A Pilot Study of Distraction for Adolescents During Allergy Testing

PURPOSE. This pilot study describes pain and anxiety associated with allergy testing; tests distraction, specifically self-selected distraction; and examines the relationship between pain, anxiety, and engagement with distraction. DESIGN AND METHODS. An experimental design was used with a convenience sample of 32 adolescents from an allergist's office randomly assigned to three groups. Pain was measured by the adolescent pediatric pain tool (APPT) and FACES scale. RESULTS. No differences in pain ratings were found among the groups. Less pain was associated with lower anxiety and greater engagement with distraction. Greater engagement with distraction occurred with less anxiety. PRACTICE IMPLICATIONS. Knowledge about allergy testing pain, anxiety, and engagement with distraction can assist nurses in preparing adolescents for this procedure.     

A Concept Analysis: Assuming Responsibility for Self-Care among Adolescents with Type 1 Diabetes

PURPOSE. This concept analysis clarifies “assuming responsibility for self-care” by adolescents with type 1 diabetes. METHODS. Walker and Avant's (2005 ) methodology guided the analysis. RESULTS. Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making. PRACTICE IMPLICATIONS. Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.     

Cognitive Function in Adolescents and Young Adults With Youth-Onset Type 1 Versus Type 2 Diabetes: The SEARCH for Diabetes in Youth Study

OBJECTIVEPoor cognition has been observed in children and adolescents with youth-onset type 1 (T1D) and type 2 diabetes (T2D) compared with control subjects without diabetes. Differences in cognition between youth-onset T1D and T2D, however, are not known. Thus, using data from SEARCH for Diabetes in Youth, a multicenter, observational cohort study, we tested the association between diabetes type and cognitive function in adolescents and young adults with T1D (n = 1,095) or T2D (n = 285).RESEARCH DESIGN AND METHODSCognition was assessed via the National Institutes of Health Toolbox Cognition Battery, and age-corrected composite Fluid Cognition scores were used as the primary outcome. Confounder-adjusted linear regression models were run. Model 1 included diabetes type and clinical site. Model 2 additionally included sex, race/ethnicity, waist-to-height ratio, diabetes duration, depressive symptoms, glycemic control, any hypoglycemic episode in the past year, parental education, and household income. Model 3 additionally included the Picture Vocabulary score, a measure of receptive language and crystallized cognition.RESULTSHaving T2D was significantly associated with lower fluid cognitive scores before adjustment for confounders (model 1; P < 0.001). This association was attenuated to nonsignificance with the addition of a priori confounders (model 2; P = 0.06) and Picture Vocabulary scores (model 3; P = 0.49). Receptive language, waist-to-height ratio, and depressive symptoms remained significant in the final model (P < 0.01 for all, respectively).CONCLUSIONSThese data suggest that while youth with T2D have worse fluid cognition than youth with T1D, these differences are accounted for by differences in crystallized cognition (receptive language), central adiposity, and mental health. These potentially modifiable factors are also independently associated with fluid cognitive health, regardless of diabetes type. Future studies of cognitive health in people with youth-onset diabetes should focus on investigating these significant factors.     

A Pilot of Interventions to Improve Health Care in Adolescents with Intellectual Disability

Background People with intellectual disability often have poor health which may be improved through better health advocacy and enhanced communication with their general practitioner. To this end, we examined the use of the Comprehensive Health Assessment Program (CHAP) and the Ask health diary previously developed for adults with intellectual disability and trialled their use in adolescents attending a Special School. Materials and methods A CHAP health review completed by both carers and General Practitioners was used to collect information about adolescents’ health. An Ask health diary was used in school to learn health advocacy and communication skills. Thirty students, their parents and their eight teachers participated in the trial. Results The CHAP health review resulted in a mean of 5.2 health conditions being found, and 1.4 planned actions by the general practitioner per adolescent. The Ask health diary was highly accepted by the students and teachers. There did not appear to be any increase in communication skills of the students after using the diary in the school for one term. Conclusion The CHAP health review and Ask health diary have the potential to improve the health of adolescents with intellectual disability.     

Adolescents with Type 1 Diabetes: transition between diabetes services

Aim. The research aimed to develop a sustainable and coordinated approach to facilitating the transition between diabetes services for adolescents. The objectives were to: (1) involve key diabetes health delivery stakeholders in expressing their concerns and issues about current service delivery and ways to improve same, and (2) reveal from the perspective of the adolescents living with Type 1 Diabetes their experiences surrounding the process of transition. Background. This paper presents research that sought to identify the major concerns and issues that stakeholders had about transition and to reveal the experience of transition for the adolescent with Type 1 Diabetes. Key representatives from seven public diabetes services in Adelaide, South Australia worked collaboratively to answer the objectives of this inquiry. Approach. Interview data were generated and analysed using a response focus framework provided by fourth generation evaluation research. In this study, the focus was on common concerns, claims and issues raised by health care professionals (n = 21) and adolescents (n = 10) aged between 15 and 18 years about transferring from children's to adult diabetes services. Findings. Data revealed education and dietetic advice was reactive rather than proactive and that the paediatric model of care is philosophically and practically different to the adult model of diabetes care. Three phases of transition were identified: preparation, formal transition and evaluation. Our findings indicated that these stages of transition were not being fully implemented in health units. Conclusion. The project findings have set the scene to establish a multidisciplinary working party to work collaboratively across agencies to develop effective transition pathways. Relevance to clinical practice. The role of diabetes nurse educators and dietitians in South Australia is under‐used throughout the transition process. Diabetes nurse educators are in an ideal position to prepare, coordinate and evaluate transitional processes.     

Bone Mineral Density and Type 1 Diabetes in Children and Adolescents: A Meta-analysis

BACKGROUNDThere is substantial evidence that adults with type 1 diabetes have reduced bone mineral density (BMD); however, findings in youth are inconsistent.PURPOSETo perform a systematic review and meta-analysis of BMD in youth with type 1 diabetes using multiple modalities: DXA, peripheral quantitative computed tomography (pQCT), and/or quantitative ultrasound (QUS).DATA SOURCESPubMed, Embase, Scopus, and Web of Science from 1 January 1990 to 31 December 2020, limited to humans, without language restriction.STUDY SELECTIONInclusion criteria were as follows: cross-sectional or cohort studies that included BMD measured by DXA, pQCT, or QUS in youth (aged <20 years) with type 1 diabetes and matched control subjects.DATA EXTRACTIONWe collected data for total body, lumbar spine, and femoral BMD (DXA); tibia, radius, and lumbar spine (pQCT); and phalanx and calcaneum (QUS). Weighted mean difference (WMD) or standardized mean difference was estimated and meta-regression was performed with age, diabetes duration, and HbA_1c as covariates.DATA SYNTHESISWe identified 1,300 nonduplicate studies; 46 met the inclusion criteria, including 2,617 case and 3,851 control subjects. Mean ± SD age was 12.6 ± 2.3 years. Youth with type 1 diabetes had lower BMD: total body (WMD −0.04 g/cm², 95% CI −0.06 to −0.02; P = 0.0006), lumbar spine (−0.02 g/cm², −0.03 to −0.0; P = 0.01), femur (−0.04 g/cm², −0.05 to −0.03; P < 0.00001), tibial trabecular (−11.32 g/cm³, −17.33 to −5.30; P = 0.0002), radial trabecular (−0.91 g/cm³, −1.55 to −0.27; P = 0.005); phalangeal (−0.32 g/cm³, −0.38 to −0.25; P < 0.00001), and calcaneal (standardized mean difference −0.69 g/cm³, −1.11 to −0.26; P = 0.001). With use of meta-regression, total body BMD was associated with older age (coefficient −0.0063, −0.0095 to −0.0031; P = 0.002) but not with longer diabetes duration or HbA_1c.LIMITATIONSMeta-analysis was limited by the small number of studies with use of QUS and pQCT and by lack of use of BMD z scores in all studies.CONCLUSIONSBone development is abnormal in youth with type 1 diabetes, assessed by multiple modalities. Routine assessment of BMD should be considered in all youth with type 1 diabetes.     

Self-care Management Intervention to Improve Psychological Wellbeing for Jordanian Patients with Type Two Diabetes Mellitus

The purpose of the study is to evaluate the effectiveness of self-care management intervention on psychological wellbeing for Jordanian patients with type two diabetes mellitus. A quasi-experimental design was used. The study was conducted in a diabetes clinic of a specialized diabetes center in Amman. One hundred and forty-nine participants completed the three-month post-treatment assessments (76 in the intervention group and 73 in the control group). Both the control and intervention groups received a standard diabetic educational program. The intervention group received the following additional interventions: (1) Diabetes Self-care Management booklet, (2)DVD viewing, (3) counseling rehearsal session, and (4) a telephone follow-up. The main study instrument was an Arabic version 20 of the depression anxiety stress scales: To assess the group differences of dependent variable changes, repeated measure ANOVA was used. It was found that psychological wellbeing was not significant at 2-week post-intervention and significant change was observed at 3-month post-intervention. The findings from this study can guide the health providers to be trained to provide relevant diabetic interventions into their nursing interventions, education, and research.     

青少年1型糖尿病患者疾病感受与体验的质性研究

目的 了解青少年1型糖尿病患者的疾病感受与体验,为制订临床护理干预措施提供参考依据.方法 采用现象学研究法对江苏省某三级甲等医院2021年1-6月收治的12例青少年1型糖尿病患者进行深入访谈,使用Colaizzi 7步分析法进行资料分析.结果 青少年1型糖尿病患者的疾病感受与体验可归纳为3个主题:经历疾病挑战、个人应对...     

Testing a Question Prompt Intervention to Improve Communication between Patients with HIV and Healthcare Providers: A Pilot Study

ABSTRACT

We tested the feasibility and acceptability of a question prompt intervention for patients recently diagnosed with HIV using a single group pretest-posttest design. Three healthcare providers (HCPs) and 18 patients, enrolled by convenience sampling, participated. Patients chose questions from a list of 14 items about patients’ adherence and health problems; then, they were provided with information. Communication time with nurses and number of questions significantly decreased, while health-related quality of life increased. The most frequently asked questions concerned medication adherence, sexual relationships, and the meaning of test results. The intervention facilitated communication with HCPs among patients.     

Peripheral Neuropathy in Adolescents and Young Adults With Type 1 and Type 2 Diabetes From the SEARCH for Diabetes in Youth Follow-up Cohort: A pilot study

OBJECTIVE

To estimate the prevalence of and risk factors for diabetic peripheral neuropathy (DPN) in a pilot study among youth participating in the SEARCH for Diabetes in Youth study.

RESEARCH DESIGN AND METHODS

DPN was assessed using the Michigan Neuropathy Screening Instrument (MNSI) (examination for foot abnormalities, distal vibration perception, and ankle reflexes). An MNSI exam (MNSIE) score >2 is diagnostic for DPN.

RESULTS

The MNSIE was completed in 399 subjects, including 329 youth with type 1 diabetes (mean age 15.7 ± 4.3 years, duration 6.2 ± 0.9 years) and 70 with type 2 diabetes (mean age 21.6 ± 4.1 years, duration 7.6 ± 1.8 years). Glycated hemoglobin (A1C) was similar in both groups (8.8 ± 1.8% for type 1 vs. 8.5 ± 2.9% for type 2). The prevalence of DPN was significantly higher in youth with type 2 compared with those with type 1 diabetes (25.7 vs. 8.2%; P < 0.0001). In unadjusted analyses, diabetes type, older age, longer duration of diabetes, increased waist circumference, elevated blood pressure, lower HDL cholesterol, and presence of microalbuminuria (urinary albumin-to-creatinine ratio >30 mg/g) were associated with DPN. The association between diabetes type and DPN remained significant after adjustment for age and sex (odds ratio 2.29 [95% CI 1.05–5.02], P = 0.03).

CONCLUSIONS

DPN prevalence among youth with type 2 diabetes approached rates reported in adult populations with diabetes. Our findings suggest not only that youth with diabetes are at risk for DPN but also that many already show measurable signs of DPN.The incidence of both type 1 and type 2 diabetes in youth is increasing worldwide (1,2). Recent reports have projected that, if this trend continues, the prevalence of diabetes among the young in the U.S. could triple by the year 2050 (3). This could incur a significant burden on health care costs and on society, especially as these young people enter their peak working and earning capacity at the time when diabetes complications begin to occur. Diabetic peripheral neuropathy (DPN) is among the most distressing of all the chronic complications of diabetes and is a cause of significant disability and poor quality of life (4). Depending on the patient population and diagnostic criteria, the prevalence of DPN among adults with diabetes ranges from 30 to 70% (5–7). However, there are insufficient data on the prevalence and predictors of DPN among the pediatric population. Furthermore, early detection and good glycemic control have been proven to prevent or delay adverse outcomes associated with DPN (5,8,9). Near-normal control of blood glucose beginning as soon as possible after the onset of diabetes may delay the development of clinically significant nerve impairment (8,9). Therefore, children and adolescents with diabetes represent a critical target for primary prevention of this complication.The American Diabetes Association (ADA) recommends screening for DPN in children and adolescents with type 2 diabetes at diagnosis and 5 years after diagnosis for those with type 1 diabetes, followed by annual evaluations thereafter, using simple clinical tests (10). Since subclinical signs of DPN may precede development of frank neuropathic symptoms, systematic, preemptive screening is required in order to identify DPN in its earliest stages.There are various measures that can be used for the assessment of DPN. The Michigan Neuropathy Screening Instrument (MNSI) is a simple, sensitive, and specific tool for the screening of DPN (11). It was validated in large independent cohorts (12,13) and has been widely used in clinical trials and longitudinal cohort studies including the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications (DCCT/EDIC) (13).The aim of this pilot study was to provide preliminary estimates of the prevalence of and factors associated with DPN among children and adolescents with type 1 and type 2 diabetes.     

Adherence as a Predictor of Glycemic Control Among Adolescents With Type 1 Diabetes: A Retrospective Study Using Real-world Evidence

PurposeMetabolic control among adolescents with type 1 diabetes mellitus (T1DM) is generally poor. Nonadherence is a contributor to this poor glycemic control, leading to adverse outcomes. The findings of studies reporting the association between adherence and glycemic control are conflicting. This study aimed to assess the level of adherence among adolescents with T1DM and its relationship with glycemic control.MethodsThis was a retrospective, cross-sectional study that was conducted at Sidra Medicine, a state-of-the-art tertiary health care facility for women and children in Qatar. Mean blood or interstitial glucose monitoring frequency (BGMF) was used to assess adherence level among adolescents with T1DM, whereas glycemic control was assessed via documented glycated hemoglobin A_1c (HbA_1c). Adolescents who had a mean BGMF of ≥4 checks per day were considered adherent, and those who had an HbA_1c level of <7% were considered as having controlled diabetes. Correlational and logistic regression analyses were performed to assess the relationship between adherence and glycemic control, incorporating other covariates into the model.FindingsThe rate of adherence among adolescents with T1DM in Qatar was 40.9%. Adherent adolescents had significantly lower median HbA_1c levels compared with nonadherent adolescents (9.0% vs. 9.7%; P = 0.002). A significant negative correlation was found between BGMF and HbA_1c level (correlation coefficient r_s = ?0.325; P < .001). Approximately 97% of nonadherent adolescents compared with 87% of adherent adolescents had suboptimal diabetes control (HbA_1c ≥7%) (P = .016). Furthermore, nonadherent adolescents were 78% less likely to have controlled diabetes compared with adherent adolescents (adjusted odds ratio = 0.221; 95% CI, 0.063?0.778; P = 0.019). The combined effect of the determinants of glycemic control among adolescents with T1DM that were included in the multiple regression model was able to explain approximately 9% of the variances in glycemic control (Cox and Snell R² = 0.092).ImplicationsThe current findings suggest that nonadherence was highly prevalent among adolescents with T1DM and was a significant independent predictor of glycemic control, explaining 9% of the variability. This finding warrants further exploration of other possible predictors of poor glycemic control among the adolescent population. Comprehensive interventions, including educational, technological, and health service delivery aspects, aimed at improving adherence and ultimately optimizing glycemic control are warranted in adolescents with T1DM.     

Addressing School Challenges for Children and Adolescents With Type 1 Diabetes: The Nurse Practitioner's Role

Children with type 1 diabetes need to monitor their blood glucose and food intake, administer insulin, and participate in physical activity during school hours. School concerns for this group include school personnel, the medical directive plan, classmates, school lunches, and physical education classes. Nurse practitioners should take an active role in advocating for improved T1DM management in schools by talking with patients and their parents about experiences in school, identifying challenges and discussing possible solutions for improving diabetes management during school hours, and accessing online resources to assist patients, parents, and school personnel.     

Internet Psycho-Education Programs Improve Outcomes in Youth With Type 1 Diabetes

OBJECTIVE

The purpose of this study was to determine the efficacy of two Internet-based psycho-educational programs designed to improve outcomes for youth with type 1 diabetes transitioning to adolescence.

RESEARCH DESIGN AND METHODS

The study was a multisite clinical trial of 320 youth (aged 11–14 years; 37% minority; 55% female) randomized to one of two Internet-based interventions: TeenCope or Managing Diabetes. Primary outcomes were HbA_1c and quality of life (QOL). Secondary outcomes included coping, self-efficacy, social competence, self-management, and family conflict. Data were collected at baseline and after 3, 6, and 12 months online. Youth were invited to cross over to the other program after 12 months, and follow-up data were collected at 18 months. Analyses were based on mixed models using intent-to-treat and per-protocol procedures.

RESULTS

Youth in both groups had stable QOL and minimal increases in HbA_1c levels over 12 months, but there were no significant differences between the groups in primary outcomes. After 18 months, youth who completed both programs had lower HbA_1c (P = 0.04); higher QOL (P = 0.02), social acceptance (P = 0.01), and self-efficacy (P = 0.03) and lower perceived stress (P = 0.02) and diabetes family conflict (P = 0.02) compared with those who completed only one program.

CONCLUSIONS

Internet interventions for youth with type 1 diabetes transitioning to adolescence result in improved outcomes, but completion of both programs was better than only one, suggesting that these youth need both diabetes management education and behavioral interventions. Delivering these programs via the Internet represents an efficient way to reach youth and improve outcomes.Youth with type 1 diabetes in transition to adolescence are a vulnerable population. They exhibit deteriorating metabolic control (1,2), poorer self-management, and increased social stressors and psychosocial distress, as well as lower quality of life (QOL) compared with children with type 1 diabetes at other ages (2). Resolving independence/dependence issues and acquiring positive acceptance by peers within the context of a complex treatment regimen are particularly challenging for these youth. Having diabetes involves fear of hypoglycemia, fear of future complications, feelings of guilt for possible wrongdoing, and feelings of stress associated with challenging self-management tasks (3). In addition, these stressors occur within the broader context of increased expectations for adolescents to maintain excellent metabolic control (4), despite the insulin resistance associated with puberty (5).As youth transition to adolescence and take on greater responsibility for their diabetes self-management, educational needs are higher. Standards of care for youth with type 1 diabetes identify the importance of education; yet, the provision of education in the clinical setting is mostly informal and inconsistent. Considerable evidence indicates that in-person psycho-educational interventions, such as Coping Skills Training (CST), improve metabolic control of type 1 diabetes as well as psychosocial adjustment and QOL in youth (6–8). However, implementing these evidence-based programs in clinical care is challenging because of provider and organizational barriers, such as lack of time, resources, and expertise (9). Rapid advances in technology and access to the Internet have made it not only a viable mode for the delivery of psycho-educational interventions but also a platform that can be widely disseminated and implemented. Internet interventions allow for standardization of program content, can be targeted to specific ages and developmental phases, allow for social interaction, and can be easily updated. Access to the Internet is increasingly available nationwide and has risen to its highest level ever, with 93% of youth using the Internet regularly for school assignments, hobbies or special interests, entertainment, and connection with others (10,11). The Internet, therefore, represents an efficient way to deliver psycho-educational interventions to youth with type 1 diabetes.Psycho-educational interventions delivered via the Internet have demonstrated efficacy in improving symptoms and health behaviors in youth of different ages and illness experiences (12–14). In a pilot study, youth with type 1 diabetes who completed an Internet program with a focus on problem solving and social networking demonstrated improved self-management and problem solving compared with a control group (15). Internet-based interventions that can reach large numbers of youth with diabetes have the potential to result in significant improvements in long-term health, as well as reductions in the costs of care for diabetes-related complications. They also have the potential to improve access for diverse youth with type 1 diabetes. While there is ongoing evidence of the digital divide, this has been decreasing over time, particularly with English-speaking youth in the U.S. (10).TeenCope, a new Internet-based version of CST, was developed by our group. It is based on social cognitive theory and posits that improving coping skills will lead to improved self-efficacy and self-management of diabetes that result in better outcomes, as has been demonstrated in studies of CST delivered in a group-based in-person format (16). Managing Diabetes was developed to serve as the control condition and was a diabetes education and problem-solving program.Thus, the purpose of this multisite randomized clinical trial was to compare the efficacy of two Internet-based programs on the primary outcomes of HbA_1c and QOL and on the secondary outcomes of stress, coping, self-efficacy, self-management, social competence, and family conflict at 12 months. At 12-month follow-up, youth were invited to participate in the alternate program, allowing us to explore the effect of participating in two programs compared with participating in only one. We hypothesized that youth who participated in TeenCope would have lower HbA_1c levels and better QOL after 12 months than those who participated in Managing Diabetes.