Correlates and Patterns of COVID-19 Vaccination Intentions among Parents of Children with Type 1 Diabetes.

OBJECTIVE: To examine psychosocial, sociodemographic, medical, and coronavirus disease 2019 (COVID-19) experiences as correlates of COVID-19 vaccination intentions among parents of children with type 1 diabetes (T1D). METHODS: 121 parents of children with T1D (Mchild age = 7.78 ± 1.70; MA1c = 8.3% ± 1.5%) in the mid-Atlantic and Southwest regions completed self-report measures in February to March 2021. RESULTS: Parents' general vaccination behaviors and attitudes were associated with COVID-19 vaccination intentions. Child insurance type and social distancing adherence were associated with vaccination intention in the Southwest site. Higher A1c was associated with lower intention. Vaccine safety was the top reported concern. CONCLUSIONS: COVID-19 vaccination intentions are important to address in parents of youth with health conditions.

Increase in the Diagnosis and Severity of Presentation of Pediatric Type 1 and Type 2 Diabetes during the COVID-19 Pandemic.

INTRODUCTION: The impact of the COVID-19 pandemic on the incidence of pediatric type 1 (T1D) and type 2 diabetes (T2D) and severity of presentation at diagnosis is unclear. METHODS: A retrospective comparison of 737 youth diagnosed with T1D and T2D during the initial 12 months of the COVID-19 pandemic and in the preceding 2 years was conducted at a pediatric tertiary care center. RESULTS: Incident cases of T1D rose from 152 to 158 in the 2 years before the pandemic (3.9% increase) to 182 cases during the pandemic (15.2% increase). The prevalence of diabetic ketoacidosis (DKA) at T1D diagnosis increased over 3 years (41.4%, 51.9%, and 57.7%, p = 0.003); severe DKA increased during the pandemic as compared to the 2 years before (16.8% vs. 28%, p = 0.004). Although there was no difference in the mean hemoglobin A1c (HbA1c) between racial and ethnic groups at T1D diagnosis in the 2-years pre-pandemic (p = 0.31), during the pandemic HbA1c at T1D diagnosis was higher in non-Hispanic Black (NHB) youth (11.3 ± 1.4%, non-Hispanic White 10.5 ± 1.6%, Latinx 10.8 ± 1.5%, p = 0.01). Incident cases of T2D decreased from 54 to 50 cases (7.4% decrease) over the 2-years pre-pandemic and increased 182% during the pandemic (n = 141, 1.45 cases/month, p < 0.001). As compared to the 2-years pre-pandemic, cases increased most among NHB youth (56.7% vs. 76.6%, p = 0.001) and males (40.4% vs. 58.9%, p = 0.005). Cases of DKA (5.8% vs. 23.4%, p < 0.001) and hyperosmolar DKA (0 vs. 9.2%, p = 0.001) increased among youth with T2D during the pandemic. CONCLUSIONS: During the pandemic, the incidence and severity of presentation of T1D increased modestly, while incident cases of T2D increased 182%, with a nearly 6-fold increase in DKA and nearly a 10% incidence of hyperosmolar DKA. NHB youth were disproportionately impacted, raising concern about worsening of pre-existing health disparities during and after the pandemic.

Sleepless in the Pandemic? Changes in Sleep among Parents with Children with Type 1 Diabetes (T1D)

Introduction: Parents of youth with T1D have poorer sleep due to T1D management and worries. During the COVID-19 pandemic, managing T1D may be more demanding and new stressors and routines can impact sleep. We compared parental sleep pre-pandemic to the initial months of the pandemic. Methods: Parents (n=100, 98% mothers) of youth with T1D (M age = 6.7±1.6 yrs, M duration = 2.9±.5 yrs) who were in a behavioral RCT completed surveys at RCT completion and ≥ 6 months later in June/July 2020. They completed the Pittsburgh Sleep Quality Index (PSQI) adapted to include T1D-related sleep questions, and 2 sleep items from a COVID-19 survey. M A1c at RCT completion = 8.2±1.4. We compared pre-pandemic vs. 2020 data using χ2 and t tests. Results: Many parents (40%) reported moderate-extreme difficulty sleeping during the pandemic. From pre- to during the pandemic, PSQI Latency scores increased significantly and Duration and Daytime Dysfunction decreased. More parents had PSQI Global Scores above the clinical cut-off during the pandemic. See Table for details. Conclusions: Parents of children with T1D experienced increased sleep challenges during the COVID-19 pandemic, despite lower T1D-related disruption and daytime impairment. Nighttime T1D management may have been less disruptive as parents slept less. Parental sleep warrants clinical attention as it impacts psychosocial well-being and T1D management for families.

Experiences of Emerging Adults with T1D during the COVID-19 Pandemic

Introduction: Emerging adults (EAs) with T1D may be disproportionately affected by COVID-19 related disruptions given the many transitions that occur during this developmental period. The current study examined self-reported challenges in daily routines and T1D care in a sample of EAs during the COVID-19 pandemic. Method: Participants included 22 EAs with T1D (M age=21.6±1.1 yrs;45.4% male;40.9% non-Hispanic white;86.4% enrolled in higher education;77.3% employed;M A1c=7.8%±1.2%). EAs completed surveys about exposure/personal impact of COVID-19 (n=13), a structured interview (n=2), or both (n=7) during the first 9 months of the COVID-19 pandemic (3/2020 - 11/2020). Results: Most EAs (86.4%) denied COVID-19 symptoms, diagnoses, or hospitalizations in themselves or close contacts;3 EAs (13.6%) reported COVID-19 diagnoses in family members, with one reported death of a family member. Fifty-five percent of EAs reported strictly social distancing. On the survey, 85% of EAs reported significant disruptions due to COVID-19, including job loss/reduction in hours (45%), education changes (45%), and moving (40%). T1D impact varied, with 50% reporting easier management of T1D;30% reporting less exercise/worse diet;30% reporting sleep problems;and 40% reporting more health anxiety. For EAs with more than one instance of survey completion (n=9), diabetes-specific impact worsened over time (t(8)=-2.20, p=.06;Cohen's d = -.72). Interview data (n=9) supported quantitative results, with themes related to the impact of COVID-19 on daily routines for T1D management and delayed transition to adult T1D care. Discussion: EAs with T1D experienced many COVID-related changes and increasing negative impact on T1D self-care over time. EAs may be particularly vulnerable to the widespread impacts of COVID-19 on employment, education, and receipt of medical care. Future research should examine longitudinal responses to the COVID-19 pandemic to identify EAs who may need additional support or resources for T1D care.

The COVID-19 Pandemic and New-Onset Pediatric Type 2 Diabetes

Introduction: Reports are emerging about the impact of the COVID-19 pandemic on pediatric T1D, however few studies have explored pediatric T2D. We aimed to investigate changes in T2D initial clinical presentation and patient demographic characteristics during COVID-19. Methods: A retrospective cross-sectional review of youth diagnosed with T2D during the COVID-19 pandemic (3/11/2020-11/30/2020) and in the time matched period in 2019 was conducted at a pediatric tertiary care center. BMI Z-score (>1.64), age (>8) and the absence of DKA and autoantibodies at diabetes diagnosis (A1c >6.5%) were used to screen for T2D, with confirmation by chart review. Chi-square, Fisher's exact, and independent samples t-tests were used for analyses. Results: During the pandemic, cases of T2D increased 233% from 2019 (n=36, Mage=14.1±2.6 years, 56% F) to 2020 (n=84, Mage=14.6±2.2 years, 42% F). Rates of new onset T2D increased as the pandemic continued, from 4-8 per month in April-June to 20 and 16 cases, respectively, in October and November. Only 3 youth were actively infected with COVID-19 at T2D diagnosis. Rates of DKA at diagnosis increased from 6% in 2019 to 21% in 2020 (p=0.03), with 6 cases of hyperosmolar DKA during the pandemic as compared to none in 2019. Before the pandemic, 53% of youth diagnosed with T2D were Black, compared to 77% during the pandemic (p=0.03). Similar increases were seen among those with public insurance, rising from 67% to 86% (p=0.02). Conclusions: Cases of T2D and severity of initial presentation increased during the first 9 months of the COVID-19 pandemic, particularly among Black and publicly insured youth. These findings align with prior reports highlighting the disproportionate impact of the COVID-19 pandemic on racial/ethnic and socioeconomically disadvantaged communities. As few youth were infected with COVID-19 at T2D diagnosis, pandemic-related social distancing measures may also have disproportionate impacts on these communities and serve to worsen pre-existing health disparities.

Predictors of mood, diabetes-specific and COVID-19-specific experiences among parents of early school-age children with type 1 diabetes during initial months of the COVID-19 pandemic.

OBJECTIVE: The current study explored pre-pandemic sociodemographics, medical characteristics, social/family support, and mood symptoms, and current COVID-19 experiences as predictors of mood, positive/negative diabetes-specific experiences, and COVID-19-specific distress among parents of children with type 1 diabetes during the COVID-19 pandemic. We hypothesized that parents from marginalized backgrounds, youth with higher pre-pandemic A1c and no CGM use, parents with lower pre-pandemic social/family support and more pre-pandemic mood/anxiety symptoms, and those with more negative COVID-19 experiences would have more depressive symptoms, fewer positive and more negative diabetes-specific experiences, and more COVID-19-specific distress during the initial months of the pandemic. RESEARCH DESIGN AND METHODS: Participants were parents of early school-age children with type 1 diabetes (n = 100; 65% non-Hispanic, white, 92% mothers, 75% married; Mchild age  = 6.74 ± 1.59 years) who had completed a behavioral intervention trial ≥6 months ago and were re-contacted in June/July 2020 to report on their COVID-19 pandemic experiences and parent psychosocial outcomes. Pre-pandemic parent mood/anxiety symptoms, family/social support, and children's medical characteristics (CGM use; MA1C  = 8.17% ± 1.40%) were assessed M = 1.45 ± 0.59 years prior. RESULTS: More pre-pandemic social support predicted fewer depressive symptoms, more positive diabetes-specific experiences, and less COVID-19-specific distress during the pandemic. More pre-pandemic depressive symptoms predicted more depressive symptoms during the pandemic. More life disruptions due to the pandemic were associated with more negative diabetes-specific experiences and more COVID-19-specific distress. Parents of color had more negative diabetes-specific experiences. CONCLUSIONS: Social support may be particularly important to assess and address through intervention. Pediatric diabetes care providers should monitor parent experiences in relation to children's diabetes management. ClinicalTrials.gov identifier: NCT02527525.

COVID-19 Pandemic-Related Practices and Policies Affecting the Continuity of Behavioral Health Care Among Children With Diabetes.

COVID-19 has led to substantial challenges in continuing to deliver behavioral health care to all patients, including children with chronic diseases. In the case of diabetes, maintaining strong connections among children, their families, and their care team is essential to promote and sustain daily adherence to a complex medical regimen. The purpose of this paper is to describe COVID-19 pandemic-related practices and policies affecting the continuity of behavioral health care among children with diabetes. Challenges and opportunities were encountered at the provider, patient, and family levels throughout the rapid transition period from in-person to online care to ensure continuity of services. Institutional, regional, and national policies that impacted the care team's capacity to respond swiftly to patients' changing needs were counterbalanced by those related to standards of care, education and training, and resource constraints. At the policy level, COVID-19 re-exposed a number of long-standing and complicated issues about professional licensure among behavioral health providers at the local and state levels and national long-distance practice restrictions during times of crisis. Issues of insurance reimbursement and regulations intended to protect the public may need to adapt and evolve as the practice of behavioral medicine increasingly takes place remotely, online, and over great distances. The sudden transition to telehealth instigated by COVID-19, in addition to the increasing recognition of the benefits of telehealth to favorably affect the reach and impact of traditional behavioral medicine services, offers an unprecedented opportunity to reimagine the medical home and continuity of care for children with diabetes.