Purpose: To examine the following questions with regard to the initiation of a new intensive management program for adolescents with Type 1 diabetes mellitus: (a) What clinical and psychosocial factors are associated with achievement of metabolic control treatment goals after 1 year? and (b) What baseline clinical and psychosocial factors are associated with improvement in the quality of life after 12 months?Methods: Eighty-one subjects (of 83 who began; aged 14.3 +/- 2.0 years at entry; 48 females, 33 males; 95% white; diabetes duration 8.9 +/- 3.9 years) with Type 1 diabetes completed 12 months of follow-up in a study of intensified treatment of diabetes. Assessments at baseline and at 12 months used the Diabetes Quality of Life for Youth scale, the Self-efficacy for Diabetes Scale, the Children's Depression Inventory, the Issues in Coping with Diabetes Scale, and the Diabetes Family Behavior Scale. Data were analyzed using multiple and logistic regression.Results: From a baseline of >9%, HbA1c levels decreased to a mean of 7.8 +/- 0.7%, with 30% of the subjects achieving our treatment goal of less than or equal to7.2%. Logistic regression demonstrated that achievement of goal levels of HbA1c were associated with better metabolic control at study entry (p = .05), participation in coping skills training (p = .003), and more parental participation in guidance and control (p = .05). Multiple regression analysis demonstrated that participation in coping skills training with lower impact of diabetes on quality of life at baseline and less depression at baseline contributed significantly to the variance (0.57) in quality of life at 12 months.Conclusions: Providers need to pay particular attention to adolescents with poorer metabolic control and impact of diabetes on quality of life when they intensify their treatment because they are less likely to reach treatment goals. Furthermore, behavioral interventions such as coping skills training may help teens achieve their goals. (C) Society for Adolescent Medicine, 2001.

Diabetes Technology & TherapeuticsVol. 2, No. supplement 1 Orginal ArticlesContinuous Glucose Monitoring in Youth with Type 2 Diabetes: Overcoming Barriers to Successful TreatmentElizabeth A. Boland and William V. TamborlaneElizabeth A. BolandSearch for more papers by this author and William V. TamborlaneSearch for more papers by this authorPublished Online:5 Jul 2004https://doi.org/10.1089/15209150050214131AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail FiguresReferencesRelatedDetailsCited byReal-Time Continuous Glucose Monitoring in Adolescents and Young Adults With Type 2 Diabetes Can Improve Quality of Life23 November 2022 | Journal of Diabetes Science and Technology, Vol. 169Use of Continuous Glucose Monitoring in Youth-Onset Type 2 Diabetes19 July 2017 | Current Diabetes Reports, Vol. 17, No. 9Clinical Use of Continuous Glucose Monitoring in Pediatrics Rayhan A. Lal and David M. Maahs1 May 2017 | Diabetes Technology & Therapeutics, Vol. 19, No. S2Pascal's Wager: Combining Continuous Glucose Monitoring and Continuous Subcutaneous Insulin Infusion David Kerr and Tolu Olateju1 June 2010 | Diabetes Technology & Therapeutics, Vol. 12, No. S1Randomized controlled trial to assess the impact of continuous glucose monitoring on HbA 1c in insulin-treated diabetes (MITRE Study)Diabetic Medicine, Vol. 26, No. 5A hipoglicemia silenciosa é parte do controle glicêmico ideal em pacientes com DM1? - tempo de hipoglicemia pelo CGMS versus média glicêmicaArquivos Brasileiros de Endocrinologia & Metabologia, Vol. 52, No. 6Uso da monitorização contínua de glicose (CGMS) por quatro (96 horas) ou cinco (120 horas) dias em pacientes com DM1: existe vantagem?Arquivos Brasileiros de Endocrinologia & Metabologia, Vol. 52, No. 3Efficacy of continuous glucose monitoring system (CGMS) to detect postprandial hyperglycemia and unrecognized hypoglycemia in type 1 diabetic patientsDiabetes Research and Clinical Practice, Vol. 75, No. 1Acurácia, efeitos na terapia insulínica e controle glicêmico e complicações do sistema de monitorização contínua da glicose em pacientes com diabetes mellitus tipo 1Arquivos Brasileiros de Endocrinologia & Metabologia, Vol. 49, No. 4Efficacy of continuous glucose monitoring system to detect unrecognized hypoglycemia in children and adolescents with type 1 diabetesArquivos Brasileiros de Endocrinologia & Metabologia, Vol. 49, No. 4Disease Management in the Young Diabetic Patient: Glucose Monitoring, Coping Skills, and Treatment Strategies2 July 2016 | Clinical Pediatrics, Vol. 44, No. 5Continuous Monitoring of the Subcutaneous Glucose Level in Freely Moving Normal and Diabetic Rats and in Humans with Type 1 Diabetes Reza Jamali, Johnny Ludvigsson, and Simin Mohseni5 July 2004 | Diabetes Technology & Therapeutics, Vol. 4, No. 3Unresolved Challenges with Insulin Therapy in Type 1 and Type 2 Diabetes: Potential Benefit of Replacing Amylin, a Second β-Cell Hormone S. V. Edelman and C. Weyer5 July 2004 | Diabetes Technology & Therapeutics, Vol. 4, No. 2New technologies and therapeutic approaches for the management of pediatric diabetesCurrent Diabetes Reports, Vol. 1, No. 1 Volume 2Issue supplement 1Dec 2000 To cite this article:Elizabeth A. Boland and William V. Tamborlane.Continuous Glucose Monitoring in Youth with Type 2 Diabetes: Overcoming Barriers to Successful Treatment.Diabetes Technology & Therapeutics.Dec 2000.53-59.http://doi.org/10.1089/15209150050214131Published in Volume: 2 Issue supplement 1: July 5, 2004PDF download

OBJECTIVE:To determine whether initial effects on metabolic control and quality of life associated with a behavioral intervention combined with intensive diabetes management (IDM) can be sustained over 1 year in youth implementing intensive therapy regimens.STUDY DESIGN:Seventy-seven patients (43 females, 95% white) 12 to 20 years (mean = 14.2 +/- 1.9; duration, 8.7 +/- 3.9) electing to initiate IDM were randomly assigned to one of two groups: with or without coping skills training (CST), which consists of 6 small group sessions and monthly follow-up to help youth cope with their lives in the context of diabetes management; skills included social problem solving, cognitive behavior modification, and conflict resolution. Data were collected before the intervention and at 3, 6, and 12 months after the intervention by using the Self-Efficacy for Diabetes Scale, Children's Depression Inventory, Issues in Coping with IDDM, and the Diabetes Quality of Life: Youth scales. Clinical data (glycosylated hemoglobin level, height, weight, adverse effects) were collected monthly.RESULTS:The CST and IDM groups were comparable at baseline. CST subjects had lower glycosylated hemoglobin (P =.001) and better diabetes (P =.002) and medical (P =. 04) self-efficacy, and less impact of diabetes on their quality of life (P =.005) than youth receiving IDM alone after 1 year. In males, CST did not affect adverse outcomes of IDM hypoglycemia, diabetic ketoacidosis, and weight gain, but CST decreased the incidence of weight gain (P =.05) and hypoglycemia in females (P =.03).CONCLUSIONS:The addition of behavioral intervention to IDM in adolescence results in improved metabolic control and quality of life over 1 year.

PURPOSE This study examined the metabolic trend and factors associated with an unexpected rise in HbA1c levels during the summer, with a return to baseline when school resumed, in 40 intensively treated adolescents with type 1 diabetes. METHODS Psychosocial data were collected using a variety of diabetes evaluation instruments. HbA1c was measured monthly. RESULTS HbA1C values increased by a mean of .73% from May to July and decreased by a mean of .75% from August to October. Lack of consistency in summer routines compared with school days was associated with a worsening in metabolic control during the summer months. Other factors associated with the summer increase in HbA1c included lower guidance scores on the Diabetes Family Behavior Scale, and higher impact and worry scores on the Diabetes Quality of Life for Youth Scale. CONCLUSIONS Interviews suggested that teenagers need to take a vacation from intensive diabetes care during the summer.

PURPOSE this study examined the metabolic and quality-of-life effects of using lispro insulin in teenagers. METHODS Teenagers on multiple daily injections who had not reached metabolic treatment goals were offered the opportunity to use lispro insulin as part of a larger ongoing study of intensive management in youth. Of the 51 who were eligible, 35 used lispro and were followed for 12 months; the remaining 16 had reached treatment goals, were not offered lispro, and comprised the control group. RESULTS After 12 months, the teens who received lispro insulin achieved equivalent levels of metabolic control to those achieved by teens in the control group, without differences in total daily dose, insulin regimen, or adverse events. Those who received lispro found coping with diabetes less difficult than those who continued on regular insulin, and they reported less negative impact of diabetes on quality of life and fewer worries about diabetes. Both groups were equally satisfied with their diabetes treatment. CONCLUSIONS Lispro insulin is a safe alternative for youth on intensive regimens, may assist youth in coping with diabetes, and may improve their quality of life.

The purpose of this study was to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve the metabolic control and quality of life in adolescents who are implementing intensive therapy. A total of 77 youths (age range, 12.5-20 years) who were beginning intensive insulin therapy were randomly assigned to one of two groups: intensive management with CST or without CST. CST consists of a series of small group efforts designed to teach problem solving skills and communication. Data were collected preintervention and at 3 and 6 months post-intervention by using established clinical and psychosocial indicators. Randomization produced equivalent groups. After 6 months, subjects who received CST had better metabolic control (F = 3.89, p = .02) and better general self-efficacy (F = 4.54, p = 0.01). They reported less negative impact of diabetes on their quality of life (F = 4.55, p = .01) and had fewer worries about diabetes (F = 3.82, p = .02). Thus, nurses may find CST useful in assisting youths with diabetes to achieve metabolic and quality of life goals. Copyright (C) 1999 by WB. Saunders Company.

OBJECTIVE Quality of life is an important criterion for assessing outcomes of treatment in chronic illness related to psychosocial well-being. The purpose of this study was to evaluate the factors that influence quality of life in adolescents with IDDM. RESEARCH DESIGN AND METHODS Self-reports were obtained from 52 adolescents (age 13-20 years, mean 16.1 ± 1.9 [mean ± SD], diabetes duration 8.2 ± 3.4 years, 49% female) using the following scales: Diabetes Quality of Life for Youths, Children's Depression Inventory, Issues in Coping with Diabetes, Diabetes Family Behavior Scale, Family Adaptability and Cohesion, Self-Efficacy for Diabetes, and the Adolescent Coping Orientation. Metabolic control was measured by HbA1c. RESULTS Teenagers whose diabetes had the greater impact (R2 = 0.48) and were less satisfied (R2 = 0.45) felt that management was more difficult (r = 0.56) and that diabetes was more upsetting (r = 0.63). They also used fewer rebellion strategies for coping (r = −0.44), had lower diabetes self-efficacy (r = −0.36), and had more depressive symptoms (r = 0.61). Higher impact was also associated with higher family warmth and caring (r = −0.54) and lower family adaptability (r = −0.42). Teenagers who were more worried (R2 = 0.37) about their diabetes felt that management was more difficult (r = 0.40) and that diabetes was more upsetting (r = 0.58), and they used less rebellion (r = −0.49) and more ventilation (r = 0.42) to cope, had lower diabetes (r = −0.40) and medical (r = −0.30) self-efficacy, were more depressed (r = 0.55), and their families were less warm and caring (r = −0.33). HbA1c levels were not associated with quality of life or any other psychosocial factors except in teenagers who perceived their families as providing more guidance and control. These teenagers had lower HbA1c values than those whose families were less involved. CONCLUSIONS Even teenagers who are successfully achieving HbA1c goals of therapy may perceive diabetes as having a negative impact on their lives, be depressed, and find diabetes difficult to manage. Diabetes treatment teams need to pay equal attention to the psychosocial needs to the quiet, nonrebellious teen with well-controlled diabetes from a supportive family as they do to the rebellious adolescent with poorly controlled diabetes.

OBJECTIVE:Given the urgent need to develop effective programs that improve the ability for adolescents to achieve metabolic control equivalent to programs studied in the Diabetes. Control and Complications Trial, we have undertaken a clinical trial to determine if a behavioral intervention (coping skills training [CST]) combined with intensive diabetes management can improve metabolic control and quality of life in adolescents implementing intensive therapy regimens.RESEARCH DESIGN AND METHODS:A total of 65 youths between the ages of 13 and 20 years, who elected to initiate intensive insulin therapy, were randomly assigned to one of two groups: the intensive management with CST group and the intensive management without CST group. CST consists of a series of small group efforts designed to teach adolescents the coping skills of social problem-solving, social skills training, cognitive behavior modification, and conflict resolution. Data were collected at pre-intervention and at 3 months following the use of the Self-Efficacy for Diabetes scale, Children's Depression Inventory, Issues in Coping with IDDM scale, and the Diabetes Quality of Life: Youth scale. Clinical data (HbA1c, adverse effects) were collected monthly.RESULTS:The experimental and control groups were comparable on all measures at baseline. Results show that adolescents who received CST had lower HbA1c and better diabetes self-efficacy and were less upset about coping with diabetes than adolescents receiving intensive management alone. In addition, adolescents who received the CST found it easier to cope with diabetes and experienced less of a negative impact of diabetes on quality of life than those who did not receive CST.CONCLUSIONS:CST is useful in improving not only an adolescent's metabolic control, but also their quality of life. As more pediatric providers aim for improved control, in adolescents with diabetes, the addition of this behavioral intervention may be helpful in achieving metabolic and life goals.

PURPOSE:To review the potential use and application of coping-skills training in teaching adolescents effective ways of managing the stressors related to living with diabetes mellitus.POPULATION:Adolescents ages 13 to 20 with insulin-dependent diabetes mellitus who are participating in the research project, "Nursing Intervention to Implement DCCT Therapy in Youth" at Yale University School of Nursing.CONCLUSIONS:Teaching adolescents with diabetes mellitus to use appropriate coping skills may help them cope with the day-to-day management of the illness and aid in long-term adaptation.PRACTICE IMPLICATIONS:Research has suggested that the use of effective coping skills may aid in healthy long-term adaptation to diabetes mellitus. Thus, nurses caring for adolescents with this illness should teach and be role models for these effective coping strategies.

Continuous subcutaneous insulin infusion (CSII) was initiated in a young female adolescent with severe insulin resistance, decreased growth velocity, and poor metabolic control. The patient's insulin dose had been 3 u/kg/day, and it was hypothesized that her insulin requirements would be much less when only regular insulin was used. Because of the potential risk of severe hypoglycemia from giving regular insulin in amounts equivalent to her injection total daily dose as a constant subcutaneous infusion, the patient was hospitalized to begin pump therapy. Hourly glucose levels were collected for 24 hours to determine insulin requirements with this therapy. The patient subsequently required a significantly reduced dose of insulin (1.2 u/kg/day) with CSII, and her growth velocity improved. Metabolic control based on glycosylated hemoglobin levels also improved. Insulin pump treatment proved to be a viable solution for this young adolescent who required large doses of insulin to maintain reasonable control. Challenges of using this type of therapy in young patients are discussed.

School-age children (N = 43) with insulin-dependent diabetes mellitus were studied to determine if the coping strategies they used were associated with their self-care management and/or with their metabolic control. Instruments used included the Schoolagers Coping Strategy Inventory and the Self-care Questionnaire. Results indicated that the choice of coping strategies did not differ by demographic characteristics, and level of self-care was not associated with metabolic control. Participants used cognitive coping strategies most often; higher frequencies tended to be associated with higher levels of self-care and metabolic control. Those who utilized distracting strategies also tended to have higher levels of self-care. Emotional coping strategies tended to be related to poorer metabolic control. The use of coping strategies explained approximately 18% of the variance in metabolic control. These data suggest that healthcare providers should assess what coping strategies are employed by school-age children with diabetes because the choice of strategies may have a significant impact on their metabolic control. The use of strategies related to poorer metabolic control (eg, emotional strategies) should be discouraged, and the use of more effective strategies related to higher levels of self-care and metabolic control (eg, cognitive strategies) should be modeled and encouraged.