1型糖尿病儿童及青少年患者生存质量调查分析

目的调查1型糖尿病儿童及青少年患者的生存质量。方法采用儿童生存质量普适性核心量表和应对方式问卷分别对63例1型糖尿病儿童、青少年患者及63名患者家长进行调查。结果 1型糖尿病儿童及青少年患者生存质量总均分为(84.84±11.31)分,糖尿病患者家长的应对方式主要以成熟的应对方式(例如:解决问题、求助)为主,糖尿病儿童及青少年患者的年龄、是否独生子女、测血糖者、胰岛素注射工具和家长自责影响患者生存质量。结论关注非独生子女、青少年糖尿病患者的生存质量,鼓励儿童及青少年患者自己测血糖,以提高其自我管理能力。     

2型糖尿病病人低血糖恐惧与心理幸福感的关系:生命质量的中介作用

目的:分析2型糖尿病(T2DM)病人低血糖恐惧与心理幸福感之间的关系,探讨生命质量在低血糖恐惧与心理幸福感之间的中介作用。方法:对420例T2DM病人分别进行低血糖恐惧、生命质量和心理幸福感评价,共354例病人完成。先行Pearson相关性分析低血糖恐惧、生活质量与心理幸福感之间的相关性。再行中介效应分析验证生命质量在T2DM病人低血糖恐惧与心理幸福感之间的中介效应。结果:T2DM病人的低血糖恐惧量表(CHFSⅡ-WS)得分为(11.05±5.67)分,生命质量量表(EQ-5D VAS)得分为(72.94±14.41)分,幸福感指数量表(WHO-5)得分为(70.67±16.98)分。经Pearson相关性分析,CHFSⅡ-WS评分与WHO-5评分呈负相关(r=-0.398,P<0.01),与EQ-5D VAS评分也呈负相关(r=-0.564,P<0.01),EQ-5D VAS评分与WHO-5评分呈正相关(r=0.511,P<0.01);经中介效应分析,T2DM病人的生命质量在低血糖恐惧、幸福感之间的总效应为-1.191,直接效应为-0.481,中介效应为-0.709,中介效应占总效应的比例为59.61%,且间接效应的Bootstrap 95%置信区间不包含0,中介效应有统计学意义(P<0.05)。结论:生命质量在T2DM病人的低血糖恐惧与心理幸福感之间具有显著中介效应,且起部分中介效应。     

社区老年2型糖尿病患者低血糖反应及生存质量现状研究

目的：调查社区老年2型糖尿病患者自我感知的低血糖反应发生频率和生存质量现状。方法：采用自行设计的问卷调查上海市某一社区203例老年2型糖尿病患者过去一年内和过去一个月内发生低血糖反应的情况;采用中文版糖尿病患者生存质量特异性量表（DSQL）对患者进行生存质量测评。结果：有22.2%的患者在过去一年内出现过至少1次的低血糖反应,有12.8%的患者在过去一个月内出现过至少1次的低血糖反应;患者生存质量评价得分为（41.9±8.6）分。结论：城市社区老年2型糖尿病患者生存质量水平处于中等水平,尚有提升的空间;应减少患者低血糖反应发生的频率,提高其生存质量。     

Experiences of children/young people and their parents, using insulin pump therapy for the management of type 1 diabetes: qualitative review

What is known and Objective: Advances in medical technology have made insulin pumps an attractive treatment option for patients with type 1 diabetes and in particular for children and young people. Previous studies have accounted the experiences and views of children/young people and their parents for the use of the injection therapy, but very few have focused on the use of insulin pumps. The objective of this review was to identify studies that explore the experiences of children/young people and their parents on the transition from injections to insulin pump therapy, in the context of their social life. Methods: A systematic literature search was conducted, and six studies meeting the inclusion and exclusion criteria were identified. Results: Views and perspectives from the studies identified mainly focused on: introduction to the pump; reasons for the transition to pump therapy; advantages and disadvantages of this treatment option; and impact on quality of life (QoL). Parents and/or children reported that they learned about pump therapy either formally from a healthcare professional or informally from a friend or the internet. Many reasons were identified for the transition, the most important being the pursuit of stable and controlled blood sugar levels and the desire for a more flexible lifestyle. Participants highlighted the advantages of insulin pumps in terms of improved diabetes control. Moreover, there was a positive impact on the QoL, as insulin pumps provided children greater flexibility in lifestyles especially with regards to meals and socialization. In contrast, psychosocial issues such as pump visibility and physical restrictions were highlighted as disadvantages. Issues such as day‐to‐day management were also discussed. What is new and Conclusion: Exploring children/young people’s perspectives on the use of pump therapy for managing their diabetes, and parental reflections in caring for those children is important as it provides evidence informing policy for the wider implementation of this technology in the management of diabetes in children. However, the review revealed that there is a scarcity of data in this area and that further research is needed.     

Chronic sorrow in parents of children with type 1 diabetes

Title.  Chronic sorrow in parents of children with type 1 diabetes.
Aim.  This paper reports on a study exploring parents' longer-term experiences of having a child with type 1 diabetes.
Background.  Parents of children with type 1 diabetes may experience a grief reaction at diagnosis similar to that normally associated with bereavement, but little is known about their long-term emotional adaptation. Chronic sorrow, a sustained but intermittent grief reaction, is identified in adults with diabetes but has not previously been explored in relation to parents.
Methodology.  In-depth interviews were conducted in 2007 with a convenience sample of 17 parents of children with type 1 diabetes 7–10 years after diagnosis. Data were explored within a theoretical framework of grief, loss, adaptation, and change.
Findings.  Parents had adapted to the needs of diabetes management but most had not 'come to terms' with the diagnosis. They experienced a resurgence of grief at critical times during their child's development and some, particularly mothers, became upset during their interviews, even though these took place 7–10 years after their child's diagnosis. Mothers elaborated more on their emotions than fathers, but continuing feelings associated with grief, such as anger and guilt, were expressed by both fathers and mothers.
Conclusion.  Greater understanding of parents' long-term emotional responses and recognition that grief may never resolve in these parents may enable healthcare professionals to provide appropriate and timely support at critical times.     

2型糖尿病患者心理-致感、应对方式与生存质量关系的研究

目的：探讨2型糖尿病患者心理-致感、应对方式与生存质量的关系。方法：采用一般资料调查表、心理-致感量表、医学应对方式问卷及糖尿病生存质量特异性量表对某三级甲等医院511例2型糖尿病患者进行问卷调查。结果：心理一致感总分与面对呈显著正相关,与回避、屈服、生存质量总分及其各维度呈显著负相关;面对与生存质量总分及其各维度呈显著负相关,回避及屈服与生存质量总分呈显著正相关,且三种应对方式在心理一致感和生存质量之间具有中介作用（P〈0．05）。结论：护理人员应加强患者心理状态的评估与干预,提高患者心理-致感水平及使用积极应对方式的能力,从而改善患者的生存质量。     

Health-related quality of life in Icelandic school children

This study evaluated generic health-related quality of life (HRQOL) among 10 to 12-year-old Icelandic school age children who were either with or without chronic health condition. The children and their parents answered self-report questionnaires. For the 480 children who participated, girls were found to perceive their HRQOL significantly higher than the boys, children who visited the school nurse over a one-week period and children who indicated they were bullied by other children, perceived their HRQOL to be significantly lower than children who did not visit the school nurse over this time period or children who did not indicate they were bullied by other children in school. From the stepwise regression analysis, perception of health, school connectedness, health promotion, bullying victimization, visits to the school nurse and age, significantly predicted 43.8% of the variance of the girls' perception of their HRQOL. However, perception of health, school connectedness, and chronic health condition/illnesses, bullying victimization and after school activities predicted 48.1% of the boys' perception of their HRQOL. Children with chronic health condition or illnesses, reported their HRQOL to be significantly lower than children without chronic health condition. Assessing HRQOL among 10 to 12-year-old children might be helpful to take preventive action early on in children's life and development.     

High serum ACE activity predicts severe hypoglycaemia over time in patients with type 1 diabetes

Abstract

Aims/hypothesis. High serum angiotensin-converting enzyme (ACE) activity is associated with increased risk of severe hypoglycaemia (SH) within 1 year in type 1 diabetes. We wanted to find out whether ACE activity is stable over time and predicts SH beyond 1 year, and if gender differences exist in the association between ACE activity and risk of SH. Methods. A follow-up study of 128 adult patients with type 1 diabetes was conducted. At entry, ACE activity was measured. For 12 months, patients prospectively recorded events of severe hypoglycaemia (SH). At a median of 40 months, ACE activity was measured again and participants recalled the number of SH in the last year. Results. ACE activity is reproducible over 40 months (p < 0.00001). Patients with SH during the baseline study also had SH during follow-up (p < 0.00001). Serum ACE activity measured at baseline was positively associated with the rate of SH at follow-up (p = 0.0003) with a 3.2-fold increased rate of SH in subjects belonging to the upper ACE quartile compared to subjects in the three lowest quartiles (p < 0.00001). The association between high serum ACE activity and increased risk of SH did not differ significantly in women and men. Conclusion. In type 1 diabetes individual serum ACE activity is reproducible over time. High ACE activity predicts recurrent SH over at least 40 months with no differences between genders.     

Redefining relationships and identity in young adults with type 1 diabetes

Title.  Redefining relationships and identity in young adults with type 1 diabetes.
Aim.  This paper is a report of a study exploring the meaning of interactions with and supports of self-management from parents and other significant others for young adults with type 1 diabetes.
Background.  Adolescence and young adulthood is known to be a critical period for people living with diabetes in terms of diabetes control, which is why support from significant others is of utmost importance during the transition to adult life.
Method.  A grounded theory approach was used. Interviews with 13 young adults with type 1 diabetes and 13 parents 2 years after transfer to adult diabetes care were conducted during 2006–2007. Internet communication between young people on a diabetes website was also included in the constant comparative analysis.
Findings.  Transition to adult life for young adults with diabetes was characterized by a relational and reflexive process leading to ongoing redefinition of relationships and identity. Parents were perceived as the most reliable supporters, compared to partners, siblings and other significant others. Chat friends can also become important through emotional, social and diabetes-related support in internet communication. The young adults showed growing awareness of their own capacities, shortcomings and emotional reactions, reflections which contribute to a redefinition of self.
Conclusion.  Further research is needed to explore how contemporary interactions contribute to development of the self. By focusing on supporting relationships, nurses are in a strategic position to develop knowledge and modify clinical programmes that promote diabetes management and care by taking supporting interactions into account from a contemporary point of view.     

Effects of a diabetes self-management program on glycemic control, coronary heart disease risk, and quality of life among Thai patients with type 2 diabetes

Uncontrolled diabetes is a major health problem in Thailand. The objective of this study was to determine the effects of a diabetes self-management program on glycemic control, coronary heart disease (CHD) risk, and quality of life in 147 diabetic patients (aged 56.8 +/- 10.2 years). Type 2 diabetic patients who met the research criteria were randomized into two groups for a period of 6 months: the experimental group received the diabetes self-management program and the control group received the usual nursing care. The findings indicated that the experimental group demonstrated a significant decrease in the hemoglobin A(1c) level and CHD risk, with an increase in quality of life (QOL) compared to the control group. The diabetes self-management program was effective for improving metabolic control and the QOL for individuals with diabetes. Further studies should be replicated using larger groups over a longer time frame.     

家庭护理干预对儿童期糖尿病患儿治疗依从性及生活质量的影响

目的探讨家庭护理干预对儿童期糖尿病患儿治疗依从性及生活质量的影响。方法将90例1型糖尿病(T1DM)儿童随机分为观察组和对照组,各45例。对照组实施常规护理,观察组在对照组的基础上实施家庭护理干预。干预后随访24周,评价2组患儿治疗依从性并观察干预前及干预后24周时Peds QLTM 4.0量表评分。结果观察组的依从率84.44%(38/45)显著高于对照组的66.67%(30/45)(P0.05);干预后24周时,2组患儿Peds QLTM 4.0生存量表各方面功能评分均显著高于干预前,且观察组显著高于对照组(P0.01)。结论家庭护理干预能够提高儿童期糖尿病患儿的治疗依从性和生活质量。     

基于质量反馈的强化跟踪管理对1型糖尿病患儿血糖、并发症及生活质量的影响

目的探讨基于质量反馈的强化跟踪管理对I型糖尿病(T1DM)患儿血糖、并发症及生活质量的影响。方法选取2019年1月至2022年1月苏州大学附属儿童医院收治的94例T1DM患儿作为研究对象,随机数字表法分为对照组(47例)和研究组(47例)。对照组给予常规管理干预,研究组给予基于质量反馈的强化跟踪管理干预。比较两组患儿血糖指标水平、并发症发生率及生活质量。结果管理前(出院时),两组患儿的空腹血糖(FPG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbAlc)水平比较差异无统计学意义(P>0.05),管理后(出院6个月)两组患儿FPG、2hPG、HbAlc水平均降低(P<0.05),且研究组低于对照组(P<0.05)。研究组管理期间并发症发生率低于对照组(P<0.05)。管理前,两组患儿的儿童生存质量普适性核心量表所包含的情感功能、生理功能、角色功能、社会功能评分比较差异无统计学意义(P>0.05),管理后上述评分均升高(P<0.05),且研究组高于对照组(P<0.05)。结论对T1DM患儿实施基于质量反馈的强化跟踪管理可有效改善患儿血糖水平,减少并发症发生率,提高患儿的生活质量。     

影响社区哮喘患儿父母生活质量因素的调查分析

目的了解社区哮喘患儿父母生活质量水平并探讨其影响因素。方法采用儿童照护者生活质量问卷(paediatric asthma caregiver’s quality of life questionnaire,PACQLQ)对125名哮喘患儿父母进行调查。结果 125名社区哮喘患儿父母的PACQLQ总均分为(4.34±1.03)分,其中活动限制维度得分为(4.29±1.55)分,情感功能维度得分为(4.36±0.89)分。患儿父亲PACQLQ得分为(5.01±0.97)分,母亲得分为(4.02±0.90)分,两者比较,t=5.592,P<0.05,差异具有统计学意义。与患儿关系和患儿病程为影响患儿父母生活质量的主要因素。结论社区哮喘患儿父母生活质量处于中等水平。哮喘患儿母亲的生活质量水平较父亲低,且哮喘患儿在诊断哮喘初期,其父母的生活质量水平是最低的。在进行健康教育时应更关注患儿母亲的心理压力,而且健康教育的工作应当在患儿确诊为哮喘后尽快开展。     

Colesevelam‐induced hypoglycaemia in a patient with type 1 diabetes mellitus

Colesevelam possesses antidiabetic properties, which could potentiate sulphonylurea or insulin‐induced hypoglycemia; clinically significant hypoglycemia, as a side effect to bile acid sequestrants, may be under‐recognized in clinical practice.