The Role of Nurses in Taking Care of Children With Type 1 Diabetes.

Type 1 diabetes (T1D) is an autoimmune disease leading to an insulin deficiency that causes hyperglycemia and associated symptoms. It is considered the most common type of diabetes, with the 4Ts (going to the toilet a lot, being really thirsty, feeling more tired than usual, losing weight or looking thinner than usual) being the most prevalent symptoms. Non-specific signs and symptoms are also possible, and delaying or missing the diagnosis can have a devastating effect on a child's health. Children with a definitive diagnosis of diabetes often require medical treatment for problems such as ketoacidosis, hypoglycemia and hyperglycemia. To reach glycated hemoglobin (HbA1c) values of 48 mmol/mol, lifetime rigorous monitoring and management of blood glucose levels via insulin replacement treatment is needed in T1D. Physical and psychosocial issues arise frequently with a diabetes diagnosis, resulting in poor management. Nurses play a significant role in detecting diabetes in a number of healthcare settings, resulting in quick diagnoses and prompt initiation of treatment. Not only do they provide critical assistance to help children and their families with the diagnosis, they also place particular emphasis on managing difficult days and common problems with ongoing management. Nurses can provide invaluable assistance managing this chronic condition by coping with day-to-day challenges.

Nursing interventions for people with type 1 diabetes and frequent hypoglycaemia.

Type 1 diabetes is a lifelong condition which affects all age ranges, for reasons unknown, and the UK has one of the highest incidences of this complex condition in the world. Type 1 diabetes is caused by autoimmune damage to the insulin-producing ß-cells found in the pancreatic islet cells, leading to severe insulin deficiency. People with diabetes need to achieve a target glyosylated haemoglobin level to avoid macro- and microvascular complications, but there is the associated risk of hypoglycaemic events. These can vary in severity and consequences but will likely always cause worry for the person living with diabetes. There are many risk factors and reasons to be explored when looking at hypoglycaemia. This case study explores the nursing interventions that can be safely worked through and prioritised, within the community setting, to allow people with diabetes to be safe from severe hypoglycaemia, thus improving their quality of life and safety, as well as reducing costs for the NHS.

A Nurse Practitioner-Led Multidisciplinary Diabetes Clinic for Adult Patients Discharged From Hospital.

OBJECTIVES: In this study, we evaluated the feasibility of a nurse practitioner-led outpatient clinic (NPC) to facilitate the safe transition of patients with diabetes receiving insulin therapy between hospital and the community. METHODS: An NPC was set up to manage patients who had diabetes education in hospital and who were discharged on insulin. In addition to patient demographics and admission diagnosis, days seen postdischarge, duration of follow up, diabetes interventions and discharge care plan were recorded. For quality improvement, patients were asked to complete a questionnaire at the time of discharge from the NPC. RESULTS: Within a 12-month period, 71 patients with diabetes attended the NPC 3 to 21 days after discharge and they were followed for 1 to 98 days. Thirteen patients required management of hypoglycemia and 56 patients had adjustment of medications to basal/prandial insulin or switched to oral antihyperglycemic agents. Fifty-four patients were returned to the care of their family physicians and 18 patients required a referral to a diabetes specialist. A postclinic questionnaire indicated that the clinic enabled patients to improve management of their diabetes. However, communication of the diabetes management plan to the family physician was an identified concern. CONCLUSIONS: An NPC clinic can provide timely management and is a viable option to ensure safe transition of patients with diabetes from hospital back to their family physicians.

The impact of the COVID-19 pandemic on people with diabetes and diabetes services: A pan-European survey of diabetes specialist nurses undertaken by the Foundation of European Nurses in Diabetes survey consortium.

AIM: To describe diabetes nurses' perspectives on the impact of the COVID-19 pandemic on people with diabetes and diabetes services across Europe. METHODS: An online survey developed using a rapid Delphi method. The survey was translated into 17 different languages and disseminated electronically in 27 countries via national diabetes nurse networks. RESULTS: Survey responses from 1829 diabetes nurses were included in the analysis. The responses indicated that 28% (n = 504) and 48% (n = 873) of diabetes nurses felt the COVID-19 pandemic had impacted 'a lot' on the physical and psychological risks of people with diabetes, respectively. The following clinical problems were identified as having increased 'a lot': anxiety 82% (n = 1486); diabetes distress 65% (n = 1189); depression 49% (n = 893); acute hyperglycaemia 39% (n = 710) and foot complications 18% (n = 323). Forty-seven percent (n = 771) of respondents identified that the level of care provided to people with diabetes had declined either extremely or quite severely. Self-management support, diabetes education and psychological support were rated by diabetes nurse respondents as having declined extremely or quite severely during the COVID-19 pandemic by 31% (n = 499), 63% (n = 1,027) and 34% (n = 551), respectively. CONCLUSION: The findings show that diabetes nurses across Europe have seen significant increases in both physical and psychological problems in their patient populations during COVID-19. The data also show that clinical diabetes services have been significantly disrupted. As the COVID-19 situation continues, we need to adapt care systems with some urgency to minimise the impact of the pandemic on the diabetes population.

Diagnósticos de enfermagem em pacientes diabéticos: revisão integrativa / Nursing diagnoses in diabetic patients: an integrative review / Diagnósticos de enfermería en pacientes diabéticos: revisión integradora

Objetivo: identificar os diagnósticos de enfermagem segundo a taxonomia NANDA Internacional, Inc. evidenciados em pacientes com diabetes mellitus. Método: trata-se de uma revisão integrativa da literatura realizada no mês de maio de 2020, nas bases CINAHL, Scopus, PUBMED, LILACS, BDEnf e Biblioteca Eletrônica Científica Online SciELO. Foram selecionados artigos científicos que abordavam diagnósticos de enfermagem em pacientes adultos com diabetes mellitus tipo 1 e 2, no recorte temporal de 2004 a 2020. Resultados: selecionados 21 artigos, sendo a maioria brasileiros, do tipo descritivo e transversal. Encontrou-se 60 diferentes diagnósticos de enfermagem, destes, 43 eram com foco no problema, 15 de risco e dois de promoção da saúde. Conclusão: os domínios predominantes foram: Promoção da Saúde, Nutrição, Eliminação e Troca, Atividade/repouso, Enfrentamento/Tolerância ao Estresse e Segurança/proteção. As evidências de diagnósticos de enfermagem norteiam o cuidado de enfermagem, subsidiam o raciocínio clínico e científico dos profissionais potencializando, assim, a sistematização da assistência.

Objective: to identify nursing diagnoses in patients with diabetes mellitus, by the NANDA International, Inc. taxonomy. Method: this integrative review was conducted in May 2020 in the CINAHL, Scopus, PUBMED, LILACS, BDENF and Scientific Electronic Library Online (SciELO) databases, resulting in a selection of scientific articles on nursing diagnoses in adult patients with type 1 and 2 diabetes mellitus, published between 2004 and 2020. Results: most of the 21 articles selected were Brazilian, descriptive and cross-sectional. Sixty different nursing diagnoses were identified, of which 43 focused on the problem, 15 on the risk, and two on health promotion. Conclusion: the predominant areas were Health Promotion, Nutrition, Elimination and Exchange, Activity/Rest, Coping and Stress Tolerance, and Safety/Protection. Evidence from nursing diagnoses in diabetic patients guides nursing care and informs health personnel's clinical and scientific reasoning, thus making for more systematic care.

Objetivo: identificar los diagnósticos de enfermería, según la taxonomía de la NANDA International, Inc., evidenciados en pacientes con diabetes mellitus. Método: revisión integradora, celebrada en el mes de mayo de 2020, en las bases de datos CINAHL, Scopus, PUBMED, LILACS, BDENF y Scientific Electronic Library Online SciELO. Se seleccionaron los artículos científicos que abordan diagnósticos de enfermería en pacientes adultos con diabetes mellitus tipo 1 y 2, en el recorte temporal de 2004 a 2020. Resultados: se seleccionaron 21 artículos, siendo la mayoría brasileña, descriptiva y transversal. Se encontraron 60 diferentes diagnósticos de enfermería; de éstos, 43 se centraron en el problema, 15 en el riesgo y dos en la promoción de la salud. Conclusión: las áreas predominantes fueron: Promoción de la Salud, Nutrición, Eliminación e Intercambio, Actividad/descanso, Enfrentamiento y Tolerancia al Estrés y Seguridad/protección. Las evidencias de diagnósticos de enfermería en pacientes diabéticos guían la atención de enfermería, subsidian el razonamiento clínico y científico de los profesionales y, por lo tanto, potencian la sistematización de la asistencia.

Bridging the Needs of Adolescent Diabetes Care During COVID-19: A Nurse-Led Telehealth Initiative.

Amidst the unprecedented global pandemic of COVID-19, attending to the needs of adolescents with diabetes mellitus became more challenging. They faced the uncertainty of access to care and the attendant problems of a lockdown. We present the nurse-led telehealth initiative for adolescents with diabetes mellitus, leveraging on existing infrastructure and resources with the aim of addressing the anticipated challenges that many of the adolescents might face. The initiative was well received among those who participated, and there were no significant adverse effects noted.

Awakening cortisol indicators, advanced glycation end products, stress perception, depression and anxiety in parents of children with chronic conditions.

This cross-sectional study aims to investigate awakening cortisol indicators and to explore their association with stress perception, advanced glycation end products (AGEs), depression and anxiety in parents of children with chronic conditions. We included five parental groups according to children's diagnoses: Down syndrome (DS; N = 31), autistic spectrum disorder (ASD; N = 29), cerebral palsy (CP; N = 15), diabetes mellitus type 1 (DMT1; N = 38), and a control group of heathy children (CG; N = 33). Salivary cortisol and AGEs were measured, alongside with psychological indices. Partial correlation and multiple linear regression were used in the analysis to identify parental characteristics associated with total awakening cortisol output (area under the curve with respect to the ground, AUCG), cortisol awakening response (area under the curve with respect to the increase, AUCI), perceived stress, and health outcomes (AGEs, depression and anxiety). There was no difference between groups for AUCG, while DS and DMT1 groups showed reduced AUCI (ß = -0.241, p = 0.040; ß = -0.249, p = 0.028, respectively), and ASD parents had a borderline insignificant result (ß = -0.205, p = 0.081). Non-smokers had higher AUCG, and parental sedentary activity and sleep duration were associated with AUCI. AUCG was positively associated with AGEs (ß = 0.218, p = 0.013), anxiety (ß = 0.207, p = 0.004), and with depression (ß = 0.156, p = 0.034), unlike the AUCI. DS parental group showed lower general stress perception (ß = -0.260, p = 0.005). Parents of children with DMT1 had more pronounced depressive symptoms (ß = 0.183, p = 0.039), while CP parents had a borderline insignificant result for depression (ß = 0.143, p = 0.058). Based on these results, parents of children with chronic conditions have altered awaking cortisol response and are under increased risk of adverse health consequences.

Health professionals' perspectives on delivering home and hospital management at diagnosis for children with type 1 diabetes: A qualitative study from the Delivering Early Care in Diabetes Evaluation trial.

OBJECTIVE: To explore the delivery of home and hospital management at diagnosis of type 1 diabetes in childhood and any impact this had on health professionals delivering care. METHODS: This qualitative study was undertaken as part of the Delivering Early Care in Diabetes Evaluation randomized controlled trial where participants were individually randomized to receive initiation of management at diagnosis, to home or hospital. Semi-structured telephone interviews were planned with a purposive sample of health professionals involved with the delivery of home and hospital management, to include consultants, diabetes and research nurses, and dieticians from the eight UK centres taking part. The interview schedule focused on their experiences of delivering the two models of care; preferences, impact, and future plans. Data were subject to thematic analysis. RESULTS: Twenty-two health professionals participated, represented by consultants, diabetes and research nurses, and dieticians. Overall, nurses preferred home management and perceived it to be beneficial in terms of facilitating a unique opportunity to understand family life and provide education to extended family members. Nurses described a special bond and lasting relationship that they developed with the home managed children and families. Consultants expressed concern that it jeopardized their relationship with families. Dieticians reported being unable to deliver short bursts of education to families in the home managed arm. All health professionals were equally divided over which was logistically easier to deliver. CONCLUSIONS: A hybrid approach, of a brief stay in hospital and early home management, offers a pragmatic solution to the advantages and challenges presented by both systems.

Modern diabetes devices in the school setting: Perspectives from school nurses.

OBJECTIVE: To explore the experiences, practices, and attitudes of school nurses related to modern diabetes devices (insulin pumps, continuous glucose monitors, and hybrid-closed loop systems). RESEARCH DESIGN AND METHODS: Semistructured interviews were conducted with 40 public school nurses caring for children in elementary and middle schools. Developed with stakeholder input, the interview questions explored experiences working with devices and communicating with the health care system. Deidentified transcripts were analyzed through an iterative process of coding to identify major themes. RESULTS: School nurses reported a range of educational backgrounds (58% undergraduate, 42% graduate), geographic settings (20% urban, 55% suburban, 25% rural), and years of experience (20% <5 years, 38%, 5-15 years, 42% >15 years). Four major themes emerged: (a) As devices become more common, school nurses must quickly develop new knowledge and skills yet have inconsistent training opportunities; (b) Enthusiasm for devices is tempered by concerns about implementation due to poor planning prior to the school year and potential disruptions by remote monitors; (c) Barriers exist to integrating devices into schools, including school/classroom policies, liability/privacy concerns, and variable staff engagement; and (d) Collaboration between school nurses and providers is limited; better communication may benefit children with diabetes. CONCLUSIONS: Devices are increasingly used by school-aged children. School nurses appreciate device potential but share structural and individual-level challenges. Guiding policy is needed as the technology progressively becomes standard of care. Enhanced training and collaboration with diabetes providers may help to optimize school-based management for children in the modern era.

Empowerment comunitário em saúde escolar - adolescente com diabetes mellitus tipo 1 / Community empowerment in school health - adolescent with diabetes mellitus type 1

Type 1 Diabetes Mellitus (DM1) is one of the most prevalent chronic diseases in school age. Health policies point to a greater intervention and accountability of the community towards the health of its members and their full integration in society, promoting the development of health literacy based on an empowerment philosophy. Since the school is a favorable context for intervention, this study, through a review of the literature and based on the Empowerment Nursing-User Model and Laverack Community Empowerment Model, aims to elaborate a Nursing Care Plan Model aimed at training the school community with adolescents with DM1, using ICNP 2017. Agglutinating the first phase of the Laverack Community Empowerment Model (personal action) with the examples of Empowerment Nursing-User Model empowering behaviors (access to information, support, resources, opportunities to learn and grow, informal power and formal power), we identified diagnoses as: potential to raise awareness of the relationship between the therapeutic regimen and DM1 control and potentiality to improve the problematic meaning attributed to the therapeutic regime or illness by the adolescent. According to the phases of approach of small community groups and development of community organizations, we identified diagnoses aimed at the school community and the family like the potential to improve awareness of their role towards the adolescent with DM1. Community empowerment is an instrument to be used in the development of the process of school inclusion and training adolescents with DM1 as well as the whole school community

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Effectiveness of home or hospital initiation of treatment at diagnosis for children with type 1 diabetes (DECIDE trial): a multicentre individually randomised controlled trial.

OBJECTIVE: To determine whether, in children with newly diagnosed type 1 diabetes who were not acutely unwell, management at home for initiation of insulin treatment and education of the child and family, would result in improved clinical and psychological outcomes at 2 years postdiagnosis. DESIGN: A multicentre randomised controlled trial (January 2008/October 2013). SETTING: Eight paediatric diabetes centres in England, Wales and Northern Ireland. PARTICIPANTS: 203 clinically well children aged under 17 years, with newly diagnosed type 1 diabetes and their carers. INTERVENTION: Management of the initiation period from diagnosis at home, for a minimum of 3 days, to include at least six supervised injections and delivery of pragmatic educational care. MAIN OUTCOME MEASURES: Primary outcome was glycosylated haemoglobin (HbA1c) concentration at 24 months postdiagnosis. Secondary outcomes included coping, anxiety, quality of life and use of NHS resources. RESULTS: 203 children, newly diagnosed, were randomised to commence management at home (n=101) or in hospital (n=102). At the 24 month primary end point, there was one withdrawal and a follow-up rate of 194/202 (96%). Mean HbA1c in the home treatment arm was 72.1 mmol/mol and in the hospital treated arm 72.6 mmol/mol. There was a negligible difference between the mean HbA1c levels in the two arms adjusted for baseline (1.01, 95% CI 0.93 to 1.09). There were mostly no differences in secondary outcomes at 24 months, apart from better child self-esteem in the home-arm. No home-arm children were admitted to hospital during initiation and there were no adverse events at that time. The number of investigations was higher in hospital patients during the follow-up period. There were no differences in insulin regimens between the two arms. CONCLUSIONS: There is no evidence of a difference between home-based and hospital-based initiation of care in children newly diagnosed with type 1 diabetes across relevant outcomes. TRIAL REGISTRATION NUMBER: ISRCTN78114042.

Effects of a home-based nursing intervention programme among adolescents with type 1 diabetes.

AIMS AND OBJECTIVE: To investigate the effects of a home-based nursing intervention programme established based on the Health Promotion Model on the health outcomes of adolescents with type 1 diabetes mellitus. BACKGROUND: After diagnosed with diabetes, it is necessary to ensure that nursing care is not limited to the hospital setting but continues at home. DESIGN: A quasi-experimental design with a pre- and post-test control group was used. The researchers have complied with the guidelines of TREND Checklist in presenting this study. METHOD: This study was conducted in Izmir, Turkey, with 71 adolescents (35 in an intervention group and 36 in a control group) diagnosed with type 1 diabetes mellitus who were registered at the paediatric endocrinology outpatient clinics of two hospitals and were selected using the convenience sampling method between June-December 2017. A home-based nursing intervention programme (5 week) was provided to the intervention group while standard care was provided to the control group. Data were collected at the baseline, and 3 and 6 months after a 5-week home-based nursing intervention. Multi-way and one-way analysis of variance, the Bonferroni correction, regression analysis, t test, chi-squared analysis and a structural equation model were used for data analysis of the iterative measurements. RESULTS: At the end of the home-based nursing intervention programme, the HbA1c mean scores significantly decreased, while self-efficacy perception, frequency of managing diabetes and taking responsibility in managing diabetes increased in the intervention group compared to those in the control group. Frequency of admission to the hospital and average costs were lower in the intervention group than in control group. The home-based nursing intervention programme using structural equation modelling increased the frequency of managing diabetes and taking responsibility in managing diabetes and decreased HbA1c levels. CONCLUSION: The home-based nursing intervention programme was effective in decreasing HbA1c levels, increasing the frequency of diabetes management and taking responsibility in managing diabetes, and improving the self-efficacy of the adolescents. RELEVANCE TO CLINICAL PRACTICE: The home-based nursing intervention programme can be applied by nurses to ease the transition of adolescents with type 1 diabetes mellitus and their parents to healthy daily life practices and ensure their glycemic controls after being discharged.

Programa de Atención y Educación Terapéutica dirigido a jóvenes con diabetes tipo 1 trasladados desde el centro pediátrico al hospital de adultos. Percepción de las enfermeras / Therapeutic education program addressed to young people with type 1 diabetes transferred from the pediatric center to the adult hospital

El traslado de los jóvenes con diabetes tipo 1 desde los centros pediátricos a las unidades de adultos se realiza durante la adolescencia, periodo caracterizado por cambios fisiológicos y psicológicos que los hace especialmente vulnerables. En este periodo se aconseja que las familias y/o cuidadores trasladen, en parte, la responsabilidad del manejo de la diabetes a los jóvenes de forma progresiva. El cambio de rol en el autocuidado, de centro y de profesionales añadido a la gran vulnerabilidad se relaciona con el empeoramiento del control metabólico y pérdida de seguimiento asistencial. Se requieren programas educativos específicos, estructurados y coordinados con los centros pediátricos para minimizar los posibles efectos adversos del traslado y mantener y/o mejorar el control metabólico y la calidad de vida de estos jóvenes. Siguiendo las recomendaciones de la Sociedad Española de Diabetes y la Sociedad Española de Endocrinología Pediátrica, presentamos la estructura, el proceso y los resultados del programa de acogida a los jóvenes con diabetes tipo 1 trasladados desde el centro pediátrico de Sant Joan de Déu al Hospital Clínic de Barcelona, durante el primer año después del traslado

The transfer of young people with type 1 diabetes from pediatric centers to adult units takes place during adolescence, a period characterized by physiological and psychological changes that make them especially vulnerable. In this period it is recommended that families and /or caregivers progressively leave the responsibility of managing diabetes to the young people themselves. The change of role in self-care, center and professionals in addition to the inherent vulnerability is related to the worsening of metabolic control and loss of these patients to follow-up care. Specific educational programs are required, which are structured and coordinated with the pediatric centers to minimize the possible adverse effects of the transfer and maintain and / or improve the metabolic control and the quality of life of these young people. Following the recommendations of the Spanish Society of Diabetes and the Spanish Society of Pediatric Endocrinology, we present the structure, process and results of the reception program for young people with type 1 diabetes transferred from the pediatric center of Sant Joan de Déu to the Hospital Clínic of Barcelona during the first year after the transfer

A systematic review of the association between coping strategies and quality of life among caregivers of children with chronic illness and/or disability.

BACKGROUND: Parents of children with chronic illness have reported decreased psychological and physical quality of life (QoL) relative to parents of children without such illness, which may be associated with the extent of complexity involved in the caregiving role. Given that coping strategies have been reported to influence QoL, our goal was to synthesize existing research about the association between coping strategies and QoL in caregivers of children with chronic illness. We were particularly interested in whether coping strategies may mediate the association between caregiving complexity and QoL, or may modify the association. METHODS: We developed an electronic search strategy to identify relevant citations in Medline, EMBASE, PsycINFO and CINAHL. Two reviewers independently assessed retrieved citations against pre-specified inclusion criteria in two stages of screening. One reviewer abstracted data on study characteristics, methods to address confounding, measurement tools, risk of bias, and results with respect to associations of interest. A second reviewer validated extracted data. We summarized results narratively. RESULTS: 2602 citations were screened and 185 full-text articles reviewed. The 11 articles that met inclusion criteria addressed 5 diseases and included a total of 2155 caregivers. Ten of the 11 included studies were cross-sectional. We identified some evidence that coping was associated with QoL: in three studies, coping strategies considered to be adaptive were positively associated with psychological QoL while in one study, maladaptive strategies were negatively associated with psychological QoL. Only two studies considered coping as a potential mediating variable in the association between caregiving complexity and parental QoL, with inconsistent findings and challenges in interpreting cross-sectional associations. No studies considered coping as a moderating variable. The variability among instruments used to measure key constructs, particularly coping strategies, made it difficult to synthesize results. CONCLUSIONS: We found that coping strategies may be associated with psychological QoL among parents of children with chronic illness. We also identified important research gaps related to the consistent and clear measurement of coping strategies and their prospective association with QoL. Understanding how coping strategies are associated with QoL is important to inform the development of interventions to support families of children with chronic illness.

Self-management of sick days in young people with type 1 diabetes enhanced by phone support: A qualitative study.

Aims and Objectives: The aim of this paper was to evaluate the impact of phone support on sick day management of young people with type 1 diabetes. Method: Qualitative exploratory study to understand the usage of a phone support service available, 8am to 8.30pm, seven days a week. Inclusion criteria were: (a) young people with type 1 diabetes who attend an age-specific service; (b) experienced acute diabetes crisis. Interviews were coded for themes using QSR NVivo™ Version 11 software. Findings were examined through the theoretical lens of the Health Belief Model. Results: Of 20 eligible individuals, 8 participated in the study. Five avoided emergency presentation by accessing the phone support service; three who did not were admitted for diabetic ketoacidosis. The interviews generated 3 major themes: (a) self-efficacy, (b) cues to action, (c) susceptibility. Conclusion: Enhancing self-efficacy and promoting confidence to seek help early during an acute health crisis enables young people to effectively self-manage and avoid hospitalization.

[Improving the management of children with type 1 diabetes and their families: What role for the advanced practice nurse, coordinator of complex care pathways? A qualitative, exploratory study using semi-directed interviews]. / Améliorer la prise en charge de l'enfant atteint de diabète de type 1 et celle de sa famille : quel rôle pour l'infirmière de pratique avancée, coordinatrice de parcours complexe de soins ? Une étude qualitative et exploratoire.

BACKGROUND: Type 1 diabetes in children in Switzerland is becoming increasingly prevalent. The coordination of care seems to be a determining element and is essential for effective and efficient care. OBJECTIVE: Identify the difficulties and the levers of coordination faced by healthcare workers and families during the discovery of type 1 diabetes in children aged from birth to fifteen. METHOD: Qualitative analysis using semi-directed interviews. RESULTS: Three families and five healthcare workers participated in the study. Confirmation of the diagnosis was received badly and was a shock for the families. Nurses specializing in pediatric diabetes are recognized for being experts in diabetes care and education. Non-specialist nurses consider diabetes care to be stressful and complex. Collaboration between units is described as compartmentalized. ICT tools are not shared between units. Psychological support is considered to be unsatisfactory by the families. DISCUSSION: Interdisciplinary nurses need to work together and with a structured coordination of care.

Blood glucose monitoring in diabetes: rationale and procedure.

Diabetes mellitus is a condition that results in elevated blood glucose levels. Continued elevation can contribute to progressive micro- and macrovascular complications, leading to renal, nerve and ocular damage, representing a significant contributor to patient morbidity and mortality. The measurement of blood glucose provides information on the effectiveness of blood glucose metabolism and guides interventions to achieve optimal glucose control within the body. All nurses should be familiar with the importance of blood glucose monitoring and the procedure to carry out testing safely and effectively. Appropriate and timely monitoring of blood glucose will allow for the successful management of blood glucose that is out of the target range. This will ensure ongoing patient safety during episodes of acute illness or effective management of diabetes mellitus in the longer term, minimising future diabetic-related health complications.