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Daily predictors of diabetes adherence in adolescents and young adults with T1D
Abstract
Abstract Body
Glycemic control is typically measured by aggregate glucose data spanning 14 days. Little is known about the daily fluctuations in diabetes self-management, glycemic control, and ability to achieve goals in adolescents and young adults (AYA) with type 1 diabetes. There are likely a myriad of underlying physiological, emotional, and cognitive factors that fluctuate on a day-by-day basis that predict these daily diabetes outcomes. This is important because daily patterns and habits are proximal to the momentary experience of AYA, and may provide unique foci for precision interventions to improve diabetes self-management among AYA with diabetes. Newer health behavior theories such as Two Minds Theory suggest that such momentary biopsychosocial factors require state-level assessment close to the time of the actual behavior rather than trait-level global assessment. We prospectively studied 100 AYA with T1D on a daily basis to determine novel biopsychosocial factors that predict glycemia, adherence, and goal attainment, in an effort to identify novel intervention targets and strategies to improve glycemic control in AYA with type 1 diabetes.
Is Education still important or is technology enough to reach recommended targets?
Which is best at improving impaired awareness of hypoglycemia: Technology, insulins or training & Education
Abstract
Abstract Body
Impaired awareness is a major acquired complication of diabetes which affects around 25% and 10% of those with type 1 and type 2 diabetes respectively. Those developing impaired awareness have an increased risk of severe hypoglycaemic episodes as much as 6 times greater compared to those with normal awareness in some prospective studies. Studies in the 90s showed that a failure to recognise hypoglycaemia is due to an altered relationship between the glycaemic threshold for cognitive impairment and protective counterregulatory responses particularly sympathoadrenal activation. The latter both generates symptoms and opposes the glucose lowering effects of insulin through glycogenolysis. This led to the programmes of reversal of impaired awareness by avoidance of hypoglycaemia initially by intensive professional support and structured education and more recently by technologies including CGM and hybrid closed loop. These approaches have all proved useful but are not universally successful; for example, technology may reduce rates of hypoglycaemia without restoring normal awareness or impaired counterregulatory responses. Thus, hypoglycaemia remains a major factor preventing those on insulin and sulphonylureas from achieving recommended glucose targets. Those in the field continue to seek a greater understanding of the pathophysiological processes which lead to impaired awareness and risk of severe hypoglycaemia which may result in more successful targeted therapy.