Novel predictors of daily fluctuations in glycemia and self‐management in adolescents and young adults with type 1 diabetes

Abstract

Aims To understand morning biopsychosocial factors that predict glycemia, adherence, and goal attainment in adolescents and young adults (AYA) with type 1 diabetes (T1D) on a daily basis. Methods Eight‐eight AYA (mean 17.6 ± 2.6 years, 54% female, HbA1c 7.9 ± 1.4%, diabetes duration 8.5 ± 4.5 years) with T1D who use Continuous Glucose Monitoring (CGM) completed a 2‐week prospective study. Participants chose a self‐management goal to focus on during participation. For six days, participants prospectively completed a 25‐item Engagement Prediction Survey to assess biopsychosocial factors to predict daily diabetes outcomes and an end‐of‐day Goal Survey. Lasso and mixed‐model regression were used to determine items in the Engagement Prediction Survey most predictive of perceived goal attainment, CGM Time‐in‐Range (TIR, 70–180 mg/dl), sensor mean glucose, number of insulin boluses and hyperglycemia response (bolus within 30 min of high alert or glucose <200 mg/dl within 2 hours). Results A 7‐item model (including current glucose, planning/wanting to manage diabetes, wanting to skip self‐management, feeling good about self, health perception and support needs) explained 16.7% of the daily variance in TIR, 18.6% of mean sensor glucose, 2.1% of the number of boluses, 14% of hyperglycemia response, and 28.7% of goal attainment perceptions. The mean absolute change in day‐to‐day TIR was 16%, sensor glucose was 30 mg/dl, and the number of boluses was 2. AYA reported more positive Engagement Prediction Survey responses on mornings when they awoke with lower glucose levels. Conclusions Morning biopsychosocial state factors predict glycemic and adherence outcomes in AYA with diabetes and could be a novel intervention target for future behavioural interventions.

Situational Awareness and Proactive Engagement Predict Higher Time in Range in Adolescents and Young Adults Using Hybrid Closed-Loop

“…Strengths of this study include a sample of adolescents and young adults with a wide range of baseline glycemia and duration of diabetes, as well as novel measurements of situational awareness and diabetes behaviors spanning multiple days. We also report granular information about Control-IQ engagement behaviors, furthering the published literature on user behaviors [ 12 ]. The study’s major weakness was its small sample size, although we were able to partially compensate for this by using multilevel models to capitalize on the availability of multiple data points provided by each participant.…”

“…giving insulin boluses, monitoring glucose levels, and so on) is one subset of self-management, together with other behaviors like food selection or timing, and physical activity. We have previously shown how adolescents and young adults have high interpersonal and intrapersonal variability in their diabetes self-management behaviors, and how a variety of biopsychosocial daily factors correlate with these fluctuations [ 12 ]. Therefore, more research about their engagement with their diabetes care is warranted.…”

Similar Perceptions on Continuous Glucose Monitor Use amongst Youth with Type 1 and Type 2 Diabetes

“…Youth with T2D also often require insulin therapy and glucose monitoring with a potentially similar burden of management [4]. Continuous glucose monitoring (CGM) improves glycemic trends and reduces complications of diabetes in youth with T1D, while also improving quality of life (QoL) [5,6]. Although there have been studies on the perceptions of CGM in pediatric patients with T1D, the perceptions of CGM in pediatric T2D patients are limited [7,8].…”

Effectiveness of resilience-promoting interventions in adolescents with diabetes mellitus: a systematic review and meta-analysis

“…Research evidence has shown that many adolescents experience declines in diabetes self-management behaviors and worsening glycemic control, as indicated by increases in hemoglobin A1c (HbA1c) [ 9 , 10 ]. Globally, only 17%–22% of adolescents with T1DM currently meet glycemic targets [ 1 , 11 , 12 ]. Again, evidence from SEARCH, an observational longitudinal study of youth with diabetes diagnosed before the age of 20 years in the United States, showed that the mean HbA1c of youth with T2DM changed from 7.3% within the first year of diagnosis to 8.8% five years later, which is similar to the trajectory of glucose deterioration in patients with T1DM [ 13 ].…”