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1.
Pan Afr Med J ; 40: 76, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34804343

RESUMO

Introduction: COVID-19 pandemic has had a greater psychological impact on patients with chronic ailments such as diabetes mellitus, tuberculosis, and HIV/AIDS compared to those without chronic conditions. We explored the psychological impacts of COVID-19 among people living with diabetes mellitus in Ghana. Methods: this study employed a hospital-based cross-sectional design involving 157 diabetes mellitus patients aged 20 years and above. We assessed diabetes distress by the seventeen-item diabetes stress (DDS17) scale and COVID-19 worries by 3 specific benchmarks: "worry about overly affected due to diabetes if infected with COVID-19", "worry about people with diabetes characterized as a risk group" and "worry about not able to manage diabetes if infected with COVID-19". A close-ended questionnaire was used in data collection. Results: of 157 diabetic patients interviewed, the majority had type 2 diabetes mellitus with known complications and only 42.7% were managing COVID-19 symptoms. The participants showed moderate to high level of COVID-19 specific worry, moderate fear of isolation, and low level of diabetes-associated distress. About 33.8% of the study population expressed a sense of worry towards the pandemic. The logistic regression showed that age, employment status, and presence of other chronic diseases were significantly associated with worries about being overly affected if infected with COVID-19 due to their diabetes status. Age and sex were associated with worries about people with diabetes being characterized as a risk group and age, sex and employment status were associated with participants who were worried about not being able to manage diabetes if infected with COVID-19. Conclusion: the general trend indicates a sense of worry among diabetes patients during the COVID-19 pandemic which is associated with poorer psychological health. Clients' education and counseling on COVID-19 are necessary to address some of their concerns to minimize the level of anxiety and emotional stress in these individuals.


Assuntos
COVID-19/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Adulto , Fatores Etários , Ansiedade/epidemiologia , Estudos Transversais , Medo , Feminino , Gana , Humanos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Fatores de Risco , Fatores Sexuais , Estresse Psicológico/epidemiologia , Inquéritos e Questionários , Adulto Jovem
2.
Nutr Metab Cardiovasc Dis ; 31(11): 3243-3246, 2021 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-34629250

RESUMO

BACKGROUND AND AIMS: Vaccine Hesitancy (VH) is a relevant obstacle for the COVID-19 vaccination campaign. The aim of this study is to assess the proportion of subjects unwilling to vaccinate among patients with type 1 (T1DM) and 2 (T2DM) diabetes, exploring factors associated with VH. METHODS AND RESULTS: A purposely created interview was delivered from physicians to a consecutive series of adult (>18 years) subjects with diabetes referring to the Diabetes Outpatient Clinic of Careggi Hospital, Florence, from January 1st to April 30th 2021. Out of 502 subjects enrolled, 92 were vaccine hesitant respondents (18.3%); the corresponding figure for T1DM and T2DM was 13.0% (N = 14), and 19.9% (N = 78), respectively. After adjusting for age, higher HbA1c (1.07 [1.02-1.13], p = 0.008) and triglycerides levels (1.03 [1.01-1.06], p = 0.011) were positively associated with VH, among patients with T1DM. At multivariate analysis, after adjusting for age, creatinine, and statin use, patients with T2DM affected by obesity (9.98 [4.89-9.59], p < 0.01) and with lower levels of creatinine (0.36 [0.21-0.54], p = 0.029) were more likely to refuse COVID vaccination. CONCLUSIONS: Hesitancy toward COVID-19 vaccination among subjects with diabetes is not negligible and seems to be more prevalent in individuals with lower adherence to medical prescriptions and/or reduced concerns over their health. This suggests the need for specific interventions to increase awareness and counter prejudices on vaccines.


Assuntos
Vacinas contra COVID-19/uso terapêutico , COVID-19/terapia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Vacinação/psicologia , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Análise Multivariada , SARS-CoV-2 , Inquéritos e Questionários , Recusa de Vacinação/psicologia
3.
Ital J Pediatr ; 47(1): 176, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34446073

RESUMO

INTRODUCTION: The Post-traumatic Stress Disorder (PTSD) is a group of persistent psychological and physiological symptoms due to a traumatic, severe, event. Only few studies focused on the effects of Covid-19 on psychosocial outcomes in children with Type 1 Diabetes (T1D) and their parents. AIM OF THE STUDY: The aim of this study was to evaluate the presence PTSD in parents of children with T1D during COVID-19 pandemic lockdown. PATIENTS AND METHODS: In the period between March and May 2020 we submitted the "Impact of Event Scale - Revised" (IES-R) questionnaire to the parents of 34 children with Type 1 Diabetes, asking them to express their emotions about the ongoing Covid-19 pandemic. RESULTS: A total of thirty mothers (mean age 43.0 ± 4.2 years) and 25 fathers (mean age 45.6 ± 5.9 years) participated in the survey and completed the questionnaires. 29.1% of parents had a score that allows to define a clinically relevant level of PTSD; ten mothers and 6 fathers had a PTSD clinically relevant score, corresponding, respectively, to 28.4 and 24% of total mothers and fathers. Finally, mothers and fathers, both express PTSD symptoms mainly in the form of intrusion and hyperarousal. CONCLUSIONS: The present study confirms a high prevalence symptoms related to PTSD in mothers and fathers of children with Type 1 Diabetes. We believe that psychosocial outcomes of the COVID-19 pandemic should be taken into account in the planning of the next future assistance for children with T1D.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis , Diabetes Mellitus Tipo 1/psicologia , Pai/psicologia , Mães/psicologia , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Adulto , COVID-19/epidemiologia , COVID-19/psicologia , Criança , Estudos de Coortes , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários , Avaliação de Sintomas
4.
Nutrients ; 13(7)2021 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-34371885

RESUMO

Type 1 diabetes mellitus (T1DM) patients occasionally develop disordered eating behaviors, leading to insulin manipulation without medical consultation, targeting to achieve weight control. In clinical practice, the Diabetes Eating Problem Survey-Revised Version (DEPS-R) questionnaire has been used to evaluate eating disorders in T1DM patients. This study was conducted to validate the factor structure of the Greek version of DEPS-R using Confirmatory Factor Analysis (CFA), to investigate its reliability and convergent validity in Greek T1DM adults and to compare a single factor DEPS-R model with multiple factor models. Participants were 103 T1DM adults receiving insulin, who responded to DEPS-R. Their anthropometric, biochemical and clinical history data were evaluated. The sample presented good glycemic control and 30.1% scored above the established DEPS-R cut-off score for disturbed eating behavior. CFA results revealed that the data fit well to the factor models. The DEPS-R scale had good reliability and was positively linked to BMI, HbA1c, total daily dose and time in range. Model comparison supported the superiority of the 1-factor model, implying that Greek clinicians and practitioners might not have to consider individualized treatment based on various scores across different subscales but they can adopt a single DEPS-R score for an easy and efficient screening for disordered eating.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Comportamento Alimentar/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Programas de Rastreamento/normas , Inquéritos e Questionários/normas , Adulto , Antropometria , Análise Fatorial , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Feminino , Grécia , Humanos , Masculino , Pessoa de Meia-Idade , Psicometria , Reprodutibilidade dos Testes , Traduções
6.
Psychiatr Pol ; 55(3): 511-523, 2021 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-34460878

RESUMO

OBJECTIVES: Assessment of mental state of patients with T1DM - the level of anxiety, stress and general mental health in the stressful conditions of an epidemic. Moreover, it was checked whether the stress response to the epidemic in the T1DM group differed from that in the control group. This is the first study to address these questions in the type 1 diabetes population in Poland. METHODS: An e-mail was sent to all T1DM patients under the care of a diabetes clinic with information about the possibility of online consultation with a psychologist / psychiatrist, with a set of psychological tests attached. The study included 49 patients with T1DM who responded within the first month and agreed to participate in the study. 38 people from the control group were randomly recruited. Each person completed a set of psychological tools. RESULTS: In both groups, the level of stress was higher than typical for the general population in the situation without stressor. T1DM patients who have been ill for over 10 years more often cope with stress through a task-oriented approach. Patients who have been ill for less than 10 years use avoidance strategies. In the first phase of the epidemic,women with T1DM used avoidance strategies. Patients with diabetes and mental disorders react more anxiously and thus require special care in coping with diabetes. CONCLUSIONS: In a situation of stress such as a epidemic, patients suffering from T1DM require optimization of treatment and cooperation of specialists in the field of diabetes and psychology / psychiatry.


Assuntos
Ansiedade/psicologia , COVID-19/psicologia , Diabetes Mellitus Tipo 1/psicologia , Estresse Psicológico/epidemiologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Adulto , Ansiedade/epidemiologia , COVID-19/epidemiologia , Estudos de Casos e Controles , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Humanos , Masculino , Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
7.
Pediatr Diabetes ; 22(7): 1071-1080, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34369043

RESUMO

OBJECTIVE: The current study explored pre-pandemic sociodemographics, medical characteristics, social/family support, and mood symptoms, and current COVID-19 experiences as predictors of mood, positive/negative diabetes-specific experiences, and COVID-19-specific distress among parents of children with type 1 diabetes during the COVID-19 pandemic. We hypothesized that parents from marginalized backgrounds, youth with higher pre-pandemic A1c and no CGM use, parents with lower pre-pandemic social/family support and more pre-pandemic mood/anxiety symptoms, and those with more negative COVID-19 experiences would have more depressive symptoms, fewer positive and more negative diabetes-specific experiences, and more COVID-19-specific distress during the initial months of the pandemic. RESEARCH DESIGN AND METHODS: Participants were parents of early school-age children with type 1 diabetes (n = 100; 65% non-Hispanic, white, 92% mothers, 75% married; Mchild age  = 6.74 ± 1.59 years) who had completed a behavioral intervention trial ≥6 months ago and were re-contacted in June/July 2020 to report on their COVID-19 pandemic experiences and parent psychosocial outcomes. Pre-pandemic parent mood/anxiety symptoms, family/social support, and children's medical characteristics (CGM use; MA1C  = 8.17% ± 1.40%) were assessed M = 1.45 ± 0.59 years prior. RESULTS: More pre-pandemic social support predicted fewer depressive symptoms, more positive diabetes-specific experiences, and less COVID-19-specific distress during the pandemic. More pre-pandemic depressive symptoms predicted more depressive symptoms during the pandemic. More life disruptions due to the pandemic were associated with more negative diabetes-specific experiences and more COVID-19-specific distress. Parents of color had more negative diabetes-specific experiences. CONCLUSIONS: Social support may be particularly important to assess and address through intervention. Pediatric diabetes care providers should monitor parent experiences in relation to children's diabetes management. ClinicalTrials.gov identifier: NCT02527525.


Assuntos
Ansiedade/psicologia , COVID-19/psicologia , Diabetes Mellitus Tipo 1/psicologia , Pandemias , Pais/psicologia , SARS-CoV-2 , Estresse Psicológico/psicologia , Ansiedade/epidemiologia , Ansiedade/etiologia , COVID-19/complicações , COVID-19/epidemiologia , Criança , Pré-Escolar , Comorbidade , Diabetes Mellitus Tipo 1/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Masculino , Poder Familiar/psicologia , Estudos Retrospectivos , Instituições Acadêmicas , Apoio Social , Estresse Psicológico/etiologia , Fatores de Tempo , Estados Unidos
8.
Diabet Med ; 38(11): e14665, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34327749

RESUMO

To investigate and characterise general and diabetes-specific worries related to COVID-19 among people with diabetes in Denmark during the first 3 months of the pandemic. In a longitudinal study from March to June 2020, six online questionnaires (Q1-Q6) were distributed to 2430 adult members of two diabetes panels. Worries related to COVID-19 were measured with closed- and open-ended items. Data from closed-ended items were analysed descriptively. Open-ended responses were analysed with systematic text condensation. Using chi-squared tests, changes in proportions of worries over time were analysed, and differences in diabetes-specific worries by gender and diabetes diagnosis were explored. At Q1, 1366 individuals returned a response (Q2: 1082, Q3: 992, Q4: 977, Q5: 901, Q6: 816). In the beginning of the pandemic, 2 weeks after the first lockdown in Denmark, the most frequently reported general worries related to someone close becoming seriously ill, changes in daily life such as limitations on social interactions and uncertainty about the duration of those changes. The most frequently reported diabetes-specific worries were about severity of illness with COVID-19 due to diabetes, being identified as a member of a group at risk for COVID-19 and being unable to manage diabetes if ill with COVID-19. All concerns decreased over 3 months, as the society gradually reopened, except for persistent worries about being able to manage diabetes if ill with COVID-19. More women and people with type 1 diabetes reported worries, compared with men and people with type 2 diabetes. Our study highlights the diversity of worries related to the COVID-19 pandemic among people with diabetes and changing patterns of worry over time and across subgroups as the society reopened in Denmark. These insights can be helpful when providing support for people with diabetes during health crises.


Assuntos
Ansiedade/psicologia , COVID-19 , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 2/psicologia , Autogestão/psicologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Dinamarca , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , SARS-CoV-2 , Índice de Gravidade de Doença , Fatores Sexuais , Inquéritos e Questionários , Adulto Jovem
9.
Health Psychol ; 40(5): 326-336, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34152786

RESUMO

OBJECTIVES: Prior research has linked illness identity-or the extent to which the illness is integrated into one's identity-to diabetes-specific functioning. Four illness identity dimensions have been identified: rejection, acceptance, engulfment, and enrichment. As longitudinal research on this topic is scarce, this study examined developmental trajectories of illness identity and prospective associations between illness identity and diabetes-specific functioning. METHOD: Adolescents and emerging adults with Type I diabetes, aged 14 to 25 (Mage = 19; 54% girls), participated in a four-wave longitudinal study spanning 3 years (N = 559 at Time 1). Participants filled out questionnaires on illness identity, treatment adherence, and diabetes-specific distress. Hemoglobin A1c (HbA1c) values were obtained from participants' medical records. To chart the development of illness identity over time, we performed latent growth curve modeling. Cross-lagged analysis was used to examine prospective associations between illness identity and diabetes-specific functioning. RESULTS: We observed small linear increases in acceptance (Mslope = .05, p < .01) and engulfment (Mslope = .03, p < .05) and a small linear decrease in rejection (Mslope = -.08, p < .001) across waves (with scale scores ranging between 1 and 5). Rejection negatively predicted and enrichment positively predicted treatment adherence 1 year later, which, in turn, positively predicted enrichment and negatively predicted engulfment over time. Furthermore, rejection and engulfment positively predicted diabetes-specific distress 1 year later. Finally, diabetes-specific distress and HbA1c positively predicted engulfment 1 year later. Standardized cross-lagged coefficients ranged between |.05| and |.11|. CONCLUSIONS: We identified small but interesting changes in three out of four illness identity dimensions. Prospective associations between illness identity and diabetes-specific functioning were bidirectional in nature. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Atitude Frente a Saúde , Diabetes Mellitus Tipo 1/psicologia , Ajustamento Emocional , Autoimagem , Adolescente , Adulto , Feminino , Humanos , Estudos Longitudinais , Masculino , Inquéritos e Questionários , Adulto Jovem
10.
Health Psychol ; 40(5): 337-346, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34152787

RESUMO

OBJECTIVE: Resilience processes include modifiable individual and family-based skills and behaviors and are associated with better health and emotional outcomes for youth with Type I diabetes (T1D). There is likely heterogeneity among adolescents with T1D based on differing profiles of resilience processes. At-risk adolescents with lower levels of modifiable skills and assets may benefit more from psychosocial skill-building interventions, compared to adolescents who already have strong resilience processes. This article identified whether there are subgroups of adolescents with T1D based on resilience process profiles and assessed differences in glycemic control, diabetes management behaviors, and distress at baseline. It also evaluated subgroups as moderators of the efficacy of a psychosocial skill-building program. METHOD: Two hundred sixty-four adolescents with T1D (14 to 18 years) were randomly assigned to a resilience-promoting program (N = 133) or diabetes education control (N = 131). Data were collected at seven time points over 3 years and analyzed with latent profile analysis and latent growth curve modeling. RESULTS: There were two subgroups with high- versus low-resilience processes. The low-resilience subgroup exhibited more distress, higher HbA1c, less glucose monitoring, and fewer diabetes management behaviors at baseline. Differences persisted over 3 years. Subgroup membership did not moderate the efficacy of a resilience-promoting program compared to control. The resilience program resulted in lower distress regardless of subgroup. CONCLUSIONS: There is heterogeneity in resilience process profiles, which are associated with clinically meaningful differences in distress, diabetes management, and glycemic control. Findings can be used to identify at-risk teenagers and inform a targeted approach to care. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Promoção da Saúde/métodos , Resiliência Psicológica , Adolescente , Feminino , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde
11.
Res Nurs Health ; 44(4): 643-652, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34125441

RESUMO

This prospective study tested a model to depict associations between a number of individual characteristics and 6-month glycated hemoglobin (HbA1c) levels in adolescents with type 1 diabetes (T1D). Adolescents (N = 232) aged 10-19 years with T1D were recruited from a medical center in Taiwan. Demographic characteristics, emotional autonomy, problem-solving ability, self-efficacy at baseline, and self-management information three months after baseline were collected using a self-reported questionnaire. HbA1c levels 6 months after study commencement were obtained from medical records. Structural equation modeling was used to test the model. Higher baseline self-efficacy and self-management at 3 months were directly associated with lower 6-month HbA1c levels. Higher baseline problem-solving ability and self-efficacy were directly associated with higher 3-month self-management, and higher baseline problem-solving ability was directly associated with higher baseline self-efficacy. Higher baseline emotional autonomy was directly associated with lower 6-month HbA1c levels but indirectly associated with higher 6-month HbA1c levels through the mediation of lower problem-solving ability, self-efficacy, and 3-month self-management. Findings indicate that improving self-management is essential to improving subsequent glycemic control, which might be achieved by enhancing problem-solving ability and self-efficacy. Strengthening problem-solving ability could diminish the negative impact of emotional autonomy on subsequent glycemic control in adolescents with T1D.


Assuntos
Controle Glicêmico , Autonomia Pessoal , Resolução de Problemas , Autoeficácia , Autogestão , Adolescente , Diabetes Mellitus Tipo 1/psicologia , Feminino , Hemoglobina A Glicada/análise , Humanos , Masculino , Estudos Prospectivos , Autorrelato , Inquéritos e Questionários , Taiwan
12.
Diabetes Metab Syndr ; 15(4): 102175, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34186374

RESUMO

BACKGROUND AND AIMS: We aimed to assess patient perception toward the rapid implementation of virtual phone clinics among Saudi adult patients with type 1 diabetes mellitus (T1DM) during the coronavirus disease (COVID-19) pandemic. METHODS: This cross-sectional, web-based study included Saudi adult patients with T1DM who attended at least one virtual phone visit with the diabetes clinic at King Abdulaziz Medical City, Jeddah, Saudi Arabia, between August 1 and December 31, 2020. Patients anonymously answered a Google form-created Arabic questionnaire. Information about patient characteristics, outcome, and perception of the virtual phone visit were obtained. Data were presented using descriptive statistics, chi-square, one-way ANOVA, independent t-, and Welch's t-tests. RESULTS: The questionnaire was sent to 281 patients, of whom 201 completed it. 59.2% patients were satisfied with their overall virtual phone clinic experience, and 75.6% preferred to continue attending the virtual phone clinics in the future. The average perception value of patients toward virtual phone clinics was 67.76 ± 19.9, suggesting good perception among the majority. Negative or neutral views of current health, asking to be physically seen, and missing a virtual appointment were associated with significantly lower average patient perception value (p < 0.001). CONCLUSIONS: Most Saudi patients with T1DM have adapted to virtual phone consultations, exhibiting good satisfaction and perception, and high preference to continue using this system in the future. The utilization of the service to assist patients with diabetes is highly encouraged, especially during the COVID-19 pandemic. Strategies need to be developed to further enhance the patient experience.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , COVID-19/complicações , Diabetes Mellitus Tipo 1/prevenção & controle , Hospitalização/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , SARS-CoV-2/isolamento & purificação , Adolescente , Adulto , COVID-19/transmissão , COVID-19/virologia , Estudos Transversais , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/virologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Percepção , Encaminhamento e Consulta , Arábia Saudita/epidemiologia , Inquéritos e Questionários , Adulto Jovem
13.
J Pediatr Endocrinol Metab ; 34(9): 1089-1093, 2021 Sep 27.
Artigo em Inglês | MEDLINE | ID: mdl-34171940

RESUMO

OBJECTIVES: Our study aims to assess the impact of lockdown during the coronavirus disease 2019 pandemic on glycemic control and psychological well-being in youths with type 1 diabetes. METHODS: We compared glycemic metrics during lockdown with the same period of 2019. The psychological impact was evaluated with the Test of Anxiety and Depression. RESULTS: We analyzed metrics of 117 adolescents (87% on Multiple Daily Injections and 100% were flash glucose monitoring/continuous glucose monitoring users). During the lockdown, we observed an increase of the percentage of time in range (TIR) (p<0.001), with a significant reduction of time in moderate (p=0.002), and severe hypoglycemia (p=0.001), as well as the percentage of time in hyperglycemia (p<0.001). Glucose variability did not differ (p=0.863). The glucose management indicator was lower (p=0.001). 7% of youths reached the threshold-score (≥115) for anxiety and 16% for depression. A higher score was associated with lower TIR [p=0.028, p=0.012]. CONCLUSIONS: Glycemic control improved during the first lockdown period with respect to the previous year. Symptoms of depression and anxiety were associated with worse glycemic control; future researches are necessary to establish if this improvement is transient and if psychological difficulties will increase during the prolonged pandemic situation.


Assuntos
Ansiedade/epidemiologia , COVID-19/epidemiologia , Depressão/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Controle Glicêmico , SARS-CoV-2 , Adolescente , Criança , Diabetes Mellitus Tipo 1/sangue , Feminino , Humanos , Masculino , Adulto Jovem
14.
Worldviews Evid Based Nurs ; 18(3): 217-225, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34018327

RESUMO

AIMS: To synthesize evidence about the impact of Internet and phone-based diabetes education and management on metabolic control, self-management behavior changes, and psychological effects among children and adolescents with type 1 diabetes mellitus (T1DM). BACKGROUND: Internet and mobile technologies were commonly used to improve diabetes management among children and adolescents with type 1 diabetes mellitus. The effectiveness of new technology-based diabetes education and management has previously not been synthesized. METHODS: PubMed, EBSCO, Cochrane Library, Web of Science, Joanna Briggs Institute Library, and the Chinese databases CNKI and Wanfang were searched from 1989 to March 2020. Two reviewers independently selected randomized controlled trials (RCTs), in English and Chinese, which compared an intervention group of new technology-based diabetes education and management with a control group of usual care. The primary outcomes were metabolic control, such as glycated hemoglobin (HbA1c), and secondary outcomes consisted of behavior changes and psychological effects, such as self-efficacy and quality of life. RESULTS: A total of 23 RCTs with 1,824 participants met the inclusion criteria. The meta-analysis showed that phone calls could significantly reduce HbA1c (MD = -.17; 95% CI [-.33, -.01]; I2  = 0%) in children and adolescents with T1DM. New technology-based diabetes education and management could significantly improve self-efficacy (SMD = 0.37; 95% CI [.07, .67]; I2  = 0%). No benefits on behavior changes and quality of life were identified. LINKING EVIDENCE TO ACTION: New technology-based diabetes education has potential benefits for children and adolescents with T1DM, such as improving metabolic control through phone calls and increasing their self-efficacy of diabetes management. Well-designed RCTs with larger sample sizes and longer intervention duration should be conducted, especially in developing countries.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Intervenção Baseada em Internet , Qualidade da Assistência à Saúde/normas , Adolescente , Criança , Diabetes Mellitus Tipo 1/terapia , Gerenciamento Clínico , Feminino , Humanos , Masculino , Pediatria/métodos , Melhoria de Qualidade/tendências , Qualidade da Assistência à Saúde/estatística & dados numéricos , Autocuidado/psicologia , Autoeficácia
15.
Lancet Diabetes Endocrinol ; 9(7): 436-445, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-34051936

RESUMO

BACKGROUND: With improved treatment, individuals with type 1 diabetes are living longer but there is limited information on the effects of type 1 diabetes on cognitive ability as they become older adults. We followed up individuals with type 1 diabetes to identify independent risk factors for cognitive decline as people age. METHODS: 1051 participants with type 1 diabetes enrolled in the Diabetes Control and Complications Trial (DCCT) and its follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study. Participants completed cognitive assessments at baseline (median age 27 years) and 2, 5, 18, and 32 years later (median age 59). HbA1c levels, frequency of severe hypoglycaemia, non-glycemic risk factors such as elevated blood pressure, and microvascular and macrovascular complications were assessed repeatedly. We examined the effects of these on measures of memory and psychomotor and mental efficiency. These studies are registered with clinicaltrials.gov, NCT00360815 (DCCT) and NCT00360893 (EDIC). FINDINGS: Over 32 years of follow-up, we found substantive declines in memory and psychomotor and mental efficiency. Between 18 and 32 years of follow-up, the decline in psychomotor and mental efficiency was five times larger than the change from baseline to year 18. Independent of the other risk factors and comorbidities, exposure to higher HbA1c levels, more episodes of severe hypoglycaemia, and elevated systolic blood pressure were associated with greater decrements in psychomotor and mental efficiency that was most notable by year 32 (p<0·0001). The combined effect of the presence of these three risk factors is the equivalent to an additional 9·4 years of age. INTERPRETATION: Cognitive function declines with ageing in type 1 diabetes. The association of glycaemia and blood pressure levels with cognitive decline suggests that better management might preserve cognitive function. FUNDING: United States National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Disease.


Assuntos
Cognição/fisiologia , Disfunção Cognitiva/epidemiologia , Disfunção Cognitiva/psicologia , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 1/psicologia , Adolescente , Adulto , Idoso , Disfunção Cognitiva/etiologia , Diabetes Mellitus Tipo 1/complicações , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Adulto Jovem
16.
BMC Endocr Disord ; 21(1): 96, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-33964904

RESUMO

BACKGROUND: Mental health problems are highly prevalent in people with type 1 diabetes mellitus (T1DM), which adversely impact physical health and quality of life. This study aimed to explore the experiences of people with T1DM who had completed the Mental health IN DiabeteS Optimal Health Program (MINDS OHP), a novel intervention developed to bridge the gap between physical and mental health care. METHOD: Participants with T1DM were invited to take part in a focus group or semi-structured interviews. Participants were recruited from outpatient and community settings. The focus group and interviews were audio-recorded and transcribed verbatim. Thematic content analysis was used and identified themes were cross-validated by researchers and member-checked by participants. RESULTS: Ten people with T1DM were included. Two key themes emerged: 'MINDS OHP experiences' and 'lived experiences of diabetes'. MINDS OHP experiences included five sub-themes: program benefits, follow-up and timing, suggested improvements, collaborative partners, and materials suitability. Lived experiences also included five sub-themes: bridging the gap between mental and physical health, support networks, stigma and shame, management intrusiveness, and adolescence and critical life points. CONCLUSIONS: The MINDS OHP for people with T1DM was generally well received, though study findings suggest a number of improvements could be made to the program, such as including family members, and consideration being given to its routine early inclusion in diabetes management, ideally in primary care.


Assuntos
Diabetes Mellitus Tipo 1/psicologia , Saúde Mental , Adulto , Idoso , Diabetes Mellitus Tipo 1/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa
17.
BMC Med Ethics ; 22(1): 37, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33794874

RESUMO

BACKGROUND: The transplantation of porcine islet cells provides a new potential therapy to treat patients with type 1 diabetes mellitus (T1DM). Compared to other biomedical technologies, xenotransplantation stands out in terms of its involvement of animals as graft sources, as well as the possible transmission of infectious diseases. As these aspects are especially relevant for potential xenotransplantation recipients, it is important to assess their opinion regarding this technology, in particular in terms of the requirements that should be met in the informed consent process for xenotransplantation. METHODS: We conducted qualitative interviews with seven T1DM patients to assess their information needs prior to xenotransplantation. Before the interview, the participants received a model informed consent form for a clinical trial with porcine islet cells transplantation. The interviews were transcribed and analysed using qualitative content analysis. RESULTS: In the interviews, we identified several requirements that are crucial for patients with T1DM in order to consider xenotransplantation as a potential treatment option: therapy-related requirements, professional care and supervision, successful behaviour and attitude management, improving quality of life, and managing control/self-determination challenges. Regarding the informed consent form, several of the participants' questions remained open and should be addressed in more detail. The interviewees stressed the importance of personal consultations. CONCLUSIONS: To become a sustainable therapeutic option, patients especially expected an improved diabetes control and a reduction of diabetes-related burdens. Health-related aspects prove to be pivotal for diabetic patients when considering porcine islet cell transplantation. The use of pigs as source for organ retrievals was not considered as problematic.


Assuntos
Diabetes Mellitus Tipo 1/cirurgia , Consentimento Livre e Esclarecido , Transplante das Ilhotas Pancreáticas/métodos , Transplante Heterólogo/ética , Animais , Diabetes Mellitus Tipo 1/psicologia , Humanos , Transplante das Ilhotas Pancreáticas/ética , Seleção de Pacientes , Qualidade de Vida , Suínos
18.
J Pediatr Endocrinol Metab ; 34(6): 697-705, 2021 Jun 25.
Artigo em Inglês | MEDLINE | ID: mdl-33838092

RESUMO

OBJECTIVES: To explore mental and somatic health, quality of life, alcohol-related problems, sleep problems, and diabetes related distress in university students with type 1 diabetes (T1D), compared to students without T1D. Further, we evaluated associations with gender, treatment modalities, and achieved metabolic control. METHODS: All fulltime Norwegian students aged 18-35 years pursuing higher education in 2018 (n=162.512) were invited into a comprehensive national survey on health and well-being. Students that stated having diabetes was asked further questions about their diabetes care. RESULTS: Of 49,684 participating students, 324 participants stated having T1D. Students with T1D did not show more mental or somatic health symptoms, or report a higher level of loneliness. However, T1D was significantly associated with lower quality of life (QoL). Students with good metabolic control reached the same QoL as students without T1D. Mental disorders and suicidality were associated with lacking metabolic control. The proportion of unhealthy drinking habits was generally low, and even lower in students with T1D. Sleeping patterns were generally good, but students using continuous glucose measurement were awakening more often during sleep. Females with T1D showed higher levels of diabetes related problems and distress, but good metabolic control was associated with lower diabetes distress level. CONCLUSIONS: Students with T1D scored equally on most mental and somatic health scales. Their quality of life was significantly worse compared to their healthy peers. Knowledge on the impact of metabolic control, gender and the use of CSII and CGM can be valuable for the caretakers of young adults with T1D.


Assuntos
Biomarcadores/sangue , Diabetes Mellitus Tipo 1/psicologia , Nível de Saúde , Hipoglicemiantes/uso terapêutico , Saúde Mental , Qualidade de Vida , Estudantes/psicologia , Adolescente , Adulto , Glicemia/análise , Automonitorização da Glicemia/métodos , Estudos Transversais , Diabetes Mellitus Tipo 1/tratamento farmacológico , Feminino , Seguimentos , Humanos , Sistemas de Infusão de Insulina , Masculino , Prognóstico , Inquéritos e Questionários , Universidades/estatística & dados numéricos , Adulto Jovem
19.
Acta Diabetol ; 58(7): 929-937, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33743083

RESUMO

AIMS: To determine if arterial functional and structural changes are associated with underlying cerebral small vessel disease in neurologically asymptomatic individuals with type 1 diabetes. METHODS: We enrolled 186 individuals (47.8% men; median age 40.0, IQR 33.0-45.0 years) with type 1 diabetes (median diabetes duration of 21.6, IQR 18.2-30.3 years), and 30 age- and sex-matched healthy controls, as part of the Finnish Diabetic Nephropathy (FinnDiane) Study. All individuals underwent a biochemical work-up, brain magnetic resonance imaging (MRI), ultrasound of the common carotid arteries and arterial tonometry. Arterial structural and functional parameters were assessed by carotid intima-media thickness (CIMT), pulse wave velocity and augmentation index. RESULTS: Cerebral microbleeds (CMBs) were present in 23.7% and white matter hyperintensities (WMHs) in 16.7% of individuals with type 1 diabetes. Those with type 1 diabetes and CMBs had higher median (IQR) CIMT 583 (525 - 663) µm than those without 556 (502 - 607) µm, p = 0.016). Higher CIMT was associated with the presence of CMBs (p = 0.046) independent of age, eGFR, ApoB, systolic blood pressure, albuminuria, history of retinal photocoagulation and HbA1c. Arterial stiffness and CIMT were increased in individuals with type 1 diabetes and WMHs compared to those without; however, these results were not independent of cardiovascular risk factors. CONCLUSIONS: Structural, but not functional, arterial changes are associated with underlying CMBs in asymptomatic individuals with type 1 diabetes.


Assuntos
Espessura Intima-Media Carotídea , Doenças de Pequenos Vasos Cerebrais/diagnóstico , Diabetes Mellitus Tipo 1/diagnóstico , Rigidez Vascular , Adulto , Doenças Assintomáticas , Pressão Sanguínea/fisiologia , Artérias Carótidas/diagnóstico por imagem , Estudos de Casos e Controles , Doenças de Pequenos Vasos Cerebrais/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/psicologia , Angiopatias Diabéticas/diagnóstico , Angiopatias Diabéticas/etiologia , Feminino , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Análise de Onda de Pulso , Fatores de Risco , Ultrassonografia
20.
Afr J Prim Health Care Fam Med ; 13(1): e1-e9, 2021 Feb 17.
Artigo em Inglês | MEDLINE | ID: mdl-33764139

RESUMO

BACKGROUND: Living with diabetes is challenging, especially for adolescents at risk of poor glycaemic control. Understanding the illness perceptions of this group is important to be able to develop interventions for this growing population in need. AIM: This study explored the illness perception amongst adolescents living with type 1 diabetes (T1D) and how these perceptions interacted with the management of T1D. SETTING: This study was conducted at a medical centre providing care for adolescents living with T1D in Parktown, South Africa. METHODS: A qualitative, explorative design with semi-structured interviews was followed. A non-random purposive sampling method was utilised. The illness perception amongst eight adolescents, aged 12-18 years, at risk of poor glycaemic control, was analysed through thematic analysis. RESULTS: Two subthemes related to illness perception were generated, namely (1) illness perception of T1D is negative and (2) living with T1D leads to a sense of being different. Furthermore, two subthemes were generated in relation to how illness perceptions interacted with diabetes management, namely (3) management of T1D is challenging and (4) management of T1D is motivated by fear. CONCLUSION: This group of adolescents with at-risk glycaemic control believed that T1D is difficult to manage, leading to a largely negative perception of the disease. This study contributes to the body of literature on adolescents where illness perception may play a role in adhering to diabetes care plans. This research may give additional insights into the awareness of illness perception in designing successful interventions.


Assuntos
Grupo com Ancestrais do Continente Africano/psicologia , Diabetes Mellitus Tipo 1/psicologia , Diabetes Mellitus Tipo 1/terapia , Hipoglicemiantes/uso terapêutico , Autogestão/psicologia , Adolescente , Automonitorização da Glicemia , Diabetes Mellitus Tipo 1/etnologia , Gerenciamento Clínico , Feminino , Controle Glicêmico , Humanos , Masculino , Percepção , África do Sul
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