Influence of comprehensive stage rehabilitation on compensation for type 1 diabetes mellitus in children and adolescents

Abstract

The aim of the study is to improve the rehabilitation system for children and adolescents with type 1 diabetes mellitus.Materials and methods. We observed 119 boys and 75 girls 10 — 17 years old with type 1 diabetes mellitus and disease duration of more than 1 year. Patients were divided into groups: group 1 — children who were observed at the primary (outpatient) stage of medical care (n = 28); group 2 — patients who underwent a comprehensive examination and treatment 1 — 2 times a year in the endocrinology department (n = 100); group 3 (n = 66) — patients who underwent staged rehabilitation in endocrinology department and sanatorium. In patients of different groups, the level of compensation for carbohydrate metabolism, the presence of complications of diabetes, psychological and emotional state, and the level of self-control were compared. Mathematical processing of the results of the examination of adolescents was carried out using the SPSS Statistics 17.0, Excel software packages.Results. The insufficient level of specialized care for children and adolescents with type 1 diabetes is evidenced by the unsatisfactory state of compensation of carbohydrate metabolism in 75.0 % of patients. Psychological disorders and low motivation for treatment were recorded in 61.0 %. The features of the emotional state of patients with type 1 diabetes at various levels of medical care were identified and recommendations for their correction were given. The expediency of introducing the position of a medical psychologist into the staff of specialized hospitals and sanatorium-resort institutions, as well as the need to continue self-control classes in a sanatorium, have been substantiated. A staged complex rehabilitation of patients with type 1 diabetes has been developed and its effectiveness has been evaluated. It was found that the implementation of staged rehabilitation allows increasing the level of knowledge in 77.6 % of patients, optimizing the quality of self-control in 86.3 % of patients. It also promotes long-term improvement in diabetes compensation and emotional well-being at all levels of care.Conclusions. Dynamic observation of children and adolescents with type 1 diabetes mellitus provides for continuity between the primary, secondary levels of medical care and sanatorium institutions. The system of staged rehabilitation with the involvement of a psychologist and training in self-control at the inpatient and sanatorium stages makes it possible to increase the effectiveness of diabetes treatment along with increased motivation for self-control of the disease.