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.

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.

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.