A number of new developments in the management of insulin-dependent diabetes mellitus have occurred in the past several years. Primary care providers including pediatric nurse practitioners need to be aware of these developments so that they can work effectively with specialty providers in caring for children with insulin-dependent diabetes mellitus. This article discusses the implications of the Diabetes Control and Complications Trial for children and adolescents, the Diabetes Prevention Trial-Type I, and several other recent developments in caring for children with insulin-dependent diabetes mellitus.

Child↗

PubMedDate not supplied

Coping behaviors at diagnosis and in adjustment one year later in children with diabetes.

The aim of this investigation was to determine the contributions of coping behaviors used at diagnosis to medical (metabolic control) and psychosocial adjustment (self-perceived competence; adjustment) 1 year later. A total of 89 children (8 to 14 years of age; 48% male; 59% White) received follow-up quarterly from diabetes diagnosis to 1 year later. Findings indicated that, in general, although metabolic control worsened over the first year, psychosocial status and coping behaviors were stable. Boys had worse metabolic control than girls. Multiple regression analysis indicated that self-worth at 1 year postdiagnosis was associated with less use of spirituality (beta = -.44), more use of humor (beta = .28), and more positive self-care (beta = .28); and self-care was less likely to be positive in older children (r = .32). These variables accounted for 47% of the variance (39% adjusted) in general self-worth when entry self-worth was controlled. Poorer overall adjustment at 1 year postdiagnosis was associated with more use of avoidance behaviors (beta = -.47) and poorer self-care (beta = -.71); and more use of avoidance was associated with older age. These variables accounted for 62% of the variance (58% adjusted) in adjustment when adjustment at diagnosis was controlled. Poorer metabolic control was associated with more use of avoidance (beta = .30) and female gender (beta = .39), and avoidance behaviors were more common in older children (beta = .12). This model predicted 33% of the variance (25% adjusted) in metabolic control 1 year after diagnosis.

Adaptation, Psychological↗

PubMedDate not supplied

Teaching teens to cope: coping skills training for adolescents with insulin-dependent diabetes mellitus.

PURPOSE: To review the potential use and application of coping-skills training in teaching adolescents effective ways of managing the stressors related to living with diabetes mellitus. POPULATION: Adolescents ages 13 to 20 with insulin-dependent diabetes mellitus who are participating in the research project, "Nursing Intervention to Implement DCCT Therapy in Youth" at Yale University School of Nursing. CONCLUSIONS: Teaching adolescents with diabetes mellitus to use appropriate coping skills may help them cope with the day-to-day management of the illness and aid in long-term adaptation. PRACTICE IMPLICATIONS: Research has suggested that the use of effective coping skills may aid in healthy long-term adaptation to diabetes mellitus. Thus, nurses caring for adolescents with this illness should teach and be role models for these effective coping strategies.

Adaptation, Psychological↗

PubMedDate not supplied

An integrative literature review of cardiac risk factor management in diabetes education interventions.

PURPOSE: The purposes of this paper are to (1) review the literature on educational interventions for adults with type 2 diabetes; (2) determine what kinds of interventions have been studied; (3) identify which interventions have included cardiac risk factor management; (4) determine how effective these interventions have been on metabolic control, diabetes-related outcomes, and cardiovascular-related outcomes; and (5) make recommendations for further research on combined interventions designed to promote optimal diabetes and cardiac risk factor management in adults with type 2 diabetes. METHODS: Using an integrative literature review approach, 64 studies on diabetes education interventions for adults with diabetes published between 1987 and 1998 were reviewed; 44 met these criteria. RESULTS: Few studies included cardiac risk factor management, which should be an integral part of diabetes management. Most studies demonstrated a beneficial effect of education on the management of type 2 diabetes but not cardiovascular risk. CONCLUSIONS: Identifying strategies that promote effective disease management for improved diabetes control and reduction of cardiac events in adults with diabetes is essential. Further intervention studies focusing on the combined management of diabetes and cardiac risk factors are warranted.

Adult↗

PubMedDate not supplied

Coping strategies of school-age children with diabetes mellitus.

School-age children (N = 43) with insulin-dependent diabetes mellitus were studied to determine if the coping strategies they used were associated with their self-care management and/or with their metabolic control. Instruments used included the Schoolagers Coping Strategy Inventory and the Self-care Questionnaire. Results indicated that the choice of coping strategies did not differ by demographic characteristics, and level of self-care was not associated with metabolic control. Participants used cognitive coping strategies most often; higher frequencies tended to be associated with higher levels of self-care and metabolic control. Those who utilized distracting strategies also tended to have higher levels of self-care. Emotional coping strategies tended to be related to poorer metabolic control. The use of coping strategies explained approximately 18% of the variance in metabolic control. These data suggest that healthcare providers should assess what coping strategies are employed by school-age children with diabetes because the choice of strategies may have a significant impact on their metabolic control. The use of strategies related to poorer metabolic control (eg, emotional strategies) should be discouraged, and the use of more effective strategies related to higher levels of self-care and metabolic control (eg, cognitive strategies) should be modeled and encouraged.

Adaptation, Psychological↗

PubMedDate not supplied

A primer on the use of insulin pumps in adolescents.

Optimal metabolic control to minimize long-term complications is a major treatment goal for adolescents with diabetes mellitus. Reaching this goal is extremely challenging in this population due to unique physiological changes and psychosocial variables that affect metabolic control. Continuous subcutaneous insulin infusion (CSII) may be an excellent treatment alternative for selected adolescents to help overcome some of these challenges. CSII allows for minute insulin changes at variable times throughout the day, providing greater lifestyle flexibility. The purpose of this paper is to review the use of insulin pump therapy in adolescents. Specific strategies regarding screening, initiation, and maintenance of this therapy are described, and case examples are used for illustration. Implications for nursing practice and diabetes education are discussed.

Adolescent↗

PubMedDate not supplied

A summer vacation from diabetes: evidence from a clinical trial.

PURPOSE: This study examined the metabolic trend and factors associated with an unexpected rise in HbA1c levels during the summer, with a return to baseline when school resumed, in 40 intensively treated adolescents with type 1 diabetes. METHODS: Psychosocial data were collected using a variety of diabetes evaluation instruments. HbA1c was measured monthly. RESULTS: HbA1c values increased by a mean of .73% from May to July and decreased by a mean of .75% from August to October. Lack of consistency in summer routines compared with school days was associated with a worsening in metabolic control during the summer months. Other factors associated with the summer increase in HbA1c included lower guidance scores on the Diabetes Family Behavior Scale, and higher impact and worry scores on the Diabetes Quality of Life for Youth Scale. CONCLUSIONS: Interviews suggested that teenagers need to take a vacation from intensive diabetes care during the summer.

Adolescent↗

PubMedDate not supplied

Use of lispro insulin and quality of life in adolescents on intensive therapy.

PURPOSE: This study examined the metabolic and quality-of-life effects of using lispro insulin in teenagers. METHODS: Teenagers on multiple daily injections who had not reached metabolic treatment goals were offered the opportunity to use lispro insulin as part of a larger ongoing study of intensive management in youth. Of the 51 who were eligible, 35 used lispro and were followed for 12 months; the remaining 16 had reached treatment goals, were not offered lispro, and comprised the control group. RESULTS: After 12 months, the teens who received lispro insulin achieved equivalent levels of metabolic control to those achieved by teens in the control group, without differences in total daily dose, insulin regimen, or adverse events. Those who received lispro found coping with diabetes less difficult than those who continued on regular insulin, and they reported less negative impact of diabetes on quality of life and fewer worries about diabetes. Both groups were equally satisfied with their diabetes treatment. CONCLUSIONS: Lispro insulin is a safe alternative for youth on intensive regimens, may assist youth in coping with diabetes, and may improve their quality of life.

Adaptation, Psychological↗

PubMedDate not supplied

Characteristics of the learner: children and adolescents.

PURPOSE: The purposes of this paper are to (1) review the literature on educational interventions for children and adolescents; (2) determine what kinds of interventions have been studied, how effective they are, and their outcomes; and (3) develop recommendations for further research in the field. METHODS: An integrative literature review approach was used. Articles were included in this review if they met the criteria of being an empirical study reporting results of an intervention whose primary subjects were children with type 1 diabetes and/or their families, and published between 1980 and January 1, 1999. Of the 59 articles identified, 41 met these criteria. RESULTS: The majority of the studies focused on adolescents. Results suggested that traditional educational interventions are successful in increasing knowledge but less successful in increasing quality of life or improving metabolic control. Psychosocial and family interventions (coping skills training) have been more successful in both quality-of-life and metabolic outcomes. CONCLUSIONS: There is much work to be done to strengthen our understanding of what works under what conditions. More studies of younger children, minority youth, and families are needed using well-controlled experimental designs with adequate samples.

Adaptation, Psychological↗

PubMedDate not supplied

My opinion: NPs and PAs should work together.

Explore the source record for details and available documents.

Humans↗

PubMedDate not supplied

Coping and adaptation in children with diabetes.

The purpose of this study was to investigate the influence of age, coping behavior, and self-care on psychological, social, and physiologic adaptation in preadolescents and adolescents with diabetes. Children (N = 103) with insulin-dependent diabetes mellitus (IDDM) between 8 and 18 years of age and their parents participated in the study. Findings indicated that preadolescent children were significantly less depressed, less anxious, coped in more positive ways, had fewer adjustment problems, and were in better metabolic control than their adolescent counterparts. Age and secondary sexual development were related to psychosocial adaptation and metabolic control of the diabetes. Further, those who coped by avoiding their problems and who were more depressed were the most likely to have problems in both adjustment and metabolic control with 56% of the variance in metabolic control explained by the variables studied. These findings indicate that preadolescents and adolescents cope differently with a chronic illness, and that interventions should be designed to identify and help those with inappropriate coping styles.

Adaptation, Psychological↗

PubMedDate not supplied

Initial adaptation in children with newly diagnosed diabetes and healthy children.

A cohort of children with newly diagnosed diabetes (n = 68) from four diabetes treatment centers in northeastern states were compared with a cohort of healthy peers (n = 40) 6 weeks following the diagnosis of diabetes in the ill children. Instruments used included the Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), Coping Inventory (COPE), Child & Adolescent Adjustment Profile (CAAP), and Self Perception Profile for Children (SPPC). Results indicated no demographic differences between the two groups and no differences in scores on CDI, STAIC-state anxiety, and all subscales of the CAAP and SPPC. However, the children with diabetes were reported to demonstrate less withdrawal (11.6 +/- 3.0 versus 12.4 +/- 2.3) than their healthy peers and were more likely to cope by ventilating feelings (19.7 +/- 2.0 versus 18.7 +/- 2.2). Parents reported that children with IDDM were less healthy (p < .001). These data suggest a less severe initial psychologic response to diabetes than might be expected and that there are differences in coping patterns among children with IDDM and children without chronic illness.

Adaptation, Psychological↗

PubMedDate not supplied

Future of pediatric advanced practice nursing.

Explore the source record for details and available documents.

Curriculum↗

PubMedDate not supplied

The impact of the "Put Prevention into Practice" initiative on pediatric nurse practitioner practices.

INTRODUCTION: Pediatric nurse practitioners (PNPs) are committed to health promotion and disease prevention, especially for children and adolescents. In this project the "Put Prevention into Practice" materials, developed by the Office of Disease Prevention and Health Promotion of the United States Public Health Service, were disseminated to members of the National Association of Pediatric Nurse Associates and Practitioners and evaluated for their impact on child health outcomes. METHOD: The evaluation was conducted by chart review of patients seeing PNPs during the first year of national implementation of the project. Data were collected on a form designed for the study at the time of introduction of the materials into the PNPs' practice and 6 months later. Numbers of visits for health maintenance, illness, and emergency department use were compared before and after introduction of materials. Whether the parent brought the Child Health Guide to the visit was also compared before and after materials were introduced. In addition, immunization status, recording of height, weight, developmental screening, and hearing and vision screening were compared before and after introduction of materials. To obtain information about the materials and their applicability to patients, focus groups were used to elicit information from PNPs at two national meetings. RESULTS: Usable data were received from 14 PNPs representing 194 patients. The results indicated that use of the "Put Prevention into Practice" program increased immunization rates, health maintenance visits, documentation of developmental, hearing and vision screening, and car seat use. No change was seen in documentation of height, weight, and emergency department and illness visits. Members found that the materials were difficult to implement in some populations. Despite the small numbers of participants, these data suggest that use of the "Put Prevention into Practice" materials can improve consistency of preventive care for young children.

Child↗