The Relationship between Self-Management and Glycemic Control in A Cohort of Children with Type 1 and Type 2 Diabetes

Abstract

Aim: Self-management of diabetes improves glycemic control. The development of a quick, objective questionnaire in the clinic setting may provide data to the clinician caring for the patient in overall evaluation. Objective: We developed a 23 question tool (clinic preparedness score) and administered it to type 1 and 2 (T1DM & T2DM) diabetes patients. Clinicians of patients were surveyed to determine their perception of adherence by patients. A total of 350 T1DM patients and families and 137 T2DM families were administered the questionnaire. Additionally, HbA1C was correlated to the various parameters that are related to improved glycemic control such as having a meter, carrying glucose tablets for hypoglycemia, and downloading/ writing blood sugars in log book in T1DM and T2DM. Results: T1DM subjects had a lower HbA1C with better clinic preparedness (8.2 ± 1.3 vs. 9.4 ± 1.9%) However, this did not hold true for T2DM (p NS). If T1DM subjects adjusted their insulin dose and reported that their parent was involved they had better HbA1C than those that did not change insulin dose and if parent was uninvolved in the care. Clinicians of patients were able to accurately predict that appropriate dose adjustments resulted in good glycemic control. Conclusions: Pediatric T2DM adherence measures do not mirror similar characteristics of T1DM in childhood. The variability in glucose monitoring, medication and insulin administration may affect T2DM differently than T1DM.

A Systematic Review of Instruments Measuring the Division of Care Responsibilities between Children with Type 1 Diabetes and their Parents

“…A 98% agreement-rate was obtained. Because of initial non-agreement about inclusion, 16 (2%) full-text articles were discussed until consensus was reached [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30].…”

Perspectives of Education in Diabetes

“…In the medical literature, numerous studies [6][7][8][9][10][11][12] have shown that therapeutic education significantly influences to achieve better control of Diabetes and thus avoid, prevent or delay complications, evidencing unavoidable benefits not only in metabolic and clinical parameters but also in psychosocial aspects. With the publication of the results of the Diabetes Control and Complications Trial, DCCT [13] and in DM2 the UK Prospective Diabetes Study, UKPDS [14]; in which it is emphasized that intensive therapy required greater focus of the patient in everything related to self-control, it was possible to change the focus in the care of the patient with diabetes, which went from being specific measurements of both glycemia and blood pressure to the prevention of complications and intensification of treatment with well-defined metabolic objectives and strict compliance.…”