A Course for Babysitters of Children with IDDM

Parents of children with insulin-dependent diabetes mellitus (IDDM) fre quently deny themselves social and recreational activities because they have no competent baby- sitter with whom to leave the child. This pilot pro gram was developed to train adolescents to care for children with IDDM. The program combines the American Red Cross baby-sitting course with additional training to meet the needs of children with IDDM. Although the program has not been formally evaluated, subjective response of participants has been positive.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/69024/2/10.1177_014572178501100307.pd

Understanding Young Children's Health Beliefs and Diabetes Regimen Adherence

Previous studies of chronic illness management in children have focused mainly on parents' health beliefs. However, children's health beliefs also can be an important factor in predicting adherence. Indeed, children 6 to 10 years old spend most waking hours away from home, are under less parental supervision, and are becoming more responsible for their own care. The purpose of this study was to develop a pictorial, multi-item instrument to measure dimensions of the Health Belief Model (HBM) and self-efficacy (SE), designed specifically for children with diabetes, thus making it possible to examine both the parent's and child's health beliefs; to explore the relationship between their beliefs; and to examine the extent to which these beliefs are predictors of adherence and metabolic control.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/68551/2/10.1177_014572179301900508.pd

Pregnancy in Diabetes: challenges and opportunities for improving pregnancy outcomes

Our aim was to review the data from the National Pregnancy in Diabetes (NPID) audit, and to identify the challenges and opportunities for improving pregnancy outcomes in women with diabetes. We reviewed three years of NPID data and relevant diabetes and obstetric literature, and found that there has been little change in pregnancy preparation or outcomes over the past 3 years, with substantial clinic-to clinic variations in care. Women with Type 2 diabetes remain less likely to take 5 mg preconception folic acid (22.8% vs. 41.8%; P < 0.05), and more likely to take potentially harmful medications (statin and/or ACE inhibitor 13.0% vs. 1.8%; P < 0.05) than women with Type 1 diabetes. However, women with Type 1 diabetes are less likely to achieve the recommended glucose control target of HbA1c < 48 mmol/mol (6.5%) (14.9% vs. 38.1%; P < 0.05). The following opportunities for improvement were identified. First, the need to integrate reproductive health into the diabetes care plans of all women with diabetes aged 15–50 years. Second, to develop more innovative approaches to improve uptake of pre-pregnancy care in women with Type 2 diabetes in primary care settings. Third, to integrate insulin pump, continuous glucose monitoring and automated insulin delivery technologies into the pre-pregnancy and antenatal care of women with Type 1 diabetes. Fourth, to improve postnatal care with personalized approaches targeting women with previous pregnancy loss, congenital anomaly and perinatal mortality. A nationwide commitment to delivering integrated reproductive and diabetes healthcare interventions is needed to improve the health outcomes of women with diabetes

Effectiveness of prepregnancy care for women with pregestational diabetes mellitus: protocol for a systematic review of the literature and identification of a core outcomes set using a Delphi survey

BACKGROUND: Women with pregnancy complicated by pregestational diabetes experience increased rates of adverse pregnancy outcomes. Prepregnancy care is the targeted support and additional care offered to those women who are planning pregnancy and is associated with improved outcomes. However, there is significant heterogeneity in the outcomes measured and reported in studies evaluating the effects of prepregnancy care, which makes meaningful comparison difficult. The aim of this article is to present a protocol for a study to develop a Core Outcome Set (COS) for trials and other studies evaluating the effectiveness of prepregnancy care for women with pregestational diabetes mellitus. METHODS/DESIGN: This study will include a systematic review of the literature to identify outcomes that have previously been reported in studies evaluating prepregnancy care for women with pregestational diabetes. We will then prioritise these outcomes from the perspective of key stakeholders, including women with pregestational diabetes as well as clinicians, using a Delphi survey. A final consensus meeting will be held with stakeholders to review and finalise the outcomes. DISCUSSION: The expectation is that the COS will always be collected and reported in all clinical trials, audits of practice and other forms of research that involve prepregnancy care programs for women with pregestational diabetes. This will facilitate comparing and contrasting of studies and allow for combining of appropriate studies with the ultimate goal of improved patient care. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13063-015-0894-8) contains supplementary material, which is available to authorized users

Social support, chronic stress, and health outcomes in adolescents with diabetes.

For those with Diabetes Mellitus (IDDM), the emotional, physical, and cognitive changes of adolescence are especially stressful and contribute to deterioration of metabolic control. Several psychosocial factors, such as social support and stress, have been linked to metabolic control. This cross-sectional study was to examine the relationship of support, chronic stress, and health outcomes (self-care compliance and metabolic control) in adolescents with diabetes. Social Support and Stressors of Youth with Diabetes (SSSYD) instrument was developed for this study to measure a teenager's perceptions of diabetes-related support and stress. The instrument provided a total support and stress scale with six subscale scores. The SSSYD appeared to have sufficient validity and reliability (Alpha's range 0.74 to 0.91). SSSYD was administered along with other self-administered questionnaires during the second wave of data collection in an ongoing project. Sixty-five adolescents with diabetes participating in the larger intervention study completed and returned these pre-mailed questionnaires. The sample was predominantly white, 30 females and 35 males, with a mean age of 15.9. Along with the intervention, participants received a free blood glucose (BG) monitoring device with memory (Glucometer M), and free blood tests. Metabolic control was measured by Glycosylated Hemoglobin (GHb) test of blood drawn in the diabetes clinic. Compliance was measured indirectly by self-report, and directly by the Glucometer M (total # of BG tests over 90 days, and the average # BG/day). The subjects were asked to perform glucose tests twice a day using their Glucometer M, and to attend diabetes clinic every three months for routine health-care and for group participation. Results indicated that teens reported receiving the greatest support from parents and friends. Overall, the sample reported receiving a moderate amount of support, but reported low levels of stress. Teens indicated needing the most support with glucose monitoring and diet. Emotional support was the type reported as most helpful. Teens receiving the group intervention during the first year reported significantly greater support. Results from multiple regression analysis did not show support as having any significant main or buffering effects on stress, or on any of the health-outcome measures. Support had an unexpected positive correlation with stress. Poor metabolic control was predicted by high levels of stress. Except for stress explaining 9% of the variance in control, and gender explaining 5% in compliance, much of the variance in health outcomes remained unexplained. Higher levels of stress were also associated with greater self-reported compliance. Significant findings may not have been detected due to the small sample size, which resulted in low statistical power. Therefore, caution should be used when interpreting these results.Ph.D.Health and Environmental SciencesNursingPublic healthUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/128682/2/9123990.pd