Glycemic Control In Adolescents Research Articles

Executive function, adherence, and glycemic control in adolescents with type 1 diabetes: a literature review.

The aim of the present review was to examine and report findings from published research to date that has examined associations between executive function (EF), adherence, and glycemic control in youth with type 1 diabetes. A review of the published research is presented with the objectives of reporting the following: (1) the associations between EF and adherence, (2) the associations between EF and glycemic control, (3) proposed methodological considerations needed to advance related research, (4) recommendations for future research, and (5) clinical recommendations. The major conclusions of this review support the presence of an association between EF, adherence, and glycemic control. Additional prospective and controlled studies are necessary to fully understand the impact of EF on the ability of youth to independently manage type 1 diabetes.

Serum lipid profiles and glycemic control in adolescents and young adults with type 1 diabetes mellitus.

PurposeWe aimed to investigate serum lipid profiles and glycemic control in adolescents and young adults with type 1diabetes mellitus (T1DM).MethodsThis cross-sectional study included 29 Korean young adults and adolescents with T1DM. The median age was 17 years (range, 10-25 years) and 18 (62.1%) were female. We compared the lipid profiles of patients with dyslipidemia and those without dyslipidemia. Correlations between glycosylated hemoglobin (HbA1c) and lipid profiles (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], and triglyceride [TG]) were determined by linear regression analysis.ResultsOf the 29 patients with T1DM, 11 (37.9%) were classified as having dyslipidemia due to the following lipid abnormality: TC≥200 mg/dL in 8 patients, LDL-C≥130 mg/dL in 4 patients, TG≥150 mg/dL in 2 patients, and HDL-C≤35 mg/dL in 2 patients. Compared to patients without dyslipidemia, patients with dyslipidemia were more likely to have higher values of HbA1c (median, 10.6%; range, 7.5%-12.3% vs. median, 8.0%; range, 6.6%-10.0%; P=0.002) and a higher body mass index z score (median, 0.7; range, -0.57 to 2.6 vs. median, -0.4; range, -2.5 to 2.2; P=0.02). HbA1c levels were positively correlated with TC (P=0.03, R2=0.156) and TG (P=0.005, R2=0.261).ConclusionA substantial proportion of adolescents and young adults with T1DM had dyslipidemia. We found a correlation between poor glycemic control and poor lipid profiles in those patients.

Impact of elective hospital admissions on glycaemic control in adolescents with poorly controlled type 1 diabetes

AimDifferent treatment strategies have been used to manage adolescents with poorly controlled type 1 diabetes. We investigated whether a brief elective hospital admission improves haemoglobin A1c (HbA1c) over 12months. MethodsWe studied a retrospective cohort of adolescents with poorly controlled type 1 diabetes attending a tertiary care pediatric diabetes clinic in Montreal, Canada, between January 2005 and December 2010. Hospitalized adolescents (admitted group) were matched with controls (non-admitted group) for age and baseline HbA1c. HbA1c values at baseline, 6 and 12months were obtained from the clinic database. ResultsThirty patients aged 11 to 17 years with a first elective admission for poor metabolic control were paired with 30 non-admitted patients. At baseline, HbA1c was 12.2±1.6% in admitted and 12.0±1.2% in non-admitted patients. There were no clinically important differences in potential confounders between groups. There was no improvement in the primary outcome as assessed by the change in HbA1c at 12months in the admitted group (–1.3±2.3%) compared with the non-admitted group (–2.1±1.7%) (P=0.078). No improvement in intermediary measures of glycaemic control was observed (HbA1c at 6months or change at 6months). After 12months, HbA1c values were higher in the admitted group (10.9±1.9%) versus the non-admitted group (9.9±1.4%) (P=0.016). ConclusionElective hospital admission for adolescents with poorly controlled type 1 diabetes does not seem to be an effective strategy to improve HbA1c over 12months.

A Multicomponent Motivational Intervention to Improve Adherence Among Adolescents With Poorly Controlled Type 1 Diabetes: A Pilot Study

To adapt and pilot test a multicomponent motivational intervention that includes family-based contingency management (CM) for adolescents with poorly controlled type 1 diabetes. A total of 17 adolescents, age 12-17 years (M = 14.8, SD = 1.5), with type 1 diabetes (duration M = 6.2 years, SD = 4.5) and mean HbA1c of 11.6% (SD = 2.5%) were enrolled. Adolescents and their parents received 14 weeks of motivational interviewing, clinic-based CM, and parent-directed CM that targeted increased blood glucose monitoring (BGM). Adolescents significantly increased their BGM (p < .001) and showed significantly improved HbA1c levels (glycemic control) from pre-to posttreatment (p < .0001). The magnitude of improvements in the frequency of BGM and glycemic control in adolescents with type 1 diabetes is encouraging and will be tested in a randomized controlled trial.

Parent–adolescent conflict, treatment adherence and glycemic control in Type 1 diabetes: The importance of adolescent externalising symptoms

Parent–adolescent conflict has been demonstrated to relate to treatment adherence and glycemic control in adolescents with Type 1 diabetes. The present longitudinal study investigated how these variables were interrelated over time, and examined whether externalising and internalising symptoms function as mediating variables. A total of 109 adolescents with diabetes participated at four annual time points and completed measures on conflict with parents, internalising and externalising symptoms. Information on treatment non-adherence and glycemic control was obtained from treating physicians. Cross-lagged analyses from a structural equation modelling approach indicated that father–adolescent but not mother–adolescent conflict positively influenced treatment non-adherence over time, which, in turn, was associated with higher glycosylated haemoglobin-values. Further, externalising but not internalising symptoms were found to mediate the pathway from father–adolescent conflict to treatment adherence over time. Finally, mother–adolescent conflict was found to relate indirectly to treatment non-adherence through its relationship with externalising symptoms. Hence, the present longitudinal study provides evidence that externalising symptoms represent an important mechanism through which earlier experiences of parent–adolescent conflict may influence later treatment non-adherence and poorer glycemic control. Implications and suggestions for future research are outlined.

The perceived self-efficacy and its interrelation with communication in family and glycemic control in adolescents with type 1 diabetes

Objective: In this study the effect of self -efficacy and family functioning on glycemic control of adolescence with Type 1 Diabetes (T1D) in Isfahan was investigated.Methodology: In this Randomized Controlled Open Trial, adolescence with type 1 DM were studied. Selected patients were randomized in four intervention groups including group counselling with Cognitive Behavioural Therapy (CBT) approach for self-efficacy enhancement for diabetic patients, group training for Communication Skills Training (CST) for parents of diabetic patients, combination of CBT+ CST and routine diabetes management. Family functioning, self- efficacy for diabetes self-management and glycemic control of diabetic patients was measured using The McMaster Family Assessment Device (FAD), self-efficacy scale and HbA1c, respectively. Mentioned variables in all studied groups were measured before and after intervention and three months after intervention.Results: CBT increased self -efficacy of studied population significantly which decrease the mean of HbA1c in studied population (P < 0.05).CBT + CST and CST had not significant effect on HbA1c (P > 0.05). HbA1c was not significantly different in different stages of evaluation in each group, but it was significantly different between CBT and control groups (P=0.07).Conclusion: In order to obtain more conclusive results it is recommended to study larger sample size of patients with T1D with consideration of their demographic and cultural factors, to design and implement multi-component studies to determine the relation between different psychosocial factors and their adherence to treatment regimens and metabolic control. Designing relatively long term multi-component and compilation strategies would be helpful in this regard also.doi: http://dx.doi.org/10.12669/pjms.291(Suppl).3528How to cite this:Najmi SB, Marasi MR, Hashemipour M, Hovsepian S, Ghasemi M. The perceived self-efficacy and its interrelation with communication in family and glycemic control in adolescents with type 1 diabetes. Pak J Med Sci 2013;29(1)Suppl:334-339.This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Impact of blood glucose monitoring affect on family conflict and glycemic control in adolescents with type 1 diabetes

BackgroundThis longitudinal study examined whether diabetes-specific family conflict and glycemic control were impacted/explained by negative affective responses to blood glucose checks (Negative BGM Affect). MethodAdolescents (N=150, ages 13–18years) with type 1 diabetes, and their caregivers, completed measures of Negative BGM Affect, diabetes-specific family conflict, and glycemic control (i.e., hemoglobin A1c) at baseline, 6-, and 12-months. ResultsCaregiver Negative BGM Affect predicted higher A1c values at 12months. Diabetes-specific family conflict mediated and explained 39% of the Negative BGM Affect-A1c relationship. Conflict around direct management tasks mediated the caregiver Negative BGM Affect-A1c relationship for adolescents (30.6% of variance). The impact of Negative BGM Affect on diabetes-specific family conflict is more pervasive for caregivers (direct and indirect diabetes management tasks) than adolescents (direct diabetes management tasks only). ConclusionsCaregiver Negative BGM Affect is an important contributor to A1c via diabetes-specific family conflict. Identifying and intervening with families who endorse high levels of Negative BGM Affect may prevent diabetes-specific family conflict, thereby minimizing the impact of family conflict on glycemic control. Brief clinic-based interventions to address Negative BGM Affect can be incorporated into clinical practice to prevent long-term negative impact on glycemic control.

Challenges in Glycemic Control for Adolescents with Type 2 Diabetes

To address the persistent challenge of maintaining glycemic control in adolescents with type 2 diabetes, researchers compared three treatment options.

Friends or Foes? A Review of Peer Influence on Self-Care and Glycemic Control in Adolescents With Type 1 Diabetes

We reviewed studies published from 1990 to 2010 examining the relation of peer influence to diabetes outcomes for adolescents with type 1 diabetes. We searched PsychInfo and MedLine databases and personal archives for studies meeting our criteria. 24 articles were included in the final review. Qualitative studies revealed that teens believe peers have an impact on diabetes behaviors, but quantitative findings are inconclusive. We found more evidence that social conflict was harmful than social support was helpful. Associations were more likely in studies that measured specific support and specific self-care variables. Studies addressing how individual differences interact with social context had promising findings. The literature linking peer relations to diabetes outcomes is mixed. Future research should consider moderator variables, expand the conceptualization of peer relationships, and consider interactions between person and social context.

Blue flash ERG PhNR changes associated with poor long-term glycemic control in adolescents with type 1 diabetes.

To investigate the relationship between long-term glycemic control and photopic negative response (PhNR) changes in the blue flash ERG in adolescents with type 1 diabetes (T1D) without diabetic retinopathy (DR). After light adaptation, ERG responses to 1.60 cd·s/m(2) blue (420 nm) flashes (blue flash ERG) and 3.0 cd·s/m(2) white flashes (LA 3.0 ERG) were recorded in 22 patients (age range, 12 to 19 years) and 28 age-similar control subjects. The primary outcome measure was the amplitude of the PhNR. Secondary outcome measures were the amplitude and implicit time of the a-wave and b-wave. Multiple regression analyses were conducted with glycated hemoglobin (HbA(1c)) values and the time since diagnosis of T1D as covariates. Blue flash ERG PhNR amplitudes were reduced (P = 0.005) in patients compared with control subjects. Multiple regression analysis demonstrated that a 1-unit increase in HbA(1c) was associated with a 15% decrease in the blue flash ERG PhNR amplitude (r = 0.61, P = 0.003). Compared with controls blue flash ERG a-waves (P = 0.03) and b-waves (P = 0.02) were delayed in patients but were not significantly associated with HbA(1c) or time since diagnosis of T1D. None of the ERG measures in the LA 3.0 ERG were significantly different in patients compared with controls. Poorer long-term glycemic control is associated with worsening inner retinal dysfunction involving short-wavelength cone pathways of adolescents with T1D and no clinically visible DR. Future studies are warranted to determine whether changes in the blue flash ERG PhNR are a predictive marker of subclinical DR.

The effectiveness of Internet-based blood glucose monitoring system on improving diabetes control in adolescents with type 1 diabetes

To determine whether the use of an Internet-based blood glucose monitoring system could improve glycemic control in adolescents with type 1 diabetes mellitus (T1DM). In a randomized, controlled clinical trial, a total of 70 adolescent subjects with T1DM were recruited. Subjects randomized to the intervention group (n = 36) were instructed to submit their blood glucose levels weekly by Internet to the diabetes care team during a period of 6 months. Subjects randomized to the control group (n = 34) did not submit results but were under routine follow-up. At baseline, patients were 15.1 ± 2.6 years of age with mean HbA1c of 8.3 ± 1.3%. At the 6-month follow-up period, no by-group differences in change from baseline to end of treatment HbA1c levels were detected. In the intervention group, 12/36 did not submit blood glucose levels and were classified as non-compliant. In a secondary exploratory analysis in which non-compliant patients were omitted, HbA1c values in the compliant intervention group declined from 8.5 ± 1.7% at baseline to 8.2 ± 1.2% at 6 months, while in the control group HbA1c values increased from 8.2 ± 1.1 to 8.4 ± 1.1%, this difference did not reach statistical significance. An Internet-based blood glucose monitoring system was not associated with improved glycemic control in adolescents with T1DM. Identification of a sub-group of compliant subjects who may improve metabolic control by using this tool is needed.

Depressive symptoms predict change in glycemic control in adolescents with type 1 diabetes: rates, magnitude, and moderators of change

To determine whether depressive symptoms in adolescents with type 1 diabetes predict change in glycemic control over time. A total of 145 adolescents (aged 13-18 yr) participated in two study visits (baseline and 6 months). They completed a measure of depressive symptoms (Children's Depression Inventory; CDI) and had their A1c values and adherence to blood glucose monitoring (BGM) documented. Three variables predicted A1c change over 6 months: CDI change score (B = 0.11; p < 0.001), BGM frequency at baseline (B = -0.21; p = 0.03), and A1c at baseline (B = -0.23; p = 0.002). A three-way interaction among these variables was significant (p < 0.01) and showed that adolescents with high adherence to BGM who were achieving optimal glycemic control (≤7.5%) at baseline were resistant to increasing A1c values, even if depressive symptoms worsened. However, as adherence to BGM declines, there is a synergistic effect with depressive symptoms to accelerate the increase of A1c values over time, making it more difficult to bring A1c back to optimal levels. Results suggest that depressive symptoms are important predictors of A1c change by themselves as well as when considered with adherence to BGM. There is a need to screen for depressive symptoms and expand and develop prevention and intervention strategies in order to put adolescents with type 1 diabetes in the best position for optimal glycemic control.

Fatores socioeconômicos, demográficos, nutricionais e de atividade física no controle glicêmico de adolescentes portadores de diabetes melito tipo 1

To identify the association of socioeconomic, demographic, nutritional and of physical activity factors in the glycemic control of adolescents with T1DM. Sectional study of 71 adolescents with type 1 diabetes. Socioeconomic, demographic and anthropometric data were obtained. The glycemic control was classified by the index of glycated hemoglobin (A1C). Four 24-hours recalls of food consumption and physical activity were applied. The A1C was inadequate for the majority of the adolescents. The low educational level of the caregivers influenced the inadequate glycemic control. Patients with lower insulin dose presented better glycemic control. The food consumption was high of fat and poor of carbohydrate. Most of the patients were sedentary. Factors related to education, insulin and food consumption influenced the glycemic control.

Endothelial Dysfunction Is Related to Poor Glycemic Control in Adolescents with Type 1 Diabetes under 5 Years of Disease: Evidence of Metabolic Memory

The relation between endothelial dysfunction (ED), glycemic control, and early type I diabetes mellitus (T1DM) is unclear. The objective of the study was to evaluate the association of ED, glycemic control, and the duration of diabetes in T1DM. This was a cross-sectional study. The study was conducted at a public outpatient clinic. Fifty-seven T1DM adolescents and 10 healthy age-matched controls participated in the study. There were no interventions. Endothelial function (ED) was evaluated by flow-mediated dilation (FMD) in the brachial artery after reactive hyperemia. Biochemical data, including HbA1c (glycohemoglobin), high-sensitivity C-reactive protein, lipids, and urinary albumin excretion were collected. Means of four HbA1c values collected at 3-month intervals in the first and second year before FMD analyses were obtained. Mean FMD was decreased in T1DM compared with controls (P = 0.023), independent of age, smoking, hypertension, or dyslipidemia. Twenty-eight of 57 T1DM patients enrolled (49%) had ED. FMD was decreased in microalbuminuric (4.1%) compared with normoalbuminuric patients (10.1%, P = 0.01) and controls (14.6%, P < 0.001). FMD correlated inversely with mean second-year HbA1c (r = -0.426, P = 0.02), particularly in patients with less than 5 yr of T1DM (r = -0.61, P = 0.004). In these patients, high-sensitivity C-reactive protein was strongly correlated with mean first-year HbA1c (r = -0.66, P = 0.0003). In patients with more than 5 yr of T1DM, we found no significant correlations between ED and glycemic control. Endothelial dysfunction is common in T1DM adolescents with less than 5 yr of disease. It is associated with duration of disease, microalbuminuria, and mean second-year HbA1c but not with mean first-year HbA1c. These data support the metabolic memory hypothesis.

Quality of life and glycemic control in adolescents with type 1 diabetes and the impact of an education intervention.

Objective:To assess quality of life (QoL) and glycemic control in adolescents with type 1 diabetes and to investigate the impact of an educational program.Methods:A quasiexperimental study with nonrandomized experimental and control groups was conducted in which a total of 503 adolescents with type 1 diabetes completed a questionnaire using the Diabetes Quality of Life Instrument for Youth. Adolescents were then assigned to experimental and control groups. The experimental group was subjected to four 120-minute sessions of an educational program over a period of 4 months. Extracted medical chart data included the duration of diabetes, insulin dosage, and most recent hemoglobin A1c levels. Analysis of covariance was used to detect the impact of intervention.Results:The overall mean QoL score (%) was 76.51 ± 9.79, with good QoL in 38% of all adolescents. Poorer QoL was significantly associated with older age (P < 0.001), more hospital admissions in the last 6 months (P = 0.006), higher levels of depression (P < 0.001), poor self-esteem (P < 0.001), and poor self-efficacy (P < 0.001). There was significant deterioration in all domains of QoL in the experimental group after intervention. However, this deterioration was significantly less severe than in the control group. Between-group effects on total knowledge, adherence to exercise, glucose monitoring, treatment, self-efficacy, family contribution to management, glycemic control, and satisfaction with life were significantly in favor of the experimental group.Conclusion:Education intervention for adolescents with type 1 diabetes could be a safeguard against possible deterioration in QoL and glycemic control over time.

Blood glucose monitoring and glycemic control in adolescents with type 1 diabetes: meter downloads versus self-report

Reported frequencies of blood glucose monitoring (BGM) by both adolescents and their caregivers serve as adherence proxies when meter downloads are not available. Yet, correlates of reported BGM frequencies and their predictive utility are understudied. To identify sociodemographic, psychological, and disease-specific correlates of reported BGM frequencies in adolescents with type 1 diabetes and to explore the predictive utility of BGM indices on glycemic control. Study participants included caregivers and adolescents with type 1 diabetes (N=143, 13-18 yr) receiving diabetes treatment at a tertiary care setting. At the initial visit, adolescents and caregivers reported on daily BGM frequencies. A sub-sample provided meter downloads. Adolescents also completed a depression inventory. Three months later, adolescents provided blood sampling for A1c assessment. Multivariate general linear modeling identified that older adolescent age and more depressive symptoms were associated with reports of less frequent BGM. Two stepwise multivariate regression models examined the predictive utility of BGM indices (i.e., adolescent-reported BGM, caregiver-reported BGM, meter download) on glycemic control. Caregiver-reported BGM frequency predicted glycemic control in the absence of meter download data (p<0.001). However, when clinical and contextual variables were included, meter download data were the most robust predictor of glycemic control (p<0.0001). Meter downloads have the most robust association with glycemic control when contextual variables are considered. Caregiver-reported BGM frequencies can serve as reliable substitutes in the absence of meter download, but they may not be as reliable in adolescents with depressive symptoms.

From Caregiver Psychological Distress to Adolescent Glycemic Control: The Mediating Role of Perceived Burden around Diabetes Management

To examine whether perceived caregiver burden around diabetes management mediated the relationship between caregivers' psychological distress and adolescents' glycemic control. Across three visits spanning 9 months, caregivers of 147 adolescents with type 1 diabetes completed measures of anxiety and depressive symptoms and a measure of perceived burden specific to diabetes management. Adolescents' glycemic control was also measured. Perceived burden mediated the relationship between caregiver depressive symptoms and adolescents' glycemic control. The overall model was significant, F(10,132) = 5.0, p < .001, R(2) = 0.27. Fifty percent of the relationship was explained by diabetes-specific burden. The relationship between caregiver anxiety symptoms and adolescent glycemic control was partially mediated by diabetes-specific burden, F(10,133) = 5.7, p < .001, R(2) = 0.30, explaining 26% of this relationship. A variable linking caregiver psychological distress to adolescent glycemic control is perceived caregiver burden around diabetes management. Implications for clinical practice include targeting caregiver psychological functioning and reducing global and diabetes-specific distress.

Multifocal ERG Defects Associated with Insufficient Long-Term Glycemic Control in Adolescents with Type 1 Diabetes

To investigate the relationship between long-term glycemic control and localized neuroretinal function in adolescents with type 1 diabetes (T1D) without diabetic retinopathy (DR). Standard (103 hexagons) and slow-flash (61 hexagons) multifocal ERGs (standard mfERG and sf mfERG) were recorded in 48 patients and 45 control subjects. Hexagons with delayed responses were identified as abnormal. Negative binomial regression analysis was conducted with the number of abnormal hexagons as the outcome variable. Glycated hemoglobin (HbA(1c)) levels, time since diagnosis of T1D, age at diagnosis of T1D, age at testing, and sex were the covariates. Another model replacing HbA(1c) closest to the date of testing with a 1-year average was also generated. There were more abnormal hexagons for mfOPs in patients than in control subjects (P = 0.005). There was no significant difference in the mean number of abnormal hexagons for standard mfERG responses between patients and control subjects (P = 0.11). Negative binomial regression analysis for the standard mfERG data demonstrated that a 1-unit increase in HbA(1c) was associated with an 80% increase in the number of abnormal hexagons (P = 0.002), when controlling for age at testing. Analysis using the 1-year HbA(1c) averages did not result in significant findings. Poor long-term glycemic control is associated with an increase in areas of localized neuroretinal dysfunction in adolescents with T1D and no clinically visible DR. Stricter glucose control during the early stages of the disease may prevent neuroretinal dysfunction in this cohort.

An Internet-Based Program to Improve Self-Management in Adolescents With Type 1 Diabetes

OBJECTIVETo report results from YourWay, an Internet-based self-management intervention for adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODSA total of 72 adolescents with type 1 diabetes, ages 13–17 years, were randomized to a usual-care-plus-Internet support or a usual-care group. The intervention was designed to enhance problem-solving barriers to self-management. A1C was obtained from medical records, and problem-solving and self-management were obtained via adolescent report.RESULTSGroup differences were not statistically significant using intent-to-treat analyses. Using as-treated analyses, adolescents in the treatment condition showed statistically significant improvement in self-management (d = 0.64; P = 0.02) and important improvements in problem-solving (d = 0.30; P = 0.23) and A1C (d = −0.28; P = 0.27). Mean A1C for the intervention group remained constant (−0.01%), while the control group increased (0.33%).CONCLUSIONSThis brief trial suggests that self-management support delivered through a secure website may improve self-management and offset typical decreases in adolescent glycemic control.

Anxiety Symptoms in Adolescents with Type 1 Diabetes: Association with Blood Glucose Monitoring and Glycemic Control

To examine the prevalence of anxiety symptoms and their association with blood glucose monitoring (BGM) and glycemic control in adolescents with type 1 diabetes. 276 adolescents and their caregivers completed measures of anxiety symptoms. Adolescents completed a measure of depressive symptoms. Demographic and family characteristics were obtained from caregiver report. Diabetes duration, regimen type, BGM frequency, and glycemic control were also collected. Trait anxiety symptoms that suggest further clinical assessment is needed were present in 17% of adolescents; the rate was 13% for state anxiety symptoms. Higher levels of state anxiety symptoms were associated with less frequent BGM F(14, 261) = 6.35, p < .0001, R(2) = .25, and suboptimal glycemic control, F(15, 260) = 7.97, p < .0001, R(2) = .32. State anxiety symptoms were correlates of BGM frequency and glycemic control independent of depressive symptoms. State anxiety symptoms are associated with less frequent BGM and suboptimal glycemic control in adolescents with type 1 diabetes.