Early onset diabetes: parents' views

The JUBILE cohort: Quality of life after more than 40 years with type 1 diabetes

AIM

The incidence of type 1 diabetes is increasing, and more people are going to live many years with the disease. Quality of life might become the most challenging long-term complication. The JUBILE study describes the quality of life of people living with type 1 diabetes for more than 40 years.

METHODS

Patients were recruited from 35 French regional or university hospitals: patients and physicians completed questionnaires, validated by the Delphi method. From 1200 questionnaires circulated, 808 patients and their physicians returned questionnaires.

RESULTS

The duration of type 1 diabetes was 49 ± 6 years (mean±SD), age at diagnosis 15 ± 10 years, HbA1c 7.4 ± 0.9% [58 ± 10 mmol/mol] and 52% were men. Macrovascular disease was present in 32%, 46% had no or only mild non proliferative retinopathy. Insulin pumps were used by 25% and insulin pen/syringe users injected 3.9 ± 2.1 times per day. Blood glucose was self monitored at least five times per day by 67% of patients. Men had 1.8 ± 1.2 children, women 1.4 ± 1.0. More than half (55%) of this population was working, 38% had a university degree. Patients still had a busy life, going out (59%), eating out (82%), playing sports (38%) and travelling (66%). No differences appeared based on age, duration of diabetes, demography or social features.

CONCLUSIONS

Living a long and pleasant life is possible with type 1 diabetes. Diabetes does not prevent people from having children, working at highly qualified jobs, travelling abroad: a message of hope that is comforting for patients, their family, relatives and the medical teams.

Developing a Scale to Measure Parental Worry and Their Attitudes Toward Childhood Cancer After Successful Completion of Treatment

The purpose of this study is to develop and evaluate the psychometric characteristics of a scale designed to measure parents’ attitude toward childhood cancer after treatment has ended. In this study, the 2 theoretical frameworks (theory of attitude and theory of worry) were used as they related to the study. An attitude is an idea charged with negative or positive emotion, directed to a psychological object, such as cancer. A sample of 84 White, middle class, American parents (n = 49 mothers, n = 35 fathers) of 51 childhood cancer survivors, whose treatment ended between 1988 and 2005, was surveyed between November 2005 and February 2006. Two factors were extracted using principal component analysis with oblique rotation. Cronbach’s alpha reliability for Factor 1 was .91 and for Factor 2 was .76. This study suggests that most parents of cancer survivors tend to perseverate, ruminating on the idea that their child’s cancer will return; as a result, they remain in a heightened state of alertness and develop uncontrollable thoughts, or inconsolable worry, about the recurrence of the disease.

"Living with risk": mothering a child with food-induced anaphylaxis

Food-induced anaphylaxis (FIA) affects an increasing number of children and families encountered in a variety of nursing environments. Sensitive nursing care requires consideration of the psychosocial impact of the condition. The purpose of this phenomenological study was to arrive at an understanding of the mother's lived experience of parenting a child with FIA. Semistructured interviews were conducted with six mothers of children 6 to 12 years old considered at risk for FIA. Data analysis was carried out concurrently with data collection, revealing "Living with Risk" as the essence of the experience, supported by five themes: "Living with Fear," "Worrying About Well-Being," "Looking for Control," "Relying on Resources," and "It Is Hard But It Is Not." These findings should assist nurses in meeting families' education and support needs related to FIA.

The relationship between parental perceptions of diabetes and glycaemic control

AIM

To measure the relationship between perceived child competence, parental self-efficacy, and children's glycaemic control.

METHODS

Cross-sectional outpatient based questionnaire survey of 78 parents of children aged 6-12 years with insulin dependent diabetes mellitus, diagnosed for at least one year. Parental perceptions of their child's competence were assessed, together with parental perceptions of their own self-efficacy in managing their child's diabetes. Glycaemic control was assessed by the average annual HbA1C level.

RESULTS

The response rate was 64.5% (51 parents); 82% were mothers and the socioeconomic class and ethnicity spread was representative of the general population. The mean age of the children was 10 years and duration of diabetes 4.4 years. Poorer glycaemic control was associated with higher perceived child competence, together with lower perceived age of responsibility, lower perceived seriousness, and less frequent blood tests. Higher parental self-efficacy and higher perceived child competence predicted a higher level of normalisation, as did lower perceived seriousness, a lower perceived parental responsibility for management, and a less protective style of parenting.

CONCLUSION

Parents' perceptions of their children's diabetes are significantly related to glycaemic control; however, those who appear more competent at managing diabetes may overestimate their child's capabilities, leading to poorer glycaemic control.

Past 10-year status of insulin therapy for preschool-age Japanese children with type 1 diabetes

The aim of this study was to evaluate the past 10-year status of insulin therapy for preschool-age children with type 1 diabetes in Japan. One-hundred and forty-two patients who had been diagnosed at less than 5 years of age within the past 10 years (1993-2002) at 36 hospitals were registered in this study on April 2003. The methods of daily insulin therapy and episodes of severe hypoglycemia during the preschool period were investigated. Eighty-six (60.6%) children were treated with a pen-type device and 56 (39.4%) were treated with a syringe-type device. The once-a-day insulin regimen was used for 2, a twice-a-day regimen for 104, a three-times-a-day for 28 and a four-times-a-day for 8. Episodes of severe hypoglycemia were recorded in nearly half of the subjects, and one-fourth of the subjects had repeated episodes. One hundred and eleven of their parents were questioned regarding the degree of psychosocial stress experienced during the care of their children. Most parents worried about the glycosylated hemoglobin value at each hospital visit. They were next very afraid of nocturnal severe hypoglycemia, independent of any actual experience. These results suggest that although insulin therapy can involve various methods, the important point is to simultaneously provide good glycemic control and prevent severe hypoglycemia, especially during this age.

Serious illness in childhood: the different threats of cancer and diabetes from a parent perspective

OBJECTIVES

To compare the incidence of disease-related distress symptoms in parents of children with cancer and diabetes.

STUDY DESIGN

A total of 675 parents of patients with cancer, patients with diabetes, and control subjects were assessed for 11 distress symptom clusters. Patient and control parent mean differences were tested by 2-tailed t tests; illness groups were compared by means of analysis of variance. Distress variations as a function of time since diagnosis were examined by regression analysis.

RESULTS

The distress levels of patient parents exceeded those of control parents for global distress ( P <.0001) and for most symptom subcategories. Distress levels of parents of patients with cancer (CP) significantly exceeded those of parents of patients with diabetes (DP) in anxiety ( P <.0001), physical and psychologic distress ( P <.0001), depression ( P <.005), and loneliness ( P <.05). Levels in DP matched those of CP in uncertainty, loss of control/the patient, self-esteem, disease-related fear, and sleep disturbances. Distress levels were lower in CP most distant in time from diagnosis, whereas DP showed a reversed trend.

CONCLUSIONS

Parental distress patterns in childhood illness depend on illness type and time passed since diagnosis. Symptom profiles verify the need for psychosocial attention at the initial shock after the cancer diagnosis and indicate long-term consequences for many parents. In pediatric diabetes, the persistence or intensification of distress over time is of specific clinical relevance.

Constant vigilance: mothers' work parenting young children with type 1 diabetes

Little is known about the experiences of mothers raising young children with type 1 diabetes. The purpose of this study was to describe the day-to-day experiences of mothers (N = 28) raising young children under 4 years of age with type 1 diabetes. Descriptive, naturalistic inquiry principles were used to interview subjects, as well as to manage and analyze the data. The mothers reported using the management behavior of constant vigilance. Their concerns about hypoglycemia and providing competent care reflected the interplay between their fears and profound sense of responsibility for managing the disease. Mothers reported having to learn the management behaviors and to occasionally adjust the day-to-day management when either severe hypoglycemia or developmental milestones occurred. Although mothers initially had feelings of incompetence with the care they provided, with time, they became very skilled. There were also reports of limited access to babysitting, child care, or respite services. The intensity of their constant vigilance associated with their concerns, responsibility, and lack of supports resulted in some mothers having physical and/or emotional problems. The findings of the study highlight the importance of identifying family and/or community resources that may provide mothers with support that could reduce some of the tremendous stress and burden of responsibility experienced after diagnosis of diabetes.

Mothers' experiences raising young children with type 1 diabetes

ISSUES AND PURPOSE

To examine the day-to-day experiences of mothers raising children 4 years of age and younger with type 1 diabetes.

DESIGN AND METHODS

The descriptive design compared mothers of children with (n = 25) and without diabetes (n = 25). Mother-child observations were completed for children with diabetes.

RESULTS

Mothers of children with diabetes are very skilled in reading their children's behavioral cues. Mothers' concerns included the fear of hypoglycemia and seizure activity, access to daycare centers, and babysitting services capable of caring for their children's condition. These responses significantly differed from the control group mothers.

PRACTICE IMPLICATIONS

Nurses can affirm that hypoglycemia-related fears are normal and help mothers identify community resources that might ease the burden of care required, especially during the early postdiagnosis period.

Good health care improves outcomes in diabetes

Diabetes mellitus (DM) is one of the more common chronic disorders and, for reasons which are not entirely clear, is becoming more prevalent both in childhood (Gardner et al, 1997) and adulthood (Audit Commission, 2000). A worrying and relatively new trend has been the presentation of non-insulin dependent (type 2) DM among adolescent Asians. While the aetiologies of insulin-dependent (type 1) DM and type 2 diabetes are very different, good health outcomes for both conditions are dependent on adherence to high standards of self-management.

Chronic sorrow in parents of children with newly diagnosed diabetes: a review of the literature and discussion of the implications for nursing practice

Childhood (type 1) diabetes is a chronic, life-long condition, the diagnosis of which may represent multiple losses for parents. Their emotional responses to the diagnosis have been likened to the grief reactions experienced as a result of bereavement through death. The practice of health professionals who work with these families is informed by two contrasting theoretical views of the progress of grief reactions; the time bound and the chronic sorrow perspectives. This paper provides a critical appraisal of the evidence concerning grief reactions in parents of children with diabetes and evaluates the extent to which this supports the expectations of the time bound theorists, that parents normally reach an end stage of the grieving process, or those of the proponents of chronic sorrow, who anticipate lifelong, recurring sadness. It concludes with a discussion of the implications of the debate for nursing practice.

A normal lifestyle: parental stress and coping in childhood diabetes

This article forms part of an extensive literature review informing a study exploring the parental experience of home management of children with newly diagnosed diabetes. As a diagnosis of childhood diabetes may represent a major stressor event for parents, selected theories and models of stress and coping are discussed. These suggest that, influenced by a variety of interpersonal and environmental factors, parents may approach the process of coping in different ways. Coping strategies employed by parents of children with diabetes elicited from the literature are categorized according to a psychological theory of stress and coping. Normalization, a coping strategy used by parents of chronically ill children, is discussed in relation to childhood diabetes. To conclude, implications for nursing practice are outlined and suggestions made about how parents may be assisted to cope with the demands of having a child with diabetes.