Perspectives of culturally and linguistically diverse families in the management of children with type 1 diabetes in Western Australia.

OBJECTIVES: Children with Type 1 diabetes (T1D) from different ethnic backgrounds are growing in proportion in clinical practice and tend to have a higher risk of poor health outcomes. The study aimed to investigate the perspectives of culturally and linguistically diverse families in the management of children with T1D in Western Australia. DESIGN: A generic qualitative approach was used. Families of children and adolescents with T1D with first-generation African, Asian or Middle Eastern background were invited to participate in a semi-structured interview. The interviews were audio-recorded, transcribed and analysed thematically. Demographic, clinical and socio-economic data were collected from all participants. RESULTS: Fifteen families (27% African, 33% Middle Eastern, 40% Asian) participated in the study. The mean (SD) age of the child with T1D was 10.2 (5.1) years, had diabetes for 2.9 (1.6) years and an average HbA1c of 67 (15) mmol/mol. Four main themes were identified through qualitative analysis. 'Dietary challenges': lack of adequate food resources posed a barrier to determine carbohydrate amount in traditional meals; 'Linguistic challenges': inadequate reading and language skills affected comprehension of written information and the desire for pictorial resources was reported; 'Limited Support': absence of extended family made management of T1D difficult; and 'Knowledge': a key facilitator, which was acquired through clinic education, enabled families to develop skills to effectively manage T1D. CONCLUSION: The study highlights the need to consider cultural diversity, psychosocial needs, English proficiency and health literacy when assessing and planning diabetes education. These findings will be useful to formulate a more culturally sensitive approach to diabetes education to improve care and outcomes for young people with T1D from culturally and linguistically diverse families.

Effects of Dietary Fat and Protein on Glucoregulatory Hormones in Adolescents and Young Adults With Type 1 Diabetes.

CONTEXT: Dietary fat and protein impact postprandial hyperglycemia in people with type 1 diabetes, but the underlying mechanisms are poorly understood. Glucoregulatory hormones are also known to modulate gastric emptying and may contribute to this effect. OBJECTIVE: Investigate the effects of fat and protein on glucagon-like peptide (GLP-1), glucagon-dependent insulinotropic polypeptide (GIP) and glucagon secretion. METHODS: 2 crossover euglycemic insulin clamp clinical trials at 2 Australian pediatric diabetes centers. Participants were 12-21 years (n = 21) with type 1 diabetes for ≥1 year. Participants consumed a low-protein (LP) or high-protein (HP) meal in Study 1, and low-protein/low-fat (LPLF) or high-protein/high-fat (HPHF) meal in Study 2, all containing 30 g of carbohydrate. An insulin clamp was used to maintain postprandial euglycemia and plasma glucoregulatory hormones were measured every 30 minutes for 5 hours. Data from both cohorts (n = 11, 10) were analyzed separately. The main outcome measure was area under the curve of GLP-1, GIP, and glucagon. RESULTS: Meals low in fat and protein had minimal effect on GLP-1, while there was sustained elevation after HP (80.3 ± 16.8 pmol/L) vs LP (56.9 ± 18.6), P = .016, and HPHF (103.0 ± 26.9) vs LPLF (69.5 ± 31.9) meals, P = .002. The prompt rise in GIP after all meals was greater after HP (190.2 ± 35.7 pmol/L) vs LP (152.3 ± 23.3), P = .003, and HPHF (258.6 ± 31.0) vs LPLF (151.7 ± 29.4), P < .001. A rise in glucagon was also seen in response to protein, and HP (292.5 ± 88.1 pg/mL) vs LP (182.8 ± 48.5), P = .010. CONCLUSION: The impact of fat and protein on postprandial glucose excursions may be mediated by the differential secretion of glucoregulatory hormones. Further studies to better understand these mechanisms may lead to improved personalized postprandial glucose management.

Substantial Intra-Individual Variability in Post-Prandial Time to Peak in Controlled and Free-Living Conditions in Children with Type 1 Diabetes.

The optimal time to bolus insulin for meals is challenging for children and adolescents with type 1 diabetes (T1D). Current guidelines to control glucose excursions do not account for individual differences in glycaemic responses to meals. This study aimed to examine the within- and between-person variability in time to peak (TTP) glycaemic responses after consuming meals under controlled and free-living conditions. Participants aged 8-15 years with T1D ≥ 1 year and using a continuous glucose monitor (CGM) were recruited. Participants consumed a standardised breakfast for six controlled days and maintained their usual daily routine for 14 free-living days. CGM traces were collected after eating. Linear mixed models were used to identify within- and between-person variability in the TTP after each of the controlled breakfasts, free-living breakfasts (FLB), and free-living dinners (FLD) conditions. Thirty participants completed the study (16 females; mean age and standard deviation (SD) 10.5 (1.9)). The TTP variability was greater within a person than the variability between people for all three meal types (between-person vs. within-person SD; controlled breakfast 18.5 vs. 38.9 min; FLB 14.1 vs. 49.6 min; FLD 5.7 vs. 64.5 min). For the first time, the study showed that within-person variability in TTP glycaemic responses is even greater than between-person variability.

Optimization of Blood Handling and Peripheral Blood Mononuclear Cell Cryopreservation of Low Cell Number Samples.

BACKGROUND: Rural/remote blood collection can cause delays in processing, reducing PBMC number, viability, cell composition and function. To mitigate these impacts, blood was stored at 4 °C prior to processing. Viable cell number, viability, immune phenotype, and Interferon-γ (IFN-γ) release were measured. Furthermore, the lowest protective volume of cryopreservation media and cell concentration was investigated. METHODS: Blood from 10 individuals was stored for up to 10 days. Flow cytometry and IFN-γ ELISPOT were used to measure immune phenotype and function on thawed PBMC. Additionally, PBMC were cryopreserved in volumes ranging from 500 µL to 25 µL and concentration from 10 × 106 cells/mL to 1.67 × 106 cells/mL. RESULTS: PBMC viability and viable cell number significantly reduced over time compared with samples processed immediately, except when stored for 24 h at RT. Monocytes and NK cells significantly reduced over time regardless of storage temperature. Samples with >24 h of RT storage had an increased proportion in Low-Density Neutrophils and T cells compared with samples stored at 4 °C. IFN-γ release was reduced after 24 h of storage, however not in samples stored at 4 °C for >24 h. The lowest protective volume identified was 150 µL with the lowest density of 6.67 × 106 cells/mL. CONCLUSION: A sample delay of 24 h at RT does not impact the viability and total viable cell numbers. When long-term delays exist (>4 d) total viable cell number and cell viability losses are reduced in samples stored at 4 °C. Immune phenotype and function are slightly altered after 24 h of storage, further impacts of storage are reduced in samples stored at 4 °C.

Percepção do acompanhante do paciente pediátrico durante a indução e o despertar da anestesia / Perception of the pediatric patient accompany during anesthesia induction and awakening / Percepción del acompañante del paciente pediátrico durante la inducción y el despertar de la anestesia

Objetivo: Conhecer as percepções de acompanhantes das crianças na indução anestésica e no despertar da anestesia. Método: Estudo exploratório, descritivo, qualitativo, realizado em um centro cirúrgico (CC) de um hospital pediátrico de Porto Alegre, Rio Grande do Sul, Brasil, com sete mães presentes na indução anestésica e no despertar da criança da anestesia. A coleta de dados foi realizada em duas fases: 1. observação não participativa na pré-indução e na indução anestésica; 2. entrevista semiestruturada na sala de recuperação pós-anestésica (SRPA). Resultados: Da análise de conteúdo dos diários de campo emergiram duas categorias: estratégias utilizadas pelos acompanhantes e tranquilidade. As estratégias usadas foram: choro, amor e carinho. Das entrevistas emergiram duas categorias: experiência positiva e experiência negativa, sendo a primeira a mais destacada. Conclusão: Acompanhar o filho no processo anestésico-cirúrgico desencadeou mais percepções positivas do que negativas nas mães. Além de dar suporte e tranquilidade à criança, as acompanhantes se sentiram mais seguras.

Objective: To know the perceptions o children's companion in anesthetic induction and awakening. Method: An exploratory, descriptive, qualitative study carried out in the surgical center (SC) of a pediatric hospital in Porto Alegre, Rio Grande do Sul, Brazil, with seven mothers present during anesthetic induction and awakening of the child. Data collection was carried out in two parts: 1. Non-participatory observation in anesthetic pre-induction and induction; 2. Semi structured interview in the post-anesthetic recovery room (PARR). Results: Two categories emerged from the contents analysis of field journals: strategies used by companions and tranquility. The strategies used were: crying, love and affection. Two categories emerged from the interviews: positive and negative experiences, the former being the most outstanding one. Conclusion: Accompanying a child in the anesthetic-surgical process triggered more positive than negative impressions on mothers. In addition to giving support and tranquility to the child, companions themselves would feel safer.

Objetivo: Conocer las percepciones de acompañantes de los niños en la inducción anestésica y en el despertar de la anestesia. Método: Estudio exploratorio, descriptivo y cualitativo, realizado en un centro quirúrgico (CQ) de un hospital pediátrico de Porto Alegre, Rio Grande do Sul, Brasil, con siete madres presentes em la inducción anestésica y el despertar del niño de la anestesia. La recolección de datos fue realizada em dos fases: 1. Observación no participativa em la pre-inducción y en la inducción anestésica; 2. Entrevista semiestructurada en la sala de recuperación postanestésica (SRPA). Resultados: Dos categorías surgieron del análisis del contenido de los diarios de campo: estrategias utilizadas por los acompañantes y tranquilidad. Las estrategias usadas fueron: llanto, amor y afecto. Dos categorías surgieron de las entrevistas: experiencia positiva y experiencia negativa, siendo la primera la más destacada. Conclusión: Acompañar a niños en el proceso anestésico-quirúrgico desencadenó más percepciones positivas que negativas em las madres. Además de dar suporto y tranquilidad al niño, las acompañantes se sintieron más seguras.