Korey Hood

All Publications

• Patient-Reported Outcomes Improve with a Virtual Diabetes Care Model that Includes Continuous Glucose Monitoring. Telemedicine journal and e-health : the official journal of the American Telemedicine Association Hood, K., Bergenstal, R. M., Cushman, T., Gal, R. L., Raghinaru, D., Kruger, D., Johnson, M. L., McArthur, T., Bradshaw, A., Olson, B. A., Oser, S. M., Oser, T. K., Kollman, C., Weinstock, R. S., Beck, R. W., Aleppo, G. 2024

  Abstract

  Background: The objective was to examine patient-reported outcomes (PROs) associated with access to a virtual clinic model for diabetes care. Methods: Adults with diabetes (N = 234) received virtual care, including support for continuous glucose monitoring (CGM) over a 6-month study period. Care was led by a Certified Diabetes Care and Education Specialist and focused on optimizing self-management skills and response to glucose values observed on CGM. After 6 months of CGM use and access to diabetes education, participants could opt in to another 6 months of follow-up with access to the virtual care team. Participants completed PRO surveys and had health and glycemic measures collected at baseline, 3, 6, and 12 months. Results: Participants with type 1 diabetes (N = 160) were 44 ± 14 years and had mean baseline HbA1c of 61 mmol/mol (7.7%). Participants with type 2 diabetes (N = 74) were 52 ± 12 years and had mean baseline HbA1c of 66 mmol/mol (8.2%). Compared with baseline levels, at 6 months participants experienced less depression, diabetes distress, and hypoglycemic fears while also experiencing greater satisfaction with glucose monitoring, diabetes technology and specifically with CGM, and confidence for managing hypoglycemic (p < 0.05). For participants with type 1 diabetes, more time in the target range for glucose levels (70-180 mg/dL) was associated with less depression, diabetes distress, and hypoglycemic fears. Conclusions: PROs improved for adults with diabetes utilizing virtual diabetes care, including support for CGM use. Paired with the glycemic improvements observed in this virtual clinic study, there were robust benefits on the quality of life of adults with diabetes. ClinicalTrials.gov Identifier: NCT04765358.

  View details for DOI 10.1089/tmj.2024.0093

  View details for PubMedID 39166322

• Equitable implementation of a precision digital health program for glucose management in individuals with newly diagnosed type 1 diabetes. Nature medicine Prahalad, P., Scheinker, D., Desai, M., Ding, V. Y., Bishop, F. K., Lee, M. Y., Ferstad, J., Zaharieva, D. P., Addala, A., Johari, R., Hood, K., Maahs, D. M. 2024

  Abstract

  Few young people with type 1 diabetes (T1D) meet glucose targets. Continuous glucose monitoring improves glycemia, but access is not equitable. We prospectively assessed the impact of a systematic and equitable digital-health-team-based care program implementing tighter glucose targets (HbA1c < 7%), early technology use (continuous glucose monitoring starts <1 month after diagnosis) and remote patient monitoring on glycemia in young people with newly diagnosed T1D enrolled in the Teamwork, Targets, Technology, and Tight Control (4T Study 1). Primary outcome was HbA1c change from 4 to 12 months after diagnosis; the secondary outcome was achieving the HbA1c targets. The 4T Study 1 cohort (36.8% Hispanic and 35.3% publicly insured) had a mean HbA1c of 6.58%, 64% with HbA1c < 7% and mean time in the range (70-180 mg dl-1) of 68% at 1 year after diagnosis. Clinical implementation of the 4T Study 1 met the prespecified primary outcome and improved glycemia without unexpected serious adverse events. The strategies in the 4T Study 1 can be used to implement systematic and equitable care for individuals with T1D and translate to care for other chronic diseases. ClinicalTrials.gov registration: NCT04336969 .

  View details for DOI 10.1038/s41591-024-02975-y

  View details for PubMedID 38702523

  View details for PubMedCentralID 9764665

• Intersectional identities play a role in perceived discrimination for families living with type 1 diabetes. Diabetes research and clinical practice Addala, A., Medina Penaranda, R., Naranjo, D., Maahs, D. M., Hood, K. K. 2024: 111568

  View details for DOI 10.1016/j.diabres.2024.111568

  View details for PubMedID 38364908

• Patient reported outcomes (PROs) and user experiences of young children with type 1 diabetes using t:slim X2 insulin pump with control-IQ technology. Diabetes research and clinical practice Hood, K. K., Schneider-Utaka, A. K., Reed, Z. W., Buckingham, B. A., Cobry, E., DeBoer, M. D., Ekhlaspour, L., Schoelwer, M., Paul Wadwa, R., Lum, J., Kollman, C., Beck, R. W., Breton, M. D. 2024; 208: 111114

  Abstract

  Examine patient-reported outcomes (PROs) after the use of t:slim X2 insulin pump with Control-IQ technology (CIQ) in young children with type 1 diabetes.Children with type 1 diabetes, ages 2 to < 6 years (n = 102), were randomly assigned 2:1 to either CIQ or standard care (SC) with pump or multiple daily injections (MDI) plus continuous glucose monitoring (CGM) for 13 weeks. Both groups were offered to use CIQ for an additional 13 weeks after the randomized control trial's (RCT) completion. Guardians completed PRO questionnaires at baseline, 13-, and 26-weeks examining hypoglycemia concerns, quality of life, parenting stress, and sleep. At 26 weeks, 28 families participated in user-experience interviews. Repeated measures analyses compared PRO scores between systems used.Comparing CIQ vs SC, responses on all 5 PRO surveys favored the CIQ group, showing that CIQ was superior to SC at 26 weeks (p values < 0.05). User-experience interviews indicated significant benefits in optimized glycemic control overall and nighttime control (28 of 28 families endorsed). All but 2/28 families noted substantial reduction in management burden resulting in less mental burden and all but 4 stated that they wanted their children to continue using CIQ.Families utilizing CIQ experienced glycemic benefits coupled with substantial benefits in PROs, documented in surveys and interviews. Families utilizing CIQ had reduced hypoglycemia concerns and parenting stress, and improved quality of life and sleep. These findings demonstrate the benefit of CIQ in young children with type 1 diabetes that goes beyond documented glycemic benefit.

  View details for DOI 10.1016/j.diabres.2024.111114

  View details for PubMedID 38278493

• DiabetesWise: An innovative approach to promoting diabetes device awareness. Journal of diabetes Wong, J. J., Addala, A., Hanes, S. J., Krugman, S., Naranjo, D., Nelmes, S., Rose, K. J., Tanenbaum, M. L., Hood, K. K. 2023

  Abstract

  DiabetesWise is an unbranded, data-driven online resource that tailors device recommendations based on preferences and priorities of people with insulin-requiring diabetes. The objective of this study is to examine whether DiabetesWise increases uptake of diabetes devices, which are empirically supported to improve glycemic and psychosocial outcomes.The sample included 458 participants (Mage  = 37.1, SD = 9.73; 66% female; 81% type 1 diabetes) with insulin-requiring diabetes and minimal diabetes device use at enrollment. Participants used DiabetesWise and completed online surveys. Chi-square and t tests evaluated requests for a device prescription, receiving a prescription, and starting a new device at 1 and 3 months post use. Baseline predictors of these variables and past use of continuous glucose monitors (CGMs) and changes in diabetes distress post use were also examined.Within the first month of interacting with DiabetesWise 19% of participants asked for a prescription for a diabetes device. This rate rose to 31% in the first 3 months. These requests resulted in 16% of the sample starting a new device within the first 3 months. Whereas several factors were associated with prior CGM use, receiving a prescription, and starting a new device, more diabetes distress (t(343) = -3.13, p = .002) was the only factor associated with asking for a prescription. Diabetes distress decreased after interacting with DiabetesWise within 1 month (t(193) = 3.51, p < .001) and 3 months (t(180) = 5.23, p < .001).Within 3 months of interacting with DiabetesWise, one in three participants had requested a prescription for a new diabetes device and average distress levels were reduced, indicating benefit from this low-intensity online platform.

  View details for DOI 10.1111/1753-0407.13401

  View details for PubMedID 37139842

• Lived experience of CamAPS FX closed loop system in youth with type 1 diabetes and their parents. Diabetes, obesity & metabolism Hood, K. K., Garcia-Willingham, N., Hanes, S., Tanenbaum, M. L., Ware, J., Boughton, C. K., Allen, J. M., Wilinska, M. E., Tauschmann, M., Denvir, L., Thankamony, A., Campbell, F., Wadwa, R. P., Buckingham, B. A., Davis, N., DiMeglio, L. A., Mauras, N., Besser, R. E., Ghatak, A., Weinzimer, S. A., Fox, D. S., Kanapka, L., Kollman, C., Sibayan, J., Beck, R. W., Hovorka, R., DAN05 Consortium 2022

  Abstract

  AIMS: To examine changes in the lived experience of type 1 diabetes after use of hybrid closed loop (CL), including the CamAPS FX CL system.MATERIALS & METHODS: The primary study was conducted as an open-label, single-period, randomized, parallel design contrasting CL versus insulin pump (with or without CGM). Participants were asked to complete patient-reported outcomes prior to starting CL and 3 and 6 months later. Surveys assessed diabetes distress, hypoglycemia concerns, and quality of life. Qualitative focus group data were collected at the completion of the study.RESULTS: In this sample of 98 youth (age range 6-18, mean age 12.7±2.8years) and their parents, CL use was not associated with psychosocial benefits overall. However, the subgroup (n=12) using the CamAPS FX system showed modest improvements in quality of life and parent distress, reinforced by both survey (p<0.05) and focus group responses. There were no negative effects of CL use reported by study participants.CONCLUSIONS: Closed loop use via the CamAPS FX system was associated with modest improvements in aspects of the lived experience of managing type 1 diabetes in youth and their families. Further refinements of the system may optimize the user experience. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/dom.14815

  View details for PubMedID 35837984

• From Wary Wearers to d-Embracers: Personas of Readiness to Use Diabetes Devices. Journal of diabetes science and technology Tanenbaum, M. L., Adams, R. N., Iturralde, E., Hanes, S. J., Barley, R. C., Naranjo, D., Hood, K. K. 2018: 1932296818793756

  Abstract

  BACKGROUND: Diabetes devices such as insulin pumps and continuous glucose monitoring (CGM) are associated with improved health and quality of life in adults with type 1 diabetes (T1D). However, uptake remains low. The aim of this study was to develop different "personas" of adults with T1D in relation to readiness to adopt new diabetes technology.METHODS: Participants were 1498 T1D Exchange participants who completed surveys on barriers to uptake, technology attitudes, and other psychosocial variables. HbA1c data was available from the T1D Exchange for 30% of the sample. K-means cluster analyses grouped the sample by device barriers and attitudes. The authors assigned descriptive labels based on cluster characteristics. ANOVAs and chi-square tests assessed group differences by demographic and psychosocial variables (eg, diabetes duration, diabetes distress).RESULTS: Analyses yielded five distinct personas. The d-Embracers (54% of participants) endorsed few barriers to device use and had the highest rates of device use, lowest HbA1c, and were the least distressed. The Free Rangers (23%) had the most negative technology attitudes. The Data Minimalists (10%) used pumps but had lower CGM use and did not want more diabetes information. The Wary Wearers (11%) had lower overall device use, were younger, more distressed, endorsed many barriers, and had higher HbA1c. The High Distress (3%) group members were the youngest, had the shortest diabetes duration, reported the most barriers, and were the most distressed.CONCLUSION: These clinically meaningful personas of device readiness can inform tailored interventions targeting barriers and psychosocial needs to increase device uptake.

  View details for PubMedID 30132692

• Preventing Diabetes Distress in Adolescents With Type 1 Diabetes: Results One Year After Participation in the STePS Program. Diabetes care Hood, K. K., Iturralde, E., Rausch, J., Weissberg-Benchell, J. 2018

  Abstract

  OBJECTIVE: The aim is to report 1-year outcomes of the Supporting Teens Problem Solving (STePS) study, a randomized controlled trial comparing a distress and depression prevention program with a diabetes education program for adolescents with type 1 diabetes.RESEARCH DESIGN AND METHODS: With 264 adolescents in two locations (Chicago and San Francisco Bay Area), a randomized controlled trial was conducted comparing the Penn Resilience Program for type 1 diabetes (PRP T1D) to Advanced Diabetes Education. Interventions lasted 4.5 months, and assessments were conducted at baseline, and 4.5, 8, 12, and 16 months. Outcomes of interest were diabetes distress (DD), depressive symptoms, resilience, diabetes self-management, and glycemic control. Latent growth curve modeling was used to test between-group differences over time.RESULTS: Results indicate that there was acceptable randomization and exposure to interventions, and that exposure to PRP T1D was associated with substantial reductions in DD. In addition, stable glycemic control, resilience characteristics, and depressive symptoms were observed 1 year post-treatment. Diabetes management deteriorated in both groups.CONCLUSIONS: Intervening before symptoms of psychological distress start can prevent the development of the DD commonly seen in adolescents with type 1 diabetes. The STePS program represents a promising prevention program, and future reports on 2- and 3-year outcomes will explore benefits over longer periods of time.

  View details for PubMedID 29921624

• Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016;39:2126-2140 DIABETES CARE Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., Peyrot, M. 2018; 41 (3): E33–E34

  View details for PubMedID 29463672

  View details for PubMedCentralID PMC5864144

• PsychDT Working Group: Report Psychosocial Aspects of Artificial Pancreas Systems. Journal of diabetes science and technology Barnard, K. D., Venkat, M. V., Close, K., Heinemann, L., Weissberg-Benchell, J., Hood, K. K., Kubiak, T., Kowalski, A. J., Laffel, L. 2015; 9 (4): 925-928

  Abstract

  Diabetes technology is a cornerstone of diabetes management in the 21st century, with advances in available devices over recent years playing a central role in the way that health care has progressed. Psychosocial interventions have been shown to have a positive impact on glycemic control, reduce psychological distress and reduce costs of health care. Addressing and improving psychosocial outcomes that complement biomedical improvements and looking to the future are crucial to enhance patient acceptance of artificial pancreas (AP) systems.To achieve closer collaboration and comparability across different AP research trials, a working group was established.Existing measures fail to adequately capture the extent to which human and psychological factors play a role in the uptake and efficient use of AP systems. Understanding these factors will ultimately lead to the most benefit for users. Reliable measures of the psychosocial impact of AP systems for users is crucial to ensure that (1) regulatory authorities are able to robustly consider these aspects as part of their approval process, (2) government and private payers are able to factor these aspects into their decisions regarding reimbursement, and (3) persons with diabetes maximize benefits in terms of both glycemic control and quality of life to minimize the burden of diabetes in everyday life.This working group will serve as a platform to foster exchange, identify research needs, and guide and initiate collaborative research laying the groundwork for optimal utilization of diabetes technology in clinical diabetes care. A close collaboration among all key stakeholders is crucial to ensure that devices are designed, trialed, approved, and provided with minimal user burden and maximum beneficial effect.

  View details for DOI 10.1177/1932296815588332

  View details for PubMedID 26085567

• Psychosocial outcomes with the Omnipod® 5 Automated Insulin Delivery System in caregivers of very young children with type 1 diabetes. Diabetes, obesity & metabolism MacLeish, S. A., Hood, K. K., Polonsky, W. H., Wood, J. R., Bode, B. W., Forlenza, G. P., Laffel, L. M., Buckingham, B. A., Criego, A. B., Schoelwer, M. J., DeSalvo, D. J., Sherr, J. L., Hansen, D. W., Conroy, L. R., Huyett, L. M., Vienneau, T. E., Ly, T. T. 2024

  Abstract

  Automated insulin delivery (AID) systems have demonstrated improved glycaemic outcomes in people with type 1 diabetes (T1D), yet limited data exist on these systems in very young children and their impact on caregivers. We evaluated psychosocial outcomes following use of the tubeless Omnipod® 5 AID System in caregivers of very young children.This 3-month single-arm, multicentre, pivotal clinical trial enrolled 80 children aged 2.0-5.9 years with T1D to use the Omnipod 5 AID System. Caregivers completed questionnaires assessing psychosocial outcomes-diabetes distress (Problem Areas in Diabetes), hypoglycaemia confidence (Hypoglycemia Confidence Scale), well-being (World Health Organization 5 Well-Being Index), sleep quality (Pittsburgh Sleep Quality Index), insulin delivery satisfaction (Insulin Delivery Satisfaction Survey) and system usability (System Usability Scale) at baseline with standard therapy and after 3 months of AID use.Following 3 months of Omnipod 5 use, caregivers experienced significant improvements across all measures, including diabetes-related psychosocial outcomes (Problem Areas in Diabetes; p < 0.0001, Hypoglycemia Confidence Scale; p < 0.01), well-being (World Health Organization 5 Well-Being Index; p < 0.0001) and perceived system usability (System Usability Scale; p < 0.0001). Significant improvements were seen in the Pittsburgh Sleep Quality Index total score and the overall sleep quality, sleep duration and efficiency subscales (all p < 0.05). Insulin Delivery Satisfaction Survey scores improved on all subscales (greater satisfaction, reduced burden and reduced inconvenience; all p < 0.0001).Caregivers face unique challenges when managing T1D in very young children. While glycaemic metrics have unquestioned importance, these results evaluating psychosocial outcomes reveal additional meaningful benefits and suggest that the Omnipod 5 AID System alleviates some of the burdens caregivers face with diabetes management.

  View details for DOI 10.1111/dom.15906

  View details for PubMedID 39300963

• Not all healthcare inequities in diabetes are equal: a comparison of two medically underserved cohorts. BMJ open diabetes research & care Walker, A. F., Haller, M. J., Addala, A., Filipp, S. L., Lal, R., Gurka, M. J., Figg, L. E., Hechavarria, M., Zaharieva, D. P., Malden, K. G., Hood, K. K., Westen, S. C., Wong, J. J., Donahoo, W. T., Basina, M., Bernier, A. V., Duncan, P., Maahs, D. M. 2024; 12 (4)

  Abstract

  Diabetes disparities exist based on socioeconomic status, race, and ethnicity. The aim of this study is to compare two cohorts with diabetes from California and Florida to better elucidate how health outcomes are stratified within underserved communities according to state location, race, and ethnicity.Two cohorts were recruited for comparison from 20 Federally Qualified Health Centers as part of a larger ECHO Diabetes program. Participant-level data included surveys and HbA1c collection. Center-level data included Healthcare Effectiveness Data and Information Set metrics. Demographic characteristics were summarized overall and stratified by state (frequencies, percentages, means (95% CIs)). Generalized linear mixed models were used to compute and compare model-estimated rates and means.Participant-level cohort: 582 adults with diabetes were recruited (33.0% type 1 diabetes (T1D), 67.0% type 2 diabetes (T2D)). Mean age was 51.1 years (95% CI 49.5, 52.6); 80.7% publicly insured or uninsured; 43.7% non-Hispanic white (NHW), 31.6% Hispanic, 7.9% non-Hispanic black (NHB) and 16.8% other. Center-level cohort: 32 796 adults with diabetes were represented (3.4% with T1D, 96.6% with T2D; 72.7% publicly insured or uninsured). Florida had higher rates of uninsured (p<0.0001), lower continuous glucose monitor (CGM) use (18.3% Florida; 35.9% California, p<0.0001), and pump use (10.2% Florida; 26.5% California, p<0.0001), and higher proportions of people with T1D/T2D>9% HbA1c (p<0.001). Risk was stratified within states with NHB participants having higher HbA1c (mean 9.5 (95% CI 8.9, 10.0) compared with NHW with a mean of 8.4 (95% CI 7.8, 9.0), p=0.0058), lower pump use (p=0.0426) and CGM use (p=0.0192). People who prefer to speak English were more likely to use a CGM (p=0.0386).Characteristics of medically underserved communities with diabetes vary by state and by race and ethnicity. Florida's lack of Medicaid expansion could be a factor in worsened risks for vulnerable communities with diabetes.

  View details for DOI 10.1136/bmjdrc-2024-004229

  View details for PubMedID 39242122

• Time for a Reframe: Shifting Focus From Continuous Glucose Monitor Uptake to Sustainable Use to Optimize Outcomes. Journal of diabetes science and technology Mayberry, L. S., Nelson, L. A., Bergner, E. M., Raymond, J. K., Tanenbaum, M. L., Jaser, S. S., Wiebe, D. J., Allen, N., Berg, C. A., Naranjo, D., Litchman, M., Ollinger, L., Hood, K. 2024: 19322968241268560

  Abstract

  Continuous glucose monitors (CGMs) improve glycemic outcomes and quality of life for many people with diabetes. Research and clinical practice efforts have focused on CGM initiation and uptake. There is limited understanding of how to sustain CGM use to realize these benefits and limited consideration for different reasons/goals for CGM use. Therefore, we apply the Information-Motivation-Behavioral Skills (IMB) model as an organizing framework to advance understanding of CGM use as a complex, ongoing self-management behavior. We present a person-centered, dynamic perspective with the central thesis that IMB predictors of optimal CGM use vary based on the CGM use goal of the person with diabetes. This reframe emphasizes the importance of identifying and articulating each person's goal for CGM use to inform education and support.

  View details for DOI 10.1177/19322968241268560

  View details for PubMedID 39143688

• 'We're taught green is good': Perspectives on time in range and time in tight range from youth with type 1 diabetes, and parents of youth with type 1 diabetes. Diabetic medicine : a journal of the British Diabetic Association Tanenbaum, M. L., Pang, E., Tam, R., Bishop, F. K., Prahalad, P., Zaharieva, D. P., Addala, A., Wong, J. J., Naranjo, D., Hood, K. K., Maahs, D. M. 2024: e15423

  Abstract

  Continuous glucose monitoring (CGM) systems are standard of care for youth with type 1 diabetes with the goal of spending >70% time in range (TIR; 70-180 mg/dL, 3.9-10 mmol/L). We aimed to understand paediatric CGM user experiences with TIR metrics considering recent discussion of shifting to time in tight range (TITR; >50% time between 70 and 140 mg/dL, 3.9 and 7.8 mmol/L).Semi-structured interviews and focus groups with adolescents with type 1 diabetes and parents of youth with type 1 diabetes focused on experiences with TIR goals and reactions to TITR. Groups and interviews were audio-recorded, transcribed and analysed using content analysis.Thirty participants (N = 19 parents: age 43.6 ± 5.3 years, 79% female, 47% non-Hispanic White, 20 ± 5 months since child's diagnosis; N = 11 adolescents: age 15.3 ± 2 years, 55% female, 55% non-Hispanic White, 16 ± 3 months since diagnosis) attended. Participants had varying levels of understanding of TIR. Some developed personally preferred glucose ranges. Parents often aimed to surpass 70% TIR. Many described feelings of stress and disappointment when they did not meet a TIR goal. Concerns about TITR included increased stress and burden; risk of hypoglycaemia; and family conflict. Some participants said TITR would not change their daily lives; others said it would improve their diabetes management. Families requested care team support and a clear scientific rationale for TITR.The wealth of CGM data creates frequent opportunities for assessing diabetes management and carries implications for management burden. Input from people with type 1 diabetes and their families will be critical in considering a shift in glycaemic goals and targets.

  View details for DOI 10.1111/dme.15423

  View details for PubMedID 39118381

• Towards the standardisation of adult person-reported outcome domains in diabetes research: A Consensus Statement development panel. Diabetic medicine : a journal of the British Diabetic Association Barnard-Kelly, K., Marrero, D., de Wit, M., Pouwer, F., Khunti, K., Hermans, N., Pierce, J. S., Laffel, L., Holt, R. I., Battelino, T., Naranjo, D., Fosbury, J., Fisher, L., Polonsky, W., Weissberg-Benchell, J., Hood, K. K., Schnell, O., Messer, L. H., Danne, T., Nimri, R., Skovlund, S. E., Mader, J. K., Sherr, J. L., Schatz, D., O'Neill, S., Doble, E., Town, M., Lange, K., de Beaufort, C., Gonder-Frederick, L., Jaser, S. S., Liberman, A., Klonoff, D., ElSayed, N. A., Bannuru, R. R., Parkin, C. G., Snoek, F. 2024: e15332

  Abstract

  Diabetes is unique among chronic diseases because clinical outcomes are intimately tied to how the person living with diabetes reacts to and implements treatment recommendations. It is further characterised by widespread social stigma, judgement and paternalism. This physical, social and psychological burden collectively influences self-management behaviours. It is widely recognised that the individual's perspective about the impact of trying to manage the disease and the burden that self-management confers must be addressed to achieve optimal health outcomes. Standardised, rigorous assessment of mental and behavioural health status, in interaction with physical health outcomes is crucial to aid understanding of person-reported outcomes (PROs). Whilst tempting to conceptualise PROs as an issue of perceived quality of life (QoL), in fact health-related QoL is multi-dimensional and covers indicators of physical or functional health status, psychological and social well-being. This complexity is illuminated by the large number of person reported outcome measures (PROMs) that have been developed across multiple psychosocial domains. Often measures are used inappropriately or because they have been used in the scientific literature rather than based on methodological or outcome assessment rigour. Given the broad nature of psychosocial functioning/mental health, it is important to broadly define PROs that are evaluated in the context of therapeutic interventions, real-life and observational studies. This report summarises the central themes and lessons derived in the assessment and use of PROMs amongst adults with diabetes. Effective assessment of PROMs routinely in clinical research is crucial to understanding the true impact of any intervention. Selecting appropriate measures, relevant to the specific factors of PROs important in the research study will provide valuable data alongside physical health data.

  View details for DOI 10.1111/dme.15332

  View details for PubMedID 38751219

• An Exploratory Study Utilizing A Systems-Approach To Understand The Role Of Stress In Underserved Youth With Diabetes And Their Families Wu, C. A., Dasika, P., Hanes, S. J., Tanenbaum, M. L., Brown, L. M., Naranjo, D., Hood, K. K. OXFORD UNIV PRESS INC. 2024: 58

  View details for Web of Science ID 001271423400119

• Cost-Effectiveness of Closed-Loop Automated Insulin Delivery Using the Cambridge Hybrid Algorithm in Children and Adolescents with Type 1 Diabetes: Results from a Multicenter 6-Month Randomized Trial. Journal of diabetes science and technology Fox, D. S., Ware, J., Boughton, C. K., Allen, J. M., Wilinska, M. E., Tauschmann, M., Denvir, L., Thankamony, A., Campbell, F., Wadwa, R. P., Buckingham, B. A., Davis, N., DiMeglio, L. A., Mauras, N., Besser, R. E., Ghatak, A., Weinzimer, S. A., Kanapka, L., Kollman, C., Sibayan, J., Beck, R. W., Hood, K. K., Hovorka, R. 2024: 19322968241231950

  Abstract

  BACKGROUND/OBJECTIVE: The main objective of this study is to evaluate the incremental cost-effectiveness (ICER) of the Cambridge hybrid closed-loop automated insulin delivery (AID) algorithm versus usual care for children and adolescents with type 1 diabetes (T1D).METHODS: This multicenter, binational, parallel-controlled trial randomized 133 insulin pump using participants aged 6 to 18 years to either AID (n = 65) or usual care (n = 68) for 6 months. Both within-trial and lifetime cost-effectiveness were analyzed. Analysis focused on the treatment subgroup (n = 21) who received the much more reliable CamAPS FX hardware iteration and their contemporaneous control group (n = 24). Lifetime complications and costs were simulated via an updated Sheffield T1D policy model.RESULTS: Within-trial, both groups had indistinguishable and statistically unchanged health-related quality of life, and statistically similar hypoglycemia, severe hypoglycemia, and diabetic ketoacidosis (DKA) event rates. Total health care utilization was higher in the treatment group. Both the overall treatment group and CamAPS FX subgroup exhibited improved HbA1C (-0.32%, 95% CI: -0.59 to -0.04; P = .02, and -1.05%, 95% CI: -1.43 to -0.67; P < .001, respectively). Modeling projected increased expected lifespan of 5.36 years and discounted quality-adjusted life years (QALYs) of 1.16 (U.K. tariffs) and 1.52 (U.S. tariffs) in the CamAPS FX subgroup. Estimated ICERs for the subgroup were 19324/QALY (United Kingdom) and -$3917/QALY (United States). For subgroup patients already using continuous glucose monitors (CGM), ICERs were 10096/QALY (United Kingdom) and -$33616/QALY (United States). Probabilistic sensitivity analysis generated mean ICERs of 19342/QALY (95% CI: 15903/QALY to 22929/QALY) (United Kingdom) and -$28283/QALY (95% CI: -$59607/QALY to $1858/QALY) (United States).CONCLUSIONS: For children and adolescents with T1D on insulin pump therapy, AID using the Cambridge algorithm appears cost-effective below a 20000/QALY threshold (United Kingdom) and cost saving (United States).

  View details for DOI 10.1177/19322968241231950

  View details for PubMedID 38494876

• Satisfaction with diabetes involvement: Exploring parent and adolescent perspectives. Diabetic medicine : a journal of the British Diabetic Association Wong, J. J., Hanes, S. J., Flores, H., Ngo, J., Hood, K. K. 2023: e15254

  Abstract

  Both parent and adolescent involvement in type 1 diabetes management are critical during adolescence. The current study sought to understand the factors associated with parent and adolescent satisfaction with their own and one another's involvement in diabetes management.Cross-sectional baseline data from 157 parent-adolescent dyads enrolled in an RCT were used. Adolescent ages ranged from 12 to 19 (Mage  = 14.7, SD = 1.89) and were balanced by gender (50.3% male). Paired t-tests examined concordance between parent and adolescent satisfaction, bivariate correlations identified correlates, and regressions examined unique associations.Roughly, 43% of adolescents and 29% of parents were very satisfied with adolescent involvement in diabetes management, whereas 71% of adolescents and 26.1% of parents were very satisfied with parent involvement. Indicators of better glycaemic health (via higher percent time-in-range and lower HbA1c and percent time in hyperglycaemia) and psychosocial functioning (less diabetes distress and depression) were correlated with higher satisfaction. Parent satisfaction with adolescent involvement was higher among older adolescents (R = 0.198, p = 0.013). Non-Hispanic white youth were more satisfied with their own involvement than youth of colour (t(149) = -2.783, p = 0.003). Both percent time-in-range and one's own diabetes distress uniquely related to parent and adolescent satisfaction with adolescent involvement. Conversely, parent satisfaction with their own involvement was only uniquely associated with parent diabetes distress.Both adolescent and parents' satisfaction with adolescents' involvement in self-management are indicators of both glycaemic control and psychosocial well-being, whereas parents' self-evaluations are more closely tied to diabetes-specific distress.

  View details for DOI 10.1111/dme.15254

  View details for PubMedID 38010056

• "It changed everything we do": A mixed methods study of youth and parent experiences with a pilot exercise education intervention following new diagnosis of type 1 diabetes. Journal of diabetes and its complications Tanenbaum, M. L., Addala, A., Hanes, S., Ritter, V., Bishop, F. K., Cortes, A. L., Pang, E., Hood, K. K., Maahs, D. M., Zaharieva, D. P. 2023; 38 (1): 108651

  Abstract

  This pilot study delivered a comprehensive exercise education intervention to youth with new-onset type 1 diabetes (T1D) and their parents to increase knowledge and confidence with physical activity (PA) shortly after diagnosis.Youth initiated continuous glucose monitoring (CGM) and PA trackers within 1 month of diagnosis. Youth and their parents received the 4-session intervention over 12 months. Participants completed self-report questionnaires at baseline, 6- and 12-months. Surveys were analyzed using linear mixed effects models. Semi-structured interviews and focus groups explored experiences with the exercise education intervention. Groups and interviews were audio-recorded, transcribed, and analyzed using content analysis.A total of 16 parents (aged 46 ± 7 years; 88 % female; 67 % non-Hispanic White) and 17 youth (aged 14 ± 2 years; 41 % female; 65 % non-Hispanic White) participated. Worry about hypoglycemia did not worsen throughout the study duration. Parents and youth reported increased knowledge and confidence in managing T1D safely and preventing hypoglycemia during PA following receiving the tailored exercise education intervention.This study assessed a novel structured exercise education program for youth and their parents shortly following T1D diagnosis. These results support the broad translation and acceptability of a structured exercise education program in new-onset T1D.

  View details for DOI 10.1016/j.jdiacomp.2023.108651

  View details for PubMedID 38043358

• Diabetic ketoacidosis (DKA) at diagnosis in youth with type 1 diabetes (T1D) is associated with a higher hemoglobin A1c even with intensive insulin management. Diabetes technology & therapeutics Zaharieva, D. P., Ding, V., Addala, A., Prahalad, P., Bishop, F., Hood, K., Desai, M., Wilson, D. M., Buckingham, B. A., Maahs, D. M. 2023

  Abstract

  Diabetic ketoacidosis (DKA) at diagnosis is associated with short- and long-term complications. We assessed the relationship between DKA status and hemoglobin A1c (A1c) levels in the first year following type 1 diabetes (T1D) diagnosis.The Pilot 4T study offered continuous glucose monitoring to youth with T1D within 1 month of diagnosis. A1c levels were compared between historical (n=271) and Pilot 4T (n=135) cohorts stratified by DKA status at diagnosis (DKA: historical=94, 4T=67 vs without DKA historical=177, 4T=68). A1c was evaluated using locally estimated scatter plot smoothing. Change in A1c from 4- to 12-months post-diagnosis was evaluated using a linear mixed model.Median age was 9.7 [IQR: 6.6, 12.7] vs 9.7 [IQR: 6.8, 12.7] years, 49% vs 47% female, 44% vs 39% Non-Hispanic White in historical vs Pilot 4T. In historical and 4T cohorts, DKA at diagnosis demonstrated higher A1c at 6 (0.5% [95%CI: 0.21, 0.79; p<0.01] and 0.38% [95% CI: 0.02, 0.74; p=0.04], respectively) and 12 months (0.62% [95% CI: -0.06, 1.29; p=0.07] and 0.39% [95% CI: -0.32, 1.10; p=0.29], respectively). The highest % time in range (TIR; 70-180 mg/dL) was seen between weeks 15-20 (69%) vs 25-30 (75%) post-diagnosis for youth with vs without DKA in Pilot 4T, respectively.Pilot 4T improved A1c outcomes vs the historical cohort, but those with DKA at diagnosis had persistently elevated A1c throughout the study and intensive diabetes management did not mitigate this difference. DKA prevention at diagnosis may translate into better glycemic outcomes in the first year post-diagnosis.

  View details for DOI 10.1089/dia.2023.0405

  View details for PubMedID 37955644

• Evaluation of a Novel Eating Disorder Prevention Program for Young Women with Type 1 Diabetes: A Preliminary Randomized Trial. Diabetes research and clinical practice Stice, E., Wisting, L., David Desjardins, C., Hood, K. K., Hanes, S., Rubino, L., Shaw, H. 2023: 110997

  Abstract

  Evaluate whether the Body Project prevention program adapted for young women with type 1 diabetes (Diabetes Body Project) reduces eating disorder (ED) risk factors and symptoms.Young women (aged 15-30) at high-risk for EDs due to having type 1 diabetes and body image concerns (N = 55) were randomized to virtually delivered Diabetes Body Project groups or an educational control condition, completing measures at pretest, posttest, and 3-month follow-up.Diabetes Body Project versus the control participants showed significantly greater reductions in thin-ideal internalization, body dissatisfaction, diabetes distress, diabetes eating pathology, and ED symptoms by posttest, and greater reductions in diabetes eating pathology and ED symptoms, and greater improvements in quality of life by 3-month follow-up, which were medium to large effects (d's ranged from -.43 to -.90). Although control participants showed a worsening of glycemic control (time in range) verses Diabetes Body Project participants, this difference was non-significant (d = .26).Virtually delivered Diabetes Body Project decreased ED risk factors and symptoms in young women with type 1 diabetes. A well powered randomized controlled trial is warranted to evaluate this intervention over longer follow-up.

  View details for DOI 10.1016/j.diabres.2023.110997

  View details for PubMedID 37951479

• Continuous Glucose Monitoring Provides Durable Glycemic Benefit in Adolescents and Young Adults with Type 1 Diabetes: 12-Month Follow-Up Results PEDIATRIC DIABETES Miller, K. M., Bauza, C., Kanapka, L. G., Clements, M. A., Desalvo, D. J., Hood, K., Messer, L. H., Sherr, J., Bergamo, K., Criego, A., Freiner, E., Lyons, S. K., Monzavi, R., Moore, W., Prahalad, P., Simmons, J. H., Sulik, M., Wadwa, R., Weinstock, R. S., Willi, S. M., Williams, K., Laffel, L. M., CITY Study Grp 2023; 2023

  View details for DOI 10.1155/2023/6718115

  View details for Web of Science ID 001097195800001

• Second international consensus report on gaps and opportunities for the clinical translation of precision diabetes medicine. Nature medicine Tobias, D. K., Merino, J., Ahmad, A., Aiken, C., Benham, J. L., Bodhini, D., Clark, A. L., Colclough, K., Corcoy, R., Cromer, S. J., Duan, D., Felton, J. L., Francis, E. C., Gillard, P., Gingras, V., Gaillard, R., Haider, E., Hughes, A., Ikle, J. M., Jacobsen, L. M., Kahkoska, A. R., Kettunen, J. L., Kreienkamp, R. J., Lim, L. L., Männistö, J. M., Massey, R., Mclennan, N. M., Miller, R. G., Morieri, M. L., Most, J., Naylor, R. N., Ozkan, B., Patel, K. A., Pilla, S. J., Prystupa, K., Raghavan, S., Rooney, M. R., Schön, M., Semnani-Azad, Z., Sevilla-Gonzalez, M., Svalastoga, P., Takele, W. W., Tam, C. H., Thuesen, A. C., Tosur, M., Wallace, A. S., Wang, C. C., Wong, J. J., Yamamoto, J. M., Young, K., Amouyal, C., Andersen, M. K., Bonham, M. P., Chen, M., Cheng, F., Chikowore, T., Chivers, S. C., Clemmensen, C., Dabelea, D., Dawed, A. Y., Deutsch, A. J., Dickens, L. T., DiMeglio, L. A., Dudenhöffer-Pfeifer, M., Evans-Molina, C., Fernández-Balsells, M. M., Fitipaldi, H., Fitzpatrick, S. L., Gitelman, S. E., Goodarzi, M. O., Grieger, J. A., Guasch-Ferré, M., Habibi, N., Hansen, T., Huang, C., Harris-Kawano, A., Ismail, H. M., Hoag, B., Johnson, R. K., Jones, A. G., Koivula, R. W., Leong, A., Leung, G. K., Libman, I. M., Liu, K., Long, S. A., Lowe, W. L., Morton, R. W., Motala, A. A., Onengut-Gumuscu, S., Pankow, J. S., Pathirana, M., Pazmino, S., Perez, D., Petrie, J. R., Powe, C. E., Quinteros, A., Jain, R., Ray, D., Ried-Larsen, M., Saeed, Z., Santhakumar, V., Kanbour, S., Sarkar, S., Monaco, G. S., Scholtens, D. M., Selvin, E., Sheu, W. H., Speake, C., Stanislawski, M. A., Steenackers, N., Steck, A. K., Stefan, N., Støy, J., Taylor, R., Tye, S. C., Ukke, G. G., Urazbayeva, M., Van der Schueren, B., Vatier, C., Wentworth, J. M., Hannah, W., White, S. L., Yu, G., Zhang, Y., Zhou, S. J., Beltrand, J., Polak, M., Aukrust, I., de Franco, E., Flanagan, S. E., Maloney, K. A., McGovern, A., Molnes, J., Nakabuye, M., Njølstad, P. R., Pomares-Millan, H., Provenzano, M., Saint-Martin, C., Zhang, C., Zhu, Y., Auh, S., de Souza, R., Fawcett, A. J., Gruber, C., Mekonnen, E. G., Mixter, E., Sherifali, D., Eckel, R. H., Nolan, J. J., Philipson, L. H., Brown, R. J., Billings, L. K., Boyle, K., Costacou, T., Dennis, J. M., Florez, J. C., Gloyn, A. L., Gomez, M. F., Gottlieb, P. A., Greeley, S. A., Griffin, K., Hattersley, A. T., Hirsch, I. B., Hivert, M. F., Hood, K. K., Josefson, J. L., Kwak, S. H., Laffel, L. M., Lim, S. S., Loos, R. J., Ma, R. C., Mathieu, C., Mathioudakis, N., Meigs, J. B., Misra, S., Mohan, V., Murphy, R., Oram, R., Owen, K. R., Ozanne, S. E., Pearson, E. R., Perng, W., Pollin, T. I., Pop-Busui, R., Pratley, R. E., Redman, L. M., Redondo, M. J., Reynolds, R. M., Semple, R. K., Sherr, J. L., Sims, E. K., Sweeting, A., Tuomi, T., Udler, M. S., Vesco, K. K., Vilsbøll, T., Wagner, R., Rich, S. S., Franks, P. W. 2023

  Abstract

  Precision medicine is part of the logical evolution of contemporary evidence-based medicine that seeks to reduce errors and optimize outcomes when making medical decisions and health recommendations. Diabetes affects hundreds of millions of people worldwide, many of whom will develop life-threatening complications and die prematurely. Precision medicine can potentially address this enormous problem by accounting for heterogeneity in the etiology, clinical presentation and pathogenesis of common forms of diabetes and risks of complications. This second international consensus report on precision diabetes medicine summarizes the findings from a systematic evidence review across the key pillars of precision medicine (prevention, diagnosis, treatment, prognosis) in four recognized forms of diabetes (monogenic, gestational, type 1, type 2). These reviews address key questions about the translation of precision medicine research into practice. Although not complete, owing to the vast literature on this topic, they revealed opportunities for the immediate or near-term clinical implementation of precision diabetes medicine; furthermore, we expose important gaps in knowledge, focusing on the need to obtain new clinically relevant evidence. Gaps include the need for common standards for clinical readiness, including consideration of cost-effectiveness, health equity, predictive accuracy, liability and accessibility. Key milestones are outlined for the broad clinical implementation of precision diabetes medicine.

  View details for DOI 10.1038/s41591-023-02502-5

  View details for PubMedID 37794253

  View details for PubMedCentralID 8563635

• Utility and precision evidence of technology in the treatment of type 1 diabetes: a systematic review. Communications medicine Jacobsen, L. M., Sherr, J. L., Considine, E., Chen, A., Peeling, S. M., Hulsmans, M., Charleer, S., Urazbayeva, M., Tosur, M., Alamarie, S., Redondo, M. J., Hood, K. K., Gottlieb, P. A., Gillard, P., Wong, J. J., Hirsch, I. B., Pratley, R. E., Laffel, L. M., Mathieu, C. 2023; 3 (1): 132

  Abstract

  The greatest change in the treatment of people living with type 1 diabetes in the last decade has been the explosion of technology assisting in all aspects of diabetes therapy, from glucose monitoring to insulin delivery and decision making. As such, the aim of our systematic review was to assess the utility of these technologies as well as identify any precision medicine-directed findings to personalize care.Screening of 835 peer-reviewed articles was followed by systematic review of 70 of them (focusing on randomized trials and extension studies with ≥50 participants from the past 10 years).We find that novel technologies, ranging from continuous glucose monitoring systems, insulin pumps and decision support tools to the most advanced hybrid closed loop systems, improve important measures like HbA1c, time in range, and glycemic variability, while reducing hypoglycemia risk. Several studies included person-reported outcomes, allowing assessment of the burden or benefit of the technology in the lives of those with type 1 diabetes, demonstrating positive results or, at a minimum, no increase in self-care burden compared with standard care. Important limitations of the trials to date are their small size, the scarcity of pre-planned or powered analyses in sub-populations such as children, racial/ethnic minorities, people with advanced complications, and variations in baseline glycemic levels. In addition, confounders including education with device initiation, concomitant behavioral modifications, and frequent contact with the healthcare team are rarely described in enough detail to assess their impact.Our review highlights the potential of technology in the treatment of people living with type 1 diabetes and provides suggestions for optimization of outcomes and areas of further study for precision medicine-directed technology use in type 1 diabetes.

  View details for DOI 10.1038/s43856-023-00358-x

  View details for PubMedID 37794113

  View details for PubMedCentralID 8481000

• Comprehensive Telehealth Model to Support Diabetes Self-Management. JAMA network open Aleppo, G., Gal, R. L., Raghinaru, D., Kruger, D., Beck, R. W., Bergenstal, R. M., Cushman, T., Hood, K. K., Johnson, M. L., McArthur, T., Bradshaw, A., Olson, B. A., Oser, S. M., Oser, T. K., Kollman, C., Weinstock, R. S. 2023; 6 (10): e2336876

  Abstract

  As the number of patients with diabetes continues to increase in the United States, novel approaches to clinical care access should be considered to meet the care needs for this population, including support for diabetes-related technology.To evaluate a virtual clinic to facilitate comprehensive diabetes care, support continuous glucose monitoring (CGM) integration into diabetes self-management, and provide behavioral health support for diabetes-related issues.This cohort study was a prospective, single-arm, remote study involving adult participants with type 1 or type 2 diabetes who were referred through community resources. The study was conducted virtually from August 24, 2020, to May 26, 2022; analysis was conducted at the clinical coordinating center.Training and education led by a Certified Diabetes Care and Education Specialist for CGM use through a virtual endocrinology clinic structure, which included endocrinologists and behavioral health team members.Main outcomes included CGM-measured mean glucose level, coefficient of variation, and time in range (TIR) of 70 to 180 mg/dL, time with values greater than 180 mg/dL or 250 mg/dL, and time with values less than 70 mg/dL or 54 mg/dL. Hemoglobin A1c was measured at baseline and at 12 and 24 weeks.Among the 234 participants, 160 had type 1 diabetes and 74 had type 2 diabetes. The mean (SD) age was 47 (14) years, 123 (53%) were female, and median diabetes duration was 20 years. Median (IQR) CGM use over 6 months was 96% (91%-98%) for participants with type 1 diabetes and 94% (85%-97%) for those with type 2 diabetes. Mean (SD) hemoglobin A1c (HbA1c) in those with type 1 diabetes decreased from 7.8% (1.6%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (1.0%) at 6 months (mean change from baseline to 6 months, -0.6%, 95% CI, -0.8% to -0.5%; P < .001), with an 11% mean TIR increase over 6 months (95% CI, 9% to 14%; P < .001). Mean HbA1c in participants with type 2 diabetes decreased from 8.1% (1.7%) at baseline to 7.1% (1.0%) at 3 months and 7.1% (0.9%) at 6 months (mean change from baseline to 6 months, -1.0%; 95% CI, -1.4% to -0.7%; P < .001), with an 18% TIR increase over 6 months (95% CI, 13% to 24%; P < .001). In participants with type 1 diabetes, mean percentage of time with values less than 70 mg/dL and less than 54 mg/dL decreased over 6 months by 0.8% (95% CI, -1.2% to -0.4%; P = .001) and by 0.3% (95% CI, -0.5% to -0.2%, P < .001), respectively. In the type 2 diabetes group, hypoglycemia was rare (mean [SD] percentage of time <70 mg/dL, 0.5% [0.6%]; and <54 mg/dL, 0.07% [0.14%], over 6 months).Results from this cohort study demonstrated clinical benefits associated with implementation of a comprehensive care model that included diabetes education. This model of care has potential to reach a large portion of patients with diabetes, facilitate diabetes technology adoption, and improve glucose control.

  View details for DOI 10.1001/jamanetworkopen.2023.36876

  View details for PubMedID 37792375

• Adolescent- and Young Adult-Reported Outcomes and Use of Continuous Glucose Monitoring Features: A Report from the CITY Trial PEDIATRIC DIABETES Messer, L. H., Bauza, C., Miller, K. M., Clements, M. A., Desalvo, D. J., Sherr, J., Weinstock, R. S., Hood, K., Laffel, L. M. 2023; 2023

  View details for DOI 10.1155/2023/6906023

  View details for Web of Science ID 001070816200001

• The Promising Success of Project Extension for Community Healthcare Outcomes (ECHO) Diabetes: Case Series. JMIR diabetes Figg, L., Addala, A., Jain, I., Anez, C., Midney, P., DeChirico, C., Symanski, C., Fitzgerald, B. C., Colbert, K., Raymer, T., Stockton-Joreteg, C., Murphy, E., Collins, L., Bernstein, C., Hechavarria, M., Sheehan, E. P., Bernier, A., Westen, S. C., Hood, K. K., Zaharieva, D. P., Basina, M., Cuttriss, N., Filipp, S. L., Gurka, M. J., Walker, A. F., Maahs, D. M., Haller, M. J., Lal, R. A. 2023; 8: e46050

  Abstract

  In the United States, there are over 37 million people with diabetes but only 8000 endocrinologists. Therefore, many people with diabetes receive care exclusively from primary care providers (PCPs). To democratize knowledge regarding insulin-requiring diabetes through tele-education, Stanford University and the University of Florida developed Project Extension for Community Healthcare Outcomes (ECHO) Diabetes.ECHO Diabetes uses a Hub and Spoke model connecting specialists (the "Hub") with PCPs (the "Spokes"). One-hour, weekly sessions include Hub diabetes didactic presentations and Spoke deidentified case presentations. Lessons learned during these sessions target provider knowledge and confidence surrounding diabetes management and patient care.Spokes were asked to provide short descriptions of people with diabetes whose diabetes management improved directly or indirectly from their providers' participation or their involvement with a Diabetes Support Coach (DSC). We provide a case series to describe individuals and outcomes. Because this study was not a randomized controlled trial and was a prospective observation of patients with the intervention delivered to providers, the trial is not registered in a public trials registry.A case series of 11 people with diabetes was compiled from 10 PCPs and 1 DSC from California and Florida between 2021 and 2022. The principal impact of ECHO Diabetes is the education amplified from PCPs and DSCs to people with diabetes. In all cases, people with diabetes reported increased engagement and improved diabetes management. Several cases reflected increased access to diabetes technology, improvement in glycemic outcomes, and positive trends in mental health measures.This case series elucidates the potential value of the ECHO Diabetes program to people with diabetes who receive their diabetes care from PCPs. Those matched with a DSC saw clinically significant improvements in hemoglobin A1c and mental health outcomes.

  View details for DOI 10.2196/46050

  View details for PubMedID 37535407

• Psychosocial Outcomes with the Omnipod & REG; 5 Automated Insulin Delivery System in Children and Adolescents with Type 1 Diabetes and Their Caregivers PEDIATRIC DIABETES Hood, K. K., Polonsky, W. H., MacLeish, S. A., Levy, C. J., Forlenza, G. P., Criego, A. B., Buckingham, B. A., Bode, B. W., Hansen, D. W., Sherr, J. L., Brown, S. A., DeSalvo, D. J., Mehta, S. N., Laffel, L. M., Bhargava, A., Huyett, L. M., Vienneau, T. E., Ly, T. T. 2023; 2023

  View details for DOI 10.1155/2023/8867625

  View details for Web of Science ID 001025888300002

• Expanding the use of patient-reported outcomes (PROs): Screening youth with type 1 diabetes from underrepresented populations. Journal of diabetes and its complications Addala, A., Wong, J. J., Penaranda, R. M., Hanes, S. J., Abujaradeh, H., Adams, R. N., Barley, R. C., Iturralde, E., Lanning, M. S., Tanenbaum, M. L., Naranjo, D., Hood, K. K. 2023; 37 (7): 108514

  Abstract

  Youth from lower socioeconomic status (SES) have suboptimal type 1 diabetes (T1D) outcomes. Patient reported outcomes (PROs) measure psychosocial states and are associated with T1D outcomes, however are understudied in low SES youth. We aimed to evaluate associations between PROs and public insurance status, a proxy for low SES.We analyzed survey data from 129 youth with T1D (age 15.7 ± 2.3 years, 33 % publicly insured) screened with PROMIS Global Health (PGH, measuring global health) and Patient Health Questionnaire (PHQ-9, measuring depressive symptoms) during diabetes appointments. Correlation and regression analyses evaluated differences in PGH and PHQ-9 by insurance status.For youth with public insurance, lower global health correlated with lower self-monitoring blood glucose (SMBG; r = 0.38,p = 0.033) and older age (r = -0.45,p = 0.005). In youth with private insurance, lower global health correlated with lower SMBG (r = 0.27,p = 0.018) and female sex (rho = 0.26,p = 0.015). For youth with private insurance, higher depressive symptoms correlated with higher body mass index (r = 0.22,p = 0.03) and fewer SMBG (r = -0.35,p = 0.04). In multivariate regression analyses, public insurance was inversely associated with global health (p = 0.027).PGH is a particularly salient PRO in youth with public insurance. Global health may be an important psychosocial factor to assess in youth with T1D from low SES backgrounds.

  View details for DOI 10.1016/j.jdiacomp.2023.108514

  View details for PubMedID 37263033

• Development and validation of fear of hypoglycemia screener: results from the T1D exchange registry. Journal of patient-reported outcomes Liu, J., Poon, J., Bispham, J., Perez-Nieves, M., Hughes, A., Chapman, K., Mitchell, B., Hood, K., Snoek, F., Fisher, L. 2023; 7 (1): 43

  Abstract

  BACKGROUND: Fear of Hypoglycemia (FoH) in people with diabetes has a significant impact on their quality of life, psychological well-being, and self-management of disease. There are a few questionnaires assessing FoH in people living with diabetes, but they are more often used in research than clinical practice. This study aimed to develop and validate a short and actionable FoH screener for adults living with type 1 diabetes (T1D) for use in routine clinical practice.METHODS: We developed an initial screener based on literature review and, interviews with healthcare providers (HCPs) and people with T1D. We developed a cross-sectional web-based survey, which was then conducted to examine the reliability and validity of the screener. Adults (aged≥18 years) with diagnosis of T1D for ≥1 year were recruited from the T1D Exchange Registry (August-September 2020). The validation analyses were conducted using exploratory factor analyses, correlation, and multivariable regression models for predicting cut-off scores for the final screener.RESULTS: The final FoH screener comprised nine items assessing two domains, "worry" (6-items) and "avoidance behavior" (three items), in 592 participants. The FoH screener showed good internal consistency (Cronbach's alpha=0.88). The screener also demonstrated high correlations (r=0.71-0.75) with the Hypoglycemia Fear Survey and moderate correlations with depression, anxiety, and diabetes distress scales (r=0.44-0.66). Multivariable regression analysis showed that higher FoH screener scores were significantly associated with higher glycated hemoglobin (HbA1c) (b=0.04) and number of comorbidities (b=0.03).CONCLUSIONS: This short FoH screener demonstrated good reliability and validity. Further research is planned to assess clinical usability to identify patients with FoH and assist effective HCP-patient conversations.

  View details for DOI 10.1186/s41687-023-00585-9

  View details for PubMedID 37160500

• Disparities in Hemoglobin A1c Levels in the First Year After Diagnosis Among Youths With Type 1 Diabetes Offered Continuous Glucose Monitoring. JAMA network open Addala, A., Ding, V., Zaharieva, D. P., Bishop, F. K., Adams, A. S., King, A. C., Johari, R., Scheinker, D., Hood, K. K., Desai, M., Maahs, D. M., Prahalad, P. 2023; 6 (4): e238881

  Abstract

  Continuous glucose monitoring (CGM) is associated with improvements in hemoglobin A1c (HbA1c) in youths with type 1 diabetes (T1D); however, youths from minoritized racial and ethnic groups and those with public insurance face greater barriers to CGM access. Early initiation of and access to CGM may reduce disparities in CGM uptake and improve diabetes outcomes.To determine whether HbA1c decreases differed by ethnicity and insurance status among a cohort of youths newly diagnosed with T1D and provided CGM.This cohort study used data from the Teamwork, Targets, Technology, and Tight Control (4T) study, a clinical research program that aims to initiate CGM within 1 month of T1D diagnosis. All youths with new-onset T1D diagnosed between July 25, 2018, and June 15, 2020, at Stanford Children's Hospital, a single-site, freestanding children's hospital in California, were approached to enroll in the Pilot-4T study and were followed for 12 months. Data analysis was performed and completed on June 3, 2022.All eligible participants were offered CGM within 1 month of diabetes diagnosis.To assess HbA1c change over the study period, analyses were stratified by ethnicity (Hispanic vs non-Hispanic) or insurance status (public vs private) to compare the Pilot-4T cohort with a historical cohort of 272 youths diagnosed with T1D between June 1, 2014, and December 28, 2016.The Pilot-4T cohort comprised 135 youths, with a median age of 9.7 years (IQR, 6.8-12.7 years) at diagnosis. There were 71 boys (52.6%) and 64 girls (47.4%). Based on self-report, participants' race was categorized as Asian or Pacific Islander (19 [14.1%]), White (62 [45.9%]), or other race (39 [28.9%]); race was missing or not reported for 15 participants (11.1%). Participants also self-reported their ethnicity as Hispanic (29 [21.5%]) or non-Hispanic (92 [68.1%]). A total of 104 participants (77.0%) had private insurance and 31 (23.0%) had public insurance. Compared with the historical cohort, similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were observed for Hispanic individuals (estimated difference, -0.26% [95% CI, -1.05% to 0.43%], -0.60% [-1.46% to 0.21%], and -0.15% [-1.48% to 0.80%]) and non-Hispanic individuals (estimated difference, -0.27% [95% CI, -0.62% to 0.10%], -0.50% [-0.81% to -0.11%], and -0.47% [-0.91% to 0.06%]) in the Pilot-4T cohort. Similar reductions in HbA1c at 6, 9, and 12 months postdiagnosis were also observed for publicly insured individuals (estimated difference, -0.52% [95% CI, -1.22% to 0.15%], -0.38% [-1.26% to 0.33%], and -0.57% [-2.08% to 0.74%]) and privately insured individuals (estimated difference, -0.34% [95% CI, -0.67% to 0.03%], -0.57% [-0.85% to -0.26%], and -0.43% [-0.85% to 0.01%]) in the Pilot-4T cohort. Hispanic youths in the Pilot-4T cohort had higher HbA1c at 6, 9, and 12 months postdiagnosis than non-Hispanic youths (estimated difference, 0.28% [95% CI, -0.46% to 0.86%], 0.63% [0.02% to 1.20%], and 1.39% [0.37% to 1.96%]), as did publicly insured youths compared with privately insured youths (estimated difference, 0.39% [95% CI, -0.23% to 0.99%], 0.95% [0.28% to 1.45%], and 1.16% [-0.09% to 2.13%]).The findings of this cohort study suggest that CGM initiation soon after diagnosis is associated with similar improvements in HbA1c for Hispanic and non-Hispanic youths as well as for publicly and privately insured youths. These results further suggest that equitable access to CGM soon after T1D diagnosis may be a first step to improve HbA1c for all youths but is unlikely to eliminate disparities entirely.ClinicalTrials.gov Identifier: NCT04336969.

  View details for DOI 10.1001/jamanetworkopen.2023.8881

  View details for PubMedID 37074715

  View details for PubMedCentralID PMC10116368

• Trial of Hybrid Closed-Loop Control in Young Children with Type 1 Diabetes. The New England journal of medicine Wadwa, R. P., Reed, Z. W., Buckingham, B. A., DeBoer, M. D., Ekhlaspour, L., Forlenza, G. P., Schoelwer, M., Lum, J., Kollman, C., Beck, R. W., Breton, M. D., PEDAP Trial Study Group, Wadwa, R. P., Forlenza, G., Slover, R., Cobry, E., Messer, L., Geiser, L., Lange, S., Karami, A., Berget, C., Escobar, E., Jost, E., Towers, L., Boranian, E., Buckingham, B., Norlander, L., Ekhlaspour, L., Hood, K., Kingman, R., Suh, B., Morgan, M., Schneider-Utaka, A., Breton, M., DeBoer, M., Schoelwer, M., Emory, E., Krauthause, K., Sullivan, K., Oliveri, M., Cullipher, D., Lum, J., Beck, R., Reed, Z., Kollman, C., Morales, A., Hiser, S., Murphy, C., Strayer, H., Davis, J., Hellmann, A., Arreaza-Rubin, G., Eggerman, T., Green, N., Janicek, R., Gabrielson, D., Van Kirk, G., Conschafter, K., Stamates-Roerty, T., Belle, S. H., Castle, J., Green, J., Legault, L., Willi, S. M., Wysham, C. 2023; 388 (11): 991-1001

  Abstract

  BACKGROUND: Closed-loop control systems of insulin delivery may improve glycemic outcomes in young children with type 1 diabetes. The efficacy and safety of initiating a closed-loop system virtually are unclear.METHODS: In this 13-week, multicenter trial, we randomly assigned, in a 2:1 ratio, children who were at least 2 years of age but younger than 6 years of age who had type 1 diabetes to receive treatment with a closed-loop system of insulin delivery or standard care that included either an insulin pump or multiple daily injections of insulin plus a continuous glucose monitor. The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring. Secondary outcomes included the percentage of time that the glucose level was above 250 mg per deciliter or below 70 mg per deciliter, the mean glucose level, the glycated hemoglobin level, and safety outcomes.RESULTS: A total of 102 children underwent randomization (68 to the closed-loop group and 34 to the standard-care group); the glycated hemoglobin levels at baseline ranged from 5.2 to 11.5%. Initiation of the closed-loop system was virtual in 55 patients (81%). The mean (±SD) percentage of time that the glucose level was within the target range increased from 56.7±18.0% at baseline to 69.3±11.1% during the 13-week follow-up period in the closed-loop group and from 54.9±14.7% to 55.9±12.6% in the standard-care group (mean adjusted difference, 12.4 percentage points [equivalent to approximately 3 hours per day]; 95% confidence interval, 9.5 to 15.3; P<0.001). We observed similar treatment effects (favoring the closed-loop system) on the percentage of time that the glucose level was above 250 mg per deciliter, on the mean glucose level, and on the glycated hemoglobin level, with no significant between-group difference in the percentage of time that the glucose level was below 70 mg per deciliter. There were two cases of severe hypoglycemia in the closed-loop group and one case in the standard-care group. One case of diabetic ketoacidosis occurred in the closed-loop group.CONCLUSIONS: In this trial involving young children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with a closed-loop system than with standard care. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases; PEDAP ClinicalTrials.gov number, NCT04796779.).

  View details for DOI 10.1056/NEJMoa2210834

  View details for PubMedID 36920756

• Project ECHO Diabetes Cost Modeling to Support the Replication and Expansion of Tele-mentoring Programs in Non-research Settings. Diabetes therapy : research, treatment and education of diabetes and related disorders Lewit, E. M., Figg, L. E., Addala, A., Filipp, S. L., Lal, R., Gurka, M. J., Herndon, J. B., Haller, M. J., Maahs, D. M., Walker, A. F. 2023

  Abstract

  Project ECHO Diabetes is a tele-education learning model for primary care providers (PCPs) seeking to improve care for patients with diabetes from marginalized communities. Project ECHO Diabetes utilized expert "hub" teams comprising endocrinologists, dieticians, nurses, psychologists, and social workers and "spokes" consisting of PCPs and their patients with diabetes. This Project ECHO Diabetes model provided diabetes support coaches to provide additional support to patients. We sought to estimate the costs of operating a Project ECHO Diabetes hub, inclusive of diabetes support coach costs.Data from Project ECHO Diabetes from June 2021 to June 2022 and wages from national databases were used to estimate hub and diabetes support coach costs to operate a 6-month, 24-session Project ECHO Diabetes program at hubs (University of Florida and Stanford University) and spokes (PCP clinic sites in Florida and California).Hub costs for delivering a 6-month Project ECHO Diabetes program to five spoke clinics were $96,873. Personnel costs were the principal driver. Mean cost was $19,673 per spoke clinic and $11.37 per spoke clinic patient. Diabetes support coach costs were estimated per spoke clinic and considered scalable in that they would increase proportionately with the number of spoke clinics in a Project ECHO Diabetes cohort. Mean diabetes support coach costs were $6,506 per spoke clinic and $3.72 per patient. Total program costs per hub were $129,404. Mean cost per clinic was $25,881. Mean cost per patient was $15.03.Herein, we document real-world costs to operate a Project ECHO Diabetes hub and diabetes support coaches. Future analysis of Project ECHO Diabetes will include estimates of spoke participation costs and changes in health care costs and savings. As state agencies, insurers, and philanthropies consider the replication of Project ECHO Diabetes, this analysis provides important initial information regarding primary operating costs.

  View details for DOI 10.1007/s13300-022-01364-3

  View details for PubMedID 36680682

• ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes technologies: Glucose monitoring. Pediatric diabetes Tauschmann, M., Forlenza, G., Hood, K., Cardona-Hernandez, R., Giani, E., Hendrieckx, C., DeSalvo, D. J., Laffel, L. M., Saboo, B., Wheeler, B. J., Latpev, D. N., Yarhere, I., DiMeglio, L. A. 2022; 23 (8): 1390-1405

  View details for DOI 10.1111/pedi.13451

  View details for PubMedID 36537528

• Consensus Recommendations for the Use of Automated Insulin Delivery (AID) Technologies in Clinical Practice. Endocrine reviews Phillip, M., Nimri, R., Bergenstal, R. M., Barnard-Kelly, K., Danne, T., Hovorka, R., Kovatchev, B. P., Messer, L. H., Parkin, C. G., Ambler-Osborn, L., Amiel, S. A., Bally, L., Beck, R. W., Biester, S., Biester, T., Blanchette, J. E., Bosi, E., Boughton, C. K., Breton, M. D., Brown, S. A., Buckingham, B. A., Cai, A., Carlson, A. L., Castle, J. R., Choudhary, P., Close, K. L., Cobelli, C., Criego, A. B., Davis, E., de Beaufort, C., de Bock, M. I., DeSalvo, D. J., DeVries, J. H., Dovc, K., Doyle, F. J., Ekhlaspour, L., Shvalb, N. F., Forlenza, G. P., Gallen, G., Garg, S. K., Gershenoff, D. C., Gonder-Frederick, L. A., Haidar, A., Hartnell, S., Heinemann, L., Heller, S., Hirsch, I. B., Hood, K. K., Isaacs, D., Klonoff, D. C., Kordonouri, O., Kowalski, A., Laffel, L., Lawton, J., Lal, R. A., Leelarathna, L., Maahs, D. M., Murphy, H. R., Norgaard, K., O'Neal, D., Oser, S., Oser, T., Renard, E., Riddell, M. C., Rodbard, D., Russell, S. J., Schatz, D. A., Shah, V. N., Sherr, J. L., Simonson, G. D., Wadwa, R. P., Ward, C., Weinzimer, S. A., Wilmot, E. G., Battelino, T. 2022

  Abstract

  The significant and growing global prevalence of diabetes continues to challenge people with diabetes (PwD), healthcare providers and payers. While maintaining near-normal glucose levels has been shown to prevent or delay the progression of the long-term complications of diabetes, a significant proportion of PwD are not attaining their glycemic goals. During the past six years, we have seen tremendous advances in automated insulin delivery (AID) technologies. Numerous randomized controlled trials and real-world studies have shown that the use of AID systems is safe and effective in helping PwD achieve their long-term glycemic goals while reducing hypoglycemia risk. Thus, AID systems have recently become an integral part of diabetes management. However, recommendations for using AID systems in clinical settings have been lacking. Such guided recommendations are critical for AID success and acceptance. All clinicians working with PwD need to become familiar with the available systems in order to eliminate disparities in diabetes quality of care. This report provides much-needed guidance for clinicians who are interested in utilizing AIDs and presents a comprehensive listing of the evidence payers should consider when determining eligibility criteria for AID insurance coverage.

  View details for DOI 10.1210/endrev/bnac022

  View details for PubMedID 36066457

• Relationship Between Moderate-to-Vigorous Physical Activity and Glycemia Among Young Adults with Type 1 Diabetes and Overweight or Obesity: Results from the Advancing Care for Type 1 Diabetes and Obesity Network (ACT1ON) Study. Diabetes technology & therapeutics Muntis, F. R., Igudesman, D., Cristello Sarteau, A., Thomas, J., Arrizon-Ruiz, N., Hooper, J., Addala, A., Crandell, J. L., Riddell, M. C., Maahs, D. M., Pratley, R. E., Corbin, K., Mayer-Davis, E. J., Zaharieva, D. P. 2022

  Abstract

  AIMS: Using data from the ACT1ON study, we conducted secondary analyses to assess the relationship between minutes of moderate-to-vigorous physical activity (MVPA) and glycemia in adults with type 1 diabetes (T1D) and overweight or obesity.MATERIALS AND METHODS: Participants (n=66) with T1D provided measures of glycemia (HbA1c, percent of time below range [TBR, <70mg/dL], time-in-range [TIR, 70-180mg/dL], time above range [TAR, >180mg/dL]) and self-reported physical activity (Global Physical Activity Questionnaire (GPAQ), Previous Day Physical Activity Recalls (PDPAR)) at baseline, 3-, 6-, & 9-months post-intervention. Wearable activity data was available for a subset of participants (n=27). Associations were estimated using mixed effects regression models adjusted for design, demographic, clinical, and dietary covariates.RESULTS: Among young adults aged 19-30 with a baseline HbA1c of 7.9 ± 1.4% and BMI of 30.3 (IQR 27.9, 33.8), greater habitual weekly MVPA minutes were associated with higher HbA1c via the GPAQ (p<0.01) and wearable activity data (p=0.01). We did not observe a significant association between habitual MVPA and any continuous glucose monitoring metrics. Using PDPAR data, however, we observed that greater daily MVPA minutes were associated with more TAR (p<0.01) and reduced TIR (p<0.01) on the day following reported physical activity.CONCLUSIONS: Among young adults with T1D and overweight or obesity, increased MVPA was associated with worsened glycemia. As physical activity is vital to cardiovascular health and weight management, additional research is needed to determine how to best support young adults with T1D and overweight or obesity in their efforts to increase physical activity.

  View details for DOI 10.1089/dia.2022.0253

  View details for PubMedID 35984327

• How Introduction of Automated Insulin Delivery Systems May Influence Psychosocial Outcomes in Adults with Type 1 Diabetes: Findings from the First Investigation with the Omnipod 5 System. Diabetes research and clinical practice Polonsky, W. H., Hood, K. K., Levy, C. J., MacLeish, S. A., Hirsch, I. B., Brown, S. A., Bode, B. W., Carlson, A. L., Shah, V. N., Weinstock, R. S., Bhargava, A., Jones, T. C., Aleppo, G., Mehta, S. N., Laffel, L. M., Forlenza, G. P., Sherr, J. L., Huyett, L. M., Vienneau, T. E., Ly, T. T., Omnipod 5 Research Group 2022: 109998

  Abstract

  AIMS: To evaluate psychosocial outcomes for adults with type 1 diabetes (T1D) using the tubeless Omnipod 5 Automated Insulin Delivery (AID) System.METHODS: A single-arm, multicenter (across the United States), prospective safety and efficacy study of the tubeless AID system included 115 adults with T1D. Participants aged 18-70 years completed questionnaires assessing psychosocial outcomes - diabetes distress (T1-DDS), hypoglycemic confidence (HCS), well-being (WHO-5), sleep quality (PSQI), insulin delivery satisfaction (IDSS), diabetes treatment satisfaction (DTSQ), and system usability (SUS) - before and after 3 months of AID use. Associations among participant characteristics, psychosocial measures and glycemic outcomes were evaluated using linear regression analyses.RESULTS: Adults using the tubeless AID system demonstrated improvements in diabetes-specific psychosocial measures, including diabetes distress, hypoglycemic confidence, insulin delivery satisfaction, diabetes treatment satisfaction, and system usability after 3 months (all P<0.001). No changes in general well-being or sleep quality were observed. The psychosocial outcomes assessed were not consistently associated with baseline participant characteristics (i.e., age, sex, diabetes duration, glycemic outcomes including percent time in range 70-180mg/dL, percent time below range <70mg/dL, hemoglobin A1c, or insulin regimen).CONCLUSIONS: Use of the Omnipod 5 AID system was associated with significant improvements in diabetes-related psychosocial outcomes for adults with T1D.

  View details for DOI 10.1016/j.diabres.2022.109998

  View details for PubMedID 35853530

• Psychosocial Effects of the Loop Open-Source Automated Insulin Delivery System. Journal of diabetes science and technology Wong, J. J., Hood, K. K., Hanes, S. J., Lal, R. A., Naranjo, D. 2022: 19322968221105288

  Abstract

  This study examined the psychosocial impact of Loop, an open-source automated insulin dosing system that has emerged from the diabetes technology "Do-It-Yourself" (DIY) movement.Subsamples of 239 adults, 115 children, and 243 parents completed data collection at the time of Loop initiation and 3 and 6 months later. Surveys collected demographic and clinical information, percent time-in-range, HbA1c, and validated psychosocial measures. Analyses included paired t tests and McNemar's tests to compare psychosocial functioning at 3 and 6 months and regression models to assess baseline predictors of psychosocial outcomes at 6 months.Adults reported significant improvements in diabetes distress (t = -7.20 P < .001; t = -8.01, P < .001), sleep quality (t = 6.81, P < .001; t = 2.98, P = .003), fear of hypoglycemia (t = -4.42, P < .001; t = -4.97, P < .001), and hypoglycemia confidence (t = 8.68, P < .001; t = 7.96 P < .001) from baseline to 3 months and 6 months, respectively. Significant improvements in parents' and children's sleep quality and parents' fear of hypoglycemia were also observed. Several baseline characteristics were associated with psychosocial outcomes at 6 months.The current findings support the broad and sustained benefits of Loop across multiple aspects of psychosocial well-being. Advancement and dissemination of such technologies has the potential to improve mental and physiological health among people living with type 1 diabetes.

  View details for DOI 10.1177/19322968221105288

  View details for PubMedID 35771004

• Post-Traumatic Stress Disorder in pediatric Implantable Cardioverter Defibrillator patients and their parents. Heart rhythm Schneider, L. M., Wong, J. J., Adams, R., Bates, B., Chen, S., Ceresnak, S. R., Danovsky, M., Hanisch, D., Motonaga, K. S., Restrepo, M., Shaw, R. J., Sears, S. F., Trela, A., Dubin, A. M., Hood, K. K. 2022

  Abstract

  An ICD in the pediatric patient (and the precipitating events that led to ICD placement) can be traumatic for patients and their families and may lead to PTSD.This study aimed to estimate the prevalence of PTSD in pediatric ICD patients and their parents and identify the factors associated with PTSD incidence.Pediatric participants with an ICD ages 8-21 years and parents of youth ages 0-21 years completed surveys that included demographics and PTSD measures. Pediatric participants completed additional psychosocial measures, such as anxiety and depression self-report questionnaires.Fifty youth (30% female) and 43 parents (70% female) completed the measures. Six youth (12%) met the screening criteria for a likely PTSD diagnosis, while 20 parents (47%) met the cutoff for PTSD on the screening measure. Children with PTSD were more likely to have had a secondary prevention ICD (83% vs 17%, p=0.021), meet the clinical cutoff for depression (67% vs 16%, p=.005), and had higher shock anxiety (31.7 vs 17.9, p=0.003) than children without PTSD. Female gender (57% vs 23%, p=0.043) and patient depression (31% vs 5%, p=.042) were associated with PTSD among parents.Parents were found to be more likely to meet the criteria for PTSD than youth. Among youth, PTSD was associated with medical and psychosocial factors whereas PTSD among parents was associated with being female and child depression. Clinic based screenings and management planning of emotional functioning are warranted to address psychological distress in patients and parents.

  View details for DOI 10.1016/j.hrthm.2022.06.025

  View details for PubMedID 35772698

• Algorithm-Enabled, Personalized Glucose Management for Type 1 Diabetes at the Population Scale: Prospective Evaluation in Clinical Practice. JMIR diabetes Scheinker, D., Gu, A., Grossman, J., Ward, A., Ayerdi, O., Miller, D., Leverenz, J., Hood, K., Lee, M. Y., Maahs, D. M., Prahalad, P. 2022; 7 (2): e27284

  Abstract

  BACKGROUND: The use of continuous glucose monitors (CGMs) is recommended as the standard of care by the American Diabetes Association for individuals with type 1 diabetes (T1D). Few hardware-agnostic, open-source, whole-population tools are available to facilitate the use of CGM data by clinicians such as physicians and certified diabetes educators.OBJECTIVE: This study aimed to develop a tool that identifies patients appropriate for contact using an asynchronous message through electronic medical records while minimizing the number of patients reviewed by a certified diabetes educator or physician using the tool.METHODS: We used consensus guidelines to develop timely interventions for diabetes excellence (TIDE), an open-source hardware-agnostic tool to analyze CGM data to identify patients with deteriorating glucose control by generating generic flags (eg, mean glucose [MG] >170 mg/dL) and personalized flags (eg, MG increased by >10 mg/dL). In a prospective 7-week study in a pediatric T1D clinic, we measured the sensitivity of TIDE in identifying patients appropriate for contact and the number of patients reviewed. We simulated measures of the workload generated by TIDE, including the average number of time in range (TIR) flags per patient per review period, on a convenience sample of eight external data sets, 6 from clinical trials and 2 donated by research foundations.RESULTS: Over the 7 weeks of evaluation, the clinical population increased from 56 to 64 patients. The mean sensitivity was 99% (242/245; SD 2.5%), and the mean reduction in the number of patients reviewed was 42.6% (182/427; SD 10.9%). The 8 external data sets contained 1365 patients with 30,017 weeks of data collected by 7 types of CGMs. The rates of generic and personalized TIR flags per patient per review period were, respectively, 0.15 and 0.12 in the data set with the lowest average MG (141 mg/dL) and 0.95 and 0.22 in the data set with the highest average MG (207 mg/dL).CONCLUSIONS: TIDE is an open-source hardware-agnostic tool for personalized analysis of CGM data at the clinical population scale. In a pediatric T1D clinic, TIDE identified 99% of patients appropriate for contact using an asynchronous message through electronic medical records while reducing the number of patients reviewed by certified diabetes care and education specialists by 43%. For each of the 8 external data sets, simulation of the use of TIDE produced fewer than 0.25 personalized TIR flags per patient per review period. The use of TIDE to support telemedicine-based T1D care may facilitate sensitive and efficient guideline-based population health management.

  View details for DOI 10.2196/27284

  View details for PubMedID 35666570

• Cambridge hybrid closed-loop algorithm in children and adolescents with type 1 diabetes: a multicentre 6-month randomised controlled trial. The Lancet. Digital health Ware, J., Boughton, C. K., Allen, J. M., Wilinska, M. E., Tauschmann, M., Denvir, L., Thankamony, A., Campbell, F. M., Wadwa, R. P., Buckingham, B. A., Davis, N., DiMeglio, L. A., Mauras, N., Besser, R. E., Ghatak, A., Weinzimer, S. A., Hood, K. K., Fox, D. S., Kanapka, L., Kollman, C., Sibayan, J., Beck, R. W., Hovorka, R., DAN05 Consortium, Hovorka, R., Acerini, C. L., Thankamony, A., Allen, J. M., Boughton, C. K., Dovc, K., Dunger, D. B., Ware, J., Musolino, G., Tauschmann, M., Wilinska, M. E., Hayes, J. F., Hartnell, S., Slegtenhorst, S., Ruan, Y., Haydock, M., Mangat, J., Denvir, L., Kanthagnany, S. K., Law, J., Randell, T., Sachdev, P., Saxton, M., Coupe, A., Stafford, S., Ball, A., Keeton, R., Cresswell, R., Crate, L., Cripps, H., Fazackerley, H., Looby, L., Navarra, H., Saddington, C., Smith, V., Verhoeven, V., Bratt, S., Khan, N., Moyes, L., Sandhu, K., West, C., Wadwa, R. P., Alonso, G., Forlenza, G., Slover, R., Towers, L., Berget, C., Coakley, A., Escobar, E., Jost, E., Lange, S., Messer, L., Thivener, K., Campbell, F. M., Yong, J., Metcalfe, E., Allen, M., Ambler, S., Waheed, S., Exall, J., Tulip, J., Buckingham, B. A., Ekhlaspour, L., Maahs, D., Norlander, L., Jacobson, T., Twon, M., Weir, C., Leverenz, B., Keller, J., Davis, N., Kumaran, A., Trevelyan, N., Dewar, H., Price, G., Crouch, G., Ensom, R., Haskell, L., Lueddeke, L. M., Mauras, N., Benson, M., Bird, K., Englert, K., Permuy, J., Ponthieux, K., Marrero-Hernandez, J., DiMeglio, L. A., Ismail, H., Jolivette, H., Sanchez, J., Woerner, S., Kirchner, M., Mullen, M., Tebbe, M., Besser, R. E., Basu, S., London, R., Makaya, T., Ryan, F., Megson, C., Bowen-Morris, J., Haest, J., Law, R., Stamford, I., Ghatak, A., Deakin, M., Phelan, K., Thornborough, K., Shakeshaft, J., Weinzimer, S. A., Cengiz, E., Sherr, J. L., Van Name, M., Weyman, K., Carria, L., Steffen, A., Zgorski, M., Sibayan, J., Beck, R. W., Borgman, S., Davis, J., Rusnak, J., Hellman, A., Cheng, P., Kanapka, L., Kollman, C., McCarthy, C., Chalasani, S., Hood, K. K., Hanes, S., Viana, J., Lanning, M., Fox, D. S., Arreaza-Rubin, G., Eggerman, T., Green, N., Janicek, R., Gabrielson, D., Belle, S. H., Castle, J., Green, J., Legault, L., Willi, S. M., Wysham, C. 2022

  Abstract

  BACKGROUND: Closed-loop insulin delivery systems have the potential to address suboptimal glucose control in children and adolescents with type 1 diabetes. We compared safety and efficacy of the Cambridge hybrid closed-loop algorithm with usual care over 6 months in this population.METHODS: In a multicentre, multinational, parallel randomised controlled trial, participants aged 6-18 years using insulin pump therapy were recruited at seven UK and five US paediatric diabetes centres. Key inclusion criteria were diagnosis of type 1 diabetes for at least 12 months, insulin pump therapy for at least 3 months, and screening HbA1c levels between 53 and 86 mmol/mol (7·0-10·0%). Using block randomisation and central randomisation software, we randomly assigned participants to either closed-loop insulin delivery (closed-loop group) or to usual care with insulin pump therapy (control group) for 6 months. Randomisation was stratified at each centre by local baseline HbA1c. The Cambridge closed-loop algorithm running on a smartphone was used with either (1) a modified Medtronic 640G pump, Medtronic Guardian 3 sensor, and Medtronic prototype phone enclosure (FlorenceM configuration), or (2) a Sooil Dana RS pump and Dexcom G6 sensor (CamAPS FX configuration). The primary endpoint was change in HbA1c at 6 months combining data from both configurations. The primary analysis was done in all randomised patients (intention to treat). Trial registration ClinicalTrials.gov, NCT02925299.FINDINGS: Of 147 people initially screened, 133 participants (mean age 13·0 years [SD 2·8]; 57% female, 43% male) were randomly assigned to either the closed-loop group (n=65) or the control group (n=68). Mean baseline HbA1c was 8·2% (SD 0·7) in the closed-loop group and 8·3% (0·7) in the control group. At 6 months, HbA1c was lower in the closed-loop group than in the control group (between-group difference -3·5 mmol/mol (95% CI -6·5 to -0·5 [-0·32 percentage points, -0·59 to -0·04]; p=0·023). Closed-loop usage was low with FlorenceM due to failing phone enclosures (median 40% [IQR 26-53]), but consistently high with CamAPS FX (93% [88-96]), impacting efficacy. A total of 155 adverse events occurred after randomisation (67 in the closed-loop group, 88 in the control group), including seven severe hypoglycaemia events (four in the closed-loop group, three in the control group), two diabetic ketoacidosis events (both in the closed-loop group), and two non-treatment-related serious adverse events. There were 23 reportable hyperglycaemia events (11 in the closed-loop group, 12 in the control group), which did not meet criteria for diabetic ketoacidosis.INTERPRETATION: The Cambridge hybrid closed-loop algorithm had an acceptable safety profile, and improved glycaemic control in children and adolescents with type 1 diabetes. To ensure optimal efficacy of the closed-loop system, usage needs to be consistently high, as demonstrated with CamAPS FX.FUNDING: National Institute of Diabetes and Digestive and Kidney Diseases.

  View details for DOI 10.1016/S2589-7500(22)00020-6

  View details for PubMedID 35272971

• Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study. The Lancet. Healthy longevity Boughton, C. K., Hartnell, S., Thabit, H., Mubita, W. M., Draxlbauer, K., Poettler, T., Wilinska, M. E., Hood, K. K., Mader, J. K., Narendran, P., Leelarathna, L., Evans, M. L., Hovorka, R. 2022; 3 (3): e135-e142

  Abstract

  Background: Older adults with type 1 diabetes have distinct characteristics that can make optimising glycaemic control challenging. We sought to test our hypothesis that hybrid closed-loop glucose control is safe and more effective than sensor-augmented pump (SAP) therapy in older adults with type 1 diabetes.Methods: In an open-label, multicentre, multinational (UK and Austria), randomised, crossover study, adults aged 60 years and older with type 1 diabetes using insulin pump therapy underwent two 16-week periods comparing hybrid closed-loop (CamAPS FX, CamDiab, Cambridge, UK) and SAP therapy in random order. Block randomisation by means of central randomisation software to one of two treatment sequences was stratified by centre. The primary endpoint was the proportion of time sensor glucose was in target range between 3·9 and 10·0 mmol/L. Analysis for the primary endpoint and adverse events was by intention-to-treat. The study has completed and is registered at ClinicalTrials.gov NCT04025762.Findings: 38 participants were enrolled. One participant withdrew during run-in because of difficulties with the study pump infusion sets. 37 participants (median [IQR] age 68 [63-70] years, mean [SD] baseline glycated haemoglobin [HbA1c]; 7·4% [0·9%]; 57 [10] mmol/mol) were randomly assigned between Sept 4, 2019, and Oct 2, 2020. The proportion of time with glucose between 3·9 and 10·0 mmol/L was significantly higher in the closed-loop group compared to the SAP group (79·9% [SD 7·9] vs 71·4% [13·2], difference 8·6 percentage points [95% CI 6·3 to 11·0]; p<0·0001). Two severe hypoglycaemia events occurred during the SAP period. There were two non-treatment related serious adverse events: cardiac arrest from pulmonary embolism associated with COVID-19 during the SAP period resulting in death, and a hospital presentation for parenteral hydrocortisone because of COVID-19 in a participant with adrenal insufficiency during the run-in period.Interpretation: Hybrid closed-loop insulin delivery is safe and achieves superior glycaemic control to SAP therapy in older adults with long duration of type 1 diabetes. Importantly this was achieved without increasing the risk of hypoglycaemia in this population with risk factors for severe hypoglycaemia. This suggests that hybrid closed-loop therapy is a clinically important treatment option for older adults with type 1 diabetes.

  View details for DOI 10.1016/S2666-7568(22)00005-8

  View details for PubMedID 35359882

• Hybrid closed-loop glucose control compared with sensor augmented pump therapy in older adults with type 1 diabetes: an open-label multicentre, multinational, randomised, crossover study LANCET HEALTHY LONGEVITY Boughton, C. K., Hartnell, S., Thabit, H., Mubita, W. M., Draxlbauer, K., Poettler, T., Wilinska, M. E., Hood, K. K., Mader, J. K., Narendran, P., Leelarathna, L., Evans, M. L., Hovorka, R. 2022; 3 (3): E135-E142

  View details for Web of Science ID 000767501900011

• Qualitative Study of User Experiences with Loop, an Open-Source Automated Insulin Delivery (AID) System. Diabetes technology & therapeutics Suttiratana, S., Wong, J., Lanning, M. S., Dunlap, A. R., Hanes, S., Hood, K., Lal, R. A., Naranjo, D. 1800

  Abstract

  BACKGROUND: Loop is an open-source automated insulin delivery (AID) system, used by more than 9,000 people with Type 1 diabetes. Understanding the pros and cons of Loop use may help improve disease management and support population level innovation.METHODS: Focus groups revealed 72 new and existing users' perspectives on Loop uptake, use and persistence. A subsample of participants from a mixed methods observational cohort study shared first-hand accounts of their experiences using Loop. Participants were predominately white (95%), male (50%), privately insured (94%), reported annual household income ≥ $100K (73%) and education exceeding a bachelor's degree (87%) with a mean HbA1c of 6.6±0.8%. Data were analyzed and synthesized by a multidisciplinary team.RESULTS: Participants detailed their experiences with a) Loop technical support and troubleshooting, b) decreased mental/behavioral burden, c) technical issues with parts of the system, d) glycemic control, e) personalizing settings, and f) providers while using Loop. Decreased burden was the most endorsed benefit defined by less worry, stress, and cognitive effort and less time spent on diabetes management tasks. Participants highlighted the benefits of Loop overnight and their introduction to "Loop communities" during use. The most discussed challenges involved technical issues. A range of provider attitudes and knowledge about Loop complicated users' clinical experiences and disclosure.CONCLUSIONS: This sample of new and experienced Loop users reported benefits to quality of life and glycemic control that outweighed challenges of setting up system components, customizing the system to suit one's lifestyle and habits, and adjusting system settings. Challenges related to system set up and calibrating settings are remediable and, if addressed, may better serve Loop users. Users reported feeling empowered by the customizability of and the educational effects facilitated by the open source AID system. Loop helped users learn more about their chronic illness and physiology in an acceptable format.

  View details for DOI 10.1089/dia.2021.0485

  View details for PubMedID 35099278

• Randomized Trial of Closed-Loop Control in Very Young Children with Type 1 Diabetes. The New England journal of medicine Ware, J., Allen, J. M., Boughton, C. K., Wilinska, M. E., Hartnell, S., Thankamony, A., de Beaufort, C., Schierloh, U., Frohlich-Reiterer, E., Mader, J. K., Kapellen, T. M., Rami-Merhar, B., Tauschmann, M., Nagl, K., Hofer, S. E., Campbell, F. M., Yong, J., Hood, K. K., Lawton, J., Roze, S., Sibayan, J., Bocchino, L. E., Kollman, C., Hovorka, R., KidsAP Consortium, Hovorka, R., Acerini, C. L., Thankamony, A., Boughton, C. K., Dovc, K., Ware, J., Musolino, G., Wilinska, M. E., Allen, J. M., Hartnell, S., Ruan, Y., Ashcroft, N., Haydock, M., Hill, C., de Beaufort, C., Schierloh, U., Fichelle, M., Schaeffer, D., Frohlich-Reiterer, E., Fritsch, M., Jasser-Nitsche, H., Mader, J. K., Faninger, K., Kapellen, T. M., Bartelt, H., Thiele, A., Rami-Merhar, B., Berger, G., Blauensteiner, N., Gellai, R., Nagl, K., Tauschmann, M., Cvach, S., Katzenbeisser-Pawlik, S., Hofer, S. E., Abt, D., Malik, A., Lanthaler, B., Wenzel, M., Campbell, F., Yong, J., Metcalfe, E., Allen, M., Ambler, S., Waheed, S., Exall, J., Tulip, J., Sibayan, J., Beck, R., Borgman, S., Davis, J., Rusnak, J., Hellmann, A., Cheng, P., Kanapka, L., Kollman, C., McCarthy, C., Chalasani, S., Lawton, J., Kimbell, B., Rankin, D., Hart, R., Hood, K. K., Roze, S., Isitt, J., Gregory, A., Madrid Valero, J. J., Jones, T., Patterson, C., Adolfsson, P. 1800; 386 (3): 209-219

  Abstract

  BACKGROUND: The possible advantage of hybrid closed-loop therapy (i.e., artificial pancreas) over sensor-augmented pump therapy in very young children with type 1 diabetes is unclear.METHODS: In this multicenter, randomized, crossover trial, we recruited children 1 to 7 years of age with type 1 diabetes who were receiving insulin-pump therapy at seven centers across Austria, Germany, Luxembourg, and the United Kingdom. Participants received treatment in two 16-week periods, in random order, in which the closed-loop system was compared with sensor-augmented pump therapy (control). The primary end point was the between-treatment difference in the percentage of time that the sensor glucose measurement was in the target range (70 to 180 mg per deciliter) during each 16-week period. The analysis was conducted according to the intention-to-treat principle. Key secondary end points included the percentage of time spent in a hyperglycemic state (glucose level, >180 mg per deciliter), the glycated hemoglobin level, the mean sensor glucose level, and the percentage of time spent in a hypoglycemic state (glucose level, <70 mg per deciliter). Safety was assessed.RESULTS: A total of 74 participants underwent randomization. The mean (±SD) age of the participants was 5.6±1.6 years, and the baseline glycated hemoglobin level was 7.3±0.7%. The percentage of time with the glucose level in the target range was 8.7 percentage points (95% confidence interval [CI], 7.4 to 9.9) higher during the closed-loop period than during the control period (P<0.001). The mean adjusted difference (closed-loop minus control) in the percentage of time spent in a hyperglycemic state was -8.5 percentage points (95% CI, -9.9 to -7.1), the difference in the glycated hemoglobin level was -0.4 percentage points (95% CI, -0.5 to -0.3), and the difference in the mean sensor glucose level was -12.3 mg per deciliter (95% CI, -14.8 to -9.8) (P<0.001 for all comparisons). The time spent in a hypoglycemic state was similar with the two treatments (P=0.74). The median time spent in the closed-loop mode was 95% (interquartile range, 92 to 97) over the 16-week closed-loop period. One serious adverse event of severe hypoglycemia occurred during the closed-loop period. One serious adverse event that was deemed to be unrelated to treatment occurred.CONCLUSIONS: A hybrid closed-loop system significantly improved glycemic control in very young children with type 1 diabetes, without increasing the time spent in hypoglycemia. (Funded by the European Commission and others; ClinicalTrials.gov number, NCT03784027.).

  View details for DOI 10.1056/NEJMoa2111673

  View details for PubMedID 35045227

• A Real-World Prospective Study of the Safety and Effectiveness of the Loop Open Source Automated Insulin Delivery System. Diabetes technology & therapeutics Lum, J., Bailey, R., Barnes-Lomen, V., Naranjo, D., Hood, K., Lal, R. A., Arbiter, B., Brown, A., DeSalvo, D. J., Pettus, J., Calhoun, P., Beck, R. W. 2020

  Abstract

  OBJECTIVE: To evaluate the safety and effectiveness of the Loop Do-It-Yourself (DIY) automated insulin delivery system.RESEARCH DESIGN AND METHODS: A prospective real-world observational study was conducted, which included 558 adults and children (age range 1 to 71 years, mean HbA1c 6.8±1.0%) who initiated Loop either on their own or with community-developed resources and provided data for 6 months.RESULTS: Mean time-in-range 70-180 mg/dL (TIR) increased from 67±16% at baseline (prior to starting Loop) to 73±13% during the 6 months (mean change from baseline 6.6%, 95% confidence interval 5.9% to 7.4%; P<0.001). TIR increased in both adults and children, across the full range of baseline HbA1c, and in participants with both high and moderate income levels. Median time <54 mg/dL was 0.40% at baseline and changed by -0.05% (95% confidence interval -0.09% to -0.03%, P<0.001). Mean HbA1c was 6.8±1.0% at baseline and decreased to 6.5±0.8% after 6 months (mean difference= -0.33%, 95% confidence interval -0.40% to -0.26%, P<0.001). The incidence rate of reported severe hypoglycemia events was 18.7 per 100 person-years, a reduction from the incidence rate of 181 per 100 person-years during the 3 months prior to the study. Among the 481 users providing Loop data at 6 months, median CGM use was 96% (interquartile range 91% to 98%) and median time Loop was modulating basal insulin was at least 83% (interquartile range 73% to 88%).CONCLUSIONS: The Loop open source system can be initiated with community-developed resources and used safely and effectively by adults and children with T1D.

  View details for DOI 10.1089/dia.2020.0535

  View details for PubMedID 33226840

• Supporting Teen Problem-Solving (STEPS) 3 year outcomes: Preventing diabetes-specific emotional distress and depressive symptoms in adolescents with type 1 diabetes. Journal of consulting and clinical psychology Weissberg-Benchell, J., Shapiro, J. B., Bryant, F. B., Hood, K. K. 2020; 88 (11): 1019–31

  Abstract

  OBJECTIVE: This article reports the 3-year outcomes for the Supporting Teen Problem-Solving (STePS) multisite Randomized Control Trial (RCT); reporting the overall impact of the STePS trial, and the differential impact of each arm of the trial (a resilience promoting intervention [PRP T1D] vs. a diabetes education intervention [EI]) on diabetes-specific emotional distress and depressive symptoms.METHOD: Participants included 264 adolescents with Type 1 diabetes (T1D), ages 14-18, in Chicago and San Francisco. Both intervention arms lasted 4.5 months and assessments were conducted at baseline, postintervention (4.5 months), and 5 follow-up visits (8, 12, 16, 28, and 40 months from baseline). Intervention efficacy was investigated using latent growth curve modeling (LGCM) to analyze the rate and shape of change of outcomes from preintervention across postintervention and follow-up time points.RESULTS: Mean age of participants was 15.7 years, mean T1D duration was 6.9 years, mean HbA1c at baseline was 9.1%. The sample was diverse with nearly 35% identifying as racial or ethnic minorities, and 60% were female. PRP T1D participants reported significantly lower diabetes distress compared with EI participants, and the effect size increased over time. For the pooled sample, while 40% of youth reported elevated distress at baseline, only 23% reported elevated distress 3 years postintervention. Moreover, PRP T1D participants experienced a significant decline in depressive symptoms from 16 to 40 months postbaseline, while participants in the education arm did not.CONCLUSIONS: Results from the 3-year outcomes assessment demonstrate the robust effects of PRP T1D in adolescents with declines in distress and depressive symptoms. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

  View details for DOI 10.1037/ccp0000608

  View details for PubMedID 33136423

• Barriers to Continuous Glucose Monitoring in People With Type 1 Diabetes: Clinician Perspectives. Diabetes spectrum : a publication of the American Diabetes Association Lanning, M. S., Tanenbaum, M. L., Wong, J. J., Hood, K. K. 2020; 33 (4): 324–30

  Abstract

  The purpose of this study was to determine clinician attitudes about the distinct barriers to uptake of continuous glucose monitoring (CGM) among people with diabetes. Survey data were collected measuring individual barriers, prerequisites to CGM, confidence in addressing barriers, and clinic staff resources. Results show that clinicians commonly report barriers to using CGM among people with diabetes in their clinic. Furthermore, clinicians who report a high number of barriers do not feel confident in overcoming the barriers to CGM. Interventions that attempt to empower clinicians to address concerns about CGM among people with diabetes may be warranted because low uptake does not appear to be directly related to available resources or prerequisites to starting CGM.

  View details for DOI 10.2337/ds19-0039

  View details for PubMedID 33223770

• mHealth for Pediatric Chronic Pain: State of the Art and Future Directions. Expert review of neurotherapeutics Richardson, P. A., Harrison, L. E., Heathcote, L. C., Rush, G., Shear, D., Lalloo, C., Hood, K., Wicksell, R. K., Stinson, J., Simons, L. E. 2020

  Abstract

  INTRODUCTION: Chronic pain conditions are common among children and engender cascading effects across social, emotional, and behavioral domains for the child and family. Mobile health (mHealth) describes the practice of delivering healthcare via mobile devices and may be an ideal solution to increase access and reach of evidence-based behavioral health interventions.AREAS COVERED: The aim of this narrative review is to present a state-of-the-art overview of evidence-based mHealth efforts within the field of pediatric chronic pain and consider new and promising directions for study. Given the nascent nature of the field, published mHealth interventions in all stages of development are discussed. Literature was identified through a non-systematic search in PubMed and Google Scholar, and a review of reference lists of papers that were identified as particularly relevant or foundational (within and outside of the chronic pain literature).EXPERT OPINION: mHealth is a promising interventional modality with early evidence suggesting it is primed to enhance behavioral health delivery and patient outcomes. There are many exciting future directions to be explored including drawing inspiration from digital health technology to generate new ways of thinking about the optimal treatment of pediatric chronic pain.

  View details for DOI 10.1080/14737175.2020.1819792

  View details for PubMedID 32881587

• A Randomized Trial of Closed-Loop Control in Children with Type 1 Diabetes. The New England journal of medicine Breton, M. D., Kanapka, L. G., Beck, R. W., Ekhlaspour, L., Forlenza, G. P., Cengiz, E., Schoelwer, M., Ruedy, K. J., Jost, E., Carria, L., Emory, E., Hsu, L. J., Oliveri, M., Kollman, C. C., Dokken, B. B., Weinzimer, S. A., DeBoer, M. D., Buckingham, B. A., Chernavvsky, D., Wadwa, R. P., iDCL Trial Research Group, Schoelwer, M., Breton, M., DeBoer, M., Gonder-Frederick, L., Chernavvsky, D., Robic, J., Emory, E., Voelmle, M., Conschafter, K., Morris, K., Barnett, C., Carr, K., Hellmann, J., Kime, M., Oliveri, M., Wadwa, R. P., Forlenza, G., Alonso, G. T., Slover, R., Messer, L., Cobry, E., Jost, E., Berget, C., Towers, L., Lange, S., Buckingham, B., Maahs, D., Lal, R., Ekhlaspour, L., Norlander, L., Hood, K., Town, M., Weir, C., Smith, K., Hsu, L., Shinksy, D., Viana, J., Cengiz, E., Weinzimer, S., Weyman, K., Carria, L., Zgorski, M., Ruedy, K., Beck, R., Borgman, S., Rusnak, J., Kanapka, L., Kollman, C., Murphy, C., Arreza-Rubin, G., Green, N., Kovatchev, B., Brown, S., Anderson, S., Laffel, L., Pinsker, J., Levy, C., Kudva, Y. C., Doyle, F. 3., Renard, E., Cobelli, C., Reznik, Y., Lum, J., Janicek, R., Gabrielson, D. 2020; 383 (9): 836–45

  Abstract

  BACKGROUND: A closed-loop system of insulin delivery (also called an artificial pancreas) may improve glycemic outcomes in children with type 1 diabetes.METHODS: In a 16-week, multicenter, randomized, open-label, parallel-group trial, we assigned, in a 3:1 ratio, children 6 to 13 years of age who had type 1 diabetes to receive treatment with the use of either a closed-loop system of insulin delivery (closed-loop group) or a sensor-augmented insulin pump (control group). The primary outcome was the percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter, as measured by continuous glucose monitoring.RESULTS: A total of 101 children underwent randomization (78 to the closed-loop group and 23 to the control group); the glycated hemoglobin levels at baseline ranged from 5.7 to 10.1%. The mean (±SD) percentage of time that the glucose level was in the target range of 70 to 180 mg per deciliter increased from 53±17% at baseline to 67±10% (the mean over 16 weeks of treatment) in the closed-loop group and from 51±16% to 55±13% in the control group (mean adjusted difference, 11 percentage points [equivalent to 2.6 hours per day]; 95% confidence interval, 7 to 14; P<0.001). In both groups, the median percentage of time that the glucose level was below 70 mg per deciliter was low (1.6% in the closed-loop group and 1.8% in the control group). In the closed-loop group, the median percentage of time that the system was in the closed-loop mode was 93% (interquartile range, 91 to 95). No episodes of diabetic ketoacidosis or severe hypoglycemia occurred in either group.CONCLUSIONS: In this 16-week trial involving children with type 1 diabetes, the glucose level was in the target range for a greater percentage of time with the use of a closed-loop system than with the use of a sensor-augmented insulin pump. (Funded by Tandem Diabetes Care and the National Institute of Diabetes and Digestive and Kidney Diseases; ClinicalTrials.gov number, NCT03844789.).

  View details for DOI 10.1056/NEJMoa2004736

  View details for PubMedID 32846062

• Effect of Continuous Glucose Monitoring on Glycemic Control in Adolescents and Young Adults With Type 1 Diabetes: A Randomized Clinical Trial. JAMA Laffel, L. M., Kanapka, L. G., Beck, R. W., Bergamo, K., Clements, M. A., Criego, A., DeSalvo, D. J., Goland, R., Hood, K., Liljenquist, D., Messer, L. H., Monzavi, R., Mouse, T. J., Prahalad, P., Sherr, J., Simmons, J. H., Wadwa, R. P., Weinstock, R. S., Willi, S. M., Miller, K. M., CGM Intervention in Teens and Young Adults with T1D (CITY) Study Group, CDE10 2020; 323 (23): 2388–96

  Abstract

  Importance: Adolescents and young adults with type 1 diabetes exhibit the worst glycemic control among individuals with type 1 diabetes across the lifespan. Although continuous glucose monitoring (CGM) has been shown to improve glycemic control in adults, its benefit in adolescents and young adults has not been demonstrated.Objective: To determine the effect of CGM on glycemic control in adolescents and young adults with type 1 diabetes.Design, Setting, and Participants: Randomized clinical trial conducted between January 2018 and May 2019 at 14 endocrinology practices in the US including 153 individuals aged 14 to 24 years with type 1 diabetes and screening hemoglobin A1c (HbA1c) of 7.5% to 10.9%.Interventions: Participants were randomized 1:1 to undergo CGM (CGM group; n=74) or usual care using a blood glucose meter for glucose monitoring (blood glucose monitoring [BGM] group; n=79).Main Outcomes and Measures: The primary outcome was change in HbA1c from baseline to 26 weeks. There were 20 secondary outcomes, including additional HbA1c outcomes, CGM glucose metrics, and patient-reported outcomes with adjustment for multiple comparisons to control for the false discovery rate.Results: Among the 153 participants (mean [SD] age, 17 [3] years; 76 [50%] were female; mean [SD] diabetes duration, 9 [5] years), 142 (93%) completed the study. In the CGM group, 68% of participants used CGM at least 5 days per week in month 6. Mean HbA1c was 8.9% at baseline and 8.5% at 26 weeks in the CGM group and 8.9% at both baseline and 26 weeks in the BGM group (adjusted between-group difference, -0.37% [95% CI, -0.66% to -0.08%]; P=.01). Of 20 prespecified secondary outcomes, there were statistically significant differences in 3 of 7 binary HbA1c outcomes, 8 of 9 CGM metrics, and 1 of 4 patient-reported outcomes. The most commonly reported adverse events in the CGM and BGM groups were severe hypoglycemia (3 participants with an event in the CGM group and 2 in the BGM group), hyperglycemia/ketosis (1 participant with an event in CGM group and 4 in the BGM group), and diabetic ketoacidosis (3 participants with an event in the CGM group and 1 in the BGM group).Conclusions and Relevance: Among adolescents and young adults with type 1 diabetes, continuous glucose monitoring compared with standard blood glucose monitoring resulted in a small but statistically significant improvement in glycemic control over 26 weeks. Further research is needed to understand the clinical importance of the findings.Trial Registration: ClinicalTrials.gov Identifier: NCT03263494.

  View details for DOI 10.1001/jama.2020.6940

  View details for PubMedID 32543683

• Early CGM Initiation Improves HbA1c in T1D Youth over the First 15 Months Prahalad, P., Ding, V., Addala, A., New, C., Conrad, B. P., Chmielewski, A., Geels, E., Leverenz, J., Martinez-Singh, A., Sagan, P., Senaldi, J., Freeman, A., Scheinker, D., Hood, K. K., Desai, M., Maahs, D. M. AMER DIABETES ASSOC. 2020

  View details for DOI 10.2337/db20-1297-P

  View details for Web of Science ID 000554509803071

• A Telemedicine-CGM Recommendation System for Personalized Population Health Management Vallon, J., Ward, A. T., Prahalad, P., Hood, K. K., Maahs, D. M., Scheinker, D. AMER DIABETES ASSOC. 2020

  View details for DOI 10.2337/db20-1185-P

  View details for Web of Science ID 000554509802428

• Early Introduction of Continuous Glucose Monitoring Is Well Accepted by Youth and Parents Addala, A., Hanes, S., Zaharieva, D., New, C., Prahalad, P., Maahs, D. M., Hood, K. K., Tanenbaum, M. L. AMER DIABETES ASSOC. 2020

  View details for DOI 10.2337/db20-159-LB

  View details for Web of Science ID 000554509800310

• Newly Diagnosed Pediatric Patients with Type 1 Diabetes Show Steady Decline in Glucose Time-in-Range (TIR) over 1 Year: Pilot Study Zaharieva, D., Prahalad, P., Addala, A., Scheinker, D., Desai, M., Hood, K. K., Leverenz, B., Maahs, D. M. AMER DIABETES ASSOC. 2020

  View details for DOI 10.2337/db20-1295-P

  View details for Web of Science ID 000554509803069

• GETTING ONBOARD (OVERCOMING BARRIERS & OBSTACLES TO ADOPTING DIABETES DEVICES): A PILOT STUDY TO SUPPORT USE OF CONTINUOUS GLUCOSE MONITORING (CGM) Tanenbaum, M. L., Wu, C., Hanes, S., Hood, K. OXFORD UNIV PRESS INC. 2020: S136

  View details for Web of Science ID 000546262400281

• Assessing the effect of closed-loop insulin delivery from onset of type 1 diabetes in youth on residual beta-cell function compared to standard insulin therapy (CLOuD study): a randomised parallel study protocol. BMJ open Boughton, C., Allen, J. M., Tauschmann, M., Hartnell, S., Wilinska, M. E., Musolino, G., Acerini, C. L., Dunger, P. D., Campbell, F., Ghatak, A., Randell, T., Besser, R., Trevelyan, N., Elleri, D., Northam, E., Hood, K., Scott, E., Lawton, J., Roze, S., Sibayan, J., Kollman, C., Cohen, N., Todd, J., Hovorka, R., CLOuD Consortium 2020; 10 (3): e033500

  Abstract

  INTRODUCTION: Management of newly diagnosed type 1 diabetes (T1D) in children and adolescents is challenging for patients, families and healthcare professionals. The objective of this study is to determine whether continued intensive metabolic control using hybrid closed-loop (CL) insulin delivery following diagnosis of T1D can preserve C-peptide secretion, a marker of residual beta-cell function, compared with standard multiple daily injections (MDI) therapy.METHODS AND ANALYSIS: The study adopts an open-label, multicentre, randomised, parallel design, and aims to randomise 96 participants aged 10-16.9 years, recruited within 21 days of diagnosis with T1D. Following a baseline mixed meal tolerance test (MMTT), participants will be randomised to receive 24 months treatment with conventional MDI therapy or with CL insulin delivery. A further 24-month optional extension phase will be offered to all participants to continue with the allocated treatment. The primary outcome is the between group difference in area under the stimulated C-peptide curve (AUC) of the MMTT at 12 months post diagnosis. Analyses will be conducted on an intention-to-treat basis. Key secondary outcomes are between group differences in time spent in target glucose range (3.9-10 mmol/L), glycated haemoglobin (HbA1c) and time spent in hypoglycaemia (<3.9 mmol/L) at 12 months. Secondary efficacy outcomes include between group differences in stimulated C-peptide AUC at 24 months, time spent in target glucose range, glucose variability, hypoglycaemia and hyperglycaemia as recorded by periodically applied masked continuous glucose monitoring devices, total, basal and bolus insulin dose, and change in body weight. Cognitive, emotional and behavioural characteristics of participants and parents will be evaluated, and a cost-utility analysis performed to support adoption of CL as a standard treatment modality following diagnosis of T1D.ETHICS AND DISSEMINATION: Ethics approval has been obtained from Cambridge East Research Ethics Committee. The results will be disseminated by peer-reviewed publications and conference presentations.TRIAL REGISTRATION NUMBER: NCT02871089; Pre-results.

  View details for DOI 10.1136/bmjopen-2019-033500

  View details for PubMedID 32169925

• Trust in hybrid closed loop among people with diabetes: Perspectives of experienced system users JOURNAL OF HEALTH PSYCHOLOGY Tanenbaum, M. L., Iturralde, E., Hanes, S. J., Suttiratana, S. C., Ambrosino, J. M., Ly, T. T., Maahs, D. M., Naranjo, D., Walders-Abramson, N., Weinzimer, S. A., Buckingham, B. A., Hood, K. K. 2020; 25 (4): 429–38

  View details for DOI 10.1177/1359105317718615

  View details for Web of Science ID 000523776100001

• Exposure to Closed Loop Barriers Using Virtual Reality. Journal of diabetes science and technology Lanning, M., Shen, J., Wasser, D., Riddle, S., Agustin, B., Hood, K., Naranjo, D. 2020: 1932296820902771

  Abstract

  BACKGROUND: Closed loop (CL) automated insulin delivery systems are demonstrated to be safe and effective in regulating glucose levels and reducing cognitive burden in people with type 1 diabetes (T1D). However, given the limited market options and the do-it-yourself nature of most systems, it can be difficult for potential users to shape their expectations fitting them into daily lives and management routines. As such, we examined the potential feasibility of a virtual reality (VR) intervention.METHODS: A four-part VR intervention was created to expose adults with T1D to expected CL system barriers: body image, perceived hassles of using CL, deskilling fears, and unwanted social attention. Goals of the pilot were to assess feasibility and expose patients to CL. Surveys were conducted pre- and postparticipating in the VR experience.RESULTS: A total of 20 adults with T1D completed the pilot. Average time to complete the experience was 14.1minutes (8.8-39.9). Reported VR sickness was low. Willingness to use VR was maintained in 90% (n=18) and did not change expectations of CL in 95% (n=19). Virtual reality changed perceived hassles of CL in 25% (n=5) with four concerned over alarms and one connectivity issues: positive diabetes technology attitudes, confidence in managing hypoglycemia, overall perceptions of appearance, and positive affect maintained after the VR intervention. Negative affect significantly decreased after exposure and perceptions of being overweight trended toward significance.CONCLUSION: This pilot VR intervention demonstrated high potential in addressing expected barriers to uptake and usage of CL systems without decreasing enthusiasm or changing expectations of CL.

  View details for DOI 10.1177/1932296820902771

  View details for PubMedID 32019329

• Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use. Diabetes technology & therapeutics Wong, J., Barley, R., Hanes, S., Tanenbaum, M., Lanning, M. S., Naranjo, D., Hood, K. 2020

  Abstract

  BACKGROUND: Despite the demonstrated benefits of diabetes device use, uptake of insulin pumps and continuous glucose monitors (CGMs) remains quite low. The current study aimed to identify profiles of parents of youth with type 1 diabetes based on their attitudes toward diabetes-specific technology and barriers to diabetes technology uptake.METHODS: Online survey data were collected from 471 parents in the T1D Exchange Clinic Network (child's age=12.0±3.2 years; diabetes duration=7.0±2.9 years; A1c=8.4%±1.3; 75% using insulin pump; 27% using CGM).RESULTS: K-means cluster analyses revealed 5 parent profiles: Embracers (50.7%), Burdened (15.7%), Hopeful but Hassled (14.2%), Distrusting (12.7%), and Data Minimalists (6.6%). ANOVAs and Chi-square tests identified differences between groups based on diabetes distress, worry over hypoglycemia, device use, and demographic characteristics.CONCLUSIONS: Providers encouraging device uptake may benefit from tailoring their approaches based on these distinct groups and their corresponding concerns and needs.

  View details for DOI 10.1089/dia.2019.0492

  View details for PubMedID 31971451

• Putting Continuous Glucose Monitoring to Work for People With Type 1 Diabetes. Diabetes care Hood, K. K., DiMeglio, L. A., Riddle, M. C. 2020; 43 (1): 19–21

  View details for DOI 10.2337/dci19-0054

  View details for PubMedID 31862822

• Primary Care Providers in California and Florida Report Low Confidence in Providing Type 1 Diabetes Care. Clinical diabetes : a publication of the American Diabetes Association Lal, R. A., Cuttriss, N. n., Haller, M. J., Yabut, K. n., Anez-Zabala, C. n., Hood, K. K., Sheehan, E. n., Basina, M. n., Bernier, A. n., Baer, L. G., Filipp, S. L., Wang, C. J., Town, M. A., Gurka, M. J., Maahs, D. M., Walker, A. F. 2020; 38 (2): 159–65

  Abstract

  People with type 1 diabetes may receive a significant portion of their care from primary care providers (PCPs). To understand the involvement of PCPs in delivering type 1 diabetes care, we performed surveys in California and Florida, two of the most populous and diverse states in the United States. PCPs fill insulin prescriptions but report low confidence in providing type 1 diabetes care and difficulty accessing specialty referrals to endocrinologists.

  View details for DOI 10.2337/cd19-0060

  View details for PubMedID 32327888

  View details for PubMedCentralID PMC7164993

• Cost, Hassle, and On-Body Experience: Barriers to Diabetes Device Use in Adolescents and Potential Intervention Targets. Diabetes technology & therapeutics Messer, L. H., Tanenbaum, M. n., Cook, P. F., Wong, J. n., Hanes, S. n., Driscoll, K. A., Hood, K. n. 2020

  Abstract

  Adolescents with diabetes have the highest A1cs of all age group. Diabetes devices (insulin pumps and continuous glucose monitors [CGM]) can improve glycemic outcomes, and though uptake of devices have increased, they remain underutilized in this population. This study characterizes adolescent-reported barriers to diabetes device use to determine targets for clinician intervention.We surveyed 411 adolescents with type 1 diabetes (mean age 16.302.25 years) on barriers to diabetes device use, technology use attitudes (general and diabetes-specific), benefits and burdens of CGM, self-efficacy for diabetes care, diabetes distress, family conflict, and depression. We characterize barriers to device uptake; assess demographic and psychosocial differences in device users, discontinuers, and non-users; and determine differences in device use by gender and age.The majority of adolescents used an insulin pump (n=307, 75%) and more than half used CGM (n=225, 55%). Cost/insurance-related concerns were the most commonly endorsed barrier category (61%) followed by wear-related issues (58.6%) which includes hassle of wearing the device (38%), and dislike of device on body (33%). Adolescents who endorsed more barriers also reported more diabetes distress (p=0.003), family conflict (p=0.003), and depressive symptoms (p=0.014). Pump and CGM discontinuers both endorsed more barriers and more negative perceptions of technology than current users, but reported no difference from device users in diabetes distress, family conflict, or depression. Gender was not related to perceptions of devices.Clinicians can proactively assess attitudes toward diabetes technology and perceptions of benefits/burdens to encourage device uptake and potentially prevent device discontinuation among adolescents.

  View details for DOI 10.1089/dia.2019.0509

  View details for PubMedID 32163719

• Diabetes Telehealth Solutions: Improving Self-Management Through Remote Initiation of Continuous Glucose Monitoring. Journal of the Endocrine Society Gal, R. L., Cohen, N. J., Kruger, D. n., Beck, R. W., Bergenstal, R. M., Calhoun, P. n., Cushman, T. n., Haban, A. n., Hood, K. n., Johnson, M. L., McArthur, T. n., Olson, B. A., Weinstock, R. S., Oser, S. M., Oser, T. K., Bugielski, B. n., Strayer, H. n., Aleppo, G. n. 2020; 4 (9): bvaa076

  Abstract

  The purpose of this study was to evaluate feasibility of initiating continuous glucose monitoring (CGM) through telehealth as a means of expanding access. Adults with type 1 diabetes (N = 27) or type 2 diabetes using insulin (N = 7) and interest in starting CGM selected a CGM system (Dexcom G6 or Abbott FreeStyle Libre), which they received by mail. CGM was initiated with a certified diabetes care and education specialist providing instruction via videoconference or phone. The primary outcome was days per week of CGM use during the last 4 weeks. Hemoglobin A1c (HbA1c) was measured at baseline and 12 weeks. Participant self-reported outcome measures were also evaluated. All 34 participants (mean age, 46 ± 18 years; 53% female, 85% white) were using CGM at 12 weeks, with 94% using CGM at least 6 days per week during weeks 9 to 12. Mean HbA1c decreased from 8.3 ± 1.6 at baseline to 7.2 ± 1.3 at 12 weeks (P < .001) and mean time in range (70-180 mg/dL, 3.9-10.0 mmol/L) increased from an estimated 48% ± 18% to 59% ± 20% (P < .001), an increase of approximately 2.7 hours/day. Substantial benefits of CGM to quality of life were observed, with reduced diabetes distress, increased satisfaction with glucose monitoring, and fewer perceived technology barriers to management. Remote CGM initiation was successful in achieving sustained use and improving glycemic control after 12 weeks as well as improving quality-of-life indicators. If widely implemented, this telehealth approach could substantially increase the adoption of CGM and potentially improve glycemic control for people with diabetes using insulin.

  View details for DOI 10.1210/jendso/bvaa076

  View details for PubMedID 32864542

  View details for PubMedCentralID PMC7448105

• Diabetes-Specific Self-Compassion: A New Measure for Parents of Youth With Type 1 Diabetes. Journal of pediatric psychology Tanenbaum, M. L., Adams, R. N., Wong, J. J., Hood, K. K. 2020

  Abstract

  Given the high daily demands of managing type 1 diabetes (T1D), parents of youth with T1D can experience high levels of emotional distress, burden, and self-criticism, with implications for parent and child well-being and parent self-efficacy for managing diabetes. Diabetes-specific self-compassion (SC), or being kind to oneself when facing challenges related to managing diabetes, may serve as protective for parents. This study aimed to create and assess the psychometric properties of a new tool, the diabetes-specific Self-Compassion Scale (SCS-Dp), to assess diabetes-specific SC in parents of youth with T1D.We adapted a parent diabetes-specific SC measure; surveyed parents (N = 198; parent: 88% female; 95% non-Hispanic White; M age = 44 ± 8.9; child: 46% female; M age = 13 ± 3.4, range 2-18 years; 83% insulin pump users; 40% continuous glucose monitor (CGM) users; HbA1c from clinic data available for 76 participants: M HbA1c = 8.1 ± 1.3%) and conducted confirmatory factor analysis, and reliability and construct validity analyses. Validity measures included diabetes distress, diabetes empowerment, diabetes numeracy, and HbA1c.A bifactor structure provided the best fit, with one general factor and two wording-related group factors (positively and negatively worded items). The final 19-item SCS-Dp demonstrated excellent internal consistency (α =.94; range of item-total correlations: .52-.81) and good construct validity. As predicted, greater SC was associated with lower distress (r = -.68, p < .001) and greater empowerment (r = .43, p < .001) and was not associated with diabetes numeracy (p = .61). Diabetes-specific Self-Compassion Scale was not associated with HbA1c (p = .28).Results provide initial evidence of good reliability and validity of the SCS-Dp to assess diabetes-specific SC in parents.

  View details for DOI 10.1093/jpepsy/jsaa011

  View details for PubMedID 32196093

• Improving Clinical Outcomes in Newly Diagnosed Pediatric Type 1 Diabetes: Teamwork, Targets, Technology, and Tight Control-The 4T Study. Frontiers in endocrinology Prahalad, P. n., Zaharieva, D. P., Addala, A. n., New, C. n., Scheinker, D. n., Desai, M. n., Hood, K. K., Maahs, D. M. 2020; 11: 360

  Abstract

  Many youth with type 1 diabetes (T1D) do not achieve hemoglobin A1c (HbA1c) targets. The mean HbA1c of youth in the USA is higher than much of the developed world. Mean HbA1c in other nations has been successfully modified following benchmarking and quality improvement methods. In this review, we describe the novel 4T approach-teamwork, targets, technology, and tight control-to diabetes management in youth with new-onset T1D. In this program, the diabetes care team (physicians, nurse practitioners, certified diabetes educators, dieticians, social workers, psychologists, and exercise physiologists) work closely to deliver diabetes education from diagnosis. Part of the education curriculum involves early integration of technology, specifically continuous glucose monitoring (CGM), and developing a curriculum around using the CGM to maintain tight control and optimize quality of life.

  View details for DOI 10.3389/fendo.2020.00360

  View details for PubMedID 32733375

  View details for PubMedCentralID PMC7363838

• Exercising with an automated insulin delivery system: qualitative insight into the hopes and expectations of people with type 1 diabetes PRACTICAL DIABETES Collard, S. S., Regmi, P. R., Hood, K. K., Laffel, L., Weissberg-Benchell, J., Naranjo, D., Barnard-Kelly, K. 2020; 37 (1): 19–23

  View details for DOI 10.1002/pdi.2255

  View details for Web of Science ID 000511933000004

• An exploratory assessment of pediatric patient and parent needs after implantable cardioverter defibrillator implant. Pacing and clinical electrophysiology : PACE Schneider, L. M., Wong, J. J., Trela, A. n., Hanisch, D. n., Shaw, R. J., Sears, S. F., Motonaga, K. S., Ceresnak, S. R., Hood, K. K., Dubin, A. M. 2020

  Abstract

  Placement of an ICD is often accompanied by psychological adjustment issues in pediatric patients and their parents. While anxiety, depression, and lowered QOL have been seen in these patients, no studies have investigated patient or parent reported needs. This exploratory study describes the needs of pediatric ICD patients and parents and assesses whether patient factors of age, gender, depression, and anxiety are associated with specific needs.ICD patients ages 8-21 and their parents completed a needs analysis survey assessing various domains of functioning. Patients also completed self-reported measures of depression and anxiety.Thirty-two patients (28% female) and their parents (72% mothers) completed the survey. Patients' most frequently endorsed needs involved educational issues: understanding their cardiac event/diagnosis (34%), medications (34%), and how the ICD would change their lifestyle (31%). Parents' most frequently endorsed needs involved family issues; almost half of parents (47%) were concerned about their children's frustration with their overprotectiveness and 28% were concerned with their child feeling depressed or anxious. Patients who reported feeling overprotected (12.1 ± 3.4 vs 17.4 ± 3.5 years, p = .001) were significantly younger than those who did not. Experiencing peer issues was more frequently endorsed by females than males (33% of females vs 4% of males, p = .026).ICD patients and parents endorsed markedly different needs. Patients focused on understanding their ICD, while parents were more focused on their children's emotional needs. Novel ways of educating patients about their device and clinic based screenings of emotional functioning may serve to meet these needs. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/pace.13876

  View details for PubMedID 31971265

• A comment on "'Do It Yourself ' (DIY)-Automated Insulin Delivery (AID) Systems: Current Status from a German Point of View": Time for Legitimate Co-Creation. Journal of diabetes science and technology Hood, K. K. 2019: 1932296819895292

  View details for DOI 10.1177/1932296819895292

  View details for PubMedID 31875685

• Graded exposure treatment for adolescents with chronic pain (GET Living): Protocol for a randomized controlled trial enhanced with single case experimental design. Contemporary clinical trials communications Simons, L. E., Harrison, L. E., O'Brien, S. F., Heirich, M. S., Loecher, N., Boothroyd, D. B., Vlaeyen, J. W., Wicksell, R. K., Schofield, D., Hood, K. K., Orendurff, M., Chan, S., Lyons, S. 2019; 16: 100448

  Abstract

  Chronic musculoskeletal pain in adolescence is a significant public health concern with 3-5% of adolescents suffering from significant pain-related disability. Pain-related fear and avoidance of activities has been found to have a significant influence on pain outcomes in children and adolescents and is a risk factor for less favorable response to treatment. To address this need, we developed graded exposure treatment for youth with chronic pain (GET Living). We describe the rationale, design, and implementation of a two-group randomized controlled trial (RCT) enhanced with single-case experimental design (SCED) methodology with a sample of 74 adolescents with chronic musculosketal pain and their parent caregivers. GET Living includes education, behavioral exposures, and parent intervention jointly delivered by pain psychology and physical therapy providers. The multidisciplinary pain management control group includes pain psychology delivered education and pain self-management skills training (e.g., relaxation, cognitive skills) and separate physical therapy. Assessments include brief daily diaries (baseline to discharge, 7-days at 3-month and 6-month follow-up), comprehensive in-person evaluations at baseline and discharge, and questionnaire across all time points (baseline, discharge, 3-month and 6-month follow-up). Primary outcome is pain-related fear avoidance. Secondary outcome is functional disability. We also outline all additional outcomes, exploratory outcomes, covariates, and implementation measures. The objective is to offer a mechanism-based, targeted intervention to youth with musculoskeletal pain to enhance likelihood of return to function.

  View details for DOI 10.1016/j.conctc.2019.100448

  View details for PubMedID 31650069

• A retrospective multisite examination of depression screening practices, scores, and correlates in pediatric diabetes care. Translational behavioral medicine Mulvaney, S. A., Mara, C. A., Kichler, J. C., Majidi, S., Driscoll, K. A., Westen, S. C., Rawlinson, A., Jacobsen, L. M., Adams, R. N., Hood, K. K., Monaghan, M. 2019

  Abstract

  Psychosocial guidelines recommend routine screening of depressive symptoms in adolescents and young adults (AYA) with diabetes. Best practices for screening in routine care and patient characteristics associated with depressive symptoms require further investigation. The purpose of this study was to examine psychometric properties of the Patient Health Questionnaire (PHQ-2 and PHQ-9); document rates of depressive symptoms and related clinical actions; and evaluate associations with patient characteristics. The Patient Health Questionnaire (PHQ-2 or PHQ-9) was administered at five pediatric academic medical centers with 2,138 youth with type 1 diabetes. Screening was part of routine clinical care; retrospective data from electronic health records were collected for the first screening date as well as 12 months prior. The PHQ demonstrated good psychometric properties. Evaluation of item-level PHQ-9 data identified 5.0% of AYA with at least moderate depressive symptoms who would not have been flagged for further screening using the PHQ-2 only. On the PHQ-9, 10.0% of AYA with type 1 diabetes endorsed elevated depressive symptoms and 7.0% endorsed thoughts of self-harm. Patients with moderate or greater depressive symptoms had a 43.9% documented referral rate for mental health treatment. Higher BMI, older age, public insurance, shorter diabetes duration, higher HbA1C, and a diabetic ketoacidosis (DKA) event in the past year were associated with depressive symptoms. The PHQ-9 identified AYA with elevated depressive symptoms that would not have been identified using the PHQ-2. Depressive symptoms were associated with negative diabetes indicators. To improve referral rates, standardized methods for provision and documentation of referrals are needed.

  View details for DOI 10.1093/tbm/ibz171

  View details for PubMedID 31764981

• A mobile app identifies momentary psychosocial and contextual factors related to mealtime self-management in adolescents with type 1 diabetes. Journal of the American Medical Informatics Association : JAMIA Mulvaney, S. A., Vaala, S. E., Carroll, R. B., Williams, L. K., Lybarger, C. K., Schmidt, D. C., Dietrich, M. S., Laffel, L. M., Hood, K. K. 2019

  Abstract

  Effective diabetes problem solving requires identification of risk factors for inadequate mealtime self-management. Ecological momentary assessment was used to enhance identification of factors hypothesized to impact self-management. Adolescents with type 1 diabetes participated in a feasibility trial for a mobile app called MyDay. Meals, mealtime insulin, self-monitored blood glucose, and psychosocial and contextual data were obtained for 30 days. Using 1472 assessments, mixed-effects between-subjects analyses showed that social context, location, and mealtime were associated with missed self-monitored blood glucose. Stress, energy, mood, and fatigue were associated with missed insulin. Within-subjects analyses indicated that all factors were associated with both self-management tasks. Intraclass correlations showed within-subjects accounted for the majority of variance. The ecological momentary assessment method provided specific targets for improving self-management problem solving, phenotyping, or integration within just-in-time adaptive interventions.

  View details for DOI 10.1093/jamia/ocz147

  View details for PubMedID 31529065

• Realizing a Closed-Loop (Artificial Pancreas) System for the Treatment of Type 1 Diabetes. Endocrine reviews Lal, R. A., Ekhlaspour, L., Hood, K., Buckingham, B. 2019

  Abstract

  Recent, rapid changes in the treatment of type 1 diabetes have allowed for commercialization of an "artificial pancreas" which is better described as a closed-loop controller of insulin delivery. This review presents the current state of closed-loop control systems and expected future developments with a discussion of the human factor issues in allowing automation of glucose control. The goal of these systems is to minimize or prevent both short and long-term complications from diabetes and to decrease the daily burden of managing diabetes. The closed-loop systems are generally very effective and safe at night, have allowed for improved sleep and have decreased the burden of diabetes management overnight. However, there are still significant barriers to achieving excellent daytime glucose control while simultaneously decreasing the burden of daytime diabetes management. These systems utilize a subcutaneous continuous glucose sensor, an algorithm that accounts for the current glucose and rate of change of the glucose, and the amount of insulin which has already been delivered in order to safely deliver insulin to control hyperglycemia, while minimizing the risk of hypoglycemia. The future challenge will be to allow for full closed-loop control with minimal burden on the patient during the day alleviating meal announcements, carbohydrate counting, alerts and maintenance. The human factors involved with interfacing with a closed-loop system and allowing the system to take control of diabetes management are significant. It is important to find a balance between enthusiasm and realistic expectations and experiences with closed loop.

  View details for DOI 10.1210/er.2018-00174

  View details for PubMedID 31276160

• Diabetes-Related Emotional Distress Over Time PEDIATRICS Iturralde, E., Rausch, J. R., Weissberg-Benchell, J., Hood, K. K. 2019; 143 (6)

  View details for DOI 10.1542/peds.2018-3011

  View details for Web of Science ID 000474925600016

• 670G Clinical Experience Lal, R., Basina, M., Maahs, D. M., Buckingham, B. A., Hood, K. K., Conrad, B. P., Leverenz, J., Chmielewski, A., Peterson, K., Wilson, D. AMER DIABETES ASSOC. 2019

  View details for DOI 10.2337/db19-80-OR

  View details for Web of Science ID 000501366900157

• Optimizing the use of continuous glucose monitoring in young children with type 1 diabetes with an adaptive study design and multiple randomizations. Contemporary clinical trials Berget, C., Driscoll, K. A., Lagges, A., Lange, S., DiMeglio, L. A., Hannon, T. S., Woerner, S. E., Iturralde, E., Barley, R. C., Hanes, S., Hood, K. K., Buckingham, B. B. 2019

  Abstract

  Parents of young children with type 1 diabetes (T1D) experience unique, developmental challenges in managing their child's T1D, resulting in psychosocial distress. Only a small portion of young children reach glucose goals and adherence to diabetes devices that help improve T1D management have historically been low in this population. The purpose of this study is to test four interventions that couple developmentally tailored behavioral supports with education to optimize use of diabetes devices and reduce psychosocial distress for parents of young children with T1D. The study team designed four behavioral interventions, two aimed at improving glucose control and two aimed at optimizing use of diabetes devices. The goal of this paper is to describe the behavioral interventions developed for this study, including the results of a pilot test, and describe the methods and analysis plan to test this intervention strategy with ninety participants in a large-scale, randomized trial using a SMART design. A SMART design will permit a clinically relevant evaluation of the intervention strategy, as it allows multiple randomizations based on individualized assessments throughout the study instead of a fixed intervention dose seen in most traditional randomized controlled trials.

  View details for DOI 10.1016/j.cct.2019.05.008

  View details for PubMedID 31129370

• Correlates of health care use among White and minority men and women with diabetes: An NHANES study DIABETES RESEARCH AND CLINICAL PRACTICE Wong, J. J., Hood, K. K., Breland, J. Y. 2019; 150: 122–28

  View details for DOI 10.1016/j.diabres.2019.03.001

  View details for Web of Science ID 000467689500014

• CGM Benefits and Burdens: Two Brief Measures of Continuous Glucose Monitoring. Journal of diabetes science and technology Messer, L. H., Cook, P. F., Tanenbaum, M. L., Hanes, S., Driscoll, K. A., Hood, K. K. 2019: 1932296819832909

  Abstract

  BACKGROUND:: Continuous glucose monitors (CGM) are underutilized by individuals with type 1 diabetes (T1D), particularly during the adolescent years. Little is known about perceptions of CGM benefit and burdens, and few tools exist to quantify this information.METHODS:: Two questionnaires were developed and validated-Benefit of CGM (BenCGM) and Burdens of CGM (BurCGM)-in a sample of adolescents ages 12-19 years involved in the T1D Exchange Registry. We chose to start the validation process with adolescents given their low CGM uptake and high risk for suboptimal glycemic outcomes. Exploratory and confirmatory factor analyses were conducted to confirm factor structure and select items. The resultant scales were tested for internal reliability and convergent/divergent validity with critical diabetes and quality of life outcomes: age, depression, diabetes distress, self-efficacy, technology attitudes, and diabetes technology attitudes.RESULTS:: A total of 431 adolescents with T1D completed the questionnaires (51% female, mean age 16.3 ± 2.26, 83% white non-Hispanic, 70% having used CGM). Two single factor scales emerged, and scales were reduced to 8 items each. Those who perceived higher benefit of CGM exhibited lower diabetes distress, higher self-efficacy, and more positive attitudes toward technology. Those who perceived higher burden of CGM exhibited higher diabetes distress, lower self-efficacy, and less positive technology attitudes.CONCLUSION:: The BenCGM and BurCGM questionnaires each comprise 8-items that demonstrate robust psychometric properties for use in adolescents with T1D, and can be used to develop targeted interventions to increase CGM wear to improve diabetes management.

  View details for PubMedID 30854886

• Correlates of health care use among White and minority men and women with diabetes: An NHANES study. Diabetes research and clinical practice Wong, J. J., Hood, K. K., Breland, J. Y. 2019

  Abstract

  AIMS: The current study sought to identify patient-level factors related to health care use among White and minority men and women with diabetes.METHODS: A sample of 447 of non-pregnant individuals with diabetes, ages 18-64, was drawn from the 2015-2016 National Health and Nutrition Examination Surveys dataset. Poisson regression models tested associations between health care use and self-rated health, depression, medical comorbidities, body mass index, marital status, number of children, income, insurance coverage, and age, stratified by gender and racial/ethnic minority status.RESULTS: Poorer self-rated health was the only significant correlate of increased health care use among White men with diabetes whereas income and insurance were significant correlates of increased use among minority men. Among White and minority women, higher levels of depression and being single were correlated with greater health care use. Comorbid medical conditions and insurance coverage were also related to use among minority women.CONCLUSIONS: Among individuals with diabetes, health care use among White men appeared to be driven by subjective health whereas financial factors were critical among minority men. Family structure and mental health were instrumentally associated with health care use among all women. These factors can be targeted to promote equitable access to care.

  View details for PubMedID 30844470

• Connecting the Dots: Validation of Time in Range Metrics With Microvascular Outcomes. Diabetes care Hirsch, I. B., Sherr, J. L., Hood, K. K. 2019; 42 (3): 345–48

  View details for PubMedID 30787056

• Depression in Context: Important Considerations for Youth with Type 1 vs Type 2 Diabetes. Pediatric diabetes Wong, J. J., Addala, A. n., Abujaradeh, H. n., Adams, R. N., Barley, R. C., Hanes, S. J., Iturralde, E. n., Lanning, M. S., Naranjo, D. n., Tanenbaum, M. L., Hood, K. K. 2019

  Abstract

  Youth with diabetes are at increased risk for depression. However, severity and correlates of depressive symptoms may differ by diabetes type.Associations of depressive symptoms with global health, diabetes duration, and gender were compared between youth with type 1 and type 2 diabetes.A sample of 149 youth ages 12-21 diagnosed with either type 1 (n = 122) or type 2 (n = 27) diabetes were screened during routine clinic appointments. Regression models were constructed to examine differences by diabetes type.Adolescents with type 2 diabetes had significantly higher depressive symptom scores (4.89 vs 2.99, P = 0.025) than those with type 1 diabetes. A significant interaction between global health and diabetes type on depressive symptoms revealed inverse associations between global health and depressive symptoms that was stronger among youth with type 2 diabetes (β = -0.98, P < 0.001) than type 1 (β = -0.48, P < 0.001). Further probing revealed that among youth with better global health, adolescents with type 1 had more depressive symptoms than those with type 2 diabetes (β = 0.33, P = 0.035). Diabetes duration and depressive symptoms were positively associated among individuals with type 2 (β = 0.86, P = 0.043), but not type 1 diabetes. No gender differences were detected.These findings suggest that correlates of depressive symptoms in youth with diabetes differ by diabetes type. Global health appears to be an important correlate among youth with both types, whereas diabetes duration was only a significant factor among those with type 2 diabetes. The current findings can inform future psychosocial intervention efforts within both these populations. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/pedi.12939

  View details for PubMedID 31644828

• Feasibility Studies of an Insulin-Only Bionic Pancreas in a Home-Use Setting. Journal of diabetes science and technology Ekhlaspour, L. n., Nally, L. M., El-Khatib, F. H., Ly, T. T., Clinton, P. n., Frank, E. n., Tanenbaum, M. L., Hanes, S. J., Selagamsetty, R. R., Hood, K. n., Damiano, E. R., Buckingham, B. A. 2019: 1932296819872225

  Abstract

  We tested the safety and performance of the "insulin-only" configuration of the bionic pancreas (BP) closed-loop blood-glucose control system in a home-use setting to assess glycemic outcomes using different static and dynamic glucose set-points.This is an open-label non-randomized study with three consecutive intervention periods. Participants had consecutive weeks of usual care followed by the insulin-only BP with (1) an individualized static set-point of 115 or 130 mg/dL and (2) a dynamic set-point that automatically varied within 110 to 130 mg/dL, depending on hypoglycemic risk. Human factors (HF) testing was conducted using validated surveys. The last five days of each study arm were used for data analysis.Thirteen participants were enrolled with a mean age of 28 years, mean A1c of 7.2%, and mean daily insulin dose of 0.6 U/kg (0.4-1.0 U/kg). The usual care arm had an average glucose of 145 ± 20 mg/dL, which increased in the static set-point arm (159 ± 8 mg/dL, P = .004) but not in the dynamic set-point arm (154 ± 10 mg/dL, P = ns). There was no significant difference in time spent in range (70-180 mg/dL) among the three study arms. There was less time <70 mg/dL with both the static (1.8% ± 1.4%, P = .009) and dynamic set-point (2.7±1.5, P = .051) arms compared to the usual-care arm (5.5% ± 4.2%). HF testing demonstrated preliminary user satisfaction and no increased risk of diabetes burden or distress.The insulin-only configuration of the BP using either static or dynamic set-points and initialized only with body weight performed similarly to other published insulin-only systems.

  View details for DOI 10.1177/1932296819872225

  View details for PubMedID 31470740

• CGM Initiation Soon After Type 1 Diabetes Diagnosis Results in Sustained CGM Use and Wear Time. Diabetes care Prahalad, P. n., Addala, A. n., Scheinker, D. n., Hood, K. K., Maahs, D. M. 2019

  View details for DOI 10.2337/dc19-1205

  View details for PubMedID 31558548

• One Year Clinical Experience of the First Commercial Hybrid Closed-Loop. Diabetes care Lal, R. A., Basina, M. n., Maahs, D. M., Hood, K. n., Buckingham, B. n., Wilson, D. M. 2019

  Abstract

  In September 2016, the U.S. Food and Drug Administration approved the Medtronic 670G "hybrid" closed-loop system. In Auto Mode, this system automatically controls basal insulin delivery based on continuous glucose monitoring data, but requires users enter carbohydrates and blood glucose for boluses. To track real-world experience with this first commercial closed-loop device, we prospectively followed pediatric and adult patients starting the 670G system.This was a 1-year prospective observational study of patients with type 1 diabetes starting the 670G system between May 2017 and May 2018 in clinic.A total of 84 patients received 670G and consented, 5 never returned for follow-up, with 79 (aged 9-61 years) providing data at 1 week and 3, 6, 9, and/or 12 months after Auto Mode initiation. For the 86% (68 out of 79) with 1-week data, 99% (67 out of 68) successfully started. By 3 months, at least 28% (22 out of 79) stopped using Auto Mode; at 6 months, 34% (27 out of 79); at 9 months, 35% (28 out of 79); and by 12 months, 33% (26 out of 79). The primary reason for continuing Auto Mode was desire for increased time in range. Reasons for discontinuation included sensor issues in 62% (16 out of 26), problems obtaining supplies in 12% (3 out of 26), hypoglycemia fear in 12% (3 out of 26), multiple daily injection preference in 8% (2 out of 26), and sports in 8% (2 out of 26). At all visits, there was a significant correlation between hemoglobin A1c (HbA1c) and Auto Mode utilization.While Auto Mode utilization correlates with improved glycemic control, a focus on usability and human factors is necessary to ensure use of Auto Mode. Alarms and sensor calibration are a major patient concern, which future technology should alleviate.

  View details for DOI 10.2337/dc19-0855

  View details for PubMedID 31548247

• Diabetes-Related Emotional Distress Over Time. Pediatrics Iturralde, E. n., Rausch, J. R., Weissberg-Benchell, J. n., Hood, K. K. 2019

  Abstract

  Many adolescents with type 1 diabetes experience diabetes-related distress (DRD; the negative emotional reactions specific to managing diabetes), but most research on DRD among adolescents relies on cross-sectional data. We assess adolescents' longitudinal DRD patterns and predictors of chronic DRD.This secondary analysis of data from a depression prevention clinical trial included 264 adolescents with type 1 diabetes randomly assigned to a resilience or education intervention (mean age: 15.7 ± 1.1 years; 59.8% female). Youth reported their DRD at 5 assessments over 16 months. Using latent class growth analysis, we classified adolescents into trajectory groups according to baseline starting point (intercept) and rate of change (slope) of DRD. We examined bivariate associations between trajectory group membership and demographic and clinical factors. Baseline predictors of chronic DRD were assessed via multiple logistic regression.Participants were classified into 4 groups: stable high DRD (7.2%; high intercept, flat slope), stable moderate DRD (28.0%; above-average intercept, flat slope), improving DRD (33.7%; average intercept, downward slope), and low DRD (31.1%; below-average intercept, downward slope). Lower hemoglobin A1c, greater adherence, fewer socioemotional difficulties, and more adaptive coping distinguished the improving and low DRD trajectories. Chronic DRD patterns were associated with female sex and higher depressive symptoms and hemoglobin A1c.In this study of adolescents' DRD trajectories during and after a psychoeducational intervention, one-third of youth were classified as having chronic, elevated DRD. Links with multiple clinical factors support efforts for routine DRD screening and comprehensive interventions for distressed youth.

  View details for PubMedID 31043453

• Hemoglobin A1c Trajectory in Pediatric Patients with Newly Diagnosed Type 1 Diabetes. Diabetes technology & therapeutics Prahalad, P. n., Yang, J. n., Scheinker, D. n., Desai, M. n., Hood, K. n., Maahs, D. M. 2019

  Abstract

  Despite advances in diabetes technology and treatment, a majority of children and adolescents with type 1 diabetes (T1D) fail to meet hemoglobin A1c (HbA1c) targets. Among high-income nations, the United States has one of the highest mean HbA1c values. We tracked the HbA1c values of 261 patients diagnosed with T1D in our practice over a 2.5-year period to identify inflection points in the HbA1c trajectory. The HbA1c declined until 5 months postdiagnosis. There was a rise in the HbA1c between the fifth and sixth month postdiagnosis. The HbA1c continued to steadily rise and by 18 months postdiagnosis, the mean HbA1c was 8.2%, which is also our clinic mean. Understanding the HbA1c trajectory early in the course of diabetes has helped to identify opportunities for intensification of diabetes management to flatten the trajectory of HbA1c and improve clinical outcomes.

  View details for DOI 10.1089/dia.2019.0065

  View details for PubMedID 31180244

• Assessing the efficacy, safety and utility of 6-month day-and-night automated closed-loop insulin delivery under free-living conditions compared with insulin pump therapy in children and adolescents with type 1 diabetes: an open-label, multicentre, multinational, single-period, randomised, parallel group study protocol. BMJ open Musolino, G. n., Allen, J. M., Hartnell, S. n., Wilinska, M. E., Tauschmann, M. n., Boughton, C. n., Campbell, F. n., Denvir, L. n., Trevelyan, N. n., Wadwa, P. n., DiMeglio, L. n., Buckingham, B. A., Weinzimer, S. n., Acerini, C. L., Hood, K. n., Fox, S. n., Kollman, C. n., Sibayan, J. n., Borgman, S. n., Cheng, P. n., Hovorka, R. n. 2019; 9 (6): e027856

  Abstract

  Closed-loop systems titrate insulin based on sensor glucose levels, providing novel means to reduce the risk of hypoglycaemia while improving glycaemic control. We will assess effectiveness of 6-month day-and-night closed-loop insulin delivery compared with usual care (conventional or sensor-augmented pump therapy) in children and adolescents with type 1 diabetes.The trial adopts an open-label, multicentre, multinational (UK and USA), randomised, single-period, parallel design. Participants (n=130) are children and adolescents (aged ≥6 and <19 years) with type 1 diabetes for at least 1 year, and insulin pump use for at least 3 months with suboptimal glycaemic control (glycated haemoglobin ≥58 mmol/mol (7.5%) and ≤86 mmol/mol (10%)). After a 2-3 week run-in period, participants will be randomised to 6-month use of hybrid closed-loop insulin delivery, or to usual care. Analyses will be conducted on an intention-to-treat basis. The primary outcome is glycated haemoglobin at 6 months. Other key endpoints include time in the target glucose range (3.9-10 mmol/L, 70-180 mg/dL), mean sensor glucose and time spent above and below target. Secondary outcomes include SD and coefficient of variation of sensor glucose levels, time with sensor glucose levels <3.5 mmol/L (63 mg/dL) and <3.0 mmol/L (54 mg/dL), area under the curve of glucose <3.5 mmol/L (63 mg/dL), time with glucose levels >16.7 mmol/L (300 mg/dL), area under the curve of glucose >10.0 mmol/L (180 mg/dL), total, basal and bolus insulin dose, body mass index z-score and blood pressure. Cognitive, emotional and behavioural characteristics of participants and caregivers and their responses to the closed-loop and clinical trial will be assessed. An incremental cost-effectiveness ratio for closed-loop will be estimated.Cambridge South Research Ethics Committee and Jaeb Center for Health Research Institutional Review Office approved the study. The findings will be disseminated by peer-review publications and conference presentations.NCT02925299; Pre-results.

  View details for DOI 10.1136/bmjopen-2018-027856

  View details for PubMedID 31164368

• Assessing Strengths of Children with Type 1 Diabetes: Validation of the Diabetes Strengths and Resilience (DSTAR) Measure for Ages 9 to 13. Pediatric diabetes Iturralde, E. n., Hood, K. K., Weissberg-Benchell, J. n., Anderson, B. J., Hilliard, M. E. 2019

  Abstract

  Adaptive diabetes-specific attitudes and behaviors, known as diabetes strengths, relate to positive self-management and quality of life outcomes in type 1 diabetes (T1D), but have not been studied in pre-adolescence. To facilitate strengths-based care and research on this topic, we developed and evaluated the psychometric properties of a measure of diabetes strengths for children age 9-13.Participants were 187 children receiving care for T1D at a tertiary care children's hospital. They completed the 12-item self-report Diabetes Strengths and Resilience scale for children (DSTAR-Child), which we adapted from a measure validated for adolescents. Youth completed the DSTAR-Child twice, and measures of relevant constructs at baseline: general and diabetes-related quality of life, depressive symptoms, and diabetes distress. Parents rated children's engagement in self-management behaviors and general resilience. We extracted HbA1c from the medical record.The DSTAR-Child total score demonstrated reliability, including internal consistency and stability across two time points. The total score was significantly associated in expected directions with psychosocial measures and glycemic control but not self-management behaviors. In confirmatory factor analyses, the best-fitting structure contained two latent factors tapping intrapersonal and interpersonal strengths. Resulting subscale scores also appeared reliable and valid.This brief, practical measure of diabetes strengths demonstrated sound psychometric properties. Diabetes strengths appeared unrelated to self-management behaviors, perhaps because of the primary role of adult caregivers in T1D management for pre-adolescents. As a research and clinical tool, the DSTAR-Child can facilitate greater understanding of diabetes strengths and inform strengths-based strategies to foster resilient T1D outcomes. This article is protected by copyright. All rights reserved.

  View details for DOI 10.1111/pedi.12898

  View details for PubMedID 31336011

• Diabetes management mediating effects between diabetes symptoms and health-related quality of life in adolescents and young adults with type 1 diabetes PEDIATRIC DIABETES Varni, J. W., Delamater, A. M., Hood, K. K., Driscoll, K. A., Wong, J. C., Adi, S., Yi-Frazier, J. P., Grishman, E. K., Faith, M. A., Corathers, S. D., Kichler, J. C., Miller, J. L., Raymond, J. K., Doskey, E. M., Aguirre, V., Heffer, R. W., Wilson, D. P., Pediat Quality Life Inventory 3 2 2018; 19 (7): 1322–30

  Abstract

  The primary objective was to investigate the mediating effects of diabetes management in the relationship between diabetes symptoms and generic health-related quality of life (HRQOL) in adolescents and young adults (AYAs) with type 1 diabetes. The secondary objective explored patient health communication and perceived treatment adherence barriers as mediators in a serial multiple mediator model.The PedsQL 3.2 Diabetes Module 15-item diabetes symptoms summary score, 18-item diabetes management summary score, and PedsQL 4.0 generic core scales were completed in a 10-site national field test study by 418 AYA aged 13 to 25 years with type 1 diabetes. Diabetes symptoms and diabetes management were tested for bivariate and multivariate linear associations with overall generic HRQOL. Mediational analyses were conducted to test the hypothesized mediating effects of diabetes management as an intervening variable between diabetes symptoms and generic HRQOL.The predictive effects of diabetes symptoms on HRQOL were mediated in part by diabetes management. In predictive analytics models utilizing multiple regression analyses, demographic and clinical covariates, diabetes symptoms, and diabetes management significantly accounted for 53% of the variance in generic HRQOL (P < 0.001), demonstrating a large effect size. Patient health communication and perceived treatment adherence barriers were significant mediators in an exploratory serial multiple mediator model.Diabetes management explains in part the effects of diabetes symptoms on HRQOL in AYA with type 1 diabetes. Patient health communication to healthcare providers and perceived treatment adherence barriers further explain the mechanism in the relationship between diabetes symptoms and overall HRQOL.

  View details for PubMedID 29927039

• Digital Diabetes Congress 2018. Journal of diabetes science and technology King, F., Klonoff, D. C., Kerr, D., Hu, J., Lyles, C., Quinn, C., Adi, S., Chen, K., Hood, K., Salber, P., de Clercq, C., Hu, J., Gabbay, R. 2018; 12 (6): 1231–38

  Abstract

  Digital health is capturing the attention of the healthcare community. This paradigm whereby healthcare meets the internet uses sensors that communicate wirelessly along with software residing on smartphones to deliver data, information, treatment recommendations, and in some cases control over an effector device. As artificial intelligence becomes more widely used, this approach to creating individualized treatment plans will increase the opportunities for patients, even if they are in remote settings, to communicate with and learn from healthcare professionals. Simple design is needed to promote use of these tools, especially for the purpose of increased adherence to treatment. Widespread adoption by the healthcare industry will require better outcomes data, which will most likely be in the form of safety and effectiveness results from robust randomized controlled trials, as well as evidence of privacy and security. Such data will be needed to convince investors to direct resources into and regulators to clear new digital health tools. Diabetes Technology Society and William Sansum Diabetes Center launched the Digital Diabetes Congress in 2017 because of great interest in determining the potential benefits, metrics of success, and appropriate components of mobile applications for diabetes. The second annual meeting in this series took place on May 22-23, 2018 in San Francisco. This report contains summaries of the meeting's 4 plenary lectures and 10 sessions. This meeting report presents a summary of how 55 panelists, speakers, and moderators, who are leaders in healthcare technology, see the current and future landscape of digital health tools applied to diabetes.

  View details for PubMedID 30376739

• PedsQL 3.2 Diabetes Module for Children, Adolescents, and Young Adults: Reliability and Validity in Type 1 Diabetes DIABETES CARE Varni, J. W., Delamater, A. M., Hood, K. K., Raymond, J. K., Chang, N. T., Driscoll, K. A., Wong, J. C., Yi-Frazier, J. P., Grishman, E. K., Faith, M. A., Corathers, S. D., Kichler, J. C., Miller, J. L., Doskey, E. M., Heffer, R. W., Wilson, D. P., Pediat Quality Life Inventory Dia 2018; 41 (10): 2064–71

  Abstract

  The objective of the study was to report on the measurement properties of the revised and updated Pediatric Quality of Life Inventory (PedsQL) 3.2 Diabetes Module for children, adolescents, and young adults with type 1 diabetes.The 33-item PedsQL 3.2 Diabetes Module and PedsQL Generic Core Scales were completed in a 10-site national field test study by 656 families of patients ages 2-25 years with type 1 diabetes.The 15-item Diabetes Symptoms Summary Score and 18-item Diabetes Management Summary Score were derived from the factor analysis of the items. The Diabetes Symptoms and Diabetes Management Summary Scores evidenced excellent reliability (patient self-report α = 0.88-0.90; parent proxy report α = 0.89-0.90). The Diabetes Symptoms and Diabetes Management Summary Scores demonstrated construct validity through medium to large effect size correlations with the Generic Core Scales Total Scale Score (r = 0.43-0.67, P < 0.001). HbA1c was significantly correlated with the Diabetes Symptoms and Diabetes Management Summary Scores (r = -0.21 to -0.29, P < 0.001). Minimal clinically important difference scores ranged from 5.05 to 5.55.The PedsQL 3.2 Diabetes Module Diabetes Symptoms and Diabetes Management Summary Scores demonstrated excellent measurement properties and may be useful as standardized patient-reported outcomes of diabetes symptoms and diabetes management in clinical research, clinical trials, and practice in children, adolescents, and young adults with type 1 diabetes.

  View details for PubMedID 30061317

• ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes in adolescence Cameron, F. J., Garvey, K., Hood, K. K., Acerini, C. L., Codner, E. WILEY. 2018: 250–61

  View details for PubMedID 29900653

• ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes technologies Sherr, J. L., Tauschmann, M., Battelino, T., de Bock, M., Forlenza, G., Roman, R., Hood, K. K., Maahs, D. M. WILEY. 2018: 302–25

  View details for PubMedID 30039513

• Psychosocial and Human Factors During a Trial of a Hybrid Closed Loop System for Type 1 Diabetes Management. Diabetes technology & therapeutics Adams, R. N., Tanenbaum, M. L., Hanes, S. J., Ambrosino, J. M., Ly, T. T., Maahs, D. M., Naranjo, D., Walders-Abramson, N., Weinzimer, S. A., Buckingham, B. A., Hood, K. K. 2018

  Abstract

  BACKGROUND: Hybrid closed loop (HCL) systems are designed to automate insulin delivery to improve type 1 diabetes (T1D) outcomes and reduce user burden and distress. Because the systems only automate some aspects of diabetes care, psychosocial and human factors remain an important consideration in their use. Thus, we examined whether psychosocial and human factors (i.e., distress related to diabetes management, fear of hypoglycemia, and technology attitudes) would (1) change after using the system and (2) predict glycemic outcomes during the trial.SUBJECTS AND METHODS: Fourteen adults and 15 adolescents with T1D participated in a multisite clinical trial of an investigational version of the MiniMed 670G system (Medtronic, Northridge, CA) over 4 to 5 days in a semisupervised outpatient setting. Users completed surveys assessing psychosocial and human factors before beginning the HCL system and at the conclusion of the study. t-Tests and regression analyses were conducted to examine whether these factors changed following trial exposure to the HCL system and predicted glycemic outcomes during the trial.RESULTS: Diabetes management distress decreased and diabetes technology attitudes became more positive over the trial period. Fear of hypoglycemia did not change over the trial period. There was a trend toward greater pretrial management distress predicting less time in range during the trial, controlling for time in range before the trial.CONCLUSIONS: Results suggest that this system is promising for enhancing technology attitudes and reducing management distress. Psychosocial factors, such as management distress, may negatively impact glycemic outcomes and should be a priority area for further investigation.

  View details for PubMedID 30239219

• Psychosocial and Human Factors During a Trial of a Hybrid Closed Loop System for Type 1 Diabetes Management DIABETES TECHNOLOGY & THERAPEUTICS Adams, R. N., Tanenbaum, M. L., Hanes, S. J., Ambrosino, J. M., Ly, T. T., Maahs, D. M., Naranjo, D., Walders-Abramson, N., Weinzimer, S. A., Buckingham, B. A., Hood, K. K. 2018; 20 (10): 648–53

  View details for DOI 10.1089/dia.2018.0174

  View details for Web of Science ID 000445347300001

• Type 1 Diabetes in Children and Adolescents: A Position Statement by the American Diabetes Association DIABETES CARE Chiang, J. L., Maahs, D. M., Garvey, K. C., Hood, K. K., Laffel, L. M., Weinzimer, S. A., Wolfsdorf, J. I., Schatz, D. 2018; 41 (9): 2026–44

  View details for PubMedID 30093549

  View details for PubMedCentralID PMC6105320

• Diabetes symptoms predictors of health-related quality of life in adolescents and young adults with type 1 or type 2 diabetes QUALITY OF LIFE RESEARCH Varni, J. W., Delamater, A. M., Hood, K. K., Raymond, J. K., Driscoll, K. A., Wong, J. C., Adi, S., Yi-Frazier, J. P., Grishman, E. K., Faith, M. A., Corathers, S. D., Kichler, J. C., Miller, J. L., Doskey, E. M., Aguirre, V. P., Heffer, R. W., Wilson, D. P., Pediat Quality Life Inventory T M 2018; 27 (9): 2295–2303

  Abstract

  The objective was to investigate the patient-reported diabetes symptoms predictors of generic health-related quality of life (HRQOL) in adolescents and young adults (AYA) with type 1 or type 2 diabetes.The 15-item PedsQL™ 3.2 Diabetes Module Diabetes Symptoms Summary Score and PedsQL™ 4.0 Generic Core Scales were completed in a 10-site national field test study by 513 AYA ages 13-25 years with type 1 (n = 424) or type 2 (n = 89) diabetes. Diabetes symptoms were tested for bivariate and multivariate linear associations with generic HRQOL.Diabetes symptoms were associated with decreased HRQOL in bivariate analyses. In predictive analytics models utilizing hierarchical multiple regression analyses controlling for relevant demographic and clinical covariates, diabetes symptoms accounted for 38 and 39% of the variance in patient-reported generic HRQOL for type 1 and type 2 diabetes, respectively, reflecting large effect sizes. The diabetes symptoms facets hyperglycemia symptoms, hypoglycemia symptoms, and nonspecific diabetes symptoms individually accounted for a significant percentage of the variance in separate exploratory predictive analytics models after controlling for demographic and clinical covariates, with small-to-large effect sizes.Diabetes symptoms are potentially modifiable predictors of generic HRQOL in AYA with diabetes. Identifying specific diabetes symptoms or symptoms facets that are the most important predictors from the patient perspective facilitates a patient-centered approach in clinical research, clinical trials, and practice designed to enhance overall generic HRQOL in AYA with diabetes.

  View details for PubMedID 29785681

• Big Topics for Diabetes Care in 2018: Clinical Guidelines, Costs of Diabetes, and Information Technology DIABETES CARE Riddle, M. C., Bakris, G., Boulton, A. M., Blonde, L., D'Alessio, D., Greene, E. L., de Groot, M., Hood, K., Hu, F. B., Kahn, S. E., Kaul, S., LeRoith, D., Moses, R. G., Rich, S. S., Rosenstock, J., Tamborlane, W. V., Wylie-Rosett, J., Reynolds, L. 2018; 41 (7): 1327–29

  View details for PubMedID 29934474

• Using Cluster Analysis to Understand Clinician Readiness to Promote Continuous Glucose Monitoring Adoption. Journal of diabetes science and technology Tanenbaum, M. L., Adams, R. N., Lanning, M. S., Hanes, S. J., Agustin, B. I., Naranjo, D., Hood, K. K. 2018: 1932296818786486

  Abstract

  BACKGROUND: Background:Many people with type 1 diabetes (T1D) report barriers to using continuous glucose monitoring (CGM). Diabetes care providers may have their own barriers to promoting CGM uptake. The goal of this study was to develop clinician "personas" with regard to readiness to promote CGM uptake.METHODS: Diabetes care providers who treat people with T1D (N = 209) completed a survey on perceived patient barriers to device uptake, technology attitudes, and characteristics and barriers specific to their clinical practice. K-means cluster analyses grouped the sample by CGM barriers and attitudes. ANOVAs and chi-square tests assessed group differences on provider and patient characteristics. The authors assigned descriptive names for each persona.RESULTS: Analyses yielded three clinician personas regarding readiness to promote CGM uptake. Ready clinicians (20% of sample; 24% physicians, 38% certified diabetes educators/CDEs) had positive technology attitudes, had clinic time to work with patients using CGM, and found it easy to keep up with technology advances. In comparison, Cautious clinicians (41% of sample; 17% physicians, 53% CDEs) perceived that their patients had many barriers to adopting CGM and had less time than the Ready group to work with patients using CGM data. Not Yet Ready clinicians (40% of sample; 9% physicians; 79% CDEs) had negative technology attitudes and the least clinic time to work with CGM data. They found it difficult to keep up with technology advances.CONCLUSION: Some diabetes clinicians may benefit from tailored interventions and additional time and resources to empower them to help facilitate increased uptake of CGM technology.

  View details for PubMedID 29991281

• Mobile Momentary Assessment and Biobehavioral Feedback for Adolescents with Type 1 Diabetes: Feasibility and Engagement Patterns DIABETES TECHNOLOGY & THERAPEUTICS Mulvaney, S. A., Vaala, S., Hood, K. K., Lybarger, C., Carroll, R., Williams, L., Schmidt, D. C., Johnson, K., Dietrich, M. S., Laffel, L. 2018: 465–74

  Abstract

  Integration of momentary contextual and psychosocial factors within self-management feedback may provide more specific, engaging, and personalized targets for problem solving.Forty-four youth ages 13-19 with type 1 diabetes (T1D) were provided a Bluetooth meter and completed the 30-day protocol. Participants were randomized to "app + meter" or "meter-only" groups. App + meter participants completed mealtime and bedtime assessment each day. Assessments focused on psychosocial and contextual information relevant for self-management. Graphical feedback integrated self-monitored blood glucose (SMBG), insulin, and Bluetooth-transmitted blood glucose data with the psychosocial and contextual data. App + meter participants completed an interview to identify data patterns.The median number of momentary assessments per participant was 80.0 (range 32-120) with 2.60 per day. By 2 weeks participants had an average of 40.77 (SD 12.23) assessments. Dose-response analyses indicated that the number of app assessments submitted were significantly related to higher mean daily SMBG (r = -0.44, P < 0.05) and to lower% missed mealtime SMBG (r = -0.47, P < 0.01). Number of feedback viewing sessions was also significantly related to a lower% missed mealtime SMBG (r = -0.44, P < 0.05). Controlling for baseline variables, mixed-effects analyses did not indicate group × time differences in mean daily SMBG. Engagement analyses resulted in three trajectory groups distinguished by assessment frequencies and rates of decline. Engagement group membership was significantly related to gender, mean daily SMBG, and HbA1c values.Momentary assessment combined with device data provided a feasible means to provide novel personalized biobehavioral feedback for adolescents with T1D. A 2-week protocol provided sufficient data for self-management problem identification. In addition to feedback, more intensive intervention may need to be integrated for those patients with the lowest self-management at baseline.

  View details for PubMedID 29882677

• Psychometric Properties of the Problem Areas in Diabetes: Teen and Parent of Teen Versions JOURNAL OF PEDIATRIC PSYCHOLOGY Shapiro, J. B., Vesco, A. T., Weil, L. G., Evans, M. A., Hood, K. K., Weissberg-Benchell, J. 2018; 43 (5): 561–71

  Abstract

  This study adds to the literature on the psychometric properties of the Problem Areas in Diabetes-Teen (PAID-T) and Parent (P-PAID-T) Versions. It also aims to shorten the measures of diabetes-specific distress, determine construct validity, and establish cutoff scores.Data are from two independent studies (N = 1,265). Adolescent-caregiver dyads completed measures of emotional distress, diabetes strengths, hemoglobin A1c, blood glucose checks, and average blood glucose. Exploratory and confirmatory factor analyses assessed factor structures for each measure. Correlational analyses provided support for concurrent validity. Receiver-operating characteristic curves identified cutoff scores based on clinically meaningful groups identified with latent profile analysis.Analyses supported a 14-item PAID-T and a 15-item P-PAID-T, with preliminary cutoff scores ≥44 and ≥54, respectively. Measures were associated with emotional and health outcomes as hypothesized.The PAID-T and P-PAID-T are valid, reliable, and useful measures of diabetes-specific distress for teenagers with type 1 diabetes and parents of teenagers.

  View details for PubMedID 29267939

• HARNESSING DESIGN THINKING TO ENHANCE BEHAVIORAL INTERVENTIONS Tanenbaum, M. L., Breland, J. Y., Altman, M., Krugman, S. F., Gibson, B., Yingling, L., Miller, L. S., Perski, O., Hood, K. K. OXFORD UNIV PRESS INC. 2018: S423

  View details for Web of Science ID 000431185201234

• HUMAN FACTORS DURING TRIAL OF A HYBRID CLOSED LOOP SYSTEM FOR TYPE 1 DIABETES MANAGEMENT Adams, R. N., Tanenbaum, M. L., Hanes, S. J., Ambrosino, J. M., Ly, T. T., Maahs, D. M., Naranjo, D., Walders-Abramson, N., Weinzimer, S. A., Buckingham, B. A., Hood, K. K. OXFORD UNIV PRESS INC. 2018: S718

  View details for Web of Science ID 000431185202153

• Automated Insulin Delivery Systems: Hopes and Expectations of Family Members DIABETES TECHNOLOGY & THERAPEUTICS Garza, K. P., Jedraszko, A., Weil, L. G., Naranjo, D., Barnard, K. D., Laffel, L. B., Hood, K. K., Weissberg-Benchell, J. 2018; 20 (3): 222–28

  Abstract

  This study examines the hopes and expectations that children, adolescents, and adults with type 1 diabetes and their families have for new automated insulin delivery systems. The study also aims to examine how the automated insulin delivery system may impact family functioning and individual members' psychosocial adjustment.Forty-eight semistructured focus groups (n = 195) and 89 individual interviews were conducted with children, adolescents, and adults with type 1 diabetes and parents and partners. Coders reviewed results in key themes most likely to contain references to the family system. Clusters were analyzed using thematic analysis to identify participants' salient hopes and expectations of how new technology may impact family relationships and individual psychosocial functioning.Three main themes emerged for participants' hopes and expectations for implementation of the automated insulin delivery system. First, there is an expectation that this diabetes technology will alleviate diabetes-specific worry and burden for the people with diabetes and other family members. Second, there is also hope that this system may reduce day-to-day stress and, third, improve family relationships.The unique perspective of a broad age group provides insight into how individuals and families creatively address the multiple tasks required in daily diabetes management. Study findings elucidate the very high hopes and expectations held by those managing type 1 diabetes and the impact this new technology may have on family relationships. Awareness of these hopes and expectations is important for developers and clinicians in addressing potential challenges to uptake and to ensure that expectations are set appropriately.

  View details for PubMedID 29565721

• The dawn of automated insulin delivery: A new clinical framework to conceptualize insulin administration PEDIATRIC DIABETES Messer, L. H., Forlenza, G. P., Wadwa, R., Weinzimer, S. A., Sherr, J. L., Hood, K. K., Buckingham, B. A., Slover, R. H., Maahs, D. M. 2018; 19 (1): 14–17

  View details for PubMedID 28656656

• What End Users and Stakeholders Want From Automated Insulin Delivery Systems DIABETES CARE Naranjo, D., Suttiratana, S. C., Iturralde, E., Barnard, K. D., Weissberg-Benchell, J., Laffel, L., Hood, K. K. 2017; 40 (11): 1453–61

  Abstract

  The purpose of this study was to rigorously explore psychosocial factors associated with automated insulin delivery systems among people living with type 1 diabetes.Across four sites in the U.S. and U.K., 284 participants completed structured interviews or focus groups on expectations, desired features, potential benefits, and perceived burdens of automated insulin delivery systems. Recorded audio files were transcribed and analyzed using NVivo.Three themes were identified as critical for uptake of automated insulin delivery: considerations of trust and control, system features, and concerns and barriers to adoption. Children and adolescents with type 1 diabetes primarily identified needs specific to their life stage and social contexts (e.g., school). Adults with type 1 diabetes, parents of youth with type 1 diabetes, and partners of adults with type 1 diabetes were most concerned about the accuracy, adaptability, and algorithm quality alongside expectations that systems stabilize glucose levels and reduce risk for long-term complications.Incorporating stakeholder perspectives on use of automated insulin delivery systems will improve the adoption of devices, quality of life, and likelihood of optimal health. Efforts to build trust in systems, optimize user-system interactions, and provide clear guidance about device capabilities and limitations may help potential users achieve optimal glycemic outcomes.

  View details for PubMedID 28842523

  View details for PubMedCentralID PMC5864142

• Trust in hybrid closed loop among people with diabetes: Perspectives of experienced system users. Journal of health psychology Tanenbaum, M. L., Iturralde, E., Hanes, S. J., Suttiratana, S. C., Ambrosino, J. M., Ly, T. T., Maahs, D. M., Naranjo, D., Walders-Abramson, N., Weinzimer, S. A., Buckingham, B. A., Hood, K. K. 2017: 1359105317718615

  Abstract

  Automated closed loop systems will greatly change type 1 diabetes management; user trust will be essential for acceptance of this new technology. This qualitative study explored trust in 32 individuals following a hybrid closed loop trial. Participants described how context-, system-, and person-level factors influenced their trust in the system. Participants attempted to override the system when they lacked trust, while trusting the system decreased self-management burdens and decreased stress. Findings highlight considerations for fostering trust in closed loop systems. Systems may be able to engage users by offering varying levels of controls to match trust preferences.

  View details for PubMedID 28810490

• Sharing and helping: predictors of adolescents' willingness to share diabetes personal health information with peers. Journal of the American Medical Informatics Association Vaala, S. E., Lee, J. M., Hood, K. K., Mulvaney, S. A. 2017

  Abstract

  Sharing personal information about type 1 diabetes (T1D) can help adolescents obtain social support, enhance social learning, and improve self-care. Diabetes technologies, online communities, and health interventions increasingly feature data-sharing components. This study examines factors underlying adolescents' willingness to share personal T1D information with peers.Participants were 134 adolescents (12-17 years of age; 56% female) who completed an online survey regarding experiences helping others with T1D, perceived social resources, beliefs about the value of sharing information and helping others, and willingness to share T1D information. Hemoglobin A1c values were obtained from medical records.Adolescents were more willing to share how they accomplished T1D tasks than how often they completed them, and least willing to share glucose control status. In multivariate analyses, sharing/helping beliefs (β = 0.26, P  < .01) and glucose control (HbA1c value; β = -0.26, P  < .01) were related to greater willingness to share personal health information. Glucose control moderated relationships such that adolescents with worse A1c values had stronger relationships between sharing/helping beliefs and willingness to share (β = 0.18, P  < .05) but weaker relationships between helping experience and willingness to share (β = -0.22, P  = .07).Many adolescents with T1D are willing to share personal health information, particularly if they have better diabetes health status and a stronger belief in the benefits of sharing.Social learning and social media components may improve intervention participation, engagement, and outcomes by boosting adolescents' beliefs about the benefits of sharing information and helping others.

  View details for DOI 10.1093/jamia/ocx051

  View details for PubMedID 28575462

• The Diabetes Strengths and Resilience Measure for Adolescents With Type 1 Diabetes (DSTAR-Teen): Validation of a New, Brief Self-Report Measure. Journal of pediatric psychology Hilliard, M. E., Iturralde, E., Weissberg-Benchell, J., Hood, K. K. 2017

  Abstract

   Despite the challenges of managing type 1 diabetes, many adolescents achieve optimal outcomes. A validated measure of diabetes-specific strengths is needed to measure adaptive behaviors and attitudes associated with overcoming challenges and achieving "resilient" outcomes.  Baseline data from 260 adolescents (age 14-18 years, M  = 15.7 ± 1.1, 60% female, 33% Non-Caucasian, M A1c = 9.1 ± 1.9%) and caregivers in a behavioral intervention trial were analyzed to evaluate psychometric properties of the 12-item self-report Diabetes Strengths and Resilience measure for adolescents (DSTAR-Teen). Reliability and validity were examined in relation to measures of related constructs, regimen adherence, and glycemic outcomes, and confirmatory factor analysis was conducted.  Reliability was good (internal consistency: α = .89; item-total correlations: r range = .55-.78). Significant correlations demonstrated construct and criterion validity. A two-factor structure reflecting intrapersonal and interpersonal processes fit the data better than a one-factor solution.  The DSTAR-Teen has strong psychometric properties, captures adaptive aspects of adolescents' diabetes management (i.e., "strengths"), and is related to clinical outcomes.

  View details for DOI 10.1093/jpepsy/jsx086

  View details for PubMedID 28549160

• Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control PEDIATRIC DIABETES Floyd, B. D., Block, J. M., Buckingham, B. B., Ly, T., Foster, N., Wright, R., Mueller, C. L., Hood, K. K., Shah, A. C. 2017; 18 (3): 204-212

  Abstract

  Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D.SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months.A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria.HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance.SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.

  View details for DOI 10.1111/pedi.12373

  View details for Web of Science ID 000399353400005

• Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use. Journal of diabetes science and technology Tanenbaum, M. L., Adams, R. N., Hanes, S. J., Barley, R. C., Miller, K. M., Mulvaney, S. A., Hood, K. K. 2017; 11 (3): 484-492

  Abstract

  Insulin pumps and continuous glucose monitors (CGM) can improve glycemic control for individuals with type 1 diabetes (T1D). Device uptake rates continue to show room for improvement, and consistent adherence is needed to achieve better outcomes. Diabetes health care providers have important roles to play in promoting device use and adherence.We surveyed 209 clinicians who treat people with type 1 diabetes to examine perceptions of barriers to device uptake, attitudes toward diabetes technology, and resources needed for clinicians to improve device uptake. We compared findings with our survey of adults with T1D.Younger clinicians treated more patients using insulin pumps ( r = -.26, P < .001) and CGM ( r = -.14, P = .02), and had more positive attitudes about diabetes technology ( r = -.23, P = .001). The most frequently endorsed modifiable barriers were perceptions that patients dislike having the device on their body (73% pump; 63% CGM), dislike the alarms (61% CGM), and do not understand what to do with device information or features (40% pump; 46% CGM). Clinicians wanted lower cost and better insurance coverage for their patients, and they recommended counseling and education to help address barriers and improve adherence to devices.Clinicians perceive many barriers to their patients initiating and adhering to diabetes devices. Findings highlight opportunities for intervention to improve clinician-patient communication around device barriers to help address them.

  View details for DOI 10.1177/1932296816688010

  View details for PubMedID 28745093

  View details for PubMedCentralID PMC5505431

• Expectations and Attitudes of Individuals With Type 1 Diabetes After Using a Hybrid Closed Loop System DIABETES EDUCATOR Iturralde, E., Tanenbaum, M. L., Hanes, S. J., Suttiratana, S. C., Ambrosino, J. M., Ly, T. T., Maahs, D. M., Naranjo, D., Walders-Abramson, N., Weinzimer, S. A., Buckingham, B. A., Hood, K. K. 2017; 43 (2): 223-232

  Abstract

  Purpose The first hybrid closed loop (HCL) system, which automates insulin delivery but requires user inputs, was approved for treatment of type 1 diabetes (T1D) by the US Food and Drug Administration in September 2016. The purpose of this study was to explore the benefits, expectations, and attitudes of individuals with T1D following a clinical trial of an HCL system. Methods Thirty-two individuals with T1D (17 adults, 15 adolescents) participated in focus groups after 4 to 5 days of system use. Content analysis generated themes regarding perceived benefits, hassles, and limitations. Results Some participants felt misled by terms such as "closed loop" and "artificial pancreas," which seemed to imply a more "hands-off" experience. Perceived benefits were improved glycemic control, anticipated reduction of long-term complications, better quality of life, and reduced mental burden of diabetes. Hassles and limitations included unexpected tasks for the user, difficulties wearing the system, concerns about controlling highs, and being reminded of diabetes. Conclusion Users are willing to accept some hassles and limitations if they also perceive health and quality-of-life benefits beyond current self-management. It is important for clinicians to provide a balanced view of positives and negatives to help manage expectations.

  View details for DOI 10.1177/0145721717697244

  View details for PubMedID 28340542

• Avoidant Coping and Diabetes-Related Distress: Pathways to Adolescents' Type 1 Diabetes Outcomes HEALTH PSYCHOLOGY Iturralde, E., Weissberg-Benchell, J., Hood, K. K. 2017; 36 (3): 236-244

  Abstract

  Adolescents with Type 1 diabetes (T1D) are vulnerable to diabetes-related distress and often struggle to complete self-management tasks needed to maintain blood glucose values in target range. One way that youth with T1D handle problems is through avoidant coping. The current study examined cross-time associations between avoidant coping style and diabetes outcomes and tested the possible mediating role of diabetes-related distress.Adolescents with T1D (N = 264) were assessed 4 times over 1 year to measure avoidant coping style, diabetes-related distress, adherence (on the basis of glucometer data and self-report), and glycemic control (hemoglobin A1c). Mediation and direct effects were tested across time using time-lagged autoregressive path models, making use of the repeated measurement of all constructs.The hypothesized mediation effect was found for all 3 diabetes outcomes. Higher levels of avoidant coping style were associated with greater diabetes-related distress at the subsequent time point, which was related in turn to fewer blood glucose checks, less frequent self-care behaviors, and poorer glycemic control (higher A1c) at the next assessment.In the context of diabetes, an avoidant coping style may contribute to greater diabetes-specific distress followed by deterioration in self-management and glycemic control over time. Maladaptive coping styles are modifiable factors that offer an entry point into intervention before further difficulties can take hold. (PsycINFO Database Record

  View details for DOI 10.1037/hea0000445

  View details for Web of Science ID 000396002500006

• Avoidant coping and diabetes-related distress: Pathways to adolescents' Type 1 diabetes outcomes. Health psychology Iturralde, E., Weissberg-Benchell, J., Hood, K. K. 2017; 36 (3): 236-244

  Abstract

  Adolescents with Type 1 diabetes (T1D) are vulnerable to diabetes-related distress and often struggle to complete self-management tasks needed to maintain blood glucose values in target range. One way that youth with T1D handle problems is through avoidant coping. The current study examined cross-time associations between avoidant coping style and diabetes outcomes and tested the possible mediating role of diabetes-related distress.Adolescents with T1D (N = 264) were assessed 4 times over 1 year to measure avoidant coping style, diabetes-related distress, adherence (on the basis of glucometer data and self-report), and glycemic control (hemoglobin A1c). Mediation and direct effects were tested across time using time-lagged autoregressive path models, making use of the repeated measurement of all constructs.The hypothesized mediation effect was found for all 3 diabetes outcomes. Higher levels of avoidant coping style were associated with greater diabetes-related distress at the subsequent time point, which was related in turn to fewer blood glucose checks, less frequent self-care behaviors, and poorer glycemic control (higher A1c) at the next assessment.In the context of diabetes, an avoidant coping style may contribute to greater diabetes-specific distress followed by deterioration in self-management and glycemic control over time. Maladaptive coping styles are modifiable factors that offer an entry point into intervention before further difficulties can take hold. (PsycINFO Database Record

  View details for DOI 10.1037/hea0000445

  View details for PubMedID 27808528

• Diabetes Device Use in Adults With Type 1 Diabetes: Barriers to Uptake and Potential Intervention Targets. Diabetes care Tanenbaum, M. L., Hanes, S. J., Miller, K. M., Naranjo, D., Bensen, R., Hood, K. K. 2017; 40 (2): 181-187

  Abstract

  Diabetes devices (insulin pumps, continuous glucose monitors [CGMs]) are associated with benefits for glycemic control, yet uptake of these devices continues to be low. Some barriers to device uptake may be modifiable through psychosocial intervention, but little is known about which barriers and which patients to target.We surveyed 1,503 adult T1D Exchange participants (mean age 35.3 [SD 14.8] years, mean diagnosis duration 20.4 [SD 12.5] years) to investigate barriers to device uptake, understand profiles of device users versus nonusers, and explore differences by age and sex. Scales used were the Diabetes Distress Scale, Technology Use Attitudes (General and Diabetes-Specific), and Barriers to Device Use and Reasons for Discontinuing Devices.Most commonly endorsed modifiable barriers were related to the hassle of wearing devices (47%) and disliking devices on one's body (35%). CGM users (37%) were older than nonusers (mean 38.3 vs. 33.5 years), had diabetes for longer (22.9 vs. 18.8 years), had more positive technology attitudes (22.6-26.0 vs. 21.4-24.8), and reported fewer barriers to using diabetes technology than nonusers (3.3 vs. 4.3). The youngest age-group (18-25 years) had the lowest CGM (26% vs. 40-48%) and insulin pump (64% vs. 69-77%) uptake, highest diabetes distress (2.2 vs. 1.8-2.1), and highest HbA1c levels (8.3% [67 mmol/mol] vs. 7.2-7.4% [55-57 mmol/mol]).Efforts to increase device use need to target physical barriers to wearing devices. Because young adults had the lowest device uptake rates, highest distress, and highest HbA1c compared with older age-groups, they should be the focus of future interventions to increase device use.

  View details for DOI 10.2337/dc16-1536

  View details for PubMedID 27899489

• Feasibility of Long-Term Closed-Loop Control: A Multicenter 6-Month Trial of 24/7 Automated Insulin Delivery DIABETES TECHNOLOGY & THERAPEUTICS Kovatchev, B., Cheng, P., Anderson, S. M., Pinsker, J. E., Boscari, F., Buckingham, B. A., Doyle, F. J., Hood, K. K., Brown, S. A., Breton, M. D., Chernavvsky, D., Bevier, W. C., Bradley, P. K., Bruttomesso, D., Del Favero, S., Calore, R., Cobelli, C., Avogaro, A., Ly, T. T., Shanmugham, S., Dassau, E., Kollman, C., Lum, J. W., Beck, R. W. 2017; 19 (1): 18-?

  Abstract

  In the past few years, the artificial pancreas-the commonly accepted term for closed-loop control (CLC) of blood glucose in diabetes-has become a hot topic in research and technology development. In the summer of 2014, we initiated a 6-month trial evaluating the safety of 24/7 CLC during free-living conditions.Following an initial 1-month Phase 1, 14 individuals (10 males/4 females) with type 1 diabetes at three clinical centers in the United States and one in Italy continued with a 5-month Phase 2, which included 24/7 CLC using the wireless portable Diabetes Assistant (DiAs) developed at the University of Virginia Center for Diabetes Technology. Median subject characteristics were age 45 years, duration of diabetes 27 years, total daily insulin 0.53 U/kg/day, and baseline HbA1c 7.2% (55 mmol/mol).Compared with the baseline observation period, the frequency of hypoglycemia below 3.9 mmol/L during the last 3 months of CLC was lower: 4.1% versus 1.3%, P < 0.001. This was accompanied by a downward trend in HbA1c from 7.2% (55 mmol/mol) to 7.0% (53 mmol/mol) at 6 months. HbA1c improvement was correlated with system use (Spearman r = 0.55). The user experience was favorable with identified benefit particularly at night and overall trust in the system. There were no serious adverse events, severe hypoglycemia, or diabetic ketoacidosis.We conclude that CLC technology has matured and is safe for prolonged use in patients' natural environment. Based on these promising results, a large randomized trial is warranted to assess long-term CLC efficacy and safety.

  View details for DOI 10.1089/dia.2016.0333

  View details for Web of Science ID 000392822900005

  View details for PubMedID 27982707

• Optimal Use of Diabetes Devices: Clinician Perspectives on Barriers and Adherence to Device Use Journal of Diabetes Science and Technology Tanenbaum, M. L., Adams, R. N., Hanes, S. J., Barley, R. C., Miller, K. M., Mulvaney, S. A., Hood, K. K. 2017; 11 (3): 484-492

  View details for DOI 10.1177/1932296816688010

• Response to Comments on Young-Hyman et al. Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association. Diabetes Care 2016;39:2126-2140. Diabetes care Young-Hyman, D. n., de Groot, M. n., Hill-Briggs, F. n., Gonzalez, J. n., Hood, K. n., Peyrot, M. n. 2017; 40 (9): e131–e132

  View details for PubMedID 28830965

  View details for PubMedCentralID PMC5566281

• Biopsychosocial Aspects of Weight Management in Type 1 Diabetes: a Review and Next Steps. Current diabetes reports Driscoll, K. A., Corbin, K. D., Maahs, D. M., Pratley, R. n., Bishop, F. K., Kahkoska, A. n., Hood, K. K., Mayer-Davis, E. n. 2017; 17 (8): 58

  Abstract

  This review aims to summarize the type 1 diabetes (T1D) and weight literature with an emphasis on barriers associated with weight management, the unique T1D-specific factors that impact weight loss success, maladaptive and adaptive strategies for weight loss, and interventions to promote weight loss.Weight gain is associated with intensive insulin therapy. Overweight and obese weight status in individuals with T1D is higher than the general population and prevalence is rising. A variety of demographic (e.g., female sex), clinical (e.g., greater insulin needs), environmental (e.g., skipping meals), and psychosocial (e.g., depression, stress) factors are associated with overweight/obese weight status in T1D. Fear of hypoglycemia is a significant barrier to engagement in physical activity. Studies evaluating adaptive weight loss strategies in people with T1D are limited. There is a growing literature highlighting the prevalence and seriousness of overweight and obesity among both youth and adults with T1D. There is an urgent need to develop evidence-based weight management guidelines and interventions that address the unique concerns of individuals with T1D and that concurrently address glycemic control.

  View details for PubMedID 28660565

• Implementation of Depression Screening and Global Health Assessment in Pediatric Subspecialty Clinics. The Journal of adolescent health : official publication of the Society for Adolescent Medicine Iturralde, E. n., Adams, R. N., Barley, R. C., Bensen, R. n., Christofferson, M. n., Hanes, S. J., Maahs, D. M., Milla, C. n., Naranjo, D. n., Shah, A. C., Tanenbaum, M. L., Veeravalli, S. n., Park, K. T., Hood, K. K. 2017

  Abstract

  Adolescents with chronic illness face greater risk of psychosocial difficulties, complicating disease management. Despite increased calls to screen for patient-reported outcomes, clinical implementation has lagged. Using quality improvement methods, this study aimed to investigate the feasibility of standardized screening for depression and assessment of global health and to determine recommended behavioral health follow-up, across three pediatric subspecialty clinics.A total of 109 patients aged 12-22 years (median = 16.6) who were attending outpatient visits for treatment of diabetes (80% type 1), inflammatory bowel disease, or cystic fibrosis completed the 9-item Patient Health Questionnaire (PHQ-9) depression and Patient-Reported Outcomes Measurement Information System (PROMIS) Pediatric Global Health measures on electronic tablets. Patients screening positive on the PHQ-9 received same-day behavioral health assessment and regular phone check-ins to facilitate necessary follow-up care.Overall, 89% of 122 identified patients completed screening during a 6-month window. Patients completed measures in a timely manner (within 3 minutes) without disruption to clinic flow, and they rated the process as easy, comfortable, and valuable. Depression scores varied across disease type. Patients rated lower global health relative to a previously assessed validation cohort. Depression and global health related significantly to certain medical outcomes. Fifteen percent of patients screened positive on the PHQ-9, of whom 50% confirmed attending behavioral health appointments within 6 months of screening.A standardized depression and global health assessment protocol implemented across pediatric subspecialties was feasible and effective. Universal behavioral health screening for adolescents and young adults living with chronic disease is necessary to meet programmatic needs in pediatric subspecialty clinics.

  View details for PubMedID 28830798

• Quality of Life of College Students Living With Type 1 Diabetes: A Qualitative View. Western journal of nursing research Fredette, J., Mawn, B., Hood, K., Fain, J. 2016; 38 (12): 1595-1610

  Abstract

  The purpose of this phenomenological qualitative study was to examine the quality of life among college students living with Type 1 diabetes (T1D). Inclusion criteria included age 18 to 24, current college student, and a diagnosis of T1D for at least 1 year. Semi-structured interviews were conducted, in-person and by phone. During these interviews, college students shared stories of living with T1D and its impact on their quality of life. Three major themes emerged, which included "planning ahead," "thinking positive," and "seeking support." These findings provide a better understanding of the transitional experience of living with T1D and the impact on perceived quality of life while attending college. Techniques and strategies aimed at the enhancement of perceived quality of life for college students living with T1D were identified. These findings will provide valuable insight for professionals working with this population.

  View details for PubMedID 27230752

• Psychosocial Care for People With Diabetes: A Position Statement of the American Diabetes Association DIABETES CARE Young-Hyman, D., de Groot, M., Hill-Briggs, F., Gonzalez, J. S., Hood, K., Peyrot, M. 2016; 39 (12): 2126-2140

  View details for DOI 10.2337/dc16-2053

  View details for Web of Science ID 000390785000017

  View details for PubMedID 27879358

  View details for PubMedCentralID PMC5127231

• Diabetes Technology: Uptake, Outcomes, Barriers, and the Intersection With Distress. Journal of diabetes science and technology Naranjo, D., Tanenbaum, M. L., Iturralde, E., Hood, K. K. 2016; 10 (4): 852-858

  Abstract

  Patients managing type 1 diabetes have access to new technologies to assist in management. This manuscript has two aims: 1) to briefly review the literature on diabetes technology use and how this relates to psychological factors and 2) to present an example of human factors research using our data to examine psychological factors associated with technology use. Device/technology uptake and use has increased over the years and at present day is a common clinical practice. There are mixed results in terms of health and psychosocial outcomes, with specific subgroups doing better than others with technology. Our data demonstrated that patients have moderately elevated diabetes distress across differing types of technology used, from low-tech to high-tech options, possibly meaning that technology does not add or take away distress. In addition, users on multiple daily injections compared to all other technology groups have less positive attitudes about technology. Finally, we discuss implications for clinical practice and future research.

  View details for DOI 10.1177/1932296816650900

  View details for PubMedID 27234809

• A randomized clinical trial aimed at preventing poor psychosocial and glycemic outcomes in teens with type 1 diabetes (T1D). Contemporary clinical trials Weissberg-Benchell, J., Rausch, J., Iturralde, E., Jedraszko, A., Hood, K. 2016; 49: 78-84

  Abstract

  Adolescents with type 1 diabetes have an increased risk for a variety of emotional and behavioral challenges as well as negative diabetes outcomes. This study was designed to compare the effectiveness of a depression-prevention, resilience promotion program with an advanced diabetes education program. Each program consisted of 9 group-based sessions. There were 264 adolescents enrolled in this multi-site randomized clinical trial. The primary outcomes were depressive symptoms and glycemic control; secondary outcomes included resilience skills, diabetes management and adherence, and diabetes-specific distress. The goal of the present paper is to describe the study design, the intervention, and the baseline characteristics of the sample. Preliminary data suggests that enrollment, randomization and retention were successful. Longitudinal follow-up and examination of mechanisms of action as they relate to psychosocial and glycemic outcomes will be explored in the future.

  View details for DOI 10.1016/j.cct.2016.05.006

  View details for PubMedID 27267154

  View details for PubMedCentralID PMC4969210

• Whose quality of life is it anyway? Discrepancies between youth and parent health-related quality of life ratings in type 1 and type 2 diabetes QUALITY OF LIFE RESEARCH Yi-Frazier, J. P., Hilliard, M. E., Fino, N. F., Naughton, M. J., Liese, A. D., Hockett, C. W., Hood, K. K., Pihoker, C., Seid, M., Lang, W., Lawrence, J. M. 2016; 25 (5): 1113-1121

  Abstract

  Health-related quality of life (HRQOL) is a critical diabetes outcome, yet differences between youth and parent-proxy ratings can make interpretation difficult. This study aims to explore potential differences between self- and parent-reports of Pediatric Quality of Life Inventory (PedsQL) scores from youth with type 1 (T1D) or type 2 diabetes (T2D) and to evaluate associations between discrepancies, PedsQL scores, and glycemic control (HbA1c).Youth and parents in the SEARCH for Diabetes in Youth Study (T1D: age 5-18, n = 3402; T2D: age 8-18, n = 353) completed the PedsQL Generic and Diabetes Modules, and youth provided a blood sample to assess HbA1c. Discrepancies (youth minus parent PedsQL ratings) were calculated and examined by age and diabetes type, and associations with youth PedsQL scores and HbA1c were evaluated.Discrepancies existed between youth and parent-proxy reports of generic and diabetes PedsQL scores in T1D and T2D (all p values < 0.01). Higher (more favorable) ratings were reported by youth except for those 5-7-years old, where parents' scores were higher. When parent-proxy scores were higher, discrepancies were largest when the child reported low PedsQL scores. Higher HbA1c was associated with larger discrepancies (youth scores higher) for adolescents with T1D.Discrepant PedsQL ratings suggest that parents may often underestimate youths' HRQOL except in the youngest children. Although examining both reports is optimal, the youth report should be prioritized, particularly for young children with T1D and for adolescents with either T1D or T2D.

  View details for DOI 10.1007/s11136-015-1158-5

  View details for Web of Science ID 000374866600004

  View details for PubMedID 26466834

  View details for PubMedCentralID PMC4936832

• Toward Development of Psychosocial Measures for Automated Insulin Delivery. Journal of diabetes science and technology Weissberg-Benchell, J., Hood, K., Laffel, L., Heinemann, L., Ball, D., Kowalski, A., Peters, A., Damiano, E., Schiller, M., Davis, A., Beck, S., Barnard, K. 2016; 10 (3): 799-801

  Abstract

  The INSPIRE study working group launched its initial workshop in February 2015 to facilitate collaboration among key stakeholders interested in automated insulin delivery (AID) systems and the psychosocial outcomes of individuals who may use these new technologies. Specifically, the INSPIRE team's goal is to facilitate measure development assessing the psychosocial factors associated with AID systems. A second working group was held to foster exchange among key stakeholders in AID system development. Patient, health care provider, engineering, industry, academic, regulatory and payer perspectives were presented. The INSPIRE working group will continue to serve as a platform to encourage open dialogue among all stakeholders with the aim of facilitating technology that offers minimal user burden and maximum benefit from both a psychological and physiologic perspective.

  View details for DOI 10.1177/1932296815619637

  View details for PubMedID 26645792

• Stabilization of glycemic control and improved quality of life using a shared medical appointment model in adolescents with type 1 diabetes in suboptimal control. Pediatric diabetes Floyd, B. D., Block, J. M., Buckingham, B. B., Ly, T., Foster, N., Wright, R., Mueller, C. L., Hood, K. K., Shah, A. C. 2016

  Abstract

  Declining glycemic control in type 1 diabetes (T1D) during adolescence persists despite treatment advances. Non-adherence, peer relations, diabetes burnout, risk taking, transition to autonomy, family conflict, and poor quality of life (QOL) are recognized barriers. Shared medical appointments (SMAs) in adolescent T1D may offer benefits, but data are limited. Our objective was to determine whether SMAs, with multi-component interventions utilizing multidisciplinary teams, improve glycemic control and psychosocial outcomes in poorly controlled adolescent T1D.SMAs focused on self-management, communication skills, goal setting, glucose pattern recognition, and peer/diabetes team support. SMAs included: individual history and physical, labs, surveys, multidisciplinary educational ice breakers, group session, and individual wrap up. Outcomes were QOL, adherence, and retrospective and prospective glycemic control. Three to six subjects and families came to 3 SMAs and 1 individual appointment every 3 months over 9 months.A total of 37 English speaking subjects, ages 12-16 yrs, with T1D ≥ 1 year, and hemoglobin A1c (HbA1c) 7.5-11% enrolled. Thirty-two subjects attended 75% of visits, meeting inclusion criteria.HbA1c worsened in the 9 months before study (ΔHbA1c= 0.7 ± 1.2; p < 0.01), but remained stable during study (ΔHbA1c = 0.01 ± 1.2; p > 0.05). There were significant improvements in overall QOL (p = 0.005), school function (p = 0.006), psychosocial function (p = 0.008), barriers (p = 0.02), adherence (p = 0.01), and communication (p = 0.02). Improvements in school function and communication reached clinical significance.SMAs are feasible replacements to individual appointments in adolescent T1D, stabilizing glycemic control and improving QOL. Randomized controlled trials with optimizations are needed to further explore and refine this intervention.

  View details for DOI 10.1111/pedi.12373

  View details for PubMedID 26919322

• Resilience in Youth and Families Living With Pediatric Health and Developmental Conditions: Introduction to the Special Issue on Resilience. Journal of pediatric psychology Hilliard, M. E., McQuaid, E. L., Nabors, L., Hood, K. K. 2015; 40 (9): 835-839

  Abstract

  This special issue of the Journal of Pediatric Psychology showcases a growing area of research with a collection of 16 contemporary studies of resilience in youth with chronic medical or developmental conditions and their families. The research reported in this special issue covers a broad range of pediatric populations, including cancer, type 1 diabetes, and chronic pain, among others, ranging in age from early childhood through early adulthood. This introduction to the special issue reviews the various ways the articles' authors conceptualize and define risk and resilience; most analyze protective processes in relation to resilient outcomes, including both achievement of explicitly positive experiences and avoidance of dysfunction or disruption. Challenges with measurement of resilience-related constructs is reviewed. Finally, the special issue editors offer a definition of resilience in the context of pediatric and health psychology.

  View details for DOI 10.1093/jpepsy/jsv072

  View details for PubMedID 26275974

  View details for PubMedCentralID PMC4592327

• From Individuals to International Policy: Achievements and Ongoing Needs in Diabetes Advocacy CURRENT DIABETES REPORTS Hilliard, M. E., Oser, S. M., Close, K. L., Liu, N. F., Hood, K. K., Anderson, B. J. 2015; 15 (9)

  Abstract

  Diabetes impacts tens of millions of people in the United States of America and 9 % of the worldwide population. Given the public health implications and economic burden of diabetes, the needs of people with diabetes must be addressed through strategic and effective advocacy efforts. Diabetes advocacy aims to increase public awareness about diabetes, raise funds for research and care, influence policy impacting people with diabetes, and promote optimal individual outcomes. We present a framework for diabetes advocacy activities by individuals and at the community, national, and international levels and identify challenges and gaps in current diabetes advocacy. Various groups have organized successful diabetes advocacy campaigns toward these goals, and lessons for further advancing diabetes advocacy can be learned from other health-related populations. Finally, we discuss the role of healthcare providers and mental/behavioral health professionals in advocacy efforts that can benefit their patients and the broader population of people with diabetes.

  View details for DOI 10.1007/s11892-015-0636-z

  View details for Web of Science ID 000377953300003

  View details for PubMedID 26194156

  View details for PubMedCentralID PMC4581582

• Depressive Symptoms in a Trial Behavioral Family Systems Therapy for Diabetes: A Post Hoc Analysis of Change DIABETES CARE Riley, A. R., Duke, D. C., Freeman, K. A., Hood, K. K., Harris, M. A. 2015; 38 (8): 1435-1440

  Abstract

  The objective was to test whether Behavioral Family Systems Therapy for Diabetes (BFST-D), an evidence-based family therapy, produces individual changes in depressive symptoms for adolescents with type 1 diabetes in suboptimal glycemic control (HbA1c ≥9.0% [≥74.9 mmol/mol]).Data were from a randomized controlled trial (RCT) comparing two modes of BFST-D delivery: in clinic versus Internet videoconferencing. There were no significant differences between groups in the RCT, so groups were collapsed into a within-group prepost design for secondary analyses. A multiple regression analysis was performed to test for mediation of treatment outcomes by changes in family processes.Significant improvements in glycemic control, depressive symptoms, and family functioning were found from pre- to posttreatment. A multiple regression analysis for within-subject mediation indicated that improvements in depressive symptoms were partially mediated by improvements in parent-youth conflict; however, family process changes did not mediate diabetes health outcomes.In addition to improving treatment adherence and glycemic control, BFST-D has collateral benefits on depressive symptoms.

  View details for DOI 10.2337/dc14-2519

  View details for Web of Science ID 000358673200018

  View details for PubMedID 26015558

• Perceptions about professionally and non-professionally trained hypoglycemia detection dogs DIABETES RESEARCH AND CLINICAL PRACTICE Petry, N. M., Wagner, J. A., Rash, C. J., Hood, K. K. 2015; 109 (2): 389-396

  Abstract

  Patients with diabetes increasingly have questions about diabetes alert dogs. This study evaluated perceptions about dogs trained professionally or otherwise to detect glucose levels.A link to a survey about glucose detecting dogs was announced on diabetes websites.135 persons responded, with 63 answering about their child with diabetes. Most respondents obtained their dog from a professional trainer (n=54) or trained it themselves (n=51). Owners of self- and professionally-trained dogs were very positive about dogs' abilities to alert them to low and high glucose levels, while owners of dogs that learned entirely on their own (n=15) reported lower frequencies of alerts and more missed hypoglycemic episodes, p<.01. Regardless of how dogs learned, perceptions about managing diabetes were improved during periods of dog ownership relative to times without, p<.001. Self-reported rates of diabetes-related hospitalizations, assistance from others for treating hypoglycemia, and accidents or near accidents while driving reduced during periods of dog ownership compared to periods without dogs, ps<.01.These data suggest potential effectiveness of and high satisfaction with glucose-detecting dogs. Clinicians can use these results to address pros and cons of dog ownership with patients who inquire about them.

  View details for DOI 10.1016/j.diabres.2015.05.023

  View details for Web of Science ID 000358554800026

• Technology Use for Diabetes Problem Solving in Adolescents with Type 1 Diabetes: Relationship to Glycemic Control DIABETES TECHNOLOGY & THERAPEUTICS Kumah-Crystal, Y. A., Hood, K. K., Ho, Y., Lybarger, C. K., O'Connor, B. H., Rothman, R. L., Mulvaney, S. A. 2015; 17 (7): 449-454

  Abstract

  This study examines technology use for problem solving in diabetes and its relationship to hemoglobin A1C (A1C).A sample of 112 adolescents with type 1 diabetes completed measures assessing use of technologies for diabetes problem solving, including mobile applications, social technologies, and glucose software. Hierarchical regression was performed to identify the contribution of a new nine-item Technology Use for Problem Solving in Type 1 Diabetes (TUPS) scale to A1C, considering known clinical contributors to A1C.Mean age for the sample was 14.5 (SD 1.7) years, mean A1C was 8.9% (SD 1.8%), 50% were female, and diabetes duration was 5.5 (SD 3.5) years. Cronbach's α reliability for TUPS was 0.78. In regression analyses, variables significantly associated with A1C were the socioeconomic status (β=-0.26, P<0.01), Diabetes Adolescent Problem Solving Questionnaire (β=-0.26, P=0.01), and TUPS (β=0.26, P=0.01). Aside from the Diabetes Self-Care Inventory-Revised, each block added significantly to the model R(2). The final model R(2) was 0.22 for modeling A1C (P<0.001).Results indicate a counterintuitive relationship between higher use of technologies for problem solving and higher A1C. Adolescents with poorer glycemic control may use technology in a reactive, as opposed to preventive, manner. Better understanding of the nature of technology use for self-management over time is needed to guide the development of technology-mediated problem solving tools for youth with type 1 diabetes.

  View details for DOI 10.1089/dia.2014.0422

  View details for Web of Science ID 000363943000004

  View details for PubMedID 25826706

  View details for PubMedCentralID PMC4504438

• Psychosocial Assessment of Artificial Pancreas (AP): Commentary and Review of Existing Measures and Their Applicability in AP Research DIABETES TECHNOLOGY & THERAPEUTICS Barnard, K. D., Hood, K. K., Weissberg-Benchell, J., Aldred, C., Oliver, N., Laffel, L. 2015; 17 (4): 295-300

  Abstract

  This study aimed to systematically review the evidence base for the use of existing psychological and psychosocial measures suitable for use in artificial pancreas (AP) research.This systematic review of published literature, gray literature, previous systematic reviews, and qualitative and economic studies was conducted using terms and abbreviations synonymous with diabetes, AP, and quality of life (QoL).Two hundred ninety-two abstracts were identified that reported psychosocial assessment of diabetes-related technologies. Of these, nine met the inclusion criteria and were included. Only four of 103 ongoing trials evaluated psychosocial aspects as an outcome in the trial. Of these, treatment satisfaction, acceptance and use intention of AP, fear of hypoglycemia episodes, satisfaction with AP, and an unspecified QoL measure were used.A better understanding of the psychosocial side of AP systems and the extent to which human factors play a role in the uptake and efficient use of these systems will ultimately lead to the most benefit for people with diabetes.

  View details for DOI 10.1089/dia.2014.0305

  View details for Web of Science ID 000351057300011

  View details for PubMedID 25549042

  View details for PubMedCentralID PMC4365433

• Effective strategies for encouraging behavior change in people with diabetes. Diabetes management (London, England) Hood, K. K., Hilliard, M. n., Piatt, G. n., Ievers-Landis, C. E. 2015; 5 (6): 499–510

  Abstract

  Behavioral management of diabetes leads to better health outcomes. This paper reviews the available literature on facilitators of behavior change in people with diabetes and highlights approaches and strategies diabetes care providers can utilize. The research and clinical evidence points to the critical nature of considering the content and structure of recommendations, and utilizing problem solving and teamwork approaches. Furthermore, close attention to individual and community factors will optimize behavior change. These factors include health literacy, community infrastructure, support within the family, and whether there are co-occurring eating and mood issues. Recommendations are provided to optimize communication and embed behavior change approaches in clinical and community encounters.

  View details for PubMedID 30100925