bluuebunny/crossref_metadata_2025 huggingface dataset:
Anxiety in Adolescents with Type 1 Diabetes
Authors: RECHENBERG KAITLYN , SADLER LOIS S. , GREY MARGARET
Published: June 2018

Adolescents with type 1 diabetes (T1D) are at a high risk of psychosocial comorbidity, e.g., anxiety, depression, and eating disorders. Anxiety symptoms have been associated with poorer glycemic control. Anxiety symptoms have not been well studied in these youth. Our aim was to describe the experience of anxiety symptoms in adolescents with T1D, especially related to diabetes self-management and sleep patterns.

We used qualitative description, consisting of 10 open-ended questions, the State-Trait Anxiety Inventory for Children (STAIC), and Hemoglobin A1c (A1c). The analysis was guided by the principles of thematic analysis. Demographic data, A1c, and STAIC scores were used to stratify the qualitative data.

Adolescents with T1D (ages 10-16) were recruited from the Yale Program. Twenty-nine participants were interviewed. Participants were mean age 13.6+1.9 years, 32% minority, 31% lower socioeconomic status (SES), A1c 8.3+1.3%, mean disease duration 5.6+3.7 years, mean state anxiety 47.1+4.5, and mean trait anxiety 32.8+8.2.

Four themes and 7 sub-themes emerged. Participants reported that T1D was an extra layer of responsibility that took time away from their ability to participate fully in other aspects of their lives. Some participants were able to integrate diabetes management into their lives, while others were not. Participants noted that their experience of anxiety was associated with poor quality sleep, general lifestyle factors, diabetes, or all of these. Exploratory stratified analyses based on levels of STAIC findings revealed that: adolescents with high state anxiety were from lower SES single-parent families and all reported poor sleep and high A1c levels (≥9.5%); those with low state anxiety were from higher SES families with two parents, all had low A1c levels (≤7.5%), and all were still managed by their parents.

Associations between anxiety symptoms and poorer self-management should be confirmed with further data. Increased screening and interventions for anxiety symptoms might be warranted.

Disclosure

K. Rechenberg: None. L.S. Sadler: None. M. Grey: None.
Distress, Depression, or Both? Exploring Differences in the DDS-17 and the PHQ-9 in Diabetes Specialty Clinic
Authors: WARDIAN JANA L. , KANZLER KATHRYN E. , SAUERWEIN TOM J. , TRUE MARK W. , GLOTFELTER MICHAEL A.
Published: June 2018

Diabetes-related distress (DRD) is distinctly different from depression and is more common than depression in people with diabetes. DRD has serious negative outcomes, including poor glycemic control. DRD has been identified in more than 40% of people with diabetes. Recent ADA Standards recommend assessing and addressing DRD; however, in clinical settings, confusion may exist concerning utility of screening for DRD. This study explores differences in our population between scores on DRD and depression screening measures. At the USAF Diabetes Center of Excellence (DCOE), a military specialty clinic, adult patients were administered the Patient Health Questionnaire (PHQ-9) and the Diabetes-related Distress Scale (DDS-17) as part of standard care from June 2015 through August 2016. Distinct areas of DRD are: 1) Emotional Burden (EB); 2) Physician-related Distress (PD); 3) Regimen-related Distress (RD); and 4) Interpersonal Distress (ID). DDS-17 was categorized as <2.0=little or no distress; 2.0-2.9=moderate distress; and ≥3=high distress. A score ≥ 10 was considered positive for depression on the PHQ-9. Patients (n=314) completed both the DDS-17 and the PHQ-9. Most patients had neither symptoms of depression nor DRD (70.4%). However, 23.9% scored high on the DDS-17 in at least one domain while 11.8% screened positive for depression. Overall, highest DRD was found in EB (17.0%) and RD (15.7%). Furthermore, 56 patients screened positive for DRD, but not for depression (17.8%). Nearly half of patients that screened positive for depression did not have DRD (5.7%). Our study reinforces ADA guidelines to screen and treat DRD as a distinct psychosocial issue. If a clinic does not screen for DRD, they are missing an opportunity to address this common experience. High distress was found in nearly one-quarter of our patients. Regular screening for distress related to demands of living with diabetes is crucial in identifying and preventing poor health outcomes associated with DRD.

Disclosure

J.L. Wardian: None. K.E. Kanzler: None. T.J. Sauerwein: Speaker's Bureau; Self; Merck & Co., Inc., AstraZeneca. M.W. True: None. M.A. Glotfelter: None.
Comprehensive Diabetes Stigma Scale—Associations with Patient Characteristics and Outcomes
Authors: BEACH LAUREN B. , KANKOTIA SHYAM , DINH CHRISTINE U. , ELASY TOM , MAYBERRY LINDSAY S. , WALLSTON KENNETH , PHILLIPS GREGORY , JANULIS PATRICK , CAVANAUGH KERRI
Published: June 2018

Stigma related to health conditions has been linked to poor medication adherence and health outcomes. With input from patients living with diabetes, diabetes clinicians, and stigma researchers, we designed the Comprehensive Diabetes Stigma Scale (CDSS). We hypothesized that higher diabetes stigma would be associated with worse medication adherence, younger age, insulin use, and higher HbA1c values. We recruited adults with diabetes on ≥1 diabetes medication in person from one academic practice and online via ResearchMatch. Participants completed the 15-item CDSS and measures of perceived diabetes stigma from family members, psychological and behavioral consequences of diabetes stigma, and medication adherence. Participants self-reported the range of their most recent HbA1c lab value. Spearman correlations and multiple linear regression were used to assess associations between variables. Participants (n=311) were on average 61 ± 11 years; 56% female and 86% white. Most (69%) participants endorsed at least 1 CDSS-15 item, 34% reported HbA1c >7.0%, and 49% reported insulin use. CDSS-15 scores correlated with diabetes family perceived stigma (ρ=0.51, p<0.01) and consequences of diabetes stigma (ρ =0.63, p<0.01). Higher diabetes stigma correlated with worse medication adherence (ρ =0.40, p<0.01). This association remained significant after adjusting for age, sex, race, diabetes duration, insulin use, and marital, employment, and insurance status (β=0.17, p<0.01). By age, younger participants had higher CDSS-15 scores (ρ =-0.35, p<0.01). CDSS-15 scores did not differ by insulin use status (ρ =0.03, p=0.59). The mean CDSS-15 score of participants with HbA1c <6.4% (23; 95% CI 21-25) was lower than those with HbA1c >9.0% (30; 95% CI 19-41), but this difference was not significant (p=0.06). These findings reinforce that diabetes stigma is prevalent and show for the first time that diabetes stigma may be a unique factor contributing to suboptimal diabetes medication adherence.

Disclosure

L.B. Beach: None. S. Kankotia: None. C.U. Dinh: None. T. Elasy: None. L.S. Mayberry: None. K. Wallston: Advisory Panel; Self; EdLogics Inc.. G. Phillips: None. P. Janulis: None. K. Cavanaugh: None.
Adherence and Associated Follow-Ups for Diabetic Eye Examinations in Japan
Authors: MURAKAMI HIROSHI , OTAKA HIDEYUKI , MURABAYASHI MASAYA , MIZUSHIRI SATORU , KAMBA AYA , MATSUHASHI YUKI , YANAGIMACHI MIYUKI , NAKAYAMA HIROFUMI , DAIMON MAKOTO
Published: June 2018

Diabetic retinopathy (DR) is a serious complication of diabetes that causes visual impairment and blindness in Japan. Adherence to follow-up services is a key component for effective DR management. However, the attendance rates for DR follow-ups and eye examinations are unknown. We assessed the rate of follow-up for ophthalmic examinations and factors associated with discontinuation of eye examinations for patients with type 2 diabetes. In total, 624 patients with type 2 diabetes mellitus (348 males, 276 females; age 63.5±12.8 years, HbA1c 7.1±0.9%) were included. After obtaining informed consent, a questionnaire and review of the medical records were used to obtain data regarding sex, diabetic complications, body mass index (BMI), diabetes treatment, periodic eye examinations at least once a year, alcohol consumption, smoking status, the quality of life instruments (Short Form 36: SF-36), brief depression measures (CES-D), and the Big Five Personality Test (TIPI-J). In total, 510 patients (82.6%) had undergone periodic eye examinations and 114 (18.4%) had not been examined for 1 year. Patients not having examinations (non-attendance) were older (p=0.04), with higher HbA1c levels (p=0.01), and higher depression (p=0.01), and were single (p=0.03). There was no significant association between the attendance and non-attendance groups regarding sex, BMI, alcohol consumption, smoking, or stages of DR. The non-attendance group had lower scores in vitality and mental health (using the SF-36) than the attendance group (p<0.01). The non-attendance group scored lower on the neuroticism scale compared to the attendance group (p=0.04). The attendance percentage for the DR group follow-up examinations was 82%. The non-attendance group had higher depression symptom scores, higher HbA1c levels, lower quality of life and neuroticism scores, were older, and more likely divorced or separated. Improving the use of follow-up services is needed, particularly regarding improved psychosocial aspects.

Disclosure

H. Murakami: None. H. Otaka: None. M. Murabayashi: None. S. Mizushiri: None. A. Kamba: None. Y. Matsuhashi: None. M. Yanagimachi: None. H. Nakayama: None. M. Daimon: None.
Gender Differences in Psychosocial Factors Influencing Glycemic Control among Chinese Adults with Type 2 Diabetes Mellitus
Authors: LIN KEKE , QUINN LAURIE T.
Published: June 2018

Identifying gender differences in psychosocial factors associated with glycemic control will help to develop gender specific interventions to achieve optimal glycemic control for people with type 2 diabetes (T2DM). This study aimed to examine the differences between males and females in terms of diabetes self-efficacy, perceived role demands, attitudinal familism, diabetes distress, and family support among a group of Chinese adults with T2DM. A convenience sample of 210 patients with T2DM (male=99, female=111) was recruited from a community health center in Beijing, China. Study instruments included Self-efficacy Scale for Patients with T2DM, Perceived Role Demands Scale, Attitudinal Familism Scale, Diabetes Distress Scale, and Diabetes Family Behavior Checklist-II. The statistical methods included descriptive analysis, t- test and Wilcoxon rank-sum test. Females had higher attitudinal familism scores (t=-2.12, p<0.05), higher number of roles (Z= -2.33, p<0.01), and more perceived role demands related to caregiving (Z= -4.44, p<0.001) than males. Conversely, males had a significantly higher family supportive behaviors mean score (Z=2.76, p<0.01), and more perceived role demands related to jobs (Z=4.18, p<0.001) than females. There were no statistically significant gender differences in terms of diabetes distress (t=-1.04, p=0.05) and self-efficacy (t=-0.08, p>0.05). These findings indicated that females struggled more with caregiving responsibilities, were more likely to put family interest above their own health needs, yet received less family support than males. Clinicians should take these gender differences into account when designing interventions that address diabetes self-management and glycemic control.

Disclosure

K. Lin: None. L.T. Quinn: None.
Exploring Psychological Aspects of Hyperglycemia in People with Type 2 Diabetes
Authors: NEXO METTE A. , CLEAL BRYAN , WILLAING INGRID
Published: June 2018

Objective: The psychological dimension of hyperglycemia is poorly investigated. This study explored how individuals with type 2 diabetes (T2D) experienced and responded psychologically to hyperglycemia.

Method: From a larger study investigating T2D and work life we purposely selected 7 individual interviews eligible for Interpretative Phenomenological Analysis (IPA). Interviews providing rich and detailed data regarding the subjective experience of hyperglycemia were included. Participants were recruited from a Danish diabetes clinic and had at least 2 years duration of T2D and minimum 1 documented complication. Two researchers independently analyzed each individual case. Contradictions and variations of the analyses were then compared at three levels of analysis: Experiential, linguistic and interpretative. Superordinate themes were developed, if the essence of themes were generalizable across accounts.

Results: Three superordinate themes emerged: Theme 1 ’High blood sugar shuts the body down’. Experiences attributed to hyperglycemia were exemplified by body-machine metaphors and conceptualized as recognizable signs of illness inflicting a complete loss of energy, motivation and willpower. Theme 2 ’Cognitive reactions: High blood sugar is my own fault’. The causes of high blood sugar were ascribed negative personality characteristics or poor self-care abilities and threatened the conception of self. Theme 3 ’Emotional distress’. The cognitive reactions triggered a wide range of distressing emotions; mainly shame, guilt and sadness.

Conclusion: These results are the first to document the cognitive and emotional responses to hyperglycemia and can potentially inform psychological interventions targeting people with T2D. However, IPA is an idiographic approach generating theory from few homogenous cases and further studies are needed to generalize beyond the individual level.

Disclosure

M.A. Nexo: None. B. Cleal: None. I. Willaing: None.
Attitudes among Adults with Type 2 Diabetes Affecting Insulin Initiation and Discontinuation
Authors: HESSLER DANIELLE M. , POLONSKY WILLIAM , FISHER LAWRENCE , SNOEK FRANK J. , HADJIYIANNI IRENE , CAO DACHUANG , IVANOVA JASMINA I. , DESAI URVI , PEREZ-NIEVES MAGALY
Published: June 2018

Approximately 30% of patients with type 2 diabetes (T2D) are reluctant to initiate basal insulin when recommended by their healthcare provider (HCP). Even after initiation, many patients use insulin intermittently. Examining patients’ attitudes towards insulin and their links to subsequent use can aid HCPs in improving insulin uptake and adherence. 594 T2D adults across seven countries who indicated initial reluctance to begin basal insulin but eventually agreed to do so [mean age = 53.3 (SD=11.3), 56.7% male], participated in the EMOTION survey. In addition to self-reported insulin behavior (immediate initiation vs. delay, discontinued use for ≥7 days), attitudes towards insulin immediately prior to initiating insulin were captured using a modified version of the Insulin Treatment Appraisal Scale (mITAS). An exploratory factor analysis of the 21 negatively worded mITAS items (1=strongly disagree to 5=strongly agree) yielded four factors: “concerns about injections” (M=3.4, SD=1.0), “failed diabetes management” (M=3.8, SD=0.8), “increased disease severity” (M=3.0, SD=0.9), and “concerns about side effects” (i.e., weight gain, hypoglycemia) (M=3.4, SD=0.8). In models controlling for patient characteristics and clustering by country, higher scores (more negative appraisal) in all four mITAS factors were linked with greater likelihood of delaying insulin initiation (ORs: 1.34 to 1.73; all p <0.05). Only “concerns about side effects” was associated with discontinuation and inversely related (OR=0.60, p <0.05). Overall, higher mITAS scores were associated with being female, younger, more recently diagnosed, and without previous experience with injectable medications. Negative patient appraisals of insulin are linked with delays in their insulin initiation in T2D; while other factors may be more impactful for predicting discontinuation. These patient attitudes should be considered when discussing insulin initiation.

Disclosure

D.M. Hessler: Consultant; Self; Eli Lilly and Company. W. Polonsky: Consultant; Self; Abbott, AstraZeneca, Dexcom, Inc., Sanofi, Novo Nordisk Inc., Eli Lilly and Company, Intarcia Therapeutics, Inc., Servier, Ascensia Diabetes Care, Merck & Co., Inc., MannKind Corporation, Glooko, Inc., Roche Diabetes Care Health and Digital Solutions. L. Fisher: Consultant; Self; Eli Lilly and Company, Abbott, Merck & Co., Inc.. F.J. Snoek: None. I. Hadjiyianni: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. D. Cao: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company. J.I. Ivanova: Other Relationship; Self; Eli Lilly and Company. Employee; Spouse/Partner; Boehringer Ingelheim Pharmaceuticals, Inc. U. Desai: Other Relationship; Self; Eli Lilly and Company, AstraZeneca. M. Perez-Nieves: Employee; Self; Eli Lilly and Company. Stock/Shareholder; Self; Eli Lilly and Company.
Caveolin-1 Deficiency Protects Pancreatic ß Cells against Palmitate-Induced Dysfunction and Apoptosis
Authors: ZENG WEN , LIU KUNYING , TANG JIANSONG , LI HAICHENG , XU HAIXIA , LU HONGYUN , PENG HANGYA , LIN CHUWEN , GAO RILI , LIN SHUO , LIN KEYI , JIANG YAN , ZENG LONGYI
Published: June 2018

The regeneration of β-cell mass and preservation of its endocrine function under lipotoxicity are long-sought goals in diabetes research. Membrane protein caveolin-1 (Cav-1) is related to β-cell apoptosis and insulin secretion, however, the underlying mechanisms still remains unclear.

Our objective is to explore whether Cav-1 depletion protects pancreatic β cells from lipotoxicity and investigate the related mechanisms. Here, we found that Cav-1 silencing significantly promoted β-cell proliferation, inhibited palmitate (PA)-induced apoptosis and enhanced insulin production and secretion. These effects were associated with enhanced phosphorylation of Akt and ERK1/2 protein, which then downregulated the expression of cell cycle inhibitors (FOXO1, GSK3β, P21, P27 and P53) and upregulated Cyclin D2 and Cyclin D3 expression. Subsequent inhibition of PI3K/Akt and ERK/MAPK pathways abolished Cav-1 depletion induced β-cell mass protection. Furthermore,under PA enhanced endoplasmic reticulum (ER) stress, Cav-1 silencing significantly reduced eIF2α phosphorylation and expression of ER stress-responsive markers BiP and CHOP, which mediated the sensitization to lipotoxicity. Our findings suggest the potential application of the Cav-1 molecule as a target for effective T2DM treatment through preservation of lipotoxicity-induced β-cell dysfunction and mass reduction.

Disclosure

W. Zeng: None. K. Liu: None. J. Tang: None. H. Li: None. H. Xu: None. H. Lu: None. H. Peng: None. C. Lin: None. R. Gao: None. S. Lin: None. K. Lin: None. Y. Jiang: None. L. Zeng: None.
Family Impact Module and Type 1 Diabetes
Authors: ILKOWITZ JENIECE , GALLAGHER MARY PAT , LOIS BECKY , PACHECO MORGAN L. , ZELENIUCH-JACQUOTTE ANNE
Published: June 2018

Introduction: The Pediatric Quality of Life Family Impact Module (FIM) measures different domains of family functioning. Its use in type 1 diabetes (T1D) has not been widely explored. The objective of this study is to assess if baseline demographics can predict the impact of T1D on family function as measured by FIM score.

Methods: Parents of children with T1D completed the FIM during a medical appointment. Parents also completed the Holmes and Rahe (H and R) questionnaire as a measure of stressful life events.

Results: The sample included 33 parents. The children (13 males), had a median age of 13.6 years (range: 5.7-20.7), median age at diagnosis of 7.9 years (range: 1-15), median diagnosis duration of 5 years (range: 1-16) and median A1c of 8.4% (range: 6.5-11.4). The median FIM total score was 73.3 (range: 16-100) and impact on function was strongly correlated with a higher H and R score (r= -0.44, p < 0.01 after excluding one outlier). Predictive characteristics were noted in some individual domains (univariate analysis, adjusting for H and R score): poorer outcomes in parent cognitive function (p=0.02) for those with a child with additional medical conditions, more communication challenges (p=0.003) for parents of males, and more worry (p=0.05) in parents with more than 1 child with T1D. Child’s gender, A1c, pump use, CGM use, age, age at diagnosis and disease duration were not significant predictors of total FIM score or FIM subscale scores.

Conclusion: Although sample size is small, our results suggest more impact in specific domains of function for families with the following: a child with more than one medical condition, a male child, and multiple children with T1D. This requires further study. While no demographic data predicted total FIM score, the score did correlate with stressful life events. It is important to screen families for stressful life events as well as level of function. Future study will also include a larger sample size and collection of data from a local healthy community sample.

Disclosure

J. Ilkowitz: None. M. Gallagher: None. B. Lois: None. M.L. Pacheco: None. A. Zeleniuch-Jacquotte: None.
Identifying Recommendations of Health Care Providers (HCP) for Developing an Evidence-Based Reproductive Health (RH) Educational Intervention for Adolescent and Young Adult (AYA) Males with TID
Authors: FISCHL ANDREA F.R. , LIBMAN INGRID , ROFEY DANA L. , CHARRON-PROCHOWNIK DENISE
Published: June 2018

Approximately half of males with T1D report RH complications (e.g., erectile dysfunction, decreased libido, orgasmic dysfunction) as early as 25 years old and/or 10 years after diagnosis. Tight glycemic control can prevent or delay complications, including those related to RH. Yet these sensitive topics are rarely discussed by HCPs. The purpose of this study was to collect qualitative data through a focus group conference call with 6 HCPs about their experiences caring for AYA males with T1D, and their perceptions of the need and recommendations for developing an evidence-based RH educational intervention. A semi-structured discussion guide was used to elicit responses about providing care for this population, experience with managing male RH complications, and their comfort talking to male teens about diabetes and sexual health. Responses were recorded and transcribed verbatim, clustered, and analyzed to identify major themes, using a qualitative descriptive method with 2 researchers discussing themes and reaching agreement. The 6 HCPs were 2 female pediatric diabetologists, 1 male pediatric diabetologist, 2 male adult diabetologists, and a male certified diabetes nurse educator. Following discussion, consensus was reached by all participants that RH was understudied and education was needed in this population. Major themes that emerged: “diabetes risk in the offspring,” “association of the risky behaviors associated with non-adherence in diabetes self-management”, “sex and diabetes” and “professional responsibility and obligation to initiate discussion”, and age to introduce these topics.”

In conclusion, these HCP recommendations will inform the development of a RH program for AYA males with T1D. These suggestions and issues could impact the HCP’s ability to effectively advise and educate AYA males about reproductive/sexual health and diabetes.

Disclosure

A.F.R. Fischl: None. I. Libman: Consultant; Self; Novo Nordisk A/S. D.L. Rofey: None. D. Charron-Prochownik: None.
Poor Adherence in Adolescents with Type 1 Diabetes Associated with Distress, Fear of Hypoglycemia, and Executive Functioning
Authors: WESTEN SARAH C. , WARNICK JENNIFER , ENTESSARI MINA , ALBANESE-O'NEILL ANASTASIA , SCHATZ DESMOND , HALLER MICHAEL J. , JANICKE DAVID M.
Published: June 2018

Introduction: T1D poses unique challenges to adherence-related behavior due to complex treatment regimens. This study aimed to determine prevalence rates of adherence in adolescents on multiple daily injections (MDI) or subcutaneous insulin infusion (CSII). Additional aims included determination of whether adherence correlated to HbA1c and whether psychological factors predicted adherence.

Methods: Self-monitoring of blood glucose (SMBG) and insulin delivery data were downloaded for the previous 30 days. Distress was measured using the Problem Areas in Diabetes-Teen Version, the Blood Glucose Monitoring Communication Questionnaire, and the Barriers to Diabetes Adherence survey. The Hypoglycemia Fear Survey and Behavior Rating of Executive Function were administered. Bivariate correlations and hierarchical regressions were used to determine how adherence related to HbA1c and the predictive value of psychological factors. Continuous glucose monitor (CGM) use was considered as a covariate.

Results: Adolescents (N=81; 41 on MDI and 40 on CSII; 32 on CGM) aged 11 to 17 years completed the study. The mean HbA1c was 8.74% (SD=1.74%). Daily, <7% of participants engaged in SMBG ≥4 times; <7% engaged in carbohydrate entry ≥3 times, and <20% engaged in bolus delivery ≥3 times. Hyperglycemia readings were followed by a correction bolus in 58% of cases. HbA1c was negatively correlated with several adherence domains: frequency of SMBG (r=-0.465, p<.01), carbohydrate entry (r=-0.511, p<.01), and bolus insulin delivery (r=-0.522, p<.01). Distress and fear of hypoglycemia predicted adherence to correction bolusing for hyperglycemia (R2=.237, p<.05) in a model with child age, gender, and executive functioning.

Conclusions: Findings suggest adolescents do not adequately adhere to treatment for T1D. The use of diabetes treatment technology is helpful to measure specific domains of adherence and clarify relationships with psychological factors.

Disclosure

S.C. Westen: None. J. Warnick: None. M. Entessari: None. A. Albanese-O'Neill: None. D. Schatz: None. M.J. Haller: None. D.M. Janicke: None.
Correlates of Perceived Stress in Parents of Teens with Type 1 Diabetes
Authors: WHITTEMORE ROBIN , DELVY ROBERTA , COLEMAN JULIA L. , KATO BERNET , AMBROSOLI JAMES A. , MAURAO MICHAEL P. , ZINCAVAGE REBEKAH , MARCEAU LISA
Published: June 2018

Parents of teens with type 1 diabetes (T1D) are responsible for a labor-intensive and complicated daily regimen that has been described as overwhelming and requiring constant vigilance. Parents report high levels of stress, particularly during the adolescent transition. The primary aim of this study was to identify demographic (parent/child age, gender, race/ethnicity, income, marital status), clinical (T1D duration, pump use, CGM use, episodes of hypoglycemia, other health diagnoses) and psychosocial factors (depressive symptoms, family conflict, childhood-illness parenting stress, teen autonomy) associated with perceived stress in parents of teens with T1D. This was a secondary analysis of baseline data from parents (n=162) of teens with T1D (11-16 years) who were enrolled in a study to evaluate a web-based tool to help with the transition of diabetes care. Bivariate correlates of perceived stress were included in a multivariate model analysis. Parents were 45.6 (±5.3) years of age, 98% female, 91% white, 91% married/partnered, 51% high income, 36% with elevated depressive symptoms, and 40% with elevated anxiety symptoms. Teens had a mean A1C of 7.9 (±1.2), 5.(±3.62) years duration of diabetes, with 75% using an insulin pump, 69% using a CGM, and 39% reporting 20 or more episodes of hypoglycemia in the previous 3 months. Significant bivariate demographic, clinical, and psychosocial correlates were included in the model, in a stepwise procedure. Multivariate correlates of perceived stress were parent age, teen T1D duration, other teen health diagnosis (R2=0.13, p<.01), family conflict and childhood-illness parenting stress (R2 change=.30, p<.01), and parent depression (R2 change=.18, p<.01), explaining 62% of the variance. Parents of teens with T1D experience high stress and may need additional support to prevent and/or decrease family conflict, childhood-illness parenting stress, and depressive symptoms. Parent stress has health implications not only for parents, but also teens with T1D.

Disclosure

R. Whittemore: None. R. Delvy: None. J.L. Coleman: None. B. Kato: None. J.A. Ambrosoli: None. M.P. Maurao: None. R. Zincavage: None. L. Marceau: None.
Effects of Mindfulness-Based Stress Reduction on Insulin-Treated Diabetes
Authors: REIN RAQUEL , SEARL MEGHAN , BHANDARI SHREYA , COTE KATHRYN E. , HASHMI ISRA , DEL VALLE KAYLA L. , MCDONNELL MARIE E.
Published: June 2018

Patients with type 1 (T1D) and type 2 diabetes (T2D) on insulin experience significant diabetes related distress (DD) which is known to negatively impact overall health and ability to self-manage the disease. Mindfulness Based Stress Reduction (MBSR) is an 8-week in-person group-taught program that has been shown to be effective in improving outcomes in chronic diseases. However, MBSR research in diabetes has been limited and has not included complex diabetes. We hypothesized that MBSR would lower DD and improve glycemic control in patients with uncontrolled insulin-treated diabetes. We conducted a nonrandomized pilot feasibility study of MBSR in insulin-treated patients with A1c above goal. Subjects completed the Diabetes Distress Scale (DDS) and Problem Areas in Diabetes (PAID) surveys at baseline, 3 months, and 6 months post intervention. Of 335 patients screened, 10 were enrolled. Patient characteristics included mean age 50.8 years; 60% female; 100% white non-Hispanic; mean baseline A1c= 8.6% +/-0.8. Duration of diabetes was 14 years +/-9; 30% T1D, 70% T2D; 100% on insulin; 70% injected insulin at least 3 times per day. Subjects attended 26 hours of in-class contact. Nine subjects completed the study; one was excluded due to interim pregnancy. All had decreased total DDS scores. There were statistically significant reductions in two DDS domains: emotional (-1.2, p=0.01) and regimen-related distress (-1.2, p=0.004). At 6 months, the mean A1c reduction was -0.4% +/- 0.9. The reduction in PAID score correlated with A1c reduction (r= 0.5).

In conclusion, uncontrolled insulin treated diabetes patients who participated in MBSR experienced a sustainable improvement in emotional and regimen-related distress which was accompanied by lower A1c. Results suggest the need for a large clinical trial designed to optimize accessibility to a broader population of patients and to test the cost-effectiveness of this nonpharmacologic intervention.

Disclosure

R. Rein: None. M. Searl: None. S. Bhandari: None. K.E. Cote: None. I. Hashmi: None. K.L. Del Valle: None. M.E. McDonnell: None.
Pancreatic Islets in Short Duration Type 2 Diabetes (T2D) Show Macrophage Infiltration and Increased Inflammatory Signaling
Authors: WALKER JOHN T. , SHRESTHA SHRISTI , PRASAD NRIPESH , RICHARDSON TIFFANY , ARAMANDLA RADHIKA , POFFENBERGER GREG , BOTTINO RITA , BRISSOVA MARCELA , POWERS ALVIN C.
Published: June 2018

T2D is characterized by progressive pancreatic islet dysfunction; however, dissecting causes of this dysfunction in humans is challenging due to disease heterogeneity and the difficulty of obtaining relevant pancreatic samples. To address these challenges, we used an integrated approach to functionally and molecularly study the native pancreas and isolated islets from the same human T2D cadaveric donor. Using associated donor clinical information, we focused on donors with short disease duration (n=10, age 47-66 years, 2-7-year duration, oral medications). Compared to age-matched control islets, T2D islets had dysfunctional insulin (decreased) and glucagon (increased) secretion despite similar insulin and glucagon content. Tissue-section analysis of T2D pancreata showed no difference in relative endocrine (α, β and δ) cell composition. To assess for changes in the islet microenvironment, we analyzed macrophages by staining with Iba1 and endothelial cells with Caveolin-1 and found a 2-fold increase in intraislet macrophages (T2D vs. control: 3.01% vs. 1.45% by area) but no change in intraislet endothelial cell area (T2D vs. control: 8.97% vs. 8.21% by area). Interestingly, costaining with Iba1 and thioflavin S demonstrated that T2D islets with amyloid did not have increased macrophage infiltration compared to T2D islets without amyloid although a close spatial association of macrophages and amyloid deposits was noted. RNA-sequencing analysis of FACS-purified α and β cells from T2D islets showed increased inflammatory signaling pathways in both cell types. Specifically, transcripts for cytokine receptors such as IL6R, IL1R1, and IFNGR1 as well as downstream regulators including NFKB1 and NFKB2 were elevated in T2D α and/or β cells. Together, these data suggest that early in the course of T2D, increased macrophages in the islet microenvironment may lead to elevated α and β cell inflammatory signaling and contribute to human α and β cell dysfunction.

Disclosure

J.T. Walker: None. S. Shrestha: None. N. Prasad: None. T. Richardson: None. R. Aramandla: None. G. Poffenberger: None. R. Bottino: None. M. Brissova: None. A.C. Powers: None.
Dispelling Misperceptions—Family Satisfaction with Behavioral Health Screening
Authors: DUKE DANNY C. , NAGRA HARPREET , MELINDA JONES , BOLEN MORGAN , HARRIS MICHAEL A.
Published: June 2018

Objectives: The ADA has recommended routine behavioral health screening of youth with T1D given the associations among psychological factors (e.g., depression and anxiety), the skills necessary to manage diabetes (executive functioning), and adherence and health outcomes. Anecdotally, concerns of healthcare providers and staff have included stigma, inconvenience, time, and/or unacceptable burden. However, family acceptance of behavioral health screening has not been systematically assessed.

Methods: After administering a screening protocol for youth with T1D, we administered a brief patient satisfaction questionnaire. The screening protocol included the PHQ-9, GAD-7, DREFS-SF, and the DSMP-SF. During this pilot, 57 youth (11-18 years), and 84 parents completed the screenings. Youth and parents completed the brief quality improvement survey after completing the behavioral health screening. Youth and parents responded to questions using a five-point scale from “strongly agree” to “strongly disagree.”

Results:QuestionsParentChild1.Completing questionnaires was an inconvenience4.8%1.8%2.The Information from questionnaires is important for diabetes care providers98.8%94.6%3.Completing the questionnaire was a burden to me or my family6.1%7.1%4.The questionnaires were too long2.4%1.8%5.The questionnaire about how well diabetes has been managed was helpful98.8%96.4%

Conclusions: Concerns regarding family satisfaction with behavioral health screening of youth with T1D were unfounded. Behavioral health screening was very acceptable to the vast majority of youth and parents with no indication that there was stigma associated with behavioral health issues.

Disclosure

D.C. Duke: None. H. Nagra: None. M. Jones: None. M. Bolen: None. M.A. Harris: Consultant; Self; Eli Lilly and Company.
Predicting MDD with a Semistructured Depression Symptom Severity Interview in Type 2 Diabetes
Authors: SHAPIRA AMIT , ZEMON VANCE , SAFREN STEVEN , GONZALEZ JEFFREY S.
Published: June 2018

Few studies in T2D have examined the accuracy of clinician-rated depression severity interviews, the gold-standard assessment. We assessed the factor structure and item-performance of the Montgomery-Åsberg Depression Rating Scale (MADRS) in a sample of adults with T2D.

Patients from primary and specialty care clinics of an urban academic medical center (N= 213, M (SD) A1c 8.2 (1.6), age 56 (9.5); 55% male) were screened for a trial of cognitive behavioral therapy for adherence and depression. Assessments included the MADRS and a structured interview (MINI) for diagnosis of MDD. Principal Component Analysis (PCA) with oblique rotation evaluated the number and character of MADRS components. Sensitivity, specificity, and area under the curve (AUC) of determined subscales and MADRS total score in predicting an MDD were calculated. Fifty-four percent (n=118) had current MDD and the mean MADRS score (M=21.2, SD=10.5) indicated moderate severity. PCA with extraction based on an eigenvalue > 1 yielded a single component, supporting use of the MADRS total score. However, in forced multi-component solutions, each of the somatic items (reduced appetite and sleep) loaded as distinct factors, and “concentration difficulties” failed to load highly onto any factor. AUC was 89.2% [95% CI: 84.9-93.5%] when excluding the three problematic items, and 88.9% [95% CI: 84.7-93.2%] for the total MADRS, demonstrating similar performance. Appetite and sleep yielded the smallest AUCs (.59 and .71, respectively). Sensitivity and specificity of the MADRS total score were 81.2% and 80.2%, respectively, with a cutoff score of 20.5.

The MADRS is a strong instrument in predicting MDD and possibly provides a more accurate alternative to self-report measures. Results indicate that 7 of the 10 items could be administrated to T2D adults with depressive symptoms, shortening administration time.

Disclosure

A. Shapira: None. V. Zemon: None. S. Safren: None. J.S. Gonzalez: None.
Which Relationships Really Matter for Blood Glucose Control?
Authors: ROBERSON PATRICIA N.E. , MILLER MELANIE , RASPOVIC KATHERINE M. , LA FONTAINE JAVIER , FINCHAM FRANK , WUKICH DANE
Published: June 2018

Diabetes patients’ perceived social support is consistently linked to their ability to manage blood glucose (HgA1c). However, little is known about which social relationships are linked to HgA1c. We use linear regression to examine how family, marital, and friendship support/strain predict HgA1c for diabetes patients. For the marital models we included only married participants (N = 121); For the family and friend models we included all participants (N = 160).

Results (Table 1) indicate that family and friend support/strain were not linked to HgA1c. However, marital strain/support were linked to HgA1c (higher strain indicated higher HgA1c and higher support indicated lower HgA1c).

Broad measures of social support are typically examined to understand and improve diabetes outcomes. But, our results suggest a need to focus on the marital relationship in order to improve HgA1c control. As the quality of marital relationship are mutable and brief couple interventions are cost-efficient, standard care could expand to include a marital relationship evaluation and/or a list of referral resources.

Further, the null findings for family and friend strain/support highlights the gap in our knowledge for aging single adults. The number of single adults is growing in the U.S. In the absence of marital support for these adults, we must understand if and to what extent their social environment is linked to HgA1c.

Table 1.Results of the univariate linear regression models for each measure of social support. In this table we present: Unstandardized coefficients with standard error (B(SE)), 95% confidence interval (95% CI), Standardized coefficients (Beta), probability value (p-value), variance explained (R2), and effect size (Cohen’s d).VariableB(SE)95% CIBetap-valueR2Cohen’s dModel 1: Family Support.16(.19)-.22, .54.06.41.004.06Model 2: Family Strain.10(.20)-.38, .40.004.96.000.04Model 3: Friend Support.13(.19)-.25, .51.06.49.003.05Model 4: Friend Strain.07(.24)-.41, .54.02.24.000.02Model 5: Spousal Support-.57(.26)-1.06, -.07-.20.03.04.17Model 6: Spousal Strain.51(.23).06, .96.20.03.04.20

Disclosure

P.N.E. Roberson: None. M. Miller: Employee; Self; Amputee Coalition. K.M. Raspovic: None. J. La Fontaine: None. F. Fincham: None. D. Wukich: None.
Family, Marital, and Friend Relationships and Diabetics Psychological Quality of Life
Authors: ROBERSON PATRICIA N.E. , MILLER MELANIE , RASPOVIC KATHERINE M. , LA FONTAINE JAVIER , FINCHAM FRANK , WUKICH DANE
Published: June 2018

For diabetics, the mental health facets of quality of life are often comorbid with the development and progression of the disease. Compared to the general population, depressive and anxiety symptoms (D/A) are higher among diabetics. Further, several factors associated with higher D/A (e.g., obesity-promoting behaviors and neuroendocrine and inflammatory responses) cause the development of diabetes, progression of the disease, and insulin resistance. In the general population, social relationship quality is consistently linked to D/A with lower quality linked to more D/A. However, among diabetics, little is known about how social relationships are linked to D/A. In the present study, we test how diabetic patients’ marital (n = 121), family, and friendship relationship quality (n = 160) are linked to their self-reported depressive and anxiety symptoms using a series of univariate and multivariate regression models (Table 1).

Findings indicate a consistent link across relationships and A/D but especially marital and family relationships in multivariate models. These relationships are linked to patient‗s quality of life and potentially subsequent physiological and behavioral factors associated with blood glucose regulation. Therefore, as practitioners alter standard care practices to improve patient‗s quality of life, they should consider assessing social factors in addition to individual factors.Table 1.Unstandardized parameter estimates (standard errors), 95% confidence intervals, and p-values for the univariate and multivariate regression models testing marital, family, and friendship quality influence on two outcome variables: (1) depressive and (2) anxiety symptoms.Depressive Symptoms ModelsModel 1Model 2Model 3Model 4VariableB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueMarital Quality1.75(.89).00,3.51.05------------.70(.91)-1.11, 2.513.44Family Quality------3.07(.68)1.72,4.42< .001------2.32(.97).40, 4.25.02Friendship Quality------------2.89(.87)1.18,4.61.0011.40(1.19)-.96, 3.76.24Anxiety Symptom ModelsModel 5Model 6Model 7Model 8VariableB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueB(SE)95% CIp-valueMarital Quality1.88(.56).76, 3.00.001------------1.19(.58).04, 2.34.04Family Quality------2.17(.47)1.24, 3.10<.001------1.37(.62).15, 2.59.03Friendship Quality------------2.48(.59)1.31, 3.65<.0011.16(.76)-.34, 2.66.13

Disclosure

P.N.E. Roberson: None. M. Miller: Employee; Self; Amputee Coalition. K.M. Raspovic: None. J. La Fontaine: None. F. Fincham: None. D. Wukich: None.
A Reimbursable Counseling Intervention Improves Physical Activity and Function for Primary Care Patients with Type 2 Diabetes
Authors: HUEBSCHMANN AMY G. , LEAVITT IAN M. , GLASGOW RUSSELL , REGENSTEINER JUDITH G. , DUNN ANDREA L.
Published: June 2018

Physical activity (PA) is a cornerstone of treatment for type 2 diabetes mellitus (T2D). Among other benefits, regular PA improves physical function which can prevent institutionalization. However, effective PA interventions are not widely adopted in primary care. Our recent systematic review identified an effective PA intervention for adults with T2D that was nearly pragmatic enough for use in primary care. However, it still required adaptation to fit clinic work flows and to be reimbursed by insurance. After adapting the intervention (Be ACTIVE) to address these issues, we hypothesized Be ACTIVE would improve PA and physical function relative to randomized controls. This pragmatic pilot trial randomized adults with T2D to 12 weeks of Be ACTIVE (6 telephone behavioral counseling sessions + PA tracking (FitBit©); 3 primary care visits to teach strength exercises + monitor safety) vs. enhanced usual care (3 self-management mailings). At baseline and post-intervention, we assessed PA with Actigraph© accelerometers (steps/week) and physical function by a timed 400-meter walk (sec) and the Short Physical Performance Battery (SPPB, 0-12 scale). To date, we have completed assessments for 15 participants (n=8 Be ACTIVE, n=7 controls). Pre-post PA increased by 19.8% in the Be ACTIVE group (+5122 ± 10steps/week; data shown as mean ± SE) and decreased by 15.9% in controls (-3122 ± 1233 steps/week). SPPB scores increased by a clinically important >1-point difference in the Be ACTIVE group (+1.1 ± 0.2), and were stable in controls (+0.3 ± 0.1). The 400-meter walk time improved by 10.3% in Be ACTIVE participants (-38.3 ± 6.6 sec) and declined by 5.4% in controls (+17.3 ± 6.4 sec). Be ACTIVE is a reimbursable intervention delivered by primary care staff. Strong pilot data support that Be ACTIVE improves PA/physical function. If our data remain promising at trial completion, the next step towards broader dissemination will be to test Be ACTIVE in multiple clinical settings.

Disclosure

A.G. Huebschmann: Research Support; Self; Merck &Co., Inc..I.M. Leavitt: None.R. Glasgow: None.J.G. Regensteiner: None.A.L. Dunn: None.
Performance of Cleared Blood Glucose Monitor Systems
Authors: KING FRAYA G. , AHN DAVID T. , HSIAO VICTORIA , PORCO TRAVIS , KLONOFF DAVID C.
Published: June 2018

Many blood glucose monitor systems (BGMs) do not pass international standards of accuracy, even when they have been previously cleared by the FDA. Patients rely on BGM data to make treatment decisions, and inaccuracy can lead to reduced glycemic control and insulin dosing errors. In order to assess the accuracy of these BGMs and identify trends that might explain these results, we performed a literature review of publications between 2010 and 2017 that present data about the accuracy of BGMs using ISO 15197 2003 and/or ISO 15197 2013 as target standards. We found 58 publications describing the performance of 143 unique BGM systems, 59 of which were FDA-cleared. When compared with non-FDA cleared BGMs, FDA-cleared BGMs were significantly more likely to pass both the ISO 15197 2003 (OR= 2.39, CI: 1.45-3.92, p<0.01) and ISO 15197 2013 standards (OR= 2.20, CI: 1.51-3.27, p<0.01). We also found that newer meters were more likely to pass each ISO standard for both ISO 15197 2003 (OR: 1.06, CI: 1.06-1.07, p<0.001, odds ratio reported for a one-year period) and ISO 15197 2013 standards (OR=1.06, CI: 1.03-1.06, p<0.01, odds ratio reported for a one year period). Newer meters tend to favor using the test strip enzyme glucose dehydrogenase (GDH) compared to glucose oxidase (GOX), which correlates to an increased likelihood of passing ISO 15197 2003 (OR=0.23, CI: 0.13-0.38, p<0.001) and ISO 15197 2013 (OR=0.24, CI: 0.15-0.35, p<0.001). We note that many of these studies were supported by BGM manufacturers, and when compared with independent studies, an FDA-cleared BGM was significantly more likely to pass in a manufacturer-supported study for both ISO 15197 2003 (OR=22.4, CI: 8.73-21.57, p < 0.001) and ISO 15197 2013 (OR=23.08, CI: 10.16-60.03, p < 0.001). We conclude that BGM accuracy should be assessed independently, both prior to FDA clearance and again during additional surveillance studies, to ensure accurate performance over time in real-world settings. Failure to do so can result in deleterious clinical and economic effects.

Disclosure

F.G. King: None. D.T. Ahn: None. V. Hsiao: None. T. Porco: None. D.C. Klonoff: Consultant; Self; Ascensia Diabetes Care, Lifecare, Intarcia Therapeutics, Inc., Voluntis USA, Novo Nordisk Inc., Onduo, Trividia Health, Inc., American Diabetes Association, The Endocrine Society, American Association of Diabetes Educators.