Maureen Monaghan

Transition readiness in adolescents and emerging adults with diabetes: the role of patient-provider communication.

Transition from pediatric to adult care represents a high risk period for adolescents and emerging adults with diabetes. Fundamental differences between pediatric and adult care delivery models may contribute to increased risk for poor health outcomes. This review provides a brief overview of models of care in pediatric and adult settings and focuses on patient-provider communication content and quality as potential points of intervention to improve transition-related outcomes. This review also highlights disparities in transition and communication for adolescents and emerging adults from racial/ethnic minority groups and discusses recent changes in health care legislation that have significant implications for the transition process. Intervention opportunities include programs to enhance developmentally-appropriate patient-provider interactions and increased attention to promoting transition readiness skills. Improving patient-provider communication may hasten the development of vital self-advocacy skills needed in adult health care systems and, thus, help establish a lasting pattern of positive diabetes self-care.

Authoritative parenting, parenting stress, and self-care in pre-adolescents with type 1 diabetes.

Parent involvement in type 1 diabetes (T1DM) care leads to improved adherence; however, the manner in which parents approach illness management interactions with children must also be considered. It was hypothesized that greater use of an authoritative parenting style and less parenting stress would be associated with greater behavioral adherence and better metabolic control. Ninety-five primary caregivers of preadolescents (ages 8–11) with T1DM completed questionnaires assessing parenting style, pediatric parenting stress, and child behavioral adherence. Caregivers primarily self-identified as using an authoritative parenting style. Greater authoritative parenting was associated with greater behavioral adherence and less difficulty with pediatric parenting stress; no differences in metabolic control were observed. Greater engagement in authoritative parenting behaviors may contribute to increased age-appropriate child behavioral adherence and less pediatric parenting stress. Interventions highlighting diabetes-specific authoritative parenting techniques may enhance health outcomes and improve overall family functioning.

Sleep Behaviors and Parent Functioning in Young Children With Type 1 Diabetes

This study evaluates sleep characteristics among young children with type 1 diabetes and associations with parent sleep and emotional functioning and diabetes care. Study participants included 24 parents of young children with type 1 diabetes (ages 2–5) enrolled in a pilot study of a randomized-controlled trial. Child sleep characteristics were within normal limits. However, increased child bedtime resistance and behavioral insomnia were related to greater parent stress, anxiety, and depression and use of an intensive insulin regimen. Type 1 diabetes management may impact child and parent sleep as well as parent emotional functioning. Implications for practice are presented.

Using Qualitative Methods to Guide Clinical Trial Design: Parent Recommendations for Intervention Modification in Type 1 Diabetes

Parents of young children with Type 1 diabetes assume significant responsibility for a complex daily illness regimen, yet little research has evaluated supportive interventions for this population. This study presents mixed-methods program evaluation data from participants who completed a five-session intervention designed to promote parent mastery of diabetes-related tasks and increase social and emotional support. Twelve parents (75% female) of young children with Type 1 diabetes completed a satisfaction survey following intervention completion. Additionally, four parents were selected for completion of an in-depth interview designed to elicit specific recommendations for program improvement. Results suggested high levels of satisfaction with the intervention program. Thematic coding of interview data revealed two clear directions for future research, including offering the intervention program closer to the time of diagnosis and enhancing educational and supportive offerings for parents and other caregivers. Incorporation of in-depth interviews and subsequent qualitative data analyses in addition to a quantitative satisfaction survey provided richly detailed data related to program evaluation and improvement. Results highlighted critical components for intervention refinement and provided a unique window into the experiences of parents of young children with Type 1 diabetes and the need for additional support in the months following diagnosis, both for themselves and other caregivers.

Screening and Identification of Children and Adolescents at Risk for Depression During a Diabetes Clinic Visit

In Brief Among patients with type 1 or type 2 diabetes, depression is one of the most commonly occurring comorbid conditions. A dual diagnosis of depression and diabetes has been linked to poor adherence and decreased daily diabetes self-care and often leads to suboptimal metabolic control and increased diabetes-related complications. Pediatric diabetes clinicians are in a unique position to identify behavior changes over time and provide early identification and preventive intervention for children and adolescents at risk for depression. This article provides an overview of the differential diagnosis process that pediatric clinicians face and practical advice for providers when evaluating and addressing depressive symptoms during routine diabetes clinic visits.

Protective Factors in Young Children With Type 1 Diabetes

OBJECTIVE To characterize protective factors in young children with type 1 diabetes, and evaluate associations among child protective factors and indicators of diabetes resilience, including better child and parent psychosocial functioning and glycemic control. METHODS Parents of 78 young children with type 1 diabetes reported on child protective factors, child quality of life, parent depressive symptoms, and disease-specific parenting stress. A1c values were collected from medical records. RESULTS Young children with type 1 diabetes were rated as having similar levels of protective factors as normative samples. Greater child protective factors were associated with indicators of diabetes resilience, including higher child quality of life and lower parent depressive symptoms and parenting stress. Regression analyses demonstrated that child protective factors were associated with 16% of the variance in parent-reported depressive symptoms. CONCLUSIONS Attention to child protective factors can enhance understanding of adjustment to type 1 diabetes and may have implications for intervention.

The Affordable Care Act and implications for young adult health

ABSTRACTIn the USA, young adults are most likely to be uninsured and least likely to report a usual source of medical care than any age group. The Patient Protection and Affordable Care Act (ACA) recognizes the critical need for expanded insurance coverage for this age group, and multiple provisions of the ACA address insurance coverage and health care utilization in young adults. This paper presents a brief overview of the challenges of maintaining health insurance coverage and accessing health care in young adults, provisions of the ACA relevant to young adults, and early impact of the ACA on young adult health insurance status and health care access and utilization. We offer policy suggestions for behavioral health providers to address continued challenges related to health care for young adults.

Mealtime behavior and diabetes-specific parent functioning in young children with type 1 diabetes.

OBJECTIVE Management of meals and mealtime behavior is often challenging for parents of young children with Type 1 diabetes. Parent functioning related to diabetes care may directly affect mealtime behaviors and glycemic control. This study evaluated associations among diabetes-specific parent functioning, parent and child mealtime behaviors, and glycemic control. METHOD Parents of young children with Type 1 diabetes (n = 134) completed self-report measures assessing diabetes-specific functioning (hypoglycemia fear, diabetes self-efficacy, diabetes-related quality of life) and child and parent mealtime behaviors. Hemoglobin A1c and percentage of blood glucose values out of range (<70 mg/dL or >200 mg/dL) over a 30-day period were abstracted from medical charts as indicators of glycemic control. Structural equation modeling was utilized to evaluate predictors and related outcomes of child and parent mealtime behavior. RESULTS The proposed model fit the data very well. More frequent problematic child mealtime behaviors were associated with poorer glycemic control; however, more frequent problematic parent mealtime behaviors were marginally associated with better glycemic control. Poorer diabetes-specific parent functioning was associated with more frequent problematic child and parent mealtime behaviors. CONCLUSIONS Problematic child mealtime behaviors, such as disruptive behavior, present a significant risk for poorer glycemic control. Parents may engage in ineffective mealtime management strategies in an effort to meet glycemic recommendations and avoid hyperglycemia and hypoglycemia. Future research will help to determine whether parents may benefit from specific, developmentally appropriate behavioral strategies to manage meals and snacks and promote optimal diabetes management.

Feasibility of the SMART Project: A Text Message Program for Adolescents With Type 1 Diabetes

This study investigated response rates to the Self-Management and Research Technology Project, a 6-week text message program for adolescents with type 1 diabetes designed to provide diabetes self-management reminders and education. The rate of response to texts was high, with 78% of texts responded to during the 6-week period. Girls and participants who self-reported sending a large number of personal daily texts had higher response rates; other demographic and medical variables were unrelated to text response rates. Inclusion of mobile health technologies such as text messages in clinical care may be a unique, relevant method of intervention for youths with type 1 diabetes, regardless of age, socioeconomic status, or glycemic control.

Average Daily Risk Range (ADRR) in Young Children With Type 1 Diabetes.

Objective: The objective was to examine the utility of the average daily risk range (ADRR) in young children with type 1 diabetes. Methods: Self-monitored blood glucose (BG) data and A1c values were collected from 134 children (ages 2-6). Other measures of BG variability and diabetes care were calculated using self-monitored BG data. ADRR, A1c, and other glycemic indices were compared to assess their distinctiveness and utility as measures of BG variability and glycemic control. Results: Of young children’s ADRR values, 72% were in the “high-risk” range using adult guidelines. ADRR and A1c were highly correlated with indicators of hyperglycemia but only weakly correlated with measures of hypoglycemia. ADRR was moderately correlated with minimum BG value in the past 30 days but not percentage of BG values below 70 mg/dL. A1c was not correlated with either measure of hypoglycemia. Conclusions: ADRR values confirm the high degree of BG variability present in young children with type 1 diabetes, particularly as compared with adults. New ADRR risk guidelines are needed for pediatric patients. ADRR and A1c are adequate indicators of hyperglycemia in young children. However, both ADRR and A1c failed to effectively capture hypoglycemia risk in this sample, and neither ADRR nor A1c can take the place of review of raw BG data to evaluate BG variability in young children.