1
|
Kofoed PE, Thomsen J. Leaving the responsibility of booking appointments to parents in a paediatric diabetes outpatient clinic resulted in a deterioration of metabolic control. Pediatr Diabetes 2020; 21:390-394. [PMID: 31854481 DOI: 10.1111/pedi.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 11/16/2019] [Accepted: 12/16/2019] [Indexed: 12/23/2022] Open
Abstract
UNLABELLED It is recommended that children and adolescents with diabetes are seen at paediatric diabetes clinics at least four times a year. This study examined whether an increased involvement of parents in planning the contacts would help them take more responsibility and thus lead to better metabolic control. METHODS Patients with type 1 diabetes at the paediatric outpatient clinic at Lillebaelt Hospital were included in a before-after study. During the intervention, the parents were asked to contact the clinic whenever they needed help or wanted to book a consultation. HbA1c levels 1 year before, at the start of, and 1 year after the intervention were compared, as were the number of consultations and telephone contacts during the year prior to and during the intervention. RESULTS 139 patients were included in the analyses. The mean HbA1c levels were 1 year before the start of the intervention (HbA1c-1) 61.8 mmol/mol (7.8%), and at the start of the intervention (HbA1c-2) 59.9 mmol/mol (7.6%) (P = .01), and after the end of the intervention (HbA1c-3) 63.1 mmol/mol (7.9%) (HbA1c-2 vs HbA1c-3: P = .0002). During the year prior to the intervention, the mean number of consultations was 5.8, and during the intervention period, the mean was 4.4 (P = .0001); the mean number of telephone calls was 1.8 and 3.8 (P < .0001), respectively. CONCLUSION Children were seen less often when parents were responsible for booking appointments, leading to higher HbA1c levels indicating that frequent consultations are essential for good metabolic control and cannot be replaced by frequent telephone contacts.
Collapse
Affiliation(s)
- Poul-Erik Kofoed
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital/Kolding and IRS, University of Southern Denmark, Denmark
| | - Jane Thomsen
- Department of Paediatrics and Adolescent Medicine, Lillebaelt Hospital/Kolding and IRS, University of Southern Denmark, Denmark
| |
Collapse
|
2
|
Gürkan KP, Bahar Z, Böber E. Effects of a home-based nursing intervention programme among adolescents with type 1 diabetes. J Clin Nurs 2019; 28:4513-4524. [PMID: 31430410 DOI: 10.1111/jocn.15040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 06/02/2019] [Accepted: 08/04/2019] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVE To investigate the effects of a home-based nursing intervention programme established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus. BACKGROUND After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home. DESIGN A quasi-experimental design with a pre- and post-test control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study. METHOD This study was conducted in İzmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with type 1 diabetes mellitus who were registered at the paediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June-December 2017. A home-based nursing intervention programme (5 week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and 3 and 6 months after a 5-week home-based nursing intervention. Multi-way and one-way analysis of variance, the Bonferroni correction, regression analysis, t test, chi-squared analysis and a structural equation model were used for data analysis of the iterative measurements. RESULTS At the end of the home-based nursing intervention programme, the HbA1c mean scores significantly decreased, while self-efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of admission to the hospital and average costs were lower in the intervention group than in control group. The home-based nursing intervention programme using structural equation modelling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels. CONCLUSION The home-based nursing intervention programme was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self-efficacy of the adolescents. RELEVANCE TO CLINICAL PRACTICE The home-based nursing intervention programme can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.
Collapse
Affiliation(s)
- Kübra Pınar Gürkan
- Public Health Nursing Department, Faculty of Nursing, Dokuz Eylül University, Izmir, Turkey
| | - Zühal Bahar
- Public Health Nursing Department, Koç University School of Nursing, Istanbul, Turkey
| | - Ece Böber
- Internal Medicine Department of Pediatrics Pediatric Endokrinology, Faculty of Medicine, Dokuz Eylül University, Izmir, Turkey
| |
Collapse
|
3
|
Berger G, Waldhoer T, Barrientos I, Kunkel D, Rami‐Merhar BM, Schober E, Karwautz A, Wagner G. Association of insulin-manipulation and psychiatric disorders: A systematic epidemiological evaluation of adolescents with type 1 diabetes in Austria. Pediatr Diabetes 2019; 20:127-136. [PMID: 30267464 PMCID: PMC7379731 DOI: 10.1111/pedi.12784] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/20/2018] [Accepted: 09/13/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND/OBJECTIVE The aim of this study was to systematically assess the association of insulin-manipulation (intentional under- and/or overdosing of insulin), psychiatric comorbidity and diabetes complications. METHODS Two diagnostic interviews (Diabetes-Self-Management-Patient-Interview and Children's-Diagnostic-Interview for Psychiatric Disorders) were conducted with 241 patients (age 10-22) with type 1 diabetes (T1D) from 21 randomly selected Austrian diabetes care centers. Medical data was derived from medical records. RESULTS Psychiatric comorbidity was found in nearly half of the patients with insulin-manipulation (46.3%) compared to a rate of 17.5% in patients, adherent to the prescribed insulin therapy. Depression (18.3% vs 4.9%), specific phobia (21.1% vs 2.9%), social phobia (7.0% vs 0%), and eating disorders (12.7% vs 1.9%) were elevated in patients with insulin-manipulation. Females (37.7%) were more often diagnosed (P = 0.001) with psychiatric disorders than males (18.4%). In females, the percentage of psychiatric comorbidity significantly increased with the level of non-adherence to insulin therapy. Insulin-manipulation had an effect of +0.89% in HbA1c (P = <0.001) compared to patients adherent to insulin therapy, while there was no association of psychiatric comorbidity with metabolic control (HbA1c 8.16% vs 8.12% [65.68 vs 65.25 mmol/mol]). Ketoacidosis, severe hypoglycemia, and frequency of outpatient visits in a diabetes center were highest in patients with insulin-manipulation. CONCLUSIONS This is the first study using a systematic approach to assess the prevalence of psychiatric disorders in patients who do or do not manipulate insulin in terms of intentional under- and/or overdosing. Internalizing psychiatric disorders were associated with insulin-manipulation, especially in female patients and insulin-manipulation was associated with deteriorated metabolic control and diabetes complications.
Collapse
Affiliation(s)
- Gabriele Berger
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Thomas Waldhoer
- Department of Public Health, EpidemiologyMedical University ViennaViennaAustria
| | - Irene Barrientos
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Daniela Kunkel
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Birgit M. Rami‐Merhar
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Edith Schober
- Department of Pediatric and Adolescent MedicineMedical University ViennaViennaAustria
| | - Andreas Karwautz
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| | - Gudrun Wagner
- Department of Child and Adolescent PsychiatryMedical University ViennaViennaAustria
| |
Collapse
|
4
|
Dobson R, Whittaker R, Murphy R, Khanolkar M, Miller S, Naylor J, Maddison R. The Use of Mobile Health to Deliver Self-Management Support to Young People With Type 1 Diabetes: A Cross-Sectional Survey. JMIR Diabetes 2017; 2:e4. [PMID: 30291057 PMCID: PMC6238862 DOI: 10.2196/diabetes.7221] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Young people living with type 1 diabetes face not only the challenges typical of adolescence, but also the challenges of daily management of their health and evolving understanding of the impact of their diagnosis on their future. Adolescence is a critical time for diabetes self-management, with a typical decline in glycemic control increasing risk for microvascular diabetes complications. To improve glycemic control, there is a need for evidence-based self-management support interventions that address the issues pertinent to this population, utilizing platforms that engage them. Increasingly, mobile health (mHealth) interventions are being developed and evaluated for this purpose with some evidence supporting improved glycemic control. A necessary step to enhance effectiveness of such approaches is to understand young people's preferences for this mode of delivery. OBJECTIVE A cross-sectional survey was conducted to investigate the current and perceived roles of mHealth in supporting young people to manage their diabetes. METHODS Young adults (16-24 years) with type 1 diabetes in Auckland, New Zealand, were invited to take part in a survey via letter from their diabetes specialist. RESULTS A total of 115 young adults completed the survey (mean age 19.5 years; male 52/115, 45%; European 89/115, 77%), with all reporting they owned a mobile phone and 96% (110/115) of those were smartphones. However, smartphone apps for diabetes management had been used by only 33% (38/115) of respondents. The most commonly reported reason for not using apps was a lack of awareness that they existed. Although the majority felt they managed their diabetes well, 63% (72/115) reported wanting to learn more about diabetes and how to manage it. A total of 64% (74/115) respondents reported that they would be interested in receiving diabetes self-management support via text message (short message service, SMS). CONCLUSIONS Current engagement with mHealth in this population appears low, although the findings from this study provide support for the use of mHealth in this group because of the ubiquity and convenience of mobile devices. mHealth has potential to provide information and support to this population, utilizing mediums commonplace for this group and with greater reach than traditional methods.
Collapse
Affiliation(s)
- Rosie Dobson
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
| | - Robyn Whittaker
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
- Waitemata District Health Board, Auckland, New Zealand
| | - Rinki Murphy
- Auckland District Health Board, Auckland, New Zealand
- Department of Medicine, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | | | - Steven Miller
- Waitemata District Health Board, Auckland, New Zealand
| | - Joanna Naylor
- Waitemata District Health Board, Auckland, New Zealand
| | - Ralph Maddison
- National Institute for Health Innovation, School of Population Health, University of Auckland, Auckland, New Zealand
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Melbourne, Australia
| |
Collapse
|
5
|
Coffen RD. The 600-Step Program for Type 1 Diabetes Self-Management in Youth: The Magnitude of the Self-Management Task. Postgrad Med 2015; 121:119-39. [DOI: 10.3810/pgm.2009.09.2059] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
6
|
Pinhas-Hamiel O, Hamiel U, Boyko V, Graph-Barel C, Reichman B, Lerner-Geva L. Trajectories of HbA1c levels in children and youth with type 1 diabetes. PLoS One 2014; 9:e109109. [PMID: 25275650 PMCID: PMC4183551 DOI: 10.1371/journal.pone.0109109] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 08/29/2014] [Indexed: 02/05/2023] Open
Abstract
Purpose To illustrate the distribution of Hemoglobin A1c (HbA1c) levels according to age and gender among children, adolescents and youth with type 1 diabetes (T1DM). Methods Consecutive HbA1c measurements of 349 patients, aged 2 to 30 years with T1DM were obtained from 1995 through 2010. Measurement from patients diagnosed with celiac disease (n = 20), eating disorders (n = 41) and hemoglobinopathy (n = 1) were excluded. The study sample comprised 4815 measurements of HbA1c from 287 patients. Regression percentiles of HbA1c were calculated as a function of age and gender by the quantile regression method using the SAS procedure QUANTREG. Results Crude percentiles of HbA1c as a function of age and gender, and the modeled curves produced using quantile regression showed good concordance. The curves show a decline in HbA1c levels from age 2 to 4 years at each percentile. Thereafter, there is a gradual increase during the prepubertal years with a peak at ages 12 to 14 years. HbA1c levels subsequently decline to the lowest values in the third decade. Curves of females and males followed closely, with females having HbA1c levels about 0.1% (1.1 mmol/mol) higher in the 25th 50th and 75th percentiles. Conclusion We constructed age-specific distribution curves for HbA1c levels for patients with T1DM. These percentiles may be used to demonstrate the individual patient's measurements longitudinally compared with age-matched patients.
Collapse
Affiliation(s)
- Orit Pinhas-Hamiel
- Maccabi Juvenile Diabetes Center, Raanana, Israel
- Pediatric Endocrine and Diabetes Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Tel Hashomer, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- * E-mail:
| | - Uri Hamiel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Valentina Boyko
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | | | - Brian Reichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| | - Liat Lerner-Geva
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel
- The Women and Children's Health Research Unit, Gertner Institute, Tel Hashomer, Israel
| |
Collapse
|
7
|
Cooper H, Spencer J, Lancaster GA, Titman A, Johnson M, Wheeler SL, Lwin R. Development and psychometric testing of the online Adolescent Diabetes Needs Assessment Tool (ADNAT). J Adv Nurs 2013; 70:454-68. [PMID: 23998442 DOI: 10.1111/jan.12235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2013] [Indexed: 11/29/2022]
Abstract
AIM To report on the development and psychometric testing of the Adolescent Diabetes Needs Assessment Tool. BACKGROUND The UK has the fifth largest paediatric diabetes population in the world, but one of the poorest levels of diabetes control, highlighting the need for intervention development. DESIGN Mixed methods following recommendations for questionnaire design and validation. METHODS A total of 171 young people (12-18 years) participated between 2008- 2011. Methods included item selection using secondary framework analysis, item review, pre-testing, piloting and online transfer. Statistical tests assessed reliability using item-total correlations, interitem consistency and test-retest reliability; and validity using blood glucose (HbA1c) levels and the Self-Management of type 1 Diabetes in Adolescence questionnaire. RESULTS The Adolescent Diabetes Needs Assessment Tool consists of 117 questions divided between six domains of educational and psychosocial support needs. It combines reflective questioning with needs assessment to raise self-awareness to support adolescent decision-making in relation to diabetes self-care. Thirty-six of the questions provide self-care and psychosocial health assessment scores. Face and content validity of the scoring items were all positively evaluated in terms of appropriateness and readability and tests for validity found significant correlations with Self-Management of type 1 Diabetes in Adolescence and weak correlation with HbA1c , which compared favourably with Self-Management of type 1 Diabetes in Adolescence, the only comparable (USA) tool. Item response analysis validated the use of simple additive scores. CONCLUSIONS The Adolescent Diabetes Needs Assessment Tool combines reflective learning with needs assessment to support patient-centred clinical consultations.
Collapse
Affiliation(s)
- Helen Cooper
- Department of Community Health and Well-being, University of Chester, UK; Research and Development Department, Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | | | | | | | | | | |
Collapse
|
8
|
Huston SA, Houk CP. Common sense model of illness in youth with type 1 diabetes or sickle cell disease. J Pediatr Pharmacol Ther 2012; 16:270-80. [PMID: 22768011 DOI: 10.5863/1551-6776-16.4.270] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVES To qualitatively explore differences in Leventhal's common sense model (CSM) constructs between youth with type 1 diabetes (T1D) and sickle cell disease (SCD) and between different age groups and level of disease control. METHODS Two structured individual interviews were conducted in 24 youth with T1D (n=12) or SCD (n=12). Patients were between 8 and 21 years of age, had either good or poor disease control, and were seen at an outpatient children's hospital medical clinic. RESULTS YOUTH CONCEPTUALIZE THEIR CHRONIC DISEASE IN TERMS OF IDENTITY, CAUSE, TIMELINE, CONTROL, AND CONSEQUENCES: both cognitive and emotional dimensions are apparent. There was considerable contrast between discussions of youth with well- and poorly controlled T1D but little contrast between youth with well- and poorly controlled SCD. Surprisingly, youth with well-controlled T1D mentioned emotions most frequently. No youth with poorly controlled T1D described disease acceptance, but the majority of youth with well-controlled T1D did. Adolescents and young adults with good T1D control appear to understand disease cause, have better illness coherence, and habitually link discussion of symptoms and negative emotions with solutions. Youth with poorly controlled T1D appeared more likely to connect symptoms with negative consequences. Consequences included 1) disease symptoms, 2) the need to perform self-care activities, 3) physical outcomes, 4) health-system activities, 5) emotions, and 6) life impact. Interestingly, sickling crisis was mentioned more frequently by youth with good SCD control than by those with poor SCD control. Youth with SCD are distressed by others' judgmental perceptions and by feeling different from others. CONCLUSIONS In contrast to previous CSM work, youth with well-controlled T1D in this study discussed emotions more frequently than did those with poor control. Disease perceptions were similar between youth with well- and poorly controlled SCD. Results indicate there are noteworthy cognitive and emotional differences between youth with different types of disease and levels of disease control.
Collapse
|
9
|
Guo J, Whittemore R, He GP. The relationship between diabetes self-management and metabolic control in youth with type 1 diabetes: an integrative review. J Adv Nurs 2011; 67:2294-310. [PMID: 21615460 DOI: 10.1111/j.1365-2648.2011.05697.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
AIMS The purpose of this integrative review was to describe the relationship between diabetes self-management and metabolic control in youth with type 1 diabetes and to explore factors which affect this relationship. BACKGROUND In the past 15 years, research has indicated that youth with type 1 diabetes face considerable self-management challenges and are at increased risk for poor metabolic control. To enhance the development of behavioural interventions for youth with type 1 diabetes, the relationship between diabetes self-management and metabolic control needs to be more clearly elucidated. DATA SOURCES Research studies that examined the relationship between diabetes self-management and metabolic control in youth with type 1 diabetes were included (n = 18). The electronic databases searched included OVID, MEDLINE (1996 to present), SCOPUS (1996 to January 2010) and PubMed (1996 to January 2010). REVIEW METHOD An integrative literature review was carried out using Whittemore's modified framework for data collection, analysis and synthesis. RESULTS A positive relationship between diabetes self-management and metabolic control in youth with type 1 diabetes was supported in longitudinal studies and in studies where the mean age was >13 years. Factors influencing this relationship are identified. Measurement of self-management was quite variable. CONCLUSION Interventions targeting self-management in youth with type 1 diabetes are indicated, particularly in families of diverse race and ethnicity globally. Further evaluation of the measures of self-management and more longitudinal research are also indicated.
Collapse
Affiliation(s)
- Jia Guo
- School of Nursing, Central South University, Changsha, Hunan Province, China
| | | | | |
Collapse
|
10
|
Guilmin-Crépon S, Tubiana-Rufi N. L’autosurveillance glycémique chez l’enfant et l’adolescent diabétique de type 1. ACTA ACUST UNITED AC 2010. [DOI: 10.1016/s1957-2557(10)70140-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
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
|
12
|
Smart CE, Ross K, Edge JA, King BR, McElduff P, Collins CE. Can children with Type 1 diabetes and their caregivers estimate the carbohydrate content of meals and snacks? Diabet Med 2010; 27:348-53. [PMID: 20536499 DOI: 10.1111/j.1464-5491.2010.02945.x] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIMS Carbohydrate (CHO) counting allows children with Type 1 diabetes to adjust mealtime insulin dose to carbohydrate intake. Little is known about the ability of children to count CHO and whether a particular method for assessing CHO quantity is better than others. We investigated how accurately children and their caregivers estimate carbohydrate, and whether counting in gram increments improves accuracy compared with CHO portions or exchanges. METHODS One hundred and two children and adolescents (age range 8.3-18.1 years) on intensive insulin therapy and 110 caregivers independently estimated the CHO content of 17 standardized meals (containing 8-90 g CHO), using whichever method of carbohydrate quantification they had been taught (gram increments, 10-g portions or 15-g exchanges). RESULTS Seventy-three per cent (n = 2530) of all estimates were within 10-15 g of actual CHO content. There was no relationship between the mean percentage error and method of carbohydrate counting or glycated haemoglobin (HbA(1c)) (P > 0.05). Mean gram error and meal size were negatively correlated (r = -0.70, P < 0.0001). The longer children had been CHO counting the greater the mean percentage error (r = 0.173, P = 0.014). Core foods in non-standard quantities were most frequently inaccurately estimated, while individually labelled foods were most often accurately estimated. CONCLUSIONS Children with Type 1 diabetes and their caregivers can estimate the carbohydrate content of meals with reasonable accuracy. Teaching CHO counting in gram increments did not improve accuracy compared with CHO portions or exchanges. Large meals tended to be underestimated and snacks overestimated. Repeated age-appropriate education appears necessary to maintain accuracy in carbohydrate estimations.
Collapse
Affiliation(s)
- C E Smart
- Department of Paediatric Endocrinology, John Hunter Children's Hospital, Newcastle, NSW, Australia.
| | | | | | | | | | | |
Collapse
|
13
|
Hood KK, Peterson CM, Rohan JM, Drotar D. Association between adherence and glycemic control in pediatric type 1 diabetes: a meta-analysis. Pediatrics 2009; 124:e1171-9. [PMID: 19884476 DOI: 10.1542/peds.2009-0207] [Citation(s) in RCA: 239] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Although adherence has been identified in practice guidelines for youth with type 1 diabetes to promote optimal glycemic control, there has been no systematic integration of studies investigating the adherence-glycemic control link. This recommendation partly stemmed from the Diabetes Control and Complications Trial (DCCT); however, this trial did not comprehensively measure adherence and had only 195 adolescents. OBJECTIVE Our goal was to determine the magnitude of the adherence-glycemic control link in pediatric type 1 diabetes and evaluate its correlates. METHODS Our data sources were PubMed (1950-2008), Scopus (1950-2008), and references from reviews in pediatric type 1 diabetes. Studies that included youth under age 19 with type 1 diabetes and a reported association between adherence and glycemic control were eligible for inclusion. Articles were not included if they contained youth with type 2 diabetes, had study samples that overlapped with other studies, or the results came from intervention studies. Of the eligible 26 studies, 21 had sufficient statistical data. Two authors independently extracted information by using a standardized protocol. Agreement between coders was high. RESULTS The mean effect size across 21 studies, including 2492 youth with type 1 diabetes, was -0.28 (95% confidence interval: -0.32 to -0.24). As adherence increases, A1c values decrease. No sample or disease characteristics were correlates of the adherence-glycemic control link. Pre-DCCT studies had a mean effect size of -0.32 (8 studies; 1169 participants) compared with -0.25 in post-DCCT studies (13 studies; 1323 participants). CONCLUSIONS This meta-analysis supports the adherence-glycemic control link in pediatric type 1 diabetes. The weaker post-DCCT association suggests that the approach to intensive diabetes management has shortcomings. We conclude that this is because of a mismatch between what scientists and clinicians know is the best way to manage pediatric type 1 diabetes and the capabilities of youth and their families.
Collapse
Affiliation(s)
- Korey K Hood
- Department of Pediatrics, Center for the Promotion of Treatment Adherence and Selfmanagement, Cincinnati Children'sHospital Medical Center, University of Cincinnati College of Medicine, Cincinnati, Ohio 45229, USA.
| | | | | | | |
Collapse
|
14
|
Cooper H, Cooper J, Milton B. Technology-based approaches to patient education for young people living with diabetes: a systematic literature review. Pediatr Diabetes 2009; 10:474-83. [PMID: 19490492 DOI: 10.1111/j.1399-5448.2009.00509.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- Helen Cooper
- Faculty of Health and Social Care, University of Chester, Chester, CH1 4BJ UK.
| | | | | |
Collapse
|
15
|
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
|
16
|
Coffen RD, Dahlquist LM. Magnitude of type 1 diabetes self-management in youth: health care needs diabetes educators. DIABETES EDUCATOR 2009; 35:302-8. [PMID: 19218484 DOI: 10.1177/0145721708327534] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this article is to demonstrate the complexity of the type 1 diabetes regimen and to highlight the essential role of the diabetes educator in safely training and implementing the myriad skills in a developmentally appropriate manner for children and adolescents. A review of literature and a task analysis were preformed and suggest that the complexity of the regimen is often not adequately addressed. Reviewed research assessed the regimen using measures with on average about 25 items while the task analysis contains over 600 tasks. The article discusses implications for clinical practice, including implications for measurement in research, targeting of interventions by diabetes educators, and the gradual transfer of regimen control to youth. It is argued that given the magnitude of the self-management task, education cannot be accomplished in the limited time that general practice physicians, pediatricians, or endocrinology specialists can spend with each patient. It is concluded that youth must be helped to internalize the importance of the regimen tasks and that transfer of these tasks to youth requires a developmentally sensitive approach to education. Diabetes educators serve an essential role in which they help young patients and their parents manage and master this overwhelming experience through promoting youth's involvement in tasks when full responsibility is not yet appropriate. The regimen is too complex for youth to undertake self-management without multidisciplinary support.
Collapse
Affiliation(s)
- Ronald D Coffen
- The Educational and Counseling Psychology Department, Andrews University, Berrien Springs, Michigan (Dr Coffen)
| | - Lynnda M Dahlquist
- Department of Psychology, University of Maryland Baltimore County, Baltimore, Maryland (Dr Dahlquist)
| |
Collapse
|
17
|
Dashiff C, Vance D, Abdullatif H, Wallander J. Parenting, autonomy and self-care of adolescents with Type 1 diabetes. Child Care Health Dev 2009; 35:79-88. [PMID: 18991978 PMCID: PMC4797949 DOI: 10.1111/j.1365-2214.2008.00892.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND During adolescence diabetes creates a juncture of very complex disease management demands with developmental needs, including the striving of adolescents for greater autonomy. Parents' concerns and fears about the teen's diabetes self-management abilities during this time can heighten parental attachment behaviour and affect the parents' ability to support autonomy development necessary for effective self-care. Maternal parenting processes may be especially important for those adolescents who have Type 1 diabetes because mothers are the primary caregivers. PURPOSE Based on attachment theory, the aim was to test a model of the influence of mother-adolescent developmental conflict, maternal separation anxiety and maternal inhibition of autonomy and relatedness on cognitive autonomy and self-care of adolescents with Type 1 diabetes. METHOD A total of 131 families with an adolescent, aged 11-15 years, contributed data annually across three waves. Mothers and adolescents completed paper-and-pencil measures and two interaction scenarios that were coded by trained staff from audio-tapes. The adolescent also completed a structured interview and questionnaire to assess self-care. RESULTS Maternal separation anxiety when adolescents were 11-15 years of age directly predicted cognitive autonomy at 1-year follow-up, and that cognitive autonomy was directly related to self-care 1 year later, but did not mediate between separation anxiety and self-care. CONCLUSIONS Future investigation of the influence of separation anxiety of parents on adolescent autonomy development is warranted, as well as the contribution of autonomy development to diabetes self-management behaviours of adolescents.
Collapse
Affiliation(s)
- Carol Dashiff
- NB 323, School of Nursing, University of Alabama at Birmingham, 1530 3 Ave. South, Birmingham, AL 35294-1210, (205) 996-6110
| | - David Vance
- Hussein Abdullatif, MD, Associate Professor, Jan Wallander, PhD, Professor, University of Alabama at Birmingham
| | | | | |
Collapse
|
18
|
Tubiana-Rufi N, Lahaie E, Jacquin P, Guitard-Munnich C, Houdan J, du Pasquier L. Le passage des adolescents diabétiques de la pédiatrie à la médecine pour adultes: être ou ne pas être perdu en transit? Arch Pediatr 2007; 14:659-61. [PMID: 17419029 DOI: 10.1016/j.arcped.2007.02.084] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2007] [Accepted: 02/27/2007] [Indexed: 11/19/2022]
Affiliation(s)
- N Tubiana-Rufi
- Service d'endocrinologie-diabétologie, Assistance publique-Hôpitaux de Paris, hôpital Robert-Debré, 48, boulevard Sérurier, 75019 Paris, France.
| | | | | | | | | | | |
Collapse
|
19
|
Tseng FY, Lai MS. Effects of physician specialty on use of antidiabetes drugs, process and outcomes of diabetes care in a medical center. J Formos Med Assoc 2006; 105:821-31. [PMID: 17000455 DOI: 10.1016/s0929-6646(09)60269-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND/PURPOSE Physician characteristics might determine the quality of diabetes care. This study evaluated the effects of physician specialty on the use of antidiabetes drugs, process and outcomes of diabetes care. METHODS In 2002, 12,023 diabetes patients visited outpatient clinics more than four times at National Taiwan University Hospital. One-tenth of the patients were randomly sampled out. A retrospective chart review was conducted for those who were regularly cared for by endocrinologists (EN), other specialists in internal medicine (IM) and family medicine (FM) physicians. The use of antidiabetes drugs was assessed. Effects of physician specialty on the process or outcome indicators were analyzed by logistic or linear regression, accordingly. RESULTS A total of 875 diabetes patients (477 men, 398 women) with a mean age of 62.3 +/- 12.7 years were recruited. EN patients had the highest rate of being prescribed insulin, metformin or nonsulfonylurea insulin secretagogues, and the lowest rate of being given sulfonylureas. EN patients showed a significantly better adherence to glucose checkup, glycosylated hemoglobin A1C measures and urinalysis than IM patients. EN patients also showed better adherence to glucose checkup and urinalysis than FM patients. EN patients had the lowest mean fasting plasma glucose (FPG) and lowest mean postprandial plasma glucose (PPG). The difference in PPG between EN and IM patients and the difference in FPG between EN and FM patients were persistently significant following adjustment by patient and physician characteristics. CONCLUSION The use of antidiabetes drugs differed among patients cared for by EN, internists or generalists. Physician specialty had significant effects on the process and outcomes of diabetes care.
Collapse
Affiliation(s)
- Fen-Yu Tseng
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, 19 Hsu Chow Road, Taipei 100, Taiwan
| | | |
Collapse
|
20
|
Stilley CS, Lawrence K, Bender A, Olshansky E, Webber SA, Dew MA. Maturity and adherence in adolescent and young adult heart recipients. Pediatr Transplant 2006; 10:323-30. [PMID: 16677356 DOI: 10.1111/j.1399-3046.2005.00473.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Pediatric transplant (txp) teams note high rates of non-adherence and risky behaviors linked to morbidity and mortality among adolescent and young adult recipients. Clinicians and parents alike report symptoms of social immaturity and failure to appreciate consequences of risky behavior; relationships between the two have not been studied in this population. METHOD This two-phase mixed method study examined adherence, high-risk behaviors, and maturity in a sample of 27 heart recipients, aged 15-31, who underwent transplantation in childhood or adolescence at Children's Hospital of Pittsburgh. All subjects completed a projective ego development measure and a questionnaire about adherence to the post-txp regimen. Nine recipients, purposely selected for good or poor adherence according to criteria determined by the transplant team and matched on age, participated in phase 2 qualitative interviews and mood assessments. RESULTS Sixty-three percent of the phase 1 sample missed medications, 67% missed appointments, 11% smoked, 37% had difficulty with diet, 89% exercised infrequently, 33% had tattoos, 26% had more than two body piercings, and 11% used street drugs. Six themes and a core construct of maturity were identified with qualitative methodology. Poor adherers were less mature on every theme and consistently scored at a less mature level on the projective measure of ego development. Chronological age was not related to the level of maturity in qualitative or projective data. Most interview subjects reported high levels of anxiety, and two reported clinically significant levels of depression and anger; mood was not related to adherence. CONCLUSIONS Non-adherence and high-risk behaviors are prevalent among adolescent and young adult heart recipients. Level of maturity appears to be associated with ability to adhere to the treatment regimen and avoid high-risk behaviors.
Collapse
Affiliation(s)
- Carol S Stilley
- School of Nursing, Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA 15261, USA.
| | | | | | | | | | | |
Collapse
|