Dose Adjustment for Normal Eating: Longer Term Perspectives of Adults with Type 1 Diabetes

Aim:?To explore the longer term blood glucose self-monitoring outcomes and frequency of monitoring for outpatients with diabetes type 1 after completion of the Dose Adjustment for Normal Eating (DAFNE) course. The hypothesis was that DAFNE outcomes would differ according to frequency of glucose monitoring.Methods:?A?sequential data-triangulation design using existing?baseline (T0) and 12-months (T12)?DAFNE course data and interview data from 12 randomly selected participants who had completed the course two years ago.?Results: Age range was 23 to 70 years with HbA1c 6.1% to 12.6% at T0?and 6.1% to 11.4% at T12. Comparisons of HbA1c, PAID, HAD subscales?anxiety?and?depression,?and covariate data between T0?and T12indicatedsignificant reductions in the mean depression and PAID scores (both?P?< 0.001) for the whole group. For the two groups who recorded their blood glucose less than three times or three or more times per day, changes were not significantly different. For both groups, the trend between T0?and T12?was downwards for change in mean blood glucose level and all survey scales. The proportion of all participants with T12?HbA1c at or below their T0?value was greater than 50% (Proportion = 69%, 95% CI: 56% - 79%) but only the highest HbA1c tertile group showed a significant difference (P?= 0.003). There was an average decrease in the incidence of hypoglycaemic events of 0.6 overall: The greatest change was for the high HbA1c tertile with a mean decrease of 0.8. The interview data suggested that DAFNE graduates experimented more with food, exercise, and insulin;gained knowledge;learnt personal body needs;increased awareness of blood glucose level;gained confidence and improved their quality of life. Conclusions: There was insufficient evidence to conclude that frequency of blood glucose monitoring influenced metabolic control. However, people with type 1 diabetes who undertake the less restricted DAFNE approach to diabetes self-management can improve their quality of life and glycaemic control.

Healthcare-transition risk assessment for emerging adults with diabetes type 1

AIM: To identify potential risk indicators for emerging adults transitioning to adult health care. BACKGROUND: Without maturity, independence, knowledge and motivation to manage their diabetes and successfully transition to adult healthcare, a proportion of emerging adults will struggle, leaving themselves vulnerable to diabetes-related complications. METHODS: Fifty-three emerging adults (aged 17 - 19 years) recently transitioned from pediatric to adult healthcare were recruited. Data included demographic, glycated haemoglobin, Body Mass Index, base-line and 12-month data from four psychosocial measures: Problem Areas in Diabetes, Diabetes Empowerment Scale, Hospital Anxiety and Depression Scale and dichotomous questions from the Eating Attitude Test. Missed appointments were obtained from hospital records. RESULTS: No significant differences in age, gender, BMI and individual survey scales between three appointment groups. Median HbA1c in the Sat-1 group was 7% (53 mmol/mol), compared with 8.6% (70 mmol/mol) and 8.5% (69 mmol/mol) respectively in the Sat-2 and Unsatisfactory groups. A ROC curve analysis and classification tree analysis identified optimal threshold values for the survey scales and their linear combinations. These values were used to make comparisons across two appointment and three HbA1c status groups. The unsatisfactory appointment group was characterised by statistically higher proportions of participants with (1) a low score for empowerment alone or in combination (less) with perceived problems and (2) statistically higher perceived problems and anxiety scores. CONCLUSIONS: Findings suggest that diabetes self-care confidence, less perception of diabetes as a problem, could be a useful indicator of future appointment attendance. Similarly, depression levels could be a useful predictor of better metabolic control following transition. RELEVANCE TO CLINICAL PRACTICE: This study offers an innovative use of existing metrics to identify at-risk emerging adults in a busy clinic. Rather than the emphasis being solely on blood glucose control, it may be time to consider including psychosocial measures to identify at-risk individuals at the first appointment in adult healthcare.

Family responsibility dynamics for young adults in transition to adult health care

Aim: To explore family responsibility dynamics, metabolic control, clinic attendance, and emergency admissions when young adults (YA) with type 1 diabetes transition to an adult hospital. Method: A longitudinal mixed method design with two study groups (parents, n = 28;YA intervention group, n = 23) and a YA comparison group (n = 20). Sample recruited from an outpatient diabetes centre. Demographic, clinic attendance, emergency admissions, biodata, and the Diabetes Family Responsibility Questionnaire (DFRQ) were completed on entry and sixmonths later as part of an 18-month trial of a diabetes transition coordinator (DTC). The selfreport DFRQ were analyzed using derived parent-child dyadic variables to explore differences at baseline and end of study using Wilcoxon Signed Rank Test. The relationship between metabolic control and the DFRQ patterns was explored using Spearman’s rho. Results: On completion of the study, the change in HBA1Cfor both adolescent groups was not significant but was less than ideal for 25% of adolescents in the study. The YA intervention group had significantly fewer missed appointments between them compared to the comparison group. The DFRQ indicated that the derived parent-child dyadic variable of task-discordance increased during the study. Conclusion: The clinically relevant diabetes-task dissonance between parents and young adults offers a challenge and a diagnostic opportunity for diabetes educators.

Nurses’perceptions about neonatal intensive care units providing family-centered care are associated with skin-to-skin contact implementation

Skin-to-skin contact(SSC)consists of positioning the diaper-clad infant against the parent’s chest and is considered a nursing practice rooted in family-centered care(FCC).1 SSC implies simultaneous parental presence and helps to facilitate their involvement from the earliest hours of their preterm infants’lives as this intervention is delivered by parents.1 FCC has gained worldwide popularity in recent years to promote parental presence and active participation of parents in care during neonatal intensive care units(NICUs)hospitalization.2 Both practices relate to developmental care(DC),which regroups specific interventions aimed at reducing stress and improving infant neurological development.