European Diabetes Nursing

It has been well established that sub-optimal glycaemic control at conception and during early pregnancy is associated with increased fetal loss and congenital abnormalities in the infants of women with established diabetes. There is compelling evidence demonstrating that if these women improve their glycaemic control prior to and during early pregnancy, the rate of these abnormalities can be reduced.We undertook a survey of women attending a general diabetes service – in which only half of the women of reproductive age reported receiving advice specific to pre-pregnancy care. Following this, a dedicated pre-pregnancy clinic was established.Attendance at this clinic has resulted in women attending the maternity services at an earlier gestation and with better glycaemic control than those who did not attend for pre-pregnancy care. Despite the availability of this care, the number of women availing themselves of it remains less than half of those attending the maternity service.The challenge now is how to inform all women of reproductive age with diabetes about the importance of obtaining this care, and how to encourage attendance for pre-pregnancy care.

Rita Forde

The challenges in developing a dedicated pre-pregnancy clinic

建立专门孕前诊所的挑战

Although previous studies have stressed that having a brother or sister with a chronic condition may affect the healthy sibling, few have specifically focused on healthy siblings of children with type 1 diabetes.Hence, this study aimed to illuminate what it is like to be a brother or sister of a child newly diagnosed with type 1 diabetes.Individual interviews were conducted with seven siblings aged 10–17 years (median=12) from six different families. Each interview was analysed using content analysis.Three different categories emerged – Living differently, Being concerned and Participating in caring for the affected child – indicating that, for the healthy sibling, the illness entails a transformed everyday life including worry about the affected child and the need to help in the home.In conclusion, the paediatric health care service may need to develop new strategies to meet the siblings’ desired level of knowledge in educational team sessions related to diabetes. As the sibling relationship is probably the longest one that an affected child will experience in her/his lifetime, it is worth investing in it to promote this long-term support resource.

Anne Wennick

Karina Huus

What it is like being a sibling of a child newly diagnosed with type 1 diabetes: an interview study

新确诊1型糖尿病儿童兄弟姐妹的体验：一项访谈研究

EDN Spring 2013 Vol. 10 No. 1 Writing is important in all aspects of health care: clinical and academic. ‘Writing for Publication in Nursing and Healthcare: Getting it Right’ consists of 16 chapters that cover the basics of good writing. It begins with why we publish what we write and outlines some of the perceived barriers to successful writing. It was written by experts in the field, who are widely published themselves, and who have experience as editors and/or reviewers for peer-review journals. Key chapters cover most types of publications that health care professionals are likely to write: from the basics of writing for publication, to writing conference abstracts and presentations, journal articles/papers, letters, book reviews, commentaries, assignments, editorials and books. In addition, the authors explain the editorial process, the journal review process and good practice in reviewing, as well as the ethical and legal aspects of writing and publishing. Understanding the review process and legal and ethical issues is essential and helps improve the quality of the writing before it is submitted. Hard copy and electronic publication formats are discussed. The latter will become increasingly important as the number of online publications continue to increase. Although some chapters build on previous chapters in the book, it is possible to selectively read information depending on the type of publication needed. The book will be useful for diabetes educators interested in improving their writing and presentation skills and communicating in written form.

Trisha Dunning

Writing for publication in nursing and healthcare

护理与医疗出版物写作

Health care workers employed in nursing homes need sufficient diabetes knowledge to make adequate decisions in order to optimise diabetes management and minimise complications which may arise from poor diabetes control.The aim of this study was to determine levels of diabetes knowledge among health care workers when presented with a case description regarding an older person. Ten health care workers were asked to read a paper copy of the case description, reflect upon it and express their understanding of the case in question.The main results were summarised in two categories: namely, diabetes knowledge in relation to the presented case description and general diabetes knowledge. Some of the respondents considered the symptoms to be related to hyperglycaemia, while others were uncertain. Health care workers’ general diabetes knowledge varied.In order to optimise diabetes management and minimise complications, health care workers’ knowledge gaps in diabetes need to be reduced through regular diabetes education.

Bibbi Smide

Ulla Nygren

A pilot study to determine levels of diabetes knowledge among health care workers in nursing homes

一项针对养老院医护人员糖尿病知识水平的试点研究

The increasing prevalence of diabetes among older people challenges nurses and nursing aides in providing high-quality evidence-based care in nursing homes and municipal home-based services. Deficiencies in treatment and follow-up care, as well as significant need for educating personnel, are emphasised. Organisational challenges related to transferring tasks from specialist to primary health care services imply an urgent need for enhanced professional competence.We aim to describe the development, implementation and evaluation of an educational training programme for nurses and nursing aides in nursing homes and municipal home-based services.Sixteen registered nurses and four nursing aides participated (women, aged 32–59 years). Three main principles were emphasised in the development of the programme: enhancing professional authority; improving communication within professions and levels of care; and reflections based on experience with patients and perceived challenges in clinical practice. To evaluate the programme a questionnaire was used including both quantitative and qualitative data.Participants described enhanced competence in relation to: professional updating, exchange of experience, professional confidence, sharing knowledge and personal development. Further, the participants reported confidence related to evidence-based practice skills and knowledge, and providing high-quality nursing care.In conclusion, the elements of this programme seem adequate for inclusion in a programme designed to promote enhanced professional competence for nurses and nursing aides caring for older people with diabetes, and might be supplemented with annual follow-up sessions as a part of the services offered by specialist health care services on a regular basis.

MF Hausken

M Graue

Developing, implementing and evaluating diabetes care training for nurses and nursing aides in nursing homes and municipal home-based services

发展、实施和评估养老院及市政家庭护理服务中针对护士和护理员的糖尿病护理培训

The International Study of Pediatric and Adolescent Diabetes (ISPAD) guidelines state the glycaemic treatment goal for children with type 1 diabetes to be HbA1c <57mmol/mol (<7.5% DCCT standard) to minimise the risk of severe late complications. Teenagers with diabetes have a higher risk of psychiatric disorders and impaired quality of life (QoL) compared to healthy teenagers and the guidelines highlights the importance of regular measurement of health and QoL. Previous studies have shown a correlation between glycaemic control and QoL.The aim of this study was to explore which health and QoL factors correlate and predict outcome in glycaemic control (HbA1c) in young persons with type 1 diabetes. A convenience sample of 204 patients with type 1 diabetes, 12–17 years of age, from three centres in Sweden were recruited. Respondents completed four questionnaires at a regular visit. Check your Health and DISABKIDS chronic generic module DCGM-37 measures physical and emotional health, social relations and QoL. The diabetes-specific module (DCGM-37-DM) measures how the persons are affected by diabetes. The Swe-DES -23 measures four different empowerment factors and The SDD attitudes towards diabetes. Medical data were collected from the patients' medical records. The results from the questionnaires were analysed by multiple linear regression analysis. A total 22% reached the treatment goal of HbA1c <57mmol/mol, while 28% had poor glycaemic control with HbA1c >73 (>8% DCCT-standard). There was a strong positive correlation between age and HbA1c. Adolescents with poor glycaemic control reported lower physical and mental health, higher burden of diabetes, lower empowerment, more negative attitudes towards diabetes and they thought diabetes was more difficult to handle. Age, physical health, social relations, problem solving, goal achievement, and object evaluation (object = diabetes), predicted 25% of the total variation in HbA1c. Several health-related quality of life factors predict variation in glycaemic control. Our study emphasises the need for regular evaluation of QoL factors and an active discussion about these factors of life in regular care for young persons with type 1 diabetes.

G Viklund

E Örtqvist

Factors predicting glycaemic control in young persons with type 1 diabetes

预测1型糖尿病年轻患者血糖控制的因素

The aim was to compare two different regimens for children diagnosed with type 1 diabetes, hospital-based care and hospital-based home care (HBHC), in terms of the child's metabolic control, episodes of severe hypoglycaemia, the disease's impact on family and the parents' health-related quality of life, one year after diagnosis. The study had a randomised controlled design and included 60 children, aged 3–15 years old. Children were randomised to either continued hospital-based care or to HBHC. This article presents data one year after diagnosis. The results showed overall equivalence between groups. There were no differences in terms of the children's HbA1c (p=0.804), in episodes of severe hypoglycaemia (p=1.0), in insulin dose/kg/24h (p=0.115) or parents reported impact of the child's disease on the family (p=0.163). However, parents in the HBHC showed significant higher social functioning compared to parents in the hospitalbased care (p=0.006). In conclusion, few studies provide high-quality evidence when comparing hospital-based care with different models of home-based care. The results of this study one year after diagnosis support the safety and feasibility of HBHC when a child is diagnosed with type 1 diabetes.

I Tiberg

I Hallström

L Jönsson

A Carlsson

Comparison of hospital-based and hospital-based home care at diabetes onset in children

儿童糖尿病发病时院内护理与院内家庭护理的比较

Dermatological complications at insulin administration sites, like lipohypertrophy, lipoatrophy and erythema, are common in children with type 1 diabetes. These complications can be painful, disfiguring and may influence glycaemic control. Studies on epidemiology and etiology are needed before prevention or treatment is possible.The aim of this study is to determine the prevalence of common dermatological complications in children with type 1 diabetes and to assess associations between dermatological complications and possible risk factors.In this cross-sectional study 231 children with type 1 diabetes were included. Dermatological complications were assessed and a questionnaire with possible risk factors was completed. Data were evaluated using χ2 tests.The results showed that lipohypertrophy was present in 34.8% of the children, lipoatrophy in 8.1% and erythema in 24.6%. Lipohypertrophy was associated with multiple daily injection therapy (p=0.03) and insufficiencyof alternating administration sites (p<0.001). Lipoatrophy was not influenced by type of insulin therapy (p=0.44) but was found to be associated with less frequent injection site alternation in patients using multiple dailyinjections (p=0.01). Also, HbA1c level was positively associated with lipoatrophy (p=0.01). Erythema of the skin was more frequently diagnosed in children with continuous subcutaneous insulin pump therapy (p<0.001). A history of cutaneous infections and dry skin on exam day were independently associated with erythema atinsulin administration sites (p<0.001 and 0.04,respectively).Dermatological complications are a common problem in children with type 1 diabetes making frequent examination of the skin in these children an important aspect of their medical care.

Hilde E van Munster

Cathelijne Pm van de Sande

Paul G Voorhoeve

Janiëlle Aem van Alfen-van der Velden

Dermatological complications of insulin therapy in children with type 1 diabetes

1型糖尿病患儿胰岛素治疗的皮肤并发症

Cystic fibrosis is the commonest, life-threatening recessively inherited disease in the Caucasian population. The disease process which primarily affects the lungs also damages both exocrine and endocrine pancreatic function. With increasing survival, cystic fibrosis-related diabetes is becoming more prevalent increasing from 15% of adolescents with cystic fibrosis to 50% of adults. Impaired glucose tolerance is also common. Insulin secretion gradually decreases over time. Insulin resistance also occurs and can vary dramatically with intercurrent illness. Even mild degrees of hyperglycaemia adversely affect nutritional status and lung function. Good blood glucose control improves nutritional status and lung function. Cystic fibrosis-related diabetes develops insidiously, so that annual screening is recommended, ideally by oral glucose tolerance testing. HbA1c is not sufficiently sensitive to identify early abnormalities in glucose tolerance. Aims of managing cystic fibrosis-related diabetes are to relieve symptoms, maintain normal body weight and growth, improve lung function and improve life expectancy. Insulin is the treatment of choice and the regimen should be tailored to the individual. Initially, only rapid-acting insulin with the main meal may be necessary, but as insulin secretion diminishes, a full basal-bolus regimen becomes necessary. Individuals with cystic fibrosis struggle to consume sufficient calories, so that a high calorie, high fat diet is usually appropriate. Supplemental enteral nutrition, with matching insulin administration, is frequently required. Special situations, including pregnancy, require specific management. The psychological impact of cystic fibrosis-related diabetes on the individual is enormous. Successful management requires support from a multi-disciplinary team with the necessary specialist knowledge and skills.

Marie-Terese Caraher

Sally Marshall

Cystic fibrosis related diabetes – causes, impact on health and management of patients

囊性纤维化相关糖尿病——病因、对健康的影响及患者管理

International Diabetes Nursing

FEND Conference 2014

FEND会议2014

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European Diabetes Nursing

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