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Clarifying responsibility for self-management in adolescents with diabetes using insulin pumps: a qualitative study
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Vårdforskning Medicin)
University of Skövde, School of Life Sciences.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Vårdforskning Medicin)
2011 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 67, no 7, 1547-1557 p.Article in journal (Refereed) Published
Abstract [en]

Aim: To gain insight into and generate theoretical knowledge about the processes involved when insulin pump-treated adolescents take or miss taking their bolus doses.

Background: Insulin pump treatment is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. Despite insulin pump-treatment, it is hard to maintain near-normal glucose control in adolescents; one reason for this is missed bolus doses to meals.

Method: In this qualitative interview study, the grounded theory method was chosen as a model for the collection and analysis of data. Twelve adolescents (5 males and 7 females, mean age 14.4 years, range 12-19 years) from different Swedish paediatric diabetes clinics, four parents and one paediatric diabetes nurse were interviewed during 2008 and 2009.

Findings: Responsibility in the context of taking or missing bolus doses emerged as the core category. It is elaborated and explained through three subcategories: distribution of responsibility, transfer of responsibility and clarifying of responsibility. The distribution of responsibility was clear among those who took most of their doses; they had high personal responsibility or shared it with their parents. The optimal transfer of responsibility is when it gradually moves from the parents to the adolescent. The findings revealed a need to clarify the responsibility for diabetes self-management in continuous negotiations between adolescents and parents to avoid missed bolus doses.

Conclusion: Negotiations to clarify the responsibility for diabetes self-management must be a continuous process between adolescents and parents. Diabetes care teams may facilitate and encourage these negotiations.

Place, publisher, year, edition, pages
2011. Vol. 67, no 7, 1547-1557 p.
Keyword [en]
adolescent parenting, adolescents, diabetes mellitus type 1, grounded theory, insulin pump, interviews, nursing
National Category
Medical and Health Sciences
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:uu:diva-122727DOI: 10.1111/j.1365-2648.2010.05588.xISI: 000292779400013OAI: oai:DiVA.org:uu-122727DiVA: diva2:310901
Available from: 2010-04-16 Created: 2010-04-16 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Self-management of diabetes in adolescents using insulin pumps
Open this publication in new window or tab >>Self-management of diabetes in adolescents using insulin pumps
2010 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Insulin pump treatment (CSII) is considered the most physiological way to imitate the healthy body’s insulin profile in adolescents with diabetes. However, despite the use of CSII, achieving the recommended disease control is difficult for adolescents.

The aim of this thesis was to explore aspects of self-management of diabetes in adolescents using insulin pumps in order to describe conditions contributing to the recommended disease control.

Three methods of bolusing (normal, dual-wave and square-wave) in connection with pasta meals were tested in a crossover study among 15 adolescents with diabetes to assess whether one method was superior in managing glucose levels. A cross-sectional study among 90 adolescents being treated with CSII was conducted to investigate the management of CSII, including the administration of bolus doses. Two qualitative interview studies, based on the grounded theory method, were performed to gain insight into the processes involved in taking bolus doses and to investigate reasons for missed bolus doses and strategies for avoiding missing them. Twelve adolescents, four parents and one diabetes specialist nurse were interviewed.

No method of bolusing was found to be superior in managing the glucose levels after these meals. The post-prandial glucose peaks were <10 mmol/L, in 48% of the cases, regardless of bolus methods. This indicates that adolescents can be encouraged to individually test which bolus method gives them the most normal post-prandial glucose levels.

The cross-sectional study showed that adolescents were satisfied with CSII, but that 38% had missed more than 15% of the bolus doses the day under study. The frequency of bolus doses correlated with the disease control.

Findings from the interview study revealed the need to clarify the responsibility for diabetes self-management in continuous negotiation between adolescents and parents to avoid insulin omission. The main reason for missed boluses was lost focus, and the strategies for remembering them were agreements involving reminders.

The thesis describes that individual dose testing, clarification of responsibility and agreements involving reminders are conditions contributing to the recommended disease control. The thesis also describes that lost focus and a lack of responsibility can lead to insulin omission and be a hindrance to achieving disease control.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2010. 82 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 561
Keyword
Type 1 diabetes, Insulin infusion systems, Insulin omission, Adolescents, Adolescent parenting, Nursing, Qualitative research, Interviews
National Category
Nursing Endocrinology and Diabetes Pediatrics
Research subject
Caring Sciences
Identifiers
urn:nbn:se:uu:diva-122952 (URN)978-91-554-7811-7 (ISBN)
Public defence
2010-06-09, Gustavianum, Akademigatan 3, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Note
Anna Kernell avled maj 2010.Available from: 2010-05-19 Created: 2010-04-21 Last updated: 2010-05-26Bibliographically approved

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