Purpose of Review This review provides a recent update of behavioral research pertinent to young children with T1D and addresses current priorities and future directions. Recent Findings Rates of type 1 diabetes (T1D) in young children (ages 1–7) are continuing to rise. Since 2014, changes to diabetes care and management have impacted young children and reinforced the need for increased attention and interventions to support diabetes management, especially in caregivers who are primarily responsible for their young child’s diabetes management. Summary T1D is associated with unique physiologic challenges in young children, with constant management demands elevating parental diabetes-related stress and fear of hypoglycemia. Diabetes technology use has significantly increased in young children, contributing to improvements in glycemic levels and parent and child psychosocial functioning. Yet despite the positive outcomes demonstrated in select clinical behavioral interventions, research with this young child age group remains limited in scope and quantity.
Young adults with diabetes assume increasing responsibility for communicating with their health care providers, and engaging in high-quality health communication is an integral component of overall diabetes self-management. This article provides an overview of the main features of health communication, factors that may influence communication quality, interventions to promote communication skills, and practical strategies for clinicians working with young adults with diabetes. The review concludes with a comprehensive summary of future directions for health communication research.
Introduction: The transition from pediatric to adult diabetes care is particularly risky for AYAs with T1D. We evaluate preliminary outcomes of a behavioral intervention targeting AYA health communication, T1D self-care, and transition readiness. Methods: 52 AYAs (48.1% male; 48.1% non-Hispanic White; M age=20.63±1.10 yrs) enrolled in Planning, Reflecting, and Engaging with Providers for Diabetes Care (PREP-DC) and were randomized to intervention (Int; n=26) or standard care (SC; n=26) groups. AYAs reported on communication, T1D self-care, and transition readiness at baseline and 4 mos (1 mo post-intervention); A1c was taken from medical records. AYAs rated satisfaction with PREP-DC participation (1-5; 5=extremely satisfied). T-tests examined change from baseline to follow-up and by group. Results: At follow-up, 51 AYAs (98%) completed questionnaires and 37 (71%) had A1c data. AYAs reported improvements in communication, T1D self-care, and transition readiness (Table 1), with few group differences. Both groups reported high satisfaction with participation (Int M=4.41±.59; SC M=4.45±.60). Discussion: AYAs were engaged in a behavioral trial promoting health communication; the Int group did not demonstrate significant improvements as compared to SC. Future analyses will evaluate final follow-up outcomes (8 mos post-intervention), including transfer to adult care. Disclosure M.Monaghan: Employee; National Institute of Diabetes and Digestive and Kidney Diseases, Research Support; American Diabetes Association. B.L.Bryant: None. C.H.Wang: None. J.E.Bost: None. R.Streisand: None. Funding American Diabetes Association (1-18-ACE-27 to M.M.)
Introduction: Emerging adults (EAs) with T1D may be disproportionately affected by COVID-19 related disruptions given the many transitions that occur during this developmental period. The current study examined self-reported challenges in daily routines and T1D care in a sample of EAs during the COVID-19 pandemic. Method: Participants included 22 EAs with T1D (M age=21.6±1.1 yrs; 45.4% male; 40.9% non-Hispanic white; 86.4% enrolled in higher education; 77.3% employed; M A1c=7.8%±1.2%). EAs completed surveys about exposure/personal impact of COVID-19 (n=13), a structured interview (n=2), or both (n=7) during the first 9 months of the COVID-19 pandemic (3/2020 - 11/2020). Results: Most EAs (86.4%) denied COVID-19 symptoms, diagnoses, or hospitalizations in themselves or close contacts; 3 EAs (13.6%) reported COVID-19 diagnoses in family members, with one reported death of a family member. Fifty-five percent of EAs reported strictly social distancing. On the survey, 85% of EAs reported significant disruptions due to COVID-19, including job loss/reduction in hours (45%), education changes (45%), and moving (40%). T1D impact varied, with 50% reporting easier management of T1D; 30% reporting less exercise/worse diet; 30% reporting sleep problems; and 40% reporting more health anxiety. For EAs with more than one instance of survey completion (n=9), diabetes-specific impact worsened over time (t(8)=-2.20, p=.06; Cohen’s d = -.72). Interview data (n=9) supported quantitative results, with themes related to the impact of COVID-19 on daily routines for T1D management and delayed transition to adult T1D care. Discussion: EAs with T1D experienced many COVID-related changes and increasing negative impact on T1D self-care over time. EAs may be particularly vulnerable to the widespread impacts of COVID-19 on employment, education, and receipt of medical care. Future research should examine longitudinal responses to the COVID-19 pandemic to identify EAs who may need additional support or resources for T1D care. Disclosure M. Monaghan: None. B. Bryant: None. C. H. Wang: None. Funding American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
Background: Adolescents and young adults (AYAs) are at higher risk for diabetes self-care challenges and elevated A1c. Understanding AYA/health care provider (HCP) communication may provide insight to better support T1D management. The current study examined content and quality of AYA/HCP communication during routine T1D care. Methods: Thirty-two AYAs (M age=20.5 ± 9.1 yrs; 53.1% male; 43.8% non-Hispanic Black; M A1c=8.± 1.4%) and 9 HCPs (100% female) participating in an RCT promoting AYA health communication had a routine T1D visit audio-recorded and transcribed. A coding framework was developed to assess communication content and quality, including: AYA initiation, self-disclosure, preparation, and future planning; HCP goal setting, supportive language, problem-solving, education/information sharing, and warnings/threats. Coders double and triple-coded transcripts until 90% agreement was reached. Chi square analyses evaluated associations among codes. Results: Routine T1D visits were primarily attended by AYAs alone (78.1%), ranging from 8-45 min (M=30.3 ±9.3). AYAs and HCPs spoke 27.0% and 69.1% of the visit, respectively. T1D adherence, lifestyle adherence, and developmental issues were discussed in all visits (100%); insurance, mental health, and T1D support systems were each discussed in 53.1% of visits. AYA preparation (e.g., bringing glucose values, regimen knowledge) was positively associated with HCP supportive language (X2(1,N=32)=5.7, p=.02) and HCP education (X2(1,N=32)=8.3, p<.01). HCP warnings/threats were identified in 25% of visits; 75% of AYAs in these visits had A1c levels ≥7.0%. Conclusion: Results highlight reciprocal AYA-HCP communication. Improving AYA preparation for T1D care visits may facilitate more efficient and informative AYA-HCP interactions, potentially leading to improved T1D outcomes. Future studies will evaluate associations among communication and T1D outcomes over time, including A1c and transition to adult care. Disclosure M. E. Zinn: None. C. H. Wang: None. B. Bryant: None. M. Monaghan: None. Funding American Diabetes Association/Pathway to Stop Diabetes (1-18-ACE-27 to M.M.)
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