Pub Date : 2023-01-01Epub Date: 2023-11-15DOI: 10.2337/dsi23-0006
Anastasia Albanese-O'Neill
This article describes the implementation of a diabetes technology educational program targeting continuous glucose monitoring (CGM) adoption that significantly increased utilization of CGM in the Division of Pediatric Endocrinology at the University of Florida. The author proposes that diabetes care and education specialists (DCESs) are uniquely positioned in the health care ecosystem to serve as diabetes technology champions. The article provides a step-by-step roadmap that DCESs and clinicians can use as they lead efforts to expand CGM adoption and durable use.
{"title":"Roadmap to the Effective Use of Continuous Glucose Monitoring by Diabetes Care and Education Specialists as Technology Champions.","authors":"Anastasia Albanese-O'Neill","doi":"10.2337/dsi23-0006","DOIUrl":"10.2337/dsi23-0006","url":null,"abstract":"<p><p>This article describes the implementation of a diabetes technology educational program targeting continuous glucose monitoring (CGM) adoption that significantly increased utilization of CGM in the Division of Pediatric Endocrinology at the University of Florida. The author proposes that diabetes care and education specialists (DCESs) are uniquely positioned in the health care ecosystem to serve as diabetes technology champions. The article provides a step-by-step roadmap that DCESs and clinicians can use as they lead efforts to expand CGM adoption and durable use.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654133/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This article is adapted from a speech Dr. Kirksey delivered in June 2022 as President, Health Care & Education of the American Diabetes Association. He delivered his address at the Association's 82nd Scientific Sessions in New Orleans, LA. A webcast of this speech is available for viewing on the DiabetesPro website (https://professional.diabetes.org/webcast/president-health-care-education-address-and-outstanding-educator-diabetes-award-lecture).
{"title":"No Substitute for Hard Work: Dedication to the Diabetes Community.","authors":"Otis Kirksey","doi":"10.2337/ds22-0082","DOIUrl":"https://doi.org/10.2337/ds22-0082","url":null,"abstract":"<p><p>This article is adapted from a speech Dr. Kirksey delivered in June 2022 as President, Health Care & Education of the American Diabetes Association. He delivered his address at the Association's 82nd Scientific Sessions in New Orleans, LA. A webcast of this speech is available for viewing on the DiabetesPro website (https://professional.diabetes.org/webcast/president-health-care-education-address-and-outstanding-educator-diabetes-award-lecture).</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935289/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10763446","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-02-23DOI: 10.2337/ds22-0060
Jill M Olausson, Veronica J Brady, Susan Storey
Objective: The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes.
Methods: A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist.
Results: Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%).
Conclusion: The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.
{"title":"Effect of COVID-19 on Type 2 Diabetes Self-Care Behaviors: A Rapid Review.","authors":"Jill M Olausson, Veronica J Brady, Susan Storey","doi":"10.2337/ds22-0060","DOIUrl":"10.2337/ds22-0060","url":null,"abstract":"<p><strong>Objective: </strong>The aim of this review was to describe how the coronavirus disease 2019 (COVID-19) lockdown affected the self-care behaviors of people living with type 2 diabetes.</p><p><strong>Methods: </strong>A systematic rapid review was conducted using four electronic databases. Studies reporting on the lockdown's impact on at least one of the self-care behaviors that were published from January 2020 through October 2021 were included. Findings were synthesized narratively, using the Association of Diabetes Care & Education Specialists ADCES7 Self-Care Behaviors as a framework. The methodological level of evidence and quality ratings of the articles were assessed using the Joanna Briggs Institute Appraisal Checklist.</p><p><strong>Results: </strong>Fifteen articles were included. Most studies reported on at least five of the self-care behaviors. There were reported increases in diabetes-related stress, as well as in increases in dietary intake and changes in the timing of meals. Physical activity was reported to decrease. Overall, taking medications and glycemic self-monitoring of blood glucose (SMBG) were unaffected by the lockdown. Of the studies reporting glycemic outcomes, the lockdown appeared to have little negative effect. None of the articles assessed all the self-care behaviors. The self-care behavior of SMBG was the least assessed. Most articles had a medium level of evidence and a medium to high quality rating (scores >60%).</p><p><strong>Conclusion: </strong>The findings from this review found the COVID-19 lockdown had a variable impact on diabetes self-care behaviors. Because the potential for future COVID-19 surges and/or other virulent transmissible diseases remains a concern, health care providers should continue to address the importance of self-care behaviors to mitigate the risk of poor health outcomes in people with diabetes.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425230/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10388277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-03-30DOI: 10.2337/ds22-0076
Alissa J Roberts, Kristen Carlin, Joyce P Yi-Frazier, Ashley Moss, Meenal Gupta, Faisal S Malik
{"title":"Longitudinal Associations of Mental Health Comorbidities With A1C Among Adolescents and Young Adults With Type 1 Diabetes.","authors":"Alissa J Roberts, Kristen Carlin, Joyce P Yi-Frazier, Ashley Moss, Meenal Gupta, Faisal S Malik","doi":"10.2337/ds22-0076","DOIUrl":"10.2337/ds22-0076","url":null,"abstract":"","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43010075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-11-15DOI: 10.2337/dsi23-0004
Helen R Murphy
The landscape for managing type 1 diabetes during pregnancy has been transformed by increasing use of continuous glucose monitoring (CGM). Women are aiming for pregnancy-specific glucose targets or 70% time in range for pregnancy (TIRp; 63-140 mg/dL) as soon as possible, knowing that every extra 5% TIRp has benefits for reducing the risks of complications in their babies. Ongoing monitoring of maternal A1C (at pregnancy confirmation and at 20, 28, and 36 weeks' gestation) remains useful. Intensification of glycemic management and instruction in using CGM (if not already used) is recommended for individuals with an A1C >6.0% after 20 weeks. A better understanding of CGM-documented glycemic changes throughout pregnancy is needed to inform future management of gestational diabetes and pregnancy in people with type 2 diabetes. Research regarding overcoming barriers to CGM use and optimal TIRp targets for pregnant individuals with type 2 diabetes from diverse racial/ethnic groups is urgently needed.
{"title":"Roadmap to the Effective Use of Continuous Glucose Monitoring in Pregnancy.","authors":"Helen R Murphy","doi":"10.2337/dsi23-0004","DOIUrl":"10.2337/dsi23-0004","url":null,"abstract":"<p><p>The landscape for managing type 1 diabetes during pregnancy has been transformed by increasing use of continuous glucose monitoring (CGM). Women are aiming for pregnancy-specific glucose targets or 70% time in range for pregnancy (TIRp; 63-140 mg/dL) as soon as possible, knowing that every extra 5% TIRp has benefits for reducing the risks of complications in their babies. Ongoing monitoring of maternal A1C (at pregnancy confirmation and at 20, 28, and 36 weeks' gestation) remains useful. Intensification of glycemic management and instruction in using CGM (if not already used) is recommended for individuals with an A1C >6.0% after 20 weeks. A better understanding of CGM-documented glycemic changes throughout pregnancy is needed to inform future management of gestational diabetes and pregnancy in people with type 2 diabetes. Research regarding overcoming barriers to CGM use and optimal TIRp targets for pregnant individuals with type 2 diabetes from diverse racial/ethnic groups is urgently needed.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10654120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138048158","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Kevin M Pantalone, Caroline Heller, Rosemarie Lajara, Elisheva Lew, Xuan Li, Terry Dex, C Rachel Kilpatrick
Background: When type 2 diabetes is suboptimally controlled with basal insulin, prandial insulin injections are commonly added (i.e., a basal-bolus insulin regimen), which can increase treatment burden and hypoglycemia risk. The once-daily injectable iGlarLixi is an alternative treatment.
Methods: This retrospective analysis of the U.S. Optum Clinformatics database compared outcomes in adults (≥18 years of age) with type 2 diabetes who previously received basal insulin and were newly initiated on iGlarLixi or basal-bolus insulin therapy. Cohorts were propensity score-matched in a 1:1 ratio on baseline characteristics, and imbalances were adjusted in multivariate analyses. Subgroup analyses were performed for people ≥65 years of age and those with a baseline A1C ≥9%. The primary end point was persistence with therapy at 12 months in the overall population. Secondary end points were treatment adherence, health care resource utilization (HCRU), costs, any hypoglycemia, and A1C change at 12 months.
Results: Cohorts each comprised 1,070 participants. Treatment persistence at 12 months was statistically significantly higher for iGlarLixi versus basal-bolus insulin therapy (43.7 vs. 22.3%, hazard ratio 0.51, 95% CI 0.46-0.57, adjusted P <0.001). Adherence was numerically higher for iGlarLixi, and hypoglycemia events, HCRU, and costs were numerically lower for iGlarLixi. A1C reduction from baseline was slightly greater for basal-bolus insulin. Results for both subgroups (≥65 years of age and baseline A1C ≥9%) were similar to those of the overall population.
Conclusion: In this observational study, initiation of once-daily iGlarLixi versus basal-bolus insulin was associated with higher persistence, lower hypoglycemia, and similar A1C reduction without increasing HCRU or costs regardless of age or A1C. iGlarLixi could be an alternative to basal-bolus insulin, particularly for older adults with type 2 diabetes who require treatment simplification with lower hypoglycemia risk.
背景:当2型糖尿病在基础胰岛素控制下处于次优状态时,通常会增加餐前胰岛素注射(即基础胰岛素方案),这可能会增加治疗负担和低血糖风险。每日一次注射iGlarLixi是一种替代治疗方法。方法:对美国Optum Clinformatics数据库进行回顾性分析,比较了先前接受基础胰岛素治疗并新开始接受iGlarLixi或基础胰岛素治疗的2型糖尿病成人(≥18岁)的结局。队列在基线特征上按1:1的比例进行倾向评分匹配,并在多变量分析中调整不平衡。对≥65岁和基线A1C≥9%的患者进行亚组分析。主要终点是在总体人群中持续治疗12个月。次要终点是治疗依从性、卫生保健资源利用率(HCRU)、费用、任何低血糖和12个月时的A1C变化。结果:每个队列包括1,070名参与者。iGlarLixi治疗12个月时的治疗持久性比基础胰岛素治疗高(43.7 vs 22.3%,风险比0.51,95% CI 0.46-0.57,校正P)。结论:在这项观察性研究中,与基础胰岛素治疗相比,每日一次的iGlarLixi治疗与更高的持久性、更低的低血糖和类似的A1C降低相关,而不增加HCRU或成本,无论年龄或A1C。iGlarLixi可能是基础胰岛素的替代方案,特别是对于需要简化治疗并降低低血糖风险的老年2型糖尿病患者。
{"title":"Initiation of iGlarLixi Versus Basal-Bolus Insulin in Adults With Type 2 Diabetes Advancing From Basal Insulin Therapy: The SoliComplex Real-World Study.","authors":"Kevin M Pantalone, Caroline Heller, Rosemarie Lajara, Elisheva Lew, Xuan Li, Terry Dex, C Rachel Kilpatrick","doi":"10.2337/ds22-0064","DOIUrl":"https://doi.org/10.2337/ds22-0064","url":null,"abstract":"<p><strong>Background: </strong>When type 2 diabetes is suboptimally controlled with basal insulin, prandial insulin injections are commonly added (i.e., a basal-bolus insulin regimen), which can increase treatment burden and hypoglycemia risk. The once-daily injectable iGlarLixi is an alternative treatment.</p><p><strong>Methods: </strong>This retrospective analysis of the U.S. Optum Clinformatics database compared outcomes in adults (≥18 years of age) with type 2 diabetes who previously received basal insulin and were newly initiated on iGlarLixi or basal-bolus insulin therapy. Cohorts were propensity score-matched in a 1:1 ratio on baseline characteristics, and imbalances were adjusted in multivariate analyses. Subgroup analyses were performed for people ≥65 years of age and those with a baseline A1C ≥9%. The primary end point was persistence with therapy at 12 months in the overall population. Secondary end points were treatment adherence, health care resource utilization (HCRU), costs, any hypoglycemia, and A1C change at 12 months.</p><p><strong>Results: </strong>Cohorts each comprised 1,070 participants. Treatment persistence at 12 months was statistically significantly higher for iGlarLixi versus basal-bolus insulin therapy (43.7 vs. 22.3%, hazard ratio 0.51, 95% CI 0.46-0.57, adjusted <i>P</i> <0.001). Adherence was numerically higher for iGlarLixi, and hypoglycemia events, HCRU, and costs were numerically lower for iGlarLixi. A1C reduction from baseline was slightly greater for basal-bolus insulin. Results for both subgroups (≥65 years of age and baseline A1C ≥9%) were similar to those of the overall population.</p><p><strong>Conclusion: </strong>In this observational study, initiation of once-daily iGlarLixi versus basal-bolus insulin was associated with higher persistence, lower hypoglycemia, and similar A1C reduction without increasing HCRU or costs regardless of age or A1C. iGlarLixi could be an alternative to basal-bolus insulin, particularly for older adults with type 2 diabetes who require treatment simplification with lower hypoglycemia risk.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425231/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10388275","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objective: To assess the effectiveness of an interprofessional support program (Siscare) that includes motivational interviews (patient-pharmacist), electronic monitoring (EM) of medications, patient-reported and clinical outcomes monitoring, and interactions with physicians for patients with type 2 diabetes in French-speaking Switzerland.
Methods: This was a prospective, multicenter, observational cohort study using a hybrid implementation-effectiveness design. Individual daily adherence to at least one oral antidiabetic medication was measured by EM. A global adherence score was estimated by the product of a model-estimated implementation and a nonparametric estimate of persistence over time. Clinical outcomes (A1C, blood glucose, BMI, blood pressure, heart rate, and cholesterol levels) and quality of life (QoL) were analyzed over time using linear mixed-effect models.
Results: A total of 212 patients were included from 27 pharmacies; 120 patients (57%) were followed up for at least 15 months. In total, 140 patients (66%) were male, the mean age was 64 ± 11 years, and the mean number of chronic medications per patient at baseline was 5 ± 3. Of 178 patients who used EM, 95% (95% CI 92-99%) remained persistent at the end of the follow-up period. The percentage of persistent patients taking their medications appropriately (implementation) was stable during follow-up and was estimated to be 90% (95% CI 87-92%) at baseline and 88% (95% CI 84-91%) at month 15. At baseline, the mean A1C and BMI were 7.5% and 31 kg/m2, respectively, which decreased by 0.5% (P = 0.012) and 0.6 kg/m2 (P = 0.017), respectively, after 15 months. QoL remained stable during follow-up.
Conclusion: The program supports medication adherence and improves clinical outcomes, illustrating the overall preventive effect of coordinated care.
目的:评估跨专业支持项目(Siscare)的有效性,该项目包括动机访谈(患者-药剂师)、药物电子监测(EM)、患者报告和临床结果监测,以及瑞士法语区2型糖尿病患者与医生的互动。方法:这是一项前瞻性、多中心、观察性队列研究,采用实施-有效性混合设计。通过EM测量个体每天对至少一种口服抗糖尿病药物的依从性。通过模型估计的实施和随时间持续的非参数估计的产物来估计全球依从性评分。临床结果(A1C、血糖、BMI、血压、心率和胆固醇水平)和生活质量(QoL)使用线性混合效应模型随时间分析。结果:共纳入患者212例,来自27家药店;120例患者(57%)随访至少15个月。140例患者(66%)为男性,平均年龄64±11岁,基线时平均服用慢性药物5±3次。在178例使用EM的患者中,95% (95% CI 92-99%)在随访结束时仍持续使用。在随访期间,持续适当服用药物的患者比例稳定,基线时估计为90% (95% CI 87-92%),第15个月时估计为88% (95% CI 84-91%)。基线时,平均A1C和BMI分别为7.5%和31 kg/m2, 15个月后分别下降0.5% (P = 0.012)和0.6 kg/m2 (P = 0.017)。随访期间生活质量保持稳定。结论:该项目支持药物依从性并改善临床结果,说明协调护理的整体预防效果。
{"title":"Effectiveness of an Interprofessional Program (Siscare) for Supporting Patients With Type 2 Diabetes.","authors":"Noura Bawab, Marie-Paule Schneider, Pierluigi Ballabeni, Isabella Locatelli, Olivier Bugnon, Clémence Perraudin","doi":"10.2337/ds21-0084","DOIUrl":"https://doi.org/10.2337/ds21-0084","url":null,"abstract":"<p><strong>Objective: </strong>To assess the effectiveness of an interprofessional support program (Siscare) that includes motivational interviews (patient-pharmacist), electronic monitoring (EM) of medications, patient-reported and clinical outcomes monitoring, and interactions with physicians for patients with type 2 diabetes in French-speaking Switzerland.</p><p><strong>Methods: </strong>This was a prospective, multicenter, observational cohort study using a hybrid implementation-effectiveness design. Individual daily adherence to at least one oral antidiabetic medication was measured by EM. A global adherence score was estimated by the product of a model-estimated implementation and a nonparametric estimate of persistence over time. Clinical outcomes (A1C, blood glucose, BMI, blood pressure, heart rate, and cholesterol levels) and quality of life (QoL) were analyzed over time using linear mixed-effect models.</p><p><strong>Results: </strong>A total of 212 patients were included from 27 pharmacies; 120 patients (57%) were followed up for at least 15 months. In total, 140 patients (66%) were male, the mean age was 64 ± 11 years, and the mean number of chronic medications per patient at baseline was 5 ± 3. Of 178 patients who used EM, 95% (95% CI 92-99%) remained persistent at the end of the follow-up period. The percentage of persistent patients taking their medications appropriately (implementation) was stable during follow-up and was estimated to be 90% (95% CI 87-92%) at baseline and 88% (95% CI 84-91%) at month 15. At baseline, the mean A1C and BMI were 7.5% and 31 kg/m<sup>2</sup>, respectively, which decreased by 0.5% (<i>P</i> = 0.012) and 0.6 kg/m<sup>2</sup> (<i>P</i> = 0.017), respectively, after 15 months. QoL remained stable during follow-up.</p><p><strong>Conclusion: </strong>The program supports medication adherence and improves clinical outcomes, illustrating the overall preventive effect of coordinated care.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9935292/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10756267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-01-24DOI: 10.2337/ds22-0047
Julia Price, Amanda M Lewis, Jessica S Pierce, Paul T Enlow, Katherine Okonak, Anne E Kazak
Background: Few studies have examined the implementation of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines for the Psychological Care of Children and Adolescents with Type 1 Diabetes.
Objective: To collect benchmark data on psychosocial staffing and implementation of the ISPAD guidelines across U.S. pediatric diabetes clinics.
Methods: Medical (n = 95; 77 endocrinologists and 18 advance practice providers) and psychosocial (n = 86; 43 social workers and 43 psychologists) providers from 98 of 115 contacted clinics completed an online survey (85% response rate). Providers reported the number of psychosocial staff and rated the adequacy of psychosocial staffing, quality of psychosocial care, and adherence to the ISPAD guidelines in their clinics. χ2 Tests and ANOVA were used to examine differences across clinic size and across medical and psychosocial providers.
Results: Clinics averaged a total of ∼4 hours per week of psychosocial provider time per 100 patients with type 1 diabetes. Only 27% of providers agreed that psychosocial staffing was adequate, and 35% described their psychosocial care as comprehensive. Implementation of the ISPAD guidelines varied across clinics, with minimal differences across clinic size. Medical providers reported that evidence-based psychological assessment and interventions were delivered consistently by <55% of clinics. Psychosocial, compared with medical, providers were more likely to report frequent implementation of psychosocial assessment and intervention guidelines.
Conclusion: Psychological care in U.S. pediatric type 1 diabetes clinics does not consistently meet the ISPAD guidelines, and many clinics lack adequate psychosocial staff. These benchmark data are a foundational step to improve psychosocial care for pediatric patients with type 1 diabetes.
{"title":"Psychosocial Staffing and Implementation of the International Society for Pediatric and Adolescent Diabetes Psychological Care Guidelines in U.S. Pediatric Diabetes Clinics.","authors":"Julia Price, Amanda M Lewis, Jessica S Pierce, Paul T Enlow, Katherine Okonak, Anne E Kazak","doi":"10.2337/ds22-0047","DOIUrl":"10.2337/ds22-0047","url":null,"abstract":"<p><strong>Background: </strong>Few studies have examined the implementation of the International Society for Pediatric and Adolescent Diabetes (ISPAD) Clinical Practice Consensus Guidelines for the Psychological Care of Children and Adolescents with Type 1 Diabetes.</p><p><strong>Objective: </strong>To collect benchmark data on psychosocial staffing and implementation of the ISPAD guidelines across U.S. pediatric diabetes clinics.</p><p><strong>Methods: </strong>Medical (<i>n</i> = 95; 77 endocrinologists and 18 advance practice providers) and psychosocial (<i>n</i> = 86; 43 social workers and 43 psychologists) providers from 98 of 115 contacted clinics completed an online survey (85% response rate). Providers reported the number of psychosocial staff and rated the adequacy of psychosocial staffing, quality of psychosocial care, and adherence to the ISPAD guidelines in their clinics. χ<sup>2</sup> Tests and ANOVA were used to examine differences across clinic size and across medical and psychosocial providers.</p><p><strong>Results: </strong>Clinics averaged a total of ∼4 hours per week of psychosocial provider time per 100 patients with type 1 diabetes. Only 27% of providers agreed that psychosocial staffing was adequate, and 35% described their psychosocial care as comprehensive. Implementation of the ISPAD guidelines varied across clinics, with minimal differences across clinic size. Medical providers reported that evidence-based psychological assessment and interventions were delivered consistently by <55% of clinics. Psychosocial, compared with medical, providers were more likely to report frequent implementation of psychosocial assessment and intervention guidelines.</p><p><strong>Conclusion: </strong>Psychological care in U.S. pediatric type 1 diabetes clinics does not consistently meet the ISPAD guidelines, and many clinics lack adequate psychosocial staff. These benchmark data are a foundational step to improve psychosocial care for pediatric patients with type 1 diabetes.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10388271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-03-15DOI: 10.2337/ds22-0061
Rachel K Baker, Stephanie L Filipp, Laura M Jacobsen
Regular use of continuous glucose monitoring (CGM) in type 1 diabetes management increases the achievement of glycemic targets and reduces health care utilization, specifically emergency department (ED) visits. This retrospective chart review examined the effects of CGM use in patients with type 1 diabetes in a pediatric ED. Use of CGM was associated with several differences in patient management in the ED. This work is a first step toward development of guidelines for the appropriate use of CGM in the pediatric ED. In the future, CGM use in type 1 diabetes may lead to reduced ED-specific health care costs.
{"title":"Type 1 Diabetes Continuous Glucose Monitoring Use in the Pediatric Emergency Department Affects Laboratory Test Frequency but Not Treatment Timing.","authors":"Rachel K Baker, Stephanie L Filipp, Laura M Jacobsen","doi":"10.2337/ds22-0061","DOIUrl":"10.2337/ds22-0061","url":null,"abstract":"<p><p>Regular use of continuous glucose monitoring (CGM) in type 1 diabetes management increases the achievement of glycemic targets and reduces health care utilization, specifically emergency department (ED) visits. This retrospective chart review examined the effects of CGM use in patients with type 1 diabetes in a pediatric ED. Use of CGM was associated with several differences in patient management in the ED. This work is a first step toward development of guidelines for the appropriate use of CGM in the pediatric ED. In the future, CGM use in type 1 diabetes may lead to reduced ED-specific health care costs.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-01-01Epub Date: 2023-03-20DOI: 10.2337/ds22-0058
Michelle D S Boakye, Sheridan Miyamoto, Deborah Greenwood, Jennifer Kraschnewski, Kimberly Van Haitsma, Marie Boltz
Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: 1) type 2 diabetes diagnosis competes with other complex life challenges, 2) difficulty in performing behavior modification actions, 3) lack of support, 4) emergence of emotional and psychological issues, and 5) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition.
{"title":"Pathway From Type 2 Diabetes Diagnosis to Action: How to Move People Forward.","authors":"Michelle D S Boakye, Sheridan Miyamoto, Deborah Greenwood, Jennifer Kraschnewski, Kimberly Van Haitsma, Marie Boltz","doi":"10.2337/ds22-0058","DOIUrl":"10.2337/ds22-0058","url":null,"abstract":"<p><p>Seven self-care behaviors-healthy coping, healthy eating, being active, taking medication, monitoring, reducing risk, and problem-solving-are recommended for individuals with diabetes to achieve optimal health and quality of life. People newly diagnosed with type 2 diabetes may find it challenging to learn and properly incorporate all of these self-care behaviors into their life. This qualitative study explored the experiences and perceived immediate self-management and psychosocial support needs in individuals newly diagnosed with type 2 diabetes. Data analysis revealed the significant challenges individuals encounter after a type 2 diabetes diagnosis. Five main themes were identified: <i>1</i>) type 2 diabetes diagnosis competes with other complex life challenges, <i>2</i>) difficulty in performing behavior modification actions, <i>3</i>) lack of support, <i>4</i>) emergence of emotional and psychological issues, and <i>5</i>) need for planned individualized follow-up support after a type 2 diabetes diagnosis. This study revealed a gap in care after type 2 diabetes diagnosis. Individualized support is needed to assist people in moving successfully from diagnosis to being well equipped with the knowledge and skills necessary to properly manage the condition.</p>","PeriodicalId":39737,"journal":{"name":"Diabetes Spectrum","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10425228/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10012661","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}