Les pompes à insuline sont en plein essor en diabétologie pédiatrique. L’objectif de cette étude était d’évaluer la qualité de vie (QV) et la satisfaction des enfants et adolescents diabétiques de ...type 1 sous pompe à insuline. Un auto-questionnaire rétrospectif a été distribué à 41 enfants. Il portait sur la QV générale et la QV spécifique au diabète et était complété par des éléments spécifiques à la pompe et sur la satisfaction. Des paramètres cliniques et biologiques dont l’hémoglobine glyquée (HbA1c) ont été comparés avant et après la mise en place de la pompe. Le score de QV sous pompe était positif, d’autant plus qu’elle était mise en place précocement après le diagnostic de diabète (p=0,03) et chez l’enfant de moins de 8ans (p<0,02). Cet effet positif concernait surtout les spécificités de la pompe : « gestion de l’insuline » et « injections » mais aussi la gestion du diabète, les émotions et comportement, la scolarité, la vie en famille, la vie quotidienne et les activités physiques. En revanche, le score pour l’item « vie en société, entourage » n’était pas significatif. La baisse du nombre de piqûres et la souplesse des repas étaient les points les plus positifs. L’HbA1c s’améliorait dès l’indication de la pompe avant sa mise en route (p=0,005) et était stable pendant 4ans (p≤0,05). Les oublis des injections, les remarques sur le diabète et les problèmes techniques semblaient faire exception. La pompe modifiait l’image du corps par un sentiment ambivalent de normalité (libertés engendrées) et de différence (visibilité, rappel de la maladie). Les bénéfices de QV et d’équilibre glycémique sous pompe sont indissociables et ne peuvent s’envisager qu’entourés d’un accompagnement médical et paramédical. Améliorer la QV à court et à long terme en diminuant le risque de complications ultérieures constitue le défi quotidien des familles et des diabétologues.
Insulin pumps are booming in pediatric diabetology. The objective of this study was to assess changes for children and adolescents with type 1 diabetes using a pump in terms of quality of life (QOL), satisfaction, and glycosylated hemoglobin. A retrospective self-evaluation questionnaire was distributed to 41 patients. It focused on general QOL, diabetes-specific QOL supplemented by specific questions on the pump, and satisfaction. Clinical and biological parameters (glycated hemoglobin: HbA1c) were compared before and after pump use. The score for QOL with the pump was positive, more so if started early after diagnosis of diabetes (P=0.03) and with children under the age of 8 years (P<0.02). These positive results are mainly related to the characteristics of the pump, “insulin management” and “injections,” as well as “diabetes management,” “behavior,” “school,” “family life,” “daily life,” and “physical activities.” On the other hand, the improvement was not significant for the item “life in society, friends and family.” A decrease in the number of injections and the flexibility of meals were the most positive points. HbA1c improved as soon as the pump was indicated before its use was begun (P=0.005) and remained constant for 4 years (P≤0.05). Forgotten injections, comments on diabetes, and technical problems appeared to be exceptional. The pump changed the patient's body image because of ambivalent feelings between being normal (greater freedom) and different (visibility and a reminder of the disease). The benefits in terms of QOL and glycemic control with the pump cannot be dissociated and can only be considered accompanied by paramedical and medical assistance. Improving QOL over the short and long term by reducing the risk of further complications is the daily challenge of families and diabetologists.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
L’endocardite infectieuse (EI), nécessite une antibiothérapie prolongée. Ce traitement intraveineux (IV) est à la fois coûteux et contraignant. Des antibiotiques possédant une bonne biodisponibilité ...par voie sous-cutanée (SC) permettent un relais de la voie IV chez l’adulte, comme la teicoplanine.
Nous rapportons l’utilisation pratique de la teicoplanine par voie SC en relais d’une antibiothérapie initiale par voie IV chez 2 enfants traités pour endocardite infectieuse après un acte de chirurgie cardiaque. Les taux sériques de teicoplanine avaient été efficaces après adaptation des doses utilisées par voie SC. La teicoplanine avait été efficace dans les 2 cas. Aucun effet indésirable imputable au traitement n’avait été relevé.
La voie SC peut être utilisée pour l’administration prolongée de la teicoplanine chez l’enfant présentant une endocardite infectieuse, en relais d’une antibiothérapie IV. Ce traitement nécessite une surveillance biologique et des adaptations régulières de dose. Des études prospectives sont nécessaires pour juger de l’efficacité et de la tolérance de ce traitement.
Infectious endocarditis in children requires prolonged antibiotic therapy. In adults, antibiotics administrated subcutaneously such as teicoplanin are an alternative to intravenous treatment.
We report the use of subcutaneous teicoplanin, after an initial antibiotic treatment administrated intravenously, for 2 children treated for infectious endocarditis following an initial cardiac surgery. Serum concentrations of teicoplanin were within the target range after the adaptation in the teicoplanin subcutaneous dosages. The treatment was effective for both cases. No specific side effects related to the treatment were reported.
Subcutaneous administration could be used for prolonged antibiotic therapy for the treatment of infectious endocarditis in children, after an initial intravenous treatment. Variability of the bioavailability of antibiotics administrated subcutaneously requires regular testing. Prospective, randomized trials comparing intravenous and subcutaneous administration of teicoplanin should be conducted to assess the efficacy and safety of this treatment.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Insulin pumps are booming in pediatric diabetology. The objective of this study was to assess changes for children and adolescents with type 1 diabetes using a pump in terms of quality of life (QOL), ...satisfaction, and glycosylated hemoglobin. A retrospective self-evaluation questionnaire was distributed to 41 patients. It focused on general QOL, diabetes-specific QOL supplemented by specific questions on the pump, and satisfaction. Clinical and biological parameters (glycated hemoglobin: HbA1c) were compared before and after pump use. The score for QOL with the pump was positive, more so if started early after diagnosis of diabetes (P=0.03) and with children under the age of 8 years (P<0.02). These positive results are mainly related to the characteristics of the pump, "insulin management" and "injections," as well as "diabetes management," "behavior," "school," "family life," "daily life," and "physical activities." On the other hand, the improvement was not significant for the item "life in society, friends and family." A decrease in the number of injections and the flexibility of meals were the most positive points. HbA1c improved as soon as the pump was indicated before its use was begun (P=0.005) and remained constant for 4 years (P≤0.05). Forgotten injections, comments on diabetes, and technical problems appeared to be exceptional. The pump changed the patient's body image because of ambivalent feelings between being normal (greater freedom) and different (visibility and a reminder of the disease). The benefits in terms of QOL and glycemic control with the pump cannot be dissociated and can only be considered accompanied by paramedical and medical assistance. Improving QOL over the short and long term by reducing the risk of further complications is the daily challenge of families and diabetologists.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
X-linked hypophosphatemia (XLH) is a rare, chronic, genetic condition characterized by renal phosphate wasting and abnormal bone and teeth mineralization. It represents a challenging and multifaceted ...disease that causes wide-ranging impacts on patients' lives. In this context, a scientific committee has designed a support initiative for patients treated for XLH: the aXess program. We sought to determine if a patient support program (PSP) could help XLH patients cope with their condition.
During the 12 months of participation in the aXess program, XLH patients were contacted by phone by a nurse to coordinate their treatment, ensure treatment adherence, and provide motivational interviews. A Pediatric QOL inventory was conducted on all participants at enrollment (D0), at month 6, and month 12.
Altogether, a total of 59 patients were enrolled in the program. Most patients reported an improvement in QOL in all examined dimensions by month 12 (physical, emotional, social, and school, 85.4 ± 0.2 at month 12 versus 75.6 ± 0.3 at enrollment, p<0.05). Patients were very satisfied with the program, with a mean overall satisfaction score of 9.8 ± 0.6 (on a scale from 0 to 10) at month 6 and 9.2 ± 1.5 at month 12.
Our findings indicate that this program might improve the QOL for patients with chronic conditions such as XLH through patient education, therapy adherence, motivational interviews, and frequent follow-up. It links the home environment and overall illness management, bringing patients, families, and caregivers together.
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IZUM, KILJ, NUK, PILJ, PNG, SAZU, UL, UM, UPUK
Infectious endocarditis in children requires prolonged antibiotic therapy. In adults, antibiotics administrated subcutaneously such as teicoplanin are an alternative to intravenous treatment.
We ...report the use of subcutaneous teicoplanin, after an initial antibiotic treatment administrated intravenously, for 2 children treated for infectious endocarditis following an initial cardiac surgery. Serum concentrations of teicoplanin were within the target range after the adaptation in the teicoplanin subcutaneous dosages. The treatment was effective for both cases. No specific side effects related to the treatment were reported.
Subcutaneous administration could be used for prolonged antibiotic therapy for the treatment of infectious endocarditis in children, after an initial intravenous treatment. Variability of the bioavailability of antibiotics administrated subcutaneously requires regular testing. Prospective, randomized trials comparing intravenous and subcutaneous administration of teicoplanin should be conducted to assess the efficacy and safety of this treatment.
Full text
Available for:
GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
