Achievingoptimaldiabeticcontrolinadolescence:thecontinuingenigma资源-CSDN文库

论文

需积分: 5 34 浏览量 2021-06-29 21:24:10 上传评论收藏 99KB PDF 举报

资源推荐

资源详情

资源评论

Achieving optimal diabetic control in

adolescence: the continuing enigma

E. M. McConnell

R. Harper

M. Campbell

J. K. Nelson*

Diabetes Unit, Ulster Hospital,

Dundonald, Belfast, Northern Ireland

*Correspondence to: Dr J. K. Nelson,

Ulster Hospital, 700 Upper

Newtownards Road, Dundonald,

Belfast, Northern Ireland

BT16 1RH, UK.

E-mail:

susan.williams@nda.n-i-nhs.uk

Summary

The transition from childhood through adolescence to adulthood is a dif®cult

stage, particularly for patients with type 1 diabetes. The yearning for

autonomy and independence, as well as the hormonal changes around the

time of puberty, can manifest in poor glycaemic control. The focus on diet and

weight increases the prevalence of eating disorders, compounding the

dif®culties in supervising diabetes patients. This can be exacerbated by the

realisation that hyperglycaemia induces weight loss and the use of this

knowledge to further manipulate diabetes control to gain a desired body

image. The management of adolescents with type 1 diabetes is therefore

challenging and requires close collaboration between psychological medicine

and diabetes teams. This review describes the dif®culties frequently

encountered, with a description of four cases illustrating these points. Case

1 demonstrates the problem of needle phobia in a newly diagnosed patient

with type 1 diabetes leading to persistent hyperglycaemia, the recognition of

weight loss associated with this and the development of bulimia. The patient's

overall management was further complicated by risk-taking behaviour. By the

age of 24 years, she has developed diabetic retinopathy and autonomic

neuropathy and continues to partake in risk-taking behaviour. Case 2

illustrates how the lack of parental support shortly after the development of

type 1 diabetes led to poor glycaemic control and how teenagers often omit

insulin to accommodate lifestyle and risk-taking behaviour. Case 3 further

exempli®es the dif®culty in managing patients with needle phobia and the

fear of hypoglycaemia. Case 4 adds further weight to the need for parental

support and the impact of deleterious life events on glycaemic control by

manipulation of insulin dosage. Copyright # 2001 John Wiley & Sons, Ltd.

Keywords adolescence; diabetic control

Background

Type 1 diabetes mellitus is a serious disorder of childhood and is managed by

a complex and invasive treatment regimen aimed at maintaining good

glycaemic control to minimise the risk of long-term complications. It is well

documented that during adolescence, a particularly stressful time for the

normal healthy teenager, there is deterioration of glycaemic control in

patients with type 1 diabetes. This may be related to hormonal changes

around the time of puberty but is also related to the individual's desires for

independence and control over their own life. A number of problems can arise

during the management of the adolescent diabetic patient as illustrated by

four case reports from our local diabetes clinic, demonstrating the dif®culties

with treatment encountered on a daily basis and possible management

strategies that can be adopted.

The deterioration in glycaemic control during adolescence has been widely

documented. Females in particular appear to have a signi®cantly higher level

CLINICAL CHALLENGES

IN DIABETES

DIABETES/METABOLISM RESEARCH AND REVIEWS

Diabetes Metab Res Rev 2001; 17: 67±74.

of mismanagement of diabetes than males, particularly

those in late adolescence (18±24 years) compared to early

adolescence (12±14 years) [1]. Diabetes mismanagement

has been reported to have a mean age of onset around 15

years and to be at its greatest between 17 and 19 years of

age [2]. College students are at high risk of improvising

care of their diabetes because of erratic schedules, newly

acquired independence and peer pressures. Barriers to

successful management included poor time management,

stress, hypoglycaemia, dietary constraints, social isolation

and inadequate ®nance [3].

Positive life events are associated with improvement in

glycaemic control, while severe stress may provoke

poorer glycaemic control [4]. A recent study of 45

children (aged 6±14 years) with type 1 diabetes showed

that children who experienced emotional upset in the

family setting had higher subsequent glycated haemoglo-

bin concentrations than children who had not [5].

Recognizing and learning to cope with stress may help

people with diabetes maintain good glycaemic control.

Adherence to treatment may be a problem and there is

also an expectation that young people should become

independent in self-care. It has been observed that sons

are more likely to receive maternal help than daughters

[6]. Chronic hyperglycaemia in children is associated

with reduced memory and learning capacity, while age of

onset of type 1 diabetes also has a predictive negative

change on measures of intelligence, particularly affecting

visuospatial skills [7].

Young people partake in a risky lifestyle experimenting

with alcohol, cigarettes and illegal drugs, which can have

serious consequences in teenagers with diabetes. In a

recent study in which 561 people with diabetes were

compared to 1125 controls in Scandinavia, there were as

many current diabetic smokers as controls, although

signi®cantly fewer females with diabetes smoked when

considered separately (18 vs 26%; p<0.05) [8]. People

with diabetes also consumed less alcohol, had a greater

percentage of non-drinkers (22 vs 13%; p<0.01) [8] and

undertook more exercise (40 vs 28%; p<0.001). This was

also shown in a study of 155 adolescents with diabetes,

aged 10±20 years in which 39% of the cohort were using

alcohol, 34% were smoking cigarettes, 10% admitted to

illegal drug use and 29% were having unprotected sexual

intercourse [9], all substantially lower than community

samples of middle school children. However perception of

risk to peers is signi®cantly higher than perception to self,

particularly in females [9]. The frequency of risky

behaviour increased with age. As yet no studies have

examined the timing and trajectory of risk-taking

behaviour and whether the perception of risk deters

youths with type 1 diabetes from engaging in risky

behaviour. In the UK, 57 young people with diabetes were

compared over a 10-year period to a group of young

adults identi®ed at the time of a moderately acute severe

illness and demonstrated similar rates of high school

graduation, post-high school education, employment and

illicit use of drugs [10]. Fewer criminal convictions and

fewer illnesses unrelated to diabetes were recorded.

However, people with type 1 diabetes reported lower

perceived competence, particularly global self-worth,

sociability and physical appearance and they scored

lower on humour subscales.

Case reports

Case 1

A 13-year-old female was diagnosed with type 1 diabetes

in 1989 and commenced on twice-daily insulin. She had

needle phobia and omitted her insulin for 2 weeks in

January 1990. Blood glucose remained high throughout

her ®rst year of treatment and she was admitted to

hospital for stabilisation. Local anaesthetic cream was

used at her injection sites. However at her next review she

had reduced her total daily dose of insulin by 50% having

experienced severe hypoglycaemia. Over the next 2 years

she was admitted frequently with diabetic ketoacidosis

associated with poor glycaemic control and an expressed

fear of hypoglycaemia. By 1992 she was diagnosed as

having anorexia nervosa and was referred to the

psychiatric unit. Glycaemic control remained suboptimal

with HbA

9±10% (non-diabetic range 4.5±6.5%). A

basal-bolus insulin regimen was commenced in 1996

when her HbA

was 12.8%. Shortly afterwards, she

developed severe visual impairment secondary to exten-

sive macular oedema and intraretinal haemorrhage and

required laser therapy. By 1997 she had lost 9 kg in

weight, admitted to binge-eating with associated purging,

had evidence of bulimia and was re-referred to psychia-

try. She admitted to smoking marijuana and taking

ecstasy tablets. Her HbA

was 14.3%. She was given

advice to take an extra 10 units of soluble insulin during

Table 1. Case 1: 24-year-old female with 11-year history of

type 1 diabetes

Date

Age

(years)

Weight

(kg)

HbA

(%) Comments

Jan 1989 13

55 12.4 Newly diagnosed. Commenced

®xed mixture insulin

Sep 1989 14

48.9 12.2 Admitted for stabilisation.

Insulin dose increased

Mar 1990 14

47.6 13.1 Stopped insulin for 2 weeks in Jan

1990 ± needle phobia. Admitted for

stabilisation

Apr 1990 14

53.5. 11.9 Reduced insulin herself

Nov 1991 16

57.2 11.2 Claimed blood glucose was

5±9 mmol/l at home

Jan 1993 17

51.7 9.2 Referred for management

of anorexia nervosa

Oct 1996 21

55.8 12.8 Commenced basal-bolus insulin.

One week later, extensive

macular oedema,

intraretinal haemorrhage ± laser

treatment

Jun 1997 21

+11

48.1 14.3 Stopped all soluble insulin.

Intermittently took long-acting

insulin. Diagnosed as having bulimia

Feb 1999 23

53.1 10.3 Gastroparesis ± domperidone therapy

Dec 1999 24

58.1 11.9 Alcohol, illegal drugs.

Evidence of microalbuminuria

68 E. M. McConnell et al.

剩余7页未读，继续阅读

评论收藏

内容反馈

weixin_38687199

粉丝: 4
资源: 924

Achieving optimal diabetic control in adolescence: the continuin...

最新资源

Achieving optimal diabetic control in adolescence: the continuin...

在青春期实现最佳糖尿病控制：持续的谜

Achieving Data Access Control in Cloud Computing

Achieving the Impossible: Unlimited Application Scalability

基于89C51单片机控制的智能湿度控制系统设计.pdf

The.Agile.Consultant.Guiding.Clients.to.Enterprise.Agility.epub

【13】Achieving Human Parity in Conversational Speech Recognition.pdf

Deep Learning in Python: Master Data Science and Machine Learning with Modern

NT3997_V1.0_20030901.pdf

Soft.Skills.The.software.developers.life.manual

Teacher ratings of hyperactivity and self-control in learning-disabled boys: A comparison with low-achieving and average peers

RetinaFace: Single-stage Dense Face Localisation in the Wild.pdf

Micro-typographic extensions to the T EX typesetting system

Achieving the Shannon Limit: A Progress Report

W958D6NW 256Mb HyperRAM 3.0 x16 WLCSP30 datasheet-A01-007-202303

Achieving high energy density in PVDF-based polymer blends: suppression of early polarization saturation and enhancement of breakdown strength

CAP Twelve Years Later：How the "Rules" Have Changed.pdf

sanyo denki DC SERVO SYSTEMS T

2014年高考英语词汇剖析2.doc

Managing Project Delivery Maintaining Control and Achieving Success

04.CBase-EC+Achieving+Optimal+Throughput-Storage.pdf

Windows Azure Succinctly(Syncfusion,2014)

Introduction_to_Optimum_Design.pdf

2016年iOS公开可利用漏洞总结_EN1

Failing_to_fail_Achieving_Success_in_Advanced_Low_Power_Design

最新资源