Publications by authors named "Michelle L Litchman"

Purpose Of Review: Describe the connection between Deaf/hard of hearing (DHH) and diabetes, explain the bidirectional relationship of blind/low vision (BLV) and diabetes, characterize challenges DHH and BLV populations face when seeking healthcare regarding their diabetes management. Highlight the inaccessibility of diabetes technology in these populations. Provide best practices when communicating with DHH and BLV people in the clinical setting.

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Background: Older adults with type 1 diabetes (T1D) are increasingly turning to care partners (CPs) as resources to support their diabetes management. With the rise in diabetes technologies, such as continuous glucose monitoring (CGM), there is great potential for CGM data sharing to increase CP involvement in a way that improves persons with diabetes' glucose management and reduces distress.

Objective: The specific aims of this paper are to (1) evaluate the feasibility, usability, and acceptability of the Share plus intervention compared to the CGM Follow app plus diabetes self-management education and support; (2) evaluate the effect of the Share plus intervention on time-in-range (TIR; primary outcome) and diabetes distress (secondary outcome); and (3) explore differences between groups in person with diabetes and CP dyadic appraisal and coping, quality of life, diabetes self-care, and CP burden at 12 and 24 weeks and associations of dyadic variables on outcomes.

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Objective: Care partners play an important role in diabetes management of people with diabetes. Although deaf and hard of hearing (DHH) adults experience diabetes at a higher rate than their hearing counterparts, there is a lack of information regarding the experience of care partners assisting those in the DHH community. There is a need to identify intentional support for this population.

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Article Synopsis
  • Emerging adults aged 18-30 with type 1 diabetes face challenges in navigating the healthcare system and understanding their insurance options, which can worsen diabetes management and overall health outcomes.
  • A collaborative study engaged racially and ethnically diverse young adults through community advisory board meetings to create a tailored financial and health insurance toolkit to better support this demographic.
  • Key themes for the toolkit include empowering self-advocacy, incorporating personal stories and visuals for relatability, addressing clinician biases, and recognizing the unique struggles of diverse backgrounds in managing diabetes.
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Aims: This study examined the perceptions of the SHARE plus intervention and its effects on communication, collaboration, and involvement in day-to-day diabetes management in older adults with Type 1 diabetes (T1D) and their care partners.

Background: The SHARE plus intervention includes continuous glucose monitoring with a data sharing app that allows care partners to view glucose data on a smartphone and receive alerts. People with T1D and their care partners are educated about communication strategies, problem-solving strategies, and action planning when using glucose data sharing.

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Introduction: Body mass index (BMI) fails to identify up to one-third of normal weight individuals with metabolic dysfunction who may be at increased risk of obesity-related cancer (ORC). Metabolic obesity phenotypes, an alternate metric to assess metabolic dysfunction with or without obesity, were evaluated for association with ORC risk.

Methods: National Health and Nutrition Examination Survey participants from 1999 to 2018 (N = 19,500) were categorized into phenotypes according to the metabolic syndrome (MetS) criteria and BMI: metabolically healthy normal weight (MHNW), metabolically unhealthy normal weight (MUNW), metabolically healthy overweight/obese (MHO) and metabolically unhealthy overweight/obese (MUO).

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There is a gap in the literature on the role of Hispanic peer facilitators (PFs) in online peer-support communities for Hispanics with diabetes. This paper explores bilingual Hispanic PFs' training experiences and their perspectives on their role in a continuous glucose monitoring and online peer support intervention for people with type 2 diabetes. We conducted semi-structured interviews with five PFs.

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Objective: To determine the mismatch of desired support versus support received and to evaluate the impact of these mismatches on health outcomes of people with diabetes.

Methods: This cross-sectional study is a secondary data analysis of medical record and survey data of participants with Type 1 and Type 2 diabetes from a diabetes care and education program. Biophysical metrics included HbA1c, body mass index, systolic blood pressure, diastolic blood pressure, triglycerides, and high- and low-density lipoproteins.

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Background: Previous research has suggested beneficial glycemic outcomes for people with type 2 diabetes with the use of continuous glucose monitoring (CGM); yet, there is a dearth of data examining CGM in diverse populations. Additionally, the use of online peer support communities (OPSCs) can further support the application of CGM information to improve health behaviors. The purpose of this qualitative study was to assess participant experiences with a CGM+OPSC intervention.

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Diabetes self-management education and support (DSMES) interventions must be accessible to all people with diabetes. To address equity in the delivery of DSMES, interventions should consider the unique needs of various populations. This article outlines the needs of a wide range of populations, including people with diabetes who are racially or ethnically diverse; have limited English proficiency or literacy; are deaf or hard of hearing; are blind or have low vision; are neurodiverse; live with learning disabilities or intellectual or developmental disabilities; have dementia or cognitive impairment; or are of sexual and/or gender minority.

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Background: Metabolic syndrome (MetS), a group of risk factors that define metabolic dysfunction in adults, is strongly associated with obesity and is an emerging risk factor for cancer. However, the association of MetS and degree of metabolic dysfunction with obesity-related cancer is unknown.

Methods: Using National Health and Nutrition Examination Survey data from 1999 to 2018, we identified 528 obesity-related cancer cases and 18,972 cancer-free participants.

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Background: Diabetes self-management education and support (DSMES) is a crucial component of diabetes care associated with improved clinical, psychosocial, and behavioral outcomes. The American Association of Diabetes Care and Education Specialists, the American Diabetes Association, and the American Academy of Family Physicians all recommend DSMES yet accessing linguistically and culturally appropriate DSMES is challenging in rural areas. The Diabetes One-Day (D1D) program is an established DSMES group intervention that has not been adapted or evaluated in rural communities.

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Article Synopsis
  • Emerging adults with type 1 diabetes experience significant challenges in self-managing their condition, particularly due to financial barriers and difficulties with healthcare access.
  • The study included 33 emerging adults and 17 of their parents, revealing four key issues: cost of diabetes management tools, insurance navigation, communication with healthcare providers, and the emotional toll of financial stress.
  • Overall, the current healthcare system places substantial emotional and financial strain on these individuals and their families, highlighting the need for research and interventions to improve their diabetes management experience.
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Purpose: The purpose of the study was to understand care partner (CP) perceptions of an interdisciplinary diabetes self-management education and support (DSMES) intervention and explore how the interdisciplinary DSMES intervention influences diabetes-specific day-to-day interactions from the CP's perspective.

Methods: A multiple-methods research design comprised of an online survey including demographics and supportive behaviors and a semistructured interview was conducted. The survey was completed by 16 CPs.

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Purpose: The purpose of this study was to gain a better understanding of real-world hypoglycemia experiences from people living with diabetes.

Methods: An exploratory cross-sectional study of a convenience sample of 374 English-speaking adults affected by diabetes using an online survey was conducted.

Results: Participant mean age was 37 years with an average diabetes duration of 21 years.

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This study examined the feasibility of Salud Latina, a weekly synchronous online chat intervention, aimed at engaging Latinos in diabetes prevention conversations. Participants were Latino English- and Spanish-speaking individuals. Salud Latina comprised of six synchronous weekly online chats moderated by bilingual Latina moderators trained in diabetes and online engagement.

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Background: Individuals in need of medical care turn to crowdfunding websites to engage a "crowd" or group for financial support. In the last decade, access to insulin has decreased considerably for several reasons, including the rising cost of insulin, increasing popularity of high-deductible insurance plans, and increasing insurance premiums. Many people with diabetes are forced to ration or go without insulin, and they turn to crowdfunding websites to seek financial donations to purchase insulin needed to reduce health risks and mortality, and sustain quality of life.

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Background: A composite metric for the quality of glycemia from continuous glucose monitor (CGM) tracings could be useful for assisting with basic clinical interpretation of CGM data.

Methods: We assembled a data set of 14-day CGM tracings from 225 insulin-treated adults with diabetes. Using a balanced incomplete block design, 330 clinicians who were highly experienced with CGM analysis and interpretation ranked the CGM tracings from best to worst quality of glycemia.

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Care partners of older adults with type 1 diabetes often become part of the diabetes care team but lack knowledge of how to become involved with glucose management. This article describes a study confirming the feasibility of SHARE , a telehealth intervention involving continuous glucose monitoring and data-sharing to assist these individuals in working together on diabetes management. The intervention provides a strategy for increasing remote patient monitoring and facilitating care partner involvement in diabetes management.

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Article Synopsis
  • Family members or friends (referred to as care partners) of older adults with type 1 diabetes often want to help but lack knowledge about managing glucose levels, which can lead to hypo- and hyperglycemia.
  • Continuous glucose monitoring (CGM) and the Follow app allow users to track and share their glucose data in real-time, but there are challenges that prevent data sharing with care partners.
  • The study found that an intervention called SHARE plus, which includes communication and problem-solving strategies, was successful in facilitating CGM data sharing, leading to high satisfaction among participants and improvements in their quality of life.
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Purpose: The purpose of the study was to assess the feasibility and acceptability of a financial stress and health insurance education toolkit developed by a community advisory board for emerging adults, ages 18 to 25, with type 1 diabetes.

Methods: This study is a longitudinal, randomized controlled trial that enrolled 39 emerging adults with type 1 diabetes. Participants randomized to the intervention group were given access to the T1D Financial Toolkit, an online financial and health insurance education toolkit, over 30 days.

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Background: Type 2 diabetes is twice as likely to affect Hispanic people than their White counterparts. Technology and social support may be an important part of behavior change. In this study, we address gaps in diabetes care for Hispanic Spanish-speaking people with diabetes through an online peer support community (OPSC) pilot intervention using Hispanic Spanish-speaking peer facilitators with diabetes to enhance the use of continuous glucose monitoring (CGM) for diabetes management.

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Objective: This purpose of this study was to conduct a rapid review and environmental scan of diabetes online communities (DOCs) to highlight the clinical impact of DOC engagement and provide guidance to health care providers for navigating and prescribing DOCs.

Methods: This two-phase review included a rapid review of clinical outcomes and an assessment of DOC content. We conducted a literature search for studies evaluating DOC use and glucometric (glycated hemoglobin [A1C], time-in-range, hypoglycemia), behavioral, and psychosocial outcomes.

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We examined support for type 1 diabetes in casual versus committed romantic relationships and links to blood glucose, self-care, and affect in 101 young adults (M 18.8). Individuals provided survey and daily measures of support and blood glucose and affect during a 14-day diary period.

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