Chronic bacterial lung infections in cystic fibrosis (CF) are the leading cause of morbidity and mortality. While a range of bacteria are known to be capable of establishing residence in the CF lung, only a small number have a clearly established link to deteriorating clinical status. The two bacteria with the clearest roles in CF lung disease are Pseudomonas aeruginosa and bacteria belonging to the Burkholderia cepacia complex (BCC). A number of common adaptations by P. aeruginosa strains to chronic lung infection in CF have been well described. Typically, initial isolates of P. aeruginosa are nonmucoid and display a range of putative virulence determinants. Upon establishment of chronic infection, subsequent isolates ultimately show a reduction in putative virulence determinants, including swimming motility, along with an acquisition of the mucoid phenotype and increased levels of antimicrobial resistance. Infections by BCC are marked by an unpredictable, but typically worse, clinical outcome. However, in contrast to P. aeruginosa infections in CF, studies describing adaptive changes in BCC bacterial phenotype during chronic lung infections are far more limited. To further enhance our understanding of chronic lung infections by BCC bacteria in CF, we assessed the swimming motility phenotype in 551 isolates of BCC bacteria from cystic fibrosis (CF) lung infections between 1981 and 2007. These data suggest that swimming motility is not typically lost by BCC during chronic infection, unlike as seen in P. aeruginosa infections. Furthermore, while we observed a statistically significant link between mucoidy and motility, we did not detect any link between motility phenotype and clinical outcome. These studies highlight the need for further work to understand the adaptive changes of BCC bacteria during chronic infection in the CF lung.

It has been nearly 30 years since Blum et al. described the chasm between paediatric and adult health services. 1 Since then, the dramatic excursions in glycaemic control amongst adolescents (aged 12-18) and emerging adults (aged 19-30) with type 1 diabetes have been well-described. 2 As well, the short-term complications, long-term morbidity and premature mortality associated with suboptimal glycaemic control during these life stages have been well-documented. 3

Introduction: Diabetes Distress refers to the negative emotional impact and unremitting frustrations associated with living with type 1 diabetes (T1D). 1 While multiple scales have been developed to assess diabetes distress, the T1D Diabetes Distress Scale (T1-DDS) is a recently-validated scale designed to quantify diabetes distress in individuals with T1D specifically. 2 This scale consists of 28 items assessed on a 6-point Likert-type scale, grouped into 7 subscales: powerlessness, management distress, hypoglycemia, negative social perceptions, eating distress, physician distress, and friend/family distress. Diabetes distress in adolescents with diabetes has been previously evaluated, 3 but previous studies have not looked at the T1-DDS in the adolescent transition population specifically. The purpose of this study was to characterize diabetes distress in adolescents transitioning to adult care using the T1-DDS. Methods: Between 2016-2018, we recruited 100 adolescents with T1D at their last pediatric visit before transitioning to adult care. We collected demographic and basic clinical data and administered the T1-DDS using RedCap, an online data management platform. We analyzed T1-DDS scores as a continuous variable and used linear regression to determine the demographic and clinical factors associated with diabetes distress (and each diabetes distress subscale) in this population. We used the Bonferroni correction to account for multiple comparisons for each T1-DDS subscale. Results: 68% of participants completed the T1-DDS in its entirety and the mean T1-DDS score for each question was 1.93 (standard deviation 0.83), where 1 indicates low diabetes distress and where 6 indicates high diabetes distress. The only variable that was consistently associated with higher diabetes distress across most T1-DDS subscales was female sex (p <0.001 for T1-DDS total score). Higher average A1C was associated with higher diabetes distress on the management distress subscale (p = 0.009). More frequent hospitalizations were associated with higher diabetes distress in the total T1-DDS score (p = 0.009), the hypoglycemia subscale (p = 0.009), and the friend/family distress subscale (p = 0.009). Conclusions: Consistent with previous studies, female sex and poorer glycemic control were associated with higher diabetes distress. 1-3 This study showed that the T1-DDS can be used to identify diabetes distress in adolescents with T1D as they transition to adult care. Future research should collect one-year post-transition T1-DDS scores in this cohort of patients. References: 1. Dennick et al. J Diabetes Complications. 2017;31(5):898-911. 2. Fisher et al. J Diabetes Complications. 2015;29(4):572-7. 3. Hagger et al. Curr Diab Rep. 2016;16(1):9.

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