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

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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Depression, obesity, and smoking were independently associated with inadequate glycemic control in patients with type 1 diabetes

Acta Endocrinologica ◽

10.1530/eje-13-0137 ◽

2013 ◽

Vol 168 (6) ◽

pp. 861-869 ◽

Cited By ~ 35

Author(s):

Eva O Melin ◽

Maria Thunander ◽

Ralph Svensson ◽

Mona Landin-Olsson ◽

Hans O Thulesius

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Physical Inactivity ◽

Depression Scale ◽

Self Report ◽

Cross Sectional ◽

Diabetes Registry ◽

Control Of Diabetes ◽

Inadequate Glycemic Control

ObjectiveThe aim of this study was to explore the associations between inadequate glycemic control of diabetes and psychological, anthropometric, and lifestyle variables in a population-based cohort of type 1 diabetes patients.DesignCross-sectional study.MethodsIn this study, 292 patients with type 1 diabetes, aged 18–59 years, participated. Psychological data were assessed by self-report instruments: Hospital Anxiety and Depression Scale and Toronto Alexithymia Scale-20. Anthropometrics, blood analyses, data from medical records, and data from the Swedish National Diabetes Registry were collected.ResultsSelf-reported depression (adjusted odds ratio (AOR) 4.8), obesity (AOR 4.3), and smoking (AOR 3.0) were independently associated with inadequate glycemic control of diabetes (HbA1c>8.6%). Gender-stratified analyses showed that self-reported depression (AOR 19.8) and obesity (AOR 7.0) in women and smoking in men (AOR 4.2) were associated with HbA1c>8.6%. Alexithymia, antidepressant medication, and physical inactivity were associated with HbA1c>8.6% only in bivariate analyses. Alexithymia, self-rated anxiety, physical inactivity, and absence of abdominal obesity were associated with self-reported depression.ConclusionsDepression was the only psychological factor independently associated with HbA1c>8.6%. The association was of comparable importance as obesity and smoking, well-known risk factors for inadequate glycemic control and diabetes complications. The association between depression and HbA1c>8.6% was particularly strong for women. Alexithymia, which is a relatively stable personality trait, was associated with depression. In the future care of patients with diabetes, psychological aspects should be considered alongside anthropometrics and lifestyle factors in order to achieve the goals for HbA1c.

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

Journal of Diabetes Science and Technology ◽

10.1177/1932296818778608 ◽

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.

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Cognitive functions and glycemic control in children and adolescents with type 1 diabetes

Psychological Medicine ◽

10.1017/s0033291709005777 ◽

2009 ◽

Vol 40 (1) ◽

pp. 95-103 ◽

Cited By ~ 35

Author(s):

S. Ohmann ◽

C. Popow ◽

B. Rami ◽

M. König ◽

S. Blaas ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Metabolic Control ◽

Child Behavior Checklist ◽

Diabetes Management ◽

Social Activity ◽

Self Report ◽

Patients With Diabetes

BackgroundThe relationship between metabolic control and cognitive function in adolescents with type 1 diabetes (DM type 1) is not clear. We compared the quality of glycemic control (GC) and cognitive measures in adolescents with DM type 1 to find out if the quality of diabetes management is related to cognitive impairment.MethodWe assessed executive functions (EFs) and other neuropsychological and psychosocial variables in 70 adolescent patients with DM type 1 and 20 age-matched controls. Patients were divided into two groups according to their last hemoglobin A1c (HbA1c): acceptable (HbA1c 5.9–8.0%, mean 6.9%, 36 patients, mean age 14 years) and non-optimal (HbA1c 8.2–11.6%, mean 9.3%, 34 patients, mean age 15.6 years).ResultsWe found impaired EFs, mainly problems of concept formation (p=0.038), cognitive flexibility (p=0.011) and anticipation (p=0.000), in the patients with DM type 1. Both groups did not differ in intelligence, most assessed EFs and adjustment to chronic illness (Youth Self-Report; YSR). Younger patients (<15 years) were cognitively less flexible. GC was worse in older patients and in patients with longer duration of the disease. We also found significant differences between patients with diabetes and controls concerning somatic complaints, internalizing problems (Child Behavior Checklist; CBCL) and social activity (CBCL and YSR).ConclusionsDM type 1 is associated with cognitive deficits in adolescents independent of the quality of metabolic control and the duration of the disease. These deficits are probably related to the disease, especially in patients with early-onset diabetes.

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

10.2337/figshare.17136467 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline R. Richardson ◽

Iulia Dobrin ◽

Melissa J. DeJonckheere ◽

Kara Mizokami-Stout ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Survey Study ◽

Cross Sectional Survey ◽

Hypoglycemic Episode ◽

Cross Sectional ◽

The Impact ◽

Level 2

Objective: This study aims to: (1) identify the frequency of severe and level 2 hypoglycemia presenting in people with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting; (2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. Research Design and Methods: A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demographics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire) and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. Results: A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ≥1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyperglycemia avoidance was associated with severe hypoglycemia development (P<0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ≥1% of time in level 2 hypoglycemia (P=0.038). Conclusions: Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in people with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may remain to impact the effectiveness of glucose self-management.

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Predictors of Glucose Control in Children and Adolescents with Type 1 Diabetes: Results of a Cross‑Sectional Study in Khartoum, Sudan

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2018.423 ◽

2018 ◽

Vol 6 (11) ◽

pp. 2035-2039

Author(s):

Zainab Taha ◽

Zeinab Eltoum ◽

Sidiga Washi

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Children And Adolescents ◽

Cross Sectional Study ◽

Glycosylated Haemoglobin ◽

Poor Glycemic Control ◽

Sectional Study ◽

Cross Sectional ◽

Factors Associated

BACKGROUND: Type 1 diabetes mellitus (T1DM) is a rapidly growing problem in Sudan as well as other African countries. Children and adolescents with type 1 diabetes have previously been found to have poor glycemic control. Strict glycemic control reduces the incidence and progression of chronic complications. AIM: This study aimed to identify the factors associated with glycemic control among children and adolescents. METHODS: The study was a health-centre based descriptive cross-sectional study. Data on socioeconomic, demographic, disease history, and diabetes-specific variables was obtained. Glycemic control was assessed by measuring glycosylated haemoglobin (HbA1C). Linear regression analysis was done to determine factors associated with glycemic control. RESULTS: One hundred Sudanese children with T1DM aged from (1-18) years were recruited for the study (63 % females). Most of the study children (80%) had high random blood glucose levels. Less than half (40%) suffered from the presence of glucose in their urine and one-quarter of them have urine ketones. Also, Glycosylated haemoglobin (HbA1c) level of the study children showed that more than three-quarters (76%) had poor glycemic control. It was found that there is no relationship between nutritional status and glycemic control. However, there is a relationship between socioeconomic status and glycemic control (P = 0.025) CONCLUSION: To improve metabolic control, more frequent BGM should be encouraged among children and adolescents with T1DM. Emphasis needs to be put on providing families with children with diabetes with the medical, financial and social support for better control of their diabetes.

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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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Associations of Dietary Patterns and Nutrients with Glycated Hemoglobin in Participants with and without Type 1 Diabetes

Nutrients ◽

10.3390/nu13031035 ◽

2021 ◽

Vol 13 (3) ◽

pp. 1035

Author(s):

Arpita Basu ◽

Amy C. Alman ◽

Janet K. Snell-Bergeon

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Dietary Patterns ◽

Food Group ◽

Poor Glycemic Control ◽

Food Groups ◽

Cross Sectional ◽

Saturated Fats ◽

Diabetes Status

Background: Diet has been associated with poor glycemic control in diabetes. Few studies have examined this association in people with type 1 diabetes (T1D), who are at a higher risk for cardiovascular disease than people without diabetes. Methods: We report data from cross-sectional and longitudinal analyses from a coronary artery calcification in type 1 diabetes (CACTI) study (n = 1257; T1D: n = 568; non-diabetic controls: n = 689) collected between the years 2000 and 2002. Participants completed a validated food frequency questionnaire, a physical examination, and biochemical analyses. Dietary patterns based on variations in food group intake were created with principal components analysis. Linear regression was used to examine the associations of dietary patterns, macronutrients, and food groups with HbA1c in a model adjusted for relevant covariates and stratified by diabetes status. Results: Three dietary patterns were identified: “fruits, veggies, meats, cereal”, “baked desserts” and “convenience foods and alcohol” patterns. At baseline, a higher intake of the “baked dessert” pattern was significantly associated with higher HbA1c in T1D at baseline as well at year 6 of the study when adjusted for age, sex, BMI, total calories, and diabetes duration. No such associations were observed in the case of non-diabetic controls. Dietary saturated fats and animal fats were also positively associated with HbA1c in adults with T1D at baseline and/or at year 6. Conclusions: The habitual intake of a dietary pattern that is characterized by an increased intake of added sugar and saturated fats, such as in baked desserts, may increase risks of poor glycemic control in T1D.

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

10.2337/figshare.17136467.v1 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline R. Richardson ◽

Iulia Dobrin ◽

Melissa J. DeJonckheere ◽

Kara Mizokami-Stout ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Survey Study ◽

Cross Sectional Survey ◽

Hypoglycemic Episode ◽

Cross Sectional ◽

The Impact ◽

Level 2

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Beliefs Around Hypoglycemia and Their Impacts on Hypoglycemia Outcomes in Individuals with Type 1 Diabetes and High Risks for Hypoglycemia Despite Using Advanced Diabetes Technologies

Diabetes Care ◽

10.2337/dc21-1285 ◽

2022 ◽

Author(s):

Yu Kuei Lin ◽

Caroline R. Richardson ◽

Iulia Dobrin ◽

Melissa J. DeJonckheere ◽

Kara Mizokami-Stout ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Survey Study ◽

Cross Sectional Survey ◽

Hypoglycemic Episode ◽

Cross Sectional ◽

The Impact ◽

Level 2

OBJECTIVE This study aimed to 1) identify the frequency of severe and level 2 hypoglycemia presenting in individuals with type 1 diabetes using continuous glucose monitoring systems (CGMs), including those with concomitant closed-loop insulin pumps, in a clinical practice setting, and; 2) evaluate the impact of beliefs around hypoglycemia in the development of severe and level 2 hypoglycemia in this population. RESEARCH DESIGN AND METHODS A cross-sectional survey study in adults with type 1 diabetes using CGMs >6 months was conducted at a large tertiary academic center. Participant demographics, 6-month severe hypoglycemia history, hypoglycemia beliefs (with the Attitude to Awareness of Hypoglycemia questionnaire), and 4-week CGM glucose data were collected. Statistical analysis was performed to assess the presentation of severe and level 2 hypoglycemia and identify associated risk factors. RESULTS A total of 289 participants were recruited (including 257 participants with CGM data within the last 3 months). Of these, 25.6% experienced at least one severe hypoglycemic episode in the last 6 months, and 13.6% presented with ≥1% of time in level 2 hypoglycemia on CGMs. Reporting beliefs about prioritizing hyperglycemia avoidance was associated with severe hypoglycemia development (P < 0.001), while having beliefs of minimal concerns for hypoglycemia was associated with spending ≥1% of time in level 2 hypoglycemia (P = 0.038). CONCLUSIONS Despite the use of advanced diabetes technologies, severe and level 2 hypoglycemia continues to occur in individuals with type 1 diabetes and high hypoglycemia risks. Human factors, including beliefs around hypoglycemia, may continue to impact the effectiveness of glucose self-management.

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