Clinical management of children with type I diabetes mellitus : a prospective, randomized psycho-educational intervention trial

The basic question addressed in this investigation was: is it possible to exert a significant influence on the course of diabetes mellitus in children by the use of a specific initial management regimen? The conventionally, hospital care treatment regimen (control group) was compared to a multi-disciplinary programme for family-oriented crises intervention with a learn-by-doing pedagogy and care in a therapeutic environment (study group). The reactions and the adjustment to the new family situation with a diabetic child were elucidated. The long-term (i.e., 5y) metabolic control and factors with influence on poor long-term glycaemic control were explored. The social situation and relationships between the family's social situation and the long-term requirement for in- and out-patient services was studied. The dietary habits were compared to treatment received, the recommended nutritional intake, age, sex and degree of glycaemic control. 38 children, 3-15 years old at diagnosis, were followed prospectively 5 years. The conclusion is that several important aspects of the course of diabetes mellitus in children could be influenced. Family satisfaction with the treatment received was significantly higher in the study group. Two years after diagnosis, the subjective, emotional climate of the family was significantly improved in the case of the mothers and fathers in the study group, but not for the parents in the control group. Long-term glycaemic control was not influenced by the initial treatment regimen. Five years after diagnosis, the overall mean HbA1c value was 7.2% and. 30% of the children had HbA1c values of < 6.3%. An early increase of HbA1c values, large variations in blood glucose levels, the emotional responses and level of formal education of the father and whether or not the child lived in a single-parent family, a higher fat consumption and more pronounced day-to day variance in their intake of energy and certain nutrients characterised children in poorer control. At least as high frequency of divorce as in the general population was observed and younger age and living in a single parent family were associated with a longer total length of readmission to the hospital. The children in both treatment groups complied well with recommendations concerning nutritional intake. Children demonstrating poorer glycaemic control had a higher intake of fat. Factors concerning age, sex and social situation, did not significantly influence the dietary habits of our subjects.

List of scientific papers

I. Forsander G (1995). Family attitudes to different management regimens in diabetes mellitus. Practical Diabetes International. 12:80-85.
https://doi.org/10.1002/pdi.1960120211

II. Sundelin J, Forsander G, Mattson SE (1996). Family-oriented support at the onset of diabetes mellitus: a comparison of two group conditions during 2 years following diagnosis. Acta Paediatr. 85(1):49-55.
https://pubmed.ncbi.nlm.nih.gov/8834979

III. Forsander G, Persson B, Sundelin J, Berglund E, Snellman K, Hellstrom R (1998). Metabolic control in children with insulin-dependent diabetes mellitus 5 y after diagnosis. Early detection of patients at risk for poor metabolic control. Acta Paediatr. 87(8):857-864.
https://pubmed.ncbi.nlm.nih.gov/9736234

IV. Forsander G, Sundelin J, Persson B (2000). Influence of the initial management regimen and family social situation on glycemic control and medical care in children with type I diabetes mellitus. Acta Paediatr. 89(12):1462-1468.
https://pubmed.ncbi.nlm.nih.gov/11195237

V. Forsander G, Malmodin B, Eklund C, Persson B. Dietary habits of children with diabetes mellitus type I in relationship to the initial management regimen, familial social factors and glycemic control. [Submitted]