Teenagers with diabetes: self-management education and training on a big schooner.

The aims of this study are to evaluate whether diabetic teenagers participating in a group educational programme, 'the schooner programme', differ from non-participants in attitudes towards diabetes and self-care, and to evaluate the impact on the attitudes, HbA1c and treatment of the programme. Ninety teenagers aged 14-18 years attended the programme. Attitudes towards diabetes and self-care were measured with a validated questionnaire. Medical data were collected from the medical records. The participants reported more positive attitudes towards diabetes and self-care and more frequent contacts with others with diabetes monitored blood glucose more often and felt less disturbed by diabetes than non-participants. The programme had positive impact on attitudes towards diabetes. There was no change in HbA1c, but the use of insulin pumps was more frequent among participants after the programme. To get teenagers attracted to group education, the diabetes care team needs to influence them towards more positive attitudes.

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.

A controlled study of oral self-care and self-perceived oral health in type 2 diabetic patients.

A controlled study was carried out in mid-Sweden with the aim of comparing oral self-care and self-perceived oral health in 102 randomly sampled type 2 diabetic patients with that of 102 age-and-gender-matched non-diabetic controls. Oral health variables were also related to glycemic control (HbA1c), duration, anti-diabetic treatment, and late complications. Questionnaires were used to collect data on oral self-care and self-perceived oral health. Diabetes-related variables were extracted from medical records. Eighty-five percent of the diabetic subjects had never received information about the relation between diabetes and oral health, and 83% were unaware of the link. Forty-eight percent believed that the dentist/ dental hygienist did not know of their having diabetes. Most individuals, but fewer in the diabetic group, were regular visitors to dental care and the majority felt unaffected when confronted with dental services. More than 90% in both groups brushed their teeth daily and more than half of those with natural teeth did proximal cleaning. Subjects in the diabetic group as well as in the control group were content with their teeth and mouth (83% vs 85%. Those with solely natural teeth and those with complete removable dentures expressed most satisfaction. Sensation of dry mouth was common among diabetic patients (54%) and subjects with hypertension exhibited dry mouth to a greater extent (65%) than those who were normotensive. Our principal conclusion is that efforts should be made to give information about diabetes as a risk factor for oral health from dental services to diabetic patients and diabetes staff.

Type 2 diabetes and oral health: a comparison between diabetic and non-diabetic subjects.

A controlled cross-sectional study with the aim of studying oral health in patients with type 2 diabetes was carried out in a health care district in Sweden. The study included 102 randomly sampled diabetic patients and 102 age- and gender-matched non-diabetic subjects from the same geographical area, treated at the same Public Dental Service clinics. Oral conditions were measured at clinical and X-ray examinations. Diabetes-related variables were extracted from medical records. Diabetic patients suffered from xerostomia (dry mouth) to a significantly higher degree than non-diabetic controls did (53.5 vs. 28.4%; P=0.0003). Sites with advanced periodontitis were more frequent in the diabetic group (P=0.006) as were initial caries lesions (P=0.02). Diabetic subjects showed a greater need of periodontal treatment (P=0.05), caries prevention (P=0.002) and prosthetic corrections (P=0.004). Diabetes duration or metabolic control of the disease was not related to periodontal status. However, patients with longer duration of diabetes had more manifest caries lesions (P=0.05) as had those on insulin treatment when compared with patients on oral/diet or combined treatment (P=0.0001). The conclusion is that individuals with type 2 diabetes in some oral conditions exhibited poorer health. Close collaboration between the patient, the primary health care and oral health professionals could be a way of improving the diabetic patient's general and oral health.

Coping with a chronic disease.

Interviews were conducted with 55 experienced patients with insulin-dependent diabetes with the aim of identifying strategies for coping with diabetes. This study was based on a health-oriented approach known as Antonovsky's salutogenic model, which conceptualizes the person as being actively involved in maintaining biological, psychological, and social homeostasis. All patients had developed some strategy for maintaining biological balance. Twenty-two also had strategies for coping both psychologically and socially with the disease. The remaining 33 patients had developed either a psychological or a social strategy in addition to their biological strategies. The results indicate that it is important for the patient's well-being and self-esteem to establish all three coping strategies--biological, psychological, and social. The diabetes care team could be a valuable resource for the patient in this respect.

Patient perspectives of diabetes care and education.

Educating and supporting patients in managing their daily life with diabetes mellitus are important goals of diabetes care today. These goals demand not only good medical knowledge but also good communication skills in the members of the diabetes care team and in the patients. Continuity and accessibility are naturally factors influencing the communication between the patients and the care team. This study, based on 55 interviews with well-experienced insulin-dependent diabetic patients, shows further that the contacts between the diabetes care system and the patient are often only superficial and in practice mainly related to the patient's metabolic control. Patients with good or acceptable metabolic control experience positive feed-back from the care team, while those with unsatisfactory or unacceptable metabolic control do not receive positive response and support to the same degree. The patients want to be permitted to be responsible for themselves and need support from the care team in order to accomplish this. From the patient's perspective, the diabetes education consists of an overwhelming amount of new information which often is presented on only one occasion. The patients want the education to be on an acceptable but minimum level and to be a continuous process that is applicable in practice.

Health and unhealth in chronic disease.

When health is defined from a holistic view, traditional measures of control in diabetes, such as analysis of blood glucose or HbA1c, are of limited use as indicators of health and unhealth. On the other hand, evaluation of attitudes and certain personality variables might provide guidance both in discovering unhealth and in creating individual self-care programmes for its treatment. In the present study the subjective experience of health and unhealth was studied in a defined population of patients with insulin dependent diabetes mellitus (IDDM). The patients could be divided into three categories: a) those not abandoning important goals because of their diabetes, b) "adapted abandoners" and, c) those abandoning vital aspects of life. On the basis of the findings, the question of how "problem patients" can be identified and treated is discussed.

The patient's experience of diabetes and its treatment: construction of an attitude scale by a semantic differential technique.

An instrument for measuring attitudes towards diabetes and self-care was constructed by a semantic differential technique. The instrument contained nine adjective pairs. Factor analysis classified these into four factors: self-esteem/autonomy, object evaluation, quality of life supporting factor and self-strength/vulnerability. The reliability coefficient of test-retest by 28 nurses/nurse tutors was 0.93. Fifty diabetic patients completed the attitude scale for testing the validity of the instrument. Male patients had a more positive attitude towards diabetes than females. Those who had had diabetes for less than 10 years were more positive than those with a longer duration of the disease. A higher degree of education, well-performed self-monitoring of blood glucose and achievement of good metabolic control were all associated with a more negative attitude towards diabetes. A group of nurses/nurse tutors who also completed the attitude scale had a more negative attitude towards diabetes than the investigated groups of patients.