TITLE:
Manifestation of Diabetes Mellitus Type 1: A Questionnaire to Evaluate the Acceptance of Initial Intravenous Therapy
AUTHORS:
Katrin Steul, Laurenz Corvers, Joachim Pohlenz, Dorothee Maria Kieninger-Baum
KEYWORDS:
Diabetes Mellitus Type 1, Manifestation, iv. Insulin Therapy
JOURNAL NAME:
Journal of Diabetes Mellitus,
Vol.4 No.4,
November
13,
2014
ABSTRACT: For families suddenly confronted with the diagnosis of a lifelong
chronic disease, implementing a continuous iv. infusion represents restriction
of movement and possibly also a psychological burden. We designed a
questionnaire to evaluate the perception of pediatric patients and their
parents for this treatment as part of a diabetes manifestation. Patients and
their parents treated in the diabetes outpatient clinic at children’s
university hospital in Mainz were asked for their opinion about “iv. infusion” and
“frequency of blood taking” during their first stay in the hospital upon
manifestation of diabetes. They assigned scores from 1 to 10 for the following
parameters: “delivery of diagnosis”, “communication by doctor”, “execution of
training”, “atmosphere during diabetes training”, “frequency of blood taking”,
“iv. infusion” and “start of sc. insulin application”. Parents gave relatively
high ratings. Parameters such as “frequency of blood taking” were rated with
6.1 on average. Ultimately, “frequency of blood taking”, “delivery of
diagnosis” (6.11) and “iv. infusion of insulin” (6.5) scored lower than for
instance “atmosphere of diabetes training” (7.95). Children awarded scores of
3.72 for “iv. infusion”, on average, whereas they scored 7.15 for the “doctor’s
communication” and 7.28 for “diabetes training”. Asked if a decision in favor
of a subcutaneous insulin injection right at the beginning of the therapy would
have been preferable, parents were undecided. Therefore it cannot be concluded
that an instant subcutaneous therapy has psychological advantages or
disadvantages. The patients themselves (aged 12 - 17 years) were undecided,
too, (58.3%) when asked for their preference of the subcutaneous insulin regime
right at the beginning of the therapy. Nevertheless, the continuous infusion of
insulin iv. was rated poorly by them. When planning further studies on this
topic, the following questions should be analyzed: If the initial therapy had
been started subcutaneously, would the manifestation be assessed differently by
the family? Is the patients’ poor rating of the iv. insulin injection
reproducible? Do other factors more greatly influence the decision for or
against iv. insulin injection at the start of the therapy, such as the time
needed for caretaking for the iv. injection by the nurses or possible side
effects of an iv. injection? How can the start of the therapy be organized,
when starting with sc. therapy, in particular regarding the first communication
with patient and family?