Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp

Applying the use of shared medical appointments (SMAs) to improve continuous glucose monitor (CGM) use, glycemic control, and quality of life in marginalized youth with type 1 diabetes: Study protocol for a pilot prospective cohort study

Background

Continuous glucose monitors (CGMs) have been associated with improved glycemic control and diabetes-related quality of life in youth with type 1 diabetes (T1D), however use is lowest among youth from low-income households and racial/ethnic minorities. Shared medical appointments (SMAs) have been shown to improve glycemic control and reduce diabetes distress in adolescents with T1D, but a focus on marginalized youth has been lacking. This prospective cohort pilot study will assess feasibility and acceptability of the SMA intervention and impact on CGM uptake and sustained use, glycemic control, and diabetes distress in marginalized youth with elevated hemoglobin A1c (HbA1C).

Methods

The pilot study will recruit 20 publicly insured youth with T1D aged 8-12 years who identify as non-Hispanic Black or Latinx and have had at least one HbA1C value > 8% in the past year and their primary caretaker. The trial will employ an enrollment visit, SMA visits every 3 months over a 12-month study period, and a 6-month follow-up observational period. Feasibility measures include proportion of eligible youth successfully recruited for participation, proportion initiating CGM, SMA attendance, and retention through study completion. Acceptability will be assessed using satisfaction surveys. Changes in glycemic control will be assessed using CGM metrics and A1c from baseline to completion of the 12-month SMA intervention, as well as 3 and 6-months after completion of the SMA intervention.

Conclusion

Implementing SMAs for marginalized youth has the potential to address diabetes disparities by optimizing clinical and psychosocial outcomes for the most vulnerable youth living with T1D.Trial Registration: https://clinicaltrials.gov/ct2/show/NCT05431686.

Temporal Changes of Metabolic Indicators and Quality of Life by a Two-Day Patient Education Program for Metabolic Syndrome Patients

Metabolic syndrome (MetS) is a disease with a high prevalence that threatens the health of modern people. Patient education is essential to control MetS. This prospective study aimed to evaluate 6-month changes in health indicators following a two-day education program for patients with MetS aged 45 or older. Education about MetS, lifestyle modification, nutrition, and physical activity was provided. At 3 and 6 months after the program, participants visited for follow-up. Twenty-two patients completed the 6-month study. Waist circumference was reduced, and life quality and depression index improved in 3 and 6 months compared to pre-education. Blood pressure decreased, and anxiety index improved at three months. Nutritional knowledge was well maintained for 3 and 6 months. High-density lipoprotein-cholesterol levels increased at six months. Three out of twenty-two patients did not satisfy MetS criteria at the end of the study due to improved indicators. A two-day multidisciplinary education program positively affected health indicators in MetS patients. Participation in the program also help with life satisfaction and positive emotional condition. However, some indicators improved in 3 months, but the effect disappeared 6 months after the program.

Improvements in Psychosocial Outcomes Following a Summer Camp for Youth with Bleeding Disorders and Their Siblings

PURPOSE

Complications from bleeding episodes from hemophilia can interfere with children's lives and lead to negative psychosocial outcomes. The purpose of this study is to evaluate whether attitude toward illness, hope, perception of illness benefit and/or burden, and/or illness knowledge change for youth with bleeding disorders and their siblings following a five-day education and activity focused summer camp. We hypothesized that youth with bleeding disorders' attitude toward illness, hope, perception of illness benefit, and illness knowledge would improve after camp attendance, and perception of illness burden would decease after camp attendance. We hypothesized that siblings' hope and illness knowledge would improve after camp attendance.

DESIGN AND METHODS

A total of 98 youth (M = 10.9, SD = 3.33, 61.2% male) who attended a bleeding disorder summer camp participated in this study. Fifty percent of participants were diagnosed with either Hemophilia A, Hemophilia B (5%), Von Willebrand Disease (VWD) (28.3%), or platelet deficiency (1.7%), with 38 campers consisting of healthy siblings. The camp hosted "Learning about Hemophilia" breakout sessions for campers. Participants completed self-report questionnaires on the first day and last day of camp.

RESULTS

Of participants with bleeding disorders, illness knowledge, perception of illness benefit, and attitude toward their illness significantly improved from pre-camp to post-camp. Hope did not significantly improve among youth with bleeding disorders. Healthy siblings' total hope significantly improved while illness knowledge remained constant.

CONCLUSIONS

Summer camps are a promising intervention to improve psychosocial outcomes in youth with hemophilia and WVD.

CONCLUSIONS

Summer camps are a promising intervention to improve psychosocial outcomes in youth with hemophilia and WVD.

Changes in glycated hemoglobin, diabetes knowledge, quality of life, and anxiety in children and adolescents with type 1 diabetes attending summer camps: A systematic review and meta-analysis

Diabetes summer camps provide children and adolescents with type 1 diabetes opportunities to learn about the disease and its management in a supportive environment to help improve glycemic control, self-reliance, and quality of life. The objective of this quantitative review was to assess the advantages of attending summer camps and study any adverse psychological effects. Studies with a pre/post study design in children and adolescents attending summer camp were systematically reviewed. Five bibliographic databases were searched and relevant data extracted. Random effects meta-analyses were used to combine the individual study results to derive pooled estimates and meta-regression was used to explore between-study heterogeneity. Studies in the literature report short-term improvements in the glycemic control, diabetes knowledge (DK), quality of life (QOL) anxiety, diabetes self-management, and self-esteem. Thirty-three studies were identified, and those outcomes reported in five or more studies were included in meta-analyses. There were significant benefits with a pooled mean change for glycated hemoglobin (95% CI) of -0.59(-0.95,-0.23)% (-6.4[-10.4,-2.5]mmol/mol), and for standardized DK score of 1.99(1.28,2.70) but corresponding changes for QOL 0.17(-0.06,0.39) and for anxiety -0.32(-0.70, 0.06) were not significant. However, all outcomes showed considerable between-study heterogeneity little of which was explained by study characteristics. The findings suggest short-term benefits of camp on metabolic control, DK, QOL and anxiety in T1D children and adolescents, although the latter two were not statistically significant. Further research is warranted with more methodological rigor and longer-term follow-up to determine if there are long-term benefits associated with camp attendance.

Assessing disparities in barriers to attending pediatric diabetes camp

OBJECTIVES

While the benefits of diabetes camp programs are well established, minority youth are underrepresented in camp attendance. No research to date has explored barriers to camp attendance or potential disparities in those barriers. Further, little is known about sources families prioritize in seeking diabetes information and support.

METHODS

This was a prospective survey of families of children with type 1 diabetes (T1D) using convenience sampling during normally-scheduled clinic visits. Thirty-nine children and their caregivers completed the survey. Results were analyzed for prevalence and mean number of reported barriers, benefits, and diabetes information networks.

RESULTS

Age range was 5-15 years and mean duration of diabetes was 2.9 years (0.4-9y). The most prevalent barriers were location, cost, and concern about sending children to overnight camp. Caregivers had high level of knowledge of camp benefits. Participants reported engaging with the diabetes community through interactions with their diabetes team, Facebook groups, and the JDRF.

CONCLUSION

Increasing awareness, transportation assistance, and scholarship funding all may increase accessibility of diabetes camps. Diabetes clinic and online or social media groups are both acceptable means of disseminating information about diabetes camp. Further research is indicated to verify if these results are applicable to the larger diabetes community.

Measuring Quality of Life in Adolescents with Type 1 Diabetes at a Diabetes Camp

Living with Type 1 Diabetes Mellitus (T1D) significantly impacts every part of a person's life as optimal glycemic control requires frequent monitoring of blood glucose and the use of complex dose calculations and insulin delivery systems. The intensity of effective diabetes care is particularly challenging during the period of adolescence as adolescents must navigate diabetes management in conjunction with significant physical, cognitive, and psychosocial growth. The task of balancing the typical changes of adolescents alongside diabetes management can have significant negative impacts on an adolescent's quality of life. Quality of life, or an individual's view of their overall well-being, can be used as a psychological indicator of health adaptation in diabetic youth. The study seeks to examine the link between diabetes self-efficacy and perceived quality of life in adolescents living with T1D. While no statistically significant links were found in the pilot study, it is apparent that adolescents with T1D often feel different than their peers. Opportunities for youth with T1D to engage in camps with other diabetic youth is critical for adolescents in order to promote the development of self-identity and self-efficacy that includes effective diabetes management.

Racial Ethnic Disparities in Youth With Type 1 Diabetes Participating in Diabetes Summer Camps

OBJECTIVE

Diabetes camps are beneficial for campers and include benefits such as increases in diabetes knowledge, glycemic control, and psychological functioning. Racial/ethnic minority youth are likely to have poorer disease management and glycemic control. We hypothesized that minority youth with type 1 diabetes have reduced participation in diabetes summer camps.

RESEARCH DESIGN AND METHODS

We analyzed deidentified data from 5,256 campers with type 1 diabetes who participated in a network of 48 American Diabetes Association-affiliated summer camps in 2018, and we compared participation rates by racial/ethnic category to the most recent SEARCH for Diabetes in Youth study prevalence rates.

RESULTS

Camper demographics were significantly different than in the general population of children with type 1 diabetes (P < 0.001). Minority youth were more likely to attend day camp, be first-time campers, and request financial aid, and they were less likely to be on insulin pump therapy or use continuous glucose monitors.

CONCLUSIONS

Racial/ethnic minority youth with diabetes are underrepresented in diabetes camps nationwide.

Impact of insulin reduction on glycemic control in children attending a residential diabetes camp

BACKGROUND/OBJECTIVES

Children attending diabetes camp are more active, increasing the risk of hypoglycemia. Decreasing initial insulin doses may reduce this risk. The objectives of our study were to compare glycemic control between campers receiving multiple daily injections (MDI) and continuous subcutaneous insulin infusion (CSII), and analyze the impact of decreasing basal insulin by 10%.

METHODS

We analyzed 849 camp sessions (599 children, 5-19 years old) from Camp Sweeney's 2016/2017 summers. Campers were separated into groups by year and insulin route (MDI_2016, MDI_2017, CSII_2016, and CSII_2017). The MDI_2016 group had initial basal insulin decreased 10%, while CSII_2016, MDI_2017, and CSII_2017 did not. Time spent in blood glucose ranges and area under the curve (AUC) were compared by year and insulin route using ANOVA. We also performed repeated measures ANOVA using campers who attended both years.

RESULTS

No significant differences in time spent in any glucose range could be attributed to the initial 10% basal decrease, including on paired analysis. MDI_2017 had more decreases to basal insulin than the other groups. CSII campers had higher AUC and more hyperglycemia than MDI campers.

CONCLUSIONS

Campers on MDI may benefit from decreasing basal insulin, either at the beginning of camp or during the first week. Future research is needed to optimize glycemic control in the camp setting.

Challenges to Diabetes Self-Management in Emerging Adults With Type 1 Diabetes

PURPOSE

The purpose of this qualitative descriptive study undergirded by Meleis's Transition Framework was to explore developmental, situational, and organizational challenges experienced by a diverse group of emerging adults (18-29 years old) with type 1 diabetes (T1DM). Their perspectives on creating a developmentally informed diabetes self-management (DSM) program that supports transitional care were also explored.

METHODS

A purposive sample of emerging adults with T1DM was recruited from the pediatric and adult diabetes clinics of an urban academic medical center. Those who consented participated in either a single focus group or a single interview. Self-reported demographic and clinical information was also collected.

RESULTS

The sample was comprised of 21 emerging adults, with an average age of 23.6 ± 2.6 years, diabetes duration of 14.7 ± 5.0 years, and 71% female. Four main themes emerged: (1) finding a balance between diabetes and life, (2) the desire to be in control of their diabetes, (3) the hidden burden of diabetes, and (4) the desire to have a connection with their diabetes provider. Use of insulin pumps and continuous glucose monitors and attendance at diabetes camp decreased some of the DSM challenges. Different groups of individuals had different perspectives on living with diabetes and different approaches to DSM.

CONCLUSIONS

The emerging adults in this study had a strong desire to be in good glycemic control. However, all participants described having a hard time balancing DSM with other competing life priorities. They also desired personalized patient-provider interactions with their diabetes care provider in clinical follow-up services. Even though the study sample was small, important themes emerged that warrant further exploration.

Diabetes camp still matters: Relationships with diabetes-specific distress, strengths, and self-care skills

OBJECTIVE

Prior studies suggest diabetes camps improve psychosocial well-being in youth with type 1 diabetes but these studies suffer from variable levels of rigor. The present study assessed associations between camp participation and diabetes distress, perceived independence in diabetes self-care, and diabetes strengths in a large sample of children, adolescents, and their parents across 44 camps in the United States. Analyses compared viewpoints of study participants, identified moderators of change, and assessed perceived benefits of camp participation.

METHODS

There were 2488 youth and 2563 parents consented for participation in the online survey. Participants reported diabetes distress and perceived independence in youth care, their new experiences and best parts of camp, and changes in behavior following camp. T-tests, regressions, Cohen's d, and relative frequencies were used as appropriate to assess baseline differences between reporters, pre-post outcome differences, and moderators of change.

RESULTS

Parents as compared to youth reported higher pre-camp distress and lower perception of youth independence in self-care. Youth experienced a statistically significant decrease in distress and increase in independence in self-care. Diabetes strengths did not change. Higher A1c prior to camp was associated with higher levels of distress across camp participation. Campers and their parents endorsed a high frequency of positive firsts, bests, and benefits of camp.

CONCLUSIONS

Data from a large sample youth with type 1 diabetes across multiple camps showed broad-based psychosocial benefits of camp participation.

Diabetes camp matters: Assessing families' views of their diabetes camp experience

BACKGROUND

Camp offers a safe and fun environment for learning new information about diabetes care and for trying new self-care skills. It is a place where children and teens are able to meet with others who also have diabetes and who share their experiences.

MATERIALS AND METHODS

This study assessed self-reports before and after attending diabetes camp on diabetes-specific emotional distress, diabetes-specific quality of life, and self-care behaviors by surveying campers and their parents from over 42 diabetes-specific summer camps across the United States. Parents (N = 413), Teenagers (N = 154), and Children (N = 116) completed both pre- and post-camp surveys.

RESULTS

Parents reported higher levels of diabetes-specific emotional distress than their campers did. Both parents and children reported significant improvements in their own distress after camp. Teens reported improvements in distress but they were not statistically significant. Youth report higher levels of self-care skills than parents believe their children possess. Parents, Teens, and Children all reported significant improvements in the camper's self-care skills after camp. First time campers' and their parents' perspectives regarding self-care skills are consistent with veteran campers after attending camp. Self-reports post-camp reveals that campers and their parents see camp as a place where youth feel they are with others who really understand what it is like to live with diabetes. Respondents also report that camp is a place where youth are exposed to new technologies and where campers can try new self-care tasks.

Using an Expert Panel to Develop Social Support Program Sequencing for Young Adults With Type 1 Diabetes

BACKGROUND

Young adults living with type 1 diabetes (T1DM) often encounter poor health outcomes, such as uncontrolled blood glucose levels. Social support programs can be a helpful method to support T1DM self-management. Effectively planning and tailoring social support programs for young adults living with T1DM are crucial for improving these programs and associated outcomes.

OBJECTIVES

This study convened an expert panel primarily composed of young adults living with T1DM to generate ideas and key components for sequential inclusion in social support programs prioritizing them.

METHOD

Exploratory expert panel meetings consisting of four individuals living with T1DM were held where Nominal Group Technique and Ideawriting exercises were used to develop themes and discussion points.

RESULTS

Six themes emerged from the meetings representing areas of difficulty for young adults living with T1DM. Topics such as following self-care recommendations, nutrition, handling stress, coping with social situations, and navigating the health care system were identified as important issues facing young adults.

CONCLUSIONS

By incorporating this approach into new or existing support group improved program discussions for young adults can be achieved and pertinent issues addressed, thus leading to improved health care outcomes.

Blood Glucose Control and Related Factors at a Camp for Korean Children and Adolescents with Type 1 Diabetes

Data about Asian children and adolescents with type 1 diabetes are sparse. This study's objectives were to describe blood glucose (BG) levels and related factors at a camp for Korean children and adolescents with type 1 diabetes. This descriptive study was conducted January 8-10, 2015. The participants, 24 children and adolescents, were recruited for a 3-day residential diabetes camp. Data on 24 campers were analyzed. Their mean age was 13.4 (± 1.7) years; 44.4% were boys, and mean HgbA1c was 8.5% (± 1.4%). Results revealed that BG levels were maintained safely: The mean BG level during the 3-day stay was 171.1 (± 33.3) mg/dl. Multiple regression analysis showed that insulin adjustment for hyperglycemia (standardized β = .426; t = 2.431; p = .030) and snacks for hypoglycemia (standardized β = -.719; t = -3.723; p = .003) at the camp were the only independent contributors to mean BG levels during the 3-day study period. No demographic or clinical factor was found to be associated with the mean BG level. This is the first study of its kind to be conducted in an Asian population, presumably because the prevalence of type 1 diabetes in Asia is low and diabetes camps are a novel concept. Further research is recommended to assess the characteristics of campers (e.g., diet, activity levels, and cultural background) and to determine how the health outcomes of children and adolescents with type 1 diabetes are affected by camp programs.

Food exchange estimation by children with type 1 diabetes at summer camp

BACKGROUND

As exchange counting poses difficulty for children with type 1 diabetes (T1D) attending diabetes camps, they often guesstimate food amount without performing an exchange calculation. The aim of the study was to compare the accuracy of estimation with exchange counting using the mobile food exchange calculator (MFEC).

METHODS

During a summer camp, 25 children with T1D on pumps estimated the number of carbohydrate (CE) and fat/protein exchanges (FPE) appropriate for main meals. Afterwards, the number of exchanges was counted with MFEC and electronic scales.

RESULTS

There was a difference between CE (p<0.0001) and FPE (p<0.0001) estimations and counting using MFEC. The youth miscalculated the true values of ≥1 CE and ≥1 FPE by 31% and 23%, respectively. They more often underestimated than overestimated CE and FPE (p<0.0001). The estimation error increased with younger age.

CONCLUSIONS

Carbohydrate counting caused significant error in the exchange number. The use of MFEC facilitates correct exchange calculation. Patients should weigh food and calculate exchanges themselves using mobile applications.

Scoping review: strategies of providing care for children with chronic health conditions in low- and middle-income countries

OBJECTIVES

To identify and review strategies of providing care for children living with chronic health conditions in low- and middle-income countries.

METHODS

We searched MEDLINE and Cochrane EPOC databases for papers evaluating strategies of providing care for children with chronic health conditions in low- or middle-income countries. Data were systematically extracted using a standardised data charting form, and analysed according to Arksey and O'Malley's 'descriptive analytical method' for scoping reviews.

RESULTS

Our search identified 71 papers addressing eight chronic conditions; two chronic communicable diseases (HIV and TB) accounted for the majority of papers (n = 37, 52%). Nine (13%) papers reported the use of a package of care provision strategies (mostly related to HIV and/or TB in sub-Saharan Africa). Most papers addressed a narrow aspect of clinical care provision, such as patient education (n = 23) or task-shifting (n = 15). Few papers addressed the strategies for providing care at the community (n = 10, 15%) or policy (n = 6, 9%) level. Low-income countries were under-represented (n = 24, 34%), almost exclusively involving HIV interventions in sub-Saharan Africa (n = 21). Strategies and summary findings are described and components of future models of care proposed.

CONCLUSIONS

Strategies that have been effective in reducing child mortality globally are unlikely to adequately address the needs of children with chronic health conditions in low- and middle-income settings. Current evidence mostly relates to disease-specific, narrow strategies, and more research is required to develop and evaluate the integrated models of care, which may be effective in improving the outcomes for these children.

Camp for Youth With Type 1 Diabetes

Camps for youth with type 1 diabetes (T1D) have grown in size and scope since they first emerged in the 1920s. Anecdotal evidence suggests that attending camp with other youth with T1D is beneficial, largely attributed to sharing fun, active experiences and removing the isolation of living with diabetes. However, few studies have evaluated the psychosocial and medical impacts of T1D camp attendance during and after camp sessions. In addition, T1D camps have been a setting for numerous studies on a variety of T1D-related research questions not related to camp itself, such as testing novel diabetes management technologies in an active, non-laboratory setting. This paper reviews the evidence of psychosocial and medical outcomes associated with T1D camp attendance across the globe, provides an overview of other research conducted at camp, and offers recommendations for future research conducted at T1D camp.

Are diabetes camps effective?

In the present article data about Diabetes Camps (DC) from all continents were reviewed in order to answer the title question "are diabetes camps effective?". Articles from peer reviewed journals and abstracts published in international conferences proceedings were raised. The effectiveness was considered in terms of knowledge acquisition, and psychosocial and physiological changes. Even though expected improvements were not found in all studies, in a deeper and wider analysis the aspects that influence the most toward gains are identified. Among them are: number of participations in a DC, post-camp educational opportunities, staff training, and program oriented toward campers' autonomy. To conclude, practical recommendations are addressed intending to amplify DC's potential.

Impact of a pioneer diabetes camp experience on glycemic control among children and adolescents living with type 1 diabetes in sub-Saharan Africa

BACKGROUND

The metabolic impact of participating in a diabetes camp is little known among children and adolescents living with type 1 diabetes in sub-Saharan Africa. We aimed to assess the changes in glycemic control and insulin doses in a group of children and adolescents living with type 1 diabetes in Cameroon during and after camp attendance.

METHODS

During a 5-day camp, we collected data on insulin doses, HbA1c, weight and blood glucose at least six times per day in a group of children and adolescents living with type 1 diabetes. We compared the evolution of these parameters 3 and 12 months after camp.

RESULTS

Thirty-two campers completed the study. The mean age was 19 ± 2 years and the median duration of diabetes was 2 [IQR: 1.8-5] years. The mean HbA1c was 7.9 ± 2.2 % and the mean insulin dose was 49 ± 20 units/day upon arrival at camp. HbA1c dropped by 0.6 % after 12 months (p = 0.029). Despite the significant (p = 0.04) reduction in insulin dose from 49 ± 20 to 44 ± 18 units/day at the end of camp, hypoglycemic episodes occurred in 26 campers. However, the mean number of hypoglycemic episodes reduced from 1.32 (range: 0-4) on the first day, to 0.54 (range: 0-2) on the last day of camp (p = 0.006). Weight increased by 6 kg (p = 0.028) between 3 and 12 months after camp, but insulin doses remained unchanged.

CONCLUSIONS

Attending camp for children and adolescents living with diabetes is associated with a significant decrease in HbA1c twelve months after camp without changes in insulin doses. Including camps as an integral part of type 1 diabetes management in children and adolescents in sub-Saharan Africa may yield some benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02632032 . Registered 4 December 2015.

The psychological and social impact of camp for children with chronic illnesses: a systematic review update

Advances in medicine have reduced mortality among children with complex medical conditions, resulting in a growing number of young patients living with chronic illnesses. Despite an improved prognosis, these children experience significant psychosocial morbidity, such as depression and anxiety. Therapeutic summer recreation camps have been proposed as an intervention to enhance quality of life among these children. The purpose of this systematic review was to assess the psychosocial impact of camp for children with chronic illnesses. A systematic review of central databases was undertaken using key words, and a rating tool – the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies – was employed to rate methodological quality. 21 studies were included in this systematic review. Although overall methodological quality was weak, camp participation appeared to offer short-term psychosocial benefits on some parameters in children with a variety of chronic illnesses. There was some consistency in improved social outcomes, such as social interaction and acceptance. Based on the available evidence, it is premature to make robust claims regarding the psychosocial impact of camp as a therapeutic intervention. Theoretically informed camp programs, long-term follow-up, and incorporating camp-based messaging into routine hospital care,may enhance the utility of camp as a potential psychosocial intervention in paediatrics.

Blood glucose levels in children with Type 1 diabetes attending a residential diabetes camp: a 2-year review

AIMS

The objective of this retrospective analysis of blood glucose values at a week-long residential summer camp for children with Type 1 diabetes was to provide experiential data to reinforce current summer camp guidelines and to determine if specific interventions implemented between 2009 and 2010 were effective in lowering average blood glucose among our campers without increasing risk of hypoglycaemia.

METHODS

Blood glucose records were obtained from a random selection of children who attended six 1-week camp sessions, three each in 2009 and 2010. Five values per day: pre-meal breakfast, lunch and dinner, pre-evening snack and midnight values were analysed.

RESULTS

A total of 13,267 blood glucose values were included. There were no severe hypoglycaemic episodes, seizures or need for full-dose glucagon or intravenous glucose in either year. Mean blood glucose was significantly lower in 2010 compared with 2009 (9.22 vs. 10.06 mmol/l, P < 0.001). Older age and camp year were associated with lower mean blood glucose, even when controlling for gender and duration of diabetes.

CONCLUSIONS

This analysis is the largest so far conducted at a residential diabetes camp. Mean blood glucose levels were lower than other published studies. Although we cannot attribute a cause-and-effect relationship between our interventions and the improvement in blood glucose between 2009 and 2010, the use of pre-meal insulin bolus doses, low glycaemic meals and highlighting blood glucose levels in logs before being reviewed by endocrinologists are strongly encouraged. From this study we hope to establish benchmarks for comparison among camps and begin to identify best practices.

Insulin dose changes in children attending a residential diabetes camp

AIMS

  To examine the effects of insulin dose adjustments on rates of hypoglycaemia for school-aged children with Type 1 diabetes attending camp.

METHODS

  Camp records for 256 children aged 7-15 years (55% on continuous subcutaneous insulin infusion) attending a week-long residential summer camp were analysed.

RESULTS

  In anticipation of increased physical activity, basal insulin was decreased for all children on continuous subcutaneous insulin infusion and injection therapy by 10% upon arrival at camp. During the first day, children on continuous subcutaneous insulin infusion received 11.1±6.3% less basal insulin than home doses, whereas children on injections decreased intermediate/long-acting insulin by 8.2±12.8%. Despite these decreases, 60% had at least one blood sugar level <70 mg/dl (3.9 mmol/l) during the first day. Children on continuous subcutaneous insulin infusion were more likely to have hypoglycaemia during the first day than those on injections. The number of episodes of hypoglycaemia increased with increasing camper age. Overall, children did not have further significant reductions in their total daily insulin dose by the last day of camp. However, on the last day, children had fewer episodes of hypoglycaemia than during the first day (0.7±0.9 vs. 1.1±1.2, P<0.001) and 51% had no low blood sugar levels that day.

CONCLUSIONS

  An empiric 10% reduction in basal insulin appears reasonable, as nearly equal numbers of children required dose increases as dose decreases as camp progressed. However, hypoglycaemia was still common in all age groups. Prospective studies characterizing individual variables are needed in order to facilitate tailored insulin dose adjustments that minimize glycaemic variability while optimizing control in the diabetes camp setting.