The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis

AIM: An evolutionary concept analysis was undertaken to clarify the concept of self-management of type 1 diabetes in children and adolescents. BACKGROUND: Several problems exist in the literature on self-management of type 1 diabetes in children and adolescents. There is no uniform terminology and there is no uniform definition of the concept. Also, there is no differentiation in the literature between self-management of diabetes in children and adults. METHODS: Ninety-nine references were reviewed and analysed in the disciplines of nursing, medicine, and psychology. After separate analyses revealed no significant differences across disciplines, the analyses were combined to describe the attributes, antecedents, consequences, and surrogate and related concepts. RESULTS: The three essential attributes of the concept were identified as process, activities, and goals. Self-management of type 1 diabetes in children and adolescents is an active and proactive process; it is daily, lifelong, and flexible, and it involves shifting and shared responsibility for diabetes care tasks and decision-making between child and parent. It is a process that involves collaboration with health care providers. Self-management of type 1 diabetes in children and adolescents also consists of varied and many activities related to giving insulin, monitoring metabolic control, regulating diet and exercise, to name just a few. The concept also involves goals, which may differ from one parent/child dyad to another. A working definition of the concept is suggested. CONCLUSIONS: It is hoped that a more uniform definition of the concept will enable researchers to continue investigating antecedents and consequences of the concept in a way that allows for aggregating results.     

Post-conference session: Experience with patient self-management of oral anticoagulation

Long-term oral anticoagulation requires careful patient monitoring in order to optimize results and to limit hemorrhagic or thromboembolic complications of treatment. For this reason, any improvement in anticoagulant control and management can be expected to have far-reaching consequences in extending longevity and decreasing complications in anticoagulated patients after heart valve surgery. Because one attractive means of improving anticoagulant management is to give patients a share of the responsibility, a program was designed to encourage patients to take an active role in monitoring their own prothrombin time (PT) and managing their own oral anticoagulation. During the period from August 1986 to February 1992, 600 patients requiring long-term anticoagulation, mainly after heart valve replacement, were trained to measure their own PT at the Cardiac Rehabilitation Center (Herz-Krauslauf-Klinik, Bad Berleburg, Germany) and to manage their own therapy: 216 patients could be followed with regard to their self-determined prothrombin times. The results were within the target range in 83.1% of the PT determinations (n=12,306 measurements) taken by the patients themselves. Neither major bleeding nor thromboembolic complications were observed in 205 patient-years of self-monitoring of PT and self-management of oral anticoagulation.     

Economic analysis of two structured treatment and teaching programs on asthma

The aims of the present study were as follows:

• 1). to evaluate the medical outcomes of two treatment and educational asthma programs
• 2). to determine by cost-analysis both cost and economic outcome of the programs
• 3). to perform a cost-benefit analysis (determining the net cost-benefit) and a cost-effectiveness analysis (determining the cost per unit of effect and the incremental cost-effectiveness ratio) from the perspective of health program policy makers (HPP; indirect costs, i.e., loss of productivity, excluded) and of society as a whole (Saw; all costs included).

Patients were randomly assigned to a complete (CP; n = 32) or reduced (RP; n = 33) program: the RP group received a reduced education (self-reading of an educational booklet on asthma), while the CP group attended an “asthma school”, consisting of six lessons based on the same booklet and including educational videotapes. Both programs included peak-flow monitoring and treatment according to international guidelines, and follow-up. The outcome variables (asthma attacks, urgent medical examinations, admission days, working days lost) did not differ significantly between CP and RP. Morbidity savings were $1894.70 (CP) and $1697.80 (RP) according to Saw, and $1349.50 and $1301.80, respectively, according to HPP. The net cost-benefit was $1181.50 for CP and $1028.00 for RP, and the cost-benefit ratio per dollar spent was 1:2.6 for CP and 1:2.5 for RP, according to Saw. One day of admission prevented had a cost of $110.20 (CP) and $94.10 (RP). CP gave slightly better results and was slightly more cost-effective than RP in improving patients' welfare. It cannot be excluded that the retrospective analysis used to determine baseline costs might have inflated differences for both groups. Sensitivity analysis was slightly in favor of RP when the outcome variables were tested at their upper and lower 95% CI.     

Mobile Application for Promoting Gluten-Free Diet Self-Management in Adolescents with Celiac Disease: Proof-of-Concept Study

Celiac disease (CD) is a chronic disease treated by maintaining and managing a lifelong restrictive gluten-free diet. The purpose of this study was to develop a mobile application, Plan My C-Day, to promote self-management skills among youth with CD during adolescence—a time when decreased adherence often occurs—and examine its usability among adolescents with CD. Plan My C-Day contains three simulations of activities involving eating out and actions to take when preparing for these events. It was developed and pilot tested by 13 adolescents with CD. Application use and user perception data were collected and analyzed. Participants chose 160 actions within the simulations. For over 75% of participants, the time to complete the simulation decreased from the first to the third (last) simulation by an average of 50%. The average reported usability perception was 3.71 on a scale of 1 to 5, with system ease of use and ease of learning obtaining the highest scores. This study demonstrated that the Plan My C-Day mobile application’s self-management content, features, and functions operated well and that the simulations were easy to understand and complete. Further development will include the option to add self-created activities and adaptation to different languages and cultures.     

Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Diabetes mellitus (DM) and obesity account for the highest burden of non-communicable diseases. There is increasing evidence showing therapeutic patient education (TPE) as a clinically and cost-effective solution to improve biomedical and psychosocial outcomes among people with DM and obesity. The present systematic review and meta-analysis present a critical synthesis of the development of TPE interventions for DM and obesity and the efficacy of these interventions across a range of biomedical, psychosocial and psychological outcomes. A total of 54 of these RCTs were identified among patients with obesity and diabetes and were thus qualitatively synthesized. Out of these, 47 were included in the quantitative synthesis. There was substantial heterogeneity in the reporting of these outcomes (I² = 88.35%, Q = 317.64), with a significant improvement noted in serum HbA1c levels (standardized mean difference (SMD) = 0.272, 95% CI: 0.118 to 0.525, n = 7360) and body weight (SMD = 0.526, 95% CI: 0.205 to 0.846, n = 1082) in the intervention group. The effect sizes were comparable across interventions delivered by different modes and delivery agents. These interventions can be delivered by allied health staff, doctors or electronically as self-help programs, with similar effectiveness (p < 0.001). These interventions should be implemented in healthcare and community settings to improve the health outcomes in patients suffering from obesity and DM.     

云南独有少数民族居民糖尿病患病知识及自我管理比较

比较分析云南省4个独有少数民族糖尿病患病、知晓、治疗、控制及自我管理现状。方法 采用多阶段分层抽样方法,抽取云南省5 532名≥35岁纳西族、傈僳族、傣族和景颇族常住居民进行问卷调查和体格检查。结果 纳西族、傈僳族、傣族和景颇族居民标化后糖尿病患病率分别为3.9%、2.7%、7.6%和4.3%,傣族最高,傈僳族最低（P < 0.05）;知晓率分别为55.7%、66.7%、56.1%和41.6%,以傈僳族最高,景颇族最低（P < 0.05）;治疗率分别为39.1%、29.1%、41.9%和30.8%,傣族最高,傈僳族最低（P < 0.05）;控制率分别为21.9%、20.5%、23.2%和12.8%（ P >0.05）。纳西族、傈僳族、傣族和景颇族糖尿病患者自我监测血糖率分别为55.0%、12.5%、39.7%和20.0%,纳西族最高,傈僳族最低（P < 0.01）;遵医嘱服药率分别为60.0%、41.7%、82.1%和68.0%,傣族最高,傈僳族最低（P < 0.01）。4个民族糖尿病患者采取饮食控制、控制体重或减肥以及戒烟措施的比例差异均无统计学意义（P >0.05）。结论 云南省4个独有少数民族在糖尿病患病率、知晓率、治疗率和自我管理行为方面存在民族差异,其知晓率、治疗率、控制率和糖尿病自我管理行为均处于较低水平。     

社区老年人健康自我管理及一般自我效能感影响因素

目的分析河北省唐山市社区老年人健康自我管理及一般自我效能影响因素,为完善社区健康自我管理提供科学依据。方法采用自编一般人口学调查表、成年人健康自我管理能力测评量表及一般自我效能感量表对唐山市社区1 500名≥60岁老年人进行问卷调查。结果老年人健康自我管理行为、健康自我管理环境、健康自我管理认知评分分别为（54.87±9.506）、（40.36±7.352）、（61.65±6.207）分,一般自我效能评分为（25.09±5.893）分,多元线性回归分析显示,社区老年人健康自我管理行为、健康自我管理环境、健康自我管理认知的影响因素均为婚姻状况、有无固定收入、健康状况、文化程度（P均<0.05）;社区老年人一般自我效能的影响因素为性别、有无固定收入、健康状况、文化程度（P均<0.05）。结论唐山市社区老年人健康自我管理能力与一般自我效能均处于中等及偏上水平,影响因素复杂,应注重社区健康管理。     

血透患者体力活动水平自我管理教育效果分析

目的 探讨自我管理教育对维持性血液透析(MHD)患者体力活动水平的影响。方法 采用便利抽样的方法抽取80例规律透析患者,随机分为对照组40例和干预组40例;对照组进行常规护理教育,干预组在此基础上进行6个月的自我管理教育,干预前后通过人类活动概况量表(HAP)来比较2组患者体力活动水平。结果 干预6个月后,干预组患者的最大活动得分(MAS)[(77.18±16.43)分]和校正活动得分(AAS)[(68.34±17.29)分]均高于对照组[(70.01±15.26)和(60.14±16.26)分],差异均有统计学意义(P<0.05)。结论 自我管理教育能有效的提高MHD患者的体力活动水平。