'The pump was a saviour for me.' Patients' experiences of insulin pump therapy.

BACKGROUND AND AIM: The present study formed part of a larger study examining the potential long-term effects of glycaemic control and treatment satisfaction in people with Type 1 diabetes mellitus who changed from multiple daily insulin injections to insulin pump therapy. Individuals (n = 46) who made the transition between May 1999 and February 2004 participated. The aim of the study was to describe experiences of the impact of insulin pump therapy in adults with Type 1 diabetes mellitus after > 5 years' use of an insulin pump. METHOD: During spring 2009, 16 of the individuals were interviewed through a narrative approach on the effects of insulin pump therapy on daily life. The interviews were analysed using content analysis. RESULTS: The overarching theme revealed that insulin pump therapy was experienced as both a shackle and a lifeline. Six sub-themes emerged: subjected vs. empowered; dependent vs. autonomous; vulnerable vs. strengthened; routinized vs. flexible; burdened vs. relieved; and stigmatized vs. normalized. CONCLUSIONS: Users of insulin pump therapy have different views about and experience of having used the technical equipment over years. Both positive and negative views emerged. However, it is difficult to identify any general trends that cover all views and can predict which individuals will be able to manage pump therapy in the best way. Even so, the sub-themes and theme that emerged could be used by physicians and diabetes specialist nurses when counselling and planning educational programmes aimed at supporting self-management among people with insulin pump treatment.

Power and self-perceived health in blind diabetic and nondiabetic individuals.

AIMS: The aims of this study were: (1) to explore perceptions of power in blind individuals and relate presence or absence of power to self-perceived health and (2) to compare self-perceived health in blind individuals with that of the general population. BACKGROUND: The theoretical framework of this study was Barrett's Power theory, which is based on The Rogerian nursing theory. Power is defined as being aware of what one is choosing to do, feeling free to doing it, and do it intentionally. METHODS: Thirty-nine blind subjects at three adjacent ophthalmology centres agreed to participate in the study. Of those 23 had become blind because of late complications of diabetes. Power was explored during semi-structured interviews and self-perceived health was measured with the Swedish health-related quality of life questionnaire. Data on socio-economic, rehabilitative and diabetes-related variables were also collected. FINDINGS: Power was experienced by 19 of the 39 respondents and was more frequently found in nondiabetic subjects than in diabetic subjects. Those experiencing power reported a better emotional and general health compared with individuals lacking power. The perception of having power was not significantly related to any other of the studied variables. When compared with age- and gender-matched controls from the general population, nondiabetic blind subjects scored higher in positive feelings and lower in physical functioning. In contrast diabetic subjects experienced poorer general health, less satisfaction with physical health and more negative feelings, but they reported that they did not experience limitation as a result of these emotions. CONCLUSION: One way of improving health in diabetic blind individuals could be to increase the subject's perception of power.

Health-related quality of life in relation to metabolic control and late complications in patients with insulin dependent diabetes mellitus.

To investigate important factors with respect to health-related quality of life (HRQOL) in patients with longstanding insulin dependent diabetes mellitus, a patient cohort was followed prospectively for 10 years. The degree of metabolic control and the presence of late complications was assessed and HRQOL was measured with a 61-item questionnaire (SWEDQUAL) in which reference values have been obtained in a population sample. The results indicate that diabetic patients (n = 108) experienced a quality of life as good as a general population. When patients were divided into four groups based on metabolic control, those with poor control (HbA1c > or = 9%) rated their physical and emotional functioning significantly lower than those with lower HbA1c values. Nearly 15% of the patients reported 1-5 hypoglycaemic episodes during the latest 6 months. Despite a lower HbA1c they rated their general health as being poorer than patients without severe hypoglycaemia. Of the 108 patients 39% appeared to be free from late complications of diabetes. These patients rated their general health as better than patients who already had developed late complications. We conclude that a satisfactory metabolic control with a minimum of hypoglycaemic episodes is desirable not only to prevent late complications but also because poor metabolic control seems to be one reason why diabetic patients experience a poorer quality of life.