Coping and Psychosocial Adjustment in Mothers of Young Children With Type 1 Diabetes

This study examined symptoms of anxiety and depression in mothers of young children with type 1 diabetes (T1D) in relation to mothers' fears of hypoglycemia, perceptions of coping, and children's metabolic control. Sixty-seven mothers of children less than 8 years of age diagnosed with T1D completed self-report measures, and children's metabolic control was measured with glycosolated hemoglobin. Approximately 21% of mothers reported clinically significant levels of symptoms of anxiety and 24% reported clinically significant levels of depression. Lower income level and finding it more upsetting to cope with diabetes-related stress accounted for higher symptoms of anxiety and depression in mothers. Mothers' symptoms were not related to children's metabolic control. Recommendations are made for screening mothers and providing supportive interventions to alleviate their distress.     

Sleep Behaviors and Parent Functioning in Young Children With Type 1 Diabetes

This study evaluates sleep characteristics among young children with type 1 diabetes and associations with parent sleep and emotional functioning and diabetes care. Study participants included 24 parents of young children with type 1 diabetes (ages 2–5) enrolled in a pilot study of a randomized-controlled trial. Child sleep characteristics were within normal limits. However, increased child bedtime resistance and behavioral insomnia were related to greater parent stress, anxiety, and depression and use of an intensive insulin regimen. Type 1 diabetes management may impact child and parent sleep as well as parent emotional functioning. Implications for practice are presented.     

Diabetes Management and Metabolic Control in School-Age Children With Type 1 Diabetes

This study investigated the effect of mother's coping resources, cognitive resources, family stress, and demographic variables on diabetes management and the mediating role of diabetes management on metabolic control among children with diabetes. Mothers (N = 59) completed self-report measures. HbA1c was obtained from the medical records. Although cognitive resources, coping resources, and family stress accounted for 30% of the variance in diabetes management, the hypothesis of mediation was not supported. The only significant predictor of HbA1c was African American race/ethnicity. The findings identify modifiable targets for practice and highlight the increased risk for poor metabolic control for minority children.     

Pilot Study Results for a Novel Behavior Plus Nutrition Intervention for Caregivers of Young Children With Type 1 Diabetes

ObjectiveTo present results for a parent-based educational intervention targeting mealtime behaviors plus nutrition among families of young children (mean age, 5.0 ± 1.2 years) with type 1 diabetes mellitus (T1DM).MethodsThe researchers recruited 9 caregivers who participated in the 6-session intervention and completed baseline and posttreatment assessments, which included dietary intake, acceptability of diet changes, mealtime behavior, and mean blood glucose values.ResultsChildren's mean daily blood glucose levels decreased from 185 ± 46 mg/dL to 159 ± 40 mg/dL (P < .001). There were also decreases in problematic parent and child mealtime behaviors. There was no change in children's dietary intake indicators that could be detected.Conclusions and ImplicationsIt appears promising that this targeted behavior plus nutrition intervention can improve glycemic control and behavior for young children with type 1 diabetes mellitus. Larger, randomized controlled trials will clarify significant results, limitations, and sustainability. Techniques within the program may have application to current practice.     

Dietary Changes and Gut Dysbiosis in Children With Type 1 Diabetes

Objective: Gut dysbiosis in type 1 diabetes (T1D), characterized by high Bacteroides proportion, tends to reverse as T1D progresses, without reaching full recovery. Since diet influences microbiota structure, the aim was to evaluate the impact of dietary changes on Bacteroides proportion the first year of T1D evolution.

Methods: Dietary intake was assessed by 24-hour recalls and Bacteroides proportion by quantitative polymerase chain reaction, in 10 Mexican children (11.6 ± 1.92 years) with T1D at baseline and 3, 6 and 9 months' follow-up. Repeated measures analysis of variance and multiple linear regression were performed to compare ingested nutrients in relation with Bacteroides proportion. Effects over time were evaluated by mixed regression models.

Results: Patients with T1D decreased their energy (2621.89 to 1867.85 kcal, p = 0.028), protein (83.06 to 75.17 g, p = 0.012), and saturated fat consumption (40.83 to 25.23 g, p = 0.031) from baseline to 3 months, without posterior changes. Bacteroides proportion increased in the first months and tended to decrease at around 9 months (p > 0.05) and was positively correlated with saturated fat (β = 3.70, p = 0.009) and total carbohydrates (β = 0.73, p = 0.005) at 3 months. Carbohydrate consumption was related to decreased Bacteroides abundance over time (β = ?14.9, p = 0.004), after adjusting for glycosylated hemoglobin.

Conclusions: Besides autoimmunity, diet appears to have a central role determining the T1D-associated dysbiosis evolution.     

Reliability and Validity of a Carbohydrate-Counting Knowledge Questionnaire for Young Australians With Type 1 Diabetes

ObjectiveTo test the reliability and validity of a carbohydrate-counting knowledge questionnaire in young Australians with type 1 diabetes mellitus (T1DM).MethodsChildren or young adults (<20 years) with T1DM, or their parents, completed the 72-item Australian PedCarbQuiz (AusPCQ), adapted from the American PedCarbQuiz, and an expert assessment of carbohydrate-counting knowledge. Responses were scored and summed (0–72, higher scores = greater knowledge). Internal reliability was assessed using Cronbach α, and relative validity using Spearman correlations (with HbA1c) and Bland-Altman analysis (with the expert assessment).ResultsAustralian PedCarbQuiz reliability (n = 44, mean score = 59.7 ± 5.6) was acceptable (α = 0.83). There was a lack of agreement (mean bias = 10.7, P = 0.008) and significant proportional bias between AusPCQ scores and expert assessments (β = ?0.73 [95% confidence interval, ?1.82 to ?0.79]; P < 0.001).Conclusions and ImplicationsThe AusPCQ was shown to be reliable but not valid in a small sample. Testing in a larger sample is warranted.     

哈尔滨市儿童1型糖尿病危险因素研究

在对哈尔滨市１５岁以下Ｉ型糖尿病患者进行登记的基础上,为寻找发病的环境危险因素,采用１：２的病例对照研究方法,调查了５０例儿童糖尿病患者和１００例对照。经单因素分析发现易患呼吸道感染和肠道感染、有既往麻疹和水痘病史、婴儿期（１￣３个月）接触牛奶、易发热、易受惊吓以及Ｉ型糖尿病家族史均能增加发病危险。经多因素Ｌｏｇｉｓｔｉｃ回归模型分析,筛选出易患呼吸道感染和肠道感染、既往患床疹及易受惊吓为引起儿童     

Health Attitudes,Beliefs, and Risk Behaviors Among Adolescents and Young Adults With Type 1 Diabetes

Decision making about engaging in health-promoting and health-compromising behaviors among adolescents and young adults with type 1 diabetes is an important but understudied topic. The purpose of this study was to describe the health attitudes, beliefs, risk behaviors, and general psychological functioning of adolescents and young adults with diabetes and to compare these psychosocial aspects of health to those of adolescents and young adults without diabetes. Fifty-three adolescents and young adults with type 1 diabetes and 53 demographically matched controls were recruited from 2 pediatric teaching hospitals and administered a confidential self-report questionnaire consisting of individual survey items and standardized scales. Compared to healthy adolescents and young adults, adolescents and young adults with diabetes had more frequent thoughts about health and sickness, rated their health as poorer, viewed smoking as less addictive, reported greater symptoms of depression, and reported greater exposure to smoking in their households, but less smoking experimentation. Poorer metabolic control was associated with decreased physical activity. Additional research on the design and implementation of diabetes-specific cardiovascular disorder and tobacco control programs for adolescents and young adults is warranted.     

Health Attitudes, Beliefs, and Risk Behaviors Among Adolescents and Young Adults With Type 1 Diabetes

Decision making about engaging in health-promoting and health-compromising behaviors among adolescents and young adults with type 1 diabetes is an important but understudied topic. The purpose of this study was to describe the health attitudes, beliefs, risk behaviors, and general psychological functioning of adolescents and young adults with diabetes and to compare these psychosocial aspects of health to those of adolescents and young adults without diabetes. Fifty-three adolescents and young adults with type 1 diabetes and 53 demographically matched controls were recruited from 2 pediatric teaching hospitals and administered a confidential self-report questionnaire consisting of individual survey items and standardized scales. Compared to healthy adolescents and young adults, adolescents and young adults with diabetes had more frequent thoughts about health and sickness, rated their health as poorer, viewed smoking as less addictive, reported greater symptoms of depression, and reported greater exposure to smoking in their households, but less smoking experimentation. Poorer metabolic control was associated with decreased physical activity. Additional research on the design and implementation of diabetes-specific cardiovascular disorder and tobacco control programs for adolescents and young adults is warranted.     

Dietary Adherence and Mealtime Behaviors in Young Children with Type 1 Diabetes on Intensive Insulin Therapy

Diet is an important component of diabetes treatment and integral to successful management. While intensive insulin therapy can allow patients to eat more freely, it is not known how the rapid uptake of intensive therapy in young children with type 1 diabetes has impacted their diet and if diet and healthful eating in young children correlates with mealtime behaviors and glycemic control. This study examined diet, mealtime behaviors, and glucose control in a sample of 39 young children on intensive therapy. This was a one-sample, cross-sectional study. Children had a mean age of 5.1±1.1 years. Children's 3-day diet diaries were assessed using a deviation scale (measure of adherence) and a healthy eating index. Mealtime behaviors were assessed using the Behavioral Pediatric Feeding Assessment Scale. Children's glucose control was measured using continuous glucose monitoring. Children's mean carbohydrate intake was 72%±24% of the recommended levels based on their age, sex, size, and activity level, and children exceeded national guidelines for percentage of calories from fat and saturated fat. A more healthful diet correlated with fewer child mealtime behavior problems, but better dietary adherence correlated with more parent mealtime behavior problems. Even in the context of intensive management, diet can be problematic for young children with type 1 diabetes. Parent-reported problems with mealtime behaviors seem to correlate with healthy eating and dietary adherence.     

Coping and Psychological Distress in Mothers of Adolescents with Type 1 Diabetes

The purpose of this study was to describe coping in mothers of adolescents with type 1 diabetes and to examine the association among mothers’ diabetes-related stress and coping strategies and maternal psychological distress (e.g., symptoms of anxiety and depression), adolescent adjustment (e.g., symptoms of depression, quality of life), diabetes-related family conflict, and glycemic control. One hundred and eighteen mother-adolescent dyads completed measures of diabetes-related stress, coping, symptoms of anxiety and depression, quality of life, and family conflict. Data on glycemic control were collected from adolescents’ medical charts. Single/divorced mothers and mothers of color were significantly more likely to use disengagement coping strategies (e.g., avoidance) than White and married/partnered mothers. Mothers’ use of primary control coping (e.g., problem solving) and secondary control coping (e.g., acceptance) strategies was related to fewer symptoms of anxiety (r = ? .51, ?.39) and depression (r = ? .32, ?.37) and less family conflict (r = ? .22, ?.30, all p < .05). Mothers’ use of disengagement coping strategies was related to greater symptoms of anxiety (r = .30) and depression (r = .27, both p < .01). Further, secondary control coping was found to mediate the relationship between diabetes-related stress and maternal symptoms of anxiety and depression. Maternal coping was not significantly associated with adolescent outcomes. The ways in which mothers of adolescents with type 1 diabetes cope with diabetes-related stress are associated with psychological distress and family conflict. By identifying and improving mothers’ coping through screening and targeted interventions, we may have the potential to improve both maternal and adolescent outcomes.     

Maternal Health-Related Coping Patterns and Health and Adjustment Outcomes in Children With Type 1 Diabetes

Parental coping patterns can influence health outcomes of a child with a chronic illness. As part of a longitudinal study of 8- to 13-year-old children with newly diagnosed diabetes, we examined the relation between maternal health-related coping strategies and rehospitalizations and psychopathology in the child with diabetes. Forty-two pairs of children and their mothers were evaluated separately by means of a comprehensive assessment battery including a semistructured psychiatric interview, self-rated questionnaires, and overall diabetes course and management. Although results of this study suggest that mothers' coping patterns have no detectable impact on short-term health outcomes of children with diabetes, mothers considered maintaining family integration and understanding the medical situation as very helpful coping strategies. Suggestions for research using a longer follow-up period and implications for health care providers are discussed.     

Psychosocial Group Interventions for Children and Adolescents With Type 1 Diabetes: The State of the Literature

The increasing prevalence of diabetes among children increases the demand for cost-effective psychosocial interventions. This article reviews the efficacy of group-based psychological interventions designed to improve psychological adaptation, adherence to the treatment regimen, and diabetes-related medical outcomes in children and adolescents with type 1 diabetes. To help treatment providers incorporate empirically supported treatment components into group-based diabetes clinical programs, the review also discusses the challenges of transferring these interventions from clinical research trial to clinical setting.     

Psychosocial Group Interventions for Children and Adolescents With Type 1 Diabetes: The State of the Literature

The increasing prevalence of diabetes among children increases the demand for cost-effective psychosocial interventions. This article reviews the efficacy of group-based psychological interventions designed to improve psychological adaptation, adherence to the treatment regimen, and diabetes-related medical outcomes in children and adolescents with type 1 diabetes. To help treatment providers incorporate empirically supported treatment components into group-based diabetes clinical programs, the review also discusses the challenges of transferring these interventions from clinical research trial to clinical setting.     

Psychosocial Correlates of Health Care Utilization for Children and Adolescents With Type 1 Diabetes Mellitus

Our objective was to examine the relation of self-reported depressive symptomatology to health care utilization (HCU) in families with a child with Type 1 diabetes mellitus (DM1). Data were obtained from a community sample (N = 88) being followed in 2 private outpatient diabetes clinics. Children and adolescents completed measures of depressive symptomatology. Mothers provided demographic information and completed measures of HCU and depressive symptomatology. Physicians provided measures of glycosylated hemoglobin (HbA1c) and illness severity. Hierarchical regression analyses indicated that higher levels of child depressive symptomatology were associated with increased HCU for children with DM1 above and beyond demographic and illness variables. However, no significant relationship was found between either adolescent or maternal depressive symptomatology and HCU. These findings suggest self-reported depressive symptomatology in children with DM1 is a salient correlate of HCU even after statistically controlling for the influence of demographics and illness parameters. The possibility that children with DM1 with symptoms of depression may have higher utilization of health services supports the need to target psychosocial variables for intervention.     

Effect of Type 1 Diabetes on Psychosocial Maturation in Young Adults

PurposePrevious research suggests that having diabetes may complicate the passage from adolescence to adulthood. The aim of this study was to establish if young adults with Type 1 diabetes (T1DM) had delays in aspects of their psychosocial maturation compared with healthy controls (HC).MethodsA cross-sectional study compared psychosocial maturation in individuals aged 18–25 years with T1DM to age-matched healthy controls. After obtaining consent, participants completed the following measures: Responsibility and Independence Scale for Adolescents (RISA; psychosocial maturity); Social Maturation Index (SMI, social maturity); Levenson’s Locus of Control Scales (LOC, internal versus external locus of control) and the Social Density Grid (SDG, social network).ResultsIn total, 160 subjects completed the study (97 T1DM, 63 HC). Participants included 101 females. No group differences were found on the RISA total score or the Responsibility or Independence Subscales of this measure. On the SMI, the proportion of subjects within each category (good, moderate or poor) was similar for each group. The overall number of social contacts identified on the SDG was similar for all groups; however, individuals with diabetes identified fewer friends within their social network that knew each other (F (2,160) = 3.28, p < .05). No significant group differences were found for LOC.ConclusionsYoung adults with Type 1 diabetes did not show delayed psychosocial maturation when compared with healthy young adult controls.     

The Box, a Naturalistic Experiment with Young Children: The Same Object as Mediating Factor for Different Activities

There have been a number of theories suggesting that there are qualitative differences in the way that children of different ages and adults perceive the world. The most famous of these theories is Piaget's genetic epistemology, describing and documenting differences in understandings of the physical and social worlds. In this paper we make the argument that there are also qualitative differences in the way children of different ages recognize the same objects as mediating devices for their activity. The object as mediating factor is based on the child's everyday experience with similar objects combined with his/her ontological development. A naturalistic experiment in which the same object was introduced into an infant/toddler classroom and a preschool classroom is presented as an example of these types of differences. The recognition that objects have very different meanings for children of different ages has important implication for the way teachers in general, and early childhood educators in particular, think about the introduction of materials into their classrooms.     

Predictors of Deteriorations in Diabetes Management and Control in Adolescents With Type 1 Diabetes

PurposeDeteriorating type 1 diabetes management and control are common among adolescents; however, clinical evidence suggests that individual trajectories can vary. The aim of this study was to examine patterns and predictors of blood glucose monitoring (BGM) frequency and glycemic control (hemoglobin A1c).MethodsProspective data analysis spanning 18–24 months was conducted with 150 adolescent–parent pairs. Latent group-based trajectory modeling identified subgroups and determined medical, demographic, psychological, and family predictors of subgroup membership.ResultsThree subgroups emerged, representing diabetes management and control that are “meeting treatment targets” (40%; A1c at baseline = 7.4%, BGM frequency at baseline = 4.8 checks/day) and two levels “not meeting targets”:“normatively similar” youth (40%; A1c = 9.2%, BGM frequency = 2.8 checks/day), and “high-risk” youth (20%; A1c = 11.2%, BGM frequency = 2.9 checks/day). Subgroup membership was maintained over 18–24 months. There was minimal change across time, although only one-third of adolescents met treatment targets. Older age, longer diabetes duration, ethnic minority status, unmarried caregiver status, insulin delivery via injections versus continuous subcutaneous insulin infusion, greater depressive symptoms, negative affect about BGM, and diabetes-specific family conflict each predicted membership in a subgroup with poorer diabetes management and control.ConclusionsAmong the nearly two-thirds of adolescents with management and control that do not meet treatment targets, modifiable and nonmodifiable factors may signal the need for prevention or intervention. Demographic and medical factors may call for proactive efforts to prevent deterioration, and psychological symptoms and family conflict signal opportunities for clinical intervention to promote improved diabetes management and control in adolescence.