Endocrine Abstracts

Background: The Paediatric Diabetes Team at Southampton Children’s Hospital provide a home annual review service for children with T1DM led by Paediatric Diabetes Specialist Nurses. They provide patients and families with support, advice and re-education. Service-users have reported positive feedback regarding effectiveness and relevance of education provided. However, many patients, particularly adolescents, still suffer reduced quality of life (QOL) and life-threatening but preventable hospital admissions. Competency assessment may clarify the reasons for this.

Aims: This pilot, exploratory study aims to determine whether home annual reviews are effective in educating patients and families, and whether better patient/parent competency is associated with higher QOL.

Methods: In total of 11 home annual reviews of adolescent patients were attended. Patients and parents completed a competency assessment before and after the structured education, as well as Paediatric QOL Inventory Generic Core Scale and Diabetes Module questionnaires. Additionally, qualitative interviews were conducted with patients and parents to identify important themes surrounding diabetes management.

Results: A Wilcoxon signed-ranks test indicated an improvement in patients’ competency scores post-education (before Median=81.1% [IQR=67.6–86.5] vs. after Median=89.2% [IQR=75.7–91.9], n=11, P=0.003). Parents’ post-education scores also significantly improved (before Median=86.5% [IQR=77.7–90.5] vs. after Median=91.9% [IQR=88.5–97.3] n=10, P=0.005). Spearman’s rho showed a significant strong, positive correlation between parent-reported core QOL and parents’ pre-education competency scores (n=10, r_s=0.88, P=0.001). The interviews demonstrated issues important to the adolescents include self-perception, independence and impact on education, and for parents, independence and fear of hypoglycaemia.

Conclusions: The quantitative results show that competency scores were generally high in most participants, even before education, indicating information had been retained from previously. Nevertheless, scores still significantly improved, demonstrating to the Paediatric Diabetes Team that home annual reviews are effective in improving knowledge and competency. The association between parent competency and parent-reported QOL for their child may be explained and significantly affected by personal anxieties and stresses. Qualitative data indicates most participants are confident in T1DM management. Increased support may be beneficial in minimising the impact of T1DM on self-perception, independence and education. Further study is required to explore factors leading to poor self-management in emergency settings as well as other reasons for preventable admission.