Semester

Fall

Date of Graduation

2013

Document Type

Dissertation

Degree Type

DNP

College

School of Nursing

Department

Family/Community Health

Committee Chair

Susan McCrone

Committee Co-Chair

Sachin Bendre

Committee Member

Pamela Deiriggi.

Abstract

Background: Type 1 diabetes is the second most common chronic illness seen in children. Children, adolescents and young adults with type 1 diabetes are provided care in programs with diabetes educators, nurses, nurse practitioners, physicians, dietitians, and many other specialists. Even though children, adolescents and young adults receive care from many providers, their diabetes is often not in good control. In the last 10 years a new device called a continuous glucose monitor has been developed for use with people with diabetes. This new device documents the blood sugar levels in people with diabetes between finger stick blood sugar tests.;Objectives: This study utilized a newly developed investigational continuous glucose monitoring device in children, adolescents and young adults ages 7-21 who had very high blood sugars and a Hemoglobin A1c of 9% or greater. The rationale was that if the participants could see their blood sugars in between regular testing, it would help them to lower their blood sugars. The study used the Family Approach to Diabetes Management model to improve adherence to wearing the CGM monitor. The primary outcome of the study was to improve HbA1c by at least 0.5%. Secondary outcomes of the study included: adherence to wearing the continuous glucose monitor, adherence to blood sugar testing, decrease in hypoglycemia, and change in quality of life indicators.;Design: This study used a prospective, one group, pre and post-test pre experimental design, with a convenience sample of patients. The 12-week intervention tested the efficacy of a newly developed continuous glucose monitor on glycemic control. Participants were seen every four weeks during the study. At the baseline visit, demographic data were collected and participants completed the Quality of Life for Youth form. Patients and families were taught to use the continuous glucose monitor and the basic concepts of the Family Approach to Diabetes Management Model. Baseline HgA1c levels were determined, as well as reported and actual frequency of blood testing. Data collected at the subsequent visits included downloads from of the continuous glucose monitor, home finger stick blood glucose monitor and completion of a qualitative interview about experiences with the monitor use. In addition, data collected at the final study visit included collection of HbA1cs and completion of the Quality of Life for Youth forms.;Subjects: Thirty-three subjects enrolled in the study. Twenty-one (63.6%) completed the final study visit at 12 weeks. The mean age of the subjects was 15.57 years with a range of 11 to 20 years. Of the 21 that finished the study, 47.6% were male and 52.4% were female.;Results: There was a clinically and statistically significant improvement in HbA1c from baseline by 1.1095% (SD=1.9321) p=0.016. Fifteen of the participants (71.4%) had an improvement of greater than 0.5% in HbA1c. Participants wore the CGM monitor a mean of 51.1429 (SD=20.68543) days with a range of 21 to 81 days. For this study, wearing the monitor any part of the day was counted as one day. The participants wore the monitor a mean of 4.262 days a week. At the end of the study, two participants were identified as manipulating the CGM device and did not provide accurate finger stick blood glucoses to calibrate the monitor. The change in HbA1c was recalculated removing these participants from the analysis resulting in, a mean improvement of 1.4579% (SD=1.6711) p=0.001. While there were no significant differences in quality of life among the six subscales evaluated, there was a trend in improvement of areas of symptoms, treatment, parental issues, worry, and health. Data derived from qualitative interviews demonstrated an improved attitude among the participants and improved parent child interaction.;Conclusion: Continuous glucose monitoring with the Family Approach to Diabetes Management model was effective in improving glycemic control with children, adolescents and young adults with poorly controlled diabetes.

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