Group engagement in parent-focused telehealth interventions for families of children with type 1 diabetes

Introduction Group engagement is an important component of video-based telehealth interventions, yet this construct remains understudied. In the present study, we applied a multidimensional conceptualization of group engagement in two video-based telehealth interventions that either aimed to reduce fear of hypoglycemia or diabetes distress in parents of children with type 1 diabetes. We examined variability in group engagement across parents and assessed the relationship between parents’ level of group engagement and their treatment outcomes. Methods Twenty-nine parents participated in one of two manualized, closed-group, telehealth interventions and completed outcome measures pre- and post-treatment. We behaviorally coded telehealth sessions based on six dimensions of group engagement using the Group Engagement Measure (inter-rater reliability = 0.94). We examined correlations between group engagement dimensions, parent psychosocial well-being, and child hemoglobin A1c. Further, we examined independent sample t-tests to assess differences between treatment groups. Results Mean parent age was 37.69 ± 6.83 years, mean child age was 7.69 ± 3.76 years, and mean child hemoglobin A1c was 8.06 ± 1.27% (41.4% had a hemoglobin A1c <7.5%). Parents who spent more time attending to other group member's issues, reported lower hypoglycemia fear at post-treatment, and parents who showed more active support of the group leader's purpose/goals during the session also reported fewer depressive symptoms at post-treatment. Discussion We identify several dimensions of group engagement that are associate with improved parent psychosocial and child hemoglobin A1c outcomes. Intervention designs that use group engagement to guide treatment planning or inform treatment-related decisions in video-based telehealth interventions could help families achieve more optimal treatment outcomes.

Effectiveness of Mindfulness-Based Stress Reduction Training on Emotional Expressiveness and Fear of Hypoglycemia in Patients with Type 2 Diabetes

Objective: Diabetes is a common chronic disorder in which there is a high risk of physical complications and psychological problems such as hypoglycemia and inability to express emotions. Psychological interventions can be effective in this regard. The aim of this study was to investigate the effectiveness of mindfulness-based stress reduction (MBSR) training on emotional expressiveness and fear of hypoglycemia (FOH) in patients with type 2 diabetes visiting Yazd Diabetes Center. Materials and Methods: This study was a quasi-experimental study with a pretest and posttest design. The statistical population was all patients with type 2 diabetes visiting Yazd Diabetes Center in 2020. Forty men and women were selected using purposeful sampling and were randomly allocated to case and control groups. The case group received 8 sessions of MBSR training, 2 hours each and the control group received no interventions. Emotional Expressiveness Questionnaire (EEQ) and the Hypoglycemia Fear Survey (HFS) were used to collect data. Results: Results of ANCOVA showed that MBSR training significantly increases emotional expressiveness and its components (P-value< 0.0001) and decreases the fear of hypoglycemia (P-value< 0.0001) in patients with type 2 diabetes (P-value< 0.035). Conclusion: Based on the results of the study, MBSR training could improve emotional expressiveness, prevent hypoglycemia and reduce the fear of it.

Incidence of Hypoglycemia and Hospitalization Related to Chronic Diabetes Complications and Its Effect on Quality of Life Among Patients Initiating Second Line Therapy: DISCOVER Study

The management of patients with type 2 diabetes is a complex process that must be individualized and be patient centered. The aim of this study was to assess the metabolic control, the annual incidence and crude prevalence of hypoglycemia, hospitalization, and complications among patients with type 2 diabetes initiating second-line therapy. This study is an observational, longitudinal, prospective study as a part of the multinational DISCOVERing Treatment Reality of Type 2 Diabetes in Real World Settings (DISCOVER) study, that recruited 519 patients with type 2 diabetes who were non-insulin users, aged ≥18 years, and switching to second-line therapy. The cohort was clinically evaluated over three years of follow up. Fear of hypoglycemia was assessed using the Hypoglycemia Fear Survey (HFS II), while the quality of life was assessed using SF36v2 questionnaire. Using second-line therapy improved metabolic control but the annual incidence of microangiopathies were at 61/1000 patient-years, 47/1000 patient-years, and 4/1000 patient-years for neuropathy, retinopathy, and nephropathy, respectively. The incidence of hypoglycemia was 57/1000 patient-years, where 50% were recurrent during the three-years period. The HFS II showed a significant increase in patients’ worries related to hypoglycemia. The incidence of hospitalization was 31/1000 patient-years, out of which 8/1000 patient-years were related to cardiovascular events, mainly myocardial infarction. Moderate metabolic control was associated with lower incidence of macro angiopathy and an increased incidence and fear of hypoglycemia, while it was associated with improved mental component score when assessing the patients’ quality of life. The treating physician’s decision of treatment intensification should be individualized with consideration of befits of good glycemic control versus the risk of hypoglycemia, especially in elderly patients.

Diabetes Device Downloading: Benefits and Barriers Among Youth With Type 1 Diabetes

Background: The majority of youth with type 1 diabetes (T1D) fail to meet glycemic targets despite increasing continuous glucose monitoring (CGM) use. We therefore aimed to determine the proportion of caregivers who review recent glycemic trends (“retrospective review”) and make ensuant insulin adjustments based on this data (“retroactive insulin adjustments”). We additionally considered that fear of hypoglycemia and frequency of severe hypoglycemia would be associated with performing retrospective review. Methods: We conducted a cross-sectional survey of caregivers of youth with T1D, collecting demographics, diabetes technology usage, patterns of glucose data review/insulin dose self-adjustment, and Hypoglycemia Fear Survey (HFS). Results: Nineteen percent of eligible caregivers (191/1003) responded. Performing retrospective review was associated with younger child age (12.2 versus 15.4, P = .0001) and CGM use (92% versus 73%, P = .004), but was not associated with a significant improvement in child’s HbA1c (7.89 versus 8.04, P = .65). Retrospective reviewers had significantly higher HFS-behavior scores (31.9 versus 27.7, P = .0002), which remained significantly higher when adjusted for child’s age and CGM use ( P = .005). Linear regression identified a significant negative association between HbA1c (%) and number of retroactive insulin adjustments (0.24 percent lower mean HbA1c per additional adjustment made, P = .02). Conclusions: Retrospective glucose data review is associated with improved HbA1c when coupled with data-driven retroactive insulin adjustments. Barriers to data downloading existed even in this cohort of predominantly CGM-using T1D families.

Challenges and Lessons Learned From a Telehealth Community Paramedicine Program for the Prevention of Hypoglycemia: Pre-Post Pilot Feasibility Study

Background Prevention through Intervention is a community paramedicine program developed by Birmingham Fire and Rescue Services in Alabama. This program aims to reduce dependency on emergency medical services (EMS) for nonemergency-related events through education and to lower the frequency of emergency calls in underserved populations. A telehealth intervention with an emphasis on hypoglycemia was implemented to (1) tailor the intervention to meet the educational needs of participants and (2) facilitate follow-ups. A pre-post pilot feasibility evaluation of the telehealth intervention was conducted. Objective This paper describes the results of the feasibility evaluation, implementation challenges, and the lessons learned about the deployment of a hypoglycemia prevention program in an underserved area and its evaluation. Methods This single-arm pretest-posttest intervention included (1) an initial in-person visit (week 1), (2) 3 weekly telecoaching calls (weeks 2-4), (3) 1 biweekly call (week 6), and (4) a final in-person visit (week 8) for collecting posttest data from individuals who called EMS due to hypoglycemic events. In-person visits included educational sessions conducted by EMS personnel. Participants’ education included tailored content related to hypoglycemia. Weekly telecoaching calls focused on hypoglycemia symptom monitoring and education reinforcement via a telehealth dashboard. The primary measures focused on feasibility measures, and exploratory measures focused on the fear of hypoglycemia, self-efficacy, and a knowledge of diabetes. Results A total of 40 participants participated in the intervention. However, the study was marred with high attrition. The various factors behind the low retention rate were discussed. There was a decreasing trend in all three subdomains of the fear of hypoglycemia from pretest to posttest. There was also a significant increase in participants’ self-efficacy in hypoglycemia self-management (P=.03). Conclusions This study shows preliminary and promising results for a community-based intervention specifically for hypoglycemia. However, the socioeconomic setting in which the intervention was delivered may have resulted in high dropout rates and low attendance during the intervention, which are considerations for future telehealth studies. Trial Registration ClinicalTrials.gov NCT03665870; https://clinicaltrials.gov/ct2/show/NCT03665870

‘Never again will I be carefree’: a qualitative study of the impact of hypoglycemia on quality of life among adults with type 1 diabetes

IntroductionAchieving glycemic targets and optimizing quality of life (QoL) are important goals of type 1 diabetes care. Hypoglycemia is a common barrier to achieving targets and can be associated with significant distress. However, the impact of hypoglycemia on QoL is not fully understood. The aim of this study was to explore how adults with type 1 diabetes are impacted by hypoglycemia in areas of life that are important to their overall QoL.Research design and methodsParticipants responded to a web-based qualitative survey involving a novel ‘Wheel of Life’ activity. Responses were analyzed using reflexive thematic analysis.ResultsThe final sample included 219 adults with type 1 diabetes from Denmark, Germany, the Netherlands, and the UK. They had a mean±SD age of 39±13 years and diabetes duration of 20±14 years. Participants identified eight areas of life important to their overall QoL, including relationships and social life, work and studies, leisure and physical activity, everyday life, sleep, sex life, physical health, and mental health. Participants reported emotional, behavioral, cognitive, and social impacts of hypoglycemia within domains. Across domains, participants described interruptions, limited participation in activities, exhaustion, fear of hypoglycemia, compensatory strategies to prevent hypoglycemia, and reduced spontaneity.ConclusionsThe findings emphasize the profound impact of hypoglycemia on QoL and diabetes self-care behaviors. Diabetes services should be aware of and address the burden of hypoglycemia to provide person-centered care. Clinicians could ask individuals how hypoglycemia affects important areas of their lives to better understand the personal impact and develop tailored management plans.