Background Of the estimated 23.1 million individuals diagnosed with diabetes, approximately 5% have type 1 diabetes (T1D). It has been proposed that this number will triple by 2050. With increases in technology use and resources available, many individuals are using insulin pumps and continuous glucose monitors (CGMs) to help manage their T1D. They are also using online resources such as social media to find more information and advice based on real-life experiences from peers. Blogs are a particular social media modality often used by people with T1D but have not been widely investigated. Objective The purpose of this study was to assess glycated hemoglobin (HbA 1c ) differences between blog readers and blog nonusers in a population of adults with T1D. This study also looked at differences in technology use in these two groups, as well as HbA 1c differences in blog use and technology subgroups. Methods Participants were recruited both by mail and by online T1D-themed blog postings. Respondents completed a secure online eligibility assessment and were asked questions related to their T1D, blog and internet use, and insulin pump and CGM use. Demographics were also collected. Differences between blog readers and blog nonusers were tested via chi-square and t tests. Mann-Whitney U tests, Fisher exact tests, and analyses of variance (ANOVA) were used to test for differences in self-reported HbA 1c between groups and subgroups. Results A total of 282 eligible participants completed the survey (214 blog readers, 68 blog nonusers). Average duration of diabetes was 21.2 years, 77.7% (219/282) were female, 81.2% (229/282) used an insulin pump, 66.3% (187/282) used a CGM, and 95.7% (270/282) were white. HbA 1c was lower for blog readers (7.0%) than blog nonusers (7.5%), P =.006; for insulin pump users (7.0%) than multiple daily injections (7.7%), P =.001; and for CGM users (7.0%) than CGM nonusers (7.5%), P =.001. After adjusting for significant covariates, the association between blog use and HbA 1c remained significant ( P =.04). ANOVA modeling also demonstrated significant differences in HbA 1c between blog users and nonusers among subgroups by pump use and CGM use ( P <.001). Conclusions These results suggest that reading blogs is associated with lower HbA 1c values. While association does not prove causation, blog readers have the benefit of learning information from peers and having 24/7 access to a community of individuals with similar daily life struggles, where they are able to ask questions and seek advice.

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Decoding human speech requires both perception and integration of brief, successive auditory stimuli that enter the central nervous system as well as the allocation of attention to language-relevant signals. This study assesses the role of attention on processing rapid transient stimuli in adults and children. Cortical responses (EEG/ERPs), specifically mismatch negativity (MMN) responses, to paired tones (standard 100–100Hz; deviant 100–300Hz) separated by a 300, 70 or 10ms silent gap (ISI) were recorded under Ignore and Attend conditions in 21 adults and 23 children (6–11 years old). In adults, an attention-related enhancement was found for all rate conditions and laterality effects (L>R) were observed. In children, 2 auditory discrimination-related peaks were identified from the difference wave (deviant-standard): an early peak (eMMN) at about 100–300ms indexing sensory processing, and a later peak (LDN), at about 400–600ms, thought to reflect reorientation to the deviant stimuli or “second-look” processing. Results revealed differing patterns of activation and attention modulation for the eMMN in children as compared to the MMN in adults: The eMMN had a more frontal topography as compared to adults and attention played a significantly greater role in childrens’ rate processing. The pattern of findings for the LDN was consistent with hypothesized mechanisms related to further processing of complex stimuli. The differences between eMMN and LDN observed here support the premise that separate cognitive processes and mechanisms underlie these ERP peaks. These findings are the first to show that the eMMN and LDN differ under different temporal and attentional conditions, and that a more complete understanding of children’s responses to rapid successive auditory stimulation requires an examination of both peaks.

Background Self-management of type 1 diabetes (T1D) requires numerous decisions and actions by people with T1D and their caregivers and poses many daily challenges. For those with T1D and a developmental disorder such as autism spectrum disorder (ASD), more complex challenges arise, though these remain largely unstudied. Objective This study aimed to better understand the barriers and facilitators of raising a child with T1D and ASD. Secondary analysis of web-based content (phase 1) and telephone interviews (phase 2) were conducted to further expand the existing knowledge on the challenges and successes faced by these families. Methods Phase 1 involved a qualitative analysis of publicly available online forums and blog posts by caregivers of children with both T1D and ASD. Themes from phase 1 were used to create an interview guide for further in-depth exploration via interviews. In phase 2, caregivers of children with both T1D and ASD were recruited from Penn State Health endocrinology clinics and through the web from social media posts to T1D-focused groups and sites. Interested respondents were directed to a secure web-based eligibility assessment. Information related to T1D and ASD diagnosis, contact information, and demographics were collected. On the basis of survey responses, participants were selected for a follow-up telephone interview and were asked to complete the adaptive behavior assessment system, third edition parent form to assess autism severity and upload a copy of their child’s most recent hemoglobin A1c (HbA1c) result. Interviews were transcribed, imported into NVivo qualitative data management software, and analyzed to determine common themes related to barriers and facilitators of raising a child with both ASD and T1D. Results For phase 1, 398 forum posts and blog posts between 2009 and 2016 were analyzed. Common themes related to a lack of understanding by the separate ASD and T1D caregiver communities, advice on coping techniques, rules and routines, and descriptions of the health care experience. For phase 2, 12 eligible respondents were interviewed. For interviewees, the average age of the child at diagnosis with T1D and ASD was 7.92 years and 5.55 years, respectively. Average self-reported and documented HbA1c levels for children with T1D and ASD were 8.6% (70 mmol/mol) and 8.7% (72 mmol/mol), respectively. Common themes from the interviews related to increased emotional burden, frustration surrounding the amount of information they are expected to learn, and challenges in the school setting. Conclusions Caregivers of children with both T1D and ASD face unique challenges, distinct from those faced by caregivers of individuals who have either disorder alone. Understanding these challenges may help health care providers in caring for this unique population. Referral to the diabetes online community may be a potential resource to supplement the care received by the medical community.

Physical activity contributes to overall health and mental wellbeing in all adults, 1 and for adults with type 1 diabetes (T1D) there are crucial incremental benefits compared to individuals without diabetes, such as decreased cardiovascular disease and mortality. 2 The American Diabetes Association (ADA) recommends that adults with diabetes perform at least 150 minutes of moderate-to-vigorous activity and 2-3 sessions of resistance training per week, with no more than two consecutive days without exercise. 3 A recent consensus statement provides recommendations including glucose targets, nutrition, and insulin adjustments in exercise management. 4 Despite these recommendations and guidelines, most adults with T1D-like most adults in general-do not get the recommended amount of exercise. 5-7 While there are multiple barriers to exercise in the general population (eg, lack of time and/or motivation, limited 835787D STXXX10.

Objective: Pre-exposure prophylaxis (PrEP) is a recommended strategy for HIV prevention, yet PrEP prescribing rates in primary care remain low. The aim of this study was to further describe the current knowledge, attitudes, and prescribing behaviors of HIV PrEP in primary care providers with a focus on the perceived barriers and facilitators to PrEP prescribing. Methods: Cross-sectional survey of primary care providers at rural and suburban practices in a large academic institution. Results: Survey response rate was 48.0% (n = 134). Most respondents (96.3%) reported little clinical experience in care of persons living with HIV. Respondents self-reported positive attitudes and high overall knowledge of PrEP with low prescribing rates and less comfort with lab testing. More respondents are asked about PrEP by patients (54%) than start conversations about PrEP with patients (39%). Family Physicians and providers 5 to 10 years from completion of training overall reported higher knowledge, attitudes and prescribing behaviors. Lack of PrEP education was identified as the greatest barrier and an electronic medical record order set as the greatest facilitator to prescribing PrEP. Conclusions: With the goal to end the HIV epidemic, PrEP provision in nonurban primary care settings may be an important strategy for increased access to PrEP and reduced HIV transmission. This study, which includes a variety of providers that possess high knowledge, yet low experience prescribing PrEP, likely demonstrates the limitations of interventions which solely focus on provider education. System-based practice solutions, such as order sets, may be needed to target infrequent prescribers of PrEP.

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Background and Objectives: Burnout is associated with reduction in patient care time and leaving academic medicine, and is prevalent among faculty, residents, and advanced practice providers. Recognition may positively impact workplace well-being and reduce attrition. The objective of this study was to understand needs and preferences regarding recognition among faculty and providers in a large academic department. Methods: A survey including quantitative and qualitative elements was sent to faculty and providers to identify whether additional recognition was needed and, if so, to seek potential opportunities to improve recognition, with mixed-methods assessment of results. Results: Fifty-two participants completed the survey (35.9% response rate; 53.8% female, 59.6% faculty); 26.9% reported performing duties at work that are not being recognized, and 19.2% reported seriously considering leaving the institution because they did not feel appreciated. Females were more likely to want tangible goods as a source of recognition (P=.008). While providers preferred to have recommendations for recognition made by office staff (P=.007), associate professors did not (P=.005). Qualitative responses to the survey also revealed concerns regarding favoritism and risk of feeling unappreciated if a recognition system is perceived as unfair. Conclusions: This survey demonstrated a deficit of recognition and a lack of consensus regarding how or when faculty and providers should be recognized. There were concerns regarding fairness of recognition. Efforts to enhance recognition should avoid assumptions about faculty and provider preferences, and should be attuned to fairness and inclusion.