Rankin David, Harden Jeni, Barnard Katharine, Bath Louise, Noyes Kathryn, Stephen John, Lawton Julia
The Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, EH8 9AG, UK.
BHR Ltd, 42 Kilmiston Drive, Portchester, Fareham, Hants, PO16 8EG and Faculty of Health & Social Science, Bournemouth University, Royal London House, Bournemouth, BH1 3LT, UK.
BMC Endocr Disord. 2018 Oct 13;18(1):71. doi: 10.1186/s12902-018-0302-y.
When children with type 1 diabetes approach adolescence, they are encouraged to become more involved in diabetes self-management. This study explored the challenges pre-adolescent children encounter when self-managing diabetes and the factors which motivate and enable them to take on new diabetes-related tasks. A key objective was to inform the support offered to pre-adolescent children.
In-depth interviews using age-appropriate questioning with 24 children (aged 9-12 years) with type 1 diabetes. Data were analysed using an inductive, thematic approach.
Children reported several barriers to taking on self-management tasks. As well as seeking respite from managing diabetes, children described relying on their parents to: perform the complex maths involved in working out carbohydrate content in food; calculate insulin doses if they did not use a bolus advisor; and administer injections or insert a cannula in hard-to-reach locations. Children described being motivated to take on diabetes tasks in order to: minimise the pain experienced when others administered injections; alleviate the burden on their parents; and participate independently in activities with their peers. Several also discussed being motivated to take on diabetes-management responsibilities when they started secondary school. Children described being enabled to take on new responsibilities by using strategies which limited the need to perform complex maths. These included using labels on food packaging to determine carbohydrate contents, or choosing foods with carbohydrate values they could remember. Many children discussed using bolus advisors with pre-programmed ratios and entering carbohydrate on food labels or values provided by their parents to calculate insulin doses. Several also described using mobile phones to seek advice about carbohydrate contents in food.
Our findings highlight several barriers which deter children from taking on diabetes self-management tasks, motivators which encourage them to take on new responsibilities, and strategies and technologies which enable them to become more autonomous. To limit the need to perform complex maths, children may benefit from using bolus advisors provided they receive regular review from healthcare professionals to determine and adjust pre-programmed insulin-to-carbohydrate ratios. Education and support should be age-specific to reflect children's changing involvement in self-managing diabetes.
当1型糖尿病儿童步入青春期时，会鼓励他们更多地参与糖尿病自我管理。本研究探讨了青春期前儿童在自我管理糖尿病时遇到的挑战，以及促使并使他们能够承担新的糖尿病相关任务的因素。一个关键目标是为青春期前儿童提供的支持提供信息。
对24名1型糖尿病儿童（9至12岁）进行适合其年龄的深入访谈并提问。采用归纳性主题分析法对数据进行分析。
儿童报告了承担自我管理任务的几个障碍。除了寻求从管理糖尿病中解脱出来，儿童还描述了依赖父母来：计算食物中碳水化合物含量所涉及的复杂数学；如果不使用大剂量胰岛素计算器，计算胰岛素剂量；以及在难以触及的部位进行注射或插入套管。儿童表示，为了以下目的而有动力承担糖尿病任务：尽量减少他人注射时的疼痛；减轻父母的负担；以及独立参与与同龄人一起的活动。有几个儿童还讨论了在开始上中学时，有动力承担糖尿病管理责任。儿童描述了通过使用限制进行复杂数学计算需求的策略来承担新责任。这些策略包括使用食品包装上的标签来确定碳水化合物含量，或选择具有他们能记住的碳水化合物值的食物。许多儿童讨论了使用预编程比例的大剂量胰岛素计算器，并输入食品标签上的碳水化合物或父母提供的值来计算胰岛素剂量。有几个儿童还描述了使用手机来寻求关于食物中碳水化合物含量的建议。
我们 的研究结果突出了阻碍儿童承担糖尿病自我管理任务的几个障碍、鼓励他们承担新责任的动机，以及使他们能够更加自主的策略和技术。为了限制进行复杂数学计算的需求，儿童可能会从使用大剂量胰岛素计算器中受益，前提是他们接受医疗保健专业人员的定期检查，以确定和调整预编程的胰岛素与碳水化合物比例。教育和支持应根据年龄进行调整，以反映儿童在糖尿病自我管理中不断变化的参与情况。
