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The authors commend the psychological focus while questioning adherence measurement beyond session attendance, recommending tracking daily practice. They also argue for adding physiological biomarkers such as cortisol or C-reactive protein, expanding demographic and ethnic diversity, and evaluating technology-enabled self-compassion tools beyond virtual groups to improve accessibility and 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additional elements does the letter suggest for future studies?",{"text":121,"@type":113},"It recommends including physiological biomarkers (e.g., cortisol or C-reactive protein), recruiting more diverse demographic groups, and evaluating technology-based self-compassion tools such as mobile apps or AI-driven 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Pediatr Endocrinol Metab 2025](Ann Pediatr Endocrinol Metab 2025);[30:343-344](30:343-344)  \nCommentary on \"The effects of self-compassion in adolescents and young adults with type 1 diabetes: a pilot randomized controlled trial\"  \nMoeeza Fatima1, Husnain Ahmad2, Isha Munir1  \n1Shaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Pakistan  \n2Ch Pervaiz Elahi Institute of Cardiology, Multan, Pakistan, Multan, Pakistan  \nSee the article \"The effects of selfcompassion in adolescents and young adults with type 1 diabetes:  \na pilot randomized controlled trial\" via [https://doi.org/10.6065/](https://doi.org/10.6065/)[ ](https://doi.org/10.6065/)[apem.2448224.112.](apem.2448224.112.)  \nReply to commentary on \"The effects of self-compassion in adolescents and young adults with type 1 diabetes: a pilot randomized controlled trial\" via [https://doi](https://doi). org/10 .6065/apem.2550428.214.  \nReceived: 15 October, 2025  \nAccepted: 15 December, 2025  \nAddress for correspondence:  \nMoeeza Fatima  \nShaikh Khalifa Bin Zayed Al-Nahyan Medical College, Shaikh Zayed Postgraduate Medical Institute (SZPGMI), Lahore, Vehari, Pakistan  \nEmail: [fatimamoeeza@gmail.com](fatimamoeeza@gmail.com)  \n[https://orcid.org/0009-0006-1053-](https://orcid.org/0009-0006-1053-)[ ](https://orcid.org/0009-0006-1053-)9976  \nTo the editor,  \nI commend Jerawatana et al. [1] for their groundbreaking work in exploring the role of self-compassion in managing type 1 diabetes (T1D) in adolescents and young adults. Their study provides valuable insight into the psychological dimensions of diabetes care and highlights the potential for self-compassion interventions in improving glycemic control [1]. However, I would like to raise several points that could further enhance the study's scope and the understanding of this intervention's efficacy.  \nFirstly, the study did not measure participant adherence to self-compassion practices beyond session attendance. It remains unclear whether the observed benefits were due to sustained engagement with the self-compassion techniques taught during the intervention. Recent research by Yuceer and Cinar [2] underscores the importance of adherence in behavioral interventions, revealing that participants who practiced self-compassion daily showed a 1.5% greater reduction in hemoglobin A1c (HbA1c) compared to those who did not engage consistently. This adherence factor could significantly affect the outcomes, and future studies should consider tracking daily practice using mobile applications or digital tools, ensuring that self-compassion practices are applied consistently across participants.  \nSecondly, the absence of physiological biomarkers to support the findings limits the depth of the conclusions. Although the study measured HbA1c, it did not explore markers such as cortisol levels or C-reactive protein, which are critical in understanding the physiological effects of psychological interventions. A 2025 study by Kassem et al. [3] found that individuals who participated in a self-compassion program exhibited significant reductions in cortisol levels, with an average decrease of 12.5% in their baseline levels, alongside a 0.75% reduction in HbA1c. Including such biomarkers would provide a clearer picture of the underlying biological mechanisms and enhance the study's credibility by offering objective data to complement the self-reported outcomes.  \nThirdly, the study's findings may not apply to all demographic groups due to limited diversity and inclusion in participant selection. The sample was predominantly Thai, and the authors did not explore how socioeconomic status or ethnic diversity might influence the outcomes ofthe intervention. A recent study by Liu et al. [4] found that ethnic minorities with T1D in the Uni","cbCaikixC5Z7u2hD","https://ap.wps.com/l/cbCaikixC5Z7u2hD","pdf",127498,"English","# Letter to the editor\n## Acknowledgement of the study and its relevance\n## Limitations and recommendations: adherence\n## Limitations and recommendations: physiological biomarkers\n## Limitations and recommendations: demographic diversity\n## Limitations and recommendations: technology-based tools\n## Conclusion","[{\"question\":\"What does the letter commend about the original trial?\",\"answer\":\"It commends the trial’s exploration of self-compassion as a psychological intervention in managing type 1 diabetes and notes its potential relevance for improving glycemic control.\"},{\"question\":\"Why does the letter question the study’s adherence assessment?\",\"answer\":\"It states that adherence to self-compassion practices was not measured beyond session attendance, making it unclear whether benefits depended on sustained daily engagement with the techniques.\"},{\"question\":\"What additional elements does the letter suggest for future studies?\",\"answer\":\"It recommends including physiological biomarkers (e.g., cortisol or C-reactive protein), recruiting more diverse demographic groups, and evaluating technology-based self-compassion tools such as mobile apps or AI-driven platforms.\"}]","Commentary on - Commentary on The effects of self-compassion in adolescents and young adults with type 1 diabetes: a pilot randomized controlled trial - Letter to the editor | PDF"]