AN INTERVENTION PROTOCOL FOR PARENTAL MANAGEMENT OF NOCTURNAL HYPOGLYCEMIA IN YOUNG CHILDREN WITH INSULIN-DEPENDENT DIABETES MELLITUS.
Contributors: University of Pittsburgh.
Published: 1996
Number of pages: 309
Subjects: Health Sciences, Nursing.
Description: Nocturnal hypoglycemia is an acute complication of diabetes management which can contribute to neurocognitive impairment and poor metabolic control in children with IDDM. This study was conducted to determine if an intervention protocol for nocturnal hypoglycemia management prevents or minimizes the frequency of nocturnal hypoglycemic episodes (NHE: blood glucose (bg) $\le$70 mg/dl between 0300-0400) in children with IDDM without compromising metabolic control. Specific aims were to describe nocturnal bg profiles of children with IDDM; evaluate effect of intervention over a 12 week follow-up period; and determine if parent stress or hypoglycemia fear influences NHE.

A randomized controlled trial with repeated measures design was used which included 31 children, 2 to 8 years of age ($M = 74.8\pm22$ mos) with diabetes duration $>$ one year ($M = 37.9\pm22$ mos). Child bg samples were obtained by parents via capillary bg monitoring (CBGM) at 2100, 0400, and 0800 three nights/week for 12 weeks. An additional CBGM was obtained by intervention group parents only at 2230. Carbohydrate (0.3 g/kg) was given to intervention group children if bg was $\le$120 mg/dl at 2230. Parent measures included Parent Stress Index and Hypoglycemia Fear Survey.

Hypotheses. Intervention group children would have lower prevalence rates of NHE, fewer NHE, and longer time to first NHE without compromising metabolic control measured by mean fasting bg and pre- and post-study HbA1C. Parent measures of stress and hypoglycemia fear were used as predictor variables for NHE.

Prevalence of NHE was similar for both groups with all children experiencing multiple asymptomatic NHE. Intervention group children had fewer NHE ($M\sb\□rm (Intervention) □= 3.3\ \pm 4.4$ vs. $M\sb(□Control) □= 6.5 \pm 4.9;\ \□rm t\□sb(□27) □= 1.81,\ p = .04).$ Time to first NHE was not different between groups ($Mdn\sb\□rm (Intervention) □$= 5.69 weeks vs. $Mdn\sb\□rm (Control)□$ = 3.87 weeks; $\chi\sp2\sb\□rm (logrank) □= .79,\ p = .18).$ No differences in mean fasting bg were observed over time ($F\sb(□2,46) □= 1.17,\ p = .32),$ and no group differences were observed in mean HbA1C change scores $(t\sb(□29) □= -□1□.57,\ p = .13).$ No predictive relationship was observed between parent stress or hypoglycemia fear and NHE.

The intervention did not prevent NHE, but reduced the frequency of NHE over time without compromising metabolic control.
Notes: Source: Dissertation Abstracts International, Volume: 57-12, Section: B, page: 7454.

Thesis (PH.D.)--UNIVERSITY OF PITTSBURGH, 1996.

School code: 0178.