PurposeThe purpose of this study was to examine demographic and diabetes-related factors with the Diabetes Management Questionnaire (DMQ) among racially minoritized youth with type 1 diabetes.MethodsA descriptive correlational study was employed. Youth and their caregivers were enrolled in a behavioral intervention to promote optimal continuous glucose monitoring (CGM) use along with completing the DMQ at baseline.ResultsParticipants included 60 youth ages 10 to 15 years (53% Black, 27% Hispanic/Latino/a/x, 12% another minoritized identity, 8% White; mean A1C = 10.6% ± 2.0%). Only child age was significantly associated with caregiver DMQ scores. No other demographic or medical variables, including A1C, were significantly related to DMQ scores. Mean youth DMQ scores significantly differed between samples, with the current sample reporting stronger adherence to diabetes management regimens despite higher overall A1C.ConclusionsThe lack of associations between the DMQ and demographic or medical variables in this sample compared to that of the validation sample suggest that the DMQ may have weaker psychometric properties among racially minoritized families. It is crucial that existing questionnaires like the DMQ be reexamined in a larger, more racially diverse population, where structural factors, beyond individual management behaviors, also influence A1C.

High glucose variability is common among adolescents with type 1 diabetes mellitus (T1DM). On person level, poor sleep quality has been reported to be an important factor associated with high glucose variability among adolescents with T1DM. However, on day level, the effect of sleep quality on glucose variability remains unclear, limiting temporal adjustment of treatment regimens. This study aimed to concurrently explore associations between sleep quality and glucose variability at both day and person levels among Chinese adolescents with T1DM based on the 24-h Recursive Cycle model.

A multi-center, seven-day, temporal longitudinal study was conducted among Chinese adolescents with T1DM. Glucose variability measures were calculated by fingertip blood glucose level at least seven times a day. Subjective sleep quality was measured by total sleep time, wake after sleep onset, number of awakenings, a score of sleep quality, sleep time, and wake time using a sleep diary. Objective sleep quality was assessed by Fitbit Inspire HR and included total sleep time, wake after sleep onset, and number of awakenings, rapid eye movement, light sleep time, deep sleep time, sleep time, wake time, sleep midpoint, and sleep efficiency. A multilevel linear regression model was performed to examine the associations between objective and subjective sleep quality and glucose variability at day and person levels. Gender, age, diabetes duration, complications documented within the preceding 6 months, HbA1c, and insulin pump therapy were controlled at person-level model.

A total of 51 adolescents with T1DM participated in this study, which included 357 records of data. Only 21.57 % (N = 12) of adolescents met the recommended sleep time of 480 min per night measured by Fitbit. About a quarter (N = 11) of adolescents had a coefficient of variation of blood glucose >36 %. At person level, there was no significant association between sleep quality and glucose variability (p > 0.05). Multilevel models found significant associations between sleep quality and glucose variability at day level. Lower score of subjective sleep quality was significantly associated with higher standard deviation of blood glucose (p < 0.05) in the next day. Less Fitbit-measured light sleep time was significantly associated with higher standard deviation of blood glucose, and postprandial of glycemic excursions in the next day (p < 0.05). More Fitbit-measured awakenings and less rapid eye movement were associated with higher postprandial glycemic excursions in the next day (p < 0.05).

Nearly 80 % of Chinese adolescents with T1DM did not meet the recommended amount of sleep for their age group. They experienced more wakes after sleep onset at night and poorer sleep quality than their subjective experience. According to the findings on temporal relationships, intervention components targeting reducing wakes after sleep onset and improving subjective sleep quality would reduce glucose variability over time among Chinese adolescents with T1DM.

To codevelop (with children and young people with diabetes (CYPD)) an intervention to improve diabetes control and future health outcomes of CYPD from 'underserved' groups, to reduce treatment outcome inequalities between different socioeconomic and ethnic groups. To follow Medical Research Council guidance for complex interventions and the COM-B (Capability, Opportunity, Motivation, Behaviour) model for behaviour change intervention development.

In phase 1 (previously reported), we established the evidence base, conducted literature reviews and analysed data from semistructured interviews with CYPD and their carers. In phase 2 (this report), we applied the COM-B framework to identify intervention components; in phase 3 (this report), we evaluated these components, including focus groups with CYPD, their carers' and healthcare practitioner (HCP) surveys, using the Acceptability, Practicability, Effectiveness, Affordability, Spill-Over Effects, Equity criteria.

Secondary care; children, young people and their carers' were approached from two large paediatric diabetes services in England, both with socioeconomically and ethnically diverse underserved populations; paediatric diabetes HCPs were surveyed across four English regions.

N=69 underserved CYPD (aged 5-19 years) and/or family members took part in interviews; N=48 paediatric diabetes HCP survey respondents (survey 1); N=34 paediatric diabetes HCP survey respondents (survey 2); N=3 young people's advisory group participants; N=17 underserved CYPD/carers focus group participants; N=9 wider stakeholder participants.

The codevelopment process and integration of COM-B established four elements for an intervention package: (1) an enhanced peer support/mentoring programme; (2) provision of a health and well-being coach to CYPD/families; (3) family/community support to address social and community issues and (4) training for HCPs, including cultural competence, poverty proofing and to emphasise the need for increased sensitivity and better supported communication in work with CYPD from underserved groups.

The Diversity in Diabetes codevelopment work informed an intervention to improve diabetes care in underserved groups, reflecting sociocultural contexts and plausible support options at the individual, community and clinical levels. The 'Diversity in Diabetes' programme will next test feasibility and further refine the intervention package in two more paediatric diabetes centres in England.

Real-time continuous glucose monitoring (rtCGM) is now the standard care for people with type 1 diabetes. However, whilst its impact on glycaemic outcomes is well-documented, its psychosocial effects, particularly in young adults experiencing extreme hyperglycaemia, remain poorly understood.

We aimed to explore the psychosocial impact of rtCGM on young adults with extreme hyperglycaemia who thus far have not been studied extensively.

A qualitative study employing semi-structured interviews was undertaken. Young adults 18-25 years (HbA1c >75mmol/mol (9.0%)), naïve to rtCGM, were provided with rtCGM for 6-months. Interviews (centred on barriers to self-management and experience of rtCGM use) were conducted within 2-weeks of recruitment and at the end. An inductive, thematic analysis of interviews was undertaken.

Eight participants (median age (IQR) 23.0 (22.0-24.5) years, 100% non-white ethnicity) were recruited with median HbA1c 94 (88-107) mmol/mol [DCCT 10.8 (10.2-12.1)%.]. All participants used multiple daily insulin injections. Despite low rtCGM wear-time (32.2 (23.1-59.4)%), significant improvements were observed in time in range, but no change in HbA1c. Thematic analysis indicated that high levels of disease burden were reported, with rtCGM-related themes identified: 1) interaction with rtCGM data, 2) feelings of control and trust from using rtCGM, and 3) frustration of technology and alarms. Although participants reported that knowledge of glucose levels on their smartphone was convenient and led to 'greater control', this was countered by alarm-fatigue, technical difficulties and feeling overwhelmed. Three participants prematurely stopped using rtCGM.

Young adults with high-risk hyperglycaemia have complex relationships with rtCGM. rtCGM may have benefits in this high-risk group, but are likely to require additional support and must be determined on a case-by-case basis as associated effort may contribute to feelings of distress and/or burnout. Implementing structured educational, psychosocial, and technical support, alongside alternative care models such as more frequent check-ins, should be considered in order to enhance self-management practices with rtCGM and address technology-related challenges.

Despite improved outcomes in the use of a hybrid closed loop system (HCLS), significant disparities in the application of this technology exist among youth with type 1 diabetes (T1DM). The study aimed to evaluate the impact of a tubeless HCLS on glycemic outcomes in a pediatric racial-ethnic minority population.

A retrospective, single-center study included youth with T1D initiating HCLS Omnipod 5. Outcomes included HbA1c, continuous glucose monitor variables, BMI Z score, and episodes of diabetic ketoacidosis (DKA). Outcomes were compared from baseline, 3 and 6 months of Omnipod 5 start.

The study included 174 participants, aged between 2 and 22 years, with a mean age of 7.9 ± 3.7 years. Hispanics constituted 87.3 % (152) of the cohort, with 53 % males and 47 % females. Insurance coverage was 56.9 % public, 42.5 % private, and 0.5 % uninsured. Baseline HbA1c level was 8.0 % ± 1.7, 7.3 % ± 1.1 at 3 months and 7.3 % ± 1.1 at 6 months (p<0.001). Glucose time in range (TIR) was 54.5 % at baseline to 61.9 % at 3 months, and 60.5 % at 6 months (p<0.001). Notably, there were no changes in BMI z-scores or DKA episodes following the initiation of the HCLS Omnipod 5.

The study showed that a tubeless HCLS significantly improved glycemic control in a pediatric minority cohort with T1DM, without affecting BMI Z-scores or increasing DKA episodes. Ongoing efforts to address disparities in diabetes technology access are crucial for optimizing care and alleviating the burden on individuals with T1DM across racial backgrounds.

In Australia, Aboriginal and Torres Strait Islander young people in remote settings are most-affected by young onset type 2 diabetes (T2D). It is necessary to understand young people's experiences, including factors impacting on self-management, to improve models of care.

A phenomenological methodology underpinned this qualitative study in Western Australia's Kimberley region. Two Aboriginal Community Controlled Health Services supported recruitment of seven Aboriginal young people aged 12-24 with T2D, who participated in interviews. A carer and health professional of one young person in each site were also interviewed and relevant medical record data reviewed to assist with triangulation of data. De-identified transcripts were inductively coded and a coding structure developed with oversight by a Kimberley Aboriginal researcher.

Young people reported varied experiences and emotions relating to a T2D diagnosis. Most recounted this was upsetting and some reported current negative impact on emotional wellbeing. Challenges with understanding and managing diabetes were highlighted, particularly regarding healthy eating, physical activity and medication. Family are a prominent source of self-management support, with the intergenerational impact of diabetes being evident for each participant. Positive relationships with health professionals, entailing continuity of care, were valued.

There are significant emotional and medical challenges for young people with T2D and their families. Recommendations from this work will contribute to the development of local resources and initiatives to improve diabetes-related support. SO WHAT?: Alongside broader efforts to support good health at the societal level, enhanced health education and family-oriented support structures including Aboriginal clinical staff for young people with T2D are needed.

In diabetes management, oral formulation of insulin (INS) has the potential to improve safety, convenience, and patient-centered care compared to subcutaneous injections. However, its bioavailability remains limited, necessitating improved delivery strategies. Recent clinical trials indicate that taurocholic acid (TCA) can enhance the bioavailability of oral INS as an absorption enhancer. In this work, electrospray ionization mass spectrometry (ESI-MS) analysis revealed the formation of 1:1-1:4 INS-TCA complexes. MS/MS was used to explore the fragmentation pathway of complex ions and confirm binding stability in the gas phase. Circular dichroism spectra showed no clear conformational change in INS upon TCA binding, even though TCA enhanced INS's structural stability. Using Taylor dispersion analysis (TDA), we determined the diffusion coefficient and hydrodynamic radius of INS and its complexes. TCA binding was observed to increase INS size in both the 1:1 and 1:2 INS-TCA complexes. The binding constant of INS and TCA (1.3 × 103 L/mol) with approximately five binding sites was obtained via pressure-assisted capillary electrophoresis frontal analysis. Molecular docking simulations indicated that TCA binds to external binding sites on the INS B chain (near Ser-B9, Glu-B13, and Phe-B24 residues), consistent with ESI-MS and TDA results. These findings suggest that TCA binding may enhance INS absorption and increase the bioavailability of oral INS therapy.

Carbohydrate counting (CC) can be burdensome and difficulty with adherence has been reported. Automated CC through mobile apps offers innovative solutions to ease this burden.

This cross-sectional web-based survey aims to identify (1) perceived barriers to CC by Canadians living with type 1 diabetes (T1D) and (2) app features that would help reduce these barriers. The secondary objective aims to compare apps used by participants with the suggested app features.

People with T1D aged 14 years and older, living in Canada, were recruited through the BETTER Canadian registry, diabetes organizations, and social media. Participants completed a 39-question web-based survey (closed- and open-ended) to identify barriers in CC, preferred CC app features, and current app use. Respondents rated barriers and app features using a 5-point Likert scale. The features were cross-referenced in each app reported being used by participants. Descriptive statistics summarized barriers and app feature preferences, and statistical analyses identified differences by age, app use, and insulin modality. Mean scores (out of 5) were compared using 2-tailed t tests or nonparametric tests. Open-ended questions were analyzed using inductive thematic analysis.

Participants (N=196; woman: n=145, 74%; mean age 40 [SD 17] years; mean diabetes duration 22 (14) years; relied on CC to determine insulin doses at mealtimes: n=178, 90.8%) reported barriers related to carbohydrate identification, nutrient interaction, and insulin dose calculation, as well as psychosocial factors. Preferred app features included nutrient analysis (165/196, 84.2%), personalization (151/196, 77.1%), insulin bolus calculation (145/196, 74%), and health care professional support (135/196, 68.8%). Among the 16 apps used by participants, most (12/16, 75%) supported nutrient analysis but only one offered bolus calculations or health care professional support, and none offered personalization. Users on injections reported greater barriers to blood glucose monitoring for insulin adjustments compared to exclusive pump users (mean score of 3.87, SD 1.22 vs mean 3.30, SD 1.28; P=.001). They also expressed higher needs for meal logs in an electronic food journal (mean 4.06, SD 1.18 vs mean 3.69, SD 1.17; P=.01), bolus dose suggestions (mean 4.37, SD 0.98 vs mean 3.84, SD 1.26; P=.001), and app personalization (mean 4.47, SD 0.86 vs mean 3.93, SD 1.21; P<.001). No significant differences were observed based on age or app use. The thematic analysis revealed participants' perceptions of suggested barriers and features, as well as new barriers such as calculation errors from unreliable food data and nutrition labels, fear of eating disorders, limited app reliability, and insufficient health care support, with suggestions for technology-based solutions.

CC mobile apps currently used do not meet the needs of people with T1D. A novel CC app with app features such as photo recognition, reliable nutrient values, and personalized bolus calculations could reduce the CC burden.

Background: Effective self-management behaviors are crucial for diabetes management. This study examines the mediating role of self-efficacy in the relationship between compliance dimensions and self-management activities in patients with Type 1 diabetes. Methods: The current study explores a baseline analysis from a randomized controlled trial but the intervention's effectiveness is not reported here; the analysis focuses on elucidating potential mediating factors at baseline. The study investigated the relationships between seven compliance dimensions (treatment effort, intention, adaptability, integration, adherence, commitment, and indecisiveness) and six self-management activities (diet, exercise, smoking cessation, blood sugar monitoring, and foot care) through the potential mechanism of self-efficacy. Results: The analysis revealed an indirect association between three compliance dimensions (treatment effort, intention, and commitment) and foot care behavior, mediated by self-efficacy. Additionally, self-efficacy was identified as an indirect mechanism influencing the association between commitment and adaptability with dietary behaviors. Conclusions: This study highlights the importance of self-efficacy in promoting self-management behaviors in chronic conditions. By targeting specific compliance dimensions that influence self-efficacy, healthcare professionals can potentially improve patient self-management. Trial Registration: Iranian Registry of Clinical Trials number: IRCT20221029056335N1.

Low medication-adherence and persistence may reduce the effectiveness of ADHD-medication. This preregistered systematic review (PROSPERO CRD42020218654) on medication-adherence and persistence in children and adolescents with ADHD focuses on clinically relevant questions and extends previous reviews by including additional studies. We included a total of n = 66 studies. There was a lack of consistency in the measurement of adherence/persistence between studies. Pooling the medication possession ratios (MPR) and using the most common adherence definition (MPR ≥ 80%) indicated that only 22.9% of participants had good adherence at 12-month follow-up. Treatment persistence on medication measured by treatment duration during a 12-month follow-up averaged 170 days (5.6 months). Our findings indicate that medication-adherence and persistence among youth with ADHD are generally poor and have not changed in recent years. Clinicians need to be aware that various factors may contribute to poor adherence/persistence and that long-acting stimulants and psychoeducational programs may help to improve adherence/persistence. However, the evidence to whether better adherence/persistence contributes to better long-term outcomes is limited and requires further research.

Youth with type 1 diabetes (T1D) who experience avoidable complications often have dangerously high and consistently elevated HbA1c values. Novel Interventions in Children's Healthcare (NICH), a program designed to effectively intervene with this population, has demonstrated success with reducing avoidable complications and improving HbA1c in these youth. However, prior examinations of program outcomes have not included a comparison group. This is the first study to compare electronic health record (EHR) outcomes (i.e., HbA1c values, hospital utilization) of NICH youth to a comparison group.

Youth with T1D and avoidable complications were referred to NICH (n = 101; NICH = 40; comparison = 61) from the Pacific Northwest region of the United States. Retrospective EHR review included one year prior to and two years post NICH referral. Outcomes included hospitalization utilization and HbA1c values. There were no significant demographic differences between NICH and unserved youth (M age = 14.05 years; 50% female).

Within-group analyses revealed that NICH youth demonstrated a significant reduction in mean (M) admissions from one year prior to two years post-referral (M = 1.55 to M = 0.99; p = 0.011) as well as reduced HbA1c values from pre-referral to one year post-referral (M = 11.64%; 287 mg/dL; 15.9 mmol/L to M = 10.87; 265 mg/dL; 14.7 mmol/L; (p = 0.006)). Between-group analyses revealed NICH youth had lower proportions of individuals with an HbA1c over 10% (240 mg/dL; 13.3 mmol/L) (p = 0.03) compared to comparison group youth at one year post-referral. ANOVA analyses showed a significant reduction in admissions in linear interaction F (1,95) = 4.036, (p = 0.047), indicating that NICH youth demonstrated a significantly greater reduction in admissions over time compared to comparison youth.

This study was the first to compare the health outcomes of NICH youth to a comparison group. NICH youth demonstrated significant reductions in admissions and HbA1c values over time.

To investigate hospitalisation rates for the ambulatory care-sensitive conditions of epilepsy, asthma and insulin-dependent diabetes in school-aged children and young people with intellectual disabilities in comparison with their peers.

Record-linkage cohort study. Scotland's Pupil Census, 2008-2013, was used to identify pupils with and without intellectual disabilities and was linked with the Prescribing Information Service to identify pupils with epilepsy, asthma and insulin-dependent diabetes, and the Scottish Morbidity Records-01 to identify hospital admissions.

The general child population of Scotland.

School pupils aged 4-19 years; 18 278 with intellectual disabilities and 777 912 without intellectual disabilities.

Overall, emergency and non-emergency hospitalisations for epilepsy, asthma and/or diabetes; and length of stay.

Epilepsy and asthma were more prevalent in pupils with intellectual disabilities (8.8% and 8.9%, respectively, compared with 0.8% and 6.9% among pupils without intellectual disabilities, p<0.001), whereas insulin-dependent diabetes was not (0.5% prevalence). After adjusting for prevalence, pupils with intellectual disabilities and epilepsy had more epilepsy-related admissions than their peers (adjusted Hazard Ratio (aHR) 2.24, 95% CI 1.97, 2.55). For emergency admissions, these stays were longer compared with controls (adjusted incidence rate ratio (aIRR) 2.77, 95% CI 2.13, 3.59). Pupils with intellectual disabilities and asthma had similar admission rates due to asthma as control pupils with asthma (aHR 0.81, 95% CI 0.62, 1.06), but emergency admissions were longer (aIRR 2.72, 95% CI 1.49, 4.96). Pupils with intellectual disabilities and insulin-dependent diabetes had similar admission rates to controls (aHR 0.94, 95% CI 0.63, 1.41) but with shorter admissions (aIRR 0.71, 95% CI 0.51, 0.99).

Our findings suggest pupils with intellectual disabilities may receive poorer community healthcare than their peers for the common conditions of epilepsy and asthma. Hospital admissions are disruptive for both the child and their family. Epilepsy and asthma are associated with avoidable deaths; hence, a better understanding of these hospitalisations is important.

The purpose of the study was to identify the most common reasons for and timing of continuous glucose monitoring (CGM) attrition in youth with type 1 diabetes (T1DM).

This single center retrospective chart review included youth with T1DM <22 years seen between November 1, 2021, and October 31, 2022. Data were gathered from CGM cloud-based software and the electronic medical record.

Among 2663 youth, 88.3% (n = 2351) actively used CGM, and 5.9% (n = 311) had CGM attrition. Those who discontinued CGM were older (17.0 vs 14.9 years, P = .0001), had a longer T1DM duration (7.4 vs 5.1 years), higher A1C (9% vs 7.4%), and were non-Hispanic Black (NHB; 34.0% vs 11.5%). The odds of CGM attrition were 5.0 and 2.8 times higher in NHB and Latine youth, respectively, compared to non-Hispanic White youth. Median time to CGM discontinuation was 4 months, 21 days after initiation; 57% of youth who discontinued did so in the first 6 months of use. The most common reasons for CGM attrition were problems with device adhesion (18.4%), dislike device on the body (10.8%), insurance problems (9.5%), pain with device use (8.3%), and system mistrust due to inaccurate readings (8.2%). NHB and Latine youth were more likely to discontinue CGM due to insurance problems (3.2% vs 15.1% vs 16.7%).

To support equitable, uninterrupted CGM use, education at CGM initiation should address practical approaches to improve adhesion and wearability and provide a clear pathway to obtaining supplies. Interventions to support sustained CGM use should occur within the first 6 months of initiation.

Non-adherence to insulin treatment is common in adolescents and young adults (AYAs) with type 1 diabetes (T1D) and is associated with increased morbidity and mortality. However, the socio-cognitive determinants (SCDs) of adherence in AYAs with T1D are less frequently represented in systematic reviews. This systematic review aimed to investigate the key SCDs associated with adherence/non-adherence to insulin treatment in AYAs in the age range of 17-24 years with T1D. A systematic review in PubMed, Embase, Web of Science, and PsycINFO was conducted. The search took place from 2021, to January 1st, 2022, and was repeated on June 5-7, 2022 and from July 18 to July 24, 2023. The methodological quality of studies was assessed by the National Heart, Lung, and Blood Institute quality assessment tool for observational cohort and cross-sectional studies. Six articles representing 973 AYAs with T1D were included for data extraction. The identified SCDs included risk perceptions, attitude, family and friends' social support, self-efficacy, and information factors. However, there was inconsistency in correlational findings among studies. The identified SCDs influencing insulin adherence in AYAs with T1D could serve as targets for patients' consultations and tailored interventions to improve adherence and overall health outcomes, as well as for policymakers to integrate these interventions into diabetes care planning. However, further research in the area of factors affecting insulin adherence in quality-designed studies that use detailed and comprehensive measures for assessing adherence is needed.

To explore the lived experiences of Jordanian adolescents with type 1 diabetes mellitus (T1DM) and identify their specific needs.

Qualitative interviews were conducted with 10 Jordanian adolescents. Thematic analysis was used to identify key themes.

Three main themes emerged: (1) Living with diabetes as a constant struggle, including emotional turbulence, social withdrawal, and difficulty with treatment regimens; (2) Restoring balance in life through social support, following treatment protocols, and accepting the disease; and (3) Adolescents' needs for a better environment, including improved knowledge, resources, and social integration.

Adolescents with T1DM face significant challenges, including emotional distress, social isolation, and difficulties managing their disease. This study provides valuable insights into their experiences and highlights the importance of comprehensive support.

To effectively support adolescents with T1DM, healthcare providers and educators should focus on providing emotional support, social support, and practical assistance. Additionally, improving knowledge and awareness about T1DM among adolescents and their families is crucial, as well as increasing access to resources that can help them manage their disease and live fulfilling lives.

Adolescents with diabetes mellitus (DM) experience poorer glycemic outcomes and lower adherence to self-management regimens compared to other age groups. The coronavirus 2019 (COVID-19) pandemic posed new barriers to DM self-management, including social distancing measures and additional stressors. We conducted a scoping review of peer-reviewed literature to examine self-management regimens and outcomes among adolescents aged 10-17 years with type 1 and type 2 DM during the pandemic. Our scoping review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. We searched three online databases, screened articles through a rigorous process, and assessed bias using the Joanna Briggs Institute (JBI) Critical Appraisal Checklists. The findings from the included articles were categorized into six thematic areas: glycemic control/monitoring, insulin administration/regimens, weight/lifestyle behaviors, inpatient care/acute complications, outpatient care/telemedicine utilization, and psychosocial well-being. The findings from the included articles (n = 32) varied. Adolescents who used continuous glucose monitoring (CGM), regularly adjusted insulin doses, and utilized telemedicine generally maintained or improved glycemic control during the pandemic. However, many adolescents gained weight, reduced their physical activities, worsened their diet and sleep habits, and experienced increased stress, all of which negatively impacted glycemic control. Rates of acute complications and hospitalizations varied among adolescents. Telemedicine was widely used and viewed positively by adolescents with DM. Adolescents with DM faced various physical, behavioral, and psychosocial challenges during the COVID-19 pandemic. Further research is needed to assess the long-term impacts of the pandemic on this population. Multilevel interventions and preparedness efforts are required to improve and sustain adolescents' DM self-management outcomes during public health emergencies, particularly focused on promoting CGM use, increasing physical activity levels, improving dietary habits, and reducing stress.

The prevalence of Type 1 Diabetes (T1D) among youth is increasing worldwide. Mobile phones, particularly mHealth applications, can potentially improve youth's management of this chronic condition. However, the design of these services rarely accounts for users in low and middle-income countries (LMICs). In this paper, we investigate factors that influence the use of mobile phones for managing T1D among youth in rural and urban Kenya. Our analysis draws from 58 interviews conducted with T1D youth (between the ages of 11 and 18 years old), their caregivers, and other significant stakeholders, including doctors and schoolteachers. Our findings draw attention to a significant mismatch between the mobile phone features prioritized in mHealth apps and participants' usage practices. We discuss the practical implications of these findings for mHealth design and user research.

Peritonitis is the most common complication of peritoneal dialysis (PD). This study aimed to investigate changes in the incidence, risk factors, microbiology, and clinical outcomes of PD-associated peritonitis in the past decades.

This was a retrospective study that included children who initiated chronic PD at our institution between 2000 and 2017. The patients were divided into two groups according to the year of initiation: those who initiated PD between 2000 and 2008 and those who initiated PD between 2009 and 2017. The incidence and characteristics of peritonitis were compared between the groups.

A total of 184 patients with a median age of 10.2 years were included in this study. Of the patients, 92 experienced 210 episodes of peritonitis. The incidence rate of peritonitis decreased from 0.35 to 0.21 episodes/patient year during the study period (P = 0.001). During the 2000-2008 period, the 2-year peritonitis-free survival rate was significantly lower for patients under 2 years of age than for the other age groups (P = 0.004), whereas this was not observed during the 2009-2017 period. The multivariable Cox proportional hazard model showed that the <2 years age group had a significantly higher risk of developing peritonitis in the 2000-2008 period. However, this was not evident in the 2009-2017 period.

The incidence of PD-associated peritonitis decreased, particularly in children under 2 years of age. Thus, younger age may not be a risk factor for PD-associated peritonitis.

This study investigates stigma predictors across ages and genders, addressing a critical gap in understanding diverse populations to reduce related suboptimal clinical and psychosocial outcomes.

Cross-sectional analysis of self-reported data from BETTER, a Canadian registry of people with type 1 diabetes. Participants (n = 709) completed the 19-item-Diabetes-Stigma Assessment-Scale (DSAS-1) categorized into treated differently, blame and judgment, and identity concerns sub-scales. Associations with diabetes distress (DDS-17-score/102), depression (PHQ-9-score/27), social-support (ESSI-score/34), fear of hypoglycemia (HFS-II-score/132), and hyperglycemia-avoidance-behaviours (HAS-score/88) were computed.

Perceived stigma was highest in youth aged 14-24 years (46·0 ± 15·6, p < 0·001) and women (41·2 ± 15·7, p = 0·009), compared to other age groups and men. Blame and Judgment contributed to most of stigma perception. Youth perceived significantly more blame and judgment (p < 0·001) and identity concerns (p = 0·001) compared to middle-aged adults and seniors. Women perceive significantly more blame and judgment compared to men (p < 0·001). The perception of being treated differently was not reported to be an issue across ages and genders. Participants with higher scores of depression, diabetes-distress, fear of hypoglycemia, hyperglycemia-avoidance behaviours, and lesser social-support, reported increased stigma.

Stigma varies by age and gender, underscoring the need for targeted interventions to reduce it. Challenging stereotypes and reducing stigma-related stressors are essential for better outcomes.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D), necessitating effective prevention strategies. This comprehensive review consolidates current knowledge and evidence on preventing CVD in T1D patients. It begins by exploring the pathophysiological mechanisms that link T1D to an increased risk of CVD, highlighting factors such as chronic hyperglycemia, hypertension, dyslipidemia, and inflammation. The review also examines the epidemiology and specific risk factors for CVD in this population, emphasizing the need for rigorous risk assessment and screening. Lifestyle modifications, including dietary interventions, regular physical activity, and smoking cessation, are evaluated for their effectiveness in reducing CVD risk. Additionally, the review discusses pharmacological interventions, such as insulin therapy for glycemic control, antihypertensive medications, lipid-lowering agents, and antiplatelet therapy, underscoring their critical role in CVD prevention. Emerging therapies and future research directions are explored, focusing on novel pharmacological agents, advances in insulin delivery systems, and personalized medicine approaches. The importance of integrated care models involving multidisciplinary teams and the use of technology is highlighted as essential for comprehensive management. Challenges and barriers to implementing these strategies, including healthcare system limitations, patient adherence, and socioeconomic factors, are also addressed. This review provides a detailed synthesis of current strategies and future directions for preventing CVD in individuals with T1D, serving as a valuable resource for clinicians, researchers, and policymakers dedicated to improving cardiovascular outcomes in this high-risk population.

Blood glucose management around exercise is challenging for youth with type 1 diabetes (T1D). Previous research has indicated interventions including decision-support aids to better support youth to effectively contextualize blood glucose results and take appropriate action to optimize glucose levels during and after exercise. Mobile health (mHealth) apps help deliver health behavior interventions to youth with T1D, given the use of technology for glucose monitoring, insulin dosing, and carbohydrate counting.

We aimed to develop a novel prototype mHealth app to support exercise management among youth with T1D, detail the application of a co-design process and design thinking principles to inform app design and development, and identify app content and functionality that youth with T1D need to meet their physical activity goals.

A co-design approach with a user-centered design thinking framework was used to develop a prototype mHealth app "acT1ve" during the 18-month design process (March 2018 to September 2019). To better understand and respond to the challenges among youth with diabetes when physically active, 10 focus groups were conducted with youth aged 13-25 years with T1D and parents of youth with T1D. Thereafter, we conducted participatory design workshops with youth to identify key app features that would support individual needs when physically active. These features were incorporated into a wireframe, which was critically reviewed by participants. A beta version of "acT1ve" was built in iOS and android operating systems, which underwent critical review by end users, clinicians, researchers, experts in exercise and T1D, and app designers.

Sixty youth with T1D, 14 parents, 6 researchers, and 10 clinicians were engaged in the development of "acT1ve." acT1ve included key features identified by youth, which would support their individual needs when physically active. It provided advice on carbohydrates and insulin during exercise, information on hypoglycemia treatment, pre- and postexercise advice, and an educational food guide regarding exercise management. "acT1ve" contained an exercise advisor algorithm comprising 240 pathways developed by experts in diabetes and exercise research. Based on participant input during exercise, acT1ve provided personalized insulin and carbohydrate advice for exercise lasting up to 60 minutes. It also contains other features including an activity log, which displays a complete record of the end users' activities and associated exercise advice provided by the app's algorithm for later reference, and regular reminder notifications for end users to check or monitor their glucose levels.

The co-design approach and the practical application of the user-centered design thinking framework were successfully applied in developing "acT1ve." The design thinking processes allowed youth with T1D to identify app features that would support them to be physically active, and particularly enabled the delivery of individualized advice. Furthermore, app development has been described in detail to help guide others embarking on a similar project.

Australian New Zealand Clinical Trials Registry ACTRN12619001414101; https://tinyurl.com/mu9jvn2d.

Type 1 diabetes mellitus (T1DM) management in children and adolescents requires intensive supervision and monitoring to prevent acute and late diabetes complications and to improve quality of life. Digital health interventions, in particular diabetes mobile health apps (mHealth apps) can facilitate specialized T1DM care in this population. This study evaluated the initial usability of and satisfaction with the m-Health intervention Diabetes: M app, and the ease of use of various app features in supporting T1DM care in rural and remote areas of Bosnia-Herzegovina with limited access to specialized diabetes care.

This cross-sectional study, performed in February-March 2023, evaluated T1DM pediatric patients who used the Diabetes: M app in a 3-month mHealth-based T1DM management program, along with their parents and healthcare providers (HCPs). All participants completed self-administered online questionnaires at the end of the 3-month period. Data were analyzed by descriptive statistics.

The study population included 50 T1DM patients (children/parents and adolescents) and nine HCPs. The mean ± SD age of the T1DM patients was 14 ± 4.54 years, with 26 (52%) being female. The mean ± SD age of the HCPs was 43.4 ± 7.76 years; all (100%) were women, with a mean ± SD professional experience of 17.8 ± 8.81 years. The app was reported usable in the domains of ease-of-use and satisfaction by the T1DM children/parents (5.82/7.0), T1DM adolescents/young adults (5.68/7.0), and HCPs (5.22/7.0). Various app features, as well as the overall app experience, were rated positively by the participants.

The results strongly support the usability of mHealth-based interventions in T1DM care, especially in overcoming care shortage and improving diabetes management and communications between HCPs and patients. Further studies are needed to compare the effectiveness of apps used to support T1DM management with routine care.

Learning personalized self-management routines is pivotal for people with type 1 diabetes (T1D), particularly early in diagnosis. Context-aware technologies, such as hybrid closed-loop (HCL) insulin pumps, are important tools for diabetes self-management. However, clinicians have observed that practices using these technologies involve significant individual differences. We conducted interviews with 20 adolescents and young adults who use HCL insulin pump systems for managing T1D, and we found that these individuals leverage both technological and non-technological means to maintain situational awareness about their condition. We discuss how these practices serve to infrastructure their self-management routines, including medical treatment, diet, and glucose measurement-monitoring routines. Our study provides insights into adolescents' and young adults' lived experiences of using HCL systems and related technology to manage diabetes, and contributes to a more nuanced understanding of how the HCI community can support the contextualized management of diabetes through technology design.

Despite advances in diabetes treatments, youth commonly fail to meet glucose targets. Telehealth support may help youth meet diabetes related goals. The objective of the project was to assess whether intensive telehealth support in a group of poorly controlled youth with diabetes would help improve glycated hemoglobin (HbA1c) levels and decrease hospitalization rates over a 12-month time frame.

This quality improvement project included youth aged 8-18 with suboptimal insulin dependent diabetes control and Medicaid insurance, who were willing to use continuous glucose monitoring (CGM). Participants received weekly contact (phone or video) with a certified diabetes educator and monthly video visits with a nurse practitioner.

Youth (N = 27, 63 % female, 89 % Non-Hispanic Black), diabetes duration 6.2 ± 4.3 years, had baseline mean HbA1c 12.4 ± 1.8 % (112 mmol/mol); 22 % were on pump therapy (majority were non-automated insulin delivery systems). There was a sustained improvement between baseline HbA1c (mean 12.4 %±1.8) (112 mmol/mol) and 3 months (mean 11.5 %±2.8) (102 mmol/mol) (p = 0.03), 6 months (mean 11.1 %±2.1) (98 mmol/mol) (p = 0.01), 9 months (mean 11.4 %±2.3) (101 mmol/mol) (p = 0.04) and 12 months (mean 10.8 %±2.2) (95 mmol/mol) (p = 0.02).

This intensive telehealth intervention provided interim glycemic improvement in a high-risk patient cohort. Further efforts to increase connection in vulnerable pediatric patient groups could help long-term diabetes management.

There are many educational resources for adolescents and young adults living with type 1 diabetes; however, it is unknown whether they address the breadth of topics related to transition to adult care. Our aim in this study was to collect educational resources relevant to Canadian youth and assess their quality and comprehensiveness in addressing the knowledge necessary for youth to prepare for interdependent management of their diabetes.

We conducted an environmental scan, a systematic assessment and analysis, of online education resources in English and French relevant to Canadian youth living with type 1 diabetes. Resources were screened using an open education resource evaluation grid and relevant resources were mapped to the Readiness for Emerging Adults with Diabetes Diagnosed in Youth, a validated diabetes transition readiness assessment tool.

From 44 different sources, 1,245 resources were identified and, of these, 760 were retained for analysis. The majority were webpages (50.1%) and downloadable PDFs (42.4%), and 12.1% were interactive. Most resources covered Diabetes Knowledge (46.0%), Health Behaviour (23.8%), Insulin and Insulin Pump Management (11.8% and 8.6%, respectively), and Health-care System Navigation (9.7%). Topic areas with the fewest resources were disability accommodations (n=5), sexual health/function (n=4), and locating trustworthy diabetes resources (n=3).

There are many resources available for those living with type 1 diabetes preparing to transition to adult care, with the majority pertaining to diabetes knowledge and the least for navigation of the health system. Few resources were available on the topics of substance use, sexual health, and reproductive health. An interactive presentation of these resources, as well as a central repository to house these resources, would improve access for youth and diabetes care providers during transition preparation.

Adherence to insulin therapy is crucial to achieving good glycemic control for patients with type 1 diabetes (T1D) or type 2 diabetes (T2D). A comprehensive estimation of adherence to insulin therapy in patients with diabetes is currently lacking.

To explore the prevalence of adherence to insulin therapy in patients with both T1D and T2D.

A systematic search was performed using the following databases: PubMed, EMBASE, Cochrane CENTRAL, and ProQuest Dissertation and Theses from the inception of each database to August 2023. Cross-sectional studies were included if they met the following criteria: (1) conducted in patients with T1D or T2D; (2) reported adherence to insulin therapy. The Joanna Briggs Institute (JBI) critical appraisal checklist for studies reporting prevalence data was used to assess the quality of included studies. Pooled estimates of the prevalence of adherence to insulin were calculated as a percentage together with a 95 % confidence interval (95%CI) using a random-effect model. All analyses were conducted using STATA 15 (College Station, Texas, United States); PROSPERO (CRD42022322323).

Search results yielded 14,914 articles, of these 57 studies with a total of 125,241 patients met the inclusion criteria. The overall estimated prevalence of adherence to insulin therapy in both types of diabetes was 55.37 % (95%CI: 48.55 %-62.19 %). The adherence for T1D was 52.63 % (95 % CI: 37.37 %-67.87 %), whereas the adherence for T2D was 52.55 % (95 % CI: 43.08 %-62.01 %). The prevalence of adherence in lower middle-income countries was 56.79 % (95 % CI: 27.85 %-85.74 %).

The overall prevalence of adherence to insulin therapy was remarkably low. This requires attention from healthcare practitioners and policymakers to implement appropriate strategic approaches to improve adherence to insulin therapy.

Type 1 diabetes is one of the most common chronic conditions in young children and adolescents. During the period of adolescence, young people with diabetes often struggle with self-management and have compromised health-related quality of life. This often leads to familial conflicts affecting all family members negatively. The aim of this study is to provide qualitative insight into the everyday life of families with adolescents with type 1 diabetes.

The data consisted of participatory family workshops conducted using interactive dialogue tools. The total number of participants was 33 (adolescents n = 13, parents n = 20). The adolescents were between 15 and 17 years. The data were analyzed using systematic text condensation.

The results showed two main themes. The first theme, Diabetes-friendly and unfriendly social contexts, highlighted how the (dis)comfortability of disclosing diabetes was a significant factor in achieving optimal metabolic control. For parents, it affected their perception of social support. The second theme, incongruent illness representations among family members, dealt with the extended family conflict during the period of adolescence.

Insights from our study could help healthcare professionals apply a family-centered approach minimizing family conflict and supporting metabolic control when consulting families with adolescents with type 1 diabetes.

Suboptimal glycaemic control in children and adolescents with type 1 diabetes is prevalent and associated with increased risk of diabetes-related complications and mortality later in life. First, we aimed to identify distinct glycated haemoglobin (HbA1c) trajectories in children and adolescents (2-19 years) with type 1 diabetes. Second, we examined their associations with clinical and socio-demographic factors.

Data were obtained from the Danish Registry of Childhood and Adolescent Diabetes (DanDiabKids) comprising all Danish children and adolescents diagnosed with type 1 diabetes from 1996 to 2019. Subgroups of distinct mean trajectories of HbA1c were identified using data-driven latent class trajectory modelling.

A total of 5889 children (47% female) had HbA1c measured a median of 6 times (interquartile range 3-8) and contributing to 36,504 measurements. We identified four mean HbA1c trajectories, referred to as 'Stable but elevated HbA1c' (83%), 'Increasing HbA1c' (5%), 'Late HbA1c peak' (7%), and 'Early HbA1c peak' (5%). Compared to the 'Stable but elevated HbA1c' group, the three other groups presented rapidly deteriorating glycaemic control during late childhood or adolescence, had higher HbA1c at study entry, and included fewer pump users, higher frequency of inadequate blood glucose monitoring, more severe hypoglycaemic events, lower proportions with Danish origin, and worse educational status of parents. The groups also represented significant differences by healthcare region.

Children and adolescents with type 1 diabetes experience heterogenous trajectories with different timings and magnitudes of the deterioration of HbA1c levels, although the majority follow on average a stable, yet elevated HbA1c trajectory. The causes and long-term health implications of these heterogenous trajectories need to be addressed.

Adherence to insulin and blood glucose monitoring (BGM) is insufficient in adolescents and young adults (AYAs) with type 1 diabetes (T1D) worldwide and in Qatar. Little is known about the factors related to being aware of suboptimal adherence and the beliefs related to suboptimal adherence in this group. This qualitative study investigated factors related to awareness of, and beliefs about suboptimal adherence, as well as the existence of specific action plans to combat suboptimal adherence using the I-Change model.

The target group was comprised of 20 Arab AYAs (17-24 years of age) with T1D living in Qatar. Participants were interviewed via semi-structured, face-to-face individual interviews, which were audio-recorded, transcribed verbatim, and analyzed using the Framework Method.

Suboptimal adherence to insulin, and particularly to BGM, in AYAs with T1D was identified. Some AYAs reported to have little awareness about the consequences of their suboptimal adherence and how this can adversely affect optimal diabetes management. Participants also associated various disadvantages to adherence ( e.g., hypoglycemia, pain, among others) and reported low self-efficacy in being adherent ( e.g., when outside home, in a bad mood, among others). Additionally, goal setting and action-planning often appeared to be lacking. Factors facilitating adherence were receiving support from family and healthcare providers, being motivated, and high self-efficacy.

Interventions that increase awareness concerning the risks of suboptimal adherence of AYAs with T1D are needed, that increase motivation to adhere by stressing the advantages, creating support and increasing self-efficacy, and that address action planning and goal parameters.

Patients with diabetes have a high risk of developing skeletal diseases accompanied by diabetic peripheral neuropathy (DPN). In this study, we isolated the role of DPN in skeletal disease with global and conditional knockout models of sterile-α and TIR-motif-containing protein-1 (Sarm1). SARM1, an NADase highly expressed in the nervous system, regulates axon degeneration upon a range of insults, including DPN. Global knockout of Sarm1 prevented DPN, but not skeletal disease, in male mice with type 1 diabetes (T1D). Female wild-type mice also developed diabetic bone disease but without DPN. Unexpectedly, global Sarm1 knockout completely protected female mice from T1D-associated bone suppression and skeletal fragility despite comparable muscle atrophy and hyperglycemia. Global Sarm1 knockout rescued bone health through sustained osteoblast function with abrogation of local oxidative stress responses. This was independent of the neural actions of SARM1, as beneficial effects on bone were lost with neural conditional Sarm1 knockout. This study demonstrates that the onset of skeletal disease occurs rapidly in both male and female mice with T1D completely independently of DPN. In addition, this reveals that clinical SARM1 inhibitors, currently being developed for treatment of neuropathy, may also have benefits for diabetic bone through actions outside of the nervous system.

The occurrences of acute complications arising from hypoglycemia and hyperglycemia peak as young adults with type 1 diabetes (T1D) take control of their own care. Continuous glucose monitoring (CGM) devices provide real-time glucose readings enabling users to manage their control proactively. Machine learning algorithms can use CGM data to make ahead-of-time risk predictions and provide insight into an individual's longer term control.

We introduce explainable machine learning to make predictions of hypoglycemia (<70 mg/dL) and hyperglycemia (>270 mg/dL) up to 60 minutes ahead of time. We train our models using CGM data from 153 people living with T1D in the CITY (CGM Intervention in Teens and Young Adults With Type 1 Diabetes)survey totaling more than 28 000 days of usage, which we summarize into (short-term, medium-term, and long-term) glucose control features along with demographic information. We use machine learning explanations (SHAP [SHapley Additive exPlanations]) to identify which features have been most important in predicting risk per user.

Machine learning models (XGBoost) show excellent performance at predicting hypoglycemia (area under the receiver operating curve [AUROC]: 0.998, average precision: 0.953) and hyperglycemia (AUROC: 0.989, average precision: 0.931) in comparison with a baseline heuristic and logistic regression model.

Maximizing model performance for glucose risk prediction and management is crucial to reduce the burden of alarm fatigue on CGM users. Machine learning enables more precise and timely predictions in comparison with baseline models. SHAP helps identify what about a CGM user's glucose control has led to predictions of risk which can be used to reduce their long-term risk of complications.

This study aimed to evaluate the effectiveness, safety and costs of FreeStyle Libre (FSL) glucose monitoring system for children and adolescents with type 1 diabetes mellitus (T1DM) in Spain.

Prospective, multicentre pre-post study.

Thirteen Spanish public hospitals recruited patients from January 2019 to March 2020, with a 12-month follow-up.

156 patients were included.

Primary: glycated haemoglobin (HbA1c) change. Secondary: severe hypoglycaemic events (self-reported and clinical records), quality of life, diabetes treatment knowledge, treatment satisfaction, adverse events, adherence, sensor usage time and scans. Healthcare resource utilisation was assessed for cost analysis from the National Health System perspective, incorporating direct healthcare costs. Data analysis used mixed regression models with repeated measures. The intervention's total cost was estimated by multiplying health resource usage with unit costs.

In the whole sample, HbA1c increased significantly (0.32%; 95% CI 0.10% to 0.55%). In the subgroup with baseline HbA1c≥7.5% (n=88), there was a significant reduction at 3 months (-0.46%; 95% CI -0.69% to -0.23%), 6 months (-0.49%; 95% CI -0.73% to -0.25%) and 12 months (-0.43%; 95% CI -0.68% to -0.19%). Well-controlled patients had a significant 12-month worsening (0.32%; 95% CI 0.18% to 0.47%). Self-reported severe hypoglycaemia significantly decreased compared with the previous year for the whole sample (-0.37; 95% CI -0.62 to -0.11). Quality of life and diabetes treatment knowledge showed no significant differences, but satisfaction increased. Adolescents had lower sensor usage time and scans than children. Reduction in HbA1c was significantly associated with device adherence. No serious adverse effects were observed. Data suggest that use of FSL could reduce healthcare resource use (strips and lancets) and costs related to productivity loss.

The use of FSL in young patients with T1DM was associated with a significant reduction in severe hypoglycaemia, and improved HbA1c levels were seen in patients with poor baseline control. Findings suggest cost savings and productivity gains for caregivers. Causal evidence is limited due to the study design. Further research is needed to confirm results and assess risks, especially for patients with lower baseline HbA1c.

Artificial intelligence (AI) appears capable of detecting diabetic retinopathy (DR) with a high degree of accuracy in adults; however, there are few studies in children and young adults.

Children and young adults (3-26 years) with type 1 diabetes mellitus (T1DM) or type 2 diabetes mellitus (T2DM) were screened at the Dhaka BIRDEM-2 hospital, Bangladesh. All gradable fundus images were uploaded to Cybersight AI for interpretation. Two main outcomes were considered at a patient level: 1) Any DR, defined as mild non-proliferative diabetic retinopathy (NPDR or more severe; and 2) Referable DR, defined as moderate NPDR or more severe. Diagnostic test performance comparing Orbis International's Cybersight AI with the reference standard, a fully qualified optometrist certified in DR grading, was assessed using the Matthews correlation coefficient (MCC), area under the receiver operating characteristic curve (AUC-ROC), area under the precision-recall curve (AUC-PR), sensitivity, specificity, positive and negative predictive values.

Among 1274 participants (53.1% female, mean age 16.7 years), 19.4% (n = 247) had any DR according to AI. For referable DR, 2.35% (n = 30) were detected by AI. The sensitivity and specificity of AI for any DR were 75.5% (CI 69.7-81.3%) and 91.8% (CI 90.2-93.5%) respectively, and for referable DR, these values were 84.2% (CI 67.8-100%) and 98.9% (CI 98.3%-99.5%). The MCC, AUC-ROC and the AUC-PR for referable DR were 63.4, 91.2 and 76.2% respectively. AI was most successful in accurately classifying younger children with shorter duration of diabetes.

Cybersight AI accurately detected any DR and referable DR among children and young adults, despite its algorithms having been trained on adults. The observed high specificity is particularly important to avoid over-referral in low-resource settings. AI may be an effective tool to reduce demands on scarce physician resources for the care of children with diabetes in low-resource settings.

Peer support can help navigate the isolation and psychological strain frequently experienced by youth living with chronic illness. Yet, data are lacking on the impact of providing support for youth living with mixed chronic conditions. We assessed the acceptability, feasibility and preliminary mental health impacts of a clinic-based peer support group for South African youth living with chronic illnesses, including HIV.

This mixed-methods pilot study (September 2021-June 2022) enrolled 58 young patients, ages 13-24, at an urban hospital in Cape Town, South Africa. In-depth interviews elicited the perspectives of 20 young people in relation to their participation in the Better Together programme, a recurring clinic-based peer support group for patients with mixed chronic illnesses. Self-reported resilience, attitudes towards illness, stigma and mental health were captured via established measures. T-tests and multivariate analysis of variance compared psychosocial outcomes for 20 group participants and 38 control patients, controlling for socio-demographic characteristics at enrolment. Logistic regression analyses estimated the predicted probability of a positive depression or anxiety screening given peer group participation.

All interviewees valued being able to compare treatment regimens and disease management habits with peers living with different conditions. Adolescents living with HIV stated that understanding the hardships faced by those with other conditions helped them accept their own illness and lessened feelings of isolation. Compared to patients who did not participate in Better Together, those who attended ≥5 groups had statistically significantly higher individual-level resilience, a more positive attitude towards their illness(es), lower internalised stigma and a more positive self-concept. The probability of being screened positive for depression was 23.4 percentage points lower (95% CI: 1.5, 45.3) for Better Together participants compared to controls; the probability of a positive anxiety screening was 45.8 percentage points lower (95% CI: 18.1, 73.6).

Recurring, clinic-based peer support groups that integrate youth living with HIV and other chronic diseases are novel. Group sustainability will depend on the commitment of experienced peer leaders and providers, routine scheduling and transportation support. A fully powered randomised trial is needed to test the optimal implementation and causal mental health effects of the Better Together model.

To evaluate the prospects for dental implants in people with diabetes.

Thirty patients in all were enrolled. The age range was from 40 to 60. Out of 30, 8 men and 22 women were present. HbA1c values were calculated. HbA1c levels and the ratio of problems to implant numbers were shown to be correlated. Data were gathered. Software called SPSS was used to analyses the results.

Thirty patients in all were enrolled. In follow-up cases, the stratification levels of HbA1c were investigated. The implant failure rate in 8.0-8.9 was 90.91%, with 2 implants failing. The survival rate in 11.0-11.9 was 75%. Others had a 100% success rate.

Patients with diabetes have higher implant survival rates and fewer problems.

Lipodystrophy (LH) is one of the most common complications of subcutaneous insulin injection. Many factors are incriminated in the evolution of LH in children with diabetes type 1 (T1DM). LH may affect insulin absorption in the skin areas involved, resulting in a negative impact on blood glucose levels and glycemic variability.

We calculated and evaluated the prevalence of LH in relation to possible clinical factors associated with the development of LH in a cohort of children (n =115) with T1DM using insulin pens or syringes and we studied possible predisposing factors including their age, duration of T1DM, injection technique, insulin dose/kg, degree of pain perception, and HbA1c level.

In our cross-sectional study, 84% of patients were using pens for insulin injection and 52.2 % of them were rotating the site of injection on daily basis. 27 % did not experience pain during an injection while 6 % had the worst hurt. 49.5 % had clinically detectable LH. Those with LH had higher HbA1c levels and more unexplained hypoglycemic events compared to those without LH (P: 0.058). The hypertrophied site was related to the preferred site of injection which was the arms in 71.9 % of the cases. Children who had LH were older with a longer duration of T1DM, rotating sites of injection less frequently, and were more frequently reusing needles compared to children without LH (P: < 0.05).

Improper insulin injection technique, older age, and longer duration of T1DM were associated with LH. Proper education of patients and their parents must include correct injection techniques, rotating injection sites, and minimal reuse of needles.

To analyze the correlation of referral mechanism-warm handoff or electronic referral and attendance at behavioral health appointments in an outpatient pediatric primary care setting.

A retrospective cohort study was conducted in an inner-city pediatric primary care clinic from January 2019 to December 2019. Adolescent patients who screened positive for depression or anxiety were referred to a Licensed Master Social Worker (LMSW) either via a warm handoff (WH group, n = 148) or an electronic referral (EF group, n = 180). The EF group was contacted by the LMSW via telephone to schedule an appointment. Multiple logistic regression was used to analyze the correlation of type of referral, age, gender, race/ethnicity, primary language, and time between referral and first contact with attendance at three appointments.

The WH group was more likely to engage with mental health services compared to the EF group (odds ratio = 3.301, 95% confidence interval = 1.850-5.902, p = .002) while age, gender, race/ethnicity, and primary language had no correlation. Within the EF group, those who were contacted by the LMSW within 3 days (1-3 days group) were more likely to attend appointments (odds ratio = 2.680, 95% confidence interval = 0.414-8.219, p = .040). There was no difference in attendance in the WH group and the 1-3 days group (p = .913) DISCUSSION: A warm handoff between primary care providers and behavioral health clinicians is significantly correlated with engagement with behavioral health services for adolescents who screen positive for depression or anxiety. Contact with the family within 3 days of referral is significantly correlated with engagement compared to a longer duration between referral and family contact.

It was aimed to investigate the frequency of the risk of diabetes-specific eating disorder (DSED) in adolescents with type 1 diabetes mellitus (T1DM) and to reveal the accompanying psychopathologies.

Adolescents with T1DM aged 12-18 who applied to the pediatric diabetes outpatient clinic between July 2021 and March 2022 were included. Diabetes Eating Problem Survey-Revised (DEPS-R) was applied to all patients to determine the risk of DSED. In order to detect accompanying psychopathologies, Eating Disorder Examination Questionnaire (EDE-Q), Child Anxiety and Depression Scale-Child version (RCADS) and Parenting Style Scale were applied. After completing the scales, semi-structured interviews were conducted with all patients by a child and adolescent psychiatrist.

Ninety-two adolescents (45 boys, 47 girls) were included. DSED risk was found in 23.9% of the cases. A positive correlation was found between DEPS-R and EDE-Q scores (p = 0.001, rho = 0.370). RCADS mean scores were significantly higher in the group with DSED risk (p < 0.001). When the Parenting Style Scale was evaluated, psychological autonomy scores were significantly lower in the group with DSED risk (p = 0.029). As a result of the psychiatric interviews, 30 (32.6%) patients had at least 1 psychiatric disorder. Of these, 2 patients were diagnosed with eating disorder.

Almost one-fourth of adolescents with T1DM were found to be at risk of DSED. Routine screening of adolescents with T1DM with the DEPS-R scale may provide early detection of DSED, and referral of those at risk to child psychiatry enables early diagnosis and intervention for both eating disorders and accompanying psychopathologies.

Level III: Evidence obtained from cohort or case-control analytic studies.

To assess problems faced by children with type 1 narcolepsy (NT1) at school and obtain insight into potential interventions for these problems.

We recruited children and adolescents with NT1 from three Dutch sleep-wake centers. Children, parents, and teachers completed questionnaires about school functioning, interventions in the classroom, global functioning (DISABKIDS), and depressive symptoms (CDI).

Eighteen children (7-12 years) and thirty-seven adolescents (13-19 years) with NT1 were recruited. Teachers' most frequently reported school problems were concentration problems and fatigue (reported by about 60% in both children and adolescents). The most common arrangements at school were, for children, discussing school excursions (68%) and taking a nap at school (50%) and, for adolescents, a place to nap at school (75%) and discussing school excursions (71%). Regular naps at home on the weekend (children 71% and adolescents 73%) were more common than regular naps at school (children 24% and adolescents 59%). Only a minority of individuals used other interventions. School support by specialized school workers was associated with significantly more classroom interventions (3.5 versus 1.0 in children and 5.2 versus 4.1 in adolescents) and napping at school, but not with better global functioning, lower depressive symptom levels, or napping during the weekends.

Children with NT1 have various problems at school, even after medical treatment. Interventions to help children with NT1 within the classroom do not seem to be fully implemented. School support was associated with the higher implementation of these interventions. Longitudinal studies are warranted to examine how interventions can be better implemented within the school.