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1.
Sci Rep ; 13(1): 7026, 2023 04 29.
Article in English | MEDLINE | ID: covidwho-2300554

ABSTRACT

Older adults with type 1 diabetes (T1D) have unique challenges and needs. In this mixed-methods study, we explored the impact of isolation during a pandemic on diabetes management and overall quality of life in this population. Older adults (age ≥ 65 years) with T1D receiving care at a tertiary care diabetes center participated in semi-structured interviews during COVID-19 pandemic isolation between June and August 2020. A multi-disciplinary team coded transcripts and conducted thematic analysis. Thirty-four older adults (age 71 ± 5 years, 97% non-Hispanic white, diabetes duration of 38 ± 7 years, A1C of 7.4 ± 0.9% (57.3 ± 10.1 mmol/mol) were recruited. Three themes related to diabetes self-care emerged regarding impact of isolation on: (1) diabetes management and self-care behaviors (how isolation prompted changes in physical activity and dietary habits); (2) emotional stress and anxiety (related to isolation and lack of support system, economic concerns); and (3) concerns regarding the COVID-19 pandemic (impact on timely medical care and access to information). Our findings identify modifiable barriers and challenges faced by older adults with T1D during isolation. As this population has a higher risk of decline in physical and psychosocial support even during non-pandemic times, clinicians will benefit from understanding these issues to improve care of this population.


Subject(s)
COVID-19 , Diabetes Mellitus, Type 1 , Humans , Aged , Quality of Life/psychology , Self Care , Pandemics
2.
JMIR Diabetes ; 7(4): e38869, 2022 Nov 18.
Article in English | MEDLINE | ID: covidwho-2141403

ABSTRACT

BACKGROUND: The COVID-19 lockdown imposed a sudden change in lifestyle with self-isolation and a rapid shift to the use of technology to maintain clinical care and social connections. OBJECTIVE: In this mixed methods study, we explored the impact of isolation during the lockdown on the use of technology in older adults with type 1 diabetes (T1D). METHODS: Older adults (aged ≥65 years) with T1D using continuous glucose monitoring (CGM) participated in semistructured interviews during the COVID-19 lockdown. A multidisciplinary team coded the interviews. In addition, CGM metrics from a subgroup of participants were collected before and during the lockdown. RESULTS: We evaluated 34 participants (mean age 71, SD 5 years). Three themes related to technology use emerged from the thematic analysis regarding the impact of isolation on (1) insulin pump and CGM use to manage diabetes, including timely access to supplies, and changing Medicare eligibility regulations; (2) technology use for social interaction; and (3) telehealth use to maintain medical care. The CGM data from a subgroup (19/34, 56%; mean age 74, SD 5 years) showed an increase in time in range (mean 57%, SD 17% vs mean 63%, SD 15%; P=.001), a decrease in hyperglycemia (>180 mg/dL; mean 41%, SD 19% vs mean 35%, SD 17%; P<.001), and no change in hypoglycemia (<70 mg/dL; median 0.7%, IQR 0%-2% vs median 1.1%, IQR 0%-4%; P=.40) during the lockdown compared to before the lockdown. CONCLUSIONS: These findings show that our cohort of older adults successfully used technology during isolation. Participants provided the positive and negative perceptions of technology use. Clinicians can benefit from our findings by identifying barriers to technology use during times of isolation and developing strategies to overcome these barriers.

3.
Diabetes ; 70, 2021.
Article in English | ProQuest Central | ID: covidwho-1362259

ABSTRACT

Background: Older adults with type 1 diabetes (T1D) face unique challenges, especially when their support structure is disrupted, as happened during the Covid-19 lockdown. We evaluated the clinical and psychological impact of this imposed isolation on the older population with T1D. Methods: We conducted semi-structured interviews with older adults with T1D who were part of an ongoing study, which was paused from March - August 2020. The interviews were performed between May - August 2020, and were transcribed, coded, and analyzed using content analysis to derive theme. A multidisciplinary team of 12 individuals coded the interviews to identify the themes and included geriatricians, endocrinologists, a nurse educator, infomaticists, an economist, a methodologist, and research assistants. Results: We have analyzed 12/35 interviews at this time;mean age 74±4 years, 50% female, 92% non-Hispanic white, mean duration of diabetes 37±18 years, and A1C 7.3±0.7%. Three main themes have emerged. The challenges related to diabetes care included fear of hypoglycemia, interruption in supply chain related to diabetes technology (insulin pump and continuous glucose monitoring (CGM) supplies), use of telehealth, diabetes-related distress, and adapting to new routines in self-care (diet and exercise). Challenges related to the Covid-19 pandemic included fear of getting Covid-19 infection, and a lack of reliable information on pandemic. The challenges related to psychological well-being included a feeling of isolation, loneliness, inability to spend time with family and friends, lack of in-person communication, and lack of recreational activity. Conclusion: The results of this qualitative study help to understand critical areas of need when social support structures are unavailable to older adults with T1D. Our results will help develop intervention strategies to overcome barriers in maintaining support for this vulnerable population.

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