Effect of Wearable Technology on Metabolic Control and the Quality of Life in Children and Adolescents with Type 1 Diabetes: A Systematic Review and Meta-Analysis

Background: Type 1 diabetes is one of the most common chronic diseases in children. Wearable technology (insulin pumps and continuous glucose monitoring devices) that makes diabetes management relatively simple, in addition to education and follow-ups, enhances the quality of life and health of individuals with diabetes. Aims: To evaluate the impact of wearable technology on metabolic management and the quality of life in children and adolescents with type 1 diabetes. Study Design: Systematic review and meta-analysis. Methods: The Preferred Reporting System for Systematic Reviews and Meta-Analyses was used to conduct a systematic review and meta-analysis. PubMed, Web of Science, MEDLINE, Cochrane Library, EBSCO, Ulakbim and Google Scholar were searched in July 2022 and July 2023 using predetermined keywords. The methodological quality of the studies was evaluated using the Joanna Briggs Institute's Critical Appraisal Checklists for randomized controlled experimental and cross-sectional studies. The meta-analysis method was used to pool the data. Results: Eleven studies published between 2011 and 2022 were included. The total sample size of the included studies was 1,853. The meta-analysis revealed that the decrease in hemoglobin A1C (HbA1c) level in those using wearable technology was statistically significant [mean difference (MD): -0.33, Z = 2.54, p = 0.01]. However, the technology had no effect on the quality of life [standardized mean difference (SMD): 0.44, Z = 1.72, p = 0.09]. The subgroup analyses revealed that the decrease in the HbA1c level occurred in the cross-sectional studies (MD: -0.49, Z = 2.54, p = 0.01) and the 12-19 (MD = 0.59, Z = 4.40, p < 0.001) and 4-18 age groups (MD: -0.31, Z = 2.56, p = 0.01). The subgroup analyses regarding the quality of life revealed that there was no difference according to the research design. However, the quality of life was higher in the wearable technology group than in the control group in the 8-12 and 4-18 age groups (SMD: 1.32, Z = 2.31, p = 0.02 and SMD: 1.00, Z = 5.76, p < 0.001, respectively). Conclusion: Wearable technology effectively reduces the HbA1c levels in children and adolescents with type 1 diabetes in some age groups. However, it does not affect the quality of life.

Effect of using crochet octopus in reducing the pain: a randomized controlled study.

AIMS: The study aimed to determine the effect of using a crochet octopus to reduce acute pain and maintain optimal physiological measurements that develops during procedural pain in neonates. MATERIALS AND METHODS: This was a parallel design randomized controlled study. During the procedure of heel lance, experimental groups were delivered a crochet octopus 10 min before the process and let them touch the octopus during and for up to 10 min after the procedure. Control group experienced the process without any intervention. SpO2, duration of crying of neonates and pain they experienced were evaluated. RESULTS: The study was completed with 100 (50 for the experimental group and 50 for the control group) term neonates. SpO2 of neonates, touching the crochet octopus during and after in second minute of the process was found higher and also the duration of crying was shorter during whole the process, and the pain they experienced due to the process was lower than the control group. CONCLUSIONS: Crochet octopus affected physiological measurements of the neonates positively and reduced the procedural pain as well.

The Development and Validation of a Turkish Insulin Treatment Self-management Scale Child Form (Ages 8-18) and Parent Form

Objective: The aim of the study was to develop an Insulin Treatment Self-management Scale; both Child Form and Parent Form for children ages 8-18 with type 1 diabetes. Methods: Children with type 1 diabetes and their parents participated in the study. Development of a methodologically designed scale was conducted to investigate insulin treatment self-management of children with type 1 diabetes. Results: A total of 331 children and their parents were recruited. Children and parents completed the data collection tools by themselves. The final scale had two subscales; one was related to cognitive and behavioural expressions regarding insulin treatment (self-efficacy) and the other to emotional aspects of self-maagement of insulin treatment (emotional impacts). The scale was shown to be valid and reliable. Conclusion: This study was a valid and reliable scale for measuring insulin treatment self-management in children with type 1 diabetes. Thus can be used to assess insulin treatment self-management in children with type 1 diabetes and their parents as well as a tool for effective nursing care.

Psychometric Properties of the Turkish Version of the University of Virginia Parent Low Blood Sugar Survey

OBJECTIVE: The aim of this study was to produce and validate a Turkish version of the University of Virginia Parent Low Blood Sugar Survey (P-LBSS). The P-LBSS is used to assess parental fear of their diabetic children's hypoglycemia. METHODS: Linguistic, content and face validity of the translated P-LBSS was tested. Afterwards, explanatory and confirmatory factor analyses were conducted in order to evaluate construct validity. RESULTS: The sample included 390 parents of type 1 diabetic adolescents aged 12-17 years. Results of the factor analysis showed that the Turkish P-LBSS had 2 subscales (behavior and worry) as in the original. The Cronbach's alpha coefficient of the Turkish version of the total P-LBSS was found to be 0.803, and the value was 0.865 for the behavior and 0.790 for the worry subscales. Psychometric investigation of the Turkish version of P-LBSS indicated high reliability and good retestability, content and construct validity. CONCLUSION: The Turkish P-LBSS is a valid and reliable instrument to measure the fear of hypoglycemia experienced by parents of diabetic adolescents aged between 12-17 years in the Turkish population.

Impact of toilet hygiene training program: results from 11- to 16-year-old secondary school Turkish children.

OBJECTIVES: The purpose of the study is to evaluate the effectiveness of toilet hygiene education in secondary school students. METHODS: The study was quasi-experimental with a pre-test-post-test design and includes a control group. The study was conducted at a secondary school in Istanbul, Turkey with 100 students (50 students for experiment and 50 students for control). The experiment and control groups were in the same school population. Data were collected with the student information form and toilet hygiene evaluation form (THEF), which were developed by the researchers. RESULTS: When we examined the toilet hygiene techniques used by the students, they indicated 58 % (n = 58) wiped perinea from front to back, 25 % (n = 25) back to front and 17 % (n = 17) randomly. It was found that 69 % (n = 69) of the students changed their underwear every 2-3 days; 80 % (n = 80) were trained by parents on toilet hygiene. Total THEF scores, which were obtained pre and post (shortly after) education, showed significant differences in the experiment group (p = 0.000). Total THEF scores obtained post education (shortly after and 1 month later) showed significant differences in the experiment group (p = 0.009). CONCLUSIONS: The toilet hygiene education program is found to be successful in secondary school students.

Acquired activated protein C resistance in sarcoma patients.

Acquired activated protein C resistance (aAPCR) is seen more frequently in solid and hematological cancer patients. We aimed to investigate the presence of aAPCR and the frequency of clinically detectable thrombosis in sarcoma patients. Normalized activated protein C sensitivity ratio (nAPCSR), factor V Leiden (FVL) mutation, factor V (FV) levels and factor VIII (FVIII) levels were prospectively measured in 52 patients and in 52 healthy controls. Clinically detectable thrombosis was present in one patient (1.92%). Compared with healthy controls (106%), the sarcoma patients had significantly lower values of the nAPCSR at pre (87.25%) and post (94.35%) treatment period (P < 0.0001). aAPCR was found as 4.2, 13 and 0%, respectively. The post-treatment FV levels (178.1 U/dl) were significantly (P < 0.001) higher than the pretreatment levels (147.5 U/dl). Inverse correlation was found between post-treatment FV levels and nAPCSR values (r = -0.38, P < 0.02). We found out a slightly increased frequency of venous thromboembolism in sarcoma patients. As an original finding which has not been reported previously in the literature, we also found out a decrease in the nAPCSR, persisting even after treatment. Thirdly, we found out that the significantly higher rate of aAPCR at the time of diagnosis totally disappeared after treatment.

[Autologous osteochondral transplantation]. / Osteokondral otogreft transplantasyonu.

The surface of diarthrodial joints is covered by hyaline cartilage whose regeneration capacity is extremely limited. Conventional surgical techniques enable repair of full-thickness articular cartilage defects only by fibrous cartilage having poor mechanical properties. Recently, new techniques have been developed to provide hyaline or hyaline-like repair tissue in the treatment of full-thickness cartilage defects. Autologous osteochondral transplantation involves press-fit implantation of both bone and cartilage obtained from healthy articular surface. The principal indication for this technique is unifocal full-thickness chondral or osteochondral defects measuring 1 to 4 square centimeters. This surgical procedure can be performed openly or arthroscopically. The graft should be placed vertically and evenly to the joint surface. Although short-term and mid-term results are satisfactory, several problems have been reported including donor site morbidity, damage to cartilage, and incongruity and incorporation of the graft. Autologous osteochondral transplantation provides viable osteochondral units at a single stage and eliminates the need for culturing chondrocytes which is quite expensive. Currently, no surgical technique or medical treatment provide complete healing of articular cartilage defects. Autologous osteochondral transplantation is an important stage worthy of improvement in this respect.