<p> Syftet med detta arbete är att undersöka om det föreligger någon skillnad mellan hur personer med diabetes typ 1 med MDI- respektive IP-behandling skattar sin hälsorelaterade livskvalitet, behandlingstillfredsställelse och uppfattning av behandlingsformens påverkan på livskvaliteten. Vidare är syftet att undersöka om det föreligger någon skillnad mellan män och kvinnor, samt mellan kvinnor respektive män i MDI- respektive IP-gruppen, avseende hälsorelaterade livskvalitet, behandlingstillfredsställelse och uppfattning av behandlingsformens påverkan på livskvaliteten. Som instrument användes enkäten SF-36 samt en egenkonstruerad enkät med bakgrundsfrågor rörande skattning av behandlingstillfredsställelse och uppfattning av behandlingsformens påverkan på livskvaliteten. I MDI-gruppen deltog 40 deltagare och i IP-gruppen 37 deltagare. Studien har en deskriptiv jämförande design. Resultatet visade att det inte finns någon signifikant skillnad mellan MDI- och IP-gruppens skattning av hälsorelaterad livskvalitet. Skillnader kunde påvisas mellan behandlingsformerna gällande behandlingstillfredsställelse och uppfattningen av behandlingsformens påverkan på livskvalitet. IP-gruppen har en signifikant högre behandlingstillfredsställelse samt anser att behandlingsformen påverkar deras livskvalitet mer än MDI-gruppen. Kvinnor i MDI-gruppen skattade sin hälsorelaterade livskvalitet signifikant lägre än män i MDI-gruppen, ingen skillnad kunde dock påvisas mellan männen och kvinnorna i IP-gruppen. Männen i MDI-gruppen skattar sin hälsorelaterade livskvalitet signifikant högre än männen i IP-gruppen. Ingen skillnad kunde påvisas mellan männen i de båda grupperna gällande behandlingsstillfredsställelse eller uppfattningen av behandlingsformens påverkan på livskvaliteten. Kvinnorna i IP-gruppen skattade signifikant högre gällande behandlingsstillfredsställelse och uppfattningen av behandlingsformens påverkan på livskvaliteten än kvinnorna i MDI-gruppen.</p><p><p><p>Kvinnorna i IP-gruppen har likartad hälsorelaterad livskvalitetsskattning som männen i samma grupp och har även en högre behandlingstillfredsställelse än kvinnor i MDI-gruppen. Slutsatsen kan vara att IP är en lämplig behandling för kvinnor</p></p></p>

Syftet med detta arbete är att undersöka om det föreligger någon skillnad mellan hur personer med diabetes typ 1 med MDI- respektive IP-behandling skattar sin hälsorelaterade livskvalitet, behandlingstillfredsställelse och uppfattning av behandlingsformens påverkan på livskvaliteten. Vidare är syftet att undersöka om det föreligger någon skillnad mellan män och kvinnor, samt mellan kvinnor respektive män i MDI- respektive IP-gruppen, avseende hälsorelaterade livskvalitet, behandlingstillfredsställelse och uppfattning av behandlingsformens påverkan på livskvaliteten. Som instrument användes enkäten SF-36 samt en egenkonstruerad enkät med bakgrundsfrågor rörande skattning av behandlingstillfredsställelse och uppfattning av behandlingsformens påverkan på livskvaliteten. I MDI-gruppen deltog 40 deltagare och i IP-gruppen 37 deltagare. Studien har en deskriptiv jämförande design. Resultatet visade att det inte finns någon signifikant skillnad mellan MDI- och IP-gruppens skattning av hälsorelaterad livskvalitet. Skillnader kunde påvisas mellan behandlingsformerna gällande behandlingstillfredsställelse och uppfattningen av behandlingsformens påverkan på livskvalitet. IP-gruppen har en signifikant högre behandlingstillfredsställelse samt anser att behandlingsformen påverkar deras livskvalitet mer än MDI-gruppen. Kvinnor i MDI-gruppen skattade sin hälsorelaterade livskvalitet signifikant lägre än män i MDI-gruppen, ingen skillnad kunde dock påvisas mellan männen och kvinnorna i IP-gruppen. Männen i MDI-gruppen skattar sin hälsorelaterade livskvalitet signifikant högre än männen i IP-gruppen. Ingen skillnad kunde påvisas mellan männen i de båda grupperna gällande behandlingsstillfredsställelse eller uppfattningen av behandlingsformens påverkan på livskvaliteten. Kvinnorna i IP-gruppen skattade signifikant högre gällande behandlingsstillfredsställelse och uppfattningen av behandlingsformens påverkan på livskvaliteten än kvinnorna i MDI-gruppen. Kvinnorna i IP-gruppen har likartad hälsorelaterad livskvalitetsskattning som männen i samma grupp och har även en högre behandlingstillfredsställelse än kvinnor i MDI-gruppen. Slutsatsen kan vara att IP är en lämplig behandling för kvinnor

Introduction: The management of type 1 diabetes through the use of Continuous Subcutaneous Insulin Infusion (CSII); also known as insulin pump therapy, has become an increasingly popular option for children and adolescents. A systematic review of studies that measured Quality of Life (QoL) in children associated with CSII was conducted. Eighteen studies were reviewed, and the results showed insufficient evidence to conclude that CSII improves QoL in children and adolescents with type 1 diabetes. The current study aimed to address the gap in the literature by exploring children and parents’ perspectives on the use of CSII for managing diabetes. Method: Data were gathered from five children aged 8 – 14 years (and five parents), using one to one semi-structured interviews. Interviews were recorded, transcribed and analysed using Interpretative Phenomenological Analysis (IPA). Results: Five super-ordinate themes were identified for parents: ‘Parenting a Child with Diabetes’; ‘Worth the Hard Work’; ‘Strive for Normality’; The Pump as an Enabler’; and ‘An eye on the Future’. Three Super-ordinate themes were identified for children ‘Feeling Different’; Grappling for Control’; and ‘Better…’ which were associated with a central theme of ‘Developing a Relationship with the Pump’. Children’s data is presented separately within a journal article format. Discussion: Findings suggest that parents value the insulin pump, despite acknowledging the challenges, particularly the hard work required to manage it. Children seemed to have an ambivalent but developing relationship with the insulin pump. They experience a number of benefits and drawbacks associated with the use of CSII and it seems to affect their identity and their locus of control. Conclusion: This research provides a greater insight into the lived experience of CSII for children and their parents. The benefits of CSII seemed to outweigh the challenges involved particularly for parents; and children seemed to be developing a relationship with the pump within the realms of their relationship with diabetes.

Diabetes affects an estimated 29.1 million Americans, with approximately another 1/3 of Americans not yet diagnosed. Complications associated with diabetes include heart disease, stroke, hypertension, blindness, kidney disease, neuropathy and death. All of these complications can be prevented with optimal control of blood glucose levels. Advances in technology provide people living with diabetes (PLWD) a multitude of treatment options such as continuous subcutaneous insulin infusion (CSII) therapy. Unfortunately, sustained improvement in glycated hemoglobin A1c (HgA1c) is not always achieved even with this advanced therapy. The purpose of this doctoral project was to educate nurses on CSII therapy and promote improved patient compliance, knowledge and ultimately improve HgA1c control. This doctoral project is an evaluation of an Evidence-Based Quality Improvement Project (EB-QIP) that evaluated nurse-led educational sessions for PLWD using CSII therapy. The integrated theory of health behavior change was used to guide the project. The CDC process evaluation model was used to evaluate the outcomes of the education sessions. Results showed that patients who were instructed by the nurses who took part in the EB-QIP had a reduction in the overall HgA1c by an average of 1.1 points 3-months post-education. The project promotes positive social change through establishing the effectiveness of an EB-QIP that focused on the use of education on CSII therapy in improving outcomes for patients living with diabetes.

No description available.

OBJECTIVE: To measure clinical and qualitative outcomes in patients with diabetes mellitus transitioning from intensive insulin therapy using multiple daily injections (MDI) to continuous subcutaneous insulin infusion (CSII) initiated and managed by clinical pharmacists under a collaborative practice agreement in a primary care setting without an endocrinologist. RESEARCH DESIGN AND METHODS: This study was a retrospective and cross-sectional analysis of data from an electronic medical record (EMR) and patient survey at a large primary care private practice. Patients with type 1 or type 2 diabetes who were ≥18 years old, started on CSII between 2007 and 2010, and had at least one follow-up visit post-CSII were analyzed. Mean HbA1c results were stratified across 3-month intervals post-CSII initiation and compared to pre-CSII levels. Body mass index (BMI), the number of diabetes-related clinic visits with the primary care physician (PCP), and non-insulin diabetes medication use was compared pre- and post-CSII initiation. Paper-based questionnaires were used to assess patient satisfaction with CSII vs MDI and pharmacist-led services. RESULTS: Twenty-five patients were included in the analysis. HbA1c decreased from 8.69 to 7.52% pre and post-CSII, respectively (p < 0.001). HbA1c also decreased across all 3-month intervals post-CSII. BMI decreased from 33.0 to 32.3 kg/m(2) pre- and post-CSII, respectively (p = 0.085). Fewer diabetes-related PCP visits were completed post-CSII (5.09 vs 3.78 visits/year, p = 0.009), and less non-insulin diabetes medications were prescribed post-CSII (p < 0.001). Patients felt more comfortable controlling glycemic excursions and resultant insulin adjustments with CSII compared to MDI (p < 0.001). CONCLUSIONS: Pharmacist-led CSII services appear to improve diabetes control in patients requiring intensive insulin therapy. Patients report greater comfort using CSII and strong confidence in the abilities of the pharmacist. Physician-pharmacist collaboration in the management of intensive insulin therapy in the primary care setting should be further explored.

Adolescent athletes with type 1 diabetes (T1DM) face unique challenges when compared to peers with and without diabetes. Continuous subcutaneous insulin infusion (CSII) provides a method of insulin delivery that can enhance flexibility in insulin regimens and lifestyle that may be especially appealing to the adolescent athlete. No studies have explored the impact of athletics in this population. This descriptive qualitative study explored and described the experiences of adolescent athletes using CSII as their primary insulin delivery method, with a focus on athletic participation and performance. The purposeful sample consisted of four adolescent athletes, ages 13 to 15 years with T1DM, using CSII, in excellent diabetes control, and recently participated in organized sports activities. After written informed consent, data were collected through a semi-structured interview with the adolescent and parent. Results were transcribed verbatim and analyzed for emerging themes. Four themes emerged from the transcripts along with multiple subcategories. The main themes included: protecting the pump and infusion site; dealing with highs and lows; maximizing participation and performance; and keeping watch. Information gathered from this study will prepare healthcare professionals to anticipate the needs of adolescent athletes using CSII when prescribing a diabetes management regimen.

<p>Since the late 1970s, biomedical researchers have heavily invested in the development of portable insulin pumps that allow people with Type 1 Diabetes (T1D) to carry several days-worth of insulin to be injected on an as-needed basis. That means fewer needles and syringes, making regular insulin injections less time consuming and troublesome. As insulin pump use has become more widespread over the past twenty years among people with T1D, the social and cultural effects of using these medical devices on their everyday experiences have become both increasingly apparent for individuals yet consistently absent from social and cultural studies of the disease.</p><p><br></p><p>In this dissertation, I explore the technological, medical, and cultural networks of insulin pump treatment to identify the role(s) these biomedicalized treatment acts play in the structuring of people, their bodies, and the cultural values constructed around various medical technologies. As I will show, insulin pump treatment alters people’s bodies and identities as devices become integrated as co-productive actors within patient-users’ biological and social systems. By analyzing personal interviews and digital media produced by people with T1D alongside archival materials, this study identifies compulsory patterns in the practices, structures, and narratives related to insulin pump use to center chapters around the productive (and sometimes stifling) relationship between people, bodies, technologies, and American culture.</p><p><br></p><p>By analyzing the layered and intersecting sites of insulin pump treatment together, this project reveals how medical technologies, health identities, bodies, and cultures are co-constructed and co-defined in ways that bind them together—mutually constitutive, medically compelled, cultural and social. New bodies and new systems, I argue, come with new (in)visibilities, and while this new technologically-produced legibility of the body provides unprecedented management of the symptoms and side-effects of the disease, it also brings with it unforeseen social consequences that require changes to people’s everyday lives and practices. </p>