"I'll Just Forever Be That Person Who Stands in the Middle of the Dance Floor Drinking a Juice Box": Supporting the Transition to Adulthood With Type 1 Diabetes in a Post-Secondary University/College Setting.

Background: The transition to adulthood is a challenging period for individuals with type 1 diabetes, especially those attending post-secondary education (PSE) at a university or college. In addition to balancing academic responsibilities and adapting to a novel environment, young adults (YAs) with type 1 diabetes must more independently manage the daily demands of diabetes care. Objective: The aim of this study was to collect qualitative data from multiple stakeholders addressing the transition of students with type 1 diabetes into a PSE setting. Methods: A total of 15 participants were interviewed, including three health care provider diabetes educators, four parents of YAs with type 1 diabetes, and eight YAs with type 1 diabetes. Reflexive thematic analysis of the qualitative interviews revealed four major themes and 11 subthemes. Results: The four major themes revealed included 1) inappropriateness of services available to support students with type 1 diabetes in PSE settings, 2) individuals with type 1 diabetes having to compensate for inadequate systems, 3) variability of social support effectiveness, and 4) the need for a more holistic approach to improve diabetes education and social support systemically. Conclusion: This study identified some key systemic barriers experienced by PSE students with type 1 diabetes. Future research needs to extend the sample populations to understand a wider range of PSE student experiences. The findings from this study provide initial recommendations to develop new PSE readiness interventions for YAs with type 1 diabetes.

Mindfulness, disordered eating, and impulsivity in relation to glycemia among adolescents with type 1 diabetes and suboptimal glycemia from the Flexible Lifestyles Empowering Change (FLEX) intervention trial.

OBJECTIVE: To assess the relationship between mindfulness and glycemia among adolescents with type 1 diabetes (T1D) with suboptimal glycemia, and evaluate the potential mediation by ingestive behaviors, including disordered eating, and impulsivity. RESEARCH DESIGN AND METHODS: We used linear mixed models for hemoglobin A1c (HbA1c) and linear regression for continuous glucose monitoring (CGM) to study the relationship of mindfulness [Child and Adolescent Mindfulness Measure (CAMM)] and glycemia in adolescents with T1D from the 18-month Flexible Lifestyles Empowering Change (FLEX) trial. We tested for mediation of the mindfulness-glycemia relationship by ingestive behaviors, including disordered eating (Diabetes Eating Problem Survey-Revised), restrained eating, and emotional eating (Dutch Eating Behavior Questionnaire); and impulsivity (total, attentional, and motor, Barrett Impulsiveness Scale). RESULTS: At baseline, participants (n = 152) had a mean age of 14.9 ± 1.1 years and HbA1c of 9.4 ± 1.2% [79 ± 13 mmol/mol]. The majority of adolescents were non-Hispanic white (83.6%), 50.7% were female, and 73.0% used insulin pumps. From adjusted mixed models, a 5-point increase in mindfulness scores was associated with a -0.19% (95%CI -0.29, -0.08, p = 0.0006) reduction in HbA1c. We did not find statistically significant associations between mindfulness and CGM metrics. Mediation of the relationship between mindfulness and HbA1c by ingestive behaviors and impulsivity was not found to be statistically significant. CONCLUSIONS: Among adolescents with T1D and suboptimal glycemia, increased mindfulness was associated with lower HbA1c levels. Future studies may consider mindfulness-based interventions as a component of treatment for improving glycemia among adolescents with T1D, though more data are needed to assess feasibility and efficacy.

Psoriasis in childhood: effective strategies to improve treatment adherence.

Psoriasis is a relatively common chronic inflammatory skin disease in children for which there is no cure. Most children have mild disease that can be managed with topical therapy as opposed to phototherapy or systemic therapy. Despite the mild presentation of psoriasis in most children, the disease can have a significant impact on quality of life due to the need for ongoing treatment, the frequently visible nature of the cutaneous manifestations, and the social stigma that is associated with psoriasis. Adherence to treatment, in particular topical therapy, is often poor in adults and compromises response to therapy and medical provider management strategies. Multiple factors that may contribute to nonadherence in adults with psoriasis have been identified, including lack of education on the disease and expectations for management, issues related to ease of use and acceptability of topical medications, and anxiety regarding possible medication side effects. There is currently no published data on adherence in the pediatric psoriasis population; however, poor adherence is often suspected when patients fail to respond to appropriate therapy. General strategies used to assess adherence in other pediatric disease populations can be applied to children with psoriasis, and interventions that reflect experience in other chronic dermatologic disorders such as atopic dermatitis may also be helpful for medical providers caring for children with psoriasis.