Vol. 14 Supplement 2
Management of Type 1 Diabetes in Children in the First 5 Years of Life
Melissa Rearson, MSN, CRNP, Susan Sullivan-Bolyai DNSc, CNS, RN, FAAN
A significant increase in children <6 years of age being diagnosed with type 1 diabetes (T1D) is occurring. The parents (caregivers) of these children have full responsibility for the complex and individualized management while having to deal with the emotional stress of caring for a child with a chronic condition. This article will provide a summary of the diagnosis and recommended medical treatment for this special age group of children. Also presented will be common day-to-day family management issues for health care providers to consider as they provide care for this most common endocrine chronic condition.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):412-421
The Emerging Adult with Diabetes: Transitioning from Pediatric to Adult Care
Jodi Krall, PhD, Ingrid Libman, MD, PhD, Linda Siminerio, RN, PhD, CDE
Transfer from pediatric to adult health care is a significant life event for youth with chronic medical conditions. Unfortunately, youth may not be well prepared to navigate the shift in health care services, increasing their risk for loss to follow up and poor health outcomes. This review explores transition in care through the lens of type 1 diabetes, highlighting current practices and guidelines and offering recommendations for future consideration. Limited evidence suggests that transition programs that focus on strategies to prepare youth developmentally and equip the health care system appropriately have positive impact on the hand off of care, and health outcomes. Advanced practice nurses are well positioned to play a key role in helping youth with chronic conditions with the transition process.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):422-428
Current Strategies in Nutrition Education to Optimize Glycemic Management for Children with Diabetes
Francesca Annan, BSc (Hons) MSc, RD
Recent developments in the understanding of the impact of dietary quality and meal composition are driving changes in the education provided to children and young people about nutrition and lifestyle management of Type 1 Diabetes (T1D). Nutrition education is moving beyond carbohydrate counting and insulin adjustment to acknowledging the influence of whole food choices on glycemic outcomes.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):429-434
Continuous Glucose Monitoring in Pediatrics: The Gap between Potential Benefits and the Reality of Utility
Regina L. Taddeo, MA, RN, CDE, CPT, Joanne T. Moser, RN, MSN, CRNP, Pantea P. Minnock, RN, MSN, CRNP, CCRP
Continuous Glucose Monitoring (CGM) is rapidly becoming a standard of care in the management of Type 1 diabetes (T1D). Today’s devices are nearly as accurate as home glucose meters. They provide glucose data every 5 minutes, alert to high and low blood glucose levels, and allow for remote monitoring of a user’s glucose data and patterns. Use of CGM has many benefits including support for tighter glycemic control without increasing the risk for hypoglycemia. There is however emerging evidence of some negative aspects associated with using CGM, which may result in decreased utilization of the device as well as a decline in quality of life, especially in the pediatric population. This article explores some of the challenges to successful CGM use and offers guidelines for helping patients/families minimize the negative impact of these revolutionary devices.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):435-440
Gender Creative or Transgender Youth and Advanced Nursing Practice
Nicole Kirouac, RN BN, Mabel Tan, RN, MN
The World Professional Association for Transgender Health (WPATH) defines gender dysphoria as “Discomfort or distress that is caused by a discrepancy between a person’s gender identity and that person’s sex assigned at birth (and the associated gender role and/or primary and secondary sex characteristics)” (WPATH, 2016). Gender creative (GC) and transgender (TG) youth are at high risk for severe mental health disparities if they don’t receive competent and timely gender transitioning care. Although awareness and early care of TG youth in specialty clinics is improving and increasing, there is still much effort that is required to eliminate barriers to care at many levels and thus improve outcomes. Nurses, particularly advanced practice nurses, are poised to lead the way in creating safe, inclusive, family centered spaces for TG and GC children, youth and their families as well as acting as vital mentors for other nurses. The purpose of this paper is to discuss the increasing prevalence of GC and TG youth, the significance of inclusive care for GC and TG youth, treatment guidelines, and the impact parents and advanced practice nurses can have on the journey of these youth as they explore and find their place on the gender spectrum.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):441-447
The Key to Adrenal Insufficiency Education: Repetition, Repetition, Repetition
Margaret F. Keil, PhD, CRNP, Carol Van Ryzin, MS, CRNP
Described more than 150 years ago by Thomas Addison, adrenal gland dysfunction, while treatable, remains a clinically significant and potentially fatal disease. Vague and non-specific symptomatology can delay diagnosis of adrenal insufficiency and lead to adrenal crisis. Affected individuals may delay self-management due to knowledge deficits or lack of required therapies. Advanced practice nurses must remain vigilant for signs and symptoms of adrenal insufficiency and prevention of crisis. Education of patients and their caregivers/family members must emphasize early intervention with regards to adrenal insufficiency in order to prevent adrenal crisis. Repetition of education about sick day rules and demonstration of intramuscular injections should be incorporated as part of the routine follow-up care of all individuals to enhance their confidence and self-efficacy in self-management of adrenal insufficiency.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):448-453
Turner Syndrome: Care of the Patient: Birth to Late Adolescence
Denise Gruccio Paolucci, DNP, CRNP, PNP-BC, Vaneeta Bamba, MD
Turner syndrome (TS) is a genetic condition occurring in females resulting from the loss of part or all of one of the X chromosomes. The two hallmark features of Turner syndrome include short stature and primary ovarian insufficiency. In addition, Turner syndrome can involve multiple healthcare issues including cardiac and renal anomalies, autoimmune disorders, hearing loss, ophthalmologic issues, bone anomalies, dermatologic issues and psychosocial and educational concerns. The presenting signs of Turner syndrome can vary markedly, leading to delayed or even missed diagnosis. Early identification of TS allows for appropriate screening and surveillance evaluations and more timely treatment intervention. This article will provide an overview of the healthcare issues common to patients with TS, treatments available and the screening and surveillance testing that is recommended.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):454-461
Complexities of Care in Klinefelter Syndrome: An APRN Perspective
Sharron Close, PhD, MS, CPNP-PC, Amy Talboy, MD, Ilene Fennoy, MD, MPH
47,XXY (Klinefelter Syndrome) is associated with a spectrum of complex clinical needs that are associated with variable physical, neurocognitive and psychosocial aspects. For patients and families affected by this sex chromosome trisomy, navigation of health care services is difficult due to lack of 47,XXY awareness among many health care providers and little evidence to support endocrine and additional treatment plans. While endocrine management of androgen deficiency has been the mainstay of treatment for patients from puberty through adulthood, testosterone replacement, alone, fails to mitigate many symptoms and issues. Prior to the onset of puberty, boys with 47,XXY often do not receive interdisciplinary evaluations and treatment. Since multiple health and ancillary therapeutic services are required for the management of 47,XXY, patients and families often experience disjointed and uncoordinated care. We discuss complexities of caring for patients with 47,XXY and the benefit of integrating advanced practice nursing and medical perspectives to improve care delivery.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):462-471
Children with Short Stature and Growth Failure: Heightism, Gender and Racial Disparities
Terri H. Lipman, PhD, CRNP, FAAN, Ian J. McCurry, BSN
Growth is the single most important indication of the health of a child. Identification of growth disorders in all children is crucial as growth failure can be the first sign of a number of acute and chronic conditions. However, gender and racial biases have resulted in inequities in the identification, referral and treatment of children with growth disorders. In addition, short children have been impacted by a number of psychosocial issues. Heightism is prejudice or discrimination against individuals based on height, and refers to discrimination against individuals whose height is not within the normal acceptable range. Studies have shown that short children have been affected by juvenilization, teasing, bullying, victimization, loss of independence/ overprotection, and exclusion. The role of the advanced practice nurse is critical in addressing heightism and racial and gender disparities in children with growth failure/short stature.
Ref: Ped. Endocrinol. Rev. 2017;14(Suppl2):472-477