青少年2型糖尿病患者向成人护理过渡的导航：促进因素、态度、障碍及行为

Navigating transition to adult care in youth-onset type 2 diabetes: Facilitators, Attitudes, Barriers, and Behaviors.

作者信息

Glaros Sophia B, Dixon Sydney D, Malandrino Noemi, Davis Faith S, Chowdhury Aruba, Kacker Ila A, Macheret Natalie A, Cantor Samson L, Thota Geethika, Mabundo Lilian, Gordon Catherine M, Lightbourne Marissa, Estrada Doris Elizabeth, Monaghan Maureen, Chung Stephanie T

机构信息

Section on Pediatric Diabetes, Obesity, and Metabolism, National Institute of Diabetes & Digestive & Kidney Diseases, National Institutes of Health, Bethesda MD, USA.

Section on Adolescent Bone & Body Composition, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda MD, USA.

出版信息

J Clin Endocrinol Metab. 2025 Apr 15. doi: 10.1210/clinem/dgaf239.

DOI:10.1210/clinem/dgaf239

PMID:40233175

Abstract

INTRODUCTION

Transitioning from pediatric to adult-centered diabetes care may be challenging, especially for young persons at risk for and with youth-onset type 2 diabetes (Y-T2D) who have a high disease burden and rapidly progressive disease. However, the scope of transition readiness, range of psychosocial factors, and perceived barriers among Y-T2D are understudied.

OBJECTIVE

In Y-T2D attending an adult diabetes transition clinic, our objectives were to: (1) characterize attitudes towards transition readiness, (2) examine relationships among depressive and anxiety-related symptoms and transition readiness, and (3) identify perceived barriers and facilitators of diabetes self-care.

METHODS

Transition readiness was assessed with the Endocrine Society "Self-assessment of Worries, Concerns, and Burdens Related to Diabetes and Preparation for Transitioning," and mood symptoms with the Patient Health Questionnaire (PHQ-9), and the Generalized Anxiety Disorder (GAD-7) questionnaire. Logistic regression analyses evaluated the response to transition readiness by mood symptoms. Qualitative analysis identified themes of diabetes self-care in a subset of Y-T2D.

RESULTS

Survey response rate was 89%; n=65, age: 19.6±2.0y (mean±SD), 85% Y-T2D, 15% prediabetes, 57% female, 78% Black, BMI: 38.0±8.2kg/m2, and hemoglobin A1c: 7.6±2.7%. Perceived challenges were reported in 95% of participants and 54% reported worrying about their future. Mild or greater depressive and anxiety-related symptoms were associated with higher odds of reporting social, emotional, and cognitive challenges. Stress, socioeconomic difficulties, and challenges with organizational cognitive functioning were reported barriers to diabetes self-care.

CONCLUSION

Mood symptoms and difficulties with organizational cognitive functioning were commonly reported in Y-T2D during the transitioning period. Interventions are needed to successfully address these psychosocial factors.

摘要

引言

从以儿童为中心的糖尿病护理过渡到以成人为中心的糖尿病护理可能具有挑战性，特别是对于有青年发病2型糖尿病（Y-T2D）风险以及患有该疾病的年轻人，他们疾病负担高且疾病进展迅速。然而，Y-T2D患者在过渡准备方面的范围、心理社会因素的范围以及感知到的障碍尚未得到充分研究。

目的

在参加成人糖尿病过渡诊所的Y-T2D患者中，我们的目标是：（1）描述对过渡准备的态度，（2）检查抑郁和焦虑相关症状与过渡准备之间的关系，以及（3）确定糖尿病自我护理中感知到的障碍和促进因素。

方法

使用内分泌学会的“与糖尿病及过渡准备相关的担忧、关注和负担自我评估”来评估过渡准备情况，使用患者健康问卷（PHQ-9）和广泛性焦虑障碍（GAD-7）问卷来评估情绪症状。逻辑回归分析评估情绪症状对过渡准备的反应。定性分析确定了一部分Y-T2D患者糖尿病自我护理的主题。

结果

调查回复率为89%；n = 65，年龄：19.6±2.0岁（平均值±标准差），85%为Y-T2D，预糖尿病患者占15%，女性占57%，黑人占78%，体重指数（BMI）：38.0±8.2kg/m²，糖化血红蛋白（HbA1c）：7.6±2.7%。95%的参与者报告了感知到的挑战，54%的参与者报告担心自己的未来。轻度或更严重的抑郁和焦虑相关症状与报告社交、情感和认知挑战的较高几率相关。压力、社会经济困难以及组织认知功能方面的挑战被报告为糖尿病自我护理的障碍。