75 results on '"Trawley S"'
Search Results
2. Malnutrition in hospitalised older adults: A multicentre observational study of prevalence, associations and outcomes
- Author
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O’Shea, Emma, Trawley, S., Manning, E., Barrett, A., Browne, V., and Timmons, S.
- Published
- 2017
- Full Text
- View/download PDF
3. Glucose profiles of older adults with type 1 diabetes using sensor-augmented pump therapy in Australia: pre-randomisation results from the ORACL study
- Author
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Trawley, S, Ward, GM, Vogrin, S, Colman, PG, Fourlanos, S, Grills, CA, Lee, MH, MacIsaac, RJ, Alipoor, AM, O'Neal, DN, O'Regan, NA, Sundararajan, Vijaya, and McAuley, SA
- Subjects
Male ,Blood Glucose ,Health (social science) ,Blood Glucose Self-Monitoring ,Australia ,Psychiatry and Mental health ,Diabetes Mellitus, Type 1 ,Glucose ,Humans ,Insulin ,Female ,Geriatrics and Gerontology ,Family Practice ,Aged - Abstract
Background: Older adults with type 1 diabetes are recommended modified glucose targets. However, data on the effects of diabetes technology in older age are scarce. We assessed older adults established on sensor-augmented insulin pump therapy during clinical trial run-in and compared their continuous glucose monitoring (CGM) profiles with consensus recommendations. We aimed to provide insight into the applicability of currently recommended CGM-based targets while accounting for current Diabetes UK guidelines. Methods: In this analysis, adults aged 60 years or older with type 1 diabetes with a duration of at least 10 years and entering the Older Adult Closed Loop (ORACL) trial were studied. The trial was done at two tertiary hospitals in Australia. Individuals who were independent with diabetes self-management, as well as those receiving caregiver assistance for their diabetes management, were eligible for inclusion. Participants underwent baseline clinical assessment, which included medical history and examination, testing for frailty, functional ability, cognitive functioning, psychosocial wellbeing, and subjective sleep quality; fasting venous blood samples were collected for C-peptide, glucose, and glycated haemoglobin A1c measurement. Sensor-augmented pumps, carbohydrate-counting education, and diabetes education were provided to participants by diabetes nurse educators, dietitians, and endocrinologists experienced in type 1 diabetes clinical care. CGM data were subsequently collected for 2 weeks during sensor-augmented pump therapy. The ORACL trial is registered with the Australian New Zealand Clinical Trial Registry, ACTRN12619000515190. Findings: Our analysis included all 30 participants who completed the ORACL trial run-in—19 (63%) women and 11 (37%) men (mean age 67 years [SD 5], median diabetes duration 38 years [IQR 20–47], and insulin total daily dose 0·55 units [0·41–0·66] per kg bodyweight). Ten (33%) of 30 participants had impaired hypoglycaemia awareness and six (20%) were pre-frail; none were frail. The median CGM time in range 3·9–10·0 mmol/L was 71% (IQR 64–79). The time spent with glucose above 10·0 mmol/L was 27% (18–35) and above 13·9 mmol/L was 3·9% (2·4–10·2). The time with glucose below 3·9 mmol/L was 2·0% (1·2–3·1) and the time below 3·0 mmol/L was 0·2% (0·1–0·4). Only two (7%) of 30 participants met all CGM-based consensus recommendations modified for older adults. Time in hypoglycaemia was lower among the 16 participants with predictive low-glucose alerts enabled than among the 14 participants not using predictive low-glucose alerts (median difference −1·1 percentage points [95% CI −2·0 to −0·1]; p=0·038). This difference was even greater overnight (−2·3 percentage points [−3·2 to −1·0]; p=0·0018). One serious adverse event occurred (elective cardiac stent). Interpretation: Using sensor-augmented pumps after multidisciplinary education, this group of older adults without frailty achieved a time in range far exceeding minimum consensus recommendations. However, the current stringent hypoglycaemia recommendations for all older adults were not met. Predictive low alerts could reduce hypoglycaemia, particularly overnight. Investigation into the effectiveness of CGM-based targets that consider frailty, functional status, and diabetes therapies for older adults is warranted.
- Published
- 2022
4. Self-reported changes in aggressive driving within the past five years, and during COVID-19.
- Author
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Aghayan, I, Stephens, AN, Trawley, S, Ispanovic, J, Lowrie, S, Aghayan, I, Stephens, AN, Trawley, S, Ispanovic, J, and Lowrie, S
- Abstract
Aggressive driving is a significant road safety problem and is likely to get worse as the situations that provoke aggression become more prevalent in the road network (e.g. as traffic volumes and density increase and the grey fleet expands). In addition, driver frustration and stress, also recognised as triggers for aggression, are likely to stay high because of the COVID-19 pandemic and associated burdens, leading to increased aggression. However, although drivers report that other drivers are becoming more aggressive, self-report data suggests that the prevalence of aggression has not changed over time. This may be due to the methods used to define and measure aggression. This study sought to clarify whether self-reported aggression has increased over a five-year period and across three different types of aggression: verbal aggression, aggressive use of the vehicle and personal physical aggression. The influence of COVID-19 lockdowns on own and others' driving styles was also investigated. A total of 774 drivers (males = 66.5%, mean age = 48.7; SD = 13.9) who had been licensed for at least five years (M = 30.6, SD = 14.3), responded to an online survey and provided retrospective frequencies for their current aggression (considered pre-COVID-19 lockdowns) and five years prior. Two open ended questions were included to understand perceived changes in driving styles (own and others) during the COVID-19 pandemic. One third (33%) of drivers believed they were more aggressive now than five years ago but 61% of the sample believed other drivers were more aggressive now than five years ago. Logistic regression analyses on changes in self-reported aggression (same or decreased vs increased) showed the main factor associated with increases in aggressive driving was the perception that other drivers' aggression had increased. Further, almost half the sample (47%) reported that other drivers had become riskier and more dangerous during, and soon after, the COVID-19 lockdowns.
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- 2022
5. Closed-loop therapy in older adults with type 1 diabetes: hypoglycaemia benefits and risk stratification
- Author
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McAuley, SA, Trawley, S, McAuley, SA, and Trawley, S
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- 2022
6. Positive effects of nicotine on cognition: the deployment of attention for prospective memory
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Rusted, J. M., Sawyer, R., Jones, C., Trawley, S. L., and Marchant, N. L.
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- 2009
- Full Text
- View/download PDF
7. Nicotine improves memory for delayed intentions
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Rusted, J. M., Trawley, S., Heath, J., Kettle, G., and Walker, H.
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- 2005
- Full Text
- View/download PDF
8. Prospective memory slips are associated with forgetting to take glucose-lowering therapies among adults with diabetes: results from the second Diabetes MILES - Australia (MILES-2) survey
- Author
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Trawley, S, Baptista, S, Pouwer, F, Speight, J, Trawley, S, Baptista, S, Pouwer, F, and Speight, J
- Abstract
AIMS: Prospective memory has been long considered a fundamental cognitive ability for optimal medication taking, but the role of prospective memory errors (termed 'slips') in diabetes self-care is unclear. Our aim was to examine associations between prospective memory and medication taking in adults with Type 1 and Type 2 diabetes mellitus. METHODS: Some 901 adults with Type 1 diabetes and 927 with Type 2 diabetes completed a cross-sectional survey focused on the psychological and behavioural aspects of living with diabetes. Respondents reported whether they had forgotten to take their diabetes medication over the previous 14 days. RESULTS: Twenty-four per cent (n = 220) of adults with Type 1 diabetes and 23% (n = 211) with Type 2 diabetes reported that they had forgotten their medication at least once over the previous 14 days. This was associated with more prospective memory slips in adults with Type 1 diabetes [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.05 to 1.13; P < 0.001] and Type 2 diabetes (OR 1.10, 95% CI 1.05 to 1.15; P < 0.001); and with younger age (both groups), insulin pump use (Type 1 diabetes), insulin treatment (Type 2 diabetes), less frequent blood glucose checks (Type 1 diabetes) and higher HbA1c (Type 1 diabetes). CONCLUSIONS: These findings suggest that forgetting medication is relatively common among adults with Type 1 or Type 2 diabetes, and provide preliminary evidence for its relationship with self-reported prospective memory slips.
- Published
- 2019
9. Associations between attention deficit hyperactivity and internet gaming disorder symptoms: Is there consistency across types of symptoms, gender and countries?
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Stavropoulos, V, Adams, BLM, Beard, CL, Dumble, E, Trawley, S, Gomez, R, Pontes, HM, Stavropoulos, V, Adams, BLM, Beard, CL, Dumble, E, Trawley, S, Gomez, R, and Pontes, HM
- Abstract
BACKGROUND: Videogame addiction has been suggested as a tentative disorder in 2013 by the American Psychiatric Association (APA) and was recently officially recognized as a mental health disorder by the World Health Organization (WHO). Although a few studies have identified attention deficit and hyperactivity disorder (ADHD) as a key risk factor for Internet Gaming Disorder (IGD), the interplay between ADHD and IGD symptoms with gender differences across cultures remains to be further examined. OBJECTIVE: This study examined the moderating effects of gender in the association between ADHD and IGD across two nations. METHOD: A cross-sectional online survey was developed to recruit 164 Australian (Mage = 23.01, SD = 3.35, Minage = 18, Maxage = 31, Males n = 121, 73.80%) and 457 U.S.-North American (Mage = 25.25 years, SD = 2.76, Minage = 18 years, Maxage = 29 years, Males = 265, 57.98%) Massively Multiplayer Online (MMO) players aged between 18 and 29 years. RESULTS: The hierarchical linear regression, moderation and moderated moderation analyses revealed that participants presenting greater inattention and hyperactivity symptoms exhibited higher levels of IGD-related behaviors in the two samples. Moreover, these associations differed across genders between the two countries. Specifically, more hyperactive-impulsive, as well as inattentive males in the USA presented higher levels of disordered gaming. CONCLUSION: The results highlight the need for more cross-cultural and symptom-focused research in the broader IGD field.
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- 2019
10. Measure for Angry Drivers
- Author
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Stephens, A. N., primary, Lennon, A., additional, Bihler, C., additional, and Trawley, S., additional
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- 2019
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- View/download PDF
11. Prospective memory slips are associated with forgetting to take glucose‐lowering therapies among adults with diabetes: results from the second Diabetes MILES – Australia (MILES‐2) survey
- Author
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Trawley, S., primary, Baptista, S., additional, Pouwer, F., additional, and Speight, J., additional
- Published
- 2018
- Full Text
- View/download PDF
12. Effect of 6 months hybrid closed-loop insulin delivery in young people with type 1 diabetes: a randomised controlled trial protocol
- Author
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De Bock, M., McAuley, S. A., Abraham, M. B., Smith, G., Nicholas, J., Ambler, G. R., Cameron, F. J., Fairchild, J. M., King, B. R., Geelhoed, E. A., Davis, E. A., O'Neal, D. N., Jones, T.W ., Bach, L. A., Burt, M. G., Clarke, P. M., Cohen, N. D., Colman, P. G., Hendrieckx, C., Holmes-Walker, D. J., Horsburgh, J. C., Jenkins, A. J., Kaye, J., Keech, A.C ., Kumareswaran, K., Lee, M. H., MacIsaac, R. J., McCallum, R. W., Paldus, B., Sims, C., Speight, J., Stranks, S. N., Sundararajan, V., Trawley, S., Vogrin, S., Ward, G. M., De Bock, M., McAuley, S. A., Abraham, M. B., Smith, G., Nicholas, J., Ambler, G. R., Cameron, F. J., Fairchild, J. M., King, B. R., Geelhoed, E. A., Davis, E. A., O'Neal, D. N., Jones, T.W ., Bach, L. A., Burt, M. G., Clarke, P. M., Cohen, N. D., Colman, P. G., Hendrieckx, C., Holmes-Walker, D. J., Horsburgh, J. C., Jenkins, A. J., Kaye, J., Keech, A.C ., Kumareswaran, K., Lee, M. H., MacIsaac, R. J., McCallum, R. W., Paldus, B., Sims, C., Speight, J., Stranks, S. N., Sundararajan, V., Trawley, S., Vogrin, S., and Ward, G. M.
- Abstract
Introduction Automated insulin delivery (also known as closed loop, or artificial pancreas) has shown potential to improve glycaemic control and quality of life in people with type 1 diabetes (T1D). Automated insulin delivery devices incorporate an insulin pump with continuous glucose monitoring(CGM) and an algorithm, and adjust insulin in real time. This study aims to establish the safety and efficacy of a hybrid closed-loop (HCL) system in a long-term outpatient trial in people with T1D aged 12 -<25 years of age, and compare outcomes with standard therapy for T1D as used in the contemporary community. Methods and analysis This is an open-label, multicentre, 6-month, randomised controlled home trial to test the MiniMed Medtronic 670G system (HCL) in people with T1D aged 12 -<25 years, and compare it to standard care (multiple daily injections or continuous subcutaneous insulin infusion (CSII), with or without CGM). Following a run-in period including diabetes and carbohydrate counting education, dosage optimisation and baseline glucose control data collection, participants are randomised to either HCL or to continue on their current treatment regimen. The primary aim of the study is to compare the proportion of time spent in target sensor glucose range (3.9-10.0 mmol/L) on HCL versus standard therapy. Secondary aims include a range of glucose control parameters, psychosocial measures, health economic measures, biomarker status, user/technology interactions and healthcare professional expectations. Analysis will be intention to treat. A study in adults with an aligned design is being conducted in parallel to this trial. Ethics and dissemination Ethics committee permissions were gained from respective institutional review boards. The findings of the study will provide high-quality evidence on the role of HCL in clinical practice.
- Published
- 2018
13. Effect of 6 months of hybrid closed-loop insulin delivery in adults with type 1 diabetes: a randomised controlled trial protocol
- Author
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McAuley, SA, de Bock, M, Sundararajan, V, Lee, MH, Paldus, B, Ambler, GR, Bach, LA, Burt, MG, Cameron, FJ, Clarke, PM, Cohen, ND, Colman, PG, Davis, EA, Fairchild, JM, Hendrieckx, C, Holmes-Walker, DJ, Horsburgh, JC, Jenkins, AJ, Kaye, J, Keech, AC, King, BR, Kumareswaran, K, Maclsaac, RJ, McCallum, RW, Nicholas, JA, Sims, C, Speight, J, Stranks, SN, Trawley, S, Ward, GM, Vogrin, S, Jones, TW, O'Neal, DN, McAuley, SA, de Bock, M, Sundararajan, V, Lee, MH, Paldus, B, Ambler, GR, Bach, LA, Burt, MG, Cameron, FJ, Clarke, PM, Cohen, ND, Colman, PG, Davis, EA, Fairchild, JM, Hendrieckx, C, Holmes-Walker, DJ, Horsburgh, JC, Jenkins, AJ, Kaye, J, Keech, AC, King, BR, Kumareswaran, K, Maclsaac, RJ, McCallum, RW, Nicholas, JA, Sims, C, Speight, J, Stranks, SN, Trawley, S, Ward, GM, Vogrin, S, Jones, TW, and O'Neal, DN
- Abstract
INTRODUCTION: Manual determination of insulin dosing largely fails to optimise glucose control in type 1 diabetes. Automated insulin delivery via closed-loop systems has improved glucose control in short-term studies. The objective of the present study is to determine the effectiveness of 6 months' closed-loop compared with manually determined insulin dosing on time-in-target glucose range in adults with type 1 diabetes. METHODS AND ANALYSIS: This open-label, seven-centre, randomised controlled parallel group clinical trial will compare home-based hybrid closed-loop versus standard diabetes therapy in Australia. Adults aged ≥25 years with type 1 diabetes using intensive insulin therapy (via multiple daily injections or insulin pump, total enrolment target n=120) will undertake a run-in period including diabetes and carbohydrate-counting education, clinical optimisation and baseline data collection. Participants will then be randomised 1:1 either to 26 weeks of MiniMed 670G hybrid closed-loop system therapy (Medtronic, Northridge, CA, USA) or continuation of their current diabetes therapy. The hybrid closed-loop system delivers insulin automatically to address basal requirements and correct to target glucose level, while bolus doses for meals require user initiation and carbohydrate estimation. Analysis will be intention to treat, with the primary outcome time in continuous glucose monitoring (CGM) target range (3.9-10.0 mmol/L) during the final 3 weeks of intervention. Secondary outcomes include: other CGM parameters, HbA1c, severe hypoglycaemia, psychosocial well-being, sleep, cognition, electrocardiography, costs, quality of life, biomarkers of vascular health and hybrid closed-loop system performance. Semistructured interviews will assess the expectations and experiences of a subgroup of hybrid closed-loop users. ETHICS AND DISSEMINATION: The study has Human Research Ethics Committee approval. The study will be conducted in accordance with the principles of the D
- Published
- 2018
14. Strengths, Risk Factors, and Resilient Outcomes in Adolescents With Type 1 Diabetes: Results From Diabetes MILES Youth-Australia
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Hilliard, ME, Hagger, V, Hendrieckx, C, Anderson, BJ, Trawley, S, Jack, MM, Pouwer, F, Skinner, T, Speight, J, Hilliard, ME, Hagger, V, Hendrieckx, C, Anderson, BJ, Trawley, S, Jack, MM, Pouwer, F, Skinner, T, and Speight, J
- Abstract
OBJECTIVE: Despite the challenges of living with type 1 diabetes, many adolescents achieve "resilient outcomes": high engagement in self-management behaviors such as self-monitoring of blood glucose (SMBG), good quality of life (QOL), and within-target glycemic outcomes (HbA1c). Adaptive diabetes-related behaviors (i.e., "strengths") are associated with resilient outcomes, yet the combination of risks and strengths in relation to resilient outcomes is unclear. The aim of this study was to investigate relations among diabetes strengths and resilient outcomes in the context of psychological and family risk factors. RESEARCH DESIGN AND METHODS: A total of 471 Australian adolescents with type 1 diabetes (mean age 15.7 ± 1.9 years; diabetes duration 6.9 ± 4.2 years; 62% female; 53% using insulin pumps) completed a national cross-sectional survey about their diabetes-related strengths, risk factors (depressive/anxiety symptoms, family conflict), and resilient outcomes (SMBG frequency, general QOL, HbA1c). RESULTS: Greater diabetes strengths were significantly related to resilient outcomes: more frequent SMBG (r = 0.39), lower HbA1c (r = -0.31), and higher general QOL (r = 0.50), as well as to lower risks: fewer depressive (r = -0.45) and anxiety (r = -0.40) symptoms and less conflict (r = 0.28). In multivariate regressions, diabetes strengths consistently related to all resilient outcomes beyond significant risk factors. CONCLUSIONS: In a large sample of Australian adolescents, diabetes strengths were strongly related to key resilient outcomes, even in the presence of well-documented psychological and family risk factors. More research is needed to determine whether strengths reduce or buffer other risks. Given the associations with self-management, HbA1c, and general QOL, monitoring and enhancing diabetes strengths may support resilience promotion during a vulnerable developmental period.
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- 2017
15. Inconsistent blood glucose checking before driving among drivers with type 1 diabetes: Results from the Australian YourSAY: Glucose Monitoring study
- Author
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Trawley, S., primary, Holmes-Truscott, E., additional, and Speight, J., additional
- Published
- 2016
- Full Text
- View/download PDF
16. Prospective memory slips are associated with forgetting to take glucose‐lowering therapies among adults with diabetes: results from the second Diabetes MILES – Australia (MILES‐2) survey.
- Author
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Trawley, S., Baptista, S., Pouwer, F., and Speight, J.
- Subjects
- *
INSULIN therapy , *HYPOGLYCEMIC agents , *CONFIDENCE intervals , *PEOPLE with diabetes , *DRUGS , *GLYCOSYLATED hemoglobin , *INSULIN pumps , *TYPE 1 diabetes , *MEMORY , *TYPE 2 diabetes , *PATIENT compliance , *SURVEYS , *PSYCHOSOCIAL factors , *CROSS-sectional method , *ODDS ratio , *ADULTS - Abstract
Aims: Prospective memory has been long considered a fundamental cognitive ability for optimal medication taking, but the role of prospective memory errors (termed 'slips') in diabetes self‐care is unclear. Our aim was to examine associations between prospective memory and medication taking in adults with Type 1 and Type 2 diabetes mellitus. Methods: Some 901 adults with Type 1 diabetes and 927 with Type 2 diabetes completed a cross‐sectional survey focused on the psychological and behavioural aspects of living with diabetes. Respondents reported whether they had forgotten to take their diabetes medication over the previous 14 days. Results: Twenty‐four per cent (n = 220) of adults with Type 1 diabetes and 23% (n = 211) with Type 2 diabetes reported that they had forgotten their medication at least once over the previous 14 days. This was associated with more prospective memory slips in adults with Type 1 diabetes [odds ratio (OR) 1.09, 95% confidence interval (CI) 1.05 to 1.13; P < 0.001] and Type 2 diabetes (OR 1.10, 95% CI 1.05 to 1.15; P < 0.001); and with younger age (both groups), insulin pump use (Type 1 diabetes), insulin treatment (Type 2 diabetes), less frequent blood glucose checks (Type 1 diabetes) and higher HbA1c (Type 1 diabetes). Conclusions: These findings suggest that forgetting medication is relatively common among adults with Type 1 or Type 2 diabetes, and provide preliminary evidence for its relationship with self‐reported prospective memory slips. What's new?: Medication forgetting among adults with diabetes is common and impacts on glycaemic control. Nearly a quarter of adults with diabetes report forgetting medication recently.Medication forgetting was similar for adults with Type 1 or Type 2 diabetes, and was associated with younger age and higher HbA1c.Prospective memory slips were associated with medication forgetting among adults with Type 1 or Type 2 diabetes.Forgetting to take medication was associated with higher self‐reported HbA1c (+7 mmol/mol; +0.6%) among respondents with Type 1 diabetes, which is both statistically and clinically significant.There is potential for prospective memory‐based interventions to support diabetes self‐care. [ABSTRACT FROM AUTHOR]
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- 2019
- Full Text
- View/download PDF
17. Diabetes MILES Youth-Australia: methods and sample characteristics of a national survey of the psychological aspects of living with type 1 diabetes in Australian youth and their parents.
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Hagger, V, Trawley, S, Hendrieckx, C, Browne, JL, Cameron, F, Pouwer, F, Skinner, T, Speight, J, Hagger, V, Trawley, S, Hendrieckx, C, Browne, JL, Cameron, F, Pouwer, F, Skinner, T, and Speight, J
- Abstract
BACKGROUND: Type 1 diabetes is a complex and demanding condition, which places a substantial behavioural and psychological burden on young people and their families. Around one-third of adolescents with type 1 diabetes need mental health support. Parents of a child with type 1 diabetes are also at increased risk of psychological distress. A better understanding of the motivators, behaviours and psychological well-being of young people with diabetes and their parents will inform improvement of resources for supporting self-management and reducing the burden of diabetes. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Youth-Australia Study is the first large-scale, national survey of the impact of diabetes on the psychosocial outcomes of Australian adolescents with type 1 diabetes and their parents. METHODS/DESIGN: The survey was web-based to enable a large-scale, national survey to be undertaken. Recruitment involved multiple strategies: postal invitations; articles in consumer magazines; advertising in diabetes clinics; social media (e.g. Facebook, Twitter). Recruitment began in August 2014 and the survey was available online for approximately 8 weeks. A total of 781 young people (aged 10-19 years) with type 1 diabetes and 826 parents completed the survey. Both genders, all ages within the relevant range, and all Australian states and territories were represented, although compared to the general Australian population of youth with type 1 diabetes, respondents were from a relatively advantaged socioeconomic background. DISCUSSION: The online survey format was a successful and economical approach for engaging young people with type 1 diabetes and their parents. This rich quantitative and qualitative dataset focuses not only on diabetes management and healthcare access but also on important psychosocial factors (e.g. social support, general emotional well-being, and diabetes distress). Analysis of the Diabetes MILES Youth-Australia Stu
- Published
- 2016
18. Diabetes miles youth Australia: Methods and sample characteristics of a national survey of the psychological aspects of living with type 1 diabetes in Australian youth and their parents
- Author
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Hagger, V., Trawley, S., Hendrieckx, C., Browne, J.L., Cameron, F., Pouwer, F., Skinner, T., Speight, J., Hagger, V., Trawley, S., Hendrieckx, C., Browne, J.L., Cameron, F., Pouwer, F., Skinner, T., and Speight, J.
- Abstract
Background Type 1 diabetes is a complex and demanding condition, which places a substantial behavioural and psychological burden on young people and their families. Around one-third of adolescents with type 1 diabetes need mental health support. Parents of a child with type 1 diabetes are also at increased risk of psychological distress. A better understanding of the motivators, behaviours and psychological well-being of young people with diabetes and their parents will inform improvement of resources for supporting self-management and reducing the burden of diabetes. The Diabetes MILES (Management and Impact for Long-term Empowerment and Success) Youth–Australia Study is the first large-scale, national survey of the impact of diabetes on the psychosocial outcomes of Australian adolescents with type 1 diabetes and their parents. Methods/design The survey was web-based to enable a large-scale, national survey to be undertaken. Recruitment involved multiple strategies: postal invitations; articles in consumer magazines; advertising in diabetes clinics; social media (e.g. Facebook, Twitter). Recruitment began in August 2014 and the survey was available online for approximately 8 weeks. A total of 781 young people (aged 10–19 years) with type 1 diabetes and 826 parents completed the survey. Both genders, all ages within the relevant range, and all Australian states and territories were represented, although compared to the general Australian population of youth with type 1 diabetes, respondents were from a relatively advantaged socioeconomic background. Discussion The online survey format was a successful and economical approach for engaging young people with type 1 diabetes and their parents. This rich quantitative and qualitative dataset focuses not only on diabetes management and healthcare access but also on important psychosocial factors (e.g. social support, general emotional well-being, and diabetes distress). Analysis of the Diabetes MILES Yo
- Published
- 2016
19. Malnutrition in hospitalised older adults: A multicentre observational study of prevalence, associations and outcomes
- Author
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O’Shea, Emma, primary, Trawley, S., additional, Manning, E., additional, Barrett, A., additional, Browne, V., additional, and Timmons, S., additional
- Published
- 2016
- Full Text
- View/download PDF
20. Dementia in older people admitted to hospital: a regional multi-hospital observational study of prevalence, associations and case recognition
- Author
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Timmons, S, Manning, E, Barrett, A, Brady, NM, Browne, V, O'Shea, E, Molloy, DW, O'Regan, NA, Trawley, S, Cahill, S, O'Sullivan, K, Woods, N, Meagher, D, Ni Chorcorain, AM, Linehan, JG, Timmons, S, Manning, E, Barrett, A, Brady, NM, Browne, V, O'Shea, E, Molloy, DW, O'Regan, NA, Trawley, S, Cahill, S, O'Sullivan, K, Woods, N, Meagher, D, Ni Chorcorain, AM, and Linehan, JG
- Abstract
BACKGROUND: Previous studies have indicated a prevalence of dementia in older admissions of ∼42% in a single London teaching hospital, and 21% in four Queensland hospitals. However, there is a lack of published data from any European country on the prevalence of dementia across hospitals and between patient groups. OBJECTIVE: To determine the prevalence and associations of dementia in older patients admitted to acute hospitals in Ireland. METHODS: Six hundred and six patients aged ≥70 years were recruited on admission to six hospitals in Cork County. Screening consisted of Standardised Mini-Mental State Examination (SMMSE); patients with scores <27/30 had further assessment with the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE). Final expert diagnosis was based on SMMSE, IQCODE and relevant medical and demographic history. Patients were screened for delirium and depression, and assessed for co-morbidity, functional ability and nutritional status. RESULTS: Of 598 older patients admitted to acute hospitals, 25% overall had dementia; with 29% in public hospitals. Prevalence varied between hospitals (P < 0.001); most common in rural hospitals and acute medical admissions. Only 35.6% of patients with dementia had a previous diagnosis. Patients with dementia were older and frailer, with higher co-morbidity, malnutrition and lower functional status (P < 0.001). Delirium was commonly superimposed on dementia (57%) on admission. CONCLUSION: Dementia is common in older people admitted to acute hospitals, particularly in acute medical admissions, and rural hospitals, where services may be less available. Most dementia is not previously diagnosed, emphasising the necessity for cognitive assessment in older people on presentation to hospital.
- Published
- 2015
21. Malnutrition in hospitalised older adults: A multicentre observational study of prevalence, associations and outcomes.
- Author
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O'Shea, Emma, Trawley, S., Manning, E., Barrett, A., Browne, V., and Timmons, S.
- Subjects
MALNUTRITION ,DEMENTIA ,FRAIL elderly ,HOSPITAL patients ,MEDICAL cooperation ,SCIENTIFIC observation ,RESEARCH ,COMORBIDITY ,DISEASE prevalence ,NUTRITIONAL status - Abstract
Background: Malnutrition is common in older adults and is associated with high costs and adverse outcomes. The prevalence, predictors and outcomes of malnutrition on admission to hospital are not clear for this population. Design: Prospective Cohort Study. Setting: Six hospital sites (five public, one private). Participants: In total, 606 older adults aged 70+ were included. All elective and acute admissions to any speciality were eligible. Day-case admissions and those moribund on admission were excluded. Measurements: Sociodemographic and clinical data, including nutritional status (Mini-Nutritional Assessment-short form), was collected within 36 hours of admission. Outcome data was collected prospectively on length of stay, in-hospital mortality and new institutionalisation. Results: The mean age was 79.7; 51% were female; 29% were elective admissions; 67% were admitted to a medical specialty. Nutrition scores were available for 602/606; 37% had a 'normal' status, 45% were 'at-risk', and 18% were 'malnourished'. Malnutrition was more common in females, acute admissions, older patients and those who were widowed/separated. Dementia, functional dependency, comorbidity and frailty independently predicted a) malnutrition and b) being at-risk of malnutrition, compared to normal status (p <.001). Malnutrition was associated with outcomes including an increased length of stay (p <.001), new institutionalisation (p =<0.001) and in-hospital mortality (p <.001). Conclusions: These findings support the prioritisation of nutritional screening in clinical practice and public health policy, for all patients ≥70 on admission to hospital, and in particular for people with dementia, increased functional dependency and/or multi-morbidity, and those who are frail. [ABSTRACT FROM AUTHOR]
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- 2017
- Full Text
- View/download PDF
22. Positive effects of nicotine on cognition: the deployment of attention for prospective memory
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Rusted, J. M., primary, Sawyer, R., additional, Jones, C., additional, Trawley, S. L., additional, and Marchant, N. L., additional
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- 2008
- Full Text
- View/download PDF
23. Ageing well with diabetes: the role of technology.
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Maltese G, McAuley SA, Trawley S, and Sinclair AJ
- Subjects
- Humans, Hypoglycemic Agents therapeutic use, Aged, Insulin therapeutic use, Blood Glucose Self-Monitoring, Insulin Infusion Systems, Quality of Life, Blood Glucose metabolism, Aging physiology, Hypoglycemia, Diabetes Mellitus, Type 1 drug therapy
- Abstract
Over the past two decades there has been a substantial rise in the adoption of diabetes therapeutic technology among children, adolescents and younger adults with type 1 diabetes, and its use is now also advocated for older individuals. Older people with diabetes are more prone to experience hypoglycaemia because of numerous predisposing factors and are at higher risk of hypoglycaemic events requiring third-party assistance as well as other adverse sequelae. Hypoglycaemia may also have long-term consequences, including cognitive impairment, frailty and disability. Diabetes in older people is often characterised by marked glucose variability related to age-associated changes such as variable appetite and levels of physical activity, comorbidities and polypharmacotherapy. Preventing hypoglycaemia and mitigating glucose excursions may have considerable positive impacts on physical and cognitive function and general well-being and may even prevent or improve frailty. Technology for older people includes continuous glucose monitoring systems, insulin pumps, automated insulin delivery systems and smart insulin pens. Clinical trials and real-world studies have shown that older people with diabetes benefit from technology in terms of glucose management, reductions in hypoglycaemic events, emergency department attendance and hospital admissions, and improvement in quality of life. However, ageing may bring physical impairments and other challenges that hinder the use of technology. Healthcare professionals should identify older adults with diabetes who may benefit from therapeutic technology and then adopt an individualised approach to education and follow-up for individuals and their caregivers. Future research should explore the impact of diabetes technology on outcomes relevant to older people with diabetes., (© 2024. The Author(s).)
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- 2024
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24. Multigroup invariance of measure for angry drivers (MAD) scale using a representative sample of drivers in Australia.
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Stephens AN, Crotty R, Trawley S, and Oxley J
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- Humans, Male, Female, Adult, Australia, Middle Aged, Surveys and Questionnaires, Aged, Young Adult, Accidents, Traffic prevention & control, Accidents, Traffic statistics & numerical data, Accidents, Traffic psychology, Factor Analysis, Statistical, Adolescent, Anger, Automobile Driving psychology, Automobile Driving statistics & numerical data, Aggression psychology
- Abstract
Introduction: Driver anger and aggression have been linked to crash involvement and injury outcomes. Improved road safety outcomes may be achieved through understanding the causes of driver anger, and interventions designed to reduce this anger or prevent it from becoming aggression. Scales to measure anger propensities will be an important tool in this work. The measure for angry drivers (MAD; Stephens et al., 2019) is a contemporary scale designed to measure tendencies for anger across three types of driving scenarios: perceived danger from others, travel delays, and hostility or aggression from other drivers., Method: This study aimed to validate MAD using a representative sample of Australian drivers, stratified across age, gender, and location. Participants completed a 10-minute online survey that included MAD, sought demographic information (age, gender, driving purpose, crash history), as well as the frequency of aggressive driving. Multigroup confirmatory factor analyses (MGCFA) assessed how stable the structure of the MAD was across drivers of different ages, gender, purposes for driving and those who do or do not display anger aggressively. MAD was invariant across all groups, showing that all drivers interpreted and responded to MAD in the same way., Results: A comparison of latent means showed anger tendencies were higher for men compared to women, for younger drivers compared to older drivers, and for those who drive mainly for work compared to those who mainly drive for other reasons. When controlling for driver factors, driving anger was associated with increased odds of being aggressive while driving., Practical Applications: Overall, this study demonstrated that MAD is an appropriate scale to measure anger tendencies and can be used to support interventions, and evaluation of interventions, to reduce anger and aggressive driving., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
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- 2024
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25. What difference does sleep make? Continuous glucose monitoring metrics during fixed-overnight time versus sleep periods among older adults with type 1 diabetes.
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Trawley S, Kubilay E, Colman PG, Lee MH, O'Neal DN, Sundararajan V, Vogrin S, and McAuley SA
- Subjects
- Humans, Female, Male, Aged, Middle Aged, Time Factors, Continuous Glucose Monitoring, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 complications, Diabetes Mellitus, Type 1 physiopathology, Blood Glucose Self-Monitoring instrumentation, Sleep physiology, Actigraphy, Blood Glucose analysis, Hypoglycemia blood
- Abstract
Hypoglycaemia during sleep is a common and clinically important issue for people living with insulin-treated diabetes. Continuous glucose monitoring devices can help to identify nocturnal hypoglycaemia and inform treatment strategies. However, sleep is generally inferred, with diabetes researchers and physicians using a fixed-overnight period as a proxy for sleep-wake status when analysing and interpretating continuous glucose monitoring data. No study to date has validated such an approach with established sleep measures. Continuous glucose monitoring and research-grade actigraphy devices were worn and sleep diaries completed for 2 weeks by 28 older adults (mean age 67 years [SD 5]; 17 (59%) women) with type 1 diabetes. Using continuous glucose monitoring data from a total of 356 nights, fixed-overnight (using the recommended period of 00:00 hours-06:00 hours) and objectively-measured sleep periods were compared. The fixed-overnight period approach missed a median 57 min per night (interquartile range: 49-64) of sleep for each participant, including five continuous glucose monitoring-detected hypoglycaemia episodes during objectively-measured sleep. Twenty-seven participants (96%) had at least 1 night with continuous glucose monitoring time-in-range and time-above-range discrepancies both ≥ 10 percentage points, a clinically significant discrepancy. The utility of fixed-overnight time continuous glucose monitoring as a proxy for sleep-awake continuous glucose monitoring is inadequate as it consistently excludes actual sleep time, obscures glycaemic patterns, and misses sensor hypoglycaemia episodes during sleep. The use of validated measures of sleep to aid interpretation of continuous glucose monitoring data is encouraged., (© 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.)
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- 2024
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26. Treatment Satisfaction With Omnipod DASH in Adults With Type 1 Diabetes: A Nonblinded 1:1 Randomized Controlled Trial.
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Kong YW, Yuan CY, Kiburg K, Brown K, Trawley S, Partovi A, Roem K, Pham C, Harrison N, Fourlanos S, Ekinci EI, and O'Neal DN
- Subjects
- Humans, Female, Male, Adult, Middle Aged, Blood Glucose analysis, Glycated Hemoglobin analysis, Treatment Outcome, Australia, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 psychology, Patient Satisfaction, Insulin Infusion Systems, Blood Glucose Self-Monitoring methods, Blood Glucose Self-Monitoring instrumentation, Hypoglycemic Agents administration & dosage, Hypoglycemic Agents therapeutic use, Insulin administration & dosage, Insulin therapeutic use, Quality of Life
- Abstract
Context: Omnipod DASH Insulin Management System is a tubeless insulin pump that overcomes the physical inconveniences of conventional tubed insulin pump therapy (IPT)., Objective: We compared treatment satisfaction with Omnipod DASH System to usual care (multiple daily injections [MDIs] or tubed IPT) in adults with type 1 diabetes using self-monitoring blood glucose (SMBG)., Methods: Adults with type 1 diabetes on MDI (n = 40) or IPT (n = 25) from 4 diabetes centers in Australia were randomly assigned in a 1:1 nonblinded manner to Omnipod DASH System (Omnipod group) or continue usual care (Usual Care group) for 12 weeks, followed by a further 12-week extension during which all participants used the device. The primary outcome was treatment satisfaction assessed by change in Diabetes Technology Questionnaire "current" (ΔDTQ-current) score at 12 weeks (study end). Secondary outcomes included ΔDTQ-current following extension and other participant-reported outcomes (PROs) measuring quality of life, burden of disease treatment, and glycemic and device-related outcomes at 12 weeks (study end) and 24 weeks (end extension)., Results: Treatment satisfaction improved more in the Omnipod group vs the Usual Care group (ΔDTQ-current score of 16.4 [21.2] vs 0.0 [12.8]; P < .001) at study end. Significantly greater improvements in other PROs and glycated hemoglobin A1c were also observed. Improvements in DTQ-current and other PROs comparing study end and end extension were similar. While percentage in time in range change from baseline did not differ at study end (-2.0 [12.7] %), it was significantly greater at end extension (5.6 [10.9] %; P = .016)., Conclusion: The Omnipod DASH System resulted in greater treatment satisfaction at 12 weeks in adults with type 1 diabetes using SMBG that was sustained after 24 weeks of device use without compromising sleep quality and fear of hypoglycemia. Improvements in glycemia were also observed., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society.)
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- 2024
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27. Driving-Related Glucose Patterns Among Older Adults with Type 1 Diabetes.
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Kwon HJ, Trawley S, Vogrin S, Alipoor AM, Colman PG, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Ward GM, and McAuley SA
- Subjects
- Humans, Aged, Male, Female, Middle Aged, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 blood, Automobile Driving, Blood Glucose analysis, Insulin Infusion Systems, Hypoglycemia prevention & control, Hypoglycemic Agents therapeutic use, Hypoglycemic Agents administration & dosage, Insulin administration & dosage, Insulin therapeutic use, Blood Glucose Self-Monitoring
- Abstract
Older adults with type 1 diabetes may face challenges driving safely. Glucose "above-5-to-drive" is often recommended for insulin-treated diabetes to minimize hypoglycemia while driving. However, the effectiveness of this recommendation among older adults has not been evaluated. Older drivers with type 1 diabetes were assessed while using sensor-augmented insulin pumps during a 2-week clinical trial run-in. Twenty-three drivers (median age 69 years [interquartile range; IQR 65-72]; diabetes duration 37 years [20-45]) undertook 618 trips (duration 10 min [5-21]). Most trips ( n = 535; 87%) were <30 min duration; 9 trips (1.5%) exceeded 90 min and 3 trips (0.5%) exceeded 120 min. Pre-trip continuous glucose monitoring (CGM) was >5.0 mmol/L for 577 trips (93%) and none of these had CGM <3.9 mmol/L during driving (including 8 trips >90 min and 3 trips >120 min). During 41 trips with pre-trip CGM ≤5.0 mmol/L, 11 trips had CGM <3.9 mmol/L. Seventy-one CGM alerts occurred during 60 trips (10%), of which 54 of 71 alerts (76%) were unrelated to hypoglycemia. Our findings support a glucose "above-5-to-drive" recommendation to avoid CGM-detected hypoglycemia among older drivers, including for prolonged drives, and highlight the importance of active CGM low-glucose alerts to prevent hypoglycemia during driving. Driving-related CGM usability and alert functionality warrant investigation. Clinical trial ACTRN1261900515190.
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- 2024
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28. Improved Satisfaction While Maintaining Safety and High Time in Range (TIR) With a Medtronic Investigational Enhanced Advanced Hybrid Closed-Loop (e-AHCL) System.
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Yuan CY, Kong YW, Amoore T, Brown K, Grosman B, Jenkins A, Jones H, Kurtz N, Lee MH, MacIsaac R, Netzer E, Paldus B, Robinson L, Roy A, Sims CM, Trawley S, Vogrin S, and O'Neal DN
- Subjects
- Adult, Humans, Female, Blood Glucose, Blood Glucose Self-Monitoring, Algorithms, Insulin Infusion Systems, Insulin therapeutic use, Hypoglycemic Agents therapeutic use, Diabetes Mellitus, Type 1 drug therapy, Insulins
- Abstract
Objective: To determine feasibility and compare acceptance of an investigational Medtronic enhanced advanced hybrid closed-loop (e-AHCL) system in adults with type 1 diabetes with earlier iterations., Research Design and Methods: This nonrandomized three-stage (12 weeks each) exploratory study compared e-AHCL (Bluetooth-enabled MiniMed 780G insulin pump with automatic data upload [780G] incorporating an updated algorithm; calibration-free all-in-one disposable sensor; 7-day infusion set) preceded by a run-in (non-Bluetooth 780G [670G V4.0 insulin pump] requiring manual data upload; Guardian Sensor 3 [GS3] requiring calibration; 3-day infusion set), stage 1 (780G; GS3; 3-day infusion set), and stage 2 (780G; calibration-free Guardian Sensor 4; 3-day infusion set). Treatment satisfaction was assessed by Diabetes Technology Questionnaire (DTQ)-current (primary outcome) and other validated treatment satisfaction tools with glucose outcomes by continuous glucose monitoring metrics., Results: Twenty-one of 22 (11 women) participants (baseline HbA1c 6.7%/50 mmol/mol) completed the study. DTQ-current scores favored e-AHCL (123.1 [17.8]) versus run-in (101.6 [24.2]) and versus stage 1 (110.6 [20.8]) (both P < 0.001) but did not differ from stage 2 (119.4 [16.0]; P = 0.271). Diabetes Medication System Rating Questionnaire short-form scores for "Convenience and Efficacy" favored e-AHCL over run-in and all stages. Percent time in range 70-180 mg/dL was greater with e-AHCL versus run-in and stage 2 (+2.9% and +3.6%, respectively; both P < 0.001). Percent times of <70 mg/dL for e-AHCL were significantly lower than run-in, stage 1, and stage 2 (-0.9%, -0.6%, and -0.5%, respectively; all P < 0.01)., Conclusions: e-AHCL was feasible. User satisfaction increased compared with earlier Medtronic HCL iterations without compromising glucose control., (© 2024 by the American Diabetes Association.)
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- 2024
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29. Real-world lived experience of older adults with type 1 diabetes after an automated insulin delivery trial.
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Kubilay E, Trawley S, Ward GM, Fourlanos S, Colman PG, and McAuley SA
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- Aged, Humans, Blood Glucose, Blood Glucose Self-Monitoring, Cross-Over Studies, Hypoglycemic Agents therapeutic use, Insulin Infusion Systems, Treatment Outcome, Randomized Controlled Trials as Topic, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 psychology, Insulin therapeutic use
- Abstract
Aims: First-generation closed-loop automated insulin delivery improves glycaemia and psychosocial outcomes among older adults with type 1 diabetes in clinical trials. However, no study has previously assessed real-world lived experience of older adults using closed-loop therapy outside a trial environment., Methods: Semi-structured interviews were conducted with older adults who were pre-existing insulin pump users and previously completed the OldeR Adult Closed-Loop (ORACL) randomised trial. Interviews focused on perceptions of diabetes technology use, and factors influencing decisions regarding continuation., Results: Twenty-eight participants, mean age 70 years (SD 5), were interviewed at median 650 days (IQR 608-694) after their final ORACL trial visit. At interview, 23 participants (82%) were still using a commercial closed-loop system (requiring manual input for prandial insulin bolus doses). Themes discussed in interviews relating to closed-loop system use included sustained psychosocial benefits, cost and retirement considerations and usability frustrations relating to sensor accuracy and system alarms. Of the five participants who had discontinued, reasons included cost, continuous glucose monitoring-associated difficulties and usability frustrations. Cost was the largest consideration regarding continued use; most participants considered the increased ease of diabetes management to be worth the associated costs, though cost was prohibitive for some., Conclusions: Almost 2 years after completing a closed-loop clinical trial, closed-loop automated insulin delivery remains the preferred type 1 diabetes therapy for the majority of older adult participants. Chronological age is not a barrier to real-world successful use of diabetes technology. Identifying age-related barriers, and solutions, to diabetes technology use among older adults is warranted., (© 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)
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- 2024
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30. The diabetes management experiences questionnaire: Psychometric validation among adults with type 1 diabetes.
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Hendrieckx C, Husin HM, Russell-Green S, Halliday JA, Lam B, Trawley S, McAuley SA, Bach LA, Burt MG, Cohen ND, Colman PG, Holmes-Walker DJ, Jenkins AJ, Lee MH, McCallum RW, Stranks SN, Sundararajan V, Jones TW, O'Neal DN, and Speight J
- Subjects
- Adult, Humans, Female, Middle Aged, Male, Blood Glucose Self-Monitoring, Patient Satisfaction, Psychometrics, Reproducibility of Results, Retrospective Studies, Prospective Studies, Blood Glucose, Surveys and Questionnaires, Diabetes Mellitus, Type 1 drug therapy
- Abstract
Aims: To examine the psychometric properties of the Diabetes Management Experiences Questionnaire (DME-Q). Adapted from the validated Glucose Monitoring Experiences Questionnaire, the DME-Q captures satisfaction with diabetes management irrespective of treatment modalities., Methods: The DME-Q was completed by adults with type 1 diabetes as part of a randomized controlled trial comparing hybrid closed loop (HCL) to standard therapy. Most psychometric properties were examined with pre-randomization data (n = 149); responsiveness was examined using baseline and 26-week follow-up data (n = 120)., Results: Pre-randomization, participants' mean age was 44 ± 12 years, 52% were women. HbA1c was 61 ± 11 mmol/mol (7.8 ± 1.0%), diabetes duration was 24 ± 12 years and 47% used an insulin pump prior to the trial. A forced three-factor analysis revealed three expected domains, that is, 'Convenience', 'Effectiveness' and 'Intrusiveness', and a forced one-factor solution was also satisfactory. Internal consistency reliability was strong for the three subscales ( α range = 0.74-0.84) and 'Total satisfaction' ( α = 0.85). Convergent validity was demonstrated with moderate correlations between DME-Q 'Total satisfaction' and diabetes distress (PAID: r
s = -0.57) and treatment satisfaction (DTSQ; rs = 0.58). Divergent validity was demonstrated with a weak correlation with prospective/retrospective memory (PRMQ: rs = -0.16 and - 0.13 respectively). Responsiveness was demonstrated, as participants randomized to HCL had higher 'Effectiveness' and 'Total satisfaction' scores than those randomized to standard therapy., Conclusions: The 22-item DME-Q is a brief, acceptable, reliable measure with satisfactory structural and construct validity, which is responsive to intervention. The DME-Q is likely to be useful for evaluation of new pharmaceutical agents and technologies in research and clinical settings., (© 2023 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)- Published
- 2024
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31. "You can hide it if you want to, you can let it be seen if you want to": A qualitative study of the lived experiences of Australian adults with type 1 diabetes using the Omnipod DASH® system.
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Stocco A, Trawley S, Kong YW, Yuan CY, Kiburg K, Pham C, Brown K, Partovi A, Roem K, Harrison N, Fourlanos S, Ekinci EI, and O'Neal DN
- Subjects
- Adult, Humans, Female, Hypoglycemic Agents therapeutic use, Australia, Insulin therapeutic use, Injections, Insulin Infusion Systems, Blood Glucose, Diabetes Mellitus, Type 1 drug therapy, Diabetes Mellitus, Type 1 psychology
- Abstract
Aims: Understanding the lived experience of using a tubeless insulin pump and how this differs compared to usual care (tubed insulin pump therapy (IPT) vs multiple daily injections (MDI))., Methods: Interviews were conducted after 12-weeks of using the Omnipod DASH Insulin Management System (Insulet, Acton, MA) and analysed using thematic analysis., Results: Fifty-eight adults (35 female; mean age 42;SD 13 years; 35 previous MDI) were interviewed. Most (84 %) wanted to continue using the device. Experiences fit two themes: 1. Taking back control of my diabetes: many previous MDI users perceived improved glycaemic control, explained by more "nuanced" control, with some reporting positive effects during exercise and sleep. Many previous MDI and IPT users endorsed positive experiences in concealing or disclosing their diabetes to others. However, some previous MDI users reported negative psychosocial experiences due to feeling continuously "attached" to their diabetes. 2. Barriers and facilitators of device acceptability: both MDI and IPT users cited wearability, alarms and the financial cost impacted their choice to continue device use. IPT users reported positive wearability experiences., Conclusions: The tubeless pump improved diabetes management perceptions for both MDI and tubed pump users. However, participants' prior glucose management affected perceptions of its advantages and disadvantages., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)
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- 2024
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32. A pilot randomised controlled parallel arm trial evaluating treatment satisfaction with the Omnipod DASH ® Insulin Management System compared with usual care in adults with type 1 diabetes in Australia: rationale, study design and methodologies.
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Kong YW, Yuan CY, Kiburg K, Brown K, Trawley S, Partovi A, Roem K, Harrison N, Fourlanos S, Ekinci EI, and O'Neal DN
- Abstract
Background: Insulin pump therapy (IPT) improves glucose control in people with type 1 diabetes (T1D) compared with multiple daily injections (MDI). However, their size, the tethered insulin infusion set, intrusiveness when operating the device and the need to disconnect during showering limit their acceptance to many who may benefit. The Omnipod DASH
® Insulin Management System is a small waterproof tubeless device which is wirelessly controlled by a handheld device which may be an acceptable alternative. However, there are no randomised controlled trials focusing on the impact on user perceptions of tubeless insulin pump therapy. This pilot study aims to assess study feasibility and acceptability of patch pump therapy compared with usual care in adults with T1D in Australia to inform power calculations and progression to a large-scale multi-site randomised controlled study., Methods: A pilot multi-site parallel randomised controlled study will be conducted in sixty-four adults with T1D who are managed on MDI or IPT and self-monitoring with finger-stick blood glucose from four specialist diabetes centres in Victoria, Australia. Following carbohydrate counting education, participants will be randomised to use Omnipod DASH® System (Omnipod group) or continue usual care (usual care group) for 12 weeks, followed by a 12-week extension phase where all participants will use Omnipod DASH® System. The primary outcome measure is feasibility determined by study completion rates with a threshold of 0.80. Acceptability of the intervention (Omnipod DASH® System) will be assessed by the difference in Diabetes Technology Questionnaire 'current' (DTQ-current) score at 12 weeks post-randomisation compared to baseline. Secondary outcomes will include other measures of user acceptance, process outcomes, resource outcomes, participant-centred outcomes, healthcare professional perceptions and glycaemic outcomes., Discussion: This pilot study will provide insights regarding the feasibility of the study design and the first data regarding user acceptance of insulin patch pump technology in Australian T1D adults. We anticipate that this study will provide information informing the design of a larger study evaluating the impact of patch pumps on subjective outcomes that are of significance to the person living with T1D., Trial Registration: Australian New Zealand Clinical Trials Registry ( https://anzctr.org.au/ ) ACTRN12621001195842 (8th September 2021). Please refer to Additional file 1: Appendix 1 for full details., (© 2023. BioMed Central Ltd., part of Springer Nature.)- Published
- 2023
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33. Lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery in a randomised trial.
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Kubilay E, Trawley S, Ward GM, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Vogrin S, Colman PG, and McAuley SA
- Subjects
- Humans, Aged, Insulin therapeutic use, Hypoglycemic Agents therapeutic use, Quality of Life, Treatment Outcome, Insulin Infusion Systems, Blood Glucose Self-Monitoring, Cross-Over Studies, Blood Glucose, Diabetes Mellitus, Type 1 drug therapy, Frailty
- Abstract
Aim: To explore the lived experience of older adults with type 1 diabetes using closed-loop automated insulin delivery, an area previously receiving minimal attention., Methods: Semi-structured interviews were conducted with adults aged 60 years or older with long-duration type 1 diabetes who participated in a randomised, open-label, two-stage crossover trial comparing first-generation closed-loop therapy (MiniMed 670G) versus sensor-augmented pump therapy. Interview recordings were transcribed, thematically analysed and assessed., Results: Twenty-one older adults participated in interviews after using closed-loop therapy. Twenty were functionally independent, without frailty or major cognitive impairment; one was dependent on caregiver assistance, including for diabetes management. Quality of life benefits were identified, including improved sleep and reduced diabetes-related psychological burden, in the context of experiencing improved glucose levels. Gaps between expectations and reality of closed-loop therapy were also experienced, encountering disappointment amongst some participants. The cost was perceived as a barrier to continued closed-loop access post-trial. Usability issues were identified, such as disruptive overnight alarms and sensor inaccuracy., Conclusions: The lived experience of older adults without frailty or major cognitive impairment using first-generation closed-loop therapy was mainly positive and concordant with glycaemic benefits found in the trial. Older adults' lived experience using automated insulin delivery beyond trial environments requires exploration; moreover, the usability needs of older adults should be considered during future device development., (© 2022 The Authors. Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)
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- 2023
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34. Closed-Loop Insulin Delivery Effects on Glycemia During Sleep and Sleep Quality in Older Adults with Type 1 Diabetes: Results from the ORACL Trial.
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Chakrabarti A, Trawley S, Kubilay E, Mohammad Alipoor A, Vogrin S, Fourlanos S, Lee MH, O'Neal DN, O'Regan NA, Sundararajan V, Ward GM, MacIsaac RJ, Colman PG, and McAuley SA
- Subjects
- Aged, Blood Glucose, Cross-Over Studies, Humans, Hypoglycemic Agents therapeutic use, Insulin Infusion Systems, Insulin, Regular, Human therapeutic use, Sleep, Sleep Quality, Diabetes Mellitus, Type 1 drug therapy, Insulin therapeutic use
- Abstract
Sleep-related effects of closed-loop therapy among older adults with type 1 diabetes have not been well established. In the OldeR Adult Closed-Loop (ORACL) randomized, crossover trial of first-generation closed-loop therapy (MiniMed 670G), participants wore actigraphy and completed sleep diaries for 14-day periods at stage end. During objectively measured sleep (actigraphy) with closed-loop versus sensor-augmented pump therapy, glucose time-in-range 70-180 mg/dL (3.9-10.0 mmol/L) was greater (90.3% vs. 78.7%, respectively; difference 8.2 percentage points [95% confidence interval {CI} 1.5 to 13.0]; P = 0.008), and there were fewer sensor hypoglycemia episodes (18 vs. 43, respectively; incident rate ratio 0.40 [95% CI 0.20 to 0.55]; P = 0.007). Sleep quality recorded daily was worse with closed-loop therapy ( P = 0.006); Pittsburgh Sleep Quality Index did not differ. There were 30% more system alarms during monitored sleep with closed-loop therapy ( P < 0.001). First-generation closed-loop therapy has important glycemic benefits during sleep for older adults, with deterioration in some sleep quality measures. Sleep quality warrants prioritization and investigation during advancement of closed-loop technology.
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- 2022
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35. Self-reported changes in aggressive driving within the past five years, and during COVID-19.
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Stephens AN, Trawley S, Ispanovic J, and Lowrie S
- Subjects
- Accidents, Traffic, Aggression, Communicable Disease Control, Humans, Male, Middle Aged, Pandemics, Retrospective Studies, Self Report, Aggressive Driving, Automobile Driving, COVID-19 epidemiology
- Abstract
Aggressive driving is a significant road safety problem and is likely to get worse as the situations that provoke aggression become more prevalent in the road network (e.g. as traffic volumes and density increase and the grey fleet expands). In addition, driver frustration and stress, also recognised as triggers for aggression, are likely to stay high because of the COVID-19 pandemic and associated burdens, leading to increased aggression. However, although drivers report that other drivers are becoming more aggressive, self-report data suggests that the prevalence of aggression has not changed over time. This may be due to the methods used to define and measure aggression. This study sought to clarify whether self-reported aggression has increased over a five-year period and across three different types of aggression: verbal aggression, aggressive use of the vehicle and personal physical aggression. The influence of COVID-19 lockdowns on own and others' driving styles was also investigated. A total of 774 drivers (males = 66.5%, mean age = 48.7; SD = 13.9) who had been licensed for at least five years (M = 30.6, SD = 14.3), responded to an online survey and provided retrospective frequencies for their current aggression (considered pre-COVID-19 lockdowns) and five years prior. Two open ended questions were included to understand perceived changes in driving styles (own and others) during the COVID-19 pandemic. One third (33%) of drivers believed they were more aggressive now than five years ago but 61% of the sample believed other drivers were more aggressive now than five years ago. Logistic regression analyses on changes in self-reported aggression (same or decreased vs increased) showed the main factor associated with increases in aggressive driving was the perception that other drivers' aggression had increased. Further, almost half the sample (47%) reported that other drivers had become riskier and more dangerous during, and soon after, the COVID-19 lockdowns. These results show that the driving environment is seen as becoming more aggressive, both gradually and as a direct result of COVID-19 lockdowns. The data indicate that this perceived increase in aggression is likely to provoke higher levels of aggression in some drivers. Campaigns to reduce aggression on the roads need to focus on changing road culture and improving interactions, or perceived interactions, among road users., Competing Interests: The authors have declared that no competing interests exist.
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- 2022
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36. Closed-loop therapy in older adults with type 1 diabetes: hypoglycaemia benefits and risk stratification.
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McAuley SA and Trawley S
- Subjects
- Aged, Humans, Insulin Infusion Systems, Risk Assessment, Diabetes Mellitus, Type 1 drug therapy, Hypoglycemia chemically induced
- Abstract
Competing Interests: SAM reports support for research from Medtronic, speaker honoraria from Eli Lilly, Roche, and Sanofi, and has served on an advisory board for Medtronic. ST reports non-financial support from Abbott Diabetes.
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- 2022
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37. Driving with Type 1 Diabetes: Real-World Evidence to Support Starting Glucose Level and Frequency of Monitoring During Journeys.
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Trawley S, Stephens AN, McAuley SA, Speight J, Hendrieckx C, Vogrin S, Lee MH, Paldus B, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Holmes-Walker DJ, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Sims CM, Stranks SN, Sundararajan V, Ward GM, Jones TW, and O'Neal DN
- Subjects
- Adult, Blood Glucose, Blood Glucose Self-Monitoring, Humans, Hypoglycemic Agents therapeutic use, Insulin therapeutic use, Male, Diabetes Mellitus, Type 1 drug therapy, Hypoglycemia drug therapy, Hypoglycemia prevention & control
- Abstract
There is limited evidence supporting the recommendation that drivers with insulin-treated diabetes need to start journeys with glucose >90 mg/dL. Glucose levels of drivers with type 1 diabetes were monitored for 3 weeks using masked continuous glucose monitoring (CGM). Eighteen drivers (median [IQR] age 40 [35, 51] years; 11 men) undertook 475 trips (duration 15 [13, 21] min). Hypoglycemia did not occur in any trip starting with glucose >90 mg/dL (92%; n = 436). Thirteen drivers recorded at least one trip (total n = 39) starting with glucose <90 mg/dL. Among these, driving glucose was <70 mg/dL in five drivers (38%) during 10 trips (26%). Among five drivers (28%), a ≥ 36 mg/dL drop was observed within 20 min of starting their journey. Journey duration was positively associated with maximum glucose change. These findings support current guidelines to start driving with glucose >90 mg/dL, and to be aware that glucose levels may change significantly within 20 min. A CGM-based, in-vehicle display could provide glucose information and alerts that are compatible with safe driving. Clinical Trial Registration number: ACTRN12617000520336.
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- 2022
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38. Closed-Loop Insulin Delivery Versus Sensor-Augmented Pump Therapy in Older Adults With Type 1 Diabetes (ORACL): A Randomized, Crossover Trial.
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McAuley SA, Trawley S, Vogrin S, Ward GM, Fourlanos S, Grills CA, Lee MH, Alipoor AM, O'Neal DN, O'Regan NA, Sundararajan V, Colman PG, and MacIsaac RJ
- Subjects
- Aged, Blood Glucose Self-Monitoring, Cross-Over Studies, Humans, Hypoglycemic Agents therapeutic use, Insulin, Insulin Infusion Systems, Middle Aged, Blood Glucose, Diabetes Mellitus, Type 1 chemically induced, Diabetes Mellitus, Type 1 drug therapy
- Abstract
Objective: To assess the efficacy and safety of closed-loop insulin delivery compared with sensor-augmented pump therapy among older adults with type 1 diabetes., Research Design and Methods: This open-label, randomized (1:1), crossover trial compared 4 months of closed-loop versus sensor-augmented pump therapy. Eligible adults were aged ≥60 years, with type 1 diabetes (duration ≥10 years), using an insulin pump. The primary outcome was continuous glucose monitoring (CGM) time in range (TIR; 3.9-10.0 mmol/L)., Results: There were 30 participants (mean age 67 [SD 5] years), with median type 1 diabetes duration of 38 years (interquartile range [IQR] 20-47), randomized (n = 15 to each sequence); all completed the trial. The mean TIR was 75.2% (SD 6.3) during the closed-loop stage and 69.0% (9.1) during the sensor-augmented pump stage (difference of 6.2 percentage points [95% CI 4.4 to 8.0]; P < 0.0001). All prespecified CGM metrics favored closed loop over the sensor-augmented pump; benefits were greatest overnight. Closed loop reduced CGM time <3.9 mmol/L during 24 h/day by 0.5 percentage points (95% CI 0.3 to 1.1; P = 0.0005) and overnight by 0.8 percentage points (0.4 to 1.1; P < 0.0001) compared with sensor-augmented pump. There was no significant difference in HbA1c between closed-loop versus sensor-augmented pump stages (7.3% [IQR, 7.1-7.5] (56 mmol/mol [54-59]) vs. 7.5% [7.1-7.9] (59 mmol/mol [54-62]), respectively; P = 0.13). Three severe hypoglycemia events occurred during the closed-loop stage and two occurred during the sensor-augmented pump stage; no hypoglycemic events required hospitalization. One episode of diabetic ketoacidosis occurred during the sensor-augmented pump stage; no serious adverse events occurred during the closed-loop stage., Conclusions: Closed-loop therapy is an effective treatment option for older adults with long-duration type 1 diabetes, and no safety issues were identified. These older adults had higher TIR accompanied by less time below range during closed loop than during sensor-augmented pump therapy. Of particular clinical importance, closed loop reduced the time spent in hypoglycemic range overnight., (© 2022 by the American Diabetes Association.)
- Published
- 2022
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39. The impact of different responses to negative body talk on body satisfaction, shame, and future negative body talk likelihood: A UK sample.
- Author
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Mills J, Mata A, Ling M, and Trawley S
- Subjects
- Adolescent, Adult, Female, Forecasting, Humans, Personal Satisfaction, Shame, United Kingdom, Young Adult, Body Image psychology, Communication
- Abstract
A recent online experiment found that, following a negative body talk induction task, receiving a response of ignoring the comment, compared with reassuring, reciprocating, and challenging, led to worse body satisfaction and socio-emotional outcomes for Australian women. The current online study aimed to replicate and extend this study by examining the effects of these four negative body talk responses on body satisfaction, shame, and future negative body talk likelihood in UK-based women. Participants (N = 156, M
age = 25.29, SDage = 5.64, rangeage = 18-40) recalled a scenario in which they engaged in negative body talk and were randomly assigned to receive one of four responses. Contrary to hypotheses, there were no significant differences in body satisfaction, shame, or future negative body talk likelihood across the four groups. Preferred negative body talk response data were mixed, with challenge and reassurance responses preferred at comparable rates, and just under a quarter of participants preferring a response outside of the original four. Possible explanations, including that the responses used in the original Australasian study may not perfectly correspond with UK women's experiences of social interactions and heterogeneous motivations for engaging in negative body talk necessitate more nuanced and sophisticated responses, are explored., Competing Interests: Declaration of Competing Interest The authors report no declarations of interest., (Copyright © 2021 Elsevier Ltd. All rights reserved.)- Published
- 2021
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40. Meal-time glycaemia in adults with type 1 diabetes using multiple daily injections vs insulin pump therapy following carbohydrate-counting education and bolus calculator provision.
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Lu JC, Vogrin S, McAuley SA, Lee MH, Paldus B, Bach LA, Burt MG, Clarke PM, Cohen ND, Colman PG, de Bock MI, Jane Holmes-Walker D, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Roem K, Sims C, Stranks SN, Trawley S, Ward GM, Sundararajan V, Jones TW, and O'Neal DN
- Subjects
- Adult, Blood Glucose, Blood Glucose Self-Monitoring, Glycated Hemoglobin analysis, Humans, Hypoglycemic Agents therapeutic use, Insulin therapeutic use, Insulin Infusion Systems, Meals, Diabetes Mellitus, Type 1 drug therapy
- Abstract
Aims: To compare meal-time glycaemia in adults with type 1 diabetes mellitus (T1D) managed with multiple daily injections (MDI) vs. insulin pump therapy (IPT), using self-monitoring blood glucose (SMBG), following diabetes education., Methods: Adults with T1D received carbohydrate-counting education and a bolus calculator: MDI (Roche Aviva Expert) and IPT (pump bolus calculator). All then wore 3-weeks of masked-CGM (Enlite, Medtronic). Meal-times were assessed by two approaches: 1) Set time-blocks (breakfast 06:00-10:00hrs; lunch 11:00-15:00hrs; dinner 17:00-21:00hrs) and 2) Bolus-calculator carbohydrate entries signalling meal commencement. Post-meal masked-CGM time-in-range (TIR) 3.9-10.0 mmol/L was the primary outcome., Results: MDI(n = 61) and IPT (n = 59) participants were equivalent in age, sex, diabetes duration and HbA1c. Median (IQR) education time provided did not differ (MDI: 1.1 h (0.75, 1.5) vs. IPT: 1.1 h (1.0, 2.0); p = 0.86). Overall, daytime (06:00-24:00hrs), lunch and dinner TIR did not differ for MDI vs. IPT participants but was greater for breakfast with IPT in both analyses with a mean difference of 12.8%, (95 CI 4.8, 20.9); p = 0.002 (time-block analysis)., Conclusion: After diabetes education, MDI and IPT use were associated with similar day-time glycemia, though IPT users had significantly greater TIR during the breakfast period. With education, meal-time glucose levels are comparable with use of MDI vs. pumps., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Conflicts of Interest JCL reports no potential conflicts of interest relevant to this article. SV reports no potential conflicts of interest relevant to this article. SAM reports speaker honoraria from Roche and that her institution has received research support from Medtronic. BP reports speaker honoraria fees from Medtronic. MBA reports no potential conflicts of interest relevant to this article. MIdB reports no potential conflicts of interest relevant to this article. LAB reports grant funding from AstraZeneca. MGB reports no potential conflicts of interest relevant to this article. NDC reports personal fees from Medtronic and Abbott, grant funds from Ypsomed. PGC reports no potential conflicts of interest relevant to this article. EAD reports no potential conflicts of interest relevant to this article. DJHW reports no potential conflicts of interest relevant to this article. JK reports speaker fees from Novo Nordisk and AstraZeneca, advisory board fees from Abbott Diabetes. RJM reports research grants from Novo Nordisk, Servier, Medtronic, The Rebecca Cooper Medical Research Foundation, St Vincent's Research Foundation, JDRF, Grey Innovations, The Diabetes Australia Research Trust/Program, and The National Health and Medical Research Council of Australia; honoraria for lectures from Eli Lilly, Novo Nordisk, Sanofi Aventis, Astra Zeneca, Merck Sharp & Dohme, Norvartis, and Boehringer Ingelheim; travel support from Novo Nordisk, Sanofi, and Boehringer Ingelheim; is on the advisory boards for Novo Nordisk, Sanofi Aventis, Boehringer Ingelheim-Eli Lilly Diabetes Alliance, and Astra Zeneca, and has been a principal investigator for industry sponsored clinical trials run by Novo Nordisk, Bayer, Johnson-Cilag, and Abbive. ACK reports no potential conflicts of interest relevant to this article. KK reports no potential conflicts of interest relevant to this article. RJM reports no potential conflicts of interest relevant to this article. WMC reports no potential conflicts of interest relevant to this article. CMS reports no potential conflicts of interest relevant to this article. KR reports no potential conflicts of interest relevant to this article. VJS reports no potential conflicts of interest relevant to this article. ST reports non-financial support from Abbott Diabetes. GMW reports no potential conflicts of interest relevant to this article. AJJ has received research support from Medtronic, the National Health and Medical Research Council, JDRF Australia and International, Sanofi-Aventis, Abbott, and Mylan and has served on advisory boards for Medtronic, Sanofi, and Abbott (Diabetes). TWJ reports no potential conflicts of interest relevant to this article. DNO has served on advisory boards for Abbott, Medtronic, MSD, Novo, Roche, and Sanofi; received research support from Medtronic, Novo, Roche, Lilly, and Sanofi; and travel support from Novo and MSD., (Copyright © 2021 Elsevier B.V. All rights reserved.)
- Published
- 2021
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41. Reinforcement Sensitivity Theory of Personality Questionnaire: Factor Structure Based on CFA and ESEM, and Associations with ADHD.
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Gomez R, Watson S, Wynen JV, Trawley S, Stavropoulos V, and Corr PJ
- Subjects
- Adult, Emotions, Factor Analysis, Statistical, Female, Humans, Impulsive Behavior, Male, Motivation, Personality Disorders psychology, Surveys and Questionnaires, Attention Deficit Disorder with Hyperactivity psychology, Inhibition, Psychological, Personality, Reinforcement, Psychology
- Abstract
Revised reinforcement sensitivity theory (r-RST) of personality is a major neuropsychological theory of motivation, emotion and personality. This paper presents the results of a study examining: (1) the factor structure of the Reinforcement Sensitivity Theory of Personality Questionnaire (RST-PQ) using confirmatory factor analysis (CFA) and exploratory structural equation modeling (ESEM); and (2) the relationships of the r-RST constructs in the RST-PQ with attention deficit hyperactivity disorder (ADHD) symptom groups of inattention (IA) and hyperactivity/impulsivity (HI). A total of 572 (Sample 1) and 309 (Sample 2) adults completed the RST-PQ. Participants in Sample 2 also completed a questionnaire measuring ADHD symptoms. Results revealed more support for the ESEM model with six factors than the CFA model. For both the ESEM and CFA models, both IA and HI symptom groups were associated positively with the RST-PQ constructs of behavioral inhibition system (BIS) and behavioral approach system (BAS) Impulsivity, with IA also associated negatively with the BAS-Goal-Drive Persistence. The theoretical implications of these findings for understanding the factor structure of the RST-PQ, and for ADHD (IA and HI) in terms of r-RST, are discussed.
- Published
- 2021
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42. Less Nocturnal Hypoglycemia but Equivalent Time in Range Among Adults with Type 1 Diabetes Using Insulin Pumps Versus Multiple Daily Injections.
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McAuley SA, Vogrin S, Lee MH, Paldus B, Trawley S, de Bock MI, Abraham MB, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Hendrieckx C, Holmes-Walker DJ, Jenkins AJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Sims CM, Speight J, Stranks SN, Sundararajan V, Ward GM, Jones TW, and O'Neal DN
- Subjects
- Adult, Australia, Blood Glucose, Blood Glucose Self-Monitoring, Glycated Hemoglobin analysis, Humans, Hypoglycemic Agents therapeutic use, Insulin therapeutic use, Insulin Infusion Systems, Diabetes Mellitus, Type 1 drug therapy, Hypoglycemia chemically induced
- Abstract
Background: This prerandomization analysis from the Australian HCL-Adult trial (registration number: ACTRN12617000520336) compared masked continuous glucose monitoring (CGM) metrics among adults using insulin pumps versus multiple daily injections (MDIs), who were all self-monitoring blood glucose (SMBG). Methods: Adults with type 1 diabetes, using an insulin pump or MDIs without real-time CGM (and entering a trial of closed-loop technology), were eligible. MDI users were given an insulin dosage calculator. All participants received diabetes and carbohydrate-counting education, then wore masked CGM sensors for 3 weeks. Ethics Approval: HREC-D 088/16 Results: Adults using MDIs ( n = 61) versus pump ( n = 59) did not differ by age, sex, diabetes duration, insulin total daily dose, or HbA
1c at baseline. After education, median (interquartile range) CGM time in range (TIR) 70-180 mg/dL (3.9-10.0 mmol/L) was 54% (47, 62) for those using MDIs and 56% (48, 66) for those using pump ( P = 0.40). All CGM metrics were equivalent for 24 h/day for MDI and pump users. Overnight, those using MDIs (vs. pump) spent more time with glucose <54 mg/dL (<3.0 mmol/L): 1.4% (0.1, 5.1) versus 0.5% (0.0, 2.0), respectively ( P = 0.012). They also had more CGM hypoglycemia episodes (121 vs. 54, respectively; incidence rate ratio [95% confidence interval] 2.48 [1.51, 4.06]; P < 0.001). Conclusions: Adults with type 1 diabetes using pumps versus MDIs in conjunction with SMBG experienced less nocturnal hypoglycemia, measured by masked CGM, after equivalent diabetes and dietary education in conjunction with insulin dosage calculator provision to all. However, both groups had equivalent TIR. This observation may reflect advantages afforded by flexibility in basal insulin delivery provided by pumps.- Published
- 2021
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43. Six Months of Hybrid Closed-Loop Versus Manual Insulin Delivery With Fingerprick Blood Glucose Monitoring in Adults With Type 1 Diabetes: A Randomized, Controlled Trial.
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McAuley SA, Lee MH, Paldus B, Vogrin S, de Bock MI, Abraham MB, Bach LA, Burt MG, Cohen ND, Colman PG, Davis EA, Hendrieckx C, Holmes-Walker DJ, Kaye J, Keech AC, Kumareswaran K, MacIsaac RJ, McCallum RW, Sims CM, Speight J, Stranks SN, Sundararajan V, Trawley S, Ward GM, Jenkins AJ, Jones TW, and O'Neal DN
- Subjects
- Adult, Aged, Blood Glucose drug effects, Blood Glucose metabolism, Blood Glucose Self-Monitoring instrumentation, Blood Glucose Self-Monitoring methods, Blood Specimen Collection adverse effects, Blood Specimen Collection methods, Blood Specimen Collection psychology, Female, Fingers, Glycated Hemoglobin analysis, Humans, Hypoglycemic Agents administration & dosage, Hypoglycemic Agents adverse effects, Injections, Insulin adverse effects, Male, Middle Aged, Needlestick Injuries blood, Personal Satisfaction, Blood Glucose analysis, Diabetes Mellitus, Type 1 blood, Diabetes Mellitus, Type 1 drug therapy, Insulin administration & dosage, Insulin Infusion Systems
- Abstract
Objective: To investigate glycemic and psychosocial outcomes with hybrid closed-loop (HCL) versus user-determined insulin dosing with multiple daily injections (MDI) or insulin pump (i.e., standard therapy for most adults with type 1 diabetes)., Research Design and Methods: Adults with type 1 diabetes using MDI or insulin pump without continuous glucose monitoring (CGM) were randomized to 26 weeks of HCL (Medtronic 670G) or continuation of current therapy. The primary outcome was masked CGM time in range (TIR; 70-180 mg/dL) during the final 3 weeks., Results: Participants were randomized to HCL ( n = 61) or control ( n = 59). Baseline mean (SD) age was 44.2 (11.7) years, HbA
1c was 7.4% (0.9%) (57 [10] mmol/mol), 53% were women, and 51% used MDI. HCL TIR increased from (baseline) 55% (13%) to (26 weeks) 70% (10%) with the control group unchanged: (baseline) 55% (12%) and (26 weeks) 55% (13%) (difference 15% [95% CI 11, 19]; P < 0.0001). For HCL, HbA1c was lower (median [95% CI] difference -0.4% [-0.6, -0.2]; -4 mmol/mol [-7, -2]; P < 0.0001) and diabetes-specific positive well-being was higher (difference 1.2 [95% CI 0.4, 1.9]; P < 0.0048) without a deterioration in diabetes distress, perceived sleep quality, or cognition. Seventeen (9 device-related) versus 13 serious adverse events occurred in the HCL and control groups, respectively., Conclusions: In adults with type 1 diabetes, 26 weeks of HCL improved TIR, HbA1c , and their sense of satisfaction from managing their diabetes compared with those continuing with user-determined insulin dosing and self-monitoring of blood glucose. For most people living with type 1 diabetes globally, this trial demonstrates that HCL is feasible, acceptable, and advantageous., (© 2020 by the American Diabetes Association.)- Published
- 2020
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44. What Do Adults with Type 2 Diabetes Want from the "Perfect" App? Results from the Second Diabetes MILES: Australia (MILES-2) Study.
- Author
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Baptista S, Trawley S, Pouwer F, Oldenburg B, Wadley G, and Speight J
- Subjects
- Adult, Aged, Cost of Illness, Cross-Sectional Studies, Female, Follow-Up Studies, Humans, Longitudinal Studies, Male, Middle Aged, Qualitative Research, Diabetes Mellitus, Type 2 psychology, Mobile Applications, Patient Preference psychology, Self-Management psychology
- Abstract
Background: We investigated what Australian adults with type 2 diabetes (T2D) want from the "perfect" diabetes self-management application. Methods: Adults with T2D completed a national online survey including an open-ended question: "If you were describing the perfect app to help you manage your diabetes, what would it do?" Qualitative responses were subjected to thematic analysis. Results: Of the 339 participants who provided usable responses, 153 (45%) were women, the mean age was 58 ± 10 years, and 139 participants (41%) managed their diabetes with insulin. Two primary themes emerged. First, participants expressed a desire for assistance with practical aspects of diabetes self-management to improve, and reduce the cognitive burden of, self-management; this included tracking and visualizing multiple sources of data, using data to inform automated, personalized coaching, reminders, and alarms, and automating upload and linking of data through connected devices. Second, they desired assistance with psychological and emotional aspects of diabetes self-management; this included ongoing encouragement and motivation, help with stress management or negative emotions, and complementing existing health care by facilitating interconnectivity with health professionals. Conclusions: Our findings suggest that the clear desire of people with type 2 diabetes is for the "perfect app" to reduce not only the practical, but also the cognitive and emotional burden of diabetes self-management. They provide further evidence that understanding the desires of people living with diabetes needs to be the first step in app development to ensure that apps provide features, support, and benefits that people with diabetes value.
- Published
- 2019
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45. Self-reported aggression amongst active cyclists.
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Stephens AN, O'Hern S, Trawley S, Young KL, and Koppel S
- Subjects
- Accidents, Traffic prevention & control, Accidents, Traffic psychology, Adult, Anger, Bicycling statistics & numerical data, Female, Humans, Male, Middle Aged, Risk Factors, Self Report, Aggression psychology, Bicycling psychology
- Abstract
There is a paucity of research regarding aggressive behaviours of on-road cyclists and the consequences that aggression may have on their safety. To address this, we examined self-reported anger-based aggression in a sample of "active" cyclists (N = 623: males = 69%) defined as those who regularly ride a bicycle on-road (all rode at least once a week, 64% rode between 4-7 days per week). Using the Cyclist Anger Expression Inventory (CAX) three broad types of anger-based aggression were identified: 1) constructive ways of dealing with anger, 2) verbal aggression and 3) personal physical aggression. Cyclists reported that most to almost all of the time they deal with anger in adaptive constructive ways. When they were aggressive, they were most likely to express this through verbal types of aggression such as shouting or swearing aloud. Personal physical types of aggression were infrequent and these were the only type of behaviour found to be related to crashes. Regression analyses showed that factors associated with personal physical aggression included anger propensities, distance travelled, being male and younger. Interestingly, personal physical aggression was also more frequently expressed by cyclists classified as "strong and fearless" (Geller, 2009), that is avid cyclists who feel comfortable in all riding environments. Therefore, although the expressions of extreme aggression are rare, they are expressed in a group of riders who regularly ride on the road, making them particularly vulnerable. Effective strategies need to be developed to lessen cyclist aggression and mitigate the potential risks associated with these behaviours, for both cyclists and other vulnerable road users., (Copyright © 2019 Elsevier Ltd. All rights reserved.)
- Published
- 2019
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46. The impact of different responses to fat talk on body image and socioemotional outcomes.
- Author
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Mills J, Mort O, and Trawley S
- Subjects
- Adolescent, Adult, Emotions, Female, Humans, Imagination, Shame, Young Adult, Body Image psychology, Personal Satisfaction, Self Concept
- Abstract
Fat talk, the act of making disparaging comments about one's own appearance, has been associated with an extensive range of negative body image outcomes. Despite this well-established body of literature highlighting the prevalence and consequences, scant research exists on the impact of different responses to fat talk in situ. The current online experiment aimed to explore four different responses to fat talk and their impact on body satisfaction, shame, and feelings of support. Female participants (N = 191, M
age = 23.52, SDage = 4.54, rangeage = 18-40) recalled or imagined an experience of engaging in fat talk before being randomly assigned to receive a set response (where their fat talk was either challenged, ignored, reassured, or reciprocated). Largely in line with hypotheses, the Ignore condition led to the lowest level of body satisfaction and perceived support, and the highest level of shame. The Challenge condition resulted in positive outcomes for both perceived support and feelings of shame. The findings demonstrate that ignoring fat talk is associated with negative outcomes, providing evidence to inform practical guidelines aimed at tackling the social phenomenon., (Copyright © 2019 Elsevier Ltd. All rights reserved.)- Published
- 2019
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47. Associations between attention deficit hyperactivity and internet gaming disorder symptoms: Is there consistency across types of symptoms, gender and countries?
- Author
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Stavropoulos V, Adams BLM, Beard CL, Dumble E, Trawley S, Gomez R, and Pontes HM
- Abstract
Background: Videogame addiction has been suggested as a tentative disorder in 2013 by the American Psychiatric Association (APA) and was recently officially recognized as a mental health disorder by the World Health Organization (WHO). Although a few studies have identified attention deficit and hyperactivity disorder (ADHD) as a key risk factor for Internet Gaming Disorder (IGD), the interplay between ADHD and IGD symptoms with gender differences across cultures remains to be further examined., Objective: This study examined the moderating effects of gender in the association between ADHD and IGD across two nations., Method: A cross-sectional online survey was developed to recruit 164 Australian (M
age = 23.01, SD = 3.35, Minage = 18, Maxage = 31, Males n = 121, 73.80%) and 457 U.S.-North American (Mage = 25.25 years, SD = 2.76, Minage = 18 years, Maxage = 29 years, Males = 265, 57.98%) Massively Multiplayer Online (MMO) players aged between 18 and 29 years., Results: The hierarchical linear regression, moderation and moderated moderation analyses revealed that participants presenting greater inattention and hyperactivity symptoms exhibited higher levels of IGD-related behaviors in the two samples. Moreover, these associations differed across genders between the two countries. Specifically, more hyperactive-impulsive, as well as inattentive males in the USA presented higher levels of disordered gaming., Conclusion: The results highlight the need for more cross-cultural and symptom-focused research in the broader IGD field.- Published
- 2019
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48. Dementia in older people admitted to hospital: An analysis of length of stay and associated costs.
- Author
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Ahern S, Cronin J, Woods N, Brady NM, O'Regan NA, Trawley S, and Timmons S
- Subjects
- Aged, Aged, 80 and over, Cohort Studies, Female, Hospitalization statistics & numerical data, Humans, Male, Middle Aged, Prevalence, Prospective Studies, Dementia economics, Hospital Costs statistics & numerical data, Length of Stay economics
- Abstract
Objectives: Patients with dementia in the acute setting are generally considered to impose higher costs on the health system compared to those without the disease largely due to longer length of stay (LOS). Many studies exploring the economic impact of the disease extrapolate estimates based on the costs of patients diagnosed using routinely collected hospital discharge data only. However, much dementia is undiagnosed, and therefore in limiting the analysis to this cohort, we believe that LOS and the associated costs of dementia may be overestimated. We examined LOS and associated costs in a cohort of patients specifically screened for dementia in the hospital setting., Methods: Using primary data collected from a prospective observational study of patients aged ≥70 years, we conducted a comparative analysis of LOS and associated hospital costs for patients with and without a diagnosis of dementia., Results: There was no significant difference in overall length of stay and total costs between those with (μ = 9.9 days, μ = € 8246) and without (μ = 8.25 days, μ = € 6855) dementia. Categorical data analysis of LOS and costs between the two groups provided mixed results., Conclusions: The results challenge the basis for estimating the costs of dementia in the acute setting using LOS data from only those patients with a formal dementia diagnosis identified by routinely collected hospital discharge data. Accurate disease prevalence data, encompassing all stages of disease severity, are required to enable an estimation of the true costs of dementia in the acute setting based on LOS., (© 2018 John Wiley & Sons, Ltd.)
- Published
- 2019
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49. Effect of 6 months of hybrid closed-loop insulin delivery in adults with type 1 diabetes: a randomised controlled trial protocol.
- Author
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McAuley SA, de Bock MI, Sundararajan V, Lee MH, Paldus B, Ambler GR, Bach LA, Burt MG, Cameron FJ, Clarke PM, Cohen ND, Colman PG, Davis EA, Fairchild JM, Hendrieckx C, Holmes-Walker DJ, Horsburgh JC, Jenkins AJ, Kaye J, Keech AC, King BR, Kumareswaran K, MacIsaac RJ, McCallum RW, Nicholas JA, Sims C, Speight J, Stranks SN, Trawley S, Ward GM, Vogrin S, Jones TW, and O'Neal DN
- Subjects
- Adult, Australia, Blood Glucose analysis, Blood Glucose Self-Monitoring, Home Care Services, Humans, Hypoglycemia prevention & control, Insulin adverse effects, Multicenter Studies as Topic, Prospective Studies, Quality of Life, Randomized Controlled Trials as Topic, Regression Analysis, Time Factors, Treatment Outcome, Diabetes Mellitus, Type 1 drug therapy, Glycated Hemoglobin analysis, Hypoglycemic Agents administration & dosage, Insulin administration & dosage, Insulin Infusion Systems
- Abstract
Introduction: Manual determination of insulin dosing largely fails to optimise glucose control in type 1 diabetes. Automated insulin delivery via closed-loop systems has improved glucose control in short-term studies. The objective of the present study is to determine the effectiveness of 6 months' closed-loop compared with manually determined insulin dosing on time-in-target glucose range in adults with type 1 diabetes., Methods and Analysis: This open-label, seven-centre, randomised controlled parallel group clinical trial will compare home-based hybrid closed-loop versus standard diabetes therapy in Australia. Adults aged ≥25 years with type 1 diabetes using intensive insulin therapy (via multiple daily injections or insulin pump, total enrolment target n=120) will undertake a run-in period including diabetes and carbohydrate-counting education, clinical optimisation and baseline data collection. Participants will then be randomised 1:1 either to 26 weeks of MiniMed 670G hybrid closed-loop system therapy (Medtronic, Northridge, CA, USA) or continuation of their current diabetes therapy. The hybrid closed-loop system delivers insulin automatically to address basal requirements and correct to target glucose level, while bolus doses for meals require user initiation and carbohydrate estimation. Analysis will be intention to treat, with the primary outcome time in continuous glucose monitoring (CGM) target range (3.9-10.0 mmol/L) during the final 3 weeks of intervention. Secondary outcomes include: other CGM parameters, HbA
1c , severe hypoglycaemia, psychosocial well-being, sleep, cognition, electrocardiography, costs, quality of life, biomarkers of vascular health and hybrid closed-loop system performance. Semistructured interviews will assess the expectations and experiences of a subgroup of hybrid closed-loop users., Ethics and Dissemination: The study has Human Research Ethics Committee approval. The study will be conducted in accordance with the principles of the Declaration of Helsinki and Good Clinical Practice. Results will be disseminated at scientific conferences and via peer-reviewed publications., Trial Registration Number: ACTRN12617000520336; Pre-results., Competing Interests: Competing interests: MIdB and NDC report receiving speaker honoraria from Medtronic. DJHW reports receiving speaker and advisory board honoraria from Medtronic. RWM reports receiving conference travel and accommodation support from Medtronic. JS reports that the ACBRD has received honoraria from Medtronic in relation to her speaking engagements and role in advisory boards. DNON reports receiving speaker honoraria and research grants from Medtronic., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)- Published
- 2018
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50. The Use of Mobile Applications Among Adults with Type 1 and Type 2 Diabetes: Results from the Second MILES-Australia (MILES-2) Study.
- Author
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Trawley S, Baptista S, Browne JL, Pouwer F, and Speight J
- Subjects
- Adult, Australia, Cross-Sectional Studies, Diabetes Mellitus, Type 1 psychology, Diabetes Mellitus, Type 2 psychology, Female, Humans, Male, Middle Aged, Self-Management, Diabetes Mellitus, Type 1 therapy, Diabetes Mellitus, Type 2 therapy, Mobile Applications statistics & numerical data
- Abstract
Background: While the number of diabetes-specific mobile applications (apps) continues to grow, there is a lack of knowledge about their actual use., Methods: The second MILES (Management and Impact for Long-term Empowerment and Success)-Australia study was a national cross-sectional survey of the psychological, behavioral, and social aspects of diabetes for adults with type 1 diabetes (T1D) and type 2 diabetes (T2D). Associations between diabetes-specific app usage and demographic, clinical, and psychosocial variables were examined., Results: Of the 1589 respondents responding to the diabetes-specific app questions, 795 had T1D (mean ± standard deviation age 43 ± 14 years; 61% women; diabetes duration 19 ± 14 years) and 794 had T2D (age 60 ± 9 years; 40% women; diabetes duration 11 ± 7 years). Among adults with T1D, 24% (n = 188) reported using apps, with carbohydrate counting (74%; n = 139) as the most common cited purpose. App usage was significantly associated with shorter diabetes duration, more frequent glucose monitoring, and lower self-reported HbA1c. Among adults with T2D, 8% (n = 64) reported using apps, with glucose monitoring (62%; n = 39) as the most common purpose. For all respondents, the most commonly reported reason for not using apps was a belief that they could not help with diabetes self-management., Conclusions: A minority of adults with T1D and T2D use apps to support their self-management. App use among adults with T1D is associated with a more recent T1D diagnosis, more frequent glucose monitoring, and lower self-reported HbA1c. Future efforts should focus on this association and determine the mechanisms by which app use is related to better clinical outcomes.
- Published
- 2017
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