Subgroups of pre-adolescents with type 1 diabetes based on profiles of resilience-supporting resources and risk factors.

BackgroundPatients with diabetes mellitus often suffer from diabetes distress. Social support and certain psychological factors potentially influence diabetes distress, but studies exploring the mechanisms underlying these relationships are scarce.ObjectivesTo reveal the associations between social support, diabetes stigma, diabetes self-efficacy, and diabetes distress among patients with type 2 diabetes and the underlying mechanisms linking these variables.Design and methodsA multicenter cross-sectional study was adopted and a sample of 431 patients with type 2 diabetes was investigated. Social support, diabetes stigma, diabetes self-efficacy, and diabetes distress were surveyed with the Perceived Social Support Scale, Type 2 Diabetes Stigma Assessment Scale, Self-Efficacy for Diabetes Scale, and Diabetes Distress Scale, respectively. The hypothesized model was verified using structural equation modeling.ResultsSocial support and diabetes stigma had direct associations with diabetes distress. Diabetes stigma mediated the association between social support and diabetes distress, and the association between diabetes self-efficacy and diabetes distress. Diabetes stigma and self-efficacy exerted a chain mediation effect on the association between social support and diabetes distress.ConclusionSocial support and diabetes stigma were significant predictors of diabetes distress. Diabetes stigma and self-efficacy play essential mediating roles in relieving diabetes distress. This can provide guidance for the development of evidence- and theory-based interventions. Culturally sensitive interventions that aim to provide ongoing social support, decrease diabetes stigma, and enhance self-efficacy have the potential to relieve diabetes distress.

Many adolescents with type 1 diabetes experience diabetes distress which is associated with suboptimal glycemic and psychosocial outcomes. The ways in which adolescents respond to diabetes distress may serve as a risk or protective factor for these outcomes, but few studies have examined the coping strategies adolescents use to manage diabetes distress. To examine the association of coping strategies with glycemic and psychosocial outcomes among adolescents experiencing diabetes distress. Participants included 198 adolescents with elevated diabetes distress who completed baseline data for a randomized controlled trial (Mage = 15.3 ± 1.4, 58% female, 58% non-Hispanic White, MA1c = 9.1 ± 2.1%). Adolescents reported on their use of coping strategies related to diabetes stressors, including primary control engagement coping (e.g., problem-solving), secondary control engagement coping (e.g., positive thinking), and disengagement coping (e.g., avoidance). Adolescents also completed measures of diabetes distress, quality of life, and resilience. HbA1c data were extracted from electronic medical records and at-home kits. Higher use of primary control engagement coping was associated with better glycemic and psychosocial outcomes. Secondary control engagement coping was associated with better psychosocial outcomes but not glycemic outcomes. Greater use of disengagement coping strategies was associated with poorer glycemic and psychosocial outcomes. All associations were significant after adjusting for adolescent sex, age, race/ethnicity, and continuous glucose monitor use. These results build on prior findings by including a more diverse sample of adolescents and highlight the value of promoting engagement coping strategies and discouraging the use of disengagement coping strategies among adolescents experiencing diabetes distress. NCT03845465.

Background The etiology of AF is multifactorial. Genetic susceptibility and lifestyle contribute to atrial fibrillation (AF) risk.(1,2) However, the relationship between combined genetic predisposition and lifestyle risk factors on AF risk is unclear. Purpose We aimed to assess a possible interaction between modifiable risk factors and genetics on AF risk. Methods We included AF cases and a randomly drawn subcohort of 4,040 participants from the Danish Diet, Cancer, and Health study. Modifiable risk factors were assessed including smoking, body mass index, physical activity, diet, alcohol consumption, total cholesterol, and blood pressure. Based on cumulation of risk factors, a risk factor profile was determined for all participants and categorized as poor, intermediate, and ideal. Based on DNA sequence polymorphisms, we calculated a genetic risk score for AF, and categorized participants as having a low (quintile 1), intermediate (quintile 2-4) or high (quintile 5) genetic risk. Diagnoses of AF and/or atrial flutter were obtained from the Danish National Patient Register. We used weighted Cox proportional hazards regression to assess hazard ratios of AF. Results 3,094 AF cases occurred during a median follow-up of 12.9 years. Median age at baseline in the subcohort was 55 years (25th-75th percentile 52-60) and 2,092 (55%) were women. Participants at intermediate and high genetic risk had higher rates of AF compared with those at low genetic risk. Likewise, intermediate, and poor risk factor profiles were associated with higher rates of AF compared with those having ideal risk factor profiles. Weighted cumulative incidence proportions and hazard ratios of AF according to genetic risk and modifiable risk factors are shown in Figure 1. Within each category of genetic risk, incidence rates per 1,000 person-years were gradually higher with worse modifiable risk factor profiles. (Figure 2). For participants with high genetic risk, the incidence rates of AF per 1,000 person years were 5.0 (95% CI 3.4-7.3) for ideal, 6.6 (95% CI 5.4-8.1) for intermediate, and 10.4 (95% CI 9.2-11.8) for poor risk factor profiles. On an additive scale, there was a statistically significant interaction between genetic risk and modifiable risk factors (relative excess risk due to interaction=0.86 (95% 0.68-1.03, p<0.001). Conclusions A genetic risk score and modifiable risk factors were each associated with AF risk. The rates of AF increased gradually with cumulation of modifiable risk factors within each category of the genetic risk score, and we found an additive interaction between genetic risk and the modifiable risk factor profile. This underlines the importance of risk factor modification in primary AF prevention.Figure 1Figure 2

The purpose of this study was to examine the relationships between maternal environment (child behavior and coping resources), diabetes self-efficacy, diabetes management behaviors, and child glycemic control. Study participants were recruited from 3 outpatient clinics in the Midwest and included 41 mothers of children with type 1 diabetes, ages 6 to 10. All participants completed the following measures: Coping Resources Inventory, Behavioral Assessment System for Children-Parent Report, Maternal Self-Efficacy for Diabetes Scale, Diabetes Management Scale-Parent, and 24-hour diabetes behavior recall. Downloaded glucose data and child HgbA1c were obtained by chart review. Stepwise multiple regression was used to determine the influence of maternal environment on maternal diabetes self-efficacy and diabetes management behavior. Pearson product moment correlations were used to determine if relationships existed between maternal self-efficacy, diabetes management behaviors, and child metabolic control. Coping resources contributed significantly to mothers' diabetes self-efficacy. No significant relationship was found between the mothers' environment and diabetes management behavior. Self-efficacy did not predict maternal diabetes management behaviors. The blood glucose testing and maternal recall of diabetes behaviors were correlated to metabolic control. Mothers with coping resources felt more confident in managing their children's diabetes. Child behavior did not influence a mother's diabetes management behaviors. Mothers who were consistent in their diabetes management behaviors had children in better metabolic control. More information is needed to determine what mothers view as barriers in providing diabetes care for their children.

Adolescents with type 1 diabetes (T1D) and their caregivers endorse high diabetes distress (DD). Limited studies have documented the impact of DD on Black youth. The aims of the present study were to (1) describe DD among a sample of Black adolescents with T1D and their caregivers, (2) compare their DD levels with published normative samples, and (3) determine how DD relates to glycemic outcomes, diabetes self-management, parental monitoring of diabetes, and youth depressive symptoms. Baseline data from a multicenter clinical trial were used. Participants (N = 155) were recruited from 7 Midwestern pediatric diabetes clinics. Hemoglobin A1c (HbA1c) and measures of DD, parental monitoring of diabetes care, youth depression and diabetes management behaviors were obtained. The sample was split into (1) adolescents (ages 13-14; N = 95) and (2) preadolescents (ages 10-12; N = 60). Analyses utilized Cohen's d effect sizes, Pearson correlations, t-tests, and multiple regression. DD levels in youth and caregivers were high, with 45%-58% exceeding either clinical cutoff scores or validation study sample means. Higher DD in youth and caregivers was associated with higher HbA1c, lower diabetes self-management, and elevated depressive symptoms, but not with parental monitoring of diabetes management. Screening for DD in Black youth with T1D and caregivers is recommended, as are culturally informed interventions that can reduce distress levels and lead to improved health outcomes. More research is needed on how systemic inequities contribute to higher DD in Black youth and the strategies/policy changes needed to reduce these inequities.

The purpose of this study is to examine diabetes distress as a potential mediator of the relationship between depression symptoms and diabetes outcomes, including hemoglobin A1c (hemoglobin A1c [HbA1c]) and diabetes management behaviors in a clinical sample of adolescents and young adults. In a pediatric diabetes clinic, 716 youth (ages 12-21 years) completed measures of diabetes distress (Problem Areas in Diabetes-Teen [PAID-T]), a single-item of diabetes distress, and depression (Patient Health Questionnaire [PHQ-9]) as part of standard care. Electronic health records were extracted for the "Six Habits" and glycemic management (HbA1c). Overall, 3.6% (n = 26) of adolescents had clinically elevated diabetes distress and depression symptoms, 5.0% had diabetes distress alone, 8.7% had depression symptoms alone, and 82.7% had neither clinical elevation of diabetes distress nor depression symptoms. Results of mediation analysis demonstrated diabetes distress (both full and single-item measures) fully mediated the relationship between depression symptoms and HbA1c (p < .001). Also, mediation analysis results showcase incomplete mediation of the effect of the Six Habits score on HbA1c appears by PAID-T Diabetes Distress. In a clinical sample of youth with type 1 diabetes, both depressive symptoms and diabetes distress are associated with HbA1c. Furthermore, diabetes distress fully mediates the relationship between depressive symptoms and HbA1c. As part of standard clinical care, the single-item screener for diabetes distress captured similar results as the full-scaled PAID-T. With limited clinical resources, providers may consider focusing assessment and interventions on the psychological factor of diabetes distress within the diabetes clinic to maximize the impact on glycemic control and consider the use of single-item screening to identify distress.

Background: Diabetes distress (DD) is a negative emotional response commonly associated with type 1 diabetes (T1D). Similar to youth, parents may experience their own DD resulting from the burdens associated with supporting their child with T1D. Parental DD can have a negative impact on quality of life (QoL), and disruptive factors, such as family conflict, may exacerbate parental DD. Clinical and psychosocial outcomes associated with DD have been previously examined in teens, yet less is known about the association among parental DD, QoL, and diabetes outcomes in parents of teens experiencing DD. Methods: 60 parent-teen dyads have enrolled thus far in the ongoing THR1VE! study, a positive psychology texting-based intervention. Teens (M age 16.2 ± 1.5, 68% female, M T1D duration 7.7 ± 3.9) were eligible if they reported experiencing moderate or higher DD. Parents (83% female; 78% married/partnered; 78% white) completed the Parents - Problem Areas in Diabetes, Revised Diabetes-Related Family Conflict, and Type 1 Diabetes and Life questionnaires at baseline. A1c data were gathered at routine diabetes clinic appointments or through at-home A1c kits. Associations among parental reports of DD, diabetes-related family conflict, parental QoL, and A1c were examined. Results: Higher parental DD was positively associated with higher parent-reported family conflict (r= 0.54), lower parental QoL (r=0.63), and higher teen A1c (r=0.31). Higher parent-reported family conflict was also associated with lower QoL (r=0.40) and higher A1c (r= 0.35), all p &amp;lt;0.05. Conclusion: Similar to prior findings for teens with DD, results suggest that for parents of distressed teens, parents’ own experience of DD is also related to psychosocial variables including family conflict and QoL. Importantly, parental DD is related to children’s glycemic control, suggesting that increased psychological support for parents with teens with DD is warranted. Disclosure H. Inverso: None. H. R. Moore: None. T. Morrow: None. S. S. Jaser: None. R. Streisand: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)

Using Latent Profile Analysis and Related Approaches in Adolescent Health Research

Background: Continuous glucose monitor (CGM) use has been linked with better glycemic outcomes (HbA1c), yet many adolescents with type 1 diabetes (T1D) struggle to maintain optimal CGM use. Methods: This study examined CGM use and its association with HbA1c and psychosocial factors among adolescents with T1D experiencing at least moderate diabetes distress (N = 198). We examined mean differences in HbA1c, diabetes distress, diabetes-related family conflict, and quality of life among CGM user groups (Current Users, Past Users, and Never Users). Results: Current Users demonstrated significantly lower HbA1c than Never Users and significantly lower diabetes distress than Past Users. CGM use was not associated with family conflict or quality of life. Conclusions: CGM use was associated with lower HbA1c and diabetes distress but not with other psychosocial outcomes. Longitudinal data may explain why many adolescents do not experience improvements in quality of life with CGM use.

Introduction: Use of hybrid closed-loop insulin delivery systems have been associated with better glycemic control and lower hemoglobin A1c (HbA1c) values, and better glycemic control is linked with less diabetes-specific family conflict among adolescents with type 1 diabetes (T1D). Little is known, however, about how the use of closed-loop systems relates to diabetes family conflict. Methods: Participants included 60 teens ages 13-17 who had been diagnosed with T1D for ≥1 year and who reported at least moderate diabetes distress (M age= 16.15±1.4, 68% white, non-Hispanic 68% female), and their parents (78% white, non-Hispanic, 78% Married, 83% female). As part of baseline data collection of an ongoing two-site trial of a behavioral intervention, parents and teens each reported on diabetes device use and diabetes-related family conflict. HbA1c values were obtained from teens’ medical records or mail-in kits. Nonparametric (Mann-Whitney) tests were conducted to examine differences between parent and teen-reported diabetes family conflict and HbA1c in relation to use of closed-loops systems. Results: Of the participants, 12 teens (20%) were using a closed-loop system. The use of closed-loop systems was associated with lower levels of parent-reported diabetes-related family conflict (z= -2.372, p=0.018). Use of closed-loop systems was also associated with lower HbA1c values (z= -2.865, p=.004). However, teens’ own report of family conflict was not significantly related to use of the closed-loop systems (z= -1.331, .183). Conclusion: Results suggest that the use of closed-loop systems is associated with both lower HbA1c and lower parent perceptions of diabetes-related family conflict. While future studies are needed to replicate these findings in larger samples and over time, our findings further support that closed-loop systems may reduce the burden of diabetes - particularly for parents - and improve both psychosocial and glycemic outcomes in families of youth with T1D. Disclosure H. R. Moore: None. S. S. Jaser: None. R. Streisand: None. H. Inverso: None. T. Morrow: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK121316)

Diabetes Distress (DD) can be experienced differently by family members living with T1D. We examined concordance and discordance between youth and parent report of DD and the relationship with youth glycemic control, diabetes-specific family conflict and parent involvement in diabetes tasks in a sample of youth starting real-time continuous glucose monitoring (CGM). Youth (N=120, 51% male) with T1D ages 8-17 years and their parents (84% mothers) completed surveys assessing DD, family conflict and parent involvement. Previously validated cut-points of &amp;gt;41 (PAID-Peds, youth) and &amp;gt;56 (PAID-PR, parents) identified clinically significant DD. Youth/parent dyads were classified as concordant when both youth and parents scored below (Youth Low/Parent Low) or above (Youth High/Parent High) the cut-points. Youth/parent dyads were classified as discordant when youth scored below and parent scored above (Youth Low/Parent High) or youth scored above and parent scored below (Youth High/Parent Low) the cut-points. Youth had a mean±SD age of 12.7±2.7 years, T1D duration 6.1±3.6 years and A1c 8.0±0.8%; 84% were pump treated. About ¼ of youth (26%) and parents (23%) reported clinically significant DD with 62% of dyads concordant for low DD, 10% concordant for high DD and 28% discordant for DD. Concordant groups did not differ significantly from discordant groups. In the 2 discordant groups, A1c and youth-reported family conflict differed significantly; A1c: 7.5±0.9% vs. 8.3±0.7% (p=.043) and family conflict: 5.6±5.1 vs. 22.9±22.0 (p=.036) in the Youth Low/Parent High and Youth High/Parent Low groups, respectively. Parent involvement did not differ across the groups. DD can be perceived differently by youth with T1D and their parents. When youth perceive high DD and parents do not, youth appear at risk for adverse outcomes, highlighting the importance of youth perceptions. Disclosure K. Wentzell: None. M. R. Fu: None. L. K. Volkening: None. L. M. Laffel: Consultant; Self; AstraZeneca, Boehringer Ingelheim International GmbH, Dexcom, Inc., Dompe, Insulogic LLC, Janssen Pharmaceuticals, Inc., Laxmi Therapeutic Devices, LifeScan, Lilly Diabetes, Medtronic, Provention Bio, Inc. Funding National Institutes of Health (R01DK089349, K12DK094721, P30DK036836)

Self-care in people with diabetes is poor, which could be influenced by positive and negative psychosocial factors. Self-efficacy is an important factor affecting self-care, and depressive symptoms and diabetes distress may directly and indirectly affect self-efficacy. The aim of this study was to examine the relationships of depressive symptoms, diabetes distress, age, sex, self-compassion, resilience, self-esteem, and social support to diabetes self-efficacy and the mediating roles of diabetes distress and depressive symptoms in the relationships among people with diabetes. In this cross-sectional, correlational study, data on all the psychosocial and demographic factors were collected (N = 148; 57.6 years old) through Research Electronic Data Capture in 2023. The PROCESS macro for SPSS was used to address the purpose. The mean score of diabetes self-efficacy was 28.6 (range, 8-40). In 1 model, depressive symptoms were directly and indirectly associated with diabetes self-efficacy through diabetes distress (direct effect, -3.524; t = -3.020, P = .003; indirect effect, -2.089; 95% bootstrap confidence interval, -3.494 to -0.911). In another model, diabetes distress was directly and indirectly associated with diabetes self-efficacy through depressive symptoms (direct effect, -3.778; t = -3.638, P < .001; indirect effect, -0.785; 95% bootstrap confidence interval, -1.868 to -0.089). In addition, self-esteem was associated with both depressive symptoms and diabetes distress. Resilience was associated with diabetes self-efficacy in 1 model. Negative psychological factors were directly and indirectly associated with diabetes self-efficacy. Depressive symptoms, diabetes distress, self-esteem, and resilience can be important targets of interventions to improve diabetes self-efficacy.

&lt;p dir="ltr"&gt;During the teenage years, young people with consistently high diabetes distress (DD) or with DD that increased over time showed increases in HbA1c. Findings suggest that high DD is common, and may be a particularly important target for supporting adolescents with type 1 diabetes in obtaining glycemic goals.&lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Key Points&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;· Adolescents struggle with meeting glycemic targets and often experience diabetes distress (DD). This article aimed to identify risk factors for DD and to assess the relationship between patterns of DD change and glycemic outcomes.&lt;/p&gt;&lt;p dir="ltr"&gt;· DD was common in this sample, with females endorsing more DD than males. Over time, adolescents with worsening DD or persistently elevated DD at 18 months experienced rising A1C levels.&lt;/p&gt;&lt;p dir="ltr"&gt;· The findings demonstrate the interrelationship of DD and glycemic outcomes; researchers and clinicians should consider addressing DD to optimize glycemic outcomes for adolescents with type 1 diabetes.&lt;/p&gt;

&lt;p dir="ltr"&gt;During the teenage years, young people with consistently high diabetes distress (DD) or with DD that increased over time showed increases in HbA1c. Findings suggest that high DD is common, and may be a particularly important target for supporting adolescents with type 1 diabetes in obtaining glycemic goals.&lt;/p&gt;&lt;p&gt;&lt;br&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;&lt;b&gt;Key Points&lt;/b&gt;&lt;/p&gt;&lt;p dir="ltr"&gt;· Adolescents struggle with meeting glycemic targets and often experience diabetes distress (DD). This article aimed to identify risk factors for DD and to assess the relationship between patterns of DD change and glycemic outcomes.&lt;/p&gt;&lt;p dir="ltr"&gt;· DD was common in this sample, with females endorsing more DD than males. Over time, adolescents with worsening DD or persistently elevated DD at 18 months experienced rising A1C levels.&lt;/p&gt;&lt;p dir="ltr"&gt;· The findings demonstrate the interrelationship of DD and glycemic outcomes; researchers and clinicians should consider addressing DD to optimize glycemic outcomes for adolescents with type 1 diabetes.&lt;/p&gt;

To assess the associations of changes in self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment and their interactions with changes in diabetes distress in patients with type 2 diabetes mellitus. Many patients with type 2 diabetes mellitus experience diabetes distress. Few longitudinal studies have investigated the associations of changes in various psychosocial factors with changes in diabetes distress in patients with type 2 diabetes mellitus. This study adopted a longitudinal design. Data were collected at baseline and 12months later. Overall, 304 patients with type 2 diabetes were recruited from four hospitals in southern Taiwan by convenience sampling. A self-report questionnaire and medical record were used to collect demographic data, clinical indicators, self-management behaviours, diabetes self-efficacy, resilience, social support, patient empowerment, and diabetes distress. Data were collected from February 2014-March 2015. An increase in resilience or diabetes self-efficacy significantly associated with a decrease in diabetes distress, whereas an increase in patient empowerment significantly associated with an increase in diabetes distress. The interactions between increase in patient empowerment and increase in self-management behaviours significantly associated with decrease in diabetes distress. Nurses could endeavour to improve the diabetes self-efficacy and resilience to reducing diabetes distress. Arbitrarily empowering patients may increase diabetes distress. Increasing self-care management behaviours and patient empowerment might need to be simultaneously addressed to reduce the diabetes distress in patients with type 2 diabetes.