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1. From repeat diabetic ketoacidosis to expert by experience : exploring the highs and lows of living with type 1 diabetes

Author

Allcock, Bethan

Subjects
616.4, type 1 diabetes, young adults, experts by experience, psychosocial factors, repeat diabetic ketoacidosis
Abstract

This thesis explores pertinent issues regarding the psychological, social, and physical wellbeing of people living with type 1 diabetes. Chapter one presents a narrative systematic review of 22 studies concerning the psychosocial factors associated with repeat diabetic ketoacidosis (an acute and life-threatening complication of diabetes) in type 1 diabetes. Although considerable variance was noted across studies with regards to design, quality and outcomes measured, some consistent psychosocial factors were observed to be implicated in the cycle of repeat diabetic ketoacidosis. These comprised: female gender, adolescent to young adult age range, lower socioeconomic status, and poor mental health. Themes also emerged around ethnicity and, in children and young people, family, social and behavioural issues. However, firm conclusions could not be drawn about these additional themes due to particularly poor methodological rigour and scant research. Recommendations were made for enhanced monitoring and support for individuals within particularly ‘at risk’ groups. Chapter two presents a grounded theory study exploring the personal impact of expert by experience activity on young adults living with type 1 diabetes. A theory of empowerment through expert by experience activity was developed, grounded in interviews with seven participants. The theory proposes that engagement in expert by experience activity empowers individuals psychologically, socially, and in their condition management; and may lead to increased confidence and autonomy across multiple areas of their lives. These findings, in addition to existing research demonstrating the service-level benefits of expert by experience involvement, may have important implications for diabetes services to support expanding their programme of expert by experience involvement to benefit all stakeholders. Chapter three discusses further implications emerging from the first two chapters regarding future research, theory development, and clinical practice. It concludes with a reflective commentary on the research process.

Published
2020

2. Psychosocial factors associated with repeat diabetic ketoacidosis in people living with type 1 diabetes: A systematic review.

Author

Allcock, Bethan, Stewart, Rose, and Jackson, Mike

Subjects
*PSYCHOLOGY information storage & retrieval systems, *CINAHL database, *ONLINE information services, *SYSTEMATIC reviews, *AGE distribution, *TYPE 1 diabetes, *MENTAL health, *DISEASE relapse, *SEX distribution, *SOCIOECONOMIC factors, *PSYCHOSOCIAL factors, *SOCIAL classes, *MEDLINE, *DIABETIC acidosis, *PEOPLE with diabetes, *PSYCHOLOGICAL distress
Abstract

Aim: To systematically review the literature concerning the psychosocial factors associated with repeat diabetic ketoacidosis for people living with type 1 diabetes. Methods: PsycInfo, Web of Science, CINAHL, PubMed and ASSIA were searched according to a registered study protocol (PROSPERO CRD42020167381). Data were extracted into a coding spreadsheet, and findings were synthesised narratively. Included papers were also subject to a quality assessment. Results: The search yielded 548 unique articles, of which 22 met inclusion criteria for this review. There was considerable variance across studies with regard to design, quality and outcome measured. Nevertheless, there was relatively consistent evidence to suggest that repeat diabetic ketoacidosis in type 1 diabetes is associated with female gender, adolescent to young adult age range, lower socio‐economic status and poor mental health. Some evidence was also observed for the role of ethnicity and, for children and young people at least, family, social and behavioural issues. However, this was limited by issues of methodological rigour and scant investigation. Conclusions: The review identified four psychosocial factors that appear to play a key role in the cycle of repeat diabetic ketoacidosis. Individuals with these factors present may benefit from targeted support and interventions by specialist healthcare professionals. Knowledge and understanding in this area would be considerably enhanced via increased use of prospective study designs and greater consistency in the operationalisation of variables across studies. [ABSTRACT FROM AUTHOR]

Published
2022
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