Effects of comorbid conditions on health-related quality of life in youth with Type 2 diabetes: the TODAY clinical trial.

AIM: To explore associations between health-related quality of life (HRQOL) and comorbidities in youth with Type 2 diabetes. PATIENTS & METHODS: Of 699 youth in the TODAY study, 685 (98%) had baseline HRQOL data, 649 (93%) at 6 months and 583 (83%) at 24 months. Comorbidities were defined by sustained abnormal values and treatment regimens. RESULTS: At baseline, 22.2% of participants demonstrated impaired HRQOL. Only depressive symptoms distinguished those with versus without impaired HRQOL and were significantly related to later impaired HRQOL (p < 0.0001). A significant correspondence between impaired HRQOL and number of comorbidities (p = 0.0003) was noted, but was driven by the presence of depressive symptoms. CONCLUSION: Results emphasize the need for evaluation of depressive symptoms. Other comorbidities did not have a significant impact on HRQOL in this cohort

Benefits and barriers to participating in longitudinal research of youth-onset type 2 diabetes: Results from the TODAY retention survey.

BACKGROUND/AIMS: Conducting longitudinal research related to chronic illness in adolescents is inherently challenging due to developmental changes and psychosocial stressors. Participants in the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) clinical trial were socio-economically disadvantaged as well. This study assessed attitudes and beliefs about retention in TODAY to shed light on the factors that potentially promote and detract from the likelihood of sustained participation. METHODS: After an average 7.3 years of follow-up (range 4.9-9.5), TODAY participants completed a survey examining their perceptions of the benefits and barriers to sustained involvement in the protocol. RESULTS: The most common reasons for staying in TODAY included having a strong relationship with the medical team, getting study-provided diabetes care, access to free diabetes medicine and supplies, and being part of a large study to learn more about how to care for youth-onset type 2 diabetes. The most commonly endorsed challenges included scheduling conflicts, possibly disappointing others, difficulties getting to study visits, and the occurrence of other medical issues. CONCLUSIONS: Similar to other published reports, a supportive relationship with study staff was commonly endorsed as a benefit of engagement in the longitudinal study, suggesting that rapport, staff consistency, and relationship quality are important components of optimal retention. Moreover, our findings suggest the value of trying to remove logistical barriers, such as transportation and scheduling challenges, in order to promote long-term participation in research. Further research is recommended to evaluate factors that contribute to attrition versus retention in an a priori manner within longitudinal studies, especially protocols involving cohorts that are more vulnerable to attrition due to developmental transitions and/or socio-economic challenges. Additional efforts to optimize quantitative and qualitative measurement of barriers would also help to expand our understanding of how to optimally retain participants in longitudinal protocols

Longitudinal Correlates of Health Risk Behaviors in Children and Adolescents with Type 2 Diabetes.

OBJECTIVES: To characterize, over a two-year period, the proportion of youth with type 2 diabetes (T2D) enrolled in the Treatment Options for Type 2 Diabetes in Adolescents and Youth (TODAY) study that reported ever at least trying smoking cigarettes and/or drinking alcohol. STUDY DESIGN: Longitudinal data were examined for participants with T2D ages 10 to 18 years old at baseline. Youth psychosocial, parent/family, environmental, and biological correlates of trying health risk behaviors were tested via cross-sectional multivariate models at each time point. Longitudinal models were explored for selected factors. RESULTS: Data were obtained from the TODAY study’s ethnically diverse participants at baseline (N=644), 6-month (N=616), and 24-month (N=543) assessments. Percent of youth ever trying only smoking remained stable at 4%, only drinking alcohol increased from 17% to 26%, and both smoking and drinking increased from 10% to 18% over the two-year period. Factors related to trying health risk behaviors were older age, male sex, non-Hispanic White race-ethnicity, lower grades, more depressive symptoms and stressful life events. Depressive symptoms, stressful life events, and BMI Z-score (the latter with smoking only) were related to engagement in health risk behaviors over time. CONCLUSIONS: Youth with T2D who are already at risk for health complications and who reported engaging in activities that further increase the likelihood of life-threatening morbidities were characterized. Although most correlates of trying these risk behaviors are non-modifiable, intervention efforts may need to focus on potentially modifiable factors, such as depressive symptoms and lower grades

Relationships among stressful life events and physiological markers, treatment adherence, and psychosocial functioning among youth with type 2 diabetes

OBJECTIVE: To examine the relationship between stressful life events and physiological measures, medication adherence, depressive symptoms, and impaired quality of life in adolescents with recent onset type 2 diabetes (T2D). STUDY DESIGN: Data were collected from 497 ethnically diverse participants (66% female) in the final year of the Treatment Options for type 2 Diabetes in Adolescents and Youth (TODAY) multi-center clinical trial. Exposure to 32 possible events over the prior year and rating of subsequent distress or upset were collected by self-report, and summarized in a major stressors score. The score was analyzed for relationship to glycemic control (HbA1c and treatment failure), BMI, diagnosis of hypertension or triglycerides dyslipidemia, oral medication adherence, presence of depressive symptoms, and impaired quality of life. RESULTS: The total number of major stressful life events was calculated, with 33% of the sample reporting none, 67% at least one, 47% at least two, 33% at least three, and 20% reporting four or more. There were no associations between major stressors score and physiological measures or diagnosis of comorbidities. The odds of medication non-adherence increased significantly from those reporting at least one major stressor (odds ratio=1.58, p=0.0265) to those reporting at least 4 (odds ratio=2.70, p=0.0009). Significant odds of elevated depressive symptoms and impaired quality of life were also found with increased reporting of major stressors. CONCLUSIONS: Exposure to major stressful life events is association with lower adherence and impaired psychosocial functioning among adolescents with T2D