and University of Manitoba, Children's Hospital Research Institute of Manitoba, Winnipeg, Manitoba, Canada
| | - Silva Arslanian
- Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nancy Chang
- Center for Endocrinology, Diabetes and Metabolism, Children's Hospital Los Angeles, Los Angeles, California, USA
| | - Junfen Fu
- Division of Endocrinology, The Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Sackler School of Medicine, Tel-Aviv, Israel
| | - Tatsuhiko Urakami
- Department of Pediatrics, Nihon University School of Medicine, Tokyo, Japan
| | - Maria E Craig
- The Children's Hospital at Westmead, University of Sydney, Sydney, New South Wales, Australia.,Discipline of Pediatrics & Child Health, School of Clinical Medicine, University of NSW Medicine and Health, Sydney, New South Wales, Australia
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10
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Koerner R, Rechenberg K. Mindfulness in adolescents and young adults with diabetes: An integrative review. Complement Ther Clin Pract 2022; 49:101659. [PMID: 35986987 DOI: 10.1016/j.ctcp.2022.101659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 07/25/2022] [Accepted: 08/09/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND PURPOSE Type 1 diabetes (T1D), type 2 diabetes, and prediabetes are increasing in incidence. Adolescents and young adults with diabetes experience psychosocial comorbidities at an increased incidence. As such, exploring interventions that can improve psychosocial and glycemic outcomes are needed. The purpose of this integrative review is to examine and synthesize the literature on mindfulness in adolescents and young adults with type 1 or type 2 diabetes or prediabetes. METHODS Four databases were searched during May 2021. Included studies were published between 2000 and 2021, evaluated adolescents and young adults, diagnosed with type 1 or type 2 diabetes or prediabetes. Studies were excluded if they were not in English; not original research; evaluated complementary/alternative therapies as a group. To assess for risk of bias, the National Institutes of Health quality assessment tools and the Cochrane Collaboration's tool were utilized. Whittemore and Knafl's (2005) method for conducting an integrative review was utilized to synthesize results. RESULTS We identified 137 articles in our initial search and 74 articles remained after removing for duplicates. Ten articles were included in the review, with 5 including adolescents and young adults with T1D and 5 including adolescents and young adults with prediabetes. No studies evaluated mindfulness in adolescents and young adults with type 2 diabetes. CONCLUSION Mindfulness is an acceptable intervention in adolescents and young adults with T1D and prediabetes, resulting in positive psychosocial and glycemic outcomes. There were issues with feasibility of the intervention and mobile health technology delivery methods should be evaluated.
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Affiliation(s)
- Rebecca Koerner
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
| | - Kaitlyn Rechenberg
- University of South Florida, College of Nursing, 12901 Bruce B. Downs Blvd, MDC Box 22, Tampa, FL, 33612, USA.
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11
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Hoffman RP, Damilano CP, Hong KMC, Glick BA, Kamboj MK. Glycemic control, depression, diabetes distress among adolescents with type 2 diabetes: effects of sex, race, insurance, and obesity. Acta Diabetol 2022; 59:1083-1089. [PMID: 35648254 DOI: 10.1007/s00592-022-01902-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 04/27/2022] [Indexed: 11/24/2022]
Abstract
AIMS To determine (1) differences in depression and distress scores between adolescents with type 1 (T1D) and type 2 diabetes (T2D), (2) how socioeconomic factors, obesity, race, and treatment regimen affect depression and diabetes distress in adolescent T2D, (3) the relationships between depression and diabetes distress scores in adolescents with T2D, and (4) how depression and diabetes distress scores relate to current and future glycemic control in adolescents with T2D. BACKGROUND Diabetes distress is a negative emotional reaction to diabetes complications, self-management demands, unresponsive providers, poor interpersonal relationships, and to diabetes itself. It is frequently mistaken for depression and the two are interrelated. Increases in both predict poor glycemic control in adolescents with T1D. METHOD Depression (PHQ-9) and diabetes distress (PAID-T) scores from self-administered tests were studied in 364 patients with diabetes between the ages of 13-17. Kruskal-Wallis test was used to assess differences between types of diabetes, sexes, races, and insurance status. Spearman correlations, and robust rank order multivariable regression analysis were used to assess relationships. Medical records were reviewed for follow-up hemoglobin A1c (HbA1c) levels over 3 years. RESULTS HbA1c was significantly lower in females with T2D than with T1D (p = 0.019) but not in males. It, also, did not differ between females and males with T2D. Median PHQ-9 score in females with T2D was significantly greater than in females with T1D (p = 0.007) but did not differ between females and males with T2D. PHQ-9 scores did not differ between males with T2D and T1D. PAID-T scores, however, were higher in males with T2D than in males with T1D but did not differ between females. PHQ-9 scores and PAID-T scores were significantly related in T2D (rs = 0.65, p < 0.001). Neither was related to HbA1c in T2D. CONCLUSIONS As in adolescents with T1D, depression and diabetes distress screening scores are closely related in adolescent T2D. However, unlike T1D, they are not related to glycemic control in T2D. Depression and diabetes distress may be more closely related to weight and lifestyle concerns.
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Affiliation(s)
- Robert P Hoffman
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Cecilia P Damilano
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - K Ming Chan Hong
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Bethany A Glick
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Manmohan K Kamboj
- Division of Endocrinology, Nationwide Children's Hospital, The Ohio State University, 700 Children's Drive, Columbus, OH, 43205, USA
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12
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Kavookjian J, LaManna JB, Davidson P, Davis JW, Fahim SM, McDaniel CC, Ekong G, Todd A, Yehl K, Cox C. Impact of Diabetes Self-Management Education/Support on Self-Reported Quality of Life in Youth With Type 1 or Type 2 Diabetes. Sci Diabetes Self Manag Care 2022; 48:406-436. [PMID: 35899815 DOI: 10.1177/26350106221115450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The persistent requirement of self-management for diabetes impacts quality of life (QoL), yet the literature for impact of diabetes self-management education and support (DSMES) on QoL in youth has not been synthesized and reported. The purpose of this review was to systematically identify and describe the state of the science exploring the impact of DSMES on self-reported QoL in youth with type 1 diabetes (T1DM) or type 2 diabetes (T2DM). METHODS A modified Cochrane review was conducted. Retained studies were published in the English language between January 1, 2007, and March 31, 2020. Included studies specified that the intervention had diabetes education addressing at least 1 or more of The Association of Diabetes Care & Education Specialists' ADCES7 Self-Care BehaviorsTM (ADCES7™) and used an established self-reported QoL measure. Retained studies were assessed for risk of bias. RESULTS Eleven studies reported in 12 articles were retained. The interventions were primarily delivered to youth with T1DM or T2DM and included caregivers/families in some studies. The ADCES7™ were addressed across the retained studies. Five of the 11 studies assessed QoL as the primary outcome and 6 studies as a secondary outcome. CONCLUSION To enhance the QoL outcomes and to provide insight into how to positively impact self-perceptions of QoL, ongoing generic and diabetes-specific QoL assessments are warranted for youth with T1DM or T2DM. Further research is needed in structured DSMES programs to help reduce variability in research designs, methods, measures, and outcomes to generate evidence for best practices that can be translated and disseminated into real-world settings.
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Affiliation(s)
- Jan Kavookjian
- Auburn University Harrison College of Pharmacy, Auburn University, Auburn, Alabama
| | | | | | - Jean W Davis
- College of Nursing, University of Central Florida, Orlando, Florida
| | | | - Cassidi C McDaniel
- Auburn University Harrison College of Pharmacy, Auburn University, Auburn, Alabama
| | - Gladys Ekong
- Western New England University, Springfield, Massachusetts
| | - Andrew Todd
- College of Nursing, University of Central Florida, Orlando, Florida
| | - Kirsten Yehl
- Association of Diabetes Care & Education Specialists, Chicago, Illinois
| | - Carla Cox
- Mountain Vista Medicine, South Jordan, Utah
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13
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Jaser SS, Hilliard ME. Preventing, Screening, and Treating Suicidality in Pediatric Type 1 Diabetes: Roles for Behavioral Health Care Professionals. Diabetes Care 2022; 45:1035-1037. [PMID: 35561133 PMCID: PMC9375444 DOI: 10.2337/dci22-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
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14
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Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center. J Clin Psychol Med Settings 2022; 30:92-110. [PMID: 35316442 PMCID: PMC8938639 DOI: 10.1007/s10880-022-09867-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2022] [Indexed: 12/02/2022]
Abstract
Guidelines recommend routinely screening adults with diabetes for psychological concerns, but few diabetes clinics have adopted screening procedures. This study assessed patient and provider perspectives regarding the role of mental health in diabetes care, psychosocial screening procedures, and patients’ support needs. Patients with diabetes (n = 15; 73.3% type 2) and their medical providers (n = 11) participated in qualitative interviews. Thematic content analysis was used to categorize results. Participants believed that mental health was important to address within comprehensive diabetes care. Patients expressed positive or neutral opinions about psychosocial screening. Providers had mixed reactions; many thought that screening would be too time-consuming. Both groups emphasized that screening must include referral procedures to direct patients to mental health services. Patients and providers interviewed in this study viewed psychosocial screening as compatible with diabetes care. Including a mental health professional on the treatment team could reduce potential burden on other team members.
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15
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Longitudinal Association of Depressive Symptoms, Binge Eating, and Quality of Life With Cardiovascular Risk Factors in Young Adults With Youth-Onset Type 2 Diabetes: The TODAY2 Study. Diabetes Care 2022; 45:dc211995. [PMID: 35290434 PMCID: PMC9174973 DOI: 10.2337/dc21-1995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 02/16/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To report the prevalence of depression, eating disorder symptoms, and impaired health-related quality of life (HRQOL) and examine their longitudinal associations with glycemia and diabetes complications in young adults with youth-onset type 2 diabetes. RESEARCH DESIGN AND METHODS Participants recruited over a 4-year period were enrolled at 15 clinical diabetes centers in the follow-up observational Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) study. From 2014-2020, prevalence of symptoms of depression, eating disorders, and HRQOL by sex, race/ethnicity, and baseline family income were assessed annually. Longitudinal relationships between assessments of glycemia and complications with psychiatric symptoms and HRQOL were evaluated in adjusted models. RESULTS Participants (n = 514) were 21.7 ± 2.5 years old with a diabetes duration of 8.6 ± 1.5 years in year 1 of TODAY 2 (2014). Symptoms of depression and impaired HRQOL were common and increased significantly over 6 years (14.0% to 19.2%, P = 0.003; and 13.1% to 16.7%, P = 0.009, respectively). Depression and impaired HRQOL were more common in women and those with lower baseline family income but did not differ by race/ethnicity. Rates of binge eating were stable over time; self-reported purging increased. Over time, symptoms of depression were associated with higher HbA1c, hypertension, and retinopathy progression; impaired HRQOL was associated with higher BMI, systolic blood pressure, hypertension, and retinopathy progression; and symptoms of eating disorders were associated with higher BMI. CONCLUSIONS Significant psychiatric symptoms and impaired HRQOL are common among emerging adults with youth-onset type 2 diabetes and are positively associated with glycemia, hypertension, and retinopathy progression in this group that is at ongoing risk for medical morbidity.
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16
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Smigoc Schweiger D, Battelino T, Groselj U. Sex-Related Differences in Cardiovascular Disease Risk Profile in Children and Adolescents with Type 1 Diabetes. Int J Mol Sci 2021; 22:ijms221910192. [PMID: 34638531 PMCID: PMC8508122 DOI: 10.3390/ijms221910192] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/09/2023] Open
Abstract
Cardiovascular disease (CVD) is the primary cause of higher and earlier morbidity and mortality in people with type 1 diabetes (T1D) compared to people without diabetes. In addition, women with T1D are at an even higher relative risk for CVD than men. However, the underlying pathophysiology is not well understood. Atherosclerotic changes are known to progress early in life among people with T1D, yet it is less clear when excess CVD risk begins in females with T1D. This review explores the prevalence of classical CVD risk factors (such as glycemic control, hypertension, dyslipidemia, obesity, albuminuria, smoking, diet, physical inactivity), as well as of novel biomarkers (such as chronic inflammation), in children and adolescents with T1D with particular regard to sex-related differences in risk profile. We also summarize gaps where further research and clearer clinical guidance are needed to better address this issue. Considering that girls with T1D might have a more adverse CVD risk profile than boys, the early identification of and sex-specific intervention in T1D would have the potential to reduce later CVD morbidity and excess mortality in females with T1D. To conclude, based on an extensive review of the existing literature, we found a clear difference between boys and girls with T1D in the presence of individual CVD risk factors as well as in overall CVD risk profiles; the girls were on the whole more impacted.
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Affiliation(s)
- Darja Smigoc Schweiger
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Tadej Battelino
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
| | - Urh Groselj
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia; (D.S.S.); (T.B.)
- Department of Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Bohoriceva 20, 1000 Ljubljana, Slovenia
- Department of Cardiovascular Medicine, School of Medicine, Stanford University, 870 Quarry Road, Stanford, CA 94305, USA
- Correspondence: ; Tel.: +386-1-522-9235; Fax: +386-1-232-0190
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17
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Mulvaney SA, Mara CA, Kichler JC, Majidi S, Driscoll KA, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Hood KK, Monaghan M. A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care. Transl Behav Med 2021; 11:122-131. [PMID: 31764981 DOI: 10.1093/tbm/ibz171] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.
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Affiliation(s)
| | - Constance A Mara
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jessica C Kichler
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | | | | | | | | | - Korey K Hood
- Stanford University School of Medicine, Palo Alto, CA, USA
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18
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Pyle L, Kelsey MM. Youth-onset type 2 diabetes: translating epidemiology into clinical trials. Diabetologia 2021; 64:1709-1716. [PMID: 34075436 DOI: 10.1007/s00125-021-05480-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 03/10/2021] [Indexed: 12/17/2022]
Abstract
Globally, the proportion of new diagnoses of youth-onset diabetes represented by type 2 diabetes is increasing, and youth with type 2 diabetes commonly have complications and comorbidities, as well as a higher rate of mortality. In this review, we summarise what is known about the natural progression of youth-onset type 2 diabetes from published clinical trials and large-scale prospective epidemiological studies. It is important to note that the robust pathophysiological and treatment data specifically related to individuals with a diabetes onset at ≤20 years of age largely hails from the USA. Youth-onset type 2 diabetes is characterised by pathophysiological heterogeneity and inadequate glycaemic control, highlighting the need for new treatment approaches and innovative study designs in populations of varied genetic and cultural backgrounds.
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Affiliation(s)
- Laura Pyle
- Section of Paediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO, USA
| | - Megan M Kelsey
- Section of Paediatric Endocrinology, University of Colorado School of Medicine, Aurora, CO, USA.
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19
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Brodar KE, Davis EM, Lynn C, Starr-Glass L, Lui JHL, Sanchez J, Delamater AM. Comprehensive psychosocial screening in a pediatric diabetes clinic. Pediatr Diabetes 2021; 22:656-666. [PMID: 33604976 DOI: 10.1111/pedi.13193] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE The ISPAD recommends routine, comprehensive psychosocial screening for adolescents with diabetes. However, few clinics have implemented procedures consistent with these guidelines. This study describes the results of a universal, comprehensive psychosocial screening program in an integrated pediatric diabetes clinic located within an academic medical center. RESEARCH DESIGN AND METHODS Participants included 232 ethnically diverse adolescents with type 1 diabetes (55.5% female; M age = 14.85; 58.5% Hispanic; 20% Black). Adolescents completed screening measures on iPads in the waiting room before their medical visit. The proportion of adolescents screening positive on each psychosocial measure was assessed, and regression analyses evaluated how psychosocial variables accounted for variance in insulin non-adherence and glycemic control (measured by A1c). RESULTS Psychosocial concerns were common and ranged from 7% of adolescents screening positive for disordered eating and suicide risk to 52% screening positive for low motivation to manage diabetes. A1c and insulin non-adherence were positively correlated with suicide risk, depressive symptoms, anxiety, disordered eating, diabetes stress, blood glucose monitoring stress, family conflict, and total number of elevations, and negatively correlated with intrinsic motivation. Insulin non-adherence, disordered eating, diabetes stress, and family conflict uniquely predicted A1c. Age, motivation, and family conflict uniquely predicted insulin non-adherence. Eighty-three percent of eligible youth completed the screener. Referrals by physicians to the team psychologist increased by 25% after the screening program was implemented. CONCLUSIONS Comprehensive psychosocial screening can be effectively implemented as part of routine pediatric diabetes care and can identify adolescents in need of additional supports.
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Affiliation(s)
- Kaitlyn E Brodar
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA.,Department of Psychology, University of Miami, Coral Gables, Florida, USA
| | - Eileen M Davis
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Courtney Lynn
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Lolly Starr-Glass
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Joyce H L Lui
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Janine Sanchez
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Alan M Delamater
- Mailman Center for Child Development, Department of Pediatrics, University of Miami Miller School of Medicine, Miami, Florida, USA
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20
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Jurgen B, Baker CN, Kamps JL, Hempe JM, Chalew SA. Associations Between Depressive Symptoms, Fear of Hypoglycemia, Adherence to Management Behaviors and Metabolic Control in Children and Adolescents with Type 1 Diabetes. J Clin Psychol Med Settings 2021; 27:385-395. [PMID: 31728880 DOI: 10.1007/s10880-019-09676-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We examined the relationship between two malleable risk factors, depressive symptoms and fear of hypoglycemia, in children and adolescents with Type 1 diabetes and their relationship to two important outcomes, adherence behaviors and metabolic control. To assess this relationship, we used a multidimensional measure of adherence, assessing frequency of both blood glucose monitoring and healthy behaviors including diet and exercise. We predicted that higher levels of depressive symptoms and higher levels of fear of hypoglycemia would be associated with worse metabolic control as mediated by poor adherence. Eighty-three children and adolescents ages 8 to 20 (M = 13.87, SD 3.21) were recruited from March 2014 to October 2014 at an outpatient diabetes clinic in a moderately sized Southeastern city within the USA. Nested models were evaluated using structural equation modeling. Adherence significantly mediated the relationship between depressive symptoms and metabolic control with more depressive symptoms leading to worse metabolic control. Adherence marginally mediated the relationship between fear of hypoglycemia and metabolic control; however, less fear of hypoglycemia was associated with worse metabolic control. In a combined model, adherence continued to significantly mediate the relationship between depressive symptoms and metabolic control, while also independently significantly mediating the relationship between fear of hypoglycemia and metabolic control. This finding was also contrary to the predicted relationship with less fear of hypoglycemia leading to worse metabolic control. The results indicate that youth with fewer depressive symptoms and more fear of hypoglycemia had better adherence to their treatment regimen, which was associated with better metabolic control. The results of this study highlight the importance of screening for depression and fear of hypoglycemia during routine clinic visits to optimize adherence and metabolic control.
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Affiliation(s)
- Brittney Jurgen
- Department of Psychology, Tulane University, New Orleans, LA, USA. .,, Boston, USA.
| | - Courtney N Baker
- Department of Psychology, Tulane University, New Orleans, LA, USA
| | - Jodi L Kamps
- Department of Psychology, Children's Hospital of New Orleans, New Orleans, LA, USA.,Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA
| | - James M Hempe
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Research Institute for Children, Children's Hospital, New Orleans, LA, USA
| | - Stuart A Chalew
- Department of Pediatrics, Louisiana State University Health Sciences Center, New Orleans, LA, USA.,Department of Pediatrics, Children's Hospital of New Orleans, New Orleans, LA, USA
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21
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Wong JJ, Hanes S, Iturralde E, Lanning MS, Naranjo D, Tanenbaum M, Hood KK. Do Youth Want Psychosocial Screenings in Diabetes Clinic? Profiles of Acceptability. J Pediatr Psychol 2021; 46:332-340. [PMID: 33316061 DOI: 10.1093/jpepsy/jsaa112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 10/29/2020] [Accepted: 10/30/2020] [Indexed: 11/13/2022] Open
Abstract
AIMS Psychosocial screenings are recommended and increasingly common in pediatric subspecialty clinics, though little is known about their acceptability. This study seeks to uncover profiles of acceptability and assess demographic and clinical correlates among adolescents with diabetes. METHODS A sample of 124 adolescents (57.7% female) ages 12-21 years (M = 16.2 ± 2.3) completed screenings during routine diabetes appointments. K-means clustering of responses to acceptability items derived profiles; Analysis of Variance (ANOVA) and Chi-square tests assessed correlates. RESULTS Adolescents with the most common profile (72.6%) placed high importance on medical providers' awareness of their emotions and reported no difficulties/discomfort with the screener. These youth had moderate depressive symptoms, low diabetes distress, and low A1c. Those who fit a less common profile (18.5%) were uncomfortable with the screener and had the highest depressive symptoms and lowest A1c. Youth who fit a smaller profile (6.5%) endorsed technical difficulties and had high depressive symptoms and lowest diabetes distress. The smallest profile (2.4%, N = 3) had difficulty understanding and experienced discomfort with the screening and had the lowest depressive symptoms and the highest diabetes distress and A1c. These differences in depressive symptoms (F = 3.54, p = .017), A1c values (F = 4.03, p = .009), and diabetes distress (F = 3.27, p = .036) were significant though differences in age, gender, and diabetes duration were not. CONCLUSIONS Most youth responded favorably to in-clinic psychosocial screenings. Youth who were less satisfied were at increased risk for psychosocial and medical complications. Findings highlight areas of need, such as enhanced support with and an emphasized rationale for screenings, which may improve patient experience in subspecialty care.
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Affiliation(s)
- Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Esti Iturralde
- Division of Research, Kaiser Permanente Northern California
| | - Monica S Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Molly Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University
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22
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Martin H, Bullich S, Guiard BP, Fioramonti X. The impact of insulin on the serotonergic system and consequences on diabetes-associated mood disorders. J Neuroendocrinol 2021; 33:e12928. [PMID: 33506507 DOI: 10.1111/jne.12928] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/20/2020] [Accepted: 12/02/2020] [Indexed: 12/12/2022]
Abstract
The idea that insulin could influence emotional behaviours has long been suggested. However, the underlying mechanisms have yet to be solved and there is no direct and clear-cut evidence demonstrating that such action involves brain serotonergic neurones. Indeed, initial arguments in favour of the association between insulin, serotonin and mood arise from clinical or animal studies showing that impaired insulin action in type 1 or type 2 diabetes causes anxiety- and depressive symptoms along with blunted plasma and brain serotonin levels. The present review synthesises the main mechanistic hypotheses that might explain the comorbidity between diabetes and depression. It also provides a state of knowledge of the direct and indirect experimental evidence that insulin modulates brain serotonergic neurones. Finally, it highlights the literature suggesting that antidiabetic drugs present antidepressant-like effects and, conversely, that serotonergic antidepressants impact glucose homeostasis. Overall, this review provides mechanistic insights into how insulin signalling alters serotonergic neurotransmission and related behaviours bringing new targets for therapeutic options.
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Affiliation(s)
- Hugo Martin
- NutriNeuro, UMR 1286 INRAE, Bordeaux INP, Bordeaux University, Bordeaux, France
| | - Sébastien Bullich
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), CNRS UMR5169, UPS, Université de Toulouse, Toulouse, France
| | - Bruno P Guiard
- Centre de Recherches sur la Cognition Animale (CRCA), Centre de Biologie Intégrative (CBI), CNRS UMR5169, UPS, Université de Toulouse, Toulouse, France
| | - Xavier Fioramonti
- NutriNeuro, UMR 1286 INRAE, Bordeaux INP, Bordeaux University, Bordeaux, France
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23
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Monaghan M, Mara CA, Kichler JC, Westen SC, Rawlinson A, Jacobsen LM, Adams RN, Stone JY, Hood KK, Mulvaney SA. Multisite Examination of Depression Screening Scores and Correlates Among Adolescents and Young Adults With Type 2 Diabetes. Can J Diabetes 2021; 45:411-416. [PMID: 33722492 DOI: 10.1016/j.jcjd.2021.01.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 01/06/2021] [Accepted: 01/16/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Our aim was to evaluate self-reported depressive symptoms and clinical outcomes during routine screening for adolescents and young adults with type 2 diabetes (T2D), and examine associations among depressive symptoms and demographic and clinical characteristics. METHODS The Patient Health Questionnaire (PHQ) was administered to 197 adolescents and young adults with T2D using the PHQ-2 or PHQ-9 in routine pediatric diabetes care at 4 academic medical centres. Data from electronic health records were extracted from the screening date and 12 months earlier. RESULTS Adolescents and young adults with T2D (mean age, 16.85 years; 57% male; 77.2% non-Caucasian) completed the PHQ as part of routine diabetes care. On the PHQ, 19.3% of adolescents and young adults endorsed elevated depressive symptoms (PHQ score ≥10) and, among a subsample with item-level data (n=53), 18.9% endorsed thoughts of self-harm. Subsequently, 50.0% of those with depressive symptoms had a documented referral for mental health treatment in the electronic health record after the positive screening outcome. Older age, shorter diabetes duration, higher glycated hemoglobin level, being non-Hispanic white, more blood glucose checks per day and being prescribed oral medications were significantly associated with more depressive symptoms. CONCLUSIONS Screening for depressive symptoms identifies individuals in need of referral for mental health treatment. A focus on self-harm assessment, standardized methods for documentation of symptoms and mental health referrals and increased referral resources are needed.
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Affiliation(s)
- Maureen Monaghan
- Center for Translational Research, Children's National Hospital, Washington, District of Columbia, United States.
| | - Constance A Mara
- Behavioral Medicine & Clinical Psychology, Cincinnati Children's Hospital Medical Center and Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, United States
| | - Jessica C Kichler
- Department of Psychology, University of Windsor, Windsor, Ontario, Canada
| | - Sarah C Westen
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Alana Rawlinson
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, United States
| | - Laura M Jacobsen
- Division of Endocrinology, Department of Pediatrics, University of Florida, Gainesville, Florida, United States
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Jenine Y Stone
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, United States
| | - Shelagh A Mulvaney
- School of Nursing, Vanderbilt University and Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, United States
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24
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Roberts AJ, Barry D, Yi-Frazier J, Rutman L, Pihoker C, Malik FS. Screening for Mental Health Comorbidities in a Pediatric Diabetes Clinic Setting. Clin Diabetes 2021; 39:97-101. [PMID: 33551559 PMCID: PMC7839615 DOI: 10.2337/cd20-0037] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
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 an effort to improve mental health screening of patients at a pediatric diabetes clinic in Seattle, WA.
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Affiliation(s)
- Alissa J Roberts
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Research Institute, Seattle, WA
| | - Dwight Barry
- Seattle Children's Research Institute, Seattle, WA
| | | | - Lori Rutman
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Research Institute, Seattle, WA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Research Institute, Seattle, WA
| | - Faisal Saleem Malik
- Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
- Seattle Children's Research Institute, Seattle, WA
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Othman N, Wong YY, Lean QY, Mohd Noor N, Neoh CF. Factors affecting self-management among adolescents and youths with type 2 diabetes mellitus: A meta-synthesis. Eur J Integr Med 2020. [DOI: 10.1016/j.eujim.2020.101228] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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26
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Hamburger ER, Goethals ER, Choudhary A, Jaser SS. Sleep and depressive symptoms in adolescents with type 1 diabetes not meeting glycemic targets. Diabetes Res Clin Pract 2020; 169:108442. [PMID: 32941959 PMCID: PMC7736492 DOI: 10.1016/j.diabres.2020.108442] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/31/2020] [Accepted: 09/09/2020] [Indexed: 12/23/2022]
Abstract
AIMS Adolescents with type 1 diabetes (T1D) are at risk for problems with self-management and suboptimal glycemic control, and depressive symptoms and sleep disturbances predict poorer diabetes outcomes. Despite evidence for associations between adolescent depressive symptoms and sleep in the general population, few studies have investigated this link in the vulnerable group of adolescents with T1D not meeting glycemic targets. The current study sought to assess both depressive symptoms and sleep in relation to diabetes indicators in adolescents with T1D. METHODS 120 adolescents (ages 13-17 years) with above target glycemic control completed measures of depressive symptoms, sleep duration and quality, and self-management; parents also reported on adolescents' diabetes management. Clinical data (i.e., HbA1c) were extracted from medical records. RESULTS In our sample, 40% of adolescents reported at least mild depressive symptoms, and 26% reported clinically significant sleep disturbances. Adolescents with sleep disturbances were more likely to report at least mild symptoms of depression, and both depressive symptoms and sleep quality were associated with poorer diabetes management. No significant differences emerged regarding HbA1c or frequency of blood glucose monitoring. CONCLUSIONS The current findings highlight the importance of clinical assessment of both depressive symptoms and sleep in the vulnerable group of adolescents with T1D.
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Affiliation(s)
| | - Eveline R Goethals
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, United States; KU Leuven, Leuven, Belgium
| | - Arjun Choudhary
- Vanderbilt University Medical Center, Nashville, TN, United States
| | - Sarah S Jaser
- Vanderbilt University Medical Center, Nashville, TN, United States.
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Clary L, Wang C, Byrne ME, Monaghan M. COVID-19 Pandemic-Related Practices and Policies Affecting the Continuity of Behavioral Health Care Among Children With Diabetes. Transl Behav Med 2020; 10:819-826. [PMID: 32710626 PMCID: PMC7529096 DOI: 10.1093/tbm/ibaa072] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team’s capacity to respond swiftly to patients’ changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.
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Affiliation(s)
- Lauren Clary
- Division of Endocrinology & Diabetes, Children's National Hospital, Washington, DC, USA.,Departments of Psychiatry and Behavioral Sciences and Pediatrics, George Washington University School of Medicine, Washington, DC, USA
| | - Christine Wang
- Division of Endocrinology & Diabetes, Children's National Hospital, Washington, DC, USA
| | - Meghan E Byrne
- Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Maureen Monaghan
- Division of Endocrinology & Diabetes, Children's National Hospital, Washington, DC, USA.,Departments of Psychiatry and Behavioral Sciences and Pediatrics, George Washington University School of Medicine, Washington, DC, USA
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Urzeală C, Bota A, Teodorescu S, Vlăiculescu M, Baker JS. Quality of Life in Romanian Children with Type 1 Diabetes: A Cross-Sectional Survey Using an Interdisciplinary Healthcare Intervention. Healthcare (Basel) 2020; 8:healthcare8040382. [PMID: 33023137 PMCID: PMC7711784 DOI: 10.3390/healthcare8040382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/26/2020] [Indexed: 12/03/2022] Open
Abstract
Background: The purpose of this study was to assess the quality of life in Romanian type 1 diabetes mellitus (T1DM) children attending an early interdisciplinary healthcare intervention. Hypothesis: engaging T1DM children in leisure sports leads to a better quality of life. Methods: This research embeds a cross-sectional observational study, incorporating some clinical characteristics relevant for diabetes management. The Kidscreen 27 questionnaire was issued to 100 T1DM children aged between 7 and 17 years. Parents completed the questionnaire. All subjects received interdisciplinary healthcare in the previous year. Statistics were performed using SPSS, v20. The required sample size of 100 subjects was obtained with a confidence interval of 95% and a sampling error of 0.009. The tests were two-sided, with a type I error set at 0.05. Results: Subjects reached an increased level of physical well-being, psychological well-being, autonomy, parent relationships, peer and social support, and school inclusion. There was a significant difference (p < 0.05) between children who practice leisure activities and children who only participated in physical education (PE) classes, regarding their physical well-being (t = 2.123). ANOVA demonstrated significant differences between age groups regarding physical well-being. Conclusion: The interdisciplinary healthcare intervention increased the efficiency of T1DM management with positive effects on life quality.
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Affiliation(s)
- Constanta Urzeală
- Sports and Motor Performance Department, Faculty of Physical Education and Sports, National University of Physical Education and Sports from Bucharest, 060057 Bucharest, Romania
- Correspondence:
| | - Aura Bota
- Training of Teaching Staff Department, Faculty of Physical Education and Sports, National University of Physical Education and Sports from Bucharest, 060057 Bucharest, Romania;
| | - Silvia Teodorescu
- Doctoral School, National University of Physical Education and Sports from Bucharest, 060057 Bucharest, Romania;
| | - Mihaela Vlăiculescu
- Outpatient Diabetes Clinic “DiabNutriMed” Telemedicine Center, 020358 Bucharest, Romania;
- Support for Diabetes Association, 020358 Bucharest, Romania
| | - Julien S Baker
- Centre for Health and Exercise Science Research, Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, Hong Kong, China;
| | - The Kidscreen Group Europe
- Research Division “Child Public Health”, Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, Center for Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
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“Does cost of care influence the glycemic control, psychosocial illness and quality of care among adolescents with type 1 diabetes?: A hospital based cross section study in Mysuru, Karnataka. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Wolfgram P, Zhang L, Simpson P, Fiallo-Scharer R. Clinical associations of quarterly Patient Health Questionnaire-9 depression screening results in adolescents with type 1 diabetes. Pediatr Diabetes 2020; 21:871-877. [PMID: 32277561 DOI: 10.1111/pedi.13017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 03/06/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Awareness of comorbid depression in type 1 diabetes (T1D) patients is necessary to optimize health and diabetes care. Depression can occur or recur requiring regular review for depression symptoms. A validated tool to screen adolescents for symptoms of depression is the Patient Health Questionnaire (PHQ)-9 Modified for Teens (PHQ91-9 ). METHODS PHQ91-9 depression screen results, depression-related ICD-codes, demographic data, and information on complications and comorbidities of adolescents ≥11 years old with T1D were obtained. Longitudinal and single observation multivariable analyses identified associations of covariates with positive PHQ91-9 depression screens. RESULTS 5032 PHQ91-9 surveys were completed by 1225 unique participants. Overall, 6% (286/5032) of the PHQ91-9 depression screens were positive, and 60% (171/286) of the positive screens occurred in 107 unique patients without documented depression. In the longitudinal analysis, positive PHQ91-9 screens were associated (P < .05) with a diagnosis of depression listed in the medical record (OR 9.8), diabetic retinopathy (OR 4.3), female sex (OR 1.9), and use of an insulin pump (OR 0.5), while the single observation analysis at the time of a positive PHQ91-9 indicated presence of depression in the medical record (odds ratio 12.1), female sex (OR 1.9), and obesity (OR 1.8) were significantly (P < .05) associated with positive PHQ91-9 results. CONCLUSION Quarterly PHQ91-9 depression screening of adolescents with T1D during routine clinic visits can immediately inform care, and previous diagnosis of depression is the most strongly associated covariate, highlighting the importance of documenting depression in the medical record. Additionally, awareness for higher odds of positive PHQ91-9 depression screens in females, obese adolescent, and patients on insulin injections is important.
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Affiliation(s)
- Peter Wolfgram
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Liyun Zhang
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Pippa Simpson
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
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31
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How do parents of children with type 1 diabetes mellitus cope and how does this condition affect caregivers' mental health? Arch Pediatr 2020; 27:265-269. [PMID: 32418643 DOI: 10.1016/j.arcped.2020.05.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 03/25/2020] [Accepted: 05/02/2020] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To evaluate the impact that type 1 diabetes mellitus (T1DM) in children has on parents' mental health and parents' coping with this condition. METHODS A cross-sectional study involving, at the outpatient examination, 41 caregivers of T1DM patients who had been diagnosed for at least 6 months. We evaluated the parents' coping strategies with the Brief COPE and their depressive and anxiety symptoms with the Hospital Anxiety and Depression Scale (HADS). Glycemic control of patients was assessed using the last glycated hemoglobin (HbA1c) values. RESULTS The average total score at HADS was 17.62 (SD=6.98). Half of the parents had an anxious score over the cut-off. The more parents were depressed or anxious, the more they used emotion-focused coping (P=0.002 and P=0.00, respectively). The more parents were anxious or depressed, the more they used maladaptive coping strategies such as avoidance and distraction. CONCLUSION These findings emphasise the key role of healthcare providers in assessing parents' difficulties and taking special care of those who have the most problems.
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Abstract
Thyroid hormone is essential for normal fetal brain development in utero and for the first 2 years of life. The developing fetus is initially reliant upon maternal thyroid hormones that cross the placenta, until the fetal thyroid begins to supply thyroid hormone for the fetus. Maternal thyroid status affects fetal thyroid function and maternal thyroid dysfunction can have a significant impact on the fetus and neonate. There are also several neonatal factors that can influence thyroid function. Here, we describe thyroid function in the fetus and neonate and discuss the most common thyroid disorders seen in neonates.
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Primary care considerations for children and adolescents with type 1 diabetes. Curr Probl Pediatr Adolesc Health Care 2020; 50:100773. [PMID: 32376088 DOI: 10.1016/j.cppeds.2020.100773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Type 1 diabetes is one of the most common chronic conditions in pediatrics. Type 1 diabetes is unique in its effect on and response to all aspects of a patient's life. An understanding of the diabetes technology, sick- and well-child considerations, and commonly associated conditions will help the primary care physician to better care for children with type 1 diabetes when they present to their office. This article summarizes diabetes-related concerns that the primary care physician may encounter.
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Majidi S, O'Donnell HK, Stanek K, Youngkin E, Gomer T, Driscoll KA. Suicide Risk Assessment in Youth and Young Adults With Type 1 Diabetes. Diabetes Care 2020; 43:343-348. [PMID: 31822488 PMCID: PMC6971783 DOI: 10.2337/dc19-0831] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 11/16/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To describe sociodemographic and clinical characteristics of youth and young adults with type 1 diabetes who endorsed suicidal ideations as part of routine depression screening and the results of their suicide risk assessments. RESEARCH DESIGN AND METHODS The Patient Health Questionnaire-9 was used to assess depressive symptoms and suicide/death ideation in 550 youth and young adults with type 1 diabetes ages 10-24 years. Only individuals who endorsed suicidal/death ideations (n = 49) completed a standardized suicide risk assessment protocol and safety planning. RESULTS Nine percent of individuals endorsed suicidal/death ideation and of those, 83.4% reported clinically elevated depressive symptoms; 16% made a previous suicide attempt. No youth (n = 39) or young adults (n = 11) disclosed current plans or preparations for suicide, but five who expressed suicidal ideation acknowledged the lethality of insulin for an attempt. Three previously used insulin to attempt suicide. The overwhelming majority of individuals were classified as being low risk for future suicide attempt/completion. None were hospitalized as a part of the suicide risk assessment, and no suicide completions have occurred. CONCLUSIONS The findings of this study provide initial insight into the behaviors and cognitions of youth and young adults with type 1 diabetes who experience suicidal and death ideations. Comprehensive suicide risk assessment and safety planning are feasible during routine type 1 diabetes clinic appointments.
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Affiliation(s)
- Shideh Majidi
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Holly K O'Donnell
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kelly Stanek
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Erin Youngkin
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Tara Gomer
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Kimberly A Driscoll
- Barbara Davis Center for Diabetes, Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO .,Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL
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35
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Wong JJ, Addala A, Abujaradeh H, Adams RN, Barley RC, Hanes SJ, Iturralde E, Lanning MS, Naranjo D, Tanenbaum ML, Hood KK. Depression in context: Important considerations for youth with type 1 vs type 2 diabetes. Pediatr Diabetes 2020; 21:135-142. [PMID: 31644828 DOI: 10.1111/pedi.12939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 10/01/2019] [Accepted: 10/13/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type. OBJECTIVE Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes. METHODS A sample of 149 youth ages 12 to 21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type. RESULTS Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = .025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -.98, P < .001) than type 1 (β = -.48, P < .001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = .33, P = .035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = .86, P = .043), but not type 1 diabetes. No gender differences were detected. CONCLUSION These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations.
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Affiliation(s)
- Jessie J Wong
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Ananta Addala
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Hiba Abujaradeh
- School of Nursing, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Rebecca N Adams
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Regan C Barley
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Sarah J Hanes
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Esti Iturralde
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Monica S Lanning
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Diana Naranjo
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Molly L Tanenbaum
- Department of Pediatrics, Stanford University, Palo Alto, California
| | - Korey K Hood
- Department of Pediatrics, Stanford University, Palo Alto, California
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Mayoral K, Rajmil L, Murillo M, Garin O, Pont A, Alonso J, Bel J, Perez J, Corripio R, Carreras G, Herrero J, Mengibar JM, Rodriguez-Arjona D, Ravens-Sieberer U, Raat H, Serra-Sutton V, Ferrer M. Measurement Properties of the Online EuroQol-5D-Youth Instrument in Children and Adolescents With Type 1 Diabetes Mellitus: Questionnaire Study. J Med Internet Res 2019; 21:e14947. [PMID: 31714252 PMCID: PMC6880238 DOI: 10.2196/14947] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/13/2019] [Accepted: 09/24/2019] [Indexed: 11/23/2022] Open
Abstract
Background The lack of continuity between health-related quality of life (HRQoL) instruments designed for children and adults hinders change analysis with a life course approach. To resolve this gap, EuroQol (EQ) developed the EQ-5D-Youth (EQ-5D-Y), derived from the EQ-5D for adults. Few studies have assessed the metric properties of EQ-5D-Y in children with specific chronic conditions, and none have done so for children with type I diabetes mellitus (T1DM). Objective This study aimed to evaluate the acceptability, validity, reliability, and responsiveness of the EQ-5D-Y in children and adolescents with T1DM, when administered online. Methods Participants with T1DM were consecutively recruited from July to December 2014, from a list of potential candidates aged 8-19 years, who attended outpatient pediatric endocrinology units. Before every quarterly routine visit, participants received an email/telephone reminder to complete the online version of two generic HRQoL questionnaires: EQ-5D-Y and KIDSCREEN-27. The EQ-5D-Y measures five dimensions, from which an equally weighted summary score was constructed (range: 0-100). Completion rate and distribution statistics were calculated. Construct validity was evaluated through known group comparisons based on general health, acute diabetic decompensations, mental health, family function, and a multitrait, multimethod matrix between EQ-5D-Y and KIDSCREEN by using Spearman correlations. Construct validity hypotheses were stated a priori. Reliability was assessed with the intraclass correlation coefficient and responsiveness by testing changes over time and calculating the effect size. Reliability and responsiveness were tested among the stable and improved subsamples defined by a KIDSCREEN-10 index change of <4.5 points or ≥4.5 points, respectively, from the first to the fourth visit. Results Of the 136 participants, 119 (87.5%) responded to the EQ-5D-Y at the last visit. The dimensions that showed higher percentages of participants with problems were “having pain/discomfort” (34.6%) and “worried/sad/unhappy” (28.7%). The mean (SD) of the EQ-5D-Y summary score was 8.5 (10.9), with ceiling and floor effects of 50.7% and 0%, respectively. Statistically significant HRQoL differences between groups defined by their general health (excellent/very good and good/regular/bad) and mental health (Strengths and Difficulties Questionnaire score ≤15 and >16, respectively) were found in three EQ-5D-Y dimensions (“doing usual activities,” “having pain/discomfort,” and “feeling worried/sad/unhappy”), summary score (effect size for general health and mental health groups=0.7 and 1.5, respectively), and KIDSCREEN-10 index (effect size for general health and mental health groups=0.6 and 0.9, respectively). Significant differences in the EQ-5D-Y dimensions were also found according to acute diabetic decompensations in “looking after myself” (P=.005) and according to family function in “having pain/discomfort” (P=.03). Results of the multitrait, multimethod matrix confirmed three of the four relationships hypothesized as substantial (0.21, 0.58, 0.50, and 0.46). The EQ-5D-Y summary score presented an intraclass correlation coefficient of 0.83. Statistically significant change between visits was observed in the improved subsample, with an effect size of 0.7 (P<.001). Conclusions These results support the use of the EQ-5D-Y administered online as an acceptable, valid, reliable, and responsive instrument for evaluating HRQoL in children and adolescents with T1DM.
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Affiliation(s)
- Karina Mayoral
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Luis Rajmil
- Agency for Health Quality & Assessment of Catalonia, Barcelona, Spain
| | - Marta Murillo
- Pediatric Service, Department of Pediatric Endocrinology, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Angels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
| | - Jordi Alonso
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Experimental and Health Sciences, Pompeu Fabra University, Barcelona, Spain
| | - Joan Bel
- Pediatric Service, Department of Pediatric Endocrinology, University Hospital Germans Trias i Pujol, Barcelona, Spain
| | - Jacobo Perez
- Department of Pediatric Endocrine, Hospital of Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain.,University Institute Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Raquel Corripio
- Department of Pediatric Endocrine, Hospital of Sabadell, Corporació Sanitària Parc Taulí, Sabadell, Spain.,University Institute Parc Taulí, Universitat Autònoma de Barcelona, Sabadell, Spain
| | - Gemma Carreras
- Pediatric Endocrinology, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.,Medicine Department, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Javier Herrero
- Corporació de Salut del Maresme i la Selva, Hospital de Calella, Calella, Spain
| | - Jose-Maria Mengibar
- Corporació de Salut del Maresme i la Selva, Hospital de Blanes, Blanes, Spain
| | | | - Ulrike Ravens-Sieberer
- Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics, University Medical Center Hamburg - Eppendorf, Hamburg, Germany
| | - Hein Raat
- Department of Public Health, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Vicky Serra-Sutton
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain.,Agency for Health Quality & Assessment of Catalonia, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain.,Department of Paediatrics, Obstetrics and Gynaecology and Preventive Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública, Madrid, Spain
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Marker AM, Patton SR, McDonough RJ, Feingold H, Simon L, Clements MA. Implementing clinic-wide depression screening for pediatric diabetes: An initiative to improve healthcare processes. Pediatr Diabetes 2019; 20:964-973. [PMID: 31264763 PMCID: PMC7814422 DOI: 10.1111/pedi.12886] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/24/2019] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Youth with type 1 diabetes (T1D) endorse high rates of depressive symptoms, which can significantly impair self-management, glycemic control, and quality of life. Current guidelines recommend annual depression screening for all adolescents with T1D, but few models exist to implement screening procedures across clinics in this population. The primary aim of this project was to increase depression screening from 0% to 80% in four clinics, and to describe the structured quality improvement process to reach this goal. METHODS All patients aged 12 to 21 years old with T1D at four participating clinics in a Midwestern hospital system were eligible to participate. Using a two-stage process, patients were administered the Patient Health Questionnaire (PHQ-2 plus PHQ-9 if positive) annually. Rates of depression screening by clinic site, rates of positive depression screens, social worker documentation of follow-up care, and associations with diabetes-related health outcomes were analyzed. RESULTS Over 2 years, average depression screening rates increased from 0% to 75% across all clinics, and 89% of patients with a positive screen met with a social worker for a targeted mental health assessment. At initial screening, 7.6% of patients screened positive for at-risk depressive symptoms on the PHQ-2 and from that group, 6.7% additionally screened positive on the PHQ-9. CONCLUSIONS Annual depression screenings were feasibly implemented across four clinics and the use of real-time data listening and automated processes facilitated successful implementation. Future directions include further automation, targeted training and billing mechanisms, dissemination to non-metropolitan clinics, and further assessment of depression screening tools for adolescents with T1D.
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Affiliation(s)
| | | | | | | | - Lara Simon
- Children's Mercy - Kansas City, Kansas City, Missouri
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38
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Corathers S, Mara CA, Chundi PK, Kichler JC. Depression Screening of Adolescents With Diabetes: 5-Years of Implementation and Outcomes. J Am Acad Child Adolesc Psychiatry 2019; 58:628-632. [PMID: 30802493 DOI: 10.1016/j.jaac.2019.01.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Revised: 01/15/2019] [Accepted: 02/13/2019] [Indexed: 10/27/2022]
Abstract
As part of a quality improvement (QI) initiative, Cincinnati Children's Hospital Diabetes Center established a model of reliable, feasible, routine depression screening in a subspecialty clinic for adolescents with diabetes.1 On the occasion of the special section of the journal focusing on screening for, detection of, and treatment of depression in diverse settings, the purpose of this correspondence is to describe the evolution of an in-clinic, pragmatic approach to depression and suicidal ideation (SI) screening, and to evaluate depression screening scores and glycemic control across age groups over time.
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Affiliation(s)
- Sarah Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Endocrinology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH.
| | - Constance A Mara
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH
| | - Pavan K Chundi
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; James M. Anderson Center for Health Systems Excellence, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH
| | - Jessica C Kichler
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH
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40
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Essaddam L, Ben Mansour A, Ben Amor A, Ravens-Sieberer U, Klein TM, Ben Becher S. Validation of the Arabic and Tunisian Arabic version of the KINDL questionnaires for children with diabetes type 1. Libyan J Med 2019; 14:1537457. [PMID: 30481145 PMCID: PMC6263104 DOI: 10.1080/19932820.2018.1537457] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Aim: We aimed to validate the Arabic and Tunisian Arabic versions of diabetes- specific quality of life (QOL) instrument KINDL-R Diabetes Module for Tunisian children population with type 1 diabetes. Patients and methods: This a cross-sectional study to validate Arabic and Tunisian KINDL QOL instrument that we translate in literary and dialectal Arabic. Both forward and backward translations from the German version of KINDL QOL into Arabic version were performed. Our project received a GPED grant in August 2014. After the face validity of the Arabic version was established, it was then pilot-tested. Finally, the validity and reliability of the final version of the Arabic KINDL questionnaire were evaluated. Results: The KINDL-R Diabetes Module (DM) questionnaire of QOL was given to 212 persons : 108 children (aged 3–17 years) with T1DM and 104 parents. The Cronbach’s alpha coefficients of the overall items and the main domains was about 0.7. The mean total score of the KINDL-R DM was 69,56  ± 14,01 in children aged 7–13 years, 59.93± 15.17 in children aged 13–17 years and 56.6± 9.9 in parents (higher scores indicate better QOL). The parents reported lower diabetes-specific HRQOL than the children themselves (p < 0.01).Emotional score was correlated to environment (p = 0,03). Self-esteem was reported to environment (p = 0,02) and mother’s instruction level’s (p = 0,014). Conclusions: The KINDL-R Diabetes Module (DM) of QOL in literary and dialectal Arabic have sufficient acceptability, reliability and validity so as to be used for the purposes of a comparative in Tunisian and Arabic populations.
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Affiliation(s)
- Leïla Essaddam
- a University of Tunis El Manar , Tunis , Tunisia.,b Children Hospital of Tunis , Tunis , Tunisia
| | - Asma Ben Mansour
- a University of Tunis El Manar , Tunis , Tunisia.,b Children Hospital of Tunis , Tunis , Tunisia
| | - Arwa Ben Amor
- a University of Tunis El Manar , Tunis , Tunisia.,c Bougatfa Hospital of Bizert , Bizert , Tunisia
| | - Ulribe Ravens-Sieberer
- d Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Toni Maria Klein
- d Department of Child and Adolescent Psychiatry, Psychotherapy, and Psychosomatics , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Saayda Ben Becher
- a University of Tunis El Manar , Tunis , Tunisia.,b Children Hospital of Tunis , Tunis , Tunisia
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Lacomba-Trejo L, Valero-Moreno S, Casaña-Granell S, Prado-Gascó VJ, Pérez-Marín M, Montoya-Castilla I. Questionnaire on adaptation to type 1 diabetes among children and its relationship to psychological disorders. Rev Lat Am Enfermagem 2018; 26:e3088. [PMID: 30462792 PMCID: PMC6248801 DOI: 10.1590/1518-8345.2759.3088] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 09/05/2018] [Indexed: 11/21/2022] Open
Abstract
Objective: to study the psychometric properties of an adaptive disease response
questionnaire for use with Spanish children with type 1 diabetes; to analyse
this response in this sample and to observe the relationship between
adaptive response and levels of anxiety-depression. Method: a total of 100 patients with type 1 diabetes aged between nine and 16 years
(M=12.28, SD=1.78) participated in the study, of which 59% were children.
Data was collected in public hospitals via interviews using the Adaptive
Disease Response Questionnaire and Anxiety and Depression Scale. The data
was analysed using Pearson correlations, multiple hierarchical linear
regressions, Student’s t Test for independent samples, and Cohen’s d effect
size to determine reliability and validity. Result: the instrument was shown to have adequate psychometric properties. Adaptive
response was generally high. Adaptive response is negatively related to
emotional distress, being a better predictor of depression than of anxiety.
There was no association betwee adaptation and sex and age. Conclusion: promoting a better adaptive response appears to reduce emotional distress,
especially in the case of depression, regardless of the age or gender of the
patients.
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Affiliation(s)
- Laura Lacomba-Trejo
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
| | - Selene Valero-Moreno
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
| | - Sara Casaña-Granell
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
| | | | - Marián Pérez-Marín
- Universitat de València, Facultad de Psicología, València, Comunidad Valenciana, Spain
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Sweileh WM. Analysis of global research output on diabetes depression and suicide. Ann Gen Psychiatry 2018; 17:44. [PMID: 30386407 PMCID: PMC6198430 DOI: 10.1186/s12991-018-0214-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 10/16/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Diabetic patients, during the course of the disease, are most likely to experience depressive symptoms that might ultimately lead to suicidal ideation or suicide. The size of literature in diabetes depression/suicide is a good indicator of national and international efforts to address psychological co-morbidities associated with diabetes mellitus (DM). Therefore, the objective of this study was to give a comprehensive analysis, both quantitative and qualitative, of scientific literature in diabetes depression/suicide. METHODS SciVerse Scopus was used to retrieve relevant literature up to 2016. RESULTS In total, 1664 journal documents were retrieved with an average of 26.9 citations per article and an h-index of 98. Publications started in 1949 but showed a steep and noticeable increase after 2001. Retrieved articles were published in 641 different journals with Diabetes Care journal being the top productive one with a total of 130 (7.8%) articles. Researchers from 83 different countries participated in retrieved publications. Researchers from the United States of America participated in publishing 685 articles. There was a strong and positive correlation between research output and Gross Domestic Product (r = 0.083; p < 0.001) but not with prevalence or mortality caused by DM. Researchers from 4870 different institutions/organizations participated in publishing retrieved articles. Publications from the University of Washington, Seattle, USA had the highest h-index (38), while "VA medical centers" had the highest number of publications (75; 4.5%). In total, 5715 authors appeared in retrieved articles giving an average of 3.4 authors per article. Top cited articles focused on prevalence, impact of depression on glycemic control, and potential risk of diabetic complications. The total number of publications in depression/suicide in diabetic patients was lesser than that in cardiac (1938) or in cancer (1828) patients. However, publications in diabetes depression/suicide exceeded those in cardiac and cancer in the last 2 years of the study period. CONCLUSION The current study showed a noticeable growth of publications indicative of the importance of this topic. Research focusing on the psychiatric component of diabetes mellitus needs to be strengthened and encouraged. At the practical level, screening for depression/suicide among patients attending primary healthcare clinics is needed to optimize health and quality of life of diabetic patients.
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Affiliation(s)
- Waleed M. Sweileh
- Department of Physiology and Pharmacology/Toxicology, College of Medicine and Health Sciences, Nablus, Palestine
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Corbin KD, Driscoll KA, Pratley RE, Smith SR, Maahs DM, Mayer-Davis EJ. Obesity in Type 1 Diabetes: Pathophysiology, Clinical Impact, and Mechanisms. Endocr Rev 2018; 39:629-663. [PMID: 30060120 DOI: 10.1210/er.2017-00191] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 06/21/2018] [Indexed: 02/07/2023]
Abstract
There has been an alarming increase in the prevalence of obesity in people with type 1 diabetes in recent years. Although obesity has long been recognized as a major risk factor for the development of type 2 diabetes and a catalyst for complications, much less is known about the role of obesity in the initiation and pathogenesis of type 1 diabetes. Emerging evidence suggests that obesity contributes to insulin resistance, dyslipidemia, and cardiometabolic complications in type 1 diabetes. Unique therapeutic strategies may be required to address these comorbidities within the context of intensive insulin therapy, which promotes weight gain. There is an urgent need for clinical guidelines for the prevention and management of obesity in type 1 diabetes. The development of these recommendations will require a transdisciplinary research strategy addressing metabolism, molecular mechanisms, lifestyle, neuropsychology, and novel therapeutics. In this review, the prevalence, clinical impact, energy balance physiology, and potential mechanisms of obesity in type 1 diabetes are described, with a special focus on the substantial gaps in knowledge in this field. Our goal is to provide a framework for the evidence base needed to develop type 1 diabetes-specific weight management recommendations that account for the competing outcomes of glycemic control and weight management.
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Affiliation(s)
- Karen D Corbin
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida
| | - Kimberly A Driscoll
- Department of Pediatrics, School of Medicine, University of Colorado Denver, Aurora, Colorado.,Barbara Davis Center for Diabetes, Aurora, Colorado
| | - Richard E Pratley
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida
| | - Steven R Smith
- Translational Research Institute for Metabolism and Diabetes, Florida Hospital, Orlando, Florida
| | - David M Maahs
- Division of Pediatric Endocrinology, Department of Pediatrics, Stanford University, Stanford, California
| | - Elizabeth J Mayer-Davis
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Lake AJ, Rees G, Speight J. Clinical and Psychosocial Factors Influencing Retinal Screening Uptake Among Young Adults with Type 2 Diabetes. Curr Diab Rep 2018; 18:41. [PMID: 29797076 DOI: 10.1007/s11892-018-1007-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW Young adults with type 2 diabetes (T2D, 18-39 years) experience early-onset and rapid progression of diabetic retinopathy (DR), the leading cause of vision loss for working age adults. Despite this, uptake of retinal screening, the crucial first step in preventing vision loss from DR, is low. The aim of this review is to summarize the clinical and psychosocial factors affecting uptake of retinal screening. RECENT FINDINGS Barriers include lack of diabetes-related symptoms, low personal DR risk perception, high rates of depression and diabetes-related distress, fatalism about inevitability of complications, time and financial constraints, disengagement with existing diabetes self-management services, and perceived stigma due to having a condition associated with older adults. Young adults with T2D are an under-researched population who face an accumulation of barriers to retinal screening. Tailored interventions that address the needs, characteristics, and priorities of young adults with T2D are warranted.
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Affiliation(s)
- A J Lake
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia.
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, c/- 570 Elizabeth Street, Melbourne, VIC, 3000, Australia.
| | - G Rees
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3010, Australia
| | - J Speight
- School of Psychology, Deakin University, Geelong, VIC, 3220, Australia
- The Australian Centre for Behavioural Research in Diabetes, Diabetes Victoria, c/- 570 Elizabeth Street, Melbourne, VIC, 3000, Australia
- AHP Research, Hornchurch, UK
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McGavock J, Durksen A, Wicklow B, Malik S, Sellers EA, Blydt-Hansen T, Chateau D, Dart A. Determinants of Readiness for Adopting Healthy Lifestyle Behaviors Among Indigenous Adolescents with Type 2 Diabetes in Manitoba, Canada: A Cross-Sectional Study. Obesity (Silver Spring) 2018. [PMID: 29533530 DOI: 10.1002/oby.22148] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether the readiness for adopting healthy lifestyle behaviors was associated with mental health and comorbid conditions in youth with T2D. METHODS A cross-sectional comparison of various measures of mental health (distress, stress, resilience) and comorbid conditions (glycated hemoglobin, adiposity, hypertension) was conducted within a cohort of indigenous youth with T2D living in Canada, stratified according to their readiness to adopt healthy lifestyle behaviors based on Prochaska's transtheoretical model. RESULTS Within the entire cohort (n = 162), only 14% were considered ready to adopt all healthy lifestyle behaviors. The readiness to adopt all lifestyle behaviors was associated with higher positive mental health (47 vs. 39 units; P < 0.05) and sense of mastery (40 vs. 37 units; P < 0.05), lower perceived stress (27 vs. 29 units; P < 0.05) and distress (8 vs. 10 units; P < 0.05), and better glycemic control (HbA1c: 8.4 ± 2.6% vs. 9.7 ± 2.8%; P < 0.05) compared with youth who were not ready to adopt all lifestyle behaviors. CONCLUSIONS The readiness for adopting healthy lifestyle behaviors is low among adolescents with T2D. Being ready to adopt healthy lifestyle behaviors is associated with better mental health and glycemic control.
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Affiliation(s)
- Jonathan McGavock
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Anita Durksen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Brandy Wicklow
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sayma Malik
- Department of Clinical Psychology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Elizabeth Ac Sellers
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tom Blydt-Hansen
- Section of Nephrology, Department of Pediatrics, BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Dan Chateau
- Manitoba Centre for Health Policy, Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Allison Dart
- Department of Pediatrics and Child Health, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Diabetes Research Envisioned and Accomplished in Manitoba (DREAM) Research Theme, University of Manitoba, Winnipeg, Manitoba, Canada
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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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Prahalad P, Tanenbaum M, Hood K, Maahs DM. Diabetes technology: improving care, improving patient-reported outcomes and preventing complications in young people with Type 1 diabetes. Diabet Med 2018; 35:419-429. [PMID: 29356074 DOI: 10.1111/dme.13588] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/16/2018] [Indexed: 01/09/2023]
Abstract
With the evolution of diabetes technology, those living with Type 1 diabetes are given a wider arsenal of tools with which to achieve glycaemic control and improve patient-reported outcomes. Furthermore, the use of these technologies may help reduce the risk of acute complications, such as severe hypoglycaemia and diabetic ketoacidosis, as well as long-term macro- and microvascular complications. In addition, diabetes technology can have a beneficial impact on psychosocial health by reducing the burden of diabetes. Unfortunately, diabetes goals are often unmet and people with Type 1 diabetes too frequently experience acute and long-term complications of this condition, in addition to often having less than ideal psychosocial outcomes. Increasing realization of the importance of patient-reported outcomes is leading to diabetes care delivery becoming more patient-centred. Diabetes technology in the form of medical devices, digital health and big data analytics have the potential to improve clinical care and psychosocial support, resulting in lower rates of acute and chronic complications, decreased burden of diabetes care, and improved quality of life.
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Affiliation(s)
- P Prahalad
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - M Tanenbaum
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - K Hood
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
| | - D M Maahs
- Division of Pediatric Endocrinology, Stanford University, Stanford, CA, USA
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McGill DE, Volkening LK, Pober DM, Muir AB, Young-Hyman DL, Laffel LM. Depressive Symptoms at Critical Times in Youth With Type 1 Diabetes: Following Type 1 Diabetes Diagnosis and Insulin Pump Initiation. J Adolesc Health 2018; 62:219-225. [PMID: 29212599 PMCID: PMC5803334 DOI: 10.1016/j.jadohealth.2017.09.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 09/07/2017] [Accepted: 09/08/2017] [Indexed: 01/09/2023]
Abstract
PURPOSE Depressive symptoms occur at various times during the life cycle in persons with type 1 diabetes. We investigated depressive symptoms prospectively in youth with new-onset type 1 diabetes and in those beginning pump therapy. METHODS Youth with type 1 diabetes (N = 96), ages 10-17 years, completed the Children's Depression Inventory (CDI) at baseline and at 1, 6, and 12 months after diabetes onset or pump start; scores ≥13 indicated clinical elevation. The change in depressive symptoms and the association between CDI score and hemoglobin A1c (HbA1c) level were assessed over 1 year. RESULTS The new-onset group (n = 54) had an HbA1c level of 11.4% ± 2.5%. The pump group (n = 42) had a diabetes duration of 4.1 ± 3.4 years and an HbA1c level of 8.3% ± 1.3%. The baseline median CDI was 5.0 in both groups and remained low over time (ranging from 2.0 to 3.5). Most youth (new onset 72%, pump 81%) scored <13 at all times. Those with a CDI score of ≥13 in month 1 had 9-fold (95% confidence interval: 3-28) and 11-fold (95% confidence interval: 3-38) higher risks of CDI score of ≥13 at 6 and 12 months, respectively, than those with a CDI score of <13. New-onset youth with a CDI score of ≥13 in month 1 had a higher HbA1c level at 6 months (8.3% ± 1.7%) than new-onset youth with a CDI score of <13 (7.2% ± 1.6%, p = .04). CONCLUSIONS CDI scores over 1 year were similar in the new-onset and pump groups. Youth with elevated CDI in the first month after diagnosis or pump start were significantly more likely to have a CDI score of ≥13 at 6 or 12 months, supporting recommendations to screen for depressive symptoms because of persistence over time. Those with new-onset diabetes and depressive symptoms in the first month had higher HbA1c at 6 months; confirmatory research is needed.
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Affiliation(s)
- Dayna E. McGill
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Lisa K. Volkening
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - David M. Pober
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Andrew B. Muir
- Department of Pediatrics, School of Medicine, Emory University, Atlanta, GA
| | | | - Lori M. Laffel
- Section on Clinical, Behavioral, and Outcomes Research, Pediatric, Adolescent, and Young Adult Section, Joslin Diabetes Center, Harvard Medical School, Boston, MA
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49
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Fazeli Farsani S, Abdullah-Koolmees H, Souverein PC, de Boer A, Mantel-Teeuwisse AK. Psychiatric medication use before and after the onset of type 1 diabetes in children and adolescents: A population-based cohort study. Pediatr Diabetes 2018; 19:121-128. [PMID: 28436135 DOI: 10.1111/pedi.12529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 03/23/2017] [Accepted: 03/24/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Several studies showed a bidirectional association between type 2 diabetes and psychiatric disorders in adults. Because there is limited information on the association between type 1 diabetes (T1D) and psychiatric disorders (including psychiatric medication use) in children and adolescents, we assessed frequency of use of these medications before and after the onset of T1D. METHODS A population-based cohort study was conducted in the Dutch PHARMO Record Linkage System (1999-2009). Children and adolescents (<19 years) with at least 2 insulin dispensings from community pharmacies (T1D cohort, N = 925) were matched by age and sex (reference cohort without insulin use, N = 3591). The 5-year prevalence of psychiatric medication use (psycholeptics [ATC N05] and psychoanaleptics [ATC N06]) before and after onset of T1D were estimated, compared, and stratified by age, sex, and medication subgroup. RESULTS The mean age of study participants was 10.1 years and 51% were boys. The 5-year prevalence of psychiatric medication use before the index date was significantly higher in the T1D cohort than in the reference cohort (7.2% vs 4.7%, respectively; P = .002) with the same pattern after developing T1D (10.4% vs 7.9%, respectively; P = .015). In both cohorts, adolescents (15-19 years) and boys had higher prevalences of use. This increased prevalence of psychiatric medication use both before and after the index date in T1D cohort was mainly driven by an increased use of psycholeptics (predominantly anxiolytics). CONCLUSIONS Children with T1D were more likely to use psychiatric medication in the years before and after the onset of T1D which was mainly driven by psycholeptic use.
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Affiliation(s)
- Soulmaz Fazeli Farsani
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Heshu Abdullah-Koolmees
- Department of Clinical Pharmacy, Division Laboratory and Pharmacy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Patrick C Souverein
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Anthonius de Boer
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - Aukje K Mantel-Teeuwisse
- Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
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50
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Alvar CM, Coddington JA, Foli KJ, Ahmed AH. Depression in the School-Aged Child With Type 1 Diabetes: Implications for Pediatric Primary Care Providers. J Pediatr Health Care 2018; 32:43-52. [PMID: 28870495 DOI: 10.1016/j.pedhc.2017.07.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Revised: 07/09/2017] [Accepted: 07/13/2017] [Indexed: 01/09/2023]
Abstract
Depression is a common comorbid condition experienced by children with type 1 diabetes that, if undiagnosed, can lead to deterioration in glycemic control and other serious health complications. Although it is documented that children with type 1 diabetes experience high rates of depression, a comprehensive clinical guide does not exist to help direct the pediatric provider on how to best care for these children. The purpose of this article is to synthesize current evidence to aid the pediatric primary care provider in the detection and management of depression in the school-aged child with type 1 diabetes.
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