Prevalence of Type 1 Diabetes in United Kingdom
Although there have been many research studies that have focussed on the prevalence a comorbid condition of the type two diabetes, the impact of medical and health related impact on the type 1 diabetes is minimal. Type 1 diabetes or juvenile diabetes is a rising public health priority and as it involves children, the psycho-social impact of dealing with the disease is more challenging (Castensøe?Seidenfaden et al. 2017). Considering the prevalence of type 1 diabetes, United Kingdom has been ranked fifth highest in prevalence of type 1 diabetes. Hence, undoubtedly type 1 diabetes is a grave public health priority for the nation. Type 1 diabetes is a disease which is associated autoimmune destruction of the beta cells in the pancreas of the patient which develops inability of the body to produce insulin. Hence, this research will attempt to analyse the psychological difficulties that accompany the diagnosis of diabetes type 1 in the children aged 7 to 16 and the effective intervention strategies applicable to address the issues.
It has to be mentioned that this is a behaviourally and psychologically demanding disease facilitated by its chronicity and multi-factorial management modality (Mingrone et al. 2015). As a result it requires high levels of discipline and responsibility from both the patient and their family to reduce complications of the disease. Hence, this research will attempt to analyse the emotional, behavioural, cognitive and psychological difficulties that accompany the diagnosis of diabetes type 1 in the children aged 7 to 16.
Broad question:
- What is the impacts of living with diabetes type 1 on the psychological status of the patients between the ages of 7 years to 16 years?
Specific objectives:
- What is the psychological impact of living with diabetes type 1 in children aged 7 to 16 years?
- What are the plausible effective management strategies that can be applicable for the type 1 diabetes patients aged 7 to 16 years?
Type 1 diabetes is a global disaster and yet the awareness regarding the physical and psychological impact of living with the disease is insufficient at best. Lack of proper management of the type 1 diabetes in the children can lead to renal disorders, eyesight issues, and cardiac conditions, and the psychological impact includes depression, social withdrawal, denial, and loss of confidence (Barnard et al. 2015). Although, the physical health restoration after diagnosis is given importance, the psychological health and wellbeing of the type 1 diabetes patients is ignored mostly. Hence this study focuses on the exploration of the psychological issues and management strategies applicable.
The significance of this study is based on providing concrete evidence of the psychological impact of living with diabetes type 1 caused by the emotional, behavioural and cognitive issues associated with living the disease (Sansom-Daly, et al., 2012). Additionally, this study will be fertile grounds for more studies with aims of determining the specific psychological or psychiatric disorders associated with living with diabetes such as depression and how they affect the management outcome and prognosis (Ryninks, et al., 2015).
This chapter has provided the problem statement based on which this research has developed, the chosen research questions that the study is going to achieve, the justification for choosing the topic and the significance of conducting the study.
The literature review is the second chapter of a research study and it serves to accumulate the main themes of evidence available in the research studies published till date to arrive at the basic idea regarding the topic selected and the research gaps that have been left behind. The topic selected for the research study is the psychological impact of loving with type 1 diabetes for the children, the major issues reported and management strategies to address the impact.
The Challenges of Living with Type 1 Diabetes
Although, the exposure of type two diabetes is considerably higher, both the awareness and management strategies have improved considerably in the past decade. However, the incidence and consequences of type 1 diabetes have been unexplored, especially in the context of the psychological impact on the child and the applicable effective management strategies with respect to the psychological impact. Juvenile diabetes is one of the most common endocrine or metabolic disorder which affects more close 0.5 million children below the age of 16. The international diabetes federation has declared the fact that almost 24.5 children per 100000 aged 0-16 years have been diagnosed with type 1 diabetes every year (Diabetes.co.uk 2018). The type 1 diabetes is not anyhow linked to the obesity and lifestyle choices and is associated with genetic predisposition. Although the lack of knowledge, awareness and health literacy regarding the type 1 diabetes, the psychological impact is associated with social isolation and bullying as well. Browne et al. (2014) in their qualitative review study has discussed the social stigmatization of living with type 1 diabetes involving participants aged ≥18?years. The findings of the study indicates at stigmatization being a significant part of the social experience of living with type 1 diabetes for the adolescents. In support, Balfe et al. (2013) has stated that some aspects regarding loving with type 1 diabetes highly distressing for the adolescents. This qualitative study has utilized semi- structured interviews to arrive at the verdict that the impact of living diabetes is associated with various complications and most of the psychological distress is linked to the lack of proper knowledge and idea regarding management and coping with the disease is the most important contributing factor leading to the issues.
Similarly, the study by Babler and Strickland (2015) has stated that there is a normalizing paradigm introduced in the care planning and management of the type 1 diabetes that the patients aged 7 to 16 go through. Hapunda et al. (2015) have stated psychosocial issues and challenges to be a very common aspect associated with patients dealing with diabetes, and is more prominent for the patients dealing with type 1 diabetes. The semi structured interview data reveaed that stress is pertinent issue in the lives of the adolescents living with type 1 diabetes, which stemmed mainly from social, physical and psychological perspectives. Along with that, the stigma and isolation that the patients are subjected to sometimes leads to maladaptive coping strategies which does not address the core areas of concern. Lowes et al. (2015) states that more than the physical needs, the emotional and psychological needs are more pronounced for the paediatric type 1 diabetes patients, which in most cases is not addressed in the health care facility due to lack of training, knowledge and communication skills of the care providers.
Ryninks et al. (2015) has stated that even though the adolescents with type 1 diabetes understand the benefits of health promotional behaviours, the stigma and bullying related difficulties experienced in schools, and similar social settings inhibits the individuals from actively participating in these activities. The authors here described that behaviourally and psychologically chronic medical conditions such as diabetes requires extensive management programs and protocols to address the holistic needs of the patient and the families (Nicolucci, et al., 2013). Using a conversational interview in their research, the authors sought to identify the meaning of normal to the children and how the pursuit of a normal life after diagnosis of diabetes has been. In their research, the authors highlight that despite different cultures, age, education levels and socioeconomic status, the families living with diabetic type 1 patients have similar experiences that influence health and needs requirements (de Wit & Snoek, 2011). Similarly the study by Barnard et al. (2015) sought to explore the contributing factors leading to the psychological distress of the patients. The most common challenges specifically affecting the family such as financial implications, emotional needs and support. In their conclusion, the researchers suggest future researchers, to focus on the impacts of the disease on the psychological status of the young patients. Considering the financial implications of the disease, the NHS data reveals the cost of diabetes to be over £1.5m an hour or 10% of the NHS budget for England and Wales. This equates to over £25,000 being spent on diabetes every minute, hence, the financial burden coupled social issues might be the contributing factors leading to the psychological issues.
Psychological Difficulties Accompanying Diagnosis of Type 1 Diabetes in Children
The literature review could successfully identify that the diagnosis of type 1 diabetes is undoubted a considerable cause of psychologicak distress for the juvenile diabetics. The available evidence could also identify the fact that financial impact, personal accustoming to the changes in lifestyle, and social stigmatization are the three main contributors. Although the research lacks critical details on the exact cause of the distress and the resultant psychological issues. Along with that, the available research, though identified the need for modifying the existing management strategies with psychosocial or holistic purposes, lacked any emphasis on the exact intervention strategies to implement. These are the main research gaps that will be addressed in the research study being proposed.
The research methodology serves as the systematic step by step account of the steps that are going to be followed while conducting the research study (Ennis 2018). It will continue research design, sampling, data collection, data analysis, ethical consideration, and limitations of the research study.
The research design that has been selected for this study is qualitative and it will follow a systematic review format of research. Systematic reviews are very common qualitative research design and it involves a systematic method to explore and accumulate secondary data, critically appraise the data and synthesize the key themes (Ennis 2018).
The research will be carried out involving the database CINAHL and the key words being used for the research includes ‘psychological impacts’, ‘diabetes type 1’, ‘patients’, ‘normal life’, ‘children’, ‘adolescents’, ‘7 to 16 years’, ‘management strategies’, ‘holistic’, ‘psychosocial’, ‘depression’, ‘stigma’, ‘bullying’ and ‘loss of confidence’. CINAHL is the most reliable database for health care research studies and also provides a varied range of peer reviewed nursing studies (Wright, Golder and Lewis-Light 2015). The articles will be narrowed down using advanced search option of the database and the use of limiters and Boolean operators will help in streamlining the research articles chosen. The article inclusion criteria will be articles relevant, full access, abstract available, peer reviewed, published 2012 onwards and in English. The exclusion criteria will be non-human research, irrelevant, not peer reviewed, written in languages other than English, and published before 2012.
The data analysis for the selected articles will be using thematic analysis. As the aims and objectives of the research is associated with identifying the perception of the patients with type 1 diabetes and their families regarding the psychological impact of living with the disease and possible intervention strategies to address the identified issues, the thematic analysis of qualitative research design will be the most appropriate design of format to capture the exact perception, thoughts and experiences. Each theme will be discussed at large to arrive at a final conclusion.
The guidelines for the protection of human rights will be strictly followed in this research. Care will be taken to ensure the confidentiality and privacy of the articles that have been used in the study with proper citation and referencing. The intellectual property rights will also be considered effectively while conducting the research and the approval of the ethics committee will also be taken before commencement of the research.
Significance of the Study
A few limitations that might stall the success of the research study includes time constraint, financial constraint, accessibility and overlapping data extracted from the articles reviewed. The time limit may not be sufficient to acquire the desired number of articles. The financial constraint and accessibility will also be a very important issue considering access to databases.
This study will determine the psychological impacts of living with diabetes type 1 to the patients and their families. Additionally, the study will provide concrete evidence of the psychological impacts and how this will be used to generate protocols for quality patient centered management to improve compliance, prognosis and disease outcome in minimizing short and long term complications of diabetes (Schabert at al. 2013). Findings from this study will be shared with study participants, community and stakeholder members, medical professionals in the United Kingdom, online researchers for reviews and for professional review by the academic stuff in charge of this chapter and course within the institution (Balfe, et al., 2013).
Conclusion:
There still is lack of clarity on impact of the diagnosis and living with diabetes type 1 on the psychological and mental state of the patients and family members, especially as the patients and children with highly impressionable minds (Johnson at al. 2013.). This study aims to determine the exact psychological impact of living with diabetes type 1 in terms of cognitive functioning, social, behavioral and emotional states and also discover applicable interventions to help address the challenges. This research will aim at a cohort of diabetic type 1 patients from 7 to 16 years diagnosed and living with the chronic disease for at least year. The results from the secondary research will help in identification of the exact issues stemming from the impact of living with a chronic and lifelong disease like type 1 on the children and how it affects their social life so that patient centred holistic management strategies can be designed and implemented.
References:
Babler, E. and Strickland, C.J., 2015. Normalizing: Adolescent experiences living with type 1 diabetes. The diabetes educator, 41(3), pp.351-360.
Balfe, M., Doyle, F., Smith, D., Sreenan, S., Brugha, R., Hevey, D. and Conroy, R., 2013. What’s distressing about having type 1 diabetes? A qualitative study of young adults’ perspectives. BMC Endocrine Disorders, 13(1), p.25.
Barnard, K.D., Wysocki, T., Thabit, H., Evans, M.L., Amiel, S., Heller, S., Young, A., Hovorka, R. and Angela Consortium, 2015. Psychosocial aspects of closed?and open?loop insulin delivery: closing the loop in adults with Type 1 diabetes in the home setting. Diabetic Medicine, 32(5), pp.601-608.
Browne, J.L., Ventura, A., Mosely, K. and Speight, J., 2014. ‘I’m not a druggie, I’m just a diabetic’: a qualitative study of stigma from the perspective of adults with type 1 diabetes. BMJ open, 4(7), p.e005625.
Castensøe?Seidenfaden, P., Teilmann, G., Kensing, F., Hommel, E., Olsen, B.S. and Husted, G.R., 2017. Isolated thoughts and feelings and unsolved concerns: adolescents’ and parents’ perspectives on living with type 1 diabetes–a qualitative study using visual storytelling. Journal of clinical nursing, 26(19-20), pp.3018-3030.
Diabetes.co.uk. 2018. Cost of Diabetes. [online] Available at: https://www.diabetes.co.uk/cost-of-diabetes.html [Accessed 27 Nov. 2018].
diabetes.org.uk. 2018. UK has world’s 5th highest rate of Type 1 diabetes in children. [online] Diabetes UK. Available at: https://www.diabetes.org.uk/about_us/news_landing_page/uk-has-worlds-5th-highest-rate-of-type-1-diabetes-in-children [Accessed 27 Nov. 2018].
Ennis, C., 2018, October. Finding the Themes Related to Designing Learning for Post-Experience, Management Professionals: How to Conduct Qualitative Research. In 3rd World Conference on Qualitative Research (Vol. 1), pp. 25-35.
Hapunda, G., Abubakar, A., van de Vijver, F. and Pouwer, F., 2015. Living with type 1 diabetes is challenging for Zambian adolescents: qualitative data on stress, coping with stress and quality of care and life. BMC endocrine disorders, 15(1), p.20.
Lowes, L., Eddy, D., Channon, S., McNamara, R., Robling, M., Gregory, J.W. and DEPICTED Study Team, 2015. The experience of living with type 1 diabetes and attending clinic from the perception of children, adolescents and carers: analysis of qualitative data from the DEPICTED study. Journal of pediatric nursing, 30(1), pp.54-62.
Mingrone, G., Panunzi, S., De Gaetano, A., Guidone, C., Iaconelli, A., Nanni, G., Castagneto, M., Bornstein, S. and Rubino, F., 2015. Bariatric–metabolic surgery versus conventional medical treatment in obese patients with type 2 diabetes: 5 year follow-up of an open-label, single-centre, randomised controlled trial. The Lancet, 386(9997), pp.964-973.
Nicolucci, A., Kovacs Burns, K., Holt, R.I., Comaschi, M., Hermanns, N., Ishii, H., Kokoszka, A., Pouwer, F., Skovlund, S.E., Stuckey, H. and Tarkun, I., 2013. Diabetes Attitudes, Wishes and Needs second study (DAWN2™): Cross?national benchmarking of diabetes?related psychosocial outcomes for people with diabetes. Diabetic medicine, 30(7), pp.767-777.
Ryninks, K., Sutton, E., Thomas, E., Jago, R., Shield, J.P. and Burren, C.P., 2015. Attitudes to exercise and diabetes in young people with type 1 diabetes mellitus: a qualitative analysis. PloS one, 10(10), p.e0137562.
Sansom-Daly, U.M., Peate, M., Wakefield, C.E., Bryant, R.A. and Cohn, R.J., 2012. A systematic review of psychological interventions for adolescents and young adults living with chronic illness. Health Psychology, 31(3), p.380.
Schabert, J., Browne, J.L., Mosely, K. and Speight, J., 2013. Social stigma in diabetes. The Patient-Patient-Centered Outcomes Research, 6(1), pp.1-10.
Wright, K., Golder, S. and Lewis-Light, K., 2015. What value is the CINAHL database when searching for systematic reviews of qualitative studies?. Systematic reviews, 4(1), p.104
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