The cognitive and psychological effects of living with type 1 diabetes: a narrative review

Duinkerken, Eelco van; Snoek, Frank J.

doi:10.1111/dme.14216

Cited by 74 publications

(40 citation statements)

References 85 publications

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“…Managing type 1 diabetes is a persistent activity performed outside the diabetes care setting. Due to the nature of the disease, self management extends beyond glycaemic control and other biomedical outcomes, also affecting emotional health and social functioning 1 . Finding a balance between diabetes and living can be challenging regardless of age but especially so in young adulthood 2 .…”

Section: Introductionmentioning

confidence: 99%

Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study

et al. 2021

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Aim To explore young adults' experiences of outpatient follow‐up appointments, completing electronic Patient‐Reported Outcome Measures (PROMs), and using the Problem Areas In Diabetes (PAID) scale during the Diabetes Patient‐Reported Outcome Measures (DiaPROM) pilot trial. Methods We performed a qualitative study among 19 young adults (aged 22–39 years) with type 1 diabetes who participated in the pilot trial. Between February and June 2019, we conducted individual, semi‐structured telephone interviews with participants from the intervention and control arms. We analysed the data using thematic analysis. Results Our analyses generated three themes, each with two subthemes: (1) Follow‐up with limitations; (i) Marginal dialogue about everyday challenges, (ii) Value of supportive relationships and continuity, indicate that previous follow‐up had been experienced as challenging and insufficient. (2) New insights and raised awareness; (i) More life‐oriented insights, (ii) Moving out of the comfort zone, suggest mostly positive experiences with completing questionnaires and discussing the PAID scores. (3) Addressing problem areas with an open mind; (i) Need for elaboration, (ii) Preparedness for dialogue, indicate that both openness and explanations were vital in the follow‐up. Conclusions Participants characterised the previous follow‐up as challenging and insufficient. They described completing and using the PAID as somewhat uncomfortable yet worthwhile. Our findings also suggest that by utilising diabetes distress data alongside health and biomedical outcomes, consultations became more attuned to the young adults' wishes and needs, mainly because the dialogue was more focused and direct. Hence, the PAID has the potential to facilitate person‐centredness and improve patient–provider relationships.

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Section: Introductionmentioning

confidence: 99%

Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study

et al. 2021

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“…This entails the complex daily tasks of frequent monitoring of glucose levels, bolusing insulin at specific times and varying insulin doses according to meal size, physical activities and health status, whilst taking precautionary measures to avoid significant dysglycaemia [2,3]. The burden of these tasks is compounded by the demands of daily living, causing many people with type 1 diabetes to struggle and experience burnout leading to poor glycaemic outcomes [4][5][6].…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

et al. 2020

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Aims People with type 1 diabetes (T1D) face the daily task of implementing self-management strategies to achieve their glycaemic goals. The UK COVID-19 lockdown has had an impact on day-to-day behaviour, which may affect diabetes self-management and outcomes. We assessed whether sensor-based outcomes pre- and during lockdown periods were different in a cohort of glucose sensor users with T1D. Methods Data were collected from Freestyle Libre (FSL) or Dexcom G6 sensor users who remotely shared their data with the diabetes clinic web platform. Sensor metrics according to international consensus were analysed and compared between pre-lockdown period and 2 and 3 weeks into lockdown (periods 1 and 2). Results Two hundred and sixty-nine T1D patients (baseline HbA1c 57 ± 14 mmol/mol) were identified as FSL (n = 190) or Dexcom G6 (n = 79) users. In patients with sensor use > 70% (N = 223), compared to pre-lockdown period percentage TIR 3.9–10 mM (TIR) significantly increased during period 1 (59.6 ± 18.2 vs. 57.5 ± 17.2%, p = 0.002) and period 2 (59.3 ± 18.3 vs. 57.5 ± 17.2%, p = 0.035). The proportion of patients achieving TIR ≥ 70% increased from 23.3% pre-lockdown to 27.8% in period 1 and 30.5% in period 2. A higher proportion also achieved the recommended time below and above range, and coefficient of variation in periods 1 and 2. Dexcom G6 users had significantly lower % time below range (< 3.9 mM) compared to FSL users during both lockdown periods (period 1: Dexcom G6 vs. FSL: 1.8% vs. 4%; period 2: 1.4% vs. 4%, p < 0.005 for both periods). Conclusion Sensor-based glycaemic outcomes in people with T1D in the current cohort improved during COVID-19 lockdown, which may be associated with positive changes in self-management strategies. Further work is required to evaluate long-term sustainability and support.

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“…This is compounded by the increasing duration of diabetes as this cohort becomes older. Emerging evidence also reports that during this challenging period of their lives, young people living with type 1 diabetes can experience significant psychosocial burden, which adversely impacts their psychological adjustment and diabetes management (5,6).…”

mentioning

confidence: 99%

Use of Factory-Calibrated Real-time Continuous Glucose Monitoring Improves Time in Target and HbA1c in a Multiethnic Cohort of Adolescents and Young Adults With Type 1 Diabetes: The MILLENNIALS Study

et al. 2020

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International type 1 diabetes registries have shown that HbA 1c levels are highest in young people with type 1 diabetes; however, improving their glycemic control remains a challenge. We propose that use of the factory-calibrated Dexcom G6 CGM system would improve glycemic control in this cohort. RESEARCH DESIGN AND METHODSWe conducted a randomized crossover trial in young people with type 1 diabetes (16-24 years old) comparing the Dexcom G6 CGM system and self-monitoring of blood glucose (SMBG). Participants were assigned to the interventions in random order during two 8-week study periods. During SMBG, blinded continuous glucose monitoring (CGM) was worn by each participant for 10 days at the start, week 4, and week 7 of the control period. HbA 1c measurements were drawn after enrollment and before and after each treatment period. The primary outcome was time in range 70-180 mg/dL. RESULTSTime in range was significantly higher during CGM compared with control (35.7 6 13.5% vs. 24.6 6 9.3%; mean difference 11.1% [95% CI 7.0-15.2]; P < 0.001). CGM use reduced mean sensor glucose (219.7 6 37.6 mg/dL vs. 251.9 6 36.3 mg/dL; mean difference 232.2 mg/dL [95% CI 244.5 to 220.0]; P < 0.001) and time above range (61.7 6 15.1% vs. 73.6 6 10.4%; mean difference 11.9% [95% CI 216.4 to 27.4]; P < 0.001). HbA 1c level was reduced by 0.76% (95% CI 21.1 to 20.4) (28.5 mmol/mol [95% CI 212.4 to 24.6]; P < 0.001). Times spent below range (<70 mg/dL and <54 mg/dL) were low and comparable during both study periods. Sensor wear was 84% during the CGM period. CONCLUSIONSCGM use in young people with type 1 diabetes improves time in target and HbA 1c levels compared with SMBG.

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The cognitive and psychological effects of living with type 1 diabetes: a narrative review

Cited by 74 publications

References 85 publications

Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study

Young adults with type 1 diabetes and their experiences with diabetes follow‐up and participation in the DiaPROM pilot trial: A qualitative study

Impact of COVID-19 lockdown on flash and real-time glucose sensor users with type 1 diabetes in England

Use of Factory-Calibrated Real-time Continuous Glucose Monitoring Improves Time in Target and HbA1c in a Multiethnic Cohort of Adolescents and Young Adults With Type 1 Diabetes: The MILLENNIALS Study

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