Changes in the Frequency of Family Meals From 1999 to 2010 in the Homes of Adolescents: Trends by Sociodemographic Characteristics

ObjectiveTo examine secular trends from 1999 to 2010 in family meal frequency in a population-based sample of adolescents across sociodemographic characteristics.MethodsA repeated cross-sectional design was used. Participants were from middle schools and high schools in the Minneapolis/St. Paul area and included 3,072 adolescents (mean age = 14.6 ± 1.8 years) in 1999 and 2,793 adolescents (mean age = 14.4 ± 2.0 years) in 2010 from diverse ethnic/racial and socioeconomic backgrounds. Trends in family meal frequency were examined using inverse probability weighting to control for changes in sociodemographic characteristics over time.ResultsFamily meal frequency remained fairly constant from 1999 to 2010 in the overall sample, but decreases were found in population subgroups including girls, middle school students (grade: 6–8), Asians, and youth from low socioeconomic backgrounds. Among youth from the lowest socioeconomic backgrounds, the mean number of family meals in the past week decreased from 4.0 in 1999 to 3.6 in 2010 (p = .003). Furthermore, the percentage of youth from low socioeconomic backgrounds eating five or more meals in the past week decreased from 46.9% in 1999 to 38.8% in 2010 (p < .001). In contrast, family meal frequency tended to increase over time among youth from higher socioeconomic backgrounds.ConclusionsThe widening gap in family meal frequency between youth from low and high socioeconomic backgrounds is concerning, particularly given the greater risk for poor health outcomes among low-income youth. Given findings from other studies suggesting multiple benefits of family meals, interventions to increase family meal frequency are needed that target adolescents and their families from the most vulnerable segments of the population.     

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.     

Challenging Recruitment of Youth With Type 2 Diabetes Into Clinical Trials

PurposeTo better understand and overcome difficulties with recruitment of adolescents with type 2 diabetes into clinical trials at three United States institutions, we reviewed recruitment and retention strategies in clinical trials of youth with various chronic conditions. We explored whether similar strategies might be applicable to pediatric patients with type 2 diabetes.MethodsWe compiled data on recruitment and retention of adolescents with type 2 diabetes at three centers (National Institutes of Health, Bethesda, Maryland; Baylor College of Medicine, Houston, Texas; and Children's National Medical Center, Washington, DC) from January 2009 to December 2011. We also conducted a thorough literature review on recruitment and retention in adolescents with chronic health conditions.ResultsThe number of recruited patients was inadequate for timely completion of ongoing trials. Our review of recruitment strategies in adolescents included monetary and material incentives, technology-based advertising, word-of-mouth referral, and continuous patient–research team contact. Cellular or Internet technology appeared promising in improving participation among youths in studies of various chronic conditions and social behaviors.ConclusionsAdolescents with type 2 diabetes are particularly difficult to engage in clinical trials. Monetary incentives and use of technology do not represent “magic bullets,” but may presently be the most effective tools. Future studies should be conducted to explore motivation in this population. We speculate that (1) recruitment into interventional trials that address the main concerns of the affected youth (e.g., weight loss, body image, and stress management) combined with less tangible outcomes (e.g., blood glucose control) may be more successful; and (2) study participation and retention may be improved by accommodating patients' and caregivers' schedules, by scheduling study visits before and after working hours, and in more convenient locations than in medical facilities.     

Psychometric properties of the revised Parental Monitoring of Diabetes Care questionnaire in adolescents with type 1 diabetes

PurposeWe evaluated the psychometric properties of a revised version of the Parental Monitoring of Diabetes Care questionnaire (PMDC-R) designed to evaluate parental supervision and monitoring of adolescent diabetes care behaviors. The revised measure was intended to capture a broad range of ways used by parents to gather information about youth adherence to diabetes care.MethodsTwo hundred sixty-seven caregivers of 12–18-year-old adolescents with type 1 diabetes completed the PMDC-R. Measures of parental knowledge of youth illness management, illness management behavior, and metabolic control were also obtained.ResultsThe PMDC-R demonstrated good internal consistency (alpha coefficient = .91) and test–retest reliability (r = .79, p < .001). Supporting the instrument's construct validity, a bifactor model with one primary factor and three secondary factors had an acceptable fit to the data (comparative fit index = .92, root mean square error of approximation = .06). Concurrent validity was also supported. In structural equation models, parental monitoring, as assessed by the PMDC-R, had a significant direct effect on parental knowledge of adolescent diabetes management and, through knowledge, an indirect effect on adolescent diabetes management and metabolic control.ConclusionsThe PMDC-R displayed strong psychometric properties and represents an important next step in refining the measurement of parental monitoring for youth with chronic illnesses.     

Correlates of Medical Nutrition Therapy and Cardiovascular Outcomes in Youth With Type 1 Diabetes

ObjectivesTo examine whether the types of medical nutrition therapies (MNTs) taught to and used by youth with type 1 diabetes (T1D) vary by sociodemographic characteristics and cardiovascular (CVD) risk factors.DesignCross-sectional study.SettingThe SEARCH for Diabetes in Youth study is a population-based cohort of individuals with clinical diagnosed diabetes.ParticipantsA total of 1,191 individuals with T1D.Main Outcome MeasuresTypes of MNTs and frequency of use.AnalysisBivariate analysis and multivariate linear regression (P < .05)ResultsMore race/ethnic minorities (vs whites), individuals with parents with less than a high school education (vs high school or higher education), and overweight/obese (vs underweight/normal weight) were taught additional MNTs. For underweight/normal weight individuals exclusively taught carbohydrate counting, those who used this approach “often” had lower hemoglobin A1c (8.6% vs 8.9%) and triglycerides (73.5 vs 84.1 mg/dL) than those who used it “sometimes/never.” “Often” use of additional MNTs beyond carbohydrate counting was not associated with better mean values for CVD risk factors.Conclusions and ImplicationsIn individuals with T1D, race/ethnic minorities, individuals with parents with less than a high school education, and overweight/obese individuals are taught more MNTs. Further research is needed to understand the effectiveness of the various MNTs on CVD risk factors, and to identify how to translate nutrition knowledge to behavior and metabolic status.     

The Role of Cognitive and Psychosocial Maturity in Type 1 Diabetes Management

Purpose

The purpose of the article was to explore the longitudinal relationship between treatment responsibility and type 1 diabetes management (i.e., adherence and glycemic control) in adolescence and to examine whether indicators of cognitive and psychosocial maturity moderate the link between youth responsibility and diabetes outcomes.

Self-Care and Glycemic Control in Adolescents With Type I Diabetes

This study assesses the concurrence of adolescent- and parent-reported adherence to the medical regimen among youth with type 1 diabetes. Relationships between diabetes self-care and metabolic control were also examined. Adolescents' (n = 111) and their mothers' reports of adolescents' self-management of the diabetes regimen were examined for prediction to glycosylated hemoglobin (HgbA1c) levels obtained at concurrent and subsequent clinic visits. Adolescents' and parents' reports were correlated with each other, and correlations with HgbA_1c were as high as .41. Self- and parent-reported adherence to more complex aspects of the regimen (i.e., keeping blood glucose at appropriate levels) was the strongest correlate of HgbA_1c. In multivariate analyses, adolescent report predicted 30% and parent report explained 19% of the variance in concurrent HgbA1c. Self- and parent report of the adolescents' self-management may be show reliable indicators of the adolescents' self-care behaviors. As such they may be useful as indices for assessing the effectiveness of interventions to improve the management of the diabetic regimen among adolescents. In addition, aspects of diabetes management that involve higher level cognitive skills appear to be more effective in maintaining good HgbA_1c than variables that involve simply complying with physician directives. These findings emphasize the importance of education and graded practice with complex tasks and decision making in relation to diabetes management.     

Self-Care and Glycemic Control in Adolescents With Type I Diabetes

This study assesses the concurrence of adolescent- and parent-reported adherence to the medical regimen among youth with type 1 diabetes. Relationships between diabetes self-care and metabolic control were also examined. Adolescents' (n = 111) and their mothers' reports of adolescents' self-management of the diabetes regimen were examined for prediction to glycosylated hemoglobin (HgbA1c) levels obtained at concurrent and subsequent clinic visits. Adolescents' and parents' reports were correlated with each other, and correlations with HgbA_1c were as high as .41. Self- and parent-reported adherence to more complex aspects of the regimen (i.e., keeping blood glucose at appropriate levels) was the strongest correlate of HgbA_1c. In multivariate analyses, adolescent report predicted 30% and parent report explained 19% of the variance in concurrent HgbA1c. Self- and parent report of the adolescents' self-management may be show reliable indicators of the adolescents' self-care behaviors. As such they may be useful as indices for assessing the effectiveness of interventions to improve the management of the diabetic regimen among adolescents. In addition, aspects of diabetes management that involve higher level cognitive skills appear to be more effective in maintaining good HgbA_1c than variables that involve simply complying with physician directives. These findings emphasize the importance of education and graded practice with complex tasks and decision making in relation to diabetes management.     

Multiple Indicators of Poor Diet Quality in Children and Adolescents with Type 1 Diabetes Are Associated with Higher Body Mass Index Percentile but not Glycemic Control

BackgroundDiet is a cornerstone of type 1 diabetes treatment, and poor diet quality may affect glycemic control and other health outcomes. Yet diet quality in children and adolescents with type 1 diabetes remains understudied.ObjectiveTo evaluate multiple indicators of diet quality in children and adolescents with type 1 diabetes and their associations with hemoglobin A1c and body mass index percentile.DesignIn this cross-sectional study, participants completed 3-day diet records, and data were abstracted from participants' medical records. Diet quality indicators included servings of fruit, vegetables, and whole grains; Healthy Eating Index-2005 (HEI-2005) score; Nutrient Rich Foods 9.3 score (NRF 9.3); and glycemic index.Participants/settingChildren and adolescents with type 1 diabetes ≥1 year, aged 8 to 18 years, were recruited at routine clinic visits. Of 291 families enrolled, 252 provided diet data.Statistical analysesAssociations of diet quality indicators to HbA1c and body mass index percentile were examined using analysis of covariance and multiple linear regression.ResultsParticipants demonstrated low adherence to dietary guidelines; mean HEI-2005 score was 53.4±11.0 (range=26.7 to 81.2). Intake of fruit, vegetables, and whole grains was less than half the recommended amount. Almost half of the participants' daily energy intake was derived from refined-grain products, desserts, chips, and sweetened beverages. Higher fruit (P=0.04) and whole-grain (P=0.03) intake were associated with lower HbA1c in unadjusted, but not adjusted analyses; vegetable intake, HEI-2005 score, NRF 9.3 score, and glycemic index were not associated with HbA1c. Higher fruit (P=0.01) and whole-grain (P=0.04) intake and NRF 9.3 score (P=0.02), but not other diet quality indicators, were associated with lower body mass index percentile in adjusted analyses.ConclusionsData demonstrate poor diet quality in youth with type 1 diabetes and provide support for the importance of diet quality for weight management. Future research on determinants of dietary intake and methods to promote improved diet quality would be useful to inform clinical care.     

Screening Practices for Identifying Type 2 Diabetes in Adolescents

ObjectiveTo characterize pediatrician and family physician (FP) screening practices for type 2 diabetes among adolescents and to examine the impact of the 2010 American Diabetes Association (ADA) guidelines, recommending use of Hemoglobin A1c (HbA1c).MethodsWe conducted a cross-sectional mail survey of a random sample of 1,400 U.S. pediatricians and FPs and we received 604 eligible responses. Our main outcome measure was the types of tests ordered by physicians, particularly HbA1c, when presented with a hypothetical scenario.ResultsThe overall response rate was 52% (57% for pediatricians and 48% for FPs). Fasting glucose and HbA1c were the most commonly ordered tests. Overall, at least 58% of physicians ordered HbA1c; 35% ordered HbA1c in conjunction with fasting tests; and 22% ordered HbA1c alone or with nonfasting tests. Only 38% of providers were aware of the new ADA recommended HbA1c screening guidelines. However, a majority (67%) said they would change their screening practices. In the context of the guidelines, 84% of physicians would now order HbA1c. Furthermore, there was a large increase in the proportion of physicians who would shift to using HbA1c only or with other nonfasting tests.ConclusionsWhen screening adolescents for type 2 diabetes, providers are more likely to order HbA1c and order fewer fasting tests in response to the new ADA guidelines. HbA1c has lower sensitivity and higher costs than other testing modalities in children, therefore increasing uptake of this test (HbA1c) in children may have implications for both detection rates and healthcare costs.     

Longitudinal trajectories of metabolic control across adolescence: associations with parental involvement, adolescents' psychosocial maturity, and health care utilization

PurposeTo predict trajectories of metabolic control across adolescence from parental involvement and adolescent psychosocial maturity, and to link metabolic control trajectories to health care utilization.MethodsTwo hundred fifty-two adolescents (M age at study initiation = 12.5 years, SD = 1.5, range = 10–14 years) with type 1 diabetes (54.4% female, 92.8% Caucasian, length of diagnosis M = 4.7 years, SD = 3.0, range = 1–12 years) participated in a 2-year longitudinal study. Metabolic control was gathered from medical records every 3 months. Adolescents completed measures of self-reliance (functional autonomy and extreme peer orientation), self-control (self-control and externalizing behavior), and parental involvement in diabetes care (acceptance, monitoring, and frequency of help). At the end of the study, mothers reported health care utilization (diabetes-related emergency room visits and hospitalizations) over the past 6 months.ResultsLatent class growth analyses indicated two distinct trajectories of metabolic control across adolescence: moderate control with slight deterioration (92% of the sample; average HbA1c = 8.18%) and poor control with rapid deterioration (8% of the sample; average HbA1c of 12.09%). Adolescents with poor and rapidly deteriorating metabolic control reported lower paternal monitoring and frequency of help with diabetes management, lower functional autonomy, and lower self-control than others. Those with poor and rapidly deteriorating metabolic control were 6.4 times more likely to report diabetes-related emergency room visits, and 9.3 times more likely to report diabetes-related hospitalizations near the end of the study.ConclusionsParental involvement and adolescents' psychosocial maturity predict patterns of deteriorating metabolic control across adolescence and could be targeted for intervention.     

Hyperglycemia and Carotenoid Intake Are Associated with Serum Carotenoids in Youth with Type 1 Diabetes

BackgroundSerum carotenoids are commonly used as biomarkers of fruit and vegetable (F/V) intake in the general population. Although hyperglycemia induces oxidative stress, it is unknown whether this pathway is associated with lower serum carotenoid concentrations in individuals with type 1 diabetes. Consequently, the utility of serum carotenoids as markers of F/V intake in individuals with type 1 diabetes is unclear.ObjectiveThe study objectives were: 1) to investigate the relationship of glycemic control, oxidative stress, dietary carotenoid and F/V intake with serum carotenoid concentrations in youth with type 1 diabetes and 2) to determine whether glycemic control or oxidative stress moderates the association of carotenoid and F/V intake with serum carotenoids.DesignThe study was a secondary analysis of baseline data from youth with type 1 diabetes. Blood samples were drawn from youth with type 1 diabetes to assess carotenoids and markers of glycemic control (glycated hemoglobin and 1,5-anhydroglucitol); urine samples were used to assess oxidative stress (8-iso-prostaglandin F_2α); and 3-day diet records completed by families were used to determine F/V and carotenoid intake.Participants/settingThe study participants were youth with type 1 diabetes (n=136; age range: 8 to 16.9 years; diabetes duration ≥1 year; glycated hemoglobin: 5.8% to 11.9%) enrolled in a nutrition intervention trial from 2010 to 2013 at a tertiary diabetes center in Boston, MA.Main outcome measuresSerum carotenoids (total carotenoids and α-carotene, β-carotene, lycopene, β-cryptoxanthin, and lutein+zeaxanthin).Statistical analysisRegression analyses were used to estimate the association of glycemic control, oxidative stress, F/V and carotenoid intake with serum carotenoids, as well as the role of glycemic control and oxidative stress in moderating diet-serum carotenoid associations.ResultsGreater F/V intake (β=0.35, P<0.001) and carotenoid intake (β=0.28, P<0.01) were associated with higher total serum carotenoids, and no moderation by glycemic control or oxidative stress was observed. Greater hyperglycemia, as indicated by lower 1,5-anhydroglucitol (β=0.27, P<0.01), was related to lower serum carotenoids; however, glycated hemoglobin was not associated with serum carotenoids. 8-Iso-prostaglandin F2α was not associated with glycemic control or serum carotenoids.ConclusionsFindings support the validity of serum carotenoids as markers of F/V and carotenoid intake in youth with type 1 diabetes.     

Knowledge of the Therapeutic Goals of Diabetes Care among Patients with Type 2 Diabetes at a Tertiary Hospital in Ethiopia

BackgroundA comprehensive cardiovascular risk control reduces diabetes-associated complications but achieving the triplet goals (blood glucose, blood pressure (BP), and low-density lipoprotein (LDL-C)) remains a clinical challenge. Patients'' knowledge of these diabetes therapeutic goals has been shown to improve glycemic control. However, this is not well studied in Ethiopia.MethodsA cross-sectional study was conducted from March to June 2020 in Tikur Anbessa Specialized Hospital among randomly selected 419 patients with type 2 diabetes. Data was collected using a pretested, structured questionnaire. A multivariable binary logistic regression was fitted to identify determinants of knowledge.ResultsThe mean age (±SD) of study participants was 57.4 (±10.8) years and the median duration (IQR) of diabetes was 12 (7, 20) years. A quarter of them achieved fasting glycemic control, a fifth of them attained the A1c goal and only 3% achieved the triple targets. Patients who reported knowing their target goals for BP, fasting blood sugar (FBS), A1C, and LDL-C were 79.5, 77.3, 11.7, and 7.2% respectively. The factors associated with knowledge of the therapeutic goals were longer diabetes duration, increased household income, age, being divorced as compared to married, having no formal education, and primary education.ConclusionThe majority of participants knew their BP and FBS targets while only a minority understood their A1c and LDL-C targets. It highlighted the need for the provision of patient-centered diabetes education to improve knowledge of the therapeutic targets.     

Television Use and Snacking Behaviors Among Children and Adolescents in China

PurposeTelevision (TV) use has been linked with poor eating behaviors and obesity in young people. This study examines the association between TV watching and paying attention to TV commercials with buying and requesting snacks seen on commercials, and eating snacks while watching TV among youth in China.MethodsData from 1,552 participants (ages 6–17.99) in the 2004 China Health and Nutrition Survey were analyzed cross-sectionally. The 2004 China Health and Nutrition Survey was conducted in nine Chinese provinces.ResultsMost respondents (92.2%) reported watching TV; on average children (6–11.99 years old) and adolescents (12–17.99 years old) watched TV for 9–10 hours per week. Nearly half (42.9%) of all the respondents said they “sometimes” or “often” paid attention to TV commercials. Respondents who reported paying attention to commercials had higher odds of requesting snacks (odds ratio [OR] = 3.43; 95% confidence interval [CI] = 2.55–4.60) and buying snacks (OR = 2.73; 95% CI = 2.17–3.43) seen on TV, and eating snacks while watching TV (OR = 1.60; 95% CI = 1.23–2.07) than those who did not pay attention. However, frequency of watching TV was not significantly related to snacking.ConclusionAttention to TV commercials for snack foods may be one of the factors affecting the increase in obesity among children and adolescents in China.     

Intrinsic motivation in ethnic minority youth with type 1 diabetes

Increasing intrinsic motivation (IM) may be an effective way to improve regimen adherence and glycemic control in youth with type 1 diabetes (T1D). This preliminary study evaluated the reliability and validity of a new measure of intrinsic motivation for diabetes management for ethnic minority youth with T1D. The 12-item Intrinsic Motivation Inventory for Diabetes Management (IMI-DM) was developed to assess perceptions of confidence in and the importance of engaging in self-care behaviors for diabetes management. Participants included 51 11–16 year-old minority adolescents (mean age = 13.5 years) with T1D and their parents. The IMI-DM demonstrated excellent internal consistency (α = 0.92). Higher IM was associated with better diabetes self-management behaviors and glycemic control, better youth self-concept, less depression and family conflict, and greater youth responsibilities for diabetes management. These findings provide preliminary support for the reliability and validity of a new diabetes-specific IM measure for youth with T1D, and identified some key individual and family factors that may be important to consider in interventions to improve regimen adherence and glycemic control in minority youth with T1D.     

Relations Between Quality of Life,Family Factors,Adherence, and Glycemic Control in Pediatric Patients With Type 1 Diabetes Mellitus

This study examined relations among diabetes-specific family factors, adherence to medical regimen, quality of life (QOL), and glycemic control in youth and adolescents with type 1 diabetes. During an endocrinologist visit, patient and parent–caregiver dyads (n?=?70) completed family factors and QOL measures and participated in a structured interview to assess medical regimen compliance, and the patient's glycemic control was assessed by a medical professional. Combined measures accounted for 42% of the variance in glycemic control. QOL partially mediated adherence and glycemic control. Ethnic minority status was associated with poorer glycemic control.     

Self-Reported Dietary Intake of Youth with Recent Onset of Type 2 Diabetes: Results from the TODAY Study

Despite the widely recognized importance of diet in managing diabetes, few studies have documented usual dietary intake in young people with type 2 diabetes. The objectives of our study were to assess dietary intake among a large, ethnically diverse cohort of young people with type 2 diabetes and compare intake to current recommendations. The Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study is a multicenter randomized clinical trial of 699 youth aged 10 to 17 years. At baseline, following a run-in period that included standard diabetes education, diet was assessed using a food frequency questionnaire between 2004 and 2009. Analysis of variance and nonparametric tests were used to compare mean and median nutrient intakes; logistic regression was used to compare the odds of meeting predefined dietary intake recommendation cutpoints between subgroups of age, sex, and race–ethnicity. Percent of energy from saturated fat was consistently 13% to 14% across all subgroups—substantially exceeding national recommendations. Overall, only 12% of youth met Healthy People 2010 guidelines for intake of <10% of energy from saturated fat and only 1% of youth met American Diabetes Association recommendations for intake of <7% of energy from saturated fat. Dietary intake fell substantially below other Healthy People 2010 targets; only 3% met calcium intake goals, 11% met fruit consumption goals, 5% met vegetable consumption goals, and 67% met grain intake goals. Overall, dietary intake in this large cohort of young people with type 2 diabetes fell substantially short of recommendations, in ways that were consistent by sex, age, and race–ethnicity. The data suggest a critical need for better approaches to improve dietary intake of these young people.