3. Electronic Theses and Dissertations (ETDs) - All submissions
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Item Assessing fear of hypoglycaemia among parents of children with Type 1 Diabetes Mellitus(2017) Madumetse, Kitsiso OneIntroduction: Hypoglycaemia is the most widespread acute side effect of insulin therapy in individuals with type 1 diabetes mellitus. Severe hypoglycaemia can cause loss of consciousness, seizures, accidents or physical injuries, and even death. Given these severe consequences, it is almost inevitable for patients or their caregivers not to develop fear of hypoglycaemia. Fear of hypoglycaemia in children and their parents has not, thus far, been measured at diabetic clinics in South Africa. Fear of hypoglycaemia among paediatric type 1 diabetes mellitus patients and their parents affects quality of life and adherence to diabetes management strategies. However, behavioural workshops can address and decrease such fears and therefore increase compliance with T1DM management programmes. An improved understanding of fear of hypoglycaemia should assist nurses running clinics to develop appropriate programmes to offer support. Aim of the study: To assess fear of hypoglycaemia among parents whose children have type 1 diabetes mellitus. Study objectives: The objectives of the study were: 1. To identify aspects suggestive of worry about hypoglycaemia among parents whose children have type 1 diabetes mellitus, and 2. To determine the behaviours adopted by parents to prevent hypoglycaemia among children with type 1 diabetes mellitus. Method: A descriptive and cross-sectional survey design was used to identify factors suggesting fear of hypoglycaemia among parents and the actions parents take to prevent hypoglycaemia. In this study the population comprises parents of type 1 diabetes mellitus children attending a specific diabetic outpatient’s clinic (N=140). The total population was used as a sample over a period of three months due to the limited population size. Fifteen (15) patients are pre-booked for clinic services every Monday from 08h00–13h00. vi Only parents or guardians of children aged 3 to 18 years, diagnosed with type 1 diabetes mellitus and on insulin therapy, were considered eligible for the study. Data collection: A self-administered Hypoglycaemia Fear Survey – Parent version (HFS-P) was used to collect data. Besides demographic data, the HFS-P’s data collection tool focuses on worry and avoidant behaviours, with a total of 25 questions scored using Likert Scales ranging from 0 (“never”) to 4 (“always”). The Worry subscale HFS-P (W) measures different anxiety-provoking aspects of hypoglycaemia. The Behaviour subscale HFS-P (B) measures behaviours used to avoid hypoglycaemia and its consequences. The demographic data collected concerned parents’ ages, genders, marital status, employment status and levels of education. Data analysis: Data was analysed using STATA version 13.1. Data analysis was divided into descriptive and inferential statistics. Results: Parents of type 1 diabetes mellitus children are more likely to experience fear of hypoglycaemia and to practise negative behaviours to avoid hypoglycaemia, which eventually impact negatively on glycaemic control. Nurses should be able to intervene and teach such parents how to manage type 1 diabetes mellitus correctly.Item Infants of diabetic mothers: maternal and infant characteristics and incidence of hypoglcemia(2016) Magadla, YoliswaBackground: Diabetes mellitus is the most common metabolic disease affecting women during pregnancy and is associated with adverse outcomes during the neonatal period, common one being hypoglycemia. The characteristics and incidence of hypoglycemia in infants of diabetic mothers (IDM) are not well reported in South Africa. Objectives: To describe the characteristics of IDM with or without hypoglycemia and to determine prevalence of hypoglycemia in IDM. Methods: Medical records of mothers, and their infants admitted with a diagnosis of IDM at gestational age ≥34 weeks and/ or birth weight ≥2000 grams and admitted at CHBAH from January 2012 to December 2013, were retrieved. Maternal characteristics, type and treatment of diabetes, infant characteristics and glucose measurements were captured for analysis. Results: A total of 234 IDM were admitted over this 2-year period and 207 met inclusion criteria. Median maternal age was 33 years. Seven percent of mothers had stillbirths and 14% had miscarriages in previous pregnancies. A total of 56% of mothers had gestational diabetes. Among infants, 54% were born preterm, 19% were large for gestational age (LGA) and 10% were macrosomic. Pre-gestational diabetic mothers had higher preterm births than gestational diabetic mothers (64% vs 48%, p=0.037). Hypoglycemia occurred in 39% of IDM, occurring within the first 3 hours of life in 85% of infants. There were no statistically significant differences in types of maternal diabetes and its treatment between hypoglycaemic and normoglycaemic infants, but hypoglycaemic infants were more likely to be LGA (28.2% vs 12.8%, p=0.009). Conclusion: Hypoglycemia is a common finding in IDM, presenting early in postnatal age. Only just over a quarter of hypoglycaemic infants are LGA. All IDM should be monitored for hypoglycemia, especially within the first 3 hours of life.Item The effect of preoperative apple juice on the prevalence of hypoglycaemia in paediatric patients(2013-01-24) Lee, Clover-AnnBackground: Children have historically been fasted for prolonged periods preoperatively to reduce the volume and acidity of their gastric contents and thus the risk of regurgitation and pulmonary aspiration. Evidence shows that this risk is not increased by following the current recommended fasting guidelines, and that prolonged fasting may be detrimental to children, who may present with hunger, thirst, depleted intravascular volume, metabolic acidosis and hypoglycaemia. A recent study at Charlotte Maxeke Johannesburg Academic Hospital showed a 18.5% prevalence of biochemical hypoglycaemia, defined as a blood glucose concentration of less than 3.5 mmol/l, in children from one to five years of age presenting for elective surgery. Aims: The aims of this study were to document the prevalence of biochemical hypoglycaemia in children from the ages of one to five years who were given apple juice to drink at least two hours preoperatively, and to compare these results to a historical control group. Methods: A prospective, contextual comparative study design was used. Approval was obtained from the University of the Witwatersrandʼs Human Ethics Committee and other relevant authorities. The groups were matched for age and weight. Consent was obtained from the guardians of all children who met the inclusion criteria before being enrolled in the study. A standard 200 ml carton of commercially available apple juice was offered to each participant. The volume and time of the juice consumed was documented, along with relevant demographic data. Inhalational induction of anaesthesia proceeded a minimum of two hours later, and a venous glucose concentration was measured. Results: The prevalence of biochemical hypoglycaemia was statistically significantly reduced in the intervention group (p = 0.0163), eliminating the effect of prolonged preoperative fasting. Conclusion: The consumption of clear apple juice on the morning of surgery is a safe, inexpensive, effective way to reduce the prevalence of hypoglycaemia in children presenting for elective surgery.