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摘要
The goal of therapy in children and adolescents with type 1 diabetes mellitus is a most comprehensive self-management as early as possible. To reach this goal all patients have to participate in well evaluated, structured treatment and teaching programmes (STTP). Moreover, in particular in children and adolescents, it is mandatory to avoid comorbidities like disturbances of social interacting and maladaptive coping with illness tendencies. A STTP with pedagogical skills has the potency to avoid these tendencies. The present trial was performed to evaluate a STTP focused on pedagogical skills (SBSP).
Patients and methods: Totally 54 children and adolescences aged 8 to 18 years (age 13.8 +/- 2.2, diabetes duration 5.7 +/- 3.8 years, BMI 21.1 +/- 3.4 kg/m(2), HbA1c 8.54 +/- 1.20 %, insulin dosage 0.81 +/- 0.32 I.U./kg bd wt), admitted to the MEDIGREIF Inselklinik Heringsdorf GmbH to participate in a 4-week STTP, were included in the trial. In all the patients a clinical, examination was performed and laboratory and socio-demographic parameters (age, diabetes duration, body-mass index, HbA1c, blood glucose), along with diabetes-related knowledge, patients' ability of diabetes self-management and quality of life were assessed.
Results: Following the participation in the STTP there were significant improvements in diabetes-related knowledge and patients' ability of diabetes self-management (onset vs. end of the trial: ability of correct insulin injection 40.0 +/- 21.7 % vs. 54.4 +/- 20.5 %, p < 0.001, documentation 35.3 +/- 26.0 % vs. 66.3 +/- 15.5 %, p < 0.001, nutrition-related knowledge 38.0 +/- 19.7 % vs. 50.6 +/- 22.7 %, p = 0.001, acceptance of diabetes 46.5 +/- 20.0 % vs. 58.2 +/- 22.6 %, p = 0.048, independency 44.8 +/- 22.1 % vs. 55.0 +/- 22.8 %, p = 0.002, social interaction 41.6 +/- 18.6 % vs. 52.8 +/- 29.9 %, p = 0.036, motivation 73.4 +/- 30.6 vs. 85.0 +/- 25.2 %, p = 0.051, physical activity 80.0 +/- 13.7 % vs. 87.5 +/- 17.7 %, p = 0.049, hypoglycaemia-related knowledge 46.6 +/- 12.6 % vs. 70.0 +/- 12.8 %, p < 0.001, self-monitoring 15.0 +/- 6.8 % vs. 58.0 +/- 14.2 %, p < 0.001). Parallel there were tendencies for changes in quality of life and well-being (well-being at school 69.7 +/- 20.8 % vs. 68.1 +/- 18.5 %, p = 0.67, well-being with friends 76.5 +/- 18.5 % vs. 78.4 +/- 18.7 %, p = 0.58, well-being in the family 83.7 +/- 17.0 % vs. 84.7 +/- 17.4 %, p = 0.75, self assessment 62.9 +/- 21.7 % vs. 66.6 +/- 17.7 %, p = 0.32, psychological well-being 77.9 +/- 17.7 % vs. 77.6 +/- 13.9 %, p = 0.94, physical well-being 72.1 +/- 19.0 vs. 66.1 +/- 17.0, p = 0.08, quality of life 73.9 +/- 12.5 % vs. 73.8 +/- 12.1 %, p = 0.98, diabetes-related quality of life 62.4 +/- 19.4 % vs. 62.5 +/- 19.8 %, p = 0.97). Performing multivariate analysis (R-square = 0.786) the following parameters revealed associations with quality of life: Physical well-being (beta = 0.35, p < 0.001), self assessment (beta = 0.40, p < 0.001), well-being in the family (beta = 0.42, p < 0.001) and well-being with friends (beta = 0.37, p < 0.001). All other parameters integrated in the model (age, diabetes duration, sex, HbA1c, blood glucose) showed no associations.
Conclusions: A STTP focussed on pedagogical skills is highly accepted by children and adolescents with type 1 diabetes mellitus admitted to rehabilitation. Based on its multimodality and interdisciplinarity is offers substantial improvements for both patients and therapeutic staff. There is a significant improvement in diabetes-related knowledge and patients' ability of diabetes self-management.
- 出版日期2012-6
