Nocturnal blood pressure in young patients with insulin-dependent diabetes mellitus: correlation with cardiac function.

Lack of a decline in nocturnal blood pressure is associated with an adverse effect on end organs in adults with insulin-dependent diabetes mellitus (IDDM). The role of the decline in nocturnal blood pressure in young patients with IDDM is not known. We studied 25 white subjects with IDDM (age = 20.8 +/- 3.7 years, mean +/- SD), 8 of whom were female. The duration of IDDM in these subjects was 12.9 +/- 5.4 years (mean +/- SD). We determined the values for glycosylated hemoglobin (HgbA1), 24-hour ambulatory blood pressure, diastolic cardiac function (the ratio of peak E wave to peak A wave velocity (E/A) and indexed peak filling rate ¿PFR/SV¿ by Doppler echocardiography), and albumin excretion rate. The HgbA1 level was 10.9% +/- 1.9% (mean +/- SD; normal range = 4.5%-8.5%). The HgbA1 concentration was inversely correlated (p < 0.005) with the decline in systolic (r = 0.57) and diastolic (r = -0.55) nocturnal blood pressure. Diastolic cardiac dysfunction ¿E/A ratio [r = 0.42, p < 0.03) and PFR/SV (r = 0.52, p < 0.01)¿ correlated with a smaller decrease in nocturnal diastolic blood pressure. An inverse correlation between decline in nocturnal systolic blood pressure and log albumin excretion rate (r = -0.37, p = 0.07) approached statistical significance. We conclude that poor glycemic control adversely affects nocturnal blood pressure and that the latter may play an important role in cardiac and possibly renal dysfunction in early IDDM.

Diastolic dysfunction in young patients with insulin-dependent diabetes mellitus as determined by automated border detection.

Diastolic dysfunction is an early harbinger for systolic dysfunction in insulin-dependent diabetes mellitus (IDDM). To determine the role of automated border detection (ABD) in detecting diastolic abnormalities and whether IDDM control correlates with abnormalities, 21 young IDDM patients (22 +/- 4 years old) and 19 control subjects underwent echocardiography. ABD indices included the percent contribution to total left ventricular filling of the three phases of diastole (rapid filling, diastasis, and atrial contraction) and peak filling rate. Doppler indices included E/A ratio and peak filling rate. Rapid filling phase was lower in the IDDM patients compared with control subjects (73% +/- 5% versus 80% +/- 5%, p = 0.0006), and atrial contraction filling was higher (19% +/- 4% versus 14% +/- 3%, p = 0.0003). Doppler indexes showed similar changes. Glycosylated hemoglobin, insulin dosage, and duration of IDDM since puberty were associated with filling abnormalities. Young patients with IDDM have increased atrial contraction and reduced rapid filling phases detected by automatic border detection, and these diastolic abnormalities are related to the diabetic disease process.

Personal illness models of diabetes: parents of preadolescents and adolescents.

The purpose of this research was to explore personal illness models of parents of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the parents' cognitive representations of the disease. Fifty-five parents of children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Parents attributed the cause of diabetes to genetics coupled with a viral infection. Most believed the diabetes would last a lifetime but they were hopeful for a cure. Parents requested ongoing education for their children, support groups, counseling, one consistent healthcare provider, and intensive insulin therapy. Parents reported that the major problems caused by diabetes were increased structure of daily routines and that their children with diabetes felt different from healthy peers. Parents' fears about diabetes included long-term complications, early death, and severe insulin reactions.

Personal illness models of diabetes: preadolescents and adolescents.

The purpose of this research study was to explore personal illness models of preadolescents and adolescents regarding diabetes mellitus. Personal illness models were defined as the adolescents' cognitive representations of their disease. Sixty children ages 10 to 17 years with a diagnosis of insulin-dependent diabetes mellitus were interviewed using a semistructured questionnaire. Data were content analyzed for common themes. Although most participants expressed an understanding that their disease would last a lifetime, they were hopeful for a cure. Participants wanted healthcare professionals to provide strategies for controlling blood glucose to prevent future complications. Family and friends who followed the same diet as the adolescent with diabetes were viewed as supportive. The majority of adolescents were responsible for much of their own disease management. Their greatest fears concerned insulin reactions and long-term complications such as amputation of limbs.

Extended day program: bringing preschool to the hospital.

Children who must grow up in a hospital setting due to complex medical and social conditions present health care professionals with unique challenges that include (a) providing an environment to facilitate growth and development, (b) normalizing life experiences, (c) strengthening children's positive self-concepts, (d) promoting independence and exploration, and (e) introducing opportunities for learning experiences. An Extended Day Program, designed by nurses and other professionals to promote optimal development and psychosocial care for long-term hospitalized children, can offer these benefits.