Associations of Coping Strategies With Glycemic and Psychosocial Outcomes Among Adolescents With Type 1 Diabetes Experiencing Diabetes Distress.

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

Many teens with type 1 diabetes (T1D) experience diabetes distress, or the emotional burden related to living with T1D, which can negatively impact their health and overall well-being. However, few studies have explored how adolescents cope with diabetes distress. In the current study, we examined how different coping strategies related to both physical (glycemic) and psychosocial outcomes among adolescents experiencing diabetes distress. We found that using coping strategies focused on active problem-solving (primary control engagement coping) was linked to better glycemic and psychosocial outcomes. Similarly, adopting a positive mindset (secondary control engagement coping) was associated with improved psychosocial well-being but was not associated with glycemic outcomes. Conversely, the use of avoidance strategies (disengagement coping) was linked to poorer outcomes in both areas. These findings highlight the importance of promoting engagement coping strategies and discouraging the use of disengagement strategies among adolescents experiencing diabetes distress, suggesting potential areas for intervention.

Mothers' Experiences During the 2022 Infant Formula Shortage in Washington D.C.

INTRODUCTION: An unprecedented shortage of infant formula occurred in the United States (U.S.) in 2022 and posed widespread challenges to infant feeding nationwide. The purpose of this study is to investigate mothers' experiences during the 2022 infant formula shortage and its perceived impacts on infants' diet and health. METHODS: Mothers (n = 45) of infants under 8 months old from Washington D.C. were invited to participate in a virtual study meeting during the summer of 2022. Mothers completed surveys regarding their demographics, infants' anthropometrics, infant feeding practices, information they have received about infant feeding, and knowledge about infant feeding practices. They then participated in a qualitative interview about their experiences during the infant formula shortage. RESULTS: Overarching themes were: the shortage (1) had adverse impacts on mothers' mental and emotional health; (2) had significant financial and intangible costs; (3) led to changes in infant feeding practices; (4) social and family networks were helpful in navigating the shortage; and (5) mothers felt fortunate to have resources to breastfeed and/or obtain formula. DISCUSSION: The infant formula shortage adversely impacted mothers' mental and emotional health, and was costly, in terms of financial and intangible costs. Findings demonstrate the need to develop clinical and policy approaches to support mothers in feeding their infants and provide education about safe infant feeding practices.

Young Children with Type 1 Diabetes: Recent Advances in Behavioral Research.

PURPOSE OF REVIEW: This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions. RECENT FINDINGS: Rates of type 1 diabetes (T1D) in young children (ages 1-7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child's diabetes management. T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.

Mindfulness-Based Interventions: Focus on Pediatric Type 1 and Type 2 Diabetes.

PURPOSE OF REVIEW: Mindfulness-based interventions (MBIs) focus on promoting nonjudgmental, purposeful awareness of the present experience, and they include specific components such as body scan, meditation, and breathing techniques for healthier coping with stress and reduced negative affect. In adult populations with chronic illness (e.g., type 1 diabetes [T1D], type 2 diabetes [T2D], overweight), MBIs have been shown to improve psychosocial outcomes with some improvements in health outcomes as well. Youth with T1D/T2D frequently experience heightened depression as well as diabetes distress, which are associated with less frequent blood glucose monitoring, insulin administration, and nutrition oversight. Thus, MBIs have potential to alleviate psychosocial distress in youth with T1D/T2D and also improve health outcomes. This paper is a review of the literature on potential psychosocial and health benefits of MBIs for youth with T1D/T2D. RECENT FINDINGS: Among youth with T1D/T2D, MBIs have been shown to reduce symptoms of depression and diabetes distress. Improvements in health outcomes, such as A1c, have been inconsistent across studies. Although research on the efficacy of MBIs to improve psychosocial and health outcomes in youth with T1D/T2D is promising, this area of study is in its early stages. Future investigation of MBIs in youth with T1D and T2D is warranted, recognizing that these are heterogeneous groups with potential benefit of specifically tailored interventions.

Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis.

OBJECTIVE: Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis. RESEARCH DESIGN AND METHODS: One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (Mage  = 4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (Mdays since diagnosis = 29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis. RESULTS: Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress. CONCLUSIONS: Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self-efficacy and ultimately support the management of their child's diabetes.

Promoting surgical smoke management in a pediatric operating room: a best practice implementation project.

INTRODUCTION: The routine use of heat-producing tools in the perioperative setting generates surgical smoke. Surgical smoke poses a known health hazard for perioperative staff working in the operating room. OBJECTIVE: The objective of this best practice project was to promote evidence-based practices regarding surgical plume management in a pediatric operating room. METHODS: This project was guided by the JBI Model of Evidence-Based Healthcare and used the JBI Practical Application of Clinical Evidence System and the Getting Research into Practice audit and feedback strategy to promote evidence-based practices regarding surgical smoke management in a pediatric operating room. Seven audit criteria representing best-practice recommendations were used. A baseline audit was conducted, followed by the implementation of multiple strategies developed by the key stakeholders. The project was finalized with a follow-up audit to determine any changes in compliance with best-practice recommendations. RESULTS: Baseline audit data indicated an average of 41% compliance with best practices across all audit criteria, revealing the need for significant improvement in five of the seven criteria. Three barriers were identified and strategies were implemented, including the development and implementation of an educational module and a surgical smoke exposure risk assessment tool. Follow-up audits showed an overall improvement of 30% among five of the seven audit criteria. CONCLUSIONS: This project yielded improvements with best practices for surgical smoke management in the perioperative setting. However, additional work is required to ensure the sustainability of best practices in this setting.

Quality of Care during the COVID-19 Pandemic: A Qualitative Exploration of Bereaved Caregivers' Experiences at a Hospice Residence.

Background: An essential component of residential hospice care is the provision of high quality palliative care. The perspectives of quality of care from palliative care patients and bereaved caregivers have increasingly been studied to guide quality improvements. Aim: The study aimed to explore the experiences and perceptions of bereaved caregivers of patients who died in residential hospice during the coronavirus disease-19 (COVID-19) pandemic to determine perceptions of quality of care, caregiver grief and bereavement, and the impact of the COVID-19 pandemic. Design: Qualitative exploratory study using secure, web-based semistructured interviews. Data were analyzed using thematic analysis. Setting/Participants: A total of 15 bereaved caregiver participants were recruited from two residential hospice sites in Ottawa, Ontario. Results: Participants identified several factors that impacted the quality of care in residential hospice, including the impact of the COVID-19 pandemic itself. The findings are presented in three main themes: (1) quality of residential hospice end-of-life care; (2) caregiver perceptions of their grief and bereavement; and (3) impact of the COVID-19 pandemic on hospice quality of care and caregiver bereavement. Conclusions: The COVID-19 pandemic had a significant impact on the patient and caregivers experience of hospice, including perception of quality of care and caregiver experience of grief and bereavement.

Glycemic and Psychosocial Correlates of Continuous Glucose Monitor Use Among Adolescents With Type 1 Diabetes.

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

Effects of Low-Calorie Sweetener Restriction on Glycemic Variability and Cardiometabolic Health in Children with Type 1 Diabetes: Findings of a Pilot and Feasibility Study.

Low-calorie sweeteners (LCS) are commonly consumed by children with type 1 diabetes (T1D), yet their role in cardiometabolic health is unclear. This study examined the feasibility, acceptability, and preliminary effects of 12 weeks of LCS restriction among children with T1D. Children (n = 31) with T1D completed a two-week run-in (n = 28) and were randomly assigned to avoid LCS (LCS restriction, n = 15) or continue their usual LCS intake (n = 13). Feasibility was assessed using recruitment, retention, and adherence rates percentages. Acceptability was assessed through parents completing a qualitative interview (subset, n = 15) and a satisfaction survey at follow-up. Preliminary outcomes were between-group differences in change in average daily time-in-range (TIR) over 12 weeks (primary), and other measures of glycemic variability, lipids, inflammatory biomarkers, visceral adiposity, and dietary intake (secondary). Linear regression, unadjusted and adjusted for age, sex, race, and change in BMI, was used to compare mean changes in all outcomes between groups. LCS restriction was feasible and acceptable. No between-group differences in change in TIR or other measures of glycemic variability were observed. However, significant decreases in TNF-alpha (-0.23 ± 0.08 pg/mL) and improvements in cholesterol (-0.31 ± 0.18 mmol/L) and LDL (-0.60 ± 0.39 mmol/L) were observed with usual LCS intake, compared with LCS restriction. Those randomized to LCS restriction did not report increases in total or added sugar intake, and lower energy intake was reported in both groups (-190.8 ± 106.40 kcal LCS restriction, -245.3 ± 112.90 kcal usual LCS intake group). Decreases in percent energy from carbohydrates (-8.5 ± 2.61) and increases in percent energy from protein (3.2 ± 1.16) and fat (5.2 ± 2.02) were reported with usual LCS intake compared with LCS restriction. Twelve weeks of LCS restriction did not compromise glycemic variability or cardiometabolic outcomes in this small sample of youth with T1D. Further examination of LCS restriction among children with T1D is warranted.

A Pandemic Perspective: Analyzing the Impact of COVID-19 on Diabetes Management and Mood Through the Lens of Location and Family Conflict.

PURPOSE: The purpose of this study was to examine the influence of COVID-19 on teens' diabetes management and mood and their association with family conflict. METHODS: One hundred and nineteen teens ages 13 to 17 (M = 15.5 ± 1.3 years, 61.3% female, 57.1% non-Hispanic White) and 119 parents (83.2% female, 75.6% married, 63.9% non-Hispanic White) enrolled in an ongoing two-site randomized behavioral clinical trial. At baseline, dyads completed the Revised Diabetes Family Conflict scale and a survey measuring the impact of COVID-19 on teens' mood and diabetes management. RESULTS: Parent- and teen-reported impacts of COVID-19 on diabetes management and teen mood were positively correlated. Higher levels of both parent- and teen-reported family conflict were associated with greater parent-reported impact of COVID-19 on diabetes management and teen mood. In addition, teen-reported impact of COVID-19 on their mood varied by geographical location but not population density. CONCLUSIONS: COVID-19 influenced teen diabetes management and mood, and the impact of COVID-19 was related to diabetes-related family conflict and differed by geographic location. Findings lend support for mental health interventions targeting teens with T1DM affected by COVID-19 and monitoring the long-term effects of the pandemic.

Impacts of the COVID-19 Pandemic on Pediatric Type 1 Diabetes Management: A Qualitative Study.

PURPOSE: The purpose of this study was to understand impacts of the coronavirus (COVID-19) pandemic on pediatric type 1 diabetes management. METHODS: In-depth qualitative interviews were conducted with 15 parents of children (age 6-12 years) with type 1 diabetes. Parents responded to 8 open-ended questions about their experiences managing their children's type 1 diabetes during the COVID-19 pandemic. All interviews were transcribed, coded, and analyzed using qualitative thematic methods. RESULTS: Parents reported both positive and negative aspects of managing their children's type 1 diabetes during the COVID-19 pandemic. Facilitators of diabetes management included spending more time together at home and enhanced convenience of telehealth appointments and online supply ordering. Parents also described difficulties managing their children's type 1 diabetes during the COVID-19 pandemic, including a lack of structure in their child's daily routine, which led to increases in sedentary behavior. Furthermore, they reported psychosocial challenges of type 1 diabetes management, which were exacerbated by the pandemic. CONCLUSION: While the COVID-19 pandemic was described as having overall positive impacts on pediatric type 1 diabetes management, efforts to support parents in increasing children's physical activity and reducing screen time are needed, along with readily accessible mental health resources for both parents and their children with type 1 diabetes.

Rationale and design of DRINK-T1D: A randomized clinical trial of effects of low-calorie sweetener restriction in children with type 1 diabetes.

BACKGROUND: Low-calorie sweeteners (LCSs) provide sweetness without sugar or calories and are used to replace added sugars by many children with type 1 diabetes (T1D). However, the role of LCSs in diabetes management and cardiometabolic health is unclear. OBJECTIVE: The Diabetes Research in Kids Study (DRINK-T1D) aims to investigate effects of LCS restriction on glycemic variability, visceral adiposity, lipid profiles, and systemic inflammation among children 6-12 years old with T1D. METHODS: Children with T1D, who report habitual consumption of foods and beverages containing LCSs, are recruited from the Washington Nationals Diabetes Care Complex (DCC) at Children's National Hospital (CNH) in Washington, DC. Following a phone screening and two-week run-in period involving continuation of usual LCS intake, children are randomized to 12 weeks of LCS restriction (replacement of diet beverages with still or sparkling water and avoidance of other sources of LCSs) or continued usual LCS intake (control). The primary outcome is the difference in change in glycemic variability in the LCS restriction group versus the control group. Change in glycemic variability will be assessed as the difference in daily average time-in-range (TIR), measured using continuous glucose monitoring (CGM) during two weeks at the end of the 12-week intervention, compared with during the two-week run-in period prior to randomization. Participants also complete a variety of anthropometric, metabolic, dietary, and behavioral assessments throughout the 14-week study. CONCLUSIONS: DRINK-T1D is an innovative, randomized controlled trial, evaluating effects of LCS restriction on glycemic variability and cardiometabolic health in children with T1D. Findings of DRINK-T1D will support or challenge the common practice of recommending LCS use in this patient population and will have clinically relevant implications for pediatric T1D management. TRIAL REGISTRATION: ClinicalTrials.gov Identifier NCT04385888.