Diabetes Regimen Research Articles

Glycemic Control and Knowledge among Children and Adolescents with Type 1 Diabetes Mellitus; A Cross-sectional Study

Purpose: The aim of this study is to evaluate the long-term glycemic control by glycosylated hemoglobin level (HbA1c) and to assess knowledge about the diabetic regimen. The results of glycemic control in this study were compared with the results of a study conducted in 2018 that targeted almost a similar population. Study Design: A Cross-Sectional Study. Subjects and Methods: The study was conducted in October 2012 to December 2012 in a major referral Diabetic Centre. Diabetic children aged 8 to 18 years old who were attending the referral diabetic clinics were included in the study (n = 90). Knowledge of diabetes management was evaluated by using a semi-structured questionnaire and HbA1c results were obtained from medical records, available for only 71. Later, these Glycated Hemoglobin HbA1c results were compared with the results of a recent study carried out among Sudanese diabetic children and adolescents in 2018. Results: Out of 71 diabetic children 78.9% were of poor glycemic control with mean HbA1c 10.36±2.14. On the other hand, the majority had good knowledge about the diabetic treatment including insulin administration, its storage conditions, and also the effect of exercise on blood glucose. However, almost 18.8% of studied participants did not know hypoglycemia symptoms, and about 11% of these patients were unaware of hypoglycemia management. Conclusion: The study has indicated that a significant percentage of studied diabetic children and adolescents had poor glycemic control. Although children’s knowledge about insulin therapy was good, further study must be conducted to investigate factors related to glycemic control among children with type 1 diabetes mellitus (T1DM).

150 Management of diabetes in pregnancy during the COVID-19 pandemic at a New York City hospital

To compare diabetic control and maternal and neonatal outcomes in pregnant women during the Coronavirus 2019 (COVID-19) pandemic to women managed one year prior. This was a retrospective cohort study of pregnant women with diabetes managed either during the COVID-19 pandemic or one year earlier. Twenty-two gestational and pregestational diabetic subjects were identified in a city hospital clinic during the peak of the pandemic in New York City (NYC) from March 15, 2020 until May 31, 2020. Fifty-seven pregnant diabetic subjects were identified who were managed at this clinic during the same timeframe in 2019. Demographics and maternal and neonatal outcomes were collected and compared. Diabetic control was compared by measuring change in hemoglobin A1c and diabetic medication regimen at time of delivery. Outcomes documented included mode of delivery, gestational age at delivery, postpartum hemorrhage, maternal infection, birth weight, shoulder dystocia, APGAR score <7, fetal acidosis, NICU admission, neonatal glucose level and neonatal demise. Secondary outcomes included number of virtual or in person visits, COVID-19 status, and gestational age at time of the diabetes diagnosis. Patients managed during the COVID-19 pandemic had significantly more telehealth visits and fewer in person visits compared to the year prior (p<0.001). However, no significant differences in maternal or neonatal outcomes or diabetic control were noted. There was no significant change in mode of delivery (p>0.999), shoulder dystocia (p=0.075), macrosomia (p>0.999), APGARs (p=0.671) or change in hemoglobin A1c during pregnancy (p=0.342). There were no significant differences in maternal or neonatal outcomes or diabetic control for subjects managed during the COVID-19 pandemic in a NYC hospital. A decreased number of in person visits, substituted with telehealth visits, had no apparent negative effect on outcomes or diabetic control.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Review on diabetes disease management programs

To comprehensively review and integrate available data on the impact of diabetes treatment programs on care procedures and outcomes for patients with diabetes mellitus. Review of literature and morph were used in this study. From 1987 to 2001, computerized databases was conducted for English-language controlled trials evaluating the efficacy of diabetic disease management regimens. Using a standardized abstraction form, two independent reviewers collected research data. An empirical Bayes model was used to generate pooling estimates of program impacts on glycosylated hemoglobin. The pooled assessment of program effects on glycosylated hemoglobin was a 0.5-percentage-point decrease (95 percent confidence range, 0.3 to 0.6 percentage points), which is a small but substantial improvement. Research strongly supports the program's advantages in improving retinal and foot lesions screening. Diabetic programs may help to enhance glucose control and boost retinal and foot problems screening. For individuals with diabetes mellitus, greater effort will be needed to develop more successful disease management strategies.

Metformin is Associated with Decreased 30-Day Mortality Among Nursing Home Residents Infected with SARS-CoV2

ObjectivesThe COVID-19 pandemic presents an urgent need to investigate whether existing drugs can enhance or even worsen prognosis; metformin, a known mammalian target of rapamycin (m-TOR) inhibitor, has been identified as a potential agent. We sought to evaluate mortality benefit among older persons infected with SARS-CoV-2 who were taking metformin as compared to those who were not. DesignRetrospective cohort study. Setting and Participants775 nursing home residents infected with SARS-CoV-2 who resided in one of the 134 Community Living Centers (CLCs) of the Veterans Health Administration (VHA) during March 1, 2020, to May 13, 2020, were included. MethodsUsing a window of 14 days prior to SARS-CoV-2 testing, bar-coded medication administration records were examined for dispensing of medications for diabetes. The COVID-19–infected residents were divided into 4 groups: (1) residents administered metformin alone or in combination with other medications, (2) residents who used long-acting or daily insulin, (3) residents administered other diabetes medications, and (4) residents not administered diabetes medication, including individuals without diabetes and patients with untreated diabetes. Proportional hazard models adjusted for demographics, hemoglobin A1c, body mass index, and renal function. ResultsRelative to those not receiving diabetes medications, residents taking metformin were at significantly reduced hazard of death [adjusted hazard ratio (HR) 0.48, 95% confidence interval (CI) 0.28, 0.84] over the subsequent 30 days from COVID-19 diagnosis. There was no association with insulin (adjusted HR 0.99, 95% CI 0.60, 1.64) or other diabetes medications (adjusted HR 0.71, 95% CI 0.38, 1.32). Conclusions and ImplicationsOur data suggest a reduction in 30-day mortality following SARS-CoV-2 infection in residents who were on metformin-containing diabetes regimens. These findings suggest a relative survival benefit in nursing home residents on metformin, potentially through its mTOR inhibition effects. A prospective study should investigate the therapeutic benefits of metformin among persons with COVID-19.

THE INCIDENCE OF GLUCOSE IMPAIRMENT AND NEW ONSET DIABETES (NODAT) AFTER RENAL TRANSPLANT: A RETROSPECTIVE 12-MONTH REVIEW AT A SINGLE UK-CENTRE.

Aims: Following Renal transplant, recipients receive a combination of immunosuppressive prophylaxis depending on centre protocol. Whilst these drugs are vital for graft survival, a well-recognised side effect is serum glucose impairment and subsequent new onset diabetes after renal transplantation (NODAT). Methods: Retrospective data was collected and analysed from 110 patients, who underwent a cadaveric or live renal transplant between January 2018 – December 2018. Electronic records were accessed to decipher recipient blood glucose sugars and HbA1C levels at 1 month, 6 months and 12 months post renal transplant. This data was then utilised to establish the rate of glucose impairment and NODAT incidence at these time intervals. Results: Salient study findings are summarised in the table below. Mean (+/- standard deviations) are used unless otherwise specified.Discussion: Total number of renal transplants was 110. The unit has a standard immunosuppressive protocol of simulect 20 mg (day 0,4), Methylprednisolone 500 mg at induction. Maintenance includes Mycophenolate mofetil (500mg BD), and Tacrolimus (Trough levels 6-8) and prednisolone 5mg. The highest average glucose impairment was observed at 1 month following transplant.17 (15.45%) recipients remained diabetic, 67 (60.91%) recipients remained non-diabetic, whilst 7 (6.36%) recipients developed NODAT. Conclusion: Glucose impairment is seen more commonly within the first 6 months of renal transplant, with a NODAT rate of 6.3% per annum. Interestingly, 19 of 110 recipients (17.2%) who were diabetic pre-transplant showed improved glucose metabolism, and consequently required a reduced diabetic treatment regimen. The maintenance dose of steroids seems to have no impact on NODAT rate. Additionally, post-operative care may be enhanced with diabetologist specialist input for managing glucose impairment and NODAT.

Immediate and Long-Term Effects of an 8-Week Digital Mental Health Intervention on Adults With Poorly Managed Type 2 Diabetes: Protocol for a Randomized Controlled Trial.

BackgroundDiabetes is a leading cause of years of life lost and accounts for approximately one-fourth of health care dollars spent in the United States. Many of these costs are related to poor medication adherence and lack of self-care behaviors and are thus preventable. Depression, which is more prevalent among people with diabetes than in the general population, predicts poorer management of one’s diabetes, whereas positive affect predicts engaging in more positive health behaviors. Consequently, interventions that improve depression and positive affect may also improve diabetes-related outcomes among people with diabetes. Although preliminary research on the impact of such interventions among people with diabetes is promising, these studies focused primarily on in-person interventions, have had small samples, and lack long-term follow-up.ObjectiveThis study aims to examine the short- and long-term effects of a digital therapeutic platform focused on mental health among adults with poorly managed type 2 diabetes and elevated levels of depression.MethodsThis is a randomized controlled trial in which adults with a type 2 diabetes diagnosis, elevated hemoglobin A1c (HbA1c) levels (≧7), and moderate to severe depressive symptoms will be randomly assigned to a positive emotion regulation skills intervention group or a sham digital intervention with only psychoeducational content. The study will take place over 14 months, including the 8-week intervention (or control) delivered via a digital therapeutic platform (Happify Health) and follow-up assessments at 3, 6, and 12 months postintervention. Throughout the intervention and for 1 week at each postintervention follow-up, participants will complete daily assessments of diabetes-related distress, diabetes regimen adherence, and mood. Our primary outcome, HbA1c, will be self-reported every 3 months throughout the study. Secondary and exploratory outcomes will be assessed at baseline; at 8 weeks; and at 3, 6, and 12 months postintervention.ResultsRecruitment is expected to begin in June 2020. Participants will begin the study as they are recruited and will finish in waves. The final wave of data collection from the 8-week intervention is expected for winter 2020, with the completion of the 12-month follow-up in winter 2021.ConclusionsAlthough previous research suggests that in-person psychological interventions have promising effects on both psychological and physical outcomes among adults with diabetes, digital interventions can be advantageous because they are easily scalable and reduce many barriers that prevent people from seeking treatment. This trial will provide important information about the effects of a digital mental health intervention among adults with type 2 diabetes, assessing both short- and long-term effects of this intervention on HbA1c, depressive symptoms, and other diabetes-specific outcomes. If successful, this may introduce a scalable intervention that would help reduce some of the preventable costs associated with diabetes.Trial RegistrationClinicalTrials.gov NCT04068805; https://clinicaltrials.gov/ct2/show/NCT04068805.International Registered Report Identifier (IRRID)PRR1-10.2196/18578

Online assessment of problem-solving skills among fathers of young and school-age children with type 1 diabetes: Associations with parent and child outcomes.

Type 1 diabetes (T1D) is a pediatric chronic illness that is associated with significant parenting stress due to its lifelong course, burdensome disease management, and life-threatening complications. Although mothers of children with T1D have been studied extensively in relation to parenting stress, coping, and diabetes outcomes, there is a need to examine similar variables among fathers. The aim of the present study was to examine if fathers' use of problem-solving skills was related to parenting stress and diabetes regimen adherence and if problem-solving skills moderated the associations between paternal involvement in diabetes care and parenting stress in a national online sample of 215 fathers of children with T1D. Self-report measures completed by fathers through Qualtrics included a demographic and disease-related questionnaire, the Social Problem-Solving Inventory-Revised; Parenting Stress Index-Fourth Edition, Short Form; Pediatric Inventory for Parents; Dads' Active Disease Support Scale; and Self-Care Inventory-Revised. Pearson correlations were computed to assess associations among study variables. Four separate multiple linear regression analyses were conducted to determine the interactive effects of problem-solving skills and paternal involvement on parenting stress. Analyses revealed a large positive correlation between problem-solving skills and general parenting stress (r = .63), and a large negative correlation between problem-solving skills and pediatric parenting stress (r = -.52). The interaction between problem-solving skills and father involvement accounted for a significant amount of variance in a general parenting stress subscale (p < .01) and pediatric parenting stress (p < .05). These results highlight the importance of problem-solving skills for father outcomes in the context of T1D while implicating the potential benefit of a problem-solving intervention for this population.

Non-Dietary Factors Associated with Glycemic Status among Adults Diagnosed with Type 2 Diabetes Mellitus in Malawi

ABSTRACT We assessed glycemic status and associations with socio-demographic, biomedical, anthropometric, and physical activity (PA) levels among adults with type 2 diabetes mellitus (T2DM) (n = 428; urban n = 288; semi-urban n = 140) using a cross-sectional study. Multivariate linear regression was used to determine factors associated with glycosylated hemoglobin (A1C) . A1C was clinically elevated ≥8% for 60.3% of the participants. Overall, age and PA levels showed a negative association with A1C, and positively with underweight status, duration of diabetes, and participants’ view of fluctuating/unstable blood glucose and blood glucose not improved compared to first diagnosed. A significant negative association with A1C was shown with PA levels and additional blood glucose monitoring (BGM) beyond that received at the public clinic in the urban area. Whilst, in the semi-urban area, there was a significant positive association with A1C with regards to duration of diabetes and insulin regimen. Determinants of A1C in this target group are multifactorial, therefore, interventions aiming to improve diabetes clinical outcomes are needed to reduce the likelihood of serious ramifications. Additionally, a team approach from healthcare professionals is needed in conjunction with active patient engagement as well as the development of more comprehensive diabetes care guidelines and policies.

Spouses' responses to the dietary nonadherence of their partners managing diabetes

AbstractThe association between patients' dietary nonadherence and spouses' involvement in patients' diabetes diet was examined, with spouses' anxiety about nonadherence considered as a mediator of this association. Daily diary data from 128 older adult patients with type 2 diabetes and their spouses were analyzed using multilevel models. Results revealed that on days when patients reported less adherence to their diabetes diet than usual, spouses reported greater anxiety about patients' diabetes management, which, in turn, was related to greater spousal persuasion and pressure the same day. The association between patients' nonadherence and diet‐related support on the same day was not mediated, however, through spouses' anxiety. The findings contribute to an understanding of spouses' responses to patients' nonadherence to their diabetes regimen.

137-LB: Early Performance Under SGLT2 Inhibitors in High-Risk Patients: EARLY PUSH Study: A Prospective Double-Blind Comparative Study

The purpose of this study was to evaluate the changes in physical performance under new treatment with SGLT2 inhibitors during in-patient rehabilitation over 28 days. The study included 200 patients with type II diabetes mellitus which were divided in 2 groups of 100 patients: the first group was put under SGLT2 inhibitors and the second group had other diabetic regimen without SGLT2 inhibitors. The 6-minute walk test and the modified Borg scale (Range 0 - 10) were used to assess physical performance and the rate of dyspnea. Compared to baseline, the change in the mean distance covered in the 6 minute walk test at 14 days in the SGLT2-inhibitor group was +70.1 ± 60.9 m vs. + 55.7 ± 64.8 m in the non SGLT2 inhibitor group; p=0.16. At 28 days, change in the first group was +104.5 ± 76.7 m vs. + 80.8 ± 82.9 m in the second group; p=0.03 (Figure 1) The mean modified BORG scale in the first group at baseline was 5.2 ± 2.3 and declined to 4.8 ± 2.1 at 14 days and further declined to 4.2 ± 2.4 at 28 days; p=0.007, whereas in the second group the BORG scale at baseline was 4.4 ± 2.4 and changed to 4.8 ± 2.2 at 14 days and remained unchanged at 4.8 ± 2.4 at 28 days; p=0.23 In conclusion, the introduction of an SGLT2-inhibitor was associated with a measurable improvement in physical performance and concomitant decline in the rate of perceived exertion within the first month despite having inadequate glycemic control at baseline. Disclosure M. Dumartin: None. D.S. Frundi: None.

Dietary habits among type 2 diabetic patients in Erbil City

Background and objectives: Dietary modification is the cornerstone in the management of type 2 diabetes. The purpose of this study was to explore the dietary behavior of type 2 diabetic patients, along its association with glycemic control and sociodemographic factors and their perceived obstacles to follow diabetic dietary regimens. Methods: A cross-sectional study was conducted in Erbil City, Kurdistan Region of Iraq, from December 2017 to December 2018. In this study, 344 type 2 diabetic patients, who were attending Leila Qasim Center for diabetes care, were recruited. Patients who were ?18 years and diagnosed at least for one year were enrolled. Data were collected through direct interview based on the questionnaire. Dietary behavior was assessed through modified UK Diabetes and Diet Question- naire. Results: Out of all enrolled patients, 85.5% of them had unsatisfactory dietary habits. Adherence to whole grain and fish consumption were 2.9% and 5.5%, respectively, which had the lowest rate of dietary adherence. Only 24.4% of patients had their glycosylated hemoglobin level below 7%. Statistically significant association was found between dietary habits and glycemic control. Females tend to have more dietary adherence than males (16% vs 12.3%); how- ever, there was no statistically significant association between gender and age with dietary habits. Lack of palatability was perceived as the main barrier for dietary adherence by the patients. Conclusions: Type 2 diabetic patients had low adherence to the recommended diet. The educational level and source of dietary advice were significantly associated with adherence. The dietary adherence of the patients was inversely associated with their glycosylated hemoglobin.

The Multigenerational Legacy of Diabetes, Emotional Reactions, and Insulin Adherence

Abstract Purpose The purpose of this study was to estimate the effect of having a multigenerational legacy of diabetes on insulin adherence by measuring memories of family members’ experiences with insulin self-injection. Methods A cross-sectional correlational design was implemented by surveying hospitalized adults with type 2 diabetes who recently transitioned to using insulin. Surveys included items about the vividness, frequency, and controllability of memories of a family member self-injecting insulin and concordant emotional reaction, and one’s own emotional reaction to a diagnosis of diabetes and insulin regimen adherence. Results A diverse sample responded to the surveys. Significant associations were revealed between having a recollection of a family member fearing insulin injections and a negative emotional reaction toward one’s own diabetes diagnosis with suboptimal insulin adherence. Suboptimal insulin adherence may be an indication of avoidance-based coping. Inquiry into how a multigenerational legacy of diabetes influences individual coping styles for diabetes self-management will help clinicians identify patients at risk for suboptimal insulin adherence.

113-LB: Home Diabetes Regimen and Admission HbA1c as Predictors of Hospital Glycemic Control: A Pooled Analysis of Inpatient Clinical Trials

Glycated hemoglobin (HbA1c) on admission has been suggested as a predictor of glycemic control in the hospital. However, no studies have examined the interaction of pre-admission patient characteristics (i.e., complexity of home regimen or diabetes duration) and HbA1c on inpatient glycemic control. We pooled data from eight randomized controlled trials of patients assigned to a standardized basal-bolus insulin regimen in the hospital. Patients were categorized according to: A) increasing home regimen complexity [group 1: diet alone or ≤1 oral antihyperglycemic drugs (OADs) (n=338, 39%); group 2: two or more OADs (n=177, 20%); and group 3: insulin based regimens (n=356, 41%) and B) admission HbA1c categories (&amp;lt;7%, 7-9%, or &amp;gt;9%). Logistic regression models adjusting for age, gender, BMI, admission BG, and hospital service (medicine vs. surgery) were constructed to determine associations between home regimen complexity, diabetes duration, HbA1c and inpatient glycemic control. Compared to patients treated at home with OADs, patients using insulin had a longer duration of diabetes and higher admission HbA1c (both p&amp;lt;0.001). Compared to group 1 (reference), patients on insulin were less likely to achieve target glycemic control (mean BG 70-180 mg/dl without hypoglycemia) regardless of admission HbA1c [HbA1c &amp;lt;7% adjusted odd ratio (aOR) 0.36 (0.16, 0.81); HbA1c 7-9% aOR 0.5 (0.30, 0.91), or HbA1c &amp;gt;9% aOR 0.44 (0.24, 0.83), and had higher risk for hypoglycemia (all p&amp;lt;0.05). Patients with a longer duration of diabetes (&amp;gt;10 years) were less likely to achieve good glycemic control compared to patients with shorter duration of diabetes irrespective of home regimen complexity. Though admission HbA1c has been proposed as a predictor of inpatient glycemic control, our data show patients requiring complex therapy with insulin at home are less likely to achieve inpatient glucose targets independent of admission HbA1c. Disclosure M.A. Urrutia: None. Y. Guo: None. M. Fayfman: None. P. Vellanki: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. R.J. Galindo: Advisory Panel; Self; Lilly Diabetes. Consultant; Self; Valeritas, Inc. Research Support; Self; Novo Nordisk Inc. Other Relationship; Self; UpToDate. A. Migdal: None. G. Davis: None. I. Anzola: None. B.S. Albury: None. M.F. Scioscia: None. K.W. Zamudio: None. G.E. Umpierrez: None. F.J. Pasquel: Advisory Panel; Self; AstraZeneca, Eli Lilly and Company. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Merck Sharp &amp; Dohme Corp. Research Support; Self; Dexcom, Inc., Merck Sharp &amp; Dohme Corp., National Institutes of Health.

749-P: Parents’ Psychosocial Outcomes from the Strategies to Encourage New CGM Use in Early Childhood (SENCE) Trial at 12 Months

Objective: Parents of young children with type 1 diabetes report developmental and management challenges and diabetes-related distress. In the SENCE trial with children 2-&amp;lt;8 yrs, we described improved parental psychosocial outcomes from baseline to 26 wks when continuous glucose monitoring (CGM) was combined with a family behavioral intervention (FBI), compared to CGM alone and to standard blood glucose monitoring. We now explore psychosocial outcomes in the CGM+FBI and CGM alone groups over the extension phase (observation without intervention, 26 to 52 wks post-baseline). Method: Parents (N=143, children: 50% female, 68% non-Hispanic White, age=5.7±1.8 yrs, A1c=8.2±0.8%) completed validated surveys of diabetes burden, diabetes family impact, hypoglycemia fear, and treatment regimen impact at baseline, 26, and 52 wks. We analyzed 52 week outcomes using within-group t tests and between-group longitudinal models. Results: Survey scores were stable from 26 to 52 wks, although differences from baseline to 52 wks were not significant (p&amp;lt;.01) (Table). Conclusion: Introducing CGM with FBI improves parental psychosocial outcomes for at least 6 mos; the similar results at 12 mos suggest durability to 1 yr. Importantly, adding CGM to diabetes regimens in young children, especially with behavioral support, does not appear to add to parents’ perceived burden or fear of low blood glucose. Disclosure M.E. Hilliard: None. L. Kanapka: None. L.M. Laffel: Advisory Panel; Self; Roche Diabetes Care. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., ConvaTec Inc., Dexcom, Inc., Insulet Corporation, Insulogic LLC, Janssen Pharmaceuticals, Inc., Lilly Diabetes, Novo Nordisk Inc., Sanofi US. B. Anderson: None. K. Miller: None. W. Levy: None. M.A. Van Name: None. P.V. Commissariat: None. L. DiMeglio: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

1772-P: Reversibility of Altered Brain Glucose Kinetics in T2DM

Poor glycemic control is associated with central nervous system complications. We have previously shown that compared to healthy controls, individuals with uncontrolled T2DM have a blunted rise in brain glucose levels measured by 1H magnetic resonance spectroscopy (MRS). In this study, we investigate whether reduction in HbA1C improves intracerebral glucose levels. Six T2DM subjects with poor glycemic control were recruited (4F, age 46.0 ± 8.8 yrs, BMI 34.2 ± 4.1 kg/m2, HgbA1c 9.6 ± 1.1%) to participate in 1HMRS scanning at 4 Tesla during a hyperglycemic clamp (∼220 mg/dl) before and after a 12-week intervention to improve glycemic control through use of continuous glucose monitoring, intensification of diabetes regimen, and frequent visits with an endocrinologist and nutritionist. Following the intervention, HbA1c decreased by 2.1%±1.5 (P=0.02) with minimal BMI changes (P=0.10). Using a hierarchical linear regression model to compare glucose time courses during the clamp pre and post intervention, brain glucose levels were modestly and significantly higher during the clamp after the intervention (P=0.02) despite no differences in plasma glucose levels during the clamp (P=0.45). These findings suggest that brain glucose levels increase after improvement of glycemic control and provide evidence that reducing HbA1C may improve brain glucose transport and/or metabolism. Disclosure E. Sanchez Rangel: None. F. Gunawan: None. L. Jiang: None. M. Savoye: None. F. Dai: None. D.L. Rothman: None. G.F. Mason: None. J.J. Hwang: Research Support; Self; General Electric. Funding National Institutes of Health (DK109284)

Peer crowd affiliation, adherence, perceived support, and metabolic control in T1DM youth.

Youth with type 1 diabetes (T1DM) can face many challenges when adhering to their complex regimen in the context of their peer crowd. The aim of this study was to determine if peer crowd affiliation was associated with adolescents' adherence behaviors, perceived peer support, and metabolic control. A sample of 128 adolescents with T1DM completed the Peer Crowd Questionnaire, Diabetes Social Support Questionnaire-Friends Version, and Self-Care Inventory-Revised, and HbA1c readings were collected during their clinic visit. Results from this study suggest that adherence behaviors mediated the relationship between Jock peer crowd affiliation and metabolic control. Results also suggested that perceived peer support did not mediate the relationship between peer crowd affiliation and metabolic control through adherence behaviors. When examining the path coefficients for the purposed models, results showed a positive relationship between adherence and metabolic control, and more perceived peer support was related to worse metabolic control. Adolescents who identified mostly with the Jock peer crowd may hold lifestyle values that are consistent with the diabetes regimen which may make their diabetes management easier. In general, adolescents with T1DM may have a more multifaceted aspect of one's identity and therefore, their peer crowd affiliation is not as salient.

Neighborhood disadvantage, parent-adolescent relationship quality, and type 1 diabetes in late adolescents transitioning to early emerging adulthood.

We examined whether neighborhood disadvantage predicted subsequent levels, and longitudinal trajectories, of type 1 diabetes (T1D) outcomes among late adolescents transitioning into early emerging adulthood. We also examined whether such associations occur indirectly through parent-adolescent relationship quality. Seniors in high school with T1D (N=236; mean age 17.76±0.39 years; 61% female; 73.7% non-Latino White) completed selfreport measures of relationship quality with mothers and fathers, and adherence to their diabetes regimen; glycemic control was measured using HbA1c assay kits. Both T1D outcomes (i.e. adherence, HbA1c) were assessed annually across three time points (two years). Census tract indicators of neighborhood disadvantage (e.g., % unemployed) were culled from participant addresses at baseline linked to American Community Survey data. Structural Equation Modeling was used to estimate direct and indirect links between neighborhood disadvantage, relationship quality, and both subsequent levels (i.e., intercepts centered at Time 2), and trajectories of T1D outcomes (i.e., slopes across three time points). All models showed excellent fit to the data. Greater neighborhood disadvantage associated with lower relationship quality with both parents. Lower relationship quality with fathers (but not with mothers) measured at Time 1 predicted poorer levels of adherence and HbA1c at Time 2, and formed an indirect path linking neighborhood disadvantage to each Time 2 outcome. Neighborhood disadvantage and parent-adolescent relationship quality during high school did not predict longitudinal trajectories of T1D outcomes across all three time points. Parent-adolescent relationship quality (especially with fathers) remains important for T1D outcomes among late adolescents on the cusp of emerging adulthood, but may be at risk among those living within a socioeconomically-disadvantaged neighborhood.

Patterns of Diabetes Care Among People with Type1 Diabetes During Ramadan: An International Prospective Study (DAR-MENA T1DM).

IntroductionTo describe the characteristics and care of participants with type 1 diabetes during Ramadan in the Middle East and North Africa.MethodsThe DAR-MENA (Diabetes and Ramadan—Middle East and North Africa) study was a prospective, observational study of adults with type 1 and type 2 diabetes who were Muslim and did/did not intend to fast during Ramadan 2016. Baseline data were collected 6 weeks prior to Ramadan, with a follow-up visit 1–2 months after Ramadan. This is the analysis of the population with type 1 diabetes. Measurements included proportion who fasted, reasons for fasting and not fasting, changes in diabetes treatment, hypoglycemic events, and proportion with access to diabetes education.ResultsOf 136 participants with type 1 diabetes, 76.9% (100/130) fasted for at least 1 day, 72.3% (94/130) fasted for at least 15 days, and 48.5% (63/130) fasted for 30 days. The majority (63.0%, 63/100) reported personal decision as a reason to fast. Fear of diabetic complications (58.6%, 17/29) and previous complications related to fasting (48.3%, 14/29) were the most common reasons for not fasting. Adjustment of diabetic medication regimen occurred for 84.6% (115/136) of participants, and 72.8% (99/136) changed their treatment dose. The incidence and number of adverse events for confirmed and severe hypoglycemia were similar before and during Ramadan. Almost half of participants had access to diabetes education (45.6%, 62/136).ConclusionThe DAR-MENA study showed that despite the risks associated with fasting for people with type 1 diabetes, almost half fasted for the full 30 days of Ramadan with no significant change in hypoglycemia events. Since the current International Diabetes Federation and Diabetes and Ramadan guidelines do not endorse fasting for people with type 1 diabetes, it is important that those who insist on fasting work closely with their healthcare practitioner to avoid any complications.Electronic Supplementary MaterialThe online version of this article (10.1007/s12325-020-01267-4) contains supplementary material, which is available to authorized users.

English

The study determined the prevalence of non-adherence to medication, self monitoring of blood glucose (SMBG), clinic visits and the associated factors among out-patient type 2 adult diabetics at a tertiary hospital in Enugu State Nigeria. Using a descriptive cross-sectional design, 200 patients was purposively selected. Researcher-developed questionnaire was tool for data collection. Analysis was done in proportions, percentages and logistic regression (alpha level was P=0.05). Respondents&rsquo; mean age was 60.1&plusmn;10.6; 88% were married and females were 63.5%. Overall prevalence of non adherence to drugs was 24.5%; that varied from 26.9 to 11.8% depending on drug combinations. Majority (57.5%) of the respondents had no glucometer for SMBG at home; 86.1% on oral hypoglycaemic agents did not monitor their blood glucose level 2-3 times weekly; 78.9% on injection insulin combined with tablets did not monitor their blood glucose level at least once daily. Non-adherents to clinic visits were 49.0%. Age &lt;50 years (P= 0.006) and being married (P= 0.025) were associated with drug non-adherence. Cost of transportation (P= 0.000), discouraging attitudes of health workers (P= 0.003) and late commencement of clinic activities (P= 0.006) were associated with clinic visit non-adherence. There was non adherence to diverse self care activities among diabetic patients in this study therefore factors that contribute to non adherence should be addressed by healthcare providers.&nbsp; Key words:&nbsp; Non-adherence, self-care actions, diabetic management regimen, adults with type 2 diabetes. &nbsp; &nbsp

Associations Between Diagnosis with Type 2 Diabetes and Changes in Physical Activity among Middle-Aged and Older Adults in the United States.

Background and ObjectivesPhysical activity (PA) is an effective strategy for diabetes self-management and is central to the diabetes regimen. Diagnostic events present an opportunity for health behavior change; however, many older adults with type 2 diabetes (T2D) do not engage in regular PA. The relationships between diagnosis events and subsequent changes in PA are not well understood. Drawing upon life-course theory, this is the first study to examine whether the diagnosis of T2D is followed by a change in PA, whether these changes are sustained, and the sociodemographic characteristics associated with these changes.Research Design and MethodsWe examined associations between T2D diagnosis and PA changes among 2,394 adults ages 51+ from the Health and Retirement Study (2004–2014). PA changes were measured using metabolic equivalents of task (METs) estimated values accounting for the vigor and frequency of self-reported PA. Using piecewise mixed models, we examined initial and sustained changes in METs over time and tested whether these changes were modified by race/ethnicity, educational level, gender, and age at diagnosis.ResultsAcross participants, a significant postdiagnosis increase was observed in self-reported PA following the diagnostic event (β: 0.54, 95% CI: 0.10, 0.97). The steepness of decline in PA participation over time did not change significantly following T2D diagnosis. Age at diagnosis and race/ethnicity significantly moderated these relationships: participants diagnosed at older ages were less likely to improve PA following diagnosis and non-Hispanic whites experienced relatively steeper rates of decline following diagnosis with T2D.Discussion and ImplicationsModest diagnosis-related increases in PA were observed among participants overall. The usual rate of decline in PA appears unaffected by diagnosis overall. Age at diagnosis and race/ethnicity moderated these relationships. Key implications for future research and clinical practice are discussed.