Implications of the School Day on Health Behaviors for Children With Type 1 Diabetes: A Survey of Parent Perspectives During the COVID-19 Pandemic

Purpose The purpose of this study is to survey parents of youth with type 1 diabetes during the COVID-19 pandemic with school closures to better understand the implications of the school day on health care behaviors. Methods A cross-sectional, online survey was distributed to parents of youth with type 1 diabetes ≤19 years of age in a large, academic diabetes center. Questions encompassed perceived changes in management behaviors and plans for return to school. Subgroup analysis compared parent responses by child’s age, reported stressors, and socioeconomic markers. Results Parents reported a worsening in their child’s diabetes health behaviors during school closures compared to what they perceived during a regular school day before the pandemic. More than half of parents reported feeling that their child was unable to maintain a normal routine, with particular implications for snacking between meals, daily physical activity, and sleep habits. Families with adolescents or those experiencing multiple pandemic-related stressors reported greater challenges. In open-ended responses, families highlighted difficulty in balancing school, work, and diabetes care and expressed concerns about the mental health repercussions of school closures for their children. Nearly half of parents reported being at least moderately worried about return to school, whereas only a minority reported seeking guidance from their diabetes provider. Conclusions Parent-reported disruptions of school-day routines frequently had adverse consequences for diabetes management in this population. These findings highlight the importance of a school-day routine for children with type 1 diabetes; during closures, families may benefit from mitigating strategies to maintain effective habits.

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Accessibility and Openness to Diabetes Management Support via Mobile Phones: A Survey of People with Type 1 Diabetes Using Advanced Diabetes Technologies (Preprint)

10.2196/preprints.36140 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline Richardson ◽

Iulia Dobrin ◽

Rodica Pop-Busui ◽

Gretchen Piatt ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Interactive Voice Response ◽

Medical Center ◽

Academic Medical Center ◽

Text Messages ◽

Management Support ◽

Cross Sectional Survey ◽

Cross Sectional

BACKGROUND Little is known about the feasibility of mobile health (mHealth) support among people with type 1 diabetes (T1D) using advanced diabetes technologies including continuous glucose monitors (CGMs) and hybrid closed-loop insulin pumps (HCLs). OBJECTIVE To evaluate patient access and openness to receiving mHealth diabetes support in people with T1D using CGMs/HCLs. METHODS We conducted a cross-sectional survey among T1D patients using CGMs or HCLs managed in an academic medical center. Participants reported information regarding their mobile device usage, cellular call/text message/internet connectivity, and openness to various channels of mHealth communication (smartphone applications or “apps”, text messages, and interactive voice response calls or IVR calls). Participants’ demographic characteristics and CGM data were collected from medical records. Analyses focused on differences in openness to mHealth and mHealth communication channels across groups defined by demographic variables and measures of glycemic control. RESULTS Among all participants (n=310; 64% female; mean age: 45 (SD:16)), 98% reported active cellphone use, and 80% were receptive to receiving mHealth support to improve glucose control. Among participants receptive to mHealth support, 98% were willing to share CGM glucose data for mHealth diabetes self-care assistance. Most (71%) were open to receiving messages via apps, 56% were open to text messages, and 12% were open to IVR calls. Older participants were more likely to prefer text messages (P=0.009) and IVR (P=0.03) than younger participants. CONCLUSIONS Most people with T1D who use advanced diabetes technologies have access to cell phones and are receptive to receiving mHealth support to improve diabetes control. CLINICALTRIAL Not applicable

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Association of family structure with type 1 diabetes management and outcomes in adolescents: A population‐based cross‐sectional survey

Pediatric Diabetes ◽

10.1111/pedi.13166 ◽

2020 ◽

Author(s):

Christina Baechle ◽

Anna Stahl‐Pehe ◽

Katty Castillo ◽

Silvia Selinski ◽

Reinhard W Holl ◽

...

Keyword(s):

Type 1 Diabetes ◽

Family Structure ◽

Diabetes Management ◽

Population Based ◽

Cross Sectional Survey ◽

Cross Sectional

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

10.2196/preprints.9432 ◽

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)

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Physical Activity, Dietary Patterns, and Glycemic Management in Active Individuals with Type 1 Diabetes: An Online Survey

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179332 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9332

Author(s):

Sheri R. Colberg ◽

Jihan Kannane ◽

Norou Diawara

Keyword(s):

Physical Activity ◽

Type 1 Diabetes ◽

Online Survey ◽

Diabetes Management ◽

Physically Active ◽

Glucose Levels ◽

Blood Glucose Levels ◽

And Performance ◽

Glycemic Management

Individuals with type 1 diabetes (T1D) are able to balance their blood glucose levels while engaging in a wide variety of physical activities and sports. However, insulin use forces them to contend with many daily training and performance challenges involved with fine-tuning medication dosing, physical activity levels, and dietary patterns to optimize their participation and performance. The aim of this study was to ascertain which variables related to the diabetes management of physically active individuals with T1D have the greatest impact on overall blood glucose levels (reported as A1C) in a real-world setting. A total of 220 individuals with T1D completed an online survey to self-report information about their glycemic management, physical activity patterns, carbohydrate and dietary intake, use of diabetes technologies, and other variables that impact diabetes management and health. In analyzing many variables affecting glycemic management, the primary significant finding was that A1C values in lower, recommended ranges (<7%) were significantly predicted by a very-low carbohydrate intake dietary pattern, whereas the use of continuous glucose monitoring (CGM) devices had the greatest predictive ability when A1C was above recommended (≥7%). Various aspects of physical activity participation (including type, weekly time, frequency, and intensity) were not significantly associated with A1C for participants in this survey. In conclusion, when individuals with T1D are already physically active, dietary changes and more frequent monitoring of glucose may be most capable of further enhancing glycemic management.

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Perceived Stress Among Indian Children And Young Adults Living With Type 1 Diabetes During the COVID-19 Outbreak

10.21203/rs.3.rs-33172/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Neha Agarwal ◽

Mandara M Harikar ◽

Rishi Shukla ◽

Anurag Bajpai

Keyword(s):

Type 1 Diabetes ◽

Young Adults ◽

Glycemic Control ◽

Perceived Stress ◽

Diabetes Management ◽

Healthcare Services ◽

Indian Children ◽

Cross Sectional ◽

Significant Difference

Abstract Background - Strict isolation measures and interrupted healthcare services during the COVID 19 pandemic are contemplated to instigate stress universally, particularly in those with chronic illnesses such as Type 1 Diabetes (T1D).Objective- To evaluate perceived stress towards COVID-19 among T1D individuals.Study Design - A cross-sectional, observational study. Participants - Adolescents and young adults (aged 10 - 25), living with T1D; and age, gender matched controls.Interventions - An online, semi-structured survey including Perceived Stress Scale. Outcomes - Determinants of stress and its impact on glycemic control.Results - A total of 97 cases (49 males; mean age 18.8 ± 4.5 years), diagnosed with T1D (mean diabetes duration 8.0 ± 5.0 years; mean HBA1C 8.1 ± 1.5%) completed the survey. Among cases, 53.6% reported moderate stress; 41.2% low stress and 5.2% severe stress. No significant difference was observed in the mean PSS score between the cases and controls. Cases with higher PSS scores tracked pandemic-related updates with significantly lesser frequency than those with lower scores (mean rank 78.75; p = 0.01). High PSS score was significantly associated with HbA1C over last 6 months (r 0.276; p = 0.015) and worsened glycemic control (mean rank 63.97 p = 0.012). Conclusion- An increased apprehension was seen regarding the acquisition of optimal diabetes management and care during the current infectious outbreak. Tele-medicine could emerge as an effective tool and a promising initiative to manage T1D patients during the pandemic.

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A call for inclusion of work-related diabetes distress in the spectrum of diabetes management: Results from a cross-sectional survey among working people with type 1 diabetes

Diabetes Research and Clinical Practice ◽

10.1016/j.diabres.2018.03.040 ◽

2018 ◽

Vol 140 ◽

pp. 139-147 ◽

Cited By ~ 3

Author(s):

Ulla M. Hansen ◽

Kasper Olesen ◽

Jessica L. Browne ◽

Timothy C. Skinner ◽

Ingrid Willaing

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Diabetes Distress ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Work Related ◽

Working People

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Sleep Habits of Early School-Aged Children with Type 1 Diabetes and Their Parents: Family Characteristics and Diabetes Management

Behavioral Sleep Medicine ◽

10.1080/15402002.2021.1977305 ◽

2021 ◽

pp. 1-10

Author(s):

Troy Morrow ◽

Shivani H. Bhatia ◽

Angelee M. Parmar ◽

Logan Baker ◽

Fayo Abadula ◽

...

Keyword(s):

Type 1 Diabetes ◽

Diabetes Management ◽

Family Characteristics ◽

Sleep Habits ◽

School Aged Children ◽

Early School

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Assessment of Ramadan Education and Knowledge Among Diabetic Patients

Clinical Medicine Insights Endocrinology and Diabetes ◽

10.1177/1179551417751611 ◽

2018 ◽

Vol 11 ◽

pp. 117955141775161 ◽

Cited By ~ 7

Author(s):

Mussa Hussain Almalki ◽

Ibtihal Hussen ◽

Shawana A. Khan ◽

Abdulrahman Almaghamsi ◽

Fahad Alshahrani

Keyword(s):

Type 2 Diabetes ◽

Type 1 Diabetes ◽

Health Care Providers ◽

Diabetes Management ◽

Cross Sectional Study ◽

Diabetic Patients ◽

Care Providers ◽

Cross Sectional

Background: During Ramadan, Muslims fast from dawn until dusk for one lunar month every year. Most of the Muslim patients with diabetes are unaware of the potential complications that can occur while fasting, such as hypoglycemia. The aim of this study is to assess the the patient education level and patients’ overall awareness of any possible complications that could occur while fasting during Ramadan and to determine how these patients deal with these complications. Methods: We conducted a cross-sectional study and surveyed diabetic patients about their diabetes-related knowledge over a period of 4 months from the outpatient clinic at the Obesity, Endocrine, and Metabolism Center at King Fahad Medical City. Patients were included if they were ≥16 years and if they had been receiving treatment for at least 1 year before the study, irrespective of the medications used; patients were also asked about the presence or absence of complications. Results: This study included 477 patients (325 women and 152 men). Most patients (297; 62.3%) had type 2 diabetes. The patients’ mean age was 39.72 ± 15.29 years, and the mean duration of diabetes was 10.80 ± 5.88 years. During the preceding Ramadan, 76% of patients reported fasting, whereas 58% said that they monitored their blood glucose levels once per day. Hypoglycemic episodes were reported in 60.3% of cases with type 2 diabetes and in 8.3% of cases with type 1 diabetes. Among those who had hypoglycemia, 2.8% of patients with type 1 diabetes and 17.8% with type 2 diabetes broke their fast. Finally, 54% of patients reported that their health care providers offered them instructions on diabetes management during Ramadan. Conclusions: Ramadan health education in diabetes can encourage, improve, and guide patients to change their lifestyles during Ramadan while minimizing the risk of acute complications.

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Is Continuous Glucose Monitoring Underappreciated in the UK?

European Endocrinology ◽

10.17925/ee.2017.13.02.76 ◽

2017 ◽

Vol 13 (02) ◽

pp. 76 ◽

Cited By ~ 3

Author(s):

Christopher G Parkin ◽

Melissa Holloway ◽

Jeffrey Truesdell ◽

Tomas C Walker ◽

◽

...

Keyword(s):

Type 1 Diabetes ◽

Continuous Glucose Monitoring ◽

Online Survey ◽

Diabetes Management ◽

Glucose Monitoring ◽

Glycated Haemoglobin ◽

Mailing Lists ◽

The Uk ◽

Hypoglycaemia Awareness

Introduction: Information about continuous glucose monitoring (CGM) use in the UK is limited. We conducted an online survey of a representative sample of current CGM users in England, Scotland and Wales to address this deficit. Methods: The 29-item online survey was conducted between 29 December 2016 and 25 January 2017. Persons with type 1 diabetes (T1D) and caregivers of T1D children/adolescents were recruited from mailing lists, using Nielsen and Harris Polling databases. Results: 315 patients and caregivers responded to the survey – 170 adult patients and 145 caregivers. Among respondents, 144 received full funding for CGM use, 72 received partial funding and 83 received no funding. Most reported improvements in glycated haemoglobin (HbA1c) (67.0%), fewer hypoglycaemia episodes (70.2%), improved hypoglycaemia awareness (77.5%) and better diabetes management (92.4%). Self-funders reported significantly higher CGM use (76.1%) than those who were fully funded (58.9%) and/or partially funded (65.9%), p=0.0008. Fewer than 50% of all respondents reported receiving guidance in interpreting CGM data from their diabetes care team; 30.1% of self-funders reported receiving no CGM support from their diabetes team compared with fully funded (2.8%) and partially funded (1.4%) respondents, p<0.0001. Conclusions: Patients with T1D and their caregivers are realising benefits from CGM use but are largely unsupported by the UK healthcare system.

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