scholarly journals Opportunities for Enhanced Transition of Care Preparation for Adolescents and Emerging Adults With Type 1 Diabetes: Use of the READDY Transition Tool

2021 ◽  
Author(s):  
Camilia L. Kamoun ◽  
Jane C. Khoury ◽  
Sarah J. Beal ◽  
Nancy Crimmins ◽  
Sarah D. Corathers
Keyword(s):  
Type 1 Diabetes ◽  
Emerging Adults ◽  
Retrospective Chart Review ◽  
Educational Interventions ◽  
Adult Care ◽  
Patient Reported ◽  
The Impact ◽  
Transition Preparation ◽  
Confidence Ratings

There is an ongoing need to determine best practices for effective transition from pediatric to adult care for adolescents and emerging adults EAs with type 1 diabetes given the potential for poor health outcomes post-transfer. This study evaluated self-reported confidence ratings as measured by the Readiness of Emerging Adults with Diabetes Diagnosed in Youth (READDY) tool among adolescents and EAs with type 1 diabetes and the association of the confidence ratings with clinical and demographic characteristics, as well as provider documentation of relevant anticipatory guidance topics. The READDY is a diabetes-specific tool used to collect patient-reported confidence in transition preparation topics to target educational interventions. These interventions are divided into four domains: Diabetes Knowledge, Health System Navigation, Insulin Self-Management, and Health Behaviors. A retrospective chart review was conducted of patients 15–24 years of age with type 1 diabetes who completed the READDY between January 2017 and January 2018 at a single center. Overall patient-reported confidence levels were high. However, adolescents and EAs endorsed their lowest levels of confidence on items assessing knowledge of alcohol, tobacco, sexual health, and the impact of diabetes on pregnancy (females only), with the percentages of low scores of 20.7, 25.9, 35.9, and 42.9%, respectively. Documentation of provider counseling about screening and prevention of diabetes comorbidities, alcohol use, and tobacco use was associated with scores in the higher range for the corresponding item in the READDY. These findings highlight an opportunity to create interventions related to developmentally important topics for adolescents and EAs with type 1 diabetes to enhance successful transition preparation.

scholarly journals Opportunities for Enhanced Transition of Care Preparation for Adolescents and Emerging Adults With Type 1 Diabetes: Use of the READDY Transition Tool

2021 ◽  
Author(s):  
Camilia L. Kamoun ◽  
Jane C. Khoury ◽  
Sarah J. Beal ◽  
Nancy Crimmins ◽  
Sarah D. Corathers
Keyword(s):  
Type 1 Diabetes ◽  
Emerging Adults ◽  
Retrospective Chart Review ◽  
Educational Interventions ◽  
Adult Care ◽  
Patient Reported ◽  
The Impact ◽  
Transition Preparation ◽  
Confidence Ratings

There is an ongoing need to determine best practices for effective transition from pediatric to adult care for adolescents and emerging adults EAs with type 1 diabetes given the potential for poor health outcomes post-transfer. This study evaluated self-reported confidence ratings as measured by the Readiness of Emerging Adults with Diabetes Diagnosed in Youth (READDY) tool among adolescents and EAs with type 1 diabetes and the association of the confidence ratings with clinical and demographic characteristics, as well as provider documentation of relevant anticipatory guidance topics. The READDY is a diabetes-specific tool used to collect patient-reported confidence in transition preparation topics to target educational interventions. These interventions are divided into four domains: Diabetes Knowledge, Health System Navigation, Insulin Self-Management, and Health Behaviors. A retrospective chart review was conducted of patients 15–24 years of age with type 1 diabetes who completed the READDY between January 2017 and January 2018 at a single center. Overall patient-reported confidence levels were high. However, adolescents and EAs endorsed their lowest levels of confidence on items assessing knowledge of alcohol, tobacco, sexual health, and the impact of diabetes on pregnancy (females only), with the percentages of low scores of 20.7, 25.9, 35.9, and 42.9%, respectively. Documentation of provider counseling about screening and prevention of diabetes comorbidities, alcohol use, and tobacco use was associated with scores in the higher range for the corresponding item in the READDY. These findings highlight an opportunity to create interventions related to developmentally important topics for adolescents and EAs with type 1 diabetes to enhance successful transition preparation.

scholarly journals Experiences and perspectives of the parents of emerging adults living with type 1 diabetes

2020 ◽  
Vol 8 (1) ◽  
pp. e001125
Author(s):  
Cheryl Pritlove ◽  
Benjamin Markowitz ◽  
Geetha Mukerji ◽  
Andrew Advani ◽  
Janet A Parsons
Keyword(s):  
Type 1 Diabetes ◽  
Emerging Adulthood ◽  
Emerging Adults ◽  
Diabetes Management ◽  
Self Management ◽  
Comparative Approach ◽  
Transition To Adult Care ◽  
Adult Care ◽  
Difficult Time

IntroductionWhereas it is widely recognized that emerging adulthood can be a difficult time in the life of an individual living with type 1 diabetes, relatively little is known about the experiences of their parents or guardians. These individuals once shouldered much of the burden for their child’s diabetes ‘self’-management, yet their contribution is often overlooked by the adult healthcare system. Here, we set out to gain an understanding of the perspectives of parents of emerging adults living with type 1 diabetes.Research design and methodsSemi-structured interviews were performed with a purposeful sample of parents of emerging adults with type 1 diabetes recruited from two urban young adult diabetes clinics and through a national diabetes charity. Thematic coding was derived using a constant comparative approach.ResultsAnalysis of interviews with 16 parents of emerging adults with type 1 diabetes identified three themes: parental experiences of the transition to adult care; negotiating parent–child roles, responsibilities and relationships; and new and evolving fears. Parents spoke in detail about the time surrounding their child’s diagnosis of type 1 diabetes to emphasize the complexity of diabetes care and the need to establish a ‘new normal’ for the family. In turn, adolescence and emerging adulthood required a renegotiation of roles and responsibilities, with many parents continuing to play a role in high-level diabetes management. Several parents of emerging adults with type 1 diabetes (particularly those of young men) vocalized worries about their child’s readiness to assume responsibility for their self-care, and some expressed frustration with the apparent dichotomy in the role expectations of parents between the pediatric and adult care settings.ConclusionsAdult healthcare providers should recognize both the ongoing involvement of parents in the ‘self’-management of emerging adults with type 1 diabetes and the unique aspects of the caregiver burden that they experience.

scholarly journals Characterizing the transition from paediatric to adult care among emerging adults with Type 1 diabetes

2013 ◽  
Vol 30 (5) ◽  
pp. 610-615 ◽  
Author(s):  
V. S. Helgeson ◽  
K. A. Reynolds ◽  
P. R. Snyder ◽  
D. K. Palladino ◽  
D. J. Becker ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Emerging Adults ◽  
Adult Care

Interventions for Children with Diabetes and Their Families

2000 ◽  
Vol 18 (1) ◽  
pp. 149-170 ◽  
Author(s):  
MARGARET GREY
Keyword(s):  
Type 1 Diabetes ◽  
Metabolic Control ◽  
Diabetes Management ◽  
Psychosocial Interventions ◽  
Skills Training ◽  
Educational Interventions ◽  
Research Literature ◽  
Family Interventions ◽  
The Impact

The purpose of this review is to examine the research literature on interventions for children with type 1 diabetes and their families, with a specific focus on three types of intervention (educational and psychosocial/behavioral interventions that focus on individuals with diabetes and family interventions for families, usually parents, of individuals with diabetes). The aim of the review is to determine what interventions produce what outcomes in what populations of children and families. The review includes articles that met the following criteria: (a) empirical study reporting the impact of an intervention on such outcomes as knowledge, behavior, self-care, and metabolic control; (b) children with type 1 diabetes and/or their families as primary subjects; (c) publication between 1980 and January 1, 1999; and (d) publication in English. A total of 41 published papers were included. On the basis of this review, conclusions are as follows: (a) Educational interventions are useful in improving diabetes knowledge but not consistently helpful in improving metabolic control; (b) psychosocial interventions, especially coping skills training and peer support, assist primarily adolescents to improve adjustment and sometimes metabolic control; and (c) family interventions may be helpful in reducing parent-child conflict about diabetes management and care.

scholarly journals Group education for adolescents with type 1 diabetes during transition from paediatric to adult care: study protocol for a multisite, randomised controlled, superiority trial (GET-IT-T1D)

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e033806
Author(s):  
Elise Mok ◽  
Melanie Henderson ◽  
Kaberi Dasgupta ◽  
Elham Rahme ◽  
Mohammad Hajizadeh ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Cost Effectiveness ◽  
Emerging Adults ◽  
Adult Care ◽  
Group Education ◽  
Transition Care ◽  
Superiority Trial ◽  
Adult Diabetes ◽  
Secondary Outcomes

IntroductionTransition from paediatric to adult care is challenging for adolescents and emerging adults (ages 18 to 30 years) with type 1 diabetes (T1D). This transition is characterised by a deterioration in glycaemic control (haemoglobin A1c (HbA1c)), decreased clinical attendance, poor self-management and increased acute T1D-related complications. However, evidence to guide delivery of transition care is lacking. Given the effectiveness of group education in adult diabetes glycaemic control and improvements in qualitative measures in paediatric diabetes, group education is a potentially feasible and cost-effective alternative for the delivery of transition care. In emerging adults with T1D, we aim to assess the effectiveness of group education visits compared with usual care on HbA1c, T1D-related complications, psychosocial measures and cost-effectiveness after the transfer to adult care.Methods and analysisIn a multisite, assessor-blinded, randomised, two-arm, parallel-group, superiority trial, 212 adolescents with T1D (ages 17 years) are randomised to 12 months group education versus usual T1D care before transfer to adult care. Visits in the active arm consist of group education sessions followed by usual T1D care visits every 3 months. Primary outcome is change in HbA1c measured at 24 months. Secondary outcomes are delays in establishing adult diabetes care, T1D-related hospitalisations and emergency department visits, severe hypoglycaemia, stigma, self-efficacy, diabetes knowledge, transition readiness, diabetes distress, quality of life and cost-effectiveness at 12 and 24 months follow-up. Analysis will be by intention-to-treat. Change in HbA1c will be calculated and compared between arms using differences (95% CI), along with cost-effectiveness analysis. A similar approach will be conducted to examine between-arm differences in secondary outcomes.Ethics and disseminationThe study was approved by McGill University Health Centre Research Ethics Board (GET-IT/MP-37-2019-4434, version ‘Final 1.0 from November 2018). Study results will be disseminated through peer-reviewed publications.Trial registration numberNCT03703440.

scholarly journals Rationale and protocol for the Assessment of Impact of Real-time Continuous Glucose Monitoring on people presenting with severe Hypoglycaemia (AIR-CGM) study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Parizad Avari ◽  
Rozana Ramli ◽  
Monika Reddy ◽  
Nick Oliver ◽  
Rachael Fothergill
Keyword(s):  
Type 1 Diabetes ◽  
Real Time ◽  
Continuous Glucose Monitoring ◽  
Standard Care ◽  
Severe Hypoglycaemia ◽  
Glucose Monitoring ◽  
Significant Risk ◽  
Patient Reported ◽  
The Impact

Abstract Background Severe hypoglycaemia carries a significant risk of morbidity and mortality for people with type 1 diabetes. Economic costs are also high, estimated at approximately £13 million annually in England, UK. Continuous glucose monitoring (CGM) has been shown to reduce hypoglycaemia and associated fear, improve overall glycaemia and quality of life, and is cost-effective. Despite effective pathways in place with high levels of resource utilization, it has been reported there are low levels of follow-up, therapy change and specialist intervention after severe hypoglycaemia. This study is designed to assess the impact of providing real-time CGM to people with type 1 diabetes, who have had a recent episode of severe hypoglycaemia (within 72 h), compared to standard care. Methods/design Fifty-five participants with type 1 diabetes and a recent episode of severe hypoglycaemia, who are CGM naïve, will be recruited to the study. Participants will be randomised to CGM or standard care. The primary outcome is percentage time spent in hypoglycaemia (< 3.0 mmol/L, 55 mg/dL). Secondary outcomes include other measures of hypoglycaemia, time in euglycaemia, overall glucose status and patient reported qualitative measures. Discussion This study assesses the impact of providing continuous glucose monitoring at the outset in individuals at highest risk of hypoglycaemia. Changing demand means that novel approaches need to be taken to healthcare provision. This study has the potential to shape future national standards. Trial registration NCT03748433, November 2018 (UK).

scholarly journals Impact of a Novel Diabetes Support System on a Cohort of Individuals With Type 1 Diabetes Treated With Multiple Daily Injections: A Multicenter Randomized Study

2021 ◽  
Author(s):  
Alessandro Bisio ◽  
Stacey Anderson ◽  
Lisa Norlander ◽  
Grenye O’Malley ◽  
Jessica Robic ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycemic Control ◽  
Ad Hoc ◽  
Clinical Care ◽  
Randomized Study ◽  
Target Population ◽  
Multiple Daily Injections ◽  
Patient Reported ◽  
The Impact

Objective: <p>Achieving optimal glycemic control for many people with type 1 diabetes (T1D) remains challenging even with the advent of newer management tools, including continuous glucose monitoring (CGM). Management of T1D generates a wealth of data; however, its use to optimize glycemic control remains limited. We evaluate the impact of a CGM-based decision support systems (DSS) in T1D patients using multiple daily injections (MDI).</p> <p>Research design and method:</p> <p>The studied DSS included real-time dosing advice and retrospective therapy optimization. Adults and adolescents (>15yo) with T1D using MDI were enrolled at three sites in a 14-weeks randomized control trial of MDI+CGM+DSS vs. MDI+CGM. All participants (n=80), used degludec basal insulin and a Dexcom G5 CGM. CGM-based and patient reported outcomes are analyzed. Within the DSS group, ad-hoc analysis further contrasted Active vs Non-active DSS users.</p> <p>Results:</p> <p>No significant differences were detected between experimental and control groups (e.g. time in range CGM: +3.3% vs DSS: +4.4%). Participants in both groups reported lower HbA1c (-0.3%, p=0.001) with respect to baseline. While TIR may have improved in both groups, it was statistically significant only for DSS; the same was apparent for time<60. Active vs Non-active DSS users showed lower risk and exposure to hypoglycemia with system use.</p> <p>Conclusions:</p> <p>Our DSS system appears to be a feasible option for people on MDI, though the glycemic benefits associated with use need to be further investigated. System design, therapy requirements, and target population should be further refined prior to use in clinical care.</p>

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