Browsing by Subject "Diabetes Mellitus, Type 1"
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Item Benefit Finding, Negative Affect, and Daily Diabetes Management among Adolescents with Type 1 Diabetes(2010-11-02T18:19:51Z) Tran, Vincent Huy; Wieb, DeborahThis study examined whether benefit finding was associated with daily experiences of diabetes stress, negative affect, and diabetes management (e.g. daily average blood glucose and daily perceptions of coping effectiveness) among adolescents with type 1 diabetes. Early adolescents aged 10-15 with type 1 diabetes (n=209) completed a benefit finding measure prior to vi participating in a 14-day daily diary study that provided information on daily diabetes stress, daily reports of how well they managed daily diabetes stressors, and daily emotional experiences. Blood glucose readings were also collected during the two-week study, and daily averages were calculated. Hierarchical linear modeling (HLM) was utilized to investigate day-to-day fluctuations of diabetes stress, emotion, and diabetes management as well as investigate whether these daily fluctuations differed as a function of benefit finding. Benefit finding was associated with overall reported higher average daily levels of both positive and negative affect across a two-week period. Benefit finding was associated with a stronger negative correlation between anxiety and lower perceived coping effectiveness. It was also marginally associated with a greater decline in next-day anxiety among older adolescents. Although benefit finding did not buffer adverse associations between negative affect and poorer diabetes management, there was evidence that it may serve to regulate anxiety over time. These findings are consistent with prior research suggesting that benefit finding occurs in a context of distress and anxiety and may serve as an emotion coping resource. However, questions arise about whether benefit finding facilitates better daily diabetes management in the context of ongoing stress and negative emotion during adolescence.Item The Impact of Depressive Symptoms on Healthcare Utilization and Charges for Adolescents with Type 1 Diabetes (T1D)(2013-01-17) Clayton, Kyle Marcus; Stewart, Sunita, Ph.D., ABPPBackground: Poorly managed chronic illness consumes a large share of health resources. Identifying modifiable variables for those at risk for poor management is essential to containing costs. Given the growing economic burden of diabetes (approximately $200 billion annually) and that type 1 diabetes (T1D) contributes a disproportionately large share to these costs, factors associated with higher costs in this population should be examined. The present study examines the impact of adolescent and maternal depressive symptoms on healthcare utilization and charges in adolescents with T1D. Methods: This retrospective cohort study relied on archival data collected as part of a longitudinal study on treatment adherence among adolescents with diabetes in the Children’s Endocrinology Center at Children’s Medical Center of Dallas (CMCD). Two hundred and forty six adolescents with T1D (age range: 11-18 years;57% girls) and their mothers completed the Center for Epidemiological Studies Depression Scale (CES-D) at enrollment and 12 months later. Demographic and disease-related variables, including HbA1c, were also assessed.Healthcare utilization data and charges for diabetes-related care (i.e., endocrinology clinic visits, emergency room visits, hospitalizations, hospital inpatient days) for the period of 12 and 24 months following enrollment were provided by CMCD. Results: Both adolescent and maternal depressive symptoms predicted healthcare utilization/charges at 12 and 24 month follow-up, after controlling for demographic and disease-related variables. Adolescent depressive symptoms acted indirectly, by decreasing adherence behaviors. Maternal depressive symptoms predicted healthcare utilization and charges even after controlling for disease management (HbA1c) and adolescent depressive symptoms. Adolescents with high depressive symptoms incurred $5,293 more in healthcare charges over a two year period than those with low depressive symptoms. High maternal depressive symptoms resulted in total charges of $11,389 compared to an average of $3,504.25 when maternal depressive symptoms were low. Maternal depressive symptoms accounted for a portion of the variance in total healthcare charges comparable to HbA1c (5% and 7% respectively). Preliminary directional analyses suggested a path from maternal depressive symptoms to adolescent healthcare utilization, rather than the reverse. Conclusion: Both adolescent and maternal depressive symptoms impact healthcare utilization and charges for adolescents with T1D. Maternal depressive symptoms are even more important than adolescent depressive symptoms in predicting utilization of medical resources and higher costs in this population. Interventions aimed at identifying and treating depressive symptoms in youth with T1D and their mothers would not only enhance the quality of life of the individuals, they may also be economically advantageous for payers and providers. To the extent that reducing depressive symptoms would be cost-effective, addressing this issue represents additive value to optimizing the clinical care of patients and their families.Item Marital Satisfaction as a Predictor of Paternal Involvement in Adolescent Diabetes Management(2012-07-20) Parker, Alyssa Clementine; Wiebe, DeborahType 1 diabetes mellitus (DM1) is a common disease in pediatric populations that becomes especially hard to manage during the adolescent years. The family context plays an important role in facilitating adolescent diabetes management. This prospective, longitudinal observation study examined whether marital satisfaction promotes aspects of adolescent health adjustment (e.g., pediatric quality of life, adherence to diabetes regimen, and metabolic control) by facilitating paternal involvement (e.g., general and diabetes specific monitoring) in a sample of adolescents with type 1 diabetes. A sample of 188 adolescents aged 10 – 14 years (M=12.49) who had been diagnosed with DM1 for at least one year, and their mothers and fathers, were assessed every six months for one year. Participants individually completed a packet of questionnaires measuring the primary study constructs. Multiple regression analyses showed mother reports of greater marital satisfaction predicted heightened paternal involvement six months later (i.e., teen reports of paternal monitoring, father reports of diabetes monitoring), and higher father reported adherence across the subsequent year. Father reports of greater marital satisfaction similarly predicted heightened father reports of diabetes specific paternal monitoring, as well as better diabetes management across the subsequent year (i.e., improvements in teen reported quality of life, mother and father reported adherence, and HbA1c). Bootstrapping mediation analyses were conducted to determine whether marital satisfaction predicted enhanced adolescent adjustment by promoting heightened paternal involvement. Maternal marital satisfaction predicted teen reports of adherence across the subsequent year, and this association was mediated by heightened paternal monitoring at six months. Supplemental analyses on the subsample of families where fathers completed measures at all three time points further indicated that both mothers’ and fathers’ marital satisfaction predicted heightened metabolic control across the subsequent year, and this was mediated by greater paternal diabetes monitoring at six months. Marital satisfaction sets an important context for facilitating paternal involvement in diabetes and promoting adolescent adjustment. [Keywords: paternal involvement, diabetes, marital satisfaction, adolescence, illness management]Item Maternal Depressive Symptoms and Its Relationship to Outcomes of Adolescents with Type 1 Diabetes in a Diverse Sample of Caucasian and Latino Youth(2012-05-18) Godbey, Elida Isabel; Wiebe, Deborah J.Purpose/Background: Maternal depression can have deleterious effects on adolescents’ psychosocial adjustment and management of type1 diabetes. These associations have been primarily studied among Caucasian middle-income families. Ethnic minority status and economic disadvantage may alter the experience of maternal depressive symptoms and their association with adolescent diabetes management. The purpose of this study was to determine if mothers’ depressive symptoms were similarly associated with adolescent diabetes outcomes in Caucasian and Latino/a youth, and whether associations occurred independent of socioeconomic factors. Methods: Participants were Caucasian and Latina mothers and their adolescents with type I diabetes (N=118 dyads; 48% Latino; 54% female adolescents; 10 to 15 years old; illness duration > 1 year; 25% on insulin pump). Mothers completed surveys assessing depressive symptoms, household income and parental education. Adolescents reported treatment adherence and depressive symptoms. Metabolic control was measured by HbA1c from medical records. Sociodemographic information was collected through a combination of maternal report and census tract data. Results: Although Latino participants had lower socioeconomic status (SES) than Caucasian participants, there were no ethnic group differences in terms of parental marital status, adolescent age, adolescent gender, illness duration, or insulin pump status. Latina mothers reported significantly more depressive symptoms than Caucasian mothers t (112) = 2.48, p = .015, and these differences were independent of lower SES among Latina mothers. Hierarchical regression analyses revealed maternal reports of depressive symptoms were associated with higher adolescent depression t(108) = 1.98, p = .05, but this association was moderated by both a two-way interaction with adolescent age, t(105) = 2.13, p = .036, and a three-way interaction with age and ethnicity, t(104) = -2.05, p = .043. Among older Latino adolescents, maternal depressive symptoms were positively associated with adolescent report of depression; this association was not found among older Caucasian participants or among younger participants. There were no significant associations between maternal depressive symptoms and adolescent adherence. All associations remained independent of SES indicators, which were generally unrelated to adolescent outcomes Conclusion: Maternal depressive symptoms may undermine the psychosocial adjustment of adolescents with diabetes, but appears to have complex associations with diabetes management across ethnic groups. The finding that Latino youth did not experience heightened depression despite the risks of their mother’s elevated depressive symptoms and lower SES is potentially quite important. If replicable, further research should explore potential protective factors that may be contributing to adolescent diabetes outcomes in Latino families. [Keywords: adherence; metabolic control; depressive symptoms; ethnic differences; Type 1 diabetes]Item Maternal Intrusive Involvement and Adolescent Functioning in Youth with Type I Diabetes(2007-12-17) Oroza, Maria Gabriela; Wiebe, DeborahOne factor affecting emotional and physical well being in adolescents with type 1 diabetes is the degree of maternal involvement. Adolescents whose mothers are actively involved in the daily management of their diabetes tend to follow their regimen more consistently and are in better glycemic control. However, intrusive levels of involvement have been correlated with increased depression, decreased adherence, and poor metabolic control. In the past intrusive involvement has been seen as a consequence of innate maternal characteristics such as trait anxiety, and as the cause of poor child functioning in adolescents with intrusively involved caregivers. More current research takes a transactional perspective in which intrusive involvement interacts with child functioning in a reciprocal manner. To investigate the current transactional perspective, the current study explored the temporal relationships between intrusive maternal involvement in adolescent diabetes management and child functioning variables including depression, adherence, and metabolic control across two time points (an average of 16 months apart) using cross-lagged panel correlation analyses and hierarchical linear regression. The current study also investigated the role of maternal trait anxiety in the development of intrusive involvement by proposing one potential transactional process and testing it in the sample. Adolescents (N = 83, 10 to 15 years of age, 53% male) with type 1 diabetes mellitus (duration of at least 1 year) completed measures of adherence, depression, and intrusive involvement, and their mothers provided relevant demographic and illness related information. Metabolic control was collected from participants' medical records. This study found no evidence to support the workings of a transactional process within mother-teen dyads for adolescents with type 1 diabetes. However, consistent with the traditional linear model, results indicated that intrusive involvement was associated with higher levels of depressive symptoms in females at Time 1, and that the effects continued to be seen over time. No association was found between intrusive involvement and depressive symptomatology for males at either time point. These findings point to the need for interventions geared toward improving mother-daughter interactions and reducing depressive symptomatology in teenage girls with type 1 diabetes.Item Maternal Optimism and its Relationship to Coping and Illness Management Among Adolescents with Type 1 Diabetes(2010-005-14) Garcia, Ryan Michael; Wiebe, DeborahOptimism is an intriguing construct because of its relationships with positive physiological and psychological outcomes in times of adversity, including chronic illness. Coping styles often mediate significant relationships between optimism and these outcomes. Type 1 Diabetes can be difficult to manage for adolescents, and their mothers play important roles in helping and teaching them how to effectively manage their illness. Adolescents with Type 1 Diabetes often struggle with psychological adjustment, treatment adherence, and maintaining healthy metabolic control. The relationships between one maternal personality trait, dispositional optimism, and these three key outcome variables with regard to the management of adolescent Type 1 Diabetes were investigated using the Revised Life Orientation Test, Children‟s Depression Inventory, Revised Self Care Inventory, and HbA1c. Adolescent coping style, assessed by a structured Stress and Coping Interview, was investigated as a possible factor mediating the proposed relationships between maternal optimism and the outcome variables. Participants were 130 mother-adolescent dyads. Adolescents were 14.5 years old, 56% female, 93% Caucasian, and 59% were using an insulin pump. Initial correlations revealed maternal optimism was associated with better adolescent adherence and metabolic control, and trended towards a relationship with fewer adolescent depressive symptoms. Relationships between maternal optimism and adolescent adherence and metabolic control remained significant when controlling for maternal trait anxiety and adolescent insulin pump status. However, adolescent coping styles were not found to mediate these relationships. The absence of a mediation role for coping styles may have reflected the presence of very low levels of avoidance coping in the sample. Exploratory analyses examined an alternative mediational pathway, and verified maternal and adolescent reports of adherence as indirect pathways between maternal optimism and adolescent metabolic control. These findings are the first to reveal associations between caregiver personality traits and the health outcomes in those for whom they care, and provide evidence of the potential processes involved. These findings suggest that maternal optimism may serve as a resource during a difficult time of development for adolescents with Type 1 Diabetes.Item Parental Strategies for Adolescent Diabetes Management in Latino and Caucasian Youth(2013-01-16) Griffith, Katrina Courtney; Wiebe, Deborah J., Ph.D., M.P.H.Adolescence is a particularly challenging and important time for type 1 diabetes management. Parental involvement during this time has been associated with more effective diabetes management in adolescence and throughout adulthood, but research on adolescent diabetes management has primarily focused on Caucasian samples. The purpose of this study was to explore the parental strategies that Caucasian and Latina mothers employ when helping their adolescent deal with diabetes management problems, and to begin to illuminate the strategies that are associated with adolescent outcomes (i.e. metabolic control, adherence, and depressive symptoms) across ethnic groups. Participants were Caucasian and Latina mothers and their adolescents with type 1 diabetes (N=118 dyads; 48% Latino; 54% female adolescents; 10 to 15 years old; illness duration > 1 year; 25% on insulin pump). Qualitative data consisted of maternal and adolescent narrative responses to the open-ended question, “What do you (does your mother) do when diabetes management is not going well?” Quantitative data included maternal and adolescent report of adherence, teen report of depressive symptoms and metabolic control. Sociodemographic information was collected by maternal report. Qualitative analysis revealed 11 parental strategies that mothers employ when dealing with daily diabetes related problems. Across the full sample, take charge was the most commonly reported strategy by both mothers and teens, followed by negative emotional reaction and collaboration (by teen report) and collaboration and parental monitoring (by mother report). Across ethnic groups, take charge was commonly endorsed by all reporters. Caucasian families were more likely to report collaboration and general emotional support, while Latino families were more likely to report parental monitoring. Exploratory analyses of correlation differences across ethnic groups suggested parental strategies functioned differently for Caucasian and Latino families. Caucasian and Latino families differed on the frequency of parental strategies reported, as well as on associations between strategies and outcomes (i.e. glycemic control, adherence, and depressive symptoms). The mixed methods approach identified important parental strategies that enrich our understanding of how parents manage diabetes and illuminate interesting ethnic differences that should be further considered in the context of clinical intervention and future research.Item Race and Neighborhood SES Differences in the Development Trajectories of Type 1 Diabetes Management of Caucasian and Ethnic Minority Youth(2009-09-04) Wang, Jenny Tzu-Mei; None ListedPediatric diabetes is a chronic illness that significantly impacts the lives of children and adolescents and their families. Poor metabolic control increases the risks for severe long-term consequences with debilitating effects in adulthood. Adolescence is a particularly difficult period of time for Caucasian youth as they evidence characteristic declines in metabolic control. There is some cross-sectional evidence that racial disparities in pediatric diabetes exist. However, only one study has evaluated racial disparities longitudinally and no studies have evaluated these differences across the critical period of adolescence. The aims of this retrospective study were to replicate age-related declines in metabolic control in a sample of African American youth and to characterize racial differences in the developmental trajectories of metabolic control between African American and Caucasian youth. This study also aimed to evaluate whether race effects remained beyond neighborhood SES. The sample consisted of 162 Caucasian and African American subjects matched on gender and age seen at the Children's Medical Center Dallas endocrinology outpatient clinic during 2007. Retrospective medical record reviews were conducted for sociodemographic information and retrospective health data. Neighborhood SES variables were obtained through publicly available census databases. This retrospective investigation revealed age-related declines in metabolic control regardless of race. African American youth had higher HbA1c levels compared to Caucasian counterparts throughout ages 10 through 18. However, African American and Caucasian youth evidenced parallel trajectories (similar rates of change) in metabolic control across this critical period. Race retained unique explanatory effects beyond that of neighborhood SES while family structure was not a predictive variable. These results suggest that African American youth experience significant risks prior to adolescence that place them at poorer levels of metabolic control and these risks are maintained across adolescence. Adolescence may be an equally risky period for African American and Caucasian youth, highlighting the need for further research on how African American youth and their families cope with diabetes. These results provide evidence that adolescence may be a critical period for both African American and Caucasian youth and unique interventions should be developed to prevent declines in metabolic control during adolescence in both racial groups.Item Rgs16 is a Pancreatic Reporter of Chronic Hyperglycemia in Diabetes(2012-07-20) Ocal, Ozhan; Wilkie, ThomasDiabetes mellitus is a collection of metabolic diseases with chronic hyperglycemia as their common syndrome. Type 1 diabetes results from pancreatic insulin producing beta cell loss due to autoimmune attack and consequent insulin insufficiency, whereas type 2 diabetes occurs as a result of somatic cell insulin resistance under metabolic stress. Therapies include insulin supplementation for type 1 diabetics and diet control and augmented insulin release for type 2 diabetics. G-protein coupled receptors (GPCR) represent the largest non-antibiotic drug targets and several family members are expressed in beta cells. Regulators of G-protein Signaling (RGS) proteins are feedback regulators of GPCRs. Their expression can be induced by GPCR or cross-talk signals to inhibit GPCR pathway, thereby indicating when and where GPCR signaling occurs. Our studies utilizing Rgs16::GFP transgenic mouse previously showed that Rgs16 was expressed in embryonic pancreatic progenitor cells, endocrine cells, and postnatal vessel and ductal associated cells (VDAC). Euglycemic adults lacked pancreatic Rgs16::GFP expression. We investigated diabetic mice to determine if Rgs16::GFP would reactivate during beta cell expansion in adulthood. The type 1 diabetic models of beta cell death were streptozotocin (STZ) treatment and PANIC-ATTAC mice. Type 2 diabetic models consisted of ob/ob mice and diet induced obesity. In each case, Rgs16::GFP expression initiated in islets and VDAC after at least 6 days of chronic hyperglycemia. STZ induced Rgs16::GFP expression was reduced after lowering blood glucose levels with systematic insulin administrations. Furthermore, hyperglycemia dependent Rgs16::GFP expression required metabolic transcription factor Carbohydrate Response Element Binding Protein (ChREBP), as pancreatic Rgs16::GFP was absent in STZ-treated ChREBP KO mice. We found that Rgs16::GFP is also expressed in Pancreatic Ductal Adenocarcinoma (PDAC) tumors and primary tissue culture cells. RNA-Seq analysis revealed that cultured PDAC cells express many genes in common with embryonic progenitors of ductal and endocrine cells and identified expression of 63 GPCRs. In summary, our results suggest that Rgs16::GFP is stimulated by GPCR signals relayed from a “hyperglycemia sensor”. We propose that Rgs16 is a faithful pancreatic biomarker of diabetes and Rgs16::GFP PDAC culture and diabetic reporter mice are beneficial resources to identify ligands that stimulate beta cell expansion without promoting cancer. [Keywords: Rgslb, GPcR, diabetes, hyperglycemia, insulin, pancreas, ChREBP, streptozotocin (STZ), PANIC-ATTAC, pancreatic ductal adenocarcinoma (PDAC)]