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Abstract
Type 1 diabetes is a chronic disease that can lead to severe complications if poorly controlled. Adolescents are particularly vulnerable to worsening diabetes control due to changes in physiology, family dynamics, and social interactions. Good diabetes control requires following a regimen of frequent blood glucose checks, accurate carbohydrate counts, and compliance with insulin administration. Patients who are challenged in controlling their diabetes do tend to respond to behavioral interventions; however, the effect of the intervention wanes over time. Using technology to provide interventions has shown promise in terms of improving compliance. Positive family support and adequate knowledge of the developmental stages is important to ensure a successful transition from childhood to adolescence. Providers should also incorporate a structured transition from adolescent to adult diabetes care. [Pediatr Ann. 2016;45(9):e327-e331.].
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Ellis DA, Templin TN, Podolski CL, Frey MA, Naar-King S, Moltz K. The parental monitoring of diabetes care scale: development, reliability and validity of a scale to evaluate parental supervision of adolescent illness management. J Adolesc Health 2008; 42:146-53. [PMID: 18207092 DOI: 10.1016/j.jadohealth.2007.08.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2007] [Revised: 07/03/2007] [Accepted: 07/17/2007] [Indexed: 11/18/2022]
Abstract
PURPOSE Monitoring of adolescents' behavior and whereabouts has been repeatedly identified as an important predictor of adolescent behavioral outcomes. However, to date, measures of parental supervision and monitoring are lacking in the chronic illness literature. The present study describes development and initial evaluation of a measure of parental monitoring of the illness management of adolescents with diabetes: the Parental Monitoring of Diabetes Care scale (PMDC). METHODS Ninety-nine parents of 12-18-year-old children with type 1 diabetes completed the PMDC. Measures of illness management and metabolic control were also obtained. RESULTS The PMDC demonstrated good internal consistency (alpha coefficient = .81) and test-rest reliability (ICC = .80). Supporting the instrument's construct validity, confirmatory factor analysis indicated that a five subdomain structure had an acceptable fit to the data, [chi(2) (181.65)/df (126) = 1.44, Bollen-Stine chi(2) = 165.03, p = .32, comparative fit index (CFI) = .91, and root-mean-square error of approximation = .07]. In structural equation models, parental monitoring as assessed by the PMDC had a significant direct effect on adolescent diabetes management, accounting for 38% of the variance. Parental monitoring also had a significant indirect effect on metabolic control. CONCLUSIONS The PMDC represents an important first step in the development of measures of parental monitoring for use with adolescents with chronic medical conditions.
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Affiliation(s)
- Deborah A Ellis
- Carman and Ann Adams Department of Pediatrics, Wayne State University, Detroit, Michigan 48201, USA.
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Ellis DA, Frey MA, Naar-King S, Templin T, Cunningham P, Cakan N. Use of multisystemic therapy to improve regimen adherence among adolescents with type 1 diabetes in chronic poor metabolic control: a randomized controlled trial. Diabetes Care 2005; 28:1604-10. [PMID: 15983308 DOI: 10.2337/diacare.28.7.1604] [Citation(s) in RCA: 158] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The aim of this study was to determine whether multisystemic therapy (MST), an intensive, home-based psychotherapy, could improve adherence and metabolic control and decrease rates of hospital utilization among adolescents with chronically poorly controlled type 1 diabetes. RESEARCH DESIGN AND METHODS A randomized controlled trial was conducted with 127 adolescents with type 1 diabetes and chronically poor metabolic control (HbA(1c) [A1C] > or =8% for the past year) who received their diabetes care in a children's hospital located in a major Midwestern city. Participants randomly assigned to MST received treatment for approximately 6 months. Data were collected at baseline and at 7 months posttest (i.e., treatment termination). Changes in A1C adherence, as measured by semistructured interviews and blood glucose meters and hospital admissions and emergency department visits, were assessed. RESULTS In intent-to-treat analyses, participation in MST was associated with significant improvements in the frequency of blood glucose testing as assessed by blood glucose meter readings (F[1,125] = 16.75, P = 0.001) and 24-h recall interviews (F[1,125] = 6.70, P = 0.011). Participants in MST also had a decreasing number of inpatient admissions, whereas the number of inpatient admissions increased for control subjects (F[1,125] = 6.25, P = 0.014). Per protocol analyses replicated intent-to-treat analyses but also showed a significant improvement in metabolic control for adolescents receiving MST compared with control subjects (F[1,114] = 4.03, P = 0.047). CONCLUSIONS Intensive, home-based psychotherapy improves the frequency of blood glucose testing and metabolic control and decreases inpatient admissions among adolescents with chronically poorly controlled type 1 diabetes.
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Affiliation(s)
- Deborah A Ellis
- Department of Psychiatry and Behavioral Science, Wayne State University, Detroit, MI, USA.
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Harris MA, Harris BS, Mertlich D. Brief Report: In-Home Family Therapy for Adolescents with Poorly Controlled Diabetes: Failure to Maintain Benefits at 6-Month Follow-Up. J Pediatr Psychol 2005; 30:683-8. [PMID: 16260438 DOI: 10.1093/jpepsy/jsi055] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE To examine 6-month follow-up data on the effectiveness of in-home Behavioral Family Systems Therapy (BFST) for adolescents with poorly controlled diabetes, using a pilot and feasibility study. METHODS Eighteen adolescents with poorly controlled diabetes received ten 90-min sessions of in-home BFST. Diabetes-related functioning, general family functioning, and health status were assessed at baseline, immediately following treatment and 6-months after the treatment. RESULTS Although the initial posttreatment follow-up evaluation indicated decreases in general family conflict, diabetes-related family conflict, and behavior problems, evaluation at a 6-month follow-up (N = 17) demonstrated that initial posttreatment improvements were no longer present for any of the variables assessed. Metabolic control remained unchanged from baseline to initial posttreatment as well as at 6-month follow-up. CONCLUSIONS A plausible explanation for this finding is that participating families were experiencing distress that required longer-term treatment for enduring results, beyond what was employed in this study. Further research is necessary before in-home BFST can be considered an effective psychosocial intervention for adolescents with poorly controlled diabetes.
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Affiliation(s)
- Michael A Harris
- Patient Oriented Research Unit, Campus Box 8208, Washington University School of Medicine, 660 South Euclid Avenue, St. Louis, MO 63110, USA.
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Frey MA, Ellis D, Naar-King S, Greger N. Diabetes management in adolescents in poor metabolic control. DIABETES EDUCATOR 2005; 30:647-57. [PMID: 15669780 DOI: 10.1177/014572170403000416] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE This study was conducted to describe and compare adolescent and parent report of diabetes management and to identify racial/ethnic differences in diabetes management and metabolic control in adolescents in poor metabolic control. METHODS The convenience sample consisted of 31 mother-adolescent dyads. Diabetes management was measured by the Diabetes Management Scale. Descriptive statistics, bivariate correlations, and t-tests were used to analyze the data. RESULTS The overall mean of individual management activities was 66% for adolescents and 68% for mothers. Mismanagement of insulin was reported by 25% of the adolescents yet this behavior was supervised only 65% of the time. Better metabolic control was related to eating 3 meals a day, getting insulin every day, and more assistance with meals. African American adolescents were in poorer metabolic control than European Americans. CONCLUSIONS Diabetes management behaviors are performed much less frequently than recommended by adolescents and their mothers. Additional research is necessary to identify modifiable factors that contribute to inadequate diabetes management to identify intervention strategies to improve diabetes management in adolescents with poor metabolic control.
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Affiliation(s)
| | - Deborah Ellis
- Department of Psychiatry and Behavioral Neuro-sciences, Wayne State University, Detroit, Michigan
| | - Sylvia Naar-King
- Department of Pediatrics, Wayne State University, Detroit, Michigan
| | - Nancy Greger
- Department of Pediatrics, Ambulatory Care Center, University of New Mexico, Albuquerque
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Harris MA, Mertlich D. Piloting Home-Based Behavioral Family Systems Therapy for Adolescents With Poorly Controlled Diabetes. CHILDRENS HEALTH CARE 2003. [DOI: 10.1207/s15326888chc3201_5] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Maldonado MR, D'Amico S, Rodriguez L, Iyer D, Balasubramanyam A. Improved outcomes in indigent patients with ketosis-prone diabetes: effect of a dedicated diabetes treatment unit. Endocr Pract 2003; 9:26-32. [PMID: 12917089 DOI: 10.4158/ep.9.1.26] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate whether a specialized intervention program could improve diabetes-related health outcomes in indigent patients with type 1 diabetes who were prone to occurrence of diabetic ketoacidosis (DKA). METHODS Patients with type 1 diabetes mellitus admitted because of DKA during a 24-month period were invited to receive outpatient care in a diabetes treatment unit (DTU). We compared DKA-related readmission rates, change in hemoglobin A1c (HbA1c) values, and diabetes-related medical costs in patients who participated in the DTU program (+DTU) and in those who did not (-DTU). RESULTS During the study period, 115 patients underwent assessment. Of this overall group, 57 patients (49.6%) consented to participate in the DTU program, and 58 (50.4%) did not. After the follow-up period (median duration, 657 days), the following significant improvements were observed in the +DTU group (in comparison with the -DTU group): lower frequency of readmission for DKA (16% versus 43%; P = 0.001), lower number of readmissions for DKA per patient (0.22 +/- 0.6 versus 1.17 +/- 2.2 [mean +/- standard deviation]; P = 0.003), lower HbA1c level (10.4 +/- 2.3% versus 13.5 +/- 2.3%; P<0.0001), and lower cost of diabetes-related medical care (3,427.20 US dollars +/- 6,275.60 versus 10,119.10 US dollars +/- 19,688.10; P = 0.01). Multivariate analysis revealed that participation in the DTU program was the only factor associated with a significantly decreased risk of DKA-related readmission. CONCLUSION Low-cost intervention by a dedicated outpatient DTU resulted in significant decreases in DKA-associated readmissions, in HbA1c values, and in costs of diabetes care in a multiethnic, indigent, ketosis-prone patient population.
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Affiliation(s)
- Mario R Maldonado
- Section of Endocrinology, Department of Medicine, Baylor College of Medicine, and Ben Taub General Hospital, Houston, Texas 77030-3498, USA
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Freire AX, Umpierrez GE, Afessa B, Latif KA, Bridges L, Kitabchi AE. Predictors of intensive care unit and hospital length of stay in diabetic ketoacidosis. J Crit Care 2002; 17:207-11. [PMID: 12501147 DOI: 10.1053/jcrc.2002.36755] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To determine the predictive value for prolonged intensive care unit (ICU) and hospital length of stay (LOS) in patients with diabetic ketoacidosis (DKA) of the Acute Physiology and Chronic Health Evaluation II (APACHE II) score and Logistic Organ Dysfunction System (LODS), and to identify associated characteristics. DESIGN Prospective cohort, 18-month observation. SUBJECTS AND SETTING All admissions to a 12-bed, inner-city, university-affiliated hospital, medical ICU from July 1999 to December 2000. MEASUREMENTS Data for APACHE II and LODS scoring systems were collected within 24 hours of admission. Lengths of ICU and hospital stay were the primary outcomes. Prolonged ICU and hospital LOS were defined as 3 or more and 6 or more days. RESULTS A total of 584 patients, mean age 49, 56% men, 82% African American were admitted to the ICU. At admission they had (mean +/-SD) APACHE II (18 +/- 10), LODS (5 +/- 4), and predicted mortality of 32% +/- 29%. DKA was the admitting diagnosis in 42 (7.6%) patients; they had lower APACHE II (12 +/- 6), LODS (2 +/- 1), and predicted mortality 5% +/- 5% than the general ICU population (all, P <.001). Hospital mortality in non-DKA patients was 18%; there were no deaths in patients with DKA. Among DKA patients, those with insulin noncompliance had a shorter hospital stay (2.8 +/- 1 d) than those with an underlying illness as the DKA trigger (4.8 +/- 3, P =.02). Between patients with DKA, regardless of the LOS, there were no significant differences in APACHE II, LODS, or predicted mortality. CONCLUSIONS ICU-admitted patients with DKA are less ill, and have lower disease severity scores, mortality, and shorter length of ICU and hospital stay than non-DKA patients. Disease severity scores are not, but precipitating cause is, predictor associated with prolonged hospital LOS in patients with DKA.
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Affiliation(s)
- Amado X Freire
- Department of Medicine, the University of Tennessee Health Sciences Center, Memphis, TN 38163, USA.
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Schilling LS, Grey M, Knafl KA. The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis. J Adv Nurs 2002; 37:87-99. [PMID: 11784402 DOI: 10.1046/j.1365-2648.2002.02061.x] [Citation(s) in RCA: 135] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
AIM An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. BACKGROUND Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. METHODS Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. RESULTS The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. CONCLUSIONS It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.
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Affiliation(s)
- Lynne S Schilling
- Yale University, School of Nursing, New Haven, Connecticut 06536-0740, USA.
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Clark CM, Chin MH, Davis SN, Fisher E, Hiss RG, Marrero DG, Walker EA, Wylie-Rosett J. Incorporating the results of diabetes research into clinical practice: celebrating 25 years of diabetes research and training center translation research. Diabetes Care 2001; 24:2134-42. [PMID: 11723096 DOI: 10.2337/diacare.24.12.2134] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- C M Clark
- Richard L. Roudebush VA Medical Center and Indiana University, Indianapolis, Indiana 46202-2859, USA.
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Orr DP, Fineberg NS, Gray DL. Glycemic control and transfer of health care among adolescents with insulin dependent diabetes mellitus. J Adolesc Health 1996; 18:44-7. [PMID: 8750427 DOI: 10.1016/1054-139x(95)00044-s] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe glycemic control among older adolescents with insulin dependent diabetes mellitus (IDDM) as they move from pediatric to adult-focused health care. METHODS Prospective cohort study conducted in a university medical center. Participants included 82 consecutive adolescents (50 males and 32 females) with IDDM transferred from a pediatric to an adolescent/young adult diabetes clinic. Main outcome measures were the levels of total stable glycosylated hemoglobin (HbA1) obtained at each visit for up to one year before and after the transfer. RESULTS The average age of transfer to the young adult clinic was 17.3 +/- 0.8 years. Mean age at onset of IDDM was 9.6 +/- 4.2 years (1.2 to 17.3) with duration of 7.7 +/- 3.9 years (0.7 to 16.1). Glycemic control remained unchanged following transfer (9.9% +/- 1.8 vs 10.2% +/- 1.9; t = 1.6; p = 0.125). Following transfer, both males and females maintained similar levels of glycemic control (9.8% +/- 1.7 and 10.7% +/- 1.8 respectively); although the difference between males and females was significant (t = -2.0; p = 0.048) following transfer, there was no difference in the degree of change by gender (t = -2.0; p = 0.8). In both pediatric and young adult clinics, there was no relationship between duration of IDDM (< 5 vs > or = 5 years) and HbA1. CONCLUSIONS Transfer to an adult-focused diabetes program appears to have no negative impact on glycemic control.
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Affiliation(s)
- D P Orr
- Section of Adolescent Medicine, Indiana University Medical Center, Indianapolis, 46202, USA
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Henderson G. The psychosocial treatment of recurrent diabetic ketoacidosis: an interdisciplinary team approach. DIABETES EDUCATOR 1991; 17:119-23. [PMID: 1899827 DOI: 10.1177/014572179101700220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The professional expertise of the diabetes mental health professional is integral to the interdisciplinary team approach to recurrent diabetic ketoacidosis (DKA). A case report provides the context to illustrate the interconnection of concurrent strategies of diabetes management, teaching, and counseling. Specific methods include a practical approach to manipulative behavior in blood glucose monitoring, supervision of insulin administration, education, and intensive psychotherapy. In this case study, the adolescent's removal from her home environment, along with medical supervision and extensive psychosocial support, was instrumental in reversing the pattern of self-destructiveness. Recurrent DKA is a very specific problem for which the mental health professional can play an effective treatment role.
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Gray DL, Golden MP, Reiswerg J. Diabetes care in schools: benefits and pitfalls of Public Law 94-142. DIABETES EDUCATOR 1991; 17:33-6. [PMID: 1986901 DOI: 10.1177/014572179101700107] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
The implementation of the Education for All Handicapped Children Act of 1975 (Pub L No. 94-142) has brought significant changes in educational services for health-impaired children. Health-related services are one of many important services available to children under Pub L No. 94-142. For some children with IDDM, specific diabetes-related care is essential for continued progress in school. However, barriers exist that impede access to related health support services, including lack of agreement about the applicability for Pub L No. 94-142 to children with IDDM, lack of consensus as to who should provide services, and concern about liability of school personnel. This paper describes those barriers and suggests approaches to overcome them. One such approach is an Indiana State legislative amendment that provides schools with immunity from civil liability for diabetes-related care.
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Kurtz SM. Adherence to diabetes regimens: empirical status and clinical applications. DIABETES EDUCATOR 1990; 16:50-9. [PMID: 2178896 DOI: 10.1177/014572179001600112] [Citation(s) in RCA: 100] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Adherence to diabetes treatment regimens has proved to be a conceptual and empirical enigma. Consequently, reliable and valid applications to the clinical practice of diabetes care and education have been wanting. Rates of nonadherence are staggeringly high, regardless of the methodology employed, and verification of self-reports is complicated by social desirability to appear compliant. Low intertask correlations further complicate our understanding of adherence-metabolic control relationships. Studies relating to the Health Belief Model, social learning theory, and the psychology of interpersonal relationships that have sought to identify determinants of adherence behaviors have specific relevance to the clinical practice of diabetes education.
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