“Diabetes is really simple on paper, but really complicated when you actually have it”: Understanding the daily stressors of adolescents living with Type 1 diabetes

May combine two claims.

Adolescents with Type 1 diabetes are transitioning to independent management, which is often associated with additional stress and family conflict.

“and are transitioning to independent management of their diabetes, which is often associated with additional stress and family conflict on top of the already complex requirements of the disease (Brazeau et al., 2018; Ersig et al., 2016; Karavanaki et al., 2023).”

• cites Brazeau et al., 2018 sourcePartly supported

  The Introduction (page not specified) describes complex diabetes self-management and the challenge of establishing autonomy in youth, especially emerging adults. It does not say that adolescents' transition to independent diabetes management is often associated with additional stress or family conflict. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Ersig et al., 2016 sourceNot checked — no full text of the source
• cites Karavanaki et al., 2023Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Daily management tasks for children and adolescents can take an average of 78 minutes per day and up to 5 hours per day.

“These daily management tasks for children and adolescents can take an average of 78 min per day and up to 5 h per day (Shubrook et al., 2018).”

• cites Shubrook et al., 2018 sourcePartly supported

  The Results section, “Summary of Survey Results for a Child with Type 1 Diabetes,” estimates 78 minutes per day for routine self-care and 305 minutes (about 5 hours) for all self-management tasks. These are different categories of estimated time, not an average and an upper limit for the same tasks. The survey scenario concerns a child with type 1 diabetes; the cited passage does not establish the figures for adolescents generally. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing).

Telephone interviews are a reliable way of collecting qualitative data.

“Telephone interviews have been established as a reliable way of collecting qualitative data (Novick, 2008).”

• cites Novick, 2008 sourceSupported

Classified as probably not a substantial claim. May combine two claims.

Daily management of Type 1 diabetes includes constant monitoring of blood glucose, administering insulin, meal planning, recordkeeping, and complex problem solving.

“General daily management of T1D includes constant monitoring of blood glucose, administering insulin by pump and/or injection, meal planning, recordkeeping, and complex problem solving (Shubrook et al., 2018).”

• cites Shubrook et al., 2018 sourcePartly supported

  The Methods and Results describe blood-glucose checks, insulin injections, meal planning, recordkeeping, and problem-solving for a child with type 1 diabetes (page not available). The survey specifies four checks and four injections per day; it does not establish constant monitoring or address insulin pumps as an administration method. (LLM, conf=0.88)

  Experimental — accuracy not yet measured

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Individuals with Type 1 diabetes are at risk for severe infection, hospitalization, increased mortality rates, and anxiety.

“Studies have shown that high-risk groups including individuals with T1D are at risk for severe infection, hospitalization, increased mortality rates, and anxiety (Caballero et al., 2020; Karavanaki et al., 2023; Wade et al., 2022).”

• cites Caballero et al., 2020 sourcePartly supported

  The Introduction reports that people with diabetes face increased COVID-19 morbidity and mortality, including ICU treatment, and the management section describes greater risk of serious disease and hospitalization. The Perspective from Latin America reports fear of infection and death among people living with diabetes. These passages do not establish the full set of risks specifically for people with type 1 diabetes, or explicitly report anxiety; page numbers are unavailable in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Karavanaki et al., 2023Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Wade et al., 2022 sourceNot checked — no full text of the source

May combine two claims.

Diabetes-related stigma is persistent and negatively affects quality of life.

“This is a common finding throughout the existing literature as diabetes-related stigma is persistent and negatively affects quality of life (Brazeau et al., 2018; Eitel et al., 2023).”

• cites Brazeau et al., 2018 sourcePartly supported

  The Discussion (Principal Findings; page unavailable) reports that respondents with stigma had a lower sense of well-being, supporting an association with poorer quality of life. The study is cross-sectional, however, so it does not establish that stigma persists over time or that stigma causes the reduction in well-being. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Eitel et al., 2023 sourcePartly supported

  The paper’s Abstract section reports associations between diabetes stigma and depressive symptoms, anxiety, diabetes distress, and emotional distress, supporting a negative effect on well-being. It does not establish that stigma persists over time or report a direct quality-of-life outcome; its Type 1 and Type 2 Diabetes Outcomes sections focus on clinical associations. (LLM, conf=0.80)

  Experimental — accuracy not yet measured

May combine two claims.

Stress related to school and sleep was reported.

“In addition to participation in sports, stress related to school and sleep were reported.”

May combine two claims.

The sample consisted of 20 adolescents with mean age 15 years, 85% non-Hispanic white, 10% Asian, 75% female, 75% insulin pump users, and mean hemoglobin A1c 7.6%.

“In our sample of 20 adolescents, the mean age was 15 years, 85% identified as non-Hispanic white and 10% identified as Asian, 75% identified as female, 75% utilized insulin pumps, and mean hemoglobin A1c was 7.6%.”

May combine two claims.

Participants reported four main types of stress related to Type 1 diabetes: increased mental load of management tasks, impact on daily activities, embarrassment and stress of public management, and COVID-19 risk and social isolation.

“Participants reported four main types of stress related to their T1D: (1) Increased mental load of management tasks, (2) impact on daily activities, (3) embarrassment and stress of public management, and (4) COVID-19 risk and social isolation.”

May combine two claims.

Parental involvement can be annoying and cause additional stress.

“While participants were appreciative of an elevated level of involvement, they also recognized how it can be “annoying” and cause additional stress.”

May combine two claims.

Engaging in physical activity was a common technique to relieve stress, with outdoor activities described as particularly relieving.

“Engaging in physical activity (e.g., sports, walking, yoga, dance) were common techniques to relieve stress, with outdoor activities described as particularly “relieving.””

May combine two claims.

Relationships with others with Type 1 diabetes offered meaningful support and helped participants feel not alone.

“Participants described how relationships with others with T1D offered meaningful support from people who “fully understand” and helped them feel “not alone.””

Probably not a substantial claim: may not pass S3 (load-bearing).

Sampling continued until data redundancy was agreed upon by all coders.

“Sampling continued until data redundancy was agreed upon by all coders (C. G., K. R.).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Data saturation was achieved.

“We continued interviewing until data saturation was achieved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Type 1 diabetes is an autoimmune disease in which the pancreas cannot produce insulin.

“Type 1 diabetes (T1D) is an autoimmune disease in which the pancreas is unable to produce insulin (Centers for Disease Control and Prevention, 2023b).”

• cites Centers for Disease Control and Prevention, 2023bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Member checking was conducted by sharing findings with participants.

“We underwent a process of member checking, sharing findings with participants to cross-check findings.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Type 1 diabetes is usually diagnosed before age 18, with diagnosis peaking at ages 13 to 14.

“T1D is usually diagnosed before the age of 18, with diagnosis peaking at ages 13 to 14 years (Centers for Disease Control and Prevention, 2023a).”

• cites Centers for Disease Control and Prevention, 2023aNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

80% coding agreement was achieved.

“Using the final codebook, the interviews were then coded again by two coders (C. G., K. R.) concurrently until 80% coding agreement was achieved.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Almost a third of adolescents with Type 1 diabetes report diabetes-related stress and distress.

“Almost a third of adolescents with T1D report diabetes-related stress and distress (Hagger et al., 2016).”

• cites Hagger et al., 2016 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The study was approved by the University of South Florida Institutional Review Board.

“The University of South Florida Institutional Review Board approved this study.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Type 1 diabetes is a chronic, lifelong condition that requires daily administration of multiple insulin injections titrated with diet and exercise.

“T1D is a chronic, lifelong condition requiring daily administration of multiple insulin injections titrated with diet and exercise (Centers for Disease Control and Prevention, 2023b).”

• cites Centers for Disease Control and Prevention, 2023bNot matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

Two coders employed a conceptual coding method.

“A conceptual coding method was employed by two coders (C. G., K. R.).”

Classified as probably not a substantial claim. May combine two claims.

Informed consent and adolescent assent were obtained.

“Informed consent and adolescent assent were obtained from adolescents and parent or legal guardian after eligibility was established.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A detailed audit trail was maintained throughout the study.

“A detailed audit trail was maintained throughout the study.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Field notes and detailed memos were used to refine themes and bolster reliability.

“We also used field notes and detailed memos to refine themes and further bolster reliability of findings.”

Classified as probably not a substantial claim. May combine two claims.

The sample was 85% non-Hispanic white, and further studies are required to explore the experiences of adolescents in diverse racial/ethnic groups.

“This sample identified as 85% non-Hispanic, white, and further studies are required to explore the experiences of adolescents in diverse racial/ethnic groups.”

May combine two claims.

The sample included adolescents of varied ages, biological sex, and treatment modalities, which increased the generalizability of the study.

“In addition, the sample included adolescents of varied ages, biological sex, and treatment modalities, which increased the generalizability of the study.”

May combine two claims. The quote only partly states this claim.

Discomfort from public management results in social withdrawal, social awkwardness, and avoidance of social situations.

“This level of discomfort results in social withdrawal and social awkwardness, as well as avoidance of social situations (Seo, 2021).”

• cites Seo, 2021 sourceNot checked — no full text of the source

Classified as probably not a substantial claim.

The qualitative descriptive approach allowed an in-depth exploration of experiences of living with the daily burden of Type 1 diabetes.

“We used a qualitative descriptive approach, allowing an in-depth exploration of the experiences of living with the daily burden of T1D.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Strategies to ensure methodological trustworthiness included two experienced coders, reflective journaling, and a detailed audit trail.

“We used several strategies to ensure methodological trustworthiness, including two experienced coders, reflective journaling, and a detailed audit trail.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Data were collected during the COVID-19 pandemic, which introduced unique stressors that do not apply to non-pandemic times.

“The data were collected during the COVID-19 pandemic, which introduced unique stressors that do not apply to non-pandemic times.”

May combine two claims.

Embarrassment and stress related to public management of Type 1 diabetes was an important factor in daily self-management behaviors and a major contributor to primary daily stressors.

“Embarrassment and stress related to the public management of T1D was an important factor in daily self-management behaviors as well as a major contributor to their perception of their primary daily stressors.”

May combine two claims.

The findings align with current literature and add the description of mental exhaustion and the compounding that occurs with balancing daily disease management with normative activities of daily living.

“Our findings align with the current body of literature and add the description of “mental exhaustion” and the compounding that occurs with balancing daily disease management with normative activities of daily living.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Recruitment through online ads may not capture experiences of adolescents who do not have access to or are not active on social media.

“Additionally, participants were recruited through online ads, which may not capture experiences of adolescents who don’t have access to or are not active on social media.”