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Two nursing graduate students, led by Associate Professors Kashica Webber-Ritchey and Kim Amer and Assistant Professor Michelle Neuman, have performed a critical review of 37 research articles on type 1 diabetes management in children. Doctor of Nursing Practice students Aneta Rutkowski and Danielle Pehr-Szeliga were co-authors on the study.The aim of the project was to identify trends in the transition of type 1 diabetes management from caregivers to children. It is estimated that 1.2 million children and adolescents worldwide suffer from the metabolic condition, an increase of 45% in the past two decades. Type 1 diabetes is a chronic autoimmune condition that attacks the body's insulin producing cells and typically requires life-long blood glucose monitoring, insulin injections, and strategic diet and exercise. As type 1 diabetes in children is a prominent global health issue and early care interventions are essential, nurses can play a pivotal role in helping patients regulate self-care and management of the disease.
Children typically go through multiple stages of independence in disease management, with each stage posing practical challenges for successful intervention. The research team reviewed three critical stages of pediatric development: early childhood (ages 1-6), middle childhood (ages 6-11), and later childhood (ages 11-19). They identified themes in disease management unique to each development period, and the role advanced practice nurses, known as APNs, can play in supporting the transition to self-care.
These themes range, among others, from the need for remote monitoring in earliest childhood (for example, the use of insulin pumps and mobile technology to view insulin data remotely and in real time), to the necessity of patient counseling for understanding the disease and its health effects, to a shift towards autonomous problem solving in older pediatric patients. The review found that nurse-led interventions are especially vital – with APNs playing a central role in disease education that can set the stage for long-term diabetes management throughout the transitional periods leading to adulthood. Furthermore, the researchers recommend establishing guidelines for each development stage and a call for interventions as early as preschool, for example by teaching children how to recognize signs of high or low blood sugar as soon as they can express how they feel.
The full study was published in The Journal of Advanced Nursing and can be found here.