Diabetes Spectrum最新文献

Objective: Management of type 1 diabetes during illness confers risk for serious harm because sick days happen infrequently, management is complex and multistep, and errors can result in diabetic ketoacidosis and hospitalization. Simulation offers a safe, experiential learning environment in which to practice skills with the goal of identifying and closing knowledge gaps. We hypothesized that simulation of sick-day scenarios with patients and caregivers via video conference could be used to assess knowledge of sick-day management for type 1 diabetes and determine the availability of necessary supplies at home.

Research design and methods: Our study included development of performance-based, scripted sick-day scenarios; selection and training of content experts as simulation facilitators; piloting and iterative revision of scenarios; and implementation of simulation sessions. Five distinct scenarios were created for either insulin injections or continuous insulin pump therapy. Each participant was block randomized to receive three of the five scenarios. Participant performance was measured by categorizing actions as most desired, less desired, or incorrect.

Results: Ten caregivers and two young adults with type 1 diabetes participated in 12 simulations, representing 14 individuals with type 1 diabetes. The most common category of less desired and incorrect processes chosen by participants was ketone management.

Conclusion: Simulation-based training for sick-day management is a feasible, interactive form of education for people with type 1 diabetes and caregivers. Video conferences allowed firsthand observation of supplies and resources available to families at home. Participant understanding of sick-day management will inform future interventions to address challenges with ketone management and recognition of diabetes technology issues when caring for an ill child with type 1 diabetes.

People with type 1 diabetes are living longer and, by 2030, one-fifth of the U.S. population will be older adults ≥65 years of age. This qualitative study addressed the scarcity of research on the experiences of aging people with type 1 diabetes. Nineteen older adults (mean age 65.63 ± 6.27 years, mean duration of diabetes 36.97 ± 18.94 years) were interviewed about their disease management challenges and gaps in available resources. Identified themes included positive and negative changes over the life span resulting from 1) diabetes-related psychological health, 2) hypoglycemia unawareness, and 3) health care barriers. Responses also suggested that a lack of support may lead to poorer health outcomes and greater diabetes distress. Additional research is needed to better understand these issues and to inform the creation or tailoring of public policies to support older adults with type 1 diabetes.

Objective: Diabetes distress (DD) is the negative emotional toll of living with or caring for type 1 diabetes, encompassing the pervasiveness of its daily demands. We recently developed Remedy to Diabetes Distress (R2D2), a screen-to-treat intervention for families of school-aged children with type 1 diabetes. This article reports on the use of crowdsourcing methods to design the intervention and capture the voice of parent stakeholders.

Research design and methods: We recruited 41 parents of 8- to 12-year-olds with type 1 diabetes. In a secure online social network, we posted study questions to participants, who could respond to our questions and view and comment on other participants' responses (i.e., participants could interact as a "crowd"). An iterative approach allowed our questions to move from broad to specific, enabling parent input on treatment content.

Results: Using a conceptual model of DD, we examined responses and applied codes to distill qualitative categories. We established substantial agreement on identified categories, with fidelity at κ = 0.615. In addition to providing broad feedback (e.g., on preferred language for common phrases used in type 1 diabetes interventions), parents also provided feedback on specific treatment components and the overall tone of the intervention. Parents highlighted benefit-finding and positive talk/self-talk as pertinent for incorporation into treatment.

Conclusion: This study illustrates the use of crowdsourcing methods to capture the voices of parents of school-aged children with type 1 diabetes when designing a DD intervention. The next phase of R2D2 will be a small pre-trial to evaluate the feasibility and acceptability of the intervention, followed by a proof-of-concept randomized controlled trial (RCT), during which family voices will continue to be incorporated.

This article is adapted from the address Dr. Neumiller delivered as the recipient of the American Diabetes Association's Outstanding Educator in Diabetes Award for 2024. He delivered the address in June 2024 during the Association's 84th Scientific Sessions.

Objective: The purpose of this article is to describe the processes for convening and engaging an advisory board to guide the conduct of a research study of the Type 1 Diabetes Wraparound Program (T1DWP) and associated outcomes.

Research design and methods: We recruited a diverse advisory board (n = 21) consisting of youth with type 1 diabetes, parents/advocates, and health system partners. The board met monthly over 2 years to discuss all phases of the T1DWP study. We evaluated aspects of engagement and satisfaction among advisory board members using a monthly experience survey on a five-point Likert scale (ranging from strongly disagree to strongly agree) and outcomes, including modifications to the research materials, the study protocol, and implementation.

Results: We received 10 ± 3 survey responses per meeting, with representation from every role at each meeting. The overall stakeholder satisfaction score increased from 4.5 at baseline to 5.0 at month 6 and was maintained at 5.0 at month 24 as the research team responded to feedback. Average scores for specific processes of engagement were high: expectation setting (4.6 ± 0.3), co-learning (4.6 ± 0.3), transparency (4.6 ± 0.3), and decision-making (4.7 ± 0.2). Changes to the T1DWP study resulting from advisory board input included adding nine additional patient-reported measures and specific diabetes resources and programming. Furthermore, the board contributed to hiring of T1DWP study staff, fundraising activities, and clinical integration of the T1DWP, demonstrating stakeholder empowerment and knowledge translation to the clinical setting.

Conclusion: Our processes led to several meaningful contributions to the research study. This experience illustrates the willingness and importance of partnering with stakeholders to help shape resources and programs in pediatric diabetes intervention research.

Objective: Managing preexisting diabetes during pregnancy requires considerable self-management skills to achieve recommended glycemic targets and reduce fetal and obstetrical risks. Given the demands during this time, many individuals may experience diabetes distress. This study aimed to determine the prevalence of diabetes distress and associated clinical factors of diabetes distress during pregnancy.

Research design and methods: A cross-sectional study was conducted involving 36 pregnant participants with type 1 diabetes and 40 pregnant participants with type 2 diabetes. Assessments of diabetes distress, the primary outcome, were performed, along with assessments of depressive symptoms, self-efficacy, self-management, and patient care satisfaction. Linear and logistic regression analyses were conducted to determine predictors of diabetes distress scores and positive diabetes distress.

Results: The prevalence of diabetes distress was 22.4%. Age ≥35 years of age and higher education levels were significantly associated with scores on the Problem Areas in Diabetes (PAID) scale, which measures diabetes-related emotional distress (decreases of 10.18 and 11.77 points, respectively, P = 0.04). Living with others was associated with a reduction in PAID score by 21.56 points (P = 0.05) and the Patient Assessment of Chronic Illness (PACIC) total score as well as PACIC Goal-Setting, and Problem-Solving/Contextual Counseling subscale scores were each associated with a decrease of ∼4 points in PAID score (P <0.05). Having a common-law partner or spouse, comorbid depression, depressive symptoms, and depression scores were all significantly associated with increased PAID scores (P <0.05).

Conclusion: The prevalence of diabetes distress in pregnancy is similar to estimates for nonpregnant adults with type 1 or type 2 diabetes, based on limited pregnancy literature. Further research is needed to establish diabetes distress rates using a validated tool for pregnancy to understand whether diabetes distress affects obstetrical and fetal outcomes and how diabetes distress levels can be alleviated in this population.