Diabetes Management In Adolescents Research Articles

Psychometric Properties of the Turkish Version of the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes

Objective:Resilience in diabetes refers to the capacity overcome diabetes-related challenges to achieve favorable psychosocial and health outcomes. Despite the known benefits of resilience in adolescents with type 1 diabetes mellitus (T1DM), there tends to be more emphasis on risk factors in research and practice. This study evaluated the psychometric properties of the Diabetes Strengths and Resilience Measure for Adolescents with Type 1 Diabetes (DSTAR-Teen) in Turkey.Methods:This descriptive, methodological study was conducted between October 2020 and May 2021. The Turkish DSTAR-Teen was administered to 120 adolescents with T1DM, and the data were evaluated using Cronbach’s alpha coefficients, factor analyses, test-retest correlation, and item-total score correlations.Results:The Turkish DSTAR-Teen has 12 items in two factors that explained 50.64% of the total variance. Confirmatory factor analysis revealed goodness-of-fit and comparative fit indices of 0.92 and 0.95, respectively. The total Cronbach’s alpha value of the scale was 0.85. Item-total score correlations ranged from 0.49 to 0.74 (p<0.001).Conclusion:Our analyses showed that the Turkish DSTAR-Teen is a valid and reliable instrument in Turkish adolescents with T1DM. The Turkish DSTAR-Teen can be used to evaluate strengths and resilience associated with diabetes management in adolescents with T1DM in Turkey.

Tip 1 Diyabetli Adölesanların Denetim Odağı Düzeylerinin ve Anne-Baba Tutumlarının Diyabetin Yönetimine Etkisi

Tip 1 Diyabetli Adölesanların Denetim Odağı Düzeylerinin ve Anne-Baba Tutumlarının Diyabetin Yönetimine Etkisi

54-LB: Control Yourself: Impact of Self-Regulation on Diabetes Management in Adolescents

Adolescents have the poorest blood sugar control compared to other age groups (Foster et al., 2019). Adolescence is also a period of developing self-regulation (SR) abilities, defined as the ability to manage thoughts, emotions, and actions to achieve a desired outcome (Eisenberg, 2019). The attention, planning, and decision making required for optimal T1D management is both cognitively and emotionally draining on the developing system of adolescents, which may be contributing to difficultly with diabetes management and glycemic control (Duke &amp; Harris, 2014). This project examines the relationship between specific aspects of SR, including executive functions and affect; and T1D outcomes, including diabetes management behaviors and HbA1c. As part of an ongoing clinical trial (NCT03688919), adolescents (13-17 yo) diagnosed with T1D for ≥ 6 months with HbA1c ≥ 7.0 were recruited from diabetes clinics (n = 56). They completed baselines measures of self-regulation including the Behavior Rating Inventory of Executive Functioning, Positive and Negative Affect Schedule for Children, and self-reported diabetes management behaviors. HbA1c was also collected. Parent reported cognitive aspects of SR were negatively related to number of insulin boluses per day, specifically attentional shift, task completion and planning, (r(47)= -.36, -.31, -.33 respectively, all p &amp;lt; .05); however, no association was found between inhibition, self-monitoring, and working memory and diabetes outcomes (p &amp;gt;.05). With regard to emotional aspects of SR, positive affect, including excitement, enthusiasm, pride, determination, and activation (r(47)= .34, .33, .36, .31, .29 respectively, all p &amp;lt; .05) were positively related to number of insulin boluses per day. No aspects of SR were related to blood glucose testing behaviors or HbA1c. SR in adolescents may be an important factor in successful T1D management. With evidence-based approaches, SR may be an optimal target for intervention. Disclosure D. Albright: None. H.O. Riley: None. E. Fredericks: None. J. Sturza: None. S. Lo: None. K.M. Clark: None. J.M. Lee: Advisory Panel; Self; Goodrx. Consultant; Self; T1D Exchange. Research Support; Self; Lenovo. A.L. Miller: None. Funding National Institutes of Health (NCT03688919)

Pumping up a new revolution of diabetes management: insulin pumps and emphasis on psychological aspect of diabetes care

T1DM is one of the most common chronic childhood illnesses. It is characterised by insulin deficiency resulting from the destruction of pancreatic beta cells. As of 2014, there are approximately 15,000– 20,000 New Zealanders with T1DM, which is approximately 5–8% of all New Zealanders with diabetes. Individuals with T1DM are often diagnosed in childhood/adolescence. Subsequently, their need to depend on insulin for survival for the rest of their lives presents unique challenges to the individual, their family, and the healthcare providers involved in the management and monitoring. The following discussion aims to review some of the existing diabetes technologies and address the understudied psychological aspects of diabetes management in adolescents, with a special focus on our case patient.

The relation of alexithymia and attachment with type 1 diabetes management in adolescents: a gender-specific analysis

BackgroundSeveral studies indicate the role of psychosocial factors in the management and control of chronic diseases in adolescents. In this regard, the roles of attachment and alexithymia in the management of type 1 diabetes in adolescents and related gender-specific patterns have rarely been the focus of empirical research. In this study we investigate the gender-specific relationship of alexithymia and attachment with self-care and blood glucose level in adolescents with type1 diabetes.MethodsThis is a cross-sectional study conducted on adolescents aged 12–18 years, with type 1 diabetes. Participants were recruited from diabetes clinics and the Iranian Diabetes Society. Data were collected using the Farsi versions of the Toronto Alexithymia Scale (FTAS-20), the Inventory of Parent and Peer Attachment (IPPA) and the Summary of Diabetes Self-Care Activities Scale (SDSCA). Blood glucose levels were measured by determining HbA1c which were abstracted from medical records. Data were analyzed using SPSS21 software.ResultsParticipants were 150 adolescents (57% female), mean age 14.97 ± 2.30. Alexithymia (β = 0.10, P = 0.01), difficulty identifying feelings (β = 0.15, P = 0.03) and communication with mothers (β = − 0.08, P = 0.03) predicted HbA1c in girls, whereas no significant relationships were observed for HbA1c with alexithymia and attachment in boys. Factors that predicted self-care in girls were alexithymia (β = − 0.04, P = 0.02), difficulty identifying feelings (β = − 0.06, P = 0.04); in boys however in addition to these two factors predicting self-care [alexithymia (β = − 0.07, P = 0.01) and difficulty identifying feelings (β = − 0.11, P = 0.01)], we also found difficulty describing feelings (β = − 0.16, P = 0.02), communication with mother (β = 0.04, P = 0.04), alienation to mother (β = − 0.06, P = 0.03), to father (β = − 0.06, P = 0.01) and to peers (β = − 0.09, P = 0.03).ConclusionsOur results suggest that, in a gender-specific pattern, alexithymia and attachment could affect self-care and blood glucose level in adolescents with type 1 diabetes; findings that can be used to facilitate more effective treatment strategies and interventions in this age group.

Psychological interventions for adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes: a systematic review.

The aim of this review was to summarize and identify the variations in the effectiveness of psychological interventions on adherence, metabolic control, and coping with stress in adolescents with type 1 diabetes (T1D). An electronic search of literature was performed using PubMed (NLM), Embase (Ovid), CINAHL Plus (EBSCOhost), PsycINFO (Ovid), and Google Scholar. The search was limited to include articles reported the effect of one of the psychological interventions: cognitive behavioral therapy (CBT), coping skills training (CST), stress management, or psychotherapy intervention. The report included peer-reviewed articles published in English from January 1990 until May 2019 in adolescents with T1D, and summarizes the results of 24 studies that met the inclusion criteria. Psychological interventions showed differential effects on adherence, metabolic control, and coping with stress in adolescents with T1D. Behavioral interventions using principles of CBT appear to have a superior positive effect on regimen adherence compared with other types of psychological protocols. In contrast, metabolic control was significantly improved with the implementation of CST and some forms of CBT. Stress management and psychotherapy interventions showed significant promises for adolescents to cope with their diabetes-related daily stressors. However, the findings may add some promises to diabetes management in adolescents, additional research to understand the effect of these interventions is needed.

851-P: Sleep and Quality of Life in Adolescents with Type 1 or Type 2 Diabetes

Poor sleep due to the influence of mobile technology and hectic schedules is common in adolescents and may affect overall diabetes management. The purpose of this study was to examine associations between sleep quality and perceptions of physical health, emotional well-being, self, family support, friendships and life satisfaction in adolescents with diabetes. Seventy-six adolescents with either T1D (n = 49; 25 males) or T2D (n= 27) completed a self-report global measure of sleep quality using a 5-point scale with higher values representing more sleep difficulty and measures of quality of life based upon subscales from well-validated and reliable instruments. These included the Kiddo KINDL® and the Diabetes Quality of Life Instrument for Youth with higher values on a 5-point scale indicating more positive perceptions of quality of life and life satisfaction. Hemoglobin A1c% (HbA1c) was obtained using the Abbott IMx® assay method. Adolescents with T2D were significantly older (15.2±2.0 vs. 14.0±1.4 years), had higher body mass index z-scores (2.0±0.6 vs. 0.6±0.9) and less duration of diabetes (2.0±1.8 vs. 5.5±3.2 years) (P &amp;lt; 0.01). There were no group differences in median scores for sleep quality or mean HbA1c (8.1±2.4 vs. 8.8±1.8) and no association between HbA1c and sleep quality. Using Spearman rho correlational analyses, there were significant associations between sleep quality and perceptions of physical health (rho = -.44), self (rho = -.19), family (rho = -.20), friends (rho = -.23) and life satisfaction (rho = -.25), P &amp;lt;0.05). Significant associations were stronger in those with T1D, ranging from rho = -.36 to -.64, including emotional well-being, likely due to the larger sample size for those with T1D. Results indicate those with greater sleep difficulty had lower quality of life. Greater emphasis on overall sleep quality and personal health and relationships are needed in future research and the clinical management of diabetes in adolescents. Disclosure M.S. Faulkner: None. Funding National Institutes of Health (R01NR07719)

Psychological Distress Predicts HbA1c Trajectories among Type 1 Diabetic Adolescents

Diabetic adolescents have poor metabolic control. We aimed to characterize the longitudinal association between the stress-related domains of emotional burden (EB), physician related-distress (PD), regimen-related distress (RD), diabetes-related interpersonal distress (ID), and hemoglobin glycosylated (HbA1c) trajectories among Type 1 diabetics Chilean adolescents.&#x0D; Thirty-two Type 1 diabetic adolescents (Mage=15.97; SD=3.45) were followed for one year. HbA1c was assessed at three time points, and a stress measure was obtained. Using a longitudinal growth curve modeling, a marginal overall negative linear trend was found in HbA1c (b = -0.23, p = 0.096). There was an interaction between time and PD (b = -0.33, p &lt; 0.05), and a main effect of EB, RD, and ID on HbA1c. Psychological stress domains predict metabolic control trajectories. Monitoring diabetes specific stress may be a useful tool to identify adolescents at risk for poor control, and interventions that reduce such stress might lead to better management of diabetes in adolescents.

Adaptation of an Evidence-Based Diabetes Management Intervention for Delivery in Community Settings: Findings From a Pilot Randomized Effectiveness Trial.

To adapt an evidence-based intervention targeting diabetes management in adolescents with poorly controlled type 1 diabetes for use in a community setting by community health workers (CHWs) and to conduct pilot testing of the new intervention, REACH for Control (RFC). The study was conducted as a collaboration between university researchers and a federally qualified health center. Methods In a pilot effectiveness trial, feasibility and acceptability of RFC were evaluated based on participant enrollment, treatment dose, and consumer satisfaction. RFC effects on adolescent adherence, health outcomes, and quality of life were also assessed. The trial used a parallel group design. Families were randomized to 6 months of RFC plus standard medical care (n = 26) or standard care (SC) only (n = 24). Data were collected at baseline and 7-month posttest. A mixed-methods approach was used to analyze data. Qualitative analyses suggested that caregivers viewed RFC and delivery of a home-based intervention by CHWs positively. Furthermore, adolescents who received RFC had statistically significant (p = .05) and clinically meaningful improvements in hemoglobin A1c (HbA1c) (0.7%) and reported significant improvements in quality of life from baseline to follow-up (p = .001). No significant changes were found for adolescents in standard medical care. However, while dose of primary intervention session delivered was acceptable, dose of follow-up sessions used for skills practice was low. Results provide preliminary support for RFC's acceptability and effectiveness to improve health status and quality of life when used in community settings serving high-risk, low-income families. Additional testing in a full-scale effectiveness trial appears warranted.

The Role of Peers for Diabetes Management in Adolescents and Emerging Adults With Type 1 Diabetes: A Longitudinal Study.

The increasing importance of peers in adolescence and emerging adulthood has been widely acknowledged. However, longitudinal research linking the peer context to diabetes management and outcomes is scarce. The present longitudinal study in a large sample of youths with type 1 diabetes related both positive and negative peer variables to diabetes outcomes over a time interval of 1 year. Our sample consisted of 467 adolescents (14-17 years of age) and emerging adults (18-25 years of age) with type 1 diabetes who participated in a two-wave longitudinal study. Questionnaires tapped into peer support, extreme peer orientation, parental responsiveness, diabetes-related distress, and treatment adherence. HbA1c values were obtained from the treating physicians of patients. Cross-lagged analysis from a structural equation modeling approach was performed to assess the directionality of effects. Peer support negatively predicted diabetes-related distress over time. Extreme peer orientation positively predicted treatment distress over time. Parental responsiveness negatively predicted food distress over time. Treatment adherence negatively predicted extreme peer orientation, treatment distress, and HbA1c values over time. For emerging adults specifically, there was a reciprocal relationship between HbA1c values and extreme peer orientation because they positively predicted each other. This study highlights the importance of peers in predicting the functioning of youths with type 1 diabetes. Additionally, treatment adherence at baseline was found to negatively predict extreme peer orientation, treatment distress, and worse glycemic control over time. In sum, the current study underscores the importance of the peer context for adolescents and emerging adults with type 1 diabetes.

Management and Treatment of Type 1 And 2 Diabetes: State of Art

Background: Diabetes is a hormonal disorder that affects an estimated three hundred million people worldwide. In this review (meta-analysis) of the literature, we carefully analyzed the limits and methods of the management of diabetes in adolescents and adults. Objective: The study focused on the identification of technologies and therapeutic procedures currently used and tried to identify possible factors for future improvement. Methods: The literature review was carried out on search engines like: PubMed, ADA, Google Scholar and Google Patents. According to our search criteria, the selected articles were analyzed regarding evidence and critical issues reported by patients and clinicians. The results were then compared with the recalls of the U.S. Food and Drug Administration (FDA). Results: The currently in use drugs and the insulin infusion systems vary a lot and simultaneous develop of new technology adds to existing chaos. This study revealed possible areas for improvements both from a technological and a medical point of view. For instance: the multiple causes related to the different timing of insulin absorption according to the insertion site, the design of new algorithms focused on simplification of practical activities, and the identification of new methods for training patients and families on the different device’s functions. Moreover, some critical points were emerged related to the current limitations and lack of interchangeability between sensors for monitoring vital parameters. This condition restricts the correct sensor selection according to the patient’s personal preference, age and needs. However, the lack of interchangeability between different devices limits the choice of the most appropriate monitoring software and data storage. Conclusions: The collaboration between medical doctors and biomedical engineers is of great importance when analyzing available medical devices for the purpose, identifies possible weaknesses, technical problems, and areas for improvements. Moreover, multi-specialist collaboration is important to conceive new methods of training for patients and families.

Testing for rewards: a pilot study to improve type 1 diabetes management in adolescents.

OBJECTIVETo evaluate the effectiveness of monetary reinforcement to increase the frequency of self-monitoring blood glucose (SMBG).RESEARCH DESIGN AND METHODSTen adolescents with poorly controlled diabetes enrolled in a 12-week program in which they earned monetary reinforcers based on SMBG frequency ($0.10 per test, with bonuses for ≥4 tests per day, and $251.40 maximum).RESULTSSMBG increased from 1.8 ± 1.0 to 4.9 ± 1.0 tests per day (P < 0.001) with 90% completing four or more tests per day. Mean A1C fell from 9.3 ± 0.9% to 8.4 ± 1.5% (P = 0.05). Adolescents and parents reported high satisfaction with procedures.CONCLUSIONSReinforcing adolescents for SMBG may increase testing and improve A1C.

Check it! A randomized pilot of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes.

The purpose of the current study was to pilot-test a positive psychology intervention to improve adherence to diabetes management in adolescents with type 1 diabetes. A total of 39 adolescents (ages, 13-17 years) with type 1 diabetes and their caregivers were randomized to a positive psychology intervention (n = 20) or an attention control (education) intervention (n = 19). The intervention condition used positive psychology exercises (eg, gratitude, self-affirmation), small gifts, and parent affirmations to boost positive affect. Outcomes included frequency of blood glucose monitoring, quality of life, and glycemic control. No main effects for treatment were observed at the 6-month follow-up. However, there was a significant association between adolescents' levels of positive affect and measures of adherence, including self-report and meter downloads of glucose monitoring. The results from the current study support the assertion that positive affect in the context of diabetes education is an important factor to consider in adolescents with type 1 diabetes.

Telemedicine for Adolescents With Type 1 Diabetes

Diabetes is the third most common chronic disease in the pediatric population and diabetes management in adolescents presents a unique challenge for health care providers. The purpose of this article is to define telemedicine, review a variety of telemedicine intervention studies in the adolescent population, and interpret those results in the context of the current health care climate. Clinicians and researchers will be provided with education related to adolescent needs and telemedicine interventions so that telemedicine can be used effectively to promote the health of adolescents with diabetes. Because telemedicine has yet to demonstrate consistent and significant positive outcomes in this population, further research and continued development of technology are essential to improve diabetes control in adolescents and prevent the long-term complications of this disease.

Proposing an Acceptance and Commitment Therapy intervention to promote improved diabetes management in adolescents: A treatment conceptualization.

Pediatric diabetes is linked with adverse medical outcomes, the risks of which increase with poor or intermittent adherence (Diabetes Control and Complications Trial Research Group, 1994). Further, during adolescence, diabetes management tends to deteriorate (Anderson & Laffel, 1996; Bryden et al., 2001; Insabella, Grey, Knafl, & Tamborlane, 2007; La Greca, Follansbee, & Skyler, 1990). This paper proposes that cognitive fusion and experiential avoidance negatively influence diabetes management behaviors in adolescents. To date, no published interventions address these psychological processes in this patient group. Acceptance and Commitment Therapy (ACT) is presented as an approach for targeting experiential avoidance and cognitive fusion among adolescents with diabetes.

Disordered Eating Behaviors Are Associated with Poorer Diet Quality in Adolescents with Type 1 Diabetes

Disordered eating behaviors may pose a risk for poor long-term health outcomes in patients with type 1 diabetes. This cross-sectional study examined associations of disordered eating behaviors with diet quality, diet-related attitudes, and diabetes management in adolescents with type 1 diabetes (N=151, 48% female). Participants, recruited July 2008 through February 2009, completed 3-day diet records and survey measures, including the Diabetes Eating Problem Survey (DEPS) and measures of eating-related attitudes. Biomedical data were obtained from medical records. Participants scoring more than 1 standard deviation above the mean DEPS were classified as at risk for disordered eating. The Healthy Eating Index-2005 was calculated to assess diet quality. Analysis of covariance was used to test for differences between risk groups in diet quality, eating attitudes, and diabetes management, controlling for age, sex, and body mass index (BMI) percentile. Youth at risk for disordered eating were more likely to be overweight/obese than those at low risk (59.1% vs 31.8%, P=0.01). The at-risk group had poorer diet quality (P=0.003) as well as higher intake of total fat (P=0.01) and saturated fat (P=0.007) compared with the low-risk group. The at-risk group reported lower self-efficacy (P=0.005), greater barriers (P<0.001), and more negative outcome expectations (P<0.001) for healthful eating, as well as worse dietary satisfaction (P=0.004). The at-risk group had lower diabetes adherence (P<0.01), less-frequent blood glucose monitoring (P<0.002), and higher hemoglobin A1c (P<0.001). The constellation of excess weight, poorer dietary intake, and poorer diabetes management associated with youth at risk for disordered eating suggests potential risk of future poor health outcomes. Attention should be given to healthful weight management, especially among overweight youth with type 1 diabetes.

The mediating role of extreme peer orientation in the relationships between adolescent–parent relationship and diabetes management.

The study examined whether the quality of the adolescent-parent relationship was associated with better diabetes management in adolescents with Type 1 diabetes by decreasing adolescents' extreme peer orientation. Adolescents (n = 252; 46% male and 54% female) aged 10 to 14 years with Type 1 diabetes completed assessments of extreme peer orientation (i.e., tendency to ignore parental advice and diabetes care to fit in with friends), adolescent-parental relationship, and adherence; HbA1c scores indexed metabolic control. Adolescents with higher quality relationships with parents reported less peer orientation and better diabetes care. The mediational model revealed that adolescents' high quality relationships with their parents (mother and father) were associated with better treatment adherence and metabolic control through less peer orientation. It is likely that high quality adolescent-parent relationships may be beneficial to adolescent diabetes management through a healthy balance between peer and parental influence.

Patient- Versus Parent-Reported Psychological Symptoms as Predictors of Type 1 Diabetes Management in Adolescents

The purpose of this study was to assess whether psychological symptoms such as depression and anxiety were concurrently or longitudinally related to adherence, metabolic control, and subsequent hospitalization, and to determine whether patients' or parents' report of the adolescent's psychological symptoms better predicted disease management. Adolescent patients (N = 231) and their parents reported on the adolescents' psychological symptoms and adherence to the medical regimen. Information about metabolic control, and hospitalization for diabetes complications up to 5 years later, were obtained from medical records. Psychological symptoms were correlated with reports of the adolescent's adherence regardless of the informant. Patient- (but not parent-) reported symptoms correlated with concurrent metabolic control and predicted hospitalization up to 2 years later. These findings indicate that psychological symptoms are associated with the management of diabetes. Adolescents' self-report of symptoms predict diabetes management more consistently than do parents' reports.

Diabetes care in children is complex

The care of children with type 1 diabetes mellitus (T1DM) has changed dramatically in the past 20 years. This change has been fuelled, in part, by the publication of the results of the Diabetes Complications and Control Trial (DCCT) in 1993 (1). The DCCT included the evaluation of intensive diabetes management in adolescents. The DCCT taught us that glycemic control is directly related to microvascular complications. It also demonstrated the need for a dedicated, skilled, full-time diabetes education team to be co-located with physicians. This has been successfully translated into paediatric practice in the post-DCCT era. Sophisticated, full-time, paediatric diabetes teams with 24 h emergency telephone access have been established in every tertiary children’s hospital in Canada, as well as in many secondary centres with consultant paediatricians. The majority of children with T1DM at diagnosis are now managed on an ambulatory basis by such teams. Key ingredients of these modern diabetes teams are coordinated and flexible integration of care, education, support with case management, empowerment of parents and information systems for quality outcome assessment. Other remarkable developments that have catalyzed the revolution in T1DM diabetes care in children include faster and smaller blood glucose monitors, new ‘designer’ insulins and new technologies for insulin delivery. The rigid exchange system of starch, fruit and milk choices was abandoned as we recognized that all carbohydrates in the diet are similar in T1DM diabetes care and can be given in a usual eating pattern with appropriate flexible insulin doses. We have gained new insight into the psychology of diabetes in children, recognized that the most common cause of diabetic ketoacidosis is insulin omission and learned to use the hemoglobin A1c for identification of youth at risk for diabetic ketoacidosis. Insulin omission to promote weight loss is now a recognized form of an eating disorder in the Diagnostic and Statistical Manual of Mental Disorders, 4th revision (2) psychiatry diagnosis code. The globalization of information has provided parents and adolescents with endless sources of information to keep themselves well-informed. Paediatric diabetes care became even more complicated with the recognition of type 2 diabetes mellitus (T2DM) in youth in the 1980s. In most tertiary paediatric diabetes clinics in Canada, children with T2DM now account for 5% to 30% of the population followed in the clinic. Once diagnosed, T2DM is difficult to treat. It differs fundamentally from T1DM because it is a multisystem disorder, now known as the metabolic syndrome. The approach and treatment of an adolescent with T2DM must include the evaluation of the other components of the syndrome. Our understanding of the etiology, treatment and natural history of this new disease in children is evolving. It is imperative that we continue to expand our knowledge with well-designed treatment trials in this population. The extrapolation of adult data to the paediatric population is fraught with potential pitfalls. To add another wrinkle, it is now believed that 5% of children with diabetes have a monogenic form of inherited diabetes which is neither T1DM nor T2DM and which may respond to selective oral agents or insulin. We must be vigilant in asking a detailed family history of diabetes. The provision of care, education and support for children and adolescents with all forms of diabetes in children is complex. This complexity is reflected in the papers included in this special issue of Paediatrics & Child Health. All children and youth with diabetes in Canada need to have access to a coordinated and integrated diabetes care team to optimize their survival and minimize their morbidity. Diabetes is not a disease that can be managed well in isolation. We must work together to ensure that all our children and youth have access to care that truly makes a difference. The optimum system for delivery of care in our large country requires unique, flexible and creative solutions. Dedicated paediatric regional diabetes education teams are the cornerstone of this system and the creation of dedicated teams to meet the needs of vulnerable young adults with diabetes is the next logical step.

Diabetes Management in Adolescents in Poor Metabolic Control

This study was conducted to describe and compare adolescent and parent report of diabetes management and to identify racial/ethnic differences in diabetes management and metabolic control in adolescents in poor metabolic control. The convenience sample consisted of 31 mother-adolescent dyads. Diabetes management was measured by the Diabetes Management Scale. Descriptive statistics, bivariate correlations, and t-tests were used to analyze the data. The overall mean of individual management activities was 66% for adolescents and 68% for mothers. Mismanagement of insulin was reported by 25% of the adolescents yet this behavior was supervised only 65% of the time. Better metabolic control was related to eating 3 meals a day, getting insulin every day, and more assistance with meals. African American adolescents were in poorer metabolic control than European Americans. Diabetes management behaviors are performed much less frequently than recommended by adolescents and their mothers. Additional research is necessary to identify modifiable factors that contribute to inadequate diabetes management to identify intervention strategies to improve diabetes management in adolescents with poor metabolic control.