When Climate Change Shows Up in the Exam Room.

Climate change is considered one of the greatest threats to humanity and the most significant global public health emergency of our lifetime. Millions of people from throughout the globe suffer and die each year from degraded air quality, extreme heat, water and vector-borne diseases as well as the mental health effects of climate change. Because clinicians are considered one of the most trusted sources of climate information, they have a unique opportunity to communicate the many health-related effects of climate change to their patients. It is important for clinicians to understand the most beneficial techniques to use when communicating with patients who may need more information regarding climate change and extreme weather events. These include 1) meeting patients where they are, 2) providing patient education, and 3) telling authentic stories. Developing and delivering effective communication strategies to our patients to prevent and prepare for climate-related health issues are paramount- if we are to make meaningful progress.

A Web-Delivered Multicomponent Intervention for Adolescents with Poorly Controlled Type 1 Diabetes: A Pilot Randomized Controlled Trial.

Background: Type 1 diabetes is associated with significant mortality and economic cost. Management of type 1 diabetes involves completing multiple daily adherence behaviors, and many adolescents struggle with self-management and show poor glycemic control. Purpose: The purpose was to conduct an unblinded pilot randomized controlled parallel-group study of a web-delivered multicomponent intervention targeting self-monitoring of blood glucose, working memory, and parent supervision of diabetes care among adolescents with type 1 diabetes. Intervention components included high magnitude incentives for adolescents and parents, motivational and cognitive behavioral therapy and working memory training for adolescents, and training in contingency contracting for parents. Methods: Adolescents (N = 114) with poorly controlled type 1 diabetes were screened, and N = 61 were randomized using minimum likelihood allocation to usual care (usual care, N = 31) or to a 25-week/15-session web-delivered intervention (WebRx, N = 30). Results: At the end of treatment, adolescents in WebRx had higher self-monitoring of blood glucose (d = 0.58) (primary outcome), better visual spatial working memory (d = 0.48) and inhibition (d = 0.98), and lower HbA1c (d = 0.45) than those in usual care. WebRx parents reported more frequent review of the adolescent's glucometer (d = 1.30) and reduced family conflict (d = 0.56). Between-condition differences were maintained 6 months later in self-monitoring of blood glucose (d = 0.42), visual spatial working memory (d = 0.76), family conflict (d = 0.50), and HbA1c (d = 0.44). Conclusions: Results showing sustained effects on self-monitoring of blood glucose and HbA1c support moving forward with a larger trial to test this innovative web-delivered and multicomponent intervention. ClinicalTrials.gov Number (NCT01722643).

Pilot Study of a Web-Delivered Multicomponent Intervention for Rural Teens with Poorly Controlled Type 1 Diabetes.

Objective. The purpose of this study was to examine the feasibility and effectiveness of a web-delivered multicomponent behavioral and family-based intervention targeting self-regulation and self-monitoring of blood glucose levels (SMBG) and glycemic control (HbA1c) in teens with type 1 diabetes (T1DM) living in rural US. Methods. 15 teens with poorly controlled T1DM participated in a 25-week web-delivered intervention with two phases, active treatment (weekly treatment sessions and working memory training program) and maintenance treatment (fading of treatment sessions). Results. Almost all (13 of 15) participants completed at least 14 of 15 treatment sessions and at least 20 of 25 working memory training sessions. SMBG was increased significantly at end of active and maintenance treatment, and HbA1c was decreased at end of active treatment (p's ≤ 0.05). Executive functioning improved at end of maintenance treatment: performance on working memory and inhibitory control tasks significantly improved (p's ≤ 0.02) and parents reported fewer problems with executive functioning (p = 0.05). Improvement in inhibitory control was correlated with increases in SMBG and decreases in HbA1c. Conclusions. An innovative web-delivered and multicomponent intervention was feasible for teens with poorly controlled T1DM and their families living in rural US and associated with significant improvements in SMBG and HbA1c.

Technological advancements in diabetes care.

Technologic advancements in the past decade have greatly improved our ability to manage diabetes, and made it practical to achieve tight control while providing a more flexible schedule and diet for children and their families. In this article, we discuss the recent advances in blood glucose monitoring, insulin analogues, and insulin delivery, as well as the new lexicon used by patients and the diabetes team.

Gizmos and gadgets in diabetes care: new tools for sweet kids.

Diabetes care has become more complex as we strive to help children with diabetes achieve and maintain tight glycemic control. The technologic advances described herein have provided the means for safer, more convenient, and more effective diabetes care.

Assessing adolescents with insulin-dependent diabetes mellitus: a multiple perspective pilot study using visual illness narratives and interviews.

This study explored the illness experiences of adolescents with insulin-dependent diabetes mellitus (IDDM) using Video Intervention/Prevention Assessment (VIA). Five adolescents with IDDM were asked to videotape 8 hours of their lives over a 1-month period. At the conclusion of the study, the primary investigator interviewed each adolescent and their diabetes clinician. VIA visual illness narratives and follow-up interviews provided clinically important, previously unknown information about how adolescents live with diabetes, including the negative and positive influences of diabetes on the family unit and the individual, that parental involvement was associated with adolescents' diabetes control, and that gender may be a significant mediating factor in control.