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This study examined the psychometric properties of a measure of chronic disease-related parental stress, the Pediatric Inventory for Parents (PIP), in a sample of 22 children with short stature. Additionally, we investigated relations among disease-related parental stress, parental state anxiety, and children’s behavioral and psychological maladjustment. Results demonstrated acceptable internal consistency and convergent validity for the PIP. Significant and positive relations of medium to large effect sizes between parenting stress and internalizing and externalizing maladjustment were found. Recommendations for use of the PIP in clinical settings and future research directions are discussed.

This study investigated the frequency and psychosocial correlates of peer victimization in a sample of youths with diabetes. The Social Experience Questionnaire, Children’s Depression Inventory, Social Anxiety Scale for Children—Revised, and Asher Loneliness Scale were administered to 32 children diagnosed with type 1 diabetes and 32 control children without a medical diagnosis who were matched for age and gender. Results indicated that children with diabetes reported higher rates of relational victimization and lower levels of prosocial peer support than youths without diabetes. In addition, relational victimization was positively associated with depression, social anxiety, and loneliness for diabetic children. Implications of these findings for clinicians working with this population are discussed.

While blood glucose monitoring has become increasingly important in diabetes care, studies have yet to address the accuracy of youngsters' performance of blood glucose testing with current reflectance meters. The present study examined testing skills and predictors of accurate testing skills in a sample of 7-14-year-old children attending a summer camp for youth with diabetes (n=266). A 15-item behavior observational skill test was used to assess accuracy of blood glucose monitoring skills with reflectance meters. Accurate performance of individual skills ranged between 14.6% and 99.6% for the sample. However, a number of children made critical errors (errors that were likely to lead to inaccurate blood glucose testing results). When duration of diabetes and metabolic control were controlled, female gender, older age, experience with a particular meter, and absence of hypoglycemia at the time of testing were positively associated with accurate skill performance. Findings suggest that younger children, children using a new blood glucose testing meter, and children suspected of having hypoglycemia should be supervised and observed when testing. Although all young children should be supervised when blood glucose testing, boys may need closer supervision until an older age than girls. This study underscores the need for health care providers to periodically observe children's blood glucose monitoring techniques to assure accurate testing habits and to correct problematic testing behaviors.

The Diabetes Control and Complications Trial has conclusively demonstrated that improved metabolic control leads to reduction in the rate of microvascular complications of diabetes. In order to allow patients to achieve improved metabolic control, much research has focused on improved methods of glucose monitoring and more physiologic ways of insulin delivery. The 2 most promising methods of minimally invasive blood glucose monitoring are the Glucowatch, using the technique of reverse iontophoresis to measure interstitial fluid glucose levels every twenty minutes and an implantable sensor, in which a catheter resembling that used for insulin delivery through a pump is impregnated with glucose oxidase at the tip. This device monitors blood sugars every few minutes, but like a holter monitor, must be downloaded in the physician's office. Still under development are (1) implantable subcutaneous sensors with a high and low blood glucose alarm and (2) sensors in which the patient will be able to download the data using a home PC. Advances in insulin delivery have included the availability of new insulin analogs which more closely simulate endogenous insulin release, with rapid acting analogs simulating the increase in insulin production that normally occurs after meals. Phase III clinical trials are in progress of a long-acting basal insulin without peak actions to simulate the low dose continuous production of the insulin which normally inhibits hepatic glucose production. In addition, use of the insulin pump has increased markedly since publication of the DCCT with the greatest increase being among adolescents. In addition to advances in treatment of diabetes, research has continued on curing the disease using islet cell transplantation and preventing the disease with agents such as insulin (DPT-1 Trial) and nicotinamide (ENDIT). This article provides an overview of recent advances in diabetes management and prevention.

The authors describe the successful treatment of a 17-year-old female with comorbid type 1 diabetes mellitus and anorexia nervosa within the context of a residential program in a tertiary care facility. Assessment and treatment of the complex combinations of the psychological and medical symptoms involved in this patient required the interaction of medical, psychological, and nutritional services. Diagnostic and treatment challenges are discussed.

Children with insulin-dependent diabetes mellitus (IDDM) typically self-inject insulin twice daily. Injection sites must be rotated with each insulin administration to avoid lipohypertrophy. Lipohypertrophy results in erratic insulin release and threatens metabolic stability. To aid rotation, children are usually provided with a picture of a human figure with injection sites identified within a grid. Children often have difficulty using the charts or lack the skills necessary to identify injection sites. An alternative three-dimensional visual aid, a pair of "injection bears," simplifies injection site identification. Fifty-eight 6- to 11-year-old children with IDDM identified 10 injection sites using both the injection chart and the injection bears. Accuracy of injection site identification was compared on five subcomponents. Forty-four percent of informants recalled that their doctors recommended using injection charts. Of those recalling the recommendation, 81 % never or rarely used charts at home. Thirty-nine percent of the informants reported a history of lipohypertrophy. Matched sample t-tests demonstrated that children committed significantly fewer identification errors on all subcomponents (P ≤.05) when using the injection bears. Chi square analyses indicated a significant preference (P ≤.05) for the injection bears, which may be a useful tool for insulin injection rotation with younger children.

This case report of a child with insulin-dependent diabetes mellitus (IDDM) describes a naturally occurring ABABCA design. The A condition represents poor diabetes management provided in the home setting, and the B and C conditions represent improved diabetes management in residential treatment (condition B) or foster care (condition C). The A condition was consistently associated with episodes of diabetic ketoacidosis, high glycosylated hemoglobin percentage, and school failure. In contrast, the B/C conditions were consistently associated with improved health status and school performance. On two occasions, the child was returned to condition A by the state's protective service agency (HRS) in direct conflict with the recommendations of the child's psychological and medical treatment staff. During her last condition A placement, the youngster died. Chronically ill children who are neglected may not receive the protection they need because of lack of awareness about the psychosomatic aspects of their problem.

A portable pump, programmed to administer intermittent pulses of insulin subcutaneously, supplemented by premeal boluses, was used by 8 patients for periods up to 12 months. Two boys, 11 and 16 years of age, sought improved growth; four young adults age 19 to 26 years desired normalization of metabo lism to forestall microvascular complications already manifest; a 14-year-old girl had been incapacitated by unstable diabetes and a 26-year-old woman had been unable to attain sufficient control to gain weight without developing hypoglycemia. Maximal possible control with conventional insulin administra tion was attempted prior to pump use and such control was measured by glycohemoglobin (HgbA1) percentage and urine and blood sugar levels during a 24-hour period and compared with control with pump use. All initially had marked reduction in 24-hour urine volume (mean 3.3 L ± 4 SEM to 1.4 ± 0.2), urine glucose (mean 198 g ± 81 to 14 ± 4) and glycemia (mean 258 mg/dl ± 29 to 133 ± 12). HgbA1% declined markedly in all but the 14-year-old girl over the first weeks and reached normal or near normal levels in three patients. Four patients continued to use the pump after 3.5 to 12 months because of improved sense of well being, weight control, and in one, marked reduction in proteinuria. Both boys had a doubling of growth pace. Four patients are no longer using the pump after 3 to 8 months because of incon venience, manipulation with intermittent usage, intolerance of normoglycemia, or overzealous control attempts with dangerous hypoglycemia. Pump use may permit the attainment of levels of control previously not possible, but is extremely demanding for patients and health personnel and must remain an experimental method in carefully selected and monitored patients.