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Lindholm Olinder A, DeAbreu M, Greene S, Haugstvedt A, Lange K, Majaliwa ES, Pais V, Pelicand J, Town M, Mahmud FH. ISPAD Clinical Practice Consensus Guidelines 2022: Diabetes education in children and adolescents. Pediatr Diabetes 2022; 23:1229-1242. [PMID: 36120721 PMCID: PMC10107631 DOI: 10.1111/pedi.13418] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 09/16/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Anna Lindholm Olinder
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institute, Stockholm, Sweden.,Sachs' Children and Youths Hospital, Södersjukhuset, Stockholm, Sverige
| | - Matthew DeAbreu
- Parent and Advocate of Child with Type One Diabetes, Toronto, Ontario, Canada
| | | | - Anne Haugstvedt
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Karin Lange
- Medical Psychology Unit, Hannover Medical School, Hannover, Germany
| | - Edna S Majaliwa
- Department of Paediatrics and child health, Muhimbili National Hospital, Dar es Salaam, Tanzania.,Departement of peadiatrics and child health, Kilimanjaro Christian Medical University College, Moshi, Tanzania
| | - Vanita Pais
- Department of Endocrinology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Julie Pelicand
- Pediatric Diabetology Unit, San Camilo Hospital, Medicine School, Universidad de Valparaiso, San Felipe, Chile.,Childhood, Adolescence & Diabetes, Toulouse Hospital, Toulouse, France
| | - Marissa Town
- Children with Diabetes and Department of Pediatric Endocrinology, Stanford University, California, USA
| | - Farid H Mahmud
- Division of Endocrinology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Ontario, Canada
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2
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Holder M, Kapellen T, Ziegler R, Bürger-Büsing J, Danne T, Dost A, Holl RW, Holterhus PM, Karges B, Kordonouri O, Lange K, Müller S, Raile K, Schweizer R, von Sengbusch S, Stachow R, Wagner V, Wiegand S, Neu A. Diagnosis, Therapy and Follow-Up of Diabetes Mellitus in Children and Adolescents. Exp Clin Endocrinol Diabetes 2022; 130:S49-S79. [PMID: 35913059 DOI: 10.1055/a-1624-3388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Martin Holder
- Klinikum Stuttgart, Olgahospital, Department of Pediatric Endocrinology and Diabetology, Germany
| | - Thomas Kapellen
- Department of Paediatrics and Adolescent Medicine, University Hospital, Leipzig, Germany
| | - Ralph Ziegler
- Practice for Paediatrics and Adolescent Medicine, Focus on Diabetology, Münster, Germany
| | - Jutta Bürger-Büsing
- Association of Diabetic Children and Adolescents, Diabetes Center, Kaiserslautern, Germany
| | - Thomas Danne
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Axel Dost
- Department of Paediatrics and Adolescent Medicine, University Hospital Jena, Germany
| | - Reinhard W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, University of Ulm, Germany
| | - Paul-Martin Holterhus
- Department of General Paediatrics, University Hospital Schleswig-Holstein, Kiel Campus, Germany
| | - Beate Karges
- Endocrinology and Diabetology Section, University Hospital, RWTH Aachen University, Germany
| | - Olga Kordonouri
- Children's and Youth Hospital Auf der Bult, Hannover, Germany
| | - Karin Lange
- Department of Medical Psychology, Hannover Medical School, Hannover, Germany
| | | | - Klemens Raile
- Virchow Hospital, University Medicine, Berlin, Germany
| | - Roland Schweizer
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
| | - Simone von Sengbusch
- Department of Paediatrics and Adolescent Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Rainer Stachow
- Sylt Specialist Hospital for Children and Adolescents, Westerland, Germany
| | - Verena Wagner
- Joint Practice for Paediatrics and Adolescent Medicine, Rostock, Germany
| | | | - Andreas Neu
- Department of Pediatrics and Adolescent Medicine, University Hospital Tübingen, Germany
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3
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Boß K, Kirk S. Pflegerische Herausforderungen in der Betreuung und Anleitung von Kindern mit Diabetes mellitus Typ 1 und ihren Betreuungspersonen. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00837-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
In this review, we bring our personal experiences to showcase insulin from its breakthrough discovery as a life-saving drug 100 years ago to its uncovering as the autoantigen and potential cause of type 1 diabetes and eventually as an opportunity to prevent autoimmune diabetes. The work covers the birth of insulin to treat patients, which is now 100 years ago, the development of human insulin, insulin analogues, devices, and the way into automated insulin delivery, the realization that insulin is the primary autoimmune target of type 1 diabetes in children, novel approaches of immunotherapy using insulin for immune tolerance induction, the possible limitations of insulin immunotherapy, and an outlook how modern vaccines could remove the need for another 100 years of insulin therapy.
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Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindes- und Jugendalter. DIABETOLOGE 2021. [DOI: 10.1007/s11428-021-00769-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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6
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Ergun-Longmire B, Clemente E, Vining-Maravolo P, Roberts C, Buth K, Greydanus DE. Diabetes education in pediatrics: How to survive diabetes. Dis Mon 2021; 67:101153. [PMID: 33541707 DOI: 10.1016/j.disamonth.2021.101153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Diabetes mellitus is the most common abnormal carbohydrate metabolism disorder affecting millions of people worldwide. It is characterized by hyperglycemia as a result of ß-cell destruction or dysfunction by both genetic and environmental factors. Over time chronic hyperglycemia leads to microvascular (i.e., retinopathy, nephropathy and neuropathy) and macrovascular (i.e., ischemic heart disease, peripheral vascular disease, and cerebrovascular disease) complications of diabetes. Diabetes complication trials showed the importance of achieving near-normal glycemic control to prevent and/or reduce diabetes-related morbidity and mortality. There is a staggering rate of increased incidence of diabetes in youth, raising concerns for future generations' health, quality of life and its enormous economic burden. Despite advancements in the technology, diabetes management remains cumbersome. Training individuals with diabetes to gain life-long survival skills requires a comprehensive and ongoing diabetes education by a multidisciplinary team. Diabetes education and training start at the time of diagnosis of diabetes and should be continuous throughout the course of disease. The goal is to empower the individuals and families to gain diabetes self-management skills. Diabetes education must be individualized depending on the individual's age, education, family dynamics, and support. In this article, we review the history of diabetes, etiopathogenesis and clinical presentation of both type 1 and type 2 diabetes in children as well as adolescents. We then focus on diabetes management with education methods and materials.
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Affiliation(s)
- Berrin Ergun-Longmire
- Associate Professor, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA.
| | - Ethel Clemente
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Patricia Vining-Maravolo
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Cheryl Roberts
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Koby Buth
- Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Donald E Greydanus
- Professor, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI United States
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GÜLCÜ S, ARSLAN S, ARSLANOĞLU İ. Tip 1 Diyabetli Adolesanlarda Web Tabanlı Egzersiz Eğitiminin Etkinliği. DÜZCE ÜNIVERSITESI SAĞLIK BILIMLERI ENSTITÜSÜ DERGISI 2020. [DOI: 10.33631/duzcesbed.589195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Raile K, Boss K, Braune K, Heinrich-Rohr M. Versorgung von Kindern und Jugendlichen mit Typ-1-Diabetes: Lösungen für technische und psychosoziale Herausforderungen. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:856-863. [DOI: 10.1007/s00103-020-03162-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
ZusammenfassungDiabetes mellitus Typ 1 ist die häufigste endokrinologische Erkrankung bei Kindern und Jugendlichen unter 15 Jahren. Eine Heilungsperspektive bezüglich der Autoimmunreaktion gegen die insulinbildenden Betazellen ist weiterhin nicht in Sicht. Dennoch konnte durch technische Innovationsschübe bei Glukosesensoren, Insulinpumpen und Steuerungsalgorithmen innerhalb der letzten Jahre die Stoffwechselkontrolle optimiert werden. Diese Entwicklungen führen zusammen mit individuellen Diabetesschulungen und psychosozialer Unterstützung zu einer deutlichen Verbesserung der Versorgung.In diesem Übersichtsartikel wird die aktuelle Versorgungssituation von Kindern und Jugendlichen mit Typ-1-Diabetes sowie ihren Eltern dargestellt. In Deutschland ist die multidisziplinäre, spezialisierte Versorgung durch Teams aus Kinder- und Jugenddiabetolog*innen, Diabetesberater*innen, Sozialarbeiter*innen und Kinder- und Jugendpsychotherapeut*innen seit vielen Jahren etabliert und führt zu einer im internationalen Vergleich sehr guten Versorgungsqualität. Fokussiert werden die Diabetesschulung mit dem Schwerpunkt, das Selbstmanagement optimal zu unterstützen, die psychosoziale Begleitung und Intervention sowie die Inklusion in Schulen und Kindertagesstätten. Wir gehen außerdem auf neue soziale Entwicklungen der Diabetes-Online-Community ein. Ein aktuelles Beispiel ist die patientenbetriebene Bewegung „Do-It-Yourself Artificial Pancreas System“ (DIY-APS), die als Open-Source-Projekt mittlerweile Innovationsgeber auch für Medizinproduktehersteller ist. Zum Schluss beleuchten wir die damit verbundenen Chancen, aber auch die Verschiebung der klassischen Arzt-Patienten-Rollen.
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Kordonouri O, Lange K, Biester T, Datz N, Kapitzke K, von dem Berge T, Weiskorn J, Danne T. Determinants of glycaemic outcome in the current practice of care for young people up to 21 years old with type 1 diabetes under real-life conditions. Diabet Med 2020; 37:797-804. [PMID: 31498923 DOI: 10.1111/dme.14130] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2019] [Indexed: 02/03/2023]
Abstract
AIM To determine factors influencing the success of treatment for type 1 diabetes, defined as HbA1c < 58 mmol/mol (<7.5%), in a large paediatric cohort under real-life conditions. METHODS This is a monocentric observational study analysing the determinants of glycaemic outcome (sex, age, comorbidities, sociodemographic factors, diabetes technology) in an entire cohort of people with diabetes aged up to 21 years. Glycaemic outcome was defined as an individual's median HbA1c and the prevalence of acute complications over this period. RESULTS Of 700 young people with type 1 diabetes [age 13.6 years (range: 1.4-20.9 years); diabetes duration 5.8 years (range: 0.1-18.3 years)], 63% were using an insulin pump and 32% any type of continuous glucose monitoring. Mean HbA1c was 61 mmol/mol [95% confidence interval (CI) 60-62; 7.7%, 95% CI 7.5-7.8]. Some 63% of children aged < 12 years reached HbA1c (58 mmol/mol (<7.5%) compared with 43% of older participants. The prevalence of severe hypoglycaemia was 2.41 events and that of diabetic ketoacidosis 1.4 events per 100 person-years. Neither type of insulin therapy nor use of continuous glucose monitoring, sex or comorbidity with coeliac disease or thyroiditis was significantly associated with glycaemic outcome. However, age, diabetes duration, having a father not born in Germany, psychiatric comorbidities and family structure were associated with HbA1c . CONCLUSIONS Current technologies and a multidisciplinary team approach allow high numbers of children and adolescents to realize tight glycaemic control with a low prevalence of acute complications. However, age-related challenges, sociodemographic factors and psychological comorbidities are barriers to achieving best possible glycaemic outcome.
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Affiliation(s)
- O Kordonouri
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - K Lange
- Medical Psychology, Hannover Medical School, Hannover, Germany
| | - T Biester
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - N Datz
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - K Kapitzke
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - T von dem Berge
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - J Weiskorn
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
| | - T Danne
- Diabetes Centre for Children and Adolescents, Children's Hospital AUF DER BULT, Hannover, Germany
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10
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Hawkes CP, Willi SM, Murphy KM. A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control. Pediatr Diabetes 2019; 20:460-467. [PMID: 30932293 DOI: 10.1111/pedi.12849] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/22/2019] [Accepted: 03/28/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The diagnosis of type 1 diabetes (T1D) brings significant medical, psychosocial, and educational challenges for the child, family, and medical team. We developed a structured certified diabetes educator (CDE) led program spanning the year after diagnosis with the goal of supporting families as their understanding of this chronic disease and its management evolves. OBJECTIVE The aim of this study was to determine the effect of this program upon hemoglobin A1c (HbA1c), and how this effect is mitigated by socioeconomic status (SES). METHODS Patients enrolled in the type 1 year 1 (T1Y1) program were assigned a CDE who provided intensive coaching, tailored to family lifestyle, and readiness to assume independence. We identified all patients diagnosed with T1D in the 2 years before (controls) and after (T1Y1 group) the start of the T1Y1 program on January 7, 2014. RESULTS There were 675 patients diagnosed with T1D between July 2012 and June 2016 (284 controls, 391 T1Y1). HbA1c was significantly lower in the T1Y1 group at 6 (6.7% vs. 7.1%, P < 0.001), 12 (7.3% vs. 7.8%, P < 0.001) and 18 (7.6% vs. 7.9%, P = 0.01) months, but not 24 (7.8% vs. 8%, P = 0.14) months after diagnosis. This effect was not observed in patients with lower SES. CONCLUSION Additional structured education and support in the year after diagnosis can improve short-term outcomes in children with T1D, but this effect may not persist after discontinuing intensive coaching. Families of lower SES did not benefit from this approach.
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Affiliation(s)
- Colin P Hawkes
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Steven M Willi
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.,Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Kathryn M Murphy
- Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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Mangla P, Chopra A, Sudhanshu S, Bhatia E, Dabadghao P, Gupta S, Bhatia V. Validation of a diabetes knowledge test for Indian children, adolescents and young adults with type 1 diabetes mellitus. Prim Care Diabetes 2019; 13:283-287. [PMID: 30581070 DOI: 10.1016/j.pcd.2018.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 11/29/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Diabetes knowledge has a large impact on glycemic control. There is a pressing need for creation of validated tests of knowledge for different ethnic groups. OBJECTIVE To create and validate a diabetes knowledge test (DKT) for young Indians with type 1 diabetes mellitus (T1DM). METHODS We created a 34 item Hindi language DKT, with basic (19-questions) and advanced (15-questions) components. It was administered to 77 consecutive patients who had previously received in-hospital diabetes education. We hypothesized that the test scores would be higher for patients residing in urban regions, for patients with higher maternal education, and those with lower HbA1c. Cronbach's alpha (α) was used to calculate the test reliability. RESULTS The DKT score was significantly higher in families with higher (>class 12th) maternal formal education compared with lower [70.0 (95% C.I. 67.2-73.5) vs 54.2 (95% C.I. 44.0-57.3), p<0.001] and urban residence compared with rural [68.5 (95% C.I. 63.4-70.6) vs 54.5 (95% C.I. 42.5-61.7), p<0.001]. It had negative correlation with HbA1c (r=-0.268, p=0.019). The Cronbach's α was 0.87 for the entire test, and for the basic and advanced components was 0.78 and 0.74 respectively. CONCLUSION The DKT India is a valid and reliable instrument to evaluate diabetes knowledge in Hindi speaking Indian children, adolescents and young adults with T1DM.
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Affiliation(s)
- Pragya Mangla
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Aditi Chopra
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Siddhnath Sudhanshu
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Eesh Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Preeti Dabadghao
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Suchit Gupta
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India
| | - Vijayalakshmi Bhatia
- Department of Endocrinology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow-226014, Uttar Pradesh, India.
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Nakamura N, Yakushijin Y, Kanamaru T, Tani H, Ideno K, Nakai A. Development and validity testing of the revised diabetes self-care inventory for children and adolescents. Diabetol Int 2019; 10:117-125. [PMID: 31139530 DOI: 10.1007/s13340-018-0377-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/24/2018] [Indexed: 11/24/2022]
Abstract
Recently, self-care in children and adolescents with type 1 diabetes has changed with regard to both adherence to treatment and self-management. Only one diabetes self-care scale for children and adolescents is used in Japan which lacks reflection on flexible regimens. The aims of this study were to modify and subsequently test the validity of the revised diabetes self-care inventory (R-DSCI) for children and adolescents, and to construct the diabetes self-care model on the R-DSCI, HbA1c, duration of diabetes and age. Based on qualitative secondary analysis of the self-care framework for teenagers and a literature review of diabetes self-care instruments, the items concerning insulin injection and meal planning were modified from the original DSCI and new items concerning negotiation with parents and others were added. The participants in the validity testing were 122 children and adolescents with type 1 diabetes, 50.8% were girls, aged 9-18 years, mean HbA1c of 7.9%. The final version of the R-DSCI was composed of 41 items. Eight factors, which explained 40.9% of the variance, were identified using the varimax method; Cronbach's alpha for the 41 items was 0.79. The diabetes self-care model showed a negative direct effect of "diabetes self-care practice" on HbA1c (P = 0.004), and the negative indirect effect of "support and perception of life with diabetes" on HbA1c through "diabetes self-care practice" (P = 0.002; estimated effect - 0.21). In addition, "independent self-care behavior" was directly affected by age (P < 0.001). The R-DSCI should be useful for clinicians and researchers to assess the self-management in children and adolescents.
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Affiliation(s)
- Nobue Nakamura
- 1Chiba University Graduate School of Nursing, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8672 Japan
| | - Yuko Yakushijin
- 2Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime 791-0295 Japan
| | - Tomo Kanamaru
- 3Shumei University School of Nursing, 1-1 Daigaku-cho, Yachiyo, Chiba 276-0003 Japan
| | - Hiroe Tani
- 4Tokushima University Graduate School, 3-18-15 Kuramoto-cho, Tokushima, 770-8503 Japan
| | - Keiko Ideno
- 5Faculty of Nursing, Toho University, 4-16-20 Omorinishi, Ota-ku, Tokyo, 143-0015 Japan
| | - Aya Nakai
- 1Chiba University Graduate School of Nursing, 1-8-1 Inohana, Chuo-ku, Chiba, 260-8672 Japan
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Lange K, Kordonouri O. Setting the right course at type 1 diabetes diagnosis. THE LANCET. CHILD & ADOLESCENT HEALTH 2019; 3:138-139. [PMID: 30704874 DOI: 10.1016/s2352-4642(19)30031-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Karin Lange
- Medical Psychology Unit, Hannover Medical School, 30625 Hannover, Germany.
| | - Olga Kordonouri
- Diabetes Centre for Children and Adolescents, Children's Hospital Auf Der Bult, Hannover, Germany
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Phelan H, Lange K, Cengiz E, Gallego P, Majaliwa E, Pelicand J, Smart C, Hofer SE. ISPAD Clinical Practice Consensus Guidelines 2018: Diabetes education in children and adolescents. Pediatr Diabetes 2018; 19 Suppl 27:75-83. [PMID: 30175451 DOI: 10.1111/pedi.12762] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 08/28/2018] [Indexed: 11/28/2022] Open
Affiliation(s)
- Helen Phelan
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Karin Lange
- Department Medical Psychology OE 5430, Hannover Medical School, Hannover, Germany
| | - Eda Cengiz
- Division of Pediatric Endocrinology, Yale School of Medicine, New Haven, Connecticut, USA.,School of Medicine, Koc University, Istanbul, Turkey
| | - Patricia Gallego
- Department of Pediatrics, Children's Hospital London, Health Sciences Centre, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Edna Majaliwa
- Department of Paediatric and Child Health, Muhimbili National Hospital, Dar es Salaam, Tanzania
| | - Julie Pelicand
- Medical School, University of Valparaiso, San Felipe, Chile
| | - Carmel Smart
- Department of Paediatric Endocrinology and Diabetes, John Hunter Children's Hospital, Newcastle, Australia
| | - Sabine E Hofer
- Department of Pediatrics, Medical University of Innsbruck, Innsbruck, Austria
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Ziegler R, Neu A. Diabetes in Childhood and Adolescence. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 115:146-156. [PMID: 29563012 PMCID: PMC5876549 DOI: 10.3238/arztebl.2018.0146] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 08/01/2017] [Accepted: 01/30/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The incidence of type 1 diabetes mellitus in childhood and adolescence is steadily rising and now stands at 22.9 new cases per year per 100 000 persons up to age 15. METHODS This review is based on pertinent publications retrieved by a selective literature search, with special attention to the current German S3 guideline on diabetes in childhood and adolescence. RESULTS Polydipsia, polyuria, and weight loss are the characteristic presenting symptoms of diabetes mellitus. The acutely presenting patient needs immediate stabilization because of the danger of rapid metabolic decompensation (risk of keto - acidosis, 21.1%). Long-term insulin therapy can be delivered either by subcutaneous injection or by an insulin pump. The goals of treatment are the near-normalization of glucose metabolism (HbA1c <7.5%), the avoidance of acute complications (hypoglycemia and ketoacidosis), the reduction of diabetes-specific sequelae (retinopathy, nephropathy, neuropathy, hypertension, and hyperlipidemia), unrestricted participation in age-appropriate everyday activities, and normal physical and psychosocial development. Children and adolescents with diabetes need individualized treatment with frequent adjustments and holistic overall care so that these goals can be effectively met. CONCLUSION Every physician must be able to diagnose the initial presentation of diabetes and to initiate the first steps in its management. The patient should be referred as soon as possible to a diabetes team that has experience in the treatment of children and adolescents.
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Martin D, Elie C, Dossier C, Godot C, Gagnayre R, Choleau C, Cahané M, Robert JJ. Diabetes knowledge in adolescents with type 1 diabetes and their parents and glycemic control. Pediatr Diabetes 2017; 18:559-565. [PMID: 27726250 DOI: 10.1111/pedi.12458] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 08/13/2016] [Accepted: 09/09/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate diabetes knowledge and skills (DKS) in adolescents (>10 year) with type 1 diabetes (T1D) and their parents, and its effect on glycemic control. METHODS A ready-to-use program and a standardized questionnaire comprising 50 true-false questions based on this program, were elaborated by a National Committee, to help dispensing education at diagnosis of T1D. The questionnaire was completed by 2933 T1D patients (49% girls, 51% boys; 14.1 ± 2.5 year), 2180 mothers and 798 fathers, in 115 pediatric centers. Associations between DKS score (number of correct answers), glycated hemoglobin (HbA1c) and sociofamilial characteristics were assessed. RESULTS DKS score increased with age, and was higher in girls than in boys and in mothers than in fathers; it correlated strongly between adolescents and their own parents; it was higher when adolescents had previously participated in diabetes camp and when parents had higher academic levels. HbA1c decreased significantly with parents' higher DKS score and academic level, and when both parents lived together. Mean adolescent DKS score was significantly higher in patients with HbA1c below 8% or 8.5% than for patients with HbA1c above these thresholds. CONCLUSION A large survey in T1D children and adolescents and their parents showed associations between DKS and glycemic control, and the major role of sociofamilial factors.
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Affiliation(s)
- Delphine Martin
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants malades, Paris, France.,L'Aide aux Jeunes Diabétiques (AJD), Paris, France
| | - Caroline Elie
- Unité de Recherche clinique/Centre d'Investigation Clinique Paris Descartes Necker Cochin, Hôpital Necker-Enfants malades, Paris, France
| | - Claire Dossier
- Néphrologie pédiatrique, Hôpital Robert Debré, Paris, France
| | - Cécile Godot
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants malades, Paris, France
| | - Rémi Gagnayre
- Laboratoire de Pédagogie de la Santé, Université Paris 13, Bobigny, France
| | | | | | - Jean-Jacques Robert
- Endocrinologie, Gynécologie et Diabétologie Pédiatrique, Hôpital Necker-Enfants malades, Paris, France.,L'Aide aux Jeunes Diabétiques (AJD), Paris, France.,Sorbonne Paris Cité, Université René Descartes, Paris, France
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Ramchandani N, Johnson K, Cullen K, Hamm T, Bisordi J, Sullivan-Bolyai S. CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation. DIABETES EDUCATOR 2016; 43:97-104. [DOI: 10.1177/0145721716676893] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.
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Affiliation(s)
- Neesha Ramchandani
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Kim Johnson
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Karen Cullen
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Terri Hamm
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Jean Bisordi
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
| | - Susan Sullivan-Bolyai
- New York University Rory Meyers College of Nursing, New York, New York (Ms Ramchandani, Dr Sullivan-Bolyai)
- Division of Pediatric Endocrinology, University of Massachusetts, Worcester, Worcester, Massachusetts (Ms Johnson, Ms Cullen)
- Division of Pediatric Endocrinology, Rhode Island Hospital, Providence, Rhode Island (Mrs Hamm, Mrs Bisordi)
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Colson S, Côté J, Gentile S, Hamel V, Sapuppo C, Ramirez-Garcia P, Reynaud R, Lagouanelle-Simeoni MC. An Integrative Review of the Quality and Outcomes of Diabetes Education Programs for Children and Adolescents. DIABETES EDUCATOR 2016; 42:549-84. [DOI: 10.1177/0145721716658976] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose The purpose of this study was twofold: (1) to describe the content of recent diabetes education programs and their outcomes in terms of glycemic control, disease management, and psychosocial criteria for children and adolescents with type 1 diabetes and (2) to gauge the match between these programs and the recommendations of the International Society for Pediatric and Adolescent Diabetes (ISPAD). Methods The integrative review was carried out according to the Cochrane recommendations. Thirteen databases were searched for evaluations of education programs published from 2009 to 2014. Program characteristics and outcomes were described. Quality of studies was assessed, and program match with ISPAD recommendations was gauged. Results Of 2528 studies found, 43 covering 36 education programs intended for youth with type 1 diabetes were retained for review. Nine of these centered on self-care competencies, 18 on psychosocial competencies, and 9 on both types of competency (mixed program). Programs varied widely in terms of organization, procedure, and content. Glycemic control was an indicator assessed in the majority of programs, but only half of these (for the most part, self-care programs) reported positive findings in this regard. Few programs seemed to affect psychosocial indicators. An online mixed program, which was the program that best met the ISPAD recommendations, proved to have an influence on glycemic control and several psychosocial criteria. Conclusions Various avenues can be considered to improve participant engagement in education programs and to align these programs more closely with international recommendations. Further research is required to enhance knowledge in this field.
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Affiliation(s)
- Sébastien Colson
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - José Côté
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Stéphanie Gentile
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Valérie Hamel
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Cédric Sapuppo
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Pilar Ramirez-Garcia
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Rachel Reynaud
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
| | - Marie-Claude Lagouanelle-Simeoni
- Aix Marseille Université, Faculté de Médecine, EA3279-SPMC, Marseille, France (Mr Colson, Prof Gentile)
- Assistance Publique-Hôpitaux de Marseille (APHM)–Coordination Générale des Soins, Marseille, France (Mr Colson)
- Université de Montréal–Faculté de Sciences Infirmières, Research Chair in Innovative Nursing Practices, Montréal, Canada (Mr Colson, Prof Côté, Ms Ramirez-Garcia)
- Research Centre of the Centre Hospitalier de l’Université de Montréal, Research Chair in Innovative Nursing Practices, Montréal, Canada (Prof Côté)
- APHM, Service d’Evaluation Médicale, Marseille, France (Prof Gentile, Dr Lagouanelle-Simeoni)
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Schrijvers L, Beijlevelt-Van der Zande M, Peters M, Lock J, Cnossen M, Schuurmans M, Fischer K. Achieving self-management of prophylactic treatment in adolescents: The case of haemophilia. PATIENT EDUCATION AND COUNSELING 2016; 99:1179-1183. [PMID: 26851159 DOI: 10.1016/j.pec.2016.01.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Revised: 12/29/2015] [Accepted: 01/23/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Adolescents with a chronic disorder, such as haemophilia, need to attain responsibility for their disease. The aim was to gain insight into how adolescents achieve self-management of prophylactic treatment. METHODS In three Dutch Haemophilia Treatment Centres, adolescents (10-25 years) received structured questions on treatment responsibility and self-management (pre-specified definitions) during routine nursing consultation. RESULTS In total, 155 interviews were performed in 100 patients (median age 14.4 years). Self-infusion was initiated at a median age of 12.3 years (IQR 11.5-13.0) and self-management was achieved 9.6 years later, at a median age of 22.6 years. This process included three phases coinciding with known stages of adolescence. In early adolescence, patients acquired the technique of self-infusion (12.3 years) leading to independent self-infusion in middle adolescence (17.2 years). In late adolescence, patients demonstrated an increase in more complex skills, such as bleeding management and communication with the haemophilia physician (19.9-22.6 years). CONCLUSION Although, the first steps in self-management with regard to self-infusion are taken in early adolescence, complete self-management was achieved in late adolescence after almost 10 years. PRACTICE IMPLICATIONS Insight in this transitional process helps to provide individualized support and emphasizes the need for continued education with regard to self-management skills.
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Affiliation(s)
- Liesbeth Schrijvers
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | | | - Marjolein Peters
- Haemophilia Treatment Centre, Emma Children's Hospital-Academical Medical Centre Amsterdam, Amsterdam, The Netherlands
| | - Janske Lock
- Department of Paediatric Haematology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marjon Cnossen
- Department of Paediatric Haematology, Erasmus Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Marieke Schuurmans
- Nursing Science, Faculty of Health Care, University of Applied Science, Utrecht, The Netherlands; Nursing Science, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Kathelijn Fischer
- Van Creveldkliniek, University Medical Centre Utrecht, Utrecht, The Netherlands
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Martin D, Dossier C, Godot C, Taupin P, Elie C, Gagnayre R, Choleau C, Cahané M, Fermanian J, Robert JJ. Questionnaire de connaissance de l’AJD pour les enfants et les adolescents ayant un diabète de type 1. ACTA ACUST UNITED AC 2016. [DOI: 10.1051/tpe/2016006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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(4) Foundations of care: education, nutrition, physical activity, smoking cessation, psychosocial care, and immunization. Diabetes Care 2015; 38 Suppl:S20-30. [PMID: 25537702 DOI: 10.2337/dc15-s007] [Citation(s) in RCA: 160] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Lange K, Swift P, Pańkowska E, Danne T. ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents. Pediatr Diabetes 2014; 15 Suppl 20:77-85. [PMID: 25182309 DOI: 10.1111/pedi.12187] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 06/16/2014] [Indexed: 11/27/2022] Open
Affiliation(s)
- Karin Lange
- Department of Medical Psychology, Hannover Medical School, OE 5430, 30625, Hannover, Germany
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Tonyushkina KN, Visintainer PF, Jasinski CF, Wadzinski TL, Allen HF. Site of initial diabetes education does not affect metabolic outcomes in children with T1DM. Pediatr Diabetes 2014; 15:135-41. [PMID: 24033852 DOI: 10.1111/pedi.12069] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 06/11/2013] [Accepted: 07/09/2013] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To determine the difference in metabolic outcomes at 1 and 2 yr post type 1 diabetes mellitus (T1DM) diagnosis in children depending on the site of initial diabetes education: inpatient, vs. outpatient, vs. mixed locations. PATIENTS AND METHODS A retrospective chart review was performed for all patients with new onset antibody positive T1DM, aged 1-18 yr old, diagnosed in 2004-2009, and followed for at least 1 yr in a diabetes program at a tertiary academic health care center. Patients were divided into three groups based on the site of initial diabetes education: inpatient, outpatient, and mixed locations. The primary outcome was A1c at 1 and 2 yr. RESULTS We enrolled 238 children (133 boys), mean (± SD) age 9.9 (± 4.1). A1c levels did not differ among inpatient, outpatient, and mixed location groups at 1 and 2 yr post diagnosis (p = 0.85 and p = 0.69, respectively) and the long-acting insulin doses were similar at 1 and 2 yr (p = 0.18 and p = 0.15, respectively). There was no difference in the number of acute diabetes complications between the groups. At 1 yr, 21.8% of outpatient-educated children were on insulin pump therapy in contrast to 14.7% of inpatient and 2.7% of mixed educated groups (p = 0.04). CONCLUSIONS Families of children with new onset T1DM can be successfully and safely educated in a clinic setting. An 'education' admission for a medically stable patient is not necessary most of the time, however, clinical judgment and careful assessment of the family's coping and learning capabilities are important when determining the site of education.
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Affiliation(s)
- Ksenia N Tonyushkina
- Department of Pediatrics, School of Medicine, Baystate Children's Hospital/Tufts University, Springfield, MA, 01199, USA
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Wigert H, Wikström E. Organizing person-centred care in paediatric diabetes: multidisciplinary teams, long-term relationships and adequate documentation. BMC Res Notes 2014; 7:72. [PMID: 24490659 PMCID: PMC3913792 DOI: 10.1186/1756-0500-7-72] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Accepted: 01/31/2014] [Indexed: 12/30/2022] Open
Abstract
Background Type 1 diabetes is one of the most frequent long-term endocrine childhood disorders and the Swedish National Diabetes Register for children states that adolescents (12–18 years) constitute the most vulnerable patient group in terms of metabolic control. The aim of this study was to examine how a multidisciplinary team functions when caring for adolescents with type 1 diabetes. Methods Qualitative interviews were performed with 17 health professionals at a Paediatric Diabetes Care Unit in a Swedish university hospital. The interviews were analysed to gain insight into a multidisciplinary care team’s experiences of various organizational processes and circumstances related to the provision of person-centred paediatric diabetes care. Results Building long-term relationships with adolescents, the establishment of a multidisciplinary care team and ensuring adequate documentation are vital for the delivery of person-centred care (PCC). Furthermore, a PCC process and/or practice requires more than the mere expression of person-centred values. The contribution of this study is that it highlights the necessity of facilitating and safeguarding the organization of PCC, for which three processes are central: 1. Facilitating long-term relationships with adolescents and their families; 2. Facilitating multi-professional teamwork; and 3. Ensuring adequate documentation. Conclusion Three processes emerged as important for the functioning of the multidisciplinary team when caring for adolescents with type 1 diabetes: building a long-term relationship, integrating knowledge by means of multidisciplinary team work and ensuring adequate documentation. This study demonstrates the importance of clearly defining and making use of the specific role of each team member in the paediatric diabetes care unit (PDCU). Team members should receive training in PCC and a PCC approach should form the foundation of all diabetes care. Every adolescent suffering from type 1 diabetes should be offered individual treatment and support according to her/his needs. However, more research is required to determine how a PCC approach can be integrated into adolescent diabetes care, and especially how PCC education programmes for team members should be implemented.
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Affiliation(s)
- Helena Wigert
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
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Schewitz J, Aswegen HV. Rehabilitation after pectus excavatum corrective surgery: A single case report. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2013. [DOI: 10.12968/ijtr.2013.20.6.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Pectus excavatum deformity, often diagnosed in children and adults, results in psychological and physiological impairments. The minimally invasive Nuss surgical procedure is more frequently used to correct this deformity. The purpose of this single case report is to report on the interdisciplinary management provided for a 9-year-old girl who underwent this procedure for congenital pectus excavatum deformity. Content: A retrosternal steel bar was surgically placed through two small chest wall incisions made on either side of the chest and twisted over to push the sternum upwards. Interventions such as pre- and postoperative patient and family education, early postoperative mobilization, regular assessment of analgesic needs, deep breathing and coughing formed part of the rehabilitation provided in the intensive care unit and continued in the ward. Conclusion: This evidence-based inter-disciplinary approach to rehabilitation was important in the postoperative management of the patient to facilitate an uncomplicated recovery. This case report contributes to the limited body of evidence available on rehabilitation after the Nuss procedure for pectus excavatum deformity.
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Affiliation(s)
- Jacqui Schewitz
- at Waterfall City Hospital and MSc Physiotherapy student at the University of the Witwatersrand, Johannesburg, South Africa
| | - Helena Van Aswegen
- in the department of physiotherapy at the University of the Witwatersrand, Johannesburg, South Africa
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