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

BMC Research Notes

Leigh Anne Newhook¹  Donna Hagerty³  Daniel Albrechtsons²  Roger Chafe⁴ 

[1] Division of Pediatrics, Faculty of Medicine, Janeway Child Health Care Centre, Memorial University of Newfoundland, St. John’s, NL, Canada;Memorial University of Newfoundland, St. John’s, NL, Canada;Eastern Health, Outreach Department, St. John’s, NL, Canada;Janeway Pediatric Research Unit, Division of Pediatrics, Faculty of Medicine, Memorial University of Newfoundland, Room 409, Janeway Hostel, 300 Prince Phillip Drive, St. John’s A1B 3V6, NL, Canada

关键词: Rural;    Patient resources;    Patient experience;    Diabetic ketoacidosis;    Type 1 diabetes;   

Others  :  1230422
DOI  :  10.1186/s13104-015-1358-7

 received in 2015-03-05, accepted in 2015-08-17,  发布年份 2015

【 摘 要 】

Background

Diabetic 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.

Methods

Four 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.

Results

There 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.

Conclusions

The 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.

【 授权许可】

   
2015 Chafe et al.

【 参考文献 】

• [1]Wolfsdorf J, Craig ME, Daneman D, Dunger D, Edge J, Lee W, Rosenbloom A, Sperling M, Hanas R: Diabetic ketoacidosis in children and adolescents with diabetes. Pediatr Diabetes 2009, 10(Suppl 12):118-133.
• [2]Usher-Smith JA, Thompson MJ, Sharp SJ, Walter FM: Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young adults: a systematic review. BMJ 2011, 343:d4092.
• [3]Rewers A, Klingensmith G, Davis C, Petitti DB, Pihoker C, Rodriguez B, et al.: Presence of diabeteic ketoacidosis at diagnosis of diabetes mellitus in youth: the search for Diabetes in Youth Study. Pediatrics 2008, 121:e1258-e1266.
• [4]Bismuth E, Laffel L: Can we prevent diabetic ketoacidosis in children? Pediatr Diabetes. 2007, 8(Suppl 6):24-33.
• [5]Vanelli M, Chiari G, Ghizzoni L, Costi G, Giacalone T, Chiarelli F: Effectiveness of a Prevention Program for Diabetic Ketoacidosis. Diabetes Care 1999, 22(1):7-9.
• [6]King BR, Howard NJ, Verge CF, Jack MM, Govind N, et al.: A diabetes awareness campaign prevents diabetic ketoacidosis in children at their initial presentation with type 1 diabetes. Pediatric Diabetes 2012, 13:647-651.
• [7]Weber C, Kocher S, Neeser K, Joshi SR: Prevention of diabetic ketoacidosis and self-monitoring of ketone bodies: an overview. Curr Med Res Opin 2009, 25:1197-1207.
• [8]Rewers A: Current Concepts and Controversies in Prevention and Treatment of Diabetic Ketoacidosis in Children. Curr DiabRep 2012, 12:524-532.
• [9]Fleming E: The transition of adolescents with diabetes from the children’s health care service into the adult health care service: a review of the literature. J Clin Nurs 2002, 11:560-567.
• [10]Freeborn D, Dyches T, Roper SO, Mandleco B: Identifying challenges of living with type 1 diabetes: child and youth perspectives. J of Clinical Nursing 2012, 22:1890-1898.
• [11]Alaghehbandan R, Collins KD, Newhook LA, MacDonald D: Childhood type 1 diabetes mellitus in Newfoundland and Labrador. Canada. Diabetes Res Clin Pract 2006, 74(1):82-89.
• [12]Newhook LA, Curtis J, Hagerty D, Grant M, Paterson AD, Crummel C, Bridger T, Parfrey P: High incidence of childhood type 1 diabetes in the Avalon Peninsula, Newfoundland. Canada. Diabetes Care 2004, 27(4):885-888.
• [13]Newhook LA, Penney SJ, Fiander J, Dowden J: Recent incidence of type 1 diabetes mellitus in children 0-14 years in Newfoundland and Labrador, Canada, climbs to over 45/100,000. BMC Research Notes 2012, 5:628. BioMed Central Full Text
• [14]Rytkonen M, Moltchanova E, Ranta J, Taskinen O, Tuomilehto J, Karvonen M: The incidence of type 1 diabetes among children in Finland–rural-urban difference. Health Place 2003, 9(4):315-325.
• [15]Butcher MK, Gilman J, Meszaros JF, Bjorsness D, Madison M, McDowall JM, Oser CS, Johnson EA, Harwell TS, Helgerson SD, Gohdes D: Improving access to quality diabetes education in a rural state: the Montana Quality Diabetes Education Initiative. Diabetes Educ 2006, 32(6):963-967.
• [16]Reddy P, Hernan AL, Vanderwood KK, Arave D, Niebylski ML, Harwell TS, Dunbar JA: Implementation of diabetes prevention programs in rural areas: montana and south-eastern Australia compared. Aust J Rural Health 2011, 19(3):125-134.
• [17]Hale NL, Bennett KJ, Probst JC: Diabetes care and outcomes: disparities across rural America. J Community Health 2010, 35(4):365-374.
• [18]Cameron FJ, Clarke C, Hesketh K, White EL, Boyce DF, Dalton VL, Cross J, Brown M, Thies NH, Pallas G, Goss PW, Werther GA: Regional and urban Victorian diabetic youth: clinical and quality-of-life outcomes. J Paediatr Child Health 2002, 38(6):593-596.
• [19]The Rural Centre.: Rural and small town Canada analysis bulletin 3(3), November 2001.. http://www.theruralcentre.com/doc/RST-Def_Rural.pdf webcite
• [20]Green J, Thorogood N: Qualitative methods for health research. sage publication, London; 2009.
• [21]NVivo 9:. QSR International.. http://www.qsrinternational.com/products_nvivo.aspx webcite
• [22]Health Research Ethics Authority Website.. http://www.hrea.ca/Home.aspx webcite
• [23]Sibley LM, Weiner JP: An evaluation of access to health care services along the rural-urban continuum in Canada. BMC Health Serv Res 2011, 11:20. BioMed Central Full Text
• [24]Buckloh LM: Lochrie, Antal H, Milkes A, Canas JA, Hutchinson S, Wysocki T. Diabetes Complications in Youth. Diabetes Care 2008, 31:1516-1520.
• [25]Marshall M, Gidman W, Callery P: Supporting the acre of children with diabetes in school: a qualitative study of nurses in the UK. Diabet Med 2013, 30:871-877.