Stephanie Griggs

Background/Objectives: Sleep is critical for young adults, particularly those with type 1 diabetes (T1D), who face unique challenges in achieving recommended sleep and diabetes health targets. The purpose of this study guided by the theoretical framework of self-regulation theory is to explore how these individuals navigate self-regulatory processes in their sleep behaviors through mechanisms of self-monitoring, self-judgment, and self-evaluation. Methods: A qualitative descriptive design was implemented using semi-structured interviews with 34 young adults (ages 18–30) living with T1D. Data were collected through focused interviews, sleep diaries, actigraphy, and continuous glucose monitoring, followed by thematic analysis to identify sleep behavior self-regulation patterns. Results: Three primary themes were identified: (1) Sleep Behavior Self-Monitoring—highlighting participants’ awareness of their sleep habits and the diabetes-related impacts on these habits; (2) Sleep Behavior Self-Judgment—reflecting how personal and societal standards inform their evaluation of sleep health; (3) Sleep Behavior Self-Evaluation—showing emotional responses associated with sleep out-comes, where good sleep led to positive feelings and motivation, while poor sleep resulted in frustration. Conclusions: Understanding sleep behavior self-regulation among young adults with T1D is crucial for improving sleep health and diabetes management. Targeted interventions incorporating sleep education and self-regulatory strategies may enhance both perceived sleep quality and overall well-being in this population.

Background: Psychological distress among surrogate decision-makers (surrogates) for patients with critical illness is well documented. Existing interventions for supporting surrogates in their role often target surrogates’ informational needs without directly addressing surrogates’ acute emotional burden. Therefore, we developed the Reappraisal-Enhanced Foundation for Regulating Affect and Managing Emotions (REFRAME) intervention, a tablet-based app that empowers surrogates to manage their psychological distress with cognitive reappraisal. Objective: We sought to (1) determine the feasibility, acceptability, and appropriateness of implementing REFRAME and (2) examine its preliminary effects on surrogates’ psychological distress. Methods: We conducted a pilot nonrandomized trial at a tertiary medical center in northeast Ohio. We recruited adult surrogates for incapacitated intensive care unit (ICU) patients (≥48 hours). The first 20 participants received usual care (UC); the next 28 received UC and REFRAME, consisting of 3 sequential 10- to 15-minute modules administered every 24 to 48 hours (T1-T3) post enrollment (T0). We evaluated implementation outcomes both quantitatively and qualitatively by describing enrollment and completion rates, surrogates’ scores on the Acceptability of Intervention Measure and the Intervention Appropriateness Measure, and thematically analyzing feedback from each interventional module. We measured psychological distress with the Patient-Reported Outcomes Measurement Information System Anxiety and Depression short forms at enrollment (T0) and approximately 1-week post enrollment (T3). We used linear mixed-effects models to assess changes in anxiety and depression severity between groups from T0 to T3, adjusting for the surrogate’s gender, patient relationship, prior decision-making experience, and perceived stress. Results: Our analytic sample included 48 surrogates (UC=20; REFRAME=28). Two-thirds (19/28, 67.9%) of those assigned to REFRAME completed all 3 modules, with over 70% finding it acceptable and appropriate. Qualitative feedback indicated that surrogates appreciated the intervention’s normalization of their emotions and provision of practical reappraisal strategies. Both groups showed reductions in psychological distress severity, with greater reductions in depressive symptoms reported by surrogates in the REFRAME group (d=0.68). Conclusions: REFRAME was feasible to implement, well-received by users, and considered relevant in the ICU setting. We observed preliminary improvement in depressive symptoms, though the effects on anxiety are less certain. Our findings indicate that incorporating brief cognitive reappraisal tools into routine ICU practice may support surrogates’ psychological well-being. Larger, more diverse trials with longer follow-up are necessary to confirm these initial findings and assess their impact on shared decision-making.

Background : Midlife adults with type 1 diabetes mellitus (T1DM) face unique physiological and psychological challenges when balancing physical activity and rest. The Wants and Aversions for Neuromuscular Tasks model accounts for competing desires and aversions for movement and rest, addressing the limitations of general physical activity frameworks. Thus, we employed a qualitative descriptive study guided by the Wants and Aversions for Neuromuscular Tasks model to explore momentary motivational states governing movement and rest among midlife adults with T1DM following an exercise-support intervention. Methods : We conducted semistructured interviews with 23 midlife adults with T1DM (mean age 48, SD 11 y, 78% female, 91% non-Hispanic white, 35% overweight, and 26% obese). Through directed content analysis, we employed deductive Wants and Aversions for Neuromuscular Tasks framework-driven and inductive coding to map participant reflections. Results : The overarching themes mapped across the 4 quadrants revealed complex dynamics. In quadrant 1 (dread move, crave rest), participants expressed motivational conflicts driven by fatigue, device malfunctions, and glucose excursions, often opting for light movement to restore energy. Quadrant 2 (dread move, dread rest), obligation-driven resistance transformed into pride and gratification upon completion. Quadrant 3 (crave move, crave rest), participants opted for activities like yoga or outdoor walks for active recovery. In quadrant 4 (crave move, dread rest), individuals found flow in enjoyable activities and articulated an internal drive to exercise conflicting with physical fatigue or glycemic levels necessitating rest. Conclusions : The findings underscore the dynamic nature of desires and aversions of movement and rest among midlife adults with T1DM. These insights can inform future physical activity interventions.

Background: Bedtime routines are modifiable behaviors that can influence sleep health and may be shaped by cultural and caregiving experiences. African American adults experience poorer sleep outcomes, characterized by reduced sleep duration and diminished sleep quality relative to other racial and ethnic groups. Objective: This convergent mixed-methods study explored the bedtime routine of African American family caregivers and examined whether bedtime activities differ by co-residence status. Methods: Thirty African American family caregivers completed daily sleep diaries over a 7-day period, including a report on bedtime activities (quantitative approach). A subsample ( n = 24) participated in follow-up interviews about their usual bedtime routine (qualitative approach). All participants indicated if they lived with the care recipient during the baseline visit. Quantitative data were analyzed using descriptive statistics and Mann–Whitney U -tests, and qualitative data were analyzed using content analysis. Results: Participants’ mean age was 58 years. Most cared for a parent or parent-in-law, and most lived with the care recipient. The most prevalent bedtime activities were watching television and using electronic devices, while fewer participants participated in sleep-promoting activities such as reading or relaxation exercises. Qualitative results about usual bedtime routines included personal care activities, enjoyable activities, caregiving and household responsibilities, and sleep preparation routines. Quantitative and qualitative results aligned on the most reported activities. Caregivers living with the care recipient reported fewer bedtime activities. Conclusions: The results emphasize potential targets for interventions that are designed to enhance the sleep health of African American family caregivers by implementing practical and culturally relevant relaxing bedtime routines.

Pregnancy in women with type 1 diabetes (T1D) is associated with increased risk of adverse outcomes, including preeclampsia and macrosomia. Normalizing glycated hemoglobin (A1C) helps minimize these risks. Previous evidence suggests that continuous glucose monitoring (CGM) improves treatment decisions and glycemic control. However, no synthesized evidence currently assesses whether CGM use is associated with improved A1C levels in this population. The aim of this integrative review is to compare A1C levels during pregnancy between women with T1D who use CGM and those who do not use CGM (e.g. intermittent blood glucose monitoring only). An integrative review was conducted in accordance with Whittemore and Knafl's guidelines. Three databases (CINAHL, PubMed, and Web of Science) were searched on 5 June 2024. Studies were included if they involved pregnant women with T1D and reported pregnancy A1C levels for both CGM users and non-users, enabling pooled analysis using sample size as a weighting factor. Study quality was assessed using the Mixed Methods Appraisal Tool (version 2018). Of 300 screened articles, nine met the inclusion criteria. CGM users consistently demonstrated lower pooled mean A1C levels than non-users across all trimesters: first trimester (6.55% vs. 6.82%; SD = 0.72 vs. 0.93), second trimester (5.89% vs. 6.11%; SD = 0.55 vs. 0.63), and third trimester (6.07% vs. 6.24%; SD = 0.53 vs. 0.61). Overall, CGM users had a lower average pooled mean A1C throughout pregnancy (6.19% vs. 6.40%; SD = 0.61 vs. 0.74). CGM use in pregnant women with T1D may support better glycemic target achievement by providing real-time glucose data that informs insulin dosing and dietary adjustment. These findings support further investigation in larger controlled studies.

Background Adults with type 1 diabetes mellitus (T1DM) have barriers to physical activity that can be physiological, psychological, emotional, and/or contextual. To complement prior quantitative surveys on these topics, we employed a qualitative descriptive approach to explore the motivational states that influence physical activity engagement through an understanding of movement and rest (i.e., sedentary behavior) among adults with T1DM. Our objective was to elucidate internal and external factors that shape motivation states affecting physical activity among middle-aged adults with T1DM. We aimed to 1) understand perspectives and personal values related to physical activity and 2) explore experiences of motivation states related to movement and rest. Methods Twenty-three adults (mean age 48, SD 11 years, 78% female, 91% non-Hispanic white, 35% overweight, and 26% obese), who recently completed an exercise intervention, participated in semi-structured interviews guided by the Wants and Aversions for Neuromuscular Tasks (WANT) model. This model addresses desires and aversions (i.e., fears) for movement and rest. We utilized directed content analysis to identify common themes, with both deductive and inductive coding approaches. Results The WANT model illustrated how participants experienced simultaneous desires to move and rest, evidenced by choices like yoga or outdoor walks for active recovery. Competing motivations also emerged, such as the internal drive to exercise daily conflicting with physical fatigue or blood sugar levels demanding rest. Conclusions Our findings align with previous studies using the WANT model, highlighting a dynamic and fluctuating nature of motivation influenced by physiological parameters, aversive states, and recent activities. Insights gained can inform future interventions focused on psychological aspects for this unique population.

Background: While individual socioeconomic risk factors have been examined in relation to various health outcomes in young adults with type 1 diabetes (T1D), the collective impact of significant socioeconomic risk on multiple dimensions of sleep health in this population remains underexplored. Objective: We sought to examine the association between socioeconomic risk and sleep health dimensions among young adults with T1D. Methods: Using baseline data from a pilot randomized controlled trial involving 44 young adults (38.6% female, mean age 20.9 years, mean glycated hemoglobin 8.6%), socioeconomic risks were assessed using the Protocol for Responding to and Assessing Patients Assets, Risks, and Experiences framework. Sleep health was evaluated across 6 dimensions: regularity, satisfaction, alertness, timing, efficiency, and duration. We used actigraphy-derived measures of regularity, timing, efficiency, duration, alertness (via the trail-making test), and self-reported satisfaction. Analyses were adjusted for sex, T1D duration, body mass index, and area-level social vulnerability. Results: Higher socioeconomic risk composite scores were significantly associated with lower sleep satisfaction (β = 0.556, R ² = 0.281, P = .001), lower alertness (β = 0.471, R ² = 0.292, P = .005), and a lower sleep health composite score (β = −0.368, R ² = 0.210, P = .035). No significant associations were identified for sleep regularity, timing, efficiency, or duration. Conclusions: Higher socioeconomic risk is associated with lower sleep satisfaction, alertness, and multidimensional sleep health among young adults with T1D, independent of covariates. Addressing socioeconomic risk could offer an important target for interventions to improve sleep and health outcomes in this vulnerable population.

The purpose of this randomized controlled trial was to determine whether a cognitive-behavioral sleep health self-management intervention (CB-Sleep Health) would be more effective than a time-balanced attention control (AC) condition in improving multiple dimensions of sleep health (self-reported and objectively derived). Young adults with T1D (ages 18-26 years) were randomly assigned to a 12-week CB-Sleep Health (n = 21) or AC condition (n = 18). They wore concurrent continuous glucose monitors and actigraphy devices and completed daily sleep surveys for 14 days at baseline, post-intervention, and 3-month follow-up. Of the randomized participants, 31 (79.5%) completed the post-intervention, while 33 (84.6%) completed the 3-month follow-up. The CB-Sleep Health intervention had a significant effect on alertness and duration compared to the control group. The changes from baseline were -3.21 s vs. +0.71, p = .005 and +18 min vs. -25.8 min, p = .01, respectively. These effects were sustained at the 3-month follow-up. Longer sleep duration, higher daytime alertness, and sustained sleep efficiency are possible with this CB-Sleep Health intervention in young adults managing a complex condition.