الفهرس 
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Abstract
Diabetes Mellitus is defined as a genetically acquired heterogeneous group of disorders that share glucose intolerance. It can also be defined as disorder of carbohydrate metabolism characterized by total or partial deficiency of hormone insulin, resulting in metabolic adjustment or physiological change in almost area of body (Sharma, 2017).
Type 1 diabetes mellitus, one of the most common chronic diseases in childhood worldwide, is caused by insulin deficiency following destruction of the insulin-producing pancreatic beta cells. It most commonly presents in childhood, but one-fourth of cases are diagnosed in adults. Type 1 diabetes remains the most common form of diabetes in childhood, accounting for approximately two-thirds of new diagnoses of diabetes in children ≤19 years of age in the United States, despite the increasing rate of type 2 diabetes (Mayer-Davis et al., 2017).
Type 2 diabetes occurs when the pancreas cannot make enough insulin to meet the body’s demand or when insulin resistance occurs. Insulin resistance means the cells in the body that cannot respond to or use insulin, even when there are high levels of insulin present in the bloodstream (Kliegman, 2020).
Aim of the study
Study glycemic control and management in children suffering from type 1 diabetes versus type 2 diabetes.
1. Technical design:
Research design:
A descriptive design was used.
Research setting:
This study was conducted at Diabetic Outpatient Clinics in Children’s Hospital affiliated to Health Insurance at fayoum.
Study subject:
A purposive sample that consisted of 130 children with type 1diabetes and 30 children with type 2 and their accompying mothers who attended to the previously mentioned setting.
The following inclusion criteria was considered in their selection of the study subject
1. Children with confirmed diagnosis of diabetes mellitus.
2. Children in the age group of 6-18 years.
3. Able to read and write
Exclusion criteria: Children suffering from other chronic diseases, mental or psychiatric illness.
Tools of data collection:
The data was collected using the following Tool:
Structured interview questionnaire sheet: It was written in simple Arabic language by the researcher after reviewing the related literature. It consisted of two parts:
Part I: A: characteristics of children including; age, gender, level of education, attendance to school, ranking and residence, past and present history of children regarding diabetes as duration of diabetes, detection of disease, onset of symptoms, duration between symptoms and diagnosis, family history, complication and management of diabetes.
B: characteristics of children’s mothers including; age, level of education and occupation.
Part II: Concerned with children’s knowledge regarding glycemic control and management of type 1 diabetes and type 2 diabetes as the following
A: Children’s knowledge regarding diabetes mellitus it was composed of (8) questions about definition, types, causes, normal value of blood glucose level, signs and symptoms of hypoglycemia, signs and symptoms of hyperglycemia, intervention of hypoglycemia and intervention of hyperglycemia.
B : Children’s knowledge regarding glycemic control of type 1 and type 2 diabetes it was composed of (4) questions about: Definition of glycemic control, method of glycemic control, factors affecting glycemic control and parameter of glycemic control.
C: Children’s knowledge regarding management of type 1 diabetes and type 2 diabetes including:
(a)Adherence to follow up: in outpatient clinic which composed of (6) questions about: place of follow up, compliance in diabetic management, previous hospitalization, causes of hospitalization, number of hospitalization and duration of hospitalization.
(b) Treatment regimen: which composed of (12) questions about action of insulin, nature of insulin, control of insulin dose, type of insulin, site of injection, change of site of injection, route of insulin injection, side effect of insulin, effect of oral medication, preparation of oral medication, regularity in time for oral medication and complication of oral medication.
(c)Adherence to diet regimen: which composed of (7) questions about: relation between food and glycemic control, type of food, follow prescribed diabetic food, foods avoided, number of meals in day, content of food and foods that affect blood glucose level.
(d)Adherence to exercise regimen: which composed of (7) questions about: adherence to practice exercises, causes of doesn’t practice exercises, importance of exercise, frequency of practice exercises, type of exercises, taking juice before practice exercises and complications during practice exercises.
Scoring system:
Total grades of children’s knowledge was scored 44 grades that converted into percent and equal 100 %. The correct and complete answer was scored two grades, the correct and incomplete answer was scored one grade and the incorrect and didn’t know answer was scored zero. These scores were summed – up and converted into percent score. The score ranged from the following:
- Score less than 60 grade referred to unsatisfactory level of knowledge.
- Score more than 60 grade referred to satisfactory level of knowledge.
2-Operational design:
The operational design foe this study consisted of three phases namely preparatory phase, pilot study and fieldwork.
1- Preparatory phase:
It included reviewing of related literature and theoretical knowledge of various aspects of the study using books, articles, internet, periodicals and magazines was done to develop the study tools and to get acquainted with the various aspects of the research problem.
Content validity and reliability:
It was be ascertained by a jury of three expertise from pediatric and nursing staff, to review the tools for clarity, relevance, comprehensiveness and applicability.
Reliability of tool was tested using Cronbach Alpha Test equal 0.737 for the questionnaire sheet.
Pilot study:
A pilot study was carried out during April 2022 involving 10% (13 children with type 1 diabetes and 3 with type 2 diabetes) of the expected total study sample. The results of the data obtained from the pilot study were used to test the clarity and applicability of the study tools. According to the results of pilot study, very minor changes were required, therefor all children involved in the pilot study were included in the main study sample later.
Field of work:
The actual field work of the study was carried out for data collection over 3 months started from the beginning of May up to the end of July 2022. The researcher was available in the study setting every day to collect data from pediatric diabetic out-patient clinic of Health Insurance of children’s hospital from 9 am to 2 pm. The children and their mothers were interviewed (for 30 minutes). The researcher started the interview by introducing herself to both the child and his/her mothers, giving them clear and brief idea about the aim of the study. Then each child with diabetes and her / his mother was interviewed individually to answer the questionnaire.
3-Administrative Design:
An official approval was obtained to carry out the study that issued from the Dean of the Faculty of Nursing, in Shams University to the Directors of the Children‘s hospitals of Health insurance in Fayoum Governorate.
Ethical Considerations:
Ethical approval was obtained from the Scientific Ethical Committee of Faculty of Nursing at Ain-Shams University before starting the study. An oral approval was obtained from children and their mothers prior to data collection. They were assured that anonymity and confidentiality would be guaranteed and the right to withdraw from the study at any time. Ethics, values, culture and beliefs were respected. The information collected were treated confidentiality and used only for the study purpose.
4-Statistical Design:
Data collected from the studied sample were revised, coded and entered using computer. Data entry and statistical analysis were fulfilled using Statistical Package for Social Sciences (SPSS) software version 21. The obtained data was organized, tabulated, analyzed, and represented in the form of tables and figures as required. Data were presented using qualitative statistics in the form of frequencies, percentages, mean and stander deviation (SD) and chi square tests.
Level of significance was accepted at P value:
- Statistical significant difference was considered at P <0.05*
-Non significant difference was considered at P >0.05*
- High significant difference was considered at P <0.001*
Results:
Findings of the current study can be summarized as the following:
- Two third 60% of the studied children with type 1 are in the age category of 6<12 years with the mean age 11.2±2.4years, while nearly three quarters 73.3% of the studied children with type 2 are in the age category of 12≤18 with the mean age 12.63.5 years
- Two third 60% of the studied children with type 1 are male and 47.7% of them have primary education, while two third 60% of the studied children with type 2 are female and 46.7% of them have preparatory education.
- More than two third 63.1% and 66.7% of the studied children with type 1 and type 2 diabetes lived in urban.
- Less than half 40% of the studied children with type 1 diabetes have diabetes from < 1 year with mean of 1.9 0.95 years and all of them depend on insulin for management, while less than 40% of the studied children with type 2 diabetes have diabetes from <1 and 73.3% of them depend on oral hypoglycemia and healthy diet.
- Two third 64.6% of the studied children with type 1 diabetes mellitus haven’t complication of diabetes, compared to more than half 53.3% of the studied children with type 2 diabetes.
- More than half 56.9% of the studied children with type 1diabetes have positive family history of diabetes and more half 54.1% of them have type 2 of diabetes in their families, while more than 66.7% of children with type 2 have positive family history of diabetes and two third60% of them had type 2 of diabetes in their families.
- More than half 53.8% of mother’s age of the studied children with type 1 diabetes are in the age group of 28 <38 years with mean age of 34.610.6, more than one third 38.5% of them have university education and more than half 55.4% work respectively, while more than two third 66.7% of mother’s age of the studied children with type 2 diabetes are in the age group of 28 <38 years with mean age of 36.39. 8, more than half 53.3% of them have secondary education and more than half 53.3% are house wife respectively.
- There is no statistical significant difference as regards total knowledge level in both group have satisfactory level of knowledge.
- More than half 53.8% of the studied children with type 1 diabetes having diabetic identification card, compared to two third 60% of the studied children with type 2 diabetes.
- There is a statistical significant difference as regards children knowledge about methods of glycemic of control glycemic control, where the majority 86.1% of the studied children with type 1 state the healthy and balanced diet is a method of glycemic control, while more than two third 73.3%of the studied children with type 2 state the healthy and balanced diet, exercising regularly and monitoring blood glucose level regularly are methods of glycemic control.
- That there is a statistical significant difference as regards children knowledge about factors affecting glycemic control, where more than two third 64.6% of the studied children with type 1 state that complication and adherence to treatment are factors affecting glycemic control, while more than two third 73.3% of the studied children with type 2 state that age, type of diabetes, complication and adherence to follow up are factors affecting glycemic control.
- There is no statistical significant difference between types of diabetes as regards to parameter of glycemic control, where less than half (43.1% and 40%) of the studied children with type 1 and type 2 diabetes have normal value blood glucose for parameter of glycemic control.
- More than half 61.5% and 66.7% of the studied children with type 1 and type 2 diabetes are regular in Compliance in diabetic management therapy.
- There is a statistical significant difference between types of diabetes as regards causes of hospitalization where half of 50.8%of the studied children with type 1 are hospitalized because of hyperglycemia and more than two third 75.4% of them hospitalized for a week, while half of 53.3% of the studied children with type 2 are hospitalized because of hypoglycemia and all of them hospitalized for a week.
- More than 66.2% of children with type 1 diabetes change the site of injection and control of insulin dose.
- More than two third 70.8% and 80% of the studied children with type 1 and type 2 diabetes follow diabetic food all of the time.
- There is no statistical significant difference between types of diabetes, where more than two third 70.8% and 80% of the studied children with type 1and type 2 diabetes mention that there is relation between food and glycemic control.
- There is a statistical significant difference between types of diabetes as regards adherence to practice exercise, where more than two third 63.1% of the studied children with type 1 adhere to practice exercise and 56.1%of them practicing weekly, while the majority 86.7% of the studied children with type 2 adhere to practice exercise and 84.6% of them practicing weekly.
- There is no statistical significant difference with p-value >0.05 between types of diabetes as regards children knowledge about complication during practice exercises and complication of practice exercises where more than half 52.3% 0f the studied children with type 1 have complication during practice exercise and less than 43% of them mention difficulty in breathing and extra effort as a complication of practice exercise, while 60% of the studied children with type 2 haven’t complication during practice exercise and 53.3% of them mention that Difficulty in breathing, headache, tired, increase blood glucose level, decrease blood glucose level, extra effort and fatigue are complication of practice exercise.
- There is no statistical significant difference with p-value >0.05 as regards children total knowledge score.