While children with type 1 diabetes (T1D) and their parents report significant sleep problems, few studies have focused on young children and included health-related quality of life (HRQOL) as an outcome of sleep disturbance. In addition, relatively little is known about the use of diabetes devices, such as continuous glucose monitors (CGMs), in young children and their link with sleep disturbances. This brief report examines the relationship between sleep quality and HRQOL and explores sleep disturbances related to CGM use in a sample of young children with T1D. Data are from the baseline of a behavioral intervention pilot for 46 parents of children ages 2-5 years with T1D. Parents reported on their child's sleep disturbances as a result of nighttime blood glucose monitoring (NBGM). Sleep was measured objectively in a subset of children (N = 11) who wore accelerometers for a 5-day period. All parents completed measures of pediatric and parental HRQOL. Greater child sleep disturbance due to NBGM was associated with lower pediatric HRQOL. Child sleep disturbances were negatively associated with parental life satisfaction. In addition, children who used CGM experienced fewer sleep disturbances than those who did not. However, parents of children who used CGM experienced greater sleep disturbances related to a higher frequency of NBGM. Pediatric and parental HRQOL were most related to child sleep disturbances by NBGM. CGM use may be associated with better child sleep, as parents are less likely to wake their child for NBGM, although CGM use may also be associated with greater sleep difficulties in parents. Future studies should further explore the relationship between sleep and technology use and impact on clinical outcomes in young children with T1D and their parents.

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BackgroundThe Structured Clinical Interview for DSM (SCID) is considered the gold standard assessment for accurate, reliable psychiatric diagnoses; however, because of its length, complexity, and training required, the SCID is rarely used outside of research.ObjectiveThis paper aims to describe the development and initial validation of a Web-based, self-report screening instrument (the Screening Assessment for Guiding Evaluation-Self-Report, SAGE-SR) based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) and the SCID-5-Clinician Version (CV) intended to make accurate, broad-based behavioral health diagnostic screening more accessible within clinical care.MethodsFirst, study staff drafted approximately 1200 self-report items representing individual granular symptoms in the diagnostic criteria for the 8 primary SCID-CV modules. An expert panel iteratively reviewed, critiqued, and revised items. The resulting items were iteratively administered and revised through 3 rounds of cognitive interviewing with community mental health center participants. In the first 2 rounds, the SCID was also administered to participants to directly compare their Likert self-report and SCID responses. A second expert panel evaluated the final pool of items from cognitive interviewing and criteria in the DSM-5 to construct the SAGE-SR, a computerized adaptive instrument that uses branching logic from a screener section to administer appropriate follow-up questions to refine the differential diagnoses. The SAGE-SR was administered to healthy controls and outpatient mental health clinic clients to assess test duration and test-retest reliability. Cutoff scores for screening into follow-up diagnostic sections and criteria for inclusion of diagnoses in the differential diagnosis were evaluated.ResultsThe expert panel reduced the initial 1200 test items to 664 items that panel members agreed collectively represented the SCID items from the 8 targeted modules and DSM criteria for the covered diagnoses. These 664 items were iteratively submitted to 3 rounds of cognitive interviewing with 50 community mental health center participants; the expert panel reviewed session summaries and agreed on a final set of 661 clear and concise self-report items representing the desired criteria in the DSM-5. The SAGE-SR constructed from this item pool took an average of 14 min to complete in a nonclinical sample versus 24 min in a clinical sample. Responses to individual items can be combined to generate DSM criteria endorsements and differential diagnoses, as well as provide indices of individual symptom severity. Preliminary measures of test-retest reliability in a small, nonclinical sample were promising, with good to excellent reliability for screener items in 11 of 13 diagnostic screening modules (intraclass correlation coefficient [ICC] or kappa coefficients ranging from .60 to .90), with mania achieving fair test-retest reliability (ICC=.50) and other substance use endorsed too infrequently for analysis.ConclusionsThe S...

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Objective: To describe sociodemographic and parent psychosocial characteristics associated with patterns of continuous glucose monitor (CGM) use across the first 18 months post-type 1 diabetes (T1D) diagnosis among young children. Methods: One hundred fifty-seven parent-child dyads enrolled in a behavioral intervention for parents of young children (1-6 years) newly diagnosed with T1D. Parents reported on baseline sociodemographic characteristics and psychosocial functioning; child CGM use was assessed at five time points during the first 18 months postdiagnosis. Results: Most participants (81.8%) used CGM at least once. Four CGM trajectories emerged (always, later/ stable, inconsistent, and never). Participants with private insurance were more likely to be in the always, later/stable, or inconsistent groups versus the never group. Youth in the always and later/stable groups had lower mean HbA1c at 18 months than those in the never group. Conclusions: Given the health benefits of CGM, further exploration of barriers to CGM use in families with public health insurance is needed. ClinicalTrials.gov identifier: NCT02527525