The Impact of Diabetes Distress on the Glycemic Control Among Adolescents and Youth With Type 1 Diabetes in Two Tertiary Centers, Jeddah, Saudi Arabia

Background: In the management of type 1 diabetes (T1D), systematic and random errors in carb-counting can have an adverse effect on glycemic control. In this study, we performed an in silico trial aiming at quantifying the impact of different levels of carb-counting error on glycemic control. Methods: The T1D patient decision simulator was used to simulate 7-day glycemic profiles of 100 adults using open-loop therapy. The simulation was repeated for different values of systematic and random carb-counting errors, generated with Gaussian distribution varying the error mean from -10% to +10% and standard deviation (SD) from 0% to 50%. The effect of the error was evaluated by computing the difference of time inside (∆TIR), above (∆TAR) and below (∆TBR) the target glycemic range (70-180mg/dl) compared to the reference case, that is, absence of error. Finally, 3 linear regression models were developed to mathematically describe how error mean and SD variations result in ∆TIR, ∆TAR, and ∆TBR changes. Results: Random errors globally deteriorate the glycemic control; systematic underestimations lead to, on average, up to 5.2% more TAR than the reference case, while systematic overestimation results in up to 0.8% more TBR. The different time in range metrics were linearly related with error mean and SD ( R2>0.95), with slopes of [Formula: see text], [Formula: see text] for ∆TIR, [Formula: see text], [Formula: see text] for ∆TAR, and [Formula: see text], [Formula: see text] for ∆TBR. Conclusions: The quantification of carb-counting error impact performed in this work may be useful understanding causes of glycemic variability and the impact of possible therapy adjustments or behavior changes in different glucose metrics.

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Anxiety, depression, and glycemic control during Covid-19 pandemic in youths with type 1 diabetes

Journal of Pediatric Endocrinology and Metabolism ◽

10.1515/jpem-2021-0153 ◽

2021 ◽

Vol 0 (0) ◽

Author(s):

Maria Cusinato ◽

Mariangela Martino ◽

Alex Sartori ◽

Claudia Gabrielli ◽

Laura Tassara ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Psychological Impact ◽

Glucose Monitoring ◽

Severe Hypoglycemia ◽

Well Being ◽

Glucose Variability ◽

Threshold Score ◽

The Impact

Abstract Objectives Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. Methods We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. Results We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. Conclusions Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.

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Prevalence of diabetes distress and depression and their association with glycemic control in adolescents with type 1 diabetes in Dubai, United Arab Emirates

Pediatric Diabetes ◽

10.1111/pedi.13204 ◽

2021 ◽

Author(s):

Zeina M. H. Younes ◽

Alaa M. Abuali ◽

Shadi Tabba ◽

Muhammad H. Farooqi ◽

Ahmed A. K. Hassoun

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

United Arab Emirates ◽

Diabetes Distress

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Feasibility study of real-time online text-based CBT to support self-management for people with type 1 diabetes: the Diabetes On-line Therapy (DOT) Study

BMJ Open Diabetes Research & Care ◽

10.1136/bmjdrc-2020-001934 ◽

2021 ◽

Vol 9 (1) ◽

pp. e001934

Author(s):

Anne M Doherty ◽

Anne Herrmann-Werner ◽

Arann Rowe ◽

Jennie Brown ◽

Scott Weich ◽

...

Keyword(s):

Type 1 Diabetes ◽

Glycemic Control ◽

Real Time ◽

Instant Messaging ◽

Controlled Trial ◽

Self Management ◽

Diabetes Distress ◽

The Mean ◽

Distress Scale

IntroductionThis study examines the feasibility of conducting diabetes-focused cognitive–behavioral therapy (CBT) via a secure online real-time instant messaging system intervention to support self-management and improve glycemic control in people with type 1 diabetes.Research design and methodsWe used a pre–post uncontrolled intervention design over 12 months. We recruited adults with type 1 diabetes and suboptimal glycemic control (HbA1c ≥69 mmol/mol (DCCT 8.5%) for 12 months) across four hospitals in London. The intervention comprised 10 sessions of diabetes-focused CBT delivered by diabetes specialist nurses. The primary outcomes were number of eligible patients, rates of recruitment and follow-up, number of sessions completed and SD of the main outcome measure, change in HbA1c over 12 months. We measured the feasibility of collecting secondary outcomes, that is, depression measured using Patient Health Questionnaire-9 (PHQ-9), anxiety measured Generalised Anxiety Disorder (GAD) and the Diabetes Distress Scale (DDS).ResultsWe screened 3177 patients, of whom 638 were potentially eligible, from whom 71 (11.1%) were recruited. The mean age was 28.1 (13.1) years, and the mean HbA1c was 84.6 mmol/mol (17.8), DCCT 9.9%. Forty-six (65%) patients had at least 1 session and 29 (41%) completed all sessions. There was a significant reduction in HbA1c over 12 months (mean difference −6.2 (2.3) mmol/mol, DCCT 0.6%, p=0.038). The change scores in PHQ-9, GAD and DDS also improved.ConclusionsIt would be feasible to conduct a full-scale text-based synchronized real-time diabetes-focused CBT as an efficacy randomized controlled trial.

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