Management Of Childhood Diabetes Research Articles

Les négociations de « l’équipement qui convient » : enjeux relationnels dans la prise en charge du diabète de l’enfant

La multiplication des maladies chroniques et l’évolution des traitements modifient la configuration des relations de soin alors que les patients sont aujourd’hui appelés à s’autonomiser en s’appuyant sur des dispositifs médicaux de plus en plus performants. Le traitement du diabète de type 1 donne à voir une multiplicité de ces objets techniques et technologiques. À partir d’une enquête menée auprès d’enfants atteints de diabète de type 1, l’article relève les enjeux relationnels présents dans la prise en charge de la maladie et dans les négociations ayant cours quant à l’équipement qui convient (Vinck, 2006). Il propose d’analyser les prescriptions médicales en tant que prescriptions à l’autonomie évoluant au cours de la trajectoire des enfants et de leur avancée en âge, tout en rendant compte des stratégies de réappropriation développées par ces jeunes malades qui, en contournant ou en détournant les scripts contenus dans ces objets, se constituent un corps pour soi et se construisent en tant qu’acteurs.

Chronic Complications of Type 1 Diabetes in Children

Introduction: Chronic complications of type 1 diabetes are rare in children The aim of this work is to determine their prevalence in paediatric settings and the factors associated with them Methodology: This was a prospective study, conducted in two reference services in the management of childhood diabetes at the University Hospital of Dakar. We included all patients with type 1 diabetes under 20 years of age as recommended by the 2009 ISPAD. Results: Of the 67 patients in our cohort, only 46 met the inclusion criteria. There were 19 boys and 27 girls. The average age was 11.57 years +/- 4.3 years. The average age of discovery was 8.71+/- 3.8 years. The average duration of the evolution was 34 months. Almost half of the patients had an average glycated hemoglobin greater than 9%. Growth retardation was severe in 17% and moderate in 11% of cases. Five patients (20%) had significant microalbuminuria and 5 (20%) had retinopathy, 3 with macular edema and 2 with diffuse microhaemorrhages. Multivariate analysis of the different parameters studied showed that retinopathy was associated with high HbA1c values (p=0.043) and poor compliance (p=0.021). Kidney disease was only associated with poor adherence with p=0.0025. Conclusion: Chronic complications of T1D are not that uncommon, especially in our regions where management is not optimal. We suggest that they be detected around 10-11 years of age regardless of how long the diabetes progresses.

Legal and Ethical Issues Arising from the Use of Emerging Technologies in Paediatric Healthcare

Mobile health apps and wearable devices are widely available. They provide an opportunity to monitor and track health metrics continuously, and in real time, thus enabling diagnosis and chronic condition management to take place outside a hospital setting. The digital data produced can be shared with healthcare providers, researchers, and on social media. In this paper, we explore some of the legal and ethical challenges for doctors of these emerging technologies, by focusing on the example of management of childhood diabetes using continuous glucose monitors and insulin pumps. We identify and explicate these challenges through an analysis of three different case scenarios, all hypothetical but all realistic and reflective of current experiences of doctors caring for children with Type I Diabetes. We argue that current legal and ethical approaches can effectively be applied in determining duties of healthcare professionals using emerging technologies, whilst recognising the significant change in the nature of the doctor-patient relationship and the perception of therapeutic benefit of some technologies.

Childhood diabetes

There are 31 500 children in the UK with diabetes, the second-most-common chronic disease in childhood, after asthma. Most have type 1 diabetes, those remaining have type 2 diabetes, maturity onset diabetes of the young, or cystic-fibrosis-related diabetes. About 25% of newly diagnosed children present with diabetic ketoacidosis. The NHS spends about £1 000 000 per hour on diabetes and GPs have a central role in early diagnosis, prevention of complications, prompt referral and coordination of care. Engagement with good advice and support is essential for young people with diabetes and their families. This article gives an overview of the management of childhood diabetes.

3.15 Nutritional management of diabetes in childhood.

3.15 Nutritional management of diabetes in childhood.

Significance of the measurement of serum fructosamine in the management of childhood diabetes

Aims HbA1c can usually be used as the indicator of glucose control and correlated with the development of long-term diabetic complications. But there are limits that it usually reflects the mean glucose levels of 2-3 months and can be variable in the situation of hemoglobinopathy or the conditions of altered RBC lifespan. In contrast, serum fructosamine levels reflect the mean glucose levels of 23 weeks. This study was designed to see the significance of the measurement of serum fructosamine in the management of childhood diabetes and to see the correlation between the HbA1c and fructosamine.

The risk management of childhood diabetes by primary school teachers

This article explores the attitudes of primary school staff in relation to managing children with diabetes. It reports the findings of a qualitatively orientated study in which we conducted in-depth, semi-structured face-to-face interviews with 22 staff that held a variety of positions in primary schools and had a range of experience of caring for children with diabetes. We consider the anxieties and apprehensions expressed to us by our interviewees (covering topics such as injecting/blood testing, and the reactions of parents to school decisions), in both their capacities as educators and, increasingly, frontline care-givers to other people's children. The expansion and formalisation of healthcare responsibilities within the primary school is shown to have impacted upon the risk assessments made of children with diabetes. Analysis of the data therefore focuses on health related risk anxieties as they are played out in adult/child relations and in the specific context of the primary school.

Genetics in Diabetes Mellitus - Contribution to the Classification and Management

Diabetes mellitus (DM) can be classified as type 1, type 2, and other specific types according to the underlying causes. Other specific types include genetic defects of β-cell function, insulin action, and other genetic syndromes associated with diabetes. Most childhood diabetes has been thought of as type 1 diabetes mellitus (T1DM), but the incidence of type 2 (T2DM) in childhood is rapidly increasing and it can be caused by monogenic defect. In some cases, it might not be easy to determine the type of diabetes and to choose the appropriate treatment. Many susceptible genes to the development of T1DM, T2DM as well as the causative genes of the monogenic diabetes have been identified due to the development of genome-wide association studies, candidate gene analysis and familial linkage studies. Study of the genetic factors in diabetes mellitus is valuable because it enables more appropriate management, and better prediction of disease progression. Therefore, it is important to consider the genetic factors in the management of childhood diabetes.

Behavioral Challenges in the Management of Childhood Diabetes

For many individuals, the diagnosis of diabetes is accompanied by the need for significant lifestyle changes, many of which seem difficult or impossible to implement. When diabetes is diagnosed in a child, those lifestyle changes may involve radical alterations in family life and significantly impact the child's normal growth and development as well as the family's social and economic status. This article describes some of the behavioral challenges associated with childhood diabetes and the importance of identifying strong, developmentally appropriate family support. Specific emphases are given to the complexity of the treatment regimens, the physiologic and emotional challenges associated with normal growth and development, and the family's role in ensuring successful diabetes management. Challenges inherent in both type 1 and type 2 diabetes mellitus are discussed as are factors important to ensuring adherence to the treatment plan.

Paediatrics: Caring for children with type 1 diabetes

Children with type1 diabetes receive ongoing care from a multidisciplinary paediatric diabetes team, usually in a secondary care setting. Healthcare support workers have a role in paediatric diabetes care when children attend routine clinic or are admitted to hospital at diagnosis or during periods of acute illness. In this article, the management of childhood diabetes is explored.

Diabetes - Helping young people to manage their diabetes

Interactive, educational workshops are teaching children and teenagers to understand the dietary management of childhood diabetes

John Robert Hearnshaw

After national service, John Robert Hearnshaw qualified at the Middlesex in 1958, with a first class BSc intercalated degree in physiology. He also served as resident medical officer at the...

The rising incidence of childhood type 1 diabetes in New South Wales, 1990–2002

To determine the incidence of childhood type 1 diabetes mellitus (T1DM) in New South Wales from 1997 to 2002; to compare with previously published rates (1990-1996); and to analyse trends in incidence from 1990 to 2002. Prospective population-based incidence study. Primary ascertainment of incident cases aged < 15 years was from the Australasian Paediatric Endocrine Group NSW children's diabetes register. Secondary ascertainment was from the National Diabetes Supply Scheme until 1999 and from the Australian Institute of Health and Welfare thereafter. Childhood population data were obtained from the Australian Bureau of Statistics. Age-standardised incidence; trends in incidence by calendar year, and sex and age at diagnosis. There were 3260 incident cases (1629 boys, 1631 girls) in the 13 years. Case ascertainment was 99.7% complete using the capture-recapture method. Mean age-standardised incidence per 100 000 person-years was 20.9 (95% CI, 19.9 to 21.9) from 1997 to 2002 compared with 17.8 (95% CI, 17.0 to 18.7) from 1990 to 1996; there was a plateau in incidence between 1997 and 2002. Overall, the incidence increased on average by 2.8% per year (95% CI, 1.9% to 3.8%, P < 0.001) and increased with age, being 12.2 (95% CI, 11.3 to 13.1) in 0-4 year olds; 18.9 (95% CI, 17.8 to 20.0) in 5-9 year olds and 26.7 (95% CI, 25.4 to 28.1) in 10-14 year olds. The increase per year in 0-4 year olds (3.9%) was not significantly higher than in older children. The mean incidence of T1DM was 19.8 (95% CI, 18.8 to 20.7) in girls and 18.8 (95% CI, 17.9 to 19.7) in boys (P = 0.02). The incidence of childhood-onset T1DM has increased significantly in all age groups in NSW since 1990. Resource planning in the management of childhood diabetes in NSW should take these findings into account.

Management of diabetes in childhood: are children small adults?

Management of diabetes in childhood: are children small adults?

Autosurveillance dans la prise en charge du diabète de l’enfant

In the last twenty years, blood glucose self-monitoring has attained a nearly optimal level, with reliability, easiness, quickness and safety, which makes it tolerable to a greater number of patients and allows young diabetics to make more easily something which is mandatory to the management of type 1 diabetes. The principles of treatment are identical in children, adolescents and adults. However, many patients experience difficulties in applying the ideal therapeutic model. This must be particularly taken into account in children, who are in a stage of full intellectual and psychological development. Inappropriate demands can drive them to failure and go against the main objective at this period of life, which is education. Reference documents help pediatricians to the daily practice of home blood glucose monitoring and, more generally, management of childhood diabetes: ISPAD Consensus Guidelines (ISPAD=International Society for Pediatric and Adolescent Diabetes), which has been translated in French, and Cahiers de l'AJD (AJD Note books), for educating new patients. Blood glucose monitoring is recommended: to evaluate the glycemic response to the effect of insulin; to confirm hypoglycemia; to prevent hyperglycemia in case of disease; in case of physical exercise. The frequency of home blood glucose monitoring should be individualized, depending on the acceptability for the young patients and the insulin therapeutic regimen.

Specialist clinics for children with diabetes

‘The ravages of diabetic complications are not seen in a children’s diabetes clinic. Nevertheless, they haunt the paediatrician who believes that sustained control of the blood glucose concentration will protect today’s children from dying 20 years hence from renal failure’ and other vascular complications.’ Until relatively recently many chronic and potentially disabling conditions such as diabetes received insufficient attention. Dramatic remedies were not available. Long-term ‘total management’ was demanded, including patient participation, in contrast to disorders rapidly reversed by prescription or surgery. When childhood diabetes is well managed it is possible to achieve acceptable metabolic control over many years and the child is able to live an active and healthy life without major social, intellectual or physical restrictions. However, when diabetes in a child is badly managed it becomes malignantly destructive to personal and family life. The management of childhood diabetes depends more upon inter-personal, particularly parent-child, relationships and social harmony than prescriptive manipulations of insulin doses and biochemical expertise. For these reasons designated specialist children’s diabetes clinics should be available for all children with diabetes to provide an environment conducive to broadly based support and comprehensive management.

Assessing daily management of childhood diabetes using 24-hour recall interviews: Reliability and stability.

Conducted 24-hr recall interviews concerning daily diabetes management with seventy-eight 6- to 19-year-old patients and their parents. Patients and parents were interviewed independently nine times over 3 months. Data obtained were used to construct 13 adherence measures. All measures yielded statistically significant estimates of parent-child concordance. Parent-child agreement was higher for weekday versus weekend behaviors and when based on nine versus three interviews. For the sample as a whole, parent-child concordance remained stable over the course of the study. Compared to the older patients, the 6- to 9-year-olds exhibited poorer parent-child agreement on measures involving time (e.g., injection and exercise-duration measures). This deficit disappeared, however, as the children became more practiced with the interview procedure. The dietary and glucose-testing measures exhibited moderate stability over the 3-month study. Lower stability estimates were obtained for the exercise and injection measures.

Long term prognosis: juvenile onset IDDM in Japan.

The incidence of IDDM in children in Japan was found to be approximately 6 out of 100,000 in the child population of 6 to 15 years old. This prevalence is very low compared with those in Caucasian countries. Therefore, the history of management of childhood diabetes in Japan is short compared with that of western countries. Three studies which were carried out in Japan are reported and discussed in this report. The complications and prognosis of Type-1 Diabetes in Japan concluded as follows, 1) The long-term outcome of childhood diabetes was very poor. 2) The prevalence of microvascular complications were strongly related to the age of patients and the duration of diabetes. 3) The prevalence of retinopathy was dependent on the degree of diabetic control. But now, in Japan, we are using the intensive insulin therapy universally for childhood diabetes, and during recent ten years, the management and education of patients progressed rapidly. Therefore, the prognosis of childhood diabetes in Japan will improve.

Initial clinical management of childhood diabetes.

An appropriate guideline of clinical management of childhood diabetes is outlined with principle of management, which is divided into four steps mainly planning, program, goals and monitoring of management. A basic philosophy on goals of care, multi-disciplinary team approach and an intimate partnership building between care team members and patients with their families, based on true trust and respect, should be taken into proper consideration from the beginning of therapies. Balanced pragmatism, compromised between patient's lifestyle demands and medical ideal control, is emphasized with a sensible practicality.

Management of Childhood Diabetes

Management of Childhood Diabetes