• Fatigue
• Feeling disorientated 
• Sweating
• Blurred vision 

• Examined inter-individual differences in depressive symptom development in young adults with type 1.  
• Individuals with persistent depressive symptoms were at risk for bad development in terms of; illness perceptions, illness functioning and self-esteem. 
• People with diabetes twice as likely to have a lifetime depressive disorder as the general population and 20-25% of diabetics are affected by depressive symptoms. These symptoms have been linked to poor treatment adherence, increased health care costs and diabetes complications.  
• Also assessed how stability and change in depression moderated the development of self-esteem, illness perceptions (perceived consequences and control).
•  this study emphasises the need to be attentive for depressive symptoms in patients with diabetes, especially when symptoms persist over time. Given the consequences and health care costs. 

• parents are at risk for elevated psychological distress, especially immediately after diagnosis. 
• few interventions available to support parents and children during this vulnerable period. 
• aim of study: evaluate stepped care behavioural intentions for parents over the first year. Outcomes were to help children's glycemic control, parents and children's psycho-social functioning 
• significant challenges to optimal T1D management in newly diagnosed children include;  developmental challenges of unpredictable diet, behaviour, and physical activity patterns, increased insulin sensitivity, and social and behavioural development 
• Parents experience high levels of stress surrounding their child's T1D diagnosis, and providing support tailored to each individual family's needs may offer psychological and medical benefits 

• Determined the efficacy of two internet based psycho-educational programs designed to improve outcomes for young people transitioning to adolescence.  
• Primary outcomes were better blood sugar levels and quality of life (QOL). Secondary outcomes included; coping, self-efficacy, social competence, self-management and family conflict.  
• Youth who had completed both programs had lower blood sugars higher social acceptance, self efficacy and lower perceived stress.  
• Internet interventions resulted in improved outcomes but completion of both was better than one. This suggests that you need both educational and behavioural interventions. 
• Delivering these programs through the internet represents an efficient way to reach youth and improve outcomes. 

• Diabetes requires a high degree of individual self management strategies. Anxiety and stress can impact glycemic control therefore management of emotions may be the key to good control. 
• Study examines how anxiety, coping style and their interaction can effect long term control for diabetics.  
• Found that coping predicted outcomes especially for those high in trait anxiety.  
• Lower levels of emotion-orientated coping predicted clinically significant increase in blood sugars (HBA1c's).
• Task orientated coping predicted decreases in state anxiety. The use of task and emotion-orientated coping appears to be especially important for highly anxious patients, both for emotional regulation and glycemic control.  
• Concluded coping styles, anxiety and their interactions should be considered in designing follow up interventions with diabetic patients.  

• The effects and treatment/management people must follow can lead to deteriorated in quality of life especially for adolescents 
• Patients illness perceptions have shown to effect quality of life but do others illness perceptions also have an effect? 
• Investigated links between quality of life and illness perceptions. Measured: adolescents self-perceptions, parents self-perceptions and adolescents evaluations of their parents preconceptions 
• QOL was predicted by: Gender, parents emotional representations and perceptions of consequences 
• Shows parents perceptions on QOL of adolescents with type 1 diabetes.
• This new approach provides new insights into the impact of parents’ perceptions on the quality of life of adolescents with type 1 diabetes.
  
  

• Aim was to investigate psychological barriers, this include illness perceptions, insulin beliefs and coping strategies, with a specific focus on gender differences and type of treatment (insulin pen or pump).
• The Brief Illness Perception Questionnaire, the Beliefs about Medicines Questionnaire, and the Adolescent Coping Orientation for Problem Experiences were used. 
• Females had significantly more negative illness perceptions than males on all areas. 
• no difference on insulin necessity, females scored higher on insulin concern and females scored higher on coping strategies (being social and solving family problems). 
• Patients using insulin pen reported more negative perceptions of treatment control than patients using insulin pump.
•  Addressing psychological aspects may be a clinically important supplement to standard somatic T1D care.

• Looked at the effect of stress management training on glycemic control. 
• Subjects attended 3 months stress management training classes during which their prescribed insulin remained the same. HBA1 from all participants were measured before and after intervention. 
• Participants who had intervention training showed significantly improved ways of coping. Blood sugars also improved.  
• Results show a clinically significant beneficial effect of stress management training on glycaemic control.  

• Patients and physicians have different goals and discourse styles during consultations, attempts to bridge these differences by providing patients with ways to collect, visualise, and describe their behaviour.  
• Intervention where type one diabetics photograph health related behaviours. The images and blood glucose records are displayed in computer visualisations and are used during patient-physician interviews.  
• The visualisations help individuals articulate concerns about stress, peer relations, and unhealthy routines.  
• Interventions that include biomedical and bio-psychosocial data during patient-practitioner consultations may be beneficial with patients. Helps them to; reflect on correlations between behaviours and health, and physicians can understand patients issue and diabetes management better. 

• Looked at health behaviours in children/adolescents with type one in comparison to the general population using questionnaires.
• Children and adolescents with type were significantly more likely to have infrequent physical activity and high computer and television use. 
• Active smoking and prolonged use of computer were associated with higher HBA1c.
• They did show a different profile of health behaviour. 
• good glycemic control depends not only insulin but on health relevant behaviours; physical activity, nutrition, smoking and psycho-social parameters, which have a significant impact of quality of control.

• Examined the strength and consistency of the relationship between depression and diabetes complications in type 1 and type 2 patients.
• Meta-analysis of articles examining depression and complications.
• The likelihood of comorbid depression is approximately 30% of patients with type one and two diabetes. 
• Predicted that improvements in depressive symptoms would improve glycemic control. 
• Previous research such as a controlled trial of cognitive behavioural therapy (CBT) for depressive symptoms demonstrated the improvements in patients glycemic control. 
• Results indicated depression was consistently associated with increased severity of diabetic complications. 
• This was found in both types and may suggest common pathways. 
• Depression was associated with a variety of complications. 
• The study demonstrates a significant and consistent association of complications and depressive symptoms. Longitudinal studies are needed to identify pathways that mediate this association.

• Tested the construct validity of the DQOLY scale in a large representative sample of young people with type one diabetes. 
• Tested on 2,077 young adults across 18 countries across Europe from paediatric diabetic centres.
• Measures: Impact of diabetes (23 items), worries about diabetes (11 items), satisfaction with treatment (10 items), satisfaction with life (7 items) and one single item on health perception.
• Using exploratory factor analysis and confirmatory structural modally for the structure of the DQOLY was broadly supported.
• The questionnaire is 52 items long, however this is very long and limits clinical utility. The researchers examined the construct validity and the possibility of making a shortened scale.
• Analysis identified a possible shorter from which had: good construct validity, was equally valid for both sexes and seemed to be internally consistent across countries.
• Further studies are needed to address the criterion and predictive value of the shortened measure. Interestingly the the physical consequences sub-scale indicated a noticeable stronger association than the other 5 sub-scales.
• The shortened scale will enhance acceptability of assessing quality of life in adolescents with diabetes, making it more feasible to introduce as part of routine care. 
  
  

• Management of most chronic illnesses characterised by extensive responsibility patients need to take with their illness. Whether medication, lifestyle changes, preventative action patients and carers make day to day decisions about what action needs to be taken. This involvement is referred to as self-management.
• In order to have successful self-management individuals need to be able to monitor their condition and the effect to cognitive, behavioural and emotional responses have to maintain a satisfactory quality of life. Self-management is more than just treatment plans but includes social and psychological aspects to the management of people’s illnesses. 
• Optimal self-management is difficult to achieve, this is displayed in poor adherence to treatment guidelines and poor psychological wellbeing.
• Aims of self-management interventions (SMI) are: increasing individual’s involvement and control in their treatment and chronic illness. 
• Most studies using self-management interventions led to better outcomes than standard care or basic information (71% for diabetes). 
• Small samples unlikely to have reliable results, been recognised in diabetes studies as before 2002 the mean of participants was smaller than after 2002.
• Using group interventions positives: reduces costs and potential group learning, however, individual interventions are good because can tailor them to individual’s needs. 
• Study on diabetes and SMI’s comparing group and individual interventions found that the group one had greater improvements in blood glucose but only blood glucose.
• Lay leaders vs using health care professionals: lay leaders (cheaper, act as role models), health care professionals (address factual issues related to illness) not much evidence on which is more effective or whether certain groups are better at delivering SMIs. 
• Social learning theory used to help problem solving and goal setting to increase individual’s self-efficacy and increase health-related behaviours (blood glucose monitoring).
• In diabetes SMIs more intensive interventions led to greater health behaviours, group interventions are better for blood glucose control and motivational interviewing led to better HbA1c and more frequent blood glucose testing. 
• Assessment of psychological well-being as an outcome, difficult because even though mental illness rates are higher than the general population, many people on the self-management programmes might not have depressed symptoms or increased anxiety. Expecting this to improve is unrealistic? 
• Using cognitive behavioural components in interventions helped psychological well-being.
• Link between quality of life (QoL) and interventions is not yet understood, further research is needed. 
  
  

• Better management occurs when individuals actively regulate involvement with others and seek help.
• Young adults are at risk for poorer management of type 1 diabetes: changing relationships, social context of diabetes needs to be regulated.
• 18-30 years is a high risk time for management due to the uncertainty in life: moving out; university/working life; transfer from paediatric to adult care.
• Less than a third of emerging adults meet recommendations for self-care and blood sugar control. 
• Self-management behavioural example for young people: when out for dinner must test blood sugars and adjust insulin. This involves emotional regulation by reducing the distress of managing diabetes, cognition by remembering to test  and calculate carbohydrates then inject appropriately. Social aspects: must ask for help to stop potential interference's with testing/injecting. 
• managing T1D is a complex regulation task that involves emotions, cognition's and behaviours that support diabetes management.
• Interventions may be useful for young people with self-regulation issues and helping daily life.

• Self-management is the cornerstone of care for diabetes.
• Health behaviours diabetes are very big although this is known, many individuals have difficulty carrying out the necessary behaviours. 
• Creating interventions targeting the maintenance of these behaviours is important and needs to be developed. 
• Many interventions out there are limited by poor methodologies and has lead to a lack of systematic development of interventions.
• Steed developed a self managament programme based on Bandura's social cognitive theory and self-efficacy.
• Used problem solving and practical skills skills through 5 group sessions, individuals were given the opportunity to discuss difficulties with others as well as being taught healthy behavioural techniques. 
• Intervention improved self-management and quality of life of participants following the programme.

• Based on social-cognitive and self determination theories.
• Participants either had usual care or usual care with the internet-based problem solving management support. 
• 11 weeks, included multimedia stories showing psychosocial barriers and problem solving approaches and coping skills.
•  This brief trial suggests that self-management support delivered through a secure website may improve self-management and blood glucose control for young adults with type 1 diabetes.
• Rated positively by participants involved.
• Use of the internet is effective as it improves accessibility. 
• Small sample used.  

• Young people with type 1 have an increased risk of mental health problems. Treatment need is high, however there is a difficulty in recruiting young people into these psycho-social studies and interventions. 
• People were mainly unaware of their increased risk to common mental health and self-management issues.
• An issue for research/interventions with young type 1 diabetics is difficulty recruiting people.
• Higher number of participants in interventions can be helped through online interventions due to accessibility of use.
• Big motivating factor to engaging with interventions was making a difference to other type 1 diabetics lives. They thought the opportunity to engage with other people with the same illness would be helpful.
• Education evaluated to be a very important factor in interventions. 
• Health care providers have little to no discussion about psycho-social issues.
• Try to not admit emotional difficulties for the fear of having more labels and guilt.

 "Even just admitting that someone has anxiety or you need help, can be seen as almost a weakness. And if you already have a chronic illness you don't want to admit that to yourself. "