Glycemic control and the psychosocial benefits gained by patients with type 1 diabetes mellitus attending the diabetes camp
Division of Endocrinology and Metabolism, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand. Patient Education and Counseling
(Impact Factor: 2.2).
08/2008; 73(1):60-6. DOI: 10.1016/j.pec.2008.05.023
The aim of this study was to evaluate the effectiveness of diabetes camp on glycemic control, knowledge, and psychosocial benefits among patients with type 1 diabetes (T1D). Glycemic control among patients with infrequent and frequent self-monitoring of blood glucose (SMBG) was also compared.
During a 5-day camp, 60 patients were taught diabetes self-management education (DSME). After camp, patients were divided into two groups based on frequency of SMBG (<3 versus 3-4 times/day) and were followed up until 6-month post-camp. Patients' HbA1c levels and knowledge were assessed at baseline, 3- and 6-month post-camp. Patients' impressions towards camp were assessed.
In both SMBG groups, HbA1c levels decreased significantly at 3-month post-camp but did not sustain at 6-month monitoring. The patients with frequent SMBG had a lower mean HbA1c level. A significant improvement in knowledge was noted and sustained up to 6-month post-camp. The patients found diabetes camp of benefit and felt they could better cope with diabetes.
Although the effect of the diabetes camp on glycemic control was short-lived, an improvement in knowledge and a better attitude towards having diabetes were seen among participants.
The psychosocial benefits and knowledge gained by patients attending diabetes camp underline the importance of including a camp in a diabetes management plan. To improve patients' long-term glycemic control, a continuous education is required.
Available from: Themis Apostolidis
- "La discipline d'appartenance du premier auteur est restée inconnue pour deux articles. Les interventions d'ETP ont eu lieu auprès d'une population d'adultes (61,7 %), d'ado lescents (36,7 %) et d'enfants (20,0 %).; mais également de réduire le sentiment d'isolement et de partager des idées sur la façon de vivre au quotidien la maladie. L'éducation de l'entourage familial par les patients devait permettre de les amener à devenir plus compréhensifs face à la maladie et aux difficultés d'autogestion. "
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ABSTRACT: It has been established that the psychosocial skills of patients need to be strengthened in the context of therapeutic patient education, to help them to more effectively manage their disease and the associated treatments. This intervention is barely feasible at the present time because of unresolved conceptual, methodological and operational problems, particularly problems concerning the identification and evaluation of the psychosocial skills to be developed. Objectives: This study established an inventory of psychosocial skills targeted by educational intervention, and identified the criteria used to demonstrate acquisition of these skills. Method: A systematic review of the literature was performed on 60 articles dealing with evaluation of educational intervention in patients with diabetes. Results: Skills were identified in one quarter of these articles. They referred to communication and interpersonal relations, decision-making and critical thinking, and also to coping and self-management. These articles used more often used medical endpoints than psychosocial endpoints. Discussion: Psychosocial skills are poorly explained and poorly evaluated. Interventions, often based on a biomedical approach, focus more on self-care skills. The paper concludes on the importance of developing a psychosocial approach to provide a better conceptualization of the notion of social skills.
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ABSTRACT: To examine the effects of insulin dose adjustments on rates of hypoglycaemia for school-aged children with Type 1 diabetes attending camp.
Camp records for 256 children aged 7-15 years (55% on continuous subcutaneous insulin infusion) attending a week-long residential summer camp were analysed.
In anticipation of increased physical activity, basal insulin was decreased for all children on continuous subcutaneous insulin infusion and injection therapy by 10% upon arrival at camp. During the first day, children on continuous subcutaneous insulin infusion received 11.1±6.3% less basal insulin than home doses, whereas children on injections decreased intermediate/long-acting insulin by 8.2±12.8%. Despite these decreases, 60% had at least one blood sugar level <70 mg/dl (3.9 mmol/l) during the first day. Children on continuous subcutaneous insulin infusion were more likely to have hypoglycaemia during the first day than those on injections. The number of episodes of hypoglycaemia increased with increasing camper age. Overall, children did not have further significant reductions in their total daily insulin dose by the last day of camp. However, on the last day, children had fewer episodes of hypoglycaemia than during the first day (0.7±0.9 vs. 1.1±1.2, P<0.001) and 51% had no low blood sugar levels that day.
An empiric 10% reduction in basal insulin appears reasonable, as nearly equal numbers of children required dose increases as dose decreases as camp progressed. However, hypoglycaemia was still common in all age groups. Prospective studies characterizing individual variables are needed in order to facilitate tailored insulin dose adjustments that minimize glycaemic variability while optimizing control in the diabetes camp setting.
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ABSTRACT: Aims: To explore the relationship between diabetes self-management, and behavioural and emotional responses to hypoglycaemia in children and adolescents aged 8-15 years with type 1 diabetes via self-report measures. Methods: Data were collected at an overnight diabetes camp and endocrinology clinic on 127 participants who responded to two self-administered measures: the Diabetes Behavior Rating Scale (DBRS) and the Children's Hypoglycemia Index (CHI). Descriptive statistics and linear regressions were analysed to detect significant relationships. Results and conclusions: Five items from the DBRS were found to predict 80% of the variability in self-management. Five items on the CHI predicted 90% of the variability in fear of hypoglycaemia. Children aged 11-15 years with repeated (<2 years) diabetes camp attendance were found to have less fear of hypoglycaemia.
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