Patient-centered diabetes care in children: an integrated, individualized, systems-oriented, and multidisciplinary approach
Der Merkurstab 2015;68(5):339-345.
Article-ID: DMS-20535-EN
Patient-centered diabetes care in children: an integrated, individualized, systems-oriented, and multidisciplinary approach
Background: Type 1 diabetes mellitus in children is associated with various medical, psychological, emotional, social, and organizational hurdles. Patient-centered disease management should address all patient-relevant issues in an individualized, systems-oriented, and multidisciplinary approach. Case: A 10-year-old girl with type 1 diabetes mellitus, a developmental disorder with motor and sensory dysfunction and dyscalculia was cared for full-time by her mother and an assistant nurse. Receiving standard intensified insulin therapy, she still had poor glucose control with frequent mild and severe hypoglycemic episodes. She was socially isolated and not able to attend peer activities and was frustrated with her situation. The mother was substantially stressed, and the child-mother relationship was endangered. The girl and her family were referred to an integrated, patient-centered, and highly individualized, multidisciplinary diabetic care program that offered self-management education courses and psychosomatic care. A core element was to switch the main focus from technical management and laboratory data to the girl and her specific problems, wishes, goals, needs, and conditions. The child became an active partner in management and decisions. The program offered age-appropriate activities. Consequently, the girl was able to successively self-manage her disease, resulting in a substantial improvement in glucose control, quality of life, satisfaction, and the relationship between mother and daughter. Conclusion: Increasing technical sophistication in diabetes management tends to lay the focus on biomedical outcomes. Improved medical and psychosocial results may be achieved when the patient and his or her needs, hurdles, goals, and psychological and social issues are made central to the care he or she receives.
1 Patterson CC, Dahlquist GG, Gyürüs E, Green A, Soltész G; EURODIAB Study Group. Incidence trends for childhood type 1 diabetes in Europe during 1989–2003 and predicted new cases 2005–20: a multicentre prospective registration study. Lancet 2009;373(9680):2027–33.
2 International Society for Pediatric and Adolescent Diabetes, International Diabetes Federation. Global IDF/ISPAD guideline for diabetes in childhood and adolescence. International Diabetes Federation: Brussels; 2011. http://www.ispad.org/content/2011-global-idfispad-guidelinediabetes-childhoodand-adoles cence. Accessed February 26, 2013.
3 Haak T, Kellerer M (ed). Deutsche Diabetes Gesellschaft, Arbeitsgemeinschaft für Pädiatrische Diabetologie: Diagnostik, Therapie und Verlaufskontrolle des Diabetes mellitus im Kindesund Jugendalter. Mainz, Rhineland-Palatinate, Germany: Kirchheim; 2009.
4 Lange K, Sassmann H, Von Schütz W, Kordonouri O, Danne T. Prerequisites for age-appropriate education in type 1 diabetes: a model programme for paediatric diabetes education in Germany. Pediatr Diabetes 2007 Oct;8 Suppl 6:63–71. [Crossref]
5 American Diabetes Association: Standards of medical care in diabetes—2013. Diabetes Care 2013;36(1):S11–S66.
6 Hürter P, Lange K, Jastram HU, et al. Diabetes-Buch für Kinder. Diabetes bei Kindern: ein Behandlungs- und Schulungsprogramm. Mainz, Rhineland- Palatinate, Germany: Kirchheim & Co GmbH; 2005.
7 Hiort O, Danne T, Wabitsch M. Pädiatrische Endokrinologie und Diabetologie. Heidelberg, Germany: Springer; 2010.
8 Silverstein J, Klingensmith G, Copeland K, et al. Care of children and adolescents with type 1 diabetes: A statement of the American Diabetes Association. Diabetes Care 2005;28(1):186–212. [Crossref]
9 Diabetes UK. Emotional and psychological support and care in diabetes (March 2010). http://www.diabetes.org.uk/Professionals/Publications/reports-and-resources/Reports statistics-and-case-studies/Reports/Emotional-and-Psychological-Support-and-Care-in-Diabetes/. Accessed February 26, 2013.
10 Bartus B, Holder M. Diabetes bei Kindern: Mit Freude groß werden – sicher in Alltag, Schule und Freizeit. Stuttgart, Germany: Trias; 2012.
11 Hürter P, von Schütz W, Lange K. Kinder und Jugendliche mit Diabetes: Medizinischer und psychologischer Ratgeber für Eltern. Heidelberg, Germany: Springer; 2011.
12 Murphy HR. Education, technology and psycho-technological approaches to type 1 diabetes. Pract Diabetes 2012;29(6):247–251a. [Crossref]
13 Coyne I, Hayes E, Gallagher P, Regan P. Giving children a voice: investigation of children‘s experiences of participation in consultation and decision-making in Irish hospitals. Office of the Minister for Children, Dublin, Ireland. The National Children‘s Strategy Research Series; 2006. http://www.dcya.gov.ie/viewdoc.asp?fn=/documents/Research/Giving_Children_a_ Voice.pdf. Accessed February 26, 2013.
14 Coyne I. Children’s participation in consultations and decision- making at health service level: A review of the literature. Int J Nurs Stud 2008 Nov;45(11):1682–9. [Crossref]
15 Alderson P, Sutcliffe K, Curtis K. Children as partners with adults in their medical care. Arch Dis Child 2006 Apr;91(4):300–3. [Crossref]
16 Marden S, Thomas PW, Sheppard ZA, Knott J, Lueddeke J, Kerr D. Poor numeracy skills are associated with glycaemic control in type 1 diabetes. Diabet Med 2012 May;29(5):662–9. [Crossref]
17 Schwab JH, Murphy JB, Andersson P, et al. Eurythmy therapy in anxiety—a case report. Altern Ther Health Med 2011;17:58–65.
18 Hamre H, Witt C, Glockmann A, Willich SN, Ziegler R, Kiene H. Eurythmy therapy in chronic disease: a four year prospective cohort study. BMC Public Health 2007;7:61. [Crossref]
19 Bussing A, Ostermann T, Majorek M, Matthiessen PF. Eurythmy therapy in clinical studies: A systematic literature review. BMC Complement Altern Med 2008;8:8. [Crossref]
20 Kienle GS, Kiene H, Albonico HU. Anthroposophic medicine: effectiveness, utility, costs, safety. Stuttgart, Germany; New York: Schattauer Verlag; 2006.
21 Kumagai AK, Murphy EA, Ross PT. Diabetes stories: use of patient narratives of diabetes to teach patient-centered care. Adv Health Sci Educ Theory Pract 2009 Aug;14(3):315–26. [Crossref]
