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Diabetes: Management and Pharmacotherapy01:15

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The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
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Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
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Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
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Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
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Enhancing Care Coordination for Students with Type 1 Diabetes.

Mayumi Willgerodt1, Kathleen H Johnson1, Cara Helmer2

  • 1Department of Child, Family and Population Health Nursing, University of Washington, Health Sciences Box 357262, 1959 NE Pacific St., Seattle, WA, 98195.

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PubMed
Summary

Effective care coordination for Type 1 diabetes (T1D) in schools relies on family, school, and child contexts, plus team knowledge, communication, and relationships. Strategies should support these factors for better student health outcomes.

Keywords:
care coordinationchild and adolescent healthchronic diseasesschool nursesschool nursing practiceteam-based care

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Area of Science:

  • Pediatric Endocrinology
  • School Health Services
  • Chronic Disease Management

Background:

  • Care coordination is vital for students with chronic conditions like Type 1 diabetes (T1D) to achieve academic success.
  • Operational strategies for school-based T1D care coordination are underreported in scientific literature.
  • T1D necessitates a collaborative, team-based approach to management within the school setting.

Purpose of the Study:

  • To explore current care coordination practices for T1D in Washington State schools.
  • To identify facilitators and barriers impacting T1D care coordination.
  • To inform strategies for enhancing school-based T1D support.

Main Methods:

  • Qualitative study utilizing focus groups across 9 Educational Service Districts in Washington State.
  • Participants included school nurses, parents of children with T1D, and healthcare providers.
  • Content analytic techniques were applied to analyze recorded focus group notes.

Main Results:

  • Five overarching themes emerged, detailing the complexities of T1D care coordination.
  • Key themes included the influence of family, school, and developmental contexts.
  • Essential factors identified were T1D knowledge among stakeholders, team accessibility, communication, and interpersonal relationships.

Conclusions:

  • Effective T1D care coordination in schools requires a contextualized and holistic approach.
  • Facilitating supportive relationships and team-based strategies is crucial.
  • These findings can inform improved, intersectional care coordination for all chronically ill students.