RELATIONSHIPS BETWEEN DIABETES DISTRESS, TECHNOLOGY EXPECTATIONS, TECHNOLOGY EXPERIENCE AND TECHNOLOGY USE
- Linda Gonder-frederick, United States of America
- Alessandro Bisio, United States of America
- Sue A. Brown, United States of America
- Marc Breton, United States of America
- Stacey Anderson, United States of America
- Laura Kollar, United States of America
- Jessica Robic, United States of America
- Emma Emory, United States of America
- Mary C. Oliveri, United States of America
- Christian Wakeman, United States of America
- Boris Kovatchev, United States of America
Background and Aims
Adoption and use of diabetes technology may be associated with pre-existing psychosocial factors, including expectations and emotional status. This study investigated the relationships between diabetes distress and user expectations, experience, and utilization of Closed-Loop Control (CLC) and Decision Support Systems (DSS).
In Study 1, 61 T1D adults (60% F, age=42.5±11.6, T1Dyrs=22.1±12, HbA1c =7.4±1.0, regimen=insulin pump) participated in a CLC clinical trial using SAP therapy, overnight CLC (ON-CLC), and 24-hr CLC (24-CLC) over three 8-week periods. In Study 2, 57 T1D adults (59.6% F, age=33±14.1ys, T1Dyrs =16±12.6, HbA1c=7.4±1.2, regimen=MDI + CGM) used a DSS which provided insulin recommendations for meals, exercise and sleep. In both studies, participants completed the Diabetes Distress Scale (DDS), as well as Technology Expectations and Technology Experience questionnaires (Benefit and Burden subscales) at baseline and following treatment conditions.
The table below shows correlations and t-test results between the questionnaires and user score. For CLC, higher Emotional DDS scores correlated with higher experienced burdens in the SAP and ON-CLC conditions, with a similar trend in 24-CLC. For DSS, participants were divided into high and low user groups based on system interactions. High user scores correlated with higher expected and experienced benefits. Lower user scores correlated with higher expected and experienced burdens. Low user scores showed trends in correlations with higher Regimen-related and Physician-related baseline distress.
Relationships between diabetes distress and technology expectations, experience and use should be considered for successful adoption and utilization of different types of diabetes technology.
PROPOSAL FOR ESTABLISHING A PEDIATRIC DIABETES CENTER AND ENHANCING TECHNOLOGY USE
Background and Aims
Providing care for young children with type 1 diabetes requires special training and experience since the diabetes care in children is different from that in adults. Furthermore, many general pediatricians may not have the most up to- date knowledge about diabetes care.
The delivery of diabetes care in an efficient way can improve the diabetes outcome in the long term.
We evaluated obstacles which can interfere in providing an optimal care focusing on different aspects:
1- Staffing and personnel
2- Rescue medications
3- Technology utilization
4- Outcome evaluation
1- Trained staff who have experience in managing pediatric diabetes should be utilized instead of referring visits and phone calls to general pediatric personnel. The team should include dietitians and certified diabetes educators to help the current pediatric endocrinologists
2- Rescue medications (insulin and glucagon) should be available in outpatient settings for immediate use
3- Immediate testing of Hemoglobin A1c ( HbA1c), training to utilize insulin pumps and continuous glucose monitor systems (CGMs), and evaluating families readiness for technology use should be performed at diagnosis
4- Diabetes care outcomes should be evaluated by HbA1c levels, fluctuation of recorded glucose levels, prevention of hypoglycemia and quality of life
The optimal delivery of pediatric diabetes care in the society plays a major role in improving diabetes outcome for children. Early utilization of technology by dedicated well- trained staff can improve the metabolic control and allow better quality of lives, not only for children with diabetes, but also their families.
SEXUAL DYSFUNCTION IN MALE WITH TYPE 1 DIABETES MELLITUS
Background and Aims
To investigate the frequency and risk factors of sexual dysfunction (SD) in male with type 1 Diabetes Mellitus (t1DM)
We concluded patients with t1DM. The International Index of Erectile Function (IIEF) self-completed questionnaire was used to detect SD, while patients with a low score (<26 of 30) in questions regarding erectile function were considered to have erectile dysfunction (ED). Depressive symptoms were evaluated with the Zung Self-rating Depression Scale (ZDRS).The Hamilton Anxiety Rating Scale (HAM-A) was used to evaluate the severity of anxiety and the Sexual Quality of Life Questionnaire (SQOL-M) to assess the quality of sexual life. All patients had a 24-hour ambulatory blood pressure monitoring (ABPM) performed and average Blood Pressure (aBP), average Heart rate (aHR) and nighttime BP dipping (%) measured.
Thirty-eight male patients 42.7+11.7 years old and with 15.6+10.4 years DM duration were included. ED was detected in 26.3% of the patients. Mean IIF score was 56.4+18.9. Depressive symptoms were found in 21% and anxiety in 47.3% of the patients. There was correlation between IIEF score with DM duration (p<0.005, r=-0.73), the co-existence of hypertension (p=0.018, r=-0.61), the co-existence of retinopathy (p<0.005, r=-0.79) and the absence of nighttime BP dipping (p=0.041, r=0.81). Although, there was strong correlation of ED with SQOL score (p<0.005, r=0.85) there was no statistical significant correlation with depressive symptoms or anxiety.
SD seems to be frequent among male patients with t1DM and affects negatively the quality of their sexual life. Abnormal nighttime dipping status seems to be associated with ED
ENDOTHELIAL DYSFUNCTION IN PATIENTS WITH CONTROLLED AND UNCONTROLLED DIABETES MELLITUS
Background and Aims
To do comparative analysis of the level of asymmetrical dimetilarginin in two groups of the patients with controlled and uncontrolled diabetes mellitus.
94 patients were divided into 2 groups. Group I – 53 patients with uncontrolled diabetes mellitus. Group II – 41 patients with controlled diabetes mellitus. Was done clinical, laboratory and instrumental methods of examination including the levels of asymmetrical dimetilarginin, creatinine in the blood and calculated glomerular filtration rate.
During the comparative analysis concentration of asymmetrical dimetilarginin in patients of group I was higher, and was found significant positive correlation between the levels of asymmetrical dimetilarginin and creatinine. (P<0,05). Increase of the level of asymmetrical dimetilarginin in blood was in correlation with decrease of glomerular filtration rate.
In both groups was found increase of the level of asymmetrical dimetilarginin, but the level of asymmetrical dimetilarginin was higher for the patients of group I. According on our findings during the uncontrolled diabetes mellitus manifestation of endothelial dysfunction was significantly visible. Positive correlation between the levels of asymmetrical dimetilarginin and glomerular filtration rate in uncontrolled diabetic patients shows possibility to use this substance as a marker of damages of target organs.