Paper
Friday, July 23, 2004
Adolescents in Poor Metabolic Control: Perspectives of Diabetes Management
Maureen A. Frey, RN, PhD, Center for Excellence in Pediatric Nursing, Children's Hospital of Michigan, Detroit, MI, USA, Deborah Ellis, PhD, Department of Psychiatry and Behavioral Neurosciences, Wayne State University, Detroit, MI, USA, Sylvie Naar-King, PhD, Department of Pediatrics, Wayne State University, Detroit, MI, USA, and Thomas Templin, PhD, College of Nursing, Wayne State University, Detroit, MI, USA.
| Learning Objective #1: Describe diabetes management in adolescents in poor metabolic control
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| Learning Objective #2: Identify the need and direction for early intervention with school-aged children at the family level |
Deterioration of metabolic control during adolescence is well documented. Although such deterioration in is often due to physical, hormonal, and developmental changes, persistent poor metabolic control is generally related to inadequate diabetes management. The purpose of this paper is to describe adolescent and mother report of diabetes management and to examine the effect of sociodemographic variables on diabetes management and metabolic control in this population. Methods: A convenience sample consisted of 103 mother-adolescent dyads recruited for an intervention study with urban adolescents in poor metabolic control (A1C>8.0). Mean age was 12.67 years and A1c was 11.2%. The Diabetes Management Scale was used to collect data. Analyses were conducted using descriptive and inferential statistics. Results: Mean frequency of diabetes management activities ranged from 28%to 96% of the time with an overall mean of 65% for adolescents and 68% for mothers. Twenty five percent of the adolescents reported insulin mismanagement, following their food plan 56% of the time, and testing blood glucose as recommended 67% of the time. Mothers assisted with meals 34% of the time and supervised blood glucose testing and insulin administration 55% and 69% of the time, respectively. Mothers and adolescents reported considerable deviation from recommended timing around insulin and meals. Race/ethnicity was significantly related to metabolic control but not to total DMS scores. African Americans were in poorer metabolic control than their European American counterparts. Conclusions: Diabetes management behaviors are performed less frequently than recommended for good metabolic control in adolescents. Mothers are aware of their adolescent’s low level of management yet provide little supervision and assistance with critical diabetes tasks. It is very likely that many of the behaviors described here could be identified much earlier in the course of diabetes and serve as a basis for early intervention with his high risk group.
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