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[IP] Excellent Abstract (long)

 <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12387509&dopt=Abstract">Entrez-PubMed</A> 
J Pediatr Endocrinol Metab 2002 Sep-Oct;15(8):1113-30   <A HREF="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Display&dopt=pubmed_pubmed&from_uid=12387509">Related Articles, </A>>

Education and multidisciplinary team care concepts for pediatric and 
adolescent diabetes mellitus.

Brink SJ, Miller M, Moltz KC.

New England Diabetes and Endocrinology Center, Waltham, MA 02451-1136, USA. 
email @ redacted

The DCCT scientifically established the basis for optimizing blood glucose 
control in type 1 diabetes mellitus around the world using a 
multidisciplinary team approach and patient-centered adjustments of food and 
insulin based upon blood glucose data generated by the patient. Pediatric 
diabetologists no longer believe that it is prudent to allow higher blood 
glucose levels in prepubertal children but much educational emphasis must be 
placed upon minimizing serious episodes of hypoglycemia. Individualized 
treatment should be determined by a close working relationship between highly 
trained diabetes nurses, educators and dieticians with the patient as the 
focus of self-care decisions, and a pediatric diabetologist ideally setting 
the philosophical and medical goals. Rather than the diabetes health care 
team being the only ones to initiate treatment, patient and parents should be 
empowered to analyze their own data, identify patterns, solve problems with 
food and activity, and do so based upon actual blood glucose results. This 
empowerment paradigm helps decrease care frustrations and improve treatment 
outcomes. Survival education followed by in-depth problem solving education 
and organized follow-up education are all needed steps for successful 
diabetes management. Identification of psychosocial barriers and energy 
diverting behavioral and family issues just as knowledge about learning 
styles play key roles in this process. Dogma should be avoided. More 
physiological utilization of insulin analogs, greater insulin dosing 
flexibility with a multidose insulin regimen coupled with adaptation of 
insulin to food and activity, should allow maximum benefit. Four major types 
of learning styles are reviewed: concrete sequential learners, abstract 
sequential learners, abstract random learners and concrete random learners. 
Health Belief Models, Locus of Control constructs, and Self-Efficacy models 
all provide sophisticated ways to help identify and overcome learning and 
self-care barriers. Parental, child, adolescent and young adult 
responsibility for care also needs to be addressed and placed in the context 
of family functioning and glycemic goals. Age and developmental stages as 
well as parental and societal roles play important roles in the care needed 
to live well with a chronic illness. The role of the health care 
professionals who are part of the diabetes care team involves not only 
setting the stage and providing guidance but also supervising appropriate 
short- as well as long-term complications monitoring for early detection and 
treatment of microangiopathy. Applying not only telephone but also fax, 
e-mail and computers in modern diabetes care should facilitate applications 
of these psychological, educational and medical models to improve short-term 
and long-term diabetes treatment outcomes.

PMID: 12387509 [PubMed - in process]    
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