Manifestation of Diabetes Mellitus Type 1: A Questionnaire to Evaluate the Acceptance of Initial Intravenous Therapy

Abstract

For families suddenly confronted with the diagnosis of a lifelong chronic disease, implementing a continuous iv. infusion represents restriction of movement and possibly also a psychological burden. We designed a questionnaire to evaluate the perception of pediatric patients and their parents for this treatment as part of a diabetes manifestation. Patients and their parents treated in the diabetes outpatient clinic at children’s university hospital in Mainz were asked for their opinion about “iv. infusion” and “frequency of blood taking” during their first stay in the hospital upon manifestation of diabetes. They assigned scores from 1 to 10 for the following parameters: “delivery of diagnosis”, “communication by doctor”, “execution of training”, “atmosphere during diabetes training”, “frequency of blood taking”, “iv. infusion” and “start of sc. insulin application”. Parents gave relatively high ratings. Parameters such as “frequency of blood taking” were rated with 6.1 on average. Ultimately, “frequency of blood taking”, “delivery of diagnosis” (6.11) and “iv. infusion of insulin” (6.5) scored lower than for instance “atmosphere of diabetes training” (7.95). Children awarded scores of 3.72 for “iv. infusion”, on average, whereas they scored 7.15 for the “doctor’s communication” and 7.28 for “diabetes training”. Asked if a decision in favor of a subcutaneous insulin injection right at the beginning of the therapy would have been preferable, parents were undecided. Therefore it cannot be concluded that an instant subcutaneous therapy has psychological advantages or disadvantages. The patients themselves (aged 12 - 17 years) were undecided, too, (58.3%) when asked for their preference of the subcutaneous insulin regime right at the beginning of the therapy. Nevertheless, the continuous infusion of insulin iv. was rated poorly by them. When planning further studies on this topic, the following questions should be analyzed: If the initial therapy had been started subcutaneously, would the manifestation be assessed differently by the family? Is the patients’ poor rating of the iv. insulin injection reproducible? Do other factors more greatly influence the decision for or against iv. insulin injection at the start of the therapy, such as the time needed for caretaking for the iv. injection by the nurses or possible side effects of an iv. injection? How can the start of the therapy be organized, when starting with sc. therapy, in particular regarding the first communication with patient and family?