Juvenile Onset Diabetes Treatment - Essay Example

?Capstone Project of PICOT Question: For children with Type Diabetes (Juvenile Onset Diabetes) or Insulin DependentDiabetes Milletus (IDDM), will self-management education intervention through glycemic control or clinical-based therapies provide a sustainable and effective management of this disease such that it can minimize symptoms, prevent short and long-term health problems and allow children/adolescents to enjoy a normal physical, mental, emotional and social aspects of development until they reach adulthood? Instructions: Assignment 1 (1 page) Identify a theory that can be used to support your proposed solution. 1. Describe the theory and your rationale for selecting the theory. 2. Discuss how the theory works to support your proposed solution. 3. Explain how you will incorporate the theory into your project. The theory or concept of self-management of Type 1 Diabetes or Juvenile Onset Diabetes that are found in both children and adolescents states that process, activities and goals are its three essential attributes (Schilling et al., 2002). In another way, Hughes (2010) describes these attributes as knowledge/education, relationship/partnership, self-monitoring/self-care and one umbrella attribute, the action-directed skills. This equates to an active and proactive process being conducted on a daily basis, on a lifelong duration and involvement of shifting and shared responsibility of diabetes care tasks, and decision-making between the child and parent (Schilling et al., 2002). This self-management theory incorporates all survival strategies for a patient with Type 1 Diabetes so that he is able to manage the disease and yet look forward to years of growth and productivity in his later life. This is exactly my proposed solution to the disease, recognizing its no-cure properties and its presence in the body system of the child until his entire lifetime. The theory will be incorporated in this Capstone project by forming a Type 1 Diabetes Clinic in which all information about the disease itself will be made available in the clinic and translated into a simple language that can be easily shared and taught by professional nurses to the patients, their families and relatives, and other concerned individuals. Self-management will be thoroughly covered in terms of all available media resources in the aim that training the “caregivers” of Type 1 diabetic patients will contribute significantly to the positive growth and progress of the patients and will be gladly anticipated by family members thereby reducing the incidence of any form of stress, burn-out and losing of hope when dealing with the disease. Thus the strategies of the Type 1 Diabetes Clinic project is directed towards, thorough education, personalized caring of patients, positive and proactive delivery of Diabetes-management methods and, consistent positive anticipation practices of the future for diabetic patients in order to promote mental wellness as well. This project is expected to support the implementation of a quality life for Type 1 Diabetes’ patients, family and relatives, and consequently resulting to a healthy metabolic control and, development of the patients (Faulkner and Chang, 2007). References: Hughes, L. (2010). Self-Management: an evolutionary concept analysis [Online]. University of Victoria, 72 pp. Available at: http://dspace.library.uvic.ca:8080/bitstream/handle/1828/4057/Hughes_Lori_MN_2010.pdf?sequence=1 [15 Jan 2013]. Faulkner, M.S. and Chang, L. (2007), Family Influence on Self-Care, Quality of Life, and Metabolic Control in School-Age Children and Adolescents with Type 1 Diabetes. Journal of Pediatric Nursing, 22(1):59-68. Schilling, L. S. , Grey, M. and Knafl, K. A. (2002), The concept of self-management of type 1 diabetes in children and adolescents: an evolutionary concept analysis [Abstract]. Journal of Advanced Nursing, 37: 87–99. DOI: 10.1046/j.1365-2648.2002.02061.x Instructions: Assignment 2 Write a paper (1,500 words) in which you analyze and appraise each of the (15) articles identified in Module 1. Pay particular attention to evidence that supports the problem, issue, or deficit, and your proposed solution. (Summarize each section in 1-2 paragraphs.) 1) Summary of Article: 2) Research Elements: Design, Methods, Population, Strengths, Limitations: 3) Outcome(s): Research Results: 4) Significance to Nursing and Patient Care: Ref 1: Nadeem, T., Qamar, F. & Mehmood, K.T. (2010). Management of Juvenile Diabetes. Journal of Pharmaceutical Sciences and Research, 2(12): 827-831. This article is a retrospective study of 40 patients diagnosed with Type 1 Diabetes. It discussed the onset of the disease happening during childhood and children become insulin dependent since it is an auto-immune disorder. The research investigated in areas of assessment on management, treatment and control of this disease in children. They have found out from the number of patients studied that 43% took combination therapy of humulin N and humulin R, 47% showed poor dietary compliance, 39% got accustomed in facing 1-3 hypoglycemic attacks per ibtg and 40% showed poor control on diabetes using the Hb1C test. A high incidence of 50% of ketones being present was found on Benedict’s test on the children’s urine. It shows that self-management method of injecting insulin was not consistently done as properly as it should and therefore, it was ineffective as a treatment for the children. The daily intake of food is important to be monitored, so that the glucose level in the blood can be monitored as well. Nursing Care can play an important role in encouraging proper implementation of dietary requirements for Type 1 Diabetic patients, to enable children to enjoy good health inspite of the disease. Ref 2: Soltesz, G., Patterson, C. & Dahlquist, G. (2009). Diabetes in the Young: A Global Perspective. IDF Diabetes Atlas Fourth Edition. 36pp. This article discussed the fatal characteristics of Type 1 diabetes, being the most common endocrine and metabolic conditions in childhood, its high incidence of occurrence even in the youngest children and its global effects to many children who in several less-privileged families of many countries, have limited access to self-care tools and insulin thereby leading to unfortunate cases of severe handicap and early death in children. The global trends of incidence were mapped. Its increasing trends in many countries in Europe were proven. There is a risk that patients face in terms of the ability to manage and procure the necessary medicines and self-care tools. There’s a decreasing age at diagnosis which means the occurrence is greatest at younger children, most likely because of the subtle and misleading symptoms of the disease. There are challenges in out-of-hospital stabilization as it is more costly. The authors identified a high incidence rate per 100,000 on age range 0-29 years in 1996-1997 in three European countries. While an incidence rate of about up to 35% were identified in various ethnicity in the United States which afflicted 0-19 years of patient groups. This implies a big call to the Nursing professionals to further be aggressive and vigilant on treating Type 1 Diabetes because of the evidences of it spreading in many countries and affecting the youngest children the most. Perhaps, education and information dissemination campaigns worldwide on proper diet and discipline among families, schools and institutions would lead to a positive effort of mitigating the devastating occurrence of the disease. Ref 3: Ivvala, A.S., Inampudi, S., Bulakh P.M. & Vikhe, B.B. (2012). Evaluation of Oxidative Stress in Juvenile Diabetes. International Journal of PharmTech Research, 4(2): 602-608. This article is about the validation of the influence of free radical production from hyperglycemic induction, which most likely involves cardiovascular complications in Juvenile Diabetic patients. Thus, the study aimed to have a comparison of the glutathione (GSH) level and glutathione peroxidase (GPx) activity in Juvenile and normal healthy group. The researchers involved 20 normal healthy subjects and 20 juvenile diabetic patients who are 6 to 15 years old. They let them fast, and extracted from them venous blood samples that will be used for successive biochemical determinations. Results showed that red cell GSH was significantly lower in juvenile but red cell GPx was significantly increase when these are compared with the same age subjects in the normal control. A negative correlation was observed between FPG and GSH in juvenile diabetic patients when compared with healthy normal subjects, although this was not found between FPG and GPx activity. These findings indicated that indeed juvenile diabetic patients were vulnerable to oxidative stress and, higher blood glucose level is linked with free-radical-mediated lipid peroxidation. Thus, any intervention or methods that may reduce oxidative stress will be good to the slow progression of cardiovascular complication in juvenile diabetic patients. The nursing practices on care and intervention programs can help diabetic patients to prevent complications of acquiring cardiovascular diseases by also looking on the prevention of factors causing oxidative stress. A lifestyle of proper nutrition to regulate glucose in the blood and appropriate exercise, to complement the medical treatments, must be considered. Ref 4: Koton, S. (2007). Incidence of type 1 diabetes mellitus in the 0- to 17-yr-old Israel population, 1997–2003. Pediatric Diabetes 2007: 8: 60–66. This article discussed the increased incidence of children having Type 1 Diabetes in Israel. It reported the epidemiology among children within the age group of 0 to 17 years old during 1887 to 2003 year period. Data were collected from a national juvenile diabetes register which were reported by all the endocrinologists in all diabetic centers. The overall incidence rates were analysed according to sex, age and population group to identify the gravity of Type 1 Diabetes in Israel. Analyses showed that the disease increased by 34% during the duration considered in this study and that, more Jews acquired the disease compared to Arabs. Among Jews, children with Yemenite origin had the highest incidence, which peaked at earlier age in girls. In 9.1% of these cases, a first-degree family history was true. This study provides a big potential on the hereditary aspects and potentially, environmentally related aspects about Type 1 Diabetes. The nursing profession can conduct future research directed on detailed investigation on factors that deal with Israel’s high incidence of the disease. Success rates on patient care and disease management can also be investigated that can benefit other patients in other parts of the world that are inflicted with juvenile diabetes. Ref 5: Skocic, M., Darko Marcinko, D., Razic, A., Stipcevic, M. &Rudan V. (2012). Relationship between Psychopathological Factors and Metabolic Control in Children and Adolescents with Insulin-Dependent Diabetes mellitus Coll. Antropol. 36 (2): 467–472. This study was conducted to explore on the family studies suggesting that patients who are in dysfunctional families and those children coming from parents with high degrees of psychopathology, tend to have poor glycemic control. The relationship between psychological/psychopathological factors and, the metabolic control among children and adolescents with Type 1 Diabetes was sought. The effects of psychoeducational/psychotherapeutic interventions on glycemic control in patients less than 18 years old were also considered. Results showed that it is highly likely correlated, that insulin-dependent diabetes mellitus children have poor glycemic control, and children from families undergoing psychoeducationl/psychotherapeutic interventions show high potentials of contributions to improve metabolic control. The limitation though, is the research is based on an exhaustive literature review. An actual social research on the subjects involved, tapping with physiological parameters can provide a robust validation of these inferences. Nursing practices can be revolutionized with the idea of promoting healthy relationships among family structures and, seeking help should there be any sign of difficulties, as significant contributors to glycemic control. Ref 6: Knip, M., Veijola, R., Virtanen, S.M., Hyoty, H.,Vaarala, O. &Akerblom, H.K. (2005). Environmental Triggers and Determinants of Type 1Diabetes. DIABETES, 54(2) S125-S136. This article explored on the perception of Type 1 Diabetes being determined by genetics and, a series of exogenous factors with exact seasonal variation and driven by one or several other environmental determinants. Type 1 Diabetes is viewed as a chronic immune-mediated disease with its subclinical prodromal period determined by selective loss of insulin-producing Beta cells in the pancreatic islets, in those subjects that are genetically susceptible. The evidences on the contributions of exogenous factors in the development of the disease include the fact that less than 10% of individuals with HLA-conferred diabetes susceptible progress to clinical disease, concordance of Type 1 Diabetes of less than 40% monozygotic twins, more than 1—fold difference in the disease incidence in Caucasians who are in Europe and more increase in the incidence over the last 50 years, and, migration studies showed that the disease incidence has increased in population groups who moved from a region of low-incidence to a region of high-incidence. A series of literature review, case studies and research have been considered to propose the actuality of the trigger-booster hypothesis. It was found out that the progression to clinical type 1 diabetes happen from the unfortunate combination of genetic disease susceptibility, a diabetogenic trigger and high exposure to a driving antigen. It will be beneficial in the future when the environmental culprits and boosters of Beta cell autoimmunity have been identified and those exogenous factors that impact the natural history of Type 1 Diabetes. The Nursing Care procedures would also benefit from this information as the patients could be advised of additional pointers on what activities or type of places to be avoided so as not to make the condition worse. While we all wait that research informs us of these data, we stick to what we already know about Type 1 Diabetes management, and implement all that’s necessary with vigilance and care. Ref 7: Cosgrove, M. (2004). Do stressful life events cause type 1 diabetes? Occupational Medicine. 54:250–254. DOI: 10.1093/occmed/kqh047. This article explored on the connection of psychological stresses with deteriorating diabetes control. It has become a possibility as it has been commonly reported that those who have developed Type 1 Diabetes related recent stressful event before the diagnosis. A thorough electronic and manual literature search was conducted relating to known cases of stressful life events causing Type 1 Diabetes. A systematic literature review on these resources was conducted for assessment of the validity of the proposed relationship of the disease and driving factor. Results of these bigger studies disprove the hypothesis however. No difference was found between the number and severity of life events when compared with controls. It has to be taken consideration however that this study was conducted by somebody who works for a pension company. The purpose of his study was to validate a common claim by Type 1 Diabetic patients that their disease developed after a stressful event at work or in a sustained occupationally stressful environment. Although the correlation was not established in this paper, there have been similar inferences from earlier studies about Type 1 Diabetes. It is suggested that empirical data be collected to further establish this fact. Health and wellness practitioners will still advise anybody that stress is a culprit leading our bodies to lowered immune system functionalities and later to developing deadly diseases. The Nursing Care can apply that a positive outlook in life can promote good management of such disease albeit of its chronic nature. Ref 8: D. Lopes Souto, D.L. & de Miranda, M.P.(2011). Physical exercises on glycemic control in type 1 diabetes mellitus. Nutr Hosp. 26(3):425-429. DOI:10.3305/nh.2011.26.3.4962. This study investigated on the relationship of physical activity and glycemic control among patients with Type 1 Diabetes. Since it has been recognized that Type 1 Diabetes is a type of metabolic disease described by hyperglycemia which is a result of the destruction of insulin-producing pancreatic beta cells, its known effective management include insulin, dietary and physical activity. The inclusion criteria was critically applied to literatures published from 1992 to 2009. There were two studies with positive association between physical exercises and adequacy of glycemic control on long-term, determined by glycated haemoglobin (HbA1c) and increase in insulin sensitivity. However, three studies showed no relationship between exercises and glucose, insulin sensitivity and formation of ketone bodies. Thus, positive influences are observed on a long-term glycemic control but results are contrasting in the light of insulin sensitivity and fasting glucose. Glycemic control in diabetes must be based on the values of HbA1c, blood glucose monitoring and, reduction of insulin requirement. It only proves that physical exercise when complemented with diet modifications and also medications, diabetes can be well managed. This must be implemented in the Nursing Practice Care to diabetic patients, that glycemic control is a lifelong process which patients can learn to be skilled at, and physical activity can contribute significantly. Ref 9: Allen, N.A. (2009). Continuous glucose monitoring improved glucose control in adults but not in young adults or children with type 1 diabetes. Evid. Based Nurs. 12(2):44. doi:10.1136/ebn.12.2.44 This article answered the question on whether continuous glucose monitoring (CGM) can improve glucose control in both children and adult having Type 1 Diabetes. The researchers implemented a randomized controlled trial in 10 centres in the United States within 26 weeks involving 322 adults and children of over 8 years old with Type 1 Diabetes for over a year already and, have glycated haemoglobin (HbA1c) concentrations of 7 to 10%, have received intensive insulin therapy through insulin pump of more than 3 injections daily and had not recently used CGM at home,they all completed 1 week run in phase. An intervention of CGM using a subcutaneous sensor (n=165) or home monitoring using blood glucose meter of more thatn 4 times a daily (n=157). CGM was found to cause greater mean decrease in HbA1c concentration rather than monitoring through a blood glucose meter in the age group of more than 25 years. It also increase the proportion of patients who had relative reduction in HbA1c concentration of more than 10% in the oldest and youngest age groups. No difference in risk of severe hypoglycaemia in any age group. This shows a positive glucose control in Type 1 Diabetes patients who are adults, but not to the young adults or children. The Nursing Professionals can apply the CGM to the adult patients of Type 1 Diabetes. Improved glucose control can be expected. Ref 10: Iafusco D., Prisco F., Romano M.R., Dell’Omo R., Libondi T. & Costagliola C. (2011). Acute juvenile cataract in newly diagnosed type 1 diabetic patients: a description of six cases. Pediatric Diabetes, 12: 642–648. This article described about six cases of acute cataract diagnosed in young diabetic patients at the onset of Type 1 Diabetes. Cataract is a known frequent eye complications in Type 1 and Type 2 Diabetes, however acute cataract occurs very rarely. A study on 826 patients having Type 1 Diabetes showed that 0.7% or six patients had acute lens opacities. The complication of cataract was significantly correlated with HbA1c and glycemia. This relative risk intensified twice for each percentage point from 12.8 to 14.1% of HbA1c. Glycemic blood levels signified a moderate risk factor for cataractogenesis. This finding is an essential information for Nursing Care to Type 1 Diabetes patients as regarding to glycemic control in the blood of patients. Certain blood levels must be maintained to reduce the risk of having acute cataract. All disciplines and precautionary measures must then be implemented for the patients to maintain good eyesight and positive management of the disease. Ref 11: Dantzer C., Swendsen J., Maurice-Tison, S. & Salamon, R. (2003). Anxiety and depression in juvenile diabetes: A critical review. Clinical Psychology Review 23:787–800. This study conducted a critical examination on the recent literatures that report Type 1 Juvenile Diabetes being related to anxiety and depression. It specifically investigated on the general association of psychological factors to diabetes and the specific association of anxiety and depression with metabolic control. Results showed that psychological disorders are indeed related with juvenile diabetes. But the association of anxiety and depression with metabolic control are yet to be studied albeit, anxiety and depression seemed to display important and complex role in the determination of the adaptation to the disease. Further prospective and controlled investigation, with multivariate models of chronic disease were suggested to gain a better understanding. Nursing practices must be directed towards a mental wellness drive as well, apart from medical aspect to promote progressive development among adolescents with Type 1 Diabetes. Ref 12: Kocic, G., Pavlovic, R., Najman, S., Nikolic, G., Sokolovic, D., Tatjana Jevtovic-Stoimenov, T., Musovic, D., Veljkovic, A., Kocic, R. & Djindjic, N. (2011). Circulating Ribonucleic Acids and Metabolic Stress Parameters May Reflect Progression of Autoimmune or Inflammatory Conditions in Juvenile Type 1 Diabetes. TheScientificWorldJOURNAL, 11: 1496–1508. DOI 10.1100/tsw.2011.133 This research evaluated the effect of circulating ribonucleic acids (RNAs) which were isolated from Type 1 Juvenile Diabetes patients and healthy control children, investigating on the inflammatory, apoptotic, and antiviral response in human peripheral blood mononuclear cells (PBMCs) isolated from a healthy donor. The observed processes were then compared to the effects of metabolic stress parameters identified as hyperglycemia, oxidative and nitrosative stress, in this case. A total of 48 children patients with Type 1 Juvenile Diabetes patients and control were observed. A chromatographic analysis of circulating RNAs was done, with its peak at retention time 0.645 min for diabetic and control RNA samples. To identify whether these RNAs contribute an agonistic or antagonistic effect on signalling pathways involved in inflammatory, apoptotic and antiviral cascade, their effect on various human peripheral blood mononuclear cells (PBMCs). There was a significant lower level achieved when PBMCs were cultivated with circulating RNAs isolated from Type 1 Juvenile Diabetes patients compared to the intact PBMCs. This showed that all metabolic stress conditions increasingly regulated NF-?B, Bcl-2, and Bax. These imply that circulating RNAs may modulate the inflammatory and apoptotic pathway, that can direct to impaired cellular antiviral responsiveness in Type 1 Juvenile Diabetes. Nursing practitioners need to take precautions towards the management in all aspects of wellness among Type 1 Diabetes patients, so that the metabolic stressors can be avoided as this can worsen the health condition of the patients. Ref 13: Rajashree R., Kholkute, S.D. & Goudar, S.S. (2011). Effects of Duration of Diabetes on Behavioural and Cognitive Parameters in Streptozotocin-Induced Juvenile Diabetic Rats. Malaysian J Med Sci. 18(4): 26-31. This article explored the effects of different durations of hyperglycaemia on the behavioural and cognitive aspects of Type 1 Diabetes patients. One of the known complication of early onset Type 1Diabetes in children is diabetic encephalopathy. Abnormalities related to it are complex and not yet understood, its impacts are also poorly understood. To find answers to these questions, rats were used as biological assays. Young rats were induced with diabetes, those that are weaned and age-matched were injected with streptozotocin. Diabetes was confirmed on post natal day 30. They were then tested in the elevated plus maze 10 and 20days after this. Results clearly showed impaired behavioural and cognitive functions. Increased levels of anxiety and cognitive deficits were more prevalent in rats who were diabetic for 20 days when compared with 10 days. The experiment confirms that it is critical to diagnose and provide treatment for early onset Type 1 Diabetes in young children to avoid an irreversible cognitive function. The Nursing Care need to assure proper diagnosis of the disease on very young patients so that they could be given appropriate treatment, and more importantly to eliminate the risk of having serious complications on the brain specifically the cognitive dysfunction. Ref 14: Sandra L. Fritsch, S.L., Mark W. Overton, M.W. & Robbins, D.R. (2010). The Interface of Child Mental Health and Juvenile Diabetes Mellitus, Child Adolesc Psychiatric Clin N Am 19: 335–352. doi:10.1016/j.chc.2010.01.008. This article discussed all the critical aspects of Type 1 Diabetes including its characteristics, its destructive method of operations, its prevalence among patients in terms of geography, age, gender, family history, and race, and the gravity of its complications, with focus on the mental health of the children patients. It seemed that the risk of developing this disease increases with distance from the equator. The article urges the importance of psychosocial adjustment and behaviour of patients with this disease so that a good medical outcome and quality of life can still be expected, aspects of family support, monitoring and communications must be considered as well. Type 1 Diabetes is indeed a stressor for parents that may affect and complicate the normal child and adolescent development. Currently, several moderators and mediators of outcomes and, innovative interventions to manage and study Type 1 Diabetes have been developed. Actually, to improve the condition of the patients including their families, nurse practitioners need to understand and address psychosocial adaptation to the disease. The authors suggest protective factors like family communication skills, spousal support, and enhancement of positive self-perception must be encouraged to minimize short- and long-term complications. Ref 15: Sansom-Daly, U.M., Peate, M., Wakefield, C.E., Bryant, R.A. & Cohn, R.J. (2011). A Systematic Review of Psychological Interventions for Adolescents and Young Adults Living With Chronic Illness. American Psychological Association, 31(3): 380–393. DOI: This article reviewed published psychological interventions for adolescents and young adults diagnosed with cancer, diabetes, juvenile idiopathic arthritis, sickle cell disease, and asthma. The study was motivated by the known fact that the same patients also suffer common psychological challenges. To enable the research, five databases were searched for studies that involved adolescents and young adults with 10 to 30 years of age and have employed quantitative two group methods published from 1979 up to 2010. It was found out that educational interventions showed some significant positive results, especially when targeted knowledge outcomes were measured. Several skills-based programs, some including parents, showed positive results, with moderate effect sizes. Interventions that taught communication skills, incorporated practical components (e.g., role-plays, homework), involved 6 sessions, and lasted at least 3 months in duration, appeared more likely to achieve positive outcomes. Thus, the authors suggest that skills-based interventions implemented over multiple sessions may produce the most positive results in adolescents and young adults patients with chronic illness. There is a need for intervention development that teaches adaptive coping skills, based on solid foundations of theoretical frameworks, and meets the strict randomization and independent assessments to evaluate efficacy in assisting adolescents and young adults adjusting to chronic illness. These are very practical and useful directions for the Nursing practitioners who attend to the caring of adolescents and young adults with Type 1 Diabetes. Helping them prepare towards a bright future is still possible provided with the right intervention and education. Read More