Parental Diabetes Behaviors and Distress Are Related to Glycemic Control in Youth with Type 1 Diabetes: Longitudinal Data from the DINO Study

Objective. To evaluate (1) the longitudinal relationship between parental well-being and glycemic control in youth with type 1 diabetes and (2) if youth’s problem behavior, diabetes parenting behavior, and parental diabetes-distress influence this relationship. Research Design and Methods. Parents of youth 8–15 yrs (at baseline) (N=174) participating in the DINO study completed questionnaires at three time waves (1 yr interval). Using generalized estimating equations, the relationship between parental well-being (WHO-5) and youth’s HbA1c was examined. Second, relationships between WHO-5, Strength and Difficulties Questionnaire (SDQ), Diabetes Family Behavior Checklist (DFBC), Problem Areas In Diabetes-Parent Revised (PAID-Pr) scores, and HbA1c were analyzed. Results. Low well-being was reported by 32% of parents. No relationship was found between parents’ WHO-5 scores and youth’s HbA1c (β=−0.052, p=0.650). WHO-5 related to SDQ (β=−0.219, p<0.01), DFBC unsupportive scale (β=−0.174, p<0.01), and PAID-Pr (β=−0.666, p<0.01). Both DFBC scales (supportive β=−0.259, p=0.01; unsupportive β=0.383, p=0.017), PAID-Pr (β=0.276, p<0.01), and SDQ (β=0.424, p<0.01) related to HbA1c. Conclusions. Over time, reduced parental well-being relates to increased problem behavior in youth, unsupportive parenting, and parental distress, which negatively associate with HbA1c. More unsupportive diabetes parenting and distress relate to youth’s problem behavior.

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Increased stress, weight gain and less exercise in relation to glycemic control in people with type 1 and type 2 diabetes during the COVID-19 pandemic

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-002035 ◽

2021 ◽

Vol 9 (1) ◽

pp. e002035

Author(s):

Merel M Ruissen ◽

Hannah Regeer ◽

Cyril P Landstra ◽

Marielle Schroijen ◽

Ingrid Jazet ◽

...

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Weight Gain ◽

Glycemic Control ◽

Perceived Stress ◽

Medical Center ◽

Short Term ◽

Design And Methods

IntroductionLockdown measures have a profound effect on many aspects of daily life relevant for diabetes self-management. We assessed whether lockdown measures, in the context of the COVID-19 pandemic, differentially affect perceived stress, body weight, exercise and related this to glycemic control in people with type 1 and type 2 diabetes.Research design and methodsWe performed a short-term observational cohort study at the Leiden University Medical Center. People with type 1 and type 2 diabetes ≥18 years were eligible to participate. Participants filled out online questionnaires, sent in blood for hemoglobin A1c (HbA1c) analysis and shared data of their flash or continuous glucose sensors. HbA1c during the lockdown was compared with the last known HbA1c before the lockdown.ResultsIn total, 435 people were included (type 1 diabetes n=280, type 2 diabetes n=155). An increase in perceived stress and anxiety, weight gain and less exercise was observed in both groups. There was improvement in glycemic control in the group with the highest HbA1c tertile (type 1 diabetes: −0.39% (−4.3 mmol/mol) (p<0.0001 and type 2 diabetes: −0.62% (−6.8 mmol/mol) (p=0.0036). Perceived stress was associated with difficulty with glycemic control (p<0.0001).ConclusionsAn increase in perceived stress and anxiety, weight gain and less exercise but no deterioration of glycemic control occurs in both people with relatively well-controlled type 1 and type 2 diabetes during short-term lockdown measures. As perceived stress showed to be associated with glycemic control, this provides opportunities for healthcare professionals to put more emphasis on psychological aspects during diabetes care consultations.

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Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0153 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Maria Cusinato ◽

Mariangela Martino ◽

Alex Sartori ◽

Claudia Gabrielli ◽

Laura Tassara ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Psychological Impact ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Well Being ◽

Glucose Variability ◽

Threshold Score ◽

The Impact

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

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Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates

Pediatric Diabetes ◽

10.1111/pedi.13204 ◽

2021 ◽

Author(s):

Zeina M. H. Younes ◽

Alaa M. Abuali ◽

Shadi Tabba ◽

Muhammad H. Farooqi ◽

Ahmed A. K. Hassoun

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

United Arab Emirates ◽

Diabetes Distress

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Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001934 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001934

Author(s):

Anne M Doherty ◽

Anne Herrmann-Werner ◽

Arann Rowe ◽

Jennie Brown ◽

Scott Weich ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Real Time ◽

Instant Messaging ◽

Controlled Trial ◽

Self Management ◽

Diabetes Distress ◽

The Mean ◽

Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

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Families with pediatric type 1 diabetes: A comparison with the general population on child well‐being, parental distress, and parenting behavior

Pediatric Diabetes ◽

10.1111/pedi.12942 ◽

2019 ◽

Vol 21 (2) ◽

pp. 395-408 ◽

Cited By ~ 2

Author(s):

Cynthia Van Gampelaere ◽

Koen Luyckx ◽

Saskia Straaten ◽

Jolien Laridaen ◽

Eveline R. Goethals ◽

...

Keyword(s):

Type 1 Diabetes ◽

General Population ◽

Well Being ◽

Parenting Behavior ◽

Parental Distress ◽

Pediatric Type 1 Diabetes

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Diabetes Distress, Intentional Hyperglycemia at Work, and Glycemic Control Among Workers With Type 1 Diabetes

Diabetes Care ◽

10.2337/dc18-1426 ◽

2019 ◽

Vol 42 (5) ◽

pp. 797-803 ◽

Cited By ~ 5

Author(s):

Ulla M. Hansen ◽

Timothy Skinner ◽

Kasper Olesen ◽

Ingrid Willaing

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Diabetes Distress

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Covid Lockdown Impact on Type 1 Diabetes Health and Well-Being

Journal of the Endocrine Society ◽

10.1210/jendso/bvab048.689 ◽

2021 ◽

Vol 5 (Supplement_1) ◽

pp. A338-A338

Author(s):

Jamie Calma ◽

Sabrina Sangha ◽

Marina Basina

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Diabetes Management ◽

Healthcare Delivery ◽

Severe Depression ◽

Well Being ◽

Depression Symptoms ◽

Published Data ◽

The Impact

Abstract Introduction: Data on the impact of the COVID-19 lockdown on glycemic control and psychological well-being in individuals with Type 1 Diabetes Mellitus (T1DM) showed mixed results. Some studies showed improvement in glycemic control attributed to more time for self-care and a more regular lifestyle schedule during the lockdown. However, most published data reflects a short duration of 3–5 months. The impact of long-term social isolation and transition to telemedicine on the health of T1DM patients remains unknown. Our study analyzes patient perception surrounding the impact of an 11-month lockdown on glycemic control, well-being, and self-reported depression symptoms. Methods: PHQ-9 was integrated into a 55-question survey created using RedCap, a secure portal for managing surveys. The survey was sent to 160 T1DM patients over the age of 18 to gauge their current diabetes management and overall well-being prior to, and during the pandemic. The survey also inquired about patients’ perceived effectiveness of telemedicine visits. PHQ9 scores were collected and analyzed along with survey responses. Results: Data collection is still ongoing. From the 47 responders, the PHQ9 screening showed 51% were in the minimal depression score, 34% in the range of mild depression, 11% in moderate depression, and 4% scored in moderate to severe depression. No patients scored within severe depression. In a regular week during the pandemic, 40% of patients experienced difficulty with their motivation and diabetes management and 60% reported no concern, as compared to 36% and 64% respectively before the pandemic. Among the 47 of patient respondents, 30 reported both A1c levels prior and during the pandemic of which 46% showed an improved A1c amid the pandemic, 10% had no change, and 44% reported a worsened A1c level. For the telehealth part of the survey, 90% of patients reported feeling “comfortable with the level of care” they receive via telemedicine, whereas the other 10% were not. Whilst 54% of patients preferred in-person visits and 46% indicated a preference for telehealth visits. Conclusion: T1DM management is challenging. The pandemic adds to the complexity and burden to both self-management and healthcare delivery. Staying locked down for a prolonged period of time imposes economical, psychological, and medical constraints to diabetes care, as nearly half of the patients reported worsening of glycemic control. Our comprehensive survey reports the longest duration reported up to date of how the COVID-19 lockdown impacts patient’s perceived changes in their mental health and diabetes management. It helps clinicians understand the connection between mental and physical health during the pandemic and improve time-restricted telehealth visits by understanding patient concerns. Additional larger scale studies are imperative to expand the knowledge in this field.

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Different Effects of Structured Education on Glycemic Control and Psychological Outcomes in Adolescent and Adult Patients with Type 1 Diabetes: A Systematic Review and Meta-Analysis

International Journal of Endocrinology ◽

10.1155/2020/9796019 ◽

2020 ◽

Vol 2020 ◽

pp. 1-13

Author(s):

Fang Liu ◽

Yuzhu Guan ◽

Xia Li ◽

Yuting Xie ◽

Jing He ◽

...

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Glycemic Control ◽

Glycosylated Hemoglobin ◽

Well Being ◽

Psychological Outcomes ◽

Adult Patients ◽

Cochrane Library ◽

Structured Education

Aim. This systematic review aimed at investigating the effectiveness of structured education (SE) in improving glycemic control and psychological outcomes in adolescent and adult patients with type 1 diabetes. Methods. Electronic databases (EMBASE, Medline, PubMed, and the Cochrane Library) and the reference lists of included studies were searched from the beginning of the database through April 2019. Randomized controlled trials comparing SE with a control condition and reporting a change in glycosylated hemoglobin (HbA1c) level were included. The primary outcome was glycemic control measured by HbA1c. Secondary outcomes were diabetes-related distress, well-being, depression, and quality of life. Results. Eighteen studies representing 2759 patients were included. Twelve studies targeted adolescents and six targeted adults. Adolescent patients who were randomized to the intervention group did not show significant improvement of HbA1c in the short (SMD = −0.04; 95% CI: −0.14 to 0.06; P=0.41), medium (SMD = −0.03; 95% CI: −0.13 to 0.07; P=0.55), and long term (SMD = 0.04; 95% CI: −0.16 to 0.25; P=0.66) or of diabetes self-efficacy (SMD = −0.17; 95% CI: −0.33 to 0.00; overall effect P=0.05). However, SE was effective in reducing HbA1c levels in adult patients with inadequate baseline control (HbA1c higher than 7.5%) (SMD = −0.52; 95% CI: −0.86 to −0.17; P=0.003). SE significantly improved the well-being and psychological distress of adult patients but had no effect on the extent of depression. Conclusions. Development of more efficient SE programs according to the patients’ personal characteristics is needed.

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