‘Pump school’ – a structured education programme to empower children and young people using insulin pump therapy

Abstract

Background:Caring for children and young people with diabetes is a complex process that must be firmly focused on the child or young person and their family and/or other carers, supported by the skills and experiences of a wide range of healthcare professionals. Continuous subcutaneous insulin infusion (CSII) is increasingly offered as a safe and effective alternative to multiple daily injections (MDI), yet its success depends on more than the technology itself. In partnership with families, the University College London Hospitals' diabetes team has developed a pathway that uses a series of pre-defined competencies, together with an innovative psycho-educational programme (Pump school), to promote engagement, motivation and flexible self-management, and facilitate successful transition to CSII. Method: Mixed methods were applied for the development of the programme and its evaluation in terms of treatment regimen, HbA 1c levels and rate of DKA between 2004-2008. Conclusion:The programme is delivered in a clinic setting and has delivered promising improvements in self-management, psychological adjustment and long-term metabolic control. Its effectiveness is supported by significant improvements in clinical outcomes data, while acceptability to families is strongly supported by regular audit studies.

Use of continuous subcutaneous insulin infusion in children and adolescents with type 1 diabetes mellitus: a systematic mapping review

“…Nine studies concluded that the use of CSII reduced hypoglycemic episodes [ 17 , 22 , 49 , 53 , 55 , 61 , 70 , 74 , 84 ] and 11 reported that there was a reduction in severe hypoglycemic episodes [ 12 , 13 , 34 , 49 , 52 , 64 , 66 , 71 , 72 , 75 , 77 ]. Three studies described a lower occurrence of nocturnal hypoglycemic episodes [ 31 , 37 , 74 ] and another described a decrease in morning hypoglycemic episodes [ 89 ].…”

Redesigning diabetes care

“…Effective forms of diabetes education to motivate people with the condition are addressed by Petersen et al 4 who use the example of empowerment‐inspired education in theory and practice and describe how this is approached in the Hillerød Programme. The development and evaluation of a pathway for continuous subcutaneous insulin infusion to facilitate and empower young people of all ages is illustrated in the report on ‘Pump school’ by Thompson 5. Snoek et al 6 address barriers, possible solutions and new developments in a report on ‘Self‐monitoring of blood glucose: psychological barriers and benefits’.…”

Uso do sistema de infusão contínua de insulina em crianças e adolescentes com diabetes mellitus tipo 1: revisão de mapeamento sistemático

“…Em 13 estudos o risco de CAD mesmo durante o uso do SICI foi destacado (50,56,119,125,130,57,60,62,63,65,77,95,96). A ocorrência de episódios de CAD pode ser justificada pela utilização apenas da insulina de ação rápida no SICI (62).…”

“…Quinze estudos apresentaram a importância do apoio da equipe de saúde no cuidado da criança e adolescente com DM1 em uso do SICI (53,57,123,132,133,138,139,58,62,77,96,98,115,116,122). Destes, oito (58,62,77,96,116,133,138,139) assinalaram que o apoio pode ser favorecido de algumas formas: mediante oferta de treinamento prévio ao familiar e ao paciente no início do uso do SICI (58,62,77,96,138); detecção pela equipe de saúde do uso inadequado do SICI (133); uso de programa educativo pela equipe de saúde objetivando a melhora do controle glicêmico (139) identificação de outras redes de apoio, de educação, de conhecimento em saúde; e desenvolvimento de habilidades necessárias para a mudança de comportamento (116).…”

“…Onze estudos apresentaram que houve redução dos episódios de hipoglicemias graves(50,63,112,88,90,(94)(95)(96)98,100,102). Três estudos descreveram menor ocorrência de episódios…”