[Additional treatment supporting standard care for children and adolescents with diabetes mellitus type I - indication, acceptance and outcome: results from a multi-centre observational study]. / Interventionen zur Unterstützung der Regelversorgung von Kindern und Jugendlichen mit Diabetes Typ I - Indikationen, Inanspruchnahme und Effekte: Ergebnisse einer multizentrischen Beobachtungsstudie.

BACKGROUND: At various time points of routine care, additional treatment beyond standard care is required for patients with special problems (i.e. diabetes training, counselling and/or psychological support). Despite the frequency of such additional interventions, there is little information about the outcome of such measures. PATIENTS/METHODS: In an observational study, data from 765 children/adolescents and their parents were collected. The collection included data on patients&' quality of life, their psychosocial situation as well as somatic parameters (metabolic control). Members of the diabetes team rated the necessity and the realisation of interventions in addition to standard care. 22 treatment centers, providing community-based diabetes care, participated in the study. The age of the patients averaged 11.5+/-3.7 years, the average duration of diabetes was 3.7+/-3.2 years; the mean HbA1C was 7.5+/-1.3%. The effects of the additional treatment were evaluated based on the view of the diabetes care team, and based on serial HbA1C measurements (average duration between inclusion in the study and follow-up was 1.16+/-0.17 years). RESULTS: For 197 patients (25.7%) additional treatment was recommended by the diabetes team. In particular, both out-patient and in-patient diabetes training courses as well as psychological support were suggested. 69.6% of the patients followed these recommendations and accepted additional treatment. The largest effects of additional treatment were seen by the team in respect to metabolic improvement and patient compliance. The smallest effects were observed with respect to changes in behaviour and in the family situation. By using the HbA1C values as an objective criterion, however, no marked improvement in metabolic control of patients receiving additional treatment was present. The kind of additional treatment recommended did not affect the outcome, and no difference was present whether the additional intervention was actually completed or not. Metabolic control deteriorated during the observation period by+0.5+/-1.3% in patients were additional intervention had been recommended, compared to+0.16+/-1.1% in patients were no additional treatments had been recommended (p=0.002). There was no significant correlation between the judgment of the diabetes team on metabolic improvement and the HbA1c change during the observation period (r=0.11). CONCLUSIONS: These data demonstrate that many patients have problems to cope with diabetes management. Standard diabetes care is often not sufficient and patients need additional support. The results also show that the additional interventions recommended only have a moderate or minor effect on outcome. We conclude from these results that it is necessary to attend to the needs of the patients and anchor the recommendation on treatment in the standard care environment. We need a qualitatively better interconnection of multiple therapeutic approaches, in combination with the necessity for permanent monitoring of the efficiency of all interventions.

[Evaluation of an outpatient treatment program for obese children and adolescents]. / Ergebnisse einer ambulanten Behandlung von Kindern und Jugendlichen mit Adipositas.

BACKGROUND: In Germany the number of children with elevated body weights has significantly increased in the last 10 to 15 years. Resulting comorbidities lead to increasing costs for the community. The quality of life of these children is reduced. PATIENTS: 84 children and their families have been included in the study. In addition to anthropometric data informations on eating behaviour and psychosocial data of the family have been documented. At the beginning of the intervention the children had an age of 10.36 +/- 3,27 years and a BMI-SDS of 4,78 +/- 1,16. The mean time period for follow-up has been 28,7 months (mean). METHODS: Children have been treated within a family-based intervention program in a setting focusing on behaviour modification over 6 months (sessions every 4 th week). Patients have been treated in four different intervention groups (behaviour modification and eating counselling (a),a' plus one parent group session (b),b' plus two courses in cooking and preparing meals for parents and children, (c), the fourth group has been treated in addition within a more intensive inpatient setting for 6 weeks. RESULTS: Drop out rate has been 37,1 %. The weight reduction during the treating period has resulted in a reduction of the BMI-SDS of 0.57 +/- 0.51 (p = 0.0001). 33.7 % of the patients investigated during follow-up (n = 30) have not changed or even reduced their achieved body weights (BMI-SDS). In a stepwise multiple regression analysis the variables age of the patient, self-control of eating behavior and weight of the father explained 70 % of the variance of weight changes during the follow-up period. There have been no differences between the changes in BMI-SDS during follow-up between patients in groups,a',b' or,c' and the group taking part in addition in the in-patient setting. CONCLUSIONS: Treatment programs for obese children and adolescents have to focus on the specific living conditions and eating behaviours of the family especially on age, capacity for self control of the child and the eating behaviour of the father. Local networks to be established within the country for treating obese children coordinated by the paediatrician seem to be best possibilities to provide individual support. In this local networks the prevention of extreme eight increases must be a predominant task.

[Adaptation of parents to the diagnosis of a chronic disease in their child]. / Adaptation von Eltern an eine chronische Erkrankung ihres Kindes nach der Diagnosestellung.

The course and the adaptivity of parental coping with a chronical disease in their child (leukemia, solid tumors, diabetes or epilepsy) was studied during the first three months after diagnosis. 66 parents answered questionnaires to their coping and their quality of life as well as to the perceived quality of life of their children 1-2 weeks and again 8-12 weeks after diagnosis. As coping was stable, the parents' and children's quality of life increased over time. Coping strategies using communication and social support improved the physical well-being of the parents. Family orientation and optimism are helpful for parents and children, too, but rumination decreased emotional well-being of the parents. Psychosocial care for families with a chronically ill child should improve open communication and social orientation in an early stage of the disease and should try to change maladaptive cognitive reactions.