Support Group for Parents Coping with Children with Type 1 Diabetes

Objectives

Type 1 diabetes is one of the most common chronic diseases in childhood. Active parental involvement, parental support in the diabetes management and family functioning are associated with optimal diabetes management and glycemic control. The purpose of this study was to assess parental satisfaction with participation in the group and their perceptions of the impact of the intervention on living and coping with childrens T1D.

Methods

A sample of 34 parents of children with T1D participated in this trend study. The participants’ experience and satisfaction with support group was measured by a self- evaluation questionnaire, designed for the purpose of the present study.

Results

Quantitative data show that parents were overall satisfied with almost all measured items of the evaluation questionnaire (wellbeing in the group, feeling secure, experiencing new things, being able to talk and feeling being heard) during the 4-year period. However, parents from the second and third season, on average, found that the support group has better fulfilled their expectations than the parents from the first season (p = 0,010). The qualitative analysis of the participants’ responses to the open-ended questions was underpinned by four themes: support when confronting the diagnosis, transformation of the family dynamics, me as a parent, exchange of experience and good practice and facing the world outside the family.

Discussion

The presented parent support group showed to be a promising supportive, therapeutic and psychoeducative space where parents could strengthen their role in the upbringing of their child with T1D.     

The Relationship of Illness Uncertainty and Attributional Style to Long-Term Psychological Distress in Parents of Children With Type 1 Diabetes Mellitus

This preliminary study longitudinally examined the relationship of illness uncertainty and attributional style to psychological distress among parents of children with type 1 diabetes mellitus. Thirty parents who had participated in a larger study 5 to 6 years earlier completed measures of illness uncertainty, attributional style, and psychological distress. Time 1 illness uncertainty significantly predicted Time 2 distress; Time 1 negative attributional style did not. Post hoc probing revealed that Time 1 illness uncertainty did not mediate Time 1 and Time 2 distress. Results suggest that illness uncertainty continues to be a salient and robust predictor of parental adjustment outcomes over time.     

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.     

儿童1型糖尿病患者的个性特征分析

目的 了解儿童1型糖尿病患的个性特征，分析不同病程以及不同病情控制情况儿童的个性特点。方法 了解患的一般情况，测定糖化血红蛋白，同时运用艾森克个性问卷对哈尔滨市1型糖尿病患45例的个性进行调查。结果 艾森克个性问卷的3个个性维度中，只有情绪稳定性维度，患儿的T分显高于常模；患在内外倾向维度中的分布与常模相比差异有显性；病程不同的患的个性特点之间差异无显性；病情控制程度不同的患的个性差异无显性。结论 儿童1型糖尿病患的个性与常模比较，具有神经质倾向，但是在病情控制程度不同或病程长短不同的患中，没有一定的个性特征。     

Satisfaction and Quality of Life in Children with Type 1 Diabetes and Their Parents Following Transition to Insulin Pump Therapy

The purpose of this study was to describe satisfaction with the transition to insulin pump therapy and subsequent quality of life among 22 children with type 1 diabetes and their parents. Following the transition to pump therapy, children and parents completed a newly developed measure of insulin pump therapy satisfaction (Insulin Pump Therapy Satisfaction Questionnaire [IPTSQ]), and children completed a standardized measure of diabetes-related quality of life. IPTSQ results suggest that children and parents were overwhelmingly satisfied with insulin pump use. Parents and children reported greatest satisfaction with flexibility related to eating and sleeping afforded by pump therapy. Parent-child satisfaction were highly correlated (r = .53), and children's pump satisfaction was significantly positively correlated with diabetes-related quality of life (r = .51). These pilot data are among the first to document specific areas of satisfaction and indicate an association between insulin pump therapy satisfaction and quality of life. Understanding specific aspects of insulin pump therapy that are related to quality of life is important for improving health outcomes among youngsters with type 1 diabetes using insulin pumps.     

An Exploration of How Individuals with an Ostomy Communicatively Manage Uncertainty

ABSTRACT

Individuals with an ostomy (a surgical diversion of part of the digestive tract through the abdomen) face a variety of uncertainties, due to the chronic and anatomy-altering nature of living with an ostomy, as well as the perceived stigma attached to having one. However, little is known about how these individuals negotiate uncertainty, and more specifically, how they manage the information they receive and disclose in the uncertainty management process. Thus, through 21 semi-structured interviews of individuals with an ostomy and the use of Uncertainty Management Theory as a theoretical framework, the current study found individuals with an ostomy attempted to negotiate uncertainty by managing information received and disclosed and by adapting to chronic uncertainty. This investigation recommends practical applications for medical professionals, supportive others, patients with an ostomy, as well as future surgical candidates to help manage uncertainty.     

Perceived Benefits, Barriers, and Strategies of Family Meals among Children with Type 1 Diabetes Mellitus and Their Parents: Focus-Group Findings

Dietary management of type 1 diabetes mellitus has become much less restrictive and more flexible in recent years due to contemporary insulin regimens, which may afford families of children with type 1 diabetes mellitus greater ease in sharing family meals. Although these treatment advancements might facilitate family meals, overall demands of diabetes management can influence family's perceived or actual ability to do so. Youths with type 1 diabetes mellitus (ages 8 to 20 years) and parents participated in separate focus groups. Thirty-five youths with type 1 diabetes mellitus (mean age=15.1±3.6 years) and their parents participated in 21 focus groups (12 youth groups, nine parent groups). Although there was substantial variability in how often family meals occurred, both parents and youths consistently perceived family meals as valuable and enjoyable. The major barrier to family meals discussed by both youths and parents was busy schedules. Strategies for having family meals that were discussed by parents included shopping to ensure availability of the foods needed to prepare meals, planning, and cooking meals in advance, and using simplified cooking methods. These findings suggest that a family-focused approach to nutrition interventions in this population, as opposed to one targeting the child with diabetes only, can improve the chance for successful dietary change.     

Attachment to Caregivers and Type 1 Diabetes in Children

Attachment is a behavioral and physiological system, which enables individual’s dynamic adaptation to its environment. Attachment develops in close interaction between an infant and his/her mother, plays an important role in the development of the infant’s brain, and influences the quality of interpersonal relationships throughout life.Security of attachment is believed to influence individual response to stress, exposing insecurely organized individuals to deregulated autonomic nervous system and exaggerated hypothalamic-pituitary-adrenal activity, which, in turn, produces increased and prolonged exposure to stress-hormones. Such stress responses may have considerable implications for the development of diverse health-risk conditions, such as insulin resistance and hyperlipidemia, shown by numerous studies.Although the mechanisms are not yet fully understood, there is compelling evidence highlighting the role of psychological stress in the development of type 1 diabetes (T1D). One of the possible contributing factors for the development of T1D may be the influence of attachment security on individual stress reactivity. Thus, the suggestion is that insecurely attached individuals are more prone to experience increased and prolonged influence of stress hormones and other mechanisms causing pancreatic beta-cell destruction.The present paper opens with a short overview of the field of attachment in children, the principal attachment classifications and their historic development, describes the influence of attachment security on individual stress-reactivity and the role of the latter in the development of T1D. Following is a review of recent literature on the attachment in patients with T1D with a conclusion of a proposed role of attachment organization in the etiology of T1D.     

Low-Carbohydrate Diet among Children with Type 1 Diabetes: A Multi-Center Study

Aims/hypothesis: The proportion of children with type 1 diabetes (T1D) who have experience with low-carbohydrate diet (LCD) is unknown. Our goal was to map the frequency of LCD among children with T1D and to describe their clinical and laboratory data. Methods: Caregivers of 1040 children with T1D from three centers were addressed with a structured questionnaire regarding the children’s carbohydrate intake and experience with LCD (daily energy intake from carbohydrates below 26% of age-recommended values). The subjects currently on LCD were compared to a group of non-LCD respondents matched to age, T1D duration, sex, type and center of treatment. Results: A total of 624/1040 (60%) of the subjects completed the survey. A total of 242/624 (39%) subjects reported experience with voluntary carbohydrate restriction with 36/624 (5.8%) subjects currently following the LCD. The LCD group had similar HbA1c (45 vs. 49.5, p = 0.11), lower average glycemia (7.0 vs. 7.9, p = 0.02), higher time in range (74 vs. 67%, p = 0.02), lower time in hyperglycemia >10 mmol/L (17 vs. 20%, p = 0.04), tendency to more time in hypoglycemia <3.9 mmol/L(8 vs. 5%, p = 0.05) and lower systolic blood pressure percentile (43 vs. 74, p = 0.03). The groups did not differ in their lipid profile nor in current body height, weight or BMI. The LCD was mostly initiated by the parents or the subjects themselves and only 39% of the families consulted their decision with the diabetologist. Conclusions/interpretation: Low carbohydrate diet is not scarce in children with T1D and is associated with modestly better disease control. At the same time, caution should be applied as it showed a tendency toward more frequent hypoglycemia.     

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     

对128例1型糖尿病患儿的生存质量调查分析

目的：调查分析1型糖尿病患儿的生存质量,以供临床参考。方法：选取本院2010年8月-2013年7月收治的128例1型糖尿病患儿作为研究对象,分别于入院时和实施健康教育1年后采用儿童生存质量测定量表（PedsQL4.0）对其进行生存质量调查。对比实施健康教育前后一年内患儿生存质量的变化。结果：入院时患儿生活质量评分为（78.23±11.65）分,实施健康教育1年后患儿生活质量评分提高至（90.15±6.75）分,差异有统计学意义（P〈0.05）。结论：1型糖尿病患儿的生存质量处于相对较差的水平,实施健康教育可有效提高其生存质量,今后应将健康教育贯穿于药物治疗之中进行临床推广。     

Social Support among Parents of Children with Congenital Heart Disease,Parents of Children with Other Diseases and Parents of Healthy Children

The study reported here compared social support experiences among parents of children born with congenital heart disease PCCHD (n=1?092), parents of children with other diseases PCOD (n=112), and parents of healthy children PHC (n=293). In addition, factors related to social support among the parents were identified. The parents completed a questionnaire about such areas as availability of social support, financial strain, and psychological distress. The design was cross-sectional and data were collected over 20 consecutive days. The univariate analysis indicated that availability of social attachment was low among all parents and moderate concerning interaction/integration, with no significant differences between PCCHD, PCOD, and PHC. In addition, the univariate analysis indicated that mothers within all parent groups had lower availability of social support than fathers, with the lowest availability among mothers of children with CHD. The multivariate analysis indicated, however, that extra time devoted to care giving, financial instability (e.g. unemployment and financial burden of children's diseases), psychological distress, and hopelessness accounted for the variation in availability of social support more than gender, children's diseases, and their severity. The study corroborated previous findings and may have provided new insights into factors that may be associated with social support experiences among PCCHD. Implications for interventions are discussed.     

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.     

Dietary Intake and Physical Activity of Thai Children and Adolescents with Type 1 Diabetes Mellitus

Appropriate dietary intake and physical activity (PA) are essential for glycemic control and optimal growth in youth with type 1 diabetes (T1D). Thus, this study aimed to compare dietary intake and PA between youth with T1D and healthy controls. One hundred Thai youth with T1D and 100 age-matched healthy participants were recruited. A 3-day food record was completed and converted into nutrient intake data. PA data were collected via interview. Participants with T1D had a significantly higher mean ± SD carbohydrate (50.8 ± 6.8% vs. 46.2 ± 7.5%, p < 0.01), lower fat (32.4 ± 5.9% vs. 35.9 ± 6.4%, p < 0.01), and lower protein (16.8 ± 2.6% vs. 17.9 ± 3.5%, p = 0.01) intake compared to controls. Fifty percent of T1D participants and 41% of control participants consumed saturated fat more than recommendations (p = 0.20). Participants with T1D had a higher median (IQR) calcium intake compared to controls (474 (297–700) vs. 328 (167–447) mg/day, p < 0.01). Both groups consumed less fiber and more sodium compared to recommendations. Both groups had inadequate PA. Participants with T1D had significantly less PA compared to controls (25 (13–48) vs. 34 (14–77) minutes/day, p = 0.04). In addition to the need for counseling that promotes consumption of more dietary fiber and calcium and less saturated fat and sodium, the benefits of performing regular exercise need to be emphasized among youth with T1D.     

海南省儿童1型糖尿病发病率调查

目的：调查海南儿童１型糖尿病的发病率。方法：依据ＷＨＯ ＤｉａＭｏｎｄ计划,采用捕获一再捕获的方法,对１９８９－１９９６年间１５岁以下新诊断为１型糖尿病的儿童进行回顾性登记。结果：１５岁以下人口总数约２００万,共发现１型糖尿病患者５３例,其中汉族５０例,其他民族３例,按其人口比例计算,二者发病率无显著性差异。     

Exploring Disease Management Programs for Diabetes Mellitus

Diabetes mellitus is a chronic illness that affects the world on an epidemic scale. It requires complex healthcare and considerable economic resources. Diabetes disease management programs use a variety of strategies to improve clinical outcome measures and reduce costs. Studies have demonstrated the effectiveness of these programs on reducing glycosylated hemoglobin levels, improving cardiovascular risks, and reducing utilization of services. However, the most effective components of disease management strategies or combination of strategies remain unknown. This narrative review explores the components, impact, benefits, and barriers of current diabetes disease management models and also presents a novel hybrid model incorporating elements of both on-site and off-site programs.On-site disease management programs include strategies characterized by unique patient identification and evaluation, implementation of intervention methods, on-site health provider team members, and specific environmental resources. Advantages of this model include the face-to-face encounter between patients and providers, the proximity of the healthcare team members to facilitate ease of communication and build independence and trust between patients and providers, and technology resources, such as the electronic medical record. A number of clinical trials have demonstrated the effectiveness and cost effectiveness of on-site diabetes disease management programs. However, because of the methodological limitations of many studies, further studies are needed to confirm such findings. Barriers to the implementation of on-site programs may include patient population characteristics such as complexity of co-morbid illness and social Stressors, including low health literacy, that require adaptation of the disease management model. In comparison, off-site disease management programs utilize administrative resources to identify patients with chronic illnesses. Other key elements include the evaluation of clinical care practices using established guidelines with auditing and feedback to providers based on their performance, and the use of reminders for both patients and providers to influence better processes of care. This process is often independent of the traditional on-site care delivered directly by providers.A hybrid disease management model that incorporates both on-site and off-site disease management components could be the ideal model for optimizing care of patients with chronic illness. The suggested hybrid model incorporates many features of previous models of disease management but gives a new construct that can be customized to different clinic settings, provider practices, and patient populations, including patients with other complex chronic illness. This hybrid model could be applied to a variety of individual or multiple chronic illnesses. This model would engage both on-site healthcare providers and support staff along with off-site administrative staff and electronic medical data to provide patients optimal care while potentially reducing overall costs.     

An Investigation on the Incidence of Type 1 Diabetes in Hainan Children

ObjectiveTo investigate the incidence of type 1 diabe tes in Hainan children.MethodsAccording to the demands of WHO DiaMo nd Project,all the newly diagnosed cases of type 1 diabetes under 15 years old d uring 1989～1996 were retrospectively registered by the capture-recapture method .ResultsThe population under 15 years old was about two million,and 53 cases of type 1 diabetes (male 25,female 28) were found.50 of them were Han nationality(94.3%) and 3 cases were the other nationalities(5.6%).There was no significant difference between the two incidences according to their population ratios.The total ascertainment corrected incidence was 0.40/100 000/yr(95% CI0 .37～0.42).ConclusionThe Hainan children incidence of type 1 diabete s is lower than the average level of the whole country,which suggested that the incidence in south China is lower than that in north region.     

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.     

Rethinking Carbohydrate Intake and Time in Range in Children and Adolescents with Type 1 Diabetes

The aim of this study was to evaluate the association between macronutrient intake and time in range (TIR) of 70–180 mg/dL in children and adolescents with type 1 diabetes (T1D). A multi-center study recruited patients with T1D using continuous glucose monitoring (CGM) between January 2019 and January 2020 from centers across Italy. Diet intake was recorded using three-day weighed food diaries. Nutrients were evaluated as percentages of total intake. TIR was considered at target if the percentage of readings was higher than 70%. Clinical and nutritional factors associated with TIR at target were analyzed using multiple correspondence analysis and multiple logistic regression. Data from 197 participants (53% male, median age 11.6 years, median HbA1c 55.2 mmol/mol, median TIR 60%) were analyzed. Macronutrient intake was 45.9% carbohydrates, 16.9% protein, 37.3% fat, and 13.1 g/day fiber (median values). TIR > 70% was observed in 28% of participants; their diet contained more protein (17.6%, p = 0.015) and fiber (14.4 g/day, p = 0.031) than those not at target. The probability of having a TIR > 70% was significantly higher with 40–44% consumption of carbohydrates compared with 45–50% consumption of carbohydrates and with the use of a carbohydrate counting system. Based on these results, a five percent reduction in the percentage of carbohydrate intake can help children and adolescents with T1D achieve the goal of a TIR > 70%. Both a lower and higher percentage of carbohydrate intake appears to reduce the probability of reaching the target TIR > 70%. These results require validation in other populations before being used in clinical practice.