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Objective To investigate in children with type 1 diabetes mellitus and provide evidence for nursing education. Methods From January to December 2016, 450 patients with T1DM were enrolled in this research,all of them were outpatients of diabetes clinic of Beijing Children′s Hospital Affiliated to Capital Medical University. The clinical data of the patients were collected through questionnaires and physical examinations to assess the insulin treatment and related factors. Results Among 450 patients, 221 were males and 229 were females, aged 9.40 (0.83-17.97) years old; body mass index was 17.43 (12.81-28.22) kg/m2; course of disease was 2.32 (0.05-12.89) years; daily insulin dosage was 0.66 (0.11-1.78) IU·kg-1·d-1; glycosylated hemoglobin (HbA1c) was 7.54 (4.4-14.9)%, of which HbA1c<7.5% accounted for 55.8%(251/450). 7.5%-9.0% accounted for 30.0(135/450)% , and >9.0% accounted for 14.2% (64/450). 44.9% ,47.1% ,8.0% (202, 212,36 cases) patients were treated respectively with routine treatment, multiple daily injection or continuous subcutaneous insulin infusion. There was no significant difference in HbA1c between patients with different insulin regimens (P>0.05), but there were significant differences in age, course of disease, body mass index and insulin dosage (P< 0.05). Conclusion Because children with type 1 diabetes have different physiological and psychological characteristics in different stages, the content of health education should be adjusted according to the patient's condition.
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Objective To explore the nursing measures of patients with congenital hyperinsulinism during hospitalization and to develop nursing strategies. Methods A total of 131 patients with congenital hyperinsulinism were enrolled in the Department of Endocrinology and Metabolism, Beijing Children′s Hospital. The patients were divided into four nursing stages for the treatment of children. The first stage: diagnosed as soon as possible and minimized hypoglycemia on children caused by injury; the second stage: patient feeding, monitoring diazoxide caused by gastrointestinal tract, circulatory system adverse reactions; the third stage: monitoring blood glucose changes, timely adjustment of octreotide dosage; the fourth stage: perioperative period of care, the prognosis of the full mission;throughout the focus of care was to keep the vein pass patency to maintain normal blood sugar. Results The number of patients receiving one to four stages of nursing were 131, 104, 18, 5 cases, respectively. The number of patients with satisfactory results after treatment was 27, 71, 15, 1, respectively. For patients who did not receive satisfactory glycemic control of the 15 patients were followed up, of which 5 cases were lost, 6 cases with improvement of hypoglycemia symptoms 2 years later, 4 cases were dead due to multiple organ damage. Conclusions The treatment of congenital hyperinsulinism patients is responsible for the long process, targeted care measures should be carried ou aiming at different treatment methods in order to obtain a satisfactory care effect.
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Objective To investigate the incidence of newly-onset type 1 diabetes mellitus ( T1DM ) complicated with ketoacidosis(DKA) and its relevant factors in pediatrics. Methods Hospital records of 317 T1DM children below 18 years of age, diagnosed from 2010 to 2012 were reviewed. By using retrospectively analyzed data of inpatients with newly-diagnosed T1DM, the incidence of DKA was calculated. In this study, the influential factors of DKA included gender, age, residence, family history of diabetes mellitus, duration of symptoms, misdiagnosis or missed diagnosis, and delayed treatment. Patients were divided into two groups:group 1, aged5 year. Results Of all patients diagnosed with T1DM, 175 ( 55. 2%) presented with DKA, and mild, moderate, and severe DKA accounted for 26. 5%, 23. 9%, 49. 6%, respectively. The incidences of DKA in group 1 andgroup2were67.5% and48.0% (P=0.001),withthehighestfrequency(70.3%)inpatientsaged5 years was half of patients aged<5 years ( OR=0. 448, P=0. 003), and the risk of DKA in patients with misdiagnosis or missed diagnosis was higher (OR=5. 640, P=0. 005). Conclusion DKA in patients with newly-onset T1DM is frequent and often severe. Multivariate analysis revealed that patients aged <5 years and those with misdiagnosis or missed diagnosis are encountered high risk of DKA.
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<p><b>BACKGROUND</b>It has been indicated that autologous hematopoietic stem cell transplantation (AHST) is a promising treatment to adults with type 1 diabetes, however, the application of AHST therapy to children with type 1 diabetes still needs more data. The aim of this study was to assess the clinical effect of immune intervention combined with AHST and conventional insulin therapy in the treatment of children with newly diagnosed type 1 diabetes.</p><p><b>METHODS</b>This 1:2 matched case-control study was comprised of 42 children who were newly diagnosed with type 1 diabetes in the Department of Endocrinology, Beijing Children's Hospital from 2009-2010. The case group included 14 patients, who were treated with AHST within the first 3 months after being diagnosed with diabetes at request of their parents during 2009-2010. The control group included 28 patients with newly diagnosed type 1 diabetes at the same period of hospitalization. We compared the baseline and follow-up data of them, including ketoacidosis onset, clinical variables (glycosylated hemoglobin (HbA1c), insulin dosage and serum C-peptide).</p><p><b>RESULTS</b>The clinical characteristics of the patients was comparable between the case group and the control group. At 6-12 months ((10.7±4.2) months) after AHST treatment, we found 11 patients in the case group did not stop the insulin therapy, three cases stopped insulin treatment for 2, 3 and 11 months, respectively. No diabetic ketoacidosis (DKA) occurred after transplantation in all the patients in the case group. HbA1c in the control group was significant lower than that in the case group (P < 0.01), while the insulin dosage and serum C-peptide were not significant different between the two groups (P > 0.05). In order to eliminate the honeymoon effect, we performed final follow-up at the 3-5 years ((4.2±1.8) years) after AHST treatment, and found that HbA1c in the control group was still lower than that in the case group (P < 0.01); however, the insulin dosage and serum C-peptide were not significantly different between the two groups (P > 0.05). Moreover, the insulin dosage was not significant different from baseline to follow-up period in the case group.</p><p><b>CONCLUSION</b>AHST treatment showed no advantage in effectiveness in children with newly diagnosed type 1 diabetes, both in insulin dose and long term blood glucose control.</p>
Subject(s)
Adolescent , Child , Child, Preschool , Female , Humans , Infant , Male , Case-Control Studies , Diabetes Mellitus, Type 1 , Drug Therapy , Therapeutics , Hematopoietic Stem Cell Transplantation , Hypoglycemic Agents , Therapeutic Uses , Insulin , Therapeutic Uses , Transplantation, Autologous , Treatment OutcomeABSTRACT
Objective The purpose of the study was to assess the quality of life in children and adolescents with type 1 diabetes.Methods 89 patients with type 1 diabetes admitted by Beijing children's hospital and 196 matched healthy children and adolescents were involved.QOL was assessed using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scale.Results Children and adolescents with type 1 diabetes had lower general HRQOL compared with the healthy matched children and adolescents,especially in emotional functioning and school functioning,HRQOL in girls was significantly lower than HRQOL in boys regarding social functioning.Conclusions The QOL of children and adolescents with type 1 diabetes was impaired.
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Objective To research in risk factors existing in nursing of medical department and the corresponding measures.Methods 152 patients with internal disease were set as the research group from January 2009 to January 2010,147 patients from January to December 2008 were set as the control group.The control group was given routine clinical nursing,the research group was given pertinent nursing according to nursing risk factors.Results After implementation of nursing risk management,precaution consciousness greatly improved,frequency of nursing risk incidents reduced and satisfaction degree of patients with nursing service increased,the research group was better than the control group.Conclusions Risk management is an effective measure to decrease the nursing risk,and to adopt risk management is useful for elevating nursing quality and patients' satisfactory degree.