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1.
J Health Psychol ; 25(4): 429-438, 2020 03.
Article in English | MEDLINE | ID: mdl-28810490

ABSTRACT

Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.


Subject(s)
Diabetes Mellitus, Type 1/therapy , Patient Acceptance of Health Care , Self-Management/psychology , Trust , Adult , Female , Humans , Male , Qualitative Research , Self-Management/methods
2.
Diabetes Technol Ther ; 20(10): 648-653, 2018 10.
Article in English | MEDLINE | ID: mdl-30239219

ABSTRACT

BACKGROUND: Hybrid closed loop (HCL) systems are designed to automate insulin delivery to improve type 1 diabetes (T1D) outcomes and reduce user burden and distress. Because the systems only automate some aspects of diabetes care, psychosocial and human factors remain an important consideration in their use. Thus, we examined whether psychosocial and human factors (i.e., distress related to diabetes management, fear of hypoglycemia, and technology attitudes) would (1) change after using the system and (2) predict glycemic outcomes during the trial. SUBJECTS AND METHODS: Fourteen adults and 15 adolescents with T1D participated in a multisite clinical trial of an investigational version of the MiniMed™ 670G system (Medtronic, Northridge, CA) over 4 to 5 days in a semisupervised outpatient setting. Users completed surveys assessing psychosocial and human factors before beginning the HCL system and at the conclusion of the study. t-Tests and regression analyses were conducted to examine whether these factors changed following trial exposure to the HCL system and predicted glycemic outcomes during the trial. RESULTS: Diabetes management distress decreased and diabetes technology attitudes became more positive over the trial period. Fear of hypoglycemia did not change over the trial period. There was a trend toward greater pretrial management distress predicting less time in range during the trial, controlling for time in range before the trial. CONCLUSIONS: Results suggest that this system is promising for enhancing technology attitudes and reducing management distress. Psychosocial factors, such as management distress, may negatively impact glycemic outcomes and should be a priority area for further investigation.


Subject(s)
Diabetes Mellitus, Type 1/drug therapy , Diabetes Mellitus, Type 1/psychology , Hypoglycemic Agents/administration & dosage , Hypoglycemic Agents/therapeutic use , Insulin Infusion Systems/psychology , Insulin/administration & dosage , Insulin/therapeutic use , Adolescent , Adult , Attitude , Blood Glucose/analysis , Fear , Female , Humans , Hypoglycemia/psychology , Male , Stress, Psychological/etiology , Stress, Psychological/psychology , Treatment Outcome , Young Adult
3.
Diabetes Educ ; 44(4): 340-347, 2018 Aug.
Article in English | MEDLINE | ID: mdl-29949457

ABSTRACT

Purpose The purpose of this study is to examine the characteristics and health outcomes of college students with type 1 diabetes mellitus (T1DM) as it relates to membership in a local university-based diabetes student organization. Methods This descriptive, correlational research design is a secondary analysis of data. The sample consisted of nationally representative young adults in college (n = 317) between 18 and 30 years of age who were diagnosed with T1DM. Data were collected during April 2017 using a secure electronic diabetes management survey to inquire about self-reported barriers to diabetes management, hypoglycemia, and diabetic ketoacidosis of members of a diabetes organization. Results Students were evenly distributed from freshman to senior year of college with a slight decrease at the graduate level. Students who were affiliated members of a student-led diabetes student organization were less likely to report increased levels of isolation, depressive symptoms, and anxiety related to their diabetes than were general members. Conclusion Participation in a university-based diabetes student organization on campus and connecting with other college students with diabetes may have health benefits. In conclusion, the current study underscores the potential importance of peer-led, diabetes-specific support for adolescents emerging into adulthood.


Subject(s)
Diabetes Mellitus, Type 1/psychology , Self-Help Groups/organization & administration , Social Support , Students/psychology , Adolescent , Adult , Anxiety/psychology , Depression/psychology , Female , Humans , Male , Peer Group , Social Isolation/psychology , Surveys and Questionnaires , Universities , Young Adult
4.
Diabetes Educ ; 43(2): 223-232, 2017 04.
Article in English | MEDLINE | ID: mdl-28340542

ABSTRACT

Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study was to explore the benefits, expectations, and attitudes of individuals with T1D following a clinical trial of an HCL system. Methods Thirty-two individuals with T1D (17 adults, 15 adolescents) participated in focus groups after 4 to 5 days of system use. Content analysis generated themes regarding perceived benefits, hassles, and limitations. Results Some participants felt misled by terms such as "closed loop" and "artificial pancreas," which seemed to imply a more "hands-off" experience. Perceived benefits were improved glycemic control, anticipated reduction of long-term complications, better quality of life, and reduced mental burden of diabetes. Hassles and limitations included unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and being reminded of diabetes. Conclusion Users are willing to accept some hassles and limitations if they also perceive health and quality-of-life benefits beyond current self-management. It is important for clinicians to provide a balanced view of positives and negatives to help manage expectations.


Subject(s)
Blood Glucose Self-Monitoring/psychology , Diabetes Mellitus, Type 1/psychology , Health Knowledge, Attitudes, Practice , Insulin Infusion Systems , Pancreas, Artificial , Adolescent , Adult , Blood Glucose/drug effects , Blood Glucose Self-Monitoring/instrumentation , Diabetes Mellitus, Type 1/drug therapy , Female , Humans , Hypoglycemic Agents/administration & dosage , Insulin/administration & dosage , Male , Treatment Outcome , Young Adult
5.
J Pediatr Health Care ; 31(3): 327-333, 2017.
Article in English | MEDLINE | ID: mdl-27843015

ABSTRACT

INTRODUCTION: Emerging adults (EA) with disordered eating behaviors (DEBs) and Type 1 diabetes (T1D) are at increased risk for severe complications of T1D, and these behaviors have been reported in EA women with T1D. Few studies, though, have included men. This study assessed the prevalence of DEB in both EA men and women with T1D. METHODS: DEB was measured with the diabetes-specific Diabetes Eating Problem Survey-Revised (DEPS-R); scores of 20 or greater indicate need for further evaluation for DEB. RESULTS: A total of 27 women and 33 men (age range = 21 ± 2.5 years) completed the DEPS-R; 27% of women and 18% of men had scores of 20 or greater (p = .23). Hemoglobin A1c level was significantly higher in subjects with elevated DEPS-R scores (10.4 ± 2.1% vs. 7.8 ± 1.3%; p < .001), and DEPS-R scores correlated with increased body mass index values (r = 0.27, p < .05). DISCUSSION: Clinicians should assess for DEB in both male and female emerging adults with T1D, especially overweight patients with poor glycemic control.


Subject(s)
Diabetes Mellitus, Type 1/complications , Diabetic Angiopathies/etiology , Feeding and Eating Disorders/complications , Blood Glucose Self-Monitoring , Body Mass Index , Diabetes Mellitus, Type 1/metabolism , Diabetes Mellitus, Type 1/physiopathology , Diabetes Mellitus, Type 1/psychology , Diabetic Angiopathies/metabolism , Diabetic Angiopathies/physiopathology , Feeding and Eating Disorders/metabolism , Feeding and Eating Disorders/physiopathology , Feeding and Eating Disorders/psychology , Female , Glycated Hemoglobin/metabolism , Health Surveys , Humans , Male , Pilot Projects , Prevalence , Prospective Studies , Psychiatric Status Rating Scales , United States , Young Adult
6.
Endocr Pract ; 22(9): 1104-10, 2016 Sep.
Article in English | MEDLINE | ID: mdl-27295017

ABSTRACT

OBJECTIVE: Screening for depression, diabetes distress, and disordered eating in youth with type 1 diabetes (T1D) is recommended, as these comorbidities contribute to poor glycemic control. No consensus exists on which measures are optimal, and most previous studies have used nondisease-specific measures. We examined the utility of screening for these disorders using two disease-specific and one general measure at the time of transition from pediatric to adult care. METHODS: Forty-three young adults from a T1D transition clinic completed the Patient Health Questionnaire, the Diabetes Distress Scale, and the Diabetes Eating Problem Survey-Revised. Chart review determined if clinicians noted similar symptoms during the year prior to transition. Metabolic data were also recorded. RESULTS: Chart review identified 5 patients with depressive symptoms and 8 patients with diabetes distress. Screening identified 2 additional patients with depressive symptoms and 1 additional patient with diabetes distress. Of those noted to have symptomatic depression or diabetes distress on chart review, several subsequently screened negative on transition. Disordered eating was not detected by chart review, but 23.5% screened positive on transition. While depression, diabetes distress, and disordered eating positively correlated with glycated hemoglobin (HbA1c) (r = 0.31, P = .05; r = 0.40, P = .009; r = 0.63, P<.001, respectively), disordered eating accounted for the majority of observed variance (df = 1; F = 18.6; P<.001). Even though HbA1c was higher in patients with versus without disordered eating (P<.001), body mass index did not differ between the 2 groups (P = .51). CONCLUSION: In young adults with T1D, formal screening provides an opportunity to detect psychological problems, which, when treated, may help optimize metabolic control during the transition process. ABBREVIATIONS: T1D = type 1 diabetes HbA1C = hemoglobin A1c YCDP = Yale Children's Diabetes Program PHQ-8 = Patient Health Questionnaire-8 DDS = Diabetes Distress Scale DEPS-R = Diabetes Eating Problem Survey-Revised.


Subject(s)
Diabetes Mellitus, Type 1/psychology , Diabetes Mellitus, Type 1/therapy , Stress, Psychological/diagnosis , Transition to Adult Care , Adolescent , Adult , Depression/diagnosis , Depression/etiology , Diabetes Mellitus, Type 1/complications , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/etiology , Female , Humans , Male , Mass Screening/methods , Predictive Value of Tests , Psychological Tests , Surveys and Questionnaires , Young Adult
7.
Pediatr Diabetes ; 9(3 Pt 2): 74-82, 2008 Jun.
Article in English | MEDLINE | ID: mdl-18540868

ABSTRACT

OBJECTIVE: Little is known about the use of psychosocial interventions in children younger than adolescence with type 1 diabetes (T1D) and their parents. We report preliminary short-term outcomes of a randomized controlled trial of coping skills training (CST) compared with group education (GE) in school-aged children with T1D and their parents. METHODS: One hundred and eleven children (range = 8-12 yr) with T1D for at least 6 months (3.71 +/- 2.91 yr) were randomized to CST (55.6% female (F); 81.5% white (W)) or GE (69.7% F; 90.9% W). Children and parents (n = 87) who completed the intervention, baseline, 1- and 3-month data are included. Children completed measures of self-efficacy, coping, and quality of life; parents completed measures of family functioning (adaptability and cohesion), diabetes-related conflict, parent depression, and parent coping. Metabolic control was assessed with glycosylated hemoglobin A1c. Mixed-model repeated measures anova was used to analyze the data. RESULTS: CST and GE group composition was generally comparable. Children had good psychosocial adaptation and metabolic status. CST parents reported significantly more improvement in family adaptability compared with GE parents, and a trend was seen indicating that CST children showed greater improvement in life satisfaction than GE children. Effect sizes for this short-term follow-up period were small, but group participants were receptive to the intervention and reported positive gains. CONCLUSIONS: In these preliminary results, CST and GE were more similar than different across multiple measure of psychosocial adaptation, although CST showed promising statistical trends for more adaptive family functioning and greater life satisfaction. Longer term follow-up is underway.


Subject(s)
Adaptation, Psychological/physiology , Diabetes Mellitus, Type 1/psychology , Social Adjustment , Behavior Therapy , Child , Connecticut , Depression/classification , Depression/epidemiology , Diabetes Mellitus, Type 1/rehabilitation , Diabetes Mellitus, Type 1/therapy , Family , Glycated Hemoglobin/analysis , Humans , Interpersonal Relations , Parent-Child Relations , Patient Education as Topic , Patient Selection , Prospective Studies , Schools , Self Efficacy , Socioeconomic Factors , Surveys and Questionnaires
8.
J Pediatr Psychol ; 33(5): 509-19, 2008 Jun.
Article in English | MEDLINE | ID: mdl-17991690

ABSTRACT

OBJECTIVE: To examine the relationships among maternal and child depressive symptoms and child and family psychosocial factors. METHOD: Secondary analysis of baseline data for a coping skills intervention for school-age children (ages 8-12) with type 1 diabetes (T1D) and their mothers. Children and mothers completed measures of depressive symptoms, coping, quality of life, and family functioning. RESULTS: There was a strong relationship between maternal and child depressive symptoms (r = .44, p < .001). Maternal depressive symptoms were negatively related to child quality of life, perceptions of coping, and family functioning. Impact of diabetes on quality of life, finding coping with diabetes upsetting, and family warmth mediated the relationship between maternal and child depressive symptoms. CONCLUSIONS: Maternal depression may negatively affect child adjustment through its influence on quality of life, coping, and family functioning. Implications for interventions to improve psychosocial adjustment in children with T1D are discussed.


Subject(s)
Depression/psychology , Diabetes Mellitus, Type 1/psychology , Mothers/psychology , Adaptation, Psychological , Adult , Behavior Therapy , Child , Depression/diagnosis , Family Relations , Female , Humans , Male , Middle Aged , Mother-Child Relations , Personality Inventory , Quality of Life/psychology , Sick Role
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