1
|
Khamoushian S, Madrakian T, Afkhami A, Ghoorchian A, Ghavami S, Tari K, Samarghandi MR. Transdermal Delivery of Insulin Using Combination of Iontophoresis and Deep Eutectic Solvents as Chemical Penetration Enhancers: In Vitro and in Vivo Evaluations. J Pharm Sci 2023; 112:2249-2259. [PMID: 36921801 DOI: 10.1016/j.xphs.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/09/2023] [Accepted: 03/09/2023] [Indexed: 03/16/2023]
Abstract
A serious challenge in transdermal iontophoresis (IP) delivery of insulin (INS) is the low permeability of the drug across the skin. In this paper, we introduced deep eutectic solvent (DESs) as novel chemical penetration enhancers (CPEs) for transdermal IP of INS across rat skin, both in vitro and in vivo. Three different DESs based on choline chloride (ChCl), namely, ChCl/UR (ChCl and urea), ChCl/GLY (ChCl and glycerol), and ChCl/EG (ChCl and ethylene glycol) in the 1:2 molar ratios have been prepared. To evaluate the capability of studied DESs as CPEs for IP delivery of INS, the rat skin sample was treated with each DES. The effects of different experimental parameters (current density, formulation pH, INS concentration, NaCl concentration, and treatment time) on the in vitro transdermal iontophoretic delivery of INS were investigated. The in vitro permeation studies exhibited that INS was easily delivered employing ChCl/EG, and ChCl/GLY treatments, compared with ChCl/UR: the cumulative amount of permeated INS at the end of the experiment (Q24h) was found to be 131.0, 89.4, and 29.6 µg cm-2 in the presence of ChCl/EG, ChCl/GLY, and ChCl/UR, respectively. The differences in Q24h values of INS are due to the different capabilities of the studied DESs to treat the epidermis layer of skin. In vivo experiments revealed that the blood glucose level in diabetic rats could be decreased using ChCl/EG, and ChCl/GLY as novel CPEs in the IP delivery of INS. The presented work will open new doors towards searching for novel CPEs in the development of transdermal IP of INS.
Collapse
Affiliation(s)
| | - Tayyebeh Madrakian
- Faculty of Chemistry, Bu-Ali Sina University, Hamedan, Iran; Autophagy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Abbas Afkhami
- Faculty of Chemistry, Bu-Ali Sina University, Hamedan, Iran
| | | | - Saeid Ghavami
- Research Institute of Oncology and Hematology, Cancer Care Manitoba, University of Manitoba, Winnipeg, Canada
| | - Kamran Tari
- Department of Environmental Health Engineering, Faculty of Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mohammad Reza Samarghandi
- Department of Environmental Health Engineering, Faculty of Health and Research Center for Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.
| |
Collapse
|
2
|
Berget C, Sherr JL, DeSalvo DJ, Kingman RS, Stone SL, Brown SA, Nguyen A, Barrett L, Ly TT, Forlenza GP. Clinical Implementation of the Omnipod 5 Automated Insulin Delivery System: Key Considerations for Training and Onboarding People With Diabetes. Clin Diabetes 2022; 40:168-184. [PMID: 35669307 PMCID: PMC9160549 DOI: 10.2337/cd21-0083] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Automated insulin delivery (AID) systems, which connect an insulin pump, continuous glucose monitoring system, and software algorithm to automate insulin delivery based on real-time glycemic data, hold promise for improving outcomes and reducing therapeutic burden for people with diabetes. This article reviews the features of the Omnipod 5 Automated Insulin Delivery System and how it compares to other AID systems available on or currently under review for the U.S. market. It also provides practical guidance for clinicians on how to effectively train and onboard people with diabetes on the Omnipod 5 System, including how to personalize therapy and optimize glycemia. Many people with diabetes receive their diabetes care in primary care settings rather than in a diabetes specialty clinic. Therefore, it is important that primary care providers have access to resources to support the adoption of AID technologies such as the Omnipod 5 System.
Collapse
Affiliation(s)
- Cari Berget
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| | - Jennifer L. Sherr
- Section of Pediatric Endocrinology, Yale School of Medicine, New Haven, CT
| | - Daniel J. DeSalvo
- Section of Pediatric Diabetes and Endocrinology, Baylor College of Medicine, Houston, TX
| | - Ryan S. Kingman
- Department of Pediatric Endocrinology, Stanford School of Medicine, Palo Alto, CA
| | | | - Sue A. Brown
- Division of Endocrinology, Center for Diabetes Technology, University of Virginia, Charlottesville, VA
| | | | | | | | - Gregory P. Forlenza
- Barbara Davis Center for Childhood Diabetes, University of Colorado, Aurora, CO
| |
Collapse
|
3
|
Demanding devices - Living with diabetes devices as a pre-teen. Soc Sci Med 2021; 286:114279. [PMID: 34428602 DOI: 10.1016/j.socscimed.2021.114279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 06/23/2021] [Accepted: 07/27/2021] [Indexed: 11/22/2022]
Abstract
Diabetes technology is an integral part of the lives of children with type 1 diabetes (T1D). However, children's experiences with these technologies are often overlooked. Furthermore, little is known about psychosocial aspects of technology use during children's transition to adolescence. The aim of this study was to explore how children with T1D perceive, make sense of and handle diabetes technologies in their everyday lives. Data were obtained from interviews with 18 children with T1D aged 10-14 years (pre-teens). The interviews were conducted between March and August 2019 in Denmark. Photos were used as probes to facilitate discussion and reflection about issues pre-teens found important. The study was informed by a technology-in-practice perspective to articulate how diabetes technologies were embedded in practices of use. The analysis focused on insulin pumps and technologies for continuous glucose monitoring (CGM). We found that these technologies introduced tensions regarding dependence and independence, wanted and unwanted attention, worries and peace of mind, treatment and care, visibility and invisibility as well as control and loss of control. We synthesized the tensions into the following three themes which characterized the pre-teens' relationship with diabetes technology: 1) demanding devices, 2) the social context of using diabetes technologies, and 3) care and support through data. Our findings indicate the need for researchers and clinicians to engage with the social and emotional dimensions of living with diabetes technologies. Importantly, this includes recognizing the norms underlying diabetes technologies and how these inform care in pre-teens with T1D.
Collapse
|
4
|
Wong JJ, Barley RC, Hanes S, Tanenbaum ML, Lanning M, Naranjo D, Hood KK. Parental Perspectives: Identifying Profiles of Parental Attitudes and Barriers Related to Diabetes Device Use. Diabetes Technol Ther 2020; 22:674-680. [PMID: 31971451 DOI: 10.1089/dia.2019.0492] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Despite the demonstrated benefits of diabetes device use, uptake of insulin pumps and continuous glucose monitors (CGMs) remains quite low. The current study aimed to identify profiles of parents of youth with type 1 diabetes based on their attitudes toward diabetes-specific technology and barriers to diabetes technology uptake. Methods: Online survey data were collected from 471 parents in the T1D Exchange Clinic Network (child's age = 12.0 ± 3.2 years; diabetes duration = 7.0 ± 2.9 years; A1c = 8.4% ± 1.3; 75% using insulin pump; 27% using CGM). Results: K-means cluster analyses revealed five parent profiles: Embracers (50.7%), Burdened (15.7%), Hopeful but Hassled (14.2%), Distrusting (12.7%), and Data Minimalists (6.6%). ANOVAs and chi-square tests identified differences between groups based on diabetes distress, worry over hypoglycemia, device use, and demographic characteristics. Conclusions: Providers encouraging device uptake may benefit from tailoring their approaches based on these distinct groups and their corresponding concerns and needs.
Collapse
Affiliation(s)
- Jessie J Wong
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Regan C Barley
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Sarah Hanes
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Molly L Tanenbaum
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Monica Lanning
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Diana Naranjo
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Korey K Hood
- Division of Endocrinology and Diabetes, Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| |
Collapse
|
5
|
March CA, Nanni M, Kazmerski TM, Siminerio LM, Miller E, Libman IM. Modern diabetes devices in the school setting: Perspectives from school nurses. Pediatr Diabetes 2020; 21:832-840. [PMID: 32249474 PMCID: PMC7682111 DOI: 10.1111/pedi.13015] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 03/25/2020] [Accepted: 03/31/2020] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE To explore the experiences, practices, and attitudes of school nurses related to modern diabetes devices (insulin pumps, continuous glucose monitors, and hybrid-closed loop systems). RESEARCH DESIGN AND METHODS Semistructured interviews were conducted with 40 public school nurses caring for children in elementary and middle schools. Developed with stakeholder input, the interview questions explored experiences working with devices and communicating with the health care system. Deidentified transcripts were analyzed through an iterative process of coding to identify major themes. RESULTS School nurses reported a range of educational backgrounds (58% undergraduate, 42% graduate), geographic settings (20% urban, 55% suburban, 25% rural), and years of experience (20% <5 years, 38%, 5-15 years, 42% >15 years). Four major themes emerged: (a) As devices become more common, school nurses must quickly develop new knowledge and skills yet have inconsistent training opportunities; (b) Enthusiasm for devices is tempered by concerns about implementation due to poor planning prior to the school year and potential disruptions by remote monitors; (c) Barriers exist to integrating devices into schools, including school/classroom policies, liability/privacy concerns, and variable staff engagement; and (d) Collaboration between school nurses and providers is limited; better communication may benefit children with diabetes. CONCLUSIONS Devices are increasingly used by school-aged children. School nurses appreciate device potential but share structural and individual-level challenges. Guiding policy is needed as the technology progressively becomes standard of care. Enhanced training and collaboration with diabetes providers may help to optimize school-based management for children in the modern era.
Collapse
Affiliation(s)
- Christine A. March
- Division of Pediatric Endocrinology and Diabetes, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Michelle Nanni
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Traci M. Kazmerski
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Linda M. Siminerio
- Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ingrid M. Libman
- Division of Pediatric Endocrinology and Diabetes, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
6
|
Robertson C, Lin A, Smith G, Yeung A, Strauss P, Nicholas J, Davis E, Jones T, Gibson L, Richters J, de Bock M. The Impact of Externally Worn Diabetes Technology on Sexual Behavior and Activity, Body Image, and Anxiety in Type 1 Diabetes. J Diabetes Sci Technol 2020; 14:303-308. [PMID: 31441324 PMCID: PMC7196867 DOI: 10.1177/1932296819870541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND We aimed to explore the impact of externally worn diabetes technologies on sexual behavior and activity, body image, and anxiety in adopters and nonadopters of these devices. METHODS People with type 1 diabetes aged 16-60 years living in Western Australia were invited to complete an online survey. RESULTS Of the 289 respondents (mean age 34.3 years), 45% used continuous subcutaneous insulin infusion (CSII) and 35% used continuous glucose monitoring (CGM). Approximately half of CSII users stated that the pump interferes with sex. Of these, 75% disconnect their pump during sexual activity to avoid this issue. Comfort during sex influenced the location of the CSII insertion site in 22% of respondents, with the abdomen being preferred. One in four non-CSII users cited sex-related concerns as a factor for not adopting the technology. CGM interfered with sexual activity in 20% of users, but did not commonly affect CGM placement (only 18%). Sexual activity was reported as a factor for not adopting the technology in 10% of non-CGM users. No differences in body dissatisfaction (P = .514) or anxiety (P = .304) between CSII and non-CSII users were observed. No differences in sexual activity and behavior between technology users and nontechnology users were observed. CONCLUSION Wearable technologies impact upon sexual activity and this influences the decision to adopt the technology. Despite this, technology users are similar in terms of sexual behavior, anxiety, and body image compared to nontechnology users. Where appropriate, these data can be used to identify potential concerns, address strategies to mitigate them, and inform people with diabetes when considering adopting external technologies.
Collapse
Affiliation(s)
| | | | - Grant Smith
- Telethon Kids Institute, Nedlands,
Australia
| | - Anna Yeung
- Centre for Urban Health Solutions, Li Ka
Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Canada
- Australian Study of Health and
Relationships, Kirby Institute for Infection and Immunity in Society, University of
New South Wales, Sydney, Australia
| | | | - Jennifer Nicholas
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
| | - Elizabeth Davis
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
| | - Tim Jones
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
| | - Lisa Gibson
- Telethon Kids Institute, Nedlands,
Australia
| | - Juliet Richters
- Australian Study of Health and
Relationships, Kirby Institute for Infection and Immunity in Society, University of
New South Wales, Sydney, Australia
| | - Martin de Bock
- Perth Children’s Hospital, Nedlands,
Australia
- Telethon Kids Institute, Nedlands,
Australia
- School of Paediatrics and Child Health,
University of Western Australia, Nedlands, Australia
- University of Otago and Canterbury
District Health Board, Dunedin, New Zealand
| |
Collapse
|
7
|
Benioudakis ES. Perceptions in Type 1 Diabetes Mellitus with or Without the Use of Insulin Pump: An Online Study. Curr Diabetes Rev 2020; 16:874-880. [PMID: 31057119 DOI: 10.2174/1573399815666190502115754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 03/17/2019] [Accepted: 04/17/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND Technological developments concerning the treatment of Type 1 Diabetes Mellitus have been rapid in the latest years. Insulin infusion systems along with continuous glucose monitoring, as well as long-acting insulin analogues, are part of this progress. OBJECTIVE The aim of this study is to present the illness perceptions in type 1 diabetes mellitus, with or without the use of an insulin pump. Sexual life and body image among therapy groups subjected to subcutaneous insulin infusion (CSII) therapy and multiple daily injections (MDI) therapy were also examined. METHODS A modified version of the Brief Illness Perception Questionnaire was used. One hundred and nine adults with type 1 diabetes mellitus, (males / females ratio 1:2.3) completed the online survey. Thirty six of them (33%) used CSII therapy and 73 of them (67%) used MDI therapy. RESULTS Statistically important differences among the CSII and MDI therapy groups were found in treatment control, illness comprehensibility, representations of control, representation of body image and in the perception of sex life. There was no statistically significant difference among the different types of therapy for participants' negative perception of diabetes. DISCUSSION AND CONCLUSION Negative perceptions of MDI users in treatment control, illness comprehensibility, representations of control, body image and sex life with the insulin pump, differentiate CSII and MDI therapy groups to a significant degree. According to the research, these parameters seem to interfere with accepting CSII therapy for MDI users and discourage them.
Collapse
Affiliation(s)
- Emmanouil S Benioudakis
- Department of Psychology, University of Crete, Crete, Greece; 2Psychiatric Clinic, General Hospital of Chania, Chania, Greece
| |
Collapse
|
8
|
Mesbah NI, Taha NAER, Rahme ZN, Sukkar FF, Omar DM. Experiences of Adults Using Continuous Subcutaneous Insulin Infusion: A Qualitative Study. Med Princ Pract 2020; 29:255-261. [PMID: 31557759 PMCID: PMC7315212 DOI: 10.1159/000503705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 09/26/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES We aimed to determine the quality of life (QoL) of Kuwaiti adults with type 1 diabetes mellitus (T1DM) who used continuous subcutaneous insulin infusions (CSIIs) and to understand their perception of this treatment. BACKGROUND CSII is an effective and safe alternative to multiple daily injections for T1DM, with the potential to improve both glycemic control and QoL. Although CSII has been widely used in Kuwait, its effectiveness and benefits have not been properly evaluated. Healthcare providers and patients need more information on CSII before its initiation. METHODS In this qualitative case study, semi-structured individual interviews were performed using a topic guide. Interviews were stopped at data saturation point. Subsequently, a thematic analysis of transcripts was performed. RESULTS Eighteen adults with T1DM (8 males and 10 females; age 31.4 ± 6.4 years; diabetes duration 17.7 ± 9.5 years; CSII duration 3.6 ± 2.4 years) were recruited from the CSII clinic. Six main themes were studied: health benefits, lifestyle flexibility, improvement of mood and emotion, practical problems, physical and personal effects, and self-confidence to manage diabetes. CSII positively affected the QoL of participants', most notably by enhancing lifestyle flexibility; however, important negative qualities were also reported. CONCLUSION The identified themes highlight the complexity of the experiences of participants, and can be used to provide a framework to help healthcare providers understand how people with T1DM become aware of their treatment regimens. It is important to identify the positive aspects of CSII and not focus only on its negative effects.
Collapse
Affiliation(s)
- Naglaa Ibrahim Mesbah
- Department of Education and Training, Dasman Diabetes Institute, Kuwait City, Kuwait
| | | | - Zahra Nema Rahme
- Department of Education and Training, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Faten Fawzi Sukkar
- Department of Education and Training, Dasman Diabetes Institute, Kuwait City, Kuwait
| | - Dina Mohamed Omar
- Department of Clinical Services, Dasman Diabetes Institute, Kuwait City, Kuwait
| |
Collapse
|
9
|
Berget C, Messer LH, Forlenza GP. A Clinical Overview of Insulin Pump Therapy for the Management of Diabetes: Past, Present, and Future of Intensive Therapy. Diabetes Spectr 2019; 32:194-204. [PMID: 31462873 PMCID: PMC6695255 DOI: 10.2337/ds18-0091] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
IN BRIEF Insulin pump therapy is advancing rapidly. This article summarizes the variety of insulin pump technologies available to date and discusses important clinical considerations for each type of technology.
Collapse
|
10
|
Rosner B, Roman-Urrestarazu A. Health-related quality of life in paediatric patients with Type 1 diabetes mellitus using insulin infusion systems. A systematic review and meta-analysis. PLoS One 2019; 14:e0217655. [PMID: 31237873 PMCID: PMC6592525 DOI: 10.1371/journal.pone.0217655] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 05/15/2019] [Indexed: 12/20/2022] Open
Abstract
Background In 2017, more than 1.1 million children were living with type 1 diabetes mellitus (T1DM) globally. The goal in paediatric diabetes therapy is reaching optimal glycaemic control as early as possible in order to avoid complications and early mortality without compromising the quality of life (QoL) of children. Several different insulin regimens are available for T1DM patients to reach this goal. Aims This review set out to analyse whether continuous subcutaneous insulin infusion (CSII) regimens are superior to multiple daily injection (MDI) therapy in T1DM youth regarding QoL. Additionally, it assessed glycaemic control and adverse events as secondary outcomes and discussed potential future public health implications and justifications for using CSII as a first-line therapy in diabetic youth. Methods A systematic review and random effects meta-analysis was performed on studies investigating the association between QoL and diabetes treatment regimen. Differences in adverse event rates between groups were analysed using a Mann-Whitney U test. Lastly, differences in glycaemic control were assessed using a random effects meta-analysis. Results QoL and glycaemic control was significantly better in CSII subjects at baseline and follow-up. No significant differences in adverse events were found between study groups. No significant changes over time could be shown for either QoL or glycaemic control. Conclusion CSII proved to provide similar or slightly better outcomes in all analysed fields. This is consistent with previous research. However, to make credible recommendations, better-designed studies are needed to investigate the impact of CSII in children.
Collapse
Affiliation(s)
- Bastian Rosner
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, United Kingdom
| | - Andres Roman-Urrestarazu
- Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge, United Kingdom.,Faculty of Health, Medicine and Life Sciences, Department of International Health, University of Maastricht, Maastricht, Netherlands
| |
Collapse
|
11
|
Reidy C, Bracher M, Foster C, Vassilev I, Rogers A. The process of incorporating insulin pumps into the everyday lives of people with Type 1 diabetes: A critical interpretive synthesis. Health Expect 2018; 21:714-729. [PMID: 29418050 PMCID: PMC6117487 DOI: 10.1111/hex.12666] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/14/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Insulin pump therapy (IPT) is a technological advancement that has been developed to help people manage Type 1 diabetes (T1D). However, ways of managing diabetes requiring the implementation of health technologies bring new complexities and a need to understand the factors which enable people with T1D to incorporate a novel device. This new comprehension could provide an exemplar for people with long-term conditions to incorporate new technologies more generally. OBJECTIVE To determine what influences the incorporation, adaptation and use of IPT into the everyday lives of people living with diabetes. DESIGN Critical interpretive synthesis (CIS) using systematic searches undertaken in 7 electronic databases of literature, published 2008 onwards. RESULTS A total of 4998 titles were identified, 274 abstracts reviewed, 39 full articles retrieved and 22 papers selected for analysis. Three themes emerged which were of relevance to the introduction and use of IPT; Tensions between expectations and experiences in adoption and early adaptation; Negotiation of responsibility and accessing support; Reflexivity, active experimentation and feedback. CONCLUSIONS This CIS builds on earlier reviews on lived experiences of IPT. Novel insights are offered through examination of the experiences of pump users from children through to adults, their families and health-care professionals. Expectations of what the device can do to improve self-management impacts on the early stages of adoption as the reality of the technology requires substantial thought and action. Areas for intervention to improve IPT incorporation include establishing who is responsible for management tasks of the device and enabling navigation to further means of support and resources.
Collapse
Affiliation(s)
- Claire Reidy
- Faculty of Health SciencesNIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexUniversity of SouthamptonSouthamptonHampshireUK
| | - Mike Bracher
- School of Health and Social CareHealth SciencesBournemouth UniversityBournemouthDorsetUK
- Faculty of Health SciencesUniversity of SouthamptonSouthamptonHampshireUK
| | - Claire Foster
- Faculty of Health SciencesMacmillan Survivorship Research GroupUniversity of SouthamptonSouthamptonHampshireUK
| | - Ivaylo Vassilev
- Faculty of Health SciencesNIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexUniversity of SouthamptonSouthamptonHampshireUK
| | - Anne Rogers
- Faculty of Health SciencesNIHR Collaboration for Leadership in Applied Health Research (CLAHRC) WessexUniversity of SouthamptonSouthamptonHampshireUK
| |
Collapse
|
12
|
Affiliation(s)
- Laurel H Messer
- CU School of Medicine, Barbara Davis Center for Diabetes , Aurora, Colorado
| |
Collapse
|
13
|
Naranjo D, Suttiratana SC, Iturralde E, Barnard KD, Weissberg-Benchell J, Laffel L, Hood KK. What End Users and Stakeholders Want From Automated Insulin Delivery Systems. Diabetes Care 2017; 40:1453-1461. [PMID: 28842523 PMCID: PMC5864142 DOI: 10.2337/dc17-0400] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 07/23/2017] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The purpose of this study was to rigorously explore psychosocial factors associated with automated insulin delivery systems among people living with type 1 diabetes. RESEARCH DESIGN AND METHODS Across four sites in the U.S. and U.K., 284 participants completed structured interviews or focus groups on expectations, desired features, potential benefits, and perceived burdens of automated insulin delivery systems. Recorded audio files were transcribed and analyzed using NVivo. RESULTS Three themes were identified as critical for uptake of automated insulin delivery: considerations of trust and control, system features, and concerns and barriers to adoption. Children and adolescents with type 1 diabetes primarily identified needs specific to their life stage and social contexts (e.g., school). Adults with type 1 diabetes, parents of youth with type 1 diabetes, and partners of adults with type 1 diabetes were most concerned about the accuracy, adaptability, and algorithm quality alongside expectations that systems stabilize glucose levels and reduce risk for long-term complications. CONCLUSIONS Incorporating stakeholder perspectives on use of automated insulin delivery systems will improve the adoption of devices, quality of life, and likelihood of optimal health. Efforts to build trust in systems, optimize user-system interactions, and provide clear guidance about device capabilities and limitations may help potential users achieve optimal glycemic outcomes.
Collapse
Affiliation(s)
- Diana Naranjo
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Sakinah C Suttiratana
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA.,Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA
| | - Esti Iturralde
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | | | - Jill Weissberg-Benchell
- Department of Psychiatry and Behavioral Sciences, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Lori Laffel
- Joslin Diabetes Center, Harvard Medical School, Boston, MA
| | - Korey K Hood
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| |
Collapse
|
14
|
Payk M, Robinson T, Davis D, Atchan M. An integrative review of the psychosocial facilitators and challenges of continuous subcutaneous insulin infusion therapy in type 1 diabetes. J Adv Nurs 2017; 74:528-538. [PMID: 28960449 DOI: 10.1111/jan.13463] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/28/2022]
Abstract
AIM To use systematic methods to explore the psychosocial facilitators and challenges of insulin pump therapy among people with type 1 diabetes. BACKGROUND Insulin pump therapy is now widely accepted in the management of type 1 diabetes. Given the increasing use of insulin pumps, it is timely to review the evidence relating to the psychosocial impacts of this therapy which have not been addressed in previous reviews. DESIGN An integrative review of the literature (January 2005-February 2017). DATA SOURCES A systematic search of electronic databases: CINAHL, Cochrane, Medline, PsycINFO and Scopus. REVIEW METHODS Empirical literature reporting psychosocial facilitators and challenges of insulin pump therapy were eligible for inclusion. A constant comparative method was used to guide the review. Quality appraisal was performed using the Mixed Methods Appraisal Tool Version 2011. RESULTS Thirty-five potential articles identified from titles and abstracts were reviewed. Of these, 13 articles were included in the final review. Psychosocial facilitators of insulin pump therapy included the flexibility and freedom it provided for living with diabetes, enhancing social situations and daily management. In contrast, challenges included the demands of pump therapy, self-consciousness in wearing the pump and fear of hypoglycaemia and pump failure. CONCLUSION Findings can be used by health professionals to inform people embarking on insulin pump therapy and prepare them with regard to expectations of the treatment. Further research is required to explore the role of diabetes health professional in providing psychosocial support to people with type 1 diabetes on insulin pump therapy.
Collapse
Affiliation(s)
- Marlene Payk
- Faculty of Health, University of Canberra, Nurse Practitioner Westmead Hospital, Westmead, NSW, Australia
| | - Tracy Robinson
- School of Public Health, Faculty of Medicine, Nursing and Health Sciences, Monash Centre for Health Research and Implementation (MCHRI), Melbourne, Vic., Australia
| | - Deborah Davis
- Clinical Chair Faculty of Health, ACT Health Directorate and University of Canberra, University of Canberra, Canberra, ACT, Australia
| | - Marjorie Atchan
- Faculty of Health, Disciplines of Nursing and Midwifery, University of Canberra, Canberra, ACT, Australia
| |
Collapse
|
15
|
|
16
|
Hussain T, Akle M, Nagelkerke N, Deeb A. Comparative study on treatment satisfaction and health perception in children and adolescents with type 1 diabetes mellitus on multiple daily injection of insulin, insulin pump and sensor-augmented pump therapy. SAGE Open Med 2017; 5:2050312117694938. [PMID: 28321303 PMCID: PMC5347412 DOI: 10.1177/2050312117694938] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 01/25/2017] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES Diabetes management imposes considerable demands on patients. Treatment method used has an impact on treatment satisfaction. We aim to examine the relationship between treatment satisfaction and health perception with the method used for treatment of type 1 diabetes mellitus in children and adolescents. SUBJECTS AND METHOD We have interviewed patients with type 1 diabetes mellitus using questionnaires to assess treatment satisfaction and health perception. Patients were divided into three groups based on treatment used: multiple daily injection, insulin pump and sensor-augmented pump therapy. Comparison of scores was done between the groups. RESULTS A total of 72 patients were enrolled (36 males). Mean age (standard deviation) was 11.4 (4.4) years and duration of diabetes of 4.9 (3.5) years. Mean (standard deviation) HbA1c was 8.1 (1.2). Median (range) duration of sensor use was 17.7 (3-30) days/month. Mean scale for treatment satisfaction and health perception questions was 25.3, 29.7 and 31.7 and 60, 79.7 and 81 for the multiple daily injection, pump and sensor-augmented pump, respectively (p = 0.00). Significant difference was seen between the multiple daily injection and both other groups. Sensor-augmented pump group scored higher than the pump group. However, the difference was not statistically significant. Duration of sensor use showed no correlation with treatment satisfaction. CONCLUSION The method used for diabetes treatment has an impact on patients' satisfaction and health perception in children and adolescents with type 1 diabetes mellitus. Insulin pump users have a higher treatment satisfaction and better health perception than those on multiple daily injection. Augmenting pump therapy with sensor use adds value to treatment satisfaction without correlation with the duration of the sensors use.
Collapse
Affiliation(s)
- Tara Hussain
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Mariette Akle
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| | - Nico Nagelkerke
- Institute of Public Health, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Asma Deeb
- Paediatric Endocrinology Department, Mafraq Hospital, Abu Dhabi, United Arab Emirates
| |
Collapse
|
17
|
Cheung R, Young Cureton V, Canham DL. Quality of Life in Adolescents With Type 1 Diabetes Who Participate in Diabetes Camp. J Sch Nurs 2016; 22:53-8. [PMID: 16435931 DOI: 10.1177/10598405060220010901] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Quality of life in adolescents with Type 1 diabetes is a growing area of interest in pediatric research. The complex diabetes regimen imposes challenges for an adolescent. Adolescents diagnosed with diabetes are a group that appears to be at risk for having a poor health-related quality of life. Although research supports the positive relationship of social support and well-being in adolescents, there are few studies discussing quality of life in adolescents that are based on the factor of social support. This study compared the quality of life in adolescents with Type 1 diabetes who have attended at least one diabetes camp to the quality of life of those who have never attended diabetes camp. Results provided evidence of the value of social support.
Collapse
Affiliation(s)
- Ruth Cheung
- Fremont Unified School District, Fremont, CA, USA
| | | | | |
Collapse
|
18
|
Ghazanfar H, Rizvi SW, Khurram A, Orooj F, Qaiser I. Impact of insulin pump on quality of life of diabetic patients. Indian J Endocrinol Metab 2016; 20:506-11. [PMID: 27366717 PMCID: PMC4911840 DOI: 10.4103/2230-8210.183472] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
AIM Diabetes is an emerging health problem, both in developing and developed countries and has an enormous economic and social impact. The objective of our study was to find the impact of insulin pump on the quality of life of patients with type 2 diabetes (T2D) and compare it to the quality of life of patients with T2D using an insulin pen. SUBJECTS AND METHODS This is a case-control study which was conducted among patients with T2D presenting between November 2014 and November 2015. A total of 83 patients with T2D, using insulin pump were enrolled in the study as cases and 322 patients with T2D not using insulin pump but using insulin pens were enrolled as controls. Short form-36 quality of life questionnaire was used for data collection. RESULTS Mean age of patients using insulin pump was 52.49 ± 9.28 while the mean age of patients not using insulin pump was 54.72 ± 16.87. Mean score of all domains in the questionnaire was found to be higher in patients using insulin pump as compared to patients not using insulin pumps (P < 0.05). In 81.1% of the patients, the insulin pump decreased the frequency of hypoglycemic episodes. CONCLUSION Insulin pump has significantly improved the quality of life of patients in terms of better self-esteem, decreased stress, and better mood. It has resulted in improved physical health, meal time flexibility, and ease of travel. It allows patient to have more active participation in social and recreational activities improving their personal and family life.
Collapse
Affiliation(s)
| | - Syed Wajih Rizvi
- R Endocrinology Clinic and Endocrine Department of Robert Wood Johnson Hospital, New Jersey, United States of America
| | - Aliya Khurram
- R Endocrinology Clinic, New Jersey, United States of America
| | - Fizza Orooj
- R Endocrinology Clinic, New Jersey, United States of America
| | - Iman Qaiser
- R Endocrinology Clinic, New Jersey, United States of America
| |
Collapse
|
19
|
Ferrari M, McIlwain DJF, Ambler G. A qualitative comparison of needles and insulin pump use in children with type 1 diabetes. J Health Psychol 2016; 23:1332-1342. [DOI: 10.1177/1359105316653999] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Managing type 1 diabetes mellitus is an ongoing and challenging process; we investigated children’s experience of different treatment regimens. Interviews with 17 children (7–15 years) at two time points were analysed using the grounded theory approach. Illness phase and treatment regimen shaped how bodily cues were interpreted. Insulin pump therapy allowed children to listen to and trust their bodily cues rather than override. Shame was a barrier to support engagement. Different internalised and externalised views of type 1 diabetes mellitus emerged. Overall, children were insightful experts of their own experiences. Recommendations for psychological interventions would benefit from empirical testing.
Collapse
Affiliation(s)
| | | | - Geoffrey Ambler
- The Children’s Hospital at Westmead, Australia
- The University of Sydney, Australia
| |
Collapse
|
20
|
Lawton J, Kirkham J, Rankin D, White DA, Elliott J, Jaap A, Smithson WH, Heller S. Who gains clinical benefit from using insulin pump therapy? A qualitative study of the perceptions and views of health professionals involved in the Relative Effectiveness of Pumps over MDI and Structured Education (REPOSE) trial. Diabet Med 2016; 33:243-51. [PMID: 26248590 DOI: 10.1111/dme.12879] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 12/20/2022]
Abstract
AIMS To explore health professionals' views about insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] and the types of individuals they thought would gain greatest clinical benefit from using this treatment. METHODS In-depth interviews with staff (n = 18) who delivered the Relative Effectiveness of Pumps Over MDI and Structured Education (REPOSE) trial. Data were analysed thematically. RESULTS Staff perceived insulin pumps as offering a better self-management tool to some individuals due to the drip feed of insulin, the ability to alter basal rates and other advanced features. However, staff also noted that, because of the diversity of features on offer, CSII is a more technically complex therapy to execute than multiple daily injections. For this reason, staff described how, alongside clinical criteria, they had tended to select individuals for CSII in routine clinical practice based on their perceptions about whether they possessed the personal and psychological attributes needed to make optimal use of pump technology. Staff also described how their assumptions about personal and psychological suitability had been challenged by working on the REPOSE trial and observing individuals make effective use of CSII who they would not have recommended for this type of therapy in routine clinical practice. CONCLUSIONS Our findings add to those studies that highlight the difficulties of using patient characteristics and variables to predict clinical success using CSII. To promote equitable access to CSII, attitudinal barriers and prejudicial assumptions amongst staff about who is able to make effective use of CSII may need to be addressed.
Collapse
Affiliation(s)
- J Lawton
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - J Kirkham
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - D Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - D A White
- Clinical Trials Research Unit, University of Sheffield, Sheffield, UK
| | - J Elliott
- The Sheffield Diabetes and Endocrine Centre, Northern General Hospital, Sheffield, UK
| | - A Jaap
- Department of Diabetes, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - W H Smithson
- Department of General Practice, University College Cork, Ireland
| | - S Heller
- Unit of Diabetes, Endocrinology and Metabolism, University of Sheffield, Sheffield, UK
| |
Collapse
|
21
|
Pozzilli P, Battelino T, Danne T, Hovorka R, Jarosz‐Chobot P, Renard E. Continuous subcutaneous insulin infusion in diabetes: patient populations, safety, efficacy, and pharmacoeconomics. Diabetes Metab Res Rev 2016; 32:21-39. [PMID: 25865292 PMCID: PMC5033023 DOI: 10.1002/dmrr.2653] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 03/27/2015] [Indexed: 01/01/2023]
Abstract
The level of glycaemic control necessary to achieve optimal short-term and long-term outcomes in subjects with type 1 diabetes mellitus (T1DM) typically requires intensified insulin therapy using multiple daily injections or continuous subcutaneous insulin infusion. For continuous subcutaneous insulin infusion, the insulins of choice are the rapid-acting insulin analogues, insulin aspart, insulin lispro and insulin glulisine. The advantages of continuous subcutaneous insulin infusion over multiple daily injections in adult and paediatric populations with T1DM include superior glycaemic control, lower insulin requirements and better health-related quality of life/patient satisfaction. An association between continuous subcutaneous insulin infusion and reduced hypoglycaemic risk is more consistent in children/adolescents than in adults. The use of continuous subcutaneous insulin infusion is widely recommended in both adult and paediatric T1DM populations but is limited in pregnant patients and those with type 2 diabetes mellitus. All available rapid-acting insulin analogues are approved for use in adult, paediatric and pregnant populations. However, minimum patient age varies (insulin lispro: no minimum; insulin aspart: ≥2 years; insulin glulisine: ≥6 years) and experience in pregnancy ranges from extensive (insulin aspart, insulin lispro) to limited (insulin glulisine). Although more expensive than multiple daily injections, continuous subcutaneous insulin infusion is cost-effective in selected patient groups. This comprehensive review focuses on the European situation and summarises evidence for the efficacy and safety of continuous subcutaneous insulin infusion, particularly when used with rapid-acting insulin analogues, in adult, paediatric and pregnant populations. The review also discusses relevant European guidelines; reviews issues that surround use of this technology; summarises the effects of continuous subcutaneous insulin infusion on patients' health-related quality of life; reviews relevant pharmacoeconomic data; and discusses recent advances in pump technology, including the development of closed-loop 'artificial pancreas' systems. © 2015 The Authors. Diabetes/Metabolism Research and Reviews Published by John Wiley & Sons Ltd.
Collapse
Affiliation(s)
- Paolo Pozzilli
- Area of Endocrinology and DiabetesUniversity Campus Bio‐MedicoRomeItaly
| | - Tadej Battelino
- Department of Endocrinology, Diabetes and Metabolic DiseasesUniversity Children's Hospital LjubljanaLjubljanaSlovenia
- Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
| | - Thomas Danne
- Diabetes Centre for Children and AdolescentsAUF DER BULT, Kinder‐ und JugendkrankenhausHannoverGermany
| | - Roman Hovorka
- Wellcome Trust‐MRC Institute of Metabolic ScienceUniversity of CambridgeCambridgeUK
| | - Przemyslawa Jarosz‐Chobot
- Department of Pediatrics, Endocrinology and Diabetes School of Medicine in KatowiceMedical University of SilesiaKatowicePoland
| | - Eric Renard
- Department of Endocrinology, Diabetes, Nutrition and CIC INSERM 1411Montpellier University HospitalMontpellierFrance
| |
Collapse
|
22
|
Knight A, Weiss P, Morales K, Gerdes M, Rearson M, Vickery M, Keren R. Identifying Differences in Risk Factors for Depression and Anxiety in Pediatric Chronic Disease: A Matched Cross-Sectional Study of Youth with Lupus/Mixed Connective Tissue Disease and Their Peers with Diabetes. J Pediatr 2015; 167:1397-403.e1. [PMID: 26316371 PMCID: PMC5289225 DOI: 10.1016/j.jpeds.2015.07.048] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 06/09/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To investigate differences in risk factors for depression and anxiety, such as central nervous system involvement in systemic lupus erythematosus (SLE)/mixed connective tissue disease (MCTD), by comparing youth with SLE/MCTD to peers with type 1 diabetes mellitus (T1D). STUDY DESIGN We conducted a cross-sectional study of 50 outpatient pairs, ages 8 years and above, matching subjects with SLE/MCTD and T1D by sex and age group. We screened for depression, suicidal ideation, and anxiety using the Patient Health Questionnaire-9 and the Screen for Childhood Anxiety Related Emotional Disorders, respectively. We collected parent-reported mental health treatment data. We compared prevalence and treatment rates between subjects with SLE/MCTD and T1D, and identified disease-specific risk factors using logistic regression. RESULTS Depression symptoms were present in 23%, suicidal ideation in 15%, and anxiety in 27% of participants. Compared with subjects with T1D, subjects with SLE/MCTD had lower adjusted rates of depression and suicidal ideation, yet poorer rates of mental health treatment (24% vs 53%). Non-White race/ethnicity and longer disease duration were independent risk factors for depression and suicidal ideation. Depression was associated with poor disease control in both groups, and anxiety with insulin pump use in subjects with T1D. CONCLUSION Depression and anxiety are high and undertreated in youth with SLE/MCTD and T1D. Focusing on risk factors such as race/ethnicity and disease duration may improve their mental health care. Further study of central nervous system and other disease-related factors may identify targets for intervention.
Collapse
Affiliation(s)
- Andrea Knight
- Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA; Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia, PA; Children's Hospital of Philadelphia PolicyLab, Children's Hospital of Philadelphia, Philadelphia, PA.
| | - Pamela Weiss
- Division of Rheumatology, Children's Hospital of Philadelphia, 3405 Civic Center Blvd, Philadelphia, PA 19104, Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 3535 Market St. 15th Flr, Philadelphia, PA 19104, Center for Clinical Epidemiology & Biostatistics. University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia PA
| | - Knashawn Morales
- Center for Clinical Epidemiology & Biostatistics. University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia PA
| | - Marsha Gerdes
- Center for Clinical Epidemiology & Biostatistics. University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia PA, Division of General Pediatrics, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Melissa Rearson
- Division of Endocrinology and Diabetes, Children's Hospital of Philadelphia, 3401 Civic Center Blvd, Philadelphia, PA 19104
| | - Michelle Vickery
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 3535 Market St. 15th Flr, Philadelphia, PA 19104, Children's Hospital of Philadelphia PolicyLab, Children's Hospital of Philadelphia, 3535 Market St. 15th Flr, Philadelphia, PA 19104
| | - Ron Keren
- Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, 3535 Market St. 15th Flr, Philadelphia, PA 19104, Center for Clinical Epidemiology & Biostatistics. University of Pennsylvania, 8th Flr Blockley Hall, 423 Guardian Drive, Philadelphia PA
| |
Collapse
|
23
|
Shulman R, Miller FA, Daneman D, Guttmann A. Valuing technology: A qualitative interview study with physicians about insulin pump therapy for children with type 1 diabetes. Health Policy 2015; 120:64-71. [PMID: 26563632 DOI: 10.1016/j.healthpol.2015.10.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Revised: 09/28/2015] [Accepted: 10/16/2015] [Indexed: 11/24/2022]
Abstract
Insulin pumps for children with type 1 diabetes have been broadly adopted despite equivocal evidence about comparative effectiveness. To understand why and inform policy related to public funding for new technologies, we explored how physicians interpret the value of pumps. We conducted open-ended, semi-structured interviews with 16 physicians from a pediatric diabetes network in Ontario, Canada, and analyzed the data using interpretive description. Respondents recognized that pumps fell short of expectations because they required hard work, as well as family and school support. Yet, pumps were valued for their status as new technologies and as a promising step in developing future technology. In addition, they were valued for their role within a therapeutic relationship, given the context of chronic childhood disease. These findings identify the types of beliefs that influence the adoption and diffusion of technologies. Some beliefs bear on hopes for new technology that may inappropriately hasten adoption, creating excess cost with little benefit. On the other hand, some beliefs identify potential benefits that are not captured in effectiveness studies, but may warrant consideration in resource allocation decisions. Still others suggest the need for remediation, such as those bearing on disparity in pump use by socioeconomic status. Understanding how technologies are valued can help stakeholders decide how to address such beliefs and expectations in funding decisions and implementation protocols.
Collapse
Affiliation(s)
- Rayzel Shulman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Fiona A Miller
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Health Economics and Technology Assessment (THETA) Collaborative, Canada.
| | - Denis Daneman
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| |
Collapse
|
24
|
|
25
|
Rankin D, Harden J, Noyes K, Waugh N, Barnard K, Lawton J. Parents' experiences of managing their child's diabetes using an insulin pump: a qualitative study. Diabet Med 2015; 32:627-34. [PMID: 25581347 DOI: 10.1111/dme.12683] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2015] [Indexed: 11/28/2022]
Abstract
AIMS Continuous subcutaneous insulin infusion delivered via a pump is increasingly recommended for younger children with Type 1 diabetes. Our aims were: to understand the impact on parents who care for young children using insulin pumps; to help interpret psychological outcomes reported in quantitative research; and to inform provision of support to future parents. METHODS We conducted in-depth interviews with 19 parents of children (aged ≤ 12 years) with Type 1 diabetes who used an insulin pump. Data were analysed thematically. RESULTS Parents reported multiple benefits from using insulin pumps, including: no longer having to administer painful injections; fewer restrictions on the frequency, timing and carbohydrate contents of snacks and meals; and improvements in family life and their child's glycaemic control. Parents liked and felt less anxious about using bolus calculators to determine insulin doses; however, parents also described undertaking additional and unanticipated work to manage their child's diabetes using a pump. This included performing more blood glucose tests to calculate insulin doses for snacks and to address their concerns that the pump increased their child's risk of hypoglycaemia. Some parents reported doing additional blood glucose checks because they could adjust pump settings to better manage hypo- and hyperglycaemia. CONCLUSIONS Parents liked and perceived benefits for their child and themselves from using an insulin pump; however, parents would benefit from being made aware of the additional work involved in using a pump and also from education and support to address concerns about hypoglycaemia. Better measures to evaluate parents' experiences are also recommended.
Collapse
Affiliation(s)
- D Rankin
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh
| | | | | | | | | | | |
Collapse
|
26
|
Lindholm Olinder A, Kernell A, Smide B. Continuous subcutaneous insulin infusion in young girls: a two-year follow-up study. ACTA ACUST UNITED AC 2015. [DOI: 10.1002/edn.74] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
27
|
|
28
|
Feenstra B, Lawson ML, Harrison D, Boland L, Stacey D. Decision coaching using the Ottawa family decision guide with parents and their children: a field testing study. BMC Med Inform Decis Mak 2015; 15:5. [PMID: 25889602 PMCID: PMC4326318 DOI: 10.1186/s12911-014-0126-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 12/19/2014] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although children can benefit from being included in health decisions, little is known about effective interventions to support their involvement. The objective of this study was to evaluate the feasibility and acceptability of decision coaching guided by the Ottawa Family Decision Guide with children and parents considering insulin delivery options for type 1 diabetes (insulin pump, multiple daily injections, or standard insulin injections). METHODS Pre-/post-test field testing design. Eligible participants were children (≤18 years) with type 1 diabetes and their parents attending an ambulatory diabetes clinic in a tertiary children's hospital. Parent-child dyads received decision coaching using the Ottawa Family Decision Guide that was pre-populated with evidence on insulin delivery options, benefits, and harms. Primary outcomes were feasibility of recruitment and data collection, and parent and child acceptability of the intervention. RESULTS Of 16 families invited to participate, 12 agreed and 7 attended the decision coaching session. For the five missed families, two families were unable to attend the session or the decision coach was not available (N=3). Baseline and immediately post-coaching questionnaires were all completed and follow-up questionnaires two weeks post-coaching were missing from one parent-child dyad. Missing questionnaire items were 5 of 340 items for children (1.5%) and 1 of 429 for parents (0.2%). Decision coaching was rated as acceptable with higher scores from parents and their children who were in earlier stages of decision making. CONCLUSION Decision coaching with children and their parents considering insulin options was feasible implement and evaluate in our diabetes clinic and was acceptable to participants. Recruitment was difficult due to scheduling restrictions related to the timing of the study. Coaching should target participants earlier in the decision making process and be scheduled at times that are convenient for families and coaches. Findings were used to inform a full-scale evaluation that is currently underway.
Collapse
Affiliation(s)
- Bryan Feenstra
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
| | - Margaret L Lawson
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada.
| | - Denise Harrison
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Laura Boland
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada.
| | - Dawn Stacey
- School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road (Rm 1118), Ottawa, ON, K1H 8 M5, Canada.
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| |
Collapse
|
29
|
Edwards D, Noyes J, Lowes L, Haf Spencer L, Gregory JW. An ongoing struggle: a mixed-method systematic review of interventions, barriers and facilitators to achieving optimal self-care by children and young people with type 1 diabetes in educational settings. BMC Pediatr 2014; 14:228. [PMID: 25213220 PMCID: PMC4263204 DOI: 10.1186/1471-2431-14-228] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 08/22/2014] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Type 1 diabetes occurs more frequently in younger children who are often pre-school age and enter the education system with diabetes-related support needs that evolve over time. It is important that children are supported to optimally manage their diet, exercise, blood glucose monitoring and insulin regime at school. Young people self-manage at college/university. METHOD Theory-informed mixed-method systematic review to determine intervention effectiveness and synthesise child/parent/professional views of barriers and facilitators to achieving optimal diabetes self-care and management for children and young people age 3-25 years in educational settings. RESULTS Eleven intervention and 55 views studies were included. Meta-analysis was not possible. Study foci broadly matched school diabetes guidance. Intervention studies were limited to specific contexts with mostly high risk of bias. Views studies were mostly moderate quality with common transferrable findings.Health plans, and school nurse support (various types) were effective. Telemedicine in school was effective for individual case management. Most educational interventions to increase knowledge and confidence of children or school staff had significant short-term effects but longer follow-up is required. Children, parents and staff said they struggled with many common structural, organisational, educational and attitudinal school barriers. Aspects of school guidance had not been generally implemented (e.g. individual health plans). Children recognized and appreciated school staff who were trained and confident in supporting diabetes management.Research with college/university students was lacking. Campus-based college/university student support significantly improved knowledge, attitudes and diabetes self-care. Self-management was easier for students who juggled diabetes-management with student lifestyle, such as adopting strategies to manage alcohol consumption. CONCLUSION This novel mixed-method systematic review is the first to integrate intervention effectiveness with views of children/parents/professionals mapped against school diabetes guidelines. Diabetes management could be generally improved by fully implementing and auditing guideline impact. Evidence is limited by quality and there are gaps in knowledge of what works. Telemedicine between healthcare providers and schools, and school nurse support for children is effective in specific contexts, but not all education systems employ onsite nurses. More innovative and sustainable solutions and robust evaluations are required. Comprehensive lifestyle approaches for college/university students warrant further development and evaluation.
Collapse
Affiliation(s)
- Deborah Edwards
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Jane Noyes
- />School of Social Sciences, Bangor University, Bangor, LL57 2EF UK
| | - Lesley Lowes
- />School of Healthcare Sciences College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Llinos Haf Spencer
- />School of Healthcare Sciences, College of Health and Behavioural Sciences, Bangor University, Bangor, UK
| | - John W Gregory
- />Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
30
|
Alsaleh FM, Smith FJ, Thompson R, Al-Saleh MA, Taylor KMG. Insulin pump therapy: impact on the lives of children/young people with diabetes mellitus and their parents. Int J Clin Pharm 2014; 36:1023-30. [PMID: 25108411 DOI: 10.1007/s11096-014-9990-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Accepted: 07/09/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Advances in medical technology and research documenting clinical effectiveness have led to the increased use of insulin pumps worldwide. However, their use by children in the UK is relatively limited and there is little evidence regarding their impact on patients' lives. OBJECTIVE This study aimed to examine the impact of switching from multiple daily injections to insulin pumps on the glycaemic control and daily lives of children/young people and their families. SETTING University College London Hospital, London. METHOD Face-to-face semi-structured interviews were conducted with children/young people with type 1 diabetes mellitus (5-17 years; N = 34) and their parents (N = 38), receiving insulin pump therapy and attending paediatric diabetes outpatients clinics at a major university teaching hospital in London. Glycated haemoglobin A1c values from 6 months prior to, and after pump therapy were obtained. Qualitative and quantitative approaches were undertaken for data analysis. MAIN OUTCOME MEASURE Glycated haemoglobin A1c and the impact of the use of insulin pumps on the children and their families. RESULTS The majority of parents (N = 32) and the children/young people (N = 30) reported that glycaemic control was easier to maintain within the target range with pumps compared to injections. This was supported by glycated haemoglobin A1c measures. Participants generally found the devices easy to use and more acceptable than injections. However, parents and children/young people reported many challenges in the early stages of pump therapy (e.g. 7 children/young had worse control at 6 months after starting CSII). Parents and children/young people reported an overall increase in lifestyle flexibility and an improved ability to participate in home, school and social activities whilst maintaining glycaemic control. CONCLUSION Administration of insulin via pumps rather than injections was generally preferred. Participants reported most difficulty at the commencement of use. Pump therapy conferred benefits in terms of glycaemic control, general well-being, enabling young people to be more in control of their condition and live more normal lives, as reported by most participants. These are important goals of health policy for children/young people with long-term conditions in the UK.
Collapse
Affiliation(s)
- Fatemah M Alsaleh
- Department of Pharmacy Practice, Faculty of Pharmacy, Kuwait University, Jabriyah, P.O. Box: 24923, Safat, 13110, Kuwait,
| | | | | | | | | |
Collapse
|
31
|
Rashotte J, Tousignant K, Richardson C, Fothergill-Bourbonnais F, Nakhla MM, Olivier P, Lawson ML. Living with Sensor-Augmented Pump Therapy in Type 1 Diabetes: Adolescents' and Parents' Search for Harmony. Can J Diabetes 2014; 38:256-62. [DOI: 10.1016/j.jcjd.2014.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Revised: 02/03/2014] [Accepted: 02/03/2014] [Indexed: 10/25/2022]
|
32
|
Noyes JP, Lowes L, Whitaker R, Allen D, Carter C, Edwards RT, Rycroft-Malone J, Sharp J, Edwards D, Spencer LH, Sylvestre Y, Yeo ST, Gregory JW. Developing and evaluating a child-centred intervention for diabetes medicine management using mixed methods and a multicentre randomised controlled trial. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02080] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AimTo develop and evaluate an individually tailored age-appropriate diabetes diary and information pack for children and young people aged 6–18 years with type 1 diabetes to support decision-making and self-care with a specific focus on insulin management and blood glucose monitoring, compared with available resources in routine clinical practice.DesignFour-stage study following the Medical Research Council framework for designing and evaluating complex interventions. Stage 1: context – brief review of reviews and mixed-method systematic review; updating of database of children’s diabetes information; children’s diabetes information quality assessment and diabetes guideline analysis; and critical discourse analysis. Stage 2: intervention development – working with expert clinical advisory group; contextual qualitative interviews and focus groups with children and young people to ascertain their information preferences and self-care practices; ongoing consultation with children; development of intervention programme theory. Stage 3: randomised controlled trial (RCT) to evaluate the diabetes diaries and information packs in routine practice. Stage 4: process evaluation.FindingsThe RCT achieved 100% recruitment, was adequately powered and showed that the Evidence into Practice Information Counts (EPIC) packs and diabetes diaries were no more effective than receiving diabetes information in an ad hoc way. The cost per unit of producing the EPIC packs and diabetes diaries was low. Compared with treatment as usual information, the EPIC packs fulfilled all NHS policy imperatives that children and young people should receive high-quality, accurate and age-appropriate information about their condition, self-management and wider lifestyle and well-being issues. Diabetes guidelines recommend the use of a daily diabetes diary and EPIC diaries fill a gap in current provision. Irrespective of allocation, children and young people had a range of recorded glycated haemoglobin (HbA1c) levels, which showed that as a group their diabetes self-management would generally need to improve to achieve the HbA1clevels recommended in National Institute for Health and Care Excellence guidance. The process evaluation showed that promotion of the EPIC packs and diaries by diabetes professionals at randomisation did not happen as intended; the dominant ‘normalisation’ theory underpinning children’s diabetes information may be counterproductive; risk and long-term complications did not feature highly in children’s diabetes information; and children and young people engaged in risky behaviour and appeared not to care, and most did not use a diabetes diary or did not use the information to titrate their insulin as intended.LimitationsRecruitment of ‘hard to reach’ children and young people living away from their families was not successful. The findings are therefore more relevant to diabetes management within a family context.ConclusionsThe findings indicate a need to rethink context and the hierarchical relationships between children, young people, parents and diabetes professionals with regard to ‘partnership and participation’ in diabetes decision-making, self-care and self-management. Additional research, implementation strategies and service redesign are needed to translate available information into optimal self-management knowledge and subsequent optimal diabetes self-management action, including to better understand the disconnection between children’s diabetes texts and context; develop age-appropriate Apps/e-records for recording blood glucose measurements and insulin management; develop interventions to reduce risk-taking behaviour by children and young people in relation to their diabetes management; reconsider what could work to optimise children’s self-management of diabetes; understand how best to reorganise current diabetes services for children to optimise child-centred delivery of children’s diabetes information.Study registrationCurrent Controlled Trials ISRCTN17551624.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Jane P Noyes
- Centre for Health-Related Research, Bangor University, Bangor, UK
| | - Lesley Lowes
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Rhiannon Whitaker
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Davina Allen
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Cynthia Carter
- Cardiff School of Journalism, Media and Cultural Studies, Cardiff University, Cardiff, UK
| | - Rhiannon T Edwards
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | | | - Janice Sharp
- Media Resources Centre, University Hospital of Wales, Cardiff, UK
| | - Deborah Edwards
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Yvonne Sylvestre
- North Wales Organisation for Randomised Trials in Health (NWORTH), Bangor University, Bangor, UK
| | - Seow Tien Yeo
- Centre for Health Economics and Medicines Evaluation, Bangor University, Bangor, UK
| | - John W Gregory
- Department of Child Health, Wales School of Medicine, Cardiff University, Cardiff, UK
| |
Collapse
|
33
|
Driscoll KA, Johnson SB, Wang Y, Tang Y, Gill EC, Mitchell A, Wright N, Deeb LC. Importance of manually entering blood glucose readings when wireless-compatible meters are not being used with an insulin pump. J Diabetes Sci Technol 2013; 7:898-903. [PMID: 23911171 PMCID: PMC3879754 DOI: 10.1177/193229681300700412] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The objective was to determine if there were differences in blood glucose monitoring (BGM) data downloaded from insulin pumps of patients who use meters that wirelessly transmit data to their insulin pumps (i.e., wireless group) and those who do not (i.e., nonwireless group). METHODS Blood glucose monitoring data were downloaded from the meters and insulin pumps of 47 children and adolescents with type 1 diabetes mellitus. Independent and paired t tests compared BGM data downloaded from meters and BGM data downloaded from insulin pumps. RESULTS There were significant differences in BGM data downloaded from the insulin pumps of patients using wireless meters compared to those using nonwireless meters. Wireless patients appeared to engage in more BGM, had more low and in-range BG readings and fewer very high BG readingss than nonwireless patients. However, a comparison of BGM data downloaded from meters and insulin pumps of nonwireless patients indicated that their insulin pump data significantly underestimated the number of BGM readings conducted, as well as the number of low and in-range readings, while overestimating the number of very high BGM readings. CONCLUSIONS Because patients who use nonwireless-compatible meters do not manually enter their low and in-range BGM readings into the insulin pump, BGM data downloaded only from pumps may provide an incomplete representation of BGM frequency or results. It is recommended that patients use meters that directly communicate with pumps or perform bolus calculations. Patients should be educated about the importance of manually entering all BGM readings if they do not use a wireless-compatible meter with their insulin pump.
Collapse
Affiliation(s)
- Kimberly A Driscoll
- Department of Medical Humanities and Social Sciences, Florida State University College of Medicine, Tallahassee, FL 32306, USA.
| | | | | | | | | | | | | | | |
Collapse
|
34
|
Kollipara S, Silverstein JH, Marschilok K. Diabetes Technologies and Their Role in Diabetes Management. AMERICAN JOURNAL OF HEALTH EDUCATION 2013. [DOI: 10.1080/19325037.2009.10599105] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Sobha Kollipara
- Sobha Kollipara is the director, Pediatric Endocrinlolgy and Diabetes, Kaiser Permanente Roseville, Roseville, CA 95611
| | - Janet H. Silverstein
- Janet H. Silverstein is a professor and chief in the Pediatric Endocrinology Department, University of Florida, Gainesville, FL 32608
| | - Katie Marschilok
- Katie Marschilok is a diabetes clinical manager, Medtronic Diabetes, 4 Fairlawn Lane, Troy, NY, 12180
| |
Collapse
|
35
|
Abstract
Ensuring quality of life (QOL) while maintaining glycemic control within targets is an important challenge in type 1 and type 2 diabetes treatment. For children with diabetes, QOL includes enjoying meals, feeling safe in school, and perceiving positive, supportive relationships with parents, siblings, and friends. Yet many treatment-related and psychosocial barriers can interfere with a child's QOL and their ability to manage diabetes effectively. Diabetes management also imposes considerable lifestyle demands that are difficult and often frustrating for children to negotiate at a young age. Recent advances in diabetes medications and technologies have improved glycemic control in children with diabetes. Two widely used technologies are the insulin pump and continuous glucose monitoring (CGM) system. These technologies provide patients with more flexibility in their daily life and information about glucose fluctuations. Several studies report improvements in glycemic control in children with type 1 diabetes using the insulin pump or sensor-augmented pump therapy. Importantly, these technologies may impact QOL for children and families with diabetes, although they are rarely used or studied in the treatment of children with type 2 diabetes. Further, emerging closed loop and web- and phone-based technologies have great potential for supporting diabetes self-management and perhaps QOL. A deeper understanding and appreciation of the impact of diabetes technology on children's and parents' QOL is critical for both the medical and psychological care of diabetes. Thus, the purpose of this review is to discuss the impact of new diabetes technologies on QOL in children, adolescents and families with type 1 diabetes.
Collapse
Affiliation(s)
- Masakazu Hirose
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A. Beverly
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Katie Weinger
- Joslin Diabetes Center, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
36
|
Wang YL, Volker DL. Caring for students with type 1 diabetes: school nurses' experiences. J Sch Nurs 2012; 29:31-8. [PMID: 22554899 DOI: 10.1177/1059840512447123] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This qualitative study used a Husserlian phenomenological approach to obtain an understanding of the essences of five experienced Taiwanese school nurses' lived experience of caring for students with type 1 diabetes mellitus (T1DM). Audio-recorded, semi-structured, in-depth interviews were conducted. Data analysis entailed a modified method from Colaizzi. Four intertwined themes were discovered: (a) I try to put myself in the parents' and students' shoes, (b) I am not a diabetes expert, (c) managing T1DM requires teamwork, and (d) caring for students with T1DM is a struggle with practical limitations. The findings show that these school nurses encountered many challenges as they implemented their roles and responsibilities in caring for students with T1DM. The findings suggest that increasing school nurses' competence in caring for students with T1DM and developing effective strategies to overcome the challenges faced may be useful. Multidisciplinary teamwork could benefit the diabetes management activities in school settings.
Collapse
Affiliation(s)
- Yueh-Ling Wang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan.
| | | |
Collapse
|
37
|
Alsaleh FM, Smith FJ, Taylor KM. Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review. J Clin Pharm Ther 2011; 37:140-7. [PMID: 21729118 DOI: 10.1111/j.1365-2710.2011.01283.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life. METHODS A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified. RESULTS Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day-to-day management were also discussed. WHAT IS NEW AND CONCLUSION Exploring children/young people's perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed.
Collapse
Affiliation(s)
- F M Alsaleh
- Department of Practice and Policy, School of Pharmacy, University of London, UK.
| | | | | |
Collapse
|
38
|
Olinder AL, Nyhlin KT, Smide B. Clarifying responsibility for self-management of diabetes in adolescents using insulin pumps - a qualitative study. J Adv Nurs 2011; 67:1547-57. [DOI: 10.1111/j.1365-2648.2010.05588.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
39
|
Todres L, Keen S, Kerr D. Continuous subcutaneous insulin infusion in Type 1 diabetes: patient experiences of 'living with a machine'. Diabet Med 2010; 27:1201-4. [PMID: 20873363 DOI: 10.1111/j.1464-5491.2010.03058.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS The aims of this study were to provide in-depth insight into the changes that may be experienced by patients embarking on continuous subcutaneous insulin infusion and to answer the research question, what is it like to live with an insulin pump? METHODS An in-depth, qualitative, multiple interview study of individuals with Type 1 diabetes using continuous subcutaneous insulin infusion in a secondary care setting in the south of England. Four patients (two male, two female)across the age range and with varied experience of pump use, were recruited from a specialist diabetes centre. RESULTS Switching from multiple injection therapy to insulin pump therapy presents challenges in the short term.Over a longer period, use of this technology is associated with a significant improvement in quality of life for the users and also a change in the relationship between the patient and their specialist healthcare provider. CONCLUSIONS Insulin pump therapy has additional qualitative benefits beyond improvements in glycaemic control and reducing the risk of hypoglycaemia for people with Type 1 diabetes.
Collapse
Affiliation(s)
- L Todres
- School of Health and Social Care, Bournemouth University, UK.
| | | | | |
Collapse
|
40
|
Alsaleh FM, Smith FJ, Keady S, Taylor KMG. Insulin pumps: from inception to the present and toward the future. J Clin Pharm Ther 2010; 35:127-38. [PMID: 20456732 DOI: 10.1111/j.1365-2710.2009.01048.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
As an alternative to the usual insulin injections, insulin pumps have been introduced as an advanced method of insulin delivery for managing type 1 diabetes mellitus patients. This review documents the history of insulin pump development and the production of 'smart pumps' that offer patients greater dosing accuracy, flexibility, and ease of use. This has resulted in an increase in the number of insulin pump users around the world. This paper also provides a comprehensive survey of the pumps currently available on the market and their specifications. Unique features of each product and the drawbacks are addressed in the review. The future direction of insulin pump development is targeted toward closing the loop, to allow feedback control between an insulin pump and a glucose sensor, and hence finer adjustment of insulin delivery rates as required.
Collapse
Affiliation(s)
- F M Alsaleh
- Department of Practice and Policy, School of Pharmacy, University of London, UK.
| | | | | | | |
Collapse
|
41
|
Spencer J, Cooper H, Milton B. Qualitative studies of type 1 diabetes in adolescence: a systematic literature review. Pediatr Diabetes 2010; 11:364-75. [PMID: 19895566 DOI: 10.1111/j.1399-5448.2009.00603.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Joy Spencer
- University of Chester, Faculty of Health and Social Care, Chester, UK.
| | | | | |
Collapse
|
42
|
Hanna KM, Decker CL. A concept analysis: assuming responsibility for self-care among adolescents with type 1 diabetes. J SPEC PEDIATR NURS 2010; 15:99-110. [PMID: 20367781 PMCID: PMC2851236 DOI: 10.1111/j.1744-6155.2009.00218.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE This concept analysis clarifies "assuming responsibility for self-care" by adolescents with type 1 diabetes. METHODS Walker and Avant's (2005) methodology guided the analysis. RESULTS Assuming responsibility for self-care was defined as a process specific to diabetes within the context of development. It is daily, gradual, individualized to person, and unique to the task. The goal is ownership that involves autonomy in behaviors and decision-making. PRACTICE IMPLICATIONS Adolescents with type 1 diabetes need to be assessed for assuming responsibility for self-care. This achievement has implications for adolescents' diabetes management, short- and long-term health, and psychosocial quality of life.
Collapse
Affiliation(s)
- Kathleen M Hanna
- School of Nursing, Indiana University, Indianapolis, Indiana, USA.
| | | |
Collapse
|
43
|
Psychosocial problems in adolescents with type 1 diabetes mellitus. DIABETES & METABOLISM 2009; 35:339-50. [PMID: 19700362 DOI: 10.1016/j.diabet.2009.05.002] [Citation(s) in RCA: 73] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2008] [Revised: 05/11/2009] [Accepted: 05/11/2009] [Indexed: 12/11/2022]
Abstract
Adolescents with diabetes are at increased risk of developing psychiatric (10-20%) or eating disorders (8-30%), as well as substance abuse (25-50%), leading to non-compliance with treatment and deterioration of diabetic control. At high risk are female adolescents with family problems and other comorbid disorders. Impaired cognitive function has also been reported among children with diabetes, mainly in boys, and especially in those with early diabetes diagnosis (< 5 years), or with episodes of severe hypoglycaemia or prolonged hyperglycaemia. Type 1 diabetes mellitus contributes to the development of problems in parent-child relationships and employment difficulties, and negatively affects the quality of life. However, insulin pumps appear to improve patients' metabolic control and lifestyle. The contributions of family and friends to the quality of metabolic control and emotional support are also crucial. In addition, the role of the primary-care provider is important in identifying patients at high risk of developing psychosocial disorders and referring them on to health specialists. At high risk are patients in mid-adolescence with comorbid disorders, low socioeconomic status or parental health problems. Multisystem therapy, involving the medical team, school personnel, family and peer group, is also essential. The present review focuses on the prevalence of nutritional and psychosocial problems among adolescents with diabetes, and the risk factors for its development, and emphasizes specific goals in their management and prevention.
Collapse
|
44
|
Delvecchio M, Zecchino C, Salzano G, Faienza MF, Cavallo L, De Luca F, Lombardo F. Effects of moderate-severe exercise on blood glucose in Type 1 diabetic adolescents treated with insulin pump or glargine insulin. J Endocrinol Invest 2009; 32:519-24. [PMID: 19474521 DOI: 10.1007/bf03346499] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Few papers focus on exercise-related blood glucose (BG) in patients on continuous sc insulin infusion (CSII) or multiple daily injections (MDI) with glargine. AIM The main objective was to evaluate the degree of glycemic control in Type 1 diabetes mellitus adolescents on CSII doing physical activity with pump switched on or off. These findings were also compared with a small group of patients on MDI with glargine. SUBJECTS AND METHODS Eight patients on CSII (basal rate continued or turned off in alternating sessions) and 5 on MDI joined 4 sessions of moderate-severe exercise. RESULTS Post-exercise BG significantly increased with the pump off and was unchanged/decreased with the pump on and MDI groups vs baseline. The hypoglycemia rate was not different among the 3 groups at any time. Pump on: hypoglycemias more frequent both at bedtime (p=0.031) and at awakening (p<0.001) than before dinner and at awakening than at bed-time (p=0.044). Pump off: hypoglycemias more frequent both at bed-time (p=0.010) and at awakening (p=0.031) than before dinner. MDI: no differences. CONCLUSIONS Glargine is safe and reducing the pre-lunch insulin is unnecessary. Subjects on insulin pump should not stop the basal rate. If they stop the pump, some actions are advisable: pre-exercise insulin bolus, pre-sleeping snack rich in carbohydrates, slight reduction of the overnight basal rate. On the other hand, if the basal rate is unmodified, the ingestion of sugary drinks during the exercise, the reduction of the overnight basal rate, a reduction of the pre-dinner insulin bolus and/or a pre-sleeping snack should be considered.
Collapse
Affiliation(s)
- M Delvecchio
- Department of Biomedicine of Developmental Age, University of Bari, Bari, Italy
| | | | | | | | | | | | | |
Collapse
|
45
|
Olinder AL, Kernell A, Smide B. Missed bolus doses: devastating for metabolic control in CSII-treated adolescents with type 1 diabetes. Pediatr Diabetes 2009; 10:142-8. [PMID: 19175898 DOI: 10.1111/j.1399-5448.2008.00462.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To investigate the management of continuous subcutaneous insulin infusion (CSII) in adolescents with type 1 diabetes including their administration of bolus doses and to study relationships between insulin omission and metabolic control, body mass index, daily frequency of self-monitoring of blood glucose (SMBG) and bolus doses, health-related quality of life (HRQOL), the burden of diabetes and treatment satisfaction. METHODS Ninety CSII-treated (> or =6 months) adolescents aged 12-18 yr, from four diabetes clinics in Sweden, participated in the study. The adolescents recorded their meal intake the previous day, which was compared with downloaded pump data, and the frequency of missed boluses was stated. Haemoglobin A1c (HbA1c) and diabetes-related data were recorded. HRQOL and treatment satisfaction were measured with questionnaires. RESULTS Thirty-eight per cent of the adolescents had missed >15% of the doses the previous day, those had higher HbA1c (7.8 +/- 1.0 vs. 7.0 +/- 1.2%, p = 0.001), took fewer daily boluses (3.8 +/- 1.7 vs. 5.3 +/- 1.7, p < 0.001) and SMBG (2.4 +/- 1.8 vs. 3.6 +/- 1.8, p = 0.003), were less satisfied with their treatment (4.8 vs. 5.3, scale 0-6, p = 0.029) and perceived the medical treatment more negatively (72.1 vs. 79.7, scale 0-100, p = 0.029). Multiple linear regression analysis showed that the variations in HbA1c could be explained by the frequency of bolus doses (p = 0.013) and SMBG per day (p < 0.0001) adjusted for duration and age (r(2) = 0.339, p < 0.0001). CONCLUSION Insulin omission was common. Those who missed doses were less satisfied and perceived more impact with the treatment. The frequencies of daily boluses and SMBG were associated with metabolic control. Diabetes teams need strategies to guide adolescents on how to avoid insulin omission.
Collapse
|
46
|
Campbell F, Macdonald AL, Gelder C, Reynolds C, Holland P, Feltbower RG. Embedding CSII therapy in the routine management of diabetes in children: a clinical audit of this service in Leeds. ACTA ACUST UNITED AC 2009. [DOI: 10.1002/pdi.1324] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
47
|
Aberle I, Zimprich D, Bach-Kliegel B, Fischer C, Gorny M, Kliegel A, Langer K, Kliegel M. Continuous subcutaneous insulin infusion leads to immediate, stable and long-term changes in metabolic control. Diabetes Obes Metab 2008; 10:329-35. [PMID: 18333891 DOI: 10.1111/j.1463-1326.2007.00707.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Evaluations of continuous subcutaneous insulin infusion (CSII) usually focus on one pre- and one post-CSII measurement to assess metabolic therapy outcome. AIM Extending this research, the aim of the present study was to provide a more fine-grained analysis of achieved glycaemic control. METHODS In 52 patients with type 1 diabetes (mean age of 37.85 years at CSII begin; s.d. +/- 12.41), haemoglobin A(1c) (HbA(1c)) levels were assessed every 3 months over a period of 5 years (1 year before and 4 years after the introduction of CSII). Mixed models were utilized to describe changes in glycaemic control. RESULTS The pre-post course showed that already in the first quarter, a statistically significant lower HbA(1c) level was obtained [7.30%, in contrast to 8.21% at the last quarter with intensified conventional therapy (ICT)]. In the following 15 quarters, the mean HbA(1c) levels remained constantly lower than that with ICT. Overall, the aggregated mean HbA(1c) level of patients with CSII therapy was 7.19%, in contrast to 8.08% with ICT; thus, an overall decrease by 11% was achieved. In addition, individual differences in blood glucose level and age of diabetes onset as a predictor for therapy success were analysed. CONCLUSIONS The data show an immediate, stable and long-term effect of CSII on HbA(1c). In addition, a significant relationship between metabolic control and age of diabetes onset was found, as well as a reduction of variance in HbA(1c) levels between subjects after change to CSII.
Collapse
Affiliation(s)
- I Aberle
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Shalitin S, Phillip M. The role of new technologies in treating children and adolescents with type 1 diabetes mellitus. Pediatr Diabetes 2007; 8 Suppl 6:72-9. [PMID: 17727388 DOI: 10.1111/j.1399-5448.2007.00279.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Given the physiological and psychological impact of type 1 diabetes in children and adolescents, these patients present special challenges to pediatric health care providers. The goals of intensive management of diabetes have been clearly established since the publication of the Diabetes Control and Complication Trial (DCCT) in 1993, which demonstrated that tight metabolic control achieved with intensive insulin therapy is superior to conventional treatment in reducing the risk of long-term microvascular complications. Thus, current recommendations mandate that youth with type 1 diabetes should aim to achieve metabolic control as close to normal as possible. However, strict glycemic control is hard to achieve requiring frequent blood glucose measurements and several insulin injections per day, and in addition is associated with an increased risk of severe hypoglycemia. Recurrent episodes of hypoglycemia, especially at young ages, may cause adverse effects on neurocognitive function, may lead to hypoglycemia unawareness, and may be associated with significant emotional morbidity for the child and parents. Since the discovery of insulin in 1921 there has been constant progress in the way patients with type 1 diabetes are treated. The introduction of recombinant insulin and insulin analogs as well as new insulin delivery systems and glucose monitoring devices enhanced the ability of both patients and medical teams to better define the therapeutic goals and to develop more effective therapeutic strategies. Recent advances in devices for insulin administration and glucose monitoring and the introduction of telemedicine are having a profound effect on the lives of youth with type 1 diabetes. This review focuses on the new technologies which have been developed for treating children and adolescents with type 1 diabetes.
Collapse
Affiliation(s)
- S Shalitin
- Institute for Endocrinology and Diabetes, National Center for Childhood Diabetes, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | | |
Collapse
|
49
|
Schiaffini R, Patera PI, Bizzarri C, Ciampalini P, Cappa M. Basal insulin supplementation in Type 1 diabetic children: a long-term comparative observational study between continuous subcutaneous insulin infusion and glargine insulin. J Endocrinol Invest 2007; 30:572-7. [PMID: 17848840 DOI: 10.1007/bf03346351] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
No long-term data are available on the efficacy of glargine insulin in comparison with continuous sc insulin infusion (CSII) in children and adolescents affected by Type 1 diabetes (T1D). Our aim was to compare the 2-yr efficacy of the 2 insulin approaches, in order to know how to best supply basal insulin in these patients. Thirty-six 9 to 18-yr-old consecutive children with at least 3 yr previous T1D diagnosis were enrolled. As part of routine clinical care, the patients consecutively changed their previous insulin scheme (isophane insulin at bedtime and human regular insulin at meals) and were randomly selected in order to receive either multiple daily injections (MDI) treatment with once-daily glargine and human regular insulin at meals, or CSII with aspart or lispro insulin. Both groups showed a significant decrease in glycosylated hemoglobin (HbA1c) values during the 1st year of therapy, though only in the CSII treated children was the decrease also observed during the 2nd year. The overall insulin requirement significantly decreased only in the CSII group and exclusively during the 1st year, while no significant differences were observed concerning body mass index SD score, severe hypoglycemic episodes and basal insulin supplementation. The work illustrates the first long-term study comparing the efficacy of CSII to MDI using glargine as basal insulin in children. Only with CSII were better HbA1c values obtained for prolonged periods of time, so that CSII might be considered the gold standard of intensive insulin therapy also for long-term follow-ups.
Collapse
Affiliation(s)
- R Schiaffini
- Department of Pediatric Medicine Unit of Endocrinology and Diabetology, Bambino Gesù Children's Hospital, IRRCS, 00165 Rome, Italy
| | | | | | | | | |
Collapse
|
50
|
Weissberg-Benchell J, Goodman SS, Antisdel Lomaglio J, Zebracki K. The Use of Continuous Subcutaneous Insulin Infusion (CSII): Parental and Professional Perceptions of Self-care Mastery and Autonomy in Children and Adolescents. J Pediatr Psychol 2007; 32:1196-202. [PMID: 17599966 DOI: 10.1093/jpepsy/jsm050] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To describe parent-perceived mastery of Continuous Subcutaneous Insulin Infusion (CSII) specific skills and level of autonomy for these tasks among youth with type 1 diabetes. METHODS One hundred and sixty-three parents of youth using CSII and 142 diabetes clinicians participated. Parents reported their child's mastery and autonomy of CSII-specific skills. Clinicians indicated the age at which 50% of their patients mastered these skills. RESULTS Parents report CSII skill mastery between 10.9 and 12.8 years. Very few achieved skill mastery on all CSII-related tasks. Parent- and clinician-expectations for age of skill acquisition were consistent with one another. Parents shared CSII task responsibility with their children even after their children have attained skill mastery. CONCLUSION The recent emphasis on maintaining parental involvement in diabetes care seems to have been translated into clinical practice. Parents remain involved in their child's CSII care even after they believe their child has mastered these skills.
Collapse
Affiliation(s)
- Jill Weissberg-Benchell
- Childrens's Memorial Hospital, Department of Child and Adolescent Psychiatry, Feinberg School of Medcicine, Northwestern University, 2300 Children's Plaza, Box 10, Chicago, Illinois 60614, USA.
| | | | | | | |
Collapse
|