Reducing episodes of diabetic ketoacidosis within a youth population: a focus group study with patients and families

Abstract

BackgroundDiabetic ketoacidosis (DKA) is the most common cause of morbidity and mortality for youth with type 1 diabetes mellitus (T1DM). This article reports qualitative data from focus groups with youth and parents of youth with T1DM on the barriers that they identify to DKA prevention and resources that may aid youth better manage their diabetes.MethodsFour focus groups were held in three communities, two rural and one urban, in the Canadian province of Newfoundland and Labrador (NL) with adolescents and parents of youth with diabetes. Open-ended questions focused on knowledge of DKA, diabetes education, personal experiences with DKA, barriers to diabetes self-management, situations which put them at risk for DKA and resources that could be developed to aid youth in preventing DKA.ResultsThere were 19 participants (14 parents and 5 youth). Participants identified factors which increased their risk of DKA as difficulty in distinguishing cases of DKA from other illnesses; variations in diabetes education received; information overload about their condition; the long period from initial diagnosis, when most education about the condition was received; and stress regarding situations where youth are not in the direct care of their parents. Participants from rural areas reported geographical isolation and lack of regular access to specialist health care personnel as additional barriers to better diabetes management.ConclusionsThe project identified barriers to DKA prevention for youth which were not previously identified in the medical literature, e.g., the stress associated with temporary guardians, risk of information overload at initial diagnosis and the long period from initial diagnosis when most diabetes education is received. Families from rural areas do report additional burdens, but in some cases these families have developed community supports to help offset some of these problems. Mobile and online resources, educational refreshers about DKA, concise resources for teachers and other temporary guardians, and DKA treatment kits for parents may help improve diabetes management and prevent future episodes of DKA.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-015-1358-7) contains supplementary material, which is available to authorized users.

Implementation of a Diabetes Educator Care Model to Reduce Paediatric Admission for Diabetic Ketoacidosis

“…Many barriers are known leading to delay in diagnosing DKA. Of those, there are difficulty in distinguishing cases of DKA from other illnesses, information overload, and ling period from initial diagnosis [ 16 ]. Such barriers remain a major obstacle in prevention of DKA in children even in developed countries with active prevention campaigns [ 17 ].…”

Interprofessional, multiple step simulation course improves pediatric resident and nursing staff management of pediatric patients with diabetic ketoacidosis

“…Crossen et al[25] concluded that signs of impending DKA were seen in children with type I diabetes who had recent emergency department visits and had infrequent subspecialty primary care visits. Chafe et al[26] utilized a focus study group of patients and families to identify ways to reduce episodes of DKA in the youth population. This project identified factors that put the youth at increased risks and recognized areas to improve those odds.…”

Daily Behavioural Penderita Diabetes Mellitus Tipe 1 Sebagai Triggers Kekambuhan Ketoasidosis Diabetikum

“…Terdapat beberapa faktor yang meningkatkan resiko terjadinya ketoasidosis pada penderita diabetes yaitu : perbedaan informasi tentang diabetes yang diterima, banyaknya informasi tentang keadaan penyakit yang diterima, lamanya menderita penyakit, informasi yang berlebihan tentang kondisi penyakit, keadaan geografis daerah tempat tinggal, kurangnya akses terhadap tenaga kesehatan spesialis, serta beban psikologis yang dialami oleh remaja yang dirawat oleh keluarga selain orang tua. (Chafe, et al 2015). Anak dengan DM tipe 1 yang tidak tinggal atau tidak dirawat langsung oleh orang tua memiliki kecenderungan mengalami komplikasi berupa KAD (Usher-Smith Et al, 2011).…”

“…Dukungan dari masyarakat sekitar, informasi baru tentanga KAD, telpon seluler, informasi yang tepat dan ringkas bagi pihak sekolah dan keluarga/wali serta set kelengkapan perawatan KAD untuk orang tua dapat membantu meningkarkan menejemen diabetes mellitus tipe 1 dan mencegah serangan KAD berulang. Selain itu ketidakpatuhan menejemen terapi insulin juga menjadi faktor penyebab terjadinya KAD (Chafe et al, 2015)…”