Group engagement in parent-focused telehealth interventions for families of children with type 1 diabetes

2021 ◽  
pp. 1357633X2110670
Author(s):  
Alexandra D Monzon ◽  
Mark A Clements ◽  
Susana R Patton
Keyword(s):  
Type 1 Diabetes ◽  
Treatment Outcomes ◽  
Hemoglobin A1c ◽  
Well Being ◽  
Post Treatment ◽  
Diabetes Distress ◽  
Treatment Groups ◽  
Fear Of Hypoglycemia ◽  
Group Engagement

Introduction Group engagement is an important component of video-based telehealth interventions, yet this construct remains understudied. In the present study, we applied a multidimensional conceptualization of group engagement in two video-based telehealth interventions that either aimed to reduce fear of hypoglycemia or diabetes distress in parents of children with type 1 diabetes. We examined variability in group engagement across parents and assessed the relationship between parents’ level of group engagement and their treatment outcomes. Methods Twenty-nine parents participated in one of two manualized, closed-group, telehealth interventions and completed outcome measures pre- and post-treatment. We behaviorally coded telehealth sessions based on six dimensions of group engagement using the Group Engagement Measure (inter-rater reliability = 0.94). We examined correlations between group engagement dimensions, parent psychosocial well-being, and child hemoglobin A1c. Further, we examined independent sample t-tests to assess differences between treatment groups. Results Mean parent age was 37.69  ±  6.83 years, mean child age was 7.69  ±  3.76 years, and mean child hemoglobin A1c was 8.06  ±  1.27% (41.4% had a hemoglobin A1c <7.5%). Parents who spent more time attending to other group member's issues, reported lower hypoglycemia fear at post-treatment, and parents who showed more active support of the group leader's purpose/goals during the session also reported fewer depressive symptoms at post-treatment. Discussion We identify several dimensions of group engagement that are associate with improved parent psychosocial and child hemoglobin A1c outcomes. Intervention designs that use group engagement to guide treatment planning or inform treatment-related decisions in video-based telehealth interventions could help families achieve more optimal treatment outcomes.

scholarly journals Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic (Preprint)

2020 ◽  
Author(s):  
Alexandra Monzon ◽  
Nicole Kahhan ◽  
Arwen Marker ◽  
Susana Patton
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Diabetes Distress ◽  
Treatment Needs ◽  
Treatment Groups ◽  
Manualized Treatment ◽  
Fear Of Hypoglycemia ◽  
Psychosocial Concerns ◽  
P Type

UNSTRUCTURED Type 1 diabetes management can be challenging for children and their families. To address psychosocial concerns for parents of youth with type 1 diabetes, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early stages of the COVID-19 pandemic and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents’ treatment needs.

scholarly journals Challenges and Considerations for Reducing Diabetes Distress and Fear of Hypoglycemia in Parents of Youth With Type 1 Diabetes During the COVID-19 Pandemic

10.2196/25106 ◽  
2021 ◽  
Vol 4 (2) ◽  
pp. e25106
Author(s):  
Alexandra Monzon ◽  
Nicole Kahhan ◽  
Arwen Marker ◽  
Susana Patton
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Diabetes Distress ◽  
Treatment Needs ◽  
Treatment Groups ◽  
Manualized Treatment ◽  
Early Stages ◽  
Fear Of Hypoglycemia ◽  
Psychosocial Concerns

Type 1 diabetes management can be challenging for children and their families. To address psychosocial concerns for parents of youth with type 1 diabetes, we developed two parent-focused interventions to reduce their diabetes distress and fear of hypoglycemia. Our team conducted several of these interventions during the early stages of the COVID-19 pandemic and recognized a need to make timely adjustments to our interventions. In this viewpoint article, we describe our experience conducting these manualized treatment groups during the pandemic, the range of challenges and concerns specific to COVID-19 that parents expressed, and how we adjusted our approach to better address parents’ treatment needs.

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

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Minke M. A. Eilander ◽  
Frank J. Snoek ◽  
Joost Rotteveel ◽  
Henk-Jan Aanstoot ◽  
Willie M. Bakker-van Waarde ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Problem Behavior ◽  
Well Being ◽  
Diabetes Distress ◽  
Parental Distress ◽  
Family Behavior ◽  
Parental Diabetes ◽  
Design And Methods

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.

scholarly journals Cross-national comparison of psychosocial well-being and diabetes outcomes in adults with type 1 diabetes during the COVID-19 pandemic in US, Brazil, and Iran

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Samereh Abdoli ◽  
Monica S. V. M. Silveira ◽  
Mehri Doosti-Irani ◽  
Paulo Fanti ◽  
Katherine Miller-Bains ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Depressive Symptoms ◽  
Fixed Effects ◽  
Well Being ◽  
The United States ◽  
Survey Study ◽  
Diabetes Distress ◽  
Diabetes Outcomes ◽  
Cross National

Abstract Background The COVID-19 pandemic is a global public health emergency, which presents wide-ranging negative impacts on individuals with diabetes. To examine psychosocial well-being and diabetes outcomes in individuals with type 1 diabetes during the COVID-19 pandemic, and investigate how these factors vary in different countries. Methods Between April and June 2020 we employed a cross national comparative research study in the United States (US), Brazil, and Iran to collect data from 1788 adults with type 1 diabetes using web-based survey. Study participants answered questions relevant to diabetes distress, diabetes burnout, depressive symptoms, COVID-19 related changes, and socio-demographic characteristics. They also reported their last Hemoglobin A1c (HbA1c) and daily Time-in-Range (TiR) blood glucose. We analyzed data using comparative tests (Chi-square, Kruskal–Wallis and McNemar test), logistic and linear regression adjusted for fixed effects. Results There were significant changes prior and during the pandemic regarding access to diabetes care, diabetes supplies and medications, healthy food and safe places to exercise in all countries (p < 0.05). Participants in Iran experienced higher levels of diabetes distress (57.1%), diabetes burnout (50%), and depressive symptoms (60.9%), followed by Brazil and US (p < 0.0001). US participants reported better glycemic control (HbA1c = 6.97%, T1R = 69.64%) compared to Brazil (HbA1c = 7.94%, T1R = 51.95%) and Iran (HbA1c = 7.47%, T1R = 51.53%) (p < 0.0001). There were also significant relationships between psychosocial well-being, diabetes outcomes, socio-demographic data, and COVID-19 related challenges in overall sample (p < 0.05). Conclusions Regardless of differences among US, Brazil, and Iran, our findings revealed that different countries may experience similar challenges related to the COVID-19 pandemic which can impact negatively diabetes outcomes and psychosocial well-being in individuals with type 1 diabetes. Countries need to consider modifiable variables associated with poor diabetes outcomes and sub optimal psychosocial well-being and target vulnerable population using significant socio-demographic variables.

scholarly journals Sustained Intensive treatment and Long-term Effects on HbA1c Reduction (SILVER Study) by CGM in persons with type 1 diabetes treated with MDI

2020 ◽  
Author(s):  
Marcus Lind ◽  
Arndís F. Ólafsdóttir ◽  
Irl B. Hirsch ◽  
Jan Bolinder ◽  
Sofia Dahlqvist ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Treatment Satisfaction ◽  
Glucose Monitoring ◽  
Well Being ◽  
Diabetes Distress ◽  
Control Treatment ◽  
Long Term Effects ◽  
Self Monitoring

Objective: Continuous Glucose Monitoring (CGM) reduces HbA1c and time spent in hypoglycemia in persons with type 1 diabetes treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns and overall well-being over longer periods of time <p><br> Research design and methods: The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in persons with type 1 diabetes treated with MDI. Persons completing the trial (n=141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months. <br> <br> </p> <p>Results: The primary endpoint, change in HbA1c over 1.0-1.5 years CGM use compared with previous self-monitoring of blood glucose (SMBG) during GOLD, showed a decrease in HbA1c of 0.35% (95% CI 0.19-0.50), p<0.001. Time spent in hypoglycemia <3.0 mmol/l (54 mg/dl) and <4.0 mmol/l (72 mg/dl) decreased from 2.1% to 0.6% (p<0.001) and from 5.4% to 2.9% (p<0.001), respectively. Overall well-being (WHO-5, p=0.009), treatment satisfaction (DTSQ, p<0.001) and hypoglycemic confidence (p<0.001) increased, while hypoglycemic fear (HFS-Worry, p=0.016) decreased and diabetes distress tended to decrease (PAID, p=0.06). From randomization and screening in GOLD, HbA1c was lowered by 0.45% (p<0.001) and 0.68% (p<0.001) after 2.3 and 2.5 years, respectively. <br> <br> Conclusions: The SILVER study supports beneficial long-term effects from CGM on HbA1c, hypoglycemia, treatment satisfaction, well-being and hypoglycemic confidence in persons with T1D managed with MDI. </p>

scholarly journals Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes

2020 ◽  
Vol 45 (5) ◽  
pp. 488-497
Author(s):  
Molly L Tanenbaum ◽  
Rebecca N Adams ◽  
Jessie J Wong ◽  
Korey K Hood
Keyword(s):  
Type 1 Diabetes ◽  
Construct Validity ◽  
Insulin Pump ◽  
Well Being ◽  
Diabetes Distress ◽  
General Factor ◽  
Good Reliability ◽  
Self Compassion ◽  
Compassion Scale

Abstract Objective Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D. Methods We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2–18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c. Results A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52–.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = −.68, p &lt; .001) and greater empowerment (r = .43, p &lt; .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28). Conclusions Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.

scholarly journals Sustained Intensive treatment and Long-term Effects on HbA1c Reduction (SILVER Study) by CGM in persons with type 1 diabetes treated with MDI

2020 ◽  
Author(s):  
Marcus Lind ◽  
Arndís F. Ólafsdóttir ◽  
Irl B. Hirsch ◽  
Jan Bolinder ◽  
Sofia Dahlqvist ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Treatment Satisfaction ◽  
Glucose Monitoring ◽  
Well Being ◽  
Diabetes Distress ◽  
Control Treatment ◽  
Long Term Effects ◽  
Self Monitoring

Objective: Continuous Glucose Monitoring (CGM) reduces HbA1c and time spent in hypoglycemia in persons with type 1 diabetes treated with multiple daily insulin injections (MDI) when evaluated over shorter time periods. It is unclear to what extent CGM improves and helps to maintain glucose control, treatment satisfaction, diabetes distress, hypoglycemic concerns and overall well-being over longer periods of time <p><br> Research design and methods: The GOLD trial was a randomized crossover trial performed over 16 months of CGM treatment in persons with type 1 diabetes treated with MDI. Persons completing the trial (n=141) were invited to participate in the current SILVER extension study in which 107 patients continued CGM treatment over 1 year along with the support of a diabetes nurse every 3 months. <br> <br> </p> <p>Results: The primary endpoint, change in HbA1c over 1.0-1.5 years CGM use compared with previous self-monitoring of blood glucose (SMBG) during GOLD, showed a decrease in HbA1c of 0.35% (95% CI 0.19-0.50), p<0.001. Time spent in hypoglycemia <3.0 mmol/l (54 mg/dl) and <4.0 mmol/l (72 mg/dl) decreased from 2.1% to 0.6% (p<0.001) and from 5.4% to 2.9% (p<0.001), respectively. Overall well-being (WHO-5, p=0.009), treatment satisfaction (DTSQ, p<0.001) and hypoglycemic confidence (p<0.001) increased, while hypoglycemic fear (HFS-Worry, p=0.016) decreased and diabetes distress tended to decrease (PAID, p=0.06). From randomization and screening in GOLD, HbA1c was lowered by 0.45% (p<0.001) and 0.68% (p<0.001) after 2.3 and 2.5 years, respectively. <br> <br> Conclusions: The SILVER study supports beneficial long-term effects from CGM on HbA1c, hypoglycemia, treatment satisfaction, well-being and hypoglycemic confidence in persons with T1D managed with MDI. </p>

Fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes

2016 ◽  
Vol 24 (2) ◽  
pp. 209-218 ◽  
Author(s):  
Tanja Pate ◽  
Simona Klemenčič ◽  
Tadej Battelino ◽  
Nataša Bratina
Keyword(s):  
Type 1 Diabetes ◽  
Children And Adolescents ◽  
Diabetes Management ◽  
Severe Hypoglycemia ◽  
Well Being ◽  
Subjective Well Being ◽  
Paired Samples ◽  
Fear Of Hypoglycemia ◽  
Fear And Anxiety

This study explored the association between parental fear of hypoglycemia, anxiety, and subjective well-being in parents of children and adolescents with type 1 diabetes. A total of 120 mothers and 79 fathers participated. Mothers’ and fathers’ fear of hypoglycemia was significantly associated with anxiety and negative affect as well as with worse glycemic control in child. Paired-samples t-test showed that mothers were more involved in diabetes management and reported more fear and anxiety compared to fathers, but they did not differ in worries about hypoglycemia. The findings suggest screening for fear of hypoglycemia and subjective well-being in all parents regardless of whether their child experienced severe hypoglycemia.

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