Glycemic Control In Young Adults Research Articles

Psychosocial Factors and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes

Youth-onset type 2 diabetes is associated with poor glycemic control and early onset of complications. Identification of psychosocial factors associated with poor glycemic control is needed to inform efficacious interventions. To identify psychosocial factors associated with glycated hemoglobin (HbA1c) levels in young adults with youth-onset type 2 diabetes. For the iCount cohort study, HbA1c levels were measured twice (at baseline [T1] and at 1 year [T2]) during the last years (2017-2019) of the observational phase of the multicenter Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY2) study. Participants were young adults who had been diagnosed with type 2 diabetes during childhood or adolescence. Data were analyzed from December 2021 to September 2023. Glycemic control was examined categorically (high [≥8.0%] vs low [<8.0%] HbA1c), continuously (HbA1c level), and over time (change in HbA1c: decreased ≥0.5%, remained stable, or increased ≥0.5%). Psychosocial measures included beliefs about medicines, depression and anxiety symptoms, diabetes distress, diabetes self-efficacy, self-management support, and unmet material needs. Multivariable logistic and linear regression models evaluated the association of each psychosocial factor with the probability of T2 HbA1c of 8.0% or greater, T2 HbA1c level, and change in HbA1c. Of the 411 TODAY2 participants approached, 381 enrolled in the iCount study, and 348 with T1 and T2 HbA1c data comprised the analysis group. The 348 participants had a mean (SD) age of 26.1 (2.5) years and a mean (SD) HbA1c of 9.4% (2.8%). Most participants (229 [65.8%]) were women. In adjusted multivariable regressions, greater beliefs that diabetes medicines are necessary (odds ratio [OR], 1.19 [95% CI, 1.03-1.37]; P = .02), concerns about medicines (OR, 1.20 [95% CI, 1.00-1.45]; P = .049), diabetes distress (OR, 1.08 [95% CI, 1.02-1.15]; P = .006), and high distress (OR, 2.18 [95% CI, 1.15-4.13]; P = .02) increased the odds of high HbA1c at T2. Greater support (OR, 0.67 [95% CI, 0.46-0.97]; P = .04) and diabetes self-efficacy (OR, 0.91 [95% CI, 0.84-0.99]; P = .02) decreased the odds of high HbA1c at T2. Diabetes distress was associated with higher HbA1c level at T2 (coefficient, 0.08 [95% CI, 0.02-0.13]; P = .01). Beliefs that diabetes medicines are necessary (OR, 1.20 [95% CI, 1.03-1.39]; P = .02) and concerns about medicines (OR, 1.22 [95% CI, 1.00-1.47]; P = .048) increased the odds of an HbA1c decrease of at least 0.5% over 1 year. In this cohort study of young adults with youth-onset type 2 diabetes, beliefs about medicines, high diabetes distress, low diabetes self-efficacy, and self-management support were associated with high HbA1c over time. Future research should assess whether interventions that address these factors result in improved glycemic control in this at-risk group.

An Online Structured Diabetes Self-Management Education and Support Programme Improves Glycaemic Control in Young Adults with Type 1 Diabetes.

We explore the effect of a structured online DSMES program on glycaemic control and the self-management behaviour of adolescents and young adults with T1DM. We used a pre-post uncontrolled intervention design over a period of 6 months. A total of 37 youths with T1DM aged 10-45 years were enrolled. The intervention comprised 11 structured online DSMES course sessions; these were video-based and delivered by a diabetes specialist, nurses and a dietitian. The primary outcome was a change in (glycated hemoglobin) HbA1c. The secondary outcomes were changes in hypoglycaemia frequency, time in target range (TIR) among patients using a continuous glucose monitoring (CGM) system and self-management behaviour; the latter was measured using a T1DM self-management scale for Chinese adults (SMOD-CA) and the Chinese version of the diabetic behaviour rating scale in adolescents with T1DM (DBRS). Twenty-three (85.2%) participants attended ≥8 of the online sessions. There was a significant reduction in HbA1c (from 6.92% to 6.47%, P = 0.002), hypoglycaemic episodes (from 6.0 to 4.0 during the preceding month, P = 0.026) and a significant increase in TIR (from 74.0% to 80.5%, P = 0.027) and an increase in the SMOD-CA score (from 79.6 to 84.6, P = 0.026) in young adults. No significant change in glucose control, hypoglycaemic events or DBRS score were found among children and adolescents. The score of the 12-item version of the Barrett-Lennard Relationship Inventory (B-L RI:mini) indicated that more than half of the participants experienced congruence, positive regard, and an empathic understanding in this programme. The online structured DSMES programme was effective in improving the glycaemic control and self-management behaviour of young adults with T1DM; however, integrating offline visits or appointments with online consultations may be necessary for youth patients.

43-OR: Beliefs about Medicines, Self-Efficacy, and Health Care Coverage Predict Glycemic Control in Young Adults with Youth-Onset Type 2 Diabetes—The TODAY2 iCount Study

Background: Little is known about psychosocial factors that predict glycemic control (A1c) in young adults with youth-onset type 2 diabetes. Aim: To identify psychosocial predictors of A1c in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY2) cohort. Design: Longitudinal, measured at T1 (baseline) and T2 (1 year later). Logistic and linear regressions, adjusted for covariates (including T1 A1c), identified T1 predictors of A1c at T2. Participants: N= 348 participants in TODAY2. Mean age=26.0 years, 65.8% female, 37.6% non-Hispanic Black, 36.5% Hispanic, 20.4% non-Hispanic white, mean A1c=9.4%. Measures: Reliable, valid measures of beliefs about medicines, depressive and anxiety symptoms, diabetes distress, diabetes self-efficacy, diabetes attitudes, self-management support and material need insecurities. A1c was examined categorically (high vs. low: high ≥8%) and continuously (percent). Key Results: The high A1c group had more belief in the necessity of (p=0.023), but concerns about (p=0.029), medicines, higher diabetes distress (p&amp;lt;0.001), and lower diabetes self-efficacy (p=0.017). In adjusted analyses, every 5-point higher score measuring beliefs that medicines are overused predicted 3.6 times higher odds of high A1c at T2 (p=0.010). Every 5-point higher self-efficacy score predicted 16.7% lower odds of high A1c at T2 (p=0.033). Surprisingly, those who lacked healthcare coverage were less likely to have high A1c at T2 vs. those with coverage (p=0.10). Every 5-point higher medicines are overused score predicted 48.5% higher % A1c at T2 (p=0.017). No other psychosocial measures predicted A1c. Conclusions: High A1c is common in young adults with youth-onset type 2 diabetes and is predicted over time by beliefs about medicines, diabetes self-efficacy and healthcare coverage status. We must address these factors to help this vulnerable group establish optimal glycemic control. Disclosure P.M.Trief: None. D.Uschner: None. B.Anderson: None. H.Wen: None. J.D.Bulger: None. R.S.Weinstock: Consultant; Jaeb Center for Health Research, Other Relationship; Wolters Kluwer Health, Research Support; Insulet Corporation, Medtronic, Eli Lilly and Company, Novo Nordisk, Boehringer Ingelheim Inc., Hemsley Charitable Trust, National Institute of Diabetes and Digestive and Kidney Diseases, Tandem Diabetes Care, Inc., Kowa Pharmaceuticals America, Inc. Funding National Institute of Diabetes and Digestive and Kidney Diseases (R01DK110456)

171-LB: The Online Structured DSMES Program Improved Glycemic Control in Young Adults but Not in Children and Adolescence with T1DM

Background: The COVID-19 pandemic has forced rapid reconsideration of the way in which health care is delivered in patients with T1DM. We explored the effect of an online structured DSMES program on glycemic control and self-management behavior in patients with T1DM. Methods: The intervention included 2 modules: (1) series of online DSMES sessions based video courses and personalized discussion on diabetes management; (2) continuous interactions and support based Wechat platform through text, audio or video. Results: A total of 36 subjects were enrolled into the final analysis, of them, 26 (72.2%) were young adults above 18 years and 10 (27.8%) were children and adolescence below 18. There were significant changes in HbA1c, TIR and hypoglycemic event in young adults; however, no significant difference were found in children and adolescence. There were significant behavior change measured using self-management scale of T1DM for Chinese adults (SMOD-CA) in participants aged ≥18, mainly in the domains of daily performance, coping with disease-related problems and goals of disease management; however, no significant behavior change were found in adolescence with T1DM (DBRS). (Table 1) Conclusions: The online structured DSMES program improved glycemic control, self-management behavior and reduced hypoglycemic event in young adults but not in children and adolescence with T1DM. Disclosure L. An: None. L. Ji: Other Relationship; Eli Lilly and Company, Novo Nordisk, Merck &amp; Co., Inc., Bayer Inc., Sanofi-Aventis U. S., Roche Pharmaceuticals, MSD Life Science Foundation, AstraZeneca, Boehringer Ingelheim Inc., Abbott, Metronics.

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.

ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes in adolescence.

Adiposity, Blood Glucose and Insulin Levels in Adolescents and Young Adults in Mumbai City: Association with Consumption of Milk and Milk Products

Background &amp; Aim: Milk has been studied extensively for its potential benefits, and some possible harmful effects on health. However, there is a paucity of Indian data in this context. Therefore, this study examined the association between milk consumption and anthropometric measurements, body composition and biochemical markers of glycaemic control in young adults (16-25 years) in Mumbai city. Material &amp; Methods: 1313 young adults who had participated in a previous study between 2017 to 2019, were approached, among whom 563 agreed to participate. Anthropometric measurements, blood pressure, body composition and biochemical markers of glycaemic control had been done during the original screening. These data were used to examine the association with milk consumption. Information about their milk consumption practices was obtained in 2020 and 2021 through personal interviews of participants. Results: 28 participants did not consume milk and were excluded from the statistical analysis. Daily mean milk consumption was 314 ± 239 mL. Daily milk consumption was divided into quartiles. Although, anthropometric measurements and glycaemic markers did not differ significantly between the four quartiles of milk consumption, participants in Q1 and Q2 tended to have a higher per cent body fat, HC, and fasting and stimulated insulin. Also, mean muscle mass in Q4 was significantly higher than in the lower three quartiles. Conclusion: Results show some trends that are in line with existing literature supporting the beneficial role of milk in health. Larger epidemiological studies on Indians are warranted to confirm these trends. Keywords: milk, diabetes, obesity, body fat, milk products, adolescents.

The impact of COVID-19 lockdown on glycaemic control in young adults with type 1 diabetes mellitus.

BackgroundIn December 2019, a novel coronavirus strain, COVID-19, was identified in Wuhan, China. The first case was reported in the Republic of Ireland that month. Since then, along with many other countries worldwide, Ireland has imposed intermittent strict lockdowns to mitigate the spread of the virus.AimsTo investigate the impact of lockdown on glycaemic control in young adult patients with type 1 diabetes mellitus.MethodsPre- and post-lockdown HbA1c levels were recorded for 118 patients attending the Young Adult Diabetes clinic in Beaumont Hospital, Dublin, and the results were compared. Changes in weight, insulin requirements and incidence of DKA/severe hypoglycaemia were also assessed.ResultsHbA1c results were 3.81 mmol/mol lower post-lockdown. Weight increased by 1.8 kg. Both of these results were statistically significant.ConclusionsLockdown was associated with improved glycaemic control in young adult diabetic patients, and also with an increase in body weight. Changes in lifestyle factors associated with lockdown may explain this finding.

Abstract #1183979: Prevalence of hypogonadism and its relation with glycemic control in young adults with chronic type 2 diabetes mellitus

There is an increased prevalence of hypogonadism in type 2 diabetes mellitus our study was aimed at to study the prevalence of hypogonadism in young adults with chronic type 2 diabetes mellitus In this cross sectional study 260 patients from 3 different cities of India were included between age group 30-39 with history of type 2 diabetes mellitus. Patients were divided into 2 groups, group A(130 patients) with history of type 2 diabetes mellitus more than 6 years and group B( 130 patients) with history of type 2 diabetes less than 6 years. Levels of hypogonadism and erectile dysfunction was compared between 2 groups on the basis parameters of Total Testosterone values and ADAMS questionnaire, glycemic parameters were measured on the basis of HbA1c. One-way ANOVA followed by post hoc Tukey's test and Pearson's coefficient of correlation tests were used for analysis. Hypogonadism was measured with levels of total testosterone less than 250 - Mean HbA1c levels of group A was 8.12% and group B was 8.09% 9 patients opted out of the study due to non consent, 5patients from group A and 4 patients from group B. Hypogonadism TT < 250 was observed in 25.6% of males(32/125) in group A as compared to 10% of males(13/126) in group B. Prevalence of erectile dysfunction was observed in 54.4% of males(68/125) in group A as compared to 31.74 % in males(40/126) in group B Higher degree of low testosterone was observed in group A with chronic history of type 2 diabetes as compared to group B, prevalence of erectile dysfunction in group A was non significantly higher as compared to group B An overall positive correlation was found between levels of hypogonadism and chronic history of type 2 diabetes. – We observed hypogonadism as indicated in significant proportion of males with chronic history of type 2 diabetes mellitus

Diabetes distress and glycaemic control in young adults with type 1 diabetes: Associations by use of insulin pumps and continuous glucose monitors.

We determined whether high diabetes distress (DD) in young adults with type 1 diabetes was associated with higher glycated haemoglobin (HbA1c ) levels and whether this association was similar among those who were and were not using diabetes devices (insulin pumps and/or continuous glucose monitors [CGMs]). In 2017, an online survey was completed by 423 of 743 (57%) young adults (19-31years) with type 1 diabetes receiving care at a specialty clinic in New York City. HbA1c level was the primary outcome measure, and high DD (Diabetes Distress Scale score ≥3) was the primary exposure. Associations were adjusted for sociodemographic covariates. Of the 419 respondents with complete DD data, 59% were female and 69% were non-Hispanic white. Both devices (pump and CGM) were used by 35%, either device by 42% and neither device by 24%. The mean (SD) HbA1c was 64 (19)mmol/mol (8.0 [1.7] %) and 24% had high DD. The adjusted mean (95% confidence interval) HbA1c was 10 (6, 14)mmol/mol (0.9 [0.5, 1.2] %) greater in those with high DD than in those without it. This HbA1c difference associated with high DD was similar regardless of device use: 9 (3, 15)mmol/mol (0.8 [0.3, 1.4] %) greater among those using both devices; and 9 (-0.9, 18)mmol/mol (0.8 [-0.1, 1.7] %) greater among those using neither device. High DD in young adults requires more attention because it is associated with higher HbA1c levels, even among those using insulin pumps and CGMs.

Continuous Glucose Monitoring and Glycemic Control in Young Adults with Type 1 Diabetes: Benefit for Even the Simplest Insulin Administration Methods.

The impact of continuous glucose monitoring (CGM) on glycemic control in young adults with type 1 diabetes (T1D) is controversial. Data from 888 young adults with T1D were reviewed (ages 18-30 years, 52% female, glycated hemoglobin [HbA1c] 8.1% ± 1.5%). Prescription of CGM was recorded for 54% of young adults; 66% were pump users, 46% on insulin injections and carbohydrate (carb) counting, and 32% on insulin doses without carb counting (P ≤ 0.001). HbA1c was lower in young adults with CGM versus no CGM (7.7% ± 1.3% vs. 8.2% ± 1.7%, P ≤ 0.001). Difference in HbA1c between CGM versus no CGM was greater in young adults noncarb counting (7.9% ± 1.4% vs. 8.9% ± 2.3%, P = 0.002) than carb counting (7.7% ± 1.5% vs. 8.2% ± 1.7%, P = 0.0008), or pump users (7.6 ± 1.2 vs. 7.9 ± 1.1, P = 0.01). Prescription of CGM was higher with increasing complexity of insulin regimens; however, impact of CGM was greatest with simpler insulin administration methods. Further studies are needed to clarify this association.

814-P: Clinical Factors Impacting Glycemic Control in Young Adults with Type 1 Diabetes at Transition to Adult Clinical Care

Young adults (YA) with type 1 diabetes (T1D) transfer from pediatric to adult diabetes care during a time when many of them experience suboptimal glycemic control. To determine the factors impacting glycemic control in YA transitioning to adult care, we conducted a retrospective study of YA (age 17-30 years) with T1D establishing care at an adult tertiary diabetes-only clinic. Demographic, clinical characteristics, A1c at first visit, use of insulin pump or continuous glucose monitor (CGM), referral center, and insurance information were collected from the electronic medical record. Among 329 YA with T1D (55% female, 75% white, 40% on CGM, 55% on insulin pump), average age of transition was 23±3 years and mean A1c at first visit was 8.5±1.6%. We divided YA by A1c at first visit as ≤7.5% (n=96) and A1c≥8.5% (n=130). Patients with better glycemic control (A1c < 7.5% at first visit) were older and had more private insurance. Patients with better glycemic control also used more diabetes technology (59% vs. 43% on pump, 51% vs. 35% on CGM). In our cohort, older age at transfer, use of diabetes technology, referral center and private insurance status were associated with better glycemic control at first visit in adult care. These factors may be important for adult clinicians to consider when assessing YA with T1D at their first visit to develop a tailored diabetes self-management plan.View largeDownload slideView largeDownload slide DisclosureK. Flint: None. M. Bennetti: None. A. Atakov-castillo: None. E. Toschi: Consultant; Self; Medtronic.FundingSteven M. and Joyce E. Tadler Charitable Trust

142-OR: Health Care Coverage and Access and Associations with Glycemic Control in Young Adults with Youth-Onset Diabetes: The SEARCH for Diabetes in Youth and TODAY Studies

Background: Young adults with diabetes face transitions in health care (provider, insurance, costs) and commonly have suboptimal glycemic control. We explored healthcare coverage and access to care and their associations with HbA1c, by diabetes type. Methods: In the SEARCH (T1D and T2D) and TODAY (T2D) studies, interviewer-administered surveys collected data on health care coverage at study visits (2017-2019). The associations between healthcare coverage or access and HbA1c were examined separately in T1D and T2D. Results: A total of 1374 participants, mean age 25 years, completed the survey. Mean HbA1c was similar in T1D and T2D for those with public insurance, but higher in T1D with no insurance. Having health insurance and a usual place for diabetes care were associated with lower HbA1c for T1D participants but not for those with T2D (Table). Participants from states with Medicaid eligibility expansion were more likely to have health insurance for T1D: 99% with vs. 91% without expansion; and T2D: 93% with vs. 75% without expansion. Conclusion: Having healthcare coverage and access was associated with better glycemic control for young adults with T1D, but not T2D. Medicaid eligibility expansion was associated with having health insurance. Examining how healthcare access factors affect self-care differently in T1D and T2D is essential. Disclosure C. Pihoker: None. J. Divers: None. P. Zhang: None. D. M. Nathan: None. K. Drews: None. D. Dabelea: None. P. Zeitler: Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc., Daiichi Sankyo, Eli Lilly and Company, Janssen Research & Development, LLC, Merck & Co., Inc. B. H. Braffett: None. T. Songer: Employee; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. W. H. Herman: Advisory Panel; Spouse/Partner; Rhythm Pharmaceuticals, Inc., Consultant; Self; RTI International, Other Relationship; Self; American Diabetes Association, American Diabetes Association, American Diabetes Association, International Diabetes Federation, Merck Sharp & Dohme Corp., National Committee for Quality Assurance, National Institute of Diabetes and Digestive and Kidney Diseases, Special Government Employee, Research Support; Spouse/Partner; Nestle. M. Tung: None. S. Kuo: None. A. Bellatorre: None. E. M. Isganaitis: None. E. T. Jensen: None.

Health Care Coverage and Glycemic Control in Young Adults With Youth-Onset Type 2 Diabetes: Results From the TODAY2 Study.

To examine the relationship between health care coverage and HbA1c in young adults with youth-onset type 2 diabetes who transitioned to community diabetes care after receiving care during the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) study. Participants completed questionnaires annually. HbA1c was measured in a central laboratory. Data from 2 years before and after transitioning to community care (2013-2016) were examined and compared between states with and without expanded Medicaid. In 2016 (n = 427; mean age 24 years), 2 years after transitioning to community care, 93% of participants in states with Medicaid expansion had health care coverage compared with 68% (P < 0.0001) in states without Medicaid expansion. Mean HbA1c was 9.8% in participants with government coverage, 9.3% with commercial coverage, and 10.1% in those with no coverage (P = 0.0774). Additionally, 32%, 42%, and 66% of those with government coverage, commercially covered, and no coverage, respectively, were not attending outpatient diabetes visits (P < 0.0001). Of those with government coverage, 83% reported they had adequate coverage for insulin syringes/needles/pens, and 89% for glucose-monitoring supplies, with more limited coverage in those with commercial plans. Participants with commercial coverage had higher education attainment (P < 0.0001); 52% had HbA1c ≥9.0% compared with 64% of those who were government covered and 58% with no coverage (P = 0.0646). More young adults with type 2 diabetes from the TODAY cohort had health care coverage in states with expanded Medicaid but glycemic control remained poor, regardless of coverage. New therapies and approaches are needed for this vulnerable population.

1321-P: Reduced Heart Rate Variability (HRV) in Young Adults with Youth-Onset Type 2 Diabetes (T2D) Is Related to Glycemic Control: The TODAY Study

Cardiovascular autonomic neuropathy (CAN), a complication of T2D, affects the autonomic nerves innervating the heart and can adversely affect cardiac performance. Reduction in HRV is an early manifestation of CAN with parasympathetic loss preceding sympathetic dysfunction. Whether HRV is influenced by prior diabetes treatment or glycemic control in young adults with youth-onset T2D is not known. Heart beats over 10 minutes from an ECG were measured by Sphygmocor to derive the normal R-R intervals (NN intervals). HRV outcomes included: the standard deviation of the NN intervals (SDNN), the root mean square differences of the NN intervals (RMSSD), and the frequency domain low to high (LF:HF) power. TODAY participants (n=400) 7 y post-randomization (T2D duration 7.7±1.5 y) were compared to 133 obese controls without T2D. We assessed whether prior randomized treatment (metformin alone, metformin+ rosiglitazone or metformin+ intensive lifestyle) or glycemic control over time (time-weighted HbA1c) were associated with HRV. Compared to obese controls, TODAY subjects were younger (mean age 20.7±2.5 vs. 22.6±3.7 y) but not different by sex or BMI (35% male, BMI 36.6±8.1 kg/m2). TODAY participants had reduced overall HRV (SDNN; 57.9±29.6 vs. controls 67.1±25.4, p&amp;lt;0.0001), including a pattern of parasympathetic loss (RMSSD; 53.0±36.6 vs. controls 67.9±35.2, p&amp;lt;0.0001) with sympathetic overdrive (LF:HF power; 1.4±1.7 vs. controls 1.0±1.1, p&amp;lt;0.0001). Among TODAY subjects, HRV did not differ by previously randomized treatment, but higher HbA1c over time was independently associated with lower SDNN and RMSSD and higher LF:HF power independent of age, race, sex, T2D duration and BMI. Young adults with youth-onset T2D show early manifestations of CAN with both parasympathetic and sympathetic impairments that are associated with higher HbA1c. Disclosure A.S. Shah: None. L. El Ghormli: None. F. Bacha: Research Support; Self; National Institute of Diabetes and Digestive and Kidney Diseases, Pediatric Diabetes Consortium. Other Relationship; Self; AstraZeneca, Jaeb Center for Health Research. R.M. Farrell: Stock/Shareholder; Self; Tandem Diabetes Care. S. Gidding: Research Support; Self; Color Genomics. L.E. Katz: None. J.B. Tryggestad: None. M. Vajravelu: None. N.H. White: None. E.M. Urbina: None. Funding National Institutes of Health; National Institute of Diabetes and Digestive and Kidney Diseases

Stressful Life Events in Young Adults With Type 1 Diabetes in the U.S. T1D Exchange Clinic Registry.

The purpose was to test associations among stressful life events, frequency of missed insulin doses, and glycemic control in young adults with type 1 diabetes (T1D). The study was a cross-sectional descriptive secondary analysis. Data from 2,921 participants (ages 18-26 years) in the U.S. T1D Exchange Clinic Registry were analyzed. Report of a stressful life event was defined as one or more positive responses on a 17-item stressful life events index and defined as a dichotomous variable (yes or no). Frequency of missed insulin doses was measured using a single self-report item and collapsed into two levels (fewer than three times a week, three or more times a week). The glycosylated hemoglobin (A1c) level recorded at the time of enrollment was used to assess glycemic control. Nearly half (48.6%) of the participants reported having a stressful life event during the previous year. The most frequently reported stressful life events were problems at work or school (16.1%), serious arguments with family members or a close friend (15.2%), and financial problems in the family (13.8%). Compared to the participants not reporting stressful life events, those who reported stressful life events were more likely to be older, female, with a higher educational attainment level, and not working or unemployed. Those who reported a stressful life event were more likely than those who did not to say they typically missed insulin doses at least three times a week and less likely to say they typically missed insulin doses fewer than three times a week (p < .001 adjusted for age, sex, race or ethnicity, educational attainment level, duration of T1D diagnosis, and insulin delivery method). Mean A1c level was higher for the group who reported having a stressful life event in the past 12 months compared to the group who did not (8.7 ± 1.8% vs. 8.2 ± 1.6%; adjusted p < .001). The results of a mediation analysis suggest that the measure of frequency of missed insulin doses may be a mediator of the relationship between recent stressful life events and glycemic control (Sobel test: ab = .841, 95% confidence interval = 0.064-1.618). These findings suggest that, for young adults with T1D, the experience of stressful life events may increase their risk for poorer glycemic control, possibly by disrupting adherence with insulin doses. Further exploration of these relationships may allow for the potential for identifying those at risk and assisting them with more positive approaches to managing stressful events.

Delay discounting associated with challenges to treatment adherence and glycemic control in young adults with type 1 diabetes

IntroductionMany young adults with type 1 diabetes (T1D) face challenges in adherence to self-management practices and have above-target HbA1c. Poorer decision-making skills, indicated by greater delay discounting, may be linked to these factors. MethodsAn online survey using social media ads targeted young adults aged 18–26 with T1D. Participants completed the Self-Care Inventory and the 5-trial delay discounting task and self-reported their last HbA1c value. ResultsDiscounting was significantly associated with treatment adherence (r = −.14, p < .05) and HbA1c (r = .18, p < .01). Adherence was also associated with HbA1c (r = −.26, p < .01). In a hierarchical regression, adding discounting explained significant additional variance in HbA1c after controlling demographics (F(1, 257) = 3.99, p < .05); adding adherence next explained significant additional variance in HbA1c (F(1, 256) = 12.96, p < .01). In the final model, adherence significantly explained HbA1c variance (β = −.21, p < .01). DiscussionThese results expand the literature on cognitive factors and glycemic control among patients with T1D. Factors like delay discounting represent potentially modifiable risk factors targetable through interventions.

Associations of demographic and behavioural factors with glycaemic control in young adults with type 1 diabetes mellitus.

Despite recognised benefits of optimal glycaemic control in patients with type 1 diabetes mellitus (T1DM), good control is still difficult to achieve, particularly for adolescents and young adults. Recognition of factors that may assist early optimisation of glycaemic control is therefore important. We explored associations of demographic, social and behavioural factors with glycosylated haemoglobin (HbA1c) levels in participants with T1DM aged 18-25 years. A cross-sectional analysis was performed on young adults attending a dedicated multidisciplinary clinic at Fremantle Hospital, Western Australia from January to August 2014. Data from 93 participants were analysed. Mean age was 21.4 ± 2.3 years, and 39.8% of the cohort were female. Longer duration of diabetes was associated with higher HbA1c (r = 0.25, P = 0.04). Men had lower HbA1c than women (8.2 ± 1.6 vs 9.2 ± 2.0%, P = 0.01). Increased frequency of clinic attendance was associated with lower HbA1c (r = -0.27, P = 0.02). Those engaged in work or study had better HbA1c compared with those who were not (8.9 ± 2.1 vs 10.5 ± 2.1%, P = 0.03). Socioeconomic disadvantage, risk-taking behaviour, insulin pump use and distance travelled to clinic were not associated with differences in HbA1c. In young adults with T1DM, geographical separation, socioeconomic disadvantage and risk-taking behaviours did not influence glycaemic control. Longer duration of diabetes identifies young adults at higher risk of poor control, while attendance at a multidisciplinary clinic and engagement in work or study was associated with better glycaemic control. Additional studies are warranted to clarify the role of behavioural interventions to improve diabetes management in young adults.

Cardiovascular Risk Factors from Early Life Predict Future Adult Cardiac Structural and Functional Abnormalities: A Systematic Review of the Published Literature

BackgroundClinical practice evaluates cardiovascular risk based on current risk factor (RF) levels [Blood pressure (BP), body mass index (BMI) and glycaemic control] largely disregarding previous risk-factor history over the totality of the life course. RFs are related to contemporaneous echocardiographic measures of cardiac structure and function which in turn are independently related to cardiovascular morbidity and mortality in cross-sectional studies. However, the effect of lifetime or earlier RF history on future echocardiographic changes has never been systematically examined.MethodsA systematic review of the published literature identified 24 studies relating either earlier BP, BMI, glycaemic control or a combination to future cardiac structure and/or function.ResultsThe majority of studies showed that elevated BP and BMI in earlier life and greater cumulative burden of these factors resulted in worse cardiac structure up to 24 years later. Studies examining glycaemic control as RF were few, but poorer glycaemic control in young adults was associated with increased future left ventricular mass.While only 5 papers related RFs to future cardiac function, all RFs were positively associated with worse future diastolic function.ConclusionsBP, BMI and glycaemic control measures in childhood, adolescence and early adulthood and subsequent longitudinal trajectories of BP and BMI are predictive of future abnormalities in cardiac structure and function. Lifetime RF history should be used to inform clinical practice. Further research is required to enable the identification of any sensitive periods in the life course to enable prevention when it is most likely to be effective.

Mechanism of action of pre-meal consumption of whey protein on glycemic control in young adults

Whey protein (WP), when consumed in small amounts prior to a meal, improves post-meal glycemic control more than can be explained by insulin-dependent mechanisms alone. The objective of the study was to identify the mechanism of action of WP beyond insulin on the reduction of post-meal glycemia. In a randomized crossover study, healthy young men received preloads (300 ml) of WP (10 and 20 g), glucose (10 and 20 g) or water (control). Paracetamol (1.5 g) was added to the preloads to measure gastric emptying. Plasma concentrations of paracetamol, glucose, and β-cell and gastrointestinal hormones were measured before preloads (baseline) and at intervals before (0–30 min) and after (50–230 min) a preset pizza meal (12 kcal/kg). Whey protein slowed pre-meal gastric emptying rate compared to the control and 10 g glucose (P<.0001), and induced lower pre-meal insulin and C-peptide than the glucose preloads (P<.0001). Glucose, but not WP, increased pre-meal plasma glucose concentrations (P<.0001). Both WP and glucose reduced post-meal glycemia (P=.0006) and resulted in similar CCK, amylin, ghrelin and GIP responses (P<.05). However, compared with glucose, WP resulted in higher post-meal GLP-1 and peptide tyrosine-tyrosine (PYY) and lower insulin concentrations, without altering insulin secretion and extraction rates. For the total duration of this study (0–230 min), WP resulted in lower mean plasma glucose, insulin and C-peptide, but higher GLP-1 and PYY concentrations than the glucose preloads. In conclusion, pre-meal consumption of WP lowers post-meal glycemia by both insulin-dependent and insulin-independent mechanisms.

Relation between energy intake and glycemic control in physically active young adults with type 1 diabetes

To examine the relationships between daily energy expenditure, energy intake and glycemic control in young adults with type 1 diabetes. Cross-sectional study. Energy expenditure (kcal kg(-1)d(-1)) and duration of participation in physical activity were measured from a 3-d activity diary and categorized according to their intensity on a 1-9 scale. Energy intake was measured by a 3-d food record. Glycemic control was measured using the HbA1c. Energy expenditure and intake were assessed in 35 young adults with type 1 diabetes (age: 28 ± 7 years). Participants with higher energy expenditure from moderate to intense physical activity (categories 6-9) presented higher proportion of energy intake derived from carbohydrate and lower proportion of lipids in the diet with significantly higher HbA(1c) values (7.3 ± 1.0% vs 6.7 ± 0.6%). These results suggest that highly physically active individuals with type 1 diabetes consume more carbohydrates than lipids, a strategy that may affect their glycemic control. Further studies are needed to develop interventions to improve glycemic control in highly active individuals with type 1 diabetes.