Education, technology and psycho‐technological approaches to type 1 diabetes

Abstract

A gap exists between our expectations of tight blood glucose control for type 1 diabetes and the reality of safely achieving it, particularly during adolescence and pregnancy. Technological and pharmaceutical advances will not alone achieve near‐normal blood glucose control and optimal health outcomes without recognising the social, cultural and behavioural context of those living with diabetes. Neither will educational programmes completely overcome the fundamentally disordered metabolic pathways and/or the additional physiological challenges of adolescence and pregnancy. Improved integration of the technological, behavioural and educational aspects of care will pave the way for truly personalised, diabetes self‐management and improved health outcomes for women and children with type 1 diabetes. Copyright © 2012 John Wiley & Sons. Practical Diabetes 2012; 29(6): 247–251 This paper was presented as the 2012 Janet Kinson lecture at the 2012 Diabetes UK Annual Professional Conference held in Glasgow

Patient-centered Diabetes Care in Children: An Integrated, Individualized, Systems-oriented, and Multidisciplinary Approach

“…The increasing technical sophistication and the focus being laid on measuring and recording biomedical outcomes threatens to distract practitioners from compassion, communication, and the health outcomes that matter to children. 12 Children have a varied experience of being involved in their care and in fact usually occupy a marginal role. Decisions are often made by parents or healthcare professionals while children tend to be seen as inactive, passive, or incompetent.…”

“…Pediatric diabetes education still has to identify how best to support children and adolescents—how to integrate intensive insulin dose adjustment into daily routines; adequately teach the various necessary skills; delegate and share responsibility for daily self-management tasks; find a workable balance between delegating too much responsibility too soon or being too protective; enhance the communication skills required for continued parent and adolescent motivation and empowerment; and prevent families from entering the vicious circle of frustration and diabetes burnout 12 —thus enabling good quality of life, healthy development, emotional maturation, and the diabetic children's key goals: to be “normal” and “get on with their lives.” 15 …”

“…Diabetes self-management education courses as well as insulin pumps are well investigated and considered state-of-the-art in diabetic care. 2 - 7 Still, the optimal integration of the technical diabetes interventions into patient-centered care—the rhetoric having not yet turned into clinical reality 12 —does obviously go beyond guidelines and trials. Outlining strategies for the individualization of care may depend on many transparent examples published as case reports.…”