Type 1 Diabetes Mellitus (T1DM) Self Management in Hospital; Is It Possible? A Literature Review

By Munt, Rebecca; Hutton, Alison | Contemporary Nurse : a Journal for the Australian Nursing Profession, February 1, 2012 | Go to article overview

Type 1 Diabetes Mellitus (T1DM) Self Management in Hospital; Is It Possible? A Literature Review


Munt, Rebecca, Hutton, Alison, Contemporary Nurse : a Journal for the Australian Nursing Profession


INTRODUCTION

Type 1 diabetes mellitus (T1DM) is a chronic condition for which there is currently no cure. T1DM is an autoimmune disorder that destroys the pancreas cells ability to produce insulin leading to high plasma glucose levels (Drury & Gatling, 2005). In 2011 the NDSS register recorded that over 129,000 Australians have T1DM (NDSS, 2011). In order for people with T1DM to maintain normal blood glucose levels (BGLs; normoglycaemia) and reduce the potential microvascular, macrovascular and neurologic complications that are associated with poor glycaemic control, a daily management routine is required (The Diabetes Control and Complications Trial Research Group [DCCT], 1993). This daily management routine includes blood glucose monitoring (BGM), insulin administration, controlling dietary intake and partaking in physical activity (Due-Christensen, Borrild, & Larsen, 2006; Germain & Nemchik, 1988; Toljamo & Hentinen, 2001). The intricate complex daily management routine also incorporates timing of all management tasks, decision making around those tasks and implementing treatment in response to alterations of BGLs (Paterson & Thorne, 2000b). This routine which encompasses complex daily management performed by the individual is known as self management. For the purpose of this review the term self management 'makes reference to the activities people undertake to create order, discipline and control in their lives' (Kralik, Koch, Price, & Howard, 2004, p. 260).

While adults with T1DM self manage in their daily environment there is a dearth of literature on whether they can continue their self management regime in the hospital setting. It is recognised that people with T1DM will develop complications overtime (Colagiuri et al., 2009; DCCT, 1993; Dunning, 2003). As a consequence of microvascular and macrovasular complications developing, an individual will be admitted to the hospital setting with a variety of primary admission diagnosis, other than unstable glycaemia control (Colagiuri et al., 2009). In 2004/05 a total of 531, 069 people admitted to hospital in Australia (8% of all recorded hospital admissions) had diabetes as a principle or additional diagnosis with 22% of those identified as having T1DM (Australian Institute of Health and Welfare, 2008). Regardless of this primary admission diagnosis these adults will require their daily T1DM management to continue. However Dunning (2003) suggests, through clinical observation and patient's stories, inpatients are stripped of their normal self management regime by health professionals leaving them feeling incompetent. Cohen, Sedhom, Sailfu, and Friedman (2007) also suggests the person with T1DM in hospital is often required to alter or relinquish their daily self management responsibility. In addition, inpatients express fear for the treatment they receive from health professionals for their T1DM, especially linked to medication and hypoglycaemia management (Dunning, 2003). Furthermore patients' express being labelled as poor self managers and non compliant if their BGLs are elevated especially if consuming foods containing sugar (Dunning, 2003).Therefore an understanding of what self management means to the person with T1DM is needed in order for health professionals to provide support and plan collaborative care in the hospital setting.

AIM

The aim is to review the published health literature on self management of T1DM in hospital and to analyse and critically appraise the findings. In particular the focus of this review is on adults who were admitted for a primary admission diagnosis other than T1DM. The inclusion criteria were studies that focused only on adults in relation to type 1 diabetes management, self management, the person with T1DMs perspective or management of the T1DM in the hospital environment. Articles were excluded if the research focus was on outcomes of community led self management support groups or health professional management of uncontrolled BGL in hospital. …

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