Associations of diabetes self-management characteristics, HbA1c, and psychosocial outcomes with depressive symptoms in a contemporary sample of adolescents with type 1 diabetes

Purpose The objectives of this umbrella review were to describe various aspects of diabetes self-management education and support (DSMES)-related interventions and their effect on clinical, behavioral, and psychosocial outcomes among children and young adults with type 1 diabetes (T1DM) and identify gaps in current DSMES-related research. Methods An umbrella review of systematic reviews on DSMES interventions was conducted in accordance with the PRISMA 2009 statement. Four international medical databases were searched for eligible review articles published in English in the last 10 years that dealt with children and youths with T1DM and were conducted in accordance with a priori protocol. Results Out of the 234 citations screened, only 8 systematic reviews representing 166 studies were considered eligible for further analysis. Glycemic management (A1C) is the most common outcome variable (108 studies). Common behavioral and psychosocial outcome variables examined are episodes of hypoglycemia (27 studies) and diabetic ketoacidosis (21 studies) and self-care behavior and generic quality of life (20 studies each). Several gaps in DSMES-related research studies are identified, including uneven geographical distribution of study population, methodological weaknesses in study designs, missing important outcome variables, use of nonstandardized assessment tools, and lack of assessment of the sustainability of effects. Conclusion The effects of DSMES interventions on clinical, behavioral, and psychosocial outcomes are varied. The heterogeneity of implementation and evaluation makes it difficult to draw clear conclusions about elements of DSMES that are most effective. There is a need for long-term assessment of the psychosocial and behavioral outcomes using validated and generalizable instruments.

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Positive Well-Being in Youth With Type 1 Diabetes During Early Adolescence

The Journal of Early Adolescence ◽

10.1177/0272431617692444 ◽

2017 ◽

Vol 38 (9) ◽

pp. 1215-1235 ◽

Cited By ~ 2

Author(s):

Dara M. Steinberg ◽

Barbara J. Anderson ◽

Maartje de Wit ◽

Marisa E. Hilliard

Keyword(s):

Type 1 Diabetes ◽

Depressive Symptoms ◽

Glycemic Control ◽

Early Adolescence ◽

Well Being ◽

Developmental Period ◽

Self Management ◽

Increased Risk ◽

Positive Experiences

Developmental shifts during early adolescence relate to type 1 diabetes (T1D) self-management, increased risk of emotional distress, and worsening health status. Less is known about positive experiences related to T1D. This study evaluated associations of positive well-being (PWB) with diabetes burden, self-management, and glycemic control. Youth ( N = 55, age = 12-13 years; [Formula: see text] age = 12.75 + 0.56 years, 50.9% male, 38.2% non-Caucasian) reported PWB, depressive symptoms, and diabetes burden. Parents reported on overall T1D adherence. Adherence behaviors and glycemic control were assessed objectively. Higher PWB correlated with lower depressive symptoms ( rs = −.45), less diabetes burden ( rs = −.48), and better glycemic control ( rs = −.43), all p < .01. When controlling for diabetes duration, higher PWB correlated with lower depressive symptoms and better glycemic control. PWB was not related to demographics or adherence. Initial exploration suggests PWB is related to key diabetes constructs, and maybe valuable to consider along with efforts to support youth with T1D during a vulnerable developmental period.

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State and Trait Anxiety and Diabetes Outcomes in Youth With Type 1 Diabetes

The Diabetes Educator ◽

10.1177/0145721719866146 ◽

2019 ◽

Vol 45 (5) ◽

pp. 477-483 ◽

Cited By ~ 1

Author(s):

Kaitlyn Rechenberg ◽

Laura Szalacha ◽

Alison Salloum ◽

Margaret Grey

Keyword(s):

Type 1 Diabetes ◽

Trait Anxiety ◽

State Anxiety ◽

Psychosocial Outcomes ◽

Anxiety Symptoms ◽

Self Management ◽

Lower State ◽

Diabetes Outcomes ◽

State And Trait Anxiety

Purpose The purpose of this exploratory pilot study was to examine the associations of state and trait anxiety with glycemic control, self-management, and diabetes-specific quality of life (QOL) in youth 10 to 16 years of age with type 1 diabetes (T1D). Methods Bivariate Pearson correlations and multiple linear regression modeling were conducted to examine the relationship among anxiety symptoms, hemoglobin A1C (A1C), self-management, QOL, and covariates. Results A sample of 67 adolescents was 50.7% female, and 87.1% were non-Hispanic white, with a mean ± SD age of 13.4 ± 1.85 years and an A1C of 8.3% ± 1.2% (67 mmol/mol). Higher state anxiety was correlated with older age. Better self-management was correlated with lower trait anxiety and lower state anxiety. Higher state and trait anxiety were associated with poorer self-management. Higher state anxiety was associated with higher A1C. Higher trait anxiety was associated with poorer diabetes-specific QOL. Conclusions State and trait anxiety may differentially affect diabetes outcomes. State anxiety may be a modifiable target for physiologic (A1C) and psychosocial (QOL) outcomes in youth with T1D, while trait anxiety may be a modifiable target for psychosocial outcomes (QOL). Anxiety symptoms should be assessed at regular clinic visits. Interventions to improve anxiety symptoms may in turn improve physiologic and psychosocial outcomes.

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Transfer in care and diabetes distress in young adults with type 1 diabetes mellitus

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2021-002603 ◽

2021 ◽

Vol 9 (2) ◽

pp. e002603

Author(s):

Jane Sattoe ◽

Mariëlle Peeters ◽

Madelon Bronner ◽

AnneLoes van Staa

Keyword(s):

Diabetes Mellitus ◽

Type 1 Diabetes ◽

Young Adults ◽

Type 1 Diabetes Mellitus ◽

Short Form ◽

Psychosocial Outcomes ◽

Self Management ◽

Diabetes Distress ◽

Adult Care

IntroductionDiabetes distress (DD) is a serious problem in many people with diabetes and is associated with unfavorable clinical and psychosocial outcomes in children and adults. Little is known about DD in young adults (YAs) with type 1 diabetes mellitus (T1DM) who transferred to adult care. This study aimed to explore the differences between YAs with/without DD regarding transfer experiences, self-management and health-related quality of life (HRQoL).Research design and methodsCross-sectional online questionnaire completed by YAs with T1DM after transfer. DD was measured with the short-form Problem Areas in Diabetes scale. Descriptive analyses were followed by t-tests and χ2 tests to explore differences between the groups with/without DD. Effect sizes were calculated.ResultsOf 164 respondents with mean age 22.7 (±1.56) years, 60.7% was female. The total sample scored low on DD (6.52±4.67; range: 0–17), but 57 (34.8%) had a score ≥8, indicating DD. YAs with DD felt less ready to transfer to adult care than those without DD and scored lower on alliance between pediatric and adult care and reception in adult care. They also reported poorer self-management skills and lower HRQoL in all domains of functioning.ConclusionsMore than one-third YAs experienced DD after transfer; this was associated with less favorable transition, self-management and psychosocial outcomes. Transfer in care seems to be a source of DD. Systematic screening on DD and attention for YAs’ worries is recommended in both pediatric and adult care.

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