An analysis of the relationships between peer support and diabetes outcomes in adolescents with type 1 diabetes

This study explores the relationships between the various subtypes of global and diabetes-specific peer support and health outcomes in adolescents with type 1 diabetes. Global peer support significantly predicted self-care and glycated haemoglobin, although no associations were identified for diabetes-specific support overall, nor its factors. When comparing participants with above or below average glycaemic control, significantly greater diabetes-specific support was reported in those with poorer control. It is suggested that this may be related to feelings of nagging, in which diabetes-specific support is perceived as harassment.

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Factors associated with high levels of glycated haemoglobin in patients with type 1 diabetes: a multicentre study in Brazil

BMJ Open ◽

10.1136/bmjopen-2017-018094 ◽

2017 ◽

Vol 7 (12) ◽

pp. e018094 ◽

Cited By ~ 13

Author(s):

Carine Sousa Andrade ◽

Guilherme Sousa Ribeiro ◽

Carlos Antonio Souza Teles Santos ◽

Raimundo Celestino Silva Neves ◽

Edson Duarte Moreira

Keyword(s):

Type 1 Diabetes ◽

Glycaemic Control ◽

Hba1c Level ◽

Glycated Haemoglobin ◽

Poor Adherence ◽

Adherence To Diet ◽

The Mean ◽

Lower Education ◽

Hba1c Levels

ObjectiveLong-term complications of type 1 diabetes mellitus (DM1) can be prevented with adequate glycaemic control. However, high levels of glycated haemoglobin (HbA1c) occur in 60%–90% of the patients with DM1. Thus, we aimed to investigate the role of sociodemographic, behavioural and clinical factors on the HbA1c levels of patients with DM1 in Brazil.Design, setting and participantsA cross-sectional study was conducted in ambulatory patients with DM1 aged ≥18 years from 10 Brazilian cities. Sociodemographic, behavioural and clinical data were obtained through interviews.Main outcome measuresHbA1c level was measured by liquid chromatography. Hierarchical multiple variable linear regression models were used to identify factors correlated with high levels of HbA1c.ResultsOf 979 patients with DM1, 63.8% were women, and the mean age was 40 (SD 14.6) years. The mean HbA1c level was 9.4% (SD 2.2%), and 89.6% of the patients had HbA1c ≥7.0%. Factors independently correlated with increased HbA1c levels included: lower education, non-participation in diabetes classes/lecture during the year before, having a self-perception of poor adherence to diet and insulin, not having private medical care and not measuring the HbA1c levels in the prior year. Of note, poor adherence to diet and insulin were the independent factors most strongly associated with high levels of HbA1c (mean increment in HbA1c levels of 0.88% and 1.25%, respectively).ConclusionPoor glycaemic control, which is common among Brazilian patients with DM1, is associated with lower education, self-perception of insufficient adherence to diet and insulin and inadequate monitoring of HbA1c levels. Specific actions, particularly those targeting improving adherence to diet and insulin, may contribute to successful management of patients with DM1.

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Effectiveness of quality improvement strategies for type 1 diabetes in children and adolescents: a systematic review protocol

HRB Open Research ◽

10.12688/hrbopenres.13223.1 ◽

2021 ◽

Vol 4 ◽

pp. 87

Author(s):

Paul M Ryan ◽

Michael Zahradnik ◽

Kristin J Konnyu ◽

Tamara Rader ◽

Michael Halasy ◽

...

Keyword(s):

Type 1 Diabetes ◽

Quality Improvement ◽

Glycaemic Control ◽

Quality Assessment ◽

Children And Adolescents ◽

Care Delivery ◽

Data Extraction ◽

Meta Analysis ◽

Glycated Haemoglobin

Introduction: Optimal glycaemic control is often a challenge in children and adolescents with type 1 diabetes (T1D). Implementation of patient, clinician or organisation-targeted quality improvement (QI) strategies has been proven to be beneficial in terms of improving glycaemic outcomes in adults living with diabetes. This review aims to assess the effectiveness of such QI interventions in improving glycaemic control, care delivery, and screening rates in children and adolescents with T1D. Methods and analysis: MEDLINE, EMBASE, CINAHL and Cochrane CENTRAL databases will be searched for relevant studies up to January 2021. Trial registries, ClinicalTrials.gov and ICTRP, will also be explored for any ongoing trials of relevance. We will include trials which examine QI strategies as defined by a modified version of the Cochrane Effective Practice and Organisation of Care 2015 Taxonomy in children (<18 years) with a diagnosis of T1D. The primary outcome to be assessed is glycated haemoglobin (HbA1c), although a range of secondary outcomes relating to clinical management, adverse events, healthcare engagement, screening rates and psychosocial parameters will also be assessed. Our primary intention is to generate a best-evidence narrative to summarise and synthesise the resulting studies. If a group of studies are deemed to be highly similar, then a meta-analysis using a random effects model will be considered. Cochrane Risk of Bias 1.0 tool will be applied for quality assessment. All screening, data extraction and quality assessment will be performed by two independent researchers. Dissemination: The results of this review will be disseminated through peer-reviewed publication in order to inform invested partners (e.g., Paediatric Endocrinologists) on the potential of QI strategies to improve glycaemic management and other related health outcomes in children with T1D, thereby guiding best practices in the outpatient management of the disorder. PROSPERO registration number: CRD42021233974 (28/02/2021).

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Cognitive behavioural therapy stabilises glycaemic control in adolescents with type 1 diabetes-Outcomes from a randomised control trial

Pediatric Diabetes ◽

10.1111/pedi.12519 ◽

2017 ◽

Vol 19 (1) ◽

pp. 106-113 ◽

Cited By ~ 2

Author(s):

Christina Wei ◽

Ruth J Allen ◽

Patricia M Tallis ◽

Fiona J Ryan ◽

Linda P Hunt ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycaemic Control ◽

Cognitive Behavioural Therapy ◽

Behavioural Therapy ◽

Randomised Control Trial ◽

Diabetes Outcomes ◽

Cognitive Behavioural

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Diabetes stigma and its association with diabetes outcomes: a cross-sectional study of adults with type 1 diabetes

Scandinavian Journal of Public Health ◽

10.1177/1403494819862941 ◽

2020 ◽

Vol 48 (8) ◽

pp. 855-861

Author(s):

Ulla Møller Hansen ◽

Kasper Olesen ◽

Ingrid Willaing

Keyword(s):

Type 1 Diabetes ◽

Glycaemic Control ◽

Diabetes Duration ◽

Diabetes Distress ◽

Psychosocial Burden ◽

Cross Sectional ◽

Diabetes Outcomes ◽

Clinical Records ◽

The Relationship

Aims: The aim of this study was to investigate the relationship between diabetes stigma as experienced by adults with type 1 diabetes and diabetes outcomes using the novel, validated measure of the Type 1 Diabetes Stigma Assessment Scale. Methods: A total of 1594 adults with type 1 diabetes completed a questionnaire on socio-economic factors, psychosocial health, and diabetes stigma and these self-reported data were linked with data from electronic clinical records on glycaemic control, diabetes duration, age, and diabetes-related complications. Bivariate analyses and multivariate linear regressions were performed to assess the relationship between diabetes stigma as measured by three subscales, Identity concern, Blame and judgement, and Treated differently on the one hand, and patient characteristics and diabetes outcomes on the other. Results: Endorsement of the stigma statements ranged from 3.6–78.3% of respondents. Higher stigma scores in relation to Identity concern and Blame and judgement were significantly associated with being female, of lower age, lower diabetes duration, and having at least one complication. Those who reported higher levels of perceived stigma reported significantly higher levels of diabetes distress (β = 0.37 (95% CI: 0.33–0.40), 0.35 (95% CI: 0.30–0.39), 0.41 (95% CI: 0.35–0.46)), and HbA1c levels (β = 0.11 (95% CI: 0.02–0.21), 0.28 (95% CI: 0.16–0.40), 0.26 (95% CI: 0.14–0.42) for Identity concern, Blame and judgement, and Treated differently, respectively). Conclusions: The findings demonstrated that diabetes stigma is negatively associated with both diabetes distress and glycaemic control and should be considered part of the psychosocial burden of adults with type 1 diabetes.

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Hypomagnesemia in persons with type 1 diabetes: associations with clinical parameters and oxidative stress

Therapeutic Advances in Endocrinology and Metabolism ◽

10.1177/2042018820980240 ◽

2020 ◽

Vol 11 ◽

pp. 204201882098024

Author(s):

Peter R. van Dijk ◽

F. Waanders ◽

Jiedong Qiu ◽

Hannah H. R. de Boer ◽

H. van Goor ◽

...

Keyword(s):

Oxidative Stress ◽

Type 1 Diabetes ◽

Glycaemic Control ◽

Multivariable Analysis ◽

Glycated Haemoglobin ◽

Routine Care ◽

Magnesium Concentration ◽

Relevant Topic ◽

And Oxidative Stress

Background: Among persons with type 1 diabetes mellitus (T1DM) low concentrations of magnesium have been reported. Previous (small) studies also suggested a relation of hypomagnesemia with (poor) glycaemic control and complications. We aimed to investigate the magnitude of hypomagnesemia and the associations between magnesium with parameters of routine T1DM care in a population of unselected outpatients. Methods: As part of a prospective cohort study, initially designed to measure quality of life and oxidative stress, data from 207 patients with a mean age of 45 [standard deviation (SD) 12] years, 58% male, diabetes duration 22 [interquartile range (IQR) 16, 31] years and glycated haemoglobin (HbA1c) of 60 (SD 11) mmol/mol [7.6 (SD 1.0)%] were examined. Hypomagnesemia was defined as a concentration below <0.7 mmol/l. Results: Mean magnesium concentration was 0.78 (SD 0.05) mmol/l. A deficiency was present in 4.3% of participants. Among these persons, mean concentration was 0.66 (SD 0.03) mmol/l. There was no correlation between magnesium and HbA1c at baseline ( r = –0.014, p = 0.843). In multivariable analysis, free thiols (reflecting the degree of oxidative stress) were significantly and negatively associated with magnesium concentrations. Conclusion: In this cohort of T1DM outpatients, the presence of hypomagnesemia was infrequent and, if present, relative mild. Magnesium was not associated with glycaemic control nor with presence of micro- and macrovascular complications. Although these results need confirmation, in particular the negative association of magnesium with free thiols, this suggests that hypomagnesemia is not a relevant topic in routine care for people with T1DM.

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A systematic review of parent/peer-based group interventions for adolescents with type 1 diabetes: interventions based on theoretical/therapeutic frameworks

British Journal of Diabetes ◽

10.15277/bjd.2018.177 ◽

2018 ◽

Vol 18 (2) ◽

pp. 51-65

Author(s):

Kalsoom Akhter ◽

Triece Turnbull ◽

David Simmons

Keyword(s):

Systematic Review ◽

Type 1 Diabetes ◽

Glycaemic Control ◽

Systematic Reviews ◽

Diabetes Management ◽

Self Care ◽

Effect Sizes ◽

Cochrane Library ◽

The Impact

Objective: Although interventions which provide psychosocial support can have a positive impact on diabetes self-care, the impact of family/peer- and theory-based interventions has not yet been clearly identified. This systematic review investigates the randomised controlled trials (RCTs) employing family/peer-based interventions (based on theoretical/ therapeutic frameworks) which aim to improve adolescents’ glycaemic control, psychosocial and/or behavioural functioning.Methods: The Cochrane Library, database of systematic reviews, database of abstracts of reviews of effectiveness and Health Technology Assessment database were searched (from start date until February 2016) for any previously conducted systematic reviews. Seventeen RCTs/interventions were included. The literature was also identified by contacting the leading researchers. Glycaemic control was measured by HbA1c and psychosocial functioning by measures of self-care, knowledge and communication, collaboration/teamwork, quality of life, problem solving, social functioning and family functioning. Only those interventions which reported the use of theories/therapies to manage type 1 diabetes and other psychosocial issues among adolescents (aged 12–17) were included in the present review. Data summarising the key features of the interventions was extracted from each article. Where possible, the effect sizes were calculated.Results: The effect sizes could be computed for HbA1c in six of the 17 interventions. The overall outcomes indicated that interventions including parents have a small to large effect size on a variety of diabetes management and psychosocial outcomes. This review identified interventions, mostly including parents and rarely including peers.Conclusion: The results of this systematic review demonstrate that multicomponent interventions may be more successful for adolescents than ones that just focus on one aspect. Effectiveness is also greater if they demonstrate inter-relatedness with the various aspects of diabetes management. Short-term behavioural approach-based interventions promote improvements in parent/adolescent relationships. Outreach home-based interventions could be a more accessible alternative for intervening with families than office/hospital-based interventions. This approach may also be more acceptable to adolescents and their families. There is a need to develop evaluated interventions for adolescents involving parents. Development should involve stakeholders (ie, adolescents, their families and healthcare professionals) to co-design potentially cost-effective and feasible interventions in the context of NHS diabetes services.

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