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Mathias P, Corathers SD, Carreon SA, Hilliard ME, Papadakis JL, Weissberg-Benchell J, Raymond JK, Pyatak EA, Agarwal S. Young Adults with Type 1 Diabetes. Endocrinol Metab Clin North Am 2024; 53:39-52. [PMID: 38272597 DOI: 10.1016/j.ecl.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
Young adults experience multiple developmental transitions across social, educational, vocational, residential, and financial life domains. These transitions are potential competing priorities to managing a chronic condition such as type 1 diabetes and can contribute to poor psychosocial and medical outcomes. In this narrative review, we describe population outcomes of young adult populations and the unique considerations associated with managing type 1 diabetes in young adulthood. We provide an overview of the current evidence-based strategies to improve care for young adults with type 1 diabetes and recommendations for future directions in the field.
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Affiliation(s)
- Priyanka Mathias
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA
| | - Sarah D Corathers
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Avenue, Cincinnati, OH 45229, USA
| | - Samantha A Carreon
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Marisa E Hilliard
- Baylor College of Medicine and Texas Children's Hospital, 1102 Bates Avenue, Suite 940, Houston, TX 77030, USA
| | - Jaclyn L Papadakis
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jill Weissberg-Benchell
- Northwestern University Feinberg School of Medicine, Pritzker Department of Psychiatry and Behavioral Health, Ann and Robert H. Lurie Children's Hospital of Chicago, 225 East Chicago Avenue, Box 10, Chicago, IL 60611, USA
| | - Jennifer K Raymond
- Division of Pediatric Endocrinology, Children's Hospital Los Angeles, 4650 Sunset Boulevard. MS 61, Los Angeles, CA, USA
| | - Elizabeth A Pyatak
- Chan Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, 1540 Alcazar Street, CHP-133, Los Angeles, CA 90089-9003, USA
| | - Shivani Agarwal
- Fleischer Institute for Diabetes and Metabolism, Albert Einstein College of Medicine-Montefiore Medical Center, 1180 Morris Park Avenue, Bronx, NY 10467, USA; NY Regional Center for Diabetes Translation Research, Albert Einstein College of Medicine, 1180 Morris Park Avenue, Bronx, NY 10467, USA.
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2
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Núñez-Baila MÁ, Gómez-Aragón A, Marques-Silva AM, González-López JR. Lifestyle in Emerging Adults with Type 1 Diabetes Mellitus: A Qualitative Systematic Review. Healthcare (Basel) 2024; 12:309. [PMID: 38338194 PMCID: PMC10855310 DOI: 10.3390/healthcare12030309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/22/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Emerging adulthood is a transitional stage with significant lifestyle changes, making it especially challenging for those living with type 1 diabetes mellitus. This systematic review synthesizes qualitative research to explore how emerging adulthood (18-29 years) influences lifestyle behaviors in individuals with type 1 diabetes mellitus. CINAHL, Cochrane Library, Global Health, Nursing & Allied Health Premium, PsycINFO, PubMed, Scopus, and WOS were searched for original qualitative studies addressing the lifestyle of 18-31-year-olds with type 1 diabetes mellitus, published between January 2010 and March 2021 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Thirty-five studies met the inclusion criteria and their findings were categorized into eight topics (emotions and feelings, nutrition, perceptions, risky behaviors, self-care, sleep, social relationships, and stigma) using meta-aggregation, as outlined in the Joanna Briggs Institute Manual for Evidence Synthesis. The spontaneity characteristic of emerging adulthood can undermine self-care. This is because new environments, schedules, and relationships encountered during this life stage often lead to the neglect of diabetes management, owing to the various social, academic, and occupational demands. This review highlights the necessity of creating health promotion strategies tailored to the unique lifestyle aspects of emerging adults with type 1 diabetes mellitus.
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Affiliation(s)
- María-Ángeles Núñez-Baila
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Anjhara Gómez-Aragón
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
| | - Armando-Manuel Marques-Silva
- Department of Nursing, Escola Superior de Enfermagem de Coimbra, 3004-011 Coimbra, Portugal;
- Unidade de Investigação em Ciências da Saúde: Enfermagem (UICISA: E), 3004-011 Coimbra, Portugal
| | - José Rafael González-López
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, Universidad de Sevilla, 41009 Seville, Spain; (M.-Á.N.-B.); (J.R.G.-L.)
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Mishra S, Streeter PR. Targeted delivery of harmine to xenografted human pancreatic islets promotes robust cell proliferation. Sci Rep 2022; 12:19127. [PMID: 36351917 PMCID: PMC9646720 DOI: 10.1038/s41598-022-19453-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 08/29/2022] [Indexed: 11/11/2022] Open
Abstract
Type 1 diabetes (T1D) occurs as a consequence of the autoimmune destruction of insulin-producing pancreatic beta (β) cells and commonly presents with insulin deficiency and unregulated glycemic control. Despite improvements in the medical management of T1D, life-threatening complications are still common. Beta-cell replication to replace lost cells may be achieved by using small-molecule mitogenic drugs, like harmine. However, the safe and effective delivery of such drugs to beta cells remains a challenge. This work aims to deploy an antibody conjugated nanocarrier platform to achieve cell-specific delivery of candidate therapeutic and imaging agents to pancreatic endocrine cells. We approached this goal by generating core-shell type micellar nanocarriers composed of the tri-block copolymer, Pluronic®F127 (PEO100-PPO65-PEO100). We decorated these nanocarriers with a pancreatic endocrine cell-selective monoclonal antibody (HPi1), with preference for beta cells, to achieve active targeting. The PPO-based hydrophobic core allows encapsulation of various hydrophobic cargoes, whereas the PEO-based hydrophilic shell curbs the protein adhesion, hence prolonging the nanocarriers' systemic circulation time. The nancarriers were loaded with quantum dots (QDots) that allowed nanocarrier detection both in-vitro and in-vivo. In-vitro studies revealed that HPi1 conjugated nanocarriers could target endocrine cells in dispersed islet cell preparations with a high degree of specificity, with beta cells exhibiting a fluorescent quantum dot signal that was approximately five orders of magnitude greater than the signal associated with alpha cells. In vivo endocrine cell targeting studies demonstrated that the HPi1 conjugated nanocarriers could significantly accumulate at the islet xenograft site. For drug delivery studies, the nanocarriers were loaded with harmine. We demonstrated that HPi1 conjugated nanocarriers successfully targeted and delivered harmine to human endocrine cells in a human islet xenograft model. In this model, targeted harmine delivery yielded an ~ 41-fold increase in the number of BrdU positive cells in the human islet xenograft than that observed in untreated control mice. By contrast, non-targeted harmine yielded an ~ 9-fold increase in BrdU positive cells. We conclude that the nanocarrier platform enabled cell-selective targeting of xenografted human pancreatic endocrine cells and the selective delivery of the hydrophobic drug harmine to those cells. Further, the dramatic increase in proliferation with targeted harmine, a likely consequence of achieving higher local drug concentrations, supports the concept that targeted drug delivery may promote more potent biological responses when using harmine and/or other drugs than non-targeting approaches. These results suggest that this targeted drug delivery platform may apply in drug screening, beta cell regenerative therapies, and/or diagnostic imaging in patients with type 1 diabetes.
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Affiliation(s)
- Swati Mishra
- grid.5288.70000 0000 9758 5690Brenden-Colson Center for Pancreatic Care, Oregon Health and Science University, Portland, OR USA ,grid.5288.70000 0000 9758 5690Department of Pediatrics, Papé Family Pediatric Research Institute, Oregon Stem Cell Center, Oregon Health and Science University, Portland, OR USA
| | - Philip R. Streeter
- grid.5288.70000 0000 9758 5690Department of Pediatrics, Papé Family Pediatric Research Institute, Oregon Stem Cell Center, Oregon Health and Science University, Portland, OR USA
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4
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Griggs S, Grey M, Strohl KP, Crawford SL, Margevicius S, Kashyap SR, Li CSR, Rajagopalan S, Hickman RL. Variations in Sleep Characteristics and Glucose Regulation in Young Adults With Type 1 Diabetes. J Clin Endocrinol Metab 2022; 107:e1085-e1095. [PMID: 34698348 PMCID: PMC8852208 DOI: 10.1210/clinem/dgab771] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Indexed: 11/19/2022]
Abstract
CONTEXT Short sleep duration and sleep disruptions are associated with impaired glucoregulation in type 1 diabetes (T1D). However, the mechanistic pathways between sleep and glucose variability remain unclear. OBJECTIVE To determine within- and between-person associations between objective sleep-wake characteristics and glucose variability indices. METHODS Multilevel models were used to analyze concurrent sleep and glucose patterns over 7 days in 42 young adults with T1D in their natural home environment. Young adults with T1D (mean age 22.2 ± 3.0 years, HbA1c 7.2%, 32.6% male) for at least 6 months with no other medical or major psychiatric comorbidity were included. Sleep-wake characteristics were measured via wrist actigraphy and glucose variability indices via a continuous glucose monitor (CGM). RESULTS Lower sleep efficiency predicted higher glucose variability (less time in range β = 0.011 and more time in hyperglycemia β = -0.011) within-person. A longer wake after sleep onset and more sleep disruptions were associated with higher glucose variability between persons (β = 0.28 and 0.31). Higher glucose variability predicted poorer sleep within-person (delayed bedtime, waketime, mid-sleep time, and lower sleep efficiency), while higher glucose variability was associated with poorer sleep and more sleep disruptions between persons (lower sleep efficiency, longer wake after sleep onset, and a higher sleep fragmentation index). CONCLUSION Clinicians can address the reciprocal nature of the sleep-glucose relationship by optimizing sleep and targeting efforts toward a euglycemic range overnight. Sleep habits are a modifiable personal target in diabetes care.
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Affiliation(s)
- Stephanie Griggs
- Assistant Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, USA
- Correspondence: Stephanie Griggs, PhD, RN, Assistant Professor, Case Western Reserve University, Frances Payne Bolton School of Nursing, 10900 Euclid Avenue, Cleveland, OH 44106, USA.
| | - Margaret Grey
- Annie Goodrich Professor of Nursing and Professor of Pediatrics, Yale University, School of Nursing and School of Medicine, West Haven, CT 06477, USA
| | - Kingman P Strohl
- Professor of Medicine, and Physiology and Biophysics, Case Western Reserve University, School of Medicine, Cleveland, OH 44106, USA
| | - Sybil L Crawford
- Professor of Nursing, University of Massachusetts Medical School, Graduate School of Nursing, Worcester, MA 01655, USA
| | - Seunghee Margevicius
- Senior Research Associate, Case Western Reserve University, Department of Population and Quantitative Health Sciences, Case Comprehensive Cancer Center, School of Medicine, Cleveland, OH 44106, USA
| | - Sangeeta R Kashyap
- Professor of Medicine, Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, OH 44106, United States
| | - Chiang-Shan R Li
- Professor of Psychiatry and of Neuroscience, Yale University, School of Medicine, West Haven, CT 06477, USA
| | - Sanjay Rajagopalan
- Professor of Medicine, Director, Cardiovascular Research Institute, Case Western Reserve University, School of Medicine, USA
| | - Ronald L Hickman
- Ruth M. Anderson Endowed Professor of Nursing and Associate Dean for Research, Case Western Reserve University, Frances Payne Bolton School of Nursing, Cleveland, OH 44106, USA
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5
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Ash GI, Stults-Kolehmainen M, Busa MA, Gaffey AE, Angeloudis K, Muniz-Pardos B, Gregory R, Huggins RA, Redeker NS, Weinzimer SA, Grieco LA, Lyden K, Megally E, Vogiatzis I, Scher L, Zhu X, Baker JS, Brandt C, Businelle MS, Fucito LM, Griggs S, Jarrin R, Mortazavi BJ, Prioleau T, Roberts W, Spanakis EK, Nally LM, Debruyne A, Bachl N, Pigozzi F, Halabchi F, Ramagole DA, Janse van Rensburg DC, Wolfarth B, Fossati C, Rozenstoka S, Tanisawa K, Börjesson M, Casajus JA, Gonzalez-Aguero A, Zelenkova I, Swart J, Gursoy G, Meyerson W, Liu J, Greenbaum D, Pitsiladis YP, Gerstein MB. Establishing a Global Standard for Wearable Devices in Sport and Exercise Medicine: Perspectives from Academic and Industry Stakeholders. Sports Med 2021; 51:2237-2250. [PMID: 34468950 PMCID: PMC8666971 DOI: 10.1007/s40279-021-01543-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2021] [Indexed: 10/20/2022]
Abstract
Millions of consumer sport and fitness wearables (CSFWs) are used worldwide, and millions of datapoints are generated by each device. Moreover, these numbers are rapidly growing, and they contain a heterogeneity of devices, data types, and contexts for data collection. Companies and consumers would benefit from guiding standards on device quality and data formats. To address this growing need, we convened a virtual panel of industry and academic stakeholders, and this manuscript summarizes the outcomes of the discussion. Our objectives were to identify (1) key facilitators of and barriers to participation by CSFW manufacturers in guiding standards and (2) stakeholder priorities. The venues were the Yale Center for Biomedical Data Science Digital Health Monthly Seminar Series (62 participants) and the New England Chapter of the American College of Sports Medicine Annual Meeting (59 participants). In the discussion, stakeholders outlined both facilitators of (e.g., commercial return on investment in device quality, lucrative research partnerships, and transparent and multilevel evaluation of device quality) and barriers (e.g., competitive advantage conflict, lack of flexibility in previously developed devices) to participation in guiding standards. There was general agreement to adopt Keadle et al.'s standard pathway for testing devices (i.e., benchtop, laboratory, field-based, implementation) without consensus on the prioritization of these steps. Overall, there was enthusiasm not to add prescriptive or regulatory steps, but instead create a networking hub that connects companies to consumers and researchers for flexible guidance navigating the heterogeneity, multi-tiered development, dynamicity, and nebulousness of the CSFW field.
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Affiliation(s)
- Garrett I Ash
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Center for Medical Informatics, Yale University, New Haven, CT, USA
| | - Matthew Stults-Kolehmainen
- Digestive Health Multispecialty Clinic, Yale-New Haven Hospital, New Haven, CT, USA
- Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, USA
| | - Michael A Busa
- Center for Human Health and Performance, Institute for Applied Life Sciences, University of Massachusetts Amherst, Amherst, MA, USA
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
| | - Allison E Gaffey
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Department of Internal Medicine (Cardiovascular Medicine), Yale School of Medicine, New Haven, CT, USA
| | | | - Borja Muniz-Pardos
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
| | - Robert Gregory
- Department of Health and Movement Sciences, Southern Connecticut State University, New Haven, CT, USA
| | - Robert A Huggins
- Department of Kinesiology, Korey Stringer Institute, University of Connecticut, Storrs, CT, USA
| | | | | | | | | | | | - Ioannis Vogiatzis
- Department of Sport, Exercise and Rehabilitation, School Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
- European Respiratory Society (ERS), Digital Health Working Group, Lausanne, Switzerland
| | - LaurieAnn Scher
- Consumer Technology Association Working Groups for Health Technology Standards, Washington, DC, USA
- Fitscript LLC, New Haven, CT, USA
| | - Xinxin Zhu
- Center for Biomedical Data Science, Yale School of Medicine, New Haven, CT, USA
| | - Julien S Baker
- Faculty of Sports Science, Ningbo University, Ningbo, China
- School of Health and Life Sciences, Institute for Clinical Exercise and Health Science, University of the West of Scotland, South Lanarkshire, Scotland, UK
- Department of Sport, Physical Education and Health, Centre for Health and Exercise Science Research, Hong Kong Baptist University, Kowloon Tong, Hong Kong
| | - Cynthia Brandt
- Veterans Affairs Connecticut Healthcare System, West Haven, CT, USA
- Center for Medical Informatics, Yale University, New Haven, CT, USA
- Emergency Medicine, Yale School of Medicine, New Haven, CT, USA
| | - Michael S Businelle
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Tobacco Settlement Endowment Trust Health Promotion Research Center, Stephenson Cancer Center, Oklahoma City, OK, USA
| | - Lisa M Fucito
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
- Yale Cancer Center, New Haven, CT, USA
- Smilow Cancer Hospital, Yale-New Haven Hospital, New Haven, CT, USA
| | - Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Robert Jarrin
- Department of Emergency Medicine, George Washington University, Washington, DC, USA
- Department of Biochemistry and Molecular and Cellular Biology, Georgetown University Medical Center, Washington, DC, USA
| | - Bobak J Mortazavi
- Department of Computer Science and Engineering, Texas A&M University, College Station, TX, USA
| | | | - Walter Roberts
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA
| | - Elias K Spanakis
- University of Maryland School of Medicine, Baltimore, MD, USA
- Division of Endocrinology, Baltimore Veterans Affairs Medical Center, Maryland, USA
| | - Laura M Nally
- Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Andre Debruyne
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
| | - Norbert Bachl
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Institute of Sports Science, University of Vienna, Vienna, Austria
- Austrian Institute of Sports Medicine, Vienna, Austria
| | - Fabio Pigozzi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
- Villa Stuart Sport Clinic, FIFA Medical Center of Excellence, Rome, Italy
| | - Farzin Halabchi
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Sports and Exercise Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Dimakatso A Ramagole
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Dina C Janse van Rensburg
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Bernd Wolfarth
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Sports Medicine, Humboldt University and Charité University School of Medicine, Berlin, Germany
| | - Chiara Fossati
- Department of Movement, Human and Health Sciences, University of Rome "Foro Italico", Rome, Italy
| | - Sandra Rozenstoka
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- FIMS Collaboration Centre of Sports Medicine, Sports Laboratory, Riga, Latvia
| | - Kumpei Tanisawa
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Mats Börjesson
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Department of Molecular and Clinical Medicine, Center for Health and Performance, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
- Department of MGA, Region of Western Sweden, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - José Antonio Casajus
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Alex Gonzalez-Aguero
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
| | - Irina Zelenkova
- GENUD Research Group, Faculty of Health and Sport Sciences, University of Zaragoza, Zaragoza, Spain
- I.M. Sechenov First Moscow State Medical University (Sechenov University, Ministry of Health of Russia, Moscow, Russia
| | - Jeroen Swart
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland
- Division of Physiological Sciences and HPALS Research Centre, FIMS Collaboration Centre of Sports Medicine, University of Cape Town, Cape Town, South Africa
| | - Gamze Gursoy
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - William Meyerson
- Duke Psychiatry and Behavioral Sciences, Duke Medicine, Durham, NC, USA
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
| | - Jason Liu
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
| | - Dov Greenbaum
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
- Zvi Meitar Institute for Legal Implications of Emerging Technologies, Interdisciplinary Center Herzliya, Herzliya, Israel
- Harry Radyzner Law School, Interdisciplinary Center Herzliya, Herzliya, Israel
| | - Yannis P Pitsiladis
- Centre for Stress and Age-related Disease, University of Brighton, Brighton, UK.
- International Federation of Sports Medicine (FIMS), Lausanne, Switzerland.
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland.
| | - Mark B Gerstein
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, CT, USA
- Department of Molecular Biophysics and Biochemistry, Yale University, New Haven, CT, USA
- Department of Computer Science, Yale University, New Haven, CT, USA
- Department of Statistics and Data Science, Yale University, New Haven, CT, USA
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6
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Ash GI, Griggs S, Nally LM, Stults-Kolehmainen M, Jeon S, Brandt C, Gulanski BI, Spanakis EK, Baker JS, Whittemore R, Weinzimer SA, Fucito LM. Evaluation of Web-Based and In-Person Methods to Recruit Adults With Type 1 Diabetes for a Mobile Exercise Intervention: Prospective Observational Study. JMIR Diabetes 2021; 6:e28309. [PMID: 34047700 PMCID: PMC8299346 DOI: 10.2196/28309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 04/12/2021] [Accepted: 05/08/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Our clinical trial of a mobile exercise intervention for adults 18 to 65 years old with type 1 diabetes (T1D) occurred during COVID-19 social distancing restrictions, prompting us to test web-based recruitment methods previously underexplored for this demographic. OBJECTIVE Our objectives for this study were to (1) evaluate the effectiveness and cost of using social media news feed advertisements, a clinic-based approach method, and web-based snowball sampling to reach inadequately active adults with T1D and (2) compare characteristics of enrollees against normative data. METHODS Participants were recruited between November 2019 and August 2020. In method #1, Facebook and Instagram news feed advertisements ran for five 1-to-8-day windows targeting adults (18 to 64 years old) in the greater New Haven and Hartford, Connecticut, areas with one or more diabetes-related profile interest. If interested, participants completed a webform so that the research team could contact them for eligibility screening. In method #2, patients 18 to 24 years old with T1D were approached in person at clinical visits in November and December 2019. Those who were interested immediately completed eligibility screening. Older patients could not be approached due to clinic restrictions. In method #3, snowball sampling was conducted by physically active individuals with T1D contacting their peers on Facebook and via email for 48 days, with details to contact the research staff to express interest and complete eligibility screening. Other methods referred participants to the study similarly to snowball sampling. RESULTS In method #1, advertisements were displayed to 11,738 unique viewers and attracted 274 clickers (2.33%); 20 participants from this group (7.3%) volunteered, of whom 8 (40%) were eligible. Costs averaged US $1.20 per click and US $95.88 per eligible volunteer. Men had lower click rates than women (1.71% vs 3.17%; P<.001), but their responsiveness and eligibility rates did not differ. In method #2, we approached 40 patients; 32 of these patients (80%) inquired about the study, of whom 20 (63%) volunteered, and 2 of these volunteers (10%) were eligible. Costs including personnel for in-person approaches averaged US $21.01 per inquirer and US $479.79 per eligible volunteer. In method #3, snowball sampling generated 13 inquirers; 12 of these inquirers (92%) volunteered, of whom 8 (67%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $20.59 per eligible volunteer. Other methods yielded 7 inquirers; 5 of these inquirers (71%) volunteered, of whom 2 (40%) were eligible. Incremental costs to attract inquirers were negligible, and total costs averaged US $34.94 per eligible volunteer. Demographic overrepresentations emerged in the overall cohort (ie, optimal glycemic control, obesity, and low exercise), among those recruited by news feed advertisements (ie, obesity and older age), and among those recruited by snowball sampling (ie, optimal glycemic control and low exercise). CONCLUSIONS Web-based advertising and recruitment strategies are a promising means to attract adults with T1D to clinical trials and exercise interventions, with costs comparing favorably to prior trials despite targeting an uncommon condition (ie, T1D) and commitment to an intervention. These strategies should be tailored in future studies to increase access to higher-risk participants. TRIAL REGISTRATION ClinicalTrials.gov NCT04204733; https://clinicaltrials.gov/ct2/show/NCT04204733.
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Affiliation(s)
- Garrett I Ash
- Pain, Research, Informatics, Medical Comorbidities and Education Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, United States
| | - Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States
| | - Laura M Nally
- Section of Pediatric Endocrinology & Diabetes, Yale University School of Medicine, New Haven, CT, United States
| | - Matthew Stults-Kolehmainen
- Digestive Health Multispecialty Clinic, Yale-New Haven Hospital, New Haven, CT, United States.,Department of Biobehavioral Sciences, Teachers College, Columbia University, New York, NY, United States
| | - Sangchoon Jeon
- School of Nursing, Yale University, Orange, CT, United States
| | - Cynthia Brandt
- Pain, Research, Informatics, Medical Comorbidities and Education Center, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Center for Medical Informatics, Yale University School of Medicine, New Haven, CT, United States
| | - Barbara I Gulanski
- Section of Endocrinology, Veterans Affairs Connecticut Healthcare System, West Haven, CT, United States.,Section of Endocrinology, Yale University School of Medicine, New Haven, CT, United States
| | - Elias K Spanakis
- Division of Endocrinology, Baltimore Veterans Administrative Medical Center, Baltimore, MD, United States.,Division of Endocrinology, Diabetes, and Nutrition, University of Maryland School of Medicine, Baltimore, MD, United States
| | - Julien S Baker
- Department of Sport, Physical Education and Health, Hong Kong Baptist University, Kowloon Tong, China (Hong Kong)
| | | | - Stuart A Weinzimer
- Section of Pediatric Endocrinology & Diabetes, Yale University School of Medicine, New Haven, CT, United States
| | - Lisa M Fucito
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.,Yale Cancer Center, New Haven, CT, United States.,Smilow Cancer Hospital, Yale-New Haven Hospital, New Haven, CT, United States
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Griggs S, Strohl KP, Grey M, Barbato E, Margevicius S, Hickman RL. Circadian characteristics of the rest-activity rhythm, executive function, and glucose fluctuations in young adults with type 1 diabetes. Chronobiol Int 2021; 38:1477-1487. [PMID: 34128443 DOI: 10.1080/07420528.2021.1932987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Circadian alignment is an important element in individual health, and one behavioral marker, rest-activity rhythm, could influence self-management in young adults with type 1 diabetes (T1D). Little is known about the rest-activity rhythms, executive function, and glycemia among young adults with type 1 diabetes (T1D). The purpose of this study was to evaluate parametric and nonparametric circadian characteristics of the rest-activity rhythm and the associations between these variables, sleep-wake behavior, executive function, and glycemia among young adults with T1D. Young adults with T1D, recruited from diabetes clinics, wore wrist actigraphs and a continuous glucose monitor (CGM) concurrently for 6-14 days. Participants completed a 3-minute Trail Making Test on paper and electronic questionnaires - 8-item PROMIS v1.0 Emotional Distress Scale, 17-item Diabetes Distress Scale, including twice-daily Pittsburgh sleep diaries. Cosinor and nonparametric analyses were used to compute the rest-activity rhythm parameters, and linear regression modeling procedures were performed to determine the associations among the study variables. The sample included 46 young adults (mean age 22.3 ± 3.2; 32.6% male; 84.8% non-Hispanic White, HbA1c mean 7.2 ± 1.1%, BMI mean 27.0 ± 4.4 kg/m2). A number of parametric associations were observed between a stronger rhythm, better objective sleep-wake characteristics, and less daytime sleepiness. Nonparametric circadian parameters were significantly associated with several outcomes: a stronger rhythm adherence (higher inter-daily stability) with better objective sleep-wake characteristics, better executive function, lower diabetes distress, less hyperglycemia risk, and more time spent in hypoglycemia/hypoglycemia risk; and a more robust rhythm (higher relative amplitude) with better objective sleep-wake characteristics and more time spent in hypoglycemia/higher hypoglycemia risk. Future work should be directed at designs that test causality, such as interventions directed at the strength and stability of rest-activity rhythms, for the potential to improve glucoregulation and other diabetes outcomes.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kingman P Strohl
- Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Margaret Grey
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut, USA
| | - Eric Barbato
- Department of Genetics and Genome Sciences, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Seunghee Margevicius
- Department of Population and Quantitative Health Sciences, School of Medicine, Cleveland, Ohio, USA
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, Ohio, USA
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Griggs S, Hickman RL, Strohl KP, Redeker NS, Crawford SL, Grey M. Sleep-wake characteristics, daytime sleepiness, and glycemia in young adults with type 1 diabetes. J Clin Sleep Med 2021; 17:1865-1874. [PMID: 33949941 DOI: 10.5664/jcsm.9402] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES The purpose of this study was to describe objective sleep-wake characteristics and glycemia over 7 - 14 days in young adults with type 1 diabetes (T1D). Additionally, person level associations among objective sleep-wake characteristics (total sleep time, sleep variability, and sleep fragmentation index), daytime sleepiness, and glycemia (glycemic control and glucose variability) were examined. METHODS In this cross-sectional study, objective sleep-wake characteristics were measured via actigraphy and glucose variability via continuous glucose monitoring (CGM) over 6-14 days. At baseline, participants completed a psychomotor vigilance test (PVT), Trail Making Test, and questionnaires on daytime sleepiness, sleep quality, and sleep disturbance including sleep diaries. RESULTS Forty-six participants (mean age 22.3 ± 3.2 years) wore a wrist actigraph and CGM concurrently for 6-14 days. Greater sleep variability was directly associated with greater glucose variability (mean of daily differences) (r = 0.33, p = .036). Higher daytime sleepiness was directly associated with greater glucose variability (mean of daily differences) (r = 0.50, p = .001). The association between sleep variability and glucose variability (mean of daily differences) was no longer significant when accounting for daytime sleepiness and controlling for T1D duration (p > .05). A higher sleep fragmentation index was associated with greater glucose variability (B = 1.27, p = .010, pr2 = .40) after controlling for T1D duration and accounting for higher daytime sleepiness. CONCLUSIONS Sleep-wake variability, sleep fragmentation, daytime sleepiness, and the associations with glycemia are new dimensions to consider in young adults with T1D. Sleep habits in this population may explain higher glucose variability and optimizing sleep may improve overall diabetes management.
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Affiliation(s)
- Stephanie Griggs
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Ronald L Hickman
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH
| | - Kingman P Strohl
- School of Medicine, Case Western Reserve University, Cleveland, OH
| | - Nancy S Redeker
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut
| | - Sybil L Crawford
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA
| | - Margaret Grey
- School of Nursing and School of Medicine, Yale University, West Haven, Connecticut
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