FNP Capstone: Diabetes Education & Outcomes in Low SES Children Study

This report focuses on diabetes education for children from low socioeconomic status (SES) families, addressing the challenges they face in managing their condition due to limited access to specialized care. The PICOT question was formulated to explore how healthcare systems can better meet the needs of these children with type 1 diabetes. A literature review was conducted using databases like PubMed and Web Search, focusing on studies published within the last 10 years. The review highlights the benefits of home-based education, lifestyle modifications, and dietary adjustments in reducing A1C levels. Key findings from the selected papers emphasize the importance of self-management skills, parental involvement, and diabetes awareness campaigns in controlling glycemic levels and preventing diabetic ketoacidosis (DKA). The report concludes by advocating for patient teaching sessions, emphasizing healthy living and dietary habits, and regular monitoring to improve health outcomes for children with type 1 diabetes from low SES backgrounds. The dissemination of EBP project can be done through conferences, education seminars and posters.

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Socio-economic gradients increases the prevalence of various health risk factors like
diabetes as low income is associated with poor diabetes control and related complications. Socio-
economic status (SES) is the determinants of health that are associated with disease prevalence
and access to care (Kanaya et al., 2012). According to Lysy et al., (2013) the link between
diabetes risk and income status is complex however there is increased risk among the low SES
groups especially children prone to type 1 diabetes. The children belonging to low SES are
unable to visit speciality care and as a result have poor utilization of diabetes care centres in
controlling the condition. Therefore, the following discussion involves the summarizing of
evidences that was gathered in the weeks 8, 9 and 10 regarding the diabetes education among the
children belonging to low SES groups.
The purpose for this PICOT question was that children with diabetes mellitus belonging
to low SES families have poor health outcomes as they have less access to diabetes care
specialists in controlling their condition. There is increased mortality, severe morbidity and life-
threatening complications among the children with worse health outcomes due to poor disease
control. Therefore, PICOT question was formulated to gain insight on how to structure
healthcare systems that meet the needs of the children with type 1 diabetes belonging to SES
families.
For aligning the PICOT outcomes with research objectives, literature review was
conducted on the topic. Relevant literature was sorted from the vast pool and conclusions
analyzed. The summarization of main findings was studied and the review was done in
understanding how education sessions about lifestyle modifications and daily diet are beneficial
in reducing A1C levels. Databases were used to carry out literature reviews as it provided
required literature relevant to PICOT question. Electronic databases PubMed and Web Search

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were used for the review. They have full-text journals published in English in last 10 years. The
keywords like diabetes in children, diabetes education, dietary modifications in children with
type 1 diabetes were used along with Boolean operators like AND and OR. Finally, three papers
were retrieved from the search that is published after 2011 were selected.
According to a paper published by Clapin et al., (2016) children with type 1 diabetes who
received home based education with adequate support are able to manage their condition
followed by practical skills training. The aim of the study was to compare hybrid home-based
education and inpatient model of care that examined diabetes knowledge, psychosocial and
metabolic outcomes, patient satisfaction and length of stay for the children newly diagnosed with
type 1 diabetes. The study design was randomized control trial and 50 patients (children aged 3
to 16 years) recruited 25 to each group were included in the study. The results showed that
families preferred home-based hybrid care as compared to hospital-based management with no
differences in diabetes knowledge or psychosocial outcomes. The use of simulations, proper
engagements and demonstrations to the children during the teaching sessions was helpful as
compared to speaking alone for enhancing understanding.
Another paper published by Nilsson, (2016) highlighted the fact hat type 1 diabetes is a
common diagnosis that is inherited along with environmental factors that is incompletely
understood. Children with type 1 diabetes belonging to low SES families can self-manage their
diabetic condition by using insulin replacement therapy and lifestyle modifications like diet and
physical exercise. Self-management diabetic activities not only help in making treatment safer,
but also help them to take care of themselves when they are in hospital. Moreover, self-
management of diabetes imparts a sense of control to the children newly diagnosed with type 1
diabetes. They learn to self-administer insulin therapy and parents play an important role in

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diabetes management of their children with type 1 diabetes. The results suggested that self-
management of diabetes among children is not only related to their physical and cognitive
ability, but also on the diabetic knowledge and its effects.
King et al., (2012) studied the effectiveness of diabetes awareness campaign on Diabetic
ketoacidosis (DKA) occurrence among 6 to 18 years children with type 1 diabetes. The findings
suggested that interventions like post cards displaying the signs and symptoms of the disease
along with provision of equipments that tests ketones and BGL helped in reducing the DKA
prevalence in children with newly diagnosed type 1 diabetes. A specialist diabetic educator who
visits childcare centers and schools can help to provide diabetes education to the children in
controlling their glycemic condition.
In context to patient preferences, the diet and physical exercise should be designed
according to the children’s choices. This would be helpful in eliciting children in taking an active
part in the diabetes management program. The interventions should be consistent with children’s
preferences so that it increases motivation among them to engage in diabetic interventions (Fan
& Sidani, 2016). For the clinical expertise, diabetic specialists and nurses are required who
would educate the children in schools and childcare centres. Although, there might be some
resistance during implementation, however with proper dissemination of diabetic knowledge and
awareness, people would be empowered to promote healthy living with dietary and lifestyle
modifications that cannot happen overnight.
The outcome and reduction in A1C levels can be evaluated through clinical audit after six
months in schools and childcare centres. The identification and promotion of good practice can
be evaluated through clinical audit providing a measure of quality improvement.

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The dissemination of EBP project can be done through conferences, education seminars
and posters. The target audiences like doctors, physicians, diabetologists and nurses are
considered in settings like hospitals and community healthcare centres. The projects outcomes
can be discussed while communicating and interacting the lifestyle modification activities to the
target audience regarding diabetic control among children.
From the above evidences, it can be concluded that patient teaching is important for
children with newly diagnosed type 1 diabetes. A one-hour patient teaching session held bi-
weekly with the children belonging to low SES about healthy living and diet is much needed.
Teaching children and their parents about the physical activities and healthy diet is important for
self-diabetic management at homes. Therefore, it can be concluded that education regarding
diabetes knowledge, insulin administration and site for injections can help to reduce the A1C
levels with repeated checks after 6 months.

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References
Clapin, H., Hop, L., Ritchie, E., Jayabalan, R., Evans, M., & Browne-Cooper, K. et al. (2016).
Home-based vs inpatient education for children newly diagnosed with type 1
diabetes. Pediatric Diabetes, 18(7), 579-587.
Fan, L., & Sidani, S. (2016). Preferences for Diabetes Self-Management Education
Interventions: An Exploration. Canadian Journal of Diabetes, 40(5), S30.
Kanaya, A. M., Santoyo-Olsson, J., Gregorich, S., Grossman, M., Moore, T., & Stewart, A. L.
(2012). The live well, be well study: a community-based, translational lifestyle program
to lower diabetes risk factors in ethnic minority and lower–socioeconomic status
adults. American journal of public health, 102(8), 1551-1558.
King, B. R., Howard, N. J., Verge, C. F., Jack, M. M., Govind, N., Jameson, K., ... & Bandara,
D. M. (2012). A diabetes awareness campaign prevents diabetic ketoacidosis in children
at their initial presentation with type 1 diabetes. Pediatric diabetes, 13(8), 647-651.
Lysy, Z., Booth, G. L., Shah, B. R., Austin, P. C., Luo, J., & Lipscombe, L. L. (2013). The
impact of income on the incidence of diabetes: a population-based study. Diabetes
research and clinical practice, 99(3), 372-379.
Nilsson, S. (2016). How young people can learn about newly diagnosed type 1 diabetes. Nursing
Children And Young People, 28(3), 22-26. doi: 10.7748/ncyp.28.3.22.s21