Novel Use of a Simulation in Pediatric Type 1 Diabetes Sick-Day Education for Patients and Caregivers

Management of type 1 diabetes during illness confers risk for serious harm because sick days happen infrequently, management is complex and multistep, and errors can result in diabetic ketoacidosis and hospitalization. Simulation offers a safe, experiential learning environment in which to practice skills with the goal of identifying and closing knowledge gaps. We hypothesized that simulation of sick-day scenarios with patients and caregivers via video conference could be used to assess knowledge of sick-day management for type 1 diabetes and determine the availability of necessary supplies at home.

Our study included development of performance-based, scripted sick-day scenarios; selection and training of content experts as simulation facilitators; piloting and iterative revision of scenarios; and implementation of simulation sessions. Five distinct scenarios were created for either insulin injections or continuous insulin pump therapy. Each participant was block randomized to receive three of the five scenarios. Participant performance was measured by categorizing actions as most desired, less desired, or incorrect.

Ten caregivers and two young adults with type 1 diabetes participated in 12 simulations, representing 14 individuals with type 1 diabetes. The most common category of less desired and incorrect processes chosen by participants was ketone management.

Simulation-based training for sick-day management is a feasible, interactive form of education for people with type 1 diabetes and caregivers. Video conferences allowed firsthand observation of supplies and resources available to families at home. Participant understanding of sick-day management will inform future interventions to address challenges with ketone management and recognition of diabetes technology issues when caring for an ill child with type 1 diabetes.