Education and multidisciplinary team care concepts for pediatric and adolescent diabetes mellitus.

Abstract

The DCCT scientifically established the basis for optimizing blood glucose control in type 1 diabetes mellitus around the world using a multidisciplinary team approach and patient-centered adjustments of food and insulin based upon blood glucose data generated by the patient. Pediatric diabetologists no longer believe that it is prudent to allow higher blood glucose levels in prepubertal children but much educational emphasis must be placed upon minimizing serious episodes of hypoglycemia. Individualized treatment should be determined by a close working relationship between highly trained diabetes nurses, educators and dieticians with the patient as the focus of self-care decisions, and a pediatric diabetologist ideally setting the philosophical and medical goals. Rather than the diabetes health care team being the only ones to initiate treatment, patient and parents should be empowered to analyze their own data, identify patterns, solve problems with food and activity, and do so based upon actual blood glucose results. This empowerment paradigm helps decrease care frustrations and improve treatment outcomes. Survival education followed by in-depth problem solving education and organized follow-up education are all needed steps for successful diabetes management. Identification of psychosocial barriers and energy diverting behavioral and family issues just as knowledge about learning styles play key roles in this process. Dogma should be avoided. More physiological utilization of insulin analogs, greater insulin dosing flexibility with a multidose insulin regimen coupled with adaptation of insulin to food and activity, should allow maximum benefit. Four major types of learning styles are reviewed: concrete sequential learners, abstract sequential learners, abstract random learners and concrete random learners. Health Belief Models, Locus of Control constructs, and Self-Efficacy models all provide sophisticated ways to help identify and overcome learning and self-care barriers. Parental, child, adolescent and young adult responsibility for care also needs to be addressed and placed in the context of family functioning and glycemic goals. Age and developmental stages as well as parental and societal roles play important roles in the care needed to live well with a chronic illness. The role of the health care professionals who are part of the diabetes care team involves not only setting the stage and providing guidance but also supervising appropriate short- as well as long-term complications monitoring for early detection and treatment of microangiopathy. Applying not only telephone but also fax, e-mail and computers in modern diabetes care should facilitate applications of these psychological, educational and medical models to improve short-term and long-term diabetes treatment outcomes.