scholarly journals A Time-Friendly, Feasible Measure of Nutrition Knowledge in Type 1 Diabetes: The Electronic Nutrition and Carbohydrate Counting Quiz (eNCQ)

2018 ◽  
Vol 13 (1) ◽  
pp. 68-74
Author(s):  
Arwen M. Marker ◽  
Amy E. Noser ◽  
Nicole Knecht ◽  
Mark A. Clements ◽  
Susana R. Patton
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Nutrition Education ◽  
Diabetes Management ◽  
Clinical Care ◽  
Nutrition Knowledge ◽  
Diabetes Diagnosis ◽  
Carbohydrate Counting ◽  
One Year

Background: Greater knowledge about nutrition and carbohydrate counting are associated with improved glycemic control and quality of life in youth with type 1 diabetes (T1D). However, limited assessments of nutrition and carbohydrate knowledge have been developed, and existing measures can be time-consuming, overly broad, or not conducive to routine clinical use. To fill this gap, we developed and examined the feasibility of administering the electronic Nutrition and Carbohydrate Counting Quiz (eNCQ). Method: Ninety-two caregivers and 70 youth with T1D (mean age 12.5 years; mean time since diagnosis 5 years; English speaking) completed the 19-item eNCQ via tablet during a routine clinical visit. Completion time and item completion rates were used to assess feasibility. Relationships between eNCQ scores and patient demographics, diabetes management, and health outcomes were examined. Results: Participants took 10 minutes, on average, to complete the eNCQ. Total and Carbohydrate subscale scores (youth report) were negatively correlated with youth hemoglobin A1c (total r = –.38, carbohydrate r = –.38, Ps < .05), indicating that greater nutrition knowledge related to better glycemic control. Nutrition knowledge scores were generally high, but knowledge was negatively related to time since diabetes diagnosis ( r = –.276, P < .05). Conclusions: Findings support feasibility of the eNCQ to assess nutrition knowledge in routine clinical care. Following additional acceptability and validity testing, the eNCQ may identify families in need of further nutrition education. Nutrition assessment is particularly indicated for youth over one year since T1D diagnosis, as these families displayed lower nutrition knowledge and may need continuing education to maintain diabetes-specific nutrition knowledge over time.

scholarly journals Stigma and Its Association With Glycemic Control and Hypoglycemia in Adolescents and Young Adults With Type 1 Diabetes: Cross-Sectional Study (Preprint)

2017 ◽  
Author(s):  
Anne-Sophie Brazeau ◽  
Meranda Nakhla ◽  
Michael Wright ◽  
Mélanie Henderson ◽  
Constadina Panagiotopoulos ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Diabetes Management ◽  
Severe Hypoglycemia ◽  
Poor Glycemic Control ◽  
Self Report ◽  
Diabetes Diagnosis ◽  
Hypoglycemic Episode ◽  
Cross Sectional

BACKGROUND Qualitative studies in type 1 diabetes indicate that visibility of diabetes supplies, self-care, and hypoglycemia symptoms are associated with stigma and suboptimal management. This may be particularly salient in youth who face concurrent challenges such as establishing autonomy and making vocational choices. OBJECTIVE The aim of the study was to estimate stigma prevalence in youth (aged 14-24 years) with type 1 diabetes and its associations with glycemic control. METHODS Participants, recruited largely through social media, were asked to complete a Web-based survey and to send via mail capillary blood samples for glycated hemoglobin (HbA1c) measurement. The primary definition of stigma required endorsement of one or more of 3 stigma-specific items of the Barriers to Diabetes Adherence questionnaire. These addressed avoidance of diabetes management with friends present, difficulty telling others about diabetes diagnosis, and embarrassment in performing diabetes care with others present. Poor glycemic control was defined as HbA1c>9% (ie, >75 mmol/mol; measured value when available, else self-report) and/or ≥1 severe hypoglycemic episode in the previous year (reported requiring assistance from someone else during the episode). Stigma prevalence was computed (95% CI), and associations with glycemic control were evaluated (multivariate logistic regression models). RESULTS Among the 380 respondents, stigma prevalence was 65.5% (95% CI 60.7-70.3). Stigma was associated with a 2-fold higher odds of poor glycemic control overall (odds ratio [OR] 2.25, 95% CI 1.33-3.80; adjusted for age, sex, and type of treatment). There were specific associations with both HbA1c>9% (75 mmol/mol; OR 3.05, 95% CI 1.36-6.86) and severe hypoglycemia in the previous year (OR 1.86, 95% CI 1.05-3.31). CONCLUSIONS There is a high prevalence of stigma in youth with type 1 diabetes that is associated with both elevated HbA1c levels and severe hypoglycemia. Targeted strategies to address stigma are needed. CLINICALTRIAL ClinicalTrials.gov NCT02796248; http://clinicaltrials.gov/ct2/show/NCT02796248 (Archived by WebCite at http://www.webcitation.org/6yisxeV0B)

scholarly journals Type 1 Diabetes Management With Technology: Patterns of Utilization and Effects on Glucose Control Using Real-World Evidence

2021 ◽  
Author(s):  
Ran Sun ◽  
Imon Banerjee ◽  
Shengtian Sang ◽  
Jennifer Joseph ◽  
Jennifer Schneider ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Language Processing ◽  
Diabetes Management ◽  
Clinical Care ◽  
Glucose Monitoring ◽  
Diabetes Diagnosis ◽  
Cohort Identification ◽  
Patterns Of Utilization ◽  
Device Use

<b>Key Points</b> <p>· About one-third of patients with type 1 diabetes were found to use continuous glucose monitoring (CGM) and/or continuous subcutaneous insulin infusion (CSII) in routine clinical care.</p> <p>· Disparities exist in CGM and CSII adoption, with device use more common in patients of higher socioeconomic status.</p> <p>· Mining clinical narratives with natural language processing techniques can be applied successfully for medical device surveillance and cohort identification for observational studies.</p> <p>· CGM use in conjunction with CSII after type 1 diabetes diagnosis is more effective than other therapy regimens and may translate to improved long-term glycemic control. </p>

scholarly journals Type 1 Diabetes Management With Technology: Patterns of Utilization and Effects on Glucose Control Using Real-World Evidence

2021 ◽  
Author(s):  
Ran Sun ◽  
Imon Banerjee ◽  
Shengtian Sang ◽  
Jennifer Joseph ◽  
Jennifer Schneider ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Language Processing ◽  
Diabetes Management ◽  
Clinical Care ◽  
Glucose Monitoring ◽  
Diabetes Diagnosis ◽  
Cohort Identification ◽  
Patterns Of Utilization ◽  
Device Use

<b>Key Points</b> <p>· About one-third of patients with type 1 diabetes were found to use continuous glucose monitoring (CGM) and/or continuous subcutaneous insulin infusion (CSII) in routine clinical care.</p> <p>· Disparities exist in CGM and CSII adoption, with device use more common in patients of higher socioeconomic status.</p> <p>· Mining clinical narratives with natural language processing techniques can be applied successfully for medical device surveillance and cohort identification for observational studies.</p> <p>· CGM use in conjunction with CSII after type 1 diabetes diagnosis is more effective than other therapy regimens and may translate to improved long-term glycemic control. </p>

scholarly journals Training adolescents with type 1 diabetes to carbohydrate counting without parents' help

2016 ◽  
Vol 29 (1) ◽  
pp. 77-84
Author(s):  
Beatriz Diniz GABRIEL ◽  
Cristiano Tulio ALBUQUERQUE ◽  
Marcella Lobato Dias CONSOLI ◽  
Patrícia Amaral Fulgêncio da Cunha MENEZES ◽  
Janice Sepúlveda REIS
Keyword(s):  
Type 1 Diabetes ◽  
Nutrition Education ◽  
Education Program ◽  
Carbohydrate Counting ◽  
New Therapy ◽  
Healthy Nutrition ◽  
Before And After ◽  
Nutrition Education Program ◽  
Diabetes Center

ABSTRACT Objective: To develop and evaluate the effectiveness of a nutrition education program to enable adolescents with type 1 diabetes to count carbohydrates without the parents' help. Methods: Nineteen adolescents with type 1 diabetes from a diabetes center participated in four fortnightly meetings of one hour, with lectures and discussions about healthy nutrition, importance of nutrients for blood glucose, portion sizes, food replacements, and carbohydrate counting therapy. All meetings ended with exercises to check the learning. Adolescents were followed for one year after the intervention. Results: All participants were 100% successful in all the steps of the program and started carbohydrate counting in the main meals. Nutritional status and total daily insulin doses before and after the study did not differ. After 12 months, 68% of the adolescents counted carbohydrates at all times, 16% did so in extra snacks, and 16% were suspended from the new therapy. Eighty percent of the parents were satisfied with the program, believing teenagers were trained in the new therapy. Conclusion: A short nutrition education program successfully trained adolescents to count carbohydrates without the parents' help.

scholarly journals Impact of Carbohydrate Counting Errors on Glycemic Control in Type 1 Diabetes

2018 ◽  
Vol 51 (27) ◽  
pp. 186-191 ◽  
Author(s):  
Florian Reiterer ◽  
Guido Freckmann ◽  
Luigi del Re
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Carbohydrate Counting

Impact of Real-Time CGM Data Sharing on Quality of Life in the Caregivers of Adults and Children with Type 1 Diabetes

2020 ◽  
pp. 193229682097842
Author(s):  
William H. Polonsky ◽  
Addie L. Fortmann
Keyword(s):  
Quality Of Life ◽  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Health Outcomes ◽  
Real Time ◽  
Data Sharing ◽  
Diabetes Management ◽  
Health Benefits

Background: To examine caregivers’ experiences with real-time continuous glucose monitoring (RT-CGM) data sharing and its impact on quality of life (QoL) and health outcomes. Methods: Parents of children with type 1 diabetes (T1D) ( N = 303) and spouses/partners of T1D adults ( N = 212) using the Dexcom G5 Mobile or G6 RT-CGM system and who were actively following their T1Ds’ RT-CGM data completed a survey examining their perceived value of data sharing, the impact of sharing on their own QoL and their child/partner’s health, and how they used RT-CGM data to support their T1Ds’ diabetes management. Regression analyses examined whether their actions were linked to reported changes in QoL and health outcomes. Results: Respondents were predominantly non-Hispanic White (91.1% parents; 88.7% partners), female (78.2% parents; 54.7% partners), and college-educated (65.3% parents; 61.8% partners). The majority reported that data sharing had enhanced hypoglycemic confidence (97.7% parents; 98.1% partners), overall well-being (60.4% parents; 63.2% partners), and sleep quality (78.0% parents; 61.3% partners). Of note, three positive caregiver actions were broadly consistent and significant predictors of QoL and health benefits for both parents and partners: celebrating success related to glycemic control, providing encouragement when glycemic control is challenging, and teamwork discussions about how the caregiver should respond to out-of-range values. Conclusions: RT-CGM data sharing was associated with a range of QoL and health benefits for caregivers. Degree of benefits was influenced by the collaborative actions taken by caregivers to support their child’s or partner’s diabetes management. To determine the most effective strategies for collaborative data sharing, longitudinal trials are needed.

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

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.

scholarly journals Carbohydrate Counting App Using Image Recognition for Youth With Type 1 Diabetes: Pilot Randomized Control Trial

10.2196/22074 ◽  
2020 ◽  
Vol 8 (10) ◽  
pp. e22074
Author(s):  
Jeffrey E Alfonsi ◽  
Elizabeth E Y Choi ◽  
Taha Arshad ◽  
Stacie-Ann S Sammott ◽  
Vanita Pais ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Digital Health ◽  
Controlled Trial ◽  
Qualitative Interviews ◽  
Mobile App ◽  
Thinking Aloud ◽  
Carbohydrate Counting ◽  
Scale Scores

Background Carbohydrate counting is an important component of diabetes management, but it is challenging, often performed inaccurately, and can be a barrier to optimal diabetes management. iSpy is a novel mobile app that leverages machine learning to allow food identification through images and that was designed to assist youth with type 1 diabetes in counting carbohydrates. Objective Our objective was to test the app's usability and potential impact on carbohydrate counting accuracy. Methods Iterative usability testing (3 cycles) was conducted involving a total of 16 individuals aged 8.5-17.0 years with type 1 diabetes. Participants were provided a mobile device and asked to complete tasks using iSpy app features while thinking aloud. Errors were noted, acceptability was assessed, and refinement and retesting were performed across cycles. Subsequently, iSpy was evaluated in a pilot randomized controlled trial with 22 iSpy users and 22 usual care controls aged 10-17 years. Primary outcome was change in carbohydrate counting ability over 3 months. Secondary outcomes included levels of engagement and acceptability. Change in HbA1c level was also assessed. Results Use of iSpy was associated with improved carbohydrate counting accuracy (total grams per meal, P=.008), reduced frequency of individual counting errors greater than 10 g (P=.047), and lower HbA1c levels (P=.03). Qualitative interviews and acceptability scale scores were positive. No major technical challenges were identified. Moreover, 43% (9/21) of iSpy participants were still engaged, with usage at least once every 2 weeks, at the end of the study. Conclusions Our results provide evidence of efficacy and high acceptability of a novel carbohydrate counting app, supporting the advancement of digital health apps for diabetes care among youth with type 1 diabetes. Further testing is needed, but iSpy may be a useful adjunct to traditional diabetes management. Trial Registration ClinicalTrials.gov NCT04354142; https://clinicaltrials.gov/ct2/show/NCT04354142

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