European Diabetes Nursing最新文献

The aim was to compare two different regimens for children diagnosed with type 1 diabetes, hospital-based care and hospital-based home care (HBHC), in terms of the child's metabolic control, episodes of severe hypoglycaemia, the disease's impact on family and the parents' health-related quality of life, one year after diagnosis. The study had a randomised controlled design and included 60 children, aged 3–15 years old. Children were randomised to either continued hospital-based care or to HBHC. This article presents data one year after diagnosis. The results showed overall equivalence between groups. There were no differences in terms of the children's HbA1c (p=0.804), in episodes of severe hypoglycaemia (p=1.0), in insulin dose/kg/24 h (p=0.115) or parents reported impact of the child's disease on the family (p=0.163). However, parents in the HBHC showed significant higher social functioning compared to parents in the hospital-based care (p=0.006). In conclusion, few studies provide high-quality evidence when comparing hospital-based care with different models of home-based care. The results of this study one year after diagnosis support the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes.

Dermatological complications at insulin administration sites, like lipohypertrophy, lipoatrophy and erythema, are common in children with type 1 diabetes. These complications can be painful, disfiguring and may influence glycaemic control. Studies on epidemiology and etiology are needed before prevention or treatment is possible.

The aim of this study is to determine the prevalence of common dermatological complications in children with type 1 diabetes and to assess associations between dermatological complications and possible risk factors.

In this cross-sectional study 231 children with type 1 diabetes were included. Dermatological complications were assessed and a questionnaire with possible risk factors was completed. Data were evaluated using χ² tests.

The results showed that lipohypertrophy was present in 34.8% of the children, lipoatrophy in 8.1% and erythema in 24.6%. Lipohypertrophy was associated with multiple daily injection therapy (p=0.03) and insufficiency of alternating administration sites (p<0.001). Lipoatrophy was not influenced by type of insulin therapy (p=0.44) but was found to be associated with less frequent injection site alternation in patients using multiple daily injections (p=0.01). Also, HbA1c level was positively associated with lipoatrophy (p=0.01). Erythema of the skin was more frequently diagnosed in children with continuous subcutaneous insulin pump therapy (p<0.001). A history of cutaneous infections and dry skin on exam day were independently associated with erythema at insulin administration sites (p<0.001 and 0.04, respectively).

Dermatological complications are a common problem in children with type 1 diabetes making frequent examination of the skin in these children an important aspect of their medical care.

This quality is evident in the current edition which has some important work emphasising the needs of children and young people with diabetes.

In the study of Viklund and Örtqvist we see yet further evidence that some young people still struggle with the psychological burden of the disease. This seems to be a constant finding in research of this population. While the authors suggest more screening for the impact of diabetes on quality of life, it also seems to be an imperative to try and target those with most difficulty and provide much more effective psychosocial interventions. In the future more studies of intervention would be important and very welcomed by this journal.

In the study of Tiberg et al we have a comparison of hospital and home based support for newly diagnosed children with diabetes. The study shows that overall the two models are equivalent, although there may be enhanced satisfaction in the home based group. However, we should consider the translational impact of this study. Given that care provision is so variable between countries, we need more consideration of the common principles that impact on the way we support children and parents at diagnosis so these can be applied in different settings. We might also explore the economic benefits of different models.

The study by Munster et al focuses on a specific clinical problem that of hyperlipotrophy in children. The analysis highlights some important clinical take away points and in particular the need for effective site rotation practices.

Finally, we have an example of a different kind of article that the journal has promoted, the clinical review. These papers provide state of the art updates on important and sometimes quite complex topics. In this edition we have a review on cystic fibrosis and diabetes from Marshall and Caraher. The paper highlights the many challenges of managing diabetes in this population, alongside some important strategies for dealing with those problems. Again it is the inclusion of such material that hopefully makes the journal of interest and highlights its importance as a means to disseminate knowledge.

So within this edition we have some clear evidence of why the journal is important to the professionof diabetes nurses. However, it is also clear that the journal has scope to develop further and become more important to the diabetes nursing community across Europe.

The journal currently has a preponderance of papers from the Nordic countries and the UK. It would be greatly enhanced if we could have more high quality submission from elsewhere in Europe. While in part this may reflect the lack of investment in research infrastructure for diabetes nurses across Europe and the increasingly tight funding environment, it is incumbent on all professional groups to take responsibility to ensure that they generate the knowledge necessary to improve the quality of the care they deliver. Hence, we need to

The International Study of Pediatric and Adolescent Diabetes (ISPAD) guidelines state the glycaemic treatment goal for children with type 1 diabetes to be HbA1c <57mmol/mol (<7.5% DCCT standard) to minimise the risk of severe late complications. Teenagers with diabetes have a higher risk of psychiatric disorders and impaired quality of life (QoL) compared to healthy teenagers and the guidelines highlights the importance of regular measurement of health and QoL. Previous studies have shown a correlation between glycaemic control and QoL.

The aim of this study was to explore which health and QoL factors correlate and predict outcome in glycaemic control (HbA1c) in young persons with type 1 diabetes. A convenience sample of 204 patients with type 1 diabetes, 12–17 years of age, from three centres in Sweden were recruited. Respondents completed four questionnaires at a regular visit. Check your Health and DISABKIDS chronic generic module DCGM-37 measures physical and emotional health, social relations and QoL. The diabetes-specific module (DCGM-37-DM) measures how the persons are affected by diabetes. The Swe-DES -23 measures four different empowerment factors and The SDD attitudes towards diabetes. Medical data were collected from the patients' medical records. The results from the questionnaires were analysed by multiple linear regression analysis.

A total 22% reached the treatment goal of HbA1c <57mmol/mol, while 28% had poor glycaemic control with HbA1c >73 (>8% DCCT-standard). There was a strong positive correlation between age and HbA1c. Adolescents with poor glycaemic control reported lower physical and mental health, higher burden of diabetes, lower empowerment, more negative attitudes towards diabetes and they thought diabetes was more difficult to handle. Age, physical health, social relations, problem solving, goal achievement, and object evaluation (object=diabetes), predicted 25% of the total variation in HbA1c. Several health-related quality of life factors predict variation in glycaemic control. Our study emphasises the need for regular evaluation of QoL factors and an active discussion about these factors of life in regular care for young persons with type 1 diabetes.

Cystic fibrosis is the commonest, life-threatening recessively inherited disease in the Caucasian population. The disease process which primarily affects the lungs also damages both exocrine and endocrine pancreatic function. With increasing survival, cystic fibrosis-related diabetes is becoming more prevalent increasing from 15% of adolescents with cystic fibrosis to 50% of adults. Impaired glucose tolerance is also common. Insulin secretion gradually decreases over time. Insulin resistance also occurs and can vary dramatically with intercurrent illness. Even mild degrees of hyperglycaemia adversely affect nutritional status and lung function. Good blood glucose control improves nutritional status and lung function. Cystic fibrosis-related diabetes develops insidiously, so that annual screening is recommended, ideally by oral glucose tolerance testing. HbA1c is not sufficiently sensitive to identify early abnormalities in glucose tolerance. Aims of managing cystic fibrosis-related diabetes are to relieve symptoms, maintain normal body weight and growth, improve lung function and improve life expectancy. Insulin is the treatment of choice and the regimen should be tailored to the individual. Initially, only rapid-acting insulin with the main meal may be necessary, but as insulin secretion diminishes, a full basal-bolus regimen becomes necessary. Individuals with cystic fibrosis struggle to consume sufficient calories, so that a high calorie, high fat diet is usually appropriate. Supplemental enteral nutrition, with matching insulin administration, is frequently required. Special situations, including pregnancy, require specific management. The psychological impact of cystic fibrosis-related diabetes on the individual is enormous. Successful management requires support from a multi-disciplinary team with the necessary specialist knowledge and skills.