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Pembroke S, Roche EF, Sleath B, Brenner M, Hilliard C, Cody D, Coyne I. Developing a video intervention to improve youth question-asking and provider education during paediatric diabetes clinic encounters: The Promoting Adolescents Communication and Engagement study. PATIENT EDUCATION AND COUNSELING 2021; 104:2170-2176. [PMID: 33640232 DOI: 10.1016/j.pec.2021.02.021] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/27/2020] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Research on long-term health conditions indicates that adolescents are not actively involved during their medical visits. Active involvement is essential because this can help adolescents learn how to self-manage their treatment plan. OBJECTIVE To co-design a video intervention to improve youth question-asking and provider education during paediatric diabetes visits. PATIENT INVOLVEMENT A participatory-led approach was used to co-design the video, through a combination of interviews/ focus groups and the establishment of a Youth Advisory Group. METHODS First, focus groups and one-to-one interviews were held with adolescents, parents and healthcare providers. Second, two workshops were held with the Youth Advisory Group, Parent Advisory Group and stakeholders on script design. Finally, an iterative development of the video took place between the research team, videographer, both advisory groups and the steering committee. There were three rounds of feedback before the video was finalised. RESULTS Adolescents' content preferences included: 1) message of empowerment; 2) managing your diabetes so you can get on with the fun stuff in life; 3) Promoting independence; 4) Reasons for not speaking at clinic visits and reassurance; 5) Becoming comfortable to speak and ask questions at clinic visits; 6) Practical advice on how to ask questions. Formatting preferences included that the video should be short, divided into segments, with adolescents with diabetes acting in it, and speaking directly to the camera. DISCUSSION Identifying and reflecting adolescents' needs and preferences for engagement with healthcare providers was critical in the development process. Adolescents' participation in the co-design process was pivotal to the acceptability of the intervention for adolescents with diabetes. PRACTICAL VALUE The intervention may increase adolescents' participation in communication and interactions with healthcare providers, which may help them to be more active in the self-management of their condition.
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Affiliation(s)
- Sinead Pembroke
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland.
| | - Edna F Roche
- Department of Endocrinology and Diabetes, Children's Health Ireland, Tallaght, Dublin 24, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Betsy Sleath
- University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Maria Brenner
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
| | - Carol Hilliard
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland; School of Medicine, Trinity College Dublin, the University of Dublin College Green, Dublin 2, Ireland
| | - Declan Cody
- Department of Diabetes and Endocrinology, Children's Health Ireland, Crumlin, Cooley Road, Dublin 12, Ireland
| | - Imelda Coyne
- School of Nursing and Midwifery, Trinity College Dublin, the University of Dublin College Green, 24 D'Olier Street, Trinity College Dublin, Dublin 2, Ireland
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2
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Hu S, Yang H, Chen Z, Leng X, Li C, Qiao L, Lv W, Li T. Clinical Outcome and Cost-Effectiveness Analysis of CSII Versus MDI in Children and Adolescent With Type 1 Diabetes Mellitus in a Public Health Care System of China. Front Endocrinol (Lausanne) 2021; 12:604028. [PMID: 33859614 PMCID: PMC8043415 DOI: 10.3389/fendo.2021.604028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 01/20/2021] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To evaluate the clinical and economic consequences of continuous subcutaneous insulin infusion (CSII) vs. multiple daily injections (MDI) in children and adolescents with type 1 diabetes mellitus (T1DM) from a public health care system in developed areas of developing country, considering changes in glycemic Control, daily insulin requirements, lipid profile, body mass index (BMI), frequency of severe hypoglycemia and Diabetic Ketoacidosis (DKA) and diabetic complications. METHODS This was a retrospective cohort study of children and adolescents with T1DM. Data were collected at baseline and the end of every year including glycated hemoglobin (HbA1c), insulin dose, lipid profile, blood pressure, and adverse events (severe hypoglycemia and DKA). The Cost-effectiveness analysis was performed using the IQVIA CORE Diabetes Model (CDM) to simulate diabetes progression by utilizing the clinical data obtained from the two groups. The main outcome measures were Life Expectancy, Quality adjusted life years (QALYs), Total Costs and Incremental Costs and Effectiveness Ratio (ICER) of CSII compared with MDI in Chinese pediatric patients with T1DM in Qingdao City (60 years). RESULTS Mean HbA1c values and daily insulin doses were significantly lower in those receiving CSII therapy throughout follow-up. Mean direct lifetime costs were ¥ 67,137 higher with CSII treatment than with MDI for pediatric patients. Treatment with CSII was associated with an improvement in life expectancy of 0.41 years for pediatric patients compared with MDI based on CORE diabetes model simulation. The corresponding gains in QALYs were 0.42. These data produced corresponding ICER is ¥ 161,815 per QALY for pediatric T1DM patients in Qingdao. Sensitivity analyses suggested that our base-case assumptions were mostly robust. CONCLUSIONS CSII is associated with improved long-term clinical outcomes compared with MDI. Based on this model analysis, CSII appears to be more cost-effective for the Qingdao TIDM pediatric population and health care system.
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Affiliation(s)
- Sicui Hu
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Hongxiu Yang
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Zhihong Chen
- Neuroendocrine Pediatric Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Xuefei Leng
- Neuroendocrine Pediatric Department, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Cheng Li
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Lingyan Qiao
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
| | - Weiqing Lv
- Research and Development Department, Medtronic (Shanghai) Management Co, Ltd, Shanghai, China
| | - Tang Li
- Paediatric Endocrinology and Metabolism Department, Qingdao Women and Children’s Hospital, Qingdao, China
- *Correspondence: Tang Li,
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3
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Boucher SE, Gray AR, Wiltshire EJ, de Bock MI, Galland BC, Tomlinson PA, Rayns JA, MacKenzie KE, Chan H, Rose S, Wheeler BJ. Effect of 6 Months of Flash Glucose Monitoring in Youth With Type 1 Diabetes and High-Risk Glycemic Control: A Randomized Controlled Trial. Diabetes Care 2020; 43:2388-2395. [PMID: 32788281 DOI: 10.2337/dc20-0613] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/15/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To investigate whether intermittently scanned continuous glucose monitoring (isCGM) significantly improves glycemic control compared with capillary self-monitored blood glucose (SMBG) in youth with type 1 diabetes and high-risk glycemic control. RESEARCH DESIGN AND METHODS This multicenter 6-month randomized, controlled, parallel-arm trial included 64 participants aged 13-20 years with established type 1 diabetes and glycated hemoglobin (HbA1c) ≥9% (≥75 mmol/mol). Participants were allocated to 6-month intervention (isCGM; FreeStyle Libre; Abbott Diabetes Care, Witney, U.K.) (n = 33) or control (SMBG; n = 31) using minimization. The primary outcome was the difference in change in HbA1c from baseline to 6 months. RESULTS There was no evidence of a difference between groups for changes in HbA1c at 6 months (adjusted mean 0.2% greater improvement for isCGM [95% CI -0.9 to 0.5] [-2.1 mmol/mol (95% CI -9.6 to 5.4)]; P = 0.576). However, glucose-monitoring frequency was 2.83 (95% CI 1.72-4.65; P < 0.001) times higher in the isCGM group compared with that in the SMBG group at 6 months. The change in the Diabetes Treatment Satisfaction Questionnaire mean item score also favored isCGM at 6 months (P = 0.048), with no significant differences between groups for fear of hypoglycemia and quality of life (both general and diabetes specific) (all P > 0.1). CONCLUSIONS For youth with high-risk glycemic control, isCGM led to improvements in glucose testing frequency and diabetes treatment satisfaction. However, these did not translate to greater improvement in glycemic control over usual care with SMBG at 6 months.
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Affiliation(s)
- Sara E Boucher
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Andrew R Gray
- Centre for Biostatistics, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Esko J Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, Wellington, New Zealand.,Capital & Coast District Health Board, Wellington, New Zealand
| | - Martin I de Bock
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Barbara C Galland
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul A Tomlinson
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jenny A Rayns
- Endocrinology Department, Southern District Health Board, Dunedin, New Zealand
| | - Karen E MacKenzie
- Paediatric Department, Canterbury District Health Board, Christchurch, New Zealand
| | - Huan Chan
- Department of Endocrinology and General Medicine, Canterbury District Health Board, Christchurch, New Zealand
| | - Shelley Rose
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand .,Paediatric Department, Southern District Health Board, Dunedin, New Zealand
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4
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Hannon TS, Moore CM, Cheng ER, Lynch DO, Yazel-Smith LG, Claxton GE, Carroll AE, Wiehe SE. Codesigned Shared Decision-Making Diabetes Management Plan Tool for Adolescents With Type 1 Diabetes Mellitus and Their Parents: Prototype Development and Pilot Test. J Particip Med 2018; 10:e8. [PMID: 33052121 PMCID: PMC7434065 DOI: 10.2196/jopm.9652] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 03/14/2018] [Accepted: 04/22/2018] [Indexed: 12/22/2022] Open
Abstract
Background Adolescents with type 1 diabetes mellitus have difficulty achieving optimal glycemic control, partly due to competing priorities that interfere with diabetes self-care. Often, significant diabetes-related family conflict occurs, and adolescents’ thoughts and feelings about diabetes management may be disregarded. Patient-centered diabetes outcomes may be better when adolescents feel engaged in the decision-making process. Objective The objective of our study was to codesign a clinic intervention using shared decision making for addressing diabetes self-care with an adolescent patient and parent advisory board. Methods The patient and parent advisory board consisted of 6 adolescents (teens) between the ages 12 and 18 years with type 1 diabetes mellitus and their parents recruited through our institution’s Pediatric Diabetes Program. Teens and parents provided informed consent and participated in 1 or both of 2 patient and parent advisory board sessions, lasting 3 to 4 hours each. Session 1 topics were (1) patient-centered outcomes related to quality of life, parent-teen shared diabetes management, and shared family experiences; and (2) implementation and acceptability of a patient-centered diabetes care plan intervention where shared decision making was used. We analyzed audio recordings, notes, and other materials to identify and extract ideas relevant to the development of a patient-centered diabetes management plan. These data were visually coded into similar themes. We used the information to develop a prototype for a diabetes management plan tool that we pilot tested during session 2. Results Session 1 identified 6 principal patient-centered quality-of-life measurement domains: stress, fear and worry, mealtime struggles, assumptions and judgments, feeling abnormal, and conflict. We determined 2 objectives to be principally important for a diabetes management plan intervention: (1) focusing the intervention on diabetes distress and conflict resolution strategies, and (2) working toward a verbalized common goal. In session 2, we created the diabetes management plan tool according to these findings and will use it in a clinical trial with the aim of assisting with patient-centered goal setting. Conclusions Patients with type 1 diabetes mellitus can be effectively engaged and involved in patient-centered research design. Teens with type 1 diabetes mellitus prioritize reducing family conflict and fitting into their social milieu over health outcomes at this time in their lives. It is important to acknowledge this when designing interventions to improve health outcomes in teens with type 1 diabetes mellitus.
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Affiliation(s)
- Tamara S Hannon
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Courtney M Moore
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Erika R Cheng
- Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Dustin O Lynch
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Lisa G Yazel-Smith
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Gina Em Claxton
- Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
| | - Aaron E Carroll
- Pediatric and Adolescent Comparative Effectiveness Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States
| | - Sarah E Wiehe
- Children's Health Services Research Center, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States.,Community Health Partnerships Patient Engagement Core, Indiana Clinical and Translational Sciences Institute, Indiana University, Indianapolis, IN, United States
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5
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Kime NH, Waldron S, Webster E, Lange K, Zinken K, Danne T, Aschemeier B, Sumnik Z, Cinek O, Raposo JF, Vazeou A, Bratina N, Campbell F. Pediatric diabetes training for healthcare professionals in Europe: Time for change. Pediatr Diabetes 2018; 19:578-585. [PMID: 28880485 DOI: 10.1111/pedi.12573] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 07/21/2017] [Accepted: 07/27/2017] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Training for healthcare professionals (HCPs) in Europe who care for children and young people (CYP) with type 1 diabetes and their families is variable depending on the country. Building on the work of SWEET (Better control in Pediatric and Adolescent diabeteS: Working to crEate CEnTers of Reference) and using the German Certified Diabetes Educators (CDEs) curriculum, a European collaboration of pediatric diabetes experts aimed to (1) establish current core elements that should be included in a pediatric diabetes education training course and (2) create a template for a European CDE's training curriculum. METHODS A qualitative methodology incorporating a survey questionnaire, focus group discussions, individual semi-structured interviews and workshops was employed to explore participants' experiences and opinions. HCPs-pediatric consultants, diabetes nurses, dietitians and psychologists, national and local diabetes leads, academic and education leads and children, and young people with diabetes and families took part in the study. The total number of participants equaled 186. RESULTS A template for a European Certified Diabetes Educator Curriculum (EU-CDEC) was developed based on the themes that emerged from the participants' expertise and experiences. This provides a model for HCPs' pediatric diabetes training provision. CONCLUSIONS There is a severe shortage of high quality, standardized training for HCPs across the majority of European countries. Lack of trained HCPs for CYP with diabetes will result in the delivery of suboptimal care and impact on health, wellbeing and clinical and psychological outcomes. The EU-CDEC template can be used to increase access to high quality training provision for all HCPs across Europe and worldwide.
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Affiliation(s)
- Nicky Helen Kime
- Carnegie School of Sport, Leeds Beckett University, Leeds, England
| | - Sheridan Waldron
- Children and Young People's Diabetes Centre, St. James's University Hospital, Leeds, England
| | | | - Karin Lange
- Medizinische Psychologie 5430, Medizinische Hochschule Hannover, Hannover, Germany
| | - Katarzyna Zinken
- Ward KD-A, Crisis and Diagnostics, ZPP Mannheim am Zentralinstitut für seelische Gesundheit, Mannheim, Germany
| | - Thomas Danne
- Diabeteszentrum für Kinder und Jugendliche AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Bärbel Aschemeier
- Diabeteszentrum für Kinder und Jugendliche AUF DER BULT, Kinder- und Jugendkrankenhaus, Hannover, Germany
| | - Zdenek Sumnik
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | | | - Andriani Vazeou
- A' Department of Pediatrics, Diabetes Center, P&A Kyriakou Children's Hospital, Athens, Greece
| | - Natasa Bratina
- Department for Endocrinology, Diabetes and Metabolic Diseases, University Childrens Hospital Ljubljana, Ljubljana, Slovenia
| | - Fiona Campbell
- Children and Young People's Diabetes Centre, St. James's University Hospital, Leeds, England
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6
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Selvakumar D, Al-Sallami HS, de Bock M, Ambler GR, Benitez-Aguirre P, Wiltshire E, Tham E, Simm P, Conwell LS, Carter PJ, Albert BB, Willis J, Wheeler BJ. Insulin regimens for newly diagnosed children with type 1 diabetes mellitus in Australia and New Zealand: A survey of current practice. J Paediatr Child Health 2017; 53:1208-1214. [PMID: 28727196 DOI: 10.1111/jpc.13631] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2016] [Revised: 03/27/2017] [Accepted: 05/15/2017] [Indexed: 12/16/2022]
Abstract
AIM There is no consensus on the optimal insulin treatment for children newly diagnosed with type 1 diabetes mellitus (T1DM). The aims of this study were (i) to describe the insulin regimens used at diagnosis by patient age and geographical region and (ii) to explore differences between and within Australia (AU) and New Zealand (NZ) with regards to other aspects of patient management and education. METHODS An online survey of medical professionals caring for children with T1DM in AU and NZ was undertaken. Questions included clinic demographics, insulin regimen/dosing choices and patient education. RESULTS Of 110 clinicians identified, 100 responded (91%). The majority of those in AU (69%, P < 0.0001) favour multiple daily injections (MDI) for all ages. In NZ, for patients < 10 years old, (twice daily (BD)) BD therapy was favoured (75%, P < 0.0001), with MDI dominant for ages ≥ 10 years (82%, P < 0.0001). Insulin pump therapy was never considered at diagnosis in NZ, but 38% of clinicians in AU considered using pumps at diagnosis in patients <2 years, but rarely in patients aged 2 and over (16%). Differences in clinician choices were also seen in relation to starting insulin dose. CONCLUSION This is the first study to examine current clinical practice with regards to children newly diagnosed with T1DM. Practice varies across Australasia by clinician and region. This lack of consensus is likely driven by ongoing debates in the current paediatric diabetes evidence base as well as by differences in clinician/centre preference, variations in resourcing and their interpretations of the influence of various patient factors.
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Affiliation(s)
| | | | - Martin de Bock
- Department of Paediatric and Child Health, Princess Margaret Hospital, Perth, Western Australia, Australia
| | - Geoffrey R Ambler
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - Paul Benitez-Aguirre
- Institute of Endocrinology and Diabetes, Children's Hospital at Westmead and University of Sydney, Sydney, New South Wales, Australia
| | - Esko Wiltshire
- Department of Paediatrics and Child Health, University of Otago, Wellington, New Zealand
| | - Elaine Tham
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Peter Simm
- Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
| | - Louise S Conwell
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Endocrinology and Diabetes, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia
| | - Phillipa J Carter
- Starship Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - Benjamin B Albert
- Starship Paediatric Diabetes and Endocrinology, Starship Children's Health, Auckland, New Zealand
| | - Jinny Willis
- Don Beaven Medical Research Centre, Christchurch, New Zealand
| | - Benjamin J Wheeler
- Department of Women's and Children's Health, University of Otago, Dunedin, New Zealand
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7
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Gesuita R, Skrami E, Bonfanti R, Cipriano P, Ferrito L, Frongia P, Iafusco D, Iannilli A, Lombardo F, Mozzillo E, Paleari R, Rabbone I, Sabbion A, Salvatoni A, Scaramuzza A, Schiaffini R, Sulli N, Toni S, Carle F, Cherubini V. The role of socio-economic and clinical factors on HbA1c in children and adolescents with type 1 diabetes: an Italian multicentre survey. Pediatr Diabetes 2017; 18:241-248. [PMID: 26990605 DOI: 10.1111/pedi.12378] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/02/2016] [Accepted: 02/16/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To identify the role of the family's socio-economic and clinical characteristics on metabolic control in children and adolescents with type 1 diabetes. METHODS In this cross-sectional, multicentre study, 768 subjects with type 1 diabetes under 18 years of age were consecutively recruited from January 2008 to February 2009. Target condition was considered for HbA1c values <7.5% (<58 mmol/mol). A multiple correspondence analysis (MCA) was performed to analyze the association between the socio-economic and clinical characteristics of the participants. A logistic regression analysis was performed to identify factors associated with the subjects metabolic control. In both analyses, the family's socio-economic status was represented, measured by the Hollingshead Four-Factor Index of Social Status (SES) or by parental years of education. RESULTS A total of 28.1% of subjects reached target HbA1c values. The MCA identified a strong association between at-target condition and several factors: high levels of SES or high levels of parental education, the use of the carbohydrate counting system, the use of insulin pumps, the use of the insulin delivery system over a short period of time, a normal body mass index. The logistic regression analysis showed that SES and the mother's years of education were significantly associated with the target condition [odds ratio (OR): 1.01, 95% confidence interval (CI): 1.01-1.03, p = 0.029; OR: 1.05, 95% CI: 1.01-1.10, p = 0.027, respectively). CONCLUSIONS Personal, clinical, and family characteristics were found to be associated with HbA1c target. Their identification can be crucial in addressing strategies to optimize metabolic control and improve diabetes management.
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Affiliation(s)
- Rosaria Gesuita
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Edlira Skrami
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Riccardo Bonfanti
- Centre of Paediatric Diabetology, San Raffaele Hospital, Milan, Italy
| | - Paola Cipriano
- Centre of Paediatric Diabetology, University of Chieti, Chieti, Italy
| | - Lucia Ferrito
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | - Paola Frongia
- Unit of Paediatric Diabetes, Brotzu Hospital, Cagliari, Italy
| | - Dario Iafusco
- Centre of Paediatric Diabetology, Second University of Naples, Naples, Italy
| | - Antonio Iannilli
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
| | | | - Enza Mozzillo
- Centre of Paediatric Diabetology, University Federico II, Naples, Italy
| | - Renata Paleari
- Department of Physiopathology and transplantation, University of Milan, Milan, Italy
| | - Ivana Rabbone
- Department of Pediatrics, University of Turin, Turin, Italy
| | - Alberto Sabbion
- Centre of Paediatric Diabetology, University of Verona, Verona, Italy
| | | | | | | | - Nicoletta Sulli
- Centre of Paediatric Diabetology, University La Sapienza, Rome, Italy
| | - Sonia Toni
- Pediatrics, AOU Meyer Children's Hospital, Florence, Italy
| | - Flavia Carle
- Centre of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy.,General Direction of Health Care Planning, Health Ministry, Rome, Italy
| | - Valentino Cherubini
- Division of Paediatric Diabetes, Women's and Children's Health, AOU Ancona, Salesi Hospital, Ancona, Italy
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8
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Mousa M, Al-Mahdi M, Al-Sanaa H, Al-Kandari H. A Comparison of Continuous Subcutaneous Insulin Infusion vs. Multiple Daily Insulin Injection in Children with Type I Diabetes in Kuwait: Glycemic Control, Insulin Requirement, and BMI. Oman Med J 2015; 30:336-43. [PMID: 26421114 DOI: 10.5001/omj.2015.69] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE Continuous subcutaneous insulin infusion (CSII) and multiple daily insulin injections (MDI) are two methods currently used to manage type I diabetes mellitus (T1DM). Here we compare our experiences with CSII and MDI in a large cohort of pediatric patients in Kuwait. METHODS Data on 326 patients with T1DM who were started on CSII between 2007 and 2012 were retrospectively compared with those of 326 patients on MDI. They were matched for sex, age at diagnosis, T1DM duration, glycemic control, insulin requirement, and body mass index (BMI). Data were collected at baseline and every three months and included glycated hemoglobin (HbA1c), insulin dose, and adverse events (severe hypoglycemia, diabetic ketoacidosis, and skin problems). RESULTS The main reason for switching to CSII was to achieve better glycemic control (37%), followed by reducing hypoglycemia, and improving the quality of life (13.3% each). Although HbA1c decrease was most significant in the first year, it continued to be significantly lower in the CSII group compared to the MDI throughout the study period. Total daily insulin requirements were significantly lower in the CSII group. BMI increased in both groups, but the difference was significant only at the end of the fifth year. There was no significant change in the rate of diabetic ketoacidosis in either group. The CSII patients had more severe hypoglycemic episodes at baseline; however, it significantly decreased throughout the study period. Only five patients discontinued CSII therapy and two of these restarted within three months. CONCLUSION CSII is a safe intensive insulin therapy in youngsters with T1DM and achieved markedly fewer severe hypoglycemic episodes and lower daily insulin requirements.
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Affiliation(s)
| | - Mohammad Mousa
- Department of Community Medicine, Kuwait University, Jabriya City, Kuwait
| | - Maria Al-Mahdi
- Department of Pediatrics, Adan Hospital, AlAhmadi City, Kuwait
| | - Hala Al-Sanaa
- Department of Pediatrics, Amiri Hospital, Kuwait city, Kuwait
| | | | - Hessa Al-Kandari
- Department of Pediatrics, Farwania Hospital, Farwaniya City, Kuwait
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9
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Abstract
Technological innovations have revolutionized the treatment of type 1 diabetes. Although technological advances can potentially improve diabetes outcomes, maintenance of target glycemic control, at the present time, remains largely dependent on patient and family motivation, competence, and adherence to daily diabetes care requirements. Trials of closed loop or "artificial pancreas" technology show great promise to automate insulin delivery and achieve near normal glucose control and reduced hypoglycemia with minimal patient intervention.
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Affiliation(s)
- Katharine Garvey
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA.
| | - Joseph I Wolfsdorf
- Division of Endocrinology, Department of Medicine, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA; Department of Pediatrics, Harvard Medical School, 25 Shattuck St, Boston, MA 02115, USA
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10
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Abstract
Diabetes is one of the most common chronic medical disorders in children. The management of diabetes remains a substantial burden on children with diabetes and their families, despite improvements in treatment and rates of morbidity and mortality. Although most children with diabetes have type 1 diabetes, the increasing recognition of type 2 diabetes and genetic forms of diabetes in the paediatric population has important treatment implications. Diabetes therapy focuses strongly on targets for good metabolic control to reduce the risk of long-term complications. A parallel goal is to minimise short-term complications of hypoglycaemia and diabetic ketoacidosis. Technology offers opportunity for improvement in care, but has not yet fully lived up to its potential. New insights into the pathogenesis of diabetes and the development of new therapies have led to clinical trials aimed at the prevention of diabetes.
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Affiliation(s)
- Fergus J Cameron
- Centre for Hormone Research, Department of Endocrinology and Diabetes, The Royal Children's Hospital, Murdoch Children's Research Institute and Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, VIC, Australia
| | - Diane K Wherrett
- Division of Endocrinology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada.
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11
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Wheeler BJ, Heels K, Donaghue KC, Reith DM, Ambler GR. Insulin pump-associated adverse events in children and adolescents--a prospective study. Diabetes Technol Ther 2014; 16:558-62. [PMID: 24796368 DOI: 10.1089/dia.2013.0388] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Intensive insulin regimens are now the mainstay of modern, type 1 diabetes mellitus management. Insulin pumps (CSII) are a key technique used. Although there has been considerable study of outcomes, there are few recent data on CSII-associated adverse events (AEs) and their incidence and characteristics. SUBJECTS AND METHODS Phone calls to our 24-h diabetes support service were screened for CSII-associated AEs. Phone interviews were conducted with the parent/patient, within 96 h of the event. Interviews explored AE characteristics and the role of the user, as well as questions relating to outcome and the impact to the family and patient. Comparisons were made with clinic CSII patients not reporting an AE. RESULTS Over a 16-week study period, 50 confirmed AEs occurred in 45 of 405 (11.1%) patients. This was annualized to an AE incidence of 40 AEs/100 person-years. Pump malfunction and infusion set/site failures were the most common events reported, occurring in 27 (54.0%) and 18 (36.0%) AEs, respectively. A user- or education-related issue was implicated in 22 (44.0%) events. Pump replacement occurred in 19 of 50 occurrences (38.0%). Additionally, 16 (32.0%) reported a hospital admission or emergency department attendance as a consequence. When compared with those on CSII not reporting an AE, AEs were associated with age <10 years (odds ratio=3.2 [95% confidence interval, 1.7-6.1]) but not with gender, glycosylated hemoglobin, diabetes duration, or pumping duration. CONCLUSIONS This is the first prospective study to look at AEs in modern-generation insulin pumps. AEs appear common and should be anticipated. Their origin is multifactorial, with the pump, associated consumables, and the user all being important factors. Ongoing support and anticipatory education are essential to minimize pump-associated AEs and their impact.
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Affiliation(s)
- Benjamin J Wheeler
- 1 The Institute of Endocrinology and Diabetes, The Children's Hospital at Westmead , Sydney, Australia
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12
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Johnson B, Elliott J, Scott A, Heller S, Eiser C. Medical and psychological outcomes for young adults with Type 1 diabetes: no improvement despite recent advances in diabetes care. Diabet Med 2014; 31:227-31. [PMID: 23952498 DOI: 10.1111/dme.12305] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/12/2013] [Indexed: 11/29/2022]
Abstract
AIM To assess medical and psychological outcomes among young people with Type 1 diabetes and to compare medical outcomes with a previous audit. METHODS An observational study in two diabetes clinics for young adults (aged 16-21 years) in Sheffield, UK. Young people (n = 96: 81.4% response rate) with Type 1 diabetes (diagnosed > 6 months) completed measures of depressive symptoms, anxiety and disordered eating and consented for their medical records to be consulted. RESULTS Mean HbA1c (86 ± 23 mmol/mol; 10.0 ± 2.1%); was comparable with that reported previously and considerably higher than recommended (< 58 mmol/mol or 7.5%). Screening rates were improved and non-attendance was lower than previously reported, but levels of non-proliferative retinopathy have increased. Microvascular complications are present in 46.9% of those diagnosed more than 7 years. Elevated levels of disordered eating were reported by 35.1%. Those scoring above cut-off levels for clinical anxiety (26.6%) and depression (10.9%) are comparable with other work with young people with Type 1 diabetes. CONCLUSIONS Despite technological advances and improvements to delivery of care, HbA1c remain above recommended levels in a significant proportion of young people, many of whom already have microvascular complications. We need to learn from European centres who achieve better results, improve transition from paediatric care, integrate mental health support with diabetes care provision and take into account young people's views about clinic.
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Affiliation(s)
- B Johnson
- Department of Psychology, University of Sheffield, Sheffield, UK; NIHR CLAHRC for South Yorkshire, Sheffield, UK
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13
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Cameron FJ, de Beaufort C, Aanstoot HJ, Hoey H, Lange K, Castano L, Mortensen HB. Lessons from the Hvidoere International Study Group on childhood diabetes: be dogmatic about outcome and flexible in approach. Pediatr Diabetes 2013; 14:473-80. [PMID: 23627895 DOI: 10.1111/pedi.12036] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2012] [Revised: 02/03/2013] [Accepted: 03/07/2013] [Indexed: 12/20/2022] Open
Affiliation(s)
- F J Cameron
- Department of Endocrinology and Diabetes, Royal Children's Hospital, Murdoch Children's Research Institute, University of Melbourne, Melbourne, Australia
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14
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Neylon OM, O'Connell MA, Skinner TC, Cameron FJ. Demographic and personal factors associated with metabolic control and self-care in youth with type 1 diabetes: a systematic review. Diabetes Metab Res Rev 2013; 29:257-72. [PMID: 23364787 DOI: 10.1002/dmrr.2392] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Revised: 12/02/2012] [Accepted: 01/02/2013] [Indexed: 11/11/2022]
Abstract
Optimal use of recent technological advances in insulin delivery and glucose monitoring remain limited by the impact of behaviour on self-care. In recent years, there has been a resurgence of interest in psychosocial methods of optimizing care in youth with type 1 diabetes. We therefore sought to examine the literature for demographic, interpersonal and intrapersonal correlates of self-care and/or metabolic control. Studies for this systematic review were obtained via an electronic search of Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and PsycINFO databases. Seventy studies fulfilled the inclusion criteria. These studies have indicated that identifiable individual characteristics in each domain are robustly associated with metabolic control and/or self-care in children and adolescents. We present these characteristics and propose a theoretical model of their interactions and effect on diabetes outcomes. There is currently no consensus regarding patient selection for insulin pump therapy. In this era of scarce healthcare resources, it may be prudent to identify youth requiring increased psychosocial support prior to regimen intensification. The importance of this review lies in its potential to create a framework for rationally utilizing resources by stratifying costly therapeutic options to those who, in the first instance, will be most likely to benefit from them.
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Affiliation(s)
- Orla M Neylon
- University of Tasmania, Burnie, Tasmania, Australia.
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15
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Boot M, Volkening LK, Butler DA, Laffel LMB. The impact of blood glucose and HbA(1c) goals on glycaemic control in children and adolescents with Type 1 diabetes. Diabet Med 2013. [PMID: 23190135 PMCID: PMC3614346 DOI: 10.1111/dme.12083] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
AIMS To evaluate parents' goals and parents' perceptions of physicians' goals for blood glucose and HbA(1c) in children and adolescents with Type 1 diabetes. METHODS In a cross-sectional observational assessment, parents (80% mothers) of 153 children/adolescents (56% female), aged 12.9 ± 2.3 years (range 8-16 years) with Type 1 diabetes for 6.3 ± 3.5 years, completed surveys regarding their goals and their perceptions of physicians' goals for their child's blood glucose and HbA(1c) levels. RESULTS Children/adolescents had a mean HbA(1c) of 69 ± 16 mmol/mol (8.4 ± 1.4%) and checked blood glucose levels 3.8 ± 1.2 times/day; 23% received pump therapy. Almost half of parents reported a blood glucose goal of 130 (80-180) mg/dl [7.2 (4.4-10) mmol/l]; 75% of parents reported a HbA(1c) goal of 42-64 mmol/mol (6-8%). HbA(1c) was significantly lower when parents reported HbA(1c) goals ≤ 64 mmol/mol (≤ 8%) vs. > 64 mmol/mol (> 8%) [67 ± 14 mmol/mol (8.3 ± 1.2%) vs. 76 ± 20 mmol/mol (9.1 ± 1.8%), respectively, P = 0.02]. Parents' blood glucose and HbA(1c) goals were tightly linked with parents' perceptions of physicians' blood glucose and HbA(1c) goals (69% concordant, P < 0.0001; 88% concordant, P < 0.0001, respectively). CONCLUSIONS There was a significant association between lower parent HbA(1c) goals and lower child/adolescent HbA(1c) . Further, parents appear to set glycaemic goals based upon their perceptions of physician goals. Future studies should assess the relationship between parents' perceptions of health-care providers' goals and health-care providers' actual goals and the impact of unified family/provider goal-setting on glycaemic control.
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Affiliation(s)
- M Boot
- Pediatric, Adolescent and Young Adult Section, Genetics & Epidemiology Section, Joslin Diabetes Center, Boston, MA, USA
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16
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Spencer JE, Cooper HC, Milton B. The lived experiences of young people (13-16 years) with Type 1 diabetes mellitus and their parents--a qualitative phenomenological study. Diabet Med 2013; 30:e17-24. [PMID: 22998426 DOI: 10.1111/dme.12021] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2012] [Indexed: 11/28/2022]
Abstract
AIMS Within a programme of research aiming to develop a technology-based educational intervention for young people with Type 1 diabetes, this study aimed to explore adolescents' and parents' experiences of living with Type 1 diabetes from an interpretive phenomenological perspective. METHODS In-depth interviews were conducted with 20 adolescents with Type 1 diabetes from a diabetes clinic in North West England, and 27 of their parents. RESULTS Living with Type 1 diabetes in adolescence was characterized by three distinct stages: (1) adapting to the diagnosis; (2) learning to live with Type 1 diabetes; (3) becoming independent. Experiential learning was key to adolescents developing self-management skills and independence. Parents and health professionals were instrumental in facilitating environments that gave adolescents the freedom to learn through trial and error. They also provided the support, feedback and discussion necessary to facilitate such learning. CONCLUSIONS For adolescents to become independent in Type 1 diabetes self-management, they must develop capability through experiential learning. It is important that parents and health professionals understand the important role they play in this process and have the skills to support adolescents in this way. Data from this study have been used to develop an online interactive 'Adolescent Diabetes Needs Assessment Tool', which assesses individual learning and support needs to aid the process of feedback and discussion.
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Affiliation(s)
- J E Spencer
- School of Health Sciences, University of Liverpool, Liverpool, UK
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17
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Tiberg I, Carlsson KS, Carlsson A, Hallström I. Metabolic control, healthcare satisfaction and costs 1 month after diagnosis of type 1 diabetes: a randomised controlled trial of hospital-based care vs. hospital-based home care. Pediatr Diabetes 2012; 13:625-31. [PMID: 22759218 DOI: 10.1111/j.1399-5448.2012.00879.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Revised: 03/30/2012] [Accepted: 04/12/2012] [Indexed: 11/28/2022] Open
Abstract
Procedures for the initial management of children newly diagnosed with diabetes vary greatly worldwide and the evidence available is insufficient for conclusively determining the best process regarding hospital-based or home-based care. The aim of the study was to compare two different regimens for children with newly diagnosed type 1 diabetes; hospital-based care and hospital-based home care (HBHC), defined as specialist care in a home-based setting. A randomised controlled trial, including 60 children, took place at a university hospital in Sweden during the period of March 2008 to September 2011. After 2-3 d with hospital-based care, children from 3 to 15 yr of age were randomised to either continued hospital-based care for a total of 1-2 wk or to HBHC. This article presents results 1 month after diagnosis. No differences were shown in the daily mean glucose level or in its variability when the children received care but, after discharge, children who received HBHC showed lower mean plasma glucose values and lower variability compared to children who received hospital-based care. Children in HBHC had fewer episodes of hypoglycaemia during the first month after diagnosis. In the HBHC group, parents were more satisfied with the healthcare received and healthcare costs for the first month were 30% lower as compared to hospital-based care. The results 1 month after diagnosis support the HBHC programme as being a safe and cost-effective way of providing care. A follow-up will continue for 2 yr to evaluate which process was best for the majority of families over time.
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Affiliation(s)
- Irén Tiberg
- Division of Nursing, Department of Health Sciences, Lund University, Lund, Sweden.
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18
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Haugstvedt A, Wentzel-Larsen T, Rokne B, Graue M. Psychosocial family factors and glycemic control among children aged 1-15 years with type 1 diabetes: a population-based survey. BMC Pediatr 2011; 11:118. [PMID: 22185481 PMCID: PMC3282662 DOI: 10.1186/1471-2431-11-118] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2011] [Accepted: 12/20/2011] [Indexed: 12/05/2022] Open
Abstract
Background Being the parents of children with diabetes is demanding. Jay Belsky's determinants of parenting model emphasizes both the personal psychological resources, the characteristics of the child and contextual sources such as parents' work, marital relations and social network support as important determinants for parenting. To better understand the factors influencing parental functioning among parents of children with type 1 diabetes, we aimed to investigate associations between the children's glycated hemoglobin (HbA1c) and 1) variables related to the parents' psychological and contextual resources, and 2) frequency of blood glucose measurement as a marker for diabetes-related parenting behavior. Methods Mothers (n = 103) and fathers (n = 97) of 115 children younger than 16 years old participated in a population-based survey. The questionnaire comprised the Life Orientation Test, the Oslo 3-item Social Support Scale, a single question regarding perceived social limitation because of the child's diabetes, the Relationship Satisfaction Scale and demographic and clinical variables. We investigated associations by using regression analysis. Related to the second aim hypoglycemic events, child age, diabetes duration, insulin regimen and comorbid diseases were included as covariates. Results The mean HbA1c was 8.1%, and 29% had HbA1c ≤ 7.5%. In multiple regression analysis, lower HbA1c was associated with higher education and stronger perceptions of social limitation among the mothers. A higher frequency of blood glucose measurement was significantly associated with lower HbA1c in bivariate analysis. Higher child age was significantly associated with higher HbA1c both in bivariate and multivariate analysis. A scatterplot indicated this association to be linear. Conclusions Most families do not reach recommended treatment goals for their child with type 1 diabetes. Concerning contextual sources of stress and support, the families who successfully reached the treatment goals had mothers with higher education and experienced a higher degree of social limitations because of the child's diabetes. The continuous increasing HbA1c by age, also during the years before puberty, may indicate a need for further exploring the associations between child characteristics, context-related variables and parenting behavior such as factors facilitating the transfer of parents' responsibility and motivation for continued frequent treatment tasks to their growing children.
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Affiliation(s)
- Anne Haugstvedt
- Faculty of Health and Social Sciences, Bergen University College, Norway.
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19
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Ho J, Huang C, Nettel-Aguirre A, Pacaud D. Insulin detemir in a twice daily insulin regimen versus a three times daily insulin regimen in the treatment of type 1 diabetes in children: A pilot randomized controlled trial. INTERNATIONAL JOURNAL OF PEDIATRIC ENDOCRINOLOGY 2011; 2011:15. [PMID: 22067102 PMCID: PMC3223134 DOI: 10.1186/1687-9856-2011-15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 11/08/2011] [Indexed: 11/10/2022]
Abstract
Background Methods Results Conclusions Trial registration
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20
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Tiberg I, Carlsson A, Hallström I. A Methodological Description of a Randomised Controlled Trial Comparing Hospital-Based Care and Hospital-Based Home Care when a Child is Newly Diagnosed with Type 1 Diabetes. Open Nurs J 2011; 5:111-9. [PMID: 22371819 PMCID: PMC3263442 DOI: 10.2174/18744346011050100111] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 09/23/2011] [Accepted: 09/28/2011] [Indexed: 01/22/2023] Open
Abstract
AIM AND OBJECTIVE To describe the study design of a randomised controlled trial with the aim of comparing two different regimes for children with newly diagnosed type 1 diabetes; hospital-based care and hospital-based home care. BACKGROUND Procedures for hospital admission and sojourn in connection with diagnose vary greatly worldwide and the existing evidence is insufficient to allow for any conclusive determination of whether hospital-based or home-based care is the best alternative for most families. Comparative studies with adequate power and outcome measurements, as well as measurements of cost-effectiveness are needed. DESIGN The study design was based on the Medical Research Council framework for complex interventions. After two to three days with hospital-based care, children between the ages of 3 and 16 were randomised to receive either continued hospital-based care for a total of 1-2 weeks or hospital-based home care, which refers to specialist care in a home-based setting. The trial started in March 2008 at a University Hospital in Sweden and was closed in September 2011 when a sufficient number of children according to power calculation, were included. The primary outcome was the child's metabolic control during the following two years. Secondary outcomes were set to evaluate the family and child situation as well as the organisation of care. DISCUSSION Childhood diabetes requires families and children to learn to perform multiple daily tasks. Even though intervention in health care is complex with several interacting components entailing practical and methodological difficulties, there is nonetheless, a need for randomised controlled trials in order to evaluate and develop better systems for the learning processes of families that can lead to long-term improvement in adherence and outcome. TRIAL REGISTRATION Trial Register NCT00804232.
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Affiliation(s)
- Irén Tiberg
- Division of Nursing, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
- Department of Paediatrics, Lund University Hospital, SE-221 85 Lund, Sweden
- The Swedish Institute for Health Sciences, Lund University, Sweden
| | - Annelie Carlsson
- Department of Paediatrics, Lund University Hospital, SE-221 85 Lund, Sweden
| | - Inger Hallström
- Division of Nursing, Department of Health Sciences, Lund University, 221 00 Lund, Sweden
- The Swedish Institute for Health Sciences, Lund University, Sweden
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