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Rioles N, March C, Muñoz CE, Ilkowitz J, Ohmer A, Wolf RM. Stakeholder Engagement in Type 1 Diabetes Research, Quality Improvement, and Clinical Care. Endocrinol Metab Clin North Am 2024; 53:165-182. [PMID: 38272594 DOI: 10.1016/j.ecl.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
The integration of stakeholder engagement (SE) in research, quality improvement (QI), and clinical care has gained significant traction. Type 1 diabetes is a chronic disease that requires complex daily management and care from a multidisciplinary team across the lifespan. Inclusion of key stakeholder voices, including patients, caregivers, health care providers and community advocates, in the research process and implementation of clinical care is critical to ensure representation of perspectives that match the values and goals of the patient population. This review describes the current framework for SE and its application to research, QI, and clinical care across the lifespan.
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Affiliation(s)
| | - Christine March
- Division of Pediatric Endocrinology and Diabetes, University of Pittsburgh, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Cynthia E Muñoz
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Amy Ohmer
- International Children's Advisory Network, Atlanta, GA, USA
| | - Risa M Wolf
- Department of Pediatrics, Division of Endocrinology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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McCarthy MM, Yan J, Jared MC, Ilkowitz J, Gallagher MP, Dickson VV. Time, Technology, Social Support, and Cardiovascular Health of Emerging Adults With Type 1 Diabetes. Nurs Res 2023; 72:185-192. [PMID: 37084321 PMCID: PMC10123545 DOI: 10.1097/nnr.0000000000000645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/23/2023]
Abstract
BACKGROUND Emerging adults with Type 1 diabetes (T1DM) face an increased risk of cardiovascular disease; however, there are both barriers and facilitators to achieving ideal cardiovascular health in this stage of their lives. OBJECTIVES The aim of this study was to qualitatively explore the barriers and facilitators of achieving ideal levels of cardiovascular health in a sample of emerging adults with T1DM ages 18-26 years. METHODS A sequential mixed-methods design was used to explore achievement of ideal cardiovascular health using the seven factors defined by the American Heart Association (smoking status, body mass index, physical activity, healthy diet, total cholesterol, blood pressure, and hemoglobin A1C [substituted for fasting blood glucose]). We assessed the frequency of achieving ideal levels of each cardiovascular health factor. Using Pender's health promotion model as a framework, qualitative interviews explored the barriers and facilitators of achieving ideal levels of each factor of cardiovascular health. RESULTS The sample was mostly female. Their age range was 18-26 years, with a diabetes duration between 1 and 20 years. The three factors that had the lowest achievement were a healthy diet, physical activity at recommended levels, and hemoglobin A1C of <7%. Participants described lack of time as a barrier to eating healthy, being physically active, and maintaining in-range blood glucose levels. Facilitators included the use of technology in helping to achieve in-range blood glucose and social support from family, friends, and healthcare providers in maintaining several healthy habits. DISCUSSION These qualitative data provide insight into how emerging adults attempt to manage their T1DM and cardiovascular health. Healthcare providers have an important role in supporting these patients in establishing ideal cardiovascular health at an early age.
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Baby M, Ilkowitz J, Cheema Brar P. Impacts of the COVID-19 pandemic on the diagnosis of idiopathic central precocious puberty in pediatric females in New York City. J Pediatr Endocrinol Metab 2023:jpem-2022-0628. [PMID: 37114861 DOI: 10.1515/jpem-2022-0628] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/04/2023] [Indexed: 04/29/2023]
Abstract
BACKGROUND The COVID-19 pandemic had profound effect on physical and mental health. Stress was due physical inactivity, increased screen time, social isolation, fear of illness/death, as well as relative lack of resources including healthy food and finances. These stressors may be associated with an increase in idiopathic central precocious puberty (ICPP). OBJECTIVES To assess the incidence of ICPP in females during the COVID-19 pandemic and compare biochemical and radiological parameters of females diagnosed in the previous two years, looking at associations among BMI, screen time, isolation, and stress in relation to the development of early puberty. METHODS A retrospective chart review was performed of females diagnosed with ICPP. We divided subjects into a pandemic group and pre-pandemic group based on time of diagnosis. We compared anthropometric, serologic and radiologic data between the two groups. To assess psychosocial stress, we reviewed a COVID-19 impact survey which was administered to families at our endocrine clinic. RESULTS There were a total of 56 subjects in the study; 23 subjects in the pre-pandemic group and 33 in the pandemic group. The pandemic cohort had significantly higher estradiol and LH levels and larger ovarian volumes. Survey results showed parental report of stress was moderate in 38 % of subjects and severe in 25 % of parents. In children, reported stress was moderate in 46 % of subjects. CONCLUSIONS As puberty is influenced by exogenous factors including weight gain and psychosocial stress, we suspect that the environmental stress surrounding the pandemic influenced the increase in ICPP.
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Affiliation(s)
- Merilyn Baby
- Pediatric Endocrine Fellow, Division of Pediatric Endocrinology and Diabetes, NYU, New York, USA
| | - Jeniece Ilkowitz
- Clinical Research Nurse, Division of Pediatric Endocrinology and Diabetes, NYU, New York, USA
| | - Preneet Cheema Brar
- Pediatric Endocrine Attending, Associate Professor, Division of Pediatric Endocrinology and Diabetes, NYU, New York, USA
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McCarthy M, Ilkowitz J, Zheng Y, Vaughan Dickson V. Exercise and Self-Management in Adults with Type 1 Diabetes. Curr Cardiol Rep 2022; 24:861-868. [PMID: 35524882 DOI: 10.1007/s11886-022-01707-3] [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] [Accepted: 04/20/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The purpose of this review paper is to examine the most recent evidence of exercise-related self-management in adults with type 1 diabetes (T1D). RECENT FINDINGS This paper reviews the benefits and barriers to exercise, diabetes self-management education, the role of the healthcare provider in assessment and counseling, the use of technology, and concerns for special populations with T1D. Adults with T1D may not exercise at sufficient levels. Assessing current levels of exercise, counseling during a clinical visit, and the use of technology may improve exercise in this population.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, New York, NY, USA.
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, NYU Langone Health, New York, NY, USA
| | - Yaguang Zheng
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Ilkowitz J, Wissing V, Gallagher MP. Pediatric Smart Insulin Pen Use: The Next Best Thing. J Diabetes Sci Technol 2022; 16:635-640. [PMID: 34474591 PMCID: PMC9294571 DOI: 10.1177/19322968211041362] [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] [Indexed: 11/16/2022]
Abstract
In the pediatric population, insulin pump therapy, or CSII, is often considered the gold standard for intensive diabetes management. Insulin pump technology offers families and caregivers many beneficial features including a calculator for insulin dosing and the ability to review diabetes management data to provide data-driven diabetes management. However, for those who find CSII challenging or choose to use multiple daily injections (MDI) there is an option that offers similar features called the Smart Insulin Pen (SIP). Even though SIP technology provides a safe and data-driven diabetes self-management tool for the pediatric population using MDI, there is limited pediatric specific literature. This article will describe current options, data-driven diabetes management, benefits, challenges and clinical use of SIP technology in the pediatric population.
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Affiliation(s)
- Jeniece Ilkowitz
- The NYU Pediatric Diabetes Center,
Hassenfeld Childrens’ Hospital at NYU Langone, New York, NY, USA
- Jeniece Ilkowitz, RN, MA, CDCES, The NYU
Pediatric Diabetes Center, Hassenfeld Childrens’ Hospital at NYU Langone, 135
East 31st street, Floor 2, New York, NY 10016, USA.
| | - Vanessa Wissing
- The NYU Pediatric Diabetes Center,
Hassenfeld Childrens’ Hospital at NYU Langone, New York, NY, USA
| | - Mary Pat Gallagher
- The NYU Pediatric Diabetes Center,
Hassenfeld Childrens’ Hospital at NYU Langone, New York, NY, USA
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Calcagno-davi B, Powell S, Ilkowitz J, Gonzalez J, Gallagher M. A-42 Examining the Utility of the DREFs: Does it Correlate to HbA1c Levels. Arch Clin Neuropsychol 2021. [DOI: 10.1093/arclin/acab062.60] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Objective
Previous research suggests that kids with T1D are at higher risk for attention and executive weaknesses, which are the exact skills necessary for proper management of their diabetes (Gaudieri, Chen, Greer et al., 2008; Lin, Northam, Rankins, Werther, et al., 2010; McNally, Rohan, Pendley et al., 2010; American Diabetes Association, 2018). In an attempt to quantify the specific executive skills that impact poor glycemic control in youth, Duke, Raymond & Harris (2014) created the Diabetes Related Executive Functioning Scale (DREFS) (Parent version, Cronbach’s alphas α =0.97). The current study expands on the one published research article on the DREFs, by examining the link between Parent DREFs and child’s HbA1c levels in a northeast population.
Method
HbA1c levels and scores on parent DREFs of 23 youth (10–17 years-old; 10 males) in ongoing research at the NYU Diabetes Center were reviewed. All participants were English speaking.
Results
The sample as a whole had relatively high HbA1c level, which is above the American Diabetes Associations recommended upper limit of 7% (M = 7.92, SD = 1.38) with DREF total score (M = 276, SD = 44). Spearman’s Correlations revealed a significant positive correlation between emotional control and higher HbA1c (rs [23] = −0.482, p = 0.020).
Conclusion
In our sample in the north east, urban clinic, poor emotional regulation was strongly correlated with poorer diabetes control. Unlike the initial study on the DREFS, many aspects of executive functioning were not strongly correlated to blood glucose control. This highlights the need for better understanding psychosocial functioning in children with chronic health conditions.
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McCarthy M, Yan J, Jared MC, You E, Ilkowitz J, Gallagher MP, Vaughan Dickson V. Cardiovascular health in emerging adults with type 1 diabetes. Eur J Cardiovasc Nurs 2021; 21:213-219. [PMID: 34498041 DOI: 10.1093/eurjcn/zvab062] [Citation(s) in RCA: 4] [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: 03/12/2021] [Revised: 05/19/2021] [Accepted: 07/06/2021] [Indexed: 12/18/2022]
Abstract
AIMS Individuals with type 1 diabetes (T1D) face increased risk for cardiovascular disease (CVD). Controlling individual cardiovascular risk factors can prevent or slow the onset of CVD. Ideal cardiovascular health is associated with a lower incidence of CVD. Identifying areas of suboptimal cardiovascular health can help guide CVD prevention interventions. To assess cardiovascular health and explore the barriers and facilitators to achieving ideal cardiovascular health in a sample of young adults with T1D. METHODS AND RESULTS We used a sequential mixed-method design to assess the seven factors of cardiovascular health according to American Heart Association. Qualitative interviews, guided by Pender's Health Promotion Model, were used to discuss participant's cardiovascular health results and the barriers and facilitators to achieving ideal cardiovascular health. We assessed the frequency of ideal levels of each factor. The qualitative data were analysed using content analysis. Qualitative and quantitative data were integrated in the final analysis phase. The sample (n = 50) was majority female (70%), White (86%), with a mean age of 22 ± 2.4 and diabetes duration of 10.7 ± 5.5 years. Achievement of the seven factors of cardiovascular health were: non-smoking (96%); cholesterol <200 mg/dL (76%); body mass index <25 kg/m2 (54%); blood pressure <120/<80 mmHg (46%); meeting physical activity guidelines (38%); haemoglobin A1c <7% (40%); and healthy diet (14%). Emerging qualitative themes related to the perceived benefits of action, interpersonal influences on their diabetes self-management, and perceived self-efficacy. CONCLUSION We found areas of needed improvement for cardiovascular health. However, these young adults expressed a strong interest in healthy habits which can be supported by their healthcare providers.
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Affiliation(s)
- Margaret McCarthy
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA
| | - Joeyee Yan
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA
| | - Mary Christine Jared
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA
| | - Erica You
- Rory Meyers College of Nursing, New York University, 433 First Avenue, New York, NY 10010, USA
| | - Jeniece Ilkowitz
- Pediatric Diabetes Center, New York University Langone Health, 135 East 31st Street, New York, NY 10016, USA
| | - Mary Pat Gallagher
- Pediatric Diabetes Center, New York University Langone Health, 135 East 31st Street, New York, NY 10016, USA
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