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Introduction To assess the effects of alcohol and illicit drug use in young adults (age 18–35) with type 1 diabetes (T1D) on flash glucose monitor sensor glucose (SG) readings. Methods Twenty young adults with T1D were enrolled from a tertiary referral hospital outpatient department in Melbourne, Australia for a 6‐week prospective observational study using flash glucose monitoring (FGM). Glucometrics comparing substance using days (SUEDs) to those without substance use (non‐SUEDS) were analysed. The primary outcomes were the difference in mean SG values, its standard deviation and minutes/24‐h period out of range (SG 10.0 mmol/L) between matched SUEDs vs non‐SUEDs. An interaction model with the primary effect of HbA1c on SG values was also performed. Results There were no differences in the primary outcome measures between SUEDS and non‐SUEDs. However, there were differences in the regression coefficients for HbA1c and glucometrics between non‐SUEDs and SUEDs for mean SG, time out of range and time with SG > 10 mmol/L. This difference was also identified between non‐SUEDS and days of ≥40 g alcohol for mean SG. Conclusions While there was no difference between glucometrics for SUEDs and non‐SUEDs on primary outcomes, HbA1C was found to be a less reliable predictor of glucose patterns in the 24‐h period following substance use than control days. Young adults with T1D need to monitor and respond to their glucose levels following substance use and engage in harm minimisation practices irrespective of baseline glucose control., Using FGM, we found no difference in glucometrics in young adults with type 1 diabetes following days of substance use than those without. However, HbA1C values were less predictive of glucometrics on days of substance use than those without substance use. Young adults with T1D, even those with adequate glucose control, need to engage in harm reduction measures, including closer monitoring of their glucose levels, should they choose to consume alcohol or illicit drugs.

Alcohol and other recreational drug use reaches peak prevalence in young adulthood, including for those with chronic medical conditions such as type 1 diabetes. This review summarises the current literature on the patterns of substance use amongst young adults with type 1 diabetes and the mechanisms through which alcohol and recreational drugs may affect diabetes related health outcomes. These include the direct physical effect of intoxication, as well as the effects of alcohol and drugs on mental health and glucose metabolism. Evidence for increased associated mortality and morbidity is also presented, and current guidelines, management strategies and directions for further research are discussed.

Background: After a diagnosis of diabetes mellitus, people not only have to cope with the physical aspects and common complications that require daily self-management, they are also faced with ongoing psychosocial challenges. Subsequently they find themselves having to navigate the health system to engage multidisciplinary supports; the combination of these factors often resulting in reduced health-related quality of life. To maintain optimal diabetes control, interventions need to incorporate psychosocial supports and a skill base for disease management. Therefore, our aim was to evaluate an 'Optimal Health Program' that adopts a person-centred approach and engages collaborative therapy to educate and support the psychosocial health of people diagnosed with type I or II diabetes. Methods: This prospective randomised controlled trial will include 166 people diagnosed with diabetes: 83 in the intervention (Optimal Health Program) and 83 in the control (usual care) group. Participants with type diabetes mellitus will be recruited through hospital outpatient clinics and diabetes community organisations. Participants in the intervention group will receive nine (8 + 1 booster session) sequential sessions, based on a structured treatment manual emphasising educational and psychosocial support self-efficacy and skills building. The primary outcome measures will be generalised self-efficacy (GSE) and health-related quality of life (AQoL-6D and EQ-5D). Secondary measures will be anxiety and depression (HADS), social and workplace functioning (WSAS), diabetes-related quality of life (DQoL), diabetes-related distress (PAID), and type of coping strategies (Brief COPE). In addition, a health economic cost analysis and process evaluations will be performed to assess the economic cost and efficacy of the program's operations, implementation and service delivery. Discussion: We envisage that the Optimal Health Program's emphasis on self-efficacy and self-management will provide participants with the skills and knowledge to achieve increased empowerment and independence in aspects of health, which in turn, will help participants deal more effectively with the physical and psychosocial complexities of diabetes. Trial registration:ACTRN12614001085662. Registered on 10 October 2014.

Aim: To perform a review of studies to identify the prevalence of depression and anxiety in adults with Type 1 diabetes mellitus compared to adults without Type 1 diabetes mellitus. Methods: A computer search was conducted using the PubMed, EBSCOhost, PsychINFO, Cochrane, CINAHL and MEDLINE from 2009 onwards. The essential information extracted from the identified publications were: participant demographics; measurement tools; prevalence of depression; diabetes-specific and non-diabetes specific risk and protective factors for depression or anxiety in people with Type 1 DM; outcomes for Type 1 DM management and complications; and relevant qualitative data. Results: An extensive literature search identified twenty-one key articles which were reviewed to provide strong evidence further supporting the notion that there is increased prevalence of comorbid depression and anxiety in Type 1 DM. Based on the literature reviewed, approximately one in five people living with Type 1 DM suffer from comorbid clinical depression, and one in four experience anxiety. There was variation in the exact rates reported between articles, however, which may be reflective of differences in methods or samples.Conclusion: The pertinence of the evidence analyzed in this review is underpinned by findings from large international studies that have shown depression results in worse health outcomes for individuals compared to any other chronic disease, including diabetes. Further, the combination of depression and diabetes leads to even poorer outcomes than does the combination of diabetes and other chronic diseases.

Psychosocial factors are becoming increasingly recognised as an important component in the holistic management of people living with diabetes. However, there is limited literature available that describes the psychosocial impact of insulin pump therapy on people living with type 1 diabetes mellitus. This paper systematically reviews recurrent themes within extant qualitative research and suggests avenues for future research. These themes explore the pump's impact on diabetes self-management, altered self-identity, perceptions by others and the emotional toll. The findings inform multidisciplinary health care professionals of the importance of a holistic approach to people living with type 1 diabetes. Copyright © 2017 John Wiley & Sons.