Understanding the Lived Experience of Children With Type 1 Diabetes in Kenya: Daily Routines and Adaptation Over Time

The Illness Experiences of Adolescents with Type 1 Diabetes Mellitus: A Qualitative Meta-synthesis

This study aims to systematically review the illness experience of adolescent patients with type 1 diabetes mellitus (T1DM). The JBI qualitative systematic review method was used and meta-aggregate analysis of 14 qualitative studies was performed. Qualitative studies on the disease experience of adolescent patients with T1DM were obtained from Cochrane, PubMed, Web of Science, CINAHL, Embase, Wanfang, CNKI, and VIP, and the search period was from 1995 to 2024. The qualitative research quality evaluation tool of JBI the Evidence-based Health Care Center in Australia was used to evaluate the analysis results. Thirty-one results were distilled and categorized into 7 themes and then synthesized into 3 overarching findings: (1) experiencing psychological distress and developing coping mechanisms following adjustment; (2) acknowledging self-management shortcomings and actively seeking support; and (3) overcoming challenges and growing through experiences. The findings illuminate that adolescents with T1DM often experience negative physical and emotional challenges during their illness. Transitioning from dependency to independence poses numerous obstacles that can be overcome by improving both internal and external support, cultivating self-management skills, strengthening coping mechanisms, and achieving control over the disease while fostering personal growth.

Humanistic burden of pediatric type 1 diabetes on children and informal caregivers: systematic literature reviews

BACKGROUND

Diagnosis of children with type 1 diabetes (T1D) imposes an unprecedented burden on children and their caregivers.

OBJECTIVE

To assess the burden of T1D on children and their informal caregivers, both after a recent diagnosis or after a longer duration of disease.

METHODS

A series of systematic literature reviews were performed to explore the burden of T1D on children with the disease and their primary informal caregivers, based on the time of diagnosis. After the extraction of the qualitative and quantitative data from the included studies, two literature-based conceptual frameworks were developed: on the burden of pediatric T1D on children, and on informal caregivers. A third conceptual framework on the shared burden of pediatric T1D on both children and informal caregivers as part of the same family unit was also developed.

RESULTS

The review of literature has identified a series of factors that affect the quality of life of children with T1D and their informal caregivers, with a direct impact on physical, emotional, and social outcomes. Generally, female patients and older adolescents experience more worry and stress that affects their quality of life. Other categories of factors affecting the child's and caregiver's burden include social, emotional, and physical factors, treatment-related and disease-related factors, as well as their coping abilities. Anxiety, depression, stress, and worry were commonly found among children and caregivers, starting with the diagnosis of T1D and continuing over time in relation to new challenges pertaining to aging or the disease duration.

CONCLUSION

T1D causes a significant burden to affected children and their caregivers, both independently and through transactional interaction within the family unit. Disease burden can be reduced by strengthening individuals for the benefit of the whole family.

Diabetes Care in Humanitarian Settings

Despite the increasing prevalence of diabetes in populations experiencing humanitarian crisis, along with evidence that people living with diabetes are at higher risk for poor outcomes in a crisis, diabetes care is not routinely included in humanitarian health interventions. We here describe 4 factors that have contributed to the inequities and lack of diabetes inclusion in humanitarian programmes: (1) evolving paradigms in humanitarian health care, (2) complexities of diabetes service provision in humanitarian settings, (3) social and cultural challenges, and (4) lack of financing. We also outline opportunities and possible interventions to address these challenges and improve diabetes care among crisis-affected populations.

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.

Psychosocial Impact of Sickle Cell Disease and Diabetes Mellitus on Affected Children and Their Parents in Khartoum State, Sudan

This study aimed to assess the psychosocial impact of sickle cell disease (SCD) and diabetes mellitus on children and their parents in Sudan, and the relationship between socioeconomic status and psychosocial issues. A descriptive, cross-sectional study was conducted among n = 320 children aged 6-12 years, of whom n = 170 were diagnosed with SCD, n = 150 children with diabetes mellitus and their parents. The strengths and difficulties questionnaire (SDQ scale) was used to assess the psychosocial aspect of children. Depression, Anxiety, Stress Scale -21 Items (DASS 21) was used to assess the psychological well-being of the caregivers. Data on psychological problems of children with SCD showed that 66.5% had emotional symptoms, 18.2% had conduct problems and 19.4% hyperactivity. Data of parents showed that 45.9% of parents did not experience depression; 27.9% were moderately depressed group. Data on psychological problems among children with diabetes showed that 57.3% experienced emotional symptoms, conduct problems were close to the average among 66%. Data on psychological problems among parents of children with diabetes showed that 45.3% of parents did not experience depression; 22.7% belonged to the moderately depressed group. Psychosocial problems were common both among children and parents. More research is needed in the context of caring for a child with chronic diseases and the role of health care providers in adapting and mitigating psychological problems among both parents and children.

Improving access to diabetes care for children: An evaluation of the changing diabetes in children project in Kenya and Bangladesh

BACKGROUND

The changing diabetes in children (CDiC) project is a public-private partnership implemented by Novo Nordisk, to improve access to diabetes care for children with type 1 diabetes. This paper outlines the findings from an evaluation of CDiC in Bangladesh and Kenya, assessing whether CDiC has achieved its objectives in each of six core program components.

RESEARCH DESIGN AND METHODS

The Rapid Assessment Protocol for Insulin Access (RAPIA) framework was used to analyze the path of insulin provision and the healthcare infrastructure in place for diagnosis and treatment of diabetes. The RAPIA facilitates a mixed-methods approach to multiple levels of data collection and systems analysis. Information is collected through questionnaires, in-depth interviews and focus group discussions, site visits, and document reviews, engaging a wide range of stakeholders (N = 127). All transcripts were analyzed thematically.

RESULTS

The CDiC scheme provides a stable supply of free insulin to children in implementing facilities in Kenya and Bangladesh, and offers a comprehensive package of pediatric diabetes care. However, some elements of the CDiC program were not functioning as originally intended. Transitions away from donor funding and toward government ownership are a particular concern, as patients may incur additional treatment costs, while services offered may be reduced. Additionally, despite subsidized treatment costs, indirect costs remain a substantial barrier to care.

CONCLUSION

Public-private partnerships such as the CDiC program can improve access to life-saving medicines. However, our analysis found several limitations, including concerns over the sustainability of the project in both countries. Any program reliant on external funding and delivered in a high-turnover staffing environment will be vulnerable to sustainability concerns.