This study aimed to analyze the efficacy of resilience-promoting interventions among adolescents and youth aged 10–24 years with any type of diabetes. A systematic literature search was performed using the PubMed, Web of Science, Embase, Cochrane Library, CINAHL, and PsycINFO databases from inception to May 25, 2022. The Cochrane risk of bias tool (version 2) was used to assess the quality of the included studies. A meta-analysis was performed to calculate the pooled effects of resilience-promoting interventions. Nineteen articles were included covering an overall sample of 2048 adolescents with diabetes. When analyzing the effectiveness of resilience-promoting interventions, hemoglobin A1c (HbA1c) at six months [mean difference = − 0.47, 95% confidence interval (CI) = − 0.83 to − 0.12, P = 0.009] after the intervention was improved. However, long-term (≥ 12 months) improvement in HbA1c was not significant. In addition, comparing the control group, there were significant differences in the effect size for stress [standardized mean difference (SMD) = − 0.87, 95% CI = − 1.25 to -0.48, P < 0.05], self-efficacy (SMD = 0.50, 95% CI = 0.02–0.98, P = 0.04) and quality of life (SMD = 0.27, 95% CI = 0.03–0.51, P = 0.03). Resilience-promoting intervention is a promising way for adolescent diabetes management to improve HbA1c, stress, self-efficacy, and quality of life. Incorporating resilience-promoting components into diabetes education and re-enforcing these contents every six months are recommended for implementation in clinical practice. 

/pdf/effectiveness-of-resilience-promoting-interventions-in-2qg5rnej.pdf

Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis

Background. Adolescents and young adults with type 1 diabetes have high HbA1c levels and often struggle with self-management behaviors and attention to diabetes care. Hybrid closed-loop systems (HCL) like the t:slim X2 with Control-IQ technology (Control-IQ) can help improve glycemic control. The purpose of this study is to assess adolescents’ situational awareness of their glucose control and engagement with the Control-IQ system to determine significant factors in daily glycemic control. Methods. Adolescents (15–25 years) using Control-IQ participated in a 2-week prospective study, gathering detailed information about Control-IQ system engagements (boluses, alerts, and so on) and asking the participants’ age and gender about their awareness of glucose levels 2-3 times/day without checking. Mixed models assessed which behaviors and awareness items correlated with time in range (TIR, 70–180 mg/dl, 3.9–10.0 mmol/L). Results. Eighteen adolescents/young adults (mean age 18 ± 1.86 years and 86% White non-Hispanic) completed the study. Situational awareness of glucose levels did not correlate with time since the last glucose check (
 
 p
 =
 0.8
 
 ). In multivariable modeling, lower TIR was predicted on days when adolescents underestimated their glucose levels (r = −0.22), received more CGM alerts (r = −0.31), and had more pump engagements (r = −0.27). A higher TIR was predicted when adolescents responded to CGM alerts (r = 0.20) and entered carbohydrates into the bolus calculator (r = 0.49). Conclusion. Situational awareness is an independent predictor of TIR and may provide insight into patterns of attention and focus that could positively influence glycemic outcomes in adolescents. Proactive engagements predict better TIR, whereas reactive engagement predicted lower TIR. Future interventions could be designed to train users to develop awareness and expertise in effective diabetes self-management.

https://downloads.hindawi.com/journals/pedi/2023/1888738.pdf

Situational Awareness and Proactive Engagement Predict Higher Time in Range in Adolescents and Young Adults Using Hybrid Closed-Loop

Background and Objective. Continuous glucose monitoring (CGM) is shown to improve quality of life (QoL) in youth with type 1 diabetes (T1D), yet there is limited data on CGM in youth with type 2 diabetes (T2D). The objective was to compare perceptions of CGM and QoL between patients with T1D and T2D. Methods. Youth with T1D and T2D (currently on insulin therapy) without current CGM participated in a prospective CGM study and were given a series of questionnaires when starting CGM intervention. BenCGM and BurCGM questionnaires assessed the participant’s perspectives on continuous glucose monitor use, while DDS surveys assessed participants’ QoL associated with diabetes. Survey results were compared between T1D and T2D groups, and multivariable analysis was used to assess differences in perceptions of continuous glucose monitor use in youth with diabetes. Results. Participants with T1D (n = 26, 65.4% male, 42.3% non-Hispanic black, median age 14.2 years, median HbA1c 10.3%) and T2D (n = 41, 39% male, 80.5% non-Hispanic black, median age 16.2 years, median HbA1c 10.3%) scored similarly on the BenCGM, BurCGM, and DDS surveys. In a pooled analysis of both T1D and T2D, there was no difference in survey results by race/ethnicity, but female youth had an increased odd of diabetes-related distress, specifically regimen-related distress. Conclusions. Youth with T1D and T2D on insulin therapy report similar perspectives on continuous glucose monitor use and QoL measures. Insulin use in both T1D and T2D may carry a similar burden of management, and CGM may help improve quality of life. Trial registration: This trial is registered with NCT04721145, NCT04721158.

/pdf/similar-perceptions-on-continuous-glucose-monitor-use-2wsd2wcz.pdf

Similar Perceptions on Continuous Glucose Monitor Use amongst Youth with Type 1 and Type 2 Diabetes

The aim of this study is to test the feasibility of a smartphone serious game-based intervention to promote resilience for adolescents with type 1 diabetes mellitus (T1DM). 

Delivering a Smartphone Serious Game-Based Intervention to Promote Resilience for Adolescents With Type 1 Diabetes: A Feasibility Study

Introduction: The frequency of type 1 diabetes (T1D) as one of the most prevalent endocrine disease in adolescents is increasing globally. This type of diabetes is a progressive degeneration β cells of the islets of Langerhans, which decreases insulin production and causes permanent dependence on insulin injection. It is essential to control diabetes in adolescents and increase awareness about the effective factors (self-care) on the health of adolescents with diabetes. Therefore, this study aimed to evaluate the effect of self-care training intervention on self-management subscales and some diabetes indicators (glycosylated hemoglobin level and fasting blood sugar) in adolescents with T1D. Materials and Methods: This study was conducted on 50 adolescents with T1D, who were referred to the Diabetes Clinic of Golestan Hospital, aged 12 to 18 and selected for this semi-experimental intervention and case–control study by the census. Six one-hour self-help sessions were held for adolescents and their parents. The data collection tools were the Adolescent Self-Care Questionnaire and the Diabetes Index Form for T1D (SMOD-A), used before and three months after the intervention. Chi-square, t-pair tests, and SPSS software version 23 were utilized for statistical data analysis. Results: There was no significant difference between the case and control group regarding gender, age, race, course of the disease, education level, and family history of diabetes (P = 0.771, 0.551, 0.074, and 0.111, respectively). Three months after the intervention, a significant increase was observed in all subscales of self-management and total self-management (P < 001), and a significant decrease was seen in fasting blood sugar (P = 0.001) and glycosylated hemoglobin changes (P = 0.001). Conclusion: Based on the results, training adolescents through a T1D self-care program effectively improved their overall and subscale self-management and reduced fasting glucose and HbA1c levels.

Improving self-management and diabetes indicators in adolescents with type 1 diabetes through self-care education

To understand morning biopsychosocial factors that predict glycemia, adherence, and goal attainment in adolescents and young adults (AYA) with type 1 diabetes (T1D) on a daily basis.

Novel predictors of daily fluctuations in glycemia and self‐management in adolescents and young adults with type 1 diabetes

Sleep is a key component in health maintenance. Adolescents often struggle to obtain sufficient sleep, and those with T1D are at increased risk for diabetes-related sleep disruptions and shorter sleep duration. We sought to examine sleep quality and glycemic outcomes between youth aged 11-17 with T1D, comparing summer (free schedule) and fall (school schedule). Twenty youth (mean 13.8 yrs, 65% female, 90% Non-Hispanic White), ten each during summer and fall, participated in an observational study. Participants were age matched due to sleep recommendation variations. Actigraphy data (sleep duration, sleep efficiency, sleep onset latency, wake after sleep onset) and glycemic data from CGM (TIR, time hyperglycemic (>180mg/dL), time hypoglycemic (<70mg/dL)) were collected simultaneously for one week. No significant differences were found between summer and fall participants for demographics or sleep outcomes. Statistically significant differences were found for time hypoglycemic (p=0.034) and mean sensor glucose (p=0.021) and clinically notable differences were seen with higher TIR and lower hyperglycemia during summer. This study highlights that insufficient sleep is obtained in adolescents with T1D, regardless of season, and seasonal differences appear to exist in glycemic measures. Further research is needed to elucidate the extent of these differences and methods to improve both sleep and glycemia throughout the year.
 
 
 
 E.Fivekiller: None. C.Sakamoto: None. A.J.Karami: None. L.J.Meltzer: Consultant; Egetis Therapeutics, Harmony Biosciences. L.Pyle: None. E.C.Cobry: None.
 
 
 
 JDRF (5-ECR-2022-1179-A-N to E.C.C.)


1155-P: Seasonal Impact on Sleep and Glycemia in Adolescents with Type 1 Diabetes


 
 
 Sleep is recognized as an important component of health for people with type 1 diabetes (T1D), with significant associations identified between sleep quality, glycemic outcomes, and diabetes self-management. Adolescents, who are particularly vulnerable to insufficient sleep and have difficulty meeting glycemic targets, typically experience differences in sleep during the summer versus school months. We examined barriers to sufficient sleep during summer and fall months amongst adolescents ages 11-17 with T1D.
 
 
 
 Adolescents (n=10, mean age 14.1 years, 40% female, 80% non-Hispanic White) with T1D participated in qualitative, semi-structured interviews to explore seasonal differences in barriers to sleep. Interviews were audio and video recorded, transcribed using Otter-AI software with manual review for accuracy, independently coded by two trained research staff, and themes were identified.
 
 
 
 Interviews were completed by five adolescents during the summer and five during school months. Barriers to achieving sufficient sleep for both time periods included diabetes-related issues (e.g. hypoglycemic episodes, glucose variability, fear of hypoglycemia, and device use), peers, activities, and family factors. School, activities, family and diabetes disruptions were equally prominent barriers during the school year, whereas diabetes disruptions were the most common barriers during the summer. While device alarms disrupted sleep at both times, adolescents reported that diabetes technologies had an overall net positive impact on sleep during the school year due to reduced worry, but a neutral impact during the summer. Adolescents agreed it would be helpful to talk about sleep concerns or ways to improve sleep.
 
 
 
 Diabetes management is a consistent reason for insufficient sleep duration in adolescents with T1D. In addition, similar to adolescents without T1D, academic, social, and family obligations were barriers to obtaining sufficient sleep during the school year. While some sleep disruptors may not be modifiable, assessment by a clinician who can provide guidance on methods to improve sleep health may be beneficial and well received. Because diabetes health care providers have frequent contact, routine visits provide an opportunity to identify sleep concerns and provide both diabetes and non-diabetes guidance to address sleep health. Further exploration of sleep behaviors and barriers in adolescents with T1D is warranted.
 
 
 
 5-ECR-2022-1179-A-N, JDRF and Helmsley


/pdf/0761-differences-in-sleep-barriers-between-summer-and-school-488c52tj.pdf

0761 Differences in Sleep Barriers Between Summer and School in Adolescents with Type 1 Diabetes

700-P: Quality of Life in Youth and Young Adults (YYA) with Type 1 Diabetes (T1D) That Experience Device-Related Skin Reactions

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