Diabetes is a complex chronic condition that requires ongoing self-management. People with diabetes (PWD) and their caregivers (ie, parent) spend less than 1% of their time in a year visiting with their diabetes health care provider (HCP). 1,2 As a result, PWD and their caregivers troubleshoot day-today activities on their own. It is estimated PWD spend 8000 hours per year self-managing their diabetes outside of the medical setting. 1 The Diabetes, Attitudes, Wishes and Needs Second Study (DAWN2) suggests PWD feel that their HCPs aren't always available to provide patient-centered care related to their diabetes. 3 This lack of support, intensity of diabetes management, and social stigma can be associated with burnout, diabetes distress, 4 higher hemoglobin A1C (A1C) and body mass index. 5 In 831042D STXXX10.

Adults and children with type 1 diabetes and their care partners are empowered by the ability to share and follow RT-CGM data. Our findings suggest that RT-CGM data sharing between an individual with diabetes and their care partner can complicate relationships. Healthcare providers need to engage patients and care partners in discussions about best practices related to RT-CGM sharing and following to avoid frustrations within the relationship.

Children with cancer were able to relate detailed descriptions of their symptoms and symptom self-management strategies when presented with developmentally sensitive approaches. Healthcare providers are well positioned to integrate arts-based approaches to symptom assessment and to support children in implementing their preferred strategies to alleviate symptoms.

he incidence of type 1 diabetes is rising (1), as is the number of older adults (>65 years of age) who are living with type 1 diabetes (2). The life expectancy of individuals diagnosed with type 1 diabetes increased by 15 years between 1950-1964 and 1965-1980 (3). Type 1 diabetes is associated with a number of health complications, including myocardial infarction, cerebrovascular accidents, retinopathy, neuropathy, nephropathy (4), hypoglycemia and hypoglycemia unawareness (5), and dementia-all of which are more common among older adults (3,6,7). Although individuals are now living longer with type 1 diabetes, they may experience significant functional and cognitive decline as a result of their illnesses. Older adults with type 1 diabetes are generally an understudied population. Type 1 diabetes management in adulthood is most often examined at the individual level (8,9). Although couple relationships are the most important resource for supporting

Objectives: Describe pediatric palliative care consult in children with heart disease; retrospectively apply Center to Advance Palliative Care criteria for pediatric palliative care consults; determine the impact of pediatric palliative care on end of life. Design: A retrospective single-center study. Setting: A 16-bed cardiac ICU in a university-affiliated tertiary care children’s hospital. Patients: Children (0–21 yr old) with heart disease admitted to the cardiac ICU from January 2014 to June 2017. Measurements and Main Results: Over 1,000 patients (n = 1, 389) were admitted to the cardiac ICU with 112 (8%) receiving a pediatric palliative care consultation. Patients who received a consult were different from those who did not. Patients who received pediatric palliative care were younger at first hospital admission (median 63 vs 239 d; p = 0.003), had a higher median number of complex chronic conditions at the end of first hospitalization (3 vs 1; p < 0.001), longer cumulative length of stay in the cardiac ICU (11 vs 2 d; p < 0.001) and hospital (60 vs 7 d; p < 0.001), and higher mortality rates (38% vs 3%; p < 0.001). When comparing location and modes of death, patients who received pediatric palliative care were more likely to die at home (24% vs 2%; p = 0.02) and had more comfort care at the end of life (36% vs 2%; p = 0.002) compared to those who did not. The Center to Advance Palliative Care guidelines identified 158 patients who were eligible for pediatric palliative care consultation; however, only 30 patients (19%) in our sample received a consult. Conclusions: Pediatric palliative care consult rarely occurred in the cardiac ICU. Patients who received a consult were medically complex and experienced high mortality. Comfort care at the end of life and death at home was more common when pediatric palliative care was consulted. Missed referrals were apparent when Center to Advance Palliative Care criteria were retrospectively applied.

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Background: The Centers for Disease Control and Prevention (CDC) in United States initially alerted the public to three COVID-19 signs and symptoms-fever, dry cough, and shortness of breath. Concurrent social media posts reflected a wider range of symptoms of COVID-19 besides these three symptoms. Because social media data have a potential application in the early identification novel virus symptoms, this study aimed to explore what symptoms mentioned in COVID-19-related social media posts during the early stages of the pandemic. Methods: We collected COVID-19-related Twitter tweets posted in English language between March 30, 2020 and April 19, 2020 using search terms of COVID-19 synonyms and three common COVID-19 symptoms suggested by the CDC in March. Only unique tweets were extracted for analysis of symptom terms. Results: A total of 36 symptoms were extracted from 30,732 unique tweets. All the symptoms suggested by the CDC for COVID-19 screening in March, April, and May were mentioned in tweets posted during the early stages of the pandemic. Discussion: The findings of this study revealed that many COVID-19-related symptoms mentioned in Twitter tweets earlier than the announcement by the CDC. Monitoring social media data is a promising approach to public health surveillance.

Background: The cost of diabetes medications and supplies is rising, resulting in access challenges. This study assessed the prevalence of and factors predicting underground exchange activities—donating, trading, borrowing, and purchasing diabetes medications and supplies. Research Design and Methods: A convenience sample of people affected by diabetes was recruited online to complete a survey. Mixed method analysis was undertaken, including logistic regression to examine the relationship between self-reported difficulty purchasing diabetes medications and supplies and engagement in underground exchange activity. Thematic qualitative analysis was used to examine open-text responses. Results: Participants ( N = 159) self-reported engagement in underground exchange activities, including donating (56.6%), donation receiving (34.6%), trading (23.9%), purchasing (15.1%), and borrowing (22%). Such activity took place among a variety of individuals, including friends, family, coworkers, online acquaintances and strangers. Diabetes-specific financial stress predicted engagement in trading diabetes mediations or supplies (OR 6.3, 95% CI 2.2-18.5) and receiving donated medications or supplies (OR 2.8, 95% CI 1.1-7.2). One overarching theme, unmet needs, and three subthemes emerged: (1) factors influencing underground exchange activity, (2) perceived benefits of underground exchange activity, and (3) perceived consequences of underground exchange activity. Conclusion: Over half of the participants in this study engaged in underground exchange activities out of necessity. Providers must be aware about this underground exchange and inquire about safety and possible alternative resources. There is an urgent need to improve access to medications that are essential for life. Our study points to a failure in the US healthcare system since such underground exchanges may not be necessary if medications and supplies were accessible.