Introduction: The management of type 1 diabetes (T1D) is especially complex during adolescence when youths are transferred to adult care centres. The objectives of this qualitative study were to: a) ...determine the expectations of young T1D patients prior to transfer, b) evaluate the transfer process between the 2 centres, and c) evaluate the therapeutic education and care programme (TECP) in the adult centre from their point of view. Material and Methods: Opinion sampling of adolescents from 2018-2019 was performed: Phase 1: adolescents with T1D prior to transfer to the adult hospital; Phase 2: adolescents with T1D one or two years after transfer and having undergone TECP. A focus group (1.5h) and semi-structured interviews (45 min) were performed and taped, transcribed, and sent to the participants for confirmation. Date analysis was performed of the transcriptions of the focus group and interviews. Fragments were selected and meta-categories created. Results: Eleven youths accepted to participate: 7 in Phase 1, 4 repeated in Phase 2 and 4 more transferred 2 years previously were added. The meta-categories obtained were: 1) perception of the quality of care and therapeutic education in the paediatric hospital. 2) transfer to the adult hospital. 3) experience of the youths 1-2 years after transfer and having undergone TECP. The data are presented in narrative form and are supported with text fragments of the participants' discussions. Discussion and conclusions: Analysis of patients' experience complemented by clinical-educational evaluation of TECP provides understanding of the perspectives of youths on the complexity of living with a chronic disease since childhood. It also provides information regarding the factors favouring quality care and therapeutic education, the complexity of transfer from paediatric to adult care, determination of the strong and weak points and the establishment of strategies to improve the programme. Keywords: Type 1 diabetes, adolescents, transition to adult care, qualitative research, patient experience, therapeutic patient education
OBJECTIVEEvaluate the results of a healthcare and therapeutic education programme (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a paediatric centre. METHODOLOGYThis was a ...prospective, pre-postest in young T1D patients transferred from 2005-2015. The programme has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es < 65 vs. > 65%). RESULTSA total of 330 patients were transferred (age 18.19 ± 0.82 years, 49% females, glycated haemoglobin HbA1c 8.6 ± 1.4%). The programme was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3 ± 1.4 vs. 8.2 ± 1.4%), there were changes in severe hypoglycaemias/patient/year (0.23 ± 0.64 to 0.05 ± 0.34 p < 0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p = 0.09). DQK2 knowledge increased (25.7 ± 3.6 vs. 27.8 ± 3.8 p < 0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n = 21) performed more blood glucose controls and showed greater programme adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p < 0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥ 0.5% (p < 0.05) CONCLUSIONS: The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.
Evaluate the results of a healthcare and therapeutic education program (TEP) aimed at young patients with type 1 diabetes (T1D) transferred from a pediatric center.
This was a prospective, ...pre-postest in young T1D patients transferred from 2005–2015. The program has four phases: coordinated transfer, evaluation and objective pacting, knowledge (DKQ2) adherence (SCI-R.es) and quality of life (DQoL and SF12). Results were compared according to Multiple Daily Injections (MDI) vs. Continuous Subcutaneous Insulin Infusión (CSII) and adherence (SCI-R.es <65 vs. >65%).
A total of 330 patients were transferred (age 18.19±0.82 years, 49% females, glycated hemoglobin HbA1c 8.6±1.4%). The program was completed by 68%, and 61% did a group course. While no changes in HbA1c were observed at one year (8.3±1.4 vs. 8.2±1.4%), there were changes in severe hypoglycaemias/patient/year (0.23±0.64 to 0.05±0.34 p<0.001) and mild > 5 hypoglycaemias/patient/week (6.9% vs. 3.9% p=0.09). DQK2 knowledge increased (25.7±3.6 vs. 27.8±3.8 p<0.001), with no changes in quality of life or grade of adherence. Patients with CSII (n=21) performed more blood glucose controls and showed greater program adherence with no changes in metabolic control. Patients with the best initial adherence presented the best control (p<0.0001). A lower initial HbA1c and receiving the group course were associated with better clinical HbA1c results ≥0.5% (p<0.05).
The TEP improved some parameters of metabolic control without modifying the quality of life in young T1D patients. When comparing patients on MDI vs. CSII, there were no differences in metabolic control but there were when differences were evaluated considering treatment adherence.
Evaluar los resultados de un programa de atención y educación terapéutica (PAET-Traslados) dirigido a jóvenes con diabetes tipo 1 (DT1) trasladados de Pediatría.
Estudio prospectivo, pre-postest en jóvenes con DT1 trasladados entre 2005-2015. El programa tiene cuatro fases: traslado coordinado; valoración y pacto de objetivos; curso en grupo; seguimiento. Al inicio y 12 meses se evaluó control metabólico, conocimientos (DKQ2), adherencia (SCI-R.es) y calidad de vida (DQoL y SF12). Se compararon resultados según tratamiento (Múltiples Dosis de Insulina-MDI vs. Bomba Insulina-BI) y según adherencia (SCI-R.es<65 vs. > 65%).
Se trasladaron 330 pacientes (edad 18,19±0,82 años, 49% mujeres, HbA1c 8,6±1,4%). El 68% completó el programa y el 61% realizó el curso en grupo. Al año no se observaron cambios en la HbA1c (8,3±1,4 vs. 8,2±1,4%) aunque si en las hipoglucemias graves/paciente/año (0,23±0,64 a 0,05±0,34 p<0,001) y leves > 5 hipoglucemias/paciente/semana (6,9 vs. 3,9% p=0,09). Aumentaron los conocimientos DQK2 (25,7±3,6 vs. 27,8±3,8 p<0,001), sin cambios en la calidad de vida, ni el grado de adherencia. Los pacientes con BI (n21) realizaron más glucemias capilares y seguimiento del programa, sin observarse cambios de control metabólico. Los pacientes con mejor adherencia inicial presentaron mejor control (p<0,0001). Una menor HbA1c inicial y realizar el curso en grupo se asoció con una mejoría clínica de la HbA1c ≥ 0,5% (p<0,05)
El PAET-Traslados mejora algunos parámetros del control metabólico sin modificar la calidad de vida. No se observaron diferencias en el control metabólico entre pacientes con MDI vs. BI, aunque si según el grado de adherencia al tratamiento.
Therapeutic education (TE) has been gradually introduced progressively into diabetes mellitus care programs with the aim of providing patients and their families or caregivers with the necessary ...skills for the self-management of the disease. The Diabetes Attitudes, Wishes and Needs 2 (DAWN2) study helps to clarify what are the unmet needs with regards to self-management and the TE offer available to patients and their families. The objective of this paper is to analyse the results of the DAWN2 study regarding self-care habits and participation in TE activities in Spain.
The DAWN2 is an observational, cross-national study. In this paper, an analysis was performed on the Spanish sample of diabetic patients (502) and family members (123).
Patients report taking their medications as recommended by their doctor an average of 6.4 days/week, and self-monitor their blood glucose an average of 3.4 days/week. The large majority (86%) of patients with diabetes mellitus type 1, 59% of patients with diabetes mellitus type 2, and 21% of family members state to have participated in education activities.
Diabetes educators should reinforce the messages about the benefits of self-care, particularly for patients who are in the early stages of the disease. Likewise, access for family members and people with diabetes mellitus type 2 to TE programs should be improved, and these programs for diabetic patients and their families should be included in the services portfolio of health centres.
Resumen Introducción La educación terapéutica (ET) se ha introducido progresivamente en los programas de atención a la diabetes mellitus para dotar a las personas con diabetes, sus familiares y ...cuidadores de los conocimientos necesarios para la autogestión de la enfermedad. El estudio Diabetes Attitudes, Wishes and Needs 2 (DAWN2) contribuye a clarificar cuáles son las necesidades no cubiertas en relación con la autogestión de la enfermedad y la ET a disposición de las personas con diabetes y sus familias. El objetivo de este trabajo es analizar los resultados del estudio DAWN2 relativos a hábitos de autocuidado y la asistencia a actividades de ET en España. Métodos El DAWN2 es un estudio internacional, observacional transversal. En este trabajo hemos tomado en consideración la muestra española de personas con diabetes (502) y familiares (123). Resultados Las personas con diabetes manifiestan tomar la medicación prescrita en la pauta recomendada por su médico 6,4 días de media a la semana y reconocen autocontrolar su nivel de glucosa una media de 3,4 días a la semana. El 86% de los pacientes con diabetes mellitus tipo 1 y el 59% de los pacientes con diabetes mellitus tipo 2 reconocen haber recibido algún tipo de actividad educativa, al igual que el 21% de los familiares. Conclusiones Los educadores en diabetes deberían reforzar los mensajes acerca de los beneficios derivados del autocuidado, en especial para los pacientes que están en las etapas iníciales de la enfermedad. Asimismo, convendría mejorar el acceso de familiares y personas con diabetes mellitus tipo 2 a programas de ET y reflejar en la cartera de servicios de los centros sanitarios los programas de ET disponibles para las personas con diabetes y sus familiares.
Abstract Introduction Therapeutic education (TE) has been gradually introduced progressively into diabetes mellitus care programs with the aim of providing patients and their families or caregivers ...with the necessary skills for the self-management of the disease. The Diabetes Attitudes, Wishes and Needs 2 (DAWN2) study helps to clarify what are the unmet needs with regards to self-management and the TE offer available to patients and their families. The objective of this paper is to analyze the results of the DAWN2 study regarding self-care habits and participation in TE activities in Spain. Methods The DAWN2 is an observational, cross-national study. In this paper, an analysis was performed on the Spanish sample of diabetic patients (502) and family members (123). Results Patients report taking their medications as recommended by their doctor an average of 6.4 days/week, and self-monitor their blood glucose an average of 3.4 days/week. The large majority (86%) of patients with diabetes mellitus type 1, 59% of patients with diabetes mellitus type 2, and 21% of family members state to have participated in education activities. Conclusions Diabetes educators should reinforce the messages about the benefits of self-care, particularly for patients who are in the early stages of the disease. Likewise, access for family members and people with diabetes mellitus type 2 to TE programs should be improved, and these programs for diabetic patients and their families should be included in the services portfolio of health centers.
