Care of children with type 1 diabetes mellitus in school – An interventional study

AbstractObjectivesPaucity of data from India on care of children with Type 1 diabetes in schools. Aims: To study assess the knowledge, attitude, practices and fear of Type 1 diabetes in school teachers and to assess the impact of an educational model on the fear of teachers and care of children in Type 1 DM at school hours.MethodsA community based study, involving school teachers and the intervention being educating them about diabetes conducted. Data pertaining to basic demography, attitude of teachers towards diabetic children, Hypoglycemia fear factor survey- parent version with worries domain and preparedness of school was collected. An education program was conducted on diabetes care in children. Immediately and after three months, the proforma details and HFSP-W scores reassessed.ResultsForty two teachers (mean age: 38.7±5.4; M:F ratio 2:40) participated in the study. Post intervention, a higher willingness to have the diabetic child in class (100 vs. 57.1%; p>0.05), better support in daily care (100 vs. 92%; p>0.05), participation in sports activities (100 vs. 7.1%; p<0.05) observed. HFSP-W scores were 38.8±4.5 (pre-intervention), 22.5±4.3 (immediate post intervention) and 29.5±3.2 (at 3months) (p<0.05). To study the determinants of improvement in HFSP-W a regression analysis was performed: presence of glucometer the most likely determining factor (T=1.999, p=0.05).ConclusionThere is a significant element of fear in the minds of teachers towards hypoglycemia which improves with a structured education program.

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Restoration of Hypoglycemia Awareness Alters Brain Activity in Type 1 Diabetes

10.2337/figshare.13235441 ◽

2020 ◽

Author(s):

Munachiso Nwokolo ◽

Stephanie A. Amiel ◽

Owen O’Daly ◽

Ian A. Macdonald ◽

Fernando O. Zelaya ◽

...

Keyword(s):

Decision Making ◽

Blood Flow ◽

Type 1 Diabetes ◽

Anterior Cingulate ◽

Partial Recovery ◽

Post Intervention ◽

Pump Therapy ◽

Brain Responses ◽

The Impact

Objective Impaired awareness of hypoglycemia (IAH) in type 1 diabetes (T1D) is a major risk factor for severe hypoglycemia (SH), and is associated with atypical responses to hypoglycemia in brain regions involved in arousal, decision-making and memory. Whether restoration of hypoglycemia awareness alters these responses is unknown. We sought to investigate the impact of awareness restoration on brain responses to hypoglycemia. Research Design and Methods Twelve T1D IAH adults underwent pseudo-continuous arterial spin labelling functional MRI during a hypoglycemic clamp (5mmol/L-2.6mmol/L), before and after a hypoglycemia avoidance program of structured education (Dose Adjustment for Normal Eating, DAFNE), specialist support and sensor-augmented pump therapy (Medtronic Minimed™ 640G). Hypoglycemic cerebral blood flow (CBF) responses were compared pre- and post-intervention using predefined region of interest analysis of the thalamus, anterior cingulate cortex (ACC), orbitofrontal cortex (OFC) and hippocampus. Results Post-intervention, Gold and Clarke scores fell (6.0±1.0 to 4.0±1.6, p=0.0002; 5.7±1.7 to 3.4±1.8, p=0.0008), SH rates reduced (1.5±2 to 0.3±0.5 episodes per year, p=0.03), hypoglycemic symptom scores increased (18.8±6.3 to 27.3±12.7, p=0.02), epinephrine responses did not change (p=0.2). Post-intervention, hypoglycemia induced greater increases in ACC CBF (p=0.01, peak voxel coordinates [6,40,-2]), while thalamic and OFC activity did not change. Conclusions Increased blood flow is seen within brain pathways involved in internal self-awareness and decision-making (ACC) after restoration of hypoglycemia awareness, suggesting partial recovery of brain responses lost in IAH. Resistance of frontothalamic networks, involved in arousal and emotion processing, may explain why not all IAH individuals achieve awareness restoration with education and technology alone.

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