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BackgroundType 1 Diabetes Mellitus Virtual Patient Network (T1DM-VPN) is a private Facebook group for youths with type 1 diabetes mellitus (T1DM) in Canada intended to facilitate peer-to-peer support. It was built on the finding that stigma is prevalent among youth with T1DM and impedes self-management. ObjectiveWe aim to determine if T1DM-VPN provides support as intended and to ascertain what type of members provide support. Specifically, we will (1) identify text consistent with any one of 5 social support categories, (2) describe the network by visualizing its structure and reporting basic engagement statistics, and (3) determine whether being a designated peer leader is related to a member’s centrality (ie, importance in the network) and how frequently they offer social support. MethodsWe will manually extract interaction data from the Facebook group (posts, comments, likes/reactions, seen) generated from June 21, 2017 (addition of first member), to March 1, 2020. Two researchers will independently code posts and comments according to an existing framework of 5 social support categories—informational, emotional, esteem, network, and tangible—with an additional framework for nonsocial support categories. We will calculate how frequently each code is used. We will also report basic engagement statistics (eg, number of posts made per person-month) and generate a visualization of the network. We will identify stable time intervals in the history of T1DM-VPN by modeling monthly membership growth as a Poisson process. Within each interval, each member’s centrality will be calculated and standardized to that of the most central member. We will use a centrality formula that considers both breadth and depth of connections (centrality = 0.8 × total No. of connections + 0.2 × total No. of interactions). Finally, we will construct multivariate linear regression models to assess whether peer leader status predicts member centrality and the frequency of offering social support. Other variables considered for inclusion in the models are gender and age at diagnosis. ResultsT1DM-VPN was launched in June 2017. As of March 1, 2020, it has 196 patient-members. This research protocol received ethics approval from the McGill University Health Centre Research Ethics Board on May 20, 2020. Baseline information about each group member was collected upon addition into the group, and collection of interaction data is ongoing as of May 2020. ConclusionsThis content analysis and social network analysis study of a virtual patient network applies epidemiological methods to account for dynamic growth and activity. The results will allow for an understanding of the topics of importance to youth with T1DM and how a virtual patient network evolves over time. This work is intended to serve as a foundation for future action to help youth improve their experience of living with diabetes. International Registered Report Identifier (IRRID)PRR1-10.2196/18714

BackgroundA potential barrier to weight loss and vascular risk reduction is difficulty in operationalizing dietary education into a concrete plan. Although a variety of Internet-based software tools are now available to address this issue, there has been little formal evaluation of these tools. ObjectiveThe aim of this single-arm pilot study is to determine the effect of a 24-week Internet-based menu-planning program, by examining pre- to postintervention changes in the body weight, blood pressure, and glycemia, specifically among overweight adults with type 2 diabetes mellitus (DM2), a clinical population at high risk for vascular diseases. MethodsA total of 33 adults with DM2 were recruited by collaborating registered dietitians to a 24-week Internet-based menu-planning program. Individualized dietary prescriptions were operationalized into weekly Internet-delivered menu plans through an adapted version of a commercially available service. Adherence was defined as logging into the program at least once per week for a minimum of 18 of the 24 weeks. Multiple imputations were used for missing data. Using baseline and postintervention assessments, we calculated the weight changes (mean, 95% CI) and investigated the corresponding effects (linear regression models) on blood pressure (systolic, diastolic) and hemoglobin A1C (ie, glycemia). ResultsThe mean age was 58 (SD 7) years and the mean baseline body mass index was 34.4 (SD 4.6) kg/m2. The results of this study showed that ≥5% weight reduction was achieved by 6/33 participants (18%) and by 5/18 adherent participants (28%). A mean weight change of −2.0% (95% CI −2.6 to −1.4) was observed, with changes occurring in the adherent (−3.6%, 95% CI −4.5 to −2.8) but not in the nonadherent (0%, 95% CI −0.6 to 0.7). It was found that each 1% reduction in body weight was associated with a −2.4 mmHg change in systolic (95% CI −3.5 to −1.2) and a −0.8 mmHg change in diastolic blood pressure (95% CI −1.4 to −0.2). Percent weight change was not found to be related to changes in A1C. ConclusionsIn adults with DM2, an Internet-based menu-planning program has the potential to lead to clinically important weight reductions in more than one quarter of those who adhere, with corresponding improvements in blood pressure.

The article discusses a study which compared continuous positive airway pressure (CPAP) treatment with nasal dilator strip (NDS) control in pregnant individuals with gestational diabetes mellitus (GDM). Topics include assessment of adherence to CPAP by downloading CPAP usage reports every two weeks, analysis of glucose profiles, and primary analysis of CGM data using multiple imputation.

Aims: Evidence is lacking on whether diabetes duration is associated with type 1 diabetes (T1D) self‐management during late adolescence before transfer from paediatric to adult care. We examined associations of diabetes duration with dimensions of perceived comfort with diabetes self‐management (self‐efficacy, transition readiness, diabetes distress) and glycaemic control in late adolescence. Methods: Using a cross‐sectional design, we conducted a secondary analysis of baseline data of adolescents (ages 16–17 years) with T1D followed at paediatric diabetes academic hospitals in Montreal and enrolled in the Group Education Trial to Improve Transition (GET‐IT‐T1D). Participants completed validated questionnaires on self‐efficacy (Self‐Efficacy for Diabetes Self‐Management Measure [SEDM], score 1 to 10), diabetes distress and transition readiness, as well as a haemoglobin (HbA1c) capillary blood test. Our primary outcome was self‐efficacy. We examined associations of diabetes duration with self‐efficacy, diabetes distress, transition readiness and HbA1c using linear and logistic regression models adjusted for sex, socioeconomic status, insulin pump use, glucose sensor use and psychiatric comorbidity. Results: Of 203 adolescents with T1D, mean diabetes duration (SD) was 7.57 (4.44) years. Mean SEDM score was 6.83 (SD 1.62). Diabetes duration was not associated with self‐efficacy, diabetes distress or transition readiness. Each additional year of diabetes duration was associated with 0.11% (95% CI, 0.05 to 0.16) higher HbA1c. Conclusions: Although diabetes duration is not associated with dimensions of perceived comfort with diabetes self‐management, adolescents with longer diabetes duration are at risk for higher HbA1c and may need additional support to improve glycaemic control before transition to adult care. [ABSTRACT FROM AUTHOR]

Aims: In type 1 diabetes (T1D), psychosocial factors may impact quality of life (QOL) and clinical outcomes, but remain understudied, particularly during late adolescence. Our aim was to determine whether stigma, diabetes distress and self‐efficacy are associated with QOL in adolescents with T1D as they are preparing to transition to adult care. Methods: We conducted a cross‐sectional study of adolescents (ages 16–17 years) with T1D participating in the Group Education Trial to Improve Transition (GET‐IT) in Montreal, Canada. Participants completed validated questionnaires on stigma using the Barriers to Diabetes Adherence (BDA) stigma subscale, self‐efficacy (Self‐Efficacy for Diabetes Self‐Management Measure [SEDM], score 1–10), diabetes distress (Diabetes Distress Scale for Adults with type 1 diabetes) and QOL (Pediatric Quality of Life Inventory [PedsQL] 4.0 Generic Core Scale and PedsQL 3.2 Diabetes Module). We examined associations of stigma, diabetes distress and self‐efficacy with QOL using multivariate linear regression models adjusted for sex, diabetes duration, socioeconomic status and HbA1c. Results: Of 128 adolescents with T1D, 76 (59%) self‐reported having the diabetes‐related stigma and 29 (22.7%) reported experiencing diabetes distress. Those with stigma had lower diabetes‐specific and general QOL scores compared with those without stigma, and stigma and diabetes distress were both associated with lower diabetes‐specific QOL and lower general QOL. Self‐efficacy was associated with higher diabetes‐specific and general QOL. Conclusions: Stigma and diabetes distress are associated with lower QOL, whereas self‐efficacy is associated with higher QOL in adolescents with T1D preparing to transfer to adult care. [ABSTRACT FROM AUTHOR]