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Fibrotic Encapsulation Is the Dominant Source of Continuous Glucose Monitor Delays.
McClatchey PM, McClain ES, Williams IM, Malabanan CM, James FD, Lord PC, Gregory JM, Cliffel DE, Wasserman DH
(2019) Diabetes 68: 1892-1901
MeSH Terms: Animals, Blood Glucose, Blood Glucose Self-Monitoring, Equipment Failure, Fibrosis, Mice, Subcutaneous Fat
Show Abstract · Added August 11, 2019
Continuous glucose monitor (CGM) readings are delayed relative to blood glucose, and this delay is usually attributed to the latency of interstitial glucose levels. However, CGM-independent data suggest rapid equilibration of interstitial glucose. This study sought to determine the loci of CGM delays. Electrical current was measured directly from CGM electrodes to define sensor kinetics in the absence of smoothing algorithms. CGMs were implanted in mice, and sensor versus blood glucose responses were measured after an intravenous glucose challenge. Dispersion of a fluorescent glucose analog (2-NBDG) into the CGM microenvironment was observed in vivo using intravital microscopy. Tissue deposited on the sensor and nonimplanted subcutaneous adipose tissue was then collected for histological analysis. The time to half-maximum CGM response in vitro was 35 ± 2 s. In vivo, CGMs took 24 ± 7 min to reach maximum current versus 2 ± 1 min to maximum blood glucose ( = 0.0017). 2-NBDG took 21 ± 7 min to reach maximum fluorescence at the sensor versus 6 ± 6 min in adipose tissue ( = 0.0011). Collagen content was closely correlated with 2-NBDG latency ( = 0.96, = 0.0004). Diffusion of glucose into the tissue deposited on a CGM is substantially delayed relative to interstitial fluid. A CGM that resists fibrous encapsulation would better approximate real-time deviations in blood glucose.
© 2019 by the American Diabetes Association.
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2 Members
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7 MeSH Terms
Measures of Adherence and Challenges in Using Glucometer Data in Youth with Type 1 Diabetes: Rethinking the Value of Self-Report.
Datye KA, Patel NJ, Jaser SS
(2017) J Diabetes Res 2017: 1075428
MeSH Terms: Adolescent, Adolescent Behavior, Blood Glucose, Blood Glucose Self-Monitoring, Caregivers, Cross-Sectional Studies, Diabetes Mellitus, Type 1, Female, Glycated Hemoglobin A, Humans, Hyperglycemia, Hypoglycemia, Hypoglycemic Agents, Insulin, Insulin Infusion Systems, Male, Patient Compliance, Self Report, Self-Management, Tennessee
Show Abstract · Added May 18, 2018
Purpose - The current study compares the relative strength of associations of different adherence measures with glycemic control in adolescents with type 1 diabetes, while highlighting the challenges in using more objective measures (i.e., glucometer data).
Methods - Adolescents with type 1 diabetes ( = 149) and their caregivers completed a questionnaire measure assessing adolescents' adherence (Self-Care Inventory (SCI)) to the diabetes regimen. Adolescents' glucometers were downloaded to determine average blood glucose checks per day, as an objective measure of adherence. A measure of glycemic control (hemoglobin A1c (HbA1c)) was obtained as part of adolescents' regular clinic visits.
Results - Adolescents' self-reported adherence to the treatment regimen was more strongly correlated with HbA1c than caregivers' reports of adherence. In multivariate analyses, both adolescents' self-report of adherence and average blood glucose checks per day (obtained via a glucometer) were significant predictors of HbA1c. Challenges to obtaining glucometer data were identified.
Conclusions - The findings highlight adolescents' self-report of adherence using the SCI as a brief and meaningful measure to understand and improve adolescents' glycemic control, particularly when glucometer data is difficult to obtain.
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20 MeSH Terms
Executive Function in Adolescents With Type 1 Diabetes: Relationship to Adherence, Glycemic Control, and Psychosocial Outcomes.
Perez KM, Patel NJ, Lord JH, Savin KL, Monzon AD, Whittemore R, Jaser SS
(2017) J Pediatr Psychol 42: 636-646
MeSH Terms: Adolescent, Biomarkers, Blood Glucose, Blood Glucose Self-Monitoring, Cross-Sectional Studies, Depression, Diabetes Mellitus, Type 1, Executive Function, Female, Glycated Hemoglobin A, Humans, Male, Patient Compliance, Quality of Life, Self-Management, Surveys and Questionnaires
Show Abstract · Added June 1, 2017
Objective - Impairments in executive function (EF) skills have been observed in youth with type 1 diabetes (T1D), and these skills are critical for following the complex treatment regimen. This study examines parent reports of EF in relation to measures of adherence, glycemic control (A1c), and psychosocial outcomes (depression and quality of life) in adolescents with T1D. A total of 120 adolescents (aged 13-17 years, 52.5% female, 87.5% White) with T1D and their parents completed questionnaires. Glucometers were downloaded and A1c was obtained during clinical visits at the time of enrollment. The prevalence of clinically significant elevated scores on specific EF skills ranged from 11 to 18.6%. In multivariate analyses, parent-reported EF deficits were associated with poorer adherence and lower quality of life, explaining 13 and 12% of the variance, respectively. Adolescents with T1D exhibit specific EF deficits that may negatively impact their quality of life and their ability to engage in self-management activities.
© The Author 2016. Published by Oxford University Press on behalf of the Society of Pediatric Psychology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com
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1 Members
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16 MeSH Terms
Type 1 Diabetes Prevention: A Goal Dependent on Accepting a Diagnosis of an Asymptomatic Disease.
Ziegler AG, Bonifacio E, Powers AC, Todd JA, Harrison LC, Atkinson MA
(2016) Diabetes 65: 3233-3239
MeSH Terms: Asymptomatic Diseases, Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, Humans, Insulin
Show Abstract · Added April 26, 2017
Type 1 diabetes, a disease defined by absolute insulin deficiency, is considered a chronic autoimmune disorder resulting from the destruction of insulin-producing pancreatic β-cells. The incidence of childhood-onset type 1 diabetes has been increasing at a rate of 3%-5% per year globally. Despite the introduction of an impressive array of therapies aimed at improving disease management, no means for a practical "cure" exist. This said, hope remains high that any of a number of emerging technologies (e.g., continuous glucose monitoring, insulin pumps, smart algorithms), alongside advances in stem cell biology, cell encapsulation methodologies, and immunotherapy, will eventually impact the lives of those with recently diagnosed or established type 1 diabetes. However, efforts aimed at reversing insulin dependence do not address the obvious benefits of disease prevention. Hence, key "stretch goals" for type 1 diabetes research include identifying improved and increasingly practical means for diagnosing the disease at earlier stages in its natural history (i.e., early, presymptomatic diagnosis), undertaking such efforts in the population at large to optimally identify those with presymptomatic type 1 diabetes, and introducing safe and effective therapeutic options for prevention.
© 2016 by the American Diabetes Association.
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6 MeSH Terms
Frequency of Missed Insulin Boluses in Type 1 Diabetes and Its Impact on Diabetes Control.
Jaser SS, Datye KA
(2016) Diabetes Technol Ther 18: 341-2
MeSH Terms: Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, Humans, Hypoglycemic Agents, Insulin, Medication Adherence
Added June 1, 2017
0 Communities
1 Members
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7 MeSH Terms
Good cop, bad cop: quality of parental involvement in type 1 diabetes management in youth.
Young MT, Lord JH, Patel NJ, Gruhn MA, Jaser SS
(2014) Curr Diab Rep 14: 546
MeSH Terms: Adaptation, Psychological, Adolescent, Adolescent Behavior, Attitude to Health, Blood Glucose, Blood Glucose Self-Monitoring, Conflict, Psychological, Diabetes Mellitus, Type 1, Diet, Diabetic, Exercise, Glycated Hemoglobin A, Health Knowledge, Attitudes, Practice, Humans, Insulin, Medication Adherence, Monitoring, Physiologic, Parent-Child Relations, Parents, Self Care
Show Abstract · Added March 11, 2015
Sustained parental involvement in diabetes management has been generally advised to counteract the deteriorating adherence and glycemic control often seen during adolescence, yet until recently, little attention has been given to the optimal amount, type, and quality of parental involvement to promote the best health outcomes for adolescents with type 1 diabetes (T1D). This review synthesizes research regarding the involvement of caregivers-primarily mothers and fathers-of youth with T1D, with a focus on biopsychosocial outcomes. The recent literature on parental involvement in diabetes management highlights a shift in focus from not only amount but also the types (e.g., monitoring, problem-solving) and quality (e.g., warm, critical) of involvement in both mothers and fathers. We provide recommendations for ways that both parents can remain involved to facilitate greater collaboration in shared direct and indirect responsibility for diabetes care and improve outcomes in youth with T1D.
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19 MeSH Terms
Check it! A randomized pilot of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes.
Jaser SS, Patel N, Rothman RL, Choi L, Whittemore R
(2014) Diabetes Educ 40: 659-67
MeSH Terms: Adolescent, Adolescent Behavior, Affect, Blood Glucose, Blood Glucose Self-Monitoring, Caregivers, Cognitive Behavioral Therapy, Diabetes Mellitus, Type 1, Directive Counseling, Feasibility Studies, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Male, Medication Adherence, Parents, Pilot Projects, Quality of Life, Treatment Outcome
Show Abstract · Added March 11, 2015
PURPOSE - The purpose of the current study was to pilot-test a positive psychology intervention to improve adherence to diabetes management in adolescents with type 1 diabetes.
METHODS - A total of 39 adolescents (ages, 13-17 years) with type 1 diabetes and their caregivers were randomized to a positive psychology intervention (n = 20) or an attention control (education) intervention (n = 19). The intervention condition used positive psychology exercises (eg, gratitude, self-affirmation), small gifts, and parent affirmations to boost positive affect. Outcomes included frequency of blood glucose monitoring, quality of life, and glycemic control.
RESULTS - No main effects for treatment were observed at the 6-month follow-up. However, there was a significant association between adolescents' levels of positive affect and measures of adherence, including self-report and meter downloads of glucose monitoring.
CONCLUSIONS - The results from the current study support the assertion that positive affect in the context of diabetes education is an important factor to consider in adolescents with type 1 diabetes.
© 2014 The Author(s).
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20 MeSH Terms
Development of a positive psychology intervention to improve adherence in adolescents with type 1 diabetes.
Jaser SS, Patel N, Linsky R, Whittemore R
(2014) J Pediatr Health Care 28: 478-85
MeSH Terms: Adolescent, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 1, Feasibility Studies, Female, Follow-Up Studies, Humans, Hypoglycemic Agents, Male, Medication Adherence, Motivation, Parents, Patient Acceptance of Health Care, Patient Satisfaction, Pilot Projects, Program Development, Psychotherapy, Self Care, Surveys and Questionnaires, Treatment Outcome
Show Abstract · Added March 11, 2015
INTRODUCTION - Novel interventions are needed to improve adherence to treatment in adolescents with type 1 diabetes. In this article, we describe the development, feasibility, and acceptability of a positive psychology intervention for this population.
METHOD - Adolescents and their parents (n = 39) were randomly assigned to either a positive psychology intervention or an attention control group. Quantitative and qualitative data were collected on feasibility and acceptability. Descriptive and content analysis methods were used.
RESULTS - Recruitment was successful, participation and satisfaction were high in both groups, and retention was excellent over 6 months. In the positive psychology group, adolescents and their parents noted benefits related to increased positive communication and thinking more about diabetes care. We also identified challenges to implementation.
DISCUSSION - Although more research is indicated, a positive psychology framework emphasizing positive emotions and strengths, rather than problems, may be beneficial to adolescents living with a complex chronic illness.
Copyright © 2014 National Association of Pediatric Nurse Practitioners. Published by Elsevier Inc. All rights reserved.
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20 MeSH Terms
Family support, medication adherence, and glycemic control among adults with type 2 diabetes.
Mayberry LS, Osborn CY
(2012) Diabetes Care 35: 1239-45
MeSH Terms: Adult, Aged, Blood Glucose, Blood Glucose Self-Monitoring, Diabetes Mellitus, Type 2, Family, Female, Focus Groups, Glycated Hemoglobin A, Humans, Male, Medication Adherence, Middle Aged, Self Care, Social Support, Surveys and Questionnaires
Show Abstract · Added December 10, 2013
OBJECTIVE - We used a mixed-methods approach to explore the relationships between participants' perceptions of family members' diabetes self-care knowledge, family members' diabetes-specific supportive and nonsupportive behaviors, and participants' medication adherence and glycemic control (A1C).
RESEARCH DESIGN AND METHODS - Adults with type 2 diabetes participated in focus group sessions that discussed barriers and facilitators to diabetes management (n = 45) and/or completed surveys (n = 61) to collect demographic information, measures of diabetes medication adherence, perceptions of family members' diabetes self-care knowledge, and perceptions of family members' diabetes-specific supportive and nonsupportive behaviors. Most recent A1C was extracted from the medical record.
RESULTS - Perceiving family members were more knowledgeable about diabetes was associated with perceiving family members performed more diabetes-specific supportive behaviors, but was not associated with perceiving family members performed fewer nonsupportive behaviors. Perceiving family members performed more nonsupportive behaviors was associated with being less adherent to one's diabetes medication regimen, and being less adherent was associated with worse glycemic control. In focus groups, participants discussed family member support and gave examples of family members who were informed about diabetes but performed sabotaging or nonsupportive behaviors.
CONCLUSIONS - Participant reports of family members' nonsupportive behaviors were associated with being less adherent to one's diabetes medication regimen. Participants emphasized the importance of instrumental help for diabetes self-care behaviors and reported that nonsupportive family behaviors sabotaged their efforts to perform these behaviors. Interventions should inform family members about diabetes and enhance their motivation and behavioral skills around not interfering with one's diabetes self-care efforts.
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1 Members
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16 MeSH Terms
A pilot test of a tailored mobile and web-based diabetes messaging system for adolescents.
Mulvaney SA, Anders S, Smith AK, Pittel EJ, Johnson KB
(2012) J Telemed Telecare 18: 115-8
MeSH Terms: Adolescent, Blood Glucose Self-Monitoring, Cell Phone, Diabetes Mellitus, Type 1, Female, Humans, Male, Motivation, Patient Compliance, Patient Education as Topic, Pilot Projects, Self Care, Telemedicine, Text Messaging
Show Abstract · Added December 5, 2013
We conducted a pilot trial of a new mobile and web-based intervention to improve diabetes adherence. The text messaging system was designed to motivate and remind adolescents about diabetes self-care tasks. Text messages were tailored according to individually-reported barriers to diabetes self-care. A total of 23 adolescents with type 1 diabetes used the system for a period of three months. On average, they received 10 text messages per week (range 8-12). A matched historical control group from the same clinic was used for comparison. After three months, system users rated the content, usability and experiences with the system, which were very favourable. Comparison of the intervention and control groups indicated a significant interaction between group and time. Both groups had similar HbA(1c) levels at baseline. After three months, the mean HbA(1c) level in the intervention group was unchanged (8.8%), but the mean level in the control group was significantly higher (9.9%), P = 0.006. The results demonstrate the feasibility of the messaging system, user acceptance and a promising effect on glycaemic control. Integrating this type of messaging system with online educational programming could prove to be beneficial.
1 Communities
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14 MeSH Terms