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Brown J, Cox L, Mulligan K, Wilson S, Heys M, Livermore P, Gray S, Bogosian A. Gaining consensus on emotional wellbeing themes and preferences for digital intervention type and content to support the mental health of young people with long-term health conditions: A Delphi study. Health Expect 2024; 27:e14025. [PMID: 38591848 PMCID: PMC11003273 DOI: 10.1111/hex.14025] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 02/21/2024] [Accepted: 03/07/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Young people (YP) with long-term conditions (LTCs) are at greater risk of psychological distress than those without LTCs. Despite this, there is a scarcity of quality digital interventions designed to help improve mental wellbeing in this population. The aim of this study was to determine what YP, parents and health professionals preferred for future interventions. METHODS Twenty-six YP with asthma, diabetes and/or epilepsy (the three most common LTCs in YP), 23 parents of YP with LTCs and 10 health professionals mainly in paediatric specialisms (total n = 59) took part in an online Delphi study to gain consensus (set at 75% agreement) on four questions across three rounds. Participants ordered psychological themes that may be experienced by YP with LTCs by importance and ranked digital intervention types and delivery modes by importance or usefulness. The most common results were reported if no consensus was reached by round 3. RESULTS Participants preferred a mobile phone app (73% agreement) and a mixture of one-on-one and group support for an intervention (75% agreement). The two highest ranked psychological themes were anxiety (44%) and wanting to appear 'normal' (38%), and the top intervention type was 'general counselling' (54% agreement). CONCLUSION There was a clear desire for an app to help with the psychological aspects of living with LTCs and for a combination of one-to-one and group intervention elements. Anxiety and wanting to appear 'normal' might be two closely linked psychological challenges that could be addressed by a single intervention. IMPLICATIONS The results will be important to consider for a future intervention, although further consultation will be needed for app development. PATIENT OR PUBLIC CONTRIBUTION Two YP with a LTC provided feedback on the study protocol including the aims and procedures of the project. Another six YP with LTCs were consulted on an early draft of the study questionnaire (the four questions), which was subsequently revised. Once the project began, a patient and public involvement group consisting of two YP with LTCs and one parent of a YP with an LTC gave feedback on the research process, lay report of the results and dissemination plan.
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Affiliation(s)
- Jennie Brown
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Lauren Cox
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Kathleen Mulligan
- School of Health and Psychological SciencesCity University of LondonLondonUK
| | - Stephanie Wilson
- School of Mathematics, Computer Science and EngineeringCity University of LondonLondonUK
| | - Michelle Heys
- East London NHS Foundation TrustLondonUK
- Population, Policy and Practice DepartmentUniversity College LondonLondonUK
| | - Polly Livermore
- Great Ormond Street Institute of Child Health (GOS ICH)LondonUK
| | - Suzy Gray
- Great Ormond Street Institute of Child Health (GOS ICH)LondonUK
| | - Angeliki Bogosian
- School of Health and Psychological SciencesCity University of LondonLondonUK
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2
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Hornung RJ, Reed PW, Gunn AJ, Albert B, Hofman PL, Farrant B, Jefferies C. Transition from paediatric to adult care in young people with diabetes; A structured programme from a regional diabetes service, Auckland, New Zealand. Diabet Med 2023; 40:e15011. [PMID: 36398457 DOI: 10.1111/dme.15011] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 10/26/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
AIM To assess participation with a structured transition programme for adolescents with diabetes. METHODS Data from a regional cohort aged less than 16 years of age with type 1 (T1) and type 2 diabetes (T2D) in Auckland, New Zealand (2006-2016). Participation was defined as opting into a structured transition programme. RESULTS Five hundrend and twelve adolescents who were to be transferred to adult care (476 type 1 (T1D) and 36 type 2 (T2D)), overall participation rate of 83%, 86% (408/476) with T1D compared to 47% (17/36) with T2D. Within the cohort of T1D, participation rates for Māori and Pacific were lower (74% and 77%, respectively) than New Zealand Europeans (88%, p = 0.020 and p = 0.039, respectively). Lower socio-economic status was associated with reduced participation (77%) compared to higher socio-economic status (90%, p = 0.002). Of the 476 T1D who participated, 408 (96%) subsequently attended at least one adult service clinic ("capture"). 42% attended an adult clinic within the planned 3 months, 87% at 6 months and retention in adult clinics over 5 years of follow-up was 78%. By contrast, the 68 young people with T1D who did not participate in the structured transition had a capture rate of 78% (p < 0.001) and retention of 63% (p = 0.036). CONCLUSIONS In adolescents with diabetes, a formal transition from a paediatric service was associated with high rates of adult capture and subsequent retention in adult care over a 5-year follow-up period. Low socio-economic status, Māori or Pacific ethnicity and T2D were associated with reduced participation in the structured transition programme.
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Affiliation(s)
- Rosalie J Hornung
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Peter W Reed
- Starship Children's Health Children's Research Centre, Auckland District Health Board, Auckland, New Zealand
| | - Alistair J Gunn
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- Department of Physiology, University of Auckland, Auckland, New Zealand
| | - Ben Albert
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
| | - Paul L Hofman
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
- The Liggins Institute, University of Auckland, Auckland, New Zealand
| | - Bridget Farrant
- Centre for Youth Health, Counties Manukau District Health Board, Auckland, New Zealand
| | - Craig Jefferies
- Starship Children's Health, Paediatric Diabetes and Endocrinology Service, Auckland District Health Board, Auckland, New Zealand
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Viswanathan A, Wood JR, Hatipoglu BA. What Is a Honeymoon in Type 1, Can It Go into Remission? Endocrinol Metab Clin North Am 2023; 52:175-185. [PMID: 36754493 DOI: 10.1016/j.ecl.2022.08.001] [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: 11/19/2022]
Abstract
Type 1 diabetes is a chronic autoimmune disorder that results in destruction of insulin-producing cells in the pancreas. The autoimmune process is thought to be waxing and waning resulting in variable endogenous insulin secretion ability. An example of this is the honeymoon phase or partial remission phase of type 1 diabetes, during which optimal control of blood glucoses can be maintained with significantly reduced exogenous insulin, and occasionally exogenous insulin can be temporarily discontinued altogether. Understanding this phase is important because even fairly small amounts of endogenous insulin secretion is associated with reduced risk of severe hypoglycemia and microvascular complications.
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Affiliation(s)
- Anuradha Viswanathan
- Section for Pediatric Endocrinology, Cleveland Clinic Children's, 9500 Euclid Avenue, R Building- R-3, Cleveland, OH 44195, USA.
| | - Jamie R Wood
- University Hospitals Cleveland Medical Center, Rainbow Babies and Children's Hospital, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
| | - Betul A Hatipoglu
- University Hospitals Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106, USA
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4
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Geneti Y, Wondwossen K, Adimasu M, Deressa D, Aga F, Lami M, Abdisa L, Abebe S, Dinku H. Adherence to Diabetes Self-Management and Its Associated Factors Among Adolescents Living with Type 1 Diabetes at Public Hospitals in Addis Ababa, Ethiopia: A Cross-Sectional Study. Diabetes Metab Syndr Obes 2022; 15:659-670. [PMID: 35256847 PMCID: PMC8898021 DOI: 10.2147/dmso.s350168] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/16/2022] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the level of adherence to diabetes self-management and associated factors among adolescents living with type 1 diabetes at Public Hospitals in Addis Ababa, Ethiopia. METHODS An institutional-based cross-sectional study was carried out among 422 adolescents with type 1 diabetes attending outpatient diabetic clinics at public hospitals in Addis Ababa. The adolescents were interviewed using pretested questionnaires to give information on adherence to diabetes self-management. A variable that has a P-value of <0.2 in bi-variable logistic regression analysis was subjected to multivariable logistic regression analysis to control the confounding factors. The level of significance was pronounced at P-value <0.05. RESULTS In this study, a total of 414 adolescents living with type 1 diabetes were interviewed making a 98.1% response rate. About 218 participants (52.7%) had poor adherence to overall diabetes self-management. Self-efficacy (AOR=8.7, 95% CI:1.9-14.1, P=0.005), social support (AOR=4.6, 95% CI:1.5-13.5, P=0.006), age (AOR=0.2, 95% CI:0.1-0.4, P=0.001), good knowledge of the disease (AOR=9.046, 95% CI:3.83-13.5, P=0.000), moderate knowledge (AOR=6.763, 95% CI:2.18-12.921, P=0.001), and time since diagnosis of type 1 diabetes (AOR=0.1, 95% CI:0.02-0.2, P=0.005) were significantly associated with adherence to diabetes self-management. CONCLUSIONS AND RECOMMENDATIONS More than half of this population had poor adherence to diabetes self-management. The finding suggested that implementing a comprehensive guideline of adherence and expanding the recurrence of follow-up visits could be important for this population.
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Affiliation(s)
- Yomilan Geneti
- Department of Nursing and Midwifery, Dire Dawa University, Dire Dawa, Ethiopia
- Correspondence: Yomilan Geneti, Department of Nursing and Midwifery, Dire Dawa University, PO Box 1362, Dire Dawa, Ethiopia, Tel +251 928651326, Email
| | - Kalkidan Wondwossen
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Mekonen Adimasu
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Dereje Deressa
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Fekadu Aga
- Department of Nursing and Midwifery, Addis Ababa University, Addis Ababa, Ethiopia
| | - Magarsa Lami
- Department of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Lemesa Abdisa
- Department of Nursing and Midwifery, Haramaya University, Harar, Ethiopia
| | - Seboka Abebe
- Department of Nursing and Midwifery, Wolkite University, Wolkite, Ethiopia
| | - Hirut Dinku
- Department of Nursing and Midwifery, Wolkite University, Wolkite, Ethiopia
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Abstract
Introduction: The number of individuals under 18 years of age with type 2 diabetes is increasing at an alarming rate worldwide. These patients are often characterized by obesity and they often experience a more rapid disease progression than adults with type 2 diabetes. Thus, focus on prevention and management of complications and comorbidities is imperative. With emphasis on weight loss and optimal glycemic control, treatment includes lifestyle changes and pharmacotherapy, which in this patient group is limited to metformin, liraglutide and insulin. In selected cases, bariatric surgery is indicated.Areas covered: This perspective article provides an overview of the literature covering pathophysiology, diagnosis, characteristics and treatment of pediatric type 2 diabetes, and outlines the gaps in our knowledge where further research is needed. The paper draws on both mechanistic studies, large scale intervention trials, epidemiological studies and international consensus statements.Expert opinion: Type 2 diabetes in pediatric patients is an increasing health care problem, and the current treatment strategies do not successfully meet the many challenges and obstacles in this patient group. Treatments must be early, intensive, multifaceted and durable. Also, prevention of obesity and type 2 diabetes in at-risk children should be addressed and prioritized on all levels.
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Affiliation(s)
- Magnus F G Grøndahl
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jesper Johannesen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Department of Pediatrics, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Kurt Kristensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Steno Diabetes Center Aarhus - Children and Adolescence, Aarhus University, Aarhus, Denmark
| | - Filip K Knop
- Center for Clinical Metabolic Research, Copenhagen University Hospital - Herlev and Gentofte, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Steno Diabetes Center Copenhagen, Gentofte, Denmark.,Novo Nordisk Foundation for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Neu A, Bürger-büsing J, Danne T, Dost A, Holder M, Holl RW, Holterhus P, Kapellen T, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Ziegler R. Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. Diabetologe 2021; 17:557-84. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijani
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran.,Endocrinology and Metabolism Research Institute, Beneath Dr. Shariati Hospital, 3rd floor, Gomnam highway, Tehran, 1411713137 Iran
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8
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Abstract
Development of updated guidelines for management of diabetes in Ramadan Fasting is of paramount importance. Nonetheless, evidence-based guidelines in the field of Ramadan Fasting and Diabetes are scarce. Moreover, findings of some recent research such as effects of Ramadan fasting on microbiota, genetics and epigenetics, hormonal changes (such as adiponectin, leptin, testosterone…), and alternations in circadian rhythm should also be reviewed and included on a yearly basis. It is documented that self-monitoring of blood glucose (SMBG) is of vital importance for patients with type 1 diabetes who fast, and advantages of continuous glucose monitoring (CGM) or flash glucose monitoring (FGM) techniques should be highlighted. Moreover, the recent findings about applications of advanced insulin delivery technology in patients with diabetes who fast in Ramadan should also considered in the annual updates of the guidelines.
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Affiliation(s)
- Ali Tootee
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Bagher Larijan
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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9
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Jasim SK, Al-Momen H, Wahbi MA. Treatment options of Adolescent Gestational Diabetes: Effect on Outcome. Pak J Med Sci 2021; 37:1139-1144. [PMID: 34290797 PMCID: PMC8281180 DOI: 10.12669/pjms.37.4.3966] [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: 12/02/2020] [Revised: 03/01/2021] [Accepted: 03/18/2021] [Indexed: 11/15/2022] Open
Abstract
Objectives: Teenage pregnancy with gestational diabetes mellitus (GDM) offers a real challenge to the health system and needs a special care. We aimed to evaluate possible obstetrical and neonatal adverse events of different treatment protocols in adolescent GDM including lifestyle, metformin (MTF), and insulin. Methods: All teen pregnant women ≤ 19 years old visiting Baghdad Teaching Hospital throughout four years (from June 1, 2016 till May 31, 2020) diagnosed with GDM were included in this cohort study and followed-up closely throughout pregnancy and after delivery. Included adolescents were put on lifestyle alone during the first week of presentation. Adolescents who reached target glucose measurements were categorized into lifestyle group, while other adolescents were randomly allocated into MTF and insulin groups. Also, adolescent pregnant women without GDM were recruited as control group using computer randomization. Results: The GDM (110 cases) and control (121 individuals) groups had matched general features at recruitment except for diabetes family history. Also, GDM treatment groups had matched features. Glycemic readings (fasting and random) was significantly (p< 0.05) higher in insulin group having odds ratio (OR) of 1.41, and 1.57, respectively. In MTF group, significant protective OR was found in preeclampsia (OR=0.76, p< 0.05). MTF showed non-significant protective OR regarding prematurity and five minutes Apgar score>7 [(OR=0.83, p=0.24), and (OR=0.94, p=0.73), respectively], and significant protective association with large for gestational age and admission to neonatal intensive unit. Insulin had significantly higher prematurity, small for gestational age, and hypoglycemia [OR=1.89, 2.53, and 2.84, respectively]. Conclusion: Metformin (MTF) showed less pregnancy and neonatal complications in adolescent GDM than insulin and lifestyle.
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Affiliation(s)
- Shaymaa Kadhim Jasim
- Shaymaa Kadhim Jasim Department of Obstetrics and Gynecology, College of Medicine, University of Baghdad, Bab Al-Moaddam, Baghdad, Iraq
| | - Hayder Al-Momen
- Hayder Al-Momen Department of Pediatrics, Al-Kindy College of Medicine, University of Baghdad, Al-Nahda square, Baghdad, Iraq
| | - Maisaa Anees Wahbi
- Maisaa Anees Wahbi Department of Obstetrics and Gynecology, Baghdad Teaching Hospital, Medical City Health Directorate, Ministry of Health, Bab Al-Moaddam, Baghdad, Iraq
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Macek J, Battelino T, Bizjak M, Zupanc C, Bograf AK, Vesnic S, Klemencic S, Volk E, Bratina N. Impact of attention deficit hyperactivity disorder on metabolic control in adolescents with type1 diabetes. J Psychosom Res 2019; 126:109816. [PMID: 31493719 DOI: 10.1016/j.jpsychores.2019.109816] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 08/20/2019] [Accepted: 08/21/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Diabetes mellitus type 1 (T1D) incidence is increasing in pediatric population. Good metabolic control, measured by glycated hemoglobin (HbA1c), significantly reduces the risk for chronic complications. Comorbid disorders, including attention-deficit hyperactivity disorder (ADHD), may influence glycemic control. To date little is known about the prevalence of ADHD among adolescents with T1D and its influence on diabetes self-management. Therefore, we aimed to identify adolescents with T1D and ADHD and assess the effect of ADHD on metabolic control. METHOD This cross-sectional case-control study included 101 patients (11-17 years old) with T1D. Development and Well-Being Assessment (DAWBA) questionnaire and subsequent psychiatric clinical examination were used to identify ADHD in a group with T1D. Indicators of metabolic control were collected from available medical documentation for preceding 12 months and compared between the group of patients with T1D and ADHD and the group of T1D patients without ADHD. RESULTS ADHD was diagnosed in 11.9% adolescents with T1D (12 of 101). We found a statistically significant difference (p = .022) in HbA1c between the two groups - higher in the group with T1D and ADHD (8.4% or 68.3 mmol/mol) than in the group with T1D without ADHD (7.8% or 61.7 mmol/mol). CONCLUSIONS Almost 12% of adolescents with type 1 diabetes were diagnosed with ADHD and they had poorer glycemic control. Adolescents with T1D and ADHD must be diagnosed early and offered appropriate treatment focused on preventing negative ADHD impact on metabolic control.
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Affiliation(s)
- Jerneja Macek
- Department of Child Psychiatry, University Children's Hospital, University Medical Center Ljubljana, Bohoriceva 20, Ljubljana, Slovenia.
| | - Tadej Battelino
- Clinical Department of Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Center Ljubljana, Bohoriceva 20, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Masa Bizjak
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Cita Zupanc
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Ana Kovac Bograf
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Sabina Vesnic
- Faculty of Medicine, University of Ljubljana, Vrazov trg 2, 1000 Ljubljana, Slovenia
| | - Simona Klemencic
- Clinical Department of Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Center Ljubljana, Bohoriceva 20, Ljubljana, Slovenia
| | - Eva Volk
- Clinical Department of Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Center Ljubljana, Bohoriceva 20, Ljubljana, Slovenia
| | - Natasa Bratina
- Clinical Department of Endocrinology, Diabetes and Metabolic Disease, University Children's Hospital, University Medical Center Ljubljana, Bohoriceva 20, Ljubljana, Slovenia
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11
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Abstract
BACKGROUND Physical activity presents a significant challenge for glycemic control in individuals with type 1 diabetes. As accurate glycemic predictions are key to successful automated decision-making systems (eg, artificial pancreas, AP), the inclusion of additional physiological variables in the estimation of the metabolic state may improve the glucose prediction accuracy during exercise. METHODS Predictor-based subspace identification is applied to a dynamic glucose prediction model including heart rate measurements along with variables representing the carbohydrate consumption and insulin boluses. To demonstrate the improvement in prediction ability due to the additional heart rate variable, the performance of the proposed modeling technique is evaluated with (SID-HR) and without heart rate (SID-2) as an additional input using experimental data involving adolescents at ski camp. Furthermore, the performance of the proposed approach is compared to that of the metabolic state observer (MSO) model currently used in the University of Virginia AP algorithm. RESULTS The addition of heart rate in the subspace-based model (SID-HR) yields a statistically significant improvement in the root-mean-square error compared to the SID-2 model (P < .001) and the standard MSO (P < .001). Furthermore, the SID-HR model performed favorably in comparison to the SID-2 and MSO models after accounting for its increased complexity. CONCLUSIONS Directly considering the effects of physical activity levels on glycemic dynamics through the inclusion of heart rate as an additional input variable in the glucose dynamics model improves the glucose prediction accuracy. The proposed methodology could improve exercise-informed model-based predictive control algorithms in artificial pancreas systems.
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Affiliation(s)
- Nicole Hobbs
- Department of Biomedical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
| | - Iman Hajizadeh
- Department of Chemical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
| | - Mudassir Rashid
- Department of Chemical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
| | - Kamuran Turksoy
- Department of Biomedical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
| | - Marc Breton
- Center for Diabetes Technology,
University of Virginia, Charlottesville, VA, USA
| | - Ali Cinar
- Department of Biomedical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
- Department of Chemical Engineering,
Illinois Institute of Technology, Chicago, IL, USA
- Ali Cinar, PhD, Illinois Institute of
Technology, Department of Chemical and Biological Engineering, 10 W 33rd St,
Chicago, IL 60616, USA.
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12
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Nakamura N, Yakushijin Y, Kanamaru T, Tani H, Ideno K, Nakai A. Development and validity testing of the revised diabetes self-care inventory for children and adolescents. Diabetol Int 2019; 10:117-125. [PMID: 31139530 DOI: 10.1007/s13340-018-0377-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
Abstract
Recently, self-care in children and adolescents with type 1 diabetes has changed with regard to both adherence to treatment and self-management. Only one diabetes self-care scale for children and adolescents is used in Japan which lacks reflection on flexible regimens. The aims of this study were to modify and subsequently test the validity of the revised diabetes self-care inventory (R-DSCI) for children and adolescents, and to construct the diabetes self-care model on the R-DSCI, HbA1c, duration of diabetes and age. Based on qualitative secondary analysis of the self-care framework for teenagers and a literature review of diabetes self-care instruments, the items concerning insulin injection and meal planning were modified from the original DSCI and new items concerning negotiation with parents and others were added. The participants in the validity testing were 122 children and adolescents with type 1 diabetes, 50.8% were girls, aged 9-18 years, mean HbA1c of 7.9%. The final version of the R-DSCI was composed of 41 items. Eight factors, which explained 40.9% of the variance, were identified using the varimax method; Cronbach's alpha for the 41 items was 0.79. The diabetes self-care model showed a negative direct effect of "diabetes self-care practice" on HbA1c (P = 0.004), and the negative indirect effect of "support and perception of life with diabetes" on HbA1c through "diabetes self-care practice" (P = 0.002; estimated effect - 0.21). In addition, "independent self-care behavior" was directly affected by age (P < 0.001). The R-DSCI should be useful for clinicians and researchers to assess the self-management in children and adolescents.
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Affiliation(s)
- Nobue Nakamura
- 1Chiba University Graduate School of Nursing, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8672 Japan
| | - Yuko Yakushijin
- 2Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Tomo Kanamaru
- 3Shumei University School of Nursing, 1-1 Daigaku-cho, Yachiyo, Chiba 276-0003 Japan
| | - Hiroe Tani
- 4Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Keiko Ideno
- 5Faculty of Nursing, Toho University, 4-16-20 Omorinishi, Ota-ku, Tokyo, 143-0015 Japan
| | - Aya Nakai
- 1Chiba University Graduate School of Nursing, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8672 Japan
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13
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Grzelak T, Wedrychowicz A, Grupinska J, Pelczynska M, Sperling M, Mikulska AA, Naughton V, Czyzewska K. Neuropeptide B and neuropeptide W as new serum predictors of nutritional status and of clinical outcomes in pediatric patients with type 1 diabetes mellitus treated with the use of pens or insulin pumps. Arch Med Sci 2019; 15:619-631. [PMID: 31110527 PMCID: PMC6524189 DOI: 10.5114/aoms.2018.75818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/25/2018] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION The aim of our study was to determine the relationship between neuropeptide B (NPB), neuropeptide W (NPW), nutritional and antioxidant status and selected fat- and bone-derived factors in type 1 diabetes mellitus (T1DM) treated using pens (T1DM pen group) or insulin pumps (T1DM pump group) in order to investigate the potential role of NPB and NPW in the clinical outcomes of T1DM. MATERIAL AND METHODS Fifty-eight patients with T1DM and twenty-five healthy controls (CONTR) participated in the study. Assessments of NPB, NPW, total antioxidant status (TAS), leptin, adiponectin, osteocalcin, and free soluble receptor activator for nuclear factor κB (free sRANKL) were conducted. RESULTS NPB, NPW, leptin, and TAS were lower (by 33%, p < 0.013; 34%, p < 0.008; 290%, p < 0.00004; 21%, p < 0.05; respectively), while adiponectin was by 51% higher (p < 0.006) in T1DM vs. CONTR, while osteocalcin and free sRANKL levels were similar in both groups. NPW was lower in the T1DM pen group both vs. the T1DM pump group (36% lower, p < 0.0009) and vs. the CONTR group (35% lower, p < 0.002). In the T1DM pen group, but not in the T1DM pump group or the CONTR group, the Cole index and TAS levels explain (besides NPB) the variation in NPW values. ROC curves showed that serum levels of leptin, adiponectin, NPB and NPW (but not osteocalcin or free sRANKL) were predictive indicators for T1DM. CONCLUSIONS Measurements of NPB and NPW, besides leptin and adiponectin, are worth considering in the detailed prognosis of nutritional status in T1DM, primarily in the T1DM pen-treated population.
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Affiliation(s)
- Teresa Grzelak
- Department of Physiology, Poznan University of Medical Sciences, Poznan, Poland
| | - Anna Wedrychowicz
- Department of Pediatric and Adolescent Endocrinology, Pediatric Institute, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Grupinska
- Department of General Chemistry, Poznan University of Medical Sciences, Poznan, Poland
| | - Marta Pelczynska
- Division of Biology of Civilization-Linked Diseases, Department of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland
| | - Marcelina Sperling
- Division of Biology of Civilization-Linked Diseases, Department of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland
| | - Aniceta A. Mikulska
- Division of Biology of Civilization-Linked Diseases, Department of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland
- Nutrigenomics Student Research Group, Poznan University of Medical Sciences, Poznan, Poland
| | - Violetta Naughton
- Biomedical Sciences Research Institute, Ulster University, Coleraine, Northern Ireland
| | - Krystyna Czyzewska
- Division of Biology of Civilization-Linked Diseases, Department of Chemistry and Clinical Biochemistry, Poznan University of Medical Sciences, Poznan, Poland
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14
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Iversen E, Kolltveit BCH, Hernar I, Mårtensson J, Haugstvedt A. Transition from paediatric to adult care: a qualitative study of the experiences of young adults with type 1 diabetes. Scand J Caring Sci 2019; 33:723-730. [PMID: 30866071 DOI: 10.1111/scs.12668] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 01/23/2019] [Indexed: 12/13/2022]
Abstract
AIM The aim of the present study was to explore how young adults with type 1 diabetes (T1D) experienced the transition from paediatric to adult health care services. DESIGN A qualitative, explorative design was used. METHODS Eleven young adults with T1D receiving adult diabetes care at a hospital in western Norway participated in semi-structured interviews. Data were analysed using Interpretive Description, an inductive approach inspired by grounded theory, ethnography and phenomenology, and specifically designed to explore phenomena in clinical practice aiming to generate new knowledge and skills. RESULTS Four main themes regarding the adolescents' experiences of the transfer from paediatric to adult care emerged: (i) limited information about the transition; (ii) transition from frequent, thorough and personal follow-up to a less comprehensive and less personal follow-up; (iii) the importance of being seen as a whole person; (iv) limited expectations of how the health care services were organised. CONCLUSIONS The study showed that the existing routines for transfer between paediatric and adult care are not optimal. The participants expressed that they were not prepared for the dissimilarities in follow-up and were predominantly less pleased with the adult care follow-up. RELEVANCE TO CLINICAL PRACTICE The findings support a need for structured transition programmes, that is programmes that contribute to young adults with T1D receiving a safe and positive transition at an otherwise demanding life phase. Young peoples' individual needs for the transition to and follow-up in adult care may be promoted by an approach based on person-centred care.
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Affiliation(s)
- Elisabeth Iversen
- Department of Medicine, Haukeland University Hospital, Bergen, Norway
| | | | - Ingvild Hernar
- Department of Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Jan Mårtensson
- Department of Nursing, School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
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15
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Andrade CJDN, Alves CDAD. Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus. J Pediatr (Rio J) 2019; 95:48-53. [PMID: 29305827 DOI: 10.1016/j.jped.2017.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 10/11/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVE To evaluate the influence of socioeconomic and psychological factors on glycemic control in young children with type 1 diabetes mellitus. METHODS This was a cross-sectional study assessing prepubertal children with type 1 diabetes mellitus. The authors analyzed the socioeconomic status using the Brazil Economic Classification Criterion (Critério de Classificação Econômica Brasil [CCEB]) and psychological conditions through the Brazilian version of the Problem Areas in Diabetes, associated with glycemic control, measured by glycated hemoglobin (HbA1c). Descriptive analysis was used. The variables were assessed by bivariate and multivariate robust Poisson regression model, as well as Fisher's exact and Pearson's chi-squared tests to obtain the ratios of gross and adjusted prevalence ratio, with confidence interval being estimated at 95%. RESULTS A total of 68 children with type 1 diabetes mellitus were included in the study. A negative association between glycemic control (glycated hemoglobin levels), socioeconomic status (Brazil Economic Classification Criterion), and psychological condition (Brazilian version of the Problem Areas in Diabetes) was observed. Among the study participants, 73.5% (n=50) of the children had an unfavorable socioeconomic status; these participants were 1.4 times more likely to present altered glycated hemoglobin values. In relation to individuals with compromised psychological status, 26 (38.2%) had a score above 70, thus being classified with psychological stress; these children were 1.68 times more likely (95% confidence interval: 1.101, 1.301) to have higher glycated hemoglobin levels. CONCLUSIONS The socioeconomic conditions and psychological characteristics of the study participants were negatively associated with glycated hemoglobin results. These data reinforce the importance of the studied variables as predictors of glycemic control.
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Affiliation(s)
| | - Crésio de Aragão Dantas Alves
- Universidade Federal da Bahia (UFBA), Faculdade de Medicina, Hospital Universitário Prof. Edgard Santos, Departamento Pediátrico, Unidade de Endocrinologia Pediátrica, Salvador, BA, Brazil
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16
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Andrade CJDN, Alves CDAD. Influence of socioeconomic and psychological factors in glycemic control in young children with type 1 diabetes mellitus. Jornal de Pediatria (Versão em Português) 2019; 95:48-53. [DOI: 10.1016/j.jpedp.2018.01.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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17
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Lukács A, Mayer K, Sasvári P, Barkai L. Health-related quality of life of adolescents with type 1 diabetes in the context of resilience. Pediatr Diabetes 2018; 19:1481-1486. [PMID: 30203556 DOI: 10.1111/pedi.12769] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/12/2018] [Accepted: 09/04/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Adolescents with type 1 diabetes (T1D) can be faced with deterioration in glycemic control (GC), reduced health-related quality of life (HRQoL), and other psychosocial problems. It is important to understand how the disease and its clinical conditions influence HRQoL and how adolescents are able to overcome the life adjustment difficulties. OBJECTIVE To assess HRQoL of adolescents with T1D from demographic, clinical, personal, and behavioral point of view. SUBJECTS A total of 229 adolescents with T1D (51.2% males) with a mean age of 15.35 (2.29) years old were recruited from three diabetes centers. The mean diabetes duration was 7.48 (3.87), the mean hemoglobin A1C (HbA1c) level was 10.3 (1.76) mmol/L. METHODS A multicenter quantitative correlational design study was applied to investigate the influence of sex, age, diabetes duration, GC expressed by HbA1c, intensive insulin regimen, physical activity (PA), resilience (RS), and socioeconomic background on HRQoL. RESULTS Presence of the diabetes symptoms and worry about the disease has negative impact on the patients' HRQoL. Stepwise multiple regression analyses indicated that insulin pump therapy, male sex, and higher level of RS were significantly related to an increase in HRQoL, whereas the higher level of PA, male sex, and better HRQoL was significantly related to positive change in RS. Patients treated with insulin pump therapy had significantly better HRQoL. CONCLUSIONS Significant association can be observed between HRQoL and RS. Supposedly, higher level of PA promotes higher level of RS that in turn helps increase HRQoL in adolescents with T1D. Treatment with insulin pump therapy also promotes better HRQoL.
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Affiliation(s)
- Andrea Lukács
- Faculty of Health Care, University of Miskolc, Miskolc-Egyetemváros, Hungary
| | - Krisztina Mayer
- Faculty of Health Care, University of Miskolc, Miskolc-Egyetemváros, Hungary
| | - Péter Sasvári
- Faculty of Mechanical Engineering and Informatics, University of Miskolc, Miskolc-Egyetemváros, Hungary.,National University of Public Service, Budapest, Hungary
| | - László Barkai
- Faculty of Health Care, University of Miskolc, Miskolc-Egyetemváros, Hungary.,Department of Paediatrics and Adolescent Medicine, Faculty of Medicine, Pavol Jozef Šafárik University in Kosice, Košice, Slovakia
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18
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Fonte D, Colson S, Côté J, Lagouanelle-Simeoni MC, Apostolidis T. 'Adolescents are reckless': Representations at stake in the construction of the relationship of trust in paediatric diabetology. J Health Psychol 2018; 26:270-282. [PMID: 30426776 DOI: 10.1177/1359105318809861] [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: 11/16/2022] Open
Abstract
A total of 10 focus groups were held with adolescents living with diabetes, their parents and health professionals in order to explore their needs in therapeutic education. The analysis showed that the relationship of trust was a central concern for a number of participants. Several adults were divided between a feeling of confidence inspired by the need to empower adolescents to cope with the chronic condition and a sense of distrust inspired by the idea of carelessness and irresponsibility thought to characterize adolescence. Adolescents, for their part, seemed relatively clear-sighted about how they can be perceived, and blamed adults for not trusting them. These findings emphasize the importance of considering the representations at stake in the dynamics of the therapeutic relationship in order to better understand the construction of the relational climate.
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Affiliation(s)
- David Fonte
- Aix Marseille Univ, LPS, Aix-en-Provence, France
| | - Sébastien Colson
- Aix Marseille Univ, UFR Sciences médicales et paramédicales, Ecole des Sciences Infirmières, CEReSS, Marseille, France
| | - José Côté
- Université de Montréal, Faculté des Sciences Infirmières, Montréal, Canada.,CRCHUM, Chaire de recherche sur les nouvelles pratiques de soins infirmiers, Montréal, Canada
| | - Marie-Claude Lagouanelle-Simeoni
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,APHM, Hôpital Conception, Service d'évaluation médicale, 13385, Marseille, France
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19
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Zeitler P, Arslanian S, Fu J, Pinhas-Hamiel O, Reinehr T, Tandon N, Urakami T, Wong J, Maahs DM. ISPAD Clinical Practice Consensus Guidelines 2018: Type 2 diabetes mellitus in youth. Pediatr Diabetes 2018; 19 Suppl 27:28-46. [PMID: 29999228 DOI: 10.1111/pedi.12719] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 05/24/2018] [Indexed: 02/06/2023] Open
Affiliation(s)
- Phillip Zeitler
- Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Silva Arslanian
- Children's Hospital, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Junfen Fu
- The Children's Hospital of Zhejiang University School of Medicine, Hangzhou, China
| | - Orit Pinhas-Hamiel
- Edmond and Lily Safra Children's Hospital, Tel-Hashomer, Sackler School of Medicine, Tel-Aviv, Israel
| | - Thomas Reinehr
- Vestische Children's Hospital, University of Witten/Herdecke, Witten, Germany
| | - Nikhil Tandon
- All India Institute of Medical Sciences, New Delhi, India
| | | | - Jencia Wong
- Royal Prince Alfred Hospital, University of Sydney, Sydney, Australia
| | - David M Maahs
- Lucile Packard Children's Hospital, Stanford University, Stanford, California
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20
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Abstract
Patients with chronic diseases manifesting in childhood, such as type 1 diabetes, need to make an optimal transition from pediatric to adult medical care. This or transitionis a challenge for patients and their treatment teams, since metabolic control is often unstable at this time of life. Additional factors like the social environment, as well as concomitant diseases, also need to be taken into account and often represent hurdles to optimal therapy. Transition is an important process to guarantee good self-management of diabetes therapy and good outcomes in the long term. This review provides an overview and recommendations on the topic of transition in diabetes.
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Affiliation(s)
- B Gallwitz
- Medizinische Klinik IV, Universitätsklinikum Tübingen, Otfried-Müller-Str. 10, 72076, Tübingen, Deutschland.
| | - A Neu
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen, Tübingen, Deutschland
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21
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Strand M, Broström A, Haugstvedt A. Adolescents’ perceptions of the transition process from parental management to self‐management of type 1 diabetes. Scand J Caring Sci 2018; 33:128-135. [DOI: 10.1111/scs.12611] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 07/15/2018] [Indexed: 01/14/2023]
Affiliation(s)
- Marianne Strand
- Department of Pediatrics Ålesund Hospital Ålesund Norway
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
| | - Anders Broström
- Department of Nursing School of Health and Welfare Jönköping University Jönköping Sweden
- Department of Clinical Neurophysiology Linköping University Hospital Linköping Sweden
| | - Anne Haugstvedt
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Bergen Norway
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22
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Bohn B, Mönkemöller K, Hilgard D, Dost A, Schwab KO, Lilienthal E, Hammer E, Hake K, Fritsch M, Gohlke B, de Beaufort C, Holl RW. Oral contraception in adolescents with type 1 diabetes and its association with cardiovascular risk factors. A multicenter DPV study on 24 011 patients from Germany, Austria or Luxembourg. Pediatr Diabetes 2018; 19:937-944. [PMID: 29411927 DOI: 10.1111/pedi.12656] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To investigate differences in cardiovascular risk factors and metabolic control in girls with type 1 diabetes with or without use of oral contraceptives (OC) from the multicenter "diabetes prospective follow-up" (DPV) registry. METHODS Twenty-four thousand eleven adolescent girls (13 to < 18 years of age) from Germany, Austria or Luxembourg with type 1 diabetes from the DPV registry were included in this cross-sectional study. Multivariable regression models were applied to compare clinical characteristics (hemoglobin A1c [HbA1C ], blood pressure, serum lipids, body mass index) and lifestyle factors (smoking, physical inactivity, alcohol consumption) between girls with or without OC use. Confounders: age, diabetes duration and migration background. STATISTICAL ANALYSIS SAS 9.4. RESULTS In girls with type 1 diabetes and OC use, clinical characteristics and lifestyle factors were less favorable compared to non-users. Differences were most pronounced for the prevalence of dyslipidemia (OC-users: 40.0% vs non-users: 29.4; P < .0001) and the number of smokers (OC-users: 25.9% vs non-users: 12.5%; P < .0001). OC use, sociodemographic characteristics and lifestyle factors explained between 1 and 7% of the population variance in serum lipids and blood pressure. The use of OC explained a small additional proportion in all variables considered (<1%). CONCLUSIONS OC use in adolescent girls with type 1 diabetes was associated with a poorer cardiovascular risk profile. Biological risk factors were partly explained by a clustering of sociodemographic and lifestyle factors with a small additional contribution of OC use. Prescription of OC should therefore be combined with a screening for cardiovascular risk factors and targeted education.
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Affiliation(s)
- Barbara Bohn
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich, Germany
| | - Kirsten Mönkemöller
- Department of Paediatrics, Kinderkrankenhaus Amsterdamer Straße, Cologne, Germany
| | - Dörte Hilgard
- Department of Paediatrics, Gemeinschaftskrankenhaus Herdecke, Herdecke, Germany
| | - Axel Dost
- Department of Paediatrics, University Hospital Jena, Jena, Germany
| | - Karl Otfried Schwab
- Department of Paediatrics and Adolescent Medicine, University Medical Centre, Freiburg, Germany
| | | | - Elke Hammer
- Department of Paediatrics, Katholisches Kinderkrankenhaus Wilhelmstift, Hamburg, Germany
| | - Kathrin Hake
- Children's Hospital, Müritzklinikum Waren, Waren, Germany
| | - Maria Fritsch
- Department of Paediatric and Adolescent Medicine, Medical University of Vienna, Vienna, Austria
| | - Bettina Gohlke
- Department of Paediatric Endocrinology and Diabetology, University Hospital Bonn, Bonn, Germany
| | - Carine de Beaufort
- Department of Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg.,Department of Paediatrics, University Hospital Brussels, UZB, Brussels, Belgium
| | - Reinhard W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich, Germany
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23
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Affiliation(s)
- L Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA, USA
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24
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Friedemann-Sánchez G, Capistrant BD, Ron J, Novak L, Zuijdwijk C, Ogle GD, Anderson B, Moran A, Pendsey S. Caregiving for children with type 1 diabetes and clinical outcomes in central India: The IDREAM study. Pediatr Diabetes 2018; 19:527-533. [PMID: 28809093 DOI: 10.1111/pedi.12567] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 07/10/2017] [Accepted: 07/17/2017] [Indexed: 01/09/2023] Open
Abstract
AIMS Parental care influences outcomes for children's type 1 diabetes (T1D). There is little evidence about the impact of parental caregiving in developing countries, where fixed dose human insulin (conventional) therapy and limited self-monitoring of blood glucose are common. This article investigates whether performance of key T1D management tasks by children or their caregivers impacts hemoglobin A1c (HbA1c). METHODS We surveyed the caregivers of 179 children with T1D routinely treated in a specialized diabetes clinic in Maharashtra, India to determine who performs key diabetes care tasks: child or parent. We used linear regression to estimate the relationship between parental caregiving and HbA1c, and how this association varies by child age and time since diagnosis. RESULTS Caregivers of older children were less involved in care tasks, though caregivers of 11- to 18-year olds performed more care for children diagnosed for a longer duration. Parental involvement in key insulin delivery tasks was associated with lower HbA1c levels for all children. These reductions were greatest among children 11 to 14 years old and diagnosed for less than 2 years: mean HbA1c levels were 8.5% (69 mmol/mol) if the caregiver, and 14.4% (134 mmol/mol) if the child, performed the tasks (P < .05). CONCLUSION Parents of children diagnosed with T1D early in life remain involved in care throughout the child's adolescence. Parents of children diagnosed in late childhood and early adolescence are significantly less involved in care, and this is associated with worse glycemic control. Clinics must know who performs care tasks and tailor diabetes education appropriately.
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Affiliation(s)
| | - Beatrix D Capistrant
- School of Public Health, Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, Minnesota.,Statistics and Data Science, Smith College, Northampton, Massachusetts
| | - James Ron
- Hubert H. Humphrey School of Public Affairs and Department of Political Science, University of Minnesota, Minneapolis, Minnesota.,Centro de Investigación y Docencia Económicas (CIDE), Mexico City, Mexico
| | - Lindsey Novak
- Department of Economics, Colby College, Waterville, Maine
| | - Caroline Zuijdwijk
- Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario (CHEO), CHEO Research Institute, Ottawa, Canada
| | - Graham D Ogle
- International Diabetes Federation, Life for a Child Program, Glebe, Australia
| | - Barbara Anderson
- Department of Pediatrics, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas
| | - Antoinette Moran
- Division of Pediatric Endocrinology, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota
| | - Sharad Pendsey
- Diabetes Research Education and Management Trust, Nagpur, India
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Takaike H, The Japanese Study Group of Insulin Therapy for Childhood and Adolescent Diabetes (JSGIT), Uchigata Y, Matsuura N, Sasaki N, Amemiya S, Urakami T, Kawamura T, Kikuchi N, Sugihara S. The incidences of and risk factors for severe retinopathy requiring photocoagulation and albuminuria in Japanese patients with childhood-onset type 1 diabetes. Diabetol Int 2018; 9:121-128. [DOI: 10.1007/s13340-017-0336-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Abualula NA, Rodan MF, Milligan RA, Jacobsen KH. Self-rated health among American adolescents with type 1 diabetes in the T1D Exchange Clinic Registry. J Diabetes Complications 2018; 32:83-88. [PMID: 29092790 DOI: 10.1016/j.jdiacomp.2017.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Revised: 08/28/2017] [Accepted: 09/20/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND The goal of this study was to examine the self-rated health (SRH) of adolescents with type 1 diabetes (T1D). METHODS A logistic regression analysis of baseline data from adolescents in the United States included in the T1D Exchange Clinic Registry in 2010-2012 was conducted. Participants were 13-18years old at the time of enrollment in the registry and had been diagnosed with T1D at least one year before enrollment (n=5799). RESULTS Half (49.0%) of the participants were female, 46.3% were ages 16-18years, 22.5% were non-white, 35.7% did not have private/military health insurance, and 78.8% had HbA1c levels >7.5%, indicating poor T1D management, 20.7% reported having diabetes-related stress often or very often, and 46.4% used insulin injections or pens rather than a pump. In total, 10.3% (n=600) of the participants rated their health as poor or fair and 59.3% (n=3439) rated their health as very good or excellent. Participants with poor or fair SRH were more likely than those with very good or excellent SRH to be female (adjusted OR=1.7(1.4, 2.1)), 16 to 18years old (OR=2.1(1.7, 2.5)), and non-white (OR=2.7(2.2, 3.4)), to be without private or military insurance (OR=2.4(2.1, 3.0)), to have HbA1c levels >7.5% (OR=3.3(2.4, 4.7)), to report having diabetes-related stress often or very often (OR=6.1(5.1, 7.2)), and to use an injection or pen rather than a pump (OR=2.1(1.6, 2.4)). CONCLUSIONS Because adolescents with T1D who report lower SRH are more likely to have uncontrolled blood glucose and frequent diabetes-related stress, use of pumps and stress-reduction strategies may improve SRH among adolescents with T1D.
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Affiliation(s)
- Nada A Abualula
- College of Nursing, Taibah University, Universities Road, Medina, Saudi Arabia; School of Nursing, George Mason University, Fairfax, VA 22030, USA.
| | - Margaret F Rodan
- School of Nursing, George Mason University, Fairfax, VA 22030, USA.
| | - Renee A Milligan
- School of Nursing, George Mason University, Fairfax, VA 22030, USA.
| | - Kathryn H Jacobsen
- Department of Global & Community Health, George Mason University, Fairfax, VA 22030, USA.
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Boman Å. Learning by supporting others-experienced parents' development process when supporting other parents with a child with type 1 diabetes. J Clin Nurs 2017; 27:e1171-e1178. [PMID: 29266575 DOI: 10.1111/jocn.14235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2017] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To describe and analyse coach-parents' development process when supporting parents of children recently diagnosed with type 1 diabetes mellitus (T1DM). BACKGROUND It has been found repeatedly that providing social support for families with a child diagnosed with T1DM promotes health and well-being for both the child and the parents. Less explored are the processes experienced by those who provide this support. However, research has found that acting as a provider of social support promotes personal development, strengthens communication skills and increases self-confidence. METHODS The study design was based on Constructivist Grounded Theory, and data were collected, through repeated focus-group discussions, from eight coach-parents at a Swedish hospital from 2012-2015. RESULTS The core category in the data was identified as a learning process where coach-parents emphasised their own learning in the dyad supporter-supported, and in the interaction with other parents in the repeated focus-group discussions. The coach-parents' motivation for participation was a wish to learn more and to help other parents in a life-changing situation. They also pointed out hindrances and their frustration when unable to provide support. CONCLUSIONS This study leads to the conclusion that people who provide support benefit from doing so. Encountering people with similar experiences in a supportive situation promotes a reciprocal learning process, based on the supporter's wish to help people in a situation they recognise. A further conclusion is that social support is not only essential initially, but is also important over a longer period and that it follows various life stages. RELEVANCE TO CLINICAL PRACTICE Setting up repeated focus-group discussions might be a relevant and effective tool for paediatric diabetes nurses to use in promoting health and well-being for both families with a newly diagnosed child and experienced families.
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Affiliation(s)
- Åse Boman
- Department of Health Sciences, University West, Trollhättan, Sweden
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Haas J, Persson M, Brorsson AL, Toft EH, Olinder AL. Guided self-determination-young versus standard care in the treatment of young females with type 1 diabetes: study protocol for a multicentre randomized controlled trial. Trials 2017; 18:562. [PMID: 29178923 PMCID: PMC5702043 DOI: 10.1186/s13063-017-2296-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 06/27/2017] [Accepted: 10/30/2017] [Indexed: 01/17/2023] Open
Abstract
Background Female adolescents with type 1 diabetes mellitus (T1DM) have the most unsatisfactory glycaemic control of all age groups and report higher disease burden, poorer perceived health, and lower quality of life than their male counterparts. Females with T1DM face an excess risk of all-cause mortality compared with men with T1DM. New methods are needed to help and support young females with T1DM to manage their disease. A prerequisite for successful diabetes management is to offer individualized, person-centred care and support the patient’s own motivation. Guided self-determination (GSD) is a person-centred reflection and problem-solving method intended to support the patient’s own motivation in the daily care of her diabetes and help develop skills to manage difficulties in diabetes self-management. GSD has been shown to improve glycaemic control and decrease psychosocial stress in young women with T1DM. The method has been adapted for adolescents and their parents, termed GSD-young (GSD-Y). The aim of this study was to evaluate whether an intervention with GSD-Y in female adolescents with T1DM leads to improved glycaemic control, self-management, treatment satisfaction, perceived health and quality of life, fewer diabetes-related family conflicts, and improved psychosocial self-efficacy. Methods/design This is a parallel-group randomized controlled superiority trial with an allocation ratio of 1:1. One hundred female adolescents with T1DM, 15–20 years of age, and their parents (if < 18 years of age), will be included. The intervention group will receive seven individual GSD-Y education visits over 3 to 6 months. The control group will receive standard care including regular visits to the diabetes clinic. The primary outcome is level of glycaemic control, measured as glycosylated haemoglobin (HbA1c). Secondary outcomes include diabetes self-management, treatment satisfaction, perceived health and quality of life, diabetes-related family conflicts, and psychosocial self-efficacy. Data will be collected before randomization and at 6 and 12 months. Discussion Poor glycaemic control is common in female adolescents and young adults with T1DM. Long-standing hyperglycaemia increases the risks for severe complications and may also have an adverse impact on the outcome of future pregnancies. In this study, we want to evaluate if the GSD-Y method can be a useful tool in the treatment of female adolescents with T1DM. Trial registration Current controlled trials, ISRCTN57528404. Registered on 18 February 2015. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-2296-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Josephine Haas
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden. .,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.
| | - Martina Persson
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Medicine, Clinical Epidemiological Unit, Karolinska Institute, Stockholm, Sweden
| | - Anna Lena Brorsson
- Department of Women's and Children's Health, Karolinska Institute and Hospital, Stockholm, Sweden
| | - Eva Hagström Toft
- Department of Medicine, Karolinska Institute at Karolinska University Hospital, Huddinge, Sweden.,Ersta Hospital, Diabetes Unit, Stockholm, Sweden
| | - Anna Lindholm Olinder
- Department of Clinical Science and Education, Karolinska Institute, Södersjukhuset, Stockholm, Sweden.,Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden.,Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Archinkova M, Konstantinova M, Savova R, Iotova V, Petrova C, Kaleva N, Koprivarova K, Popova G, Koleva R, Boyadzhiev V, Mladenov W. Glycemic control in type 1 diabetes mellitus among Bulgarian children and adolescents: the results from the first and the second national examination of HbA1c. BIOTECHNOL BIOTEC EQ 2017. [DOI: 10.1080/13102818.2017.1379360] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Margarita Archinkova
- Clinic for Endocrinology, Diabetes and Metabolism, University Pediatric Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Maia Konstantinova
- Clinic for Endocrinology, Diabetes and Metabolism, University Pediatric Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Radka Savova
- Clinic for Endocrinology, Diabetes and Metabolism, University Pediatric Hospital, Medical University of Sofia, Sofia, Bulgaria
| | - Violeta Iotova
- Department of Pediatrics, Medical University – Varna, Varna, Bulgaria
| | - Chayka Petrova
- Clinic for Children's Diseases, University Hospital “George Stransky,” Medical University – Pleven, Pleven, Bulgaria
| | - Narcis Kaleva
- Clinic of Pediatrics and Genetic Diseases, UMBAL “St. George,” Medical University – Plovdiv, Plovdiv, Bulgaria
| | | | | | - Reni Koleva
- Diagnosis – Consulting Center, Stara Zagora, Bulgaria
| | | | - Wilchelm Mladenov
- Department of Pediatrics, Medical University – Varna, Varna, Bulgaria
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Eray Ş, Uçar HN, Çetinkaya F, Eren E, Vural P. The Relationship Between Perceived Family Climate and Glycemic Control in Type 1 Diabetes Mellitus Adolescent Patients. J Clin Res Pediatr Endocrinol 2017; 9:253-259. [PMID: 28218068 PMCID: PMC5596807 DOI: 10.4274/jcrpe.3825] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Type 1 diabetes mellitus (T1DM) is a chronic disease which ranks third in children under age 16 years. Expressed emotion (EE) is a term that indicates a specific family climate including lack of emotional support (LES), irritability, and emotional over-involvement. It is known that the family environment is highly important for glycemic control in diabetic adolescents. In this study, the relationship between perceived EE and glycemic control in adolescents diagnosed with T1DM not accompanied by psychopathology were investigated. METHODS The study included 49 adolescents with T1DM and 50 adolescents as a control group. Adolescents with psychopathology and intellectual disability were excluded from the study. Perceived EE was measured by the Shortened Level of Expressed Emotion Scale (SLEES) and blood sugar regulation was assessed by HbA1c levels. RESULTS The adolescents with T1DM showed a significant difference in perceived EE (p=0.020) and LES (p=0.014) when compared with the control group. When diabetic adolescents were compared among themselves, the diabetic adolescents with poor glycemic control perceived greater EE (p=0.033) and less emotional support (p=0.049). In regression analyses, the predictive power of mother's educational level, the employment status of mothers and the subscale "LES" of SLEES combined to explain HbA1c level was determined to be 37.8%. CONCLUSION The strong relationship between perceived EE and glycemic control showed us that perceived EE can hinder treatment compliance without causing psychopathology. For this reason, it is recommended that not only patients with psychopathology, but all diabetic adolescents receive psychosocial support and family interventions.
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Affiliation(s)
- Şafak Eray
- Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey
,* Address for Correspondence: Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey E-mail:
| | - Halit Necmi Uçar
- Van Training and Research Hospital, Clinic of Child and Adolescent Psychiatry, Van, Turkey
| | - Fatma Çetinkaya
- Taksim Training and Research Hospital, Clinic of Child Health and Diseases, İstanbul, Turkey
| | - Erdal Eren
- Uludağ University Faculty of Medicine, Department of Pediatric Endocrinology, Bursa, Turkey
| | - Pınar Vural
- Uludağ University Faculty of Medicine, Department of Child and Adolescent Psychiatry, Bursa, Turkey
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Fonte D, Lagouanelle-Simeoni MC, Apostolidis T. “Behave like a responsible adult” – Relation between social identity and psychosocial skills at stake in self-management of a chronic disease. Self and Identity 2017. [DOI: 10.1080/15298868.2017.1371636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- David Fonte
- Aix Marseille Univ, LPS, Aix-en-Provence, France
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Fonte D, Colson S, Côté J, Reynaud R, Lagouanelle-Simeoni MC, Apostolidis T. Representations and experiences of well-being among diabetic adolescents: Relational, normative, and identity tensions in diabetes self-management. J Health Psychol 2017; 24:1976-1992. [PMID: 28810470 DOI: 10.1177/1359105317712575] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: 11/16/2022] Open
Abstract
We explore representations of well-being in adolescents with Type 1 diabetes in order to better understand their expectations and needs in therapeutic patient education. In total, 28 interviews were performed and then submitted to thematic content analysis and lexicometric analysis. Results show the intervention of psychosocial processes in the relationship that adolescents maintain with well-being and self-management. More specifically, we observed that well-being is impacted by areas of tension between the expectations of adolescents and the therapeutic objectives expressed by health professionals. These tensions should be taken into account in the conception, implementation, and evaluation of therapeutic education programs.
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Affiliation(s)
- David Fonte
- Aix Marseille Univ, LPS, Aix-en-Provence, France
| | - Sébastien Colson
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,APHM, Coordination générale des soins, 13005, Marseille, France.,Aix Marseille Univ, SPMC, Marseille, France.,Université de Montréal, Faculté des Sciences Infirmières, Montréal, Canada
| | - José Côté
- Université de Montréal, Faculté des Sciences Infirmières, Montréal, Canada.,Centre de recherché du centre hospitalier de l'Université de Montréal, Montréal, Canada
| | - Rachel Reynaud
- APHM, Hôpital de la Timone Enfants, Service de pédiatrie multidisciplinaire, Marseille, France
| | - Marie-Claude Lagouanelle-Simeoni
- Aix Marseille Univ, LPS, Aix-en-Provence, France.,APHM, Hôpital Conception, Service d'évaluation médicale, 13385, Marseille, France
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Abstract
The health problems related to the nervous system are on rise in young infants leading to high mortality amongst this age group. A chronic medical condition (CC) is present in this age group to the tune of 10–20%. We searched the electronic database PubMed for pre-clinical as well as clinical controlled trials reporting variable chronic conditions especially in pediatric patients. Most of these reports revealed that type 1 diabetes mellitus is the most common CC in young infants. In female patients, metabolic control is often disturbed during CC in this age group. Poor metabolism regulation often results in long-term complications, including cognitive disorders. In cognitive disorders, memory loss and learning problems are the most among adolescents. Executive problems are observed to be associated with low physical activities. The review article concludes that knowledge about factors influencing treatment adherence is crucial in chronically ill infants. Further, we should focus on protective factors in order to prevent health risk behavior.
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Affiliation(s)
- Mingwei Jin
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Qi An
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
| | - Lei Wang
- Department of Pediatric Internal Medicine, Xuzhou Children's Hospital, Xuzhou, Jiangsu 221002, P.R. China
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Deja R, Froelich W, Deja G, Wakulicz-Deja A. Hybrid approach to the generation of medical guidelines for insulin therapy for children. Inf Sci (N Y) 2017. [DOI: 10.1016/j.ins.2016.07.066] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Schultz AT, Smaldone A. Components of Interventions That Improve Transitions to Adult Care for Adolescents With Type 1 Diabetes. J Adolesc Health 2017; 60:133-146. [PMID: 27939878 DOI: 10.1016/j.jadohealth.2016.10.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 09/15/2016] [Accepted: 10/06/2016] [Indexed: 12/11/2022]
Abstract
Adolescents with type 1 diabetes struggle with glycemic control with decline further exacerbated by transfer from pediatric to adult care. The purpose of this systematic review/meta-analysis was to examine which components of transition programs are effective in improving outcomes following transfer. We searched six databases for studies that assessed the efficacy of a transition program on diabetes outcomes. Studies reporting hemoglobin A1c (HbA1c) or its change for the intervention versus control group pretransition and posttransition were pooled using a random effects meta-analysis model. Of 4,689 studies identified, 18 (1 randomized control trial, 6 quasi-experimental, 1 prospective, and 10 retrospective cohort) met inclusion criteria. Findings represent data from 3,382 youth with type 1 diabetes (52% male, age 16-23 years) undergoing transition. Programs varied and included transition coordinators (n = 7), transition clinics (n = 10), and group education meetings (n = 5). Average age of transfer was 17.7 years. All but one study reported improvement/maintenance of HbA1c posttransition. However, pooling data from four studies with a control group (418 youth), there were no differences in HbA1c at 12 months (-.11 [95% confidence interval: -.31, .08]). Of other outcomes studied (clinic attendance [n = 12], severe hypoglycemia [n = 8], and diabetic ketoacidosis [n = 7]), transition programs showed greatest consistency in reducing diabetic ketoacidosis episodes. Findings suggest that transition interventions may be effective in maintaining glycemic control and reducing diabetic ketoacidosis episodes posttransition. Further research is needed to determine which program types are most effective.
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Affiliation(s)
- Alan T Schultz
- Columbia University School of Nursing, New York, New York
| | - Arlene Smaldone
- Columbia University School of Nursing, New York, New York; College of Dental Medicine, Columbia University Medical Center, New York, New York.
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Brorsson AL, Lindholm Olinder A, Viklund G, Granström T, Leksell J. Adolescents' perceptions of participation in group education using the Guided Self-Determination-Young method: a qualitative study. BMJ Open Diabetes Res Care 2017; 5:e000432. [PMID: 29225894 PMCID: PMC5717419 DOI: 10.1136/bmjdrc-2017-000432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 10/30/2017] [Accepted: 11/09/2017] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Guided Self-Determination (GSD) is a person-centered communication and reflection method. Education in groups may have a greater impact than the content of the education, and constructive communication between parents and adolescents has been shown to be of importance. The purpose of this study was to describe adolescents' perceptions of participation in group education with the Guided Self-Determination-Young (GSD-Y) method, together with parents, in connection with the introduction of continuous subcutaneous insulin infusion. RESEARCH DESIGN AND METHODS In the present qualitative interview study, 13 adolescents with type 1 diabetes were included after completing a GSD-Y group education program in connection with the introduction of continuous subcutaneous insulin infusion at three hospitals located in central Sweden. The adolescents were interviewed individually, and qualitative content analysis was applied to the interview transcripts. RESULTS Two categories that emerged from the analysis were the importance of context and growing in power through the group process. An overarching theme that emerged from the interviews was the importance of expert and referent power in growing awareness of the importance of self-management as well as mitigating the loneliness of diabetes. CONCLUSIONS GSD-Y has, in various ways, mitigated experiences of loneliness and contributed to conscious reflection about self-management in the group (referent power) together with the group leader (expert power). Overall, this highlights the benefits of group education, and the GSD method emphasizes the person-centered approach. TRIAL REGISTRATION NUMBER ISRCTN22444034; Results.
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Affiliation(s)
- Anna Lena Brorsson
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
- School of Education, Health and Social Studies, Högskolan Dalarna, Falun, Sweden
| | - Anna Lindholm Olinder
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
- Department of Clinical Science and Education, Karolinska Institute, Stockholm, Sweden
| | - Gunnel Viklund
- Department of Women's and Children's Health, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Therese Granström
- School of Education, Health and Social Studies, Högskolan Dalarna, Falun, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Janeth Leksell
- School of Education, Health and Social Studies, Högskolan Dalarna, Falun, Sweden
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
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Passone CGB, Esteves LSO, Savoldelli RD, Harris MA, Damiani D, Manna TD. Translation and validation of diabetes self-management profile (DSMP) into Brazilian Portuguese language: first instrument to assess type 1 diabetes self-management in a pediatric population. Diabetol Metab Syndr 2017; 9:51. [PMID: 28702090 PMCID: PMC5504641 DOI: 10.1186/s13098-017-0250-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2017] [Accepted: 06/30/2017] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To translate and validate the instrument Diabetes Self-Management Profile (DSMP)-Conventional and Flexible Regimens into Brazilian Portuguese language in order to evaluate the quality of diabetes self-management in children and adolescents with type 1 diabetes and their caregivers. METHODS DSMP was submitted to forward and back translation method and validated in a group of type 1 diabetes youths between 6 and 18 years (n = 102), and their families. Analysis of DSMP internal consistency, intra and interobserver reliability and concurrent correlation with HbA1c were done. RESULTS DSMP total scores demonstrated adequate internal consistency (Cronbach's α = 0.79), 3-month test-retest reliability (ρ = 0.53; p < 0.001), inter-interviewer agreement (ρ = 0.55; p < 0.001). DSMP total score was significantly correlated to HbA1c (ρ = -0.54, p < 0.001). CONCLUSION DSMP-translated version is a reliable and valid tool to assess diabetes self-management.
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Affiliation(s)
- Caroline Gouveia Buff Passone
- Pediatric Endocrinology Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Joaquim Távora, 550, ap123a, São Paulo, Brazil
| | - Lygia Spassapan Oliveira Esteves
- Pediatric Endocrinology Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Joaquim Távora, 550, ap123a, São Paulo, Brazil
| | - Roberta Dias Savoldelli
- Pediatric Endocrinology Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Joaquim Távora, 550, ap123a, São Paulo, Brazil
| | - Michael A. Harris
- Pediatrics & Anesthesiology, Oregon Health & Science University, Portland, OR USA
| | - Durval Damiani
- Pediatric Endocrinology Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Joaquim Távora, 550, ap123a, São Paulo, Brazil
| | - Thais Della Manna
- Pediatric Endocrinology Unit, Instituto da Criança do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, Rua Joaquim Távora, 550, ap123a, São Paulo, Brazil
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Roche EF, McKenna AM, Ryder KJ, Brennan AA, O'Regan M, Hoey HM. Is the incidence of type 1 diabetes in children and adolescents stabilising? The first 6 years of a National Register. Eur J Pediatr 2016; 175:1913-9. [PMID: 27659662 DOI: 10.1007/s00431-016-2787-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 09/05/2016] [Accepted: 09/12/2016] [Indexed: 02/06/2023]
Abstract
UNLABELLED The Irish Childhood Diabetes National Register (ICDNR) was established in 2008 to define accurately the incidence and monitor the epidemiology of type 1 diabetes (T1D) in the Irish population. Here, we report data from the first 6 years of the National Register and compare with previous national data. Prospective national incident data regarding T1D in those under 15 years resident in Ireland were collected from 2008 to 2013 and national incidence rates (IRs) calculated. Ascertainment completeness was assessed using capture-recapture methodology. The period identified 1566 new cases of T1D, ascertainment reached 96.8 % in 2013. The standardised incidence rate was 27.5 in 2008 stabilising at 28.7 and 28.8 cases /100,000/year in 2012 and 2013. There was no evidence that the incidence changed significantly in the 6-year period either overall or for each age group and gender. There was evidence of a difference in the incidence of T1D across the age groups with the overall incidence highest in the 10-14 year age category. A strong seasonal association was demonstrated. CONCLUSIONS This study confirms Ireland as a high-incidence country for type 1 diabetes whilst demonstrating that the previous marked increase in IR from 16.3 cases/100,000/year in 1997 has not continued. Ongoing monitoring through the robust mechanism of the ICDNR is required to clarify whether this is a fluctuation or if the incidence of T1D diabetes has stopped rising in our population. Alternatively, this apparent stabilisation may reflect a shift to a later age at diagnosis. "What is known :" • The incidence of Type 1 diabetes (T1D) is increasing in most populations worldwide although in certain high-incidence populations, it may be stabilising • There was a marked increase in T1D in Ireland between 1997 and 2008 • T1D incidence increases with affluence "What is New:" • The high incidence of T1D in Ireland has been confirmed at 28.8 cases/100,000/year in 2013 and has been effectively stable in the period 2008-2013 • Incidence is highest in Irish 10-14 year olds • Changes in incidence possibly reflecting life style and economic climate • Marked seasonality of diagnosis confirmed.
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Konrad K, Vogel C, Bollow E, Fritsch M, Lange K, Bartus B, Holl RW. Current practice of diabetes education in children and adolescents with type 1 diabetes in Germany and Austria: analysis based on the German/Austrian DPV database. Pediatr Diabetes 2016; 17:483-491. [PMID: 26530288 DOI: 10.1111/pedi.12330] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 09/23/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Diabetes education of patients and/or parents is an essential part of diabetes care with effects on diabetes outcome. The objective of our study was to describe the current practice of diabetes education in Germany and Austria with regard to training frequency, patient age, migration background and diabetes therapy in a large cohort of pediatric patients with diabetes mellitus type 1 (T1DM). METHODS We analyzed data from pediatric T1DM patients with diabetes training in 2013 and complete data available for treatment year in the multicenter Diabetes Patienten Verlaufsdokumentation (DPV) registry using sas 9.4. RESULTS In 2013 21 871 pediatric patients with T1DM were documented [52.4% male, age: 12.70 (9.35-15.30) yr (median (interquartile range)], diabetes duration: 3.80 (1.45-7.00) yr, migration background: 21.4%, twice daily injections: 5.5%, multiple daily injections: 52.5%, insulin-pump therapy: 42%. Of these 32.31% were trained in 2013. Younger patients and their parents were trained more intensely and more frequently as inpatients compared with older patients (0-6 vs. 6-12 and 12-18 yr: teaching units: 13.07 vs. 12.05 and 9.79; inpatient: 79% vs. 72% and 70%). There was also a difference in training frequency with regard to migration background. Severe hypoglycemia or ketoacidosis resulted in intensification of training (4.0 vs. 2.0%; 7.8 vs. 3.1%). Centre-specific education tools were used frequently alone or in combination with published, standardized education programs. CONCLUSION Training frequency was highest in younger patients and during the first year of diabetes. Acute complications resulted in more frequent diabetes training, indicating that currently many education sessions take place in consequence to these complications.
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Affiliation(s)
- K Konrad
- Department of Pediatric and Adolescent Medicine, University of Cologne, Cologne, Germany. .,Department of Pediatric and Adolescent Medicine, Elisabeth-Hospital Essen, Essen, Germany.
| | - C Vogel
- Department of Pediatrics, Childrens Hospital Chemnitz, Chemnitz, Germany
| | - E Bollow
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
| | - M Fritsch
- Department of Pediatric and Adolescent Medicine, University of Vienna, Vienna, Austria
| | - K Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | - B Bartus
- Department of Pediatrics Filderstadt Hospital, Filderklinik, Filderstadt, Germany
| | - R W Holl
- Institute of Epidemiology and Medical Biometry, ZIBMT, University of Ulm, German Center for Diabetes Research (DZD), Ulm, Germany
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Abualula NA, Jacobsen KH, Milligan RA, Rodan MF, Conn VS. Evaluating Diabetes Educational Interventions With a Skill Development Component in Adolescents With Type 1 Diabetes: A Systematic Review Focusing on Quality of Life. Diabetes Educ 2016; 42:515-28. [PMID: 27402637 DOI: 10.1177/0145721716658356] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE Adolescents with type 1 diabetes mellitus (T1DM) may have reduced quality of life (QOL) when compared with their peers. This systematic review evaluated the effectiveness of diabetes self-management education (DSME) interventions with a skills development component on the QOL of adolescents with T1DM. METHODS Six databases were systematically searched for studies on the QOL outcomes of DSME interventions for adolescents with T1DM. Fourteen studies published between 1994 and 2014 met the inclusion criteria. RESULTS Of the 14 studies, only 4 had significant QOL outcomes for the intervention participants. Successful DSME interventions had indirect behavioral skills foci or a combination of indirect and direct behavioral skills foci and a duration ≥2 months. CONCLUSION This review provides evidence that educational interventions with an indirect behavioral skills development that facilitates diabetes management may improve QOL among adolescents with T1DM. Structured interventions targeting adolescents' QOL are needed to determine which are most effective in improving QOL. Adolescents with T1DM should be routinely screened and monitored for low QOL and referred to QOL-improving interventions.
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Affiliation(s)
- Nada A Abualula
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan),College of Nursing, Taibah University, Madina, Saudi Arabia (Ms Abualula)
| | - Kathryn H Jacobsen
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Renee A Milligan
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Margaret F Rodan
- College of Health and Human Services, George Mason University, Fairfax, Virginia, USA (Ms Abualula, Dr Milligan, Dr Jacobsen, Dr Rodan)
| | - Vicki S Conn
- Sinclair School of Nursing, University of Missouri, Columbia, Missouri, USA (Dr Conn)
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Bonfanti R, Lepore G, Bozzetto L, Corsi A, Di Blasi V, Girelli A, Grassi G, Iafusco D, Rabbone I, Schiaffini R, Laviola L, Bruttomesso D. Survey on the use of insulin pumps in Italy: comparison between pediatric and adult age groups (IMITA study). Acta Diabetol 2016; 53:403-12. [PMID: 26429560 DOI: 10.1007/s00592-015-0810-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 09/14/2015] [Indexed: 01/22/2023]
Abstract
AIMS The aim of the study was to evaluate and compare continuous subcutaneous insulin infusion (CSII) use in pediatric and adult age groups. METHODS Data were collected with a questionnaire sent by e-mail to CSII-experienced Diabetes Centers. The questionnaire assessed: (1) number of CSII-treated patients; (2) patient demographic data and characteristics; (3) structure and organization of Diabetes Centers providing CSII therapy; (4) pump characteristics (conventional pump, sensor-augmented pump); and (5) CSII dropouts. RESULTS A total of 217 out of 1093 Italian centers participated: 51 pediatric (23.5 %) and 166 (76.5 %) adult centers (AP). Compared to a survey performed in 2005, there was a significant increase in the number of pediatric units when compared to adult units (112 vs 37 %, respectively, p < 0.05). Pediatric age is characterized by a greater concern for quality of life and injections, and a higher dropout rate (10.6 vs 8.9 %) mainly related to pump wearability and site reactions. A complete diabetes-care team is associated with a superior use of technology (fewer dropouts, increased CGM and advanced bolus use) which is, however, still used in a small percentage of patients. CONCLUSIONS In Italy, the number of CSII-treated pediatric patients (PP) is growing more significantly when compared to adults. Only 60 % of all patients are using advanced functions and 20 % are using CGMs continuously. This confirms the great interest in diabetes technology that is growing in pediatric diabetologists. However, much improvement is warranted in the organization and specialized training of pediatric, adult and transitional facilities.
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Affiliation(s)
- R Bonfanti
- Pediatric Department and Diabetes Research Institute (OSR-DRI), IRCCS Ospedale San Raffaele, Via Olgettina 60, 20132, Milan, Italy.
| | - G Lepore
- Unit of Endocrine Disease and Diabetology, A.O Papa Giovanni XXIII, Bergamo, Italy
| | - L Bozzetto
- Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - A Corsi
- Unit of Diabetology and Endocrinology, P.O. Metropolitano, ASL 3, Genoa, Italy
| | - V Di Blasi
- Department of Endocrinology and Diabetology, ASL Salerno, Salerno, Italy
| | - A Girelli
- Unit of Diabetology, A.O. Spedali Civili, Brescia, Italy
| | - G Grassi
- Division of Endocrinology, Diabetology and Metabolism, A.O Città della Salute e della Scienza, Turin, Italy
| | - D Iafusco
- Department of Pediatrics, Second University of Naples, Naples, Italy
| | - I Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - R Schiaffini
- Unit of Endocrinology and Diabetes, IRCCS Bambino Gesù Children's Hospital, Rome, Italy
| | - L Laviola
- Section of Internal Medicine, Endocrinology, Andrology and Metabolic Diseases, Department of Emergency and Organ Transplantation, University of Aldo Moro, Bari, Italy
| | - D Bruttomesso
- Department of Medicine, DIMED, Metabolic Diseases, University of Padua, Padua, Italy
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Kelsey MM, Bjornstad P, McFann K, Nadeau K. Testosterone concentration and insulin sensitivity in young men with type 1 and type 2 diabetes. Pediatr Diabetes 2016; 17:184-90. [PMID: 25611822 PMCID: PMC4510044 DOI: 10.1111/pedi.12255] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Reduced testosterone, a recognized comorbidity of reduced insulin sensitivity (IS) and type 2 diabetes (T2D), has also been reported in adult males with type 1 diabetes (T1D). However, there are limited data on how early reduced testosterone occurs, and whether it is related to the reduced IS in T1D. Leptin, a modulator of the HPG-axis, may also influence testosterone in T1D. We hypothesized that IS and leptin would be associated with total testosterone (TT), and free androgen index (FAI) in adolescent males with T1D. METHODS T1D (n = 35), T2D (n = 13), lean (n = 13) and obese (n = 9) adolescent males had IS measured by hyperinsulinemic-euglycemic clamps (glucose infusion rate [GIR]), in addition to leptin, sex hormone binding globulin (SHBG), TT, and FAI. The cohort was stratified into those with T1D (n = 35) and those without (n = 35). RESULTS TT and SHBG were lower in T2D boys vs. lean controls, and GIR and leptin correlated with FAI and TT in non-T1D participants. However, despite being insulin resistant, adolescent males with T1D had normal TT and FAI, unrelated to GIR. In T1D, leptin was inversely associated with TT (p = 0.005) and FAI (p = 0.01), independent of puberty, hemoglobin A1c (HbA1c), diabetes duration, body mass index (BMI) z-score and GIR. CONCLUSION Leptin accounted for a significant proportion of the variability of testosterone in T1D. However, despite reduced IS, there was no association between IS and testosterone in T1D adolescents. These observations suggest that the mechanisms affecting testosterone may differ between adolescent males with and without T1D.
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Affiliation(s)
- Megan M. Kelsey
- Department of Pediatric Endocrinology, University of Colorado Denver, Aurora, CO
| | - Petter Bjornstad
- Department of Pediatrics, University of Colorado Denver, Aurora, CO
| | - Kim McFann
- Department of Biostatistics, University of Colorado Denver, Aurora, CO
| | - Kristen Nadeau
- Department of Pediatric Endocrinology, University of Colorado Denver, Aurora, CO
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Ozturk C, Ayar D, Bektas M. Psychometric properties of a Turkish version of the Diabetes Management Self-Efficacy Scale in Adolescents with Type 1 Diabetes Mellitus. Children's Health Care 2016. [DOI: 10.1080/02739615.2016.1163492] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Candan Ozturk
- Nursing Department, Faculty of Health Sciences, Istanbul Sabahattin Zaim University, Istanbul, Turkey
| | - Dijle Ayar
- Pediatric Nursing Department, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
| | - Murat Bektas
- Pediatric Nursing Department, Faculty of Nursing, Dokuz Eylul University, Izmir, Turkey
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Karges B, Rosenbauer J, Holterhus PM, Beyer P, Seithe H, Vogel C, Böckmann A, Peters D, Müther S, Neu A, Holl RW. Hospital admission for diabetic ketoacidosis or severe hypoglycemia in 31,330 young patients with type 1 diabetes. Eur J Endocrinol 2015; 173:341-50. [PMID: 26088822 DOI: 10.1530/eje-15-0129] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 06/17/2015] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To investigate rates and risk factors of hospital admission for diabetic ketoacidosis (DKA) or severe hypoglycemia in young patients with established type 1 diabetes. DESIGN In total, 31,330 patients with type 1 diabetes (median age 12.7 years) from the Diabetes Patienten Verlaufsdokumentation (DPV) Prospective Diabetes Registry treated between 2011 and 2013 in Germany were included. METHODS Admission rates for DKA (pH < 7.3 or bicarbonate <15 mmol/l) and severe hypoglycemia (requiring assistance from another person) were calculated by negative binomial regression analysis. Associations of DKA or hypoglycemia with patient and treatment characteristics were assessed by multivariable regression analysis. RESULTS The mean admission rate for DKA was 4.81/100 patient-years (95% CI, 4.51-5.14). The highest DKA rates were observed in patients with HbA1c ≥ 9.0% (15.83 (14.44-17.36)), age 15-20 years (6.21 (5.61-6.88)) and diabetes duration of 2-4.9 years (5.60 (5.00-6.27)). DKA rate was higher in girls than in boys (5.35 (4.88-5.86) vs 4.34 (3.95-4.77), P = 0.002), and more frequent in migrants than in non-migrants (5.65 (4.92-6.49) vs 4.57 (4.23-4.93), P = 0.008). The mean admission rate for severe hypoglycemia was 1.45/100 patient-years (1.30-1.61). Rates were higher in migrants compared to non-migrants (2.13 (1.72-2.65) vs 1.28 (1.12-1.47), P < 0.001), and highest in individuals with severe hypoglycemia within the preceding year (17.69 (15.63-20.03) vs patients without preceding hypoglycemia 0.42 (0.35-0.52), P < 0.001). Differences remained significant after multivariable adjustment. CONCLUSIONS The identification of at-risk individuals for DKA (patients with high HbA1c, longer diabetes duration, adolescents, girls) and for severe hypoglycemia (patients with preceding severe hypoglycemia, migrants) may facilitate targeted diabetes counselling in order to prevent these complications.
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Affiliation(s)
- Beate Karges
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlin
| | - Joachim Rosenbauer
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Paul-Martin Holterhus
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Peter Beyer
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Horst Seithe
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Christian Vogel
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Andreas Böckmann
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Dirk Peters
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Silvia Müther
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Andreas Neu
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
| | - Reinhard W Holl
- Division of Endocrinology and DiabetesDepartment of Gynecological Endocrinology and Reproductive MedicineMedical Faculty, RWTH Aachen University, German Center for Diabetes Research (DZD), Pauwelsstraße 30, D 52074 Aachen, GermanyDepartment of PediatricsBethlehem Krankenhaus, Stolberg, GermanyInstitute for Biometrics and EpidemiologyGerman Diabetes Center, Leibniz Center at University of Düsseldorf, Düsseldorf, Germany, German Center for Diabetes Research (DZD)Division of Pediatric Endocrinology and DiabetesDepartment of Pediatrics, University Hospital Schleswig-Holstein, Christian-Albrechts University Kiel, Kiel, GermanyDepartment of PediatricsEvangelisches Krankenhaus Oberhausen, Oberhausen, GermanyDepartment of PediatricsKlinikum Nürnberg Süd, Nürnberg, GermanyDepartment of PediatricsKlinikum Chemnitz, Chemnitz, GermanyDepartment of PediatricsKlinikum Konstanz, Konstanz, GermanyDepartment of PediatricsAsklepios Klinik St. Augustin, St. Augustin, GermanyDiabetes Center for Children and AdolescentsDRK Kliniken Berlin Westend, Berlin, GermanyDepartment of PediatricsUniversity of Tübingen, Tübingen, GermanyInstitute of Epidemiology and Medical BiometryZIMBT, German Center for Diabetes Research (DZD), University of Ulm, Ulm, Germany
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Abstract
PURPOSE OF REVIEW Adolescence is a well known, high-risk time period for all youth, and in patients with type 1 diabetes, glycemic control is at its worst. This manuscript will review updates in adolescent diabetes literature between February 2014 and February 2015. The article will highlight new research in the behavioural and psychosocial literature focused on type 1 diabetes in adolescents, including compliance with standards of care, quality of life, depression, psychological burden of type 1 diabetes, parental involvement, the parent-child relationship, self-management, socioeconomic status and transition and transfer of care. Recent behavioural interventions focusing on adolescents with type 1 diabetes will also be discussed. RECENT FINDINGS These literature updates have found that behavioural and psychosocial concerns remain prevalent in adolescents with type 1 diabetes, psychological needs in the population are not being met and current interventions have not been largely successful in impacting outcomes. SUMMARY Behavioural and psychosocial issues in adolescents with type 1 diabetes greatly impact their diabetes and general life outcomes. Additional research, specifically interventions successfully addressing the behavioural and psychosocial issues in this population, is desperately needed.
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Affiliation(s)
- Jennifer Raymond
- The Barbara Davis Center for Childhood Diabetes, Children's Hospital Colorado, University of Colorado, Anschutz Medical Campus, Colorado, USA
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Abstract
OBJECTIVE Establishing care with adult providers is essential for emerging adults with type 1 diabetes (T1D) transitioning from pediatric care. Although research evaluating the transition from pediatric to adult care has been focused primarily on patients' perceptions, little is known about the adult providers' perspectives. We sought to ascertain adult providers' perspectives of caring for the medical and psychosocial needs of this patient population. METHODS We developed and mailed a survey to 79 regional adult endocrinologists and 186 primary care physicians (PCPs) identified through 2 regional insurance plans. Questions addressed perceived aptitude in clinical aspects of diabetes management, importance and availability of diabetes team members, and opinions regarding recommended transition methods. RESULTS The response rate was 43% for endocrinologists and 13% for PCPs. Endocrinologists reported higher aptitude in insulin management (P<.01). PCPs reported greater aptitude in screening and treating depression (P<0.01). Although endocrinologists and PCPs did not differ in their views of the importance of care by a comprehensive team, endocrinologists reported better access to diabetes educators and dieticians than PCPs (P<.01). Recommended transition methods were described as useful. CONCLUSION These preliminary results suggest that endocrinologists are better prepared to assume diabetes care of emerging adults, whereas PCPs may be better prepared to screen and treat associated depression. Future studies are needed to determine if a medical home model with cooperative management improves care for emerging adults with T1D.
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Kamel Boulos MN, Gammon S, Dixon MC, MacRury SM, Fergusson MJ, Miranda Rodrigues F, Mourinho Baptista T, Yang SP. Digital games for type 1 and type 2 diabetes: underpinning theory with three illustrative examples. JMIR Serious Games 2015; 3:e3. [PMID: 25791276 PMCID: PMC4382565 DOI: 10.2196/games.3930] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Revised: 01/20/2015] [Accepted: 02/06/2015] [Indexed: 01/08/2023] Open
Abstract
Digital games are an important class of eHealth interventions in diabetes, made possible by the Internet and a good range of affordable mobile devices (eg, mobile phones and tablets) available to consumers these days. Gamifying disease management can help children, adolescents, and adults with diabetes to better cope with their lifelong condition. Gamification and social in-game components are used to motivate players/patients and positively change their behavior and lifestyle. In this paper, we start by presenting the main challenges facing people with diabetes—children/adolescents and adults—from a clinical perspective, followed by three short illustrative examples of mobile and desktop game apps and platforms designed by Ayogo Health, Inc. (Vancouver, BC, Canada) for type 1 diabetes (one example) and type 2 diabetes (two examples). The games target different age groups with different needs—children with type 1 diabetes versus adults with type 2 diabetes. The paper is not meant to be an exhaustive review of all digital game offerings available for people with type 1 and type 2 diabetes, but rather to serve as a taster of a few of the game genres on offer today for both types of diabetes, with a brief discussion of (1) some of the underpinning psychological mechanisms of gamified digital interventions and platforms as self-management adherence tools, and more, in diabetes, and (2) some of the hypothesized potential benefits that might be gained from their routine use by people with diabetes. More research evidence from full-scale evaluation studies is needed and expected in the near future that will quantify, qualify, and establish the evidence base concerning this gamification potential, such as what works in each age group/patient type, what does not, and under which settings and criteria.
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Affiliation(s)
- Maged N Kamel Boulos
- The Alexander Graham Bell Centre for Digital Health, Moray College UHI, University of the Highlands and Islands, Elgin, United Kingdom.
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