Transition to College Campus Living With a Chronic Condition: Type 1 Diabetes Exemplar

Sunday, 30 July 2017

Jennifer L. Saylor, PhD, APRN, ACNS-BC
School of Nursing, University of Delaware, Newark, DE, USA
Christina Calmaro, PhD
Nemours Alfred I. duPont Hospital for Children, Wilmington, DE, USA

Purpose: The purpose of this study is to examine sleep, resilience, and diabetes related quality of life (DQOL) and their effect on diabetes management in young adults ages 18-24 living on university/college campuses. RQ1: What is the relationship between sleep and HgbA1c (HgbA1c) and resilience and HgbA1c and quality of life and HgbA1c among those with type 1 diabetes 18-24 years of age living in dormitories. RQ2: What are the inter-relationships between sleep and HgbA1c and quality of life among those with type 1 diabetes 18-24 years of age living in dormitories?

Significance/Literature Review: Young adults with chronic conditions, like their healthy counterparts, have the same excitement and goals as they look forward to the independence of college. Yet for those living with a chronic condition, the diagnosis can create serious intrusions into the lives of young adults as they transition to campus life. While transitioning, the young adult with a chronic condition like type 1 diabetes (T1D) must negotiate a delicate balance between adhering to a management regimen that supports a stable blood glucose level while attempting to integrate into campus life. There are 1.25 million Americans with T1D and a 23% increase is expected over the next 40 years among those < 20 years of age (American Diabetes Association, 2012; SEARCH for diabetes in youth, 2015). T1D is becoming more common in the United States. Between 2001 and 2009 there was a 21% increase in the prevalence of T1D in people under age 20 (Dabelea et al., 2014). More than 18,000 new cases of T1D are estimated to be diagnosed among U.S. youth < 20 years of age each year. This may results in more students entering college and living on campuses. By 2050 In the U.S., 5 million people are expected to have T1D by 2050, including nearly 600,000 youth (Dabelea et al., 2014; Imperatore et al., 2012). This will dramatically increase the number of college students matriculating with T1D. Students with a chronic condition had impaired health related quality of life (QOL) compared to those without a chronic condition and a higher level of loneliness (Herts, Wallis, & Maslow, 2014; Maslow, Haydon, McRee, Ford, & Halpern, 2011). Surprisingly, only 7% of first year college students with chronic conditions knew another student with a chronic illness and 57% reported not knowing anyone with chronic illness (Herts, Wallis, & Maslow, 2014). Many young adults without a chronic condition have difficulty adjusting to this campus living and balancing academic, social life, and psychological well-being. This balancing act is even more complex for students with T1D who require vigilant self-management that includes consistent insulin administration, regular nutrition, and physical activity and sleep patterns. Therefore, inconsistency occurs because of new-found freedoms in an unstructured living environment. There is a paucity of information on effect of campus life for students with T1D and potential effects on diabetes management and long-term health outcomes.

Campus life is not only about academics and socialization, but potentially encompasses changing patterns of sleep, nutrition, physical activity, mental health, and risk behaviors. For optimal health, students must manage many changing patterns and behaviors that are unique to the college environment. This can be exacerbated in young adults managing a chronic condition such as T1D. Campus experiences can aggressively affect those students with T1D from new student ice-cream social with unknown nutritional information for insulin administration to late night studying and lacking sleep. Using T1D as an exemplar, this proposal will examine sleep, resilience, and Diabetes related QOL as potential components of campus living that have not been fully explored in the literature. This allows universities to implement programs/interventions to better support the needs of those with T1D and possibly other chronic conditions. By surveying young adults with T1D, ages 18 to 24 years, this proposed study will provide further information on potential components of campus life effect diabetes management in college. This work will contribute to the body of knowledge on T1D to further identify barriers to a successful campus living and effect on diabetes management HgbA1c. Also, this will inform a larger research body focused on young adults with chronic conditions during campus life transition.

Methods: This research study used a descriptive, cross-sectional research design to examine how much sleep (sleep duration) (Calamaro, Mason, & Ratcliffe, 2009; Eliasson, Lettieri, & Eliasson, 2010), how adaption to changes and stress (resilience) (Santos, Bernardo, Gabbay, Dib, & Sigulem, 2013) and level of quality of life (Varni et al., 2003) among young adults ages 18-24 living on university/college campuses.

Sample: A total of 50 participants will be enrolled in the study with the exploratory research questions. Participants will be recruited with the agreed upon assistance of the Disability Support Services (DSS) and the College Diabetes Network (CDN). The inclusion criteria includes participants must be at least 18 years old, have a formal diagnosis of T1D, and live on campus during the undergraduate college years. Participants are considered properly diagnosed if they are fully dependent on insulin administration via a vial and syringe or an insulin pump. The exclusion criteriainclude a diagnosis of Type 2 Diabetes, no diagnosis of T1D, younger than 18 years of age, unable to read or write English, or does not live on college/university campus housing.

Variables/Outcomes/Measurements: The outcome or dependent variable is HgbA1c determines extent of diabetes management. This is self-reported on the electronic questionnaire. HgbA1c is an average of blood sugar control over the past 2-3 months. Thus, this laboratory blood test is typically completed every 3 months for those with T1D and it shows how well their diabetes is being management. Sleep, Resilience and Diabetes Quality of Life are the independent variables. Sleep is measured using the Sleep, Caffeine Intake, and Technology Use questionnaire. This is a 36-item, 3-concept instrument that measures intake of caffeinated drinks, use of nighttime media-related technology, and sleep behaviors (Calamaro et al., 2009). Content and face validity were established by using 5 sleep experts to judge the relevancy of each item to the intent of the questionnaire (Calamaro et al., 2009). The instrument that takes approximately 10-15 minutes to complete is validated in adolescents and young adults. Resilience is measured using the Resilience Scale (RS-14). This 14-item scale Likert scale format measures one’s individual resilience and take about 2-4 minutes to complete. The higher the score, the greater his/her resilience in response to an event (Resilience Center, 2015; Wagnild, 1993) The RS-14 in use since 2008; it is significantly correlated with the longer RS (r=.97) and internal consistency reliability for the RS-14 is α = .93. The Diabetes-Related Quality of Life (DQOL) will be assessed using a modified version of Ingersoll and Marrero 1991 DQOL scale (Ingersoll & Marrero, 1991). This 5-point Likert Scale is the most commonly used quality of life scale for youths and young adults with T1D. The modified electronic tool takes approximately 15-20 minutes and includes subscales for life satisfaction (17 items), disease impact (23 items), disease-related worries (11 items), and 1 item relating to health (Hanna, Weaver, Slaven, Fortenberry, & DiMeglio, 2014). The test-retest reliability ranged from 0.78-0.92 (Ingersoll & Marrero, 1991).

Procedure:After receiving Human Subjects approval, emails will be sent to participants via DSS. Also, the CDN will post an IRB approved Facebook and twitter post to their members. Using REDCap (Research Electronic Data Capture) the participants will be screened by answering a few inclusion/exclusion criteria. After the screening, the participants will receive the electronic consent, followed by the survey. The confidentiality of the participant information was protected. All identifiers were be removed and each participant was assigned a unique anonymized subject identifier. Also, all study data will be on password protected computers in a locked office (double lock principle). Updated anti-virus protection will be on researchers’ computers used to access data. The key to the data set will be kept separately in a locked cabinet in a locked office (double lock principle). For this study we apply principles of the Market Model to justify our compensation (Dickert & Grady, 1999; Grady, 2005). Incentives are given to enhance the likelihood of participation, and money is justifiable as an incentive for a healthy individual or one who would otherwise not benefit from participation. Therefore, to enhance the likelihood of enrollment of busy college students, participants will receive remuneration in the form electronic gift cards in the amount of $10.

Data Analysis: All statistical procedures will be completed using the Statistical Package for Social Sciences. Standard descriptive statistics will be used to describe the outcomes, demographic and independent variables of interest. Internal reliability of the questionnaires and instruments included in the surveys will be examined using Coefficient α for each of the constructs identified and included in the survey, i.e. sleep, diabetes-specific quality of life, and resilience. All of these measures will be correlated with diabetes management (HgbA1c) using a Pearson correlation.

Results: The data collection will occur November, 2016 through March, 2017.

Conclusion: A conclusion will be presented on the poster as data collection and analysis will be complete before the 28th International Nursing Research Congress.