XI. STRATEGIES FOR IMPROVING DIABETES CARE D iabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term complications. Diabetes care is complex and requires that many issues, beyond glycemic control, be addressed. A large body of evidence exists that supports a range of interventions to improve diabetes outcomes. These standards of care are intended to provide clinicians, patients, researchers, payors, and other interested individuals with the components of diabetes care, treatment goals, and tools to evaluate the quality of care. While individual preferences, comorbidities, and other patient factors may require modification of goals, targets that are desirable for most patients with diabetes are provided. These standards are not intended to preclude more extensive evaluation and management of the patient by other specialists as needed. For more detailed information, refer to Bode (Ed.): Medical Management of Type 1 Diabetes (1), Burant (Ed): Medical Management of Type 2 Diabetes (2), and Klingensmith (Ed): Intensive Diabetes Management (3). The recommendations included are diagnostic and therapeutic actions that are known or believed to favorably affect health outcomes of patients with diabetes. A grading system (Table 1), developed by the American Diabetes Association (ADA) and modeled after existing methods, was utilized to clarify and codify the evidence that forms the basis for the recommendations. The level of evidence that supports each recommendation is listed after each recommendation using the letters A, B, C, or E.

Standards of Medical Care in Diabetes

Although the association between maternal depression and adverse child outcomes is well established, the strength of the association, the breadth or specificity of the outcomes, and the role of moderators are not known This information is essential to inform not only models of risk but also the design of preventive interventions by helping to identify subgroups at greater risk than others and to elucidate potential mechanisms as targets of interventions A meta-analysis of 193 studies was conducted to examine the strength of the association between mothers’ depression and children’s behavioral problems or emotional functioning Maternal depression was significantly related to higher levels of internalizing, externalizing, and general psychopathology and negative affect/behavior and to lower levels of positive affect/behavior, with all associations small in magnitude These associations were significantly moderated by theoretically and methodologically relevant variables, with patterns of moderation found to vary somewhat with each child outcome Results are interpreted in terms of implications for theoretical models that move beyond main effects models in order to more accurately identify which children of depressed mothers are more or less at risk for specific outcomes

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Maternal Depression and Child Psychopathology: A Meta-Analytic Review

Personality psychology addresses views of human nature and individual differences. Biological and goal-based views of human nature provide an especially useful basis for construing coping; the five-factor model of traits adds a useful set of individual differences. Coping—responses to adversity and to the distress that results—is categorized in many ways. Meta-analyses link optimism, extraversion, conscientiousness, and openness to more engagement coping; neuroticism to more disengagement coping; and optimism, conscientiousness, and agreeableness to less disengagement coping. Relations of traits to specific coping responses reveal a more nuanced picture. Several moderators of these associations also emerge: age, stressor severity, and temporal proximity between the coping activity and the coping report. Personality and coping play both independent and interactive roles in influencing physical and mental health. Recommendations are presented for ways future research can expand on the growing understanding of how personality and coping shape adjustment to stress.

https://www.annualreviews.org/doi/pdf/10.1146/annurev.psych.093008.100352

Personality and Coping

The American Heart Association, in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, diet, and weight) and health factors (cholesterol, blood pressure, and glucose control) that contribute to cardiovascular health. The Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, congenital heart disease, rhythm disorders, subclinical atherosclerosis, coronary heart disease, heart failure, valvular disease, venous disease, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs).The American Heart Association, through its Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States to provide the most current information available in the annual Statistical Update. The 2022 Statistical Update is the product of a full year's worth of effort by dedicated volunteer clinicians and scientists, committed government professionals, and American Heart Association staff members. This year's edition includes data on the monitoring and benefits of cardiovascular health in the population and an enhanced focus on social determinants of health, adverse pregnancy outcomes, vascular contributions to brain health, and the global burden of cardiovascular disease and healthy life expectancy.Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics.The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions. 

https://www.ahajournals.org/doi/pdf/10.1161/CIR.0000000000001052

Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association

Summary Type 1 diabetes is a chronic autoimmune disease characterised by insulin deficiency and resultant hyperglycaemia. Knowledge of type 1 diabetes has rapidly increased over the past 25 years, resulting in a broad understanding about many aspects of the disease, including its genetics, epidemiology, immune and β-cell phenotypes, and disease burden. Interventions to preserve β cells have been tested, and several methods to improve clinical disease management have been assessed. However, wide gaps still exist in our understanding of type 1 diabetes and our ability to standardise clinical care and decrease disease-associated complications and burden. This Seminar gives an overview of the current understanding of the disease and potential future directions for research and care.

Type 1 diabetes

In this meta-analytic and narrative review, we examine several overarching issues related to the study of coping, emotion regulation, and internalizing and externalizing symptoms of psychopathology in childhood and adolescence, including the conceptualization and measurement of these constructs. We report a quantitative meta-analysis of 212 studies (N = 80,850 participants) that measured the associations between coping and emotion regulation with symptoms of internalizing and externalizing psychopathology. Within the meta-analysis we address the association of broad domains of coping and emotion regulation (e.g., total coping, emotion regulation), intermediate factors of coping and emotion regulation (e.g., primary control coping, secondary control coping), and specific coping and emotion regulation strategies (e.g., emotional expression, cognitive reappraisal) with internalizing and externalizing symptoms. For cross-sectional studies, which made up the majority of studies included, we examine 3 potential moderators: age, measure quality, and single versus multiple informants. Finally, we separately consider findings from longitudinal studies as these provide stronger tests of the effects. After accounting for publication bias, findings indicate that the broad domain of emotion regulation and adaptive coping and the factors of primary control coping and secondary control coping are related to lower levels of symptoms of psychopathology. Further, the domain of maladaptive coping, the factor of disengagement coping, and the strategies of emotional suppression, avoidance, and denial are related to higher levels of symptoms of psychopathology. Finally, we offer a critique of the current state of the field and outline an agenda for future research. (PsycINFO Database Record

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review

Chronic illnesses, such as cardiovascular disease, cancer, and diabetes, are among the most prevalent and costly of all global health problems (World Health Organization, 2011). They are the primary reason adults seek health care and are the leading cause of death and disability in the United States (U.S. Centers for Disease Control and Prevention, 2011). Chronic illnesses are long term, uncertain, and can be very intrusive to individuals' everyday lives (Larsen, 2009). Often, chronic illnesses have a course that varies over time specific to the etiology and physiology of the particular illness. However, there are common challenges across chronic illnesses, which include recognizing symptoms and taking appropriate actions, using medications effectively, managing complex regimens, developing strategies to deal with the psychological consequences of the illness, and interacting with the healthcare system over time (Wagner et al., 2001; U.K. Department of Health, 2003). Chronic illness management has been recognized as an important component of health care, and there is increasing awareness that similar strategies can be effective across different types of chronic illnesses (Dowrick, Dixon-Woods, Holman, & Weinman, 2005; Harvey et al., 2008; Swendeman, Ingram, Rotheram-Borus, 2009).

/pdf/processes-of-self-management-in-chronic-illness-2tapon5fus.pdf

Processes of Self-Management in Chronic Illness

Chronic illnesses and medical conditions present millions of children and adolescents with significant stress that is associated with risk for emotional and behavioral problems and interferes with adherence to treatment regimens. We review research on the role of child and adolescent coping with stress as an important feature of the process of adaptation to illness. Recent findings support a control-based model of coping that includes primary control or active coping (efforts to act on the source of stress or one's emotions), secondary control or accommodative coping (efforts to adapt to the source of stress), and disengagement or passive coping (efforts to avoid or deny the stressor). Evidence suggests the efficacy of secondary control coping in successful adaptation to chronic illness in children and adolescents, disengagement coping is associated with poorer adjustment, and findings for primary control coping are mixed. Avenues for future research are highlighted.

Coping with chronic illness in childhood and adolescence.

This article considers the role of temperament in the development of depression during childhood and adolescence. The features of depression in young people and aspects of temperament that are most relevant to depression are briefly reviewed. Studies that have tested the direct and indirect associations of temperament and depressive symptoms in young people are summarized. Evidence suggests that the temperamental characteristics of positive and negative emotionality, and to a lesser extent attentional control, are implicated in depressive symptoms. The role of stress, stress responses, and coping are then examined in the association of temperament and depression. Temperamental characteristics may moderate and be moderated by stress responses and coping in their effects on depression. Directions for future research are highlighted.

Temperament, stress reactivity, and coping:implications for depression in childhood and adolescence.

In children with type 1 diabetes (T1DM), parents are ultimately responsible for daily management of T1DM, which has a significant impact on family life. Daily management of T1DM is time-consuming and requires a change to many well-established family routines. Although technological advances have greatly enhanced the ability of parents to monitor and manage T1DM in youth,1 the responsibility of T1DM management can contribute to parental stress, distress, and diminished quality of life. Understanding the experience of parenting a child with T1DM can provide insight into the challenges and needs of parents, thus informing the development of parental and/or family interventions. Considerable research has been undertaken to examine aspects of the parenting experience; however, there is a need to synthesize this literature to inform future research and clinical work.

Caring for a child with T1DM has been described as an overwhelming experience, requiring constant vigilance.2 Parents must come to terms with having a child with a life-threatening illness and carrying out a labor-intensive and complicated daily regimen.3 Parents live with constant worry about hypoglycemia or hyperglycemia, heightened feelings of responsibility for their child’s health, and the desire to promote optimal growth and development.4 At different developmental phases, new issues arise that require a complete reevaluation of previously established and effective management strategies.5 The ongoing stress and worry manifest in elevated rates of parents’ perception of stress and increased risk for depression and anxiety.

There is considerable research on the prevalence of parental psychological distress and the impact of such distress on child and family outcomes. Although the majority of parents of children with T1DM adjust well, approximately 20% to 30% of parents report clinically significant distress, which has been defined as stress (life stress or parenting stress) and symptoms of anxiety, depression, and/or posttraumatic stress.6–8 Parental psychological distress at the time of diagnosis has been found to predict later parental distress.9 In addition, parental psychological distress has health implications for the parent, the child with T1DM, and the overall functioning of the family.10 In parents of children with T1DM, psychological distress has been shown to affect family communication,11 increase family conflict,12 decrease the ability to parent effectively,13 negatively affect child psychological adjustment,9 and contribute to poor parental mental and physical health.14

Greater understanding of the relationship of parental psychological responses to having a child with T1DM is needed to guide clinical practice and future research. Thus, the purpose of this systematic mixed-studies review is to synthesize the research on the parental experience of having a child with T1DM, focusing on parental psychological adjustment. The aims are to describe the prevalence of psychological distress in parents of children with T1DM, the relationship between parental psychological distress and health outcomes, and the parental experience of having a child with T1DM. Clinical and research implications will also be presented.

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Sarah S. Jaser

Papers

Coping, emotion regulation, and psychopathology in childhood and adolescence: A meta-analysis and narrative review

Processes of Self-Management in Chronic Illness

Coping with chronic illness in childhood and adolescence.

Temperament, stress reactivity, and coping:implications for depression in childhood and adolescence.

Psychological Experience of Parents of Children With Type 1 Diabetes A Systematic Mixed-Studies Review