Search

Aims To assess the importance of family factors in determining metabolic outcomes in adolescents with Type 1 diabetes in 19 countries. Methods Adolescents with Type 1 diabetes aged 11–18 years, from 21 paediatric diabetes care centres, in 19 countries, and their parents were invited to participate. Questionnaires were administered recording demographic data, details of insulin regimens, severe hypoglycaemic events and number of episodes of diabetic ketoacidosis. Adolescents completed the parental involvement scale from the Diabetes Quality of Life for Youth—Short Form (DQOLY-SF) and the Diabetes Family Responsibility Questionnaire (DFRQ). Parents completed the DFRQ and a Parental Burden of Diabetes score. Glycated haemoglobin (HbA1c) was analysed centrally on capillary blood. Results A total of 2062 adolescents completed a questionnaire, with 2036 providing a blood sample; 1994 parents also completed a questionnaire. Family demographic factors that were associated with metabolic outcomes included: parents living together ( t = 4.1; P < 0.001), paternal employment status ( F = 7.2; d.f. = 3; P < 0.001), parents perceived to be over-involved in diabetes care ( r = 0.11; P < 0.001) and adolescent–parent disagreement on responsibility for diabetes care practices ( F = 8.46; d.f. = 2; P < 0.001). Although these factors differed between centres, they did not account for centre differences in metabolic outcomes, but were stronger predictors of metabolic control than age, gender or insulin treatment regimen. Conclusions Family factors, particularly dynamic and communication factors such as parental over-involvement and adolescent–parent concordance on responsibility for diabetes care appear be important determinants of metabolic outcomes in adolescents with diabetes. However, family dynamic factors do not account for the substantial differences in metabolic outcomes between centres. [ABSTRACT FROM AUTHOR]

Albuminuria is a marker of diabetic kidney disease. Raised albuminuria in children and young people with diabetes is associated with an increased risk of microvascular and macrovascular complications. This review provides guidance for paediatricians caring for children and young people with type 1 and type 2 diabetes on screening, investigations and treatments for albuminuria in line with relevant national and international recommendations. [ABSTRACT FROM AUTHOR]

Diabetes mellitus is a lifelong metabolic disorder that impacts people's well-being and biopsychosocial status. Psychiatric problems and diabetes mellitus have a complex, reciprocal interaction in which one condition affects the other. In this narrative review, we provide an overview of the literature on the psychological effects of diabetes, expound on the evaluation of emotional disorders in the setting of diabetes, and suggest interventions aimed at enhancing both mental and physical health. Diabetes can make daily life complicated and stressful. Frequent blood glucose testing, taking medications on a regular basis, adhering to a tight diet plan, and exercising are some examples of the suggested daily routine of subjects with diabetes. Furthermore, comorbid diseases and typical diabetic complications can have a detrimental impact on quality of life. When mental health conditions coexist with diabetes mellitus, there is a greater likelihood of medication noncompliance, a decreased commitment to diabetes-related self-care, increased functional impairment, inadequate glycemic control, a higher risk of complications, and overall higher healthcare expenses. Thus, evaluation of the mental health status of patients with diabetes is crucial. When treating psychological issues and psychiatric disorders, a comprehensive biopsychosocial approach should be taken, and where appropriate, psychopharmacological therapies or psychotherapy should be applied. The goal of continuous education and assistance for self-care is to give individuals with the disease the information and abilities they need to control their condition over time. [ABSTRACT FROM AUTHOR]

Background. Non-standardized insulin injection has an impact on the efficacy of glucose control. Objectives. The aim of the study was to explore the effectiveness of a nursing project in improving the insulin self-injection accuracy of diabetes mellitus patients. Materials and methods: A total of 200 type 2 diabetes patients who received insulin therapy with an insulin pen were recruited at the First Affiliated Hospital of Army Medical University (Chongqing, China). Patients were randomly assigned to a control (n = 100) or intervention (n = 100) group. Conventional health education was conducted in the control group, while a nursing project and conventional health education were undertaken in the intervention group. The following parameters were analyzed between the 2 groups: standardized insulin pen use at admission and discharge, glycosylated hemoglobin (HbA1c), time in range (TIR), and adipose hyperplasia incidence rate 6 months after discharge. Results: Concerning standardized insulin self-injection, the intervention group was superior to the control group, and the difference between the 2 groups was statistically significant (p < 0.05). The HbA1c levels (p = 0.000), TIR (p = 0.005) and adipose hyperplasia incidence rate 6 months after discharge (p = 0.000) all improved in the intervention group compared to the control group. Conclusions. The application of the nursing project effectively improved the efficacy of glucose control in diabetes mellitus patients. [ABSTRACT FROM AUTHOR]

Aim and Objectives: Metabolic control in type 1 diabetes (T1D) depends on many factors such as sleep patterns, eating habits, and exercise. The study aimed to determine the difficulties experienced by Turkish children with T1D and their parents during the COVID-19 pandemic, and the effects of the pandemic on children’s activities of daily living and physiologic parameters. Materials and Methods: This study, which was carried out with a descriptive and retrospective design, was conducted in the pediatric endocrinology outpatient clinic of a university hospital in Turkey. Data were obtained from 38 children with T1D and their parents who were followed up in this clinic between April 2020 and May 2022. Results: The mean age of the children was 14.79±3.05 years, and 65.8% were diagnosed as having T1D 6 years or more ago. When the difficulties experienced by the children during lockdown were examined, it was determined that 50% had difficulties with eating and sleeping patterns. Compared with the other periods, the children’s compliance with diet and regular activity decreased significantly, their sleep duration and screen time increased significantly, and the frequency of communication with peers decreased significantly during lockdown (P < 0.001). It was observed that the mean body mass index (P < 0.001) and HbA1c levels (P = 0.02) of the children increased significantly in the full reopening period after lockdown compared with the prepandemic period and the lockdown period (P < 0.001), and the frequency of blood glucose monitoring was found to be higher during lockdown (P < 0.001). Conclusion: This study reflects how T1D management has changed between prepandemic, lockdown, and postpandemic periods and its impact on children with T1D. It appears that frequent follow-up of children has an effect on their glycemic control as well as long-term physiological parameters including sleep, exercise, and eating patterns. [ABSTRACT FROM AUTHOR]

Importance: Diabulimia is a disordered eating behavior in which a person with type 1 diabetes withholds insulin injections to lose weight. It is thought that the psychosocial stress of managing this chronic disease, which is termed diabetes distress, may contribute to developing diabulimia. Objective: This paper explores links between diabetes distress and diabulimia and their relevance to the diagnosis and treatment of diabulimia by assessing whether people with diabulimia report measurable evidence of diabetes distress. Evidence Review: We evaluated studies examining the qualitative experiences of people with disordered eating behaviors in the setting of type 1 diabetes for themes of diabetes distress by identifying aspects of the patients' stories that matched the criteria in the Diabetes Distress Scale. Selected studies recorded primary data, analyzed qualitative data, examined lived experiences of individuals with diabulimia, and were made available in English-language peer-reviewed journals between January 1, 2000 and August 31, 2022. Exclusion criteria included partial articles, editorials, reviews, and abstracts along with studies of patients with type 2 diabetes. Findings. Over forty individual participants across twelve studies were found to have aspects of their experiences that met one or more criteria from the Diabetes Distress Scale. Participants reported experiences that matched criteria items from each of the seven subscales of the Diabetes Distress Scale. Participants in the twelve studies included 185 individuals with type 1 diabetes experiencing diabulimia, including 164 females (88.6%), 20 males (10.8%), and 1 non-reported gender (0.54%). Conclusion: We believe this discovery warrants further research probing the prevalence of diabetes distress among people with diabulimia as well as other links between the two conditions. We advocate for a diabetes distress-informed approach to diabulimia treatment and for diabetes distress screening in every patient with type 1 diabetes. Highlights: It is thought that the psychosocial stress of managing diabetes, termed diabetes distress, may contribute to developing diabulimia, which is a disordered eating behavior in which a person withholds insulin injections to lose weight. We explore links between diabetes distress and diabulimia and their relevance to the diagnosis and treatment of diabulimia. Studies were evaluated by examining the qualitative experiences of people with disordered eating behaviors in the setting of type 1 diabetes for themes of diabetes distress by identifying aspects of the patients' stories that matched the criteria in the Diabetes Distress Scale. Over forty individual participants across twelve studies were found to have aspects of their experiences that met one or more criteria from the Diabetes Distress Scale. We believe this discovery warrants further research probing the prevalence of diabetes distress among people with diabulimia as well as other links between the two conditions. Plain English summary: Diabulimia is a disordered eating behavior in people with type 1 diabetes who intentionally withhold insulin injections to lose weight. This study investigates the connection between diabulimia and diabetes distress, the daily psychosocial stress of managing diabetes. We examined the qualitative narratives of 40 participants with diabulimia as recorded in 12 studies and found that they reported experiences matching criteria from the Diabetes Distress Scale, a tool to measure diabetes-related stress. We suggest further research to understand the prevalence of diabetes distress in people with diabulimia. Also, we advocate for using a diabetes distress-informed approach in diabulimia treatment, including screening for diabetes distress in all individuals with type 1 diabetes. [ABSTRACT FROM AUTHOR]

The article aims to assist health care professionals (HCPs) working with individuals with diabetes to understand disordered eating and eating disorders, the relationship between disordered eating and the onset and progression of diabetes, and the impacts of disordered eating on diabetes and psychosocial outcomes. Topics include identifying and assessing disordered eating and eating disorders and advising individuals with diabetes about their eating issues.

For all other aspects concerning the management of patients with diabetes, we refer to the recommendations from diabetes associations, e.g. the European Association for the Study of Diabetes (EASD) or the American Diabetes Association (ADA).[1] These Guidelines offer evidence-based recommendations to manage CV risk in patients with diabetes and provide guidance for the treatment of atherosclerotic cardiovascular disease (ASCVD) in patients with diabetes. The impact of diabetes on peripheral atherosclerosis Diabetes is one of the most important risk factors for the development and progression of atherosclerosis.[[749], [751], [753]] The number of patients with atherosclerosis associated with diabetes is steadily increasing alongside the increasing number of patients with diabetes worldwide. There has not been a specific trial on revascularization strategies in patients with diabetes; however, a review of 56 studies including patients with diabetes suggested higher limb-salvage rates after revascularization (78-85% at 1 year) compared with conservative management.[770] Due to disease progression, long-term follow-up is very important in patients with diabetes and LEAD.[771] 10.1.2. [Extracted from the article]

Objective: The aim of this study was to evaluate the validity and reliability of the Turkish translation of the Parent Diabetes Distress Scale (PDDS). Methods: The PDDS is a 5-point Likert-type scale with 20 items. After obtaining permission from the scale developers, the study commenced. First, a systematic adaptation of the scale into the Turkish language was performed including translation, expert panel review, back translation, and pilot study. Test-retest was applied to 35 participants. After these procedures, data collection was undertaken using the adapted PDDS and a demographic data collection form. The collected data were analyzed for reliability, including stability of the scale with test-retest and internal consistency of the scale (Cronbach's a), and validity including construct validity of the scale with confirmatory factor analysis (CFA). Results: The parents of 210 teenagers, aged >11 and <18 years, who had been diagnosed with type 1 diabetes mellitus for at least one year were included. Of these parents, 71.9% (n=151) were mothers and 53.3% (n=112) of the children were girls. The Cronbach's a value was 0.906. The results of the CFA were X2/df=4.406, p<0.001, comparative fit test 0.704, and goodness of fit tests 0.749. The mean total PDDS score was 2.2±0.7. These results indicate that scores of 1.6 points or less was evaluated as "little or no distress" 1.7-2.4 as "moderate distress," and >2.4 points as "high distress". This showed that the majority of the parents in the study experienced moderate or severe diabetes-related distress. Conclusion: The Turkish version of the PDDS fulfilled the validity and reliability tests at an acceptable level. [ABSTRACT FROM AUTHOR]

Aims: Disordered eating behaviour (DEB) and diabetes distress are prevalent in adults with type 1 diabetes (T1D). Emotion regulation strategies, such as cognitive reappraisal and expressive suppression, are associated with DEB and managing stress in general. Here we examine the associations between DEB, diabetes distress, and emotion regulation strategies in the context of T1D. Methods: Adults with T1D in The Netherlands and Italy completed an online survey, covering DEB (DEPS‐R), diabetes distress (PAID‐5), and emotion regulation strategies (ERQ). Associations between DEB, diabetes distress, and emotion regulation strategies were examined using path analysis. Results: N = 291 participants completed the survey (78.9% women, 39 ± 13 years, HbA1c: 55 ± 16 mmol/mol (7.2% [3.6%]); TIR: 66% ± 25). N = 79 participants (27.1%) reported DEB (DEPS‐R ≥ 20) and n = 159 participants (54.6%) reported elevated diabetes distress (PAID‐5 ≥ 8). The path analysis, with small‐to‐medium effect sizes, revealed that more diabetes distress was associated with more DEB (β = 0.23, 95% CI [0.13, 0.34]). Less diabetes distress was associated with more use of cognitive reappraisal (β = −0.24, 95% CI [−0.36, −0.12]). More DEB was associated with more use of expressive suppression (β = 0.14, 95% CI [0.04, 0.24]). Conclusions: This cross‐sectional study suggests an association between DEB and diabetes distress, between cognitive reappraisal and less diabetes distress and between expressive suppression and more DEB. The results suggest that it may prove beneficial to prioritize strengthening emotion regulation strategies in interventions for people with T1D and DEB. Future research should help clarify causality with regard to emotion regulation and DEB in adults with T1D. [ABSTRACT FROM AUTHOR]

According to recent researches, people with diabetes mellitus (type 1 and 2) have a higher incidence of coronavirus disease 2019 (COVID-19), which is caused by a SARS-CoV-2 infection. In this regard, COVID-19 may make diabetic patients more sensitive to hyperglycemia by modifying the immunological and inflammatory responses and increasing reactive oxygen species (ROS) predisposing the patients to severe COVID-19 and potentially lethal results. Actually, in addition to COVID-19, diabetic patients have been demonstrated to have abnormally high levels of inflammatory cytokines, increased virus entrance, and decreased immune response. On the other hand, during the severe stage of COVID-19, the SARS-CoV-2-infected patients have lymphopenia and inflammatory cytokine storms that cause damage to several body organs such as β cells of the pancreas which may make them as future diabetic candidates. In this line, the nuclear factor kappa B (NF-κB) pathway, which is activated by a number of mediators, plays a substantial part in cytokine storms through various pathways. In this pathway, some polymorphisms also make the individuals more competent to diabetes via infection with SARS-CoV-2. On the other hand, during hospitalization of SARS-CoV-2-infected patients, the use of some drugs may unintentionally lead to diabetes in the future via increasing inflammation and stress oxidative. Thus, in this review, we will first explain why diabetic patients are more susceptible to COVID-19. Second, we will warn about a future global diabetes tsunami via the SARS-CoV-2 as one of its long-term complications. [ABSTRACT FROM AUTHOR]

Unique to individuals with insulin-dependent diabetes mellitus is a disordered eating behaviour whereby insulin is deliberately restricted or omitted. Despite growing research in this area, experiential perspectives of individuals remain understudied. Therefore, this meta-synthesis sought to explore the experiences of individuals with Type 1 Diabetes Mellitus by identifying, analysing and synthesising existing knowledge concerning this misuse of insulin. Meta-aggregative techniques were employed to generate synthesised findings related to individuals' understanding and experience, physical and psychological impacts, support and treatment-related needs, noted in twelve studies. A multifaceted relationship with insulin misuse, beyond weight control was identified. Many individuals experienced diabetes-related complications alongside increased distress, loss of control and feelings of regret, guilt, and shame. Almost all individuals valued support from those who shared a 'diabulimic' identity; peer support appeared more conducive to recovery than support from others including formal support services. This meta-synthesis highlights the need for empathic, collaborative care, and proactive prevention and intervention. The findings highlight the value of peer support, the need for increased knowledge among informal supports, training among multidisciplinary teams and support services, and crucially the development of evidence-based treatments informed by the behaviour as a unique distinct construct. [ABSTRACT FROM AUTHOR]

Copyright of Medical Journal of Bakirkoy is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Journal of Psychiatry & Clinical Psychology / Psychiatria i Psychologia Kliniczna is the property of Medical Communications Sp. z o.o. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes is an age-related chronic health condition and a major public health concern. Diabetes is one of the significant causes of morbidity and mortality and a major contributing factor to dementia. Recent research reveals that Hispanic Americans are at an increased risk of chronic conditions such as diabetes, dementia, and obesity. Recent research also revealed that diabetes develops at least ten years earlier in Hispanics and Latinos than in neighboring non-Hispanic whites. Furthermore, the management of diabetes and providing necessary/timely support is a challenging task for healthcare professionals. Caregiver support is an emerging area of research for people with diabetes, mainly family caregiver support work for Hispanic and Native Americans. Our article discusses several aspects of diabetes, factors associated with diabetes among Hispanics, its management, and how caregivers can support individuals with diabetes. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Diabetes is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Diabetes is a chronic health condition that aects how the body turns food into energy. Research has demonstrated a relationship between diabetes and various mental health issues, which include psychiatric disorders and other problems that are specific for people living with diabetes. Although previous studies have shed light on the associations between diabetes and various types of mental health issues with a focus on depression and anxiety, much less is known about how diabetes is associated with other dimensions of mental health such as social dysfunction and anhedonia and loss of confidence in a large nationally representative survey from the United Kingdom. The aim of the current study is to replicate the factor structure of the GHQ-12 and investigate how diabetes is related to general mental health and dimensions of mental health. By adopting a train-and-test approach to data from the UKHLS including 2,255 diabetes patients and 14,585 age and sex-matched participants who indicated that they were not clinically diagnosed with diabetes, the current study found that hypotheses are well-supported by the results [ABSTRACT FROM AUTHOR]

Background According to the literature, eating disorders are an increasing problem for more than a quarter of people with Type 1 diabetes and they are associated with accentuated diabetic complications. The clinical outcomes in this group when given standard eating disorder treatments are disappointing. The Medical Research Council guidelines for developing complex interventions suggest that the first step is to develop a theoretical model. Aim To review existing literature to build a theoretical maintenance model for disordered eating in people with Type 1 diabetes. Method The literature in diabetes relating to models of eating disorder (Fairburn's transdiagnostic model and the dual pathway model) and food addiction was examined and assimilated. Results The elements common to all eating disorder models include weight/shape concern and problems with mood regulation. The predisposing traits of perfectionism, low self-esteem and low body esteem and the interpersonal difficulties from the transdiagnostic model are also relevant to diabetes. The differences include the use of insulin mismanagement to compensate for breaking eating rules and the consequential wide variations in plasma glucose that may predispose to 'food addiction'. Eating disorder symptoms elicit emotionally driven reactions and behaviours from others close to the individual affected and these are accentuated in the context of diabetes. Conclusion The next stage is to test the assumptions within the maintenance model with experimental medicine studies to facilitate the development of new technologies aimed at increasing inhibitory processes and moderating environmental triggers. [ABSTRACT FROM AUTHOR]

This paper contributes to the debate regarding the adoption/rejection of technologies by focusing on the selective use of therapeutic devices among people with type 1 diabetes. I show that patients often refuse to use a device (either insulin pumps or sensors for glycaemic control), despite suggestions from diabetologists. The study was conducted in Italy in 2019. Theoretically, the paper relied on a perspective that amalgamates actor-network theory and postphenomenology around the key concept of multistability. I then detected the three main features of stabilities that explain device use/non-use: relation to embodied users, contextual embedment (within larger social assemblages), concrete tailoring. Findings helped to stress the relevance of not only focusing on the type of device and its technical functioning, but also unveiling the underlying ongoing and situated socio-technical processes. Selective adoption of devices should be investigated at the level of the whole patient-device assemblage in order to assess the diverse stabilities that may arise from such networks. [ABSTRACT FROM AUTHOR]

Objective: To assess the prevalence of disordered eating behaviors (DEBs) in a large sample of Italian adolescents with type 1 diabetes and to explore potential demographic, clinical, and psychological differences (understood as emotional and behavioral problems) among adolescents with and without DEBs. Method: Adolescents (11–19 years) with type 1 diabetes completed the Diabetes Eating Problems Survey‐revised (DEPS‐r) and the Youth Self Report (YSR). Demographic and clinical data were also collected. Results: Of 690 adolescents with type 1 diabetes (mean age 14.97 ± 1.81, n = 337 girls) assessed in this study, 28.1% (21% boys, 35% girls) were DEPS‐r positive (score ≥ 20). Girls had higher DEPS‐r total scores (p <.0001, d =.42) than boys, although no age differences were found in mean DEPS‐r total scores (p =.961). In both genders, adolescents with DEBs had significantly higher zBMI (p <.0001, d =.52) and HbA1c values (p <.0001, d =.54) and showed more emotional and behavioral problems (both as internalizing and externalizing problems) than those without DEBs (all p <.0001). These differences were largely confirmed in all age groups. Adolescents reporting insulin misuse had higher HbA1c values (p =.001, d =.26), higher DEPS‐r mean scores (p <.0001, d = 1.07), and greater psychological problems (all p <.001) than those who did not. Discussion: DEBs are prevalent among adolescents with type 1 diabetes, and those with eating problems showed adverse clinical and psychological conditions. Routine screening for DEBs and of general psychological condition should be a fundamental part of diabetes care, especially during adolescence. Public significance statement: This nationwide study indicated that DEBs are common in adolescents with T1D, and those suffering from them show poorer clinical conditions and higher emotional and behavioral problems. As such, it offers important contributions for those working with EDs and in the T1D field, as it provides a deeper understanding of the co‐occurring DEBs–emotional/behavioral problems in youths with T1D and highlights the importance of continuous monitoring of their psychological condition by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

In this study, an adaptive backstepping method is proposed to regulate the blood glucose induced by meals for type-1 diabetic patients. The backstepping controller is used to control the blood glucose level and an adaptive algorithm is utilized to compensate for the blood glucose induced by meals. Moreover, the effectiveness of the proposed method is evaluated by comparing results in two different case studies: in the presence of actuator faults and the loss of control input for a short while during treatment. Effects of unannounced meals three times a day are investigated for a nominal patient in every case. It is argued that adaptive backstepping is the preferred control method in either case. The Lyapunov theory is used to prove the stability of the proposed method. Obtained results, indicated that the adaptive backstepping controller is stable, and the desired level of glucose concentration is being tracked efficiently. [ABSTRACT FROM AUTHOR]

Introduction: Glycosylated hemoglobin is used to achieve glycemic control in diabetes, and adherence to treatment is the amount of behavioral therapy performed by an individual. This study aimed to determine effective factors on treatment adherence dimensions and glycosylated hemoglobin in diabetic patients at Aran and Bidgol in 2019. Methods: This was a descriptive-analytical study on diabetic patients referred to Aran and Bidgol health centers from 2019 to 2020. Data were collected through the Madanlu treatment adherence questionnaire and measuring the latest HbA1c level in the patient's file during the last three months. Literate patients completed the questionnaire, and the illiterate ones were interviewed. Data were analyzed using multiple regression tests and the Pearson correlation coefficient. Results: The mean age of participants was 60.04±10.75 and the duration of treatment was 9.46±6.81 years. The number (%) was 258(67%) for women, 302(78.4%) for married, 234(60.8%) for employed, 381(99%) for type 2 diabetes. According to the multiple regression test, the amount of glycosylated hemoglobin decreases for each unit of increasing participation in treatment by 0.088, combination by 0.038 and adherence to treatment by 0.156. Also, the value of glycosylated hemoglobin is increases 0.056 for each unit of increasing in commitment to treatment and 0.089 for each unit of tact in execution. R2 was 0.683 and P <0.001. Conclusion: Glycosylated hemoglobin level has a negative and significant correlation with treatment adherence rate. Due to the improvement of glycosylated hemoglobin levels as a result of better adherence to treatment, promotional interventions are recommended to increase adherence to treatment. [ABSTRACT FROM AUTHOR]

Background and Purpose: Comorbidity between diabetes and depression, and diabetes and eating disorders (ED) conveys significant diagnostic, clinical and therapeutic implications. The present study was conducted on a sample of adult outpatients affected by Type 1 Diabetes (T1DM) to assess lifetime prevalence of ED; current prevalence of depression and Disturbed Eating Behaviors (DEB) and their impact on glycemic control. We hypothesized that patients with depression would have higher rates of lifetime ED and current DEB. We hypothesized a significant and independent association between DEB and the prevalence of depression. Materials and Methods: The study was carried out using a cross-sectional design in a sample of 172 diabetic patients with T1DM aged from 17 to 55 years. Lifetime prevalence of ED according to DSM-5 criteria was assessed by means of the Module H modified of the Structured Clinical Interview for DSM-IV Axis I Disorder (SCID-I). The following questionnaires were used: Beck Depression Inventory-IA version (BDI-IA) and Diabetes Eating Problems Survey--Revised (DEPS-R), to assess respectively the current presence of depression and DEB. Socio-demographic, clinical, and laboratory data were also collected. Results: High rates of depression (35.5%) and DEB (19.2%) were observed in our sample of 172 adult outpatients with T1DM. Lifetime history of ED was present in 20.9% of the sample and was more frequently diagnosed in patients with current depression (34.4% vs. 13.9%, p = 0.002). Higher levels of DEB at DEPS-R significantly increased the odds of depression (adjOR: 1.09; 95% CI: 1.03-1.15; p = 0.003). The presence of DEB was associated with poor glycemic control. On the other hand, no association was found between depression and metabolic compensation. Conclusion: Adult patients with T1DM and depression should be screened for ED and DEB. Treating DEB could positively impact both mood and glycemic control in this population. Further studies should be carried out on a larger patient population using a longitudinal design and an accurate method of evaluation to explore the complex relationship between diabetes, depression, ED, and DEB. Future research should investigate treatment strategies for DEB in T1DM patients and their impact on both psychopathological and metabolic outcomes. [ABSTRACT FROM AUTHOR]

The kidney plays an essential role in homeostasis, accomplished through the regulation of pH, electrolytes and fluids, by the building blocks of the kidney, the nephrons. One of the important markers of the proper functioning of a kidney is the glomerular filtration rate. Diabetes is characterized by an enlargement of the glomerular and tubular size of the kidney, affecting the afferent and efferent arteriole resistance and hemodynamics, ultimately leading to chronic kidney disease. We postulate that the diabetes-induced changes in kidney may exhibit significant sex differences as the distribution of renal transporters along the nephron may be markedly different between women and men, as recently shown in rodents. The goals of this study are to (i) analyze how kidney function is altered in male and female patients with diabetes, and (ii) assess the renal effects, in women and men, of an anti-hyperglycemic therapy that inhibits the sodium-glucose cotransporter 2 (SGLT2) in the proximal convoluted tubules. To accomplish these goals, we have developed computational models of kidney function, separate for male and female patients with diabetes. The simulation results indicate that diabetes enhances Na+ transport, especially along the proximal tubules and thick ascending limbs, to similar extents in male and female patients, which can be explained by the diabetes-induced increase in glomerular filtration rate. Additionally, we conducted simulations to study the effects of diabetes and SGLT2 inhibition on solute and water transport along the nephrons. Model simulations also suggest that SGLT2 inhibition raises luminal [Cl–] at the macula densa, twice as much in males as in females, and could indicate activation of the tubuloglomerular feedback signal. By inducing osmotic diuresis in the proximal tubules, SGLT2 inhibition reduces paracellular transport, eventually leading to diuresis and natriuresis. Those effects on urinary excretion are blunted in women, in part due to their higher distal transport capacity. [ABSTRACT FROM AUTHOR]

This article outlines how social and health care determinants can affect young adults with diabetes. The authors provide a detailed description of each determinant's influence on diabetes self-management and offer solutions to help mitigate these harmful effects. [ABSTRACT FROM AUTHOR]

Introduction: Glycemic control is a valuable goal for people with diabetes; however, the greatest challenge to achieving tight glycemic control is hypoglycemia. Hypoglycemic events are probably common in type 1 diabetes; however, little is known about hypoglycemia in Ethiopia. Therefore, this study aimed to assess the prevalence and the associated factors of hypoglycemia among type 1 diabetes (T1D) patients after insulin use at Metu Karl Referral Hospital in southwest Ethiopia. Materials and Methods: A hospital-based cross-sectional study was conducted among 242 T1D patients at Metu Karl Referral Hospital in southwest Ethiopia. The prevalence of hypoglycemia was assessed by a structured questionnaire through a face-to-face interview in which all the possible symptoms of hypoglycemia were included. If the patients reported that they had experienced the symptoms at least two times in a month and the symptoms were relieved upon consuming sugar/candy/honey, such cases were considered to have had a hypoglycemic episode. Binary logistic regression analysis was done to identify the factors associated with the occurrence of hypoglycemia. Results: Out of 242 T1D patients interviewed, 114 (47.1%) had self-reported hypoglycemia. The most reported symptom of hypoglycemia was sweating (91.7%), followed by dizziness and hunger and nausea with a prevalence of 24.8 and 14.5%, respectively. The study also found that educational level with reading and writing skills up to primary level [adjusted odds ratio, AOR = 0.41; 95% confidence interval, CI (0.19–0.88)] and secondary level and above [AOR = 0.32, 95% CI (0.14–0.70)], poor knowledge of diabetes [AOR = 2.26, 95% CI (1.06–4.84)], good knowledge of insulin self-administration [AOR = 0.54, 95% CI (0.30–0.99)], and duration of insulin use ≥5 years [AOR = 3.93, 95% CI (1.44–10.7)] were factors associated with hypoglycemia. Conclusions: The prevalence of hypoglycemia was found remarkable. We can conclude that hypoglycemia is of public health importance among T1D patients. Since the study assesses hypoglycemia after insulin injection, this prevalence may be due to the poor practice of insulin injection. Therefore, imparting education on the proper technique of insulin administration should be considered at each follow-up visit. [ABSTRACT FROM AUTHOR]

Objectives: Screening of the community for diabetes is generally costly and imposes a significant financial burden. Therefore, some non-invasive measures such as the Finnish Diabetes Risk Score (FINDRISK) Scale have been developed and are generally recommended for screening of people, particularly those with a high risk of diabetes. However, the screening of the university employees including academics with FINDRISK scale has not been performed so far. Therefore, in this study, we intended to assess the risk of diabetes by FINDRISC among the academics and other employees of a university as well as to make diabetes awareness among them. Methods: 442 subjects were included in this study. "Diabetes awareness meetings" were organized, posters with awareness themes were displayed and brochures were distributed to academics and employees of our university. The FINDRISK was used for diabetes risk assessment. Participants' height, weight, waist circumference, and body mass indexes were measured and were recorded. Results: The mean age of the participants was 36.76±9.05. About 62%, 67%, and 32% of the participants were females, married, and academic staff, respectively. The mean waist circumference and body mass index of the participants were 84.71±14.49 cm and 26.8±4.91 kg/m2, respectively, and the median FINDRISK score was 7 (3-10). The 10-year risk of developing diabetes, assessed by FINDRISK score was very high and high, moderate, mild, and low in 8, 10.6, 32.4, and 43.9% of the participants, respectively. Significant differences were found between FINDRISK scores according to gender, age, marital status, smoking status, and occupational positions of the participants (p<0.001 for all parameters). However, the FINDRISK scores of the academics were significantly higher than in other groups. Conclusion: Our study results suggest that the 10-year risk of developing diabetes is higher in academics compared to the other employees. Therefore, to raise awareness among people, diabetes prevention training is of paramount importance, regardless of the education levels of the people, to prevent or delay the development of diabetes. [ABSTRACT FROM AUTHOR]

Introduction: Poor medication adherence and disordered eating are major self-care problems in patients with type 2 diabetes that worsen glycemic control and increase the risk of developing severe diabetes complications. Affective temperament, which remains mostly unchanged throughout life, is speculated to predict poor treatment response and high comorbidity. The aim of this study was to explore the link between affective temperament and poor glycemic control due to insufficient self-care. Methods: This single-center case–control study involved 77 outpatients divided into the 'poor glycemic control' group (n = 52) and the 'better glycemic control' group (n = 25) based on their mean glycated hemoglobin (HbA1c) levels over the past 12 months. All participants underwent one-on-one interviews during which they completed the following psychometric questionnaires: (1) the Mini-International Neuropsychiatric Interview 5.0.0; (2) the Temperament Evaluation of Memphis, Pisa, and San Diego Auto-questionnaire; (3) a researcher-designed single question for assessing subclinical stress-induced overeating; and (4) the Morisky Medication Adherence Scale. The difference between two continuous independent variables was determined using Student's t test. Discrete variables were compared using the Chi-square (χ2) or Fisher's exact test. Multiple testing corrections were performed using the false discovery rate. Results: Those outpatients in the poor glycemic control group exhibited significantly more stress-induced overeating (χ2 = 1.14, q statistic = 0.040) and poor medication adherence (t = 3.70, q = 0.034) than those in the better glycemic control group. However, there were no significant differences between the two groups in terms of affective temperaments, clinical eating disorders, or diabetes-specific distress. Patients with stress-induced overeating (t = − 2.99, p = 0.004) and poor medication adherence (t = − 4.34, p = 0.000) exhibited significantly higher scores for cyclothymic temperament than their counterparts. Conclusion: Cyclothymic temperament is significantly associated with disordered eating and/or poor medication adherence in patients with type 2 diabetes and is possibly linked to poor glycemic control. [ABSTRACT FROM AUTHOR]

Earlier works have revealed increased generation of reactive oxygen species (ROS) and decreased antioxidant levels in type 1 diabetes mellitus (T1DM). The current study aimed to investigate the effect of mixed insulin therapy on oxidative stress and antioxidant status in patients with T1DM. This study involved 75 participants who were divided into three groups: 20 healthy subjects as a control, 25 newly diagnosed patients with T1DM (without treatment) and 30 patients with T1DM treated with insulin (regular and Human Neutral Protamine Hagedorn (NPH)) twice daily. Fasting serum glucose (FSG), serum concentrations of insulin, malondialdehyde (MDA), catalase (CAT), reduced glutathione (GSH), and vitamins (C and E) were measured in all participants. Compared with the healthy control, serum glucose and MDA concentrations were observed to be significantly higher, while significantly lower concentrations of CAT, GSH, and vitamins (C and E) were found in both the treated and untreated diabetic groups. Although insulin therapy caused a significant decrease in blood sugar with a marked elevation in the levels of insulin, CAT, GSH and vitamin E compared to the untreated patients, the changes in the levels of MDA and vitamin C between diabetic groups were not significant. Moreover, the level of insulin resistance was significantly increased in insulin-treated patients as compared to the control and untreated diabetic groups. In conclusion, twice daily treatment with regular and NPH insulin can ameliorate hyperglycemia and improve antioxidant levels in patients with T1DM. However, the insulin regimen used in this study did not reveal a beneficial effect on oxidative stress and insulin resistance. Hence, exogenous antioxidants (vitamins C and E) can be used in combination with insulin to control these parameters. [ABSTRACT FROM AUTHOR]

Research suggests that as many as 60% of people with type 1 diabetes (T1D) admit to misusing insulin. Insulin omission (IO) for the purpose of weight loss, often referred to as diabulimia, is a behaviour becoming increasingly recognised, not least since prolonged engagement can lead to serious vascular complications and mortality. Several risk factors appear to be relevant to the development of IO, most notably gender, anxiety and depression and increased weight concerns and body dissatisfaction. Evidence suggests that women, especially young girls, are more likely to omit insulin as a method of weight loss compared to men. Mental health conditions such as anxiety and depression are increasingly prevalent in people with T1D compared to their peers, and appear to contribute to the risk of IO. Increased weight concerns and body dissatisfaction are further prominent risk factors, especially given increases in weight which often occur following diagnosis and the monitoring of weight by diabetes teams. This review presents evidence examining these risk factors which increase the likelihood of a person with T1D engaging in IO and highlights the complications associated with prolongment of the behaviour. Further research looking at the comorbidities of these risk factors, alongside other factors, would provide greater insight into understanding IO in people with T1D. [ABSTRACT FROM AUTHOR]

We suggest a reconsideration of the role of 'attachment orientation' in the context of eating disorders and paediatric diabetes. Attachment orientation is a psychological construct that describes a relatively stable set of expectations and behaviours an individual relies upon in managing relationships. There is considerable evidence of an association between attachment orientation and the development and maintenance of disordered eating in individuals without diabetes, though evidence is more scant in populations with diabetes. We discuss the underpinning theory and critically examine the existing literature for the relationship between attachment orientation and disordered eating in paediatric diabetes. Finally, we draw on adjacent literatures to highlight potential future directions for research should this area be revisited. Overall, we contextualise our discussion in terms of patient-centred, holistic care that addresses the mind and body (i.e., our discussion of attachment orientation assumes a psycho-biological approach). [ABSTRACT FROM AUTHOR]

Aims: During transition from paediatric to adult diabetes care, adolescents with diabetes are at increased risk of psychiatric disorders compared with those without diabetes. Prolonged gaps between the last paediatric and first adult diabetes care visit are associated with higher perceived stress and lower life satisfaction. We assessed the effect of a gap (>180 days) in establishing adult diabetes care on the risk of psychiatric disorders and determined other risk factors associated with psychiatric disorders during the transfer to adult care. Methods: Using provincial health administrative databases, we conducted a retrospective cohort study of individuals from Québec, Canada, diagnosed with diabetes between ages 1 and 15 years in 1997–2015. These individuals were followed from 6 months after their last paediatric visit until age 25 years. We used multivariable Cox proportional hazard models to determine the association of gap in care with psychiatric disorders risk. Results: Among 1772 youth with diabetes, 740 (42%) had a gap in care. There was a non‐statistically significant association between gap in care and mood disorders diagnosed in the emergency department or hospital (hazard ratio [HR] 1.38, 95% confidence interval [CI]: [0.92, 2.07]). Older age at transfer, recent birth year and higher number of all‐cause emergency department visits in the year before transfer increased the risks of psychiatric disorders. Conclusions: Prolonged gaps in care during transfer to adult care are common and may be associated with increased psychiatric disorder risk. Developmental factors associated with adolescence and emerging adulthood may further amplify this risk. [ABSTRACT FROM AUTHOR]

We aimed to screen for depression among a sample of adolescents with type 1 Diabetes Mellitus (T1DM) and to determine the impact of obesity and poor diabetic control as potential risk factors. One hundred adolescents with T1DM (aged between 14 and 18 years) were randomly selected and subjected to detailed history, physical examination, and laboratory investigations. BMI and Glycated Hemoglobin (HbA1c) were measured. The "PHQ-9" questionnaire- Arabic version was used to screen for depression. We found that 51% of the sample was at moderate to severe risk for depression. There was a statistically significant association between the depression and older age and female gender. Depression severity was positively correlated with HbA1c, frequency of hospital admission, presence of diabetic complications and the degree of obesity. In this study, the best cut-off points that could predict depression in T1DM adolescent patients were: HbA1c of >10.1 or more, while the best cut-off point regarding BMI was found to be more than >22.3 Kg/m2. We can conclude adolescents with T1DM are at increased risk for depression especially females, with poor diabetic control and overweight problems. [ABSTRACT FROM AUTHOR]

The article presents a study which assessed the relationships between self-reported psychosocial measures like diabetes distress and diabetes outcomes in minority youth and young adults (YYA) with type 1 diabetes, particularly Latinx. Other topics include the association of global well-being with A1C, the barriers to diabetes care like communication issues, medical care cost, and low health literacy, and the YYAs' self-care behaviors like self-monitoring of blood glucose (SMBG).

The present study aimed to evaluate choroidal changes and alternations within the structure of the retina prior to visible morphologic signs of diabetic retinopathy (DR) in pediatric type 1 diabetes (T1D) cases. Two hundred and six eyes of 103 pediatric patients with T1D without DR and 88 eyes of 44 healthy controls were enrolled. They underwent a comprehensive ophthalmic examination and optical coherence tomography evaluation. Choroidal thickness (ChT) measurements were performed manually on macular and peripapillary regions. There was no significant difference between the two groups in terms of age, intraocular pressure, and axial length (p > 0.05). ChT measurements of subfoveal, nasal, and temporal macula were slightly thinner in the diabetic group, and no statistical significance was found (p = 0.835, p = 0.305, and p = 0.054, respectively). Peripapillary ChT of eight sectors were also thinner in T1D; however, superonasal, nasal, inferonasal, and inferior sector values were significantly different (p = 0.010, p = 0.020, p = 0.019, and p = 0.018, respectively). In conclusion; this study demonstrated evidence of peripapillary choroidal thinning in pediatric diabetic patients without visible signs of retinopathy. [ABSTRACT FROM AUTHOR]

Nocturnal hypoglycemia is a serious complication of insulin-treated diabetes, and it is often asymptomatic. A novel CGM metric-gradient was proposed in this paper, and a method of combining mean sensor glucose (MSG) and gradient was presented for the prediction of nocturnal hypoglycemia. For this purpose, the data from continuous glucose monitoring (CGM) encompassing 1,921 patients with diabetes were analyzed, and a total of 302 nocturnal hypoglycemic events were recorded. The MSG and gradient values were calculated, respectively, and then combined as a new metric (i.e., MSG+gradient). In addition, the prediction was conducted by four algorithms, namely, logistic regression, support vector machine, random forest, and long short-term memory. The results revealed that the gradient of CGM showed a downward trend before hypoglycemic events happened. Additionally, the results indicated that the specificity and sensitivity based on the proposed method were better than the conventional metrics of low blood glucose index (LBGI), coefficient of variation (CV), mean absolute glucose (MAG), lability index (LI), etc., and the complex metrics of MSG+LBGI, MSG+CV, MSG+MAG, and MSG+LI, etc. Specifically, the specificity and sensitivity were greater than 96.07% and 96.03% at the prediction horizon of 15 minutes and greater than 87.79% and 90.07% at the prediction horizon of 30 minutes when the proposed method was adopted to predict nocturnal hypoglycemic events in the aforementioned four algorithms. Therefore, the proposed method of combining MSG and gradient may enable to improve the prediction of nocturnal hypoglycemic events. Future studies are warranted to confirm the validity of this metric. [ABSTRACT FROM AUTHOR]

Purpose Emerging adults with type 1 diabetes (T1D) are at increased risk for poor health outcomes as they transition from paediatric to adult healthcare providers. This is in part due to the complexities of young adult life as individuals with T1D enter the workforce, leave home or start college while learning to manage the disease on their own. We sought to identify the barriers and facilitators adolescents face during their emerging adult years with T1D. Methods: Young adults, aged 24–35, who lived with T1D during their adolescent years were recruited online to complete a survey regarding their experience with care transition. Categorical data were analysed using descriptive statistics. A thematic analysis, guided by the Framework for Emerging Adults with T1D, was used to explore the free‐text data. Results: In total, 25 adults (84% female) with mean age of 28 ± 3.2 years participated. Themes that arose from the analysis of the paediatric to adult care transition experiences included (1) importance of support from key players, (2) challenges navigating the healthcare system, (3) mental health needs of emerging adults with T1D, (4) managing day‐to‐day life with T1D and (5) early independence to ease transition. Conclusion: Individuals with T1D face a variety of challenges as they transition from paediatric to adult care providers. A proactive approach in educating adolescents is needed. [ABSTRACT FROM AUTHOR]

Introduction: Type-1 diabetes mellitus (T1DM) which is also known as insulin-dependent diabetes is diagnosed mainly during childhood and accounts for approximately 5%–10% of all cases of DM. In India, early onset diabetes (<15 years age) constitutes about 1%–4% of the total diabetic population. The insulitis as well as to a humoral (B cell) response with production of antibodies to IAA, GAD, and the protein tyrosine phosphatase IA2 (IA-2AA) is the main pathogenesis of T1DM. Human leukocyte antigen (HLA)-DR and DQ contributes approximately 40%–50% of the inherited susceptibility for T1DM and most frequently involved haplotypes are DRB1*0301-DQB1*0201, DRB1*0301-DQA1*0501-DQB1*0201, and DRB1*0401-DQB1*0302. Method and Material: Total 70 cases of DM in age group of 10 years to 65 years and 25 healthy controls of same age group 30 cases of complicated diabetic mellitus were included in the study. 2 mL blood was taken in an EDTA vial for HLA typing and 5 mL blood was taken in a plain vial for anti-GAD antibody. HLA DQB1 and DRB1 were done by sequence specific priming polymerase chain reaction method. Indirect immunofluorescent test was used for anti-GAD antibody. Statistical analysis was performed using SPSS version-16. Results: Total 40.9% cases of type-I DM were found seropositive for anti-GAD antibody. None of the cases of type-II DM was anti-GAD antibody positive. HLA DRB1*03010 were significantly more in diabetic patient (P < 0.011) as compared to control. DRB1*O403/6 shows that a relative risk of 1.08 was slightly more frequent in DM cases as compared to the control. DQB1*0201 was significantly high (P < 0.004) in DM patient as compared to control with a relative risk of 1.68. Correlation of DR, DQ antigen with types of DM showed that in type-I DM, DRB1*03010 was significantly high (P = 0.009) with a relative risk of 2.78 as compared type-II DM. In DQ typing, DQB1*0201 was significantly high in type-I DM in comparison to type-II DM (65% vs. 30%, P = 0.026, RR = 2.05). Comparison of DQB1 in type-I DM with healthy control showed that DQB1*0201 was significantly high in type-I DM as compared to healthy control (P = 0.0003, RR = 3.09). In type-I DM patient's homozygosity at DRB1*03010, DRB1*03010 was significantly high as compared to the control (P < 0.047, RR = 2.33). Correlation of anti-GAD antibody with DRB1 and DQB1 showed that 77.7% anti-GAD antibody positive cases were DRB1*03010 positive. Similarly, in DQB1 typing, 66.6% anti-GAD positive cases have DQB1*0201. Conclusion: Prevalence of anti-GAD antibody in Indian population was found up to 45%. HLA DRB1*3010 and HLA DQB1*0201 were the most susceptible haplotypes for type-I DM. HLA DRB1*14 and HLA DRB1*15 were the protective haplotypes for type-I DM. Susceptibility to type-I DM increases when the homozygosity for DRB1*03010 was present. Diagnosis of type-I DM by anti-GAD antibody was possible in only 40.9% cases but if DRB1 and DQB1 typing is added in the diagnosis then diagnostic efficacy increases up to 83%. [ABSTRACT FROM AUTHOR]

Background: Diabetic ketoacidosis (DKA) is considered to be a serious acute life-menacing complication of diabetes type (1) and type (2). The study aims to assess the level of awareness regarding DKA among diabetic patients in the Riyadh population. Methodology: The study is an institution-based cross-sectional study with a sample size of 150 participants. The participants are chosen through systemic random sampling, who have type (1) or type (2) diabetes mellitus patients and are 18–35 years of age. The medical personnel were excluded from the study. A self-administered, precoded, and pretested questionnaire was developed especially for this study after consulting literature and epidemiologists containing data about the risk factor, management, and complication. Data were analyzed using (SPSS). A P value of less than 0.05 was considered significant. Results: 38.67% (58) participants have poor awareness regarding complications, 67.34% (101) have poor knowledge regarding management, and 6% (9) participants have a good knowledge, 38% (57) participants have poor knowledge regarding risk factors and 30% (45) of the participants have good awareness. The relation between having a first degree relative with diabetes and awareness regarding management is significant with a P value of 0.022; 73% (110) of the participants had no relatives with diabetes mellitus and 71% (79) had a poor level of awareness regarding the management of DKA. However, 55% (22) of respondents who had relatives with diabetes mellitus also had a poor level of awareness regarding treatment. Conclusion: The majority of the participants had a poor level of awareness. There is a relationship between having a first-degree relative with diabetic mellitus and the level of awareness regarding DKA. [ABSTRACT FROM AUTHOR]

Background. The purpose of this study was to investigate the accuracy of the continuously stored data from the Abbott FreeStyle Libre flash glucose monitoring (FGM) system in Chinese diabetes patients during standard meal tests when glucose concentrations were rapidly changing. Subjects and Methods. Interstitial glucose levels were monitored for 14 days in 26 insulin-treated patients with type 2 diabetes using the FGM system. Standard meal tests were conducted to induce large glucose swings. Venous blood glucose (VBG) was tested at 0, 30, 60, and 120 min after standard meal tests in one middle day of the first and second weeks, respectively. The corresponding sensor glucose values were obtained from interpolating continuously stored data points. Assessment of accuracy was according to recent consensus recommendations with median absolute relative difference (MARD) and Clarke and Parkes error grid analysis (CEG and PEG). Results. Among 208 paired sensor-reference values, 100% were falling within zones A and B of the Clarke and Parkes error grid analysis. The overall MARD was 10.7% (SD, 7.8%). Weighted least squares regression analysis resulted in high agreement between the FGM sensor glucose and VBG readings. The overall MTT results showed that FGM was lower than actual VBG, with MAD of 22.1 mg/dL (1.2 mmol/L). At VBG rates of change of -1 to 0, 0 to 1, 1 to 2, and 2 to 3 mg/dl/min, MARD results were 11.4% (SD, 8.7%), 9.4% (SD, 6.5%), 9.9% (SD, 7.5%), and 9.5% (SD, 7.7%). At rapidly changing VBG concentrations (>3 mg/dl/min), MARD increased to 19.0%, which was significantly higher than slow changing BG groups. Conclusions. Continuously stored interstitial glucose measurements with the FGM system were found to be acceptable to evaluate VBG in terms of clinical decision during standard meal tests. The continuously stored data from the FGM system appeared to underestimate venous glucose and performed less well during rapid glucose changes. [ABSTRACT FROM AUTHOR]

Aims: To identify key gaps in the research evidence base that could help to improve the mental well‐being of people with diabetes, and to provide recommendations to researchers and research funders on how best to address them. Methods: A 2‐day international research workshop was conducted, bringing together research experts in diabetes and in mental health, people living with diabetes and healthcare professionals. Results: The following key areas needing increased financial investment in research were identified: understanding the mechanisms underlying depression; understanding the multifactorial impact of social stigma; improving the language used by healthcare professionals; supporting people who find it difficult to engage with their diabetes; supporting significant others; supporting people with diabetes and eating disorders; improving models of care by learning from best practice; the potential benefits of screening and managing diabetes distress in routine diabetes care pathways; primary prevention of mental health issues at the time of diagnosis of diabetes; establishing the effectiveness of diabetes therapies on mood and other mental health issues; and understanding the impact of current diabetes technologies on mental health. Research recommendations as to how to address each of these priority areas were also developed. Conclusions: This inaugural position statement outlines recommendations to address the urgent unmet need related to the mental well‐being of people living with diabetes, and calls on the research community and funders to develop research programmes and strategies to reduce this need. What's new?: There is an increased prevalence of psychological and psychiatric disorders in people with diabetes which impairs quality of life.Research prioritization exercises have identified mental well‐being as an area in which further research is needed.Diabetes UK convened a workshop that identified 11 areas for future research. [ABSTRACT FROM AUTHOR]

The article discusses the eating disorder diabulimia, a combination of diabetes and bulimia, which involves the unhealthy avoidance of insulin by diabetics for the purpose of losing weight. This body-image disorder is potentially fatal, as it can induce diabetic ketoacidosis and kidney failure. Warning signs which may indicate diabulimia are provided for the benefit of athletic trainers working with diabetic athletes.

Adherence to treatment regimen is associated with improved glycemic control and is particularly problematic during adolescence for those with type 1 diabetes mellitus (T1DM). Both glycemic control and adherence may be negatively impacted by poor psychological outcomes in adolescence, such as depressive symptoms and low hopefulness. The purpose of this study was to examine associations between the mealtime insulin bolus score (BOLUS), a more robust proxy measure of adherence than frequency of blood glucose monitoring or self‐report, with depressive symptoms, hope, and hemoglobin A1c (HbA1c). Ninety adolescents completed measures of hope (Children's Hope Scale) and depressive symptoms (Center for Epidemiologic Studies—Depression Scale), as well as lab‐based measures of HbA1c and mealtime insulin bolus scores (BOLUS). Higher levels of hope were associated with lower levels of depressive symptoms, more frequent mealtime insulin boluses, and better glycemic control. Higher levels of BOLUS behavior were associated with lower depressive symptoms and better glycemic control. Both BOLUS behavior and hope independently and significantly impacted the relationship between depressive symptoms and HbA1c, suggesting a possible mediation. Since hope and BOLUS were each associated with the relationship between depressive symptoms and glycemic control, following confirmation of this relationship in a longitudinal study, clinics may consider measuring hope and BOLUS among youth with high depressive symptoms and further investigating BOLUS behavior and hope as potential intervention targets to improve glycemic control. [ABSTRACT FROM AUTHOR]

Abstract: Aims: To perform a qualitative review of online blogs authored by people self‐identifying as having Type 1 diabetes and an eating disorder or ‘diabulimia’, a term used by people with Type 1 diabetes to describe an eating disorder that is characterized by deliberate restriction of insulin to control weight. Methods: We conducted a structured qualitative review of online blogs published between 2012 and 2017 authored by people who report having Type 1 diabetes and an eating disorder or diabulimia. The subsequent thematic analysis followed a six‐phase process and was conducted by two independent researchers. Results: From 147 000 search results, 11 blogs (304 posts) matched criteria for further analyses. Three key themes and 18 subthemes emerged: 1) different aspects of bloggers’ relationship with insulin, including motives for omitting insulin, secrecy of insulin omission and perception of control; 2) bloggers’ experiences of diabetes complications, and diabetes ketoacidosis in particular, as well as their worries about future complications; 3) strategies for recovery and triggers for relapse, which involved diabetes self‐management and setting up a support system. Conclusions: Qualitative analyses of blogs authored by people with Type 1 diabetes and an eating disorder or diabulimia have identified high levels of diabetes distress and provided insight into different motives for insulin omission and strategies for recovery. Considering the limited evidence for effective interventions, these findings may help the development of complex interventions to improve biomedical and psychological outcomes in this group. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We hypothesized that participant well‐being and satisfaction with services would be positively associated with a satisfactory clinical course during transition from child to adult health care. Methods: Some 150 young people with Type 1 diabetes mellitus from five diabetes units in England were recruited to a longitudinal study of transition. Each young person was visited at home four times by a research assistant; each visit was 1 year apart. Satisfaction with services (Mind the Gap; MTG) and mental well‐being (Warwick–Edinburgh Mental Well‐being Scale; WEMWBS) were captured. Change in HbA1c, episodes of ketoacidosis, clinic and retinal screening attendance were used to assess clinical course. In total, 108 of 150 (72%) young people had sufficient data for analysis at visit 4. Results: Mean age at entry was 16 years. By visit 4, 81.5% had left paediatric healthcare services. Median HbA1c increased significantly (P = 0.01) from 69 mmol/mol (8.5%) at baseline to 75 mmol/mol (9.0%) at visit 4. WEMWBS scores were comparable with those in the general population at baseline and were stable over the study period. MTG scores were also stable. By visit 4, some 32 individuals had a ‘satisfactory’ and 76 a ‘suboptimal’ clinical course. There were no significant differences in average WEMWBS and MTG scores between the clinical course groups (P = 0.96, 0.52 respectively); nor was there a significant difference in transfer status between the clinical course groups. Conclusions: The well‐being of young people with diabetes and their satisfaction with transition services are not closely related to their clinical course. Investigating whether innovative psycho‐educational interventions can improve the clinical course is a research priority. [ABSTRACT FROM AUTHOR]

Diabetes is a chronic metabolic disorder that impacts physical, social and mental including psychological well-being of people living with it. Additionally, psychosocial problems that are most common in diabetes patients often result in serious negative impact on patient's well-being and social life, if left un-addressed. Addressing such psychosocial aspects including cognitive, emotional, behavioral and social factors in the treatment interventions would help overcome the psychological barriers, associated with adherence and self-care for diabetes; the latter being the ultimate goal of management of patients with diabetes. While ample literature on self-management and psychological interventions for diabetes is available, there is limited information on the impact of psychological response and unmanaged emotional distresses on overall health. The current review therefore examines the emotional, psychological needs of the patients with diabetes and emphasizes the role of diabetologist, mental health professionals including clinical psychologists to mitigate the problems faced by these patients. Search was performed using a combination of keywords that cover all relevant terminology for diabetes and associated emotional distress. The psychological reactions experienced by the patient upon diagnosis of diabetes have been reviewed in this article with a focus on typical emotional distress at different levels. Identifying and supporting patients with psychosocial problems early in the course of diabetes may promote psychosocial well-being and improve their ability to adjust or take adequate responsibility in diabetes self-management – the utopian state dreamt of by all diabetologists !. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the association of clinical, metabolic and socioeconomic factors with disordered eating behaviors (DEB) among adolescents with type 1 diabetes screened using the Diabetes Eating Problem Survey‐Revised (DEPS‐R). Methods: A cross‐sectional, population‐based study involved 163 adolescents with type 1 diabetes, aged 11–20 years, recruited from the registry for type 1 diabetes of Marche Region, Italy, who completed the DEPS‐R (response rate 74.4%). Clinical characteristics, lipid profile, HbA1c, family profile of education and occupation were evaluated. The Italian version of DEPS‐R was validated, and the prevalence of DEB estimated. The association of demographic, socioeconomic, and clinical factors with DEB was evaluated by multiple correspondence analysis and multiple logistic regression. Results: The prevalence of DEPS‐R‐positive (score ≥20) was 27% (95% CI 17–38) in boys and 42% (95% CI 31–53) in girls. A clinical profile of DEPS‐R‐positive was identified: overweight, little time spent in physical activity, low socioeconomic status, poor metabolic control, skipping insulin injections. Furthermore, the probability of DEPS‐R‐positive increased 63% for every added unit of HbA1c, 36% for every added number of insulin injections skipped in a week and decreased about 20% for every added hour/week spent in physical activity. Overweight youth were six times more likely to be DEPS‐R‐positive. Discussion: A specific clinical profile of DEPS‐R‐positive was identified. A multidisciplinary clinical approach aimed to normalize eating behaviors and enhance self‐esteem should be used to prevent the onset of these behaviors, and continuous educational programs are needed to promote healthy behaviors and lifestyles. [ABSTRACT FROM AUTHOR]

Background: A paucity of reports in the literature exists concerning the co‐existence between autism spectrum disorder (ASD) and type 1 diabetes (T1D). Objective: To compare clinical characteristics, diabetes management and metabolic control in youth with T1D and ASD (T1D‐ASD) with youth without ASD (T1D‐non ASD). Methods: Using the German/Austrian diabetes patient follow‐up registry, this study analyzed aggregated data from the last available year of observation for each patient with T1D, ages 1‐20 with consistent data on insulin regimen and glycated hemoglobin (A1C), between January, 2005 and March, 2017. Results: From 61 749 patients, 150 (0.24%) were identified as T1D‐ASD. Non‐adjusted comparisons showed similar results for mean age at onset and duration of diabetes, but not for gender (male: T1D‐ASD: 85.3%; T1D‐non ASD: 52.8%; P < .001). Unadjusted comparisons showed no difference for severe hypoglycemia, diabetic ketoacidosis, insulin doses, insulin pump therapy, and body mass index. A statistical difference was observed for A1C (P‐value .01) and in the number of blood glucose (SMBG) tests/day (median [interquartile range]: T1D‐ASD 6.0 [4.4‐7.0]; T1D‐non ASD 5.0 [4.4‐7.0]; P‐value < .001). After adjusting for age, gender, duration of diabetes, and year of observation, only SMBG remained significant (P‐value .003). T1D‐ASD used psycho‐stimulants (15.3% vs 2.2%; P‐value < .001), antipsychotics (10.7% vs 0.6%; P‐value < .001), and antidepressive medications (3.6% vs 0.7%; P‐value < .001) more frequently. Conclusion: Metabolic control was similar in the T1D‐ASD group compared to T1D‐non ASD despite their comorbidity. Awareness of ASD remains important in T1D treatment, as both conditions require long‐term multi‐disciplinary medical follow‐up for optimal outcomes. [ABSTRACT FROM AUTHOR]

Background/Objective: Recent studies suggest that uric acid (UA) is a mediator of diabetic nephropathy. We hypothesized that serum UA would associate with the prevalence of diabetic nephropathy in youth with type 1 diabetes (T1D), and that this relationship would differ by sex. Methods: We examined 120 young boys and the same number of girls with T1D. C‐reactive protein (CRP), interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), tumor necrosis factor α (TNF‐α), UA, cystatin C serum concentrations, albumin excretion rate and blood pressure were also analyzed. Results: T1D boys had higher serum UA and creatinine concentration, as well as albumin excretion rate and estimated glomerular filtration rate than T1D girls. Moreover, newly diagnosed nephropathy was more common in male subjects in comparison to female patients. Only in T1D boys serum UA was positively correlated with concentrations of subclinical inflammatory markers (CRP, IL‐6, TNF‐α), the indicators of renal function (albumin excretion rate, serum cystatin C level), blood pressure and negatively correlated with anti‐inflammatory IL‐10. In addition, only in T1D girls serum UA concentration was negatively correlated with hemoglobin A1c. Conclusions: Serum UA is associated with nephropathy prevalence, albeit only in boys with T1D and may be an important risk factor for predicting diabetes‐related cardiorenal complications in these patients. [ABSTRACT FROM AUTHOR]

Objective: Eating disorder (bulimia) is common in young diabetic patients which may influence insulin levels. To reduce calories by manipulating insulin is known as Diabulimia. The purpose of this paper is to define Diabulimia and relative issues and highlight the need for early diagnosis and treatment of the disease. Studies showed that early diagnosis and intervention in the treatment of diabulimia can reduce the risk of premature death. [ABSTRACT FROM AUTHOR]