The aim of this literature review was to explore the views of parents and children with type 1 diabetes mellitus regarding having a school nurse.
Six databases were selected for the analysis. The ...research strategy was based on the PICO model. The research participants were children with type 1 diabetes mellitus and/or their parents.
The present review of research papers includes 12 publications. The majority of works deal with the perspectives of children with type 1 diabetes and their parents on various aspects related to the role of a school nurse in the care of a child with type 1 diabetes:the presence of a school nurse;the role of a school nurse in the prevention and treatment of hypoglycaemia, in performing the measurements of blood glucose, and in insulin therapy;the role of a nurse in improving metabolic control of children with type 1 diabetes;a nurse as an educator for children with type 1 diabetes, classmates, teachers, teacher's assistants, principals, administrators, cafeteria workers, coaches, gym teachers, bus drivers, and school office staff;a nurse as an organiser of the care for children with type 1 diabetes.
According to parents and children with type 1 diabetes mellitus, various forms of school nurse support (i.e., checking blood glucose, giving insulin, giving glucagon, treating low and high blood glucose levels, carbohydrate counting) are consistently effective and should have an impact on the condition, improvement of metabolic control, school activity and safety at school.
Hypoglycaemia is the major barrier for glycaemic target achievement in patients treated with insulin. The aim of the present study was to investigate real-world incidence and predictors of ...hypoglycaemia in insulin-treated patients.
More than 300 consecutive patients with type 1 or type 2 diabetes treated with insulin were enrolled during regular out-patient visits from 36 diabetes practices throughout the whole country. They completed a comprehensive questionnaire on hypoglycaemia knowledge, awareness, and incidence in the last month and last six months. In addition, in the prospective part, patients recorded incidence of hypoglycaemic events using a special diary prospectively on a daily basis, through 4 weeks.
At least one hypoglycaemic event was self-reported in 84.1%, and 56.4% of patients with type 1 and type 2 diabetes, respectively, during the prospective period of 4 weeks. 43.4% and 26.2% of patients with type 1 and type 2 diabetes, respectively, experienced a nocturnal hypoglycaemic event. In the same time-period, severe hypoglycaemia was experienced by 15.9% and 7.1% of patients with type 1 and type 2 diabetes, respectively. Lower glycated haemoglobin was not a significant predictor of hypoglycaemia.
Rates of self-reported hypoglycaemia in patients treated with insulin in the largest and most comprehensive study in Slovenia so far are higher than reported from randomised control trials, but comparable to data from observational studies. Hypoglycaemia incidence was high even with high glycated haemoglobin values.
Navezanost je vedenjski in fiziološki sistem, ki posamezniku omogoča dinamično prilagajanje na okolje. Navezanost se razvija pri sovplivu med dojenčkom in materjo, igra pomembno vlogo pri razvoju ...otrokovih možgan in vpliva na kvaliteto posameznikovih socialnih odnosov vse življenje.
Attachment is a behavioral and physiological system, which enables individual’s dynamic adaptation to its environment. Attachment develops in close interaction between an infant and his/her mother, ...plays an important role in the development of the infant’s brain, and influences the quality of interpersonal relationships throughout life.
Security of attachment is believed to influence individual response to stress, exposing insecurely organized individuals to deregulated autonomic nervous system and exaggerated hypothalamic-pituitary-adrenal activity, which, in turn, produces increased and prolonged exposure to stress-hormones. Such stress responses may have considerable implications for the development of diverse health-risk conditions, such as insulin resistance and hyperlipidemia, shown by numerous studies.
Although the mechanisms are not yet fully understood, there is compelling evidence highlighting the role of psychological stress in the development of type 1 diabetes (T1D). One of the possible contributing factors for the development of T1D may be the influence of attachment security on individual stress reactivity. Thus, the suggestion is that insecurely attached individuals are more prone to experience increased and prolonged influence of stress hormones and other mechanisms causing pancreatic beta-cell destruction. The present paper opens with a short overview of the field of attachment in children, the principal attachment classifications and their historic development, describes the influence of attachment security on individual stress-reactivity and the role of the latter in the development of T1D. Following is a review of recent literature on the attachment in patients with T1D with a conclusion of a proposed role of attachment organization in the etiology of T1D.
Navezanost je vedenjski in fiziološki sistem, ki posamezniku omogoča dinamično prilagajanje na okolje. Navezanost se razvija pri sovplivu med dojenčkom in materjo, igra pomembno vlogo pri razvoju otrokovih možgan in vpliva na kvaliteto posameznikovih socialnih odnosov vse življenje.
Varnost ali oblika navezanosti vpliva na posameznikov odziv na stres (stresno reaktivnost). Tako pride pri negotovo navezanih posameznikih do slabše reguliranega avtonomnega živčnega sistema in pretirane reaktivnosti hipotalamo-hipofizno-suprarenalne osi, zaradi česar so ti v življenju pogosteje in dalj časa izpostavljeni delovanju stresnih hormonov. Tovrsten odziv na stres pa ima pomembno vlogo pri razvoju inzulinske rezistence, hiperlipidemije in drugih stanj, ki predstavljajo tveganje za zdravje.
Čeprav natančni mehanizmi še niso znani, je vedno več dokazov, da psihološki stres pomembno prispeva k razvoju sladkorne bolezni tipa 1 (SBT1). Eden od mehanizmov razvoja te bolezni bi lahko bil tudi vpliv oblike navezanosti na posameznikovo stresno reaktivnost. Tako so lahko negotovo navezani posamezniki pogosteje, dlje in v večji meri izpostavljeni delovanju stresnih hormonov, ki skupaj z drugimi dejavniki povzročajo uničenje beta celic trebušne slinavke.
Ta prispevek prikaže najprej kratek pregled področja navezanosti pri otrocih, glavne oblike navezanosti in njihov zgodovinski razvoj, oriše vpliv oblike navezanosti na posameznikovo stresno reaktivnost in vpliv te reaktivnosti na razvoj SBT1. Zaključi se s predlogom o vlogi oblike navezanosti pri razvoju SBT1 pri otrocih.
Background. Type 1 diabetes (T1D) is an autoimmune chronic disease where hyperglycemia, increased risk of oxidative stress, advanced glycation end-products and other genetic and environmental factors ...lead to T1D complications. Shorter telomeres are associated with hyperglycemic levels and lower serum vitamin D levels.
Methods. Average telomere length (ATL) in whole blood DNA samples was assessed with qPCR method in 53 Slovenian T1D children/adolescents (median age 8.7 years, 1:1.3 male/female ratio). Body mass index standard deviation score (BMI-SDS), glycated haemoglobin and serum level of vitamin D metabolite (25-(OH)-D3) and the age at the onset of T1D were collected from the available medical documentation.
Results. Results indicate shorter ATL in subjects with higher BMI-SDS when compared to those with longer ATL (0.455 ± 0.438, -0.63 ± 0.295; p=0.049). Subjects with higher BMI-SDS had lower serum vitamin D levels when compared to those with lower BMI-SDS (40.66 ± 3.07 vs. 52.86 ± 4.85 nmol/L; p=0.045). Vitamin D serum levels did not significantly differ between subjects with longer/shorter ATL.
Conclusion. T1D children/adolescents with shorter ATL tend to have higher BMI-SDS. Lower serum vitamin D levels were associated with higher BMI-SDS, while associations between vitamin D serum levels, age at the onset of T1D, glycated haemoglobin and ATL were not observed. Additional studies with more participants are required to clarify the role of the telomere dynamics in T1D aetiology and development of complications.
Izhodišče. Sladkorna bolezen tipa 1 (SBT1) je kronična avtoimunska bolezen, pri kateri hiperglikemija ter zvišana raven oksidativnega stresa in končnih produktov glikacije skupaj z genetskimi in okoljskimi dejavniki privedeta do nastanka diabetičnih zapletov. Krajše dolžine telomerov so povezane s hiperglikemičnimi epizodami in nižjimi serumskimi vrednostmi vitamina D.
Metode. Z metodo qPCR smo iz vzorcev DNK periferne krvi določili povprečne dolžine telomerov 53 slovenskim bolnikom s SBT1 (povprečna starost 8,7 leta, razmerje med dečki in deklicami 1:1,3). Indeks standardnega odklona indeksa telesne teže (BMI-SDS), vrednosti serumskega metabolita vitamina D - 25-hidroksikalcifediola (25-(OH)-D3), glikiran hemoglobin in starost preiskovancev ob izbruhu bolezni smo pridobili iz razpoložljive medicinske dokumentacije.
Rezultati. Rezultati nakazujejo krajše dolžine telomerov pri bolnikih z višjimi vrednostmi BMI-SDS (0,455 ± 0,438, -0,63± 0,295; p=0,049). Preiskovanci z višjimi vrednostmi BMI-SDS so imeli nižje vrednosti 25-(OH)-D3 kot preiskovanci z nižjimi vrednostmi BMI-SDS (40,66 ± 3,07 proti 52,86 ± 4,85 nmol/L; p=0,045). Vrednosti 25-(OH)-D3 niso statistično značilno različne pri preiskovancih z višjimi oziroma nižjimi povprečnimi dolžinami telomerov.
Zaključki. Otroci in mladostniki s SBT1 s krajšimi dolžinami telomerov imajo nekoliko višje vrednosti BMI-SDS. Nižje vrednosti 25-(OH)-D3 so povezane z višjim BMI-SDS. Povezav med serumskimi vrednostmi 25-(OH)-D3, starostjo bolnikov ob izbruhu bolezni, glikiranim hemoglobinom in povprečnimi dolžinami telomerov nismo zaznali. Za razjasnitev vloge telomerov v etiologiji, patogenezi in nastanku zapletov SBT1 bodo potrebne nadaljnje raziskave z večjim številom preiskovancev.
Namen raziskave. Pri mladih s sladkorno boleznijo tipa 1 je prisotno večje tveganje za razvoj depresivne motnje, pogosto pa ti bolniki poročajo tudi o obremenjenosti s sladkorno boleznijo. Zato se ...priporoča psihološko presejalno testiranje. V letu 2012 smo presejalno testiranje za mladostnike in mlade odrasle uvedli tudi v Sloveniji ter prve rezultate predstavili v tej raziskavi.
Type 1 diabetes is a chronic autoimmune disease that affects mainly young people. In the last 50 years, a steady increase of the T1D incidence in the young is reported worldwide, with an average 4 % ...increase annually. In addition, the mean age at the diagnosis is decreasing. Studies show that good metabolic control is important not only for delaying the chronic complications of diabetes but also for improving the quality of life of patients and their families. Continuous education, together with modern technology, is crucial in achieving these goals. Longitudinal data on glycated hemoglobin (HbA1c), along with the data on severe hypoglycemia and severe diabetic ketoacidosis, can describe the quality of care in a defined population. Two national reference diabetes centres taking care of children, adolescents and young adults with diabetes in Israel and Slovenia are described.
Sladkorna bolezen tipa 1 je kronično avtoimuno obolenje, ki najpogosteje prizadene mlade ljudi. Incidenca bolezni zadnjih 50 let narašča po vsem svetu, v povprečju je letni porast incidence ocenjen na 4 %, ob tem pa starost bolnikov ob času diagnoze pada. Raziskave kažejo, da je dobra presnovna urejenost bolnikov s sladkorno boleznijo zelo pomembna, saj je s tem mogoče odložiti pozne zaplete bolezni ter izboljšati kvaliteto življenja bolnikov in njihovih družin. Neprekinjena edukacija bolnikov skupaj z možnostmi moderne tehnologije lahko prispeva k izboljšanju njihove presnovne urejenosti. Presnovno urejenost spremljamo z določanjem glikoziliranega hemoglobina (HbA1c) ter s številom težkih hipoglikemij in ketoacidoz na populacijo pacientov v določenem časovnem obdobju. V prispevku sta opisana dva nacionalna referenčna centra za obravnavo otrok, mladostnikov in mladih odraslih s sladkorno boleznijo v Izraelu in Sloveniji.
Aim. Youth and young adults with type 1 diabetes are at a great risk for developing depression and diabetes specific distress, therefore, systematic psychological screening is recommended. Routine ...psychological screening was implemented in Slovene diabetes clinic for children, adolescents and young adults in 2012. One-year results are presented.
Methods. Adolescents and young adults (N = 159, aged 11 - 25 years), attending the obligatory yearly educational outpatient visit at University Children’s Hospital, Ljubljana, Slovenia, were examined using questionnaires measuring depression (depression scale from Slovene version of Trauma Symptom Checklist for Children) and diabetes distress (Diabetes Distress Screening Scale). Six additional items were included to assess the fear of hypoglycemia and family support. Socio-demographic and diabetes-related data were collected. Questionnaires were analyzed by a psychologist, and the patients that scored above cut-off point were invited to an individual psychological assessment.
Results. Of the sample, 1.3 % reached the threshold for elevated depressive symptoms, and 32.7 % reported significant diabetes distress. The need for psychological support from a specialist was expressed by 5.0 %. There were statistically significant associations between all psychological variables; moreover, better glycemic control was associated with lower diabetes distress and better family support. Nine patients (5.7 %) started with psychological treatment according to the referrals after screening.
Conclusions. The results after one year of psychological screening in Slovene type 1 diabetes population displayed small rates of depression and a large proportion of diabetes distress. Only a small percentage of patients attended the offered individual psychological assessment.
Namen raziskave. Pri mladih s sladkorno boleznijo tipa 1 je prisotno večje tveganje za razvoj depresivne motnje, pogosto pa ti bolniki poročajo tudi o obremenjenosti s sladkorno boleznijo. Zato se priporoča psihološko presejalno testiranje. V letu 2012 smo presejalno testiranje za mladostnike in mlade odrasle uvedli tudi v Sloveniji ter prve rezultate predstavili v tej raziskavi.
Metode. Rednega letnega edukacijskega pregleda na Kliničnem oddelku za endokrinologijo, diabetes in bolezni presnove Pediatrične klinike se je udeležilo 175 mladostnikov in mladih odraslih, starih od 11 do 25 let. Od teh jih je 159 rešilo presejalni vprašalnik, ki je ocenjeval depresivne simptome (lestvica depresije iz vprašalnika o travmatiziranosti otrok in mladostnikov) in obremenjenost s sladkorno boleznijo (presejalna lestvica za oceno obremenjenosti s sladkorno boleznijo). Dodanih je bilo šest postavk za oceno strahu pred hipoglikemijo in podporo družine. Zbrali smo podatke o sladkorni bolezni in sociodemografskem ozadju. Psiholog je pregledal vprašalnike in podal kratko mnenje, mladostnike in odrasle, ki so presegli kritično število točk, pa smo povabili na posvet in dodatno obravnavo k psihologu.
Rezultati. Rezultate, ki pomenijo povečano tveganje za depresijo, je doseglo 1,3 % udeležencev, 32,7 % udeležencev pa je poročalo o pomembni obremenjenosti s sladkorno boleznijo. Željo po psihološki obravnavi je izrazilo 5 % preiskovanih. Prisotna je bila statistično pomembna povezanost med vsemi psihološkimi parametri. Dobra presnovna urejenost je bila povezana z manjšo obremenjenostjo s sladkorno boleznijo in boljšo podporo družine. Devet (5,7 %) mladih je po presejalnem psihološkem testiranju pričelo obravnavo pri psihologu.
Zaključki. Prvo leto presejalnega psihološkega testiranja mladih s sladkorno boleznijo tipa 1 je pokazalo nizek delež udeležencev z depresivnimi simptomi in visok delež pacientov, ki so izrazito obremenjeni s sladkorno boleznijo. Le majhen delež udeležencev se je odzval na povabilo na obravnavo pri psihologu in začel obravnavo.
Sladkorna bolezen tipa 1 je kronično avtoimuno obolenje, ki najpogosteje prizadene mlade ljudi. Incidenca bolezni zadnjih 50 let narašča po vsem svetu, v povprečju je letni porast incidence ocenjen ...na 4 %, ob tem pa starost bolnikov ob času diagnoze pada. Raziskave kažejo, da je dobra presnovna urejenost bolnikov s sladkorno boleznijo zelo pomembna, saj je s tem mogoče odložiti pozne zaplete bolezni ter izboljšati kvaliteto življenja bolnikov in njihovih družin. Neprekinjena edukacija bolnikov skupaj z možnostmi moderne tehnologije lahko prispeva k izboljšanju njihove presnovne urejenosti. Presnovno urejenost spremljamo z določanjem glikoziliranega hemoglobina (HbA1c) ter s številom težkih hipoglikemij in ketoacidoz na populacijo pacientov v določenem časovnem obdobju. V prispevku sta opisana dva nacionalna referenčna centra za obravnavo otrok, mladostnikov in mladih odraslih s sladkorno boleznijo v Izraelu in Sloveniji.
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