Sleep in children with type 1 diabetes and their parents in the T1D Exchange

Objectives Sleep has physiological and behavioral impacts on diabetes outcomes, yet little is known about the impact of sleep disturbances in children with type 1 diabetes. The current study sought to characterize sleep in children with type 1 diabetes and in their parents and to examine the associations between child sleep, glycemic control and adherence, parent sleep and well-being, parental fear of hypoglycemia, and nocturnal caregiving behavior. Methods Surveys were emailed to parents of 2- to 12-year-old participants in the Type 1 Diabetes (T1D) Exchange clinic registry. Clinical data were obtained from the registry for the 515 respondents. Results In our sample, 67% of children met criteria for poor sleep quality. Child sleep quality was related to glycemic control (HbA1c of 7.9% [63 mmol/mol] in children with poor sleep quality vs 7.6% [60 mmol/mol] in children with non-poor sleep quality; P < 0.001) but not mean frequency of blood glucose monitoring (BGM) (7.6 times/day vs 7.4 in poor/non-poor quality; P = 0.56). Associations were similar for sleep duration. Children with poor sleep quality were more likely to experience severe hypoglycemia (4% in children with poor sleep quality vs 1% in children with non-poor sleep quality; P = 0.05) and more likely to experience DKA (7% vs 4%, respectively; P < 0.001). Poorer child sleep quality was associated with poorer parental sleep quality, parental well-being, and fear of hypoglycemia (P < 0.001 for all). Child sleep was not related to the use of diabetes-related technology (CGM, insulin pump). Conclusions Sleep may be a modifiable factor to improve glycemic control and reduce parental distress

Design and Psychometrics for New Measures of Health-Related Quality of Life in Adults with Type 1 Diabetes: Type 1 Diabetes and Life (T1DAL)

AIMS: To use a three-phase process to develop and validate new self-report measures of diabetes-specific health-related quality of life (HRQOL) for adults with type 1 diabetes. We report on four versions of the Type 1 Diabetes and Life (T1DAL) measure for people age 18-25, 26-45, 46-60, and over 60 years. METHODS: We first conducted qualitative interviews to guide measure creation, then piloted the draft measures. We evaluated psychometric properties at six T1D Exchange Clinic Network sites via completion of T1DAL and validated measures of related constructs. Participants completed the T1DAL again in 4-6 weeks. We used psychometric data to reduce each measure to 23-27 items in length. Finally, we obtained participant feedback on the final measures. RESULTS: The T1DAL-Adult measures demonstrated good internal consistency (α=0.85-0.88) and test-retest reliability (r=0.77-0.87). Significant correlations with measures of general quality of life, generic and diabetes-specific HRQOL, diabetes burden, self-management, and glycemic control demonstrated validity. Factor analyses yielded 4-5 subscales per measure. Participants were satisfied with the final measures and reported they took 5-10 minutes to complete. CONCLUSIONS: The strong psychometric properties of the newly developed self-report T1DAL measures for adults with type 1 diabetes make them appropriate for use in clinical research and care

Importance of Patient–Provider Communication to Adherence in Adolescents with Type 1 Diabetes

Effective communication between pediatric diabetes patients and their providers has the potential to enhance patient satisfaction and health outcomes, as well as improve diabetes-related self-management. In this review, we highlight the importance of communication between patients and providers, focusing on the effect of communication on adherence in the high-risk population of adolescents with type 1 diabetes. We synthesize the literature describing patient–provider communication in pediatric populations and provide implications for practice that focus on the most relevant, modifiable factors for improving self-management in adolescents with type 1 diabetes

Measures of Adherence and Challenges in Using Glucometer Data in Youth with Type 1 Diabetes: Rethinking the Value of Self-Report

Purpose. The current study compares the relative strength of associations of different adherence measures with glycemic control in adolescents with type 1 diabetes, while highlighting the challenges in using more objective measures (i.e., glucometer data). Methods. Adolescents with type 1 diabetes (n=149) and their caregivers completed a questionnaire measure assessing adolescents’ adherence (Self-Care Inventory (SCI)) to the diabetes regimen. Adolescents’ glucometers were downloaded to determine average blood glucose checks per day, as an objective measure of adherence. A measure of glycemic control (hemoglobin A1c (HbA1c)) was obtained as part of adolescents’ regular clinic visits. Results. Adolescents’ self-reported adherence to the treatment regimen was more strongly correlated with HbA1c than caregivers’ reports of adherence. In multivariate analyses, both adolescents’ self-report of adherence and average blood glucose checks per day (obtained via a glucometer) were significant predictors of HbA1c. Challenges to obtaining glucometer data were identified. Conclusions. The findings highlight adolescents’ self-report of adherence using the SCI as a brief and meaningful measure to understand and improve adolescents’ glycemic control, particularly when glucometer data is difficult to obtain

Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes

AIMS: Although research exists on parental communication in adolescents with type 1 diabetes (T1D), the role of communication by health care providers remains understudied. Grounded in Self-Determination Theory, this study examined the role of autonomy-supportive communication (i.e., providing meaningful rationale and offering choices with regard to treatment recommendations) by providers and parents, and how they interact in the prediction of diabetes outcomes. METHODS: In this cross-sectional study, 135 adolescents (mean age 14.3 ± 2.1SD years), 171 mothers, and 121 fathers reported on autonomy-supportive communication from health care providers and parents, and on adolescent treatment adherence. HbA1c values were retrieved from the medical record. RESULTS: In adolescent reports, perceived autonomy-supportive communication from providers but not from parents was positively related to treatment adherence. A significant interaction between autonomy-supportive communication from providers and parents pointed to the highest level of treatment adherence when adolescents perceived both providers and parents as autonomy-supportive. In contrast, parental reports revealed that parental autonomy-supportive communication was positively related to treatment adherence, whereas autonomy-supportive communication by providers was not. CONCLUSIONS: Autonomy-supportive communication by providers and parents is associated with better treatment adherence in adolescents with T1D. Interventions to improve autonomy-supportive communication by parents and providers may improve treatment adherence of adolescents (e.g., communication training).status: publishe

Communication matters: The role of autonomy-supportive communication by health care providers and parents in adolescents with type 1 diabetes

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