Patient and Parent Well-Being and Satisfaction With Diabetes Care During a Comparative Trial of Mobile Self-Monitoring Blood Glucose Technology and Family-Centered Goal Setting.

Patient engagement in the process of developing a diabetes treatment plan is associated with person-centered care and improved treatment outcomes. The objective of the present study was to evaluate the self-reported patient and parent-centered satisfaction and well-being outcomes associated with the three treatment strategies utilized in a comparative effectiveness trial of technology-enhanced blood glucose monitoring and family-centered goal setting. We evaluated data from 97 adolescent-parent pairs at baseline and 6-months during the randomized intervention. Measures included: Problem Areas in Diabetes (PAID) child and parent scales, pediatric diabetes-related quality of life, sleep quality, and satisfaction with diabetes management. Inclusion criteria were 1) ages 12-18 years, 2) a T1D diagnosis for at least six months and 3) parent/caregiver participation. Longitudinal changes in survey responses were measured at 6 months from baseline. Differences between and within participant groups were evaluated using ANOVA. The average age of youth participants was 14.8 ± 1.6 years with half of the participants being female (49.5%). The predominant ethnicity/race was Non-Hispanic (89.9%) and white (85.9%). We found that youth perceived 1) greater of diabetes-related communication when using a meter capable of transmitting data electronically, 2) increased engagement with diabetes self-management when using family-centered goal setting, and 3) worse sleep quality when using both strategies together (technology-enhanced meter and family-centered goal setting). Throughout the study, scores for self-reported satisfaction with diabetes management were higher in youth than parents. This suggests that patients and parents have different goals and expectations regarding their diabetes care management and care delivery. Our data suggest that youth with diabetes value communication via technology and patient-centered goal setting. Strategies to align youth and parent expectations with the goal of improving satisfaction could be utilized as a strategy to improve partnerships in diabetes care management.

Clinician Perceptions of a Computerized Decision Support System for Pediatric Type 2 Diabetes Screening.

OBJECTIVE: With the increasing prevalence of type 2 diabetes (T2D) in youth, primary care providers must identify patients at high risk and implement evidence-based screening promptly. Clinical decision support systems (CDSSs) provide clinicians with personalized reminders according to best evidence. One example is the Child Health Improvement through Computer Automation (CHICA) system, which, as we have previously shown, significantly improves screening for T2D. Given that the long-term success of any CDSS depends on its acceptability and its users' perceptions, we examined what clinicians think of the CHICA diabetes module. METHODS: CHICA users completed an annual quality improvement and satisfaction questionnaire. Between May and August of 2015 and 2016, the survey included two statements related to the T2D-module: (1) "CHICA improves my ability to identify patients who might benefit from screening for T2D" and (2) "CHICA makes it easier to get the lab tests necessary to identify patients who have diabetes or prediabetes." Answers were scored using a 5-point Likert scale and were later converted to a 2-point scale: agree and disagree. The Pearson chi-square test was used to assess the relationship between responses and the respondents. Answers per cohort were compared using the Mann-Whitney U-test. RESULTS: The majority of respondents (N = 60) agreed that CHICA improved their ability to identify patients who might benefit from screening but disagreed as to whether it helped them get the necessary laboratories. Scores were comparable across both years. CONCLUSION: CHICA was endorsed as being effective for T2D screening. Research is needed to improve satisfaction for getting laboratories with CHICA.

Short-Term Change in Measures of Glycemia in Obese Youth Meeting Criteria for Prediabetes: A Retrospective Chart Review.

BACKGROUND: The prevalence of youth diagnosed with prediabetes is increasing, yet there is a lack of guidelines on how to manage this condition clinically. OBJECTIVES: The aim was to determine the short-term outcomes of patients referred with prediabetes and to determine predictors of worsening dysglycemia in youth. STUDY DESIGN: This is a retrospective chart review of patients referred to our Youth Diabetes Prevention Clinic (YDPC) with laboratory tests indicating an increased risk for type 2 diabetes (T2D). We defined glycemic categories by HbA1c with normoglycemia as HbA1c <5.7%, prediabetes I (P1) as HbA1c 5.7 to <6.0%, and prediabetes II (P2) as HbA1c 6.0 to <6.5%. We compared HbA1c at the time of referral (screening HbA1c) and at the YDPC visit (YDPC HbA1c) to assess for improvement or worsening. Multinomial logistic regression was used to assess predictors of prediabetes. RESULTS: Among 562 patients seen, 336 had both screening and YDPC HbA1c values. Race (p < 0.001) and screening glycemic category (p < 0.001) were significantly associated with dysglycemia at the YDPC visit, while sex (p = 0.50), BMI z-score change (p = 0.27), and days from referral (p = 0.83) were not. As compared to those who reverted to normoglycemia, patients with prediabetes at YDPC were 7 times more likely to have a higher screening HbA1c (both P1 and P2). The majority of patients referred with prediabetes had lower HbA1c at the YDPC (75.4-82.6%). CONCLUSION: Patients with screening HbA1c <6% might benefit from a 4-month follow-up at primary care while recommending lifestyle changes. Patients of minority race and screening HbA1c ≥6% are more likely to have a persistent elevation of HbA1c.

Integrating Diabetes Prevention Education Among Teenagers Involved in Summer Employment: Encouraging Environments for Health in Adolescence (ENHANCE).

Type 2 diabetes (T2D) in youth is a growing healthcare and public health concern. It is costly, and youth suffer from disabling and deadly comorbid conditions at a faster pace than adult onset. However, T2D is preventable. The population of obese youth at greatest risk for T2D is of minority race/ethnicity and socioeconomically disadvantaged background, which creates barriers to health promoting lifestyles. Despite being the first line of prevention efforts for T2D, efficacious behavioral lifestyle interventions are still lacking at the community level. During the summers of 2016 and 2017, a study integrated obesity and diabetes prevention health education into TeenWorks summer employment program at Indy Urban Acres in Indianapolis, Indiana. Results were analyzed using paired sample t-tests. Participants (N = 168) had a mean age of 15.8 ± 0.7 years, 61% female, 13% Hispanic, 80% Black. By the end of the intervention, physical activity (p = 0.000) and prevention knowledge (p = 0.000) were significantly higher. Dietary intake (p = 0.204), self-efficacy (p = 0.58), food insecurity (p = 0.058) and depression screening scores (p = 0.809) were not significantly different. In light of the continuing childhood obesity epidemic and increasing prevalence of prediabetes and T2D in youth, there is a pressing need to understand and reduce barriers to obesity and diabetes prevention in high-risk populations. This study demonstrated the feasibility of integrating obesity and T2D prevention health education into a teen summer employment program.

Forever-Fit Summer Camp: The Impact of a 6-Week Summer Healthy Lifestyle Day Camp on Anthropometric, Cardiovascular, and Physical Fitness Measures in Youth With Obesity.

Pediatric obesity is a public health concern with lifestyle intervention as the first-line treatment. Forever-Fit Summer Camp (FFSC) is a 6-week summer day program offering physical activity, nutrition education, and well-balanced meals to youth at low cost. The aim of the study was to assess the efficacy of this program that does not emphasize weight loss rather emphasizes healthy behaviors on body mass index, cardiovascular and physical fitness. Methods: The inclusion criteria were adolescents between 8 and 12 years and body mass index (BMI) ≥85th percentile. The data were collected at baseline and week 6 (wk-6) and was analyzed for 2013-2018 using paired-sample t tests. Results: The participants' (N = 179) average age was 10.6 ± 1.6 years with a majority of females (71%) and black race/ethnicity (70%). At wk-6, BMI and waist circumference decreased by 0.8 ± 0.7 kg/m2 and 1.0 ± 1.3 in, respectively. Resting heart rate, diastolic and systolic blood pressure decreased by 8.5 ± 11.0 bpm, 6.3 ± 8.8 mmHg, and 6.4 ± 10.1 mmHg, respectively. The number of pushups, curl-ups, and chair squats were higher by 5.8 ± 7.5, 6.7 ± 9.1, and 7.7 ± 8.5, respectively. Conclusion: The FFSC is efficacious for improving BMI, cardiovascular, and physical fitness in the short term. The effect of similar episodic efforts that implement healthy lifestyle modifications throughout the school year should be investigated.

Assessing the referral of clients with respiratory symptoms to general physicians: a survey of community pharmacists in Beirut.

OBJECTIVES: The main objective of this study was to assess the ability of community pharmacists practicing in Beirut to identify red flag respiratory symptoms, and therefore to adequately refer clients to a general physician when warranted. Secondary objectives included determining whether demographic factors affect the odds of referral, and to qualify degree of agreement of community pharmacists with a panel of expert physicians. METHODS: In this cross-sectional study, pharmacies were randomly selected and invited to complete a self-administered survey, each containing 10 clinical vignettes that combined different characteristics (age group, gender, presenting symptom, duration of symptoms). Bivariate and multivariate logistic regressions were used to inspect predictors of referral, correct referral and under-referral. KEY FINDINGS: A total of 214 pharmacies were visited and 141 (65.9%) responded. Pharmacists were more likely to refer female patients (P = 0.035) and patients who presented with a longer duration of symptoms (P < 0.001). Correct referral was higher in pharmacies that were more than 20 min away from the nearest hospital (P = 0.013) and with clients who presented with haemoptysis (P < 0.001), dyspnoea (P < 0.001) or wheezing (P < 0.027), while it was lower with female patients (P < 0.001). Under-referral was higher in pharmacies that served more than 500 clients weekly (P = 0.048) and in patients presenting for dry cough (P < 0.001) or productive cough (P < 0.001). CONCLUSION: This study has shown that there is a need for further investigation into the practices of community pharmacists of Beirut. An action plan may be advised to alleviate the burden of patients who might currently be under-referred and experience morbidity as a result.