bluuebunny/crossref_metadata_2025_split 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 &lt;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 &gt;7.0%, and 49% reported insulin use. CDSS-15 scores correlated with diabetes family perceived stigma (ρ=0.51, p&lt;0.01) and consequences of diabetes stigma (ρ =0.63, p&lt;0.01). Higher diabetes stigma correlated with worse medication adherence (ρ =0.40, p&lt;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&lt;0.01). By age, younger participants had higher CDSS-15 scores (ρ =-0.35, p&lt;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 &lt;6.4% (23; 95% CI 21-25) was lower than those with HbA1c &gt;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&lt;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&lt;0.05), higher number of roles (Z= -2.33, p&lt;0.01), and more perceived role demands related to caregiving (Z= -4.44, p&lt;0.001) than males. Conversely, males had a significantly higher family supportive behaviors mean score (Z=2.76, p&lt;0.01), and more perceived role demands related to jobs (Z=4.18, p&lt;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&gt;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 &lt;0.05). Only “concerns about side effects” was associated with discontinuation and inversely related (OR=0.60, p &lt;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 &lt; 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.