Diabetes Technologies and the Human Factor
2024; Mary Ann Liebert, Inc.; Volume: 26; Issue: S1 Linguagem: Inglês
10.1089/dia.2024.2513
ISSN1557-8593
AutoresAlon Liberman, Katharine Barnard‐Kelly,
Tópico(s)Pancreatic function and diabetes
ResumoDiabetes Technology & TherapeuticsVol. 26, No. S1 Original ArticlesFree AccessDiabetes Technologies and the Human FactorAlon Liberman and Katharine Barnard-KellyAlon LibermanJesse and Sara Lea Shafer Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.Search for more papers by this author and Katharine Barnard-KellyFaculty of Health and Social Sciences, Bournemouth University, Bournemouth, United Kingdom.Search for more papers by this authorPublished Online:1 Mar 2024https://doi.org/10.1089/dia.2024.2513AboutSectionsPDF/EPUB Permissions & CitationsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookXLinked InRedditEmail IntroductionAs technologies continue to advance rapidly and devices become smaller and increasingly innovative, the impact on human factors remains a crucial aspect in the devices' uptake and continued successful use. Of particular note this year are the growing disparities in access across socioeconomic and ethnic groups, with subsequent poorer outcomes for those arguably the most in need. Where policies exist, often health-care staff are unaware of them or fail to adhere to them, which negatively impacts the experience and treatment of people with diabetes both from a physical perspective but also from quality of life and lived experience perspectives.Continuous glucose monitor (CGM) devices continue to demonstrate benefits not only as an adjunct to structured education programs but also outside of such programs, as seen in the AH-HA! project and the hypoglycemia study. The discrepancies in results may come from the different populations that are studied, and it will be important to explore such issues more deeply in future research. Sleep, sensor inaccuracy, alarms, and factors continue to impact people's experience with closed-loop technologies, as highlighted in the study with older adults. The psychosocial and glycemic benefits overall, however, continue to outweigh the reported downsides. Device satisfaction and usability were examined in both youths and their caregivers in the context of psychosocial outcomes such as distress, well-being, hypoglycemia confidence, and sleep quality. The Omnipod tubeless system was rated highly on these outcomes among children, adolescents, and their caregivers, demonstrating the increasing acceptability of such systems and improved time-in-target range.Downloading of data remains challenging, and health-care professionals do not always look at the information when it has been downloaded. This raises questions of how frequently data should be downloaded and who has responsibility for acting on that information. If health-care professionals believe their patients are downloading and making adjustments or diabetes-related decisions based on that data, but the patients believe they are downloading the data for their health-care professional to review and make decisions, then there is a clear gap in communication. Greater understanding is necessary to ensure that it is clear to patients how to download the data, how to interpret it, and what to do with that new information so they feel confident and competent in practice. Without clear guidance, it is unlikely that downloading will increase any time soon.Integration of psychological services into routine care was examined among the SWEET registry centers. Although glycemic control did not improve significantly at centers where psychological support was offered, there was a significant improvement in the rates of diabetic ketoacidosis (DKA). It has long been recognized that psychological support is crucial for people living with diabetes; however, as seen in this study almost a third of centers did not provide relevant data, and of those that did, one in ten did not provide psychological support, despite the requirement to do so.Key Articles ReviewedAssessment of Glucose Monitoring Adherence in Medicare Beneficiaries with Insulin-treated DiabetesPuckrein GA, Hirsch IB, Parkin CG, Taylor BT, Norman GJ, Xu L, Marrero DGDiabetes Technol Ther2023; 25:31–28Control-IQ Technology Positively Impacts Patient Reported Outcome Measures and Glycemic Control in Youth with Type 1 Diabetes in a Real-World SettingZuijdwijk C, Courtney J, Mitsakakis N, Hayawi L, Sutherland S, Newhook D, Ahmet A, Goldbloom EB, Khatchadourian K, Lawrence SPediatr Diabetes. Published online April 12, 2023. doi: 10.1155/2023/5106107Attitudes and Behaviors with Diabetes Technology Use in the Hospital: Multicenter Survey Study in the United StatesMadhun NZ, Galindo RJ, Donato J, Hwang PR, Shabir HF, Fowler MJ, Molitch-Hou E, Bena JF, Umpierrez GE, Lansang MCDiabetes Technol Ther2023; 25:39–49Improved Effectiveness of Immediate Continuous Glucose Monitoring in Hypoglycemia-prone People with Type 1 Diabetes Compared with Hypoglycemia-focused Psychoeducation Following a Previous Structured Education: A Randomized Controlled TrialSerné EH, van den Berg IK, Racca C, van Raalte DH, Kramer MHH, de Wit M, Snoek FJ for the BIDON-Consortium InvestigatorsDiabetes Technol Ther2023; 25:50–61The AH-HA! Project: Transforming Group Diabetes Self-management Education through the Addition of Flash Glucose MonitoringPolonsky WH, Fortmann AL, Soriano EC, Guzman SJ, Funnell MMDiabetes Technol Ther2023; 25:194–200Diabetes Device Downloading: Benefits and Barriers among Youth with Type 1 DiabetesPalmer BA, Soltys K, Zimmerman MB, Norris AW, Tsalikian E, Tansey MJ, Pinnaro CTJ Diabetes Sci Technol2023; 17:381–389Psychological Care for Children and Adolescents with Diabetes and Patient Outcomes: Results from the International Pediatric Registry SWEETChobot A, Eckert AJ, Biester T, Corathers S, Covinhas A, de Beaufort C, Imane Z, Kim J, Malatynska A, Moravej H, Pokhrel S, Skinner T, SWEET Study GroupPediatr Diabetes. Published online June 2, 2023. doi: 10.1155/2023/8578231Lived Experience of Older Adults with Type 1 Diabetes Using Closed-Loop Automated Insulin Delivery in a Randomised TrialKubilay E, Trawley S, Ward GM, Fourlanos S, Grills CA, Lee MH, MacIsaac RJ, O'Neal DN, O'Regan NA, Sundararajan V, Vogrin S, Colman PG, McAuley SADiabet Med2023; 40:e15020Psychosocial Outcomes with the Omnipod 5 Automated Insulin Delivery System in Children and Adolescents with Type 1 Diabetes and Their CaregiversHood KK1, Polonsky WH, MacLeish SA, Levy CJ, Forlenza GP, Criego AB, Buckingham BA, Bode BW, Hansen DW, Sherr JL, Brown SA, DeSalvo DJ, Mehta SN, Lafel LM, Bhargava A, Huyett LM, Vienneau TE, Ly TTPediatr Diabetes. Published online June 29, 2023. doi: 10.1155/2023/8867625Sexual Dysfunction in Women with Type 1 Diabetes in Norway: A Qualitative Study of Women's ExperiencesBuskoven MEH, Kjørholt EKH, Strandberg RB, Søfteland E, Haugstvedt ADiabet Med2022; 39:e14856The Ubiquity of Diabetes Distress among Adults with Type 1 Diabetes in an Urban, Academic Practice: A Template for InterventionMasharani U, Strycker LA, Fisher LDiabet Med2022; 39:e14832Sleep Quality and Quantity in Caregivers of Children with Type 1 Diabetes Using Closed-Loop Insulin Delivery or a Sensor-augmented PumpMadrid-Valero JJ, Ware J, Allen JM, Boughton CK, Hartnell S, Wilinska ME, Thankamony A, de Beaufort C, Schierloh U, Campbell FM, Sibayan J, Bocchino LE, Kollman C, Hovorka R, Gregory AM, KidsAP ConsortiumPediatr Diabetes. Published online June 13, 2023. doi: 10.1155/2023/7937007Assessment of Glucose Monitoring Adherence in Medicare Beneficiaries with Insulin-treated DiabetesPuckrein GA1, Hirsch IB2, Parkin CG3, Taylor BT4, Norman GJ4, Xu L1, Marrero DG51National Minority Quality Forum, Washington, DC; 2University of Washington, Seattle, WA; 3CGParkin Communications, Inc., Henderson, NV; 4Dexcom, Inc., San Diego, CA; 5University of Arizona, Tucson, AZDiabetes Technol Ther 2023;25:31–28The authors studied the potential correlations between race/ethnicity and adherence to prescribed glucose monitoring in a sample of Medicare beneficiaries with diabetes and the way adherence to the method used effected diabetes-related inpatient hospitalizations and correlated costs among beneficiaries with intensive insulin-treated diabetes.MethodsThis 12-month retrospective analysis utilized Centers for Medicare & Medicaid Services data to identify Medicare beneficiaries who used intensive insulin therapy from January through December 2018 and classified them into four groups: (1) persons using real-time continuous glucose monitoring (rtCGM), (2) persons using any method of blood glucose monitoring (BGM) who followed prescribed use patterns (adherent), (3) persons who were prescribed BGM but were nonadherent in its use, and (4) no record of any form of BGM. Analyses compared these groups and the role that comorbidities (Charlson Comorbidity Index [CCI]), and race/ethnicity played on group assignment, diabetes-related inpatient hospitalizations, and costs.ResultsAmong the 1,329,061 persons assessed, 38.14% had no record of glucose monitoring and 35.42% were BGM nonadherent. Similarly, among the 629,514 beneficiaries with a CCI risk score of ≥ 2, 466,646 (74.13%) were either nonadherent to BGM or had no monitoring record. The percentage of White (3.65%) rtCGM adherent beneficiaries was significantly larger than Black (1.58%) and Hispanic (1.28%) beneficiaries, both P < 0.0001. Hospitalizations and costs were higher for Black and Hispanic beneficiaries versus Whites within the risk score ≥ 2 group regardless of glucose monitoring method.ConclusionsRace is correlated with increased hospitalizations and costs associated with diabetes care and lack of any form of BGM was correlated with higher rates of comorbidities. Persons of color were less likely to use rtCGM despite Medicare coverage. To increase the use of glucose monitoring among Medicare diabetic patients, new programs that enhance diabetes self-management education and support services are required.CommentsPuckrein and colleagues provide yet another study reporting widespread inequalities in access and outcomes across ethnic diversity pertaining to diabetes technologies. Although often mooted as a consequence of the U.S. health system, the reality is that such inequalities exist across many health systems. In the United Kingdom, national diabetes pediatric audit data continue to show widespread inequalities in use of technologies in diabetes management across ethnic diversity, inequalities that have widened every year for the past 7 years. The reality remains that these disparities have real consequences for real people. Furthermore, they have financial consequences that are increasingly unsustainable and unjustifiable. Greater efforts are required to understand the reasons behind such inequalities and strategies urgently needed to address them.Control-IQ Technology Positively Impacts Patient Reported Outcome Measures and Glycemic Control in Youth with Type 1 Diabetes in a Real-World SettingZuijdwijk C1,2,3, Courtney J2, Mitsakakis N2, Hayawi L2, Sutherland S2, Newhook D2, Ahmet A1,2,3, Goldbloom EB1,2,3, Khatchadourian K1,2,3, Lawrence S1,2,31Division of Endocrinology and Metabolism, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; 2CHEO Research Institute, Ottawa, Ontario, Canada; 3University of Ottawa, Faculty of Medicine, Ottawa, Ontario, CanadaPediatr Diabetes. Published online April 12, 2023. doi: 10.1155/2023/5106107In a real-world setting, the effect of the t:slim X2 insulin CSII with Control-IQ technology was investigated, focusing on the quality of life and glycemic management in adolescents with type 1 diabetes (T1D) and their parents.MethodsThis single-center, prospective study of pediatric patients (6–18 years old) with type 1 diabetes (T1D) used a Tandem t:slim X2 pump and Control-IQ technology as part of routine care. Youths (≥ 8 years) and parents filled in validated patient-reported outcome measures (PROMs) at baseline and the end of the study (16 weeks). Glycemic control measures were recorded at baseline and every 4 weeks until the end of the study.ResultsThe study enrolled 59 youths, median age of 13.8 years (IQR, 11.1–15.7) and T1D duration of 6.3 years (IQR, 3.1–8.4). The INSPIRE scores (evaluating expectations [baseline] and impact [post] of Control-IQ technology) were favorable: unchanged at the end of the study for the youths and lower for the parents (P = 0.04). Other PROM scores were improved by the end of the study with mean differences for youth and parents, respectively, as follows: Diabetes Impact and Device Satisfaction (DIDS) Scale Diabetes Impact −1.08 ([95% CI, −1.51 to −0.64], P < 0.001) and −1.41 ([95% CI, −1.96 to −0.87], P < 0.001); DIDS Scale Device Satisfaction + 0.43 ([95% CI, 0.11–0.74], P = 0.01) and + 0.58 ([95% CI, 0.31–0.85], P < 0.001); Hypoglycemia Fear Survey −4.41 ([95% CI, −7.65 to −1.17], P = 0.01) and −7.64 ([95% CI, −11.66 to −3.62], P < 0.001); and WHO-5 Well-Being Index + 5.10 ([95% CI, −1.40 to 11.6], P = 0.12) and + 9.60 ([95% CI, 3.40–15.8], P = 0.003). The mean time in range increased from 52.6% at baseline to 62.6% (P < 0.001) at 4 weeks, sustained to 16 weeks.ConclusionsControl-IQ technology in a real-world setting significantly diminished the negative effect of diabetes on daily life in youths while simultaneously improving their glycemic control.CommentsThe study by Zuijdwijk and colleagues reflects the trend of transition from automated insulin delivery systems clinical trials to real-world studies. The importance of patient-reported outcome measures (PROMs) in assessing medical devices is increasingly recognized as one way to directly measure the health condition of patients from their own report, without outside interpretation. From a patient perspective, both changes in glycemic control and quality of life are important when considering the use of automated insulin delivery (AID). Recent real-world studies with both adults and children and adolescents with type 1 diabetes (T1D) using AID systems have shown improvement in psychosocial outcomes and persistent achievement of glycemic targets (1–5). Pediatric clinical studies evaluating the use of AID systems have shown improvement in glycemic control as well as patient-reported outcome measures (e.g., improvements in parental sleep and fear of hypoglycemia).Attitudes and Behaviors with Diabetes Technology Use in the Hospital: Multicenter Survey Study in the United StatesMadhun NZ1, Galindo RJ2, Donato J3, Hwang PR4, Shabir HF4, Fowler MJ5, Molitch-Hou E6, Bena JF7, Umpierrez GE2, Lansang MC11Endocrinology and Metabolism Institute, Cleveland Clinic Foundation, Cleveland, OH; 2Division of Endocrinology, Emory University School of Medicine, Atlanta, GA; 3Department of Hospital Medicine, Cleveland Clinic Foundation, Cleveland, OH; 4Division of Hospital Medicine, Emory University School of Medicine, Atlanta, GA; 5Division of Diabetes, Endocrinology, and Metabolism, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN; 6Section of Hospital Medicine, Department of Medicine, University of Chicago, Chicago, IL; 7Department of Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, OHDiabetes Technol Ther 2023;25:39–49To evaluate the attitudes, behaviors, and barriers with diabetes technology use in the general medicine hospital wards.MethodsA nonincentivized, web-based, anonymous survey collected demographic and practice data regarding continuous subcutaneous insulin infusion (CSII) and continuous glucose monitor (CGM) as used in four large hospital systems in the United StatesResultsAmong 128 survey respondents, 76%, 10%, and 6% were hospitalists, advanced practice providers, and primary care physicians, respectively. The majority of respondents rated the treatment of inpatient hyperglycemia (96%) and the continuation of CSII during the hospital stay (93%) "important." While most respondents (64%) acknowledged knowing the existence of their institution's policies for CSII use, only 84% of those respondents felt somewhat to very familiar with the policy. The most common barrier to CSII use in the inpatient setting was lack of practitioner (70%) and nursing (67%) knowledge of using the device. With regard to CGM use in the hospital, a minority (28%) of respondents were aware of their institution's CGM policies. Less than half of the providers, 43.8%, stated that, when admitting a patient, they reviewed CGM data to guide insulin dosing.ConclusionsIn this U.S. multicenter survey, most inpatient practitioners valued glycemic control, but many were unaware of their institutional policies, had lacked CSII understanding, and were not reviewing CGM data.CommentsThis age-old challenge of the gulf between awareness and engagement is reflected in the results of this study. It potentially reflects the silos that exist in hospital settings where different departments operate in isolation. There is a clear willingness on the part of health-care practitioners to support the use of diabetes technologies, but there is poor understanding of the policies and the devices themselves. Institutional barriers such as these prevent optimized support and outcomes for patients with diabetes, but they are theoretically easily overcome with greater thought and implementation of appropriate policies. Close collaboration between specialist diabetes centers and inpatient teams could reduce these barriers and promote the delivery of best practices, providing greater work-related satisfaction for health-care practitioners as well as improved health outcomes for patients.Improved Effectiveness of Immediate Continuous Glucose Monitoring in Hypoglycemia-prone People with Type 1 Diabetes Compared with Hypoglycemia-focused Psychoeducation Following a Previous Structured Education: A Randomized Controlled TrialSerné EH1, van den Berg IK2, Racca C1, van Raalte DH1, Kramer MHH1, de Wit M2, Snoek FJ2 for the BIDON-Consortium Investigators1Department of Internal Medicine, Diabetes Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; 2Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The NetherlandsDiabetes Technol Ther 2023;25:50–61Stepped-care has been suggested in the management of patients with suboptimal hypoglycemia and impaired awareness of hypoglycemia (IAH), at first with psychoeducational programs based on blood glucose awareness training, progressing to diabetes technology in those with urgent need. The authors tested the clinical effectiveness of stepped-care starting with HypoAware and adding continuous glucose monitoring (CGM) as needed, versus immediate CGM in type 1 diabetes (T1D) patients with suboptimal hypoglycemia despite prior structured education in insulin adjustment.MethodsIn this randomized controlled trial (N = 52; mean age 53 years; 56% females), the stepped-care group attended HypoAware. If a severe hypoglycemic event (SHE) had occurred or IAH was still present after 6 months, CGM was initiated. The control group started immediate CGM. The primary end point was the number of participants with self-reported SHE. The secondary outcomes, evaluated at 6 and 12 months, were glycated hemoglobin (HbA1c), the number of participants with IAH time below range (TBR, < 54 mg/dL), and patient-reported outcomes (PROs).ResultsAt 6 months, the number of patients reporting SHE had decreased significantly more in the CGM group: −39% (P < 0.05). HbA1c decreased more in the CGM group (−0.47 percentage points, P < 0.05). IAH was restored in 31% of patients in both groups. TBR (< 54 mg/dL) was lower in the CGM group (−2.4 percentage points, P < 0.05). In the stepped-care group, 93% started CGM/intermittently scanned CGM. At 12 months, the number of patients reporting SHE was still higher in the stepped-care group. No differences were found in PROs.ConclusionsImmediate start of CGM was found more effective than a hypoglycemia-focused reeducation program in reducing SHE risk and attaining glycemic outcomes in patients with problematic hypoglycemia and IAH despite prior education in insulin dose adjustment.The AH-HA! Project: Transforming Group Diabetes Self-management Education through the Addition of Flash Glucose MonitoringPolonsky WH1,2, Fortmann AL3, Soriano EC3, Guzman SJ1, Funnell MM41Behavioral Diabetes Institute, San Diego, CA; 2University of California, San Diego, CA; 3Scripps Whittier Diabetes Institute, Scripps Health, La Jolla, CA; 4Learning Health Sciences, University of Michigan Medical School, Ann Arbor, MIDiabetes Technol Ther 2023;25:194–200Most patients who are referred to diabetes self-management education and support (DSMES) programs do not use this tool. Among those who do attend them, dropout rates are high, with anecdotal reports suggesting that low use and completion rates of these programs are a result of their didactic and impersonal nature. This study introduced a more engaging form of DSMES for adults with type 2 diabetes (T2D): a nondidactic "discovery learning"-based DSMES program centered on real-time flash glucose monitoring (FGM).MethodsIn this single-arm pilot study, 35 adults with T2D of duration 1–5 years (aged 21–75 years, hemoglobin A1c (HbA1c) ≥ 8.0%, and not using insulin) were introduced to FGM and participated in five weekly group sessions. The DSMES content was personalized, emerging from the concerns and questions that arose from participants' FGM discoveries. The primary outcome was glycemic change as assessed by masked FGM at baseline and month 3. The secondary outcomes included psychosocial and behavioral measures.ResultsThere was a significant gain in percentage time in range (% TIR) 70–180 mg/dL from baseline (55%) to month 3 (74%), and a parallel drop in percentage time above range (TAR) >180 mg/dL from 44% to 25% (P = 0.01). Overall the participants' well-being rose significantly (P = 0.04), and their diabetes distress showed a nonsignificant drop. Participants reported improvements in healthy eating (P < 0.001) and physical activity, although the latter did not reach statistical significance.ConclusionsA novel DSMES strategy that combines FGM with a highly engaging and participatory patient-driven "discovery learning" form of education improves patients' care.CommentsRecent consensus statements and several studies have recommended structured education and psychoeducational programs for the management of both T1D and T2D that may contribute to beneficial glycemic control as well as various PROMs such as lifestyle and to a risk reduction for hypoglycemia in patients with problematic hypoglycemia.Psychoeducational programs have some important advantages. They can make the experience more personally meaningful for participants, thereby enhancing their perceived value and subsequently enhancing retention; they may ameliorate the hassle of wearing the device, and may deliver cost-savings by limiting the use of more expensive CGM-based systems. On the other hand, they can expose patients to unnecessary risks in terms of hypoglycemia, they may not help achieve glycemic targets, and they have a low accessibility rate.In these two studies, the tension between psychoeducational programs and diabetes technologies is highlighted. The first study suggests that immediately starting CGM is more effective in reducing self-reported severe hypoglycemia risk than a stepped-care approach in individuals with T1D and problematic hypoglycemia. On the other hand, the novel diabetes self-management education and support program in the second study successfully enhanced the use of real-time flash glucose monitoring.Diabetes Device Downloading: Benefits and Barriers among Youth with Type 1 DiabetesPalmer BA1, Soltys K1, Zimmerman MB2, Norris AW1,3, Tsalikian E1, Tansey MJ1,3, Pinnaro CT1,31Division of Endocrinology and Diabetes, Stead Family Department of Pediatrics; 2College of Public Health; and 3Fraternal Order of Eagles Diabetes Research Center, University of Iowa, Iowa City, IAJ Diabetes Sci Technol 2023;17:381–389The majority of adolescents with type 1 diabetes (T1D) do not achieve their glycemic targets in spite of their increased use of continuous glucose monitoring (CGM). This study determined the proportion of caregivers who review recent glycemic trends ("retrospective review") and make insulin adjustments based on the data ("retroactive insulin adjustments"). Fear of hypoglycemia and frequency of severe hypoglycemia episodes were considered as well.MethodsThis cross-sectional survey of caregivers of adolescents with T1D collected demographics, diabetes technology usage data, patterns of glucose data review/insulin dose self-adjustment, and scores from the Hypoglycemia Fear Survey (HFS).ResultsOf the 1003 eligible caregivers approached for this study, 191 (19%) responded and participated. Regularly performing retrospective data reviews was associated with having a younger child (12.2 vs 15.4, P = 0.0001) and with CGM use (92% vs 73%, P = 0.004), but was not associated with a significant improvement in the child's hemoglobin A1c (HbA1c) (7.89 vs 8.04, P = 0.65). The caregivers who were regular retrospective reviewers had significantly higher HFS behavior scores (31.9 vs 27.7, P = 0.0002), which remained significantly higher when adjusted for child's age and CGM use (P = 0.005). Linear regression identified a significant negative association between HbA1c (%) and number of retroactive insulin adjustments (0.24% lower mean HbA1c per additional adjustment made, P = 0.02).ConclusionsRetrospective glucose data review is correlated with better HbA1c when coupled with data-driven retroactive insulin adjustments. However, obstacles to downloading the data were evident even in this cohort of motivated, predominantly CGM-using T1D families.CommentsThe low response rate to this survey raises interesting questions about paternalism in health care and the way that people choose to use their diabetes devices to support their own self-management. Perhaps a more useful question should be "What benefits do users perceive from device download?" The hassles and burdens of diabetes technologies are often underestimated in routine care visits, where the medical model of health care is dominant. Although the results are presented as statistically significant, they are not particularly clinically significant. As such, it must be asked, What impact has been achieved? For example, do the results reflect a need for greater attention in routine visits to how these devices and diabetes management are integrated into an individual's lived experience? Or do the results reflect a need for greater education on how to review retrospective data to inform basal rate adjustments and bolus doses? Or do they reflect a broader need to better understand the way that people with diabetes interact with their devices to optimize both blood glucose levels and quality of life? A greater exploration of these issues is clearly needed if outcomes are to improve.Psychological Care for Children and Adolescents with Diabetes and Patient Outcomes: Results from the International Pediatric Registry SWEETChobot A1,2, Eckert AJ3,4, Biester T5, Corathers S6, Covinhas A7, de Beaufort C8,9, Imane Z10, Kim J11, Malatynska A2, Moravej H12, Pokhrel S13, Skinner T14,15,16, SWEET Study Group171Institute of Medical Sciences, University of Opole, Department of Pediatrics, Poland; 2University Clinical Hospital in Opole, Department of Pediatrics, Poland; 3Institute of Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany; 4German Center for Diabetes Research (DZD), Munich-Neuherberg, Germany; 5AUF DER BULT, Diabetes Center for Children and Adolescents, Hannover, Germany; 6Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, Division of Endocrinology, Cincinnati, OH; 7APDP, Diabetes Portugal, Lisbon, Portugal; 8Pediatric Clinic/Centre Hospitalier de Luxembourg, Department of Pediatric Diabetes and Endocrinology, Faculty of Technology, Science and Medicine, University of Luxembourg, Esch Belval, Luxembourg; 9UZ Brussels, Department of Pediatric Endocrinology, Brussels, Belgium; 10Children's Hospital of Rabat, UM5S, Rabat, Morocco; 11Seoul National University Bundang Hospital, Seoul National University College of Medicine, Department of Pediatrics, Seongnam, Republic of Korea; 12Neonatal Research Center, Shiraz University of Medical Sciences, Shiraz, Iran; 13Siddhartha Children and Women Hospital, Department of Pediatrics, Butwal, Nepal; 14Institute of Psychology, University of Copenhagen, Copenhagen, Denmark; 15Department of Psychology, La Trobe University, Bendigo, VIC, Australia; 16Australian Centre for Behavioural Research in Diabetes, Melbourne, VIC, Australia; 17SWEETe.V. Coordination Center, Diabetes Center for Children and Adolescents Kinder- und Jugendkrankenhaus Auf Der Bult, Hannover, GermanyPediatr Diabetes. Published online June 2, 2023. doi: 10.1155/2023/8578231Because children and youths with type 1 diabetes mellitus (T1D) and their families should have easy access to psychosocial care, this study assessed the availability of psychological care and its correlations with glycemic control in centers from the multinational SWEET (Better Control in Pediatric and Adolescent Diabetes: Working to Create Centers of Reference) registry.MethodsCenters participating in SWEET (n = 112) were invited to complete a specially designed, structured online survey about their psychology services. Linear/logistic regression models adjusted for several confounders were used to determine the patient's hemoglobin A1c (HbA1c in mmol/mol) and odds ratios for diabetic ketoacidosis (DKA) and severe hypoglycemia (SH) as related to the survey responses.ResultsOf the centers with relevant data in the SWEET database, 76 (68%) responded to the survey, and 89% of the centers provided psychological s
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