CDE Perspectives of Providing New-Onset Type 1 Diabetes Education Using Formal Vignettes and Simulation

2016 ◽  
Vol 43 (1) ◽  
pp. 97-104 ◽  
Author(s):  
Neesha Ramchandani ◽  
Kim Johnson ◽  
Karen Cullen ◽  
Terri Hamm ◽  
Jean Bisordi ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetes Management ◽  
Qualitative Content Analysis ◽  
Patient Simulation ◽  
Human Patient Simulation ◽  
Newly Diagnosed ◽  
Human Patient ◽  
Diabetes Educators ◽  
New Onset

Purpose The purpose of this article is to describe the 4 Parent Education Through Simulation-Diabetes (PETS-D) nurse certified diabetes educators’ (CDEs) perspectives of teaching parents of children with newly diagnosed type 1 diabetes mellitus (T1DM) early diabetes management skills using formal vignettes and a human patient simulator/human patient simulation (HPS) to augment/enhance the teaching–learning process. Methods A qualitative descriptive approach was used. Four CDEs were interviewed by phone about their teaching experiences. Meticulous notes were taken. Data were analyzed using qualitative content analysis. Results The vignettes (and use of HPS) provided structure, especially for parents who were struggling to learn. Certified diabetes educators described a short learning curve to master the use of the HPS manikin. Human patient simulation-enhanced education was described as helpful for teaching multiple caregivers about diabetes. Certified diabetes educators also described factors that affect parent learning, mechanical issues with the HPS, and additional space requirements for HPS-enhanced education. Conclusion Vignettes and HPS-enhanced education can successfully be used to educate parents of children with new-onset T1DM and were preferred by the CDEs when compared with previous teaching strategies. The results of this study support the use of both vignette-based and HPS-enhanced education when a child is newly diagnosed with T1DM. Further studies need to be done to see if these effects persist with different populations, during different stages of the disease, and for individuals with other chronic illnesses.

scholarly journals Qualitative study of barriers to clinical trial retention in adults with recently diagnosed type 1 diabetes

BMJ Open ◽  
2018 ◽  
Vol 8 (7) ◽  
pp. e022353 ◽  
Author(s):  
Catherine Henshall ◽  
Parth Narendran ◽  
Robert C Andrews ◽  
Amanda Daley ◽  
Keith A Stokes ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Type 1 Diabetes ◽  
Qualitative Study ◽  
Qualitative Methodology ◽  
Cell Function ◽  
Retention Rates ◽  
Newly Diagnosed ◽  
Advance Study ◽  
New Onset

ObjectivesRegular physical exercise may preserve β cell function in newly diagnosed adults with type 1 diabetes (T1D). However, clinical trials to test this theory require the recruitment and retention of adults with new-onset T1D, which can be challenging. We sought to determine the overall experiences of newly diagnosed adults with T1D in an exercise study, to understand issues that influence the retention of trial participants in such studies.DesignQualitative methodology using individual face-to-face (n=6) and telephone interviews (n=14). Interview transcripts were thematically analysed using the framework method.SettingThe study took place at five participating UK hospitals.ParticipantsTwenty participants, aged 19–55 years, in the Exercise for Type 1 Diabetes study were interviewed to explore their study experiences and identify motivators and deterrents towards the study. Participants in control and intervention arms were interviewed, as were people with T1D who had completed (n=16) and withdrawn (n=4).ResultsParticipants revealed barriers and facilitators to retention; the majority were generalisable to clinical trials of people with newly diagnosed T1D. Coming to terms with a diagnosis of T1D, lack of time, work pressures, level of health professional support, volume, clarity and consistency of information and feedback and a desire for knowledge about their condition were all cited as influencing factors to trial retention.ConclusionsTo our knowledge, this is the first qualitative study to examine the experience of being involved in an exercise trial by people with T1D. Findings suggest appointments could be shorter, available outside of working hours and planned longer in advance; study information should be clear, consistent and in electronic and paper formats; questionnaires need minimising; healthcare support and feedback needs providing regularly; thought is required around how to support non-exercising arm participants. These considerations may improve participant retention rates in new-onset T1D studies.

scholarly journals Circulating Levels of MicroRNA from Children with Newly Diagnosed Type 1 Diabetes and Healthy Controls: Evidence That miR-25 Associates to Residual Beta-Cell Function and Glycaemic Control during Disease Progression

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Lotte B. Nielsen ◽  
Cheng Wang ◽  
Kaspar Sørensen ◽  
Claus H. Bang-Berthelsen ◽  
Lars Hansen ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glycaemic Control ◽  
Beta Cell ◽  
Beta Cell Function ◽  
Cell Function ◽  
Control Group ◽  
Healthy Controls ◽  
Newly Diagnosed ◽  
New Onset

This study aims to identify key miRNAs in circulation, which predict ongoing beta-cell destruction and regeneration in children with newly diagnosed Type 1 Diabetes (T1D). We compared expression level of sera miRNAs from new onset T1D children and age-matched healthy controls and related the miRNAs expression levels to beta-cell function and glycaemic control. Global miRNA sequencing analyses were performed on sera pools from two T1D cohorts (n= 275 and 129, resp.) and one control group (n= 151). We identified twelve upregulated human miRNAs in T1D patients (miR-152, miR-30a-5p, miR-181a, miR-24, miR-148a, miR-210, miR-27a, miR-29a, miR-26a, miR-27b, miR-25, miR-200a); several of these miRNAs were linked to apoptosis and beta-cell networks. Furthermore, we identified miR-25 as negatively associated with residual beta-cell function (est.: −0.12,P= 0.0037), and positively associated with glycaemic control (HbA1c) (est.: 0.11,P= 0.0035) 3 months after onset. In conclusion this study demonstrates that miR-25 might be a “tissue-specific” miRNA for glycaemic control 3 months after diagnosis in new onset T1D children and therefore supports the role of circulating miRNAs as predictive biomarkers for tissue physiopathology and potential intervention targets.

scholarly journals Cognitive Function following Diabetic Ketoacidosis in Children with New Onset or Previously Diagnosed Type 1 Diabetes

2020 ◽  
Author(s):  
Simona Ghetti ◽  
Nathan Kuppermann ◽  
Arleta Rewers ◽  
Sage R. Myers ◽  
Jeff E. Schunk ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hemoglobin A1c ◽  
Economic Status ◽  
Digit Span ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Neurocognitive Assessment ◽  
New Onset

<b>Objective. </b>This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes, and whether the same is true in children who had been previously diagnosed after accounting for variations in glycemic control and other relevant factors.<b> Design. </b>We prospectively enrolled 758 children, 6- to 18-years-old, who presented with DKA in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled. <b>Results. </b>Among all patients, moderate/severe DKA was associated with lower IQ (β=-.12, p<0.001), item-color recall (β=-0.08, p=0.010), and forward digit span (β=-0.06, p=0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β=-0.08, p=0.04). Among previously diagnosed patients, repeated DKA exposure and higher hemoglobin A1c were independently associated with lower IQ (β=-.10 and β=-0.09, respectively, ps <.01) and higher hemoglobin A1c was associated with lower item-color recall (β=-0.10, p=0.007), after accounting for hypoglycemia, diabetes duration, and socio-economic status.<b> Conclusion. </b>A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.<b> <br> </b>

Teamwork, Targets, Technology, and Tight Control in Newly Diagnosed Type 1 Diabetes: Pilot 4T Study

2021 ◽  
Author(s):  
Priya Prahalad ◽  
Victoria Y Ding ◽  
Dessi P Zaharieva ◽  
Ananta Addala ◽  
Ramesh Johari ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Glucose Monitoring ◽  
Newly Diagnosed ◽  
Tight Control ◽  
Target Setting ◽  
Multivariable Regression ◽  
Historic Cohort ◽  
Hba1c Levels ◽  
New Onset

Abstract Context Youth with type 1 diabetes (T1D) do not meet hemoglobin A1c (HbA1c) targets. Objective To assess HbA1c outcomes in children with new onset T1D enrolled in the Teamwork, Targets, Technology and Tight Control (4T) Study. Method HbA1c levels were compared between the 4T and Historical cohorts. HbA1c differences between cohorts were estimated using locally estimated scatter plot smoothing (LOESS). The change from nadir HbA1c (month 4) to 12 months post-diagnosis was estimated by cohort using a piecewise mixed effects regression model accounting for age at diagnosis, sex, ethnicity, and insurance type. Setting and Participants We recruited 135 youth with newly diagnosed T1D at Stanford Children’s Health. Intervention Starting July 2018, all youth within the first month of T1D diagnosis were offered continuous glucose monitoring (CGM) initiation and remote CGM data review was added in March 2019. Main Outcome Measure HbA1c. Results HbA1c at 6, 9, and 12 months post-diagnosis was lower in the 4T cohort than in the Historic cohort (-0.54%, -0.52%, and -0.58%, respectively). Within the 4T cohort, HbA1c at 6, 9, and 12 months post-diagnosis was lower in those patients with Remote Monitoring than those without (-0.14%, -0.18%, -0.14%, respectively). Multivariable regression analysis showed that the 4T cohort experienced a significantly lower increase in HbA1c between months 4 and 12 (p &lt; 0.001). Conclusions A technology-enabled team-based approach to intensified new onset education involving target setting, CGM initiation, and remote data review significantly decreased HbA1c in youth with T1D 12 months post-diagnosis.

Video Consultation for Parents with a Child Newly Diagnosed with Type 1 Diabetes: A Qualitative Study

2021 ◽  
Author(s):  
Jana Doerdelmann ◽  
Fabian-Simon Frielitz ◽  
Karin Lange ◽  
Tanja Meinsen ◽  
Sandra Reimers ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
High Frequency ◽  
Standard Care ◽  
Qualitative Content Analysis ◽  
Qualitative Interviews ◽  
Newly Diagnosed ◽  
Supplementary Video ◽  
One Year ◽  
Families With Children

Abstract Aims With the exception of the coronavirus pandemic, video consultations have not been a part of the standard care for children with diabetes in Germany. The "Virtual Diabetes Outpatient Clinic for Children and Adolescents 2.0" (VIDIKI 2.0) study investigated the effect of monthly and supplementary video consultations on standard care over one year. The qualitative substudy investigated the experiences of families with a child newly diagnosed with type 1 diabetes mellitus (T1DM) who received at least four weekly supplementary video consultations. Methods Guideline-based qualitative interviews were conducted with seven families with children under the age of eight and T1DM onset shortly before study entry. The answers were analyzed using a qualitative content analysis approach, particularly inductive category formation. Results Families of patients with T1DM onset have questions, almost daily, concerning various aspects of insulin therapy. The offer of high-frequency video consultations can reduce the number of trips to the diabetes team, facilitate the organization of daily life and increase the sense of security. Conclusion Video consultations as a supplementary offer of health care, especially after diabetes onset, were considered very helpful by the affected families. High-frequency video consultations may provide a tool to overcome existing deficiencies in specialized diabetes care.

scholarly journals A USABILITY EVALUATION OF PORTABLE BREATH KETONE SENSOR DEVICES BY AND FOR YOUNG PEOPLE WITH TYPE 1 DIABETES MELLITUS

2021 ◽  
Author(s):  
Nicola Brew-Sam ◽  
Jane Desborough ◽  
Anne Parkinson ◽  
Krishnan Murugappan ◽  
Eleni Daskalaki ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 1 Diabetes ◽  
Young People ◽  
Type 1 Diabetes Mellitus ◽  
Diabetes Management ◽  
Usability Evaluation ◽  
Design Features ◽  
Design Preferences ◽  
Diabetes Educators

Background. Portable breath ketone sensors may help people with Type 1 Diabetes Mellitus (T1DM) avoid episodes of diabetic ketoacidosis; however the design features preferred by users have not been studied. We aimed to elucidate design preferences associated with breath ketone sensors among young people with T1DM aged 12-16 years, their parents, and diabetes educators. Research Designs and Methods. Two commercially available breath ketone sensors, designed for ketogenic diet monitoring, were assessed over one week by ten young people with T1DM following a usability evaluation approach. Participants interacted with the devices at least twice daily for five days, taking breath ketone, blood ketone and blood glucose measurements. Semi-structured interviews were conducted post-testing with participants, parents and two diabetes educators to elicit design preferences to inform the co-design of diabetes breath ketone sensor prototypes. Results. Participants acknowledged the non-invasiveness of breath sensors as compared to blood testing. Affordability, reliability and accuracy were identified as prerequisites for breath ketone sensors used for diabetes management. Design features valued by young people included portability, ease of use, sustainability, readability and suitability for use in public. The time required to use breath sensors was similar to that for blood testing. The requirement to maintain a 10-second breath exhalation posed a challenge for users. Conclusions. Breath ketone sensors for diabetes management bear potential to facilitate ketone testing in young people. Our study affirms features for young people that drive usability of breath sensors among this population, and provides a model of usability assessment of medical devices among young users.

scholarly journals Cognitive Function following Diabetic Ketoacidosis in Children with New Onset or Previously Diagnosed Type 1 Diabetes

2020 ◽  
Author(s):  
Simona Ghetti ◽  
Nathan Kuppermann ◽  
Arleta Rewers ◽  
Sage R. Myers ◽  
Jeff E. Schunk ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Diabetic Ketoacidosis ◽  
Hemoglobin A1c ◽  
Economic Status ◽  
Digit Span ◽  
Diabetes Diagnosis ◽  
Newly Diagnosed ◽  
Neurocognitive Assessment ◽  
New Onset

<b>Objective. </b>This study assessed whether a single diabetic ketoacidosis (DKA) episode is associated with cognitive declines in children with newly diagnosed type 1 diabetes, and whether the same is true in children who had been previously diagnosed after accounting for variations in glycemic control and other relevant factors.<b> Design. </b>We prospectively enrolled 758 children, 6- to 18-years-old, who presented with DKA in a randomized multi-site clinical trial evaluating intravenous fluid protocols for DKA treatment. DKA was moderate/severe in 430 children and mild in 328 children. 392 children with DKA had new onset of type 1 diabetes, and the rest were previously diagnosed. Neurocognitive assessment occurred 2-6 months after the DKA episode. A comparison group of 376 children with type 1 diabetes, but no DKA exposure, was also enrolled. <b>Results. </b>Among all patients, moderate/severe DKA was associated with lower IQ (β=-.12, p<0.001), item-color recall (β=-0.08, p=0.010), and forward digit span (β=-0.06, p=0.04). Among newly diagnosed patients, moderate/severe DKA was associated with lower item-color recall (β=-0.08, p=0.04). Among previously diagnosed patients, repeated DKA exposure and higher hemoglobin A1c were independently associated with lower IQ (β=-.10 and β=-0.09, respectively, ps <.01) and higher hemoglobin A1c was associated with lower item-color recall (β=-0.10, p=0.007), after accounting for hypoglycemia, diabetes duration, and socio-economic status.<b> Conclusion. </b>A single DKA episode is associated with subtle memory declines soon after type 1 diabetes diagnosis. Sizable IQ declines are detectable in children with known diabetes, suggesting that DKA effects may be exacerbated in children with chronic exposure to hyperglycemia.<b> <br> </b>

scholarly journals Anti-SARS-CoV-2 antibodies in new-onset type 1 diabetes in children during pandemic in Belgium

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Anissa Messaaoui ◽  
Lucia Hajselova ◽  
Sylvie Tenoutasse
Keyword(s):  
Type 1 Diabetes ◽  
Base Excess ◽  
Newly Diagnosed ◽  
Onset Type ◽  
Two Samples ◽  
Long Term Consequences ◽  
Mean Time ◽  
New Onset

Abstract Objectives Questions are emerging concerning the long-term consequences of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, as a possible increase in type 1 diabetes. This study aims to describe the prevalence of anti-SARS-CoV-2 antibodies in children developing type 1 diabetes during this pandemic in Belgium. Methods This observational study included children and adolescents (under 16 years) admitted with new-onset type 1 diabetes. SARS-CoV-2 serology was taken within the first month of diabetes. Results Of the 75 participants, anti-SARS-CoV-2 antibodies were positive in 20% of patients. They had an increased bicarbonate and base excess at diagnosis. Overall 29% of patients presented diabetic ketoacidosis at diagnosis and 9% of them were positive for anti-SARS-CoV-2 antibodies. Insulinoma-associated protein 2 antibodies positivity had significantly higher frequencies in children without anti-SARS-CoV-2 antibodies (49 (81%) vs. 5 (33%), p=0.038). Nine (15%) patients, initially seronegative, have developed anti-SARS-CoV-2 antibodies between the two samples (mean time 8 ± 4 weeks). Conclusions The prevalence of anti-SARS-CoV-2 antibodies in children with newly diagnosed type 1 diabetes (20%) is similar to that found in children without diabetes in Belgium, a country severely affected by this pandemic.

scholarly journals Leptin in Children with Newly Diagnosed Type 1 Diabetes: Effect of Insulin Therapy

2001 ◽  
Vol 2 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Kenneth L. McCormick ◽  
Gail J. Mick ◽  
Lisa Butterfield ◽  
Hugh Ross ◽  
Elaine Parton ◽  
...  
Keyword(s):  
Type 1 Diabetes ◽  
Insulin Therapy ◽  
Serum Insulin ◽  
Insulin Dose ◽  
Newly Diagnosed ◽  
Baseline Serum ◽  
Serum Leptin ◽  
Onset Type ◽  
New Onset

Leptin, the gene product of adipose tissue that signals caloric plentitudeviacentral nervous system receptors, may also have diverse peripheral metabolic actions. Of paramount interest has been the potential interaction(s) between leptin and insulin. Insofar as insulin alters leptin secretion/action (orvice versa), dysregulation of this system could contribute to disease states such as diabetes.The purpose of this study was to examine the effect of exogenous insulin on serum leptin in children with newly-diagnosed Type 1 diabetes. Since these patients are hypoinsulinemic (insulindeplet. ed) at diagnosis, they present an ideal opportunity to examine the effect of insulin repletion on serum leptin. Seventeen patients were enrolled. At baseline (prior to insulin therapy), leptin levels were 4.3 ± 1.1ng/ml; they were not statistically related to the baseline serum insulin or illness severity. There was no significant change in serum leptin before, shortly (1–6 days) or several weeks (3–26 weeks) after insulin treatment even when the data was corrected for changes in BMI, hemoglobinA1C, and daily insulin dose. Since repletion of the insulin deficiency that is present in non-acidotic, ambulatory patients with new onset Type 1 diabetes did not alter serum leptin, these results argue against an effect of insulin on serum leptin in the absence of the acute diabetic ketoacidosis. Because as the recuperative months following the diagnosis of new onset Type 1 diabetes are marked by weight gain, the absence of a rise in serum leptin might also indicate either an adaptive (weight permissive) or pathologic (impaired secretory) deficit.

scholarly journals Assessing generalizability of a new-onset type 1 diabetes Biobank

2018 ◽  
Vol 1 (1) ◽  
Author(s):  
Colette Ciresi ◽  
Kathleen Wendholt ◽  
Maureen Mullen ◽  
Carmella Evans-Molina ◽  
Linda DiMeglio
Keyword(s):  
Type 1 Diabetes ◽  
Pancreatic Beta Cell ◽  
Large Population ◽  
Urine Samples ◽  
Diabetes Research ◽  
Newly Diagnosed ◽  
Disease Heterogeneity ◽  
Beta Cell Destruction ◽  
New Onset

Background and Hypothesis:   Type 1 diabetes (T1D) is characterized by insulin deficiency due to autoimmune pancreatic beta cell destruction. The Wells Center Pediatric Diabetes Research Program is collecting blood and urine samples from children with new onset T1D admitted to Riley Hospital. These samples are being used to discover biomarkers predictive of disease heterogeneity and course. Since not every newly-diagnosed child enrolls in the Biobank, we examined if persons enrolled are similar or different from the at-large population of newly-diagnosed children to know how generalizable samples collected are from our newly-diagnosed population.  Project Methods:    Between September 2016 and May 2018, 71 newly-diagnosed children (mean age 9.6±4.3 years) and their caregivers were approached by researchers and asked to provide blood/urine samples. Thirty-four consented/assented (as required); 21 had blood and urine collected; 13 urine only. We looked for differences in age, sex, race, BMI, socioeconomic status (based on zip code), and admission bloodwork parameters between participants and non-participants.   Results:   Overall, participants were more likely to be white and have higher admission bicarbonate. Children who provided blood and urine had no other significant differences from non-participants. Children who provided urine only were more likely to be male and to have higher admission bicarbonate than non-participants. Currently, we are obtaining data to make comparisons with the general population of all patients diagnosed at Riley.   Conclusion/Potential Impact:  Our Biobank will provide samples to explore novel biomarkers to facilitate highly-targeted therapies and to screen future preventative treatments. As we continue to collect data, it will remain important to monitor and carefully consider its generalizability. 

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