Multidisciplinary management of type 2 diabetes in children and adolescents

Although once considered a disease of adults, the prevalence of type 2 diabetes in youth is increasing at a significant rate. Similar to adults, youth with type 2 diabetes are at increased risk for developing hypertension, lipid abnormalities, renal disease, and other diabetes-related complications. However, children and adolescents with type 2 diabetes also face many unique management challenges that are different from adults with type 2 diabetes or children with type 1 diabetes. To deliver safe, effective, high-quality, cost-effective health care to adolescents with type 2 diabetes, reorganization and redesign of health care systems are needed. Multidisciplinary health care teams, which allow individuals with specialized training to maximally utilize their skills within an organized diabetes treatment team, may increase efficiency and effectiveness and may improve outcomes in children with type 2 diabetes. This review article provides a brief review of type 2 diabetes in children and adolescents, provides an overview of multidisciplinary health care teams, and discusses the role of multidisciplinary health care management in youth with type 2 diabetes

Patients’, Caregivers’, and Providers’ Perceived Strategies for Diabetes Care

Objectives: To explore strategies to improve type 2 diabetes mellitus (T2DM) self-management among low-income and minority groups. Methods: Focus groups centered on T2DM self-care behaviors were conducted using convenient sample of patients with T2DM (N = 17), caregivers (N = 5) and healthcare providers (N = 15). Results: Patients and caregivers perceived strategies included improving patient-provider communication, providers’ accessibility and compassion, and flexible clinic hours. Strategies identified by providers were realistic patient’s expectations, family support, and community resources. Conclusions: To our knowledge, this study is the first to elicit strategies to improve T2DM self-management through a joint meeting of patients, caregivers, and healthcare providers. Study findings could help inform future efforts to assist patients better manage their T2DM

Perspective: The Role of Numeracy in Health Care

Numeracy, the “ability to understand and use numbers in daily life” is an important but understudied component of literacy. Numeracy-related tasks are common in healthcare and include understanding nutrition information, interpreting blood sugar readings and other clinical data, adjusting medications, and understanding probability in risk communication. While literacy and numeracy are strongly correlated, we have identified many patients with adequate reading ability but poor numeracy skills. Better tools to measure numeracy and more studies to assess the unique contribution of numeracy are needed. This research can contribute to developing interventions to improve outcomes for patients with poor numeracy

Racial and Ethnic Differences in Injury Prevention Behaviors Among Caregivers of Infants

African American and Latino children experience higher rates of traumatic injury and mortality, but the extent to which parents of different races and ethnicities disparately enact injury prevention behaviors has not been fully characterized. The objective of this study is to evaluate the association between caregiver race/ethnicity and adherence to injury prevention recommendations

Bottle Size and Weight Gain in Formula-Fed Infants

Formula-fed infants may be at greater risk for overfeeding and rapid weight gain. Different size bottles are used for feeding infants, although little is known about whether bottle size is related to weight gain in bottle-fed infants

Development and validation of the Diabetes Numeracy Test (DNT)

<p>Abstract</p> <p>Background</p> <p>Low literacy and numeracy skills are common. Adequate numeracy skills are crucial in the management of diabetes. Diabetes patients use numeracy skills to interpret glucose meters, administer medications, follow dietary guidelines and other tasks. Existing literacy scales may not be adequate to assess numeracy skills. This paper describes the development and psychometric properties of the Diabetes Numeracy Test (DNT), the first scale to specifically measure numeracy skills used in diabetes.</p> <p>Methods</p> <p>The items of the DNT were developed by an expert panel and refined using cognitive response interviews with potential respondents. The final version of the DNT (43 items) and other relevant measures were administered to a convenience sample of 398 patients with diabetes. Internal reliability was determined by the Kuder-Richardson coefficient (KR-20). An <it>a priori </it>hypothetical model was developed to determine construct validity. A shortened 15-item version, the DNT15, was created through split sample analysis.</p> <p>Results</p> <p>The DNT had excellent internal reliability (KR-20 = 0.95). The DNT was significantly correlated (p < 0.05) with education, income, literacy and math skills, and diabetes knowledge, supporting excellent construct validity. The mean score on the DNT was 61% and took an average of 33 minutes to complete. The DNT15 also had good internal reliability (KR-20 = 0.90 and 0.89). In split sample analysis, correlations of the DNT-15 with the full DNT in both sub-samples was high (rho = 0.96 and 0.97, respectively).</p> <p>Conclusion</p> <p>The DNT is a reliable and valid measure of diabetes related numeracy skills. An equally adequate but more time-efficient version of the DNT, the DNT15, can be used for research and clinical purposes to evaluate diabetes related numeracy.</p

Confirmatory factor analysis of the Infant Feeding Styles Questionnaire in Latino families

Parent feeding practices affect risk of obesity in children. Latino children are at higher risk of obesity than the general population, yet valid measure of feeding practices, one of which is the Infant Feeding Styles Questionnaire (IFSQ), have not been formally validated in Spanish

Effect of Health Literacy and Exercise Intervention on Medical Mistrust of Type 2 Diabetes Patients in the Community

BackgroundMedical distrust in patients has been related with poor compliance to medications and suboptimal clinical outcomes. Effective interventions may improve medical distrust in patients which is warranted specific studies.ObjectiveTo evaluate the effect of health literacy and exercise interventions on medical mistrust in patients with type 2 diabetes (T2DM) .MethodsThis study was based on a cluster randomized-controlled trial conducted during February 2015 to March 2016. A total of 800 T2DM patients were recruited from four community health service centers in Minhang and Changning Districts of Shanghai by using a multi-stage sampling method. All patients were randomly divided into the control group and 3 intervention groups in the community. Routine care was provided to all the patients, and on this basis, health literacy intervention, exercise intervention and health literacy + exercise intervention (comprehensive intervention) were performed to the three intervention groups based on partnership to improve diabetes education (PRIDE) toolkit, respectively. Information was collected using the Chinese versions of Health Literacy Management Scale (c-HeLMS) , the 5-item Diabetes Numeracy Test Scale (c-DNT-5) , and Medical Mistrust Index (c-MMI) at baseline, 3-, 6-, 12- (end of intervention) and 24-months follow-up (post-intervention) . The generalized estimating equation was used to evaluate the effect of the interventions at each time point.ResultsA total of 780 patients were recruited in this study. The c-MMI was a reliable and valid scale to measure medical mistrust in our subjects, with Cronbach&apos;s &#x03B1; of 0.826. The median score and interquartile range of c-MMI was 31 (7) at baseline while the rate of medical mistrust (scores≥30) was 65.9% (514/780) , both of which decreased at almost each follow-up survey in four groups. Compared with the control group, a lower risk of medical mistrust was observed at the 3-months〔OR (95%CI) =0.42 (0.23, 0.78) 〕 and 6-months of follow-up〔OR (95%CI) =0.46 (0.24, 0.88) 〕 for the health literacy group, at the 6-months〔OR (95%CI) =0.50 (0.25, 0.99) 〕, 12-months〔OR (95%CI) =0.43 (0.22, 0.86) 〕 and 24-months of follow-up〔OR (95%CI) =0.37 (0.19, 0.72) 〕 for the exercise group, and at the 6-months〔OR (95%CI) =0.30 (0.16, 0.56) 〕 for the comprehensive group.ConclusionBoth health literacy and exercise intervention may effectively decrease the scores of c-MMI and reduce the risk of medical mistrust in diabetes patients

The Building Blocks of Interoperability. A Multisite Analysis of Patient Demographic Attributes Available for Matching.

BackgroundPatient matching is a key barrier to achieving interoperability. Patient demographic elements must be consistently collected over time and region to be valuable elements for patient matching.ObjectivesWe sought to determine what patient demographic attributes are collected at multiple institutions in the United States and see how their availability changes over time and across clinical sites.MethodsWe compiled a list of 36 demographic elements that stakeholders previously identified as essential patient demographic attributes that should be collected for the purpose of linking patient records. We studied a convenience sample of 9 health care systems from geographically distinct sites around the country. We identified changes in the availability of individual patient demographic attributes over time and across clinical sites.ResultsSeveral attributes were consistently available over the study period (2005-2014) including last name (99.96%), first name (99.95%), date of birth (98.82%), gender/sex (99.73%), postal code (94.71%), and full street address (94.65%). Other attributes changed significantly from 2005-2014: Social security number (SSN) availability declined from 83.3% to 50.44% (p&lt;0.0001). Email address availability increased from 8.94% up to 54% availability (p&lt;0.0001). Work phone number increased from 20.61% to 52.33% (p&lt;0.0001).ConclusionsOverall, first name, last name, date of birth, gender/sex and address were widely collected across institutional sites and over time. Availability of emerging attributes such as email and phone numbers are increasing while SSN use is declining. Understanding the relative availability of patient attributes can inform strategies for optimal matching in healthcare

Interventions Aimed at Decreasing Obesity in Children Younger Than 2 Years: A Systematic Review

To assess the evidence for interventions designed to prevent or reduce overweight and obesity in children younger than 2 years