OBJECTIVE -To review key advances in the behavioral science literature related to psychosocial issues and therapies for persons with diabetes, to discuss barriers to research progress, and to make recommendations for future research.RESEARCH DESIGN AND METHODS -Key findings from the literature on psychosocial research in diabetes are reviewed separately for children and adults. Specific issues covered include psychosocial adjustment and psychiatric disorders, neurocognitive functioning, quality of life, and psychosocial therapies. Barriers that must be addressed to allow research in this area to progress are discussed. Recommendations are then made concerning high-priority areas for advancing research in the field.CONCLUSIONS -A substantial amount of behavioral science research has demonstrated that psychosocial factors play an integral role in the management of diabetes in both children and adults. Research has also shown the efficacy of a number of psychosocial therapies that can improve regimen adherence, glycemic control, psychosocial functioning, and quality of life. More research in this area is needed to develop psychosocial intervention programs for specific patient populations and to demonstrate the cost-effectiveness of these approaches. Diabetes Care 24:1286 -1292, 2001T his study presents the summary and recommendations of the Psychosocial Therapies Working Group, originally presented at the conference on Behavioral Science Research in Diabetes, held in November 1999, at the National Institutes of Health. In this study, we first highlight the significance of psychosocial issues in diabetes care and key advances in the field separately for children, adolescents, and adults. This review of the literature in this area is not intended to be detailed and comprehensive; several other literature reviews of behavioral and psychosocial research in diabetes have been published in recent years (1-4). Our objective is to provide examples of key findings from the field of behavioral research addressing psychosocial issues and therapies. We then discuss barriers to research progress and conclude with specific recommendations for future research. CHILDREN AND ADOLESCENTS SignificanceThe incidence of type 1 diabetes in young children has increased in recent years (5,6). In addition, the incidence of type 2 diabetes has been increasingly recognized in older children and adolescents, often in association with obesity (7). Large numbers of children are currently affected by diabetes, and many more will be affected by diabetes in the future.Diabetes imposes considerable demands on children and their families. Because they are coping with normal developmental challenges, the additional burden of diabetes may be difficult for many children to deal with effectively. Especially burdensome may be the demands of intensive management. With children as patients, families play a significant role in diabetes management and are instrumental in the implementation of interventions. Diabetes can adversely affect both psychosocial and...

Overall, participants reported a positive experience of the closed loop technology. Results are consistent with previous research with size of equipment continuing to be a problem. Progress is being made in the usability of the closed-loop system.

National Institutes of Health and National Institute of Diabetes Digestive Diseases and Kidney and the Helmsley Charitable Trust.

Aims To assess the factor structure of the PedsQL Diabetes Module, and to compare the PedsQL general and diabetes-specific quality of life (QOL) measures regarding psychometric properties and relations to relevant outcomes. Methods The instruments were completed by 447 children age 9 to 15.5 with type 1 diabetes >1 year from four US paediatric diabetes clinics; parents completed the parallel parent-proxy measures. Principal components factor analysis was used to examine the factor structure of the PedsQL diabetes module. Analyses of the generic and diabetes QOL measures included psychometric properties, parent-child correlations, and correlations with depression, adherence, and A1c. Results The factor structure of the PedsQL diabetes module did not support the original 5 subscales. Both one and two factor models were supported; however parallel parent and child subscales did not emerge. While the generic and diabetes-specific measures of QOL were moderately to highly correlated with each other, the constructs were differentially associated with relevant diabetes outcomes. Generic QOL was more highly associated with depression than diabetes QOL. Conversely, diabetes QOL was more highly associated with adherence and A1c, though this was seen to a greater extent for parent-proxy report than for child report. Conclusions Factor analysis of the PedsQL diabetes module supports the use of a total diabetes QOL score. Findings regarding the associations of the generic and diabetes modules with diabetes outcomes underscore the unique contribution provided by both generic and diabetes QOL.

The feasibility of a family-based clinic-integrated behavioral intervention to improve family management of type 1 diabetes was evaluated. In each of four clinical sites, 30 to 32 families (122 total) were randomized to intervention or usual care comparison group. The WE*CAN intervention, based on family problem-solving methods, was delivered during 3 routine clinic visits by trained "Health Advisors". Of eligible families across the four sites, 83% agreed to participate, of whom 96% completed the baseline, mid-term, and post-intervention assessments. Families participated in an average of 2.85 intervention sessions over an 8-month period. The intervention was integrated into the clinic setting without impairing clinic flow, and was implemented with fidelity and consistency across sites by trained non-professionals. The findings provide evidence of the feasibility of conducting a multi-site trial to evaluate the effects of a clinic-integrated problem-solving intervention to improve family management. Many lessons were learned that provide guidance for recruitment, measurement, and intervention for the larger clinical trial.