ISPAD Clinical Practice Consensus Guidelines 2014. Diabetes education in children and adolescents

Investigation of the therapeutic education effect on glycemic control and quality of life of children and adolescents with type-1 diabetes mellitus: A non-randomized controlled study

BACKGROUND

Type-1 diabetes mellitus (T1DM) is one of the most dreaded chronic diseases, especially in children or youth. To help patients and their families effectively manage their disease, structured therapeutic patient education (TPE) is essential.

MATERIALS AND METHOD

The purpose of this non-randomized before and after controlled study was to assess TPE program effects. In total, 200 T1DM children and adolescents, aged 8-18 years, selected from two pediatric departments, were equally assigned to the intervention and control groups. The primary endpoints were differences between groups at 3 months follow-up in measured HbA1c and health-related quality of life (QoL) assessed by a validated questionnaire.

RESULTS

At 3 months follow-up of a TPE intervention for T1DM children and adolescents, although there was no significant change in HbA1c for both groups, a significant improvement was observed in the maximum pre- and postprandial blood glucose levels (r: ~0.3; variation rates: -10,47% and -3,85%, respectively) in the intervention group, whereas there was a significant increase in the maximum and minimum of preprandial blood glucose levels in the control group (r: ~0.3, variation rates: 14.29% and 25%, respectively). Global and dimensional QoL mean scores variation rates showed a significant difference between groups, with an improvement in the intervention group (r ≥ 0.7, Cohen's > 0.8) and a decrease in the control group (r ≥ 0.7).

CONCLUSION

These results support the hypotheses of difference between the study groups in favor of better glycemic control and QoL for the intervention group.

Information needs on type 1 diabetes mellitus (T1DM) and its management in children and adolescents: a qualitative study

OBJECTIVE

The objective of this study is to explore the information needs related to insulin therapy in children and adolescents with type 1 diabetes mellitus (T1DM) from the children's perspectives as well as their caregivers.

DESIGN

Qualitative study; semistructured interviews. To identify emerging themes relating to information needs, open coding and thematic analysis were employed.

SETTING

Participants were recruited from a tertiary care children's hospital in Kuala Lumpur, Malaysia and a specialist hospital in Riyadh, Saudi Arabia.

PARTICIPANTS

Thirty one children with a mean age of 11.5 years (SD=1.9) and their caregivers were interviewed. Seventeen participants were from Malaysia and 14 were from Saudi Arabia.

RESULTS

Four themes of information emerged from the interviews, including information related to (1) hypoglycaemia and hyperglycaemia, (2) insulin therapy, (3) injection technique and (4) other information needs pertaining to continuous glucose monitoring, access to peer groups and future advances in insulin therapy.

CONCLUSION

This study provided valuable insights into the information needs related to T1DM and insulin therapy among children and adolescents with T1DM that should be considered by stakeholders in the development of age-appropriate education materials. Such materials will assist children and adolescents to better manage their life-long T1DM condition from adolescence until adulthood.

Effects of therapeutic patient education program on glycemic control and quality of life among children and adolescents with type 1 diabetes mellitus in Fez city, Morocco

Context

Type 1 diabetes mellitus (T1DM) is a chronic disease, mainly observed in children or youth, with a significantly increased incidence in young children. Structured therapeutic patient education (TPE) is a must to help them manage their disease effectively and lead a healthy lifestyle.

Aims

This study aimed to assess the effects of a structured TPE program on glycemic markers and quality of life (QOL) of T1DM children and adolescents in Fez city, Morocco.

Settings and Design

It is a quasi-experimental study.

Materials and Methods

One hundred T1DM children and adolescents, aged 8-18, participated in a TPE intervention at the pediatric department in a hospital center in Fez, Morocco. Glycemic markers were measured and QOL was assessed by a validated questionnaire.

Statistical Analysis Used

Parametric and nonparametric tests were used and statistical significance determined by P < 0.05.

Results

At 3 months' follow-up, both global and dimensional QOL mean scores improved significantly (P ≤ 0.0001), whereas glycosylated hemoglobin (HbA1c) decreased (10.28% vs. 10.62%), tough with no statistical significance (P = 0.160). Furthermore, a significant improvement was observed in the maximum preprandial (2, 11 g/L [1.51-2.58] vs. 2, 37 g/L [1.81-3.21], P = 0.001) and postprandial blood glucose levels (2, 50 g/L [1.90-3.27] vs. 2, 95 g/L [2.07-3.99], P = 0.001) after 3 months; with no significant change in their minimum.

Conclusion

Although this TPE intervention was more effective in improving patients' QOL than their HbA1c, it is worth striving to implement regular TPE programs for T1DM pediatric patients and adjust them to achieve a better patients' glycemic markers levels.

The burdens faced by parents of preschoolers with type 1 diabetes mellitus: an integrative review

PURPOSE

This study examined the literature concerning the burdens of parents of preschool-aged children diagnosed with type 1 diabetes mellitus.

METHODS

We employed an integrative review methodology based on Whittemore and Knafl's framework. The literature search was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines across four electronic databases: PubMed, Web of Science, the Cumulative Index to Nursing Allied Health Literature (CINAHL), and PsycINFO. Ultimately, 18 articles were included in the review.

RESULTS

The review yielded four themes: (1) parental burdens, (2) factors related to the burdens, (3) coping strategies, and (4) implications for clinical practice. Parents experienced psychological, physical, and social burdens due to the diabetes care of their children. Several factors influenced burdens, including child-related characteristics such as age, severity of diabetes, and hospitalization experience, as well as parental factors like family income, race, and residential area. Parents initially felt burdened when their child was diagnosed with type 1 diabetes, but over time, they often adapted to the situation through support and sharing of responsibilities. Parents desired education and interventions reflecting the unique characteristics of preschoolers.

CONCLUSION

This integrative literature review revealed that parents experience numerous burdens when their child is diagnosed with diabetes. Future research should focus on developing interventions to address parents' psychological difficulties, including tracking parental psychological changes over time. Tailored nursing interventions should also be provided to parents of preschool-aged children, as opposed to the more generic nursing interventions traditionally applied across all age groups of children in clinical settings.

Deep Analysis of Clinical Parameters and Temporal Evolution of Glycemic Parameters Based on CGM Data for the Characterization of Severe Hypoglycemia in a Cohort of Children and Adolescents with Type 1 Diabetes

This study aims to evaluate the determinants and clinical markers of patients at risk for severe hypoglycemia (SH) in children and adolescents with type 1 diabetes. In the EPI-GLUREDIA study, clinical parameters and continuous glucose monitoring metrics from children and adolescents with type 1 diabetes were retrospectively analyzed between July 2017 and June 2022. Their clinical parameters were collected during traditional and quarterly medical consultations according to whether they experienced severe hypoglycemia or not. Then, continuous glucose monitoring metrics were analyzed on days surrounding SH during specific periods. According to the glycemic parameters, glycemic hemoglobin and glycemic mean were significantly lower in the three months preceding a SH compared with during three normal months (p < 0.05). Moreover, the time spent in hypoglycemia(time below the range, TBR_<3.3) and its strong correlation (R = 0.9, p < 0.001) with the frequency of SH represent a sensitive and specific clinical parameter to predict SH (cut-off: 9%, sensitivity: 71%, specificity: 63%). The second finding of the GLUREDIA study is that SH is not an isolated event in the glycemic follow-up of our T1DM patients. Indeed, most of the glycemic parameters (i.e., glycemic mean, glycemic variability, frequency of hypoglycemia, and glycemic targets) vary considerably in the month preceding an SH (all p < 0.05), whereas most of these studied glycemic parameters remain stable in the absence of a severe acute complication (all p > 0.05). Furthermore, the use of ROC curves allowed us to determine for each glycemic parameter a sensitive or specific threshold capable of more accurately predicting SH. For example, a 10% increase in the frequency of hypoglycemia predicts a risk of near SH with good combination of sensitivity and specificity (sensitivity: 80%, specificity: 60%). The GLUREDIA study aimed to target clinical and glycemic parameters to predict patients at risk for SH. First, we identified TBR_<3.3 < 9% as a sensitive and specific tool to reduce the frequency of SH. In addition, SH was not an isolated event but rather it was accompanied by glycemic disturbances in the 30 days before SH.

Educational needs of type 1 diabetes mellitus T1DM children and adolescents in Morocco: A qualitative study

BACKGROUND

Type 1 Diabetes Mellitus T1DM is a chronic disease, mainly observed in children or young adults, with a significantly increased incidence in young children. To enable diabetic children and adolescents to lead a healthy life and manage their disease effectively, right from diagnosis, they must benefit from therapeutic patient education TPE whose first stage is an educational diagnosis. This study aimed to identify the educational needs of T1DM children and adolescents through an educational diagnosis.

METHODS AND MATERIAL

A qualitative study was conducted with T1DM children and adolescents, aged 8 to 18, at the pediatric department. This qualitative study was conducted through semi-structured face-to-face individual interviews based on a guide with 20 participants in 2022. The internationally recognized ethical research principles were respected and ethical approval was obtained. Data analysis were carried out according to the principles of the reflexive approach of thematic analysis.

RESULTS

The interviews' thematic analysis revealed five educational themes: Knowledge about T1DM and its complications risks, measures and attitudes for disease monitoring and therapy management, crisis and short-term complications management, diet and physical activity management, and adaptation of daily life to the disease and treatment constraints.

CONCLUSIONS

The educational diagnosis is an essential TPE step to identify the educational needs of children and adolescents with T1DM, and to set up if needed, an educational program allowing them to develop the required skills. Hence, the health policy in Morocco should integrate the TPE approach systematically in T1DM patients' care.

Analysis of the impact of a diabetes education program on glycemic control and prevalence of chronic complications

Objective

Diabetes mellitus (DM) is a chronic disease of increasing importance in public health, associated with chronic complications including retinopathy, neuropathy, and kidney, cardiovascular and cerebrovascular disease. This study assessed the impact of strategic DM education actions on glycemic control and prevalence of chronic complications in patients with DM.

Subjects and methods

Retrospective, quantitative, cohort study at a diabetes patients association comprised of a multidisciplinary team. In all, 533 individuals with DM were included. Sociodemographic and clinical data were collected using questionnaire and medical records. Of these, 333 patients evaluated for 12 to 24 months, with type 2 DM (T2DM, n = 317) and other types of DM (n = 16), were selected to collect data on retinopathy and diabetes kidney disease (DKD).

Results

There was a predominance of elderly individuals, low education level, women, high rate of overweight and obesity, physical inactivity, dietary errors, dyslipidemia, and T2DM. More patients with T2DM versus type 1 DM had optimal glycemic control (46.3% vs. 12.2%, respectively; p < 0.001). The impact of the educational processes was demonstrated by the analysis of the initial and final glycated hemoglobin (HBA1c) levels. There was an increased prevalence of individuals with well-controlled DM during follow-up (prevalence ratio [PR] 2.76, 95%, p = 0.001), along with a significant reduction in retinopathy (PR: 0.679, p = 0.001) and albuminuria (PR: 0.637, 95%, p = 0.002) when these variables were evaluated in well-controlled versus uncontrolled HbA1c groups.

Conclusion

A multidisciplinary approach with integration and quality was associated with improvements in DM control and reduced occurrence of chronic DM complications.

Clinically elevated parent depressive symptoms and stress at child type 1 diabetes diagnosis: Associations with parent diabetes self-efficacy at 18-months post-diagnosis

OBJECTIVE

Eighteen percent of new diagnoses of type 1 diabetes (T1D) occur in children ages 9 and younger, and the burden of diabetes management in young children predominantly falls on parents. Despite the significant amount of information parents must learn and implement quickly after diagnosis, little research has examined diabetes self-efficacy in parents of young children soon after diagnosis in a longitudinal manner. The current study examined changes in parent diabetes self-efficacy over time, and parent depressive symptoms and stress soon after child T1D diagnosis as predictors of parent diabetes self-efficacy at 12- and 18-months post-diagnosis.

RESEARCH DESIGN AND METHODS

One hundred fifty-seven primary caregivers (91.7% female, 62.2% White, Non-Hispanic) of young children (M_age  = 4.47 ± 1.65 years, 54.8% female, 60% White, Non-Hispanic) were recruited within 2 months of their child's T1D diagnosis from two pediatric hospitals in the United States as part of a randomized clinical trial. Parents self-reported on their diabetes self-efficacy, depressive symptoms, and stress and at baseline (M_days since diagnosis = 29) and on parent diabetes self-efficacy again 12- and 18-months post-diagnosis.

RESULTS

Parent diabetes self-efficacy significantly improved from baseline to 12-months and 18-months post-diagnosis (p < 0.05). Parents exhibiting clinically elevated levels of depressive symptoms and stress at baseline had significantly lower parent diabetes self-efficacy 12- and 18-months post-diagnosis compared to parents with normal levels of depressive symptoms and stress.

CONCLUSIONS

Brief interventions for parents with clinically elevated depressive symptoms and stress soon after their child's diagnosis may improve parents' diabetes self-efficacy and ultimately support the management of their child's diabetes.

Standardized evaluation of the quality and persuasiveness of mobile health applications for diabetes management

This study evaluates diabetes self-management mobile health applications available from European app stores with respect to quality, concordance with recommended self-management tasks and implementation of persuasive system design principles. The European Play Store and Apple App Store were systematically searched and relevant apps were tested. Two raters independently assessed app quality using the Mobile Application Rating Scale and conducted a content analysis of provided persuasive system design principles and self-management tasks. A total of 2,269 mobile health applications were identified and 120 could be included in the evaluation. The overall quality was rated as moderate M = 3.20 (SD = 0.39, min = 2.31, max = 4.62), with shortcomings in the subcategories of engagement (M = 2.80, SD = 0.67) and information quality (M = 2.26, SD = 0.48). Scientific evidence is available for 8% of the apps. The reviewed apps implemented a median of three persuasive system design principles (range 0-15) and targeted a median of 4.5 (range 1-8) self-management tasks, however, with a lack of information about psychosocial coping strategies. Most available diabetes self-management apps lack a scientific evidence base. Persuasive system design features are underrepresented and may form a promising tool to improve app quality. Furthermore, the interaction of physical and behavioral health should be improved in existing diabetes self-management mobile health applications.

Two Sides of a Coin: Parental Disease-Specific Training as Seen by Health Care Practitioners and Parents in Pediatric Liver Transplantation

In the absence of widely accepted education standards for parents of children after liver transplantation (LTx), the content and structure of parental training are influenced by health care practitioners’ (HCP) individual knowledge and assessment of the relevance of its contents. This study examines the hypothesis that expectations towards training differ between HCPs and parents, and that the quality of parental training affects the job-satisfaction of HCPs. Attitudes towards disease-specific education were assessed by tailor-made questionnaires in HCPs (n = 20) and parents of children with chronic liver disease or after LTx (n = 113). These were supplemented by focused interviews in n = 7 HCPs and n = 16 parents. Parents were more satisfied with current counseling than HCP. Language barriers and low parental educational background were perceived as obstacles by 43% of HCPs. The quality of parental knowledge was felt to have a strong influence on HCPs job satisfaction. The expectations towards the content of disease-specific education largely overlap but are not synonymous. HCP and parents agreed with regards to the importance of medication knowledge. Parents rated the importance about the meaning of laboratory values and diagnostic procedures significantly higher (3.50 vs. 2.85, p < 0.001 and 3.42 vs. 2.80, p < 0.001) than HCPs. Parents and HCPs would prefer a structured framework with sufficient staff resources for disease-specific counseling.

Development and Validity Testing of a Type 1 Diabetes Resource for 10-19-Years Old Adolescents in China

PURPOSE

This phase 1 study aimed to develop a Type 1 diabetes (T1DM) educational resource for adolescents (10-19 years) in China, and to test its validity for improving diabetes knowledge, self-efficacy and adherence.

DESIGN AND METHODS

This phase 1 study was carried out in four phases: preliminary development of the Type 1 diabetes educational resource in English based on the health belief model (HBM) and the International Society for Pediatric and Adolescent Diabetes (ISPAD) Consensus Guidelines 2014; translation of the resource into Chinese; readability testing of the resource; and face and content validity testing for scientific and clinical accuracy.

RESULTS

Type 1 diabetes educational resource with 17 "topics" in four sections was developed for 10-19-years old adolescents in China. Cartoon story, images, stories, questions & answers, and quizzes were used to attract adolescents' interest. Furthermore, the educational resource was confirmed to be understandable among adolescents, clinically accurate, and consistent with its purpose.

CONCLUSIONS

This resource with good readability and content validity is a potential facilitator for diabetes education and self-management in adolescents with T1DM in China.

PRACTICAL IMPLICATIONS

This type 1 diabetes resource can be used to educate adolescents with T1DM as a validated resource after further testing in an effectiveness study.

Short-Term Effects of COVID-19 Lockdown in Italian Children and Adolescents with Type 1 Diabetes Mellitus: The Role of Separation Anxiety

In March 2020, the Italian Government imposed mandatory home confinement to limit the spread of COVID-19. Few studies assessed the psychophysical impact of COVID-19 on chronically ill children. This study examined these effects on children with Type 1 Diabetes Mellitus (T1D) and their caregivers. Seventy-one patients (7-13 years) with T1D and their caregivers were administered a survey created ad hoc and some standardized questionnaires, assessing psychological well-being and anxiety. Medical data (physical and biochemical characteristics) were recorded before (T₀, January-February) and after (T₁, May-June) the lockdown. Paired Student t-test, Spearman two-tailed correlations, and a linear regression model were used for statistical analysis. Children at T₁ showed higher BMI (body mass index), daily total and basal insulin dose, and time spent in therapeutic range, and they showed lower HbA1c (glycated hemoglobin), time spent above the therapeutic range, and standard deviations of the mean glucose values than at T₀. A total of 32.9% scored in the clinical range for separation anxiety. The increase in separation anxiety was predicted by younger age, female gender, more recent T1D diagnosis, less time spent in therapeutic range at T₁, and higher perceived fear of COVID-19 infection. In a pandemic context, separation anxiety may be stronger in younger females, with more recent T1D diagnosis and poor metabolic control, thus affecting the parent's ability to manage diabetes and to support children's autonomy.

Effects of the Information-Motivation-Behavioral Skills Model on Metabolic Control of Adolescents with Type 1 Diabetes in Turkey: Randomized Controlled Study

PURPOSE

To evaluate the effects of information-motivation-behavioral skills model interventions given by nurses during home visits on the knowledge levels, personal and social motivation levels, behavioral skills, and HbA1C levels of adolescents with poor glycemic control.

DESIGN AND METHODS

The present study was designed as randomized controlled trial. 50 adolescents with type 1 diabetes were equally divided into study and control groups. Socio-Demographic Form, Diabetes Information Evaluation Form, The Child Attitude Toward Illness Scale, The Multidimensional Scale of Perceived Social Support, and Diabetes Management Self-Efficacy Scale were utilized in data collection. The scales were administered at the beginning of the study and six months later. HbA1c levels of adolescents were evaluated in the third and sixth months. Multiple home visits and phone calls were made to each participant in the intervention group. Interventions to improve the information-motivation-behavioral skills model-based knowledge, personal and social motivation, and behavioral skills were applied during the home visits.

RESULTS

As a result of information-motivation-behavioral skills model-based interventions, knowledge levels (p<0.001), personal motivation levels (p = 0.001), social motivation levels (p = 0.004), and behavioral skills (p<0.001) of the study group improved. Additionally, HbA1c levels decreased significantly in the third (p<0.001) and sixth months (p<0.001).

CONCLUSION

Information-Motivation-Behavioral Skills Model-based intervention effectively improved glycemic control among adolescents with type 1 diabetes.

PRACTICE IMPLICATIONS

Nurses should develop strategies to increase personal motivation, social motivation, and behavioral skills to training programs planned for adolescents with type 1 diabetes.

Comparison of the Effect of Cardiac Rehabilitation on Functional Capacity of Diabetic and Nondiabetic Patients after CABG

Background:

After a coronary artery bypass graft (CABG), diabetic patients deal with various hemodynamic disorders. This study aimed to compare the effect of cardiac rehabilitation (CR) on the functional capacity of diabetic and nondiabetic patients following CABG.

Methods:

This descriptive-analytical study was performed on 40 diabetic and nondiabetic patients attending a similar CR program following CABG. The subjects were selected by convenience sampling and were divided into two diabetes and nondiabetes groups. All patients attended 24 exercise sessions held 3 days a week. The functional capacity of patients was measured and recorded with the metabolic equivalent of Task criterion before and after the CR program. In addition, data analysis was performed in SPSS version 19.

Results:

In this study, the mean age of the diabetic and nondiabetic patients was 54.45 ± 5.82 and 56.85 ± 5.36 years, respectively. There was no significant difference between the research groups regarding the systolic and diastolic blood pressure (P > 0.05). The mean functional capacity in the diabetes and nondiabetes groups was 4.5 ± 0.79 and 5.2 ± 1.7 before the rehabilitation, respectively. However, the results of Mann–Whitney U-test were indicative of a lack of a significant difference in this respect (P > 0.05). After the CR program, the mean functional capacity in the diabetes and nondiabetes groups was 5.7 ± 1.31 and 6.3 ± 1.7, respectively, demonstrating an insignificant difference in this regard (P > 0.05).

Conclusions:

According to the results of the study, there was no significant difference between the diabetic and nondiabetic patients, who underwent CABG, after a CR program. However, replication of the study is warranted.

Do children and adolescents with type 1 diabetes suffer from a lack of resources in France? Results from a benchmark study in the New Aquitaine region

BACKGROUND

A benchmark study was conducted in the southwest of France, in the New Aquitaine region, to investigate metabolic outcomes and availability of resources in pediatric diabetes units. We assessed whether the level of care was in accordance with the International Society for Pediatric and Adolescent Diabetes recommendations.

METHODS

Demographic and clinical data were collected, as were all HbA1c tests for the 2017 calendar year. Pediatricians specialized in diabetes care were invited to complete an online survey concerning means allocated to the management of type 1 diabetes in their centers.

RESULTS

Sixteen centers provided data for 1277 patients and 3873 clinical visits. A total of 1115 children suffering from diabetes for more than 1 year were studied. Median HbA1c was 8% (7.4-8.6) for the whole region. Only 29.2% of children had good metabolic control in accordance with the <7.5% target. We identified slight but significant variation in glycemic control among centers (P=0.029). The use of an insulin pump varied greatly among centers but did not explain HbA1c differences. We did not identify a correlation between medical or paramedical time dedicated to the follow-up of diabetic patients and the mean HbA1c of each center. For 100 diabetic patients, follow-up was provided by 0.42 physicians (0.23-1.50), 0.15 nurses (0-0.56), 0.12 dietitians (0-0.48), and 0.07 psychologists (0-0.30).

CONCLUSION

This study demonstrates a lack of human resources allocated to the management of type 1 diabetes in the region that is far below international recommendations. The proportion of children achieving the international glycemic target is low. There is a clear need to improve glycemic control in children, which will only be possible with improved professional practices, encouraged by benchmark studies, and by increasing the size of our multidisciplinary teams.

The division and transfer of care responsibilities in paediatric type 1 diabetes: A qualitative study on parental perspectives

Aim

To determine which factors other than child age play a role in the division and transfer of diabetes care responsibilities between parents and children with type 1 diabetes.

Design

Qualitative focus group study.

Methods

Across four sites in the Netherlands, 18 parents (13 mothers) of children (9–14 years) with type 1 diabetes participated in four focus groups in 2015–2016, as part of the research project 'Whose diabetes is it anyway?'. Qualitative content analysis and the constant comparison method were used to analyse the data.

Results

According to parents, the transfer process included both direct and indirect tasks, had different levels (remembering, deciding, performing), was at times a difficult and stressful process, and showed large variation between families. A large number of child, parent and context factors were identified that affected the division and transfer of diabetes care responsibilities according to parents. Both positive and negative consequences of the transfer process were described for parental and child health, behaviour and well‐being. Parental final evaluations of the division and transfer of diabetes care responsibilities appeared to be dependent on parenting values.

Conclusion

How families divide and transfer diabetes care tasks appeared to be affected by a complex interplay of child, parent and context characteristics, which had an impact on several parent and child domains.

Impact

Parents struggle with the right timing of transfer, which calls for more support from diabetes nurses. The identified factors can be used as input for integrating a more family‐based approach into current age‐based guidelines, to improve regular care.

Fusarium as a Novel Fungus for the Synthesis of Nanoparticles: Mechanism and Applications

Nanotechnology is a new and developing branch that has revolutionized the world by its applications in various fields including medicine and agriculture. In nanotechnology, nanoparticles play an important role in diagnostics, drug delivery, and therapy. The synthesis of nanoparticles by fungi is a novel, cost-effective and eco-friendly approach. Among fungi, Fusarium spp. play an important role in the synthesis of nanoparticles and can be considered as a nanofactory for the fabrication of nanoparticles. The synthesis of silver nanoparticles (AgNPs) from Fusarium, its mechanism and applications are discussed in this review. The synthesis of nanoparticles from Fusarium is the biogenic and green approach. Fusaria are found to be a versatile biological system with the ability to synthesize nanoparticles extracellularly. Different species of Fusaria have the potential to synthesise nanoparticles. Among these, F. oxysporum has demonstrated a high potential for the synthesis of AgNPs. It is hypothesised that NADH-dependent nitrate reductase enzyme secreted by F. oxysporum is responsible for the reduction of aqueous silver ions into AgNPs. The toxicity of nanoparticles depends upon the shape, size, surface charge, and the concentration used. The nanoparticles synthesised by different species of Fusaria can be used in medicine and agriculture.

Do guidelines provide evidence-based guidance to health professionals on promoting developmentally appropriate chronic condition self-management in children? A systematic review

OBJECTIVES

To determine whether evidence-based practice guidelines promote developmentally appropriate chronic condition self-management for children with asthma, type 1 diabetes mellitus, and cystic fibrosis.

METHODS

Systematic review of clinical guidelines current as at 22 September 2017, including assessment of quality of each guideline using the iCAHE 'Guideline Quality Checklist', and mapping of the supporting evidence.

RESULTS

Fifteen guidelines were identified: asthma (n=7) and type 1 diabetes mellitus (n=7), CF (n=1). Guideline quality was variable, and 11 different grading systems were used. In total, there were 28 recommendations promoting age/developmental considerations. Recommendations focused on: collaboration (n=15), chronic condition self-management education (n= 17), clinicians' skills (n= 4); personalized action plans (n=3), problem-solving (n=2); and the assessment of children's chronic condition self-management needs (n=3). Developmental transitions are highlighted as important time points in some guidelines: preschool (n=2), and adolescence (n=3). All guidelines encouraged triadic partnerships between children, adult caregivers and clinicians. Evidence supporting the developmental aspects of the guidelines' recommendations was poor; only 14 out of 57 journals listed as evidence were concordant.

DISCUSSION

Current guidelines articulate that developmentally appropriate chronic condition self-management is important; however, more work needs to be done to translate the concept into practical clinical tools.

Challenges and Strategies of Needs Assessment Implementing in Diabetes Self-management Education in Iran: A Qualitative Study

Background:

Many diabetes educators in Iran do not have the necessary skills and competence for performing a needs assessment, and thus, cannot provide Diabetes Self-Management Education (DSME) to suit individual educational needs and conditions. The purpose of the present study was to explore and analyze needs assessment implementation in DSME and evaluate the barriers and the appropriate strategies from educators' viewpoints.

Materials and Methods:

The present qualitative study was conducted using a conventional content analysis approach with semi-structured and in-depth interviews and using a purposeful sampling method on 20 nurses, physicians, and endocrinologists. The data of this study were collected from April to October 2018. The interviews were analyzed using the content analysis method of Graneheim and Lundman.

Results:

Qualitative data analysis resulted in the emergence of two main categories of educational challenges of needs assessment and managerial challenges of needs assessment and four subcategories (lack of structured educational planning, lack of needs assessment practical patterns, managers' insufficient support and supervision, and managers' insufficient attention to motivational factors).

Conclusions:

Educational strategic planning, managers' obligation and support in designing practical patterns, and supervision tools to evaluate educators' performance in the needs assessment domain can result in the promotion of DSME needs assessment, the efficiency of plans, and the promotion of society's health.

Versorgung von Kindern und Jugendlichen mit Typ-1-Diabetes: Lösungen für technische und psychosoziale Herausforderungen

Diabetes 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.

Pre-empting the challenges faced in adolescence: A systematic literature review of effects of psychosocial interventions for preteens with type 1 diabetes

INTRODUCTION

Numerous psychosocial interventions have been conducted in children and adolescents with type 1 diabetes, aiming to improve their self-management and autonomy acquisition. However, these tend to address family conflict and parental perspectives, and a scarce number of interventions explore the outcomes among preteens. This review examined the outcomes of psychosocial interventions for preteens with type 1 diabetes, as an under-researched field to date.

METHODS

A systematic literature review of intervention studies with randomized controlled trial design, targeting preteens with type 1 diabetes, was conducted. Six databases were searched for publication periods from 1995 to October 2019. Quality of the interventions according to the International Society for Pediatric and Adolescent Diabetes (ISPAD), as well as reporting and effect sizes, were assessed.

RESULTS

Twelve studies were selected, covering ten interventions. According to the topics identified, four of these interventions were categorized as self-care programmes, three as psychosocial programmes and three as mixed. All of the interventions, except for one, covered ≥50% of the ISPAD recommendations. Reporting adequacy was negative only in one intervention. Main outcomes were glycemic control and self-management, but effect sizes could only be calculated for half of the interventions with no overall significant effect.

CONCLUSIONS

This review shows a lack of adequate psychosocial interventions targeting preteens with type 1 diabetes and actively involving them as participants. These intervention's educational programmes and methods should be standardized to guarantee successful results. New technologies and peer support implementation could be a promising pathway when designing these studies.

Assessing the effect of closed-loop insulin delivery from onset of type 1 diabetes in youth on residual beta-cell function compared to standard insulin therapy (CLOuD study): a randomised parallel study protocol

INTRODUCTION

Management of newly diagnosed type 1 diabetes (T1D) in children and adolescents is challenging for patients, families and healthcare professionals. The objective of this study is to determine whether continued intensive metabolic control using hybrid closed-loop (CL) insulin delivery following diagnosis of T1D can preserve C-peptide secretion, a marker of residual beta-cell function, compared with standard multiple daily injections (MDI) therapy.

METHODS AND ANALYSIS

The study adopts an open-label, multicentre, randomised, parallel design, and aims to randomise 96 participants aged 10-16.9 years, recruited within 21 days of diagnosis with T1D. Following a baseline mixed meal tolerance test (MMTT), participants will be randomised to receive 24 months treatment with conventional MDI therapy or with CL insulin delivery. A further 24-month optional extension phase will be offered to all participants to continue with the allocated treatment. The primary outcome is the between group difference in area under the stimulated C-peptide curve (AUC) of the MMTT at 12 months post diagnosis. Analyses will be conducted on an intention-to-treat basis. Key secondary outcomes are between group differences in time spent in target glucose range (3.9-10 mmol/L), glycated haemoglobin (HbA1c) and time spent in hypoglycaemia (<3.9 mmol/L) at 12 months. Secondary efficacy outcomes include between group differences in stimulated C-peptide AUC at 24 months, time spent in target glucose range, glucose variability, hypoglycaemia and hyperglycaemia as recorded by periodically applied masked continuous glucose monitoring devices, total, basal and bolus insulin dose, and change in body weight. Cognitive, emotional and behavioural characteristics of participants and parents will be evaluated, and a cost-utility analysis performed to support adoption of CL as a standard treatment modality following diagnosis of T1D.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from Cambridge East Research Ethics Committee. The results will be disseminated by peer-reviewed publications and conference presentations.

TRIAL REGISTRATION NUMBER

NCT02871089; Pre-results.

Glycemic control in adolescents with type 1 diabetes: Are computerized simulations effective learning tools?

OBJECTIVE

Type 1 diabetes mellitus (T1DM) in adolescent patients is often characterized by poor glycemic control. This study aimed at exploring the contribution of learning with computerized simulations to support: (a) mechanistic understanding of the biochemical processes related to diabetes; (b) diabetes self-management knowledge; and (c) glycemic control. We hypothesized that learning with such simulations might support adolescents in gaining a better understanding of the biochemical processes related to glucose regulation, and consequently improve their glycemic control.

METHODS

A prospective case-control study was conducted in 12- to 18-year-old adolescents with T1DM (n = 85) who were routinely treated at an outpatient diabetes clinic. While the control group (n = 45) received the routine face-to-face follow-up, the intervention group (n = 40) learned in addition with computerized simulations that were embedded in pedagogically supportive activities. Participants in both groups completed a set of questionnaires regarding sociodemographic characteristics, diabetes mechanistic reasoning and diabetes self-management. Clinical data and serum glycated hemoglobin (HbA1c) levels were gathered from medical records. All the data was collected at recruitment and 3 months later.

RESULTS

Analysis revealed improvement HbA1c levels in the intervention group (8.7% ± 1.7%) vs the controls (9.6% ± 1.6%) after 3 months (P < .05). Regression analysis showed that levels of diabetes mechanistic understanding and diabetes self-management knowledge, in addition to sociodemographic parameters, accounted for 31% of the HbA1c variance (P < .001).

CONCLUSION

These results suggest that learning with computerized simulations about biochemical processes can improve adolescents' adherence to medical recommendations and result in improved glycemic control. Implementing scientific learning into the hospital educational setting is discussed.

A person-centered education for adolescents with type 1 diabetes-A randomized controlled trial

INTRODUCTION

Young people with type 1 diabetes and their parents need to receive person-centered education to be able to manage their diabetes. Guided Self-Determination-Young (GSD-Y) is a person-centered communication and reflection education model that can be used in educational program for young people with type 1 diabetes.

OBJECTIVE

To evaluate whether GSD-Y leads to improved glycaemic control, increased self-perceived health and health-related quality of life, fewer diabetes-related family conflicts, and improved self-efficacy in a group-based intervention for adolescents starting continuous subcutaneous insulin infusion (CSII) and their parents.

METHODS

This randomized controlled trial included 71 adolescents starting CSII. Participants were followed for 12 months. The intervention group (n = 37) attended seven group training sessions over a period of 5 months, using the GSD-Y model, the control group received standard care. Variables evaluated were HbA1c, self-perceived health, health-related quality of life, family conflicts, self-efficacy, and usage of continuous glucose monitoring.

RESULTS

When adjusted for sex and family conflicts, there was a difference in glycaemic control between the groups at 12 months, favoring the intervention group (62 vs 70 mmol/mol, P = .009). When analyses were performed on boys and girls separately and adjusted for family conflicts, the only difference detected was for boys after 12 months (P = .019). The intervention showed no effect on self-perceived health, health-related related quality of life, family conflicts, or self-efficacy.

CONCLUSIONS

An intervention with GSD-Y may have an effect on glycaemic control. The content of the GSD-Y groups may serve as a model for person-centered care in adolescents with type 1 diabetes.

Comparison of the effect of a compact vs a conventional, long-term education program on metabolic control in children and adolescents with type 1 diabetes: A pilot, randomized clinical trial

BACKGROUND

Effective education is considered essential for people with type 1 diabetes mellitus (T1DM) to adhere to a complex and long-term medical regimen and to delay or prevent the onset of diabetes-related complications.

OBJECTIVE

We compared the effect of a compact, cost-effective, education program (CEPT1) vs a long-term program on the metabolic control of children and adolescents with T1DM.

METHODS

Young people aged 8 to 21 years with T1DM were randomized to a short-term (experimental) or an extensive education program (control). The experimental group participated in three sessions of 90 minutes, with one session per week, containing five short videos. The control group attended an extended program delivered through 45-minute PowerPoint lectures, with one class every 3 months. The primary outcome was change in glycated hemoglobin A1c (HbA1c) levels from baseline to endpoint (baseline, 3, 6, 9, and 12 months).

RESULTS

In total, 62 patients were randomized to the experimental (CEPT1) (n = 32) or control (n = 30) groups. Both groups showed comparable improvement in HbA1c levels at the end of 12 months (P = .183). In a per-protocol analysis, the mean HbA1c level reduction was -2.3% (-2.6, -2.0) in the experimental group and - 1.8% (-2.0, -1.5) in the control group (P = .008).

CONCLUSION

CEPT1 was comparable with an extensive education program in reducing HbA1c levels. In a per-protocol analysis, the CEPT1 was more effective than the control program in reducing HbA1c levels. CEPT1 is a simple and cost-effective tool that can equally be used in settings with limited resources and specialized centers.

The Development and Validation of a Turkish Insulin Treatment Self-management Scale Child Form (Ages 8-18) and Parent Form

OBJECTIVE

The aim of the study was to develop an Insulin Treatment Self-management Scale; both Child Form and Parent Form for children ages 8-18 with type 1 diabetes.

METHODS

Children with type 1 diabetes and their parents participated in the study. Development of a methodologically designed scale was conducted to investigate insulin treatment self-management of children with type 1 diabetes.

RESULTS

A total of 331 children and their parents were recruited. Children and parents completed the data collection tools by themselves. The final scale had two subscales; one was related to cognitive and behavioural expressions regarding insulin treatment (self-efficacy) and the other to emotional aspects of self-maagement of insulin treatment (emotional impacts). The scale was shown to be valid and reliable.

CONCLUSION

This study was a valid and reliable scale for measuring insulin treatment self-management in children with type 1 diabetes. Thus can be used to assess insulin treatment self-management in children with type 1 diabetes and their parents as well as a tool for effective nursing care.

Effects of a home-based nursing intervention programme among adolescents with type 1 diabetes

AIMS AND OBJECTIVE

To investigate the effects of a home-based nursing intervention programme established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus.

BACKGROUND

After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home.

DESIGN

A quasi-experimental design with a pre- and post-test control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study.

METHOD

This study was conducted in İzmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with type 1 diabetes mellitus who were registered at the paediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June-December 2017. A home-based nursing intervention programme (5 week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and 3 and 6 months after a 5-week home-based nursing intervention. Multi-way and one-way analysis of variance, the Bonferroni correction, regression analysis, t test, chi-squared analysis and a structural equation model were used for data analysis of the iterative measurements.

RESULTS

At the end of the home-based nursing intervention programme, the HbA1c mean scores significantly decreased, while self-efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of admission to the hospital and average costs were lower in the intervention group than in control group. The home-based nursing intervention programme using structural equation modelling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels.

CONCLUSION

The home-based nursing intervention programme was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self-efficacy of the adolescents.

RELEVANCE TO CLINICAL PRACTICE

The home-based nursing intervention programme can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.

A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control

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.

Development and validity testing of the revised diabetes self-care inventory for children and adolescents

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.

Effect of patient education through a social network in young patients with type 1 diabetes in a Sub-Saharan context

BACKGROUND

Patient education is essential in management of type 1 diabetes (T1D).

OBJECTIVE

To evaluate the short-term impact of patient education through WhatsApp on the knowledge of the disease and glycemic control of adolescents and young adults living with T1D in a resource-limited setting.

METHODS

A double arm non-randomized clinical trial was carried out in two clinics for diabetes in Cameroon, over a period of 2 months. The intervention consisted in providing four sessions of patient education through WhatsApp to an intervention group compared to a control group with their classic follow-up. We evaluate their knowledge on diabetes, acute events, and glycemic control, before and after intervention.

RESULTS

We recruited 54 patients of which 25 subjects and 29 controls. Median age was 19 (17-20) and 19 (17-21) years for the intervention and control group, respectively. There was a significant improvement of knowledge on diabetes in the intervention group from 13/20 to 16/20 (P < 0.01) after 2 months, compared to a slight decrease in control group (from 11.6/20 to 11.3/20 (P = 0.33). The mean proportion of acute complications decreased from 28% to 16% (P = 0.46) in the intervention group, and increased from 7% to 34%, P = 0.01 in the control group. There was no improvement in glycosylated hemoglobin level in both groups.

CONCLUSION

Patient education through social network helped to improve knowledge on T1D and to reduce acute complications without an improvement of glycemic control after 2 months.

The psychosocial self-efficacy in adolescents with type 1 diabetes

AIM

To analyse psychosocial self-efficacy in adolescents with type 1 diabetes, evaluate associations between self-efficacy and metabolic control and background variables and determine psychometric properties of the Finnish Diabetes Empowerment Scale (Fin-DES-28).

DESIGN

A descriptive correlational survey.

METHODS

The data were collected with the Finnish Diabetes Empowerment Scale from 13-16-year-old adolescents with type 1 diabetes (N = 189, 34%) in one university hospital district area in 2014.

RESULTS

The level of psychosocial self-efficacy was quite good. The highest scores were in managing the psychosocial aspects of diabetes, followed by assessing dissatisfaction and readiness to change and setting and achieving diabetes goals. The self-efficacy did not correlate with metabolic control or background variables. A positive association was found between self-efficacy and understanding of diabetes and its treatment, adjustment of diabetes to life and the relationship with the doctor and the nurse. The internal consistency of the Finnish Diabetes Empowerment Scale was adequate. The low response rate limits generalization.

What are the components of effective chronic condition self-management education interventions for children with asthma, cystic fibrosis, and diabetes? A systematic review

OBJECTIVE

To articulate the components of educational interventions that help children learn about managing their asthma, cystic fibrosis, or diabetes, relevant to their age/developmental status.

METHODS

A systematic review of chronic condition self-management (CCSM) educational interventions that included age/developmentally appropriate components, published before 27 January 2018, including evidence level and quality assessments. Teaching approaches were extracted and translated into practical components.

RESULTS

Twenty education interventions were identified, published across 30 studies. Most studies (n = 20/30) were based on the theories of Piaget and Bandura. Similar teaching approaches were used across conditions, incorporating sequenced curriculum and a variety of active elements. Age/developmentally appropriate interventions resulted in improvements in the CCSM capabilities of children. Outcomes were improved when compared with usual care. For very young children, educational interventions were directed at parents/families. As children reached school age, interventions increasingly became child-focused, promoting autonomy. Integrated play and reinforcement were common. Adolescent interventions placed greater emphasis on communication, problem-solving, and role division.

CONCLUSION

Eight key components were identified: structured and sequenced curricula; reinforcement; active participation; collaboration; autonomy; feedback; multiple exposures; and, problem-solving. Different components are relevant to specific life stages.

PRACTICE IMPLICATIONS

Clinicians require age/developmentally appropriate practical education tools to provide effective paediatric health care.

Effect of Telehealth System on Glycemic Control in Children and Adolescents with Type 1 Diabetes

OBJECTIVE

A close diabetes team-patient relationship is required for establishing satisfactory metabolic control. The purpose of this study was to investigate the effect of a telehealth system on diabetes control.

METHODS

The study was carried out between June 2015 and January 2016 at the Gazi University Faculty of Medicine, Pediatric Endocrinology Department. The telehealth system was developed by the diabetes team. The demographic characteristics, frequency of use and hemoglobin A1c (HbA1c) changes of type 1 diabetic (T1DM) patients using this communication network were analysed.

RESULTS

Eighty two patients [43 (52.4%) females, mean (±standard deviation) age 10.89±4 years] used the telehealth system. Fourteen (17.1%) of the cases were on pump therapy and 59 (72.0%) were counting carbohydrates. The individuals with diabetes or their families preferred WhatsApp communication. Whatsapp provided a means for instant messaging in most instances (57.3%), contact with diabetes education nurse (32.9%) and consultation with the diabetes team about insulin doses and blood glucose regulation (42.7%). HbA1c values after six months were significantly lower in patients/parents calling frequently (p<0.001) compared with HbA1c values recorded at the beginning of the study.

CONCLUSION

Increase in frequency of counselling by the diabetes team led to improved blood glucose control in T1DM patients. A telehealth system is useful for early detection of the need for changes in treatment and for intervention. It also promoted better self care.

Evaluation of a generic patient education program in children with different chronic conditions

For frequent pediatric chronic conditions, especially less common chronic conditions patient education programs are missing. A recently developed modular patient education approach (ModuS) combines disease-specific modules with generic psychosocial topics. ModuS was associated with increased disease-specific knowledge and improvements in families' well-being in children with asthma. In this study we tested if new developed ModuS programs for seven, mostly less common, chronic conditions show comparable program-associated effects. ModuS education programs were offered to the affected child and its parents. Disease-specific knowledge, children's health-related quality of life, life satisfaction and condition-specific burden were measured before, directly following and 6 weeks after participation in the program. The results were compared with families who received a ModuS asthma program. One hundred and sixty-eight children participated. Families were highly satisfied with the programs. Program participation was associated with increased families' knowledge, children`s self-reported health-related quality of life and reduced condition-specific burden. The results were comparable with the results of 230 families who participated in a ModuS asthma program. The ModuS approach allowed the development of patient education programs for children with a variety of chronic conditions. Therefore, ModuS closed an important healthcare gap.

Being Facilitators in a Challenging Context-School Personnel's Experiences of Caring for Youth with Diabetes Type 1

PURPOSE

The purpose of the study was to describe school personnel's experiences of caring for youth with diabetes type 1.

DESIGN AND METHODS

A qualitative design was chosen for this study. Data were collected with individual interviews that were subjected to inductive qualitative content analysis. The sample consisted of 24 school personnel (teachers, principals and school nurses) from Swedish schools. All had experience with youth aged 6 to 18 years old with diabetes type 1.

RESULTS

School personnel experienced caring for youth with diabetes type 1 as "Being facilitators in a challenging context" and described establishing trusting relationships, finding strategies to support self-care, feeling uncertain and incapable in need of education, and dealing with unclear responsibility.

CONCLUSIONS

School personnel (teachers, principals and school nurses) are key professionals supporting youth with diabetes type 1 and self-care in school. Lack of education and unclear responsibility created feelings of uncertainty and insecurity for school personnel and a need for mandatory education of school personnel regarding T1DM and self-care, including legislation was identified.

IMPLICATIONS

Mandatory education should be provided for all school personnel regarding diabetes type 1, self-care and current legislation. A liason position in form of a nurse specialist should manage the education.

Educational Workshop using games improves self-monitoring of blood glucose among children

Objective:

to evaluate the effectiveness of an educational workshop using games to improve self-monitoring of blood glucose techniques for school children with type 1 diabetes.

Method:

a quasi-experimental study was conducted with school children who attended two outpatient clinics of a university hospital. Data were collected by systematic observation of the self-monitoring of blood glucose (SMBG) technique before and after the intervention. Data analysis consisted of verifying changes while performing the technique, using pre- and post-intervention compliance rates using statistical tests. The sample consisted of 33 children. Each child participated in one session; 17 educational workshops were conducted in total.

Results:

we found an increased frequency of SMBG, changing lancets, rotation of puncture sites, as well as calibration and periodic checking of date and time of the glucose meter. Comparisons pre- and post-intervention showed that the average number of steps in accordance with the SMBG technique increased from 5.30 to 6.58, whereas the steps “Changing the lancet of the lancing device”, “Pressing the puncture site” and “Disposing of materials used in a needlestick container” showed statistically significant differences.

Conclusion:

the educational workshop was effective, as it improved children’s performance of the SBMG technique.

Type 2 diabetes mellitus in children and adolescent: an Indonesian perspective

The prevalence of type 2 diabetes mellitus (T2DM) in children and adolescents has increased globally over the past 2 decades. Metabolic syndrome, including obesity and overweight at a young age, increases the occurrence of T2DM. Studies in Indonesia have found that obese children and adolescents are more likely to have insulin resistance, a risk factor for T2DM. There are no data on the current incidence of T2DM in youth in Indonesia, but there has been a significant rise in the prevalence of overweight in adolescents. The diagnosis of T2DM in youth is similar to that in adults, with special consideration of when to test asymptomatic children. Management of T2DM in Indonesia follows the recommendations of the Indonesian Pediatric Society, which include lifestyle modifications, such as improving dietary habits and exercise, as well as appropriate medications. Metformin is the drug of choice for young T2DM patients; if marked hyperglycemia is present, basal insulin is given with metformin. Monitoring of T2DM is generally done through selfmonitoring of blood glucose and glycosylated hemoglobin.

Social Media Use in Interventions for Diabetes: Rapid Evidence-Based Review

Background

Health authorities recommend educating diabetic patients and their families and initiating measures aimed at improving self-management, promoting a positive behavior change, and reducing the risk of complications. Social media could provide valid channel to intervene in and deliver diabetes education. However, it is not well known whether the use of these channels in such interventions can help improve the patients’ outcomes.

Objective

The objective of our study was to review and describe the current existing evidence on the use of social media in interventions targeting people affected with diabetes.

Methods

A search was conducted across 4 databases (PubMed, Scopus, EMBASE, and Cochrane Library).The quality of the evidence of the included primary studies was graded according to the Grading of Recommendations Assessment, Development and Evaluation criteria, and the risk of bias of systematic reviews was assessed by drawing on AMSTAR (A MeaSurement Tool to Assess systematic Reviews) guidelines. The outcomes reported by these studies were extracted and analyzed.

Results

We included 20 moderate- and high-quality studies in the review: 17 primary studies and 3 systematic reviews. Of the 16 publications evaluating the effect on glycated hemoglobin (HbA_1c) of the interventions using social media, 13 reported significant reductions in HbA_1c values. The 5 studies that measured satisfaction with the interventions using social media found positive effects. We found mixed evidence regarding the effect of interventions using social media on health-related quality of life (2 publications found positive effects and 3 found no differences) and on diabetes knowledge or empowerment (2 studies reported improvements and 2 reported no significant changes).

Conclusions

There is very little good-quality evidence on the use of social media in interventions aimed at helping people with diabetes. However, the use of these channels is mostly linked to benefits on patients’ outcomes. Public health institutions, clinicians, and other stakeholders who aim at improving the knowledge of diabetic patients could consider the use of social media in their interventions.

Pediatric diabetes training for healthcare professionals in Europe: Time for change

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.