ESPE Abstracts (2015) 84 P-2-251

Sick Day Rule: Survey of Parents of Children with Type 1 Diabetes (Experience and Knowledge)

Juliana Chizomam Agwua, S May Ngb, J Drewc, J Edged, M Kershawe, N Wrightf & C Gardnerg


aSandwell and West Birmingham NHS Trust, West Midlands, UK; bSouthport and Ormskirk NHS Trust, Ormskirk, Lancashire, UK; cNottingham Children’s Hospital, Nottingham, UK; dOxford Children’s Hospital, Oxford University Hospitals NHS Trust, UK, Oxford, UK; eBirmingham Children’s Hospital NHS Foundation Trust, West Midlands, UK; fSheffied Children’s Hospital, Sheffield, UK; gWarwickshire County Council, Warwickshire, UK


Background: Inappropriate management of illness/stress, accidental or deliberate insulin omission are some of the causes of Diabetes ketoacidosis (DKA) in patients with established diabetes. During illness, patients with type 1 diabetes are advised to monitor for hyperglycaemia and ketosis, maintain fluid intake and if required, to administer supplemental insulin. Previous studies have confirmed that comprehensive diabetes self- management education (DSME) programs on management of sick days and availability of telephone support can lead to a reduction in the rates of DKA.

Objective and hypotheses: The aim of the study is to establish parent’s experience of self-management education programs and out of hours telephone support. In addition we evaluated their knowledge of sick day rules.

Method: Parents of children with Type I diabetes completed an online questionnaire posted (October 2014-February 2015) on social media fora popular with parents of children with diabetes living in United Kingdom. The questionnaire was set up to allow only one response per internet protocol (IP) address. The questionnaire was validated for consistency by a panel of parents. It tested four domains of sick-day self-management; glucose monitoring, ketone monitoring, fluid intake and supplemental insulin administration. It also sought information on their experience of self- management education programs and telephone support.

Results: completed the questionnaire. Median duration of their child’s diabetes was three years. Median age of their children was ten years. 86% reported receiving training on managing sick days. Of these the majority (52.2%) received this as an informal session at diagnosis, with only 6.3% receiving annual updates. 32.7% reported that they received an information leaflet only with no formal or informal teaching session. The majority (52.1%) had access to their diabetes team out of hours, whilst 14.6% had access to ward staff/Paediatric Registrar for advice. Other popular sources of information when dealing with illness included other parents (49.2%), Facebook (63.3%) and Google (31.5%). Worryingly 40% either did not know what to do in the presence of raised blood glucose (BG) and high blood ketones (BK) or would have taken no action to prevent DKA

Conclusion: Survey results highlight the need to improve quality of sick day rule education programs for parents of children with type 1 diabetes.

Funding information: This work was supported by funding from ACDC (Association of children’s diabetes clinicians) in United Kingdom who payed for the online survey.

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