Blood glucose monitoring skills in children with Type I diabetes

Accuracy of blood glucose meters for self-monitoring affects glucose control and hypoglycemia rate in children and adolescents with type 1 diabetes

AIMS/HYPOTHESIS

This study investigated the accuracy of blood glucose meters for self-monitoring and its influence on glycated hemoglobin (HbA1c) levels and the frequency of hypoglycemic coma.

MATERIALS AND METHODS

Self-measured and simultaneously obtained laboratory blood glucose values from 9,163 patients with type 1 diabetes <18 years of age in the German/Austrian Diabetes Prospective Documentation Initiative registry were analyzed by investigating their compliance with the International Organization for Standardization (ISO) criteria (versions 2003 and 2013) and by error grid analyses. Regression models elucidated effects on glucose control and hypoglycemia rates.

RESULTS

Depending on the respective subgroup (defined by sex, age, duration of diabetes, mode of insulin therapy), 78.7-94.7% of the self-monitoring of blood glucose (SMBG) values met the old and 79.7-88.6% met the new ISO criteria. In Clarke and Parkes error grid analyses, the percentages of SMBG values in Zone A ranged between 92.8% and 94.6% (Clarke) and between 92.2% and 95.0% (Parkes). The patient group with SMBG devices measuring "far too low" (compared with the laboratory-obtained glucose levels) presented with a higher HbA1c level than those measuring "far too high," "too high," "identical/almost identical," or "too low" (based on quintiles of deviation). Performing "far too high" was associated with the highest rate of hypoglycemic coma in comparison with the other deviation quintiles.

CONCLUSIONS

This study showed that current SMBG devices fulfilled neither the previous nor the new ISO criteria. Large deviations of the SMBG values from the "true" glucose levels resulted in higher HbA1c levels and markedly increased rates of hypoglycemic events.

A systematic review of patient medication error on self-administering medication at home

INTRODUCTION

Medication errors have been analyzed as a health professionals' responsibility (due to mistakes in prescription, preparation or dispensing). However, sometimes, patients themselves (or their caregivers) make mistakes in the administration of the medication. The epidemiology of patient medication errors (PEs) has been scarcely reviewed in spite of its impact on people, on therapeutic effectiveness and on incremental cost for the health systems.

AREAS COVERED

This study reviews and describes the methodological approaches and results of published studies on the frequency, causes and consequences of medication errors committed by patients at home. A review of research articles published between 1990 and 2014 was carried out using MEDLINE, Web-of-Knowledge, Scopus, Tripdatabase and Index Medicus.

EXPERT OPINION

The frequency of PE was situated between 19 and 59%. The elderly and the preschooler population constituted a higher number of mistakes than others. The most common were: incorrect dosage, forgetting, mixing up medications, failing to recall indications and taking out-of-date or inappropriately stored drugs. The majority of these mistakes have no negative consequences. Health literacy, information and communication and complexity of use of dispensing devices were identified as causes of PEs. Apps and other new technologies offer several opportunities for improving drug safety.

Can the Newest Vital Sign be used to assess health literacy in children and adolescents?

CONTEXT

We evaluated the validity of the Newest Vital Sign (NVS) as a brief screen for health literacy in children.

OBJECTIVES

To (a) test the hypothesis that child performance on the NVS correlates with performance on a test of child reading comprehension and (b) establish age-based cutoffs for expected performance on the NVS.

DESIGN

Children aged 7 to 17 years were administered the NVS followed by the Gray Silent Reading Test (GSRT).

RESULTS

The NVS score correlated strongly with GSRT score (ρ = 0.71, P < .0001) and increased with age. Children aged 7 to 9 years had a median NVS score of 1 (interquartile range = 1-2); children aged 10 to 17 years had a median score of 3 (interquartile range = 2-4), P < .0001.

CONCLUSION

The NVS performs well in this population. Children aged 10 to 17 years with an NVS score lower than 2 may have low health literacy.

Association between health literacy and child and adolescent obesity

OBJECTIVE

We tested the association between child and parental health literacy (HL) and odds of child and adolescent obesity.

METHODS

We conducted an anonymous cross-sectional survey of a convenience sample of English-speaking child-parent dyads. Newest Vital Sign (NVS) measured HL. We used multivariable logistic regression to test adjusted association between child and parental NVS and obesity. Analyses were stratified for school-aged children (aged 7-11) vs. adolescents (aged 12-19).

RESULTS

We surveyed 239 child-parent dyads. Median child age was 11 [inter-quartile range 9-13]; 123 (51%) were male; 84% Medicaid recipients; 27% obese. For children, the odds of obesity [adjusted odds ratio (95% confidence interval)] decreased with higher parent NVS [0.75 (0.56,1.00)] and increased with parent obesity [2.53 (1.08,5.94)]. For adolescents, odds of obesity were higher for adolescents with the lowest category of NVS [5.00 (1.26, 19.8)] and older parental age [1.07 (1.01,1.14)] and lower for Medicaid recipients [0.21 (0.06,0.78)] and higher parental education [0.38 (0.22,0.63)].

CONCLUSION

Obesity in school-aged children is associated with parental factors (obesity, parental HL); obesity in adolescents is strongly associated with the adolescent's HL.

PRACTICE IMPLICATIONS

Strategies to prevent and treat obesity should consider limited HL of parents for child obesity and of adolescents for adolescent obesity.

Glucose meter inaccuracy and the impact on the care of patients

Blood glucose testing utilizing point-of-care (POC) glucose meters has become increasingly common--in hospital settings, in outpatient areas, and in the self-care of patients. It is rightly considered an essential tool for the management of diabetes. But many who rely on these meters are unaware of the pitfalls in their use and do not realize that there are settings where misleading results obtained by POC glucose meters may alter clinical decisions in the care of persons with diabetes and in some cases have caused catastrophic errors in care, even deaths. Their use in critical care settings is of great concern because many of the factors that increase the risk of inaccuracy of the POC glucose meters exist in critical care settings. Unfortunately, many clinicians are still uncritically accepting data from the POC glucose meters, to the potential detriment of the care of the patients. To improve the quality of care of those with diabetes, we need to establish better standards for the evaluation of POC glucose meters, encourage wider use of technologies that have improved the accuracy and precision of the meters, and adopt clear rules, particularly in inpatient settings, as to when to avoid using POC glucose meters and also when to verify their results before accepting the results of the POC glucose measurement. Such strategies are essential if we are to use these meters successfully.

Self-care of school-age children with diabetes: an integrative review

AIM

This paper is a report of an integrative review of findings from empirical studies on self-care in school-age children with type 1 diabetes. The purpose is to generate insight into opportunities to develop empowering patient education.

BACKGROUND

Managing diabetes is demanding and requires parental involvement in care. Good self-care forms the basis for diabetes management and self-care patterns are established at school age, but how and to what extent school-age children increase their self-care capabilities is unclear.

DATA SOURCES

A search for studies from 1998 to 2010 focusing on self-care in school-age children with diabetes was conducted through electronic databases.

REVIEW METHODS

Using integrative methods, quantitative and qualitative papers surveyed were analysed separately, but the themes that arose were combined at the end of the analysis.

FINDINGS

Self-care is formed in a learning process involving the objectives of normality, being able to cope and independence. The content of self-care is a combination of knowledge and skills. Children have the technical skill, but they need their parents to participate in the care and share responsibility for it. The factors related to self-care comprised the characteristics of the child; the nature of the illness and care; and support from the parents, school environment, peers and healthcare team.

CONCLUSION

A balance between diabetes care requirements and a child's maturity should be found. Nurses must adopt an empowering manner of education and recognize and assess a child's readiness to learn diabetes care and bear responsibility for it. Nurses must also help parents and other adults to gradually shift the responsibility to the children.

Effects of gender, age, and diabetes duration on dietary self-care in adolescents with type 1 diabetes: a Self-Determination Theory perspective

This study tests a model derived from Self-Determination Theory (SDT) (Deci and Ryan, 2000) to explain the mechanisms by which non-modifiable factors influence dietary self-care in adolescents with type 1 diabetes (n = 289). SEM analyses adjusted for HbA1c levels revealed that longer diabetes duration and female gender were indicative of poorer dietary self-care. This effect was mediated by contextual and motivational factors as posited by SDT. Poorer autonomy support from practitioners was predominant in girls with longer diabetes duration. Perceived autonomous motivation and self-efficacy were indicative of greater autonomy support, and led to better dietary self-care.

Gender differences in adherence and metabolic control in urban youth with poorly controlled type 1 diabetes: the mediating role of mental health symptoms

OBJECTIVE

To examine gender differences in adherence and metabolic control and test the mediating role of mental health symptoms in a sample of predominantly African-American, low-income youth with chronically poor metabolic control.

METHODS

Baseline questionnaire data from an intervention study were collected from 119 youth and their primary caregiver.

RESULTS

Boys had worse adherence than girls, but there were no gender differences in hemoglobin A1C (HbA1C). Boys had more externalizing symptoms, whereas girls had more anxiety; there were no gender differences in depression. Externalizing symptoms were associated with poor adherence and metabolic control. Although anxiety was correlated with poor adherence, this relationship was not significant in the invariate analysis. Results of structural equation modeling (SEM) suggested that externalizing symptoms mediated the relationship between gender and adherence.

CONCLUSIONS

Results suggest that gender differences in adherence may be attributed, in part, to gender differences in externalizing symptoms in urban youth with poor metabolic control. Interventions targeting these symptoms may be necessary to improve adherence and HbA1C in both boys and girls.

Islet transplant: an option for childhood diabetes?

Careful assessment of the safety and efficacy of islet transplantation should guide the selection process of a small number of children with type 1 diabetes who may be eligible for the procedure--some of whom are already receiving immunosuppression because of a previous transplant, others who are scheduled to receive de novo islet alone transplantation because of a life threatening risk of hypoglycemia. The outcomes of these initial investigations are predicted to shape the future boundaries of islet transplantation, diabetes, and transplantation.