This Research Topic is the first volume of Highlights in Diabetes Self-Management. Please see the second volume <a href="https://www.frontiersin.org/research-topics/57500/highlights-in-diabetes-self-management-202223">here</a> We are pleased to introduce the collection Frontiers in Clinical Diabetes and Healthcare – Highlights in Diabetes Self-Management 2021/22. This collection will welcome and showcase a selection of high impact articles authored by leaders in the field. The work presented here highlights the broad diversity of research performed across the Diabetes Self-Management section, and aims to put a spotlight on the main areas of interest. This collection aims to further support Frontiers’ strong community by shining a spotlight on our authors' highly impactful research.

Research Institute of the Diabetes Academy Mergentheim (FIDAM)

Queen's University Belfast

Korle Bu Teaching Hospital

Explore high impact articles from leaders in diabetes self-management with Frontiers’ new collection.

This research topic focuses on the psychosocial care needs of young children with type 1 diabetes, the impact of diabetes sports camps on individuals with type 1 diabetes, and the correlation between medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes. Key findings include: <ul> <li>Healthcare professionals provided child-centred care through play-based approaches that make diabetes care meaningful and relevant.</li> <li>Individuals with type 1 diabetes who attended diabetes sports camps felt empowered and experienced improved general well-being and glucose control.</li> <li>Depressive symptoms and diabetes-specific distress were strongly associated with suboptimal intake and barriers in both diabetes types.</li> <li>Patient-centered methods and technological advances have helped to improve the fit of diabetes care both at the point of care and at the point of life.</li> </ul>

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Frontiers in Clinical Diabetes and Healthcare

Diabetes Self-Management

Highlights in Diabetes Self-Management 2021/22

Self-management is arguably the cornerstone and the most challenging aspect of diabetes care for people living with diabetes, irrespective of the type of diabetes. Self-management encompasses the routines necessary for managing glycaemic levels and includes; glucose monitoring, portioning meals/snacks, meal timing, physical activity, taking medication, healthy coping, and foot care. Self-care can be demanding for people living with diabetes, as it requires cognitive, emotional, and behavioural effort on a daily basis. Sustaining self-care routines over a lifetime is burdensome; however, this enduring effort is important in supporting long-term health and wellbeing.People living with diabetes should therefore have access to continuous diabetes self-management support. Unfortunately, this is often not the case, particularly in low-income countries. Even in well-resourced settings, access to self-management education and support is often limited and not provided on a structural basis. Clearly, person-centred self-management education and support deserves more attention, both in youth and adults with diabetes.Evidence from papers in this collection are summarised in the sections below.Using qualitative methods specifically observation and interviews <a href="https://doi.org/10.3389/fcdhc.2021.707553">DeCosta et&nbsp;al</a> examined established care practices which address the mental and social needs of young children living with type 1 diabetes (T1DM), by interviewing professionals from specialist centres in Denmark. Half of the professionals interviewed had up to 19 years of experience in paediatric endocrinology. Although their findings cannot be generalised they provide rare insights into approaches to diabetes self-management in children: very young children.Attention to immediate needs, child centeredness and participation, and communication style were themes emerging from their study. Delivering diabetes care using these strategies facilitated the process of drawing these young children into their self-care.<a href="https://doi.org/10.3389/fcdhc.2021.707553">DeCosta et&nbsp;al.</a> report a paradigm shift from the biomedical model to the biopsychosocial model, in providing care for children with T1DM. Deliberate effort now goes into improving a child’s experience in hospital at the time of diagnosis. Consistent messaging from the same team of healthcare providers and predictability helps a child living with T1DM to build relationships and helps to create a safe environment for the child. Learning, including learning about diabetes and self-care happens when a child feels secure. At the time of diagnosis, the immediate needs of children living with T1DM should be and can be met by limiting change, limiting pain, and enhancing predictability.By removing the focus from diabetes to the child as a whole person and what matters to them the providers invest in the ability of the child to share diabetes self-care related challenges with clinicians in the future. Connecting to the child on matters unrelated to diabetes management provides a channel for effective diabetes self-management education and support.During consultations, clinicians prevent &#x2018;sugars&#x2019; from getting in the way. Abstract numbers are complex for children and prevent them from getting involved in their care. Clinicians ensured that consultations were pleasant experiences by using several techniques to limit pain and fear. Role play improved child involvement; but more importantly helped them recover from unpleasant experiences.Understanding the child&#x2019;s world and using positive feedback and gifts made it possible to earn children&#x2019;s corporation for unpleasant procedures.Factors associated with self-reported medication taking may be modified to improve medication taking. <a href="https://doi.org/10.3389/fcdhc.2021.645609">Hogervorst et&nbsp;al.</a> reported that depression and diabetes-related distress were negatively associated with medication taking in both T1DM and T2DM. Suggesting that in adults living with diabetes self-care is influenced by mental health.Furthermore, medication taking was associated with lower HbA1c values for all sub-types of diabetes. Adults living with diabetes on insulin therapy irrespective of sub-type of diabetes were shown to be taking their medication more often than adults living with diabetes who were not on insulin. However, the effect sizes were small.Importantly, among adults living with T1DM, fewer events of severe hypoglycaemia was associated with less frequent medication taking and more perceived barriers to taking medication, after adjusting for multiple confounders. This finding underlines the complexity of self-management in T1DM. In adults living with T2DM shorter duration of diabetes and mental health challenges remained positively associated with not taking medication and perceived barriers to medication taking.These findings underscore the need for clinicians to be alert to characteristics in adults living with T1DM and T2DM, which may pre-dispose persons living with diabetes to depression, not taking medication, and increased perceived barriers to medication taking. These factors should also addressed as part of modern individualised diabetes self-management education.The study population in this study were a non-representative sample of Dutch adults with self-reported diabetes participating in an online cross-sectional study. The generalisability of these findings may therefore be limited.Self-management education does not always translate into improved self-care behaviours for multiple reasons. Wide variations in glycaemic levels can frustrate self-management efforts of physically active people. These challenges may be mitigated by empowering through education. <a href="https://doi.org/10.3389/fcdhc.2021.655238">Mattsson et&nbsp;al.</a> employ qualitative techniques (telephone interviews) to study how new learnings become habits. The study population comprised of 15 people living with T1DM for a mean of 15 years, who participated in a 3-day diabetes sports camp. Self-reported increases in diabetes specific knowledge was observed after immersion in a sports camp. The presence of peers, and engagement with multi-disciplinary teams, practical sessions, timely individualised feedback including technology-assisted feedback, seemed to have facilitated the process of behaviour change.This perspective piece by <a href="https://doi.org/10.3389/fcdhc.2021.658817">Ruissen et&nbsp;al.</a> shed light on the overarching principle that diabetes care needs to be tailor-made. Unfortunately, one-size simply cannot fit all. It is not only impossible but also impractical to deliver tailor made diabetes self-management education and support without involving the patient and their support persons. Patient centeredness must be the guiding principle for all diabetes related encounters.The studies summarised above are reflective of the complexity of self-management in diabetes. They provide an insight into the determinants of self-management as well as potentially useful interventions to support self-management in a way that centres on the holistic needs of persons living with diabetes.RL prepared the first draft. All authors made modifications and approved the final version.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

Editorial: Highlights in diabetes self-management 2021/22

IntroductionLittle is known about the psychosocial experiences and care needs of young children under the age of 7 years who have been diagnosed with type 1 diabetes. To address this knowledge gap, we examine children’s psychosocial care needs through the lens of child-centred care and the framework of Zone of Proximal Development.</sec>ObjectivesTo explore current care practices for young children with diabetes and identify aspects of child-centred care already successfully integrated into current practice.</sec>MethodIndividual face-to-face, semi-structured interviews were conducted with 20 Healthcare Professionals, representing 11 of 17 paediatric diabetes clinics in Denmark.</sec>ResultsOur data provided valuable insights into existing child-centred practices. Our analysis identified practices covering four main themes: 1. Accommodating immediate emotional needs, 2. Putting children before diabetes, 3. Encouraging meaningful participation, 4. Playful communication.</sec>DiscussionHealthcare Professionals provided child-centred care, largely through play-based approaches that make diabetes care meaningful and relevant. Such practices provide the scaffolding necessary to enable young children to gradually engage, comprehend and participate in their own care.</sec>

Introduction: Little is known about the psychosocial experiences and care needs of young children under the age of 7 years who have been diagnosed with type 1 diabetes. To address this knowledge gap, we examine children’s psychosocial care needs through the lens of child-centred care and the framework of Zone of Proximal Development.Objectives: To explore current care practices for young children with diabetes and identify aspects of child-centred care already successfully integrated into current practice.Method: Individual face-to-face, semi-structured interviews were conducted with 20 Healthcare Professionals, representing 11 of 17 paediatric diabetes clinics in Denmark.Results: Our data provided valuable insights into existing child-centred practices. Our analysis identified practices covering four main themes: 1. Accommodating immediate emotional needs, 2. Putting children before diabetes, 3. Encouraging meaningful participation, 4. Playful communication.Discussion: Healthcare Professionals provided child-centred care, largely through play-based approaches that make diabetes care meaningful and relevant. Such practices provide the scaffolding necessary to enable young children to gradually engage, comprehend and participate in their own care.

Playful Communication and Care: Exploring Child-Centred Care of Young Children With Type 1 Diabetes Through the Framework of Zone of Proximal Development

AimsTo describe the experiences of individuals with diabetes type 1 (T1D) participating in diabetes sports camps and how acquired knowledge could be used in daily self-management.</sec>MethodsSemi-structured telephone interviews were conducted with 15 adults with T1D. A strategic sample procedure was chosen. The interviews were analyzed using qualitative content analysis.</sec>ResultsThe overarching theme ”Empowered by intertwined theory and practice”, included three main categories: Learning in a motivation-enhancing environment, incorporation of new habits and perceptions of glycemic control and health-related outcomes. The participants considered the camp to be an excellent opportunity to share feelings, ideas, and knowledge. They felt empowered by the camp atmosphere as well as supportive environment. After the camp, the general well-being was improved by incorporating new habits and improvements in glucose control. </sec>ConclusionsA diabetes sports camp constitutes an excellent, but resource-intensive, complimentary support in diabetes care and provides opportunities for T1D individuals to become more independent and autonomous. The findings indicate the need for more directed learning activities for individuals with type 1 diabetes and health care providers to increase their competence in the area of T1D and exercise in order to adequately manage counseling in various types of sports.</sec>

Aims: To describe the experiences of individuals with diabetes type 1 (T1D) participating in diabetes sports camps and how acquired knowledge could be used in daily self-management.Methods: Semi-structured telephone interviews were conducted with 15 adults with T1D. A strategic sample procedure was chosen. The interviews were analyzed using qualitative content analysis.Results: The overarching theme ”Empowered by intertwined theory and practice”, included three main categories: Learning in a motivation-enhancing environment, incorporation of new habits and perceptions of glycemic control and health-related outcomes. The participants considered the camp to be an excellent opportunity to share feelings, ideas, and knowledge. They felt empowered by the camp atmosphere as well as supportive environment. After the camp, the general well-being was improved by incorporating new habits and improvements in glucose control. Conclusions: A diabetes sports camp constitutes an excellent, but resource-intensive, complimentary support in diabetes care and provides opportunities for T1D individuals to become more independent and autonomous. The findings indicate the need for more directed learning activities for individuals with type 1 diabetes and health care providers to increase their competence in the area of T1D and exercise in order to adequately manage counseling in various types of sports.

Empowered by Intertwined Theory and Practice – Experiences From a Diabetes Sports Camp for Physically Active Adults With Type 1 Diabetes

PurposeThe purpose of this study is to investigate medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes.</sec>MethodsIn this cross-sectional study, 3,383 Dutch adults with diabetes (42% type 1; 58% type 2) completed the 12-item ‘Adherence Starts with Knowledge’ questionnaire (ASK-12; total score range: 12-60) and reported socio-demographics, clinical and psychological characteristics and health behaviors. Univariable and multivariable logistic regression analyses were used.</sec>ResultsAdults with type 1 diabetes had a slightly lower mean ASK-12 score (i.e. more optimal medication intake and fewer perceived barriers) than adults with non-insulin-treated type 2 diabetes. After adjustment for covariates, correlates with suboptimal intake and barriers were fewer severe hypoglycemic events and more depressive symptoms and diabetes-specific distress. In type 2 diabetes, correlates were longer diabetes duration, more depressive symptoms and diabetes-specific distress.</sec>ConclusionsAdults with type 1 diabetes showed slightly more optimal medication intake and fewer perceived barriers than adults with non-insulin treated type 2 diabetes. Correlates differed only slightly between diabetes types. The strong association with depressive symptoms and diabetes-specific distress in both diabetes types warrants attention, as improving these outcomes in some people with diabetes might indirectly improve medication intake.</sec>

Purpose: The purpose of this study is to investigate medication intake, perceived barriers and their correlates in adults with type 1 or type 2 diabetes.Methods: In this cross-sectional study, 3,383 Dutch adults with diabetes (42% type 1; 58% type 2) completed the 12-item ‘Adherence Starts with Knowledge’ questionnaire (ASK-12; total score range: 12-60) and reported socio-demographics, clinical and psychological characteristics and health behaviors. Univariable and multivariable logistic regression analyses were used.Results: Adults with type 1 diabetes had a slightly lower mean ASK-12 score (i.e. more optimal medication intake and fewer perceived barriers) than adults with non-insulin-treated type 2 diabetes. After adjustment for covariates, correlates with suboptimal intake and barriers were fewer severe hypoglycemic events and more depressive symptoms and diabetes-specific distress. In type 2 diabetes, correlates were longer diabetes duration, more depressive symptoms and diabetes-specific distress.Conclusions: Adults with type 1 diabetes showed slightly more optimal medication intake and fewer perceived barriers than adults with non-insulin treated type 2 diabetes. Correlates differed only slightly between diabetes types. The strong association with depressive symptoms and diabetes-specific distress in both diabetes types warrants attention, as improving these outcomes in some people with diabetes might indirectly improve medication intake.

Medication Intake, Perceived Barriers, and Their Correlates Among Adults With Type 1 and Type 2 Diabetes: Results From Diabetes MILES – The Netherlands

The care of patients with diabetes requires plans of care that make intellectual, practical, and emotional sense to patients. For these plans to fit well, patients and clinicians must work together to develop a common understanding of the patient’s problematic human situation and co-create a plan of care that responds well to it. This process, which starts at the point of care, needs to continue at the point of life. There, patients work to fit the demands of their care plan along with the demands placed by their lives and loves. Thought in this way, diabetes care goes beyond the control of metabolic parameters and the achievement of glycemic control targets. Instead, it is a highly individualized endeavor that must arrive at a care plan that reflects the biology and biography of the patient, the best available research evidence, and the priorities and values of the patient and her community. It must also be feasible within the life of the patient, minimally disrupting those aspects of the patient life that are treasured and justify the pursuit of care in the first place. Patient-centered methods such as shared decision making and minimally disruptive medicine have joined technological advances, patient empowerment, self-management support, and expert patient communities to advance the fit of diabetes care both at the point of care and at the point of life.

The care of patients with diabetes requires plans of care that make intellectual, practical, and emotional sense to patients. For these plans to fit well, patients and clinicians must work together to develop a common understanding of the patient&#x2019;s problematic human situation and co-create a plan of care that responds well to it. This process, which starts at the point of care, needs to continue at the point of life. There, patients work to fit the demands of their care plan along with the demands placed by their lives and loves. Thought in this way, diabetes care goes beyond the control of metabolic parameters and the achievement of glycemic control targets. Instead, it is a highly individualized endeavor that must arrive at a care plan that reflects the biology and biography of the patient, the best available research evidence, and the priorities and values of the patient and her community. It must also be feasible within the life of the patient, minimally disrupting those aspects of the patient life that are treasured and justify the pursuit of care in the first place. Patient-centered methods such as shared decision making and minimally disruptive medicine have joined technological advances, patient empowerment, self-management support, and expert patient communities to advance the fit of diabetes care both at the point of care and at the point of life.